Safety analysis of cesarean myomectomy in twin pregnancies with intramural myomas / 中华妇产科杂志

Objective:To estimate the safety of myomectomy in twin pregnant women with intramural myomas during cesarean section.Methods:The clinical data of 145 cases of twin pregnancies with intramural myomas who were delivered by cesarean section in Beijing Obstetrics and Gynecology Hospital, Capital Medical University from June 2013 to December 2021 were collected. Maternal demographics, fibroids′ characteristics, maternal and fetal outcomes were compared between groups of cesarean section with myomectomy (myomectomy group, 49 cases) and cesarean section only (non-myomectomy group, 96 cases).Results:Compared with non-myomectomy group, myomectomy group had significantly prolonged operative time [50.0 minutes (37.5-57.5 minutes) vs 40.0 minutes (35.0-50.0 minutes), respectively; P=0.007] and significantly longer postoperative hospital stay [4.0 days (3.0-4.0 days) vs 3.0 days (3.0-4.0 days), respectively; P=0.047). Other maternal and fetal outcomes such as estimated blood loss, hemoglobin difference, postpartum hemorrhage, blood transfusion, B-Lynch structure, uterine artery ligation, postoperative fever and neonatal Apgar score showed no significant differences (all P>0.05). For intramural myomas <5 cm, there were no significant differences in maternal and fetal outcomes between myomectomy group and non-myomectomy group (all P>0.05). For intramural myomas ≥5 cm, operative time [55.0 minutes (40.0-60.0 minutes) vs 42.5 minutes (40.0-50.0 minutes), respectively; P=0.019] was significantly prolonged, postoperative hospital stay [4.0 days (4.0-5.0 days) vs 4.0 days (3.0-4.0 days), respectively; P=0.048] was significantly longer in myomectomy group than non-myomectomy group, but there were no significant differences in other maternal and fetal outcomes (all P>0.05). Conclusion:For twin pregnancies with intramural myomas, it is safe and feasible to remove intramural myomas during cesarean section by experienced obstetricians.

Evaluation of rapid identification methods for foodborne diarrhea Campylobacter and detection of drug resistance / 中华检验医学杂志

Objective:To explore and evaluate a appropriate suitable method for detection of Campylobacter and antibiotic sensitivity test for foodborne diarrhea in clinical laboratories. Methods:Pre-experiment:a total number of 400 fecal samples of patients with foodborne diarrhea were prospectively collected from the intestinal disease clinic of Beijing Tongren Hospital from September 2017 to January 2018. Double-hole filtration culture method and modified cefoperazone charcoal deoxycholate (CCD) agar culture method were used for fecal culture in micro-aerobic environment for 48 hours, and then suspicious colonies were identified by matrix assisted laser desorption ionization-time of flight (MALDI-TOF) mass spectrometry. Meanwhile, C. jejuni and C. coli were detected by real-time quantitative polymerase chain reaction(qPCR). Large sample verification: 2 062 fecal samples of patients with foodborne diarrhea in three hospitals of different levels in different areas of Beijing were collected for qPCR detection and culture from April 2018 to March 2019. The antimicrobial sensitivity test (AST) of C. jejuni and C. coli was performed according to the disk diffusion method and agar dilution method recommended by Clinical and Laboratory Standards Institute and National Antimicrobial Resistance Monitoring System for Enteric Bacteria. The results of the three detection methods and the consistency of the two antibiotic sensitivity tests were compared. Results:In the pre-experiment, the positive rates of Campylobacter ( jejuni/coli) detected of qPCR, double-hole filtration culture and modified CCD agar culture were 9.0% (36/400), 5.0% (20/400)and 3.5% (14/400), and the difference was statistically significant ( P<0.01). The samples with negative result of qPCR were negative by both culture methods. The total positive rates of Campylobacter detected by qPCR was 8.1% (168/ 2 062)including 7.0% (144/2 062) for C. jejuni and 1.2% (24/2 062) for C. coli. The samples with positive qPCR results were cultured by double-hole filtration culture method and the positive rate was 61.9%(104/168), among which, the positive rate of C. jejuni and C. coli were 58.3%(84/144) and 83.3%(20/24) respectively, which was not significantly different from the detection rate and culture positive rate in the pre-test ( P>0.1). The resistance rates of C. jejuni and C. coli to ciprofloxacin were 94.0%(94/100) and 100.0%(24/24) and to erythromycin were 6.0%(6/100) and 33.3%(8/24). The results from two antibiotic sensitivity test methods were consistent (Kappa>0.75). Conclusions:qPCR is rapid, sensitive and easy to operate, so it is suitable for routine development in clinical laboratories. The double-hole filtration culture method is beneficial to the acquisition of strains and is essential for the further study of Campylobacter. There was no significant difference between agar dilution method and disk diffusion method in antibiotic sensitivity test. Campylobacter showed a very high resistance rate to quinolones, which was no longer suitable for the treatment of Campylobacter foodborne diarrhea in Beijing area. Macrocyclic lipid antibiotics should be preferred.

