Rapid and living guidelines are those developed in response to public health emergencies in a short period of time using a scientific and standardized approach. Subsequently， they provide timely and credible recommendations for decision makers through regular and frequent updates of clinical evidence and recommendations. In this paper， we introduced the definition of rapid and living guideline as well as analyzed the basic characteristics of eight rapid and living guidelines in the field of traditional Chinese medicine （TCM） published till 2023 June， summarizing three core methodological issues in relation to how to rapidly develop guidelines， how to formulate recommendations when there is lack of evidence， and how to ensure the timeliness of guidelines. Based on the analysis of current rapid and living guidelines， it is implicated that there is necessity to carry out rapid and living guideline in the field of TCM， and the methodology of rapid integration of multivariate evidence in the field of TCM needs to be further explored； furthermore， it is necessary to further explore the obstacles of implementation of guidelines and promote timely updating， all of which provide certain theoretical references for relevant guideline developers and researchers.

In developing rapid and living guidelines of traditional Chinese medicine （TCM） in response to public health emergencies， it is important that evidence continue to be reviewed， and clinical questions and recommendations updated if necessary， due to the rapid changes in disease progression and the continuous generation of relevant research evidence. This paper proposed that the updating scope in dynamic mode should first be identified； then evidence monitoring should be carried out in four aspects， including clinical research， related guidelines or laws and regulations， disease progression， as well as clinical use of recommendations and clinical needs； finally， based on the results of the evidence monitoring， different options should be made， including revising the clinical questions， updating the evidence and recommendations， and withdrawing the guideline.

OBJECTIVE To provide reference for improving the level of hospital pharmaceutical management for operating room drugs. METHODS The operating room pharmacy of our hospital utilized the concept and means of the Internet of Things （IoT） to build an intelligent IoT system for operating room drugs （hereinafter referred to as the “IoT system”）， and optimized and improved it. The quality of drug management in the operating room of our hospital during the initial phase of the IoT system （Q1 2022） and after optimization and improvement （Q1 2023） were compared by setting indicators from four aspects： quality， efficiency， cost， and satisfaction. RESULTS After more than a year of optimization and improvement， our hospital has built a traceable IoT system for the entire drug process that integrated surgical anesthesia systems and hospital information systems， with the direction of drug circulation in the operating room as the axis， using intelligent drug vehicles as the hardware foundation， and anesthesia doctor’s order information system as the software medium. After the optimization and improvement of the IoT system， the standardized score of anesthesia orders in the operating room increased from （68.5±3.5） points in the initial period to （97.0± 2.7） points； the consistency rate between accounts and materials increased from （82.40±8.85）% to （96.50±4.80）%； the time of taking medicine was shortened from （40±8） min to （12±3） min； the frequency of drug withdrawal was reduced from （36.0± 6.5） times/day to （15.5±3.0） times/day； the cost of loss drugs was decreased from （1 292.61±305.90） yuan to （594.24±195.05） yuan； the satisfaction was increased from （80.5±6.5） points to （96.0±3.0） points. All indicators were significantly improved with statistically significant differences （P＜0.05）. CONCLUSIONS The intelligent IoT system constructed by our hospital effectively ensures the accessibility， timeliness， and safety of intraoperative medication， which is conducive to improving the quality of drug management in the operating room.

OBJECTIVES: To examine the reliability and accuracy of Walker's model for estimating the sex of Han adults in western China by using cranium three-dimensional (3D) CT reconstruction, and to study the suitable cranial sex estimation model for Han people in western China. METHODS: A total of 576 cranial CT 3D reconstructed images from Hanzhong Hospital in Shaanxi Province from 2017 to 2021 were collected. These images were divided into the experimental group with 486 samples and the validation group with 90 samples. Walker's model was used by observer 1 to estimate the sex of experimental group samples. The logistic function applicable to Han people in western China was corrected by observer 1. The 90 samples in the validation group were scored and substituted into the modified logistic function to complete the back substitution test by observer 1, 2 and 3. RESULTS: The accuracy of sex estimation of Han adults in western China was 63.2%-77.2% by applying Walker's model. The accuracy of modified logistic function was 82.9%. The accuracy of sex estimation through back substitution test by 3 observers was 75.6%-91.1%, with a Kappa value of 0.689 (P<0.05) for inter-observer consistency and 0.874 (P<0.05) for intra-observer consistency. CONCLUSIONS There are great differences in bone characteristics among people from different regions. The modified logistic function can achieve higher accuracy in Han adults in western China.
Humans ; Adult ; Reproducibility of Results ; Sex Determination by Skeleton/methods* ; Forensic Anthropology ; Skull/anatomy & histology* ; Imaging, Three-Dimensional ; China ; Tomography, X-Ray Computed

