OBJECTIVE To investigate the application status of prescription pre-review systems in healthcare institutions of Yunnan province， evaluate their system functions and management capabilities， and provide a practical basis for promoting rational drug use. METHODS A questionnaire survey was conducted among public healthcare institutions at or above the secondary level in Yunnan province to investigate the deployment status of the systems. A capability maturity assessment framework was constructed， encompassing 6 dimensions and 39 indicators， including real-time prescription review， prescription correlation review， rule setting， evidence-based information support， prescription authority management， and system operation management. This framework was then used to evaluate the institutions that had implemented the pre-review systems. RESULTS A total of 100 valid questionnaires were collected， with 37 institutions having adopted prescription pre-review systems， mainly tertiary hospitals. The system predominantly adopted a modular architecture and was embedded into the hospital information system through application programming interfaces and middleware， providing certain capabilities for real-time prescription risk identification. Evaluation results indicated that basic functions such as reviewing indications， contraindications， and drug compatibility performed well， while deficiencies remained in functions related to parenteral nutrition prescription， review of drug dosage for specific diseases， individual patient characteristic recognition， and rule setting. Moreover， the construction of review centers and establishment of management systems were also not well-developed. CONCLUSIONS The overall application rate of prescription pre-review systems in Yunnan province remains low. System functions and management mechanisms require further improvement. It is recommended to enhance information infrastructure in lower-level institutions and explore regionally unified review models to promote standardized and intelligent development of prescription review practices.

Objective To explore a novel method for early lung cancer screening based on exhaled breath analysis. Methods This study enrolled patients with suspected pulmonary malignancies and healthy individuals undergoing physical examinations at Sir Run Run Shaw Hospital, Zhejiang University School of Medicine (Qingchun and Qiantang campuses) from September 2023 to June 2024. Enrolled subjects were categorized into a lung cancer group, a benign nodule/tumor group, and a healthy control group. Exhaled breath samples were collected using a sensor array constructed from multiple graphene composite materials to capture breath fingerprints. Based on the collected data, screening and diagnostic models for lung cancer were developed and their performance was evaluated. Results A total of 4 580 subjects were included. Among them, 3 195 were pathologically diagnosed with pulmonary malignancies, including 1 394 males and 1 801 females with a mean age of (58.93±12.37) years, 599 were diagnosed with benign nodules/tumors including 339 males and 260 females with a mean age of (57.10±11.06) years, and 786 were healthy controls with no pulmonary nodules detected on chest CT including 420 males and 366 females with a mean age of (29.75±9.32) years. There were 4 031 patients in the training set and 549 patients in the external testing set. The screening model for high-risk populations (distinguishing patients with lung cancer/high-risk pulmonary nodules from healthy individuals) demonstrated excellent performance, with an area under the receiver operating characteristic curve (AUC) of 0.926. At the optimal Youden’s index (cutoff threshold of 63.5%), the external testing set achieved a specificity of 85.2%, a sensitivity of 88.4%, and an accuracy of 86.8%. The diagnostic model (distinguishing patients with lung cancer/premalignant lesions from those with benign pulmonary nodules/healthy individuals) achieved an AUC of 0.818. At its optimal Youden’s index (cutoff threshold of 47.0%), the external testing set showed a specificity of 71.7%, a sensitivity of 77.3%, and an accuracy of 74.5%. Conclusion The non-invasive breath analysis platform based on a sensor array, developed in this study, can achieve rapid and relatively accurate lung cancer screening by analyzing breath fingerprints. This confirms the feasibility of this technology for early lung cancer screening and holds promise for facilitating the early detection and intervention of lung cancer.

Objective To investigate the characteristics of epilepsy onset based on the theory of five circuits and six qi in traditional Chinese medicine(TCM).Methods A total of 8 389 epilepsy patients from a community-based natural population cohort study from UK Biobank were included.Frequency and constituent ratio analyses were performed to describe the distribution of epilepsy onset in relation to the five circuits and six qi elements,and statistical inferences were made using chi-square tests.Results The analysis revealed statistically significant differences existed in epilepsy onset across different heavenly stems,earthly branches,recombinant yearly circuit,celestial control and terrestrial effect,and dominant qi(all P＜0.05).From the perspective of circuits,the highest incidence occurred in years corresponding to the"Ji"and"Hai"years,while the lowest incidence was observed in"Bing"and"Mao"years.Years dominated by wood circuit and wind manifestations exhibited the highest incidence,whereas years with cold manifestations showed the lowest incidence,suggesting the liver as the primary pathological site in epilepsy.From the perspective of qi,the third dominant qi was most frequently associated with onset.Regarding presiding and subordinate qi,years with taiyin damp earth presiding and taiyang cold water subordinate had the highest incidence,while years with yangming dry metal presiding and shaoyang monarch fire subordinate had the lowest incidence,indicating that cold-damp years and midsummer periods are potential triggers for epilepsy.Conclusion There is a certain regularity in the epilepsy onset correlated with the features of five circuits and six qi,which can guide prevention and clinical diagnosis and treatment of epilepsy.

