OBJECTIVE To investigate the impact of Netupitant and palonosetron hydrochloride capsules （NEPA） on the pharmacokinetics of Paclitaxel for injection （albumin bound） （i. e. albumin-bound paclitaxel） under different intestinal microenvironment conditions. METHODS Male SD rats were divided into a normal group and a model group （n＝16）. Rats in the model group were intragastrically administered vancomycin solution to establish an intestinal disorder model. The next day after modeling， intestinal microbiota diversity was analyzed， and the mRNA expressions of cytochrome P450 3A1 （CYP3A1） and CYP2C11 in small intestine and liver tissues as well as those protein expressions in liver tissue were measured. Male SD rats were grouped as described above （n＝16）. The normal group was subdivided into the TP chemotherapy group （TP-1 group） and the TP chemotherapy+NEPA group （TP+NEPA-1 group）； the model group was subdivided into the TP chemotherapy group （TP-2 group） and the TP chemotherapy+NEPA group （TP+NEPA-2 group） （n＝8）. Rats in the TP+NEPA-1 and TP+NEPA-2 groups received a single intragastric dose of NEPA suspension （25.8 mg/kg， calculated by netupitant）. One hour later， all four groups received a single tail vein injection of albumin-bound paclitaxel and cisplatin. Blood samples were collected at different time points after the last administration. Using azithromycin as the internal standard， plasma paclitaxel concentrations were determined by liquid chromatography-tandem mass spectrometry. The main pharmacokinetic parameters were calculated using DAS 2.0 software and compared between groups. RESULTS Compared with the normal group， the model group showed significantly decreased Chao1 and Shannon indexes （P＜0.05）， significant alterations in microbiota composition and relative abundance， and significantly downregulated expressions of CYP3A1 mRNA in liver tissue and CYP2C11 mRNA in both small intestine and liver tissues （P＜0.05）. Compared with the TP-1 group， the AUC0－t， AUC0－∞， MRT0－t of paclitaxel in the TP-2 group， the cmax， AUC0－t， AUC0－∞ of paclitaxel in the TP+NEPA-1 group and TP+NEPA-2 group were significantly increased or prolonged； CL of paclitaxel in the TP-2 group， Vd and CL of paclitaxel in the TP+NEPA-1 group and the TP+NEPA-2 group were significantly decreased or shortened （P＜0.05）. Compared with the TP-2 group， cmax of paclitaxel in the TP+NEPA-2 group was significantly increased， and Vd and MRT0－t were significantly decreased or shortened （P＜0.05）. CONCLUSIONS Intestinal microbiota disorder affects the mRNA expressions of CYP3A1 and CYP2C11， leading to decreased clearance and increased systemic exposure of paclitaxel. Concomitant administration of NEPA under normal intestinal microbiota condition increases paclitaxel exposure. However， under conditions of intestinal microbiota disorder， concomitant administration of NEPA has a limited impact on paclitaxel systemic exposure.

Objective:To study the allocation efficiency of private ophthalmology health resources in Shanxi,and to provide references for improving the allocation efficiency of health resources in Chinese private ophthalmology medical institutions.Methods:The resource allocation and services of 70 private ophthalmic medical institutions in Shanxi were collected through a questionnaire survey,and Data Envelopment Analysis(DEA)was used to evaluate the efficiency of health resource allocation in medical institutions of Shanxi.Results:The average values of technical efficiency,pure technical efficiency,and scale efficiency of health resource allocation in private ophthalmic medical institutions in Shanxi were 0.963,0.980,and 0.982,respectively.Among the 70 private ophthalmology institutions,7 institutions were DEA-strongly efficient in health resource allocation,26 institutions were DEA-weakly efficient,37 institutions were non-DEA efficient,15 institutions had constant return to scale,40 institutions had increasing return to scale,and 15 institutions had decreasing return to scale.The allocation of health resources in 7 cities,including Taiyuan,Datong,and Shuozhou,etc.were DEA-strongly efficient;Changzhi and Jincheng were DEA-weakly efficient,both with increasing return to scale;and Linfen was non-DEA efficient with increasing return to scale.Conclusion:The efficiency of health resource allocation in some municipalities of Shanxi needs to be improved;the level of inter-organization varied,and the problems of insufficient resources and wasted inputs coexisted.In the future,ophthalmic resources should be rationally allocated,and input and output indicators should be adjusted according to the actual situation.

