Objective To investigate the clinical efficacy of tiotropium bromide in the treatment of patients with acute exacerbation of chronic obstructive pulmonary disease(AECOPD)complicated with acute respiratory failure.Methods A total of 106 patients with AECOPD complicated with acute respiratory failure admitted to the First People's Hospital of Huzhou from March 2019 to March 2022 were selected and divided into observation group and control group according to random number table method,with 53 cases in each group.Both groups were given routine treatment.The control group was treated with noninvasive biphasic positive airway pressure ventilation.The observation group was treated with tiotropium bromide on the basis of control group.Both groups were treated for 14 days.The clinical efficacy,lung function,blood gas index,inflammatory factors and adverse reactions were compared between two groups.Results The total effective rate of observation group was significantly higher than that of control group(94.34%vs.79.25%,χ2=5.267,P=0.023).After treatment,forced expiratory volume in one second(FEV1),FEV1/forced vital capacity,peak expiratory flow,pH,percutaneous arterial oxygen saturation and arterial partial pressure of oxygen in observation group were significantly higher than those in control group(P<0.05),while arterial partial pressure of carbon dioxide,interleukin-6,interleukin-8,tumor necrosis factor-α and hypersensitive C-reaction protein were lower than those in control group(P<0.05).There were no significant differences in the incidence of adverse drug reactions and ventilator adverse reactions between two groups(P>0.05).Conclusion Titropium bromide in the treatment of AECOPD complicated with acute respiratory failure can significantly improve the curative effect,improve pulmonary function and arterial blood gas,but attention should be paid to the timely treatment of adverse reactions of dry mouth.

Objective To analyze the spatiotemporal distribution characteristics of respiratory bacterial infections in Sanmenxia City from 2012 to 2022, and explore key areas for respiratory infection prevention and control. Methods Respiratory bacterial infection cases admitted to our hospital from 2012 to 2022 was collected, use OpenGeoDal software for spatial autocorrelation analysis, and SaTScan software for spatiotemporal scanning analysis. Results From 2012 to 2022, 8762 cases of respiratory bacterial infection were reported in Sanmenxia , with an average annual incidence of 173.47/100 000 and a standardized incidence of 132.63/100 000，and the overall incidence showed a downward trend (χ²=48.093，P<0.01). The incidence of respiratory tract bacterial infection has gender characteristics,the incidence of respiratory tract bacterial infection is the highest among people aged 50 years and above (P<0.05). There was no global spatial autocorrelation, and local autocorrelation results showed that the "high-high" clustering area was mainly located in Yima City. The spatiotemporal scanning results showed that the first level aggregation area was located in Yima City, with a time span of 2020-2022 and a radiation radius of 4.57 km (LLR=40.19, RR=3.27, P<0.001). Conclusion The overall trend of respiratory bacterial infections in Sanmenxia City is decreasing, and Yima City is a ^“high- high^” gathering area, which is a key region to prevention and control.

Objective:To explore the effects of Jianpi Bushen Jiedu Prescription on the proliferation and migration of hepatocellular carcinoma cells; To discuss its possible mechanism.Methods:Using human highly metastatic liver cancer cell line (HCCLM3) as the research object, they were randomly divided into control group and TCM group (100, 200, 400, 800, 1 600, 3 200 μg/ml Jianpi Bushen Jiedu Prescription) and Western medicine group (2.5, 5, 10, 20, 40 μmol/L sorafenib) using a random number table method. Cell viability was detected using cell counting reagent (CCK-8) method; HCCLM3 cells were divided into control group and TCM (Jianpi Bushen Jiedu Prescription 800 μg/ml) group and combined group (Jianpi Bushen Jiedu Prescription 800 μg/ml +sorafenib 20 μmol/L). Western blot method was used to detect the protein expressions of kinase/signaling transducer and transcriptional activator (JAK2/STAT3) pathway related proteins (p-JAK2, JAK2, p-STAT3, STAT3) in each group.Results:Compared with the control group, viability and mobility of HCCLM cell in TCM group and Western medicine group decreased ( P<0.01 or P<0.05); compared with the control group, the protein expressions of P-JAK2, JAK2, P-STAT3 and STAT3 in the TCM group and the combined group decreased ( P<0.05), and the JAK2 protein expression in the combined group was lower than that in the TCM group ( P<0.05). Conclusion:Jianpi Bushen Jiedu Prescription can inhibit the proliferation and migration of HCC cells by regulating JAK2/STAT3 pathway.

