Objective:To investigate the level of serum lipoprotein a [Lp (a)] in patients with diffuse large B-cell lymphoma (DLBCL) and its clinical significance.Methods:A retrospective cohort study was performed. The clinical data of 87 patients with DLBCL who were treated at Changshu No.2 People's Hospital from January 2017 to June 2022 (the newly treated DLBCL group) were retrospectively analyzed, and 78 healthy physical examination subjects were selected as the control group. The level of Lp(a) in the two groups and the level of Lp(a) in DLBCL patients achieving different therapeutic effects after treatment were compared. The receiver operating characteristic (ROC) curve was used to analyze the efficacy of serum Lp(a) in predicting the therapeutic effect of DLBCL patients, and the area under the curve (AUC) was calculated to determine the optimal critical value. Based on the optimal critical value, patients with DLBCL were divided into low Lp(a) group and high Lp(a) group, and the clinicopathological characteristics of DLBCL patients with different Lp(a) levels were compared. Cox proportional hazards model was used to analyze the factors affecting the prognosis of DLBCL patients. Kaplan-Meier method was used to compare the relapse-free survival (RFS) and overall survival (OS) of DLBCL patients with different Lp(a) levels.Results:The level of Lp (a) in the newly treated DLBCL group was higher than that in the control group[ (0.24±0.09) g/L vs. (0.09±0.06) g/L], and the difference was statistically significant ( t = 3.61, P = 0.019). Among 87 patients, 54 achieved complete remission (CR), 23 achieved partial remission (PR), and 10 achieved progression of the disease (PD). The Lp (a) levels of patients achieving CR, PR, and PD were (0.09±0.09) g/L, (0.12±0.08) g/L, and (0.25±0.15) g/L, respectively. The Lp (a) levels in patients achieving CR and PR were lower than those in the newly treated DLBCL patients [(0.24±0.09) g/L], and the differences were statistically significant (all P < 0.05). There was no statistically significant difference in the Lp (a) levels between patients achieving PD and the newly treated DLBCL patients ( P > 0.05). The ROC curve results showed that the optimal critical value of serum Lp (a) in predicting the efficacy of DLBCL patients was 0.25 g/L, AUC was 0.776 (95% CI: 0.676-0.876, P < 0.05), and its sensitivity and specificity was 66.67%, 82.76%, respectively. According to the optimal critical value of Lp (a) (0.25 g/L), patients were divided into the low Lp (a) group (≤ 0.25 g/L) (57 cases) and the high Lp (a) group (>0.25 g/L) (30 cases). The proportion of patients with lactate dehydrogenase level >227 U/L, Ann Arbor stage Ⅲ-Ⅳ, and extranodal organ involvement >1 in the high Lp (a) group was higher than that in the low Lp (a) group, and the differences were statistically significant (all P < 0.05). Cox multivariate analysis results showed that Ann Arbor stage Ⅲ-Ⅳ, international prognostic index (IPI) score 3-5, and Lp (a)>0.25 g/L were independent risk factors for OS in DLBCL patients (all P < 0.05); Ann Arbor stage Ⅲ-Ⅳ and IPI score 3-5 were independent risk factors for RFS in DLBCL patients (all P < 0.05). The median OS in the low Lp (a) group was not reached; the median OS of the high Lp (a) group was 21 months, and there was a statistically significant difference in OS between the two groups ( P = 0.001). The median RFS time was not reached in the low Lp (a) group and the high Lp (a) group; and there was no statistically significant difference in RFS between the two groups ( P = 0.102) . Conclusions:Lp(a) level of DLBCL patients is increased, and Lp(a) could be a factor influencing the prognosis of DLBCL.

Since the concept of patient versions of guidelines （PVGs） was introduced into China， several PVGs have been published in China， but we found that there is a big difference between the concept of PVG at home and abroad， and the reason for this difference has not been reasonably explained， which has led to ambiguity and even misapplication of the PVG concept by guideline developers. By analyzing the background and purpose of PVGs， and the understanding of the PVG concept by domestic scholars， we proposed the term patient guidelines （PGs）. This refers to guidelines developed under the principles of evidence-based medicine， centered on health issues that concern patients， and based on the best available evidence， intended for patient use. Except for the general attribute of providing information or education， which is typical of common health education materials， PGs also provide recommendations and assist in decision-making， so PGs include both the patient versions of guidelines （PVG） as defined by the Guidelines International Network （GIN） and "patient-directed guidelines"， i.e. clinical practice guidelines resulting from the adaptation or reformulation of recommendations through clinical practice guidelines.

