OBJECTIVE To investigate the current status of quality management of cold chain medicines in direct-to-patient （DTP） pharmacies and propose measures for pre-emptive risk management， providing references for the quality risk management of cold chain medicines. METHODS Based on the requirements of national regulations， a survey was conducted on the quality management of cold chain medicines in DTP pharmacies of J Province from November 2023 to February 2024， focusing on the receipt， storage， distribution， and delivery processes， using questionnaires， telephone interviews， and on-site visits. Common quality management issues in the operation of cold chain medicines were identified， and the causes of these issues were analyzed to propose feasible pre-emptive risk management measures. RESULTS & CONCLUSIONS A total of 122 DTP pharmacies participated in the questionnaire survey， and personnel from 30 DTP pharmacies participated in on-site and telephone interviews. Typical problems were identified in some DTP pharmacies， including insufficient personnel allocation or training， incomplete or inadequate implementation of quality system documentation， inadequate provision or management of cold chain facilities and equipment， and non-compliant storage and distribution of cold chain medicines. These issues posed certain risks to the quality management of cold chain medicines. It is recommended that DTP pharmacies strengthen personnel allocation and training， improve quality system documentation， enhance the provision and management of facilities and equipment， standardize storage and transportation operations， and strengthen supervision and assessment as pre-emptive measures. In addition， all sectors of society should also collaborate in governance from the perspective of ensuring the safety of cold chain drug storage and transportation， in order to mitigate the risk of quality and safety issues during the distribution of cold chain drugs and guarantee the safe and effective use of medications for patients.

At present,there are policies for hepatitis B testing in 89.8%of countries and regions around the world.In 2022,the global hepatitis B vaccine birth dose coverage reached 45%,while the third-dose coverage reached 85%.Approximately 3%of pregnant women with high viral loads have received antiviral therapy,and the prevalence rate of HBsAg is about 0.7%among children aged≤5 years.While significant progress has been made in various countries towards eliminating mother-to-child transmission of hepatitis B virus(HBV),there are still large gaps across countries and numerous challenges.There are differences in the prevalence of hepatitis B,vaccination,and access to antiviral drugs across the globe,and in addition,the factors such as insufficient laboratory testing capacity and difficulties in ensuring sustained access to treatment among pregnant and parturient women with HBV infection pose obstacles to eliminating the mother-to-child transmission of HBV.

Objective:To understand the loss to follow-up of children born to pregnant women with HIV infection (HIV-exposed children) and analyze its influencing factors in China in 2019.Methods:The data were collected from the follow-up records of pregnant women with HIV infection and their children reported by the national "Management Information System for the Prevention of HIV, syphilis and Hepatitis B Mother-to-Child Transmission" in 2019. HIV-exposed children were defined as those who were not followed up after birth or who were not followed up at 18 months of age and who were not followed up at 21 months of age. The univariate and multivariate influencing factors of loss to follow-up of children born to HIV-infected pregnant women were analyzed by χ2 test and logistic regression model. SPSS 25.0 software was used for statistical analysis. Results:The number of HIV-infected pregnant women was 5 039, the number of live-born children was 5 035, the number of loss to follow-up children within 18 months of age was 283, and the loss to follow-up rate children was 5.62%(283/5 035). The results of multivariate logistic regression analysis showed that the rate of loss to follow-up of exposed children born to pregnant women who worked as farmers (animal husbandry and fishery) (a OR=0.34, 95% CI: 0.22-0.53), unmarried (a OR=0.47, 95% CI: 0.24-0.93), first marriage (a OR=0.38, 95% CI: 0.22-0.67), remarriage (a OR=0.36, 95% CI: 0.20-0.67) and cohabiting (a OR=0.47, 95% CI: 0.23-0.97), and knew they had HIV infection before this pregnancy (a OR=0.53, 95% CI: 0.40-0.70) was lower. Han nationality (a OR=1.52, 95% CI: 1.09-2.13), primary school (a OR=2.06, 95% CI: 1.10-3.89) and junior middle school (a OR=1.81, 95% CI: 1.03-3.17) educational level, non-use of antiviral drugs (a OR=6.21, 95% CI: 4.32-8.93) and delivery in township (street) level midwifery institutions (a OR=5.72, 95% CI: 1.61-20.27) had higher rates of loss to follow-up among infants born to HIV-infected pregnant women. Conclusions:HIV-exposed children still have a specific rate of loss to follow-up in China in 2019. In order to further reduce the rate of loss to follow-up, it is of great significance to improve the detection rate of HIV before pregnancy and the rate of antiviral drugs used in pregnant women with HIV infection, which is of great significance for the effective implementation of comprehensive intervention measures of prevention of mother-to-child transmission of HIV.

