Objective To investigate the risk factors for unplanned readmission within 30 days after discharge in cirrhotic patients with esophagogastric variceal bleeding undergoing transjugular intrahepatic portosystemic shunt(TIPS),and to construct a nomogram predictive model.Methods A total of 241 cirrhotic patients who underwent TIPS due to esophagogastric variceal bleeding in Affiliated Drum Tower Hospital of Nanjing University Medical School from January 2020 to June 2023 were enrolled as subjects,and unplanned readmission within 30 days was analyzed.According to the presence or absence of unplanned readmission,they were divided into readmission group with 36 patients and non-readmission group with 198 patients,and related clinical data were collected from all patients.The independent-samples t test was used for comparison of normally distributed continuous data between two groups,and the Mann-Whitney U test was used for comparison of non-normally distributed continuous data between two groups;the chi-square test was used for comparison of categorical data between two groups.A logistic regression analysis was used to identify independent risk factors for unplanned readmission.A nomogram prediction model was constructed,and the receiver operating characteristic(ROC)curve was plotted to assess its discriminatory ability for unplanned readmission;the calibration curve was plotted to evaluate the consistency of the nomogram model in predicting unplanned readmission;the ResourceSelection package of R language was used for the Hosmer-Lemeshow goodness-of-fit test to evaluate the degree of fitting of the mode;the decision curve analysis was used to investigate the practicality of the model.Results Age(odds ratio[OR]=2.664,95%confidence interval[CI]:1.139-6.233,P<0.05),CTP score(OR=1.655,95%CI:1.098-2.495,P<0.05),and blood ammonia(OR=1.032,95%CI:1.016-1.048,P<0.05)were independent risk factors for unplanned readmission within 30 days after discharge in the patients undergoing TIPS.The multivariate analysis showed that for the nomogram predictive model constructed in this study,repeated sampling for 1 000 times using the Bootstrap method was performed for internal validation,and the area under the ROC curve was 0.773,which was significantly higher than that of age(0.582),CTP score(0.675),and blood ammonia(0.641).The calibration curve showed good consistency between the probability of unplanned readmission predicted by the nomogram model and the actual probability,and the Hosmer-Lemeshow goodness-of-fit test showed good degree of fitting(c2=5.647 3,P=0.686 7).Conclusion Age,CTP score,and blood ammonia are independent risk factors for unplanned readmission within 30 days after TIPS,and the nomogram prediction model constructed based on these factors can help to predict the risk of unplanned readmission in TIPS patients and provide an accurate decision-making basis for early prevention.

Objective:To investigate the effects of cervical cold knife conization (CKC) on preterm delivery, other pregnancy complications and neonatal outcomes, and explore the relationship between preterm delivery risk and the depth and volume of conization.Methods:The clinical data and pregnancy outcomes of 272 women who underwent CKC in Peking Union Medical College Hospital from January 2002 to March 2018 (conization group) and 1 647 pregnant women who gave birth in Peking Union Medical College Hospital during January to December 2019 (control group) were collected. The preterm delivery, premature rupture of membranes, other pregnancy complications and neonatal outcomes of the two groups were compared, and the relationship between the depth and volume of conization and the risk of preterm delivery in postoperative singleton pregnancy was analyzed.Results:(1) There were no significant differences between the two groups in delivery age, parity, proportion of singleton pregnancy, proportion of assisted reproductive technology (all P>0.05). (2) The rate of preterm delivery in the conization group was significantly higher than that in the control group [14.8% (39/264) vs 5.7% (91/1 589); χ2=28.397, P<0.001]. There were still significant differences in preterm delivery rates between the two groups at <34 weeks and 34-37 weeks (all P<0.01). There was no significant difference in the incidence of premature rupture of membrane between the two groups [23.5% (62/264) vs 23.4% (372/1 589); χ2=0.001, P=0.979], but the incidence of preterm premature rupture of membrane in the conization group was significantly higher than that in the control group [11.4% (30/264) vs 2.2% (35/1 589); χ2=56.132, P<0.001]. (3) The rate of cesarean section in the conization group was higher than that in the control group [59.6% (162/272) vs 38.8% (639/1 647); χ2=41.377, P<0.001]. The birth weight of preterm infants in the conization group was significantly higher than that in the control group [(2 409±680) vs (2 150±684) g; t=2.184, P=0.030]. However, there were no statistically significant differences in the incidence of gestational diabetes mellitus, hypertensive disorders in pregnancy, the birth weight of full-term infants, incidence of small for gestational age infant and neonatal intensive care unit admission rate between the two groups (all P>0.05). (4) The preterm delivery rates of coning depth >15 mm, cone size ≥2 cm 3 and cone size <2 cm 3 were higher than that in the control group (all P<0.05). When the coning depth ≤15 mm, the preterm delivery rate in the conization group was higher than that in the control group, but there was no significant difference ( P=0.620). The rate of preterm delivery of pregnant women with coning depth >15 mm was significantly higher than those with coning depth ≤15 mm ( RR=3.084, 95% CI: 1.474-6.453; P=0.001). There was no significant difference in the preterm delivery rate between pregnant women with cone size >2 cm 3 and those with cone size ≥2 cm 3 ( RR=1.700, 95% CI: 0.935-3.092; P=0.077). Conclusion:The risk of preterm delivery and preterm premature rupture of membranes in subsequent pregnancies are increased after cervical CKC, and the risk of preterm delivery is positively correlated with the depth of cervical coning.