Objective:To explore the optimal regimen of standardized mite allergen immunotherapy for airway allergic diseases in children, and to observe the clinical efficacy, safety and compliance.Method:Use a retrospective real-world study, clinical data from 156 children aged 5-16 years who received subcutaneous immunotherapy (SCIT) with double mite allergen preparation in the pediatrics department of the Third Affiliated Hospital of Sun Yat sen University from June 2019 to September 2020 were selected for allergic rhinitis (AR) and/or allergic asthma (bronchial asthma, BA), including gender, age, total VAS(visual analogue scale) score and CSMS(combined symptom and medication scores) score at different time points (before treatment, 4-6 months, 1 year, and 2 years after initiation of desensitization), peripheral blood eosinophil counts (EOS), serum total IgE (tIgE), specific IgE (tIgE), and serum IgE (tIgE), specific IgE (sIgE), tIgG4, and incidence of local and systemic adverse reactions. All patients had a consistent regimen during the initial treatment phase (dose-escalation phase), which was performed as directed. Among them, 81 cases (observation group) continued to continue subcutaneous injection of 1 ml of vial No. 3 every 4-6 weeks during the dose maintenance phase, while 75 cases (control group) followed the old traditional regimen during the maintenance phase (i.e., change to a new vial to halve the amount of vial No. 3 by 0.5 ml, and then 0.75 ml after 1-2 weeks, and 1 ml in a further interval of 1-2 weeks). The clinical efficacy, safety and adherence to the treatment were compared between the two groups.Results:A total of 81 cases of 156 children were included in the observation group, of which 58 children with AR, 15 children with BA, and 8 children with AR combined with BA; 75 cases were included in the conventional control group, of which 52 children with AR, 16 children with BA, and 7 children with AR combined with BA. In terms of safety, the difference in the incidence of local and systemic adverse reactions between the two groups was not statistically significant ( χ2=1.541 for local adverse reactions in the control group, χ2=0.718 for the observation group; χ2=0.483 for systemic adverse reactions in the control group, χ2=0.179 for the observation group, P value >0.05 for all of these), and there were no grade Ⅱ or higher systemic adverse reactions in any of them. In the control group, there were 15 cases of dropout at 2 years of follow-up, with a dropout rate of 20.0%; in the observation group, there were 7 cases of dropout at 2 years of follow-up, with a dropout rate of 8.6%, and there was a statistically significant difference in the dropout rates of the patients in the two groups ( χ2=4.147, P<0.05). Comparison of serological indexes and efficacy (compared with baseline at 3 different time points after treatment, i.e., 4-6 months, 1 year and 2 years after treatment), CSMS scores of the observation group and the conventional control group at 4-6 months, 1 year and 2 years after treatment were significantly decreased compared with the baseline status ( t-values of the conventional group were 13.783, 20.086 and 20.384, respectively, all P-values <0.001, and t-values of the observation group were 15.480, 27.087, 28.938, all P-values <0.001), and VAS scores also decreased significantly from baseline status in both groups at 4-6 months, 1 year, and 2 years of treatment ( t-values of 14.008, 17.963, and 27.512 in the conventional control group, respectively, with all P-values <0.001, and t-values of 9.436, 13.184, and 22.377 in the observation group, respectively; all P-values <0.001). Intergroup comparisons showed no statistically significant differences in CSMS at baseline status, 4-6 months, 1 year and 2 years ( t-values 0.621, 0.473, 1.825, and 0.342, respectively, and P-values 0.536, 0.637, 0.070, and 0.733, respectively), and