ObjectiveTo assess the therapeutic effectiveness and safety of the traditional Chinese medicine compound Shenlong decoction in addressing the symptoms of pulmonary deficiency and stasis in patients with idiopathic pulmonary fibrosis （IPF）. MethodsSixty eligible patients with lung deficiency and collateral stasis syndrome of IPF were randomly assigned to the observation （30 patients） and control groups （30 patients）. All patients underwent standard Western medical therapy. Additionally，the observation group received Shenlong decoction granules，while the control group received a placebo. Both treatments were packaged in four doses of 10.5 g each，taken twice daily for three months. The indexes of the patients during the treatment cycle were observed，and the main indexes include traditional Chinese medicine （TCM） syndrome scores and 6 min walk test （6MWT）. The secondary indexes include pulmonary function test ［actual value/expected value of total lung volume （TLC%），actual value/expected value of vital capacity（FVC%），actual/predicted diffusing capacity of the lung for carbon monoxide（DLCO%），actual/predicted forced expiratory volume in one second （FEV₁%），and FEV₁/ forced vital capacity （FVC）］，blood gas analysis ［arterial blood diathesis partial pressure of oxygen （PaO₂），partial pressure of carbon dioxide （PaCO₂），and arterial oxygen saturation （SaO₂）］，serum inflammatory factors ［transforming growth factor-β₁ （TGF-β₁），interleukin-4 （IL-4），interleukin-13 （IL-13），interleukin-12 （IL-12），and gamma-interferon （IFN-γ）］，and quality of survival evaluation ［St George's Respiratory Questionnaire （SGRQ） score］. The patients' clinical manifestations were determined at the end of the treatment， and the occurrence of adverse events was recorded. ResultsA total of 53 patients completed the study，comprising 27 in the control group and 26 in the observation group. Upon completion of the treatment period，the control group achieved a total effective rate of 33.33% （9/27），whereas the observation group demonstrated a total effective rate of 53.85% （14/26），which was statistically superior to the control group （χ²=4.034，P<0.05）. After the treatment，the TCM syndrome scores，6MWT，DLCO%，FEV₁%，PaO₂，PaCO₂，TGF-β₁，IL-4，IL-13，IL-12，and IFN-γ in the two groups were all significantly improved （P<0.01）. Compared with those in the control group after treatment at the same period，the TCM syndrome scores，6MWT，PaO₂，and PaCO₂ were significantly improved in the observation group after 60 days and 90 days of medication （P<0.01）. Three months after the end of medication，the SGRQ score in the observation group showed significant improvement when compared to that in the control group （P<0.05），and no severe adverse events were reported during the follow-up period. ConclusionCompound Shenlong decoction can alleviate clinical symptoms such as shortness of breath and wheezing in patients with lung deficiency and collateral stasis syndrome of IPF，enhance exercise tolerance，improve the quality of life，and have certain potential advantages in improving pulmonary function.

