ObjectiveTo analyze the characteristics of policy texts related to the physician periodic assessment system in China, providing references for the improvement of the system. MethodsContent analysis was employed, examining 116 policy documents from three dimensions: policy process, policy themes, and policy tools. ResultsA total of 298 codes were obtained. The number of policies related to the periodic assessment of physicians showed an overall trend of increasing first and then decreasing, with the peak annual issuance period between 2011 and 2021, and the average number of policy texts showing a downward trend. Policy documents were summarized into 3 levels: physician periodic assessment work, individual behavior, and institutional systems, encompassing a total of 8 categories of themes. The proportion of supply-oriented, environmental-oriented, and demand-oriented policy tools were 4.03%, 60.40%, and 35.57%, respectively. Moreover, environmental-oriented tools continued to dominate over time, followed by demand-oriented tools, with supply-oriented tools being the least. ConclusionThe policy themes are relatively broad and difficult to implement, focusing on establishing regulations while neglecting resource provision, and failing to continuously improve the construction of the system. It is recommended to clearly define the scope of the periodic assessment management, improve supporting systems, increase resource supply, and continuously promote the execution of assessments and policy revisions.

ObjectiveTo explore the current status and issues regarding the application of ancient books in clinical practice guidelines and expert consensus of traditional Chinese medicine （TCM） published in China， and to provide methodological recommendations for the incorporation of ancient books in the development of TCM guidelines. MethodsWe searched China National Knowledge Infrastructure （CNKI）， WanFang Data， VIP， SinoMed， PubMed， Embase， as well as six industry websites including China Association of Chinese Medicine， National Group Standards Information Platform， and Chinese Association of the Integration of Traditional and Western Medicine，etc. TCM clinical practice guidelines or expert consensus issued during January 1st， 2017， to November 26th， 2022 were searched. Clinical practice guidelines or expert consensus that explicitly referred to ancient books were included， and the content regarding the searching for ancient books， sources of access to ancient books， methods of evaluating the level of evidence， methods of evaluating the level of recommendation， and methods of evaluating the evidence for the ancient books were analysed. ResultsA total of 1,215 TCM clinical practice guidelines or expert consensus were retrieved， with 442 articles explicitly mentioning the application of ancient books， including 300 （67.87%） clinical practice guidelines and 142 （32.13%） expert consensus. Sixty of the 442 publications explicitly reported that ancient books searching had been conducted （13.57%）； among these 60 publications 27 （45.00%） explicitly reported ancient books searching strategies， and the most frequent method was manual searching with a total of 24 articles （40.00%）. The most popular search source was Chinese Medical Dictionary， a TCM classics database， with a total of 18 articles. 197 articles （44.57%） explicitly reported the evaluation criteria for the level of evidence， of which 141 articles （71.57%） involved the evaluation criteria for the ancient books； 413 articles （93.44%） mentioned ancient books in the recommendations， and only the source of formula name was mentioned in 409 （99.03%） of the publications. ConclusionThe current application of ancient books in TCM clinical practice guidelines and expert consensus is limited， with issues of non-standard searching and evaluation methods. Standar-dization and uniformity are needed in evidence grading and recommendation standards. Future research should clarify the scope and methods of applying ancient book， emphasize their integration with modern research evidence， and enhance their value and quality in the development of TCM clinical practice guidelines.

Gaining a better understanding of autoprotection against drug-induced liver injury(DILI)may provide new strategies for its prevention and therapy.However,little is known about the underlying mechanisms of this phenomenon.We used single-cell RNA sequencing to characterize the dynamics and functions of hepatic non-parenchymal cells(NPCs)in autoprotection against DILI,using acetaminophen(APAP)as a model drug.Autoprotection was modeled through pretreatment with a mildly hepatotoxic dose of APAP in mice,followed by a higher dose in a secondary challenge.NPC subsets and dynamic changes were identified in the APAP(hepatotoxicity-sensitive)and APAP-resistant(hepatotoxicity-resistant)groups.A chemokine(C-C motif)ligand 2+endothelial cell subset almost disappeared in the APAP-resistant group,and an R-spondin 3+endothelial cell subset promoted hepatocyte proliferation and played an important role in APAP autoprotection.Moreover,the dendritic cell subset DC-3 may protect the liver from APAP hepatotoxicity by inducing low reactivity and suppressing the autoimmune response and occurrence of inflammation.DC-3 cells also promoted angiogenesis through crosstalk with endothelial cells via vascular endothelial growth factor-associated ligand-receptor pairs and facilitated liver tissue repair in the APAP-resistant group.In addition,the natural killer cell subsets NK-3 and NK-4 and the Sca-1-CD62L+natural killer T cell subset may promote autoprotection through interferon-y-dependent pathways.Furthermore,macrophage and neutrophil subpopulations with anti-inflammatory phenotypes promoted tolerance to APAP hepatotoxicity.Overall,this study reveals the dynamics of NPCs in the resistance to APAP hepatotoxicity and provides novel insights into the mechanism of autoprotection against DILI at a high resolution.