At present， the process and methodology of patient guidelines （PGs） development varies greatly and lacks systematic and standardised guidance. In addition to the interviews with PG developers， we have sorted out the relevant methodology for the adaptation and development of existing clinical practice guideline recommendations and facilitated expert deliberations to achieve a consensus， so as to finally put forward a proposal for guidance on the process and methodology for the development of PGs. The development of PGs can be divided into the preparation stage， the construction stage， and the completion stage in general， but the specific steps vary according to the different modes of development of PGs. The development process of Model 1 is basically the same as the patient version of the guideline development process provided by the International Guidelines Network， i.e.， team formation， screening of recommendations， guideline drafing， user testing and feedback， approval and dissemination. The developer should also first determine the need for and scope of translating the clinical practice guideline into a patient version during the preparation phase. Model 2 adds user experience and feedback to the conventional clinical practice guideline development process （forming a team， determining the scope of the PG， searching， evaluating and integrating evidence， forming recommendations， writing the guideline， and expert review）. Based on the different models， we sort out the process and methods of PG development and introduce the specific methods of PG development， including how to identify the clinical problem and how to form recommendations based on the existing clinical practice guidelines， with a view to providing reference for guideline developers and related researchers.

Objective:To explore the influencing factors and implementation paths of medical and preventive integration of chronic disease in county medical communities (CMCs), providing references for further promoting the integration of medical and prevention and improving the collaborative mechanism of medical and prevention.Methods:From October to November 2023, based on the principle of geographically balanced sampling, medical staff from 6 leading hospitals and 18 other member units of 6 CMCs in Zhejiang Province were selected as survey subjects. A self-designed survey questionnaire was conducted, mainly including the development and evaluation of chronic disease medical and preventive integration services in CMCs. The service development was designed according to the collaborative symbiosis management model, including 4 dimensions of collaborative symbiosis scenarios, willingness, ability, and process, as well as 11 secondary elements. Using secondary elements as the conditional variables and the integration effect of chronic disease medical and prevention as the outcome variable, a qualitative comparative analysis method was used to explore the relationship between multiple conditional variables and their combinations with high integration effect of chronic disease medical and prevention.Results:571 valid questionnaires were collected, with an effective response rate of 96.62%. The consistency of a single secondary element(including conditional non sets) on the high effectiveness of medical and preventive integration was less than 0.9, which cannot constitute a necessary condition for explaining the outcome variable. The configuration analysis results showed that the consistency of the condition combination formed by the interaction of multiple secondary elements was 0.835-0.845, indicating that the condition combination of multiple elements constituted a sufficient non necessary condition for the high integration effect of chronic disease medical and prevention. The configuration path for achieving high integration of medical and preventive effects could be divided into four categories, among which the feature of scenario-process dominance was to create a perfect service scenario and service process as the main focus; The characteristic of the willingness-process dominant type was to stimulate the service willingness of medical staff and improve the service process as the leading factor; The characteristic of the scenario-willingness-ability dominant type was to create a comprehensive service scenario, stimulate the service willingness of medical staff, and enhance service capabilities as the main focus; The characteristic of the willingness-ability-process dominant type was to stimulate the service willingness of medical staff, enhance service capabilities, and improve the service process as the dominant factor. In addition, the four types of configuration paths mentioned above all covered the two secondary elements of endogenous dynamics and professional competence, with a total coverage of 0.626 and a total consistency of 0.821.Conclusions:The configuration path formed through the interaction of multiple elements can effectively achieve the integration of chronic disease medical and prevention. The CMCs should choose the appropriate configuration path based on the actual situation. In addition, special attention should be paid to the endogenous motivation and professional capacity building of medical staff.

The standardization of classification methods of Traditional Chinese Medicine(TCM) ancient books can provide a clear and reliable reference for all kinds of TCM ancient books collection units, which can also promote the sharing and utilization of TCM ancient books. We studied and investigated the classification methods of TCM ancient books in past dynasties. The standard on classification of TCM ancient books was formulated by compared with the classification table of Zhongguo Zhongyi Guji Zongmu, and referred to the classification table of Zhonghua Guji Zongmu. This standard specified three-level categories and classification principles of TCM ancient books, and mainly composed of basic categories, three-level category table, classification principles and examples, and instructions for use.

