OBJECTIVE To explore the correlation between drug consumption index and diagnosis related groups （DRG） overspending cases， and provide a basis for hospitals to optimize the cost structure and strengthen the refined management. METHODS Based on the data of DRG patients enrolled in a third-grade class A hospital from September to November 2023， the multivariate Logistic regression model and restricted cubic spline （RCS） model were used to analyze the correlation of drug consumption index with DRG overspending cases and its threshold effect， respectively. At the same time， rational drug use evaluation was conducted based on the drug consumption index， precise cost control and management were carried out， and the changes in the main pharmaceutical indicators of the whole hospital were analyzed before control （January-June 2023） and after control （January-June 2024）. RESULTS The results of multivariate Logistic regression analysis showed that long hospitalization days， high drug consumption index， transfer to other departments and combined diabetes mellitus were the risk factors for DRG overspending （P＜0.05）. The results of the RCS model showed that the drug consumption index had a non-linear relationship with DRG overspending. When the drug consumption index was ≥0.64， the drug consumption index was positively correlated with the risk of DRG overspending（P＜0.05）. Compared with the same period before the control， medical cost per time， drug cost per time and drug consumption index decreased significantly after the control （P＜0.01）. CONCLUSIONS The drug consumption index is a risk factor for DRG overruns， there is a non-linear relationship and threshold effect between it and DRG overruns. Each hospital can set a reasonable threshold and implement dynamic monitoring and intervention by comprehensively considering the actual drug usage， disease spectrum characteristics， and cost control targets， as well as factors such as medical quality， patient needs， and the payment capacity of medical insurance， which can effectively achieve precise control over drug usage.

Cryoablation therapy with explicit anti-tumor mechanisms and histopathological manifestations has a long history.A large number of clinical practice has shown that cryoablation therapy is safe and effective,making it an ideal tumor treatment method in theory.Previously,its efficacy and clinical application were constrained by the limitations of refrigerants and refrigeration equipment.With the development of the new generation of cryoablation equipment represented by argon helium knives,significant progress has been made in refrigeration efficien-cy,ablation range,and precise temperature measurement,greatly promoting the progression of tumor cryoablation technology.This consensus systematically summarizes the mechanism of cryoablation technology,indications for oral mucosal melanoma(OMM)cryotherapy,clinical treatment process,adverse reactions and management,cryotherapy combination therapy,etc.,aiming to provide reference for carrying out the standardized cryoablation therapy of OMM.

In order to understand the potential target and related mechanism of action of Termina-lia Chebula treatment,network pharmacology and molecular docking methods were used in this experiment,and the challenge test of Salmonella from yak was performed.The active ingredients and potential targets of Terminalia Chebula were screened through HERB cluster identification database,TCMSP database and SwissTargetPrediction web page tool,and"gastroenteritis"was searched through OMIM and GeneCards database.Cytoscape and STRING databases were used to construct the Terminalia Chebula PPI network to screen out key targets,the intersection targets between Terminalia Chebula and enteritis were obtained through Venny platform,and gene ontol-ogy(GO)and Kyoto encyclopedia database of genes and genomics(KEGG)were enriched through DAVID database.The core target of screening was verified by molecular docking.After that,the gastrointestinal inflammation model of mice was established,the pathological changes of gastroin-testinal tract were observed,and the effect of Terminalia Chebula on the target protein was veri-fied by Western blot test.The results showed that:after analyzing and sorting out 8 main active in-gredients of Terminalia Chebula,118 targets of Terminalia Chebula were screened,11 161 targets of gastroenteritis and 100 targets of intersection were obtained;the core targets of PTGS2,CASP3,SLC3A2,Bax,Bcl-2 and TP53 of Terminalia Chebula and enteritis were obtained through PPI network.GO and KEGG enrichment analysis collected 337 items and 138 items,respectively,mainly related to chemokine pathway,PI3K-Akt signaling pathway,apoptosis related pathway,i-ron ion transport related pathway,NF-κB signaling pathway,etc.The results of molecular docking showed that chebulidic acid,the first active component of chebulidic acid,can bind to Bax,Bcl-2,PTGS2 and SLC3A2 through hydrogen bonding,hydrophobic action,π-π packing force and other intermolecular forces.The pathological tissue sections showed that Terminalia Chebula could sig-nificantly recover gastrointestinal tissue injury.Western blot test results showed that Terminalia Chebula can regulate the process of apoptosis and iron death through Bax/Bcl-2 and PTGS2/SLC3A2 pathways to achieve the effect of treating intestinal inflammatory damage.The results showed that Terminalia Chebula can regulate the occurrence and development of enteritis by regu-lating apoptosis and iron death through Bax/Bcl-2 and PTGS2/SLC3A2 pathways.Terminalia Chebula has the characteristics of multi-target and multi-pathway in the treatment of enteritis.

