OBJECTIVE To provide reference for safe drug use in patients with anaplastic lymphoma kinase （ALK）-positive non-small cell lung cancer （NSCLC）. METHODS Clinical pharmacists participated in the diagnosis and treatment of a patient with ALK-positive NSCLC who developed bilateral pleural effusion and hemolytic anemia after taking alectinib； regarding symptoms such as pleural effusion and hemolytic anemia in the patient， clinical pharmacists investigated the patient’s history of medication and disease， as well as potential drug interaction； to consider the correlation between the patient’s use of alectinib and the duration of pleural effusion and hemolytic anemia， clinical pharmacists suggested that clinical doctors discontinued alectinib and used reduced dose treatment after the pleural effusion improved， but the patient suffered from bilateral pleural effusion and hemolytic anemia again； after evaluating the correlation between alectinib and bilateral pleural effusion and hemolytic anemia using the Naranjo’s assessment scale， clinical pharmacists recommend permanent discontinuation of alectinib and jointly recommend replacement with ensartinib with clinical physicians. RESULTS Physicians adopted the suggestions of clinical pharmacists. The pleural effusion subsequently regressed and hemolytic anemia improved after replacing the drug. The correlation between alectinib and bilateral pleural effusion and hemolytic anemia was confirmed. CONCLUSIONS Clinical pharmacists participate in pharmaceutical monitoring of ALK-positive NSCLC patients， assist clinical doctors in developing personalized medication recommendations， and ensure the safety of patient medication.

Objective:To explore the application of case-based learning (CBL) guided by the International Classification of Functioning, Disability and Health (ICF) in teaching internship of rehabilitation medicine undergraduates.Methods:According to the implementation time of ICF-guided CBL teaching (February 2023), 55 students who interned before February 2023 were included in the control group and received routine teaching, and 54 students who interned after February 2023 were enrolled in the observation group and received ICF-guided CBL teaching. The assessment score, professional identity score, learning adaptability score, communication ability score, and critical thinking score were evaluated before and after teaching. SPSS 23.0 was used for t-test and chi-square test. Results:After teaching, the assessment score, professional identity score, learning adaptability score, communication ability score, and critical thinking score of both groups of students significantly increased. Compared with the control group, the observation group showed significantly higher assessment score [(166.01±14.21) vs. (150.19±13.73)], professional identity score [(124.50±12.73) vs. (103.94±10.42)], learning adaptability score [(71.93±7.43) vs. (57.69±6.71)], communication ability score [(23.77±4.21) vs. (19.97±3.94)], and critical thinking score [(150.03±11.20) vs. (129.38±10.57)].Conclusions:ICF-guided CBL teaching can help to improve the professional identity and learning adaptability of rehabilitation medicine undergraduates, enhance their skill of communication with patients and critical thinking ability, and increase their professional theoretical knowledge and practical ability. Therefore, ICF-guided CBL is a beneficial exploration of teaching internship of rehabilitation medicine undergraduates.

Objective To analyze the clinical characteristics of pyogenic liver abscess(PLA)and explore the rationality and the duration of antibacterial treatment.Methods The clinical data of patients diagnosed as pyogenic liver abscess in our hospital from January 1,2020 to December 31,2022 were analyzed to explore their clinical characteristics.The rationality of antibacterial treatment was evaluated by setting evaluation criteria.The duration of antibacterial use in different treatment outcomes was counted.Results A total of 89 patients were included in the analysis.The average age was(62.0±15.6)years old,with the male accounting for 61.80%.Diabetes for 53.9%was the most common complication.Among 59 patients(66.3%)with positive culture of pos or blood,51 cases(57.3%)were Klebsiella Pneumoniaes.Among the empirical and target treatment,45 cases(50.6%)and 17 cases(28.8%)of antibacterial regimens were evaluated as unreasonable,respectively.Recovery treatment time was(17.0±7.6)d,and actual treatment time was(21.1±7.3)d.Conclusion Diabetes was the most common high-risk factor of PLA,and Klebsiella Pneumoniae was the main pathogenic bacteria.It is necessary to strengthen the management of antibacterial drugs,explore the appropriate duration of antibacterial treatment,and reduce the overuse of antibacterial drugs.

