ObjectiveTo elucidate the critical role of rehabilitation medical records (including electronic records) in rehabilitation medicine's clinical practice and management, comprehensively analyzed the structure, core content and data standards of rehabilitation medical records, to develop a standardized medical record data architecture and core dataset suitable for rehabilitation medicine and to explore the application of rehabilitation data in performance evaluation and payment. MethodsBased on the regulatory documents Basic Specifications for Medical Record Writing and Basic Specifications for Electronic Medical Records (Trial) issued by National Health Commission of China, and referencing the World Health Organization (WHO) Family of International Classifications (WHO-FICs) classifications, International Classification of Diseases (ICD-10/ICD-11), International Classification of Functioning, Disability and Health (ICF), and International Classification of Health Interventions (ICHI Beta-3), this study constructed the data architecture, core content and data standards for rehabilitation medical records. Furthermore, it explored the application of rehabilitation record summary sheets (home page) data in rehabilitation medical statistics and payment methods, including Diagnosis-related Groups (DRG), Diagnosis-Intervention Packet (DIP) and Case Mix Index. ResultsThis study proposed a systematic standard framework for rehabilitation medical records, covering key components such as patient demographics, rehabilitation diagnosis, functional assessment, rehabilitation treatment prescriptions, progress evaluations and discharge summaries. The research analyzed the systematic application methods and data standards of ICD-10/ICD-11, ICF and ICHI Beta-3 in the fields of medical record terminology, coding and assessment. Constructing a standardized data structure and data standards for rehabilitation medical records can significantly improve the quality of data reporting based on the medical record summary sheet, thereby enhancing the quality control of rehabilitation services, effectively supporting the optimization of rehabilitation medical insurance payment mechanisms, and contributing to the establishment of rehabilitation medical performance evaluation and payment based on DRG and DIP. ConclusionStructured rehabilitation records and data standardization are crucial tools for quality control in rehabilitation. Systematically applying the three reference classifications of the WHO-FICs, and aligning with national medical record and electronic health record specifications, facilitate the development of a standardized rehabilitation record architecture and core dataset. Standardizing rehabilitation care pathways based on the ICF methodology, and developing ICF- and ICD-11-based rehabilitation assessment tools, auxiliary diagnostic and therapeutic systems, and supporting terminology and coding systems, can effectively enhance the quality of rehabilitation records and enable interoperability and sharing of rehabilitation data with other medical data, ultimately improving the quality and safety of rehabilitation services.

BACKGROUND:The incidence of osteoporosis significantly increases in the patients with rheumatoid arthritis,and it remains unclear whether the presence of a large number of immune complexes in serum promotes the onset and development of osteoporosis. OBJECTIVE:To investigate the correlation between serum immune complexes and osteoporosis in patients with rheumatoid arthritis. METHODS:(1)Clinical trial:Serum and clinical data of 50 healthy controls and 50 patients with untreated rheumatoid arthritis were collected and retrospectively analyzed.Total immune complex level in serum was compared between two groups.Correlation of serum total immune complexes with bone mineral density,bone turnover markers and other clinical indicators in patients with rheumatoid arthritis was analyzed.(2)Cell experiment:Peripheral blood mononuclear cells from healthy volunteers were isolated and cultured,and divided into four groups:rheumatoid arthritis group was added with total immune complex suspension from rheumatoid arthritis patients;normal control group was added with total immune complex suspension from healthy medical checkups;positive control group was added with α-MEM medium containing macrophage colony-stimulating factor and receptor activator of nuclear factor-kappa B ligand,and negative control group was added with α-MEM medium.Tartrate-resistant acid phosphatase staining was performed to observe the formation of osteoclasts after 7 days of treatment, RESULTS AND CONCLUSION:(1)Clinical trial:The total immune complex and serum alkaline phosphatase levels in patients with rheumatoid arthritis were significantly higher than those in health controls(P＜0.01,P＜0.05).Pearson correlation analysis showed that serum total immune complex level was positively correlated with erythrocyte sedimentation rate(r=0.330,P=0.019),serum alkaline phosphatase(r=0.545,P=0.001),anti-cyclic citrullinate peptide(r=0.377,P=0.007)and c-terminal telopeptide of type Ⅰ collagen(r=0.738,P=0.001),and negatively correlated with lumbar bone mineral density(r=-0.595,P=0.001)in patients with rheumatoid arthritis.Binary Logistic regression analysis showed that age[odds ratio(OR)=1.086,95%confidence interval(CI)(1.022,1.154),P=0.008],anti-cyclic citrullinate peptide[OR=1.002,95%CI(0.999,1.005),P=0.035],c-terminal telopeptide of type Ⅰ collagen[OR=0.141,95%CI(0.015,8.900),P=0.008]and serum total immune complexes[OR=2.895,95%CI(1.228,6.827),P=0.001]were the influencing factors for abnormal bone mass(reduced bone mass or osteoporosis)in patients with rheumatoid arthritis.(2)Cell experiment:Tartrate-resistant acid phosphatase positive osteoclasts were observed in the positive control group,normal control group and rheumatoid arthritis group,and there were more osteoclasts in the rheumatoid arthritis group than in the normal control group(P＜0.01).To conclude,serum total immune complexes can be used as a potential serologic predictor of rheumatoid arthritis complicated with osteoporosis,and removing immune complexes in serum or interfering with the binding of immune complexes to their receptors may be an effective means for the prevention and treatment of rheumatoid arthritis complicated with osteoporosis.

