OBJECTIVE To build a Tibetan-language medication service platform based on “internet+” and evaluate its effect on improving medication compliance and safety of Tibetan patients with chronic disease. METHODS Medication guidance contents of commonly used drugs in the outpatient department were summarized， translated and recorded in Tibetan-language or video to form a “text-audio-video” multi-dimensional “internet+ ” Tibetan-language medication service platform. A total of 387 Tibetan outpatients with chronic disease in our hospital after the implementation of “internet+” Tibetan-language medication service platform （from January 2024 to June 2024） in our hospital were selected as the intervention group， and 387 Tibetan outpatients before the implementation （from January 2023 to June 2023） were selected as the control group. Patients in the control group received conventional window-based Chinese-language medication services， while patients in the intervention group received both conventional window-based Chinese-language medication service and “internet+ ” Tibetan-language medication service. The medication compliance of patients was evaluated using the 12-item Medication Compliance Scale. A six-level causality assessment was conducted as the principles for analyzing adverse drug reactions （ADR） set by the National Center for ADR Monitoring. Additionally， statistics were compiled on the occurrence of ADR that were assessed as “definite”“probable” or “possible” in the causality assessment. RESULTS The proportion （31.0%） of patients with good medication compliance and compliance scores [39.0 （37.0，42.0）] of patients in the intervention group were significantly better than control group [7.0%， 21.0（19.0， 23.0）]（ P＜0.05）. There were no statistically significant differences in the incidence of various types of ADR or the overall incidence between the two groups （P＞0.05）. CONCLUSIONS The “internet+” Tibetan-language medication service platform is constructed successfully； the service can effectively improve the medication compliance of Tibetan-language patients， but its effect on improving the medication safety of patients is limited.

Objective:To investigate the therapeutic effect of sequential therapy with butylphthalein on acute cerebral infarction and mild-to-moderate increases in middle cerebral artery blood flow in patients.Methods:The clinical data of 92 patients with acute cerebral infarction and mild-to-moderate increases in middle cerebral artery blood flow who received treatment at the Xiaogan Hospital Affiliated to Wuhan University of Science and Technology from January 2018 to October 2021 were retrospectively analyzed. These patients were divided into a study group and a control group using a random number table method. The control group was given an intravenous infusion of butylphthalein sodium chloride injection, while the study group took oral butylphthalein soft capsules after intravenous infusion of butylphthalein sodium chloride injection. The baseline data, hemodynamics, neurological function, and clinical outcomes were compared between the two groups. At 90 days after treatment, the National Institutes of Health Stroke Scale (NIHSS), the Activity of Daily Living Scale (ADL), and the modified Rankin Scale (mRS) were used to evaluate clinical outcomes. Transcranial Doppler ultrasound (TCD) examination was performed to evaluate hemodynamic changes.Results:A total of 92 patients completed all the observation indices as required, including 48 patients in the study group and 44 patients in the control group. There were no significant differences in demographics, vascular risk factors, laboratory results, NIHSS score, ADL score, or arterial hemodynamics of the diseased brain between the two groups (all P > 0.05). At 90 days after treatment, the NIHSS score in the study group was significantly lower than that in the control group [(4.00 ± 1.95) points vs. (4.91 ± 2.08) points; t =-2.16, P = 0.033]. The ADL score in the study group was significantly higher than that in the control group [(82.71 ± 9.56) points vs. (76.25 ± 11.47) points; t = 2.94, P = 0.004]. The good rate of outcomes in the study group was significantly higher than that in the control group [70.83% (34/48) vs. 50.00% (22/44); χ2 = 4.18, P = 0.041]. There were significant differences in the peak systolic velocity [(152.33 ± 9.58) cm/s vs. (157.41 ± 11.77) cm/s; t = 2.27, P = 0.025] and the mean velocity [(90.00 ± 8.30) cm/s vs. (94.45 ± 9.07) cm/s; t = -2.46, P = 0.016] of the middle cerebral artery between the study and control groups. The difference in pulsitility index between the two groups was not statistically significant [(0.97 ± 1.06) vs. (1.01 ± 1.21); t = 1.69, P = 0.093]. Compared with the poor outcome group, patients in the good outcome group had lower NIHSS and ADL scores after discharge (both P < 0.001), and the proportion of patients who received sequential therapy with butylphthalein in the good outcome group was higher [(60.70% (34/56) vs. 38.90% (14/36); χ2 = 4.18, P = 0.041]. Conclusion:Sequential therapy with butylphthalein can reduce neurological deficits, promote neurological function recovery, improve the hemodynamics of diseased blood vessels, and greatly improve daily living activities in patients with acute cerebral infarction complicated by mild to moderate increases in middle cerebral artery blood flow.

