OBJECTIVE To investigate the application status of prescription pre-review systems in healthcare institutions of Yunnan province， evaluate their system functions and management capabilities， and provide a practical basis for promoting rational drug use. METHODS A questionnaire survey was conducted among public healthcare institutions at or above the secondary level in Yunnan province to investigate the deployment status of the systems. A capability maturity assessment framework was constructed， encompassing 6 dimensions and 39 indicators， including real-time prescription review， prescription correlation review， rule setting， evidence-based information support， prescription authority management， and system operation management. This framework was then used to evaluate the institutions that had implemented the pre-review systems. RESULTS A total of 100 valid questionnaires were collected， with 37 institutions having adopted prescription pre-review systems， mainly tertiary hospitals. The system predominantly adopted a modular architecture and was embedded into the hospital information system through application programming interfaces and middleware， providing certain capabilities for real-time prescription risk identification. Evaluation results indicated that basic functions such as reviewing indications， contraindications， and drug compatibility performed well， while deficiencies remained in functions related to parenteral nutrition prescription， review of drug dosage for specific diseases， individual patient characteristic recognition， and rule setting. Moreover， the construction of review centers and establishment of management systems were also not well-developed. CONCLUSIONS The overall application rate of prescription pre-review systems in Yunnan province remains low. System functions and management mechanisms require further improvement. It is recommended to enhance information infrastructure in lower-level institutions and explore regionally unified review models to promote standardized and intelligent development of prescription review practices.

Objective:To investigate the clinical outcomes of Ortho-Bridge Combination System (OBCS) to achieve precise ulna-shortening osteotomy (USO) in the treatment of ulnar impaction syndrome.Methods:A retrospective study was conducted to analyze the 25 patients with ulnar impaction syndrome who had been treated at Institute of Orthopedic Trauma Research, The 920th Hospital of Joint Logistic Support Force of Chinese People's Liberation Army between January 2020 to March 2022. The patients all underwent USO using OBCS. They were 14 females and 11 males with an age of (43.2 ± 10.1) years. Their CT scans were retrieved for preoperative planning and design of a personalized USO. Intraoperatively, OBCS was fixated to the ulna before USO. After the bone was resected according to preoperative planning, the gap between the osteotomy sites was closed with compression, and OBCS was finally fixated with locking screws. The time for bone union after resection, complications, range of motion and grip strength were recorded. The clinical outcomes were evaluated by visual analogue scale (VAS) and Mayo wrist score.Results:All patients completed their operations successfully using OBCS. Their follow-up time was (13.5 ± 1.2) months. The ulnar variation was corrected and osteotomy ends got united in all patients, without nonunion, angulation, or rotation. The wrist VAS significantly decreased from 6.0 (5.0, 6.5) points before operation to 2.0 (1.0, 2.0) points at the last follow-up ( P<0.05). At the last follow-up, the Mayo wrist score [(85.4 ± 8.9) points], grip strength [(39.4 ± 1.2) kg], wrist flexion-extension (111.9° ± 12.6°), wrist pronation-supination (133.2° ± 15.7°), and ulnar radial deviation (35.3° ± 2.8°) were significantly increased compared with the preoperative values [(69.2 ± 13.3) points, (31.3 ± 5.2) kg, 102.0° ± 16.0°, 128.0° ± 15.5°, and 32.2° ± 2.8°] ( P<0.05). Conclusion:In the treatment of ulnar impaction syndrome, OBCS can facilitate the process of USO, correct ulnar variance, and avoid complications like rotation and angulation to improve functions of the wrist.

