Practice of refined management of anti-tumor drugs based on value healthcare / 中华医院管理杂志

In recent years, the rapid increase in cancer treatment costs in China had brought a huge economic burden to society, and it was urgent to standardize the rational application of anti-tumor drugs. In the context of the reform of group payment related to disease diagnosis, a tertiary first-class hospital focused on the needs of patients and guided by value-based healthcare, established a professional and normalized refined anti-tumor drug management system, setted up a multidisciplinary diagnosis and treatment team, and promoted " Internet plus pharmaceutical services" in December 2018.From 2019 to 2021, the proportion of hospital drugs were 30.8%, 30.1%, and 27.3%, respectively. The amount of money spent on anti-tumor drugs were 83.25 million yuan, 76.41 million yuan, and 62.48 million yuan, respectively, showing a decreasing trend year by year. The practice of refined management of anti-tumor drugs fully reflected the core concept of value based healthcare, achieving closed-loop management of the entire process of drugs, improving the level of rational drug use, reducing the economic burden on patients, and providing reference for improving the level of rational use of anti-tumor drugs in public hospitals.

Application value of Qisexingtai hand diagnostic method in diagnosis of coronary artery disease.

OBJECTIVE: To evaluate the diagnostic efficacy of Qisexingtai hand diagnostic method in the diagnosis of coronary artery disease (CAD). METHODS: This was an investigator-initiated, prospective, multi-center, cross-sectional study. All the participants from three hospitals in China had been diagnosed by both Qisexingtai hand diagnostic method and coronary angiography. We compared the two diagnostic methods to calculate the sensitivity, the specificity, the omission diagnostic rate, the mistaken diagnostic rate and accuracy in order to evaluate the diagnostic efficacy of Qisexingtai hand diagnostic method for CAD. RESULTS: A total of 326 subjects were enrolled, diagnosed by both Qisexingtai hand diagnostic method and coronary angiography. As a result, there were 166 positive cases according to Qisexingtai hand diagnostic method, and 131 positive cases according to coronary angiography. Compared with the results of coronary angiography, the sensitivity of Qisexingtai hand dia-gnostic method was 80.2%, the specificity was 68.7%, the omission diagnostic rate was 19.8%, the mistaken diagnostic rate was 31.3%, and the accuracy was 73.3%. Area under the receiver operating characteristic curve was estimated as 0.735 for all, and 0.718, 0.735, 0.783 for the three sub-centers. CONCLUSION: Qisexingtai hand diagnostic method with high accuracy and sensitivity has certain application value in the diagnosis of CAD.

Association of interaction between urinary glucose excretion and body mass index on serum uric acid in type 2 diabetes mellitus / 中华内分泌代谢杂志

Objective:To investigate the relationship between urinary glucose excretion, body mass index, and serum uric acid in type 2 diabetes mellitus, and to evaluate the association of interaction between uric glucose and body mass index on the risk of hyperuricemia.Methods:A total of 867 hospitalized patients with type 2 diabetes mellitus were included in this study. The height, weight, blood pressure and other general conditions were measured. 24-hour urine glucose quantification, glycolipid metabolism, and serum uric acid were collected. Multivariate linear regression analysis and multivariate logistic regression analysis were performed to determine the association of body mass index and urinary glucose with hyperuricemia.Results:After adjusting for age, sex, course of disease, blood pressure, HbA 1C, insulin, homeostasis model assessment for insulin resistance, fasting plasma glucose, 2 h postprandial blood glucose, total cholesterol, triglyceride, high density lipoprotein-cholesterol, low density lipoprotein-cholesterol, creatinine, and glomerular filtration rate, body mass index was positively associated with serum uric acid( β=4.281, 95% CI 2.645-5.917, P<0.001), and 24-hour urine glucose was negatively associated with serum uric acid( β=-0.435, 95% CI -0.708--0.162, P=0.002). Body mass index is an independent risk factor of hyperuricemia( P<0.01). There was a significant interaction between urine glucose and body mass index(interaction P<0.05). In the low urine glucose group, obese patients displayed odds ratio of 2.203 for hyperuricemia compared with non-obese patients, whereas the odds ratio was not significant in the high urine glucose group.The associations between body mass index and hyperuricemia were stronger in participants with low urine glucose than in those with high urine glucose. Conclusion:Urinary glucose excretion can weaken the positive correlation between body mass index and serum uric acid, suggesting that promoting urinary glucose excretion may be an effective strategy to control serum uric acid levels in type 2 diabetes mellitus, especially in obese patients.

