OBJECTIVE To evaluate the efficacy and safety of guideline-directed medical therapy （GDMT） combined with vericiguat in treating heart failure with reduced ejection fraction （HFrEF）. METHODS A retrospective study was conducted on 346 patients with HFrEF who received standardized diagnosis and treatment at the First People’s Hospital of Changzhou from January 2023 to May 2024. They were divided into standard treatment group （n＝215） and vericiguat group （n＝131）. Patients in the standard treatment group received GDMT， while patients in the vericiguat group received GDMT combined with vericiguat. Propensity score matching （PSM） was used to balance confounding factors between two groups， and the effectiveness （including outcome and prognostic indicators） and safety （occurrence of adverse events） of both groups were evaluated. Kaplan-Meier survival curves for primary and secondary outcome events were drawn， and the influential factors of primary outcome events were screened through univariate and multivariate Cox regression analysis. RESULTS After PSM， there were 100 patients in the standard treatment group and 100 patients in the vericiguat group， and there was no statistically significant differences in baseline data between two groups （P＞0.05）. During a 1-year follow-up， there were statistically significant differences in the cumulative incidence of major outcome events between the standard treatment group and the vericiguat group， cumulative incidence of hospitalization events due to heart failure， changes in N-terminal pro-B-type natriuretic peptide levels before and after treatment between the standard treatment group and the vericiguat group （P＜0.05）. There was no statistically significant difference in the incidence of adverse events between the two groups （P＞0.05）. Multivariate Cox regression analysis results showed that left ventricular ejection fraction ≤35% was a risk factor for the occurrence of major outcome events within 1 year [hazard ratio （HR）＝ 2.090， 95% confidence interval （CI）： 1.175-3.718， P＝0.012]， while the use of vericiguat was a protective factor for the occurrence of major outcome events within 1 year （HR＝0.505， 95%CI： 0.284-0.899， P＝0.020）. CONCLUSIONS Compared with GDMT， GDMT combined with vericiguat can improve the clinical symptoms and prognosis of HFrEF patients， and has good safety.

Purpose To establish and validate an ultrasound-based radiomics nomogram for predicting ipsilateral axillary lymph node metastasis in stage T1 breast cancer.Materials and Methods 443 stage T1 breast cancer patients in the First Affiliated Hospital of Wannan Medical College from January 2012 to June 2021 were retrospectively collected.All patients were randomly divided into training(n=310)and validation(n=133)group.ITK-SNAP was used to delineate the tumor margins,and Pyradiomics software was used to extract features.Image omics models and Rad-scores were constructed after feature screening.Clinical model,radiomics model and combined diagnostic models were developed,with the combined model's nomogram constructed.The models'predictive values were assessed via receiver operating characteristic curves.Results Multivariate Logistic regression analysis showed that the positive axillary ultrasonography,high echo halo and abundant internal blood supply were the independent risk factors of axillary lymph node metastasis.Then the clinical model was constructed,and imaging omics model was also constructed by feature screening.The combined model,which incorporated clinical and imaging features,demonstrated superior predictive performance.In the training group,the area under the curve for the combined model was 0.822,which was significantly higher than that of the clinical model(0.765)and radiomics model(0.723)(P=0.002 1,P=0.001 8).In the validation group,the area under the curve for the combined model was 0.846,outperforming the imaging omics model(0.686,P=0.001 8)and the clinical model(0.783),though the latter difference was not statistically significant(P=0.111 3).Conclusion Ultrasound-based radiomics combined diagnostic model effectively predicts ipsilateral axillary lymph node metastasis in stage T1 breast cancer,demonstrating high clinical predictive efficiency.

In recent years, the rapid increase in cancer treatment costs in China had brought a huge economic burden to society, and it was urgent to standardize the rational application of anti-tumor drugs. In the context of the reform of group payment related to disease diagnosis, a tertiary first-class hospital focused on the needs of patients and guided by value-based healthcare, established a professional and normalized refined anti-tumor drug management system, setted up a multidisciplinary diagnosis and treatment team, and promoted " Internet plus pharmaceutical services" in December 2018.From 2019 to 2021, the proportion of hospital drugs were 30.8%, 30.1%, and 27.3%, respectively. The amount of money spent on anti-tumor drugs were 83.25 million yuan, 76.41 million yuan, and 62.48 million yuan, respectively, showing a decreasing trend year by year. The practice of refined management of anti-tumor drugs fully reflected the core concept of value based healthcare, achieving closed-loop management of the entire process of drugs, improving the level of rational drug use, reducing the economic burden on patients, and providing reference for improving the level of rational use of anti-tumor drugs in public hospitals.