Management of tuberculosis outbreaks in middle schools of Bijie City / 中国学校卫生

Objective@#To understand the management of tuberculosis outbreaks in middle schools in Bijie City, and to put forward suggestions to improve the quality of tuberculosis epidemic situation in schools.@*Methods@#A unified questionnaire was used to investigate the management of tuberculosis outbreaks in middle schools reported by tuberculosis information management system from August 27, 2018 to January 6, 2019 in Bijie City.@*Results@#The screening rate of close contacts was 69.72%(99/142), which significantly varied by counties(P<0.01). The time from the date of diagnosis of patients to screening of close contacts by local CDC was 3(1-10.5) days. Rate of standardized management process for close contacts aged 15 years or older (0) was lower than that for close contacts aged younger than 15 years old (23.08%)(P<0.01). 3 462 close contacts were screened for TB symptom,and chest X-ray among those suspected individuals(process 1), and 2 439 close contacts were screened with TB symptom,PPD test,and chest X-ray among those suspected individuals or those with strong positive in PPD test(process 2). The detection rate of pulmonary tuberculosis in close contacts of Grade I was lower in Process 1 (28.89/100 000) than in Process 2 (328.00/100 000)(χ2=6.56, P=0.01). The latent infection rate of the first-class close contacts (6.39%) was higher than that of the second-class close contacts(1.93%)(χ2=54.86, P<0.01).@*Conclusion@#Management of tuberculosis outbreaks in middle schools in Bijie City in 2018 is effective and timely, but the standardization needs to be improved.

An in-depth investigation of the safety and immunogenicity of an inactivated SARS-CoV-2 vaccine

BACKGROUNDIn-depth investigations of the safety and immunogenicity of inactivated SARS-CoV-2 vaccines are needed. METHODIn a phase I randomized, double-blinded, and placebo-controlled trial involving 192 healthy adults 18-59 years of age, two injections of three different doses (50 EU, 100 EU and 150 EU) of an inactivated SARS-CoV-2 vaccine or the placebo were administered intramuscularly with a 2- or 4-week interval between the injections. The safety and immunogenicity of the vaccine were evaluated within 28 days. FINDINGIn this study, 191 subjects assigned to three doses groups or the placebo group completed the 28-day trial. There were 44 adverse reactions within the 28 days, most commonly mild pain and redness at the injection site or slight fatigue, and no abnormal variations were observed in 48 cytokines in the serum samples of immunized subjects. The serum samples diluted from 1:32 to 1:4096 and incubated with the virus did not show antibody-dependent enhancement effects (ADEs) with regard to human natural killer cells, macrophages or dendritic cells. At day 14, the seroconversion rates had reached 92%, 100% and 96% with geometric mean titers (GMTs) of 18.0, 54.5 and 37.1, and at day 28, the seroconversion rates had reached 80%, 96% and 92% with GMTs of 10.6, 15.4 and 19.6in 0, 14 and 0, 28 procedures, respectively. Seroconversion was associated with the synchronous upregulation of ELISA antibodies against the S protein, N protein and virion and a cytotoxic T lymphocyte (CTL) response. Transcriptome analysis shaped the genetic diversity of immune response induced by the vaccine. INTERPRETATIONIn a population aged 18-59 years, this inactivated SARS-CoV-2 vaccine was safe and immunogenic. Trial registrationNCT04412538 FUNDINGThe National Key R&D Program of China (2020YFC0849700), the Program of Chinese Academy of Medicine Science and the Major Science and Technology Special Projects of Yunnan Province.

