With the progress of society,the global development of scientific and technical research activities,and the increasing number of medical Institutional Review Board(IRB)review projects,the construction and management of electronic informatization have become extremely important.In the process of electronic information construction in institutional ethics review,it is necessary to take into account the new policy of ethical governance of science and technology,consider the system and standard operating procedures of IRB,and develop reasonable processes based on practical work,simplify manual operation,improve the accuracy of project management,achieve refined management,and facilitate communication among researchers,ethics committee secretaries,and members.

Objective To observe the effect of shoulder-high head back-up position on airway ob-struction and hypoxia during fiberoptic bronchoscopy under non-intubated general anesthesia.Methods A total of 170 patients undergoing painless fiberoptic bronchoscopy,97 males and 73 females,aged 18-64 years,BMI 18.5-28.0 kg/m2,ASA physical status Ⅰ-Ⅲ,were randomly divided into two groups by ran-dom number method:observation group(group D,n=84)and control group(group C,n=83).Group D adopted the shoulder-high head back-up position,and group C adopted the supine position.All the pa-tients received intravenous general anesthesia of propfol combined with sufentanil,and were oxygenated via an ordinary endoscopic mask with an oxygen flow rate of 8-10 L/min.Fiberoptic bronchoscopy was per-formed when the modified observer assessment of alertness and sedation(MOAA/S)score was≤1 point.The number of cases in which hypoxia occurred and corrective measures were taken were recorded.The changes of HR,SBP,DBP,and SpO2 before induction of anesthesia(T1),1 minute after induction of an-esthesia(T2),endotracheal surface anesthesia(T3),at the time of examination(T4),and at the end of the examination(T5)were recorded.The degree of obstruction of the retropalatal space and retroglossal space at T2 were recorded.The level of glottic exposure and operating comfort of the endoscopist were recor-ded during the examination,and the incidence of postoperative neck discomfort,postoperative headache,postoperative dizziness,and nausea and vomiting were recorded.Results Compared with group C,the in-cidence of intraoperative moderate hypoxia,severe hypoxia,jaw support,and assisted ventilation was signifi-cantly decreased in group D(P＜0.05).Compared with T1,the HR were significantly increased at T3 and T4(P＜0.05),SBP and DBP were significantly decreased at T2,T4,and T5(P＜0.05),SpO2 was sig-nificantly increased at T2 and decreased at T4 in the two groups(P＜0.05),and SpO2 in group C was sig-nificantly decreased at T3(P＜0.05).Compared with group C,SpO2 was significantly increased at T4,the incidence of non-obstruction in the retrolingual space was significantly increased,and the incidence of com-plete obstruction in the retrolingual space was significantly decreased at T2,and the incidence of good glottic exposure was significantly increased,the incidence of poor glottic exposure was significantly decreased,and the incidence of good operating comfort of the endoscopist was significantly increased in group D(P＜0.05).There was no significant difference in the incidence of postoperative adverse events between the two groups.Conclusion Shoulder-high head back-up position can alleviate airway obstruction and reduce the incidence of hypoxia during fiberoptic bronchoscopy under non-intubated general anesthesia.

OBJECTIVE To review the application and development of automatic intelligent drug cabinet in hospitals at home and abroad. METHODS The relevant research articles published from 2010 to 2022 were retrieved from CNKI, Wanfang, VIP, PubMed and other databases. RESULTS The application of automatic intelligent drug cabinet could shorten the execution time of inpatient medical orders, improve the work efficiency of pharmacists and doctors and nurses, improve the quality of drug management in wards and promote the transformation of hospital pharmaceutical care. CONCLUSION The construction of decentralized dispensing mode with automated intelligent drug cabinets as the core has important theoretical guiding significance and broad application prospects for the automation, informatization, intelligence and whole process management of drugs in medical institutions, and also helps to improve the level of medical pharmacy service management.