Objective To evaluate the bioequivalence and safety of ezetimibe tablets in healthy Chinese subjects.Methods The study was designed as a single-center,randomized,open-label,two-period,two-way crossover,single-dose trail.Subjects who met the enrollment criteria were randomized into fasting administration group and postprandial administration group and received a single oral dose of 10 mg of the subject presparation of ezetimibe tablets or the reference presparation per cycle.The blood concentrations of ezetimibe and ezetimibe-glucuronide conjugate were measured by high-performance liquid chromatography-tandem mass spectrometry(HPLC-MS/MS),and the bioequivalence of the 2 preparations was evaluated using the WinNonlin 7.0 software.Pharmacokinetic parameters were calculated to evaluate the bioequivalence of the 2 preparations.The occurrence of all adverse events was also recorded to evaluate the safety.Results The main pharmacokinetic parameters of total ezetimibe in the plasma of the test and the reference after a single fasted administration:Cmax were(118.79±35.30)and(180.79±51.78)nmol·mL-1;tmax were 1.40 and 1.04 h;t1/2 were(15.33±5.57)and(17.38±7.24)h;AUC0-t were(1 523.90±371.21)and(1 690.99±553.40)nmol·mL-1·h;AUC0-∞ were(1 608.70±441.28),(1 807.15±630.00)nmol·mL-1·h.The main pharmacokinetic parameters of total ezetimibe in plasma of test and reference after a single meal:Cmax were(269.18±82.94)and(273.93±87.78)nmol·mL-1;Tmax were 1.15 and 1.08 h;t1/2 were(22.53±16.33)and(16.02±5.84)h;AUC0_twere(1 463.37±366.03),(1 263.96±271.01)nmol·mL-1·h;AUC0-∞ were(1 639.01±466.53),(1 349.97±281.39)nmol·mL-1·h.The main pharmacokinetic parameters Cmax,AUC0-tand AUC0-∞ of the two preparations were analyzed by variance analysis after logarithmic transformation.In the fasting administration group,the 90％CI of the log-transformed geometric mean ratios were within the bioequivalent range for the remaining parameters in the fasting dosing group,except for the Cmax of ezetimibe and total ezetimibe,which were below the lower bioequivalent range.The Cmax of ezetimibe,ezetimibe-glucuronide,and total ezetimibe in the postprandial dosing group was within the equivalence range,and the 90％CI of the remaining parameters were not within the equivalence range for bioequivalence.Conclusion This test can not determine whether the test preparation and the reference preparation of ezetimibe tablets have bioequivalence,and further clinical trials are needed to verify it.

ObjectiveTo systematically analyze international disability data policies and standards, as well as the application of disability data in policymaking, service optimization and inclusive social development, and to clarify the importance of international disability data policies, standard systems and disability data application for the development of disability-related services. MethodsThrough the analysis of policy content and research on the data standard system, this study explored the disability data policy framework, standard system and technical path of data interoperability and integration of international organizations including the United Nations (United Nations Statistics Division and United Nations Children's Fund), World Health Orgnization, United Nations Educational Scientific and Cultural Organization, and International Labour Organization. ResultsInternational organizations established disability data policy frameworks based on their respective mandates, involving data and service development, data standards, data governance, and data application. The international community established a disability data standard system for disability data collection, coding, exchange, interoperability, statistical analysis, data fusion and application. Building a standardized disability data standard system based on the framework of international health classification standards such as International Classification of Functioning, Disability and Health, and International Classification of Diseases, Eleventh Revision would ensure the consistency of cross-national disability data policies, and the interoperability and comparability of disability data, promoting the development of data-driven disability-related services, accurately identifying the service needs of people with disabilities, and optimizing service provision, thereby improving the quality of life and social participation of people with disabilities. ConclusionThe construction and implementation of international disability data policies and data standards have promoted the standardization and interoperability of disability data. With the application of big data, artificial intelligence and blockchain technologies in disability data, international cooperation and cross-industry data fusion in the field of disability data have been promoted, further promoting the development of data-driven disability services, ensuring equal opportunities for people with disabilities to enjoy service resources, and improving the coverage and quality of disability services.