Mechanism of Huanglian Houpotang on Ulcerative Colitis by Network Pharmacology and Experimental Verification / 中国实验方剂学杂志

ObjectiveTo explore the active components and underlying mechanism of Huanglian Houpotang （HHD） against ulcerative colitis（UC） based on network pharmacology and animal experiments. MethodThe active components of HHD were preliminarily obtained from the Traditional Chinese Medicine Systems Pharmacology Database and Analysis Platform （TCMSP） and Bioinformatics Analysis Tool for Molecular Mechanism of Traditional Chinese Medicine （BATMAN-TCM） and screened out by TCMSP， SwissADME， and SwissTargetPrediction， and their targets were predicted. Relevant microarrays were searched for disease genes with the help of Gene Expression Omnibus （GEO）. The common targets of HHD and disease genes were screened out to obtain the potential targets of HHD against UC. The drug-active component-target-disease network was constructed using Cytoscape 3.7.2. The potential therapeutic targets were imported into the DAVID 6.8 for GO-Biological process （GO-BP） analysis to predict related biological processes which were subsequently verified by the animal experiment. Enzyme-linked immunosorbent assay （ELISA） was used to detect the effect of HHD on inflammatory factors in colon tissues of mice. Western blot was used to detect the protein expression of B-cell lymphoma 2 （Bcl-2）， Bcl-2-associated X protein （Bax）， and cysteinyl aspartate-specific protease 3 （Caspase-3）. The IVIS system was used to detect the content of reactive oxygen species （ROS） in colon tissues of mice in each group. ResultNineteen active components of HHD were screened out， involving 32 potential therapeutic targets against UC and 158 biological processes. The results of the animal experiment showed that HHD exerted its anti-UC effect by inhibiting the expression of inflammatory factors tumor necrosis factor （TNF）-α and interleukin-1β （IL-1β）， reducing the content of apoptotic proteins， and regulating the expression of ROS. ConclusionThis study revealed the rationality of predictions and guidance of network pharmacology in experimental design， and confirmed that HHD could exert its effects by participating in biological processes such as immune inflammation， apoptosis， and ROS， which is expected to provide a basis for the mechanism research of HHD in the treatment of UC.

Anti-inflammation and Regulation of HIF-1α/VEGF of 3 Kinds of Borneolum in Prevention and Treatment of AMI Model Rats / 中国实验方剂学杂志