ObjectiveTo assess the therapeutic effectiveness and safety of the traditional Chinese medicine compound Shenlong decoction in addressing the symptoms of pulmonary deficiency and stasis in patients with idiopathic pulmonary fibrosis （IPF）. MethodsSixty eligible patients with lung deficiency and collateral stasis syndrome of IPF were randomly assigned to the observation （30 patients） and control groups （30 patients）. All patients underwent standard Western medical therapy. Additionally，the observation group received Shenlong decoction granules，while the control group received a placebo. Both treatments were packaged in four doses of 10.5 g each，taken twice daily for three months. The indexes of the patients during the treatment cycle were observed，and the main indexes include traditional Chinese medicine （TCM） syndrome scores and 6 min walk test （6MWT）. The secondary indexes include pulmonary function test ［actual value/expected value of total lung volume （TLC%），actual value/expected value of vital capacity（FVC%），actual/predicted diffusing capacity of the lung for carbon monoxide（DLCO%），actual/predicted forced expiratory volume in one second （FEV₁%），and FEV₁/ forced vital capacity （FVC）］，blood gas analysis ［arterial blood diathesis partial pressure of oxygen （PaO₂），partial pressure of carbon dioxide （PaCO₂），and arterial oxygen saturation （SaO₂）］，serum inflammatory factors ［transforming growth factor-β₁ （TGF-β₁），interleukin-4 （IL-4），interleukin-13 （IL-13），interleukin-12 （IL-12），and gamma-interferon （IFN-γ）］，and quality of survival evaluation ［St George's Respiratory Questionnaire （SGRQ） score］. The patients' clinical manifestations were determined at the end of the treatment， and the occurrence of adverse events was recorded. ResultsA total of 53 patients completed the study，comprising 27 in the control group and 26 in the observation group. Upon completion of the treatment period，the control group achieved a total effective rate of 33.33% （9/27），whereas the observation group demonstrated a total effective rate of 53.85% （14/26），which was statistically superior to the control group （χ²=4.034，P<0.05）. After the treatment，the TCM syndrome scores，6MWT，DLCO%，FEV₁%，PaO₂，PaCO₂，TGF-β₁，IL-4，IL-13，IL-12，and IFN-γ in the two groups were all significantly improved （P<0.01）. Compared with those in the control group after treatment at the same period，the TCM syndrome scores，6MWT，PaO₂，and PaCO₂ were significantly improved in the observation group after 60 days and 90 days of medication （P<0.01）. Three months after the end of medication，the SGRQ score in the observation group showed significant improvement when compared to that in the control group （P<0.05），and no severe adverse events were reported during the follow-up period. ConclusionCompound Shenlong decoction can alleviate clinical symptoms such as shortness of breath and wheezing in patients with lung deficiency and collateral stasis syndrome of IPF，enhance exercise tolerance，improve the quality of life，and have certain potential advantages in improving pulmonary function.

Occupational health technical service (OHTS) is one of the core contents in the technical support system of occupational disease prevention and control, and efficient management of OHTS institutions is necessary for improving the service ability. At present, OHTS institutions in China face several issues, such as uneven distribution in terms of quantity, function, unclear area coverage and roles and overlapping responsibilities among different types of institutions, and insufficient service capabilities with inconsistent service levels in some institutions. With the implementation of the national reform like the “separating permits from business license” and “delegate power, streamline administration and optimize government services"”policies, the management mode and operational approach of OHTS institutions have been profoundly changed. In light of this, five key recommendations are proposed to improve the management of OHTS institutions and enhance their management effectiveness, ensuring the sustainable development of national OHTS services. Firstly, it is necessary to clarify the relationship between national and provincial administrative levels in managing OHTS institutions to ensure their healthy and orderly development. Secondly, multiple measurements are taken to strengthen OHTS institutional capacity building to address regional disparities in technical capabilities and service quality. Thirdly, both technical capabilities and service quality should be focused on strengthening the supervision and management of OHTS institutions, preventing the decline of key conditions such as staffing, laboratories, equipment, and quality management after obtaining qualifications. Fourthly, “dual randomized- inspections and one open” and “internet+supervision” methods are used as basic tools for managing OHTS institutions operating across multiple provincial regions and enforcing cross-regional law. Fifthly, professional integrity of radiological health service institutions should be restored to effectively apply their technical advantages in their specialized fields.