Objective:To improve the understanding of primary pulmonary lymphoepithelioma-like carcinoma (PPLELC).Methods:A retrospective case series study was conducted. The clinical data of 31 patients with PPLELC who were admitted to the First Affiliated Hospital of Guangxi Medical University from January 2012 to June 2023 were retrospectively analyzed, and their clinical features were summarized. The correlations of organ metastasis, tumor stage, serum tumor markers, lactate dehydrogenase, and albumin with survival time were analyzed.Results:Among the 31 patients, 13 (41.9%) were male and 18 (58.1%) were female, aged (50±9) years old, with no smoking history in 24 cases (77.4%). The common clinical manifestations were cough(24 cases, 77.4%) and sputum (19 cases, 61.3%), and 7 patients (22.6%) were detected by physical examination; 24 cases (77.4%) had elevated levels of serum tumor markers, and the rest of the 7 cases (22.6%) had normal levels of various tumor markers. All of the patients had a single lesion, with a predominance of the right middle lung (8 cases, 25.8%), and 23 cases (74.2%) had lymph node metastasis. Immunohistochemical detection showed that the positive rate of CK was 67.7% (21/31), and the positive rates of squamous cell carcinoma markers CK5/6, p63 and p40 were 90.3% (28/31), 80.6% (25/31) and 77.4% (24/31), respectively. The positive rate of EBER in situ hybridization detection was 85.2% (23/27). Genetic testing showed 6 cases had epidermal growth factor receptor (EGFR) mutation. The median survival time [ M ( Q1, Q3)] of the groups without lymph node metastasis and with lymph node metastasis was 33.0 months (7.3 months, 9.3 months) and 19.0 months (7.0 months, 27.0 months), and the difference was statistically significant ( P < 0.001). The median survival time of patients with stage Ⅰ-Ⅱ and with stage Ⅲ-Ⅳ was 20.0 months (12.5 months, 42.0 months) and 18.5 months (6.5 months, 38.5 months), and the difference was statistically significant ( P = 0.002). One stage Ⅰ A patient was treated with surgery alone and survived at 92 months of follow-up. Ten cases were treated with immunotherapy and had a good outcome. Conclusions:PPLELC is prevalent in non-smokers, the lesions are mostly in the right middle lung, and it is easily misdiagnosed as squamous cell carcinoma. The positive EBER in situ hybridization detection can help the diagnosis; lymph node metastasis is common. Tumor stage, lymph node metastasis and CYFRA21-1 level may be correlated with the survival of patients. The patients can benefit from immunotherapy, and anti-angiogenic therapy combined with chemotherapy is an optional treatment regimen.

The continuing discoveries of novel classes of RNA modifications in various organisms have raised the need for improving sensitive, convenient, and reliable methods for quantifying RNA modifications. In particular, a subset of small RNAs, including microRNAs (miRNAs) and Piwi-interacting RNAs (piRNAs), are modified at their 3'-terminal nucleotides via 2'-O-methylation. However, quantifying the levels of these small RNAs is difficult because 2'-O-methylation at the RNA 3'-terminus inhibits the activity of polyadenylate polymerase and T4 RNA ligase. These two enzymes are indispensable for RNA labeling or ligation in conventional miRNA quantification assays. In this study, we profiled 3'-terminal 2'-O-methyl plant miRNAs in the livers of rice-fed mice by oxidative deep sequencing and detected increasing amounts of plant miRNAs with prolonged oxidation treatment. We further compared the efficiency of stem-loop and poly(A)-tailed RT-qPCR in quantifying plant miRNAs in animal tissues and identified stem-loop RT-qPCR as the only suitable approach. Likewise, stem-loop RT-qPCR was superior to poly(A)-tailed RT-qPCR in quantifying 3'-terminal 2'-O-methyl piRNAs in human seminal plasma. In summary, this study established a standard procedure for quantifying the levels of 3'-terminal 2'-O-methyl miRNAs in plants and piRNAs. Accurate measurement of the 3'-terminal 2'-O-methylation of small RNAs has profound implications for understanding their pathophysiologic roles in biological systems.
Animals ; High-Throughput Nucleotide Sequencing ; Humans ; Methylation ; Mice ; MicroRNAs/genetics* ; Oxidative Stress ; RNA, Small Interfering/metabolism* ; Real-Time Polymerase Chain Reaction

