Objective:To investigate the effect of programmed blood glucose management model on blood glucose control and prognosis in patients with sepsis and diabetes mellitus.Methods:Seventy-six patients with sepsis and diabetes mellitus who received treatment at the Fifth Hospital Affiliated to Wenzhou Medical University (Lishui Central Hospital) were included in this study. According to the implementation time of programmed blood glucose management model, the patients were divided into a routine group ( n = 37; receiving routine nursing between January 2021 and December 2022) and an experimental group ( n = 39, receiving routine nursing and programmed blood glucose management). Length of hospital stay, 28-day mortality rate, blood glucose control level (glycosylated hemoglobin level, blood glucose variability, incidence of hypoglycemia, fasting blood glucose level, and 2-hour postprandial glucose level), and health status (Medical Outcomes Study-36-Item Shot-Form Health Status Survey) as well as incidence of adverse events were compared between the two groups. Results:The length of hospital stay in the experimental group was (14.85 ± 2.77) days, which was significantly shorter than that in the routine group [(17.42 ± 3.24) days, t = 3.72, P < 0.001]. The 28-day mortality rate in the experimental group was 7.69% (3/39), which was significantly lower than that in the control group [24.32% (9/37), χ2 = 3.95, P = 0.047]. The level of glycated hemoglobin and blood glucose variability in the experimental group were 10.4 (8.5, 12.1) mmol/L and (31.54 ± 7.16)%, which were significantly lower than those in the routine group [12.8 (8.9, 15.3) mmol/L, (45.63 ± 12.19)%, Z = 6.88, P < 0.001; t = 6.18, P < 0.001]. There was no significant difference in the incidence of hypoglycemia between the experimental and routine groups [10.81% (4/37) vs. 5.13% (2/39), χ2 = 0.84, P = 0.358]. After the intervention, the experimental group had higher scores in various dimensions of the 36-Item Shot-Form Health Status Survey, including limitations [(72.21 ± 5.37) points], bodily pain [(82.98 ± 6.41) points], general health [(81.32 ± 6.23) points], and physical function [(71.43 ± 5.22) points] compared with the routine group [(68.39 ± 6.21) points, (78.35 ± 6.17) points, (74.50 ± 7.57) points, (65.57 ± 6.96) points, t = 2.87, P = 0.005; t = 3.20, P = 0.002; t = 4.29, P < 0.001; t = 4.16, P < 0.001]. There was no significant difference in the incidence of adverse events between the experimental and routine groups [10.26% (4/39) vs. 13.51% (5/37), χ2 = 0.19, P = 0.660]. Conclusion:Programmed blood glucose management model can improve blood glucose control level and prognosis of patients with sepsis and diabetes mellitus.