Accurate classification of the acetabular injuries and appropriate treatment plan are great challenges for orthopedic surgeons because of the irregular anatomical structure of the acetabulum and aggregation of important vessels and nerves around it. Letournel-Judet classification system has been widely applied to classify acetabular fractures. However, there are several limitations, including incomplete inclusion of fracture types, difficulty in understanding and insufficient guidance for surgical treatment, etc. Serious complications such as traumatic arthritis are common due to wrong classification and diagnosis and improper selection of surgical strategy, which brings a heavy burden to the society and families. Three-column classification, based on anatomic characteristics, has advantages of containing more fracture types and being easy to understand, etc. To solve the problems existing in the diagnosis and treatment process based on Letournel-Judet classification, achieve accurate diagnosis and treatment of patients with acetabular fractures, and obtain satisfactory prognosis, the Orthopedic Trauma Emergency Center of Third Hospital of Hebei Medical University and the Trauma Orthopedic Branch of the Chinese Orthopedic Association organized experts from relevant fields to formulate the Expert consensus on the accurate diagnosis and treatment of acetabular fractures based on three-column classification ( version 2023) in terms of principles of evidence-based medicine. Based on the three-column classification, 15 recommendations were proposed, covering the diagnosis, treatment, complication prevention and management, etc, so as to provide reference for accurate diagnosis and treatment of acetabular fractures.

Objective:To discuss the effect of simultaneous implantation of artificial cavernous body and urethral sphincter for severe erectile dysfunction and urinary incontinence after traumatic posterior urethral stricture.Methods:A retrospective analysis was performed on 3 patients with traumatic posterior urethral stricture admitted to the Southern Theater General Hospital from January 2021 to December 2022, aged 42, 32, 28 years old, all of whom suffered pelvic fracture and posterior urethral stricture after trauma. Patient 2 were missing left lower limb and patient 3 were missing right lower limb, all of whom had dysuria. Preoperative cystourethrography indicated posterior urethral stricture with a length of 2, 2, 3 cm, respectively. No erectile response and severe erectile dysfunction were reported in penile nocturnal erectile function tests. Posterior urethral stricture was cured by end-to-end anastomosis surgery. After urethral stricture was cured, the nighttime erectile function test indicated severe erectile dysfunction and diagnosed erectile dysfunction and urinary incontinence. After 3 months of continuous administration of sildenafil and/or tadalafil, the erectile dysfunction did not improve, and the score of the international erectile function test was 1, 2, 2 points. Severe erectile dysfunction. The urine could not be controlled, the number of urine pads per day was 6, 6, 8, respectively, and pelvic floor rehabilitation training was adopted for urinary incontinence. 6 months later, urodynamic examination indicated severe stress incontinence, and the urine pad test was 30g, 32g, and 82g per hour. Patients were fully informed of the surgical risks before surgery. Simultaneous implantation of artificial penile cavernous body and artificial urethral sphincter were performed after full preoperative preparation: General anesthesia, supine frog position with transverse incision in upper scrotum, the urethra was separated and the artificial urethral sphincter cuff was easily inserted into the upper scrotum. Then the left and right sides of the penis cavernous sinus were dilated and the length of the cavernous body was measured. Suitable artificial penis cavernous body was implanted, water sacs were placed in the posterior pubic space and the anterior vesical space, and the tubes were connected. The erectile switch was placed under the scrotum, and the incision was closed after repeated testing of urine control and normal erectile function.Results:Three cases were successfully completed. The simultaneous implantation time of artificial cavernous body and artificial urethral sphincter was 270, 260, 240 min, respectively. The catheter was removed 1 week after surgery, and the erection switch was trained 2 weeks after surgery, and full erection was achieved after 1 week. The urine control switch was activated 6 weeks after surgery, and urine control was normal without urine pad. Following up for 12 to 18 months, 2 cases had normal erections and urinary control, 1 case had urethral corrosion 2 months after surgery, the original artificial sphincter was removed completely and a new artificial urethral sphincter was implanted in the same period, the operation was successful, and the follow-up was 1 year, urine control and erectile function returned to normal.Conclusions:For the severe erectile dysfunction and severe urinary incontinence after traumatic posterior urethral stricture, simultaneous implantation of artificial penile cavernous body and artificial urethral sphincter could be alternative choice.