Objective Evaluation of the clinical efficacy of f trochanteric flip osteotomy combined with Kocher-Langen-beck approach for high acetabular posterior wall fracture.Methods Between January 2020 and December 2022,20 patients with high acetabular posterior wall fractures were retrospectively analyzed,including 12 males and 8 females,aged 18 to 75 years old.They were divided into two groups according to the different surgical methods.Ten patients were treated with greater trochanteric osteotomy combined with Kocher-Langenbeck approach as the observation group,including 5 males and 5 fe-males,aged from 18 to 75 years old.Ten patients were treated with Kocher-Langenbeck approach alone as the control group,including 7 males and 3 females,aged from 18 to 71 years old.Matta reduction criteria were used to evaluate the reduction quality of the two groups,and Harris score was used to compare the hip function of the two groups at the latest follow-up.The operation time,blood loss and postoperative complications of the two groups were analyzed.Results All patients were followed up for 10 to 24 months.According to the Matta fracture reduction quality evaluation criteria,the observation group achieved anatomical reduction in 6 cases,satisfactory reduction in 3 cases,and unsatisfactory reduction in 1 case,while the control group only achieved anatomical reduction in 3 cases,satisfactory reduction in 3 cases,and unsatisfactory reduction in 4 cases.At the final follow-up,the Harris hip score ranged from 71.4 to 96.6 in the observation group and 65.3 to 94.5 in the control group.According to the results of Harris score.The hip joint function of the observation group was excellent in 6 cases,good in 3 cases,and fair in 1 case.The hip joint function of the control group was excellent in 2 cases,good in 3 cases,fair in 3 cases,and poor in 2 cases.In the observation group,the intraoperative blood loss ranged from 300 to 700 ml,and the operation dura-tion ranged from 120 to 180 min;in the control group,the intraoperative blood loss ranged from 300 to 650 ml,and the opera-tion duration ranged from 100 to 180 min.Complications in the observation group included 1 case of traumatic arthritis and 1 case of heterotopic ossification,while complications in the control group included 3 cases of traumatic arthritis,3 cases of het-erotopic ossification and 1 case of hip abduction weakness.Conclusions Trochanteric flip osteotomy combined with the Kocher-Langenbeck approach significantly improved anatomical fracture reduction rates,enhanced excellent and good hip joint function outcomes,and reduced surgical complication incidence compared to the Kocher-Langenbeck approach alone.Clinical application of this combined approach is promising,although larger studies are needed for further validation.

Pancreatic polypeptide(PP),a pancreatic hormone containing 36 amino acids,plays impor-tant roles in the diagnosis and evaluation of pancreatic function,injury and diseases.In this study,a phage nanobody library against PP was constructed to screen specific PP nanobodies,which would be used to evaluate whether they have binding activity with PP antigen.After PP antigen with high purity was prepared by prokaryotic expression system,it was used to immunize alpaca to construct the nanobody li-brary against PP with high storage capacity and high abundance,from which 8 strains of PP nanobodies were obtained by phage display.One of nanobody strain(PP-VHH)was selected to be expressed in a prokaryotic expression system,which was induced overnight by IPTG.After purification and identifica-tion,the antigen-antibody binding activity and PP level in serum were detected by indirect ELISA and Sandwich ELISA methods,respectively.The results showed that PP-VHH had binding activity with PP,which could be used to detect PP in chicken and human serum.The Sandwich ELISA methods with R2 of the fitting curve 0.9868 could be used to detect PP concentrations of 48-55 pg/mL in the serum of chick-ens,while the concentrations of PP in human serum varied significantly.In summary,PP-VHH screened from nanobody library against PP could detect PP in serum,which would supply the basis for evaluation of abnormal pancreatic function and diagnosis of relative disease.