OBJECTIVES: To investigate the reliability and accuracy of deep learning technology in automatic sex estimation using the 3D reconstructed images of the computed tomography (CT) from the Chinese Han population. METHODS: The pelvic CT images of 700 individuals (350 males and 350 females) of the Chinese Han population aged 20 to 85 years were collected and reconstructed into 3D virtual skeletal models. The feature region images of the medial aspect of the ischiopubic ramus (MIPR) were intercepted. The Inception v4 was adopted as the image recognition model, and two methods of initial learning and transfer learning were used for training. Eighty percent of the individuals' images were randomly selected as the training and validation dataset, and the remaining were used as the test dataset. The left and right sides of the MIPR images were trained separately and combinedly. Subsequently, the models' performance was evaluated by overall accuracy, female accuracy, male accuracy, etc. RESULTS: When both sides of the MIPR images were trained separately with initial learning, the overall accuracy of the right model was 95.7%, the female accuracy and male accuracy were both 95.7%; the overall accuracy of the left model was 92.1%, the female accuracy was 88.6% and the male accuracy was 95.7%. When the left and right MIPR images were combined to train with initial learning, the overall accuracy of the model was 94.6%, the female accuracy was 92.1% and the male accuracy was 97.1%. When the left and right MIPR images were combined to train with transfer learning, the model achieved an overall accuracy of 95.7%, and the female and male accuracies were both 95.7%. CONCLUSIONS The use of deep learning model of Inception v4 and transfer learning algorithm to construct a sex estimation model for pelvic MIPR images of Chinese Han population has high accuracy and well generalizability in human remains, which can effectively estimate the sex in adults.
Adult ; Female ; Humans ; Male ; Deep Learning ; Imaging, Three-Dimensional ; Pelvis ; Reproducibility of Results ; Tomography, X-Ray Computed ; Young Adult ; Middle Aged ; Aged ; Aged, 80 and over

Background: Cardiopulmonary resuscitation (CPR) strategies in COVID-19 patients differ from those in patients suffering from cardiogenic cardiac arrest. During CPR, both healthcare and non-healthcare workers who provide resuscitation are at risk of infection. The Working Group for Expert Consensus on Prevention and Cardiopulmonary Resuscitation for Cardiac Arrest in COVID-19 has developed this Chinese Expert Consensus to guide clinical practice of CPR in COVID-19 patients. Main recommendations: 1) A medical team should be assigned to evaluate severe and critical COVID-19 for early monitoring of cardiac-arrest warning signs. 2) Psychological counseling and treatment are highly recommended, since sympathetic and vagal abnormalities induced by psychological stress from the COVID-19 pandemic can induce cardiac arrest. 3) Healthcare workers should wear personal protective equipment (PPE). 4) Mouth-to-mouth ventilation should be avoided on patients suspected of having or diagnosed with COVID-19. 5) Hands-only chest compression and mechanical chest compression are recommended. 6) Tracheal-intubation procedures should be optimized and tracheal-intubation strategies should be implemented early. 7) CPR should be provided for 20-30 min. 8) Various factors should be taken into consideration such as the interests of patients and family members, ethics, transmission risks, and laws and regulations governing infectious disease control. Changes in management: The following changes or modifications to CPR strategy in COVID-19 patients are proposed: 1) Healthcare workers should wear PPE. 2) Hands-only chest compression and mechanical chest compression can be implemented to reduce or avoid the spread of viruses by aerosols. 3) Both the benefits to patients and the risk of infection should be considered. 4) Hhealthcare workers should be fully aware of and trained in CPR strategies and procedures specifically for patients with COVID-19.