Background: Dietary fiber is strongly recommended as the basic treatment for functional constipation according to global guidelines. However, a complete evaluation standard for the laxative functional food remains to be improved in China. Aims: To evaluate the efficacy and safety of the laxative function of a compound fructose-oligosaccharide fiber granule, so as to provide evidence-based medical basis for the evaluation of laxative functional food. Methods: In a randomized, double-blind, parallel and controlled trial with placebo as control, 120 subjects with functional constipation were enrolled in 2 clinical research centers in Beijing, and randomly divided into experimental group and control group (60 cases in each group). Subjects in experimental group were given a compound fructose-oligosaccharide fiber granule dissolved in 50 mL water orally, 1 bag (9 g) per day for 2 weeks; while those in control group were given a placebo granule with the same appearance, specification and dosage as the experimental group. The bowel movement frequency per week, defecation status and stool consistency were recorded before and after the test, and the safety tests were completed. Results: After 2 weeks of treatment, the bowel movement frequency in experimental group increased by (1.63±1.57) times per week, the stool consistency assessed by Bristol stool form scale and the difficulty in defecation were also improved as compared with the baseline (all P<0.05). Furthermore, improvements in experimental group were superior to those in control group (all P<0.05). No allergic and other adverse events were reported during the test, and there were no significant changes in blood, urine, stool routine and blood biochemical indices before and after the test. Conclusions: The compound fructose-oligosaccharide fiber granule tested in this study is proved to have laxative effect and is safety for functional constipation. The testing program is scientific and of feasibility, and may provide a methodology basis for human oral administration trials of laxative functional food.

Objective:To observe the effect of combining transcranial direct current stimulation (tDCS) with functional electrical stimulation-assisted cycling (FES-cycling) on lower limb motor function early after a stroke.Methods:Thirty-seven survivors of a recent stroke were divided into a tDCS treatment group ( n=18) and a pseudo-stimulation group ( n=19). While receiving routine rehabilitation training and clinical drug treatment, the tDCS treatment group also cycled in response to functional electrical stimulation while simultaneously receiving tDCS anode stimulation of the motor cortex M1 area. The pseudo-stimulation group followed the same protocol but with the tDCS stimulation inactivated. Both groups were treated for 20min daily, 5 days weekly for 4 weeks. Before and after the 4 weeks of treatment, the lower limb motor function, walking ability and ability in the activities of daily living of both groups were evaluated using the Fugl-Meyer assessment scale for the lower extremities (FMA-LE), the timed up and go test (TUGT) and the modified Barthel index (MBI) respectively. Transcranial magnetic stimulation was used to detect each subject′s cerebral cortex motor threshold (CMT) , cortical latency (CL) and central motor conduction time (CMCT) as well as the amplitude (Amp) of the motor evoked potential of the lower limb primary motor cortex (M1 area). Results:After 4 weeks of treatment, the average FMA-LE and MBI scores and TUGT times of the two groups had improved significantly compared with those before treatment. The average FMA-LE score and TUGT time of the tDCS group were significantly better than those of the pseudo-stimulation group. The average CMT, CL and CMCT in both groups were significantly lower than those before the intervention, while the average Amp had increased significantly, but there were significant differences in the average CMT, Amp, CL and CMCT between the two groups after the 4 weeks of treatment.Conclusions:Transcranial direct current stimulation combined with cycling assisted by functional electrical stimulation can effectively stimulate excitability in the motor cortex soon after a stroke. That should promote the recovery of nerve activity and lower limb function.

The "student-centered" concept highlights the dominant position of students in the teaching process and makes up for the deficiency of traditional teaching mode.Based on the above idea,the teaching team of the author's department tried to improve teaching effect through effective teaching design in biochemistry.Firstly,the teaching goal (the goal of knowledge,ability and emotion) and the important situational factors the learning situation analysis,the characteristics of the course and the class,etc)should be identified.suitable teaching strategies he inspiration strategy,exploration strategy and problem solution strategy,etc.),teaching method (discussion,case study,problem based learning,etc.) and proper assessment (such as the summative assessment with formative evaluation) should be determined to organize classroom teaching.At the end of the class the timely feedback and the teaching reflection should be carried outto extend classroom teaching to extra-curricular class.The results showed that effective teaching designismore likely to stimulate students' learning enthusiasm,promote students' deep learning and achieve better teaching effects.

