Use of a Remote Oncology Pharmacy Service Platform for Patients With Cancer During the COVID-19 Pandemic: Implementation and User Acceptance Evaluation.

BACKGROUND: The COVID-19 outbreak has increased challenges associated with health management, especially cancer management. In an effort to provide continuous pharmaceutical care to cancer patients, Sun Yat-sen University Cancer Center (SYSUCC) implemented a remote pharmacy service platform based on its already existing web-based hospital app known as Cloud SYSUCC. OBJECTIVE: The aim of this study was to investigate the characteristics, acceptance, and initial impact of the Cloud SYSUCC app during a COVID-19 outbreak in a tertiary cancer hospital in China. METHODS: The total number of online prescriptions and detailed information on the service were obtained during the first 6 months after the remote service platform was successfully set up. The patients' gender, age, residence, primary diagnosis, drug classification, weekly number of prescriptions, and prescribed drugs were analyzed. In addition, a follow-up telephonic survey was conducted to evaluate patients' satisfaction in using the remote prescription service. RESULTS: A total of 1718 prescriptions, including 2022 drugs for 1212 patients, were delivered to 24 provinces and municipalities directly under the Central Government of China between February 12, 2020, and August 11, 2020. The majority of patients were female (841/1212, 69.39%), and 90.18% (1093/1212) of them were aged 31-70 years old. The top 3 primary diagnoses for which remote medical prescriptions were made included breast cancer (599/1212, 49.42%), liver cancer (249/1212, 20.54%), and thyroid cancer (125/1212, 10.31%). Of the 1718 prescriptions delivered, 1435 (83.5%) were sent to Guangdong Province and 283 (16.5%) were sent to other provinces in China. Of the 2022 drugs delivered, 1012 (50.05%) were hormonal drugs. The general trend in the use of the remote prescription service declined since the 10th week. A follow-up telephonic survey found that 88% (88/100) of the patients were very satisfied, and 12% (12/100) of the patients were somewhat satisfied with the remote pharmacy service platform. CONCLUSIONS: The remote pharmacy platform Cloud SYSUCC is efficient and convenient for providing continuous pharmaceutical care to patients with cancer during the COVID-19 crisis. The widespread use of this platform can help to reduce person-to-person transmission as well as infection risk for these patients. Further efforts are needed to improve the quality and acceptance of the Cloud SYSUCC platform, as well as to regulate and standardize the management of this novel service.

Mantle Branch-Specific RNA Sequences of Moon Scallop Amusium pleuronectes to Identify Shell Color-Associated Genes.

Amusium pleuronectes (Linnaeus) that secretes red- and white-colored valves in two branches of mantle tissues is an excellent model for shell color research. High-throughput transcriptome sequencing and profiling were applied in this project to reveal the detailed molecular mechanism of this phenotype differentiation. In this study, 50,796,780 and 54,361,178 clean reads were generated from the left branch (secreting red valve, RS) and right branch (secreting white valve, WS) using the Illumina Hiseq 2000 platform. De novo assembly generated 149,375 and 176,652 unigenes with an average length of 764 bp and 698 bp in RS and WS, respectively. Kyoto encyclopedia of genes and genomes (KEGG) metabolic pathway analysis indicated that the differentially expressed genes were involved in 228 signaling pathways, and 43 genes were significantly enriched (P<0.01). Nineteen of 20 differentially expressed vitellogenin genes showed significantly high expression in RS, which suggested that they probably played a crucial role in organic pigment assembly and transportation of the shell. Moreover, 687 crystal formation-related (or biomineralization-related) genes were detected in A. pleuronectes, among which 144 genes exhibited significant difference between the two branches. Those genes could be classified into shell matrix framework participants, crystal nucleation and growth-related elements, upstream regulation factors, Ca level regulators, and other classifications. We also identified putative SNP and SSR markers from these samples which provided the markers for genetic diversity analysis, genetic linkage, QTL analysis. These results provide insight into the complexity of shell color differentiation in A. pleuronectes so as valuable resources for further research.

[Joint effects of water temperature and salinity on the expression of gill Hsp70 gene in Pinctada martensii (Dunker)].

By using central composite experimental design and response surface method, the joint effects of water temperature (16-40 degrees C) and salinity (10-50) on the expression of gill Hsp70 gene in Pinctada martensii (Dunker) were studied under laboratory conditions. The results showed that the linear and quadratic effects of temperature on the expression of gill Hsp70 gene were significant, the linear effect of salinity was not significant, while the quadratic effect of salinity was significant. The interactive effect of temperature and salinity was not significant, and the effect of temperature was greater than that of salinity. The model equation of the gill Hsp70 gene expression was established, with the R2, Adj. R2, and Pred. R2 as high as 98.7%, 97.4%, and 89.2%, respectively, suggesting that the overarching predictive capability of the model was very satisfactory, and could be practicably applied for prediction. Through the optimization of the model, the expression of the gill Hsp70 gene reached its minimum (0.5276) when the temperature was 26.78 degrees C and the salinity was 29.33, with the desirability value being 98%. These experimental results could offer theoretical reference for the high expression of gill Hsp70 gene in P. martensii, the maintenance of cell internal environment stability, and the enhancement of P. martensii stress resistance.

Superwarfarin poisoning as a cause of intestinal obstruction.

A 17-year-old boy was brought to our department with nausea, vomiting, absence of flatus or bowel movements, abdominal distension, and pain for about 5 days. Emergency abdominal CT scan showed extensive gas-fluid levels in the intestinal tract and intestinal wall swelling that indicated acute intestinal obstruction. Routine coagulation tests revealed abnormality and further provided evidence of superwarfarin poisoning. With high dosage of vitamin K1 and fresh frozen plasma therapy, surgery was avoided.