Objective:To analyze the clinical characteristics and management strategy of carotid web (CW)-related stroke and improve the understanding of CW.Methods:The clinical data of 6 patients with CW-related stroke treated at Xuanwu Hospital, Capital Medical University, from January 2018 to September 2022 were retrospectively analyzed. Relevant data included clinical manifestations, bronchial magnetic resonance imaging (MRI), CT angiography (CTA)/digital subtraction angiography (DSA), carotid ultrasonography, and transcranial color-coded Doppler sonography (TCCD). Treatments and follow-ups were also reported.Results:All 6 patients were middle-aged or young, without traditional risk factors for cerebrovascular disease. The male-to-female ratio was 2∶4. All patients had recurrent strokes, with a score of 2-4 on the National Institutes of Health Stroke Scale at the time of onset. Head MRI showed 5 patients with cerebral infarction in the middle cerebral artery supply area; 1 patient had no intracranial infarction. No significant stenosis of the vessels at the site of the CW was observed in any of the 6 patients. Four patients had ipsilateral stenosis or occlusion of the middle cerebral artery, 1 patient had microembolic signals in the middle cerebral artery, and 1 patient had no significant abnormalities in the intracranial artery. All 6 patients were initially diagnosed by ultrasound. Diagnoses were confirmed by CTA/DSA in 5 cases; the other patient did not show any significant abnormalities. All 6 patients underwent a carotid endarterectomy after a pathological examination to confirm the diagnosis. Postoperatively, regular antiplatelet aggregation and statin lipid-lowering therapies were administered. A follow-up of 0.5 to 5.2 years showed no stroke recurrence in any patient.Conclusions:CW-related stroke is a rare cause of cryptogenic stroke and has a high recurrence rate. For stroke patients who do not have traditional risk factors for cerebrovascular disease while repeatedly experiencing embolic events of the internal carotid artery system, attention should be paid to the combination of the carotid and cerebral arteries, and comprehensive hemodynamic characteristics should be checked for the presence of a CW. Carotid artery ultrasound and TCCD combined with other imaging methods can improve the detection rate of a CW. Simple antiplatelet aggregation therapy cannot effectively prevent stroke recurrence. For patients with confirmed CW-related cerebral infarction, surgical resection can be performed, and the treatment effect can be evaluated using ultrasonography.

OBJECTIVE To observe the efficacy and safety of albumin-bound paclitaxel in the treatment of advanced non- small cell lung cancer （NSCLC）. METHODS Clinical data of patients with advanced NSCLC treated in our hospital from January 2018 to December 2021 were selected. According to their chemotherapy regimen，they were divided into albumin-bound paclitaxel group and paclitaxel group， with 100 patients in each group. Both groups received chemotherapy regimen containing Paclitaxel for injection （albumin-bound） or Paclitaxel injection for at least 2 cycles （every 21 days as a cycle）. The progression-free survival （PFS） and efficacy of the two groups were compared，and the occurrence of toxic and side effects were recorded. RESULTS The patients in albumin-bound paclitaxel group completed 430 cycles of chemotherapy， with an average of 4.3 cycles； patients in paclitaxel group completed 476 cycles of chemotherapy， with an average of 4.8 cycles. The median PFS （4.0 months） and the response rate （13.00%） of albumin-bound paclitaxel group were not significantly different from those of paclitaxel group （4.0 months，9.00%） （P＞0.05）. The disease control rate （99.00%） was significantly higher than that in paclitaxel group （89.00%）， and the incidences of leukopenia， neutropenia， thrombocytopenia，anemia， sensory neuropathy， fatigue，nausea and vomiting，joint myalgia in albumin-bound paclitaxel group were significantly lower than those in paclitaxel group （P＜0.05）. CONCLUSIONS Albumin-bound paclitaxel is effective in the treatment of advanced NSCLC， and it can better control the progression of the disease and is safer than ordinary paclitaxel.