Objective:To analyze the impact of the implementation of the policy of centralized volume-based procurement of dental implant consumables on the prevention and control of corruption risk in public hospitals, and provide reference for improving the construction of corruption risk prevention and control in public hospitals.Methods:Develop a survey questionnaire for three entities: the Discipline Inspection Commission of public hospitals, dental implant doctors in public hospitals, and dental implant consumables distribution enterprises. The questionnaire content for the Discipline Inspection Commission of public hospitals mainly included the impact of the implementation of the policy of centralized volume-based procurement of dental implant consumables on the prevention and control of hospital integrity risks, as well as the development of supporting policies in hospitals; The questionnaire content for dental implant doctors mainly included their understanding of the centralized volume-based procurement policy, their communication with distribution companies, and their awareness of integrity; The questionnaire content for dental implant consumables distribution enterprises mainly included the situation of the distribution enterprises entering the centralized volume-based procurement catalog for implants, and the subsequent adjustment of business strategies.Using convenience sampling method, a questionnaire survey was conducted from February to June 2023 on the Discipline Inspection Commission of public hospitals in Zhejiang Province, dental implant doctors in public hospitals nationwide, and distribution enterprises of dental implant consumables in Zhejiang Province. Descriptive analysis was conducted on the questionnaire data.Results:Effectively collected 16 questionnaires filled out by the Discipline Inspection Commission leaders of public hospitals in Zhejiang Province. Among them, the Discipline Inspection Commission leaders of 11 public hospitals believed that the implementation of the policy of centralized volume-based procurement of dental implant consumables could reduce the existing corruption risks of public hospitals, 1 believed that it would create new corruption risks, and 4 believed that both aspects of the impact existed; 12 leaders believed that the policy′s strengthening of corruption risk prevention and control was mainly reflected in squeezing implant prices, reducing selection and procurement risks, and reducing red envelopes and kickbacks. 270 questionnaires from dental implant doctors in public hospitals were effectively collected. Regarding the implementation of the centralized volume-based procurement policy, 187 people believed that it would inhibit the development of the dental implant industry, 148 people expected their personal salaries to decrease, 78 people would participate more in lectures and training organized by enterprises, and 39 people would recommend implant systems outside the centralized volume-based procurement catalog to patients; 140 people were unable to accurately grasp all the contents of the " Nine Guidelines on Integrity for Staff of Medical Institution" ; Only 202 people believed that compliance contact with distribution companies could only be based on listening to their introduction to the implant system. 23 questionnaires were effectively collected from dental implant consumables distribution companies. Among them, 22 companies would reduce their expenses in maintaining relationships with clinical doctors after the implementation of the centralized procurement policy, and 14 companies would reduce their sales position expenses. All distribution companies believed that the phenomenon of medical institution staff receiving red envelopes and kickbacks would decrease or disappear after the implementation of the centralized volume-based procurement policy.Conclusions:The implementation of the policy of centralized volume-based procurement of dental implant consumables is beneficial for reducing the existing corruption risks in public hospitals, but if regulatory oversight is inadequate, new corruption risks will arise in the early stages of policy implementation. Public hospitals should improve the supporting system for centralized volume-based procurement of dental implant consumables, standardize the procurement process of dental implant consumables outside the centralized volume-based procurement catalog, strengthen supervision and inspection of centralized procurement, and further strengthen corruption risk prevention and control by implementing anti-corruption education.

As one of the important contents and links of doctor-patient communication, the quality of breaking bad news will affect the development of doctor-patient relationship. Bad news informed not only involves the feedback of clinical medical diagnosis results, but also involves special knowledge training and clinical experience accumulation, as well as ethical, legal, social custom and other factors. At present, it is still a difficult problem troubling physicians in the medical environment. From the different perspectives of doctors, patients and family members, this paper sorted out the domestic and international status of breaking bad news, revealed its internal dilemmas, and summarized the informing strategies to cope with these dilemmas, with a view to providing references for hospital managers and medical staff to earlier identify and properly inform, helping both doctors and patients to get rid of the dilemma of notification and improve the doctor-patient relationship.