Objective To investigate the correlation between non-alcoholic fatty liver disease(NAFLD)and coronary artery plaque and perivascular adipose tissue(PVAT)parameters.Methods A total of 119 patients who underwent liver ultrasound and coronary computed tomography angiography(CCTA)examination were selected and divided into NAFLD group(50 cases)and non-NAFLD group(69 cases).The types of coronary artery plaque,plaque vulnerability,plaque involvement length,plaque load,vascular remode-ling,degree of vessel stenosis,and parameters of pericoronary fat[pericoronary fat attenuation index(pFAI),pericoronary fat total volume of voxels(pFV),perivascular water attenuation index(PVWI)]were evaluated.The data were analyzed statistically.Results The incidence of vulnerable plaque in NAFLD group was higher than that in non-NAFLD group,and the difference was statistically significant(P＜0.001).The incidence of positive vascular remodeling in NAFLD group was higher than that in non-NAFLD group,the incidence of no remodeling was the opposite,and the differences were statistically significant(P=0.001).The incidence of non-calcified plaque in NAFLD group was higher than that in non-NAFLD group,and the incidence of calcified plaque was the opposite(P=0.011).The incidence of severe stenosis in NAFLD group was higher than that in non-NAFLD group,and the incidence of moderate stenosis was the opposite,with statistical significance(P=0.004).The pFAI and plaque load in NAFLD group was higher than that in non-NAFLD group,and the pFV value was lower than that in non-NAFLD group,with statistical significance(P＜0.001,P=0.029,P=0.002).Conclusion The incidences of vulnerable plaque,positive remodeling,non-calcified plaque,vascular severe stenosis,and plaque load are significantly higher in NAFLD group than those in non-NAFLD group.In addition,pFAI increases and pFV decreases in NAFLD group.

Patients with severe trauma require an extremely timely treatment and transfusion plays an irreplaceable role in the emergency treatment of such patients. An increasing number of evidence-based medicinal evidences and clinical practices suggest that patients with severe traumatic bleeding benefit from early transfusion of low-titer group O whole blood or hemostatic resuscitation with red blood cells, plasma and platelet of a balanced ratio. However, the current domestic mode of blood supply cannot fully meet the requirements of timely and effective blood transfusion for emergency treatment of patients with severe trauma in clinical practice. In order to solve the key problems in blood supply and blood transfusion strategies for emergency treatment of severe trauma, Branch of Clinical Transfusion Medicine of Chinese Medical Association, Group for Trauma Emergency Care and Multiple Injuries of Trauma Branch of Chinese Medical Association, Young Scholar Group of Disaster Medicine Branch of Chinese Medical Association organized domestic experts of blood transfusion medicine and trauma treatment to jointly formulate Chinese expert consensus on blood support mode and blood transfusion strategies for emergency treatment of severe trauma patients ( version 2024). Based on the evidence-based medical evidence and Delphi method of expert consultation and voting, 10 recommendations were put forward from two aspects of blood support mode and transfusion strategies, aiming to provide a reference for transfusion resuscitation in the emergency treatment of severe trauma and further improve the success rate of treatment of patients with severe trauma.

Objective:To explore the efficacy and safety of eltrombopag in the treatment of immune thrombocytopenia secondary to connective tissue diseases.Methods:Totally 23 patients with immune associated thrombocytopenia secondary to connective tissue diseases who were treated with eltrombopag in the Department of Rheumatology, the First Affiliated Hospital of Soochow University, from January 2020 to December 2022 were selected as the treatment group. Additionally, 34 patients who did not receive eltrombopag during the same period were collected as the control group. Statistical analysis was conducted using SPSS 26.0 software. The t test or Wilcoxon rank-sum test were used to compare differences between groups of categorical data.The chi-square test or Fisher′s exact test was used to compare the differences between groups of quantitative data. Results:The highest overall response rate of the 23 patients was 82.6% (19/23), which occurred at the 12th week after treatment. The blood platelet count was significantly increased from baseline at the first week[(47±29)×10 9/L, t=-5.25, P<0.001], also at the 2nd week[(111±87)×10 9/L, t=-5.31, P<0.001], the 4th week[(150±104)×10 9/L, t=-6.23, P<0.001], the 12th week [(153±92)×10 9/L, t=-6.64, P<0.001], the 24th week[(134±83)×10 9/L, t=-7.11, P<0.001], and the difference was statistically significant. Compared with the conventional treatment group, patients in the eltrombopag group had a higher proportion of patients previously being treated with IVIG[60.9%(14/23) vs. 20.6%(7/34), χ2=9.57, P=0.002], a lower proportion of patients currently using IVIG[21.7% (5/23) vs. 61.8%(21/34), χ2=8.86, P=0.003], and a lower maximum daily dose of glucocorticoid use[80(50, 120)mg/d vs. 80(55, 115)mg/d, Z=-2.02, P=0.042], the differences were statistically significant. After being followed up for 24 weeks, no patients experienced any serious adverse reactions related to eltrombopag. Conclusion:Eltrombopag is effective and safe in the treatment of immune thrombocytopenia secondary to connective tissue diseases. It can be used as one of the choices for patients who failed to respond to conventional treatment or patients who could not tolerate high-dose glucocorticoids.