Objective:To investigate the efficacy of digital reconstruction technology in assisted design of lobulated deep inferior epigastric perforator flap (DIEPF) for surgical reconstruction of large defect in lower extremity.Methods:From January 2017 to January 2022, a study was carried out to retrospectively analyse 8 patients who had massive soft tissue defects in lower extremities were admitted in the Department of Orthopaedic Surgery of the 920 Hospital of Joint Logistic Support Force of Chinese PLA. The size of defects varied from 16.0 cm×12.0 cm-28.0 cm×22.0 cm. CTA scans were performed over abdominal aorta and the arteries of lower extremities. Three-dimensional model of DIEPF and vascular pedicles were reconstructed by Mimics software. According to the shape and size of the wound, targeted perforators were determined on the 3D images, and precisely mapped in a digitised rectangular coordinate system. The lobulated flap was then digitally designed in the 3D coordinate system. Flaps were harvested according to preoperative digital designs for the reconstruction of large defects in the lower extremities. The donor site was sutured directly. The flaps and recovery of lower extremities were observed though postoperative follow-ups and were conducted through visits of outpatient clinics and distance interviews via telephone and WeChat. Recoveries of lower extremities were evaluated using Maryland ankle-foot function scoring system.Results:The 3D reconstructed models of the vessels in donor sites were successfully completed for all patients. The harvests of lobulated DIEPF were successfully guided by the digital designs. Fifteen lobes of lobulated DIEPF survived successfully in all 8 patients. All donor sites were closed in the stage-I. Necrosis occurred at the distal tip of a lobulated flap due to a local venous occlusion, and healed after debridement and re-suture. Four patients received further flap debulking surgery. Time of postoperative follow-ups had ranged 15-27 months, with an average of 20 months. At the last follow-up, all the flaps had satisfactory appearance with linear scars at the donor sites. All fractures were healed. Five patients achieved Maryland's ankle-foot function score in excellent, 2 in good, and 1 was acceptable.Conclusion:Digital reconstruction technology can accurately map the perforators and reasonably assist the design of lobulated flaps. A lobulated DIEPF offers a wider area for flap excision and allows a primary closure of the donor sites. Combination of the 2 advantages of a lobulated DIEPF can be effectively applied in reconstruction of a large-sized defect in lower extremity.

Objective To investigate the effect of lycopene(LYC)on the oxidized low-density lipoprotein(ox-LDL)induced apoptosis of cerebral vascular endothelial cells(EC)by regulating the RAS homologous gene family member A(RhoA)/Rho-related kinase(ROCK)signaling pathway.Methods Human brain microvascular endothelial cells(HBMECs)without any treatments were de-signed as NC group;the HBMECs treated with ox-LDL were divided into ox-LDL group,LYC group(HBMECs treated with 0.5 μmol/L LYC),lysophosphatidic acid(LPA)group(HBMECs treated with 5 μmol/L RhoA/ROCK signaling pathway activator LPA),and LYC+LPA group(HBMECs treated with 0.5 μmol/L LYC and 5 μmol/L LPA);after 24 hours of treatment,they were used for subsequent experiments.Enzyme-linked immunosorbent assay(ELISA)was used to detect the cyto-kine levels of HBMECs;CCK-8 method was used to detect the proliferation of HBMECs;flow cy-tometry was used to detect the apoptosis rate of HBMECs;the Western blot was used to detect the expression levels of platelet endothelial cell adhesion molecule-1(CD31),smooth muscle(SM)22α,BCL-2 associated X protein(Bax),B-cell lymphoma/leukemia 2 protein(Bcl-2),cleaved-Caspase-3,and RhoA/ROCK pathway related proteins.Results Compared with the NC group,the levels of monocyte chemotactic protein-1(MCP-1),interleukin-6(IL-6),vascular endothelial cell adhesion molecule-1(VCAM-1),apoptosis rate of HBMECs,the Bax,cleaved-Caspase-3,SM22α,RhoA and ROCK1 proteins in the ox-LDL group increased significantly,while the OD val-ue and the levels of Bcl-2 and CD31 proteins decreased significantly(P＜0.05);compared with the ox-LDL group,the levels of MCP-1,IL-6,VCAM-1,apoptosis rate of HBMECs,the Bax,cleaved-Caspase-3,SM22α,RhoA,and ROCK1 proteins in the LYC group decreased significantly,while the OD value and the levels of Bcl-2 and CD31 proteins increased significantly(P＜0.05),but the trends in the LPA group were opposite;LPA weakened the improvement effect of LYC on ap-optosis of HBMECs induced by ox-LDL.Conclusion LYC may reduce apoptosis of HBMECs by inhibiting the RhoA/ROCK signaling pathway.