VAS was no statistically significant difference in comparison between groups at different time points ( t-values of 1.663, 0.095, 0.305, 0.951, P-values of 0.099, 0.925, 0.761, 0.343, respectively); suggesting that the treatment regimens of the observation group and the conventional control group were clinically effective, and that the two regimens were comparable in terms of efficacy. The peripheral blood eosinophil counts of the observation group and the conventional control group decreased significantly from the baseline status at 4-6 months, 1 year and 2 years of treatment ( t-values of the conventional group were 3.453, 5.469, 6.273, P-values <0.05, and the t-values of the observation group were 2.900, 4.575, 5.988, P-values <0.05, respectively). 4-6 months, 1 year and 2 years compared with the baseline status tIgE showed a trend of increasing and then decreasing ( t-value in the conventional group was -5.328, -4.254, -0.690, P-value was 0.000, 0.000, 0.492, respectively, and t-value in the observation group was -6.087, -5.087, -0.324, P-value was 0.000, 0.000, 0.745, respectively). However, the results of intergroup comparisons showed no statistically significant differences in serological indices and efficacy between the two groups in terms of peripheral blood eosinophil counts at baseline status, 4-6 months, 1 year and 2 years ( t-values of 0.723, 1.553, 0.766, and 0.234, respectively; P-values of 0.471, 0.122, 0.445, and 0.815, respectively), tIgE ( t-values of 0.170, -0.166, -0.449, 0.839, P-values 0.865, 0.868, 0.654, 0.403, respectively), tIgG4 ( t-values 1.507, 1.467, -0.337, 0.804, P-values 0.134, 0.145, 0.737, 0.422, respectively). Conclusion:Both immunotherapy regimens for airway allergic diseases with double mite allergen subcutaneous immunotherapy have significant clinical efficacy, low incidence of adverse reactions, and the observation group has better patient compliance than the control group.

Objective:To explore the optimal regimen of standardized mite allergen immunotherapy for airway allergic diseases in children, and to observe the clinical efficacy, safety and compliance.Method:Use a retrospective real-world study, clinical data from 156 children aged 5-16 years who received subcutaneous immunotherapy (SCIT) with double mite allergen preparation in the pediatrics department of the Third Affiliated Hospital of Sun Yat sen University from June 2019 to September 2020 were selected for allergic rhinitis (AR) and/or allergic asthma (bronchial asthma, BA), including gender, age, total VAS(visual analogue scale) score and CSMS(combined symptom and medication scores) score at different time points (before treatment, 4-6 months, 1 year, and 2 years after initiation of desensitization), peripheral blood eosinophil counts (EOS), serum total IgE (tIgE), specific IgE (tIgE), and serum IgE (tIgE), specific IgE (sIgE), tIgG4, and incidence of local and systemic adverse reactions. All patients had a consistent regimen during the initial treatment phase (dose-escalation phase), which was performed as directed. Among them, 81 cases (observation group) continued to continue subcutaneous injection of 1 ml of vial No. 3 every 4-6 weeks during the dose maintenance phase, while 75 cases (control group) followed the old traditional regimen during the maintenance phase (i.e., change to a new vial to halve the amount of vial No. 3 by 0.5 ml, and then 0.75 ml after 1-2 weeks, and 1 ml in a further interval of 1-2 weeks). The clinical efficacy, safety and adherence to the treatment were compared between the two groups.Results:A total of 81 cases of 156 children were included in the observation group, of which 58 children with AR, 15 children with BA, and 8 children with AR combined with BA; 75 cases were included in the conventional control group, of which 52 children with AR, 16 children with BA, and 7 children with AR combined