OBJECTIVE To standardize the main processes and related technical links of the clinical comprehensive evaluation of drugs， and provide guidance and reference for improving the quality of comprehensive evaluation evidence and its transformation and application value. METHODS The construction of Guideline for the Workflow of Clinical Comprehensive Evaluation of Drugs was based on the standard guideline formulation method of the World Health Organization （WHO）， strictly followed the latest definition of guidelines by the Institute of Medicine of the National Academy of Sciences of the United States， and conformed to the six major areas of the Guideline Research and Evaluation Tool Ⅱ. Delphi method was adopted to construct the research questions； research evidence was established by applying the research methods of evidence-based medicine. The evidence quality classification system of the Chinese Evidence-Based Medicine Center was adopted for evidence classification and evaluation. The recommendation strength was determined by the recommendation strength classification standard formulated by the Oxford University Evidence-Based Medicine Center， and the recommendation opinions were formed through the expert consensus method. RESULTS & CONCLUSIONS The Guideline for the Workflow of Clinical Comprehensive Evaluation of Drugs covers 4 major categories of research questions， including topic selection， evaluation implementation， evidence evaluation， and application and transformation of results. The formulation of this guideline has standardized the technical links of the entire process of clinical comprehensive evaluation of drugs， which can effectively guide the high-quality and high-efficient development of this work， enhance the standardized output and transformation application value of evaluation evidence， and provide high-quality evidence support for the scientific decision-making of health and the rationalization of clinical medication.

OBJECTIVE To explore the clinical characteristics of Mycoplasma pneumoniae pneumonia(MPP)after COVID-19 epidemic so as to offer help for early clinical diagnosis and treatment.METHODS The clinical data that were collected from the MPP patients who were treated in the fever clinic of the First Medical Center of Chinese PLA General Hospital from Jul.2023 to Aug.2024 were retrospectively analyzed.The results of laboratory tests for the different age groups of patients complicated with other pathogens were statistically analyzed.RESULTS Of totally 161 MPP patients who were enrolled in the study,78(48.85％)were male,and 83(51.55％)were fe-male;the average age was(32.98±14.35)years old,and the patients aged between 20 and 40 years old accoun-ted for 43.48％(70 cases).The enrolled patients were divided into the simple MPP group with 92(57.14％)ca-ses and the MPP+mixed group with 69(42.86％)cases according to the result of etiological test of sputum;the patients of MPP+mixed group were divided into the MPP+bacteria group with 42(60.87％)cases,the MPP+fungi group with 10(14.49％)cases,and the MPP+viruses group with 17(24.64％)cases.There was significant difference in the age among the groups(P＜0.05);there were no significant differences in the sex,white blood cell counts and percentage of mononuclear cells among the groups,the percentage of lymphocytes was highest in the simple MPP group,the levels of C-reactive protein(CRP)and interleukin-6(IL-6)were highest in the MPP+bacteria group,and there were significant differences(P＜0.05).All of the patients were divided into three groups:the ≤20-year-old group the＞20-40-year old group and the＞40-year-old group.There were no sig-nificant differences in the white blood cell counts,percentage of lymphocytes,percentage of mononuclear cells and IL-6 level among the three groups,and the CRP level was highest in the＞20-40-year old group(P=0.025).Ran-dom forest model analysis showed that the weight of CRP was highest(22.65％)among the clinical characteristics of the MPP patients,which played a key role in construction of model.As for other factors,the weight of age was 17.02％,the percentage of lymphocytes 15.34％,the white blood cells counts 14.86％,the percentage of mono-nuclear cells 14.39％,the IL-6 13.61％,the gender 2.13％.CONCLUSION MPP maintains common among the patients aged less than 40 years old after the COVID-19 epidemic,nearly half of the patients are complicated with the infections of other pathogens,and CRP is more helpful for the clinical diagnosis and treatment of the MPP in early stage.