Objective:To investigate the influences and mechanism of extracellular vesicles from dermal papilla cells (DPC-EVs) of mice on human hypertrophic scar fibroblasts (HSFs).Methods:The study was an experimental research. The primary dermal papilla cells (DPCs) of whiskers were extracted from 10 6-week-old male C57BL/6J mice and identified successfully. The DPC-EVs were extracted from the 3 rd to 5 th passage DPCs by ultracentrifugation, and the morphology was observed through transmission electron microscope and the particle diameter was detected by nanoparticle tracking analyzer ( n=3) at 24 h after culture. The 3 rd passage of HSFs were divided into DPC-EV group and phosphate buffer solution (PBS) group, which were cultured with DPC-EVs and PBS, respectively. The cell scratch test was performed and cell migration rate at 24 h after scratching was calculated ( n=5). The cell proliferation levels at 0 (after 12 h of starvation treatment and before adding DPC-EVs or PBS), 24, 48, 72, and 96 h after culture were detected by using cell counting kit 8 ( n=4). The protein expressions of α-smooth muscle actin (α-SMA) and collagen typeⅠ (ColⅠ) in cells at 24 h after culture were detected by immunofluorescence method and Western blotting, and the protein expression of Krüppel-like factor 4 (KLF4) in cells at 24 h after culture was detected by Western blotting. After the 3 rd passage of HSFs were cultured with DPC-EVs for 24 h, the cells were divided into blank control group, KLF4 knockdown group, and KLF4 overexpression group according to the random number table. The cells in blank control group were only routinely cultured for 48 h. The cells in KLF4 knockdown group and KLF4 overexpression group were incubated with KLF4 knockdown virus for 24 h, then the cells in KLF4 knockdown group were routinely cultured for 24 h while the cells in KLF4 overexpression group were incubated with KLF4 overexpression virus for 24 h. The protein expressions of KLF4, α-SMA, and ColⅠ in cells were detected by Western blotting at 48 h after culture. Results:At 24 h after culture, the extracted DPC-EVs showed vesicular structure with an average particle diameter of 108.8 nm. At 24 h after scratching, the migration rate of HSFs in PBS group was (54±10)%, which was significantly higher than (29±8)% in DPC-EV group ( t=4.37, P<0.05). At 48, 72, and 96 h after culture, the proliferation levels of HSFs in DPC-EV group were significantly lower than those in PBS group (with t values of 4.06, 5.76, and 6.41, respectively, P<0.05). At 24 h after culture, the protein expressions of α-SMA and ColⅠ of HSFs in DPC-EV group were significantly lower than those in PBS group, while the protein expression of KLF4 was significantly higher than that in PBS group. At 48 h after culture, compared with those in blank control group, the protein expression of KLF4 of HSFs in KLF4 knockdown group was down-regulated, while the protein expressions of α-SMA and ColⅠ were both up-regulated; compared with those in KLF4 knockdown group, the protein expression of KLF4 of HSFs in KLF4 overexpression group was up-regulated, while the protein expressions of ColⅠ and α-SMA were down-regulated. Conclusions:The DPC-EVs of mice can inhibit the proliferation and migration of human HSFs and significantly inhibit the expressions of fibrosis markers α-SMA and ColⅠ in human HSFs by activating KLF4.

OBJECTIVE To investigate the role of clinical pharmacists in the treatment of a patient with Epstein-Barr （EB） virus encephalitis. METHODS Clinical pharmacist participated in drug diagnosis and therapy for a patient with EB virus encephalitis. According to the physiological characteristics of the disease and the pharmacokinetic-pharmacodynamic characteristics of antibiotics， clinical pharmacists suggested that the dose should be adjusted as ceftriaxone 2 g， q12 h+meropenem 2 g， q8 h. Based on the uncontrolled infection of the patient， pharmacists suggested that ceftriaxone should be stopped and vancomycin 1 million U and q12 h should be used as alternative therapy. According to the results of etiology， pharmacists suggested that acyclovir should be discontinued and replaced with ganciclovir 5 mg/kg， q12 h. The electrolyte disturbance of the patient may be adverse drug reactions caused by Mannitol injection， it was recommended to stop the drug. RESULTS The clinician followed the advice of the clinical pharmacists. After treatment， the patient improved and was discharged. CONCLUSIONS Clinical pharmacists can carry out pharmaceutical care for patients with EB virus encephalitis， assist physicians in optimizing the treatment plan of patients， and ensure the effectiveness and safety of drug treatment.