ObjectiveTo investigate the possible mechanism of different doses of L-Borneolum，Borneolum，and Borneolum Syntheticum in the electrophysiology，anti-inflammation，and regulation of hypoxia inducible factor-1α （HIF-1α）/vascular endothelial growth factor （VEGF） cardiovascular protection of the experimental acute myocardial infarction （AMI） rats. MethodSD male adult rats were randomly divided into thirteen groups according to their body weight，namely the sham operation group，the model group，the solvent model group，the nitroglycerin group，the Borneolum high，medium，and low-dose （0.6，0.3， 0.15 g·kg-1） groups，the L-Borneolum high，medium，and low-dose （0.2，0.1， 0.05 g·kg-1） groups，and the Borneolum Syntheticum high，medium，and low-dose （0.2，0.1， 0.05 g·kg-1） groups，with 10 rats in each group. Rats were given 10 mL·kg-1 by gavage for 3 d of pre-administration. Thirty minutes after the last administration，the left anterior descending coronary artery （LAD） was ligated to induce the model，and the successful rat model was continuously treated for 3 d. BL-420N biosystem was used to analyze the electrocardiogram （ECG） and heart rate variability （HRV） before and after modeling and after 3 d of treatment. Real-time quantitative polymerase chain reaction （Real-time PCR） was used to determine the mRNA expressions of interleukin-1β （IL-1β） and interleukin-6 （IL-6） in the myocardial tissue Western blot and immunohistochemistry were used to determine the protein expression levels of VEGF receptor 1 （VEGFR1），HIF-1α，and CD34. ResultCompared with the sham operation group，the model group significantly increased the heart rate，ECG ST wave，T wave，QRS duration，QTC interval，and Q wave on the day of modeling and after 3 d of treatment，and significantly changed HRV and T wave （P<0.05，P<0.01）. As compared with the solvent model group，on the day of modeling，the heart rate of the L-Borneolum medium and low-dose groups and the Borneolum groups，the ST wave of the L-Borneolum groups，the Borneolum high and medium-dose groups，and the Borneolum Syntheticum high-dose group，HRV parameters of the L-Borneolum groups，the Borneolum medium and low-dose groups，and the Borneolum Syntheticum high-dose group，LF/HF of the L-Borneolum high and medium-dose group，the Borneolum low-dose group，and the Borneolum Syntheticum groups，T wave of the L-Borneolum high-dose group，the Borneolum Syntheticum high-dose group，and Borneolum medium-dose group，QTC interval of the L-Borneolum medium and low-dose groups and the Borneolum high and medium-dose groups，and QRS duration of the L-Borneolum high and low-dose groups，the Borneolum high and low-dose groups，and the Borneolum Syntheticum groups were significantly reduced or shortened （P<0.05，P<0.01）. After 3 d of treatment，the heart rate of the L-Borneolum groups，the Borneolum high and medium-dose groups，and the Borneolum Syntheticum medium-dose group，ST wave of the L-Borneolum group，the Borneolum high and medium-dose groups，and the Borneolum Syntheticum high-dose group，OTC interval，ORS duration，and Q wave of the L-Borneolum high-dose group，the Borneolum high-dose group，and the Borneolum Syntheticum high and medium-dose groups，QRS duration of the L-Borneolum medium-dose group，QTC interval of the Borneolum medium-dose group，and Q wave of the Borneolum Syntheticum low-dose group were all significantly reduced or shortened（P<0.01）. The mRNA expressions of IL-1β and IL-6 in the L-Borneolum medium and low-dose groups，the Borneolum medium and low-dose groups，and the Borneolum Syntheticum high and medium-dose groups were significantly down-regulated（P<0.01），and LF/HF in the L-Borneolum high and medium-dose groups，the Borneolum high and medium-dose groups，and the Borneolum Syntheticum high and low-dose groups were significantly reduced （P<0.05，P<0.01）. HRV in the L-Borneolum high-dose group，the Borneolum groups，and the Borneolum Syntheticum high and low-dose groups，and T wave in the Borneolum high and medium-dose groups and the Borneolum Syntheticum high-dose group were increased significantly. The protein expressions of HIF-1α，VEGFR1，and CD34 in the L-Borneolum medium and low-dose groups，the Borneolum low-dose group，and the Borneolum Syntheticum high-dose group were significantly up-regulated，as well as those of VEGFR1 and CD34 in the Borneolum medium-dose group （P<0.05，P<0.01）. ConclusionThe 3 kinds of Borneolum improves the heart rate，heart rate variability，and electrocardiogram of AMI model rats to different degrees，and may play a myocardial protective effect by anti-inflammation and promotion of angiogenesis. The combined effect suggests that L-Borneolum has the superior effect next to Borneolum，and Borneolum Syntheticum has the inferior effect.

Anti-inflammation and Regulation of HIF-1α/VEGF of 3 Kinds of Borneolum in Prevention and Treatment of AMI Model Rats / 中国实验方剂学杂志

