Objective:To summarize and analyze the composition characteristics and problems of basic medical insurance policies for traditional Chinese medicine in various provinces of China,providing reference for optimizing and improving subsequent basic medical insurance policies for traditional Chinese medicine.Methods:Based on the perspective of policy instrument,combined with two dimensions of policy instrument types and policy development process,the content analysis method is used to quantitatively analyze the content of the basic medical insurance policies for traditional Chinese medicine released at the provincial level from 2011 to 2023.Results:The 93 included policy documents were coded and sorted,with a cumulative total of 487 codes.From the perspective of policy instrument dimensions,subcategories of policy instruments involve diverse themes,but there are differences in the level of attention paid to each policy tool.From the perspective of policy development process,each link also presents a discrete trend,indicating a dominant feature of policy planning and implementation.Conclusion:To improve the basic medical insurance policy system of traditional Chinese medicine in China,it is necessary to optimize the combination of policy instrument and construct a coordinated and balanced policy instrument framework;Overall planning of the development process of traditional Chinese medicine medical insurance policies,highlighting the unique advantages of traditional Chinese medicine;Emphasize policy synergy between dimensions and strengthen the implementation of traditional Chinese medicine medical insurance policies.

Objective: To understand the characteristics and influencing factors of lymph node metastasis of the right recurrent laryngeal nerve in thoracic esophageal squamous cell carcinoma (ESCC), and to explore the reasonable range of lymph node dissection and the value of right recurrent laryngeal nerve lymph node dissection. Methods: The clinicopathological data with thoracic ESCC were retrospectively analyzed, and the characteristics of lymph node metastasis along the right recurrent laryngeal nerve and its influencing factors were explored. Results: Eighty out of 516 patients had lymph node metastasis along the right recurrent laryngeal nerve, the metastasis rate was 15.5%. Among 80 patients with lymph node metastasis along the right recurrent laryngeal nerve, 25 cases had isolated metastasis to the right recurrent laryngeal nerve lymph node but no other lymph nodes. The incidence of isolated metastasis to the recurrent laryngeal nerve lymph node was 4.8% (25/516). A total of 1 127 lymph nodes along the right recurrent laryngeal nerve were dissected, 115 lymph nodes had metastasis, and the degree of lymph node metastasis was 10.2%. T stage, degree of tumor differentiation and tumor location were associated with right paraglottic nerve lymph node metastasis (all P<0.05). The lymph node metastasis rate along the right recurrent laryngeal in patients with upper thoracic squamous cell carcinoma (23.4%, 26/111) was higher than that of patients with middle (13.5%, 40/296) and lower (12.8%, 14/109) thoracic squamous cell carcinoma (P=0.033). In patients with poorly differentiated ESCC (20.6%, 37/180) the metastasis rate was higher than that of patients with moderately (14.6%, 39/267) and well-differentiated (5.8%, 4/69; P<0.05). The lymph node metastasis rate of patients with stage T4 (27.3%, 3/11) was higher than that of patients with stage T1 (9.6%, 19/198), T2 (19.0%, 16/84) and T3 (18.8%, 42/1 223; P<0.05). Multivariate regression analysis showed that tumor location (OR=0.61, 95% CI: 0.41-0.90, P=0.013), invasion depth (OR=1.46, 95% CI: 1.11-1.92, P=0.007), and differentiation degree (OR=1.67, 95% CI: 1.13-2.49, P=0.011) were independent risk factors for lymph node metastasis along right recurrent laryngeal nerve of ESCC. Conclusions: The lymph node along the right recurrent laryngeal nerve has a higher rate of metastasis and should be routinely dissected in patients with ESCC. Tumor location, tumor invasion depth, and differentiation degree are risk factors for lymph node metastasis along right recurrent laryngeal nerve in patients with ESCC.
Humans ; Esophageal Squamous Cell Carcinoma/pathology* ; Lymphatic Metastasis/pathology* ; Esophageal Neoplasms/pathology* ; Recurrent Laryngeal Nerve/pathology* ; Retrospective Studies ; Lymph Node Excision ; Lymph Nodes/pathology* ; Carcinoma, Squamous Cell/pathology* ; Esophagectomy