Objective:To evaluate the efficacy and safety of acupuncture combined with antihypertensive drugs in the treatment of essential hypertension through meta-analysis.Methods:RCTs about acupuncture combined with antihypertensive drugs in the treatment of essential hypertension were retrieved from CNKI, VIP, WANFANG, CBM, PubMed, Embase and Web of Science from the establishment of the databases to January 28, 2022. The risk and quality of literature publication bias were evaluated according to Cochrane 5.1.0 System Evaluation Manual, and relevant data were extracted. RevMan 5.4 software was used for meta-analysis.Results:A total of 36 RCTs involving 2 905 patients were included. Meta-analysis results showed that compared with antihypertensive drugs, acupuncture alone demonstrated advantages in reducing systolic blood pressure [ SMD=-0.70 (-1.05, -0.36), P<0.01], diastolic blood pressure [ SMD=-0.69(-1.06, -0.32), P<0.01], antihypertensive efficacy [ RR=1.11 (1.04, 1.19), P<0.01], symptomes efficacy [ RR=1.21 (1.11, 1.31), P<0.01] and comprehensive efficacy [ RR=1.35 (1.16, 1.57), P<0.01], without serious adverse reactions. Conclusion:Acupuncture alone has good clinical efficacy and safety in the treatment of essential hypertension, compared with antihypertensive drugs alone. However, researches with large samples and high quality are still needed to support the conclusion.

Objective:To construct a primary health care institutions performance evaluation index system from the perspective of health value orientation under the background of countywide medical alliances construction.Methods:From May 2021 to February 2022, preliminary screening was made on core performance evaluation indexes via literature review; purposive sampling was used to select the dean/vice dean, persons in charge of medical service, and those in charge of public health service responsible for performance evaluation at the community health service center. Then semi-structured interviews were made on the existing performance evaluation and assessment plans as well as existing problems of primary medical and health institutions. Based on the " input-process-output" performance evaluation model, the thematic framework analysis method was used to analyze the interview data, and combined with literature research results, a preliminary performance evaluation index system for primary medical and health institutions was built under the guidance of health value. From March to May 2022, the Delphi expert consultation method was used to evaluate the importance and operability of indexes. The threshold method was used to screen indexes, and analytic hierarchy process was used to calculate the weights of evaluation indexes.Results:The health value oriented performance evaluation index system for primary healthcare institutions included 3 first-level indexes, 9 second-level indexes, and 50 third-level indexes. The first-level indexes were output (0.377 3), input (0.336 3), and process (0.286 4) in descending order of weight. The top three weighted second-level indexes were health manpower(0.177 8), health literacy and health outcomes (0.157 6), as well as responsiveness and satisfaction (0.142 6). The third-level indexes included 17 medical indexes, 16 prevention indexes, and 17 medical prevention integration indexes. The top three weighted indexes for inpatient services were resident satisfaction with medical treatment (0.052 4), medical staff satisfaction (0.050 1), and responsiveness of residents seeking medical treatment (0.040 1); The top three weighted third-level indexes excluding inpatient services were resident satisfaction with medical treatment (0.052 4), medical staff satisfaction (0.050 1), and surplus funds used for personnel incentives (0.045 5).Conclusions:The performance evaluation index system of primary health care institutions built under the health value orientation is scientific, conducive to promoting the health-orientated transformation and improving the efficiency of primary health care services.

Objective The objective is to probe into the effects of astragaloside Ⅳ (AS-Ⅳ) on activity and proliferative function of endothelial progenitor cells (EPCs),which lays a foundation for further study on the effects of AS-Ⅳ on vascular neovascularization mediated by endothelial progenitor cells.Methods The mononuclear cells were isolated by the density gradient centrifugation in umbilical cord blood of full-term healthy infants,and EPCs were obtained by subculture and cell identification when the cells presented spindle shapes.The obtained EPCs were randomly divided into the experimental group and the control group.In the experimental group,EPCs were cultured by AS-Ⅳ with different concentration gradients (25 mg/L,50 mg/L,100 mg/L,200 mg/L and 400 mg/L),while in the control group,they were treated with the same amount of phosphate buffer saline (PBS) solutions.The effects of AS-Ⅳ on the proliferation of endothelial progenitor cells was studied by cell counting kit-8 (CCK-8) cell proliferation experiment,and the activity rate of EPCs cells was measured at the optimum concentration of EPCs proliferation.Results EPCs were successfully obtained after confirming nuclear staining test of CD31 antibody and 4',6-diamidi-no-2-phenylindole (DAPI).Further study showed that AS-Ⅳ can promote the proliferation of EPCs,and its optimal concentration of EPCs proliferation is 100 mg/L.Compared with the normal control group,the activity rate of endothelial progenitor cells after intervention of AS-Ⅳ was 98.7％,higher than 98.12％ in the control group,with significant difference (x2 =49.59,P ＜0.01).Conclusions AS-Ⅳ can enhance the activity of human EPCs and promote their proliferation in vitro.