Twenty-three secondary and higher level hospitals in Nantong City were selected from June 3 to June 19, 2019, and the anesthesia safety and quality control surveys were conducted by using "Supervision and Evaluation Scale of Medical Quality Control Index System in a Department of Anesthesiology in Nantong City (2019 edition)" and "Special Supervision and Evaluation Scale of Perioperative Management and Information Construction in a Department of Anesthesiology in Nantong City (2019 edition)" . The results showed that the total score for medical quality control was 90.2±1.3, and the rate of reaching the standard was 87%.The department configuration score was (12.4±0.7), with the rate of reaching the standard 100%, 87% hospitals had anesthesia recovery rooms, but only 2 hospitals had anesthesia clinics.The staffing score was (15.50±0.23), with the rate of reaching the standard 74%, Nantong City had 0.67 anesthesiologists per 10 000 population, the ratio between the number of anesthesiologists and the number of operating rooms was (1.55±0.10), the ratio between the number of nurse anesthetists and the number of operating room was (0.30±0.04), and three hospitals even had no nurses in the department of anesthesiology.The department management and system score was (28.6±0.5), the rate of reaching the standard was 91%, and the operation safety verification system was not implemented in place in 87% hospitals.The medical technique score was (33.6±0.7), the rate of reaching the standard was 83%, and anesthesiology department was not equipped with anesthesia depth monitor, muscle relaxation monitor, body temperature monitor and other equipment in 35% hospitals.The perioperative management and information construction score was (40.2±1.7), the rate of reaching the standard was 48%, standardized post-operative ward round system was not carried out in 43% hospitals, and the surgical anesthesia information system was not used in 65% hospitals.In conclusion, the current status of anesthesia safety and quality control in secondary and higher level hospitals in Nantong City mainly manifests in the urgent need to improve the awareness of anesthesia safety and quality control, lack of doctors and nurses in a department of anesthesiology and lag of anesthesia information construction.

【Objective】To study the relationship between circulation tumor cell（CTC）and clinicopathological characteristics in early and middlestage colorectal cancer，and to evaluate the diagnostic and prognostic value of peripheral blood CTC through dynamically monitoring the changes of peripheral blood CTC in the patients before and after operation.【Methods】 Prospectively 67 patients with early and middle stage colorectal cancer were included，and 20 healthy volunteers served as contrast during the same period. Peripheral venous blood（7.5 mL）was collected 24 h before radical operation，3 months after radical operation and in control group. SE- iFISH technique was used to isolate and identify CTC. The cutoff value of CTC in diagnosis of colorectal cancer was determined by the receiver operating curve（ROC）and Youden index. Kaplan-Meier and log-rank methods were used for survival analysis and multivariate COX regression analysis for multivariate correction. The value of CTC in the diagnosis of early and middle stage colorectal cancer was evaluated comprehensively，and then the relationship between CTC in peripheral blood and clinicopathological characteristics and prognosis was synthetically evaluated combined with clinicopathological characteristics and postoperative follow- up data. 【Results】The positive rate of CTC in patients with early and middle stage colorectal cancer was significantly higher than that in healthy people（91.0% vs. 5.0% ，P<0.01）. The CTC enumeration was significantly correlated with the depth of invasion and tumor location（P = 0.001，P = 0.044），but not with gender，age，tumor size，lymph node metastasis，TNM stage ，CEA level and CA-199 level. The preoperative CTC enumeration were not correlated with the above-mentioned clinicopathological parameters. Preoperative CTC had no predictive significance for disease free survival（DFS）and total survival（OS）（AUC = 0.359，P = 0.068；AUC = 0.428，P = 0.423），and postoperative CTC critical point of 3/7.5 mL had predictive significance for DFS and OS（AUC = 0.936 ，P < 0.001 ；AUC = 0.863 ，P < 0.001）. It was found that patients with early and middle stage colorectal cancer were divided into two groups ：good prognosis group（CTC < 3 after operation or the number of CTC after operation was equal or decreased with the number of CTC before operation）and bad prognosis group（CTC ≥ 3 after operation or the number of CTC after operation was higher than the number of CTC before operation）. The DFS of the good prognosis group was significantly longer than that of the poor prognosis group （43.7 months vs. 20.4 months，P < 0.001；48.7 months vs. 26.8 months，P < 0.001），and the OS was also significantly longer （54.7 months vs. 43.3 months，P < 0.001；54.8 months vs. 45.1 months，P < 0.001）. Multivariate analysis showed that CTC ≥ 3/7.5 mL was a bad independent factor of DFS and OS.【Conclusions】CTC has high clinical value in patients with early and middle stage colorectal cancer. Preoperative CTC values can not predict the prognosis of early and middle stage colorectal cancer ，but postoperative CTC values and dynamic detection for CTC changes before and after operation can independently predict the prognosis of early and middle stage colorectal cancer.