Objective:To study the allocation efficiency of private ophthalmology health resources in Shanxi,and to provide references for improving the allocation efficiency of health resources in Chinese private ophthalmology medical institutions.Methods:The resource allocation and services of 70 private ophthalmic medical institutions in Shanxi were collected through a questionnaire survey,and Data Envelopment Analysis(DEA)was used to evaluate the efficiency of health resource allocation in medical institutions of Shanxi.Results:The average values of technical efficiency,pure technical efficiency,and scale efficiency of health resource allocation in private ophthalmic medical institutions in Shanxi were 0.963,0.980,and 0.982,respectively.Among the 70 private ophthalmology institutions,7 institutions were DEA-strongly efficient in health resource allocation,26 institutions were DEA-weakly efficient,37 institutions were non-DEA efficient,15 institutions had constant return to scale,40 institutions had increasing return to scale,and 15 institutions had decreasing return to scale.The allocation of health resources in 7 cities,including Taiyuan,Datong,and Shuozhou,etc.were DEA-strongly efficient;Changzhi and Jincheng were DEA-weakly efficient,both with increasing return to scale;and Linfen was non-DEA efficient with increasing return to scale.Conclusion:The efficiency of health resource allocation in some municipalities of Shanxi needs to be improved;the level of inter-organization varied,and the problems of insufficient resources and wasted inputs coexisted.In the future,ophthalmic resources should be rationally allocated,and input and output indicators should be adjusted according to the actual situation.

Objective:To investigatethe heterogeneity of career growth recognition amongphysicians at the stage of standardized training and the growth characteristics of clinical physicians in the early stage, and to provide a reference for improving the quality of standardized training.Methods:The trainees who received standardized residency trainingwere randomly selected from three grade A tertiary hospitals in Chongqing, China. Mplus7.4 was used for latent profile analysis to explain the relationship between explicit continuous indicators, and the subtypes of career growth recognition were analyzed.Results:Career growth recognition at the stage of standardized training was classifiedinto three subtypes of all-round growth recognition, high resource and expectation recognition, and unclassified growth recognition, among which the subtype of unclassified growth recognition accounted for the highest percentage of 40.27% (207 trainees).Conclusions:Physicians at the stage of standardized training show obvious uncertainty aboutcareer growth recognition, and it is necessary to strengthen the education on career growth recognition during standardized training and design a development pathway based on the characteristics of career growth recognition.

Objective: To investigate the present situation of health education on school myopia prevention and control in primary and middle schools in Beijing, so as to provide scientific basis and suggestions for effective implementation of health education on school myopia prevention and control. Methods: From November 6-17, 2023, a total of 551 school doctors and health care teachers from public primary and secondary schools in seven districts of Beijing were investigated by using stratified random cluster sampling method. The contents included basic information, the basic situation of school health work, and the status of myopia prevention and control in schools. The data was described by frequency and proportion. Chisquare test was used to analyze the influencing factors. Results: A total of 89.8% of the respondents were found in the school of offering health education courses about myopia prevention and control. Among these respondents, 54.5% were equipped with health education course material of professional myopia prevention and control, and the teachers were primarily class teachers (57.6%), health care teachers (45.5%), and physical education teachers (45.1%), and most of the classes were conducted once a month (33.7%) and once a semester (28.1%). A total of 95.6% of the subjects had health education activities about myopia prevention and control at their schools. The frequency of activities was once a month (38.5%) and once a semester (27.9%). There were statistically significant differences of the report rate in setting up health education courses on myopia prevention and control, and the frequency of activities in different areas and different types of schools (χ2=19.53, 13.15, 34.30, 20.32, P<0.05). Conclusions Health education on school myopia prevention and control in primary and middle schools in Beijing is supportive. But health education courses taught by professional teachers should pay attention to the norms of the course material to complete a certain amount of class time, and development of health education activities should be diversified, so as to effectively implement health education of myopia prevention and control at school.