Objective:To investigate the clinical characteristics in older adult patients with sepsis and heart failure, and to analyze the influential factors of prognosis.Methods:Eighty-eight older adult patients with sepsis and heart failure who received treatment at Lishui Central Hospital from January 2020 to December 2022 were retrospectively included in the heart failure group. Eighty-eight older adult patients with sepsis, who did not have heart failure, were selected in a 1:1 ratio to form a non-heart failure group. Based on their survival status during hospitalization, the patients in the heart failure group were divided into two subgroups: the survival group and the death group. Logistic regression analysis was performed to identify the risk factors associated with the development of heart failure and adverse disease outcomes in older adult patients with sepsis.Results:There were no statistically significant differences in sex, smoking history, alcohol consumption history, history of hypertension, and history of diabetes between the heart failure group and the non-heart failure group (all P > 0.05). However, the proportion of patients aged 75 years or older in the heart failure group was 52.27% (46/88), which was significantly higher than the proportion in the non-heart failure group [34.09% (30/88), χ2 = 5.93, P < 0.05]. The proportion of patients with respiratory system infections in the heart failure group was 53.41% (47/88), which was significantly higher than the proportion in the non-heart failure group [29.55% (26/88), χ2 = 10.37, P < 0.05]. Logistic regression analysis showed that advanced age and respiratory system infections are independent risk factors for the development of heart failure in patients with sepsis. Among patients with sepsis and heart failure, 45 survived and 43 died, resulting in a mortality rate of 48.86%. The average age of patients in the death group was (76.27 ± 4.14) years, which was significantly higher than that in the survival group [(72.29 ± 4.06) years, t = 4.55, P < 0.05]. The brain natriuretic peptide level and the Acute Physiology and Chronic Health Evaluation II (APACHE II) score in the death group were (636.70 ± 70.29) pg/mL and (31.93 ± 3.08) points, respectively, both of which were significantly higher than those in the survival group [(552.80 ± 54.66) pg/mL, (27.06 ± 3.80) points, t = 6.27, 6.59, both P < 0.05]. The lactate clearance rate and serum albumin level in the death group were (13.63 ± 4.84)% and (26.09 ± 4.77) g/L, respectively, both of which were significantly lower than those in the survival group [(19.94 ± 5.07)%, (30.55 ± 5.17) g/L, t = 5.97, 4.20, both P < 0.05]. Logistic regression analysis showed that in patients with sepsis and heart failure, advanced age, elevated serum brain natriuretic peptide levels, and high APACHE II scores are risk factors for poor prognosis and death. A high lactate clearance rate at 24 hours and elevated serum albumin levels are protective factors for survival. Conclusion:Advanced age and respiratory system infections increase the risk of heart failure in patients with sepsis. Advanced age, elevated brain natriuretic peptide levels, and high APACHE II scores are associated with an increased risk of death in these patients. High lactate clearance rates and elevated serum albumin levels are indicative of a reduced risk of death in patients with sepsis.

Extracellular vesicles (EVs) are phospholipid bilayer vesicles actively secreted by cells, that contain a variety of functional nucleic acids, proteins, and lipids, and are important mediums of intercellular communication. Based on their natural properties, EVs can not only retain the pharmacological effects of their source cells but also serve as natural delivery carriers. Among them, plant-derived nanovesicles (PNVs) are characterized as natural disease therapeutics with many advantages such as simplicity, safety, eco-friendliness, low cost, and low toxicity due to their abundant resources, large yield, and low risk of immunogenicity in vivo. This review systematically introduces the biogenesis, isolation methods, physical characterization, and components of PNVs, and describes their administration and cellular uptake as therapeutic agents. We highlight the therapeutic potential of PNVs as therapeutic agents and drug delivery carriers, including anti-inflammatory, anticancer, wound healing, regeneration, and antiaging properties as well as their potential use in the treatment of liver disease and COVID-19. Finally, the toxicity and immunogenicity, the current clinical application, and the possible challenges in the future development of PNVs were analyzed. We expect the functions of PNVs to be further explored to promote clinical translation, thereby facilitating the development of a new framework for the treatment of human diseases.