Objective To compare the effectiveness of patient-controlled intravenous analgesia with or without background infusion of dezocine plus flurbiprofen axetil injection in patients undergoing laparoscopic colorectal cancer operation. Methods Sixty patients scheduled for laparoscopic colorectal cancer surgery,35 males and 25 females,aged 18-65 years,ASA physical status Ⅰ or Ⅱ,were randomly divided into 2 groups:common-dose background infusion group(Group CB,n = 30),and no background infusion group(Group NB, n = 30). All patients were intravenously administered a PCA pump containing dezocine 0.6 mg/kg,flurbiprofen axetil 3 mg/kg and normal saline in a volume of 120 mL.Patients in Group CB were given background infusion rate of 2 mL/h with PCA bolus dose 2 mL,patients in Group NB were given PCA bolus dose 4 mL only.NRS scores, Ramsay sedation scores,pressing times,consumption of analgesic,supplementary analgesics,incidence of ad-verse reactions,time of first exhaust,time of first leaving bed and patients'satisfaction scores were recorded after surgery. The influence factors of time of first exhaust and time of first leaving bed were also analyzed. Results Compared with group CB,the NRS scores in group NB were higher both at rest and during movement(P<0.05), the Ramsay sedation scores in group NB were lower at 24 and 48 h after surgery(P<0.05),the pressing times in group NB were higher(P < 0.05),the consumption of analgesic in group NB were lower after surgery,and the incidence of using supplementary analgesics was higher(P < 0.05). No statistical difference was found on the in-cidence of adverse reactions between the two groups(P > 0.05). Moreover,the time of first leaving bed in group NB was longer than that in group CB(P<0.05).The satisfaction scores in group NB was lower than that in group CB(P<0.05).The main influence factors of the time of first leaving bed were gender and NRS score during move-ment at 24 h after the operation(P<0.05).The main influence factors of the time of first exhaust were age,BMI and fluid infusion volume(P < 0.05). Conclusion Postoperative patient-controlled intravenous analgesia with background infusion of dezocine and flurbiprofen axetil injection was more efficacious and satisfactory,and more suitable in postoperative pain management.

Objective To evaluate the effect of intelligentized patient-controlled analgesia ( PCA) management on the quality of postoperative analgesia in the patients. Methods A total of 6601 patients who underwent postoperative PCA from January 1, 2015 to December 31, 2017 searched from the intelli-gentized PCA system database were selected as intelligentized PCA management group ( I group) , and then were divided into 3 subgroups according to the year: 2015 subgroup ( n=2221 ) , 2016 subgroup ( n=2152) and 2017 subgroup (n=2228). A total of 1235 patients who underwent PCA which was mainly performed by a department of anesthesiology in the postoperative analgesia-related multi-center questionnaire from April 11, 2016 to April 22, 2016 in 12 grade A tertiary hospitals in Guangdong Province were select-ed as the traditional PCA management group (C group). The development of moderate and severe pain, nausea and vomiting, over-sedation at rest and during activity and patient′s satisfaction were recorded on 1st and 2nd days after operation. Results Compared with C group, the incidence of moderate and severe pain, nausea and vomiting and over-sedation at rest and during activity was significantly decreased, and the rate of patient′s satisfaction was increased at each time point after operation in I group ( P<0. 05 or 0. 01) . Com-pared with 2015 subgroup, the incidence of moderate and severe pain at rest and severe pain during activity was significantly decreased in 2016 and 2017 subgroups ( P<0. 05 or 0. 01) , and the incidence of nausea and vomiting was significantly increased in 2017 subgroup ( P<0. 05) . Compared with 2016 subgroup, the incidence of nausea and vomiting was significantly increased in 2017 subgroup (P<0. 05). Conclusion Intelligentized PCA management can improve the efficacy of PCA, mitigates the occurrence of adverse reac-tions and raise the quality of postoperative analgesia in the patients.