In this study, alkali-soluble polysaccharide was extracted from Poria residue, and the structure of alkali-soluble polysaccharide was characterized by Fourier transform infrared spectroscopy (FTIR), X-ray powder diffraction (XRD), and differential scanning calorimetry (DSC). The physical morphology of alkali-soluble polysaccharide and ethyl cellulose (EC) was investigated by scanning electron microscopy (SEM), and the focus on angle of repose, bulk density, tapped density, Carr index, interparticle porosity, cohesion index, Hausner ratio, etc. The physical fingerprints were drawn, and the powder properties were evaluated by multivariate analysis. Diclofenac sodium extended-release tablets were prepared by direct compression method using alkali-soluble polysaccharide and EC as insoluble backbone materials to evaluate the basic properties of the extended-release tablets, investigate the in vitro drug release behavior and study the release mechanism. The results showed that alkali-soluble polysaccharide is a semi-crystalline polymer with smooth lamellar structure, and its stacking and compressibility are stronger than EC. The in vitro release experiments showed that the slow release performance of alkali-soluble polysaccharide is stronger than EC, and the release behavior of the prepared slow release tablets is in accordance with the Higuchi model. The pore structure is formed inside the tablets during the release process, and the release mode is pore diffusion release. The results of this study are of great significance for the development of new slow-release materials and the rational use of resources.

With the wide application of high-resolution chest CT in health check-up, the ground glass nodule(GGN) has been increasingly detected. GGNs have a complex etiology and image features, which can develop fast or very slowly. Therefore, whether to follow up or to resect it is usually very difficult to be determined. Overdiagnosis or overtreatment frequently happens. According to the development of GGNs, the process can be clinically divided into four stages: biological onset stage (pre-detection stage), observational stage, clinical treatment stage and postoperative follow-up stage. This review summarizes the progress on the natural development process, imaging monitoring and differentiation, the optimal time of surgical treatment for GGNs based on the decision of multidisciplinary team. This revie wmay be helpful for clinicians to understand the rule of GGN development in the follow-up, and find an optimal time to give surgical intervention for improving the prognosis of and life quality of the GGN patients.
Follow-Up Studies ; Humans ; Lung Neoplasms/surgery* ; Multiple Pulmonary Nodules/surgery* ; Retrospective Studies ; Solitary Pulmonary Nodule/surgery*

Esophageal cancer is one of the most common malignant tumors of digestive tract, lymph node metastasis is a frequently encountered metastasis in the esophageal cancer patients. The number of lymph node metastasis is reported as an important prognostic factor, and it also affects the choice of postoperative treatments in the esophageal cancer. It was reported that the recurrent laryngeal nerve lymph nodes are the most common sites of nodal metastasis and need to be completely dissected during the esophagectomy for thoracic esophageal cancers. Dissection of the lymph nodes along bilateral recurrent laryngeal nerves not only improves the accuracy of staging, but also improves postoperative survival of esophageal cancer patients due to reducing the local recurrence. However, it also brings problems such as injury of laryngeal recurrent nerves, and increases postoperative complications such as pulmonary complications and malnutrition due to aspiration and coughing. Therefore, it is necessary to preserve the structure and function of bilateral recurrent laryngeal nerves during esophagectomy through careful manipulations, and minimize the impact of complications in prognosis and quality of life from injury to the recurrent laryngeal nerve.
Esophageal Neoplasms/pathology* ; Esophagectomy/adverse effects* ; Humans ; Lymph Node Excision ; Lymph Nodes/surgery* ; Lymphatic Metastasis/pathology* ; Quality of Life ; Recurrent Laryngeal Nerve/pathology* ; Thoracic Neoplasms/pathology*