Objective To observe the value of dual-energy CT(DECT)for diagnosing knee gouty arthritis(GA)complicated with knee osteoarthritis(KOA).Methods Forty-eight cases of GA(GA group),30 cases of KOA(KOA group)and 60 cases of GA complicated with KOA(GA+KOA group)were retrospectively enrolled.Clinical and imaging data were compared among 3 groups and between each 2 groups,and the efficacy of DECT for diagnosing knee GA complicated with KOA was analyzed.Results Significant differences of detection rate and CT value of bone marrow edema(BME)were found among 3 groups and between each 2 groups(all P＜0.05),also of the course of disease,serum uric acid(SUA),monosodium urate(MSU)volume,bone erosion score and CT value between GA group and GA+KOA group(all P＜0.05).The area under the curve(AUC)of bone erosion score and CT value for diagnosing knee GA complicated with KOA was 0.779 and 0.824,respectively,and of the combination of the above 5 indexes was 0.898,higher than that of each parameter alone(all P＜0.05).Conclusion DECT was helpful for diagnosing knee GA complicated with KOA,and further combining with clinical parameters could improve its diagnostic efficacy.

OBJECTIVE To summarize the clinical characteristics and diagnosis and treatment experiences in dealing with non-severe Chlamydia psittaci pneumonia.METHODS The clinical data were collected from 34 patients who were diagnosed with non-severe C.psittaci pneumonia through quantitative polymerase chain reactiong(qPCR)for sputum in fever clinic of the First Medical Center of Chinese PLA General Hospital from Mar.2023 to Mar.2024 and were retrospectively analyzed.The clinical characteristics and treatment outcomes were evaluated.RESULTS The average age of the patients was(44.82±13.74)years old,the ratio of male to female was 1∶1.83;all of the patients had fever;major symptoms were cough(70.59％),pharyngodynia(44.12％),and flu-like symptoms(41.18％);82.35％of the patients had the history of contact with poultry.The C-reactive pro-tein(CRP)level,interleukin-6(IL-6),systemic inflammatory response index(SIRI)and aggregate index of sys-temic inflammation(AISI)were higher among the patients aged no less than 44 years old than among the patients less than 44 years old(P＜0.05);the percentage of lymphocytes of the patients aged no less than 44 years old was lower than that of the patients aged less than 44 years old(P＜0.05).As for the imaging findings,73.53％of the patients had consolidation shadows,26.47％had ground-glass opacities,and 32.35％involved both lungs.All of the patients received quinolones or tetracyclines for treatment of 7-14 days and all symptoms relieved.CT reexami-nated 1 month after the treatment showed that 55.88％of the cases had complete absorption of pulmonary infec-tious lesions,and 35.29％had partial absorption.CONCLUSIONS The patients with non-severe Chlamydia psitta-ci pneumonia are characterized by the history of contact with poultry,fever complicated with respiratory tract symptoms,rise of inflammatory markers(more significant among patients of advanced age)and lower lobe con-solidation shadow/ground-glass opacities.Early identification and standardized treatment may facilitate the favora-ble treatment outcomes.

Aim To investigate the effects of m6A demethylase ALKBH5 on cardiomyocytes pyroptosis in mice with myocardial infarction(MI).Methods The MI model of left anterior descending coronary artery ligation surgery was established by knocking down ALKBH5 using adeno-associated virus,and the hypox-ia model of mouse cardiomyocytes(HL-1)was estab-lished by knocking down small interfering RNA.The effects of ALKBH5 on the pyroptosis of MI mice and hypoxic HL-1 cells were observed.Subsequently,mechanism studies were conducted at the cellular lev-el,and the binding of ALKBH5 and IGF2BP2 to NL-RP3 mRNA was detected through RNA pull down and RNA immunoprecipitation(RIP)experiments.The MeRIP-qPCR method was used to determine the effects of ALKBH5 on the mRNA m6A level of NLRP3.Acti-nomycin D for RNA stability experiments were conduc-ted to detect the effects of ALKBH5 and IGF2BP2 on the stability of NLRP3 mRNA.Results Knocking down ALKBH5 in vivo and in vitro both inhibited NL-RP3 inflammasome activation and alleviated pyroptosis in MI mice and hypoxic HL-1 cells.Mechanistically,the results showed that NLRP3 mRNA could bind to ALKBH5 protein in HL-1 cells;knocking down ALK-BH5 could increase the m6A level of NLRP3 and re-duce the stability of NLRP3 mRNA;subsequently,it was confirmed that NLRP3 mRNA and IGF2BP2 pro-tein bound to each other;knocking down IGF2BP2 in-creased the mRNA stability of NLRP3.The Rescue ex-periment showed that knocking down IGF2BP2 re-versed the decrease in NLRP3 mRNA expression caused by knocking down ALKBH5.Conclusions ALKBH5 mediated m6A modification of NLRP3 pro-motes cardiomyocytes pyroptosis in mice with myocardi-al infarction.