[Effect of felodipine on the expression of NF-kappaB in rat model of atherosclerosis].

OBJECTIVE: To investigate the possible mechanism of felodipine on experimental atheroselerosis formation in rats. METHODS: The rat model of atherosclerosis was established by the methods of intraperitoneal injection of Vitamin D3 and high-fat diet. Thirty male SD rats were randomly divided into normal group, atherosclerosis model group and felodipine treating group. At the end of 6 weeks, the expression of NF-kappaB (nuclear transcription fator-kappaB) in endothelial cells and smooth muscle cells of aorta were determined. RESULTS: The positive rates of NF-kappaB in both atherosclerosis model group and felodipine treating group (46.59+/-5.68, 20.47+/-1.97) were higher than that of normal group (4.38+/-1.07, P<0.01). The expression of NF-kappaB in atherosclerosis model group was higher than that of felodipine treating group (P<0.01). CONCLUSIONS: The mechanism of felodipine in relieving atheroselerosis may correlate with the inhibition of NF-kappaBp65 activation.

[Experimental investigation on protective effect of dexamethasone therapy to traumatic brain injury in rats].

OBJECTIVE: To explore the effects of dexamethasone on nuclear factor-KappaB (NF-KappaB) expression in brain tissue after traumatic brain injury (TBI). METHODS: Forty rats were randomly divided into two groups: dexamethasone treatment and no treatment, and severe brain injury was produced by gas percussion in both groups. At 0, 6, 24, 72 and 120 hours after injury, 5 rats of each group were executed and the histopathological changes in brain tissue in rats were observed by hematoxylin-eosin (HE) stain. The expression of NF-KappaB in brain tissue of rats was detected by immunohistochemical method. RESULTS: NF-KappaB expression was significantly up-regulated at 6 hours in brain tissue of rats after TBI (P<0.05), reaching the highest level at 24 hours (P<0.01). It showed a tendency to lower, but was still high at 120 hours after TBI (P<0.05 or P<0.01). After treatment with dexamethasone, NF-KappaB level was lowered at 6, 24 and 72 hours (all P<0.01). CONCLUSION: NF-KappaB expression is up-regulated in brain tissue in early period after TBI, and keeps on a high level, thus inducing inflammatory response to produce secondary injury to brain tissue. Dexamethasone shows protective effects by regulating the levels of NF-KappaB and prevents secondary injury which is caused by the inflammatory cytokines in rat brain tissue after TBI.

[Experimental study on protective effects of dexamethasone on traumatic brain injury in rats].

OBJECTIVE: To investigate the changes of NF-kappaB in brain tissue after the treatment of naloxone in rats with traumatic brain injury, and to explore the protective effects and its mechanisms of dexamethasone on TBI. METHODS: The rat model of severe brain injury was produced by gas percussion. The histopathological changes of brain tissue were observed by HE stain. The expression of NF-kappaB in brain tissue was detected by immunohistochemical method. RESULTS: After traumatic brain injury, the expression of NF-kappaB in rat brain tissue significantly increased at 6 h (P<0.05) and reached the peak value at 48 h, then the increased level of NF-kappaB lower down slightly and maintained at quite high level to 120 h after TBI (P<0.01). With the treatment of dexamethasone, the expression level of NF-kappaB decreased significantly (P<0.05). CONCLUSIONS: Dexamethasone showed protective effects by regulating the levels of NF-kappaB and relieved the second injury caused by the inflammatory cytokines in rat brain tissue after TBI.

[Study on the expression of matrix metalloproteinase-9 in lung fibroblasts of rat with acute paraquat poisoning].

OBJECTIVE: To investigate the expression and effect of matrix metaloproteinases-9 in lung injury of rats with acute paraquat poisoning. METHODS: 50 SD rats were randomly divided into control group and poisoned group. At 1, 3, 7, 14, 28 days after exposed to paraquat, five rats of each group were used to assess lung pathological changes, and the expression of MMP-9 mRNA in lungs was evaluated by RT-PCR. RESULTS: (1) The expressions of MMP-9 protein and mRNA markedly increased at the first day of paraquat poison, reached the peak at the 7th day, decreased slowly afterwards. (2) The expressions of MMP-9 protein and mRNA markedly increased at 1, 3, 7 days. The protein expression of MMP-9 returned to baseline level at the 28th day, and mRNA expression of MMP-9 returned to baseline at the 14th day. CONCLUSION: The expression of MMP-9 in lung fibroblasts is up-regulated in silicotic fibrosis model.

[Substitution of esophagus with stomach or colon without thoracotomy in the treatment of cervical esophageal carcinoma with laryngeal function preserved].

OBJECTIVE: To study the feasibility and effect of substituting esophagus with stomach or colon without thoracotomy in the treatment of cervical esophageal carcinoma with laryngeal function preserved. METHODS: Twenty-four patients with cervical esophageal carcinoma were retrospectively reviewed. The esophagus was resected and substituted with 19 gastric pull-up and 5 colon interposition. Nineteen patients received radiotherapy postoperatively (dose 50 - 70 Gy). RESULTS: Twenty two patients were follow up over 3 years. The 3- and 5-year survival rates for T2 were 3 and 1, for T3, T4 8 and 3, respectively. The laryngeal function preservation rate was 77% (17/24) and the decannulation rate was 75% (12/16). The complication rate was 29%. CONCLUSION: Surgical resection of cervical esophageal carcinoma with removal of the extraesophageal invaded tissues while preserving the laryngeal function is possible. The continuity of the esophagus is restored by stomach transposition and colon interposition. Combined with radiotherapy, the survival rate and life quality of the patient might be improved.