Objective To analyze the clinical characteristics and changes of serum tumor markers in lung cancer patients with different smoking status in Hanzhong area. Methods A retrospective analysis was performed on 642 hospitalized lung cancer patients in Hanzhong area from March 2017 to March 2019. According to their smoking status, they were divided into observation group (smoking history, n=404) and control group (no smoking history, n=238). Age, sex, place of residence, basic information of the disease including pathological stage, pathological type, short-term efficacy, survival and serum tumor marker level were analyzed retrospectively. Results The proportion of male in observation group (67.08%) was significantly higher(57.56%) (χ²=5.855,P<0.05). Observed a group of 50 or more patients (80.94%) were significantly higher (73.53%) (χ²=4.824 , P<0.05); There was no significant difference between the two groups (χ²=2.110 , P<0.05). The proportion of adenocarcinoma in the control group (49.16%) was the highest, and that of small cell lung cancer in the observation group (41.34%) was the highest (χ²=15.291, P <0.05). Comparison of pathological stages between the two groups showed that stage IIIB (32.77%) was the highest in the control group, followed by stage IV (23.53%), Stage IIIA (20.59%), Stage II (13.03%) and stage I (10.08%). The observation group had the highest proportion in stage IIIA (35.40%), followed by Stage IIIB (25.00%), stage IV (16.09%), Stage IIIA (16.09%), stage II (15.10%) and stage I (8.42%). The difference between the two groups was statistically significant (χ²=10.817,P<0.05). Before treatment, serum CEA, CA125 and CA199 levels in observation group were significantly higher (P<0.05). After treatment, the levels of serum tumor markers in both groups were significantly decreased (P<0.05); The serum CEA, CA125 and CA199 levels in observation group were significantly higher (P<0.05). After treatment, THE ORR of the observation group (48.76%) was lower than that of the control group (53.78%), but the difference was not statistically significant (χ²=2.051, P>0.05). The 1-year survival rate of the observation group (64.85%) was significantly lower than that of the control group (73.95%) (χ²=5.255, P<0.05). Conclusion Middle-aged and elderly male smokers in Hanzhong area have a high incidence of lung cancer, multiple stage Ⅲ squamous cell carcinoma, and the level of tumor markers in serum is higher than that of non-smokers. The prognosis is not good, so we should encourage patients to quit smoking, which can improve the survival rate of patients.

Objective:To summarize the clinical experience in transoral endoscopic thyroidectomy via sublingual and vestibular approach (TOETSLVA).Methods:We retrospectively reviewed the medical record of patients who underwent TOETSLVA in our department from November 2011 to May 2020, including 3 males and 95 females, aged from 18 to 57 years old. Initial 81 cases were categorized in "Period A (November 2011-November 2015)" and subsequent 17 cases in "Period B (August 2019-May 2020)" . Data about demographics, operation time and complications were collected. SPSS 22.0 software was used for statistical analysis.Results:In Period A, the average age of patients was (34.2±9.4) years old; the mean tumor diameter was (2.33±0.80) cm; postoperative pathology showed benign nodules in 76 cases and malignant carcinoma in 5 cases; there were 65 cases of unilateral subtotal thyroid lobectomy, 6 cases of isthmus lobectomy, and 5 cases of bilateral subtotal thyroid lobectomy, with the mean operation time of (132.70±47.22) min; in 5 cases of unilateral thyroid lobectomy with central lymph node dissection, the mean operation time was (185.4±31.40) min; postoperative neck infections occurred in 6 cases; temporary vocal cord paralysis occurred in 1 case, which it recovered within two months; and CO 2 gas embolism occurred in 2 cases. In Period B, the average age of patients was (35.1±8.5) years old; mean tumor diameter was (1.32±0.67) cm; postoperative pathology indicated malignant nodules in 15 cases and benign nodules in 2 cases; in 2 cases of unilateral thyroid lobectomy, the mean operation time was (153.5±34.64) min; in 15 cases of unilateral thyroid lobectomy with central lymph node dissection, the mean operation time was (123.73±14.26) min; and none of patients developed postoperative neck infections or CO 2 gas embolism. All patients had different degree of cutaneous numbness in the submandibular region after surgery, which recovered within 1-2 weeks. There were no complications such as postoperative secondary hemorrhage, permanent vocal cord paralysis, hypoparathyroidism in both the periods. The median follow-up time was 86 months (57-105 months) in Peroid A and 5 months (3-12 months) in Peroid B. During the follow-up periods, there were no obvious abnormalities in swallowing, chewing, oral sensory function and neck activity, and also no tumor recurrence or metastasis. Conclusions:TOETSLVA is a safe and feasible surgery method, with a good cosmetic result. This approach will not lead to a postoperative cutaneous numbness of the submandibular region for a long time.

