Objective This study aimed to adapt the data-driven Palliative Care Outcomes Collaboration(PCOC)model to the local context and evaluate its feasibility and preliminary effectiveness in a palliative care unit in China,with the goal of informing its broader integration into national palliative care practice.Methods Based on international experience,a localized implementation protocol for the PCOC model was developed through expert con-sultations and a pilot study.The protocol incorporated key elements including organizational and managerial sup-port,team training and capacity building,information system integration,supervision and feedback mechanisms,pro-cess optimization,and data-driven decision-making.From June to December 2023,the protocol was piloted in the palliative care unit of a tertiary cancer hospital in Changsha,China.Implementation outcomes were assessed by comparing patients' urgent care response rates,symptom stability rates,and symptom improvement rates between the first 1～3 months and 4～6 months after implementation.Results During the study period,a total of 355 inpatients were enrolled,with the PCOC assessment achieving full coverage(100％)and a completion rate of 97.78％.There was no statistically significant difference in the urgent needs response rate between the first 1～3 months and the 4～6 months after the implementation of the PCOC model(P=0.533).However,compared to the first 1～3 months af-ter implementation,patients in the 4～6 months period showed significantly higher symptom stability rates for pain,psychological/spiritual issues,and family/caregiver problems,as well as a higher improvement rate for pain(P＜0.05).Conclusion The localized PCOC implementation protocol facilitates standardized assessment and symptom manage-ment,and its application can enhance the quality of palliative care.

Objective To explore the correlations of multimodal ultrasound manifestations of Hashimoto thyroiditis(HT)with normal thyroid function and serum thyroid peroxidase antibody(TPOAb)titer.Methods Data of gray-scale ultrasound,CDFI and shear wave elastography(SWE)of 100 HT patients with normal thyroid function were retrospectively analyzed.According to gray-scale ultrasound manifestations,HT was classified into focal type(type A),nodular-like type(type B),diffuse hypoechoic type(type C)and diffuse hyperechoic type(type D).Meanwhile,based on blood flow distribution shown on CDFI,HT was classified into abundant type,increased type,normal type and sparse type.Correlations of the mean Young's modulus(Emean)of thyroid gland and CDFI classification of HT with serum TPOAb titer were analyzed.Results For all 100 cases,serum TPOAb titer was(270.31±72.63)IU/ml.There were 38 cases of type A,26 cases of type B,20 cases of type C and 16 cases of type D based on gray-scale ultrasound,and 15 cases of abundant type,9 cases of increased type,69 cases of normal type and 7 cases of sparse type based on CDFI,respectively.The Emean of thyroid in all 100 cases was(22.31±7.38)kPa.Significant differences of serum TPOAb titer and thyroid Emean were found among different gray-scale ultrasound HT types(all P＜0.05).Thyroid Emean values of all 100 patients were positively correlated with TPOAb titer(rs=0.702,P=0.037).The thyroid Emean of patients with type A,B,C and D HT were positively correlated with TPOAb titer(rs=0.752,0.823,0.853,0.497,all P＜0.05),while the CDFI types of HT were negative correlated with serum TPOAb titer(rs=-0.746,P=0.035).Conclusion Both thyroid Emean and blood flow signals in HT patients with normal thyroid function were correlated with serum TPOAb titer.

Objective This study aimed to adapt the data-driven Palliative Care Outcomes Collaboration(PCOC)model to the local context and evaluate its feasibility and preliminary effectiveness in a palliative care unit in China,with the goal of informing its broader integration into national palliative care practice.Methods Based on international experience,a localized implementation protocol for the PCOC model was developed through expert con-sultations and a pilot study.The protocol incorporated key elements including organizational and managerial sup-port,team training and capacity building,information system integration,supervision and feedback mechanisms,pro-cess optimization,and data-driven decision-making.From June to December 2023,the protocol was piloted in the palliative care unit of a tertiary cancer hospital in Changsha,China.Implementation outcomes were assessed by comparing patients' urgent care response rates,symptom stability rates,and symptom improvement rates between the first 1～3 months and 4～6 months after implementation.Results During the study period,a total of 355 inpatients were enrolled,with the PCOC assessment achieving full coverage(100％)and a completion rate of 97.78％.There was no statistically significant difference in the urgent needs response rate between the first 1～3 months and the 4～6 months after the implementation of the PCOC model(P=0.533).However,compared to the first 1～3 months af-ter implementation,patients in the 4～6 months period showed significantly higher symptom stability rates for pain,psychological/spiritual issues,and family/caregiver problems,as well as a higher improvement rate for pain(P＜0.05).Conclusion The localized PCOC implementation protocol facilitates standardized assessment and symptom manage-ment,and its application can enhance the quality of palliative care.