Objective To investigate the effect of lycopene(LYC)on the oxidized low-density lipoprotein(ox-LDL)induced apoptosis of cerebral vascular endothelial cells(EC)by regulating the RAS homologous gene family member A(RhoA)/Rho-related kinase(ROCK)signaling pathway.Methods Human brain microvascular endothelial cells(HBMECs)without any treatments were de-signed as NC group;the HBMECs treated with ox-LDL were divided into ox-LDL group,LYC group(HBMECs treated with 0.5 μmol/L LYC),lysophosphatidic acid(LPA)group(HBMECs treated with 5 μmol/L RhoA/ROCK signaling pathway activator LPA),and LYC+LPA group(HBMECs treated with 0.5 μmol/L LYC and 5 μmol/L LPA);after 24 hours of treatment,they were used for subsequent experiments.Enzyme-linked immunosorbent assay(ELISA)was used to detect the cyto-kine levels of HBMECs;CCK-8 method was used to detect the proliferation of HBMECs;flow cy-tometry was used to detect the apoptosis rate of HBMECs;the Western blot was used to detect the expression levels of platelet endothelial cell adhesion molecule-1(CD31),smooth muscle(SM)22α,BCL-2 associated X protein(Bax),B-cell lymphoma/leukemia 2 protein(Bcl-2),cleaved-Caspase-3,and RhoA/ROCK pathway related proteins.Results Compared with the NC group,the levels of monocyte chemotactic protein-1(MCP-1),interleukin-6(IL-6),vascular endothelial cell adhesion molecule-1(VCAM-1),apoptosis rate of HBMECs,the Bax,cleaved-Caspase-3,SM22α,RhoA and ROCK1 proteins in the ox-LDL group increased significantly,while the OD val-ue and the levels of Bcl-2 and CD31 proteins decreased significantly(P＜0.05);compared with the ox-LDL group,the levels of MCP-1,IL-6,VCAM-1,apoptosis rate of HBMECs,the Bax,cleaved-Caspase-3,SM22α,RhoA,and ROCK1 proteins in the LYC group decreased significantly,while the OD value and the levels of Bcl-2 and CD31 proteins increased significantly(P＜0.05),but the trends in the LPA group were opposite;LPA weakened the improvement effect of LYC on ap-optosis of HBMECs induced by ox-LDL.Conclusion LYC may reduce apoptosis of HBMECs by inhibiting the RhoA/ROCK signaling pathway.

Objective:To analyze the clinical characteristics of hereditary diffuse leukoencephalopathy with spheroids (HDLS).Methods:A retrospective analysis was performed. The clinical data of 2 patients with genetically conformed HDLS, admitted to our hospital in August 2020 and October 2021, were collected; and a literature search was conducted in domestic and foreign databases from January 2012 to January 2022 (enrolling a total of 48 patients with HDLS caused by colony-stimulating factor-1 receptor [ CSF1R] gene mutation). The population, clinical, imaging and gene mutation characteristics of these patients were summarized and analyzed. Results:(1) In these 50 patients, 20 were male and 30 were female, with onset age of (40.72±11.27) years; 40 patients (80.0%) had been misdiagnosed. (2) The most common first symptom and sign were progressive cognitive impairment (74.0%) and progressive dementia (80.0%). The patients in the middle and old aged group (≥40 years old, n=31) had significantly higher incidences of progressive cognitive impairment and Parkinson's-like symptom, and statistically lower incidence of muscle weakness as compared with those in the youth group (<40 years old, n=19, P<0.05). (3) The highest incidence of abnormal imaging findings was white matter lesions (100.0%), followed by cerebral atrophy (84.0%), ventricular enlargement (84.0%) and corpus callosum atrophy (60.0%). DWI examination was completed in 28 patients, and all patients showed persistent limitation of diffusion (100.0%). The most affected areas of white matter lesions were around the lateral ventricles, followed by the frontal-parietal occipital lobe, and corpus callosum. The incidence of abnormal signal of central semiovale in youth group was statistically higher than that in middle and old aged group ( P<0.05). (4) A total of 36 CSF1R gene mutations or possibly pathogenic mutations were identified in 50 patients, 21 of which were novel mutations reported for the first time. Of the 47 patients whose mutations were described in detail, 8 (17.0%) and 5 (10.6%) probands carried c. 2381T>C/p. I794T and c.2345G>A/p.R782H, respectively. Conclusions:The clinical manifestations of HDLS are diverse and lack of specificity. The most common first symptom and sign are progressive cognitive impairment and progressive dementia; however, the symptom spectrum and MRI imaging changes of white matter damage are related to age. MRI follow-up and targeted gene testing help reduce misdiagnosis and missed diagnosis of HDLS.