Objective:To explore the surgical methods and treatment effects of adult anterior dislocation of the sacroiliac joint (AADSJ).Methods:A multi-center retrospective case series study was conducted to analyze the clinical data of 25 cases admitted in 5 clinical centers (affiliations of authors in this article) from January 2016 to January 2021. There were 18 males and 7 females, aged 38.8±15.5 years (range, 18-83 years). The AADSJ clinical classification system was formulated based on the radiographic morphology of anterior dislocation of the sacroiliac joint, which includes two types. Type I: complete anterior dislocation of the sacroiliac joint, and displacement of the entire iliac auricular surface to the front of the sacrum. Type II: fracture of the sacroiliac joint combined with anterior dislocation, subdivided into 3 subtypes. Type IIa: iliac fracture involves the anterior 1/3 of the sacroiliac joint, and dislocation of the ilium anterior to the sacrum. Type IIb: iliac fracture involves the posterior 2/3 of the sacroiliac joint, and dislocation of the ilium anterior to the sacrum. Type IIc: iliac fracture involves the posterior 2/3 of the sacroiliac joint, and dislocation of the ilium anteromedial to the sacrum. The reliability and repeatability of the clinical classification, Tile classification and Young-Burgess classification were performed based on the results of two-phase assessments in four observers. The operations were performed by the lateral-rectus approach and the ilioinguinal approach. The operation time and intraoperative bleeding were recorded. Pelvic X-ray and CT scan were rechecked after the operation. The quality of fracture reduction was evaluated according to Matta score. The postoperative functional rehabilitation was evaluated according to the Majeed rehabilitation standard at one-year follow-up.Results:Among 25 cases in this study, there were 3 cases of Type I, 5 cases of Type IIa, 9 cases of Type IIb and 8 cases of Type IIc according to the clinical classification system. The Kappa values of reliability tests for the clinical classification, Tile classification and Young-Burgess classification were 0.681, 0.328 and 0.383, respectively. The Kappa values of repeatability tests for the clinical classification, Tile classification and Young-Burgess classification were 0.690, 0.221 and 0.395, respectively. The reliability and repeatability of the AADSJ clinical classification were significantly better than other classifications. There were 14 cases underwent lateral rectus abdominis approach and 11 cases underwent ilioinguinal approach. The operative time for managing anterior dislocation of the sacroiliac joint was 122.0±50.7 min (range, 65-148 min) through the lateral rectus abdominis approach, and through the ilioinguinal approach was 178.0±49.9 min (range, 110-270 min), with a significant difference ( t=2.76, P=0.011). The amount of intraoperative blood loss through the lateral rectus approach was 680±330 ml (range, 350-2,120 ml), which was significantly less than that through the ilioinguinal approach (1,660±968 ml, 680-3,300 ml), with a significant difference ( t=3.55, P=0.002). The follow-up period was 1-3 years. At one week after surgery, the quality of fracture reduction evaluated by Matta score showed that the excellent and good reduction rate of the lateral-rectus approach was 79% (11/14), and that of the ilioinguinal approach was 73% (11/14), with no statistically significant difference ( P=1.000). At a one-year follow-up, according to Majeed's criteria, the overall excellent and good rate of the lateral-rectus approach was 64% (9/14), which is similar to 64% (7/11) of that of the ilioinguinal approach. No fracture reduction loss or internal fixation loosening failure occurred. Conclusion:The AADSJ clinical classification system can accurately describe the imaging features and clinical manifestations of AADSJ, with high reliability and repeatability. The AADSJ can be treated by the lateral-rectus approach or the ilioinguinal approach, with similar therapeutic effects but the former having less trauma.

With a deepened understanding of the pathophysiology and pathogenesis of thoracic malignancies, the treatment has been transited from traditional treatment on the basis of surgery, radiotherapy, and chemotherapy to individualized and precise targeted therapy and immunotherapy. As an antitumor immunotherapy, chimeric antigen receptor gene-modified T (CAR-T) cells have been approved by the FDA for the treatment of hematological malignancies in five CAR-T products. They have also achieved good therapeutic effects in solid tumors. However, significant challenges remain in the clinical application of CAR-T cell immunotherapy in thoracic malignancies. In this review, the latest research progress of CAR-T cell immunotherapy in the treatment of thoracic malignancies were summarized, including the basic characteristics of CAR-T cells, the popular target antigens, and the existing problems and challenges, to provide new ideas and strategies for clinical immunotherapy of thoracic malignancies.