A valid protective immune response elicited in rhesus macaques by an inactivated vaccine is capable of defending against SARS-CoV-2 infection

With the relatively serious global epidemic outbreak of SARS-CoV-2 infection, public concerns focus on not only clinical therapeutic measures and public quarantine for this disease but also the development of vaccines. The technical design of our SARS-CoV-2 inactivated vaccine provides a viral antigen that enables the exposure of more than one structural protein based upon the antibody composition of COVID-19 patients convalescent serum. This design led to valid immunity with increasing neutralizing antibody titers and a CTL response detected post-immunization of this vaccine by two injections in rhesus macaques. Further, this elicited immunoprotection in macaques enables not only to restrain completely viral replication in tissues of immunized animals, compared to the adjuvant control and those immunized by an RBD peptide vaccine, but also to significantly alleviate inflammatory lesion in lung tissues in histo-pathologic detection, compared to the adjuvant control with developed interstitial pneumonia. The data obtained from these macaques immunized with the inactivated vaccine or RBD peptide vaccine suggest that immunity with a clinically protective effect against SARS-CoV-2 infection should include not only specific neutralizing antibodies but also specific CTL responses against at least the S and N antigens.

Research on current situation of injury prevention attitudes and behavior among urban residents in Changsha City / 中国实用护理杂志

Objective:To understand the attitudes and behaviors status of injury prevention among urban residents' injury prevention in Changsha City and to provide evidence for urban residents' injury prevention.Methods:A stratified random sampling was conducted to extract 504 residents from 8 communities in 2 urban districts of Changsha City. The questionnaires were distributed on-site, and 420 valid questionnaires were got.Results:The attitudes and behavioral scores of urban residents' injury prevention were 43.35±14.29 and 38.92±3.75, while the agreement rate regarding injury prevention attitudes was 76.63% and the compliance rate of injury prevention behaviors was 43.10%. The scores of injury prevention behaviors among urban residents with different ages, family annual income, exercise frequency, and frequency of injuries were different ( F values were 2.815, 4.740, 4.153, P<0.05). There were differences in the scores of injury prevention attitudes among the residents of different ages, education background, and frequency of injuries ( F values were 3.030-8.162, P<0.01 or 0.05). Conclusion:The residents ′ attitude towards injury prevention was positive and the compliance rate of injury prevention behavior among urban residents in Changsha is low. Both injury prevention attitudes and behaviors differed in the residents with different backgrounds.

Maze Ⅳ in the treatment of heart valve disease with persistent atrial fibrillation in elderly patients: A cohort study / 中国胸心血管外科临床杂志

@#Objective    To investigate the clinical effect of Maze Ⅳ in the treatment of elderly patients with valvular heart disease and persistent atrial fibrillation (AF). Methods    We retrospectively analyzed the clinical data of 78 elderly patients with cardiac valve disease combined with persistent AF in our hospital from 2017 to 2018. The patients were allocated to two groups including a trial group (n=37) and a control group (n=41). There were 21 males and 16 females aged 61 to 74 (65.2±2.5) years in the trial group. There were 23 males and 18 females aged 62 to 76 (64.8±3.3) years in the control group. The clinical effects of the two groups were compared. Results    There was no statistical difference in baseline data between the two groups (P>0.05). The aortic occlusion time, extracorporeal circulation time, and operation time of the trial group were longer than those of the control group with statistical differences (P<0.05). There was no statistical difference in postoperative ventilator assistance time, complication rate, mortality, ICU retention time, perioperative drainage, red blood cell transfusion volume, or length of hospital stay between the two groups (P>0.05). At the time of discharge, postoperaive 1-month, 3-month, 6-month, and 12-month, the maintenance rates of sinus rhythm in the control group were statistically different from those of the trial group (P<0.05). Compared with the control group, left atrial diameter, left ventricular end diastolic diameter and the decrease of pulmonary artery systolic blood pressure were statistically different (P<0.05). Conclusion    Maze Ⅳ is safe and effective in the treatment of elderly patients with valvular heart disease and persistent AF, which is conducive to the recovery and maintenance of sinus rhythm, and is beneficial to the remodeling of the left atrium and left ventricle and the reduction of pulmonary systolic blood pressure with improvement of life quality of the patients.

Application of a novel nanoemulsion adjuvant for rabies vaccine which stabilizes a Krebs cycle intermediate (SDH) in an animal model.

Rabies is the most lethal zoonotic, vaccine-preventable viral disease in the world. Its treatment is complicated by insufficient vaccine supply and the requirement for four to five repeated injections, as commercially available inactivated rabies lack adjuvant and have low immunogenicity. In this study, we focused on the role of a Krebs cycle intermediate, succinate dehydrogenase (SDH), in the innate immune response to cytokine production. We formulated a novel nanoemulsion adjuvant, Golden03, which stabilizes mouse SDH activity and contains more coenzyme Q10 and succinic acid than the classic MF59 adjuvant. Mice were immunized on days 1, 3, and 7, with seroconversion rate results suggesting that Golden03 significantly enhanced vaccine-stimulated antibody production against the rabies virus. Neutralizing antibody concentration testing by RFFIT indicated that treatment with Golden03 could result in antibody levels of up to 0.74 IU/mL 5 days post infection (DPI). ELISPOT for IFN-γ in mouse spleen cells showed that Golden03 enhanced immune responses at 14 DPI, inducing a rapid and powerful cellular response compared to the control group. Furthermore, the Vaccine-Golden03 group displayed no obvious weight loss or death after intracranial injection with CVS-11. An additional advantage is that Golden03 allowed for a three-quarter reduction in dose, while maintaining its efficacy and rapid stimulation effect. We suggest that Golden03 could be developed as a potential adjuvant for use in human rabies vaccine.