Objective:To explore the effect in terms of oxidative stress of combining hyperbaric oxygen (HBO) therapy with arterial thrombolysis in treating acute ischemic stroke.Methods:A total of 166 ischemic stroke survivors were divided into a 0.15MPa group (41 cases), a 0.2MPa group (42 cases), a 0.25MPa group (40 cases), and a 0.3MPa group (43 cases), using a random number table. All received arterial thrombolysis and HBO therapy at the relevant pressure for 14 days. Before and after the treatment, all were assessed using the National Institutes of Health Stroke Scale (NIHSS), and in terms of serum levels of malondialdehyde (MDA) using the thiobarbituric acid method. Superoxide dismutase (SOD) was quantified by the SOD substrate method. Total antioxidant capacity (TAC) was assayed using enzyme-linked immunosorbent assays. Interleukin-1β (IL-1β) was quantified by immunofluorescence and chemiluminescence, and tumor necrosis factor-α (TNF-α) by chemiluminescence immunoassay.Results:After the treatment there was a significant increase in all of the groups′ average NIHSS scores, but with that of the 0.15MPa group significantly higher than the other 3 groups′ averages. The average MDA, SOD, TAC, IL-1β and TNF-α levels of all of the groups had also improved, especially the average MDA score, SOD level, TAC level, IL-1β level and TNF-α level of the 0.2MPa group. In the 0.25MPa group, the average MDA, SOD, TAC, IL-1β level and TNF-α levels had also improved significantly. There was, however, no significant difference in these measurements between the 0.2 and 0.25MPa groups.Conclusions:HBO combined with arterial thrombolysis can improve neurological functioning, regulate oxidative stress, and reduce inflammatory responses in acute ischemic stroke. The best results are at an HBO pressure of 0.2 or 0.25MPa.