Objectives:To develop a novel prediction model for mitral valve repair failure based on machine learning algorithms.Methods:Clinical and echocardiographic data were analyzed on patients,who underwent mitral valve repair in Fuwai Hospital from 2009 January 1st to 2022 December 31st.End points included immediate mitral valve repair failure (mitral replacement secondary to mitral repair failure) and recurrence regurgitation (moderate or severe mitral regurgitation before discharge).Risk factors of mitral valve repair failure were analyzed by XGBoost and shapley additive explanation (SHAP),and a machine learning model was established based on mixture of experts (MoE) as a risk prediction model and compared with conventional mitral valve repair complexity scores.Results:A total of 2314 patients were included in this study.Mitral repair was unsuccessful in 4.2％ (98 of 2314) of patients.Patient factors such as tricuspid regurgitation pressure gradient,A3 and A3P3 lesions,left ventricular end-systolic volume,and left atrium anterior and posterior diameter are associated with mitral valve repair failure;in addition,surgeon factors,such as cumulative repair failure rate,cumulative repair volume,and surgeon seniority,are also risk factors for mitral valve repair failure.The MoE model has an AUC value of 0.79,and the prediction performance is significantly better than traditional complexity scores.Conclusions:The MoE based machine learning model can predict the risk of mitral valve repair failure well.This evaluation system can effectively assist surgeons in assessing the risk of mitral valve repair failure and in selecting suitable treatment options for patients.

Objectives:To develop a novel prediction model for mitral valve repair failure based on machine learning algorithms.Methods:Clinical and echocardiographic data were analyzed on patients,who underwent mitral valve repair in Fuwai Hospital from 2009 January 1st to 2022 December 31st.End points included immediate mitral valve repair failure (mitral replacement secondary to mitral repair failure) and recurrence regurgitation (moderate or severe mitral regurgitation before discharge).Risk factors of mitral valve repair failure were analyzed by XGBoost and shapley additive explanation (SHAP),and a machine learning model was established based on mixture of experts (MoE) as a risk prediction model and compared with conventional mitral valve repair complexity scores.Results:A total of 2314 patients were included in this study.Mitral repair was unsuccessful in 4.2％ (98 of 2314) of patients.Patient factors such as tricuspid regurgitation pressure gradient,A3 and A3P3 lesions,left ventricular end-systolic volume,and left atrium anterior and posterior diameter are associated with mitral valve repair failure;in addition,surgeon factors,such as cumulative repair failure rate,cumulative repair volume,and surgeon seniority,are also risk factors for mitral valve repair failure.The MoE model has an AUC value of 0.79,and the prediction performance is significantly better than traditional complexity scores.Conclusions:The MoE based machine learning model can predict the risk of mitral valve repair failure well.This evaluation system can effectively assist surgeons in assessing the risk of mitral valve repair failure and in selecting suitable treatment options for patients.

Objective:To investigate the value of neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and blood platelet count (BPC) in judging the prognosis of adult patients with extensive burns.Methods:From January 2012 to December 2018, 99 adult patients with extensive burns who met the inclusion criteria were admitted to Union Hospital of Fujian Medical University, including 76 males and 23 females, aged 18 to 75 (43±13) years. According to the prognosis, the patients were divided into survival group of 79 cases and death group of 20 cases. Their clinical data were retrospectively analyzed by the method of case-control study. The gender, age, total burn area, inhalation injury, use of mechanical ventilation and white blood cell count, neutrophil count, lymphocyte count, and BPC on post injury day (PID) 1, 3, and 7 were collected, and the NLR, PLR, difference value of BPC on PID 3 and PID 1 (ΔBPC3), difference value of NLR on PID 3 and PID 1 (ΔNLR3), difference value of PLR on PID 3 and PID 1 (ΔPLR3), difference value of BPC on PID 7 and PID 1 (ΔBPC7), difference value of NLR on PID 7 and PID 1 (ΔNLR7), difference value of PLR on PID 7 and PID 1 (ΔPLR7) of patients in the two groups were calculated. Data were statistically analyzed with Mann-Whitney U test, independent sample t test, chi-square test to screen the death-related factors of patients. Binary classification single factor and multifactor logistic regression analysis were used to analyze the death-related factors of patients. The receiver′s operating characteristic (ROC) curve of the independent risk factor of death of patients predicting the prognosis of adult patients with extensive burns was drawn, and the area under the curve, the optimal threshold and its sensitivity and specificity were calculated. Results:(1) There were statistically significant differences in total burn area and use of mechanical ventilation of patients between the two groups ( Z=-2.615, χ2=7.282, P<0.01). (2) On PID 1, there was statistically significant difference in NLR of patients between the two groups ( Z=-2.414, P<0.05). On PID 3, there were statistically significant differences in BPC and ΔNLR3 of patients between the two groups ( Z=-2.048, -2.780, P<0.05 or P<0.01). On PID 7, there were statistically significant differences in lymphocyte count, BPC, NLR, and ΔNLR7 of patients between the two groups ( Z=-2.248, -2.231, -2.641, -3.669, P<0.05 or P<0.01). (3) Binary classification single factor logistic regression analysis showed that the total burn area, mechanical ventilation, BPC and NLR on PID 7, and ΔNLR7 were related to death of patients (odds ratio=1.038, 0.193, 0.990, 1.086, 1.105, 95% confidence interval=1.010-1.067, 0.062-0.598, 0.982-0.998, 1.012-1.165, 1.037-1.178, P<0.05 or P<0.01). Binary classification multifactor logistic regression analysis showed that ΔNLR7 was the independent risk factor of death of adult patients with extensive burns (odds ratio=1.090, 95% confidence interval=1.008-1.178, P<0.05). (4) The optimal threshold of ROC curve of ΔNLR7 for predicting the prognostic death of 97 adult patients with extensive burns was -0.073 4. The sensitivity under the optimal threshold was 65.0%, and the specificity was 78.5%. The area under the ROC curve was 0.776 (95% confidence interval=0.650-0.882, P<0.01). Conclusions:Dynamic monitoring of NLR and BPC is of great significance to assist in judging the prognosis of adult patients with extensive burns. ΔNLR7 is an independent predictor of death in adult patients with extensive burns, while PLR can not predict the death of adult patients with extensive burns.