with BA. In terms of safety, the difference in the incidence of local and systemic adverse reactions between the two groups was not statistically significant ( χ2=1.541 for local adverse reactions in the control group, χ2=0.718 for the observation group; χ2=0.483 for systemic adverse reactions in the control group, χ2=0.179 for the observation group, P value >0.05 for all of these), and there were no grade Ⅱ or higher systemic adverse reactions in any of them. In the control group, there were 15 cases of dropout at 2 years of follow-up, with a dropout rate of 20.0%; in the observation group, there were 7 cases of dropout at 2 years of follow-up, with a dropout rate of 8.6%, and there was a statistically significant difference in the dropout rates of the patients in the two groups ( χ2=4.147, P<0.05). Comparison of serological indexes and efficacy (compared with baseline at 3 different time points after treatment, i.e., 4-6 months, 1 year and 2 years after treatment), CSMS scores of the observation group and the conventional control group at 4-6 months, 1 year and 2 years after treatment were significantly decreased compared with the baseline status ( t-values of the conventional group were 13.783, 20.086 and 20.384, respectively, all P-values <0.001, and t-values of the observation group were 15.480, 27.087, 28.938, all P-values <0.001), and VAS scores also decreased significantly from baseline status in both groups at 4-6 months, 1 year, and 2 years of treatment ( t-values of 14.008, 17.963, and 27.512 in the conventional control group, respectively, with all P-values <0.001, and t-values of 9.436, 13.184, and 22.377 in the observation group, respectively; all P-values <0.001). Intergroup comparisons showed no statistically significant differences in CSMS at baseline status, 4-6 months, 1 year and 2 years ( t-values 0.621, 0.473, 1.825, and 0.342, respectively, and P-values 0.536, 0.637, 0.070, and 0.733, respectively), and VAS was no statistically significant difference in comparison between groups at different time points ( t-values of 1.663, 0.095, 0.305, 0.951, P-values of 0.099, 0.925, 0.761, 0.343, respectively); suggesting that the treatment regimens of the observation group and the conventional control group were clinically effective, and that the two regimens were comparable in terms of efficacy. The peripheral blood eosinophil counts of the observation group and the conventional control group decreased significantly from the baseline status at 4-6 months, 1 year and 2 years of treatment ( t-values of the conventional group were 3.453, 5.469, 6.273, P-values <0.05, and the t-values of the observation group were 2.900, 4.575, 5.988, P-values <0.05, respectively). 4-6 months, 1 year and 2 years compared with the baseline status tIgE showed a trend of increasing and then decreasing ( t-value in the conventional group was -5.328, -4.254, -0.690, P-value was 0.000, 0.000, 0.492, respectively, and t-value in the observation group was -6.087, -5.087, -0.324, P-value was 0.000, 0.000, 0.745, respectively). However, the results of intergroup comparisons showed no statistically significant differences in serological indices and efficacy between the two groups in terms of peripheral blood eosinophil counts at baseline status, 4-6 months, 1 year and 2 years ( t-values of 0.723, 1.553, 0.766, and 0.234, respectively; P-values of 0.471, 0.122, 0.445, and 0.815, respectively), tIgE ( t-values of 0.170, -0.166, -0.449, 0.839, P-values 0.865, 0.868, 0.654, 0.403, respectively), tIgG4 ( t-values 1.507, 1.467, -0.337, 0.804, P-values 0.134, 0.145, 0.737, 0.422, respectively). Conclusion:Both immunotherapy regimens for airway allergic diseases with double mite allergen subcutaneous immunotherapy have significant clinical efficacy, low incidence of adverse reactions, and the observation group has better patient compliance than the control group.