The adjacent anatomy of the pelvis is complicated, with digestive, urinary, reproductive and other organs as well as important blood vessels and nerves. Therefore, accurate resection of pelvic tumors and precise reconstruction of defects after resection are extremely difficult. The development of medical 3D printing technology provides new ideas for precise resection and personalized reconstruction of pelvic tumors. The “triune” application of 3D printing personalized lesion model, osteotomy guide plate and reconstruction prosthesis in pelvic tumor limb salvage reconstruction treatment has achieved good clinical results. However, the current lack of normative guidance standards such as preparation and application of 3D printing personalized lesion model, osteotomy guide plate and reconstruction prosthesis restricts its promotion and application. The formulation of this consensus provides normative guidance for 3D printing personalized pelvic tumor limb salvage reconstruction treatment.

Objective:To investigate the value of flow cytometric analysis of peripheral blood in the diagnosis of erythroderma.Methods:A total of 29 patients with erythroderma were collected from Hospital of Dermatology, Chinese Academy of Medical Sciences from September 2017 to December 2020, including 6 with erythrodermic mycosis fungoides (EMF) , 5 with Sézary syndrome (SS) , 18 with inflammatory erythroderma (IE) with different etiologies. Four healthy volunteers served as healthy controls. Flow cytometry was performed to detect peripheral blood lymphocyte subsets, immunophenotypes and clonality, and their differences were analyzed between inflammatory erythroderma and lymphoma-related erythroderma. One-way analysis of variance and least significant difference- t test were used for comparisons between groups. Results:The proportions of T cells, B cells, NK cells and CD4 -CD8 - cells significantly differed among the EMF group, SS group, IE group and control group (all P < 0.001) . The proportion of T cells was significantly higher in the SS group (93.8% ± 3.4%) than in the EMF group (42.7% ± 6.4%) and IE group (46.0% ± 6.8%, t = 12.8, 14.4, respectively, both P < 0.001) , and the proportion of CD4 -CD8 - cells was significantly lower in the IE group (0.37% ± 0.40%) than in the EMF group (2.93% ± 0.84%) and SS group (2.38% ± 0.74%, t = 9.2, 6.7, respectively, both P < 0.05) . The expression of clonal T-cell receptor β-chain variable region (TCR-vβ) was not detected in healthy controls or IE patients; the T cell subsets expressing clonal TCR-vβ were detected in 3 cases of EMF and all cases of SS, and they were all identified to be cells with a CD4 +CD7 -CD26 - phenotype. There were significant differences among the above 4 groups of subjects in the proportions of CD4 + T lymphocytes expressing chemokine receptors CCR4, CXCR3, CCR5, cutaneous lymphocyte antigen (CLA) or programmed death receptor-1 (PD-1) on the cell surface (all P < 0.001) . Compared with the SS group and EMF group, the IE group showed significant decreased proportions of CD4 + T lymphocytes expressing CCR4, CLA or PD-1 (all P < 0.001) , but significantly increased proportions of CD4 + T lymphocytes expressing CXCR3 or CCR5 (all P < 0.001) . Conclusion:Flow cytometric analysis of peripheral blood lymphocyte subsets, immunophenotypes and clonality can provide a reference for the etiological diagnosis of erythroderma, and is helpful for the differential diagnosis between lymphoma-associated erythroderma and inflammatory erythroderma.