Objective:To explore the factors related to functional recovery of the knee in patients with tibial plateau fracture complicated with intercondylar ridge fracture.Methods:Included in this retrospective study were 63 patients who had been treated at Emergency Center of Trauma, The Third Hospital of Hebei Medical University from January to June 2019 for tibial plateau fracture complicated with intercondylar ridge fracture. They were 43 males and 20 females, aged from 18 to 66 years (average, 43.9 years). According to our comprehensive classification of tibial plateau fractures, there were 27 simple ones (20 cases of type Ⅰ and 7 cases of type Ⅱ) and 36 complicated ones (16 cases of type Ⅲ, 17 cases of type Ⅳ, one of type Ⅴ and 2 cases of type Ⅵ). To screen out major influencing factors, a multiple linear regression model was used to analyze the 12 factors that might affect functional recovery of the knee by the Hospital for Special Surgery (HSS) scoring: age, gender, occupation, fracture type, way of medical payment, cause of injury, operation method, starting time for rehabilitation, postoperative brace installation, time from injury to operation, length of hospital stay, and presence or absence of a free intercondylar ridge fracture fragment.Results:The 63 patients were followed up for 6.0 to 7.1 months (average, 6.1 months). The HSS knee scores ranged from 45 to 100 points (average, 92.4 points). The HSS knee scores were significantly different between different fracture types ( P<0.05). The HSS scores were significantly higher for the patients without a free intercondylar ridge fracture fragment than for those with ( P<0.05). Multiple linear regression model analysis of the 5 variables with P<0.02 in the single factor analysis (age, fracture type, way of medical payment, hospital stay and presence or absence of a free intercondylar ridge fracture fragment) and HSS scores showed that only fracture type and presence or absence of a free intercondylar ridge fracture fragment had a significant impact on the knee function. Their regression equation was Y=125.591-7.790a-17.277b (Y indicates HSS score, a indicates fracture type and b indicates presence or absence of a free intercondylar ridge fracture fragment). Conclusions:The short-term prognosis for tibial plateau fractures of comprehensive types Ⅰ&Ⅱ (simple ones) may be better than that for tibial plateau fractures of comprehensive types Ⅲ, Ⅳ, Ⅴ&Ⅵ (complicated ones). For patients with a free intercondylar ridge fracture fragment on their lateral knee X-ray film, effective reduction and fixation is indicated but is not for those without.

An increasing number of studies have demonstrated that exosomes are closely associated with liver fibrosis and mediate the process of liver fibrosis by participating in cytokine secretion, macrophage activation, extracellular matrix remodeling, and hepatic stellate cell activation. This article summarizes that the resolution of liver fibrosis requires the reduction of pro-inflammatory and fibrotic cytokines, the reduction of extracellular matrix protein production, the increase of collagenase activity, and finally the loss of activated myofibroblasts. It is believed that exosomes play an important role in the treatment of liver fibrosis and are potential markers for diagnosis and treatment, and in future studies, it is necessary to improve exosome extraction techniques and standardization of treatment quantification.