Objective:To compare the efficacy and safety of transjugular intrahepatic portosystemic shunt (TIPS) and endoscopic treatment for liver cirrhosis with esophageal gastric variceal bleeding (EGVB) and portal vein thrombosis (PVT).Methods:A total of 183 liver cirrhosis patients with EGVB and PVT in Nanjing Drum Tower Hospital, the Affiliated Hospital of Nanjing University Medical School and the First Affiliated Hospital of Wenzhou Medical University were selected from January 2017 to December 2019, and 66 patients were assigned to the endoscopic group (received endoscopi treatment) and 117 the TIPS group (received TIPS treatment). Propensity score matching was performed according to the 1∶1 ratio, yielding 58 patients in each group for analysis, with a median follow-up time of 36 months in both groups. Postoperative survival, postoperative rebleeding rate, and postoperative hepatic encephalopathy incidence were assessed using Kaplan-Meier survival curves.Results:During the follow-up, the rebleeding rate in the endoscopic group was significantly higher [39.7% (23/58) VS 17.2% (10/58), P=0.005], and the TIPS group had a higher incidence of postoperative hepatic encephalopathy [29.3% (17/58) VS 13.8% (8/58), P=0.048], and no significant difference in survival rate was observed between the two groups [74.1% (43/58) VS 75.9% (44/58), P=0.769]. In the subgroup analysis of mild degree of PVT, there was no significant difference in survival [88.0% (22/25) VS 72.0% (18/25), P=0.164], rebleeding rate [28.0% (7/25) VS 12.0% (3/25), P=0.164], or incidence of hepatic encephalopathy [8.0% (2/25) VS 20.0% (5/25), P=0.202] between the endoscopic group and the TIPS group. In the subgroup analysis of severe degree of PVT, the rebleeding rate in the endoscopic group was significantly higher than that in the TIPS group [48.5% (16/33) VS 21.2% (7/33), P=0.010], while there was no significant difference in the incidence of hepatic encephalopathy [18.2% (6/33) VS 36.4% (12/33), P=0.133], or the survival rate [63.6% (21/33) VS 78.8% (26/33), P=0.154]. Conclusion:For liver cirrhosis patients with mild PVT and EGVB, combining endoscopic therapy with anticoagulation may be superior to TIPS. Conversely, in patients with severe PVT, TIPS may be a more suitable option due to a significantly reduced rebleeding risk without a notable increase in hepatic encephalopathy incidence.

Objective:To quantitatively analyze infection prevention and control policy texts related to medical alliance, aiming to provide reference for further policy improvement.Methods:with the " medical alliance" and " infection prevention and control" as keywords, relevant policy documents issued from January 2015 to March 2023 were searched on the Chinese government website, the official website of the National Health Commission, and the Peking University law database. Content analysis method was used to quantitatively analyze policy texts from two dimensions: policy tools (supply oriented, environmental oriented, demand oriented) and systems theory (management, service, human resources, and financing systems as internal subsystems, while political, economic, social, and technological systems as external subsystems).Results:A total of 91 infection prevention and control policy documents related to medical alliance were included, and 199 codes were obtained. There were 114, 78, and 7 codes for environmental oriented, supply oriented, and demand oriented policy tools, respectively; among the demand oriented tools, there were only 1 code for government purchases, 1 code for price subsidies, and 5 codes for demonstration project sub tools, respectively. The internal subsystem had a total of 119 codes, with only 2 codes related to the fundraising system; and the external subsystem had a total of 80 codes, with the least 10 codes related to the technical system.Conclusions:The structure of infection prevention and control policy tools in China′s medical alliance needed to be optimized, and the application of demand oriented policy tools was insufficient. It is necessary to strengthen the use of pull tools such as government purchases, price subsidies, and demonstration projects. At the same time, it is necessary to improve the construction of internal and external systems, especially in terms of fundraising and technology systems, to enhance the overall effectiveness of the medical alliance′s infection prevention and control system.

Tibetan medicine is an essential part of Chinese medicine and has unique theoretical experience and therapeutic advantages. According to the development principle of inheriting the essence, sticking to the truth, and keeping innovative, the supervision department should give clear and reasonable guidance considering the characteristics of Tibetan medicine, establish a standard system for quality control, clinical verification and evaluation, and accelerate the research and commercialization of new drugs. In view of the needs of drug supply-side reform and the current situation of Tibetan medicine and new pharmaceutical research, we ponder and provide suggestions on the confusion faced by the current supervision of Tibetan drug registration, hoping to contribute to the supervision strategy of Tibetan drug registration and the high-quality development of Tibetan medicine industry.
Tibet ; Medicine, Tibetan Traditional ; Quality Control ; Pharmaceutical Research ; Drug Industry