Objective To explore the correlations of multimodal ultrasound manifestations of Hashimoto thyroiditis(HT)with normal thyroid function and serum thyroid peroxidase antibody(TPOAb)titer.Methods Data of gray-scale ultrasound,CDFI and shear wave elastography(SWE)of 100 HT patients with normal thyroid function were retrospectively analyzed.According to gray-scale ultrasound manifestations,HT was classified into focal type(type A),nodular-like type(type B),diffuse hypoechoic type(type C)and diffuse hyperechoic type(type D).Meanwhile,based on blood flow distribution shown on CDFI,HT was classified into abundant type,increased type,normal type and sparse type.Correlations of the mean Young's modulus(Emean)of thyroid gland and CDFI classification of HT with serum TPOAb titer were analyzed.Results For all 100 cases,serum TPOAb titer was(270.31±72.63)IU/ml.There were 38 cases of type A,26 cases of type B,20 cases of type C and 16 cases of type D based on gray-scale ultrasound,and 15 cases of abundant type,9 cases of increased type,69 cases of normal type and 7 cases of sparse type based on CDFI,respectively.The Emean of thyroid in all 100 cases was(22.31±7.38)kPa.Significant differences of serum TPOAb titer and thyroid Emean were found among different gray-scale ultrasound HT types(all P＜0.05).Thyroid Emean values of all 100 patients were positively correlated with TPOAb titer(rs=0.702,P=0.037).The thyroid Emean of patients with type A,B,C and D HT were positively correlated with TPOAb titer(rs=0.752,0.823,0.853,0.497,all P＜0.05),while the CDFI types of HT were negative correlated with serum TPOAb titer(rs=-0.746,P=0.035).Conclusion Both thyroid Emean and blood flow signals in HT patients with normal thyroid function were correlated with serum TPOAb titer.

Objective To explore the clinical efficacy and mechanism of Qinggan Sanjie Xiaoying Decoction in the treatment of Hashimoto's thyroiditis with syndrome of stagnation heat of liver meridian and stagnation of spleen deficiency and phlegm.Methods Totally 70 patients were divided into control group and medicine group according to their wishes,with 35 patients in each group.Both groups were restricted to an iodine diet.The medicine group was given Qinggan Sanjie Xiaoying Granules,1 sachet at a time,twice a day,orally.The treatment for both groups lasted for 4 weeks.20 healthy people were chosen as the healthy group.The clinical efficacy of both groups was observed.TCM symptom score,thyroid antibody titer levels(TPOAb,TGAb),changes in thyroid volume and isthmus of both groups before and after treatment were compared.Levels of serum IKKα,IKBα and TNF-α of the three groups were compared.Adverse reactions of patients daring the treatment period were monitored.Results The total effective rate of the medicine group was 85.71%(30/35),while the control group was 20.00%(7/35).The medicine group was superior to the control group(P<0.05).Compared with before treatment,the medication group showed significant improvement in TCM symptom scores,TPOAb and TGAb titer levels,thyroid volume,and thyroid isthmus thickness after treatment(P<0.05).After treatment,TCM symptom score,thyroid volume in the medicine group were lower than those in the control group(P<0.05),and the decrease rate of TPOAb titer was higher than that in the group(P<0.05).The levels of IKKα and TNF-α before treatment of medicine group and control group were higher than that in the healthy control group,and the level of IKBα was lower than that of the healthy control group(P<0.05);compared with before treatment,the levels of IKKα and TNF-α in the medicine group decreased,and the level of IKBα increased(P<0.05);after treatment,the levels of IKKα and TNF-α in the medicine group were lower than that in the control group,and IKBα was higher than the control group(P<0.05).No adverse events were observed during the treatment period in both groups of patients.Conclusion Qinggan Sanjie Xiaoying Decoction can reduce the antibody titer level,thyroid enlargement,isthmus thickness,and TCM syndrome score in the treatment of Hashimoto's thyroiditis.It is safe and effective in clinical practice.Qinggan Sanjie Xiaoying Decoction may play a therapeutic role by interfering with NF-κB signaling pathway.