Objective To investigate the current status and awareness of pharmaceutical services in hospitals in Guizhou province and to provide a reference for exploring and carrying out pharmaceutical service fees.Methods The questionnaire was designed by the"wjx.cn"website.Three kinds of questionnaires were designed for pharmacists,doctors,nurses,and patients as the research objects,with corresponding differences in some questions,and promoted on WeChat,Dingxiangyuan,and other network platforms.Results A total of 655 questionnaires were collected,and 639 valid questionnaires were recovered,with an effective recovery rate of 97.56%.324 pharmacists(50.70%),82 doctors and nurses(12.83%),233 patients(36.46%)were surveyed.The average approval score of these three groups of respondents on pharmaceutical service fees was 4.67,4.23,and 4.22,respectively(full score:5).Conclusions Overall,pharmacists'professional services have received support from medical staff and patients.However,patients'pharmaceutical service projects currently focus on dispensing services.The recognition of pharmacists'work and the public's awareness of pharmaceutical services can be improved by enhancing the professional ability of pharmacists,strengthening publicity and guidance,and exploring"Internet+pharmaceutical services",etc.,to promote the sustainable development of pharmaceutical services.

Objective To retrospectively analyze the research on the integrated medical and elderly care in China in re-cent ten years,and explore the research hotspots and future research trend of the integrated medical and elderly care.Methods Using the method of literature research,the journal articles with the theme of combination of medical care and nursing,integration of medical care and nursing or medical care and nursing service from 2013 to 2023 were searched in CNKI.The sources were lim-ited to Peking University Core,CSSCI,CSCD and AMI,and the selected articles were analyzed by CiteSpace.Results This ar-ticle takes 896 literatures as research objects,we found that the number of articles reached a peak in 2018,the higher number of articles issued by the institutions are medicine-related institutions.The high-frequency keywords are the integrated medical and elderly care,elderly services,senior citizens,elderly care institutions and elderly care model.The strongest emergent word de-tected is health care integration.Conclusion In the past ten years,domestic research on the integration of medical care and eld-erly care has shown diversification and innovation.Policy tools,pension insurance,community and rural pension,quality evalua-tion index system,influencing factors were the research focus of scholars.Future research needs to focus on the application of quantitative methods,empirical and practical analysis.

Objective To explore the values of translocator protein (TSPO) and serum cell-free mitochondrial DNA (cf-mtDNA) in predicting the disease condition and prognosis of patients with traumatic shock. Methods Eighty patients (traumatic shock group) with traumatic shock and eighty patients (without traumatic shock group) without traumatic shock were selected. Complete demographic and clinical laboratory data of patients were collected. Blood samples of patients with traumatic shock were collected at the time points of immediately after admission (T₁) and the first day (T₂), the third day (T₃) and seventh day (T₄) after admission, the level of TSPO was measured by enzyme-linked immunosorbent assay (ELISA), and level of cf-mtDNA was measured by quantitative real-time polymerase chain reaction (qPCR). The levels of TSPO and cf-mtDNA were compared between patients with and without traumatic shock; the patients with traumatic shock were divided into the poor prognosis group and good prognosis group according to differed prognostic outcome, and the levels of TSPO and cf-mtDNA were compared between the two groups. The predictive values of TSPO and cf-mtDNA for the prognosis of patients with traumatic shock were analyzed by the receiver operating characteristic (ROC) curve. Results Compared with the no traumatic shock group, the traumatic shock group had higher levels of serum TSPO at T₁ to T₄ and higher levels of cf-mtDNA at T₂ to T₃, and the differences were statistically significant (P < 0.05). Compared with the good prognosis group, the poor prognosis group had higher levels of serum TSPO and cf-mtDNA at T₁ to T₄, and the differences were statistically significant (P < 0.05). Taking the prognosis of traumatic shock patients as the state variable to perform ROC curve analysis, the results showed that the area under the curve (AUC) of TSPO from T₁ to T₄ for predicting prognosis in the poor prognosis group was 0.825, 0.829, 0.695 and 0.869 respectively, while those of cf-mtDNA level from T₁ to T₄ for predicting prognosis in the poor prognosis group was 0.766, 0.766, 0.837 and 0.783 respectively, and the differences were statistically significant (P < 0.001). Conclusion Traumatic shock patients have elevated levels of TSPO and cf-mtDNA, with significantly higher levels observed in those with poor prognosis, and the TSPO level on the seventh day and cf-mtDNA level on the third day have the highest predictive value for prognosis.