The authors described the attempt of general practice in hierarchical medical system aided by the medical service partnership model.This reform has achieved an effective and efficient hierarchical medical system for chronic diseases within a medical alliance, overcoming the existing hierarchical medical system centering on a hospital.Other merits of the reform include a general practice guidance pattern between general hospitals and community hospitals and enhanced general practitioner competence in communities,effectively encouraging general practice progress.

Objective To evaluate the value of non-invasive coronary flow reserve ( CFR ) for investigating the relationship between myocardial ischemia and coronary stenosis ,and the result after percutaneous coronary intervention ( PCI) in patients with unstable angina pectoris . Methods The rest blood flow spectrum and the maximum coronary diastolic blood flow spectrum were obtained respectively for 131 coronary artery lesions including the left anterior descending coronary artery ,the left circumflex coronary artery and the right coronary artery in 86 patients from the coronary artery flow imaging of transthoracic Doppler echocardiography ,then CFR was calculated . All patients were performed by coronary angiography . Patients with the rate of coronary stenosis > 70％ and CFR ≤ 2 .0 were treated by PCI . CFR was measured again at different intervals after PCI . Results ① As the degree of stenosis increased ,CFR decreased gradually .The coronary stenosis was negatively correlated with CFR ( r = - 0 .803 , P < 0 .001) . The sensitivity of CFR ≤ 2 .0 predicting coronary stenosis rate of more than 70％ was 82 .7％ ,the specificity was 87 .7％ . ② CFR of post-PCI was higher than that of per-PCI . With a follow-up of half a year ,CFR of all coronary arteries was greater than 2 .0(44/44) ,but restenosis occurred at one year after PCI in two left anterior descending coronary arteries . Conclusions Non-invasive CFR can evaluate the relationship between myocardial ischemia and coronary stenosis ,select indications for PCI and evaluate postoperative outcome for patients with unstable angina pectoris .

OBJECTIVE To investigate the relationship between the distribution of eosinophils(Eos) of nasal secretion and serum specific IgE(sIgE) titer in patients with allergic rhinitis, and to evaluate the diagnostic value of Eos in nasal secretion for allergic rhinitis. METHODS A total of 60 allergic rhinitis patients from Department of Otolaryngology, Beijing Shunyi Hospital of Traditional Chinese Medicine during Jan.2016 to June 2017 were selected as treatment group, and another 60 cases of non-allergic rhinitis and 30 normal persons in the corresponding time period were chosen as control group. Eos in nasal secretions and serum sIgE were measured in all the subjects and the relationship between Eos distribution and serum sIgE level was analyzed. RESULTS The Eos distribution and serum level of sIgE was consistent(κ=0.264, P=0.000) and statistical significance was found. The area of ROC of the Eos in nasal secretion was 0.881, the standard deviation was 0.025 and 95％ confidence interval was 0.841 to 0.924. The Udden index of ROC reached the maximum when the Eos in nasal secretion smear was graded as level 3, the sensitivity was 88.5％ and specificity was 99.4％. CONCLUSION Eos cytological examination of nasal secretions has some auxiliary value in the diagnosis of allergic rhinitis. It is a cheap, simple and rapid method, which can be used as an effective reference index for diagnosing allergic rhinitis in primary hospital.

Objective To investigate the cognition and attitude about human papillomavirus (HPV) and HPV vaccines among nurses, so as to provide a certain basis for the popularization of HPV vaccine. Methods A self-designed questionnaire was used to survey the cognition and attitude about HPV and its vaccine among nurses in Zhejiang Cancer Hospital by a professional platform named "Wenjuanxing" from August to September 2017. A total of 206 questionnaires were collected.Results Among 206 nurses, 98.5％ of the nurses had heard of HPV, only 14.1％ knew HPV could spread through touching and 41.3％ knew that HPV infection can be self subsided. 90.3％ of the nurses had heard of HPV vaccine. 78.6％ of the nurses would like to take HPV vaccine, and 70.2％ of the nurses agreed their daughters to take HPV vaccine. Over 60％ nurses worried about the safety and efficacy of HPV vaccine.Conclusions Nurses have some knowledge about HPV and HPV vaccine, but it is not comprehensive enough. The government should strengthen the publicity of knowledge about HPV and HPV vaccine.