OBJECT IVE To evaluate the application effect of the whole cour se medication management mode led by pharmacists in rheumatic immune diseases. METHODS A total of 122 patients treated with tacrolimus or cyclosporine in the department of rheumatology and immunology of Wuhan No. 1 Hospital from 2018 to 2020 were selected as the study subjects. Among them ，44 cases in the control group were under the traditional supervision mode ；78 patients in the observation group adopted the whole course medication management mode led by pharmacists ，that was ，individual pharmacists and specialist clinical pharmacists cooperated and led ，and not only participated in the whole process of drug treatment but also involved in the whole process of therapeutic drug monitoring （TDM）. On the basis of the control group ，the division of labor and cooperation among medical，pharmaceutical and nursing parties were strengthened ，and the homogeneous supervision was carried out for the outpatients and inpatients from admission to discharge . The daily dose of medication ，the rate of reaching the standard of blood drug concentration ，the incidence of problematic samples （the sample was calculated by the number of times ），the average hospitalization days ，the re-admission rate within 6 months after discharge ，the medication compliance score and the patient ’s satisfaction rate were compared between the two groups. RESULTS In the control group ，53 times of TDM were performed ， including 18 times of tacrolimus monitoring and 35 times of cyclosporine monitoring ；in the observation group ，123 timesof TDM were performed ，including 55 times of tacrolimus monitoring and 68 times of cyclosporine monitoring. The daily dose of tacrolimus ，the daily dose of cyclosporine ，the rate of reaching the standard of cyclosporine blood drugconcentration，the inc idence of problematic samples ，the rate of re-admission within 6 months after discharge ， the medication compliance score and the patient ’s satisfaction rate in the observation group were significantly better than those in the control group （P＜0.05）. CONCLUSIONS It can effectively improve the effect of the quality of pharmaceutical care to implement whole course and homogeneous medication management led by pharmacists and provide precise drug guidance for patients with rheumatic and immune diseases.

ObjectiveTo construct a research framework on the health and functional outcomes of children with intellectual disability participating in physical activities using World Health Organization Family of International Classifications (WHO-FICs), and systematically analyze the main health and functional impairment manifestations, interventions of physical activity, and health and functional outcomes of children and adolescents with intellectual disability. MethodsInternational Classification of Diseases, Eleventh Revision (ICD-11), and International Classification of Functioning, Disability and Health (ICF) were used to systematically analyze physical activity intervention programs for children and adolescents with intellectual disability, and health and functional outcomes, to develop a structure of health and functional status, physical activity intervention programs, and health and functional outcomes. Systematic reviews about physical activity, and health and functional outcomes of children and adolescents with intellectual disability were retrieved from Scopus, PubMed, Embase, Web of Science, CNKI, VIP and Wanfang Data, from establishment to August 18th, 2022, and a systematic review of systematic reviews was conducted. ResultsEight systematic reviews were finally included, from five countries, included a total of 190 randomized controlled trials and 7 011 participants, in the fields of intellectual disability, child neurology, rehabilitation sciences, disability and health, adaptive physical education, and special education, which mainly published from 2018 to 2022. The main common health conditions were Down syndrome, autism spectrum disorder, fragile X syndrome, Prader-Willi syndrome, intellectual disability and cognitive impairment. Physical activity interventions mainly involved physical fitness, skills, and activities, with the frequency of one to five times a week, moderate to high intensity, and duration of one week to 1.5 years. The health outcomes mainly involved in three aspects: intellectual function and adaptive behavior, physical activity, and psycho-behavioral health and social adaptation, overall quality of life and well-being. ConclusionA conceptual framework for the health outcomes of physical activity and exercise rehabilitation for children and adolescents with intellectual disability has been constructed based on WHO-FICs. The main functioning of children and adolescents with intellectual disability are manifested at three levels: intellectual functioning and adaptive behavior, activity and participation, and mental health, quality of life and well-being, where limitations of intellectual functioning and adaptive behavior involve conceptual, social and practical skills; and low physical activity participation, sedentary and obesity, low mobility, and failure to develop basic motor skills and physical fitness at the level of activity and participation; for the quality of life and well-being, limitations involve mood and emotion, self-esteem, general self-concept, well-being, friendships, relationships with others or social maturity, and quality of life and well-being. Intervention programs of physical activity can be divided into physical fitness, skills and sports. The primary health and functional outcomes are synthesized in three main domains, namely intellectual functioning and adaptive behavior, activity and participation, and mental health, quality of life and well-being. In the intellectual functioning and adaptive behavior domain, the primary health outcomes involved cognitive functioning (executive functioning, cognitive plasticity, working memory, etc.) and psychological functioning (emotional self-control, self-worth, and self-esteem). In the activity and participation domain, physical activity contributes to the development of physical fitness (muscle strength and endurance, speed, agility) and motor skills (basic motor skills, balance, core stability), to increase the participation in physical activity, promote better adaptation and empowerment (socialization, prosocial behavior), and to achieve the health goals (reduction of disease risk, anxiety and depression, and management of obesity). In the domain of psycho-behavioral health and social adaptation, quality of life, and well-being, physical activity and exercise rehabilitation can improve overall quality of life and well-being.