Role of phenol red in the stabilization of the Sabin type 2 inactivated polio vaccine at various pH values.

To analyze the effects of phenol red at various pH values on the Sabin type 2 inactivated polio vaccine (sIPV2), several biophysical techniques were used to evaluate the particle size and capsid protein for conformation. sIPV2's size was assessed via transmission electron microscopy and dynamic light scattering. The effects of various pH values (from 4.0 to 7.0) on the biophysical characters of sIPV2 particles in solution were determined by dynamic light scattering and zeta potential. The results clearly indicated that aggregation and instability occurred in the solution of sIPV2 particles at a pH of 6.0. Under similar conditions, by dynamic light scattering and zeta potential, the virus particles in solution showed more dispersion and were stable with the addition of 0.05 mM phenol red. According to circular dichroism and intrinsic tryptophan fluorescence data, it was observed that the secondary and tertiary structures of the sIPV2 particles were more stable with the protection of phenol red. At a pH below 6.0, the sIPV2 solution with phenol red had more D-antigen content, which was confirmed by enzyme-linked immunosorbent assay and rat experiments. These results strongly suggested that phenol red improved the pH stability of the sIPV2. The study indicated the potential of phenol red in preserving vaccine potency of the sIPV2 at various pH values.

Study of a two?way referral mode for the treatment of cervical disease within a medical alliance / 中华健康管理学杂志

Objective To explore the establishment of a two-way referral system for the treatment of cervical diseases within a medical alliance. The two-way referral system was introduced to reduce the morbidity and mortality of cervical cancer through better management of patients'who have tested positive for cervical disease, screening effectively for early diagnosis and treatment of cervical precancerous lesions, and providing early interventions for cervical cancer patients. Methods The control group consisted of 2, 515 patients who had screened positive for cervical disease between January 2018 and December 2018 at one of four community health service centers that were not within the medical alliance. The experimental group consisted of 2, 384 patients who had screened positive for cervical disease at one of four community health service centers in the medical alliance. The control group was treated using the original management mode;the experimental group's treatment was managed within the two-way referral system, which included standardized screening, referral, follow-up, health education, and professional training. The hospital visit rates, time intervals from diagnosis to the start of interventions, detection rates, and treatment rates were observed for both groups of women. Results The hospital visit rates, detection rates, and treatment rates were higher for those in the experimental group than the control group. The time interval from receiving a diagnosis to the first hospital visit was (16.9±11.5) days for patients in the experimental group and (25.7±20.9)days for those in the control group. The difference was a statistically significant (-0.05). Conclusion The management of cases in a two-way referral system within a medical alliance facilitates patients receiving earlier diagnosis and treatment for cervical pre-cancerous lesions and malignant tumors. Such efficiency improvements may reduce morbidity and mortality as well as help control medical costs, all of which have long-term economic and social significance.

Clinical characteristics and pregnancy outcomes of pregnant women in different age groups in Beijing / 中华妇产科杂志