This paper introduced a case of ethical conflict between the principle of benefit and the principle of respect in the formulating treatment and nursing plan for patient with chronic wound nonunion by specialist nurses, and used the "structured analysis form of clinical nursing ethics" designed by the Third Affiliated Hospital of Guangzhou Medical University to conduct ethical analysis and ethical decision-making, and solve the clinical nursing ethical problems of complex nursing cases. The practice of the case showed that under the situation of ethical conflict in making nursing treatment plan for patient, the application of structured ethical analysis of clinical nursing is helpful to improve nurses’ ethical decision-making ability and strengthen their ethical thinking. It is suggested to strengthen nurses’ ethical thinking in clinical nursing, continuously improve nurses’ ethical decision-making ability, and cultivate core nursing technology integrating science and humanities, thus to enhance nursing value.

Background As an environmental pollutant, 1-bromopropane (1-BP) is ubiquitous in the living environment. However, its health effects on the general population are still unclear. Objective To assess the associations between urinary 1-BP metabolite and blood routine indices in a Chinese community population. Methods A total of 3512 community residents aged 18-80 years from the baseline of the Wuhan-Zhuhai cohort were included in our study. The demographic characteristics, disease history, and lifestyles of the participants were collected through questionnaires. Height, weight, blood pressure, and other anthropometrics were collected through physical examination. Blood routine indicators were tested using an automated hematology analyzer. Urinary 1-BP metabolite N-Acetyl-S-(n-propyl)-L-cysteine (BPMA) was measured by ultra-high-performance liquid chromatography coupled with electrospray ionization tandem mass spectrometry. Generalized linear models and logistic regression models were used to assess the associations of urinary BPMA with blood routine indices and the risks of abnormal blood routine indices, respectively. Besides, stratified analysis and effect modification analysis were further conducted to investigate the effects of individual characteristics and lifestyles on the associations of urinary BPMA with blood routine indices. All models were adjusted for gender, age, and other potential confounders. Results The mean age of the study population (30.1% male) was (52.78±12.77) years. The median (P₂₅, P₇₅) level of urinary BPMA adjusted for urinary creatinine was 0.90 (0.50, 1.73) mg·mol⁻¹. In the analysis with target indicator as continuous variable, each 1-unit increase in natural logarithm-transformed urinary BMPA level was associated with a 0.078×10⁹ L⁻¹, 0.031×10⁹ L⁻¹, 0.307%, 3.518 g·L⁻¹, and 2.469×10⁹ L⁻¹ decrease in white blood cell, lymphocyte, lymphocyte percentage, mean corpuscular hemoglobin concentration, and platelet levels, respectively (all Ps<0.05); and with a 0.440%, 1.140 fL, 0.014 fL, and 0.020 increase in hematocrit, mean corpuscular volume, and natural logarithm-transformed levels of mean platelet volume and mean platelet volume/platelet, respectively (all Ps<0.05). The categorical analysis across quartiles of BPMA level showed that BPMA was inversely associated with lymphocyte percentage, mean corpuscular hemoglobin concentration, and platelet levels in a dose-dependent manner (all P_trend<0.05), and positively related to hematocrit, mean corpuscular volume, mean platelet volume, and mean platelet volume/platelet levels in a dose-dependent manner (all P_trend<0.05). Body mass index, smoking, and drinking modified the associations of urinary BPMA level with red blood cell, mean corpuscular hemoglobin concentration lymphocyte percentage, and hemoglobin (all Ps<0.05). In addition, urinary BPMA was associated with an increased risk of abnormal increase in mean corpuscular volume (OR=1.316, 95%CI: 1.171-1.478) and red blood cell volume distribution width (OR=1.255, 95%CI: 1.030-1.528), and abnormal decrease in mean corpuscular hemoglobin concentration (OR=1.200, 95%CI: 1.035-1.392). Conclusion Exposure to 1-BP of the general population is associated with decreased white blood cells and platelets, as well as abnormal change of blood cell morphology or function.

