OBJECTIVE To explore the main factors influencing the blood concentration of duloxetine， and provide a scientific basis for the individualized use of duloxetine. METHODS Retrospective analysis was conducted on 434 inpatients with depressive disorders at the First Hospital of Hebei Medical University， who were treated with duloxetine and underwent blood concentration monitoring between January 2022 and April 2024. The study examined the impact of various factors， including gender， age， body mass index （BMI）， gene phenotypes， combined medication， drug type （original/generic）， and genotyping results of gene single nucleotide polymorphism loci， on blood concentration and the concentration-to-dose （C/D） after dose adjustment. RESULTS The blood concentration of duloxetine was 76.65 （45.57， 130.31） ng/mL， and C/D was 0.96 （0.63， 1.60） ng·d/（mL·mg）. The blood concentration of duloxetine was positively correlated with the daily dose of administration （R2＝0.253 7， P＜0.001）. Blood concentration of duloxetine in 38.94% of patients exceeded the recommended range specified in the guidelines. Gender， age， BMI， combined use of CYP2D6 enzyme inhibitors， and CYP2D6 and CYP1A2 phenotypes had significant effects on C/D of duloxetine （P＜0.05）. CONCLUSIONS The patient’s age， gender， BMI， combined medication， and genetic phenotypes are closely related to the blood concentration of duloxetine.

The relationship between dosage form and efficacy is an important aspect of traditional Chinese medicine pharmacy research.However,there is a lack of systematic analysis of how ancient physicians understood the functional characteristics of decoction.By analyzing the advantages and effects of using decoction in the Jingui Yuhan Jing,it can be observed that ancient people's understanding of the therapeutic effect of decoction did not solely stem from medical practice,but also understood and elaborated on the function of decoction through the characteristics of water.This article starts with a discussion on the application of decoction in Jingui Yuhan Jing and uses metaphorical cognitive theory to analyze how ancient physicians understood and constructed the cleansing,opening,guiding,dispersing,nourishing,and moisturizing effects of decoction in the aspects of water cleanliness,connectivity,fluidity,impact,and moisturizing.This has formed a relatively complete set of explanations on the functional characteristics of decoction based on the"water metaphor".This has affected the widespread application of decoction and selection of solvents and has developed a new thinking system for the understanding and research of ancient dosage forms.

To summarize the nursing care experience of a case of idiopathic multicentric Castleman's disease TAFRO syndrome complicated with diffuse alveolar hemorrhage.Key points of nursing:prone position ventilation with high blood risk nursing observation and bleeding prevention;early rehabilitation exercise and the reduction of the lymphedema;the optimization of transitional care to avoid unplanned returns to the ICU.The patient was transferred to the respiratory ward for further treatment after 19 days,and 33 days later,she recovered and was discharged.At 1 month of follow-up after discharge,the patient recovered well.

Objective:To establish and validate reference intervals of serum vitamin K for healthy children in China.Methods:A cross-sectional study was conducted from January 2020 to May 2023, involving 807 healthy children aged 0 to 14 years, selected by stratified random sampling based on the population distribution of children in eastern, central, western, and northeastern China. Sample collection was carried out in 16 hospitals across 12 provinces, autonomous regions, and municipalities. Basic information of the children was collected using a standardized self-design questionnaire. Serum levels of vitamin K 1 and vitamin K 2 (menaquinone-4 (MK-4), menaquinone-7 (MK-7)) were measured using liquid chromatography-tandem mass spectrometry. The reference intervals was established by direct approach. The children were divided into different groups by age. Inter-group comparisons were conducted using the Kruskal-Wallis non-parametric test, and the reference intervals ( P2.5- P97.5) were determined using non-parametric methods. Screening 40 healthy children for small sample validation based on age groups within the reference range(25 from eastern, 10 from central, and 5 from western regions). Results:The age of the 807 children was 5.00 (2.00, 9.81) years, and 495 (61.3%) were males and 312 (38.7%) females. Reference intervals were established for 795 children, of whom 303 children were aged 1 month to 3 years and 492 were aged 4 to 14 years. The reference intervals for serum vitamin K 1 were 0.09-4.54 μg/L for children aged 1 month to 3 years, and 0.10-1.73 μg/L for 4-14 years. For MK-7, the intervals were 0.07-1.42 μg/L for 1 month to 3 years and 0.19-2.03 μg/L for 4-14 years. The reference intervals for MK-4 in children aged 1 month to 14 years were 0-0.42 μg/L. The measured values of serum vitamin K 1, MK-4, and MK-7 in the validation samples did not exceed the reference limit in more than 2 samples. Conclusion:Reference intervals for vitamin K 1, MK-4, and MK-7 in healthy children aged 1 month to 14 years have been established and validated, and can be used to assess vitamin K nutritional status in children.

Aiming at the problem of blood leakage from internal fistula of patients who received dialysis during treatment,the existing Bluetooth technique was applied to design a circuit diagram.A movable monitoring device of blood leakage from internal fistula was designed,and an intelligent alarm mode for the blood leakage from internal fistula was established,which could real-timely remind the blood leakage from internal fistula.The device used the technique of moisture absorption cotton patch and real-time reminder device to supplement the design defects and related treatment schemes of the existing hemodialysis machine,which could realize the safe and effective management for blood leakage from internal fistula,and can avoid the occurrence of adverse events caused by delayed treatment.