Objective:To study the lipid metabolism and its relationship with iodine nutrition status in patients with papillary thyroid carcinoma (PTC) and benign thyroid nodules.Methods:A case-control study was conducted on patients with thyroid nodules initially diagnosed at Harbin Medical University Cancer Hospital from November 2015 to April 2019. Basic information, thyroid function indicators [thyroid stimulating hormone (TSH), free triiodothyronine (FT 3), free thyroxine (FT 4), thyroglobulin antibodies (TgAb), thyroid peroxidase antibodies (TPOAb)], and pathological diagnosis results were collected from all subjects. Fasting venous blood and morning urine samples were collected for serum iodine concentration (SIC), urine iodine concentration (UIC) and blood lipid indicators [total cholesterol (TC), triglyceride (TG), low density lipoprotein cholesterol (LDL-C), high density lipoprotein cholesterol (HDL-C), lipoprotein (a), apolipoprotein A1 (ApoA1), apolipoprotein B (ApoB), apolipoprotein E (ApoE), and non-esterified fatty acid (NEFA)] measurements. Results:A total of 1 090 subjects were included, including 907 PTC patients and 183 benign thyroid nodule patients. The UIC [ M ( Q1, Q3)] for the PTC group and benign thyroid nodule group were 143.36 (94.08, 227.94) and 146.28 (112.89, 236.07) μg/L, respectively, with statistically significant differences between the groups ( Z = 4.16, P = 0.042). Among PTC patients with different clinical pathological features, those with lymph node metastasis had higher FT 3 levels than those without lymph node metastasis ( t = 5.42, P = 0.021). The levels of TSH, TgAb, and TPOAb in patients with PTC combined with autoimmune thyroid disease (AITD) were higher than those without AITD ( Z = 11.87, 81.55, 475.96, P < 0.05). There was no statistically significant difference in the comparison of various blood lipid indicators ( P > 0.05). The correlation analysis showed that SIC in patients with thyroid nodules was positively correlated with FT 3, FT 4, ApoB, lipoprotein (a), NEFA, TG, LDL-C, and LDL-C/HDL-C ( P < 0.05). FT 3 was positively correlated with NEFA and LDL-C/HDL-C ( r = 0.12, 0.09, P < 0.05), and negatively correlated with ApoA1, TC, and HDL-C ( r = - 0.14, - 0.14, - 0.15, P < 0.001). FT 4 was positively correlated with NEFA ( r = 0.11, P < 0.001), and negatively correlated with TG ( r = - 0.10, P = 0.003). According to the iodine nutritional level, the ApoE level of PTC patients in the SIC < 45 μg/L group was higher than that in the 45 - 90 μg/L group ( P < 0.05). The levels of LDL-C and ApoB in patients with benign thyroid nodules in the SIC > 90 μg/L group were higher than those in the 45 - 90 μg/L group ( P < 0.05). The ApoE level of patients with benign thyroid nodules in the UIC < 100 μg/L group was significantly higher than that in the 100 - 299 and ≥300 μg/L groups ( P < 0.05). There was no statistically significant difference in thyroid function indicators of patients with PTC and benign thyroid nodules between different levels of SIC and UIC ( P > 0.05). Conclusions:Compared to benign thyroid nodules, PTC does not significantly affect patients' blood lipid levels. In patients with PTC and benign thyroid nodules, insufficient or excessive iodine nutrition can affect lipid metabolism.

Aim To investigate the effects of hydroxyl-safflor yellow A(HSYA)on the regenerative and re-pair functions of human umbilical cord mesenchymal stem cells(hUC-MSCs).Methods hUC-MSCs were mechanically isolated,and their morphology was ob-served.Cell surface marker expression was analyzed u-sing flow cytometry.Osteogenic differentiation was used to confirm the multipotency of the cells.The cells were treated with various concentrations of HSYA(0,100,200,400,600 μmol·L-1),and the optimal con-centration and duration of treatment were determined u-sing the CCK-8 assay.Cells were divided into four groups:control,100,200,and 400 μmol·L-1.The proliferative capacity of hUC-MSCs was assessed by EdU incorporation.Vascular endothelial growth factor(VEGF)and brain-derived neurotrophic factor(BD-NF)levels in the culture supernatant were measured u-sing enzyme-linked immunosorbent assays.Cell migra-tion ability was evaluated by Scratch assays.The ex-pression levels of VEGF,BDNF,and fibroblast growth factor 2(FGF2)were detected by Western blotting.Results The isolated cells exhibited characteristics consistent with stem cell surface markers and demon-strated osteogenic and adipogenic differentiation poten-tial.After 48 hours of treatment,no cytotoxicity was observed at concentrations of 100,200,and 400 μmol·L-1compared to the control group.HSYA signifi-cantly increased the number of EdU-positive cells and cell migration rate,with the most pronounced effect was achieved at 200 μmol·L-1(P＜0.01).VEGF and BDNF levels in the supernatant were elevated,with the highest expression observed at 200 μmol·L-1(P＜0.01).Similarly,the expression levels of BDNF,VEGF,and FGF2 were significantly upregulated in the HSYA groups,with the highest levels at 200 μmol·L-1(P＜0.01).Conclusion HSYA promotes the proliferation,migration and angiogenesis of hUC-MSCs,with an optimal concentration of 200 μmol·L-1.