Colorectal cancer （CRC） is a common malignant tumor of the digestive tract with high morbidity and mortality. Although existing treatments can prolong the survival of patients， problems such as low quality of life， obvious side effects， and unsatisfactory clinical efficacy still exist， which cannot fully satisfy the overall needs of patients. For this reason， it is crucial to explore the mechanism underlying the development of CRC and to identify new treatment strategies. In recent years， with the deepening of research， ferroptosis has been gradually proven to effectively inhibit the proliferation and metastasis of CRC cells， overcome tumor drug resistance， enhance anti-tumor efficacy， and prevent tumor progression and recurrence. Therefore， regulating ferroptosis is expected to become a new strategy for the treatment of CRC. Traditional Chinese medicine （TCM） has been widely used in CRC treatment due to its advantages of multiple components， multiple targets， low drug resistance， and few side effects， and has gradually become a current research hotspot. Extensive studies have shown that TCM active ingredients and compound formulae can regulate ferroptosis-related pathways， such as iron metabolism， lipid metabolism， the cystine/glutamate antiporter system X_c^- （System X_c^-）/glutathione （GSH）/glutathione peroxidase 4 （GPX4）， ferroptosis suppressor protein 1 （FSP1）/coenzyme Q₁₀ （CoQ₁₀）/nicotinamide adenine dinucleotide phosphate ［NAD（P）H］， tumor protein 53 （p53）， nuclear factor erythroid-2-related factor 2 （Nrf2）， and non-coding RNA pathways to inhibit the growth and proliferation of CRC， thereby exerting anti-tumor effects. This review systematically summarized the mechanisms of ferroptosis related to CRC， therapeutic targets and prognosis-related markers associated with ferroptosis in CRC， and research progress on TCM targeting and regulating ferroptosis for CRC intervention， aiming to provide new perspectives and a theoretical basis for the prevention and treatment of CRC with TCM.

Colorectal cancer （CRC） is a common malignant tumor of the digestive tract with high morbidity and mortality. Although existing treatments can prolong the survival of patients， problems such as low quality of life， obvious side effects， and unsatisfactory clinical efficacy still exist， which cannot fully satisfy the overall needs of patients. For this reason， it is crucial to explore the mechanism underlying the development of CRC and to identify new treatment strategies. In recent years， with the deepening of research， ferroptosis has been gradually proven to effectively inhibit the proliferation and metastasis of CRC cells， overcome tumor drug resistance， enhance anti-tumor efficacy， and prevent tumor progression and recurrence. Therefore， regulating ferroptosis is expected to become a new strategy for the treatment of CRC. Traditional Chinese medicine （TCM） has been widely used in CRC treatment due to its advantages of multiple components， multiple targets， low drug resistance， and few side effects， and has gradually become a current research hotspot. Extensive studies have shown that TCM active ingredients and compound formulae can regulate ferroptosis-related pathways， such as iron metabolism， lipid metabolism， the cystine/glutamate antiporter system X_c^- （System X_c^-）/glutathione （GSH）/glutathione peroxidase 4 （GPX4）， ferroptosis suppressor protein 1 （FSP1）/coenzyme Q₁₀ （CoQ₁₀）/nicotinamide adenine dinucleotide phosphate ［NAD（P）H］， tumor protein 53 （p53）， nuclear factor erythroid-2-related factor 2 （Nrf2）， and non-coding RNA pathways to inhibit the growth and proliferation of CRC， thereby exerting anti-tumor effects. This review systematically summarized the mechanisms of ferroptosis related to CRC， therapeutic targets and prognosis-related markers associated with ferroptosis in CRC， and research progress on TCM targeting and regulating ferroptosis for CRC intervention， aiming to provide new perspectives and a theoretical basis for the prevention and treatment of CRC with TCM.

ObjectiveTo understand the seropositivity of neutralizing antibodies (NAb) and low-level NAb against SARS-CoV-2 infection in the community residents, and to explore the impact of COVID-19 vaccination and SARS-CoV-2 infection on the levels of NAb in human serum. MethodsOn the ground of surveillance cohort for acute infectious diseases in community populations in Shanghai, a proportional stratified sampling method was used to enroll the subjects at a 20% proportion for each age group (0‒14, 15‒24, 25‒59, and ≥60 years old). Blood samples collection and serum SARS-CoV-2 NAb concentration testing were conducted from March to April 2023. Low-level NAb were defined as below the 25^th percentile of NAb. ResultsA total of 2 230 participants were included, the positive rate of NAb was 97.58%, and the proportion of low-level NAb was 25.02% (558/2 230). Multivariate logistic regression analysis indicated that age, infection history and vaccination status were correlated with low-level NAb (all P<0.05). Individuals aged 60 years and above had the highest risk of low-level NAb. There was a statistically significant interaction between booster vaccination and one single infection (aOR=0.38, 95%CI: 0.19‒0.77). Compared to individuals without vaccination, among individuals infected with SARS-CoV-2 once, both primary immunization (aOR=0.23, 95%CI: 0.16‒0.35) and booster immunization (aOR=0.12, 95%CI: 0.08‒0.17) significantly reduced the risk of low-level NAb; among individuals without infections, only booster immunization (aOR=0.28, 95%CI: 0.14‒0.52) showed a negative correlation with the risk of low-level NAb. ConclusionsThe population aged 60 and above had the highest risk of low-level NAb. Regardless of infection history, a booster immunization could reduce the risk of low-level NAb. It is recommended that eligible individuals , especially the elderly, should get vaccinated in a timely manner to exert the protective role of NAb.