Objective@#To investigate the influence of maternal age on the health status of pregnant women and the pregnant outcomes.@*Methods@#Data obtained from "Beijing perinatal health management registration system" was analyzed, 263 157 pregnant women with age information were included from October 1st, 2015 to September 30th, 2016, in which 43 594 women delivered at the age of 35 or above (advanced age) . According to the age of maternal age, there were 5 groups. (1) Proper age: 219 563 (83.43%, 219 563/263 157) cases of the age of 18-34 years, including 122 735 cases (46.64%, 122 735/263 157) in the ≤29 years old group and 96 828 cases (36.79%, 96 828/263 157) in 30-34 years old group. (2) Advanced age: there were 43 594 cases (16.57%, 43 594/263 157) ≥35 years old, including 37 395 cases (14.21%, 37 395/263 157) in the 35-39 years old group, 5 790 cases (2.20%, 5 790/263 157) in the 40-44 years old group and 409 cases (0.16%, 409/263 157) in the ≥45 years old group. The trend-based chi-square test and logistic regression were used to analyze the effects of different age groups on maternal complications and pregnant outcomes.@*Results@#(1) The total incidence of high risk pregnancy (HRP) : in advanced age women, the incidence of HRP was 67.83% (29 571/43 594) which was 56.73% (124 550/219 563) in proper age women, the difference was statistically significant (χ2=1 848.91, P<0.000) . In advanced age women, the incidence of severe HRP was 7.64% (3 329/43 594) which was 6.18% (13 571/219 563) in proper age women, the difference was statistically significant (χ2=128.211, P<0.000) . In advanced age women, the incidence of very severe HRP was 1.76% (769/43 594) which was 0.84% (1 838/219 563) in proper age women, the difference was statistically significant (χ2=318.58, P<0.000) . (2) Comparison of the incidence of HRP in 5 groups:the total incidence of HRP increased through the following age group ≤29 years, 30-34 years, 35-39 years, 40-44 years, ≥45 years (53.28%, 61.09%, 67.41%、70.09%, 74.57% respectively) , the difference was statistically significant (linear by linear χ2=3 165.72, P<0.000) . The incidence of very severe HPR increased (0.66%, 1.06%, 1.66%, 2.35%, 2.93% respectively) , the difference was statistically significant (linear by linear χ2=218.31, P<0.000) . The incidence of severe HPR increased (5.77%, 6.70%, 7.48%, 8.34%, 11.49% respectively) , the difference was statistically significant (linear by linear χ2=422.20, P<0.000) . The incidence of general HPR increased (46.84%, 53.34%, 58.26%, 59.40%, 60.15% respectively) , the difference was statistically significant (linear by linear χ2=1 947.51, P<0.000) . (3) As the maternal age group increased, the incidence of adverse pregnancy outcomes increased (5.54%, 6.85%, 8.77%, 9.90%, 18.09%, linear by linear χ2=674.57, P<0.000) . The incidence of perinatal death, premature birth and low birth weight also presented the above trends (perinatal death: linear by linear χ2=34.79, P<0.000; premature birth: linear by linear χ2=692.87, P<0.000; low birth weight: linear by linear χ2=379.20, P<0.000) . (4) Logistic regression analysis with the assisted reproductive technology and multiple pregnancy considered showed the same trend (P<0.000) .@*Conclusion@#The maternal age has an impact on the maternal health status and pregnancy outcomes, and the risk of various types of pregnancy complications and adverse pregnancy outcomes increase with the maternal age group, antenatal care and management should be emphasized in women with advanced maternal age, especially for women ≥40 years old.

A study on genotype of 271 mycobacterium tuberculosis isolates in 6 prefectures in Yunnan Province / 中华预防医学杂志

Objective@#To understand the characteristics of genotypes of Mycobacterium tuberculosis isolates in Yunnan province, and provide the molecular epidemiological evidence for prevention and control of tuberculosis in Yunnan Province.@*Methods@#Mycobacterium Tuberculosis isolates were collected from 6 prefectures of Yunnan province in 2014 and their Genetypes of Mycobacterium tuberculosis isolates were obtained using spoligotyping and multiple locus variable numbers of tandem repeats analysis (MLVA). The results of spoligotyping were entered into the SITVITWEB database to obtain the Spoligotyping International Type (SIT) patterns and the sublineages of MTB isolates. The genoyping patterns were clustered with BioNumerics (version 5.0).@*Results@#A total of 271 MTB isolates represented patients were collected from six prefectures in Yunnan province. Out of these patients, 196 (72.3%) were male. The mean age of the patients was (41.9±15.1) years. The most MTB isolates were from Puer, totally 94 iusolates(34.69%). Spoligotyping analysis revealed that 151 (55.72%) MTB isolates belonged to the Beijing genotype, while the other 120 (44.28%) were from non-Beijing genotype; 40 genotypes were consisted of 24 unique genotypes and 16 clusters. The 271 isolates were differentiated into 30 clusters (2 to 17 isolates per cluster) and 177 unique genotypes, showing a clustering rate of 23.62%. Beijing genotype strains showed higher clustering rate than non-Beijing genotype strains (29.14% vs 16.67%). The HGI of 12-locus VNTR in total MTB strains, Beijing genotype strains and non-Beijing genotype was 0.993, 0.982 and 0.995 respectively.@*Conclusion@#The Beijing genotype was the predominant genotype in Yunnan Province, the characteristics of Mycobacterium tuberculosis showed high genetic diversity. The genotyping data reflect the potential recent ongoing transmission in some area, which highlights the urgent need for early diagnosis and treatment of the infectious TB cases, to cut off the transmission and avoid a large TB outbreak.