Objective : To identify the factors affecting the adherence to administration of nucleoside/nucleotide analogues among patients with chronic hepatitis B (CHB), so as to provide insights into improving medication adherence among CHB patients. Methods: CHB patients at ages of 18 to 44 years that underwent treatment in Hangzhou First People's Hospital Affiliated to Zhejiang University School of Medicine from June 2021 to December 2022 were enrolled, and subjects' demographic and clinical characteristics were collected. The medication adherence was evaluated with the Morisky Medication Adherence Scale, and the negative illness perception was evaluated using the simplified Illness Perception Questionnaire, while the social support level was evaluated with the Social Support Scale. In addition, factors affecting the medical adherence were identified using a multivariable logistic regression model among CHB patients. Results: A total of 225 questionnaires were allocated and 210 valid questionnaires were recovered, with an effective recovery rate of 93.33%. The respondents had a mean age of (35.94±8.72) years, and included 119 men (56.67%) and 91 women (43.33%), with a mean total illness perception score of (44.09±12.06) points. Morisky Medication Adherence Scale classified good in 149 cases (70.95%) and poor in 61 cases (29.05%). Multivariable logistic regression analysis identified an educational level of college degree and above (OR=1.676, 95%CI: 1.105-2.910), family monthly per capita income of >5 000 Yuan (OR=2.518, 95%CI: 1.360-5.033), receiving health education pertaining to CHB (OR=3.590, 95%CI: 1.611- 7.932), high or medium level of social support (high: OR=3.202, 95%CI: 1.613-5.870; medium: OR=1.267, 95%CI: 1.085-2.409) as factors improving the medication adherence, and administration of more than 3 types of drugs (OR=0.388, 95%CI: 0.204-0.526) and high illness perception score (OR=0.601, 95%CI: 0.395-0.808) as factors constraining medication adherence among CHB patients. Conclusions The medication adherence are affected by educational level, family monthly per capita income, types of drugs, illness perception score, health education pertaining to CHB and social support level among CHB patients. Individualized intervention strategy is required targeting these influencing factors to improve the medication adherence among CHB patients.

Objective:To study the effects of Jianpi Bushen Jiedu Decoction on the epithelial-mesenchymal transformation of nude mice with HCCLM3 subcutaneous transplanted tumor by regulating JAK2/STAT3 pathway.Methods:HCCLM3 subcutaneous transplanted tumor model was established in mice. After the successful modeling, 24 nude mice were divided into blank group, TCM group and combined group according to random number table method, with 8 mice in each group. Mice in the TCM group were given 0.68 mg/ml alcohol extract of Jianpi Bushen Jiedu Decoction for gavage, and the combined group were given sorafenib suspension plus alcohol extract of Jianpi Bushen Jiedu Decoction 3.5 mg/ml for gavage, once a day, for consecutive 4 weeks. The effects of Jianpi Bushen Jiedu Decoction on tumor volume, tumor weight of HCCLM3 subcutaneous transplanted tumor and mice body weight were observed; Western blot was used to detect the expressions of E-cadherin, N-cadherin, Vimentin and JAK2/STAT3 pathway-related proteins in subcutaneous transplanted tumor tissues of hepatocellular carcinoma of mice in each group.Results:Compared with the control group, the average tumor weight of subcutaneous transplanted tumor decreased significantly in the TCM group and the combined group ( P<0.05), and the expressions of JAK2, STAT3, p-JAK2, p-STAT3, N-cadherin, and Vimentin decreased significantly in subcutaneous transplanted tumor tissue ( P<0.05), while E-cadherin increased ( P<0.05). Conclusion:Jianpi Bushen Jiedu Decoction can inhibit the growth of subcutaneous transplanted tumor of hepatocellular carcinoma in mice. The mechanism may be related to inhibiting the activation of JAK2/STAT3 pathway, thereby inhibiting the epithelial-mesenchymal transformation of hepatocellular carcinoma.