ObjectiveTo investigate the possible mechanism of different doses of L-Borneolum，Borneolum，and Borneolum Syntheticum in the electrophysiology，anti-inflammation，and regulation of hypoxia inducible factor-1α （HIF-1α）/vascular endothelial growth factor （VEGF） cardiovascular protection of the experimental acute myocardial infarction （AMI） rats. MethodSD male adult rats were randomly divided into thirteen groups according to their body weight，namely the sham operation group，the model group，the solvent model group，the nitroglycerin group，the Borneolum high，medium，and low-dose （0.6，0.3， 0.15 g·kg-1） groups，the L-Borneolum high，medium，and low-dose （0.2，0.1， 0.05 g·kg-1） groups，and the Borneolum Syntheticum high，medium，and low-dose （0.2，0.1， 0.05 g·kg-1） groups，with 10 rats in each group. Rats were given 10 mL·kg-1 by gavage for 3 d of pre-administration. Thirty minutes after the last administration，the left anterior descending coronary artery （LAD） was ligated to induce the model，and the successful rat model was continuously treated for 3 d. BL-420N biosystem was used to analyze the electrocardiogram （ECG） and heart rate variability （HRV） before and after modeling and after 3 d of treatment. Real-time quantitative polymerase chain reaction （Real-time PCR） was used to determine the mRNA expressions of interleukin-1β （IL-1β） and interleukin-6 （IL-6） in the myocardial tissue Western blot and immunohistochemistry were used to determine the protein expression levels of VEGF receptor 1 （VEGFR1），HIF-1α，and CD34. ResultCompared with the sham operation group，the model group significantly increased the heart rate，ECG ST wave，T wave，QRS duration，QTC interval，and Q wave on the day of modeling and after 3 d of treatment，and significantly changed HRV and T wave （P<0.05，P<0.01）. As compared with the solvent model group，on the day of modeling，the heart rate of the L-Borneolum medium and low-dose groups and the Borneolum groups，the ST wave of the L-Borneolum groups，the Borneolum high and medium-dose groups，and the Borneolum Syntheticum high-dose group，HRV parameters of the L-Borneolum groups，the Borneolum medium and low-dose groups，and the Borneolum Syntheticum high-dose group，LF/HF of the L-Borneolum high and medium-dose group，the Borneolum low-dose group，and the Borneolum Syntheticum groups，T wave of the L-Borneolum high-dose group，the Borneolum Syntheticum high-dose group，and Borneolum medium-dose group，QTC interval of the L-Borneolum medium and low-dose groups and the Borneolum high and medium-dose groups，and QRS duration of the L-Borneolum high and low-dose groups，the Borneolum high and low-dose groups，and the Borneolum Syntheticum groups were significantly reduced or shortened （P<0.05，P<0.01）. After 3 d of treatment，the heart rate of the L-Borneolum groups，the Borneolum high and medium-dose groups，and the Borneolum Syntheticum medium-dose group，ST wave of the L-Borneolum group，the Borneolum high and medium-dose groups，and the Borneolum Syntheticum high-dose group，OTC interval，ORS duration，and Q wave of the L-Borneolum high-dose group，the Borneolum high-dose group，and the Borneolum Syntheticum high and medium-dose groups，QRS duration of the L-Borneolum medium-dose group，QTC interval of the Borneolum medium-dose group，and Q wave of the Borneolum Syntheticum low-dose group were all significantly reduced or shortened（P<0.01）. The mRNA expressions of IL-1β and IL-6 in the L-Borneolum medium and low-dose groups，the Borneolum medium and low-dose groups，and the Borneolum Syntheticum high and medium-dose groups were significantly down-regulated（P<0.01），and LF/HF in the L-Borneolum high and medium-dose groups，the Borneolum high and medium-dose groups，and the Borneolum Syntheticum high and low-dose groups were significantly reduced （P<0.05，P<0.01）. HRV in the L-Borneolum high-dose group，the Borneolum groups，and the Borneolum Syntheticum high and low-dose groups，and T wave in the Borneolum high and medium-dose groups and the Borneolum Syntheticum high-dose group were increased significantly. The protein expressions of HIF-1α，VEGFR1，and CD34 in the L-Borneolum medium and low-dose groups，the Borneolum low-dose group，and the Borneolum Syntheticum high-dose group were significantly up-regulated，as well as those of VEGFR1 and CD34 in the Borneolum medium-dose group （P<0.05，P<0.01）. ConclusionThe 3 kinds of Borneolum improves the heart rate，heart rate variability，and electrocardiogram of AMI model rats to different degrees，and may play a myocardial protective effect by anti-inflammation and promotion of angiogenesis. The combined effect suggests that L-Borneolum has the superior effect next to Borneolum，and Borneolum Syntheticum has the inferior effect.

Conserved T-cell epitopes predicted by bioinformatics in SARS-COV-2 variants

BackgroundFinding conservative T cell epitopes in the proteome of numerous variants of SARS-COV-2 is required to develop T cell activating SARS-COV-2 capable of inducing T cell responses against SARS-COV-2 variants. MethodsA computational workflow was performed to find HLA restricted CD8+ and CD4+ T cell epitopes among conserved amino acid sequences across the proteome of 474727 SARS-CoV-2 strains. ResultsA batch of covserved regions in the amino acid sequences were found in the proteome of the SARS-COV-2 strains. 2852 and 847 peptides were predicted to have high binding affinity to distint HLA class I and class II molecules. Among them, 1456 and 484 peptides are antigenic. 392 and 111 of the antigenic peptides were found in the conseved amino acid sequences. Among the antigenic-conserved peptides, 6 CD8+ T cell epitopes and 7 CD4+ T cell epitopes were identifed. The T cell epitopes could be presented to T cells by high-affinity HLA molecules which are encoded by the HLA alleles with high population coverage. ConclusionsThe T cell epitopes are conservative, antigenic and HLA presentable, and could be constructed into SARS-COV-2 vaccines for inducing protective T cell immunity against SARS-COV-2 and their variants.

