Functional cure is currently the ideal treatment endpoint for chronic hepatitis B （CHB） in China and globally. HBsAg seroclearance and HBV DNA that cannot be detected in peripheral blood for more than 24 weeks marks the regression of hepatitis B virus （HBV） infection. However， there is still a lack of systematic description of the characteristics of intrahepatic HBV markers after HBsAg seroclearance. This article elaborates on the issues including the latest definition of functional cure， the characteristics of intrahepatic virological markers after HBsAg seroclearance， the significance of ultrasensitive serum HBsAg detection， and antiviral therapy for CHB patients with a low level of HBsAg， so as to improve the understanding of functional cure among clinicians.

[Objective] To analyze the serological characteristics and molecular biology results for a P^k phenotype. [Methods] One patient with P^k phenotype upon unexpected antibodies at Jining Blood Center in July 2022 was selected as the study subject. The blood groups and unexpected antibodies of the proband and his second son were identified using serological methods. The sequences of 3-β-N-acetylgalactosaminyltransferase gene (B3GALNT1) and the coding region of α-1,4-galactosyltransferase gene (A4GALT) were amplified and analyzed by PCR direct sequencing, and haploid sequence analysis was carried out on the variant sites of the B3GALNT1 gene. PROVEAN, SIFT, PolyPhen2 and Mutation Taster were used to analyze the effect of mutations on the protein. [Results] Serological test results suggested that the proband was a P2^k type, including anti-P antibody in his serum, and his son was the P2 phenotype. Sequencing analysis revealed that the proband had a compound heterozygous variants of the B3GALNT1 in c. 239T>A (p. Leu80Gln) and c. 433C>T (p. Arg145Ter). Further haploid analysis showed that the c. 239T>A had occurred in one haploid while c. 433C>T was present in the other haploid, and his son carried a heterozygous variant of c. 433C>T (p. Arg145Ter); the proband and his son all have homozygous mutation variants of the A4GALT in c. 903C>G. Bioinformatic analysis also predicted that the mutations were harmful to the protein function. [Conclusion] The compound heterozygous variants c. 239T>A (p. Leu80Gln) and c. 433C>T (p. Arg145Ter) in the B3GALNT1 gene may contribute to the P^k phenotype, of which the c. 239T>A variant has not been reported.

OBJECTIVE To optimize the prescription pre-review system in our hospital and evaluate its application effects. METHODS Aiming at the problems of imperfect rule base and high false positive rate in the early operation of the system， optimization measures were taken， including improving the content of the rule base， adjusting the interception level and prompt mode， refining the working model of prescription review pharmacists， and strengthening clinical communication. A retrospective cohort study was conducted， with prescription data from June to December 2023 （before optimization） as the control group and June to December 2024 （after optimization） as the observation group. Through inter group comparative analysis， the actual effect of optimizing the prescription pre-approval system was evaluated. RESULTS The prescription qualified rate increased from （82.51± 4.04）% before optimization to （90.98±1.55）% after optimization； the false positive rate decreased from （20.87±1.64）% before optimization to （7.41±2.04）% after optimization. The monthly range of prescription qualified rate narrowed from 10.24% to 4.11%， and the coefficient of variation decreased from 4.92% to 1.73%. The monthly range of false positive rate slightly increased from 4.40% to 5.34%， the coefficient of variation rose from 8.32% to 26.18%. CONCLUSIONS Through multi-dimensional optimizations of the prescription pre-review system in our hospital， its prescription review efficiency has been significantly enhanced， the quality of prescriptions has steadily improved， and the accuracy of reviews has notably improved.

Studies have suggested that the nucleus accumbens (NAc) is implicated in the pathophysiology of major depression; however, the regulatory strategy that targets the NAc to achieve an exclusive and outstanding anti-depression benefit has not been elucidated. Here, we identified a specific reduction of cyclic adenosine monophosphate (cAMP) in the subset of dopamine D1 receptor medium spiny neurons (D1-MSNs) in the NAc that promoted stress susceptibility, while the stimulation of cAMP production in NAc D1-MSNs efficiently rescued depression-like behaviors. Ketamine treatment enhanced cAMP both in D1-MSNs and dopamine D2 receptor medium spiny neurons (D2-MSNs) of depressed mice, however, the rapid antidepressant effect of ketamine solely depended on elevating cAMP in NAc D1-MSNs. We discovered that a higher dose of crocin markedly increased cAMP in the NAc and consistently relieved depression 24 h after oral administration, but not a lower dose. The fast onset property of crocin was verified through multicenter studies. Moreover, crocin specifically targeted at D1-MSN cAMP signaling in the NAc to relieve depression and had no effect on D2-MSN. These findings characterize a new strategy to achieve an exclusive and outstanding anti-depression benefit by elevating cAMP in D1-MSNs in the NAc, and provide a potential rapid antidepressant drug candidate, crocin.