Objective:To compare ocular surface dry eye-related indexes and tear cytokine level changes in chronic ocular graft-versus-host disease (oGVHD) patients after receiving topical treatment of 0.05% cyclosporine or 0.1% tacrolimus eye drops.Methods:A randomized controlled study was conducted.A total of 60 chronic oGVHD patients (60 eyes) were recruited at Beijing University Third Hospital from April 2020 to April 2021.The patients were divided into tacrolimus group and cyclosporine group by a random number table, with 30 patients (30 eyes) in each group.Patients in tacrolimus group used 0.1% tacrolimus eye drops (twice a day) and patients in cyclosporine group used 0.05% cyclosporine eye drops (4 times a day).Additionally, 0.1% flumetholon (twice a day), deproteinized calf blood extract (3 times a day), and 0.1% sodium hyaluronate eye drops (8 times a day) were applied for anti-inflammation and lubrication in both groups.Patients were screened according to exclusion criteria after 1-month treatment.Eventually, 21 patients (21 eyes) in tacrolimus group and 12 patients (12 eyes) in cyclosporine group were included for further study.Patients were examined before and 1 month after treatment.The primary evaluation indexes included Ocular Surface Disease Index (OSDI), corneal fluorescein staining scores and tear film break-up time (BUT).Expressions of interleukin (IL)-6, IL-8, IL-17, epidermal growth factor (EGF), and tumor necrosis factor-α (TNF-α) in tears were detected before and after treatment using Luminex chip.This study adhered to the Declaration of Helsinki.The study protocol was approved by the Ethics Committee of Peking University Third Hospital (No.M2020489).Written informed consent was obtained from each subject before any medical examination.Results:The OSDI differences between before and after treatment were 0.4(-5.6, 2.5) in tacrolimus group and 27.2(4.6, 45.0) in cyclosporine group, and the OSDI improvement was significantly greater in cyclosporine group than in tacrolimus group ( Z=-2.547, P=0.009).The differences of corneal fluorescein staining scores and BUT between before and after treatment were 5.0(2.5, 10.0) scores and 3.5(-0.5, 13.8) seconds in tacrolimus group, 0.0(-3.0, 0.0) scores and -1.5(-3.0, 0.0) seconds in cyclosporine group, respectively, with no significantly difference between both groups ( Z=-0.526, -0.804; both at P>0.05).The differences of IL-6, IL-8, IL-17, EGF and TNF-α expressions between before and after treatment in tacrolimus group and cyclosporine group were not significantly different ( Z=-0.487, -0.112, -0.412, -1.085, -1.198; all at P>0.05). Conclusions:Altered levels of all tested cytokines in oGVHD tears are of no significant differences between tacrolimus and cyclos porine treatment.In addition, 0.05% cyclosporine eye drops may be more comfortable than 1% tacrolimus for chronic oGVHD patients.

OBJECTIVE To introduce the construction of undergraduate specialty of clinical pharmacy based on the concept of outcome-based education （OBE），and to provide new idea and enlightenment for the construction of undergraduate specialty of clinical pharmacy in Chinese universities. METHODS Through the establishment and construction of training objectives and graduation requirements ，teaching reform was designed and implemented ，and the construction of teaching support system and teaching quality assurance system were completed. RESULTS The clinical pharmacy department of our university established the training direction of clinical pharmacy talents under the guidance of post competence ，including clarifying the training needs of undergraduate talents based on the overall requirements of national undergraduate education ；defining the social and industrial needs of clinical pharmacy talents based on the normative documents or concepts of clinical pharmacy ；clarifying the post and ability needs of clinical pharmacy talents based on the investigation of graduates and clinical pharmacists ；clarifying the development needs of clinical pharmacy based on the current situation and trends at home and abroad ；forming characteristic training objectives combined with the regional characteristics and school positioning ， so as to construct training objectives and graduation requirements. The OBE concept was introduced into the undergraduate teaching reform of clinical pharmacy ；the pharmacy talent training direction were established under the guidance of post competence ；the training system was designed by reverse design method；a training mode of both innovation and practical ability was built so as to promote teaching reform ，strengthen the construction of grass-roots teaching organizations and teaching staff ， and improve the construction of teaching quality assurance system. CONCLUSIONS The undergraduate training mode of clinical pharmacy specialty based on the concept of OBE is helpful to improve students ’personal comprehensive quality and professional knowledge and skills. The established undergraduate training model of clinical pharmacy specialty is in line with the modern educational concept and social needs ，and provides theoretical basis and practical experience for the training mode of clinical pharmacy professionals.

Epigenetics has been very hot in the research of biomedicine. In addition to genetic factors, the occurrence of a disease is also influenced by environmental factors. Retinal vascular diseases are a type of irreversible blind eye disease, such as age-related macular degeneration and diabetic retinopathy. The retinal vessel changes are the major features of retinal vascular diseases, which are the result of interaction of multiple environmental factors and genes. Epigenetic modification mainly includes DNA methylation, histone modification, and non-coding RNA regulation. Epigenetic mechanisms mediate the effects of environmental factors on genes related to retinal vascular diseases, and affect the eventual development of the diseases. Therefore, ophthalmologists should keep eyes close on the role of epigenetics in retinal vascular diseases, track the progress of epigenetic methods in the treatment of retinal vascular diseases, and pay attention to the application prospects of epigenetics. Finding the epigenetic regulators of these diseases can not only deepen the understanding of the pathological mechanism of these diseases, but also provide new ideas for the diagnosis and treatment of these diseases.