Objective:To construct a nomogram for predicting unfavorable prognosis at 6 months after moderate and severe traumatic brain injury (msTBI) and validate its predictive effectiveness.Methods:A retrospective cohort study was conducted to analyze the clinical data of 387 patients with msTBI who were admitted to 904th Hospital of the Joint Logistic Support Force of PLA from January 2020 to December 2022, including 265 males and 122 females, aged 6-97 years [58(47, 68)years]. According to the Glasgow outcome scale (GOS) score at 6 months after injury, the patients were divided into favorable prognosis group (GOS 4-5 points, n=201) and unfavorable prognosis group (GOS 1-3 points, n=186). The clinical characteristics, imaging manifestations, and laboratory test results of the two groups on admission were recorded. Univariate analysis was applied to evaluate the correlation between the aforementioned indicators and the unfavorable prognosis of the msTBI patients at 6 months after injury. Receiver operating characteristic (ROC) curves of single variable and the correlation heatmap among continuous variables were plotted. Lasso regression was used to select variables and multivariate Logistic regression analysis was used to determine independent predictive factors so as to construct Logistic regression equation and plot the nomogram. The internal verification was carried out by means of random and non-random split of data. In random split, the data were divided randomly with a ratio of 6∶4 into training group ( n=232) and verification group ( n=155). In non-random split, the patients admitted from January 2020 to December 2021 were assigned to the training group ( n=260), while those admitted from January 2022 to December 2022 to the verification group ( n=127). Area under the curve (AUC) was used to evaluate the predictive ability of the model in the training group and verification group, calibration curve and Hosmer-Lemeshow (H-L) test to evaluate its goodness of fit, and decision curve analysis (DCA) to evaluate its clinical applicability. The influence of inclusion of neutrophil-to-lymphocyte ratio (NLR) model on the warning effectiveness of poor prognosis was analyzed in comparison with the model without inclusion of NLR. Results:Univariate analysis showed that there was a certain correlation between age, length of hospital stay, Glasgow coma scale (GCS), American Society of Anesthesiologists Physical Status (ASA-PS) classification, Injury severity score (ISS), prehospital tracheal intubation, hypotension, hypoxia, pupillary responsiveness, midline shift, basilar cisterna status, traumatic subarachnoid hemorrhage (tSAH), D-Dimer, prothrombin time activity (PTA), glucose, hemoglobin, K +, Cl -, Ca 2+, HCO -, creatinine, albumin, lactic acid, platelet, lymphocyte, systemic immune-inflammation index (SII), NLR, lymphocyte-to-monocyte ratio (LMR) and unfavorable prognosis of msTBI patients at 6 months after injury ( P<0.05 or 0.01). The ROC curve of single variable showed that GCS (AUC=0.82), ISS (AUC=0.81), pupillary responsiveness (AUC=0.76), basal cistern status (AUC=0.73) and NLR (AUC=0.73) had good predictive validity. The results of the correlation heatmap showed that there was a significant correlation and collinearity among the continuous variables, while no collinearity was found between ISS and NLR. Fourteen potential predictors selected by Lasso regression were included in multivariate Logistic regression analysis and its results showed that age ( OR=0.86, 95% CI 1.38, 5.19), GCS 6-8 points ( OR=3.13, 95% CI 1.06, 9.27), GCS 3-5 points ( OR=12.36, 95% CI 2.81, 54.27), ISS ( OR=3.68, 95% CI 1.38, 9.80), pupillary responsiveness ( OR=2.45, 95% CI 0.85, 7.07), and NLR ( OR=2.62, 95% CI 1.52, 4.51) were identified as the independent risk factors for unfavorable prognosis of msTBI patients at 6 months after injury ( P<0.05 or 0.01). The multivariate Logistic regression equation was Logit [P/(1-P)]=0.066×"age"+ 1.474×"GCS 6-8"+2.357×"GCS 3-5"+0.066×"ISS"+0.965×"absence of pupillary light reflex"+0.194×"NLR"-10.704. In the internal verification of random split of data, the AUC value of the model was 0.93 (95% CI 0.89, 0.96) in the training group and 0.93 (95% CI 0.89, 0.97) in the verification group. In the internal verification of non-random split, the AUC value was 0.94 (95% CI 0.91, 0.97) in the training group and 0.93 (95% CI 0.89, 0.97) in the verification group. The calibration curve and H-L test showed that the model had good calibration ability ( P>0.5). The results of DCA showed that the application of the nomogram would increase the net benefit of the patients (risk threshold probability of 0.0-0.8). Compared with the conventional model (AUC=0.90), inclusion of NLR model (AUC=0.93) enhanced the warning effectiveness. Conclusions:Age, GCS, ISS, pupillary responsiveness and NLR are independent risk factors affecting unfavorable prognosis in msTBI patients at 6 months after injury, based on which the nomogram constructed can better predict the clinical outcome of msTBI patients.