A Retrospective Analysis on Medication Error Monitoring Results in Our Hospital in Five Years / 中国药师

Objective: To explore the potential risks in hospital medication management system and propose the preventive meas-ures. Methods: The medication error (ME) cases reported from Jan 1st2012 to Dec 31st2016 in our hospital were retrospectively ana-lyzed in terms of ME category, classification, occurrence link, cause, influencing factors, detecting person and the proportion of high-alert medication MEs. Results: A total of 425 ME reports were collected, and among them, 311 cases were related to western medi-cines (73. 18% ), and 114 cases were related to traditional Chinese medicines (26. 82% ). The proportion of ME in category A, B and C was 4. 24% , 89. 65% and 5. 41% , respectively; the proportion of ME in category D, E and F was 0. 24% . ME in category G, H and I was not reported. In terms of the ME classification, the proportion of drug variety error was the highest (23. 29% ) followed by the repeated medication error (9. 41% ) and the dosage error (8. 94% ). As for the ME occurrence link, the proportion of prescription error was the highest (73. 18% ) followed by the dispensing error (16. 94% ). The top factor to trigger ME was lack of knowledge (26. 82% ) followed by the similar drug name (21. 41% ). The main person who detected ME was pharmacists (93. 88% ). Among of the 425 ME reports, 81 cases were related to high-alert medication, and the top two were insulin errors (48. 15% ) and oral hypoglyce-mic agents errors (23. 46% ). Conclusion: It can partly prevent ME by improving selection and management of new drugs, improving drug information system, enhancing drug quality management and strengthening safe medication knowledge education.

Practice and Research of Management Mode of Long-term Medication Safety Assessment for the Patients with Chronic Obstructive Pulmonary Disease by Pharmacist Team in Medical Treatment Alliance / 中国药师

Objective:To explore the new management mode of long-term medication safety assessment for chronic obstructive pul-monary disease (COPD) with the participation of pharmacist team in medical treatment alliance to provide reference for pharmacists participating in the management of chronic diseases under the new situation of new medical reform. Methods:Totally 126 patients with COPD meeting the inclusion criteria in our hospital and medical treatment alliance were selected. The patients received medication management including drug safety comprehensive evaluation,classification management,follow-up with medication guidance,integrat-ed prescriptions checking and shared database building etc with the participation of our clinical pharmacists to guide the community pharmacists in coordination with physicians. Results:After one-year management mode practice,the cognitive ability of safe medica-tion and compliance of the patients significantly increased(P<0.01) with significant improvement of control situation of COPD(CAT score) (P<0.05 or P<0.01), and the capacity of effective identification and irrational prescription intervention significantly in-creased (P<0.01). Conclusion:The management mode of long-term medication safety assessment for COPD patients with the partic-ipation of pharmacist team in medical treatment alliance has significant effects on COPD patients' safe medication and drug efficacy, which can improve the professional service of pharmacist team.

Practice of Management Mode of Long-term Medication Safety Assessment for Chronic Airway Disease Patients Established by Pharmacists Team of Medical Consortium / 中国药房

OBJECTIVE:To provide reference for pharmacists to participate in the management of chronic disease. METHODS:A total of 259 patients with chronic airway disease [included asthma and chronic obstructive pulmonary disease (COPD)] met the inclusion criteria were selected from our hospital and 5 community health care centers of medical consortium. These patients received medication safety assessment management,which was led by clinical pharmacists of our hospital with the participation of community pharmacists,including medication safety comprehensive evaluation and risk classification management, follow-up and medication guidance, integrated prescriptions checking, establishment of shared database. 1 years after the implementation,the effectiveness were evaluated by score the relatived indicators in related groups. RESULTS:After a year of the management mode practice,compared with before intervention,the patients'safety medication cognitive ability score in high-risk and low-risk group increased from(4.49±1.26)and(7.31±1.01)to(5.40±1.56)and(7.44±0.91);medication adherence score increased from(4.96±1.21)and(7.08±1.24)to(6.66±1.08)and(7.38±0.98);ACT score from asthma patients increased from (16.15±2.58)and(21.15±1.03)to(16.80±2.57)and(21.64±1.55);CAT score from COPD patients decreased from(25.51± 4.07) and (14.90 ± 3.95) to (24.20 ± 3.96) and (13.80 ± 4.08);the rate of irrational prescription effective identification and intervention by pharmacists increased from 3.6％ and 1.4％ to 9.4％ and 7.6％,respectively. All the differences above were statistically significant (P<0.05). CONCLUSIONS:The participation of pharmacists in long-term medication safety assessment management for chronic airway disease patients can improve patients'safety medication cognitive ability,medication adherence, disease control and the pharmacists'ability of irrational drug use identification and intervention.