Comparison of the characteristics of medication fordiarrhea between adult and child in Erxu Mingyi Lei’an / 国际中医中药杂志

Objective:To compare and analyze the medication patterns for adult and children diarrhea from Erxu Mingyi Lei’an. Methods:The cases and formula prescriptions on adult and children diarrhea were recorded from Erxu Mingyi Lei ' an. The data was analyzed and compared between adult and children by the Ancient and Modern Medical Records Cloud Platform (V 2.1), including frequency statistics, association rule analysis, drug pair analysis, efficacy statistics, drug taste tropism statistics, and cluster analysis. Results:A total of 456 prescriptions of adult diarrhea were abstracted, involving 360 drugs, and the top 5 drugs were Poria, Atractylodis Macrocephalae Rhizoma, Citri Reticulatae Pericarpium, Paeoniae Radix Alba and Aucklandiae Radix. The Atractylodis Macrocephalae Rhizoma paired with Poria, Citri Reticulatae Pericarpium with Poria, Citri Reticulatae Pericarpium with Atractylodis Macrocephalae Rhizoma, and Paeoniae Radix Alba with Atractylodis Macrocephalae Rhizoma were commonly used in the treatment of adult diarrhea. Citri Reticulatae Pericarpium, Atractylodis Macrocephalae Rhizoma and Poria were the core drugs for adult diarrhea. There were 111 prescriptions for pediatric diarrhea, involving 180 drugs, and the top 5 were Atractylodis Macrocephalae Rhizoma, Poria, Paeoniae Radix Alba, Glycyrrhizae Radix et Rhizoma, and Nelumbinis Folium. The Poria paired with Atractylodis Macrocephalae Rhizoma, Atractylodis Macrocephalae Rhizoma with Glycyrrhizae Radix et Rhizoma Praeparata Cum Melle, and Aconiti Lateralis Radix Praeparata with Atractylodis Macrocephalae Rhizoma were commonly used in the treatment of diarrhea in children. The Atractylodis Macrocephalae Rhizoma, Poria and Aconiti Lateralis Radix Praeparata were the core drugs for children diarrhea. The main charateristics of drugswas warm type, sweet taste, and the main meridian belongs to spleen, followed by stomach and lung meridians. The use of carbided drugs in adults were significantly higher than children. Conclusions:The Erxu Mingyi Lei’an forcused the treatment of invigorating the spleen qi, where the adult formular often matches the drugs of drying dampness and invigorating the spleen, aromatizing dampness, slight infiltration and eliminating dampness, while the children formular often matches the drugs of warming the Yang and warming the Yang. Many kinds of carbonaceous drugs can be used in the treatment of adult diarrhea, but they should be used with caution in the treatment of children.

Correlation between metamorphopsia and foveal microstructure changes in patients with rhegmatogenous retinal detachment after vitrectomy / 中华眼底病杂志