Objective To evaluate the efficacy of distal radioulnar joint (DRUJ) dorsal ligament reconstruction using extensor retinaculum transposition with triagular fibrocartilage complex (TFCC) repair and dorsal capsuloplasty for chronic DRUJ dorsal instability.Methods From October 2007 to July 2016,data of 18 patients (11 men and 7 women with a mean age of 37.4 years) were retrospectively analyzed who underwent DRUJ dorsal ligament reconstruction with extensor retinaculum transposition,DRUJ dorsal capsuloplasty,and TFCC repair for DRUJ dorsal instability.The tissue flap of extensor retinaculum was fixed at the ulnar edge of distal radius by two micro anchors after TFCC repair and dorsal capsuloplasty of the DRUJ capsule.X-ray examination of wrist was performed for all the patients after operation to identify the reduction of DRUJ.The wrist range of flexion and extension,the forearm range of rotation,and the grip strength of hand were measured.Modified Mayo wrist scores,DASH scores and visual analogue scale (VAS) were used to evaluate the function and pain of wrist and upper extremity.Results 18 patients were followed up for 12-70 months with an average period of 34 months.The stability of the DRUJ was restored in 16 patients.The other 2 cases wore long arm splint for 6 weeks after operation due to the residual instability of the DRUJ,after that the instability of DURJ were improved to grade I.The flexion and extension of wrist,the rotation of forearm were improved,but there were no significant difference comparing to those of pre-operation.The VAS,modified Mayo and DASH scores,grip strength of hand were significantly improved from preoperative 4.2±1.1,67.4±11.2,51.3±14.2,16.3±3.7 kg to postoperative 0.2±0.5,83.9±11.6,15.9±3.2,24.9±6.4 kg at the latest follow-up.Conclusion Extensor retinaculum transposition with TFCC repair and DRUJ dorsal capsuloplasty can effectively relieve pain and recovery stability of DRUJ,which was an effective method for chronic DRUJ dorsal instability.

Objective To study the homology and clinical characteristics of healthcare-associated infection(HAI) due to Pseudomonas aeruginosa (P.aeruginosa)in medical intensive care unit (MICU),so as to guide the clinical prevention of P.aeruginosa transmission and improve therapeutic effect.Methods 55 P.aeruginosa strains isola-ted from 25 patients with HAI in the MICU of a hospital in January-December 2014 were performed pulsed-field gel electrophoresis (PFGE)homology analysis and clustering analysis,clinical characteristics,antimicrobial resistance, and transmission characteristics were analyzed.Results A total of 25 patients were investigated,with an average age of (69.62±2.13)years,mean hospital stay (49.34±3.18)days;prior to the isolation of P.aeruginosa, 84.00% of patients were treated with broad-spectrum antimicrobial agents for >2 weeks,76.00% of patients had been admitted to MICU,and 52.00% had a ventilator-assisted ventilation.55 strains of P.aeruginosa were mainly A,F,H,K,N,V,and W,which were the main epidemic strains;patients infected with A,F,H and K strains all had cross in their hospital stay;PFGE profiles of isolates from 4 patients during different periods showed different strain patterns;resistance rates of P.aeruginosa to ceftazidime (72.73%), piperacillin/tazobactam (70.91%),and imipenem(70.91%)were all high,resistance rate to amikacin was the lowest(25.45%).Conclusion Management of antimicrobial agents should be strengthened in medical institutions,HAI control meas-ures should be strengthened,so as to prevent the transmission of multidrug-resistant and extensively drug-resistant bacteria in hospitals.