Objective:To evaluate the clinical efficacy of Professor Ding Zhiguo's internal and external combined treatment of Hashimoto's disease, and to explore its mechanism.Methods:Prospective cohort study. A total of 85 patients of professor Ding Zhiguo from Sun Simmiao Hospital of Beijing University of Chinese Medicine and Dongzhimen Hospital of Beijing University of Chinese Medicine from August 2022 to March 2023 were selected and divided into control group (43 cases) and drug group (42 cases) by random number table method. Another 20 healthy volunteers were recruited for health control observation. The control group was given iodine restricted diet, the drug group was treated with Qinggan Sanjie Xiaoying Prescription combined with Liqi Sanjie Xiaoying Ointment, and the healthy control group was not treated with any intervention. Both drug group and control group were observed continuously for 4 weeks. TCM syndrome scores were performed before and after treatment. Hamilton Anxiety Scale (HAMA) and Hamilton Depression Scale (HAMD) were used to assess the degree of anxiety and depression, Pittsburgh Sleep Quality Index (PSQI) was used to assess sleep quality, and fatigue severity Scale (FSS) was used to assess the degree of fatigue. Lower limb lymphedema self-sensory symptoms assessment questionnaire was used to evaluate the symptoms of lower limb lymphedema. The serum levels of thyroid peroxidase antibody (TPOAb) and thyroglobulin antibody (TGAb) were measured by automatic electrochemiluminescence immunoassay, and the reduction rate was calculated. The levels of serum Akt, ERK and protein kinase C (PKC) were detected by ELISA. The thyroid volume was calculated and the anterior and posterior diameter of the isthmus was recorded. The clinical efficacy and safety were evaluated.Results:The total effective rate was 71.43% (30/42) in the drug group and 27.91% (12/43) in the control group, with statistical significance ( χ2=16.10, P<0.01). The serum TPOAb [137.95 (141.44) IU/ml vs. 153.40 (154.93) IU/ml, Z=-4.37] and TGAb [182.00 (238.52) IU/ml vs. 190.50 (257.55) IU/ml, Z=-2.13] levels in the drug group were lower after treatment ( P<0.01 or P<0.05), and the decrease rate of TPOAb [15.62 (21.90)% vs. -6.42 (32.89)%, Z=-4.12] and TGAb [5.25 (20.49)% vs. -0.72 (17.67)%, Z=-2.67] were higher than that in the control group ( P<0.01). The thyroid volume [11.37 (6.48) cm 3vs. 12.89 (6.63) cm 3, Z=-2.95] and isthmus thickness [0.27 (0.14) cm vs. 0.28 (0.15) cm, Z=-2.18] in the drug group were reduced after treatment compared with that before treatment ( P<0.05). TCM syndrome scores (6.10±1.38 vs. 14.42±7.35, t=-7.29), HAMA (5.21±1.32 vs. 9.28±2.25, Z=-7.02), HAMD (8.28±3.17 vs. 10.42±5.28, t=-2.26), PSQI (6.00±2.16 vs. 9.47±3.08, t=-6.01), FSS (34.71±5.51 vs. 38.23±8.35, t=-2.30), lower limb lymphedema self-induced symptom evaluation questionnaire scores (4.95±2.56 vs. 7.86±3.07, t=-4.74) after treatment were lower than before treatment and lower than control group ( P<0.001 or P<0.05).The serum levels of Akt [52.28 (17.72) μmol/L vs. 44.38 (2.75) μmol/L],ERK [2 843.43 (607.90) ng/L vs. 2 648.25 (290.74) ng/L],PKC [8.87 (3.10) pmol/L vs. 7.88 (1.25) pmol/L] in drug group were higher than those in the healthy control group before treatment ( P<0.05), the levels of Akt [37.37 (7.90) μmol/L vs. 44.38 (2.75) μmol/L], ERK [2 432.74 (402.56) ng/L vs. 2 648.25 (290.74) ng/L] in drug group were lower than those in the healthy group after treatment ( P<0.05). After treatment, the levels of Akt [37.37 (7.90) μmol/L vs. 52.28 (17.72) μmol/L, 49.56 (9.12) μmol/L], ERK [2 432.74 (402.56) ng/L vs. 2 843.43 (607.90) ng/L, 3 021.76 (360.22) ng/L], PKC [7.37 (1.84) pmol/L vs. 8.87 (3.10) pmol/L, 10.00 (2.42) pmol/L] in drug group were lower than before treatment and lower than control group ( P<0.01). There were no adverse events during treatment in both groups. Conclusion:The internal and external treatment of Hashimoto's disease by Professor Ding Zhiguo can effectively reduce the level of thyroid antibody titer, reduce the thyroid swelling and isthmus thickness, improve the clinical symptoms of patients with Hashimoto's disease, and may play a therapeutic role by interfering with MAPK signaling pathway.