Objective:To evaluate the changes of metamorphopsia in patients with rhegmatogenous retinal detachment (RRD) who underwent primary vitrectomy and to analyze the correlation between macular microstructure changes and metamorphopsia.Methods:It was a retrospective clinical study. From January 2017 to January 2019, 57 patients (57 eyes) with RRD were examined and diagnosed in the Department of Ophthalmology of Baoding First Central Hospital were enrolled in this study. All patients underwent 23G PPV. All patients had retinal anatomical reduction after the first PPV. The best corrected visual acuity (BCVA), intraocular pressure, slit-lamp microscope, indirect ophthalmoscope, changes of metamorphopsia, and optical coherence tomography (OCT) were examined before PPV and 1, 6, 12 months after the operation. The BCVA examination was performed using the international standard visual acuity chart, which was converted into a logarithm of the minimum angle of resolution (logMAR) BCVA for the record. The macular fovea retinal thickness (CRT) was measured by Carl Zeiss Cirrus HD-OCT5000 instrument from Carl Zeiss Company, Germany, and the microstructural changes in the macular area were recorded, including the presence of the anterior macular membrane (ERM), cystic macular edema (CME), subretinal fluid (SRF), and the integrity of the ellipsoid zone (EZ) and outer membrane (ELM). The value of metamorphopsia (M value) was measured by the M-Chart table. The changes of BCVA, M value, and the microstructure of the macular area before and after operation were analyzed. The correlation between BCVA and M value was analyzed by Pearson correlation. Spearman correlation analysis was used to analyze the correlation between the changes of macular microstructure and BCVA and M values.Results:The mean logMAR BCVA before the operation was 1.15±0.43. At 1, 6, and 12 months after the operation, the mean logMAR BCVA was 0.62±0.17, 0.39±0.18, and 0.34±0.13, respectively. The visual acuity improved significantly after operation compared with before operation, and the difference was statistically significant ( F=119.731, P=0.000). The mean CRT before the operation was 476.0±104.1 μm. At 1, 6, and 12 months after the operation, the average CRT were 299.8±29.9, 272.2±17.8, and 261.0±19.3 μm, respectively. The average CRT after the operation was significantly lower than those before the operation ( F=185.518, P=0.000). At 1, 6, and 12 months after the operation, the mean M values were 0.62±0.54, 0.43±0.41, and 0.32±0.36, respectively; the difference was statistically significant ( F=6.568, P=0.020). After the operation, 48 eyes (84.2%, 48/57) had microstructural abnormalities in the macular area, including EZ and ELM integrity disruption, SRF, CME, and ERM. Correlation analysis showed that M value was significantly positively correlated with BCVA, CRT, and SRF height before operation ( r/ rs=0.672, 0.385, 0.932; P<0.05). There was no correlation between M value and BCVA ( r/ rs=0.503), EZ and ELM integrity ( r/ rs=0.497, 0.472), SRF ( r/ rs=0.416), CME ( r/ rs=0.821) and ERM ( r/ rs=0.632) after operation ( P>0.05). Conclusions:The BCVA is significantly increased and the metamorphopsia is improved after anatomically successful RRD surgery. Postoperative M value is highly correlated with preoperative BCVA, CRT, and SRF.

Pre-chemotherapy nursing assessment among adult cancer patients: a best practice implantation project / 中国实用护理杂志

Objective:To promote evidence-based practice in the pre-chemotherapy nursing assessment among adult cancer patients.Methods:The Joanna Briggs Institute Practical Application of Clinical Evidence System and Getting Research into Practice audit tools were used. The project was conducted in Shanghai Cancer Center of Fudan University from May to October 2018, 12 audit criteria were developed in the program including nursing training, patient medical and allergic history, medical diagnosis, lab data and so on.Results:A baseline audit of pre-chemotherapy nursing assessment among adult cancer patients was conducted, with a sample size of 68 patients and 36 nursing staff, during this stage, the compliance of audit 11 and 12 were 100%. After the implementation of systematic strategies, a follow-up audit involving similar sample as first audit was conducted using the same audit criteria. In the follow-up audit, except criterion 4 and 10, the compliance of the remaining 8 criteria had significantly improved, and χ2 value was 10.29-132.06, P<0.01. The result of history adverse reaction in the follow-up audit showed that among 68 patients, 3 had experienced chemotherapy infusion reactions in the past (The drugs were oxaliplatin, gemcitabine and paclitaxel), 39 had chemotherapy-related symptoms before admission (most of them were relieved at admission), of which the top five were loss of appetite, fatigue, nausea, neurotoxicity and vomiting. Conclusions:The aims of the project were fulfilled. We achieved increased compliance with evidence-based best practice recommended by JBI in most of audit criteria. Further audit will need to be carried out to improve the validity and quality of nursing assessment.

The 477th case: muscular spasms, alopecia, diarrhea / 中华内科杂志

Diarrhea is a common digestive symptom. Here, we reported a case of young patient admitted with diarrhea caused by lead poisoning and cytomegalovirus infection. Through informative medical history and multi-disciplinary team discussion, Satoyoshi syndrome was finally diagnosed.