Through the analysis of Shenyang Medical College student's scientific research from 2007 to 2016, college student's scientific research has played an important role in promoting the cultivation of innovative talents, it has been an effective way that students understand the process of scientific research, cultivate scientific research ability, and that scientific research promotes teaching in university. College student's research should enhance the scientific and feasibility of the project selection, cultivate students the spirit of independent scientific research.

Objective To investigate and analyze the attitudes towards interprofessional learning among nursing students and medical students,and thereby provide basis for interprofessional education (IPE).Methods Readiness of Interprofessional Learning Scales (RIPLS) were used to investigate 107 nursing students in the third grade and 80 medical students in the fourth grade.A comparison analysis of interprofessional learning was carried out among nursing students and medical students.Results Nursing and medical students' mean scores of RIPLS were (4.48±0.42) and (4.27±0.36),respectively.Nursing students' scores of RIPLS and professional identity were significantly higher than those of medical students.Conclusions Nursing students in the third grade and medical students in the fourth grade both have a positive attitude towards interprofessional learning,so IPE is expected to carry out at these stages to achieve good teaching effect.Meanwhile,for the medical students,it may be appropriate to increase the proportion of humanities and social science courses,increase opportunities to participate in clinical practice,in order to facilitate the improvement and development of their professional identity and interdisciplinary learning attitude,and better implementation of IPE.

Objective To identify the quality of life (QOL)and major influencing factors for migrant workers in Zhejiang province.Methods The QOL of 1217 migrant workers and 1387 permanent urban residents in Zhejiang province were measured by WHOQOL-BREF scale (Chinese version)in a stratified sampling.A multiple linear regression model was used to analyze the relationship between the factors and the scores of the four domains.Results There were no significant statistical differences(P＞0.05)found in the scores of physical health,social relationship and general health between migrant workers and urban residents.Their scores of psychological health,surrounding conditions and general quality of life,however,were found lower than urban residents (3.5 ± 0.8 vs 3.6 ± 0.8).Influencing factors for their psychology were education,family conflicts and appetite; those for their surrounding conditions were daily average work hours and appetite.Conclusion Given improvements in the quality of life of migrant workers,rooms to improve were found in such scores as psychological health and surrounding conditions.

OBJECTIVETo study the effect and safety of Kudiezi injection on patients with acute ischemic stroke.

METHODSeven hundreds patients were divided into two groups by central randomization system. The study group, 346 cases, was treated with kudiezi injection plus traditional Chinese medicine (TCM) synthesis rehabilitation project, and the control group, 354 cases, was treated with synthetic rehabilitation project. The patients were treated for 10 to 21 days. Before treatment and at the 7th, 14th and 21th day of treatment, the indexes include NIHSS used for evaluating the neurological deficit degree and the motor function score (Fugl-Meyer) for evaluating motor function were observed. The safety index is defined by adverse observation event and laboratory test. The incidence of adverse events and laboratory tests results were observed before and after treatment at the same time.

RESULTApplication of generalized estimating equation model, we found that as the treatment time, NIHSS score and FMI score of the two groups showed a trend of improvement. And at the 14th days and 21th days of treatment, compared to the control group the treatment group showed significant statistical difference on the impact of NIHSS and FMI (P<0.05). No serious adverse events were observed.

CONCLUSIONKudiezi injection plus TCM rehabilitation project of ischemic stroke showed some superiority to western medicine rehabilitation program on improving the neurological deficit and motor function. Kudiezi injection is safe and effective in the treatment of acute ischemic stroke.

Aged ; Brain Ischemia ; drug therapy ; Drug-Related Side Effects and Adverse Reactions ; Drugs, Chinese Herbal ; adverse effects ; therapeutic use ; Female ; Humans ; Injections ; Male ; Medicine, Chinese Traditional ; adverse effects ; Middle Aged ; Product Surveillance, Postmarketing ; Stroke ; drug therapy