This study investigated the prevalence of canine ticks and the types of their carried pathogens in select cities of Liaon-ing Province,to provide a theoretical scientific basis for the prevention and control of ticks and tick-borne diseases.Canine ticks were collected from six cities in Liaoning Province(Shenyang,Dalian,Anshan,Chaoyang,Tieling,Dandong)and identified through a combination of morphological and molecular biology methods.PCR was used to detect five tick pathogens:Rickettsia,Borrelia burgdor-feri,Babesia,Pseudomonas aeruginosa,and Ehrlichia.Canine ticks were prevalent primarily in Liaoning Province from April to June.The collected ticks included 456 Haemaphysalis longicornis,70 Ixodes persulcatus,and 31 Rhicephalus sanguineus.Three tick borne pathogens,Ehrlichia,Borrelia burgdorferi,and Rickettsia,were detected,whereas no Babesia or Pseudomonas were detected.The to-tal detection rate of Ehrlichia(46.85%),which is significant difference with total detection rate of Borrelia burgdorferi(10.81%)(χ2=33.392,P<0.05),but insignificant difference with total detection rate of Rickettsia(34.23%)(χ2=3.370,P>0.05),Both Eh-rlichia and Rickettsia were distributed in the six cities.Haemaphysalis longicornis was the dominant tick species parasite on the surfaces of dogs in Liaoning Province.The main tick borne pathogens in dogs in Liaoning Province were Ehrlichia and Rickettsia.

Objective:To investigate the application of blended team-based learning (BTBL) in improving the clinical reasoning ability of general practitioners from different sources.Methods:From September to December in 2021, 52 postgraduates of general practice in Tongji University School of Medicine were selected as subjects, and according to their study background and practice experience, they were divided into residency training group, community group, and specialist group. BTBL was adopted for all students in the course of clinical reasoning in general practice, and a 4-station objective structured clinical examination (OSCE) test was conducted before and after the course to evaluate teaching effectiveness from the aspects of medical history collection, physical examination, doctor-patient communication, and medical record writing. SPSS 22.0 was used to perform a statistical analysis of data. Continuous data were expressed as mean±standard deviation, and an analysis of variance or the Kruskal-Wallis test was used for comparison between groups; the paired samples t-test or the Wilcoxon signed rank sum test was used for comparison of normally distributed or non-normally distributed data within each group. Categorical data were expressed as frequency and percentage. Results:There was a significant change in the score of physical examination after the course in the community group (44.88±9.17 vs. 78.06±12.11, t=-12.49, P<0.001), the specialist group (45.85±8.18 vs. 68.65±13.10, t=-6.43, P<0.001), and the residency training group (42.38±15.30 vs. 76.44±16.46, t=-5.98, P<0.001). There was a significant change in the score of doctor-patient communication after the course in the community group (63.00±13.84 vs. 78.69±7.10, t/Z=-4.33, P<0.05) and the residency training group (60.00±15.50 vs. 70.88±6.44, t/Z=-2.12, P<0.05). There was also a significant change in the score of medical record writing after the course in the community group (60.19±17.96 vs. 79.69±14.25, t=-2.96, P<0.05), the specialist group (47.77±12.59 vs. 80.31±12.93, t=-6.26, P<0.05), and the residency training group (37.00±15.50 vs. 75.88±15.88, t=-7.25, P<0.05). The score of medical record writing before the course was 60.19±17.96 in the community group, 47.77±12.59 in the specialist group, and 37.00±15.50 in the residency training group, with a significant difference between the three groups ( χ2=13.04, P=0.001); after the course, the score of medical record writing was 78.69±7.10 in the community group, 63.46±19.40 in the specialist group, and 70.88±6.44 in the residency training group, with a significant difference between the three groups ( χ2=10.13, P=0.006). Conclusions:In the course of clinical reasoning in general practice, BTBL can improve teaching efficiency, save teaching resources, and play the role of promoting strengths and avoiding weaknesses.