Objective:To investigate the correlation between right-to-left shunt (RLS) and infarct pattern in patients with cryptogenic stroke.Methods:Young and middle-aged patients with acute cryptogenic stroke admitted to the Department of Neurology, Xiaogan Central Hospital from May 2016 to January 2020 were enrolled retrospectively. The demographic data, vascular risk factors, baseline blood pressure, laboratory findings, stroke severity, infarct location and distribution pattern were documented. The patients were divided into RLS group and non-RLS group according to the findings of the transcranial Doppler ultrasound foaming test. They were divided into single lesion group and multiple-lesion group according to the findings of diffusion-weighted imaging. Multivariate logistic regression analysis was used to identify the correlation between RLS and infarct pattern. Results:A total of 68 patients with acute cryptogenic stroke were included, 37 of them were male (54.4%), and their age was 47.63±6.57 years (range, 31-59 years). Thirty patients (44.1%) had RLS, including 22 (73.3%) with mild shunt and 8 (26.7%) with severe shunt. The proportions of men, cortical-subcortical infarction and multiple blood supply area lesions in the RLS group were significantly higher than those in the non-RLS group, while triacylglycerol, body mass index, the proportions of patients with subcortical infarction and single lesions in the single vessel blood supply area were significantly lower than those in the non-RLS group ( P<0.05). The proportions of patients with anterior circulation+ posterior circulation infarction, cortical-subcortical infarction, and RLS in the multi-lesion group were significantly higher than those in the single-lesion group, while the proportion of patients with subcortical infarction was significantly lower than that in the single-lesion group (all P<0.05). Multivariate logistic regression analysis showed that RLS was an independent risk factor for multiple infarctions (odds ratio 6.681, 95% confidence interval 1.206-37.019; P=0.030). Conclusion:RLS is independently associated with multiple infarctions in patients with cryptogenic stroke.

Objective: To evaluate the association between NLRP2(NLR Family Pyrin Domain Containing 2) gene polymorphisms and classical type 1 diabetes mellitus(T1DM) in Chinese Han population. Methods: A case-control study was conducted in 510 classical T1DM patients from the Department of Metabolism and Endocrinology in the Second Xiangya Hospital affiliated to Central South University and 531 healthy controls in this region. The polymorphisms of rs1043673 in NLRP2 gene were analyzed by MassARRAY. Mann-Whitney U test and χ² test were used to compare the differences between patients and controls. Logistic regression analysis and χ² test were performed to compare the distributions of the alleles and genotypes between T1DM patients and controls. Kruskal-Wallis H test was used to compare the clinical characteristics of different genotypes in T1D patients. Results: The differences of the allele and genotype distributions in rs1043673 of NLRP2 gene were not significant between patients and controls. The polymorphisms of rs1043673 were associated with fasting C-peptide(P=0.029), postprandial 2-h C-peptide(P=0.017), and titer of GADA(P=0.043) in T1DM patients. Conclusion The polymorphisms of NLRP2 gene were associated with the characteristics of T1DM patients.

Objective To investigate the abnormal change of gray matter volume in patients with euthymic bipolar disorder Ⅰ (BD-Ⅰ),and to elucidate the relationship between the use of different mood stabilizers and brain structure variations.Methods Voxel-based morphometry (VBM) was used to analyze the volume of local gray matter in 35 patients with BD-Ⅰ and 30 healthy controls(HC).The patients were divided into BD-Ⅰ with lithium group and BD-Ⅰ with valproate group according to different mood stabilizers.The volume differences of gray matter of the three groups were compared by one-way ANOVA.Results Compared with HC,BD-Ⅰ patients showed significantly reduced gray matter volume in the medial frontal cortex (MNI (x,y,z):2,34,-18),orbital frontal cortex (MNI(x,y,z):-32,22,-4),frontal operculum (MNI(x,y,z):38,18,4) and insula cortex (MNI(x,y,z):-32,22,-4) (P＜0.05).There was no significant difference in thevolume of gray matter between BD-Ⅰ with lithium group and BD-Ⅰ with valproate group(P＞0.05).Conclusion Emotional disturbance in patients with BD-Ⅰ may be associated with reduced gray matter volume in the medial frontal cortex,orbital frontal cortex,frontal operculum and insula cortex.There are not significant difference about the effects of lithium carbonate and valproate on cerebral gray matter volume in patients with BD-Ⅰ.

Objective To determinate the heavy metal cadmium content in rice to ensure food safety.Methods Several brands and batch numbers of rice were collected and divided into groups A and B.Group A contained 24 pieces of rice from the canteens,and group B involved in 22 pieces from the farm product markets.Cadmium content in rice was detected quantitatively with X-ray fluorescence spectrometer,and then evaluated according to GB 2762-2012 which determined rice was not qualified in case cadmium content was more than 0.2 mg/kg.Results Group A had cadmium content between 0.00 and 0.477 mg/kg,the times of ultra standard being 2.385 and the disqualification rate being 29.2％ (7/24),and group B had cadmium content between 0.065 and 0.619 mg/kg,the times of ultra standard being 3.095 and the disqualification rate being 68.2％ (15/22).Excessive cadmium content in rice occurred in both canteens and markets,while the canteens was better than the markets.Conclusion X-ray fluorescence spectrometer detects cadmium content in rice rapidly and simply,and is worthy promoting in elementary facilities.