ObjectiveLupus mesenteric vasculitis (LMV) can lead to extensive necrosis of the small intestine, and it is easy to be misdiagnosed and missed in the early stage of the disease. This study aims to evaluate the clinical significance of serum D-dimer level in the early diagnosis of LMV.MethodsRetrospective analysis was performed on 38 patients with systemic lupus erythematosus (SLE) admitted to Nanjing Drum Tower Hospital from January 2006 to January 2019. There were 15 LMV patients (LMV Group) and 23 non-LMV patients (Non-LMV Group). The main observation indicators of statistical analysis were serum D-dimer level on the first day of treatment in the two groups, while the secondary indicators included patient general condition, SLE disease activity index (SLEDAI), enhanced CT examination results, laboratory examination results and serum D-dimer level after treatment.ResultsThere was no significant difference in age, SLE duration and SLEDAI between the two groups (P>0.05). On admission, CT showed LMV patients with intestinal dilatation, mesenteric edema and typical target symptoms. After high-dose hormone therapy, the dilatation of intestinal canal and intestinal wall were significantly relieved, and the target signs on CT disappeared before discharge. The serum D-dimer level of patients in the LMV Group [917 (756,1848) μg/L] was significantly higher than that in the Non-LMV Group [570 (356,896) μg/L], and the difference was statistically significant (P=0.006). ROC curve analysis showed that the critical value of serum D-dimer in early diagnosis of LMV was 624 μg/L, and the sensitivity and specificity were 93% and 61%, respectively (AUC=0.77).ConclusionSerum D- dimer level can be used as an effective index for early diagnosis of LMV patients.

Objective:Based on the previous studies, to investigate the dissolution behavior of Fuzi Lizhongwan by simultaneously determining the dissolution of benzoylmesaconine, benzoylaconine and benzoylhypaconine in Aconiti Lateralis Radix Praeparata. Method:The simultaneous determination of benzoylmesaconine, benzoylaconine and benzoylhypaconine in Fuzi Lizhongwan was established by HPLC-QQQ-MS. The dissolution amounts of three compositions in 15 batches of Fuzi Lizhongwan from 5 manufacturers at different time points, the cumulative dissolution was calculated and the dissolution curve was drawn. The f₂ similarity factor method was adopted to evaluate similarity of dissolution curves of index components in different batches of samples from the same manufacturer, and to evaluate similarity of dissolution curves of samples from different manufacturers based on the same index component. The dissolution model of Fuzi Lizhongwan was concluded by fitting with the dissolution data. Result:When hydrochloric acid solution with pH of 1.2 was used as the dissolution medium, the three alkaloids had the best dissolution effect. The dissolution behavior of three monoester alkaloids in Fuzi Lizhongwan was basically synchronous and the dissolution lasted for 24 h. Three batches of samples from the same manufacturer (manufacturer 1, 3, 4 and 5) appeared to be similar on dissolution behavior, indicating that the dissolution behavior of the majority of samples from different manufacturers was similar. The dissolution behavior of batch 1 sample was different from batch 2 and 3 samples in manufacturer 2, suggesting that the quality of different batches of samples in manufacturer 2 might be different. The fitting results of dissolution data of index components in samples from different manufacturers were consistent, and the Weibull model was the best. Conclusion:Index components in fifteen batches of samples from 5 manufacturers are continuously dissolved within 24 h, indicating that the samples have the characteristics of slow dissolution. The dissolution curves of samples from the same manufacturer are similar to each other, indicating that the quality of different batches of products from most manufacturers is stable. The dissolution behavior of benzoylmesaconine, benzoylaconine and benzoylhypaconine in samples form different manufacturers has some differences, which may be caused by the source of medicinal materials and preparation technology parameters.

Objective To evaluate the safety and efficacy of epicardial ventricular restoration (EVR) using REVIVENT system in patients with antero-septal scar and dilated ischemic cardiomyopathy. Methods Ten ischemic heart patients with antero-septal scar underwent the operation. The scarred lateral left ventricular wall was apposed to the septal scar with serial paired anchors placed through epicardial transmural excluding the non-viable portions of the chamber. Left ventricular hemodynamic assessments as well as left ventricular ejection fraction, left ventricular end-systolic/diastolic volume (LVEDV/LVESV) and their indexes (LVEDVI/LVESVI) were measured by cardiac magnetic resonance (CMR). Results Ten ischemic heart failure patients with antero-septal scar, aged(55.2±13.9)years, received a hybrid epicardial ventricular restoration. Cardiac MR done at one a month after the procedure showed an elevation of LVEF from(27.8±4.6%)to(37.5±11.4)% (+35%, P<0.01). LVESV was significantly reduced from(149.9±61.6) ml to(109.9±58.0)ml (–26.7%, P<0.01), LVESVI was reduced from(84.8±36.7)ml/m2to(63.0±34.2) ml/m2(reduced by 25.7%, P<0.01); LVEDV was reduced from(203.0±64.0)ml to(167.9±58.2)ml (reduced by 17.3%, P<0.01), and LVESV was reduced from(114.5±37.8)ml/m2to(96.2±35.2)ml/m2(reduced by 16.0%, P<0.01). Cardiac output (CO) increased from(4.0±1.5)L/min to(4.8±1.2)L/min(increased by 20.0%, P=0.034) and cardiac index (CI) increased from(2.2±0.7)L/(min ? m2) to(2.7±0.7)L/(min ? m2) (increased by 22.4%, P=0.023). Conclusions Our preliminary experience on EVR using the REVIVENT system demonstrated signifi cant increase in LVEF, CO and CI, with decreases in LVEDV/LVESV at 1 month following the procedure. Its feasibility and safety need further evaluation in the future.