Objective:To investigate the effect of continuous Z-flaps combined with scar debulking in correcting hyperplastic scar contracture deformity of children′s hand.Methods:From January 2016 to December 2018, 27 cases of children with scar contracture deformity after hand burn or scald were admitted to the Department of Burn and Plastic Surgery of Children′s Hospital of Nanjing Medical University, involving a total of 36 joint parts. 12 male patients and 15 female patients aged 10 months to 12.5 years were divided into mild, moderate and severe types according to the contracture angle of metacarpophalangeal joints and interphalangeal joints, so as to make the treatment plan. The transposition of flaps for wound closure was designed for both mild and moderate cases after continuous Z-flaps to release contracture deformity with scar debulking. For severe deformity, the transposition of flaps should be conducted to cover the wound after the complete release by continuous Z-flaps and scar debulking, and the residual wound was covered by free skin grafts. The hand function and appearance were followed up after operation.Results:In this study, 12 of the 36 joints were mildly deformed, 15 were moderately deformed, and 9 were severely deformed. No skin grafting was performed for mild and moderate deformities, and the amount of skin grafting was selectively reduced for severe deformities. All contracture joint deformities were completely corrected, with the follow-up period of 0.8-2.0 years, and no contracture deformities were found again. The hand joint function, skin flap color, texture of mild and moderate types were close to the surrounding normal skin. Severe type had only a small degree of pigmentation at the skin graft site. One 12.5-year-old child received second procedure 2 years later because of the poor elasticity of the skin graft and the tensions. The tension resolved after operation, with satisfactory results.Conclusions:Continuous Z-flaps combined with scar debulking could maximize the retention of skin of the scar surface and reduce the amount of skin grafts, providing an excellent method for the treatment of hand contracture deformities in children, with stable long-term postoperative effects.

Objective:To investigate the effect of continuous Z-flaps combined with scar debulking in correcting hyperplastic scar contracture deformity of children′s hand.Methods:From January 2016 to December 2018, 27 cases of children with scar contracture deformity after hand burn or scald were admitted to the Department of Burn and Plastic Surgery of Children′s Hospital of Nanjing Medical University, involving a total of 36 joint parts. 12 male patients and 15 female patients aged 10 months to 12.5 years were divided into mild, moderate and severe types according to the contracture angle of metacarpophalangeal joints and interphalangeal joints, so as to make the treatment plan. The transposition of flaps for wound closure was designed for both mild and moderate cases after continuous Z-flaps to release contracture deformity with scar debulking. For severe deformity, the transposition of flaps should be conducted to cover the wound after the complete release by continuous Z-flaps and scar debulking, and the residual wound was covered by free skin grafts. The hand function and appearance were followed up after operation.Results:In this study, 12 of the 36 joints were mildly deformed, 15 were moderately deformed, and 9 were severely deformed. No skin grafting was performed for mild and moderate deformities, and the amount of skin grafting was selectively reduced for severe deformities. All contracture joint deformities were completely corrected, with the follow-up period of 0.8-2.0 years, and no contracture deformities were found again. The hand joint function, skin flap color, texture of mild and moderate types were close to the surrounding normal skin. Severe type had only a small degree of pigmentation at the skin graft site. One 12.5-year-old child received second procedure 2 years later because of the poor elasticity of the skin graft and the tensions. The tension resolved after operation, with satisfactory results.Conclusions:Continuous Z-flaps combined with scar debulking could maximize the retention of skin of the scar surface and reduce the amount of skin grafts, providing an excellent method for the treatment of hand contracture deformities in children, with stable long-term postoperative effects.

Objective: To investigate the treatment of nasal deformity in patients with unicoronal craniosynostosis. Methods: In patients over 6 months old, the nasal bones were wedge-removed without fixation. The management of all patients with unicoronal craniosynostosis was distraction osteogenesis of pedicled unilateral frontal bone flap. Results: Postoperative extended distance of the frontal bone was 28—41 mm (mean, 35.4 mm). After extension, three-dimensional reconstruction of cranial CT was carried out, which showed that CVAI was 0.8—1.2 (mean, 0.98), tending to normal. After discharge, dynamic cranial braces were put on for 1 year. Postoperatively, the children were followed up for 8—36 months (mean, 28 months). The shape and nasal deformity of all children were improved compared with those before surgery. Conclusions Nasal wedge resection should be used to correct nasal deformity in children over 6 months with unicoronal craniosynostosis.