The sewage treatment station is a critical pro-environment facility in hospitals.This study presents an overview of the sewage and waste gas treatment processes in a general hospital's sewage treatment station,outlining the current operational status and identifying existing issues.By implementing targeted management measures,including outsourcing services,specializa-tion of operations and maintenance staff,standardization of work protocols,digitization of data,and enhanced inspection and o-versight,the hospital has achieved improvements in the station's operational efficiency and management quality.These advance-ments provide essential support for the hospital's uninterrupted medical services.

Objective:To analyze the mechanism of Jindan Tablets, Xiaoyan Lidan Tablets and ursodeoxycholic acid in the treatment of gallstone and cholecystitis based on network pharmacology; To conduct a comparative analysis.Methods:The chemical components of Jindan Tablets, Xiaoyan Lidan Tablets and ursodeoxycholic acid and their drug targets were collected from Traditional Chinese Medicine Database and Analysis Platform (TCMSP). DAVID 6.8 database was used to search for the associated diseases of the drug targets. The disease targets of gallstone and cholecystitis were collected from GeneCards and other databases. The protein-protein interactions network was established based on the intersecting targets of three drugs and two diseases. KEGG enrichment analysis was performed based on the DAVID 6.8 database. Cytoscape 3.7.1 software was used to construct a complex network and topology analysis of component- target- disease between three drugs and diseases.Results:222 chemical components and 3 133 drug targets were collected for Jindan Tablets. 104 chemical components and 1 425 action targets were collected for Xiaoyan Lidan Tablets. 1 chemical component and 119 action targets were collected for ursodeoxycholic acid. The three drugs were associated with 31 diseases. 1 382 disease targets for gallstones and cholecystitis were collected. There were 237, 163 and 33 targets for gallstones and cholecystitis in the three drugs, of which 17 were shared by the three drugs and 20 were shared by Jindan Tablets and Xiaoyan Lidan Tablets. Based on the DAVID database, 113, 74 and 10 significant KEGG enrichment pathways were obtained for the three drugs respectively.Conclusions:The three drugs shared many targets and pathways in the treatment of gallstones and cholecystitis, which all had the function of regulating metabolism and inhibiting inflammatory response, while participating in apoptosis, oxidative stress and cancer pathology process. However, they had their own special effects, with Jindan Tablets favoring involving in the cancer process and inhibition of inflammation, and promoting angiogenesis. Xiaoyan Lidan Tablets and ursodeoxycholic acid focused on regulating cholesterol metabolism, and Xiaoyan Lidan Tablets also regulated steroid metabolism and inhibit inflammation, while ursodeoxycholic acid regulated bile acid metabolism.

Cell Cycle Checkpoints/genetics* ; Checkpoint Kinase 1/metabolism* ; Heterozygote ; Humans ; Mitosis/genetics* ; Mutation ; Zygote/metabolism*

Objective : To investigate whether the application of melatonin (MT) in embryo culture in vitro can improve the treatment effect of in vitro fertilization embryo transfer(IVF⁃ET) in patients with decreasing ovarian reserve (DOR) . Methods : 128 DOR patients receiving assisted reproductive therapy were collected. All patients were treated with an antagonist scheme of super⁃ovulation. Patients were divided into melatonin group (n = 56) and control group (n = 72) according to whether melatonin ( melatonin concentration 10 - 9 mol/L) was added into embryo culture medium. Results : There was no statistically significant difference in oocytes fertilization rate and cleavage rate between the two groups during later embryo culture , but blastocyst formation rate ( 65. 22% vs 56. 16% ) and high⁃quality blastocyst rate (52. 96% vs 40. 94% ) in the melatonin group were higher than those in the control group , and the differences were statistically significant ( P < 0. 05 ) . There were no significant differences in the implantation rate (50. 00% vs 38. 67% ) and clinical pregnancy rate (48. 39% vs 46. 00% ) of blastocysts after freezing⁃thawing between the two groups , but the cycle number of high⁃quality blastocysts obtained in the melatonin group was higher than that in the control group (85. 71% vs 69. 44% ) , and the difference was statistically significant (P < 0. 05) . Conclusion In a way , the application of melatonin in the in vitro culture of early embryos can promote the development of oocytes in patients with DOR , improve the quality of embryos , and finally substantially improve the therapeutic effect of such patients.