Aerosol challenge model in murine by Bordetella pertussis / 医学研究生学报

Objective To evaluate the BALB/c murine infective effects in different concentrations and different aerosol challenge times by Bordetella pertussis.Methods Four experiment groups according to different concentrations and different aerosol challenge times were designed.BALB/c murines were challenged by aerosol way.Group 1: 1010cfu/mL Bordetella pertussis challenge 15 min, group 2: 1010cfu/mL challenge 30 min, group 3: 109cfu/mL challenge 30 min, group 4: 1011cfu/mL challenge 30 min, using the normal saline challenge 30 min as control.At 0d,3d,7d,14d and 21d after challenge, the WBCs of all groups were measured and lung tissues were homogenized to calculate the bordetella pertussis clone in lung.Results After 3 days of challenge, WBCs in all groups were slightly increased.The WBCs of group 1, group 2, group 3 and group 4 were significantly increased after 7 days, with the average numbers of 8.52×109 per/L, 1.74×1010per/L, 1.15×1010per/L and 5×1010per/L, respectively.After 14 days, they were 1.77×1010per/L, 1.67×1010per/L, 1.27×1010per/L and 3.84×1010per/L respectively.WBCs in all groups were dramatically declined after 21 days.The WBC of negative control group had no obvious change during the whole process with the stable number of 3.4~7.0×109per/L.Bordetella pertussis were detected in lung of all experimental groups in each sampling point.The CFU in lung wase at peak at 7d or 14d after challenge, which was obviously decreased at 21d.Conclusion This aerosol challenge method can establish a bordetella pertussis infection mouse model successfully.

Clinical Utilization Investigation and Rationality Analysis of Carbapenems in A Hospital / 中国药房

OBJECTIVE:To explore the clinical utilization of carbapenems in a hospital,analyze and evaluate its medication rationality. METHODS:All the 508 medical records of inpatients treated with carbapenems from Jul. 2012 to Jun. 2015 were retro-spectively investigated,the utilization and pathogenic examination of carbapenems were evaluated;by setting the carbapenems eval-uating standard,the medication rationality of carbapenems was evaluated and inappropriate cases were classified and analyzed statis-tically. RESULTS:The drug utilization indexed (DUI) of Imipenem and cilastatin sodium for injection and Meropenem for injec-tion were 0.80 and 1.32,respectively;the total rate of microbial inspection was 95.9%;according to the drug sensitive test result, the rate of drug selection was 62.8%;there were 54 cases(10.6%)of irrational use records,in which,irrational dosage(42.6%) and improper drug selection (31.4%) were the major problems. CONCLUSIONS:There are some inappropriate medication prob-lems in carbapenems utilization in the hospital. Developing the carbapenems utilization evaluation is helpful to discover typical medi-cation problems,which can provide reference for intervention and continuous improvement of rational drug use.

Clinical observation of partial pancreatectomy as part of primary cytoreductive surgery in advanced epithelial ovarian cancer / 中华妇产科杂志