PURPOSEPosterior fossa epidural hematomas (PFEDH) are uncommon in children but usually require timely surgical intervention due to the risk of life-threatening brainstem compression. We attempt to make the surgical procedure less invasive by treating selected pediatric patients with trephination mini-craniectomy.

METHODSWe retrospectively reviewed the clinical courses, radiological findings, surgical procedures, and prognoses of the pediatric patients who were treated in our departments for traumatic PFEDH from January 2010 to January 2015.

RESULTSDuring this period, a total of 17 patients were surgically treated for PFEDH and 7 were managed with trephination mini-craniectomy for hematoma evacuation. The outcomes were good in all 7 patients as evaluated with Glasgow Outcome Score. There was no mortality in this series. The on average 30-month clinical follow-up showed that patients experienced satisfactory recoveries without complications.

CONCLUSIONOur results suggest that trephination mini-craniectomy is a safe surgical technique for selected PFEDH patients with moderate hematoma volume and stabilized neurological functions. However, standard craniectomy is recommend when there are rapid deteriorations in patients' neurological functions or the hematomas are large and exerted severe mass effects.

Objective: To investigate the efficacy and safety of the new investigational drug pegylated interferon α-2b (Peg-IFN-α-2b) (Y shape, 40 kD) injection (180 µg/week) combined with ribavirin in the treatment of patients with genotype 1/6 chronic hepatitis C (CHC), with standard-dose Peg-IFN-α-2a combined with ribavirin as a positive control. Methods: A multicenter, randomized, open-label, and positive-controlled phase III clinical trial was performed. Eligible patients with genotype 1/6 CHC were screened out and randomly divided into Peg-IFN-α-2b(Y shape, 40kD) group and Peg-IFN-α-2a group at a ratio of 2:1. The patients in both groups were given oral ribavirin for 48 weeks in addition and then followed up for 24 weeks after drug withdrawal. Abbott Real Time HCV Genotype II was used to determine HCV genotype, and Cobas TaqMan quantitative real-time PCR was used to measure HCV RNA level at 0, 4, 12, 24, 48, and 72 weeks. Adverse events were recorded in detail. The primary efficacy endpoint was sustained virological response (SVR), and a non-inferiority test was also performed. Results: A total of 561 patients with genotype 1/6 CHC were enrolled, among whom 529 received treatment; 90.9% of these patients had genotype 1 CHC. The data of the full analysis set showed that SVR rate was 69.80% (95% CI 65.00%-74.60%) in the trial group and 74.16% (95% CI 67.73%-80.59%) in the control group (P = 0.297 0). The data of the per protocol set (PPS) showed that SVR rate was 80.63% (95% CI 76.04%-85.23%) in the trial group and 81.33% (95% CI 75.10%-87.57%) in the control group (P = 0.849 8), and the 95% CI of rate difference conformed to the non-inferiority standard. The analysis of the PPS population showed that of all subjects, 47.9% achieved rapid virologic response, with a positive predictive value of 93.8%. The incidence rate of adverse events was 96.30% in the trial group and 94.94% in the control group, and the incidence rate of serious adverse events was 5.13% in the trail group and 5.06% in the control group. Conclusion In the regimen of Peg-IFN-α combined with ribavirin for the treatment of genotype 1/6 CHC, the new investigational drug Peg-IFN-α-2b(Y shape, 40 kD) has comparable clinical effect and safety to the control drug Peg-IFN-α-2a.