Objective:To investigate the clinicopathological characteristics of acidophil stem cell pituitary neuroendocrine tumors (PitNET)/adenoma.Methods:Five cases of acidophil stem cell PitNET/adenoma were diagnosed between May 2022 and July 2023 at the Second Hospital of Hebei Medical University, Shijiazhuang, China. The clinicopathological features of the tumor were analyzed by using histology, immunohistochemistry, and electron microscopy. The relevant literature was reviewed.Results:There were 1 male and 4 females, aged from 23 to 69 years. Patient 3 was 55 years old at the time of diagnosis and first surgery, and relapsed 5 years later. The patients′ median age was 32 years. Patients 1 and 5 showed elevated blood prolactin, with various degrees of hormonal symptoms except Patient 3, who showed only tumor compression symptoms. Imaging studies showed that all cases involved the sellar floor. The tumors of Patients 1, 2 and 5 were closely related to the cavernous sinus segment of the internal carotid artery. The tumors exhibited a diffuse growth pattern with chromophobic to slightly acidophilic cytoplasm. A few of tumor cells showed chromophobic cytoplasm. The nucleoli were conspicuous. Intranuclear inclusion bodies and variably-sized clear vacuoles were observed occasionally. Under electron microscope, marked mitochondrial abnormalities were observed, including increased mitochondria number, expanded hypertrophy, and absence of mitochondrial ridge fracture. Some mitochondrial matrices were dense, while some were vacuolated.Conclusions:Acidophil stem cell PitNET/adenoma is a rare type of pituitary adenomas/PitNETs. It often has a more clinically aggressive manner with immature cells, diffuse expression of PIT1, prolactin, and varying degrees of growth hormone expression. Because of the obvious diversity of their clinical hormone status and hormone immune expression, the diagnosis of this type tumor is still a challenge.

To implement the strategy of healthy China and promote the construction of "new medicine science", it is urgent to focus on new needs and challenges to advance the reform of medical education curricula in China. Using literature research methods, we summarize the process of modern medical education curriculum reforms in the United States, and discuss the main features of the third-round reforms—introducing the concept of value-based medicine, offering health systems science courses, and promoting the curriculum system reform from the perspectives of learning time, curriculum integration, and learning methods. Based on these features, we put forward the enlightenment for the reform of medical education curricula in China.

Objective To investigate the correlation between the total CSVD burden and fundus vasculopathy,and evaluate significance of fundus vasculopathy for cognitive impairment in CSVD patients.Methods A total of 290 inpatients who taking physical examination in our department from May 2021 to August 2022 were consecutively recruited,and according to their score of CSVD,they were divided into group 0(129 cases),group 1(51 case),group 2(42 cases),group 3(44 cases),and group 4(24 cases).All the subjects underwent brain magnetic resonance imaging,fundus fluorescein angiography,and cognitive function assessment.The total CSVD burden and fundus vasculopathy were evaluated.The general clinical data,results of laboratory tests,fundus vascularization,and cognitive function were compared among the groups with different CSVD burden scores.Spearman correlation analysis and linear correlation analysis were used to explore the correlation between total CSVD burden score and fundus vascular disease.Results Significant differences were observed in terms of age,years of education,cerebral infarction/TIA,total cho-lesterol,LDL-C,creatinine,MoC A and MMSE scores,positive results of connectivity test,digit-symbol conversion test,Stroop colour-word interference test and verbal fluency test,values of CRAE,CRVE,AVR,Scheie grade,DWMH and PVWMH,enlarged perivascular space in the basal ganglia(BG-EPVS),lacunar infarct and cerebral microbleeds(CMB)in different CSVD total bur-den groups(P＜0.05,P＜0.01).Spearman correlation analysis showed that total CSVD burden was negatively correlated with CRAE and AVR(r=-0.655,P=0.000;r=-0.679,P=0.000),and positively with CRVE and Scheie grade(r=0.560,P=0.000;r=0.685,P=0.000).Multivari-ate linear analysis showed that the total CSVD burden after adjusting for relevant risk factors was significantly correlated with CRAE,CRVE,AVR and Scheie grades(P＜0.01).Conclusion Fun-dus vasculopathy is strongly associated with increased total CSVD burden,and it can be regarded as a valid predictor of CSVD-related cognitive impairment.