Objective:To delineate the clinical characteristics and outcomes associated with severe cardiac toxicity during the preconditioning phase of allogeneic hematopoietic stem cell transplantation (allo-HSCT) in patients with aplastic anemia (AA).Methods:This retrospective case series study included 31 patients with severe AA who underwent allo-HSCT and were diagnosed with severe cardiac toxicity at the Hematology Department of Peking University People′s Hospital from August 2012 to June 2022. The clinical manifestations of severe cardiac toxicity observed during the preconditioning process were assessed. Patient survival was assessed using the Kaplan-Meier method.Results:In this cohort of 31 patients, the median follow-up period was 9 days (range: 4-365 days). Severe cardiac toxicity manifested within 6 days after the initial cyclophosphamide (Cy) administration. Twenty patients died within 30 days of initiating Cy preconditioning, of which 16 patients died due to severe cardiac toxicity within 25 days. Patients whose cardiac function improved within 30 days post-preconditioning showed a median survival duration of 222 days ( n=11). Troponin I (TNI) levels in patients who died within 30 days of initiating Cy preconditioning began increasing on day 5 post-Cy, peaking sharply by day 9 after a notable rise on day 8. B-type natriuretic peptide (BNP) levels in patients who died within 30 days of initiating Cy preconditioning started to rise from day 1, stabilized between days 2 and 5, and then doubled daily from days 6 to 8, remaining elevated thereafter. Notably, the initial increases in BNP and TNI correlated with electrocardiogram (ECG) signs of low voltage and T-wave inversion in 83.87% of cases ( n=26). Most patients ( n=28, 90.32%) were administered corticosteroid therapy. In those with restored cardiac function, the ejection fraction returned to >50% within 30 days of initiating Cy preconditioning. Conclusions:Patients with severe cardiac toxicity during the preconditioning phase of allo-HSCT typically exhibit early, sustained, and marked elevations in myocardial damage markers, including BNP and TNI, accompanied by ECG abnormalities following Cy administration, with BNP often increasing first. These indicators are associated with rapid disease progression and high mortality. Prompt initiation of treatment upon clinical diagnosis is critical for improving survival outcomes.