Objective:To analyze the clinical characteristics of hereditary diffuse leukoencephalopathy with spheroids (HDLS).Methods:A retrospective analysis was performed. The clinical data of 2 patients with genetically conformed HDLS, admitted to our hospital in August 2020 and October 2021, were collected; and a literature search was conducted in domestic and foreign databases from January 2012 to January 2022 (enrolling a total of 48 patients with HDLS caused by colony-stimulating factor-1 receptor [ CSF1R] gene mutation). The population, clinical, imaging and gene mutation characteristics of these patients were summarized and analyzed. Results:(1) In these 50 patients, 20 were male and 30 were female, with onset age of (40.72±11.27) years; 40 patients (80.0%) had been misdiagnosed. (2) The most common first symptom and sign were progressive cognitive impairment (74.0%) and progressive dementia (80.0%). The patients in the middle and old aged group (≥40 years old, n=31) had significantly higher incidences of progressive cognitive impairment and Parkinson's-like symptom, and statistically lower incidence of muscle weakness as compared with those in the youth group (<40 years old, n=19, P<0.05). (3) The highest incidence of abnormal imaging findings was white matter lesions (100.0%), followed by cerebral atrophy (84.0%), ventricular enlargement (84.0%) and corpus callosum atrophy (60.0%). DWI examination was completed in 28 patients, and all patients showed persistent limitation of diffusion (100.0%). The most affected areas of white matter lesions were around the lateral ventricles, followed by the frontal-parietal occipital lobe, and corpus callosum. The incidence of abnormal signal of central semiovale in youth group was statistically higher than that in middle and old aged group ( P<0.05). (4) A total of 36 CSF1R gene mutations or possibly pathogenic mutations were identified in 50 patients, 21 of which were novel mutations reported for the first time. Of the 47 patients whose mutations were described in detail, 8 (17.0%) and 5 (10.6%) probands carried c. 2381T>C/p. I794T and c.2345G>A/p.R782H, respectively. Conclusions:The clinical manifestations of HDLS are diverse and lack of specificity. The most common first symptom and sign are progressive cognitive impairment and progressive dementia; however, the symptom spectrum and MRI imaging changes of white matter damage are related to age. MRI follow-up and targeted gene testing help reduce misdiagnosis and missed diagnosis of HDLS.