Background: Cardiopulmonary resuscitation (CPR) strategies in COVID-19 patients differ from those in patients suffering from cardiogenic cardiac arrest. During CPR, both healthcare and non-healthcare workers who provide resuscitation are at risk of infection. The Working Group for Expert Consensus on Prevention and Cardiopulmonary Resuscitation for Cardiac Arrest in COVID-19 has developed this Chinese Expert Consensus to guide clinical practice of CPR in COVID-19 patients. Main recommendations: 1) A medical team should be assigned to evaluate severe and critical COVID-19 for early monitoring of cardiac-arrest warning signs. 2) Psychological counseling and treatment are highly recommended, since sympathetic and vagal abnormalities induced by psychological stress from the COVID-19 pandemic can induce cardiac arrest. 3) Healthcare workers should wear personal protective equipment (PPE). 4) Mouth-to-mouth ventilation should be avoided on patients suspected of having or diagnosed with COVID-19. 5) Hands-only chest compression and mechanical chest compression are recommended. 6) Tracheal-intubation procedures should be optimized and tracheal-intubation strategies should be implemented early. 7) CPR should be provided for 20-30 min. 8) Various factors should be taken into consideration such as the interests of patients and family members, ethics, transmission risks, and laws and regulations governing infectious disease control. Changes in management: The following changes or modifications to CPR strategy in COVID-19 patients are proposed: 1) Healthcare workers should wear PPE. 2) Hands-only chest compression and mechanical chest compression can be implemented to reduce or avoid the spread of viruses by aerosols. 3) Both the benefits to patients and the risk of infection should be considered. 4) Hhealthcare workers should be fully aware of and trained in CPR strategies and procedures specifically for patients with COVID-19.

Objective To introduce a self-developed computer-assisted design/rapid prototyping and guidance system used for precise placement of the acetabular component in total hip arthroplasty.Methods We collected the preoperative pelvic CT scanning data of 10 hips with aeetabular dysplasia that had undergone primary total hip arthroplasty from January 2016 to January 2017.The total time for import of radiographic images,model reconstruction,model segmentation,acetabular component position design and STL model export was calculated and compared between our self-designed software and Mimics vl 7.0.Three kinds of STL model from each case were imported into our self-developed 3D printing device,Stratasys Objet30 and Stratasys Demension SST1200es respectively for rapid prototyping.The printing efficiency and accuracy were compared among the 3 printers.The accuracy of placing acetabular component with guidance system was evaluated.Results The average time forpreoperative planningwas7.7±1.3 minbyourself-designedsoftware and 52.5 ± 15.9 min by Mimics v17.0,showing a significant difference (P ＜ 0.001).In morphological point-based comparison for each case,the 3D models exported by the 2 different kinds of software showed an average difference of 0.072 1 ± 0.069 1 mm.The average durations for rapid prototyping by the 3 different printers were 5.3 ± 0.6 h,10.8 ± 0.5 h,and 9.3 ± 0.6 h,respectively,showing significant differences (P ＜ 0.001).The guidance system resulted in precise placement.The locations of the acetabular component achieved by guide-assisted placement were not significantly different from the target ones (P ＞ 0.05).Conelusion Our self-developed preoperative planning software,rapid prototyping device and guidance apparatus for acetabular component placement may lead to good accuracy and high efficiency.

Objective To compare the clinical effect of arthroscopic single-row and suture-bridge double-row fixation of full-thickness rotator cuff tear.Methods A retrospective study was conducted on 40 patients with full-thickness rotator cuff tear treated by single-row and suture-bridge double-row fixation between May 2010 and May 2012.Single-row rotator cuff repair was performed in 18 patients and doublerow repair in 22 patients.The two techniques were compared in aspects of complications,recovery time to daily life,time to achieve satisfaction score,re-tear rate,pre-and post-operative VAS,University of California at Los Angeles Shoulder Scores (UCLA),and American Shoulder and Elbow Surgeons (ASES).Results Mean period of follow-up was 15.6 months (range,13-24 months).Both treatment were effective in improving VAS,UCLA,and ASES,but the differences were insignificant (P ＞ 0.05).Recovery time to daily life,time to achieve satisfaction score,and large rotator cuff re-tear rate were 69.2 ± 16.6)d,(196.4 ±24.6)d,and 4/5 respectively in single-row fixation,with significant differences from (54.1 ± 13.3)d,(165.0 ±20.6)d,and 1/8 in suture-bridge double-row fixation (P ＜0.05).Conclusion Both treatments are effective for rotator cuff reconstruction,but suture-bridge double-row fixation provides earlier recovery to daily life,shorter time to achieve satisfaction score,and lower incidence of large rotator cuff retear.