Objective:To evaluate the relationship between preoperative free thyroxine (FT4) levels and the risk of new-onset atrial fibrillation (AF) after cardiac valve surgery in patients with normal thyroid function, and to identify high-risk individuals for postoperative AF among patients undergoing cardiac valve surgery.Methods:This retrospective study enrolled patients(≥18 years old)with valvular heart disease who underwent heart valve replacement or valvoplasty surgery from December 2019 to January 2023 in Beijing Anzhen Hospital. Patients with thyroid function tests exceeding the normal reference range(7.64-16.03 pmol/L) were excluded, resulting in a final cohort of 2 645 patients, including 1 597 males and 1 048 females; aged 18-83 years, with a median age of 56 (46, 64) years. Among them, 1 891 patients (71.5%) had hypertension, and 176 (6.7%) had type 2 diabetes. The patients were divided into four groups based on quartiles of FT4 levels: Group 1 (n=661) with FT4 levels of 7.64-10.33 pmol/L, Group 2 (n=661) with 10.33-11.36pmol/L, Group 3 (n=661) with 11.36-12.54 pmol/L, and Group 4(n=662) with 12.54-13.66pmol/L. The risk of postoperative AF was compared among the four groups, and logistic regression was used to adjust for relevant risk factors. The odds ratio ( OR) and 95% confidence interval( CI) for postoperative AF across different groups were analyzed. Subgroup analyses were performed based on age, gender, hypertension status, and B-type natriuretic peptide (BNP) levels to compare the association between FT4 levels and new-onset AF within different subgroups. Results:Statistically significant differences were observed among the four groups in terms of age, body mass index, hypertension, hyperlipidemia, BNP, glomerular filtration rate, triglyceride, and total cholesterol levels ( P<0.05), while no significant differences were found in other indicators( P<0.05). Using the lowest FT4 group as the baseline, a higher risk of postoperative new-onset AF was observed in groups with higher FT4 levels, with a significant trend of incremental increase in postoperative AF with rising FT4 levels. Similar trends were observed across subgroups stratified by age, gender, hypertension status, and BNP levels. The Youden index indicated a cut-off value of 11.485pmol/L for FT4. Conclusion:Among patients with normal thyroid function and valvular heart disease, preoperative higher FT4 levels are significantly associated with an increased risk of new-onset AF after cardiac valve surgery. Close monitoring for postoperative AF risk is recommended for patients with preoperative FT4 levels exceeding 11.485 pmol/L, even if the thyroid function is still within the normal.

Objective:To construct a composite evaluation index of fourth-level surgical, for references for horizontal comparison of fourth-level surgical between clinical departments of hospital and hospital performance appraisal.Methods:The data were extracted from the medical record information system and disease diagnosis related group information system of a tertiary public hospital, including the number of surgical patients, the number of fourth-level surgical patients, the case mix index (CMI), and the average length of hospital stay for 23 surgical departments from 2019 to 2023. Based on disease diagnosis related groups, the average length of hospital stay for patients undergoing fourth-level surgery was standardized to obtain the time cost index; Multiply the CMI and time cost index by the fourth-level surgical ratio to obtain the quality coefficient. This coefficient was used to weight the number of fourth-level surgeries to establish the contribution degree of fourth-level surgeries, which was used for the comprehensive evaluation of fourth-level surgery quality and quantity for each surgical department.Results:A total of 329 177 surgical patients were included in this study, including 139 704 patients with fourth-level surgery. From 2019 to 2023, the top 3 departments in terms of the proportion of fourth-level surgery were department J, B and A, and the proportion of fourth-level surgery in departments with high surgical difficulty, such as C and I, ranked 8th and 16th. The top 3 departments with the contribution degree of fourth-level surgery were department A, B and C, I rosed to the 9th, and J felled to the 11th.Conclusions:The fourth-level surgery contribution degree combined the four factors of surgical composition, difficulty, cost and quantity, which could objectively evaluate fourth-level surgeries in different departments.

Objective To analyze the current patient satisfaction levels and their influencing factors from the perspective of medical experience in private rehabilitation hospitals in Chongqing.This analysis aimed to provide references for these hospitals to improve the quality of medical services.Methods A questionnaire survey of 467 inpatients from three private rehabilitation hospitals in Chongqing was conducted,using convenience sampling.The x2 test and logistic regression analysis were used to i-dentify factors influencing patient satisfaction.Results The overall satisfaction rate of inpatient care was 78.6％,with an aver-age satisfaction score of 3.84±0.52.The complaint and advice service scored the higher,while logistics and environmental serv-ice and rehabilitation treatment service were assessed with lower scores.Regression analysis showed that the per capita monthly household income ranged between 2 001 and 4 000 yuan(OR=0.221,95％CI:0.077-0.635),and between 4 001 and 6 000 yuan(OR=0.296,95％CI:0.125-0.700).Additionally,out-of-pocket payment(OR=4.198,95％CI:1.035-17.027),and others payment methods,including commercial insurance(OR=9.591,95％CI:1.767-52.049)were identified as influential factors.Conclusion Inpatients'overall satisfaction with their medical experience is acceptable,but still has considerable room for improvement.It is recommended that a multidimensional approach be adopted to improve patient satisfaction.