Objective:The investigation and research on the application status of Hepatic Venous Pressure Gradient (HVPG) is very important to understand the real situation and future development of this technology in China.Methods:This study comprehensively investigated the basic situation of HVPG technology in China, including hospital distribution, hospital level, annual number of cases, catheters used, average cost, indications and existing problems.Results:According to the survey, there were 70 hospitals in China carrying out HVPG technology in 2021, distributed in 28 provinces (autonomous regions and municipalities directly under the central Government). A total of 4 398 cases of HVPG were performed in all the surveyed hospitals in 2021, of which 2 291 cases (52.1%) were tested by HVPG alone. The average cost of HVPG detection was (5 617.2±2 079.4) yuan. 96.3% of the teams completed HVPG detection with balloon method, and most of the teams used thrombectomy balloon catheter (80.3%).Conclusion:Through this investigation, the status of domestic clinical application of HVPG has been clarified, and it has been confirmed that many domestic medical institutions have mastered this technology, but it still needs to continue to promote and popularize HVPG technology in the future.

Objective:To investigation and analysis of ammonia gas leakage in a meat factory.Methods:In April 2013, Enterprise managers and workers were investigated, and clinical data of 24 patients were analyzed.Results:The company caused a leak in the ammonia pipeline maintenance operation, Among the patients, 20 had stimulus response and 4 had mild poisoning.Conclusion:To prevent group occupational ammonia poisoning, it is necessary to strengthen the awareness of occupational disease prevention of enterprise owners and the awareness of self-protection of workers.

Objective:To investigation and analysis of ammonia gas leakage in a meat factory.Methods:In April 2013, Enterprise managers and workers were investigated, and clinical data of 24 patients were analyzed.Results:The company caused a leak in the ammonia pipeline maintenance operation, Among the patients, 20 had stimulus response and 4 had mild poisoning.Conclusion:To prevent group occupational ammonia poisoning, it is necessary to strengthen the awareness of occupational disease prevention of enterprise owners and the awareness of self-protection of workers.

OBJECTIVE: To evaluate the application value of 40 Hz auditory event related potential(40 Hz AERP) in hearing assessment in workers exposed to noise by observing the consistency between pure tone audiometry(PTA) and 40 Hz AERP. METHODS: A total of 240 ears of 120 workers who exposed to noise with PTA high-frequency hearing threshold > 25 dB were selected as the research subjects using the convenient sampling method. The thresholds of PTA and 40 Hz AERP at different frequencies were investigated. According to the average hearing threshold of PTA language frequency, the workers were divided into normal hearing group and mild-, medium-, medium-severe-, severe-hearing loss groups, and the difference and correlation between the thresholds of 40 Hz auditory potential and PTA were analyzed. RESULTS: The response thresholds of 40 Hz AERP of 0.5, 1.0, 2.0 kHz in ears of normal hearing group, and mild-and moderate-hearing loss groups were higher than the PTA hearing threshold(P<0.01), while the 40 Hz AERP response thresholds of 0.5 kHz in the ears of medium-severe-and severe-hearing loss groups were lower than the hearing thresholds of PTA(P<0.05). The different value of the response threshold of 40 Hz AERP and PTA of 1.0 and 2.0 kHz in ears of normal hearing group was higher than 0.5 kHz(median: 25.0 vs 15.0 dBHL, 30.0 vs 15.0 dBHL, P<0.01). Except for 0.5 and 1.0 kHz of mild-hearing loss group, the different value of the response threshold of 40 Hz AERP and PTA in ears of the other hearing loss groups were lower than that of the normal hearing group(P<0.01). The 40 Hz AERP response threshold was frequency-specific and correlated well with PTA at the same frequency. The correlation coefficients of 0.5, 1.0 and 2.0 kHz were 0.744, 0.732 and 0.665 respectively(P<0.01). CONCLUSION: It is feasible to evaluate PTA in noise-exposed workers using 40 Hz AERP response threshold, but the 40 Hz AERP cannot completely replace PTA. The measurement frequency and the degree of hearing loss should be considered simultaneously.

It was to introduce professor 's experience in the treatment of oculomotor nerve palsy with acupuncture based on the interactions of twelve muscle regions and opposing needling theory. In the treatment, the TCM syndrome differentiation is taken as the general principle, the theory of the interactions of twelve muscle regions and opposing needling as the specific feature. The contrary needling is used at Hanyan (GB 4) and Juliao (ST 3) on the healthy side. The meridian-collateral and the exterior-interior differentiations are adopted to identify the syndromes. At the early stage of the disease, the treating principle focuses on expelling wind, eliminating cold and promoting the circulations of meridians and collaterals. The shallow needling, less acupoints and gentle stimulation are required. At the middle and late stage, the treating principle concentrates on strengthening the antipathogenic and harmonizing and blood. The deep needling, the multiple acupoints and the strong stimulation are applied. Additionally, the four-needling technique at Fengchi (GB 20), the multiple shallow needling at the eyelid margin, the opposing needling and the quantity of needling sensation are used in combination, which were developed by professor . With those comprehensivemethods, the symptoms of oculomotor nerve palsy are relieved and the significant clinical therapeutic effects achieved.