ObjectiveTo explore the effect of virtual reality on upper limb function in stroke patients through diffusion tensor imaging (DTI). MethodsFrom September, 2021 to March, 2023, 80 stroke patients in the Fuzhou Second General Hospital were randomly divided into control group (n = 40) and experimental group (n = 40). Both groups received routine rehabilitation, while the experimental group received virtual reality training additionally, for four weeks. They were assessed with Fugl-Meyer Assessment-Upper Extremities (FMA-UE) and Action Research Arm Test (ARAT) before treatment, after treatment and after four-week follow-up; and they were scaned with DTI to measure the fractional anisotropy (FA) and relative anisotropy (RA) of cerebral peduncle and posterior limb of inner capsule of the affected side before and after treatment. ResultsTwo cases dropped in each group. The FMA-UE and ARAT scores increased in both groups after treatment and follow-up (F > 2.790, P < 0.001), and increased more in the experimental group than in the control group (t > 2.297, P < 0.05). FA and RA in the posterior limb of inner capsule increased in both groups after treatment (t > 21.013, P < 0.001), and increased more in the experimental group (t > 2.006, P < 0.05). The d-value of FA of the posterior limb of internal capsule before and after treatment (ΔFA) was positively correlated with the d-value of FMA-UE score (r > 0.362, P < 0.05) in both groups, the ΔFA of the posterior limb of internal capsule was positively correlated with the d-value of ARAT score (r = 0.459, P < 0.01). ConclusionVirtual reality training can promote the recovery of upper limb function in stroke patients, which may associate with the conductivity of posterior limb of inner capsule.

Objective:To evaluate the effect of ultrasound and CT three-dimensional reconstruction in open reduction and internal fixation of fractured ribs.Methods:A retrospective case-control study was conducted to analyze the clinical data of 112 patients with chest trauma and rib fractures admitted to Yan′an People′s Hospital from January 2021 to September 2023. According to the different preoperative positioning methods used, the reconstruction group was divided into a reconstruction group ( n=61) and a combined group ( n=51). The reconstruction group positioned the surgical incision position based on conventional CT three-dimensional reconstruction, while the combined group positioned the rib fracture end based on CT three-dimensional reconstruction combined with ultrasound. Record clinical data of two groups of patients and compare their preoperative positioning accuracy, average incision length, exposure time of fracture ends, fracture healing time, incision infection rate, surgical related indicators, visual analogue pain score (VAS) at one month after surgery, and surgical incision healing levels. Measurement data with normal distribution were expressed as mean±standard deviation ( ± s), and t-test was used for inter group comparison; Comparison of count data between groups using chi-square test; The comparison of grade data were conducted using Mann-Whitney U test. Results:The preoperative localization accuracy, postoperative VAS at one month, and surgical incision healing grade A of the combined group patients were 94.4%, (2.26±0.48) points, 96.1%, respectively, the reconstruction group were 84.1%, (4.52±1.34) points, 72.1%, the combined group was better than the reconstructed group, the difference between the two groups was statistically significant ( P<0.05); The average incision length, fracture exposure time, fracture healing time, surgical time, and thoracic tube retention time of the combined group were (7.32±2.44) cm, (18.06±4.78) min, (48.16±4.58) d, (55.46±7.48) min, and (3.57±1.28) min, respectively. The reconstruction group were (10.16±2.86) cm, (29.45±5.65) min, (55.36±4.45) d, (64.36±7.52) min, and (7.49±1.52) min, respectively, the difference between the two groups was statistically significant ( P<0.05). Conclusion:Application of ultrasound combined with CT three-dimensional reconstruction in open reduction and internal fixation of fractured ribs can increase the preoperative positioning accuracy, which can guide the surgical incision, thus alleviating postoperative pain, facilitating postoperative healing, minimizing surgical trauma, and improving the patient′s prognosis.

Objective To explore the correlation of glucose and lipid metabolism indicators combined with antiphospholipid antibodies with the prognosis of patients with atherosclerosis.Methods A total of 128 patients with atherosclerosis treated in our hospital from April 2021 to March 2023 were selected as study group,and 48 healthy individuals as control group.Glycolipid metabolism indexes and antiphospholipid antibody level of the two groups were compared,and the predictive value of glycolipid metabolism indexes,antiphospholipid antibodies and combined detection for the prognosis of patients with atherosclerosis were analyzed by ROC.Results TC,TG,ACL,and anti-β2-GP1 in the study group was higher than that in the control group(P＜0.05).The study group was divided into two sub-groups according to the prognosis.The expression level of TC,TG,ACL,and anti-β 2-GP1 in poor prognosis group was higher than that in good prognosis group(P＜0.05).TC,TG,ACL,and anti-β 2-GP1 was positively correlated with the poor prognosis of patients with atherosclerosis(P＜0.05).ROC curve showed that the predictive value of six combined tests for the prognosis of patients with atherosclerosis was higher than that of single test of TC,TG,ACL,and anti-β2-GP1(P＜0.05).Conclusion The combined detection of TC,TG,ACL,and anti-β2-GP1 has high predictive value for the prognosis of patients with atherosclerosis.