Objective:To explore the influence of bromodomain-containing protein 4 (BRD4) inhibitor on wild-type Kras differentiated thyroid carcinoma (DTC) and its mechanism.Methods:The DTC cell line Kras WT TPC-1 was selected and the mutant Kras G12D TPC-1 cells were constructed. CCK-8 assay was used to detect the effect of BRD4 inhibitor JQ-1 on the proliferation activity of Kras WT TPC-1 cells. Kras WT TPC-1 cells were treated with 0.2 μmol/L JQ-1 (JQ-1 group), and a negative control group (NC group) was set. Transwell invasion assay and flow cytometry were used to detect the effect of JQ-1 on the invasion and apoptosis of Kras WT TPC-1 cells. The effect of JQ-1 on the expressions of BRD4, miR-106b-5p and P21, and the effect of P21 inhibitor UC2288 on the expressions of P21 and BRD4 were detected. Kras WT TPC-1 cells were divided into JQ-1+ NC-OE group, JQ-1+ p21-OE group (overexpression of p21) and JQ-1+ p21-OE+ miR-106b-5p mimic group (overexpression of p21 and miR-106b-5 at the same time), and the proliferation, invasion and apoptosis of cells in each group were detected. TPC-1 cells were divided into Kras WT group, Kras WT+ JQ-1 group, Kras G12D group and Kras G12D+ JQ-1 group, and the cell proliferation, invasion and apoptosis of each group were detected. Results:JQ-1 inhibited the proliferation activity of Kras WT TPC-1 cells in a dose-dependent and time-dependent manner. In the NC group and JQ-1 group, the numbers of cell invasion were 124.67±9.61 and 82.67±8.02, and the apoptosis rates were (5.91±0.34)% and (10.33±1.10)%, respectively, with statistically significant differences ( t=5.812, P=0.004; t=6.653, P=0.003). JQ-1 significantly inhibited the expressions of BRD4 and miR-106b-5p, and promoted the expression of P21 in Kras WT TPC-1 cells. UC2288 significantly inhibited P21 expression, but had no significant effect on BRD4 expression. In the JQ-1+ NC-OE group, JQ-1+ p21-OE group and JQ-1+ p21-OE+ miR-106b-5p mimic group, the proliferation activities at 24 h of Kras WT TPC-1 cells was 0.46±0.03, 0.35±0.04 and 0.44±0.03 ( F=8.720, P=0.017), and the proliferation activity of JQ-1+ p21-OE group was significantly lower than that of the JQ-1+ NC-OE group ( P<0.05). The numbers of cell invasion in the three groups were 83.00±9.17, 56.67±6.03 and 79.67±10.07 ( F=8.347, P=0.018), and the number of cell invasion in the JQ-1+ p21-OE group was significantly lower than that in the JQ-1+ NC-OE group ( P=0.009). The apoptosis rates of the three groups were (10.00±0.49)%, (15.39±1.14)% and (10.32±0.80)% ( F=37.764, P<0.001), and the apoptosis rate of the JQ-1+ p21-OE group was significantly higher than that in the JQ-1+ NC-OE group ( P<0.001). There were no significant differences in cell proliferation activity, invasion number and apoptosis rate between JQ-1+ p21-OE+ miR-106b-5p mimic group and JQ-1+ NC-OE group (all P>0.05). In Kras WT group, Kras WT+ JQ-1 group, Kras G12D group and Kras G12D+ JQ-1 group, the cell proliferation activities at 24 h were 0.50±0.05, 0.39±0.04, 0.68±0.08 and 0.64±0.05 ( F=17.776, P<0.001). Compared with the Kras WT group, cell proliferation activity in the Kras WT+ JQ-1 group was significantly decreased, while that in the Kras G12D group was significantly increased (both P<0.05). The numbers of cell invasion in the four groups were 129.33±11.50, 86.00±9.54, 161.67±13.01 and 146.33±13.20 ( F=22.598, P<0.001). Compared with the Kras WT group, the number of cell invasion in the Kras WT+ JQ-1 group was significantly decreased ( P=0.002), and that in the Kras G12D group was significantly increased ( P=0.010). The apoptosis rates in the four groups were (6.17±0.50)%, (10.42±0.73)%, (3.43±0.47)% and (3.41±0.32)% ( F=119.170, P<0.001). Compared with the Kras WT group, the apoptosis rate in the Kras WT+ JQ-1 group was significantly increased ( P<0.001), and that in the Kras G12D group was significantly decreased ( P<0.001). There were no significant differences in cell proliferation activity, invasion number and apoptosis rate between Kras G12D+ JQ-1 group and Kras G12D group (all P>0.05). Conclusion:BRD4 inhibitor can specifically inhibit the development of wild-type Kras DTC via regulating the molecular axis of BRD4/miR-106b-5p/P21, but has no significant effect on the proliferation, invasion and apoptosis of mutant Kras DTC tumor cells.