Hip fractures are among the most common fractures in the elderly, presenting to be a leading cause of disability and mortality. Surgical treatment is currently the main treatment method for hip fractures. The incidence of perioperative malnutrition is increased after hip fractures in the elderly due to the comorbidities, decreased basal metabolic rate, accelerated protein breakdown, weakened anabolism and surgical stress. However, malnutrition not only increases the incidence of postoperative complications, but also leads to increased mortality, indicating an important role of perioperative nursing management of nutrition for the elderly patients with hip fractures. At present, there still lacks scientific guidance and application standards on perioperative nursing management of nutrition for the elderly patients with hip fractures. Therefore, the Orthopedic Nursing Committee of Chinese Nursing Association and the Editorial Board of Chinese Journal of Trauma organized relevant experts to formulate the Expert consensus on perioperative nursing management of nutrition for elderly patients with hip fractures ( version 2023) according to evidence-based medical evidences and their clinical experiences. Fourteen recommendations were made from aspects of nutrition screening, nutrition assessment, nutrition diagnosis, nutrition intervention and nutrition monitoring to provide guidance for perioperative nursing management of nutrition in elderly patients with hip fractures.

The hemodynamics of children with congenital heart disease (CHD) often changes during the perioperative period. Unfortunately, the evaluation of cardiac function in children with CHD is mainly focused on the left ventricle. With the further understanding of cardiac hemodynamics, the monitoring of RV function has gradually become an important part of cardiac intensive care department. We totally searched five databases including Pubmed, Embase, Cochrane, Wanfang Med, as well as China National Knowledge Infrastructure (CNKI) and reviewed the clinical research progress of the application of TAPSE in the evaluation of RV systolic function in children with CHD to provide a theoretical basic for the monitoring of RV function before and after operation in children with CHD.

Objective:To design a set of assessment tool for the effectiveness of internal performance management in public hospitals, so as to provide reference for optimization hospital internal systems and multi-institutional comparison.Methods:From September 2022 to April 2023, literature review and expert group discussion were used to initially construct an index system for evaluating the effectiveness of performance management in public hospitals, based on the " structure-process-outcome" model. Index quantitative scoring rules and standardized staff questionnaire for supporting use were developed by drawing on the World Management Survey Hospital Edition and Chinese Hospital Management Survey. Two rounds of Delphi consultation were made to rate the importance and measurement feasibility of each index. The analytic hierarchy process was used to determine the relative importance of the finalized indexes. Results:The effective recovery rate of expert consultation questionnaire was 100%, and the authority coefficient was 0.882. The index system consisted of 3 first-level indexes (structure, process, and result), 9 second-level indexes, and 27 third-level indexes. The weights of structure, process and result were 0.307, 0.406 and 0.287, respectively. The second-level indexes with the highest weight were internal effectiveness, informationization, and performance tracking and evaluation, with values of 0.180, 0.156 and 0.115, respectively. The third-level indexes with the highest weight were the construction level of performance management information integration platform, the incentive degree of hospital performance management system to employees, and the scope of performance tracking and evaluation, with values of 0.156, 0.075 and 0.073. The third-level index quantitative scoring rules covered the management activity points that were easy to collect via investigation. Among them, the feasibility of 22 scoring rules were recognized by all the 15 experts, 5 rules were recognized by 14 experts, and 2 rules were recognized by 13 experts. A standardized survey questionnaire covering 25 questions was established based on four third-level indexes: the level of understanding, recognition, satisfaction, and motivation of employees towards the hospital performance management system. The importance scores of each question ranged from 7.43 to 8.71.Conclusions:This study developed a comprehensive suite of assessment instruments, including an index system, a set of quantitative scoring rules, and a standardized staff questionnaire, which could provide reference for hospitals to upgrade their internal performance management levels.

ObjectiveTo investigate effect of conducting training of autism spectrum disorder （ASD） early screening skill on improving the ability to early identify ASD of medical staffs in primary care hospitals. MethodsIn September 2021， the training of ASD early screening skills was carried out for medical staffs from 20 primary care hospitals in Chengdu. After training， the training effect was evaluated. The numbers of referrals from primary care hospitals to superior hospitals， confirmed ASD as well as their average diagnostic age of children with ASD before and after training were used as evaluation indicators. ResultsAfter training， the number of children with suspected ASD referred by primary care hospitals was more than that before training ［（16.65±11.60） vs. （3.40±2.23）， t=5.431， P<0.01］， the number of children diagnosed with ASD was more than that before training［（6.85±4.93） vs. （2.45±1.67）， t=4.171， P<0.01］， and the differences were statistically significant. As for the diagnosed age of ASD children， after training， the average age was lower than that before training ［（34.95±11.67） vs. （42.2±14.64）， t=-2.553， P=0.019］. ConclusionTraining of ASD early screening skills for medical staffs in primary care hospitals may help to improve their ability to early screening ASD children.

As a new therapeutic method, music therapy has a good clinical effect on improving the motor dysfunction of patients with stroke. This article reviews the concept, main forms of music therapy and its role in motor function recovery of patients with stroke.