ObjectiveTo observe the effects of Youguiwan on bone metabolism and bone morphogenetic protein-2 （BMP-2）/Smad signaling pathway in ovaries-removed rats with osteoporosis and study the mechanism of Youguiwan in the prevention and treatment of osteoporosis. MethodA postmenopausal rat model of osteoporosis was prepared by bilateral ovariectomy. The 40 female SD rats were randomly divided into five groups， including sham operation group， model group， alendronate sodium group （0.1 mg·kg^-1）， and high-dose and low-dose （5.36 and 2.68 g·kg^-1） groups of Youguiwan. The drug was given seven days after modeling， once a day for 12 weeks. After the treatment， the changes in femur tissue structure were observed by micro-CT， including bone mineral density （BMD）， bone volume/total volume （BV/TV）， trabecular number （Tb.N）， trabecular thickness （Tb.Th）， bone surface/bone volume （BS/BV）， and trabecular separation （Tb.Sp）. Ossification was observed by saffrane-solid green staining， and serum levels of bone metabolism markers， including bone alkaline phosphatase （BALP）， osteocalcin （BGP）， type Ⅰ procollagen amino terminal propeptide （PINP）， and tartrate-resistant acid phosphatase 5b （TRACP-5b）， were determined by enzyme-linked immunosorbent assay （ELISA）. The protein and mRNA expression levels of Runx2， BMP-2， and Smad1 in rat femur were detected by Western blot and Real-time fluorescence quantitative polymerase chain reaction （Real-time PCR）. ResultCompared with the sham operation group， bone trabecula in the model group was sparse. BMD， BV/TV， Tb.N， and Tb.Th were decreased （P<0.05， P<0.01）. BS/BV （P<0.05） and Tb.Sp were increased. The content of BGP， BALP， PINP， and TRACP-5b in serum was significantly increased （P<0.01）. The mRNA and protein expressions of Runx2， BMP-2， and Smad1 in rat femur were significantly decreased （P<0.05， P<0.01）. Compared with the model group， the number of bone trabeculae in the high-dose and low-dose groups of Youguiwan was increased， and the bone microstructure was improved. BMD， BV/TV， Tb.N， and Tb.Th were increased significantly （P<0.05， P<0.01）， and BS/BV and Tb.Sp were increased. The content of bone metabolic markers decreased （P<0.05， P<0.01）. ConclusionYouguiwan has certain preventive and therapeutic effects on postmenopausal osteoporosis， and its mechanism may be related to promoting bone formation by regulating the BMP-2/Smad signaling pathway.

Objective : To investigate the correlation between the expression level of YTHDF1 in oral squamous cell carcinoma ( OSCC) and clinicopathologic features and its potential prognostic value． Methods : The expression of YTHDF1 in 132 OSCC tissues and 66 paracancerous tissues was detected by immunohistochemistry (IHC) ，and the expression of YTHDF1 protein in OSCC cell lines was detected by Western blot．The correlation between YTHDF1 and clinicopathological features was analyzed by chi-square test．Kaplan-Meier and Cox factors were used to analyze the factors affecting the survival time of the patients and draw the survival curves of the YTHDF1 gene to evaluate its potential clinical significance. Results : The expression of YTHDF1 in OSCC tissues was higher than that in para- cancerous tissues (P＜0. 001) ，and the expression of YTHDF1 protein increased in OSCC cell lines compared with normal oral epithelial keratinocytes (P ＜0. 001) ．The expression of YTHDF1 was correlated with the TNM stage and T stage of patients with OSCC (P＜0. 05) ，and the patients with high expression of YTHDF1 had a shorter sur- vival time compared with those with low expression (P ＜0. 001) ． Conclusion High expression of YTHDF1 may be associated with poor patient prognosis and YTHDF1 may be able to serve as a target for OSCC treatment.

Objective:To guide cost control and the development of orthopedic specialty services in actual payment by thoroughly analyzing the functioning of DRG simulation in the pediatric orthopedic department of the Capital Institute of Pediatrics.Methods:A total of 736 patients from the orthopedic ward of the Capital Institute of Pediatrics were included as study subjects.The four-quadrant grouping method was employed to examine the profitability status of each diagnosis group in detail.A logistic regression model explored the key factors influencing profitability.Results:Congenital illnesses and traumas account for most pediatric orthopedic cases.Benefit groups(2 groups,4.8％),disadvantageous groups(15 groups,35.7％),key groups(8 groups,19.0％),and potential groups(17 groups,40.5％)are found using the Boston Matrix analysis.The profit group depends on the benefit groups(IF19,IH15)for 67.7％of its total revenue.No matter how profitable they are,medical consumables comprise a sizable portion(43％-45％).According to regression analysis,hospital profitability is highly impacted by age,consumable ratio,examination cost ratio,surgery cost ratio,and other cost ratios(P＜0.05).The consumable ratio is the most significant negative predictor(β=-2.238).Conclusion:Hospitals need to optimize their cost structure and increase the probability of profitability through refined management of consumables,the four-quadrant analysis method,strengthened cost accounting,and differentiated resource allocation.