Objective The aim of this study is to evaluate the safety and efficacy of partial pancreatectomy as part of primary cytoreductive surgery in advanced epithelial ovarian cancer (EOC). Methods A total of 8 patients were recruited in this study who underwent partial pancreatectomy during the primary cytoreductive surgeries for advanced EOC in Fudan University Shanghai Cancer Center from April 2009 to July 2015. Their clinicopathological characteristics, diameter of metastatic tumors, the scope of cytoreductive surgeries, residual diseases after cytoreductive surgeries, postoperative complications and survival situation were retrospective analyzed. Results (1) Clinicopathological characteristics:the median age of these patients was 58 years old(range: 39-63 years old). The median value of preoperative serum CA125 was 1 688 kU/L(range: 119-5 000 kU/L). The median diameter of metastatic tumors involved in pancreatic body or tail was 4.5 cm (range:3-10 cm). All the tumors from the 8 patients were confirmed to be high-grade serous carcinoma. Four patients were staged as International Federation of Gynecology and Obstetrics (FIGO)Ⅳ, and the other 4 patients were staged as FIGOⅢc. (2) Tumor metastases and the scope of cytoreductive surgeries:all of these 8 patients had widely disseminated ovarian cancer, with involvement of upper abdominal, middle abdominal and pelvic cavity. Each patient underwent extensive intra-abdominal cytoreductive surgeries, including hysterectomy, bilateral salpingo-oophorectomy, omentectomy, pelvic periton-ectomy, splenectomy, partial pancreatectomy. Each patient had cytoreductive surgeries of 9.6 different sites on average. Of all 8 patients who underwent partial pancreatectomy, 7 patients had pancreatic tails removed;the other 1 patient had pancreatic body and tail removed. The median volume of blood loss during surgery was 1 350 ml(range:300-3 500 ml), blood transfusion was performed in 7 patients with the median volume of 1 150 ml (range: 500-1 800 ml). (3) Residual diseases after cytoreductive surgeries: optimal cytoreduction was achieved in all patients, with microscopic residual disease in 3 patients, residual tumors diameter < 0.5 cm in 3 patients, and residual tumors diameter between 0.5 and 1 cm in 2 patients. (4) Postoperative complications: 4 patients suffered from complications including pancreatic leakage (2/8), intraperitoneal hemorrhage (1/8) and pancreatic pseudocyst accompanied by infection (1/8). These complications were treated successfully by conservative managements. (5) Survival situation: during the median follow-up duration of 17 months (ranged from 2 to 46 months), 5 patients were still alive until the end of follow-up, including 4 cases under treatment and 1 case survived 29 months without relapse after treatment. Three patients were respectively died in 5, 20 and 46 months after surgery. Conclusion There is a higher risk of postoperative complications of pancreas resection as part of primary cytoreductive surgery in advanced epithelial ovarian cancer, but the resection of pancreatic metastases and part of the pancreas is feasible and necessary.

Correlation between antimicrobial resistance of Acinetobacter baumannii and utilization of antimicrobial agents in our hospital / 中国基层医药

Objective To analyze the correlation between the resistance of Acinetobacter baumannii and the utilization of antimicrobial agents in the hospitalized patients of Beijng Chuiyangliu Hospital,and provide the basis for clinical rational use antimicrobial agents.Methods A retrospective analysis was conducted for the drug resistance rate and specimen source of the 2 194 strains of Acinetobacter baumannii from 2010 to 2014 in the hospital and DDDs/DUI of antimicrobial agents was analyzed by Pearson correlation.Results The resistance rate of Acinetobacter baumannii was positively correlated with the DDDs and DUI of imipenem/cilastatin(r=0.991,0.994,all P<0.01), and was positively correlated with the DDDs of cefepime(r=0.934,P=0.020).The resistance rate of Acinetobacter baumannii to amikacin was positively correlated with the DDDs of etimicin(r=0.931,P=0.022).The resistance rate of Acinetobacter baumannii was negatively correlated with the DUI of levofloxacin(r =-0.986,P =0.002). Conclusion The resistance rate of Acinetobacter baumannii was high and there was correlation between the drug resistance and the utilization of some antimicrobial agents.

Distal pancreatectomy with splenectomy for the management of splenic hilum metastasis in cytoreductive surgery of epithelial ovarian cancer / 부인종양

OBJECTIVE: Distal pancreatectomy with splenectomy may be required for optimal cytoreductive surgery in patients with epithelial ovarian cancer (EOC) metastasized to splenic hilum. This study evaluates the morbidity and treatment outcomes of the uncommon procedure in the management of advanced or recurrent EOC. METHODS: This study recruited 18 patients who underwent distal pancreatectomy with splenectomy during cytoreductive surgery of EOC. Their clinicopathological characteristics and follow-up data were retrospectively analyzed. RESULTS: All tumors were confirmed as high-grade serous carcinomas. The median diameter of metastatic tumors located in splenic hilum was 3.5 cm (range, 1 to 10 cm). Optimal cytoreduction was achieved in all patients. Eight patients (44.4%) suffered from postoperative complications. The morbidity associated with distal pancreatectomy and splenectomy included pancreatic leakage (22.2%), encapsulated effusion in the left upper quadrant (11.1%), intra-abdominal infection (11.1%), pleural effusion with or without pulmonary atelectasis (11.1%), intestinal obstruction (5.6%), pneumonia (5.6%), postoperative hemorrhage (5.6%), and pancreatic pseudocyst (5.6%). There was no perioperative mortality. The majority of complications were treated successfully with conservative management. During the median follow-up duration of 25 months, nine patients experienced recurrence, and three patients died of the disease. The 2-year progression-free survival and overall survival were 40.2% and 84.8%, respectively. CONCLUSION: The inclusion of distal pancreatectomy with splenectomy as part of cytoreduction for the management of ovarian cancer was associated with high morbidity; however, the majority of complications could be managed with conservative therapy.