Objective: To explore the clinical effects of artificial dermis combined with vacuum sealing drainage (VSD) and autologous split-thickness skin graft in repair of scar contracture deformity after extensive burn. Methods: A total of 8 patients with scar hyperplasia and contracture deformity on joint after healing of extensive burn were admitted to our hospital from August 2015 to August 2017. There were 5 females and 3 males aged 8 to 45 years with an average of 23 years. In the first stage operation, scar tissue on contracture site was removed, and the wound was covered by artificial dermis followed by continued VSD treatment. On 10-14 d after the first stage operation, the artificial dermis tissue formed, and the second stage autologous split-thickness skin grafting and continued VSD treatment were performed. Routine anti-scar therapy was carried out after healing of wounds. Time of wound healing after the second stage operation was recorded. Colour and texture of the split-thickness skin graft, scar formation condition of the donor site, and action condition of the operation site during follow-up were observed. Results: The wounds of 8 patients were healed in 10-14 d after the second stage operation. During follow-up of 6-24 months, the split-thickness skin graft was with smooth surface and good elasticity, and the function of joint recovered well. The donor site in head healed well with no scar. Only pigmentation was left in the donor site of thigh, and scar was not obvious. The patients and their family members were satisfied. Conclusions After application of artificial dermis combined with VSD and autologous split-thickness skin graft in repair of scar contracture deformity after extensive burn, the skin grafting area and donor site were with unobvious scar hyperplasia, and the joint function in the operation area was good.

Objective To investigate that brucein D (BD) possesses potent anti-colon cancer activity by inhibiting proliferation and inducing apoptosis in colon adenocarcinoma cell.Methods After human colon cancer cell line PANC-1 was treated with BD (0,5,10,20,30,80)μmol/L for 24,48,72h,the cell proliferation was detected by cell counting kit-8 (CCK-8)assay.The apoptosis of colon cancer cells was detected using Annexin V-FITC/PI.The protein expressions of JNK and p-JNK were detected using Western blot.Results After human colon cancer cell line PANC-1 was treated with BD for 24,48,72h,the cell survival rates decreased lower and apoptosis rate increased in concentration-and time-dependent manners.AS the concentration of BD got higher or the time got longer,the protein expression of JNK was down-regulated and that of p-JNK up-regulated significantly.In vivo,with the prolonged administration,the mean volume of xenograft tumor grew slowly.The protein expression of JNK was down-regulated and that of p-JNK up-regulated significantly in colon xenograft tumors cells.Conclusion With the increase of time and BD's concentration,the survival rates of colon cancer HT29 cells could be lower.Instead,the apoptosis rate has increased in a concentration-time-dependent manners.

Heilongjiang Provincial Hospital has scored an initial success in dealing with medical disputes since the medical liability insurance and third-party mediation mechanism were introduced into the hospital in 2013.The paper identified problems found in the practice,and recommended the following:rationalizing the cost of insurance coverage,expanding scope of third-party mediation properly,enhancing professional authority in assessment of medical dispute cases,simplifying insurance compensation procedure,and consolidating the legal status of the medical dispute mediation institutions,for better resolution of such disputes.