Objective:To establish a Plaque-reduction Neutralization Test (PRNT) for the detection of neutralizing antibody titers of Human Respiratory Syncytial Virus (HRSV) and optimize the conditions for preliminary application.Methods:The CHO expression system was used to produce palivizumab monoclonal antibody (palivizumab) and the influencing factors such as cell type, cell culture duration, fixation and permeabilization protocols, and blocking agents. The reproducibility of the method was verified and its correlation was verified with conventional PRNT. Finally, the optimized PRNT assay was further used to determine neutralizing antibody titers against HRSV subtypes A and B in BALB/c mouse serum (immunized by intramuscular injection of HRSV fusion proteins).Results:Palivizumab was expressed at approximately 50 mg/L. The optimal working conditions for PRNT were as follows: culturing HEp-2 cells for 2 days, fixing with 4% (V/V) paraformaldehyde at room temperature for 15 min followed by 0.2% (V/V) Triton X-100 permeabilization for 15 minutes as the optimal fixation-permeabilization and removing the blocking step. The overall coefficient of variation (CV) for the reproducibility validation of this method was <15%, showing a good linear relationship with the conventional PRNT. The Spearman correlation coefficient r s was 0.983. This method was used to detect neutralizing antibody titers in mouse sera against HRSV subtype A strain long and subtype B strain 9320, and the fusion proteins combined with AlOH and CpG adjuvant induced the highest neutralizing antibody titers in mice. Conclusion:The HRSV neutralizing antibody assay established in this study is rapid, reproducible, high-throughput, and can be used to detect neutralizing antibodies to HRSV subtypes A and B.

Objective:To establish a Plaque-reduction Neutralization Test (PRNT) for the detection of neutralizing antibody titers of Human Respiratory Syncytial Virus (HRSV) and optimize the conditions for preliminary application.Methods:The CHO expression system was used to produce palivizumab monoclonal antibody (palivizumab) and the influencing factors such as cell type, cell culture duration, fixation and permeabilization protocols, and blocking agents. The reproducibility of the method was verified and its correlation was verified with conventional PRNT. Finally, the optimized PRNT assay was further used to determine neutralizing antibody titers against HRSV subtypes A and B in BALB/c mouse serum (immunized by intramuscular injection of HRSV fusion proteins).Results:Palivizumab was expressed at approximately 50 mg/L. The optimal working conditions for PRNT were as follows: culturing HEp-2 cells for 2 days, fixing with 4% (V/V) paraformaldehyde at room temperature for 15 min followed by 0.2% (V/V) Triton X-100 permeabilization for 15 minutes as the optimal fixation-permeabilization and removing the blocking step. The overall coefficient of variation (CV) for the reproducibility validation of this method was <15%, showing a good linear relationship with the conventional PRNT. The Spearman correlation coefficient r s was 0.983. This method was used to detect neutralizing antibody titers in mouse sera against HRSV subtype A strain long and subtype B strain 9320, and the fusion proteins combined with AlOH and CpG adjuvant induced the highest neutralizing antibody titers in mice. Conclusion:The HRSV neutralizing antibody assay established in this study is rapid, reproducible, high-throughput, and can be used to detect neutralizing antibodies to HRSV subtypes A and B.