Objective:To analyze the histopathological features of primary aldosteronism(PA) based on the histopathology of primary aldosteronism(HISTALDO) consensus classification in patients undergoing unilateral adrenalectomy and explore its correlation with clinical characteristics and postoperative outcomes.Methods:A retrospective study was conducted on 105 unilateral PA patients treated at the First Affiliated Hospital of Nanjing Medical University between April 2017 and April 2022. Postoperative histopathology was classified according to the latest HISTALDO consensus and compared with traditional classifications. Differences in clinical features and primary aldosteronism surgical outcomes(PASO) were analyzed across classifications.Results:HISTALDO classification showed that 67.6% of patients were classical subtype and 32.4% were non-classical subtype. Compared to the non-classical group, the classical group showed lower age, body mass index, serum potassium concentration, fasting blood glucose, HbA 1C, and proportion of CYP11B2 negative nodules as well as higher systolic blood pressure, diastolic blood pressure, prevalence of hypokalemia, and 24-hour urine potassium(all P<0.05). Based on PASO criteria, complete clinical and biochemical success were achieved in 41.7% and 83.3% subjects respectively. A significantly higher proportion of classical group displayed complete clinical and biochemical success than nonclassical group(all P<0.05). Multivariate logistic regression analysis showed that lower serum potassium concentration( OR=0.15, 95% CI 0.03-0.84, P<0.05) and proportion of CYP11B2 negative nodules( OR=0.20, 95% CI 0.05-0.86, P<0.05) were related to classical pathological type, and classical pathological type was independently related to clinical and biochemical remission(all P<0.05). Conclusion:Standardized HISTALDO histopathological classification enhances diagnostic accuracy and predicts postoperative outcomes in unilateral PA, providing a foundation for precise stratified management of PA patients.

Objective:To investigate the effect and mechanism of human umbilical cord mesenchymal stem cells (hUCMSCs) transplantation on testicular function in aging mice with oxidative damage.Methods:Totally 18 SPF grade C57BL/C male mice aged 6-8 weeks were randomly divided into 3 groups using a complete randomization method. In control group, mice were injected with an equal amount of physiological saline; in model group, mice were subcutaneous injected D-galactose into the neck and back for 9 consecutive weeks, on the 4th weekend of modeling, the mice were injected with physiological saline via the tail vein; in hUCMSCs group: mice were subcutaneous injected D-galactose into the neck and back for 9 consecutive weeks, on the 4th weekend of modeling, the mice were injected with hUCMSCs via the tail vein of each mouse. After 9 weeks, body weight and testicular weight of the three groups mice were measured and testicular index was calculated. The contents of testosterone, malondialdehyde (MDA) and superoxide dismutase (SOD) in serum and testicular tissue were detected by enzyme-linked immunosorbent assay (ELISA) method. Visual observation of testicular appearance, the histopathological changes of testis were observed by hematoxylin-eosin (HE) staining, and the expression of NF-E2-related factor 2 (Nrf2) signal transduction-related genes and proteins were detected by RT-PCR and Western blotting, respectively.Results:Compared with control group [(0.81±0.13)%], the testicular index of mice in model group [(0.64±0.05)%, P=0.006] was decreased. In model group, the volume of testis was reduced, the integrity of spermatogenic tubules was damaged, spermatogenic cells and sperm were reduced, and the interstitium was sparse. In model group, serum testosterone [(4.10±0.67) μg/L] and SOD [(48.87±6.40) U/mg Prot] were decreased compared with control group [(5.71±0.81) μg/L, P=0.002; (78.53±9.70) U/mg Prot, P=0.001], MDA [(1.11±0.19) nmol/mg Prot] was increased compared with control group [(0.77±0.07) nmol/mg Prot, P=0.001], Keap1 mRNA and protein expression were increased ( P=0.006, P=0.043). The expression levels of Nrf2, SOD and NQO1 mRNA were significantly lower than those in control group ( P=0.002, P<0.001, P=0.001), and the expression levels of Nrf2 and HO-1 protein were significantly lower than those in control group ( P=0.011, P=0.021). Compared with the model group, the testicular index [(0.79±0.03)%, P=0.010] increased in hUCMSCs group, and the tissue structure of testis was clear and complete, spermatogenic cells at all levels of spermatogenic tubules, spermatogenic cells and stromal cells were abundant. Compared with the model group, the content of dihydrotestosterone [(5.24±0.21) μg/L, P=0.028] in serum and SOD [(79.47±14.32) U/mg Prot, P=0.001] in testicular tissue increased in hUCMSCs group, while the content of MDA [(0.77±0.08) nmol/mg Prot, P=0.001] decreased, Nrf2, SOD and NQO1 mRNA expression levels increased ( P=0.024, P=0.037, P=0.005), Keap1 mRNA expression decreased ( P=0.044), Nrf2 and HO-1 proteins expression increased ( P=0.009, P=0.012), while Keap1 protein expression decreased ( P=0.035). There were no statistically significant differences in testicular index, serum testosterone, SOD and MDA between hUCMSCs group and control group (all P>0.05). Conclusion:hUCMSCs significantly improve testicular structure and function damage caused by oxidative damage in aging mice, and the mechanism of action is related to upregulating Nrf2 signaling and downstream antioxidant activity SOD and HO-1 protein expression, reducing Keap1 mediated Nrf2 degradation.