Objective:To investigate the effectiveness of CT angiography (CTA) combined with three-dimensional modeling-assisted design of superficial peroneal artery perforator flap for reconstruction of traumatic hand wound.Methods:A retrospective case series study was conducted to analyze the clinical data of 15 patients with hand injury admitted to 920th Hospital of Joint Logistic Support Force of PLA from January 2016 to December 2019. There were 11 males and 4 females, aged 19-51 years [(27.8±8.1)years]. All patients had soft tissue defect of the hand with exposed bone or tendon, and the defect area ranged from 2.0 cm×1.0 cm to 6.0 cm×4.0 cm. All patients underwent CTA of the abdominal aorta to dorsalis pedis artery before surgery. The three-dimensional models of bones, blood vessels, skin and other tissues were reconstructed by Mimics 20.0 software. The location, diameter and length of the superficial peroneal artery perforator vessels were accurately measured, and the perforator flap was designed according to the shape and size of the defect, then the resection of flap was simulated. During the operation, the superficial peroneal artery perforator flap was removed and transplanted to repair the defect according to the design. The location, diameter and length of perforator vessels were measured intraoperatively and compared with the preoperative modeling measurement. The operation time and intraoperative blood loss were recorded. The survival of the flap and healing of the donor site were observed after operation. The function of the affected limb was evaluated according to the upper limb function evaluation standard of Chinese Medical Association before and 3 months after surgery. The appearance, sensation and motion of the donor site were observed 3 months after surgery.Results:The origin and course of superficial peroneal artery perforator vessels could be clarified preoperatively based on the three-dimensional model. There was no significant difference in the location, diameter and length of perforator vessels between the pre- and intra-operative measurements ( P>0.05). All patients were followed up for 6-20 months [(12.2±3.8)months]. The operation duration was 50-125 minutes [(91.2±10.4)minutes], with blood loss of 150-450 ml [(364.1±44.7)ml]. The partial epidermal necrosis occurred in 2 patients after surgery, which gradually healed after dressing change, and other flaps survived smoothly. All donor sites could be sutured directly, and all incisions healed by first intention. According to the upper limb function evaluation standard of the Chinese Medical Association, the affected limb scored (76.4±9.7)points 3 months after surgery, higher than the preoperative score of (48.2±10.1)points ( P<0.05). The results were excellent in 8 patients, good in 6 and fair in 1, with the excellent and good rate of 93%. All patients had slight scar growth in donor sites and showed no obvious abnormalities in the sensation of foot dorsum and donor sites, with normal walking gait. Conclusion:CT angiography combined with three-dimensional modeling can accurately locate the perforating vessels, realize the individualized and precise design of the superficial peroneal artery perforator flap, and assist in the rapid and accurate flap resection, and hence promote wound healing and functional recovery of the hand.

Alzheimer's disease (AD) is one kind of degenerative diseases of the central nervous system, constituting a major social problem and economic threat around the world. Early diagnosis and intervention are the keys to its prevention and treatment. The traditional diagnosis system based on clinical experience and biomarkers has many limitations. A completely new "digital biomarkers" diagnostic system based on wearable devices is being constructed with the rapid development on artificial intelligence, 5G network and other technologies. This article will comprehensively describe the research progress on wearable devices which used to capture different cognitive-related signals such as memory, visual space, speech, executive functions in the construction of AD "digital biomarkers" diagnosis system, and forecast its application prospect in the future diagnosis, prevention and treatment of AD.

Objective:To analyze the clinical characteristics of domestic sporadic Creutzfeldt-Jakob disease (sCJD).Methods:One patient diagnosed with probable sCJD in our hospital in October 2019 was firstly reported; the clinical data of this patient were retrospectively analyzed combining with those of 82 patients publicly reported in domestic core journals on China Biology Medicine disc, CNKI and WANFANG databases from 2009 to 2019 and met with MRI-CJD consortium criteria for sCJD.Results:Of the total 83 patients, 78 were diagnosed as clinically probable sCJD and other 5 as definite sCJD. There were 45 males and 38 females; the median age was 63 (58, 68) years. The course of disease was recorded in 56 patients, and the time from onset to death was 4.3 (2.9, 7.0) months. The onset and main symptoms were diverse and non-specific, however, progressive cognitive impairments, myoclonus, ataxia, visual dysfunction, akinetic mutism frequently occurred during the whole disease course. As compared with those in patients less than or equal to 65 years old, cerebellar symptoms and visual impairment occurred more frequently in patients over 65 years old ( P< 0.05). High diffusion weighted imaging (DWI) signals were detected on the cortex and/or the basal ganglia and/or the thalamus of 92.4% patients (73/79). Meanwhile, akinetic mutism was more likely to appear in patients with basal ganglia involvements than the unaffected ones (62.5% vs. 25.8%, P<0.05). Abnormal cortical DWI high signals in one patient were detected 7 months before the appearance of first symptom, and four patients who were clinically confirmed by dynamic follow-up DWI presented clinical symptoms highly corresponding to changes in DWI signals in brain regions. Conclusions:The sCJD tends to occur in the middle-aged and elderly patients, with high heterogeneity in clinical symptoms, durations and abnormal DWI signals, and symptoms caused by damage in posterior cranial fossa occur more frequently in patients over 65 years old; the DWI lesions in basal segment might be seen as a sign for deterioration of disease. Dynamic DWI follow-up may be helpful for early detection and objective reflection of sCJD intracerebral lesions.