Anterior mediastinal inflammatory myofibroblastoma is a rare tumor with insidious onset and easy misdiagnosis. In this report, we presented a case of anterior mediastinal inflammatory myofibroblastoma with thymoma. The mediastinal tumor was found by physical examination, and the prognosis was good after surgical treatment. For this disease, operation is an effective method for definite diagnosis and treatment, and complete excision can achieve good outcomes.

Objective:To determine the predictive value of atherogenic index of plasma (AIP) on the long-term prognosis of patients with coronary artery disease (CAD).Methods:A total of 2 500 patients with coronary heart disease who underwent coronary angiography in Affiliated Hospital of Jining Medical University from May 2013 to November 2015 were retrospectively analyzed. According to the AIP value, the subjects were divided into low AIP group (AIP<0.06) and high AIP group (AIP≥0.06). The incidence of major adverse cardiovascular events (MACE) was compared between the two groups. Kaplan-meier method was used to evaluate the MACE-free survival rate, and multivariate Cox survival analysis was used to evaluate the independent predictors of MACE.Results:A total of 2 427 patients were followed up, with a follow-up rate of 97.08% and a median follow-up time of 4.29 years. There were 1 123 cases in the low AIP group and 1 304 cases in the high AIP group, among which 624 patients (25.7%) had MACE. The total incidence of MACE in the high AIP group was higher than that in the low AIP group ( HR=1.43, 95% CI: 1.22-1.68, P<0.01). Kaplan-meier curves showed that the MACE-free survival rate was significantly lower in the high AIP group ( P<0.01). After adjusting for multiple confounding factors, AIP was still associated with the prognosis of CHD patients. Increased AIP (≥0.06) was an independent predictor of MACE in CHD patients within 4 years ( HR=1.34, 95% CI: 1.14-1.58, P<0.01). Conclusions:AIP (≥0.06) was an independent predictor of MACE occurrence in patients with CAD within 4 years. AIP has a certain value in the long-term prognosis of patients with CAD.

OBJE CTIVE To explore the rational application and management of antibiotics in burn department of our hospital based on disease diagnosis related groups （DRGs）. METHODS Patients discharged from the burn department of our hospital from July 2020 to June 2021 were selected as the research objects to collect DRG data. The overall application of antibiotics in DRG group with more than 10 cases were analyzed ，and the application of antibiotics in typical disease groups were evaluated horizontally and vertically. RESULTS Among 3 732 discharged cases in the burn department of our hospital ，a total of 3 515 cases were included in 66 DRG groups ，21 DRG groups of which were included in the study. Among 21 DRG groups ，the maximum antibiotics use density （AUD）of antibiotics was 102.20 DDDs/（100 person·d）in AH 11 group，the utilization ratio of antibiotics was 100％，and the combined use rate of antibiotics was 81.82％；case-mix index （CMI）value was 11.49. The minimum AUD was 1.01 DDDs/（100 person·d）in XR 19 group，the utilization ratio of antibiotics was 5.06％，and the combined use rate of antibiotics was 0；CMI value was 0.81. Within the same core group ，AUD increased with the increase of CMI. The horizontal comparison and analysis of WB 11 group showed that there was a large gap in AUD among different physicians. The vertical comparison of AUD in WB11 group showed relatively small changes over time. CONCLUSIONS The horizontal and vertical evaluation of antibiotics based on DRGs can provide new clues for the control of antibiotics and help to realize the fine specialized management of antibiotics.