Objective:To comprehend the main characteristics and historical evolution of health finan-cing transition in China.Methods:Data were collected from various sources,including the Global Health Expenditure Database(GHED),China Health Statistics Yearbook,National Health Finance Annual Report,China's Total Health Expenditure Research Report,et al.Descriptive statistics and liter-ature study was conducted.Results:Since the beginning of the 21st century,most countries in the world had witnessed a transition of health financing,characterized by the expansion of health financing scale and the strengthening of public financing responsibility.Notably,China's health financing transition exhibited distinctive features.Firstly,there had been a more rapid expansion in health financing scale compared with global averages.Between 2000 and 2019,total health expenditure per capita experienced a remarkable increase of 816.6％at comparable prices,significantly surpassing average growth rates observed among other countries worldwide(102.1％).Secondly,greater efforts had been made to strengthen the responsibilities of public financing.From 2000 to 2019,there was a substantial decrease of 30.6 percentage points in the proportion of out-of-pocket health expenditure as a share of total health expenditure.This decline was significantly larger than the average reduction observed among other coun-tries worldwide(5.6 percentage points).Thirdly,there had been a significant shift in government health expenditure allocation patterns,with an increased emphasis on"demand-side subsidies"surpassing"supply-side subsidies".Within the realm of"supply-side subsidies",funding directed towards hospitals had notably increased and surpassed that allocated to primary healthcare institutions and public health institutions.Based on these distinctive characteristics,this paper expanded China's health financing tran-sition into three dimensions:Scale dimension,structure dimension and flow dimension.Using a compre-hensive analytical framework,the history of China's health financing transition was roughly divided into four stages:The planned economy stage,the economic transition stage,the post-SARS stage and the new health system reform stage.The main features and evolutionary logic associated with each stage were ana-lyzed.Conclusion:Above all,the health financing system should be enhanced in terms of vertical"em-beddedness"and horizontal"complementarity".Moreover,the significance of health financing transition in preserving hidden value and mitigating public risk should be emphasized,and there is a need for an improved two-way trade-off mechanism that balances value and risk.Additionally,the ethical principles associated with health financing transition should be considered comprehensively,while optimizing budget decision-making within the government's actual governance model.Lastly,it is crucial to recognize the overall and profound impact of modern medicine development and explore long-term strategies and path-ways for health financing transition in China.

Objective:To evaluate the effect of the comprehensive reforms of clinic-pharmacy separation and medical-consumables expenditure linkage in Beijing.Methods:Monitoring data of the comprehensive reforms were collected from 363 public medical institutions in Beijing between January 2016 and December 2019, while descriptive analysis and interrupted times series analysis using segmented regression models were adopted to analyze the influence of the two reforms on medical expense and its structure. We also studied the impact mechanism of service utilization and service price factors on medical expense control.Results:During the period from 2016 to 2019, the medical expenditure of public medical institutions in Beijing increased steadily at an annual growth rate of 4.4%-7.2%. The proportion of drug expense decreased from 44.6% in 2016 to 34.6% in 2019, while the proportion of medical service expense rose from 15.6% in 2016 to 24.3% in 2019, the proportion of examination and laboratory test expenses respectively showed a significant decline in April 2017 and June 2019. These two months witnessed respectively the launch of the two comprehensive reforms. Service utilization played an important role in controlling outpatient and emergency expenses, and service price was the key factor for controlling inpatient expenditure.Conclusions:The implementation of the two reforms in Beijing has effectively curbed the unreasonable growth of medical expenditure, and the expense structure has been constantly optimized and labor value of medical staff gradually improved.

Objective: To study the current situation of humanistic quality education among residents standardized training students in Sichuan Province and analyze the effect, so as to provide references for the enhancement of humanistic quality education for these students. Methods: Five 3A hospitals in Sichuan Province were randomly chosen as the object hospital, and 15 administrators, 500 teachers, 500 students and 300 patients were included. From the aspects of cognition, opinion and suggestion on humanities quality education, a questionnaire survey was conducted. SPSS 19.0 was used to analyze data. Results: The humanistic quality education among students in these hospitals were not good. Among students, 43.1% believed that humanities quality education received deficient attention, and 71.7% thought that curriculum could not meet the training requirement; among teachers, 54.1% thought that teaching ability needed to be strengthened and 60.9% considered that the current teaching conditions and methods were not good enough. Conclusion Effect of humanistic quality education is not good and we suggest solving the problem through improving humanistic management, teachers’ construction, humanistic courses and assessment system.

Objective To analyze correlation between ultrasound features and clinical lab indexes of refractory secondary hyperparathyroidism (SHPT).Methods Two-dimensional ultrasound and CEUS were performed in 30 patients with refractory SHPT before operation.The sum volume of hyperplastic parathyroid glands and sum volume of enhanced area of parathyroid glands in each patient were measured and calculated.Clinical lab indexes,including serum intact parathyroid hormone (iPTH),serum calcium,serum phosphorus,serum alkaline phosphatase (ALP) were recorded,and corrected serum calcium and corrected serum calcium-phosphorus product were calculated 2 days before operation.The correlation between sum volume of parathyroid glands and lab indexes was analyzed.Results There were positive correlations (r=0.48,0.50,both P=0.01) between sum volume of parathyroid glands,sum volume of enhanced area of parathyroid glands and iPTH level.No correlation was found between the volume of hyperplastic parathyroid glands and serum calcium,serum phosphorus,ALP,corrected serum calcium,nor calcium-phosphorus product (all P＞0.05).Conclusion The sum volume of parathyroid can reflect active state of parathyroid glands,which is helpful to diagnosis and monitoring refractory SHPT.