Comparison and analysis of the detection performance of six new coronavirus nucleic acid detection reagents / 重庆医学

Objective To compare and analyse the detection performance of different 2019-new coronavirus (2019-nCoV) nucleic acid detection kits, in order to provide references for laboratory. Methods Six kinds of domestic reagents (A—F reagent) were selected for parallel detection of a series of samples from one patient in this hospital whose 2019-nCoV nucleic acid result was confirmed weakly positive. The samples were taken at three different times, the RNAs were extracted and amplified, and two parallel tests were performed each time by use of these six kits. The detection performance was compared according to the results of each kit. Results The three parallel test results (ORF1ab and N gene) of C and F reagents were positive, the results of D reagent showed the N gene was not detected, and the results of A, B, E reagents showed the ORF1ab gene was not detected sometimes. The reproducibility of in-batch detections by C reagent was the best, and the CT values of F reagents (N and ORF1ab), E reagents (ORF1ab) and A reagents (ORF1ab) showed changes in trend. Conclusion There are differences in the detection ability of six 2019-nCoV nucleic acid detection reagents for weakly positive samples, and the accuracy, sensitivity and reproducibility of some reagents are not good. There is an urgent need to further optimize and improve their performance in order to better meet the needs of large-scale screening.

The 477th case: muscular spasms, alopecia, diarrhea / 中华内科杂志

Diarrhea is a common digestive symptom. Here, we reported a case of young patient admitted with diarrhea caused by lead poisoning and cytomegalovirus infection. Through informative medical history and multi-disciplinary team discussion, Satoyoshi syndrome was finally diagnosed.

Substrate Stiffness-Dependent Carbon Nanotube-Induced Lung Fibrogenesis.

Most living tissues exhibit the specific stiffness, which has been known to have profound influence on cell behaviors, yet how the stiffness affects cellular responses to engineered nanomaterials has not been elucidated. Particularly, discrepancies exist between in vitro and in vivo nanotoxicological studies. Here, we investigated the effects of substrate stiffness on the fibrogenic responses of normal human lung fibroblasts (NHLFs) to multiwalled carbon nanotubes (MWCNTs). NHLFs were grown on polyacrylamide (PAAm) hydrogels with the stiffness comparable to that of human normal and fibrotic lung tissues, and treated with MWCNTs for various time. The fibrogenic responses, including cell proliferation, reactive oxygen species production, and collagen I expression, of NHLFs to MWCNTs were observed to be regulated by substrate stiffness in a time-dependent manner. NHLFs generally were rounded on soft hydrogels and required a long treatment time to exhibit fibrogenic responses, while on stiff hydrogels the cells were well-spread with defined stress fibers and short-time MWCNTs treatment sufficiently induced the fibrogenic responses. Mechanistic studies showed that MWCNTs induced fibrogenesis of NHLFs through promoting expression and phosphorylation of focal adhesion kinase (FAK), while attenuating intracellular tension in the cells on stiff gels could increase MWCNTs uptake and thus elevate the induced fibrogenic responses. Moreover, we proposed a time-stiffness superposition principle to describe the equivalent effects of treatment time and substrate stiffness on nanomaterials-induced fibrogenesis, which suggested that increasing substrate stiffness expedited fibrogenesis and shed light on the rational design of in vitro models for nanotoxicological study.

Self-injurious behavior among college students and its association with parental rearing styles / 中国学校卫生

Objective@#To examine epidemiology of self-injurious behavior and explore the association between self-injurious behavior and parental rearing styles, to provide the theoretical basis for the identification, prevention and occurrence of the self-injurious behaviors among adolescents.@*Methods@#Stratified cluster sampling was used to survey 3 683 students from three colleges in Wuhu and Huainan by using questionnaire response. Egna Minnen avBarn-dosnauppforstran(EMBU) and demographic characteristics were used by college students to assess their selfinjurious behavior and parental rearing styles.@*Results@#For college students, the detection rate of reporting of 1-2 self-injurious behavior was 30.4%, and the rate of reporting of 3 or more self-injurious behavior was 11.8%. In terms of the occurrences of self-injurious behavior, gender(χ2=76.98), classification of colleges and universities(χ2=153.71) and the relationship with father (χ2=47.48) and with mother (χ2=40.01) were markedly different(P<0.05). Correlation and regression analysis indicated that the risks leading to self-injurious behavior were involved in medical students, overprotection from father and preference from mother(OR=2.05, 95%CI=1.64-2.55; OR=1.13, 95%CI=1.06-1.20; OR=1.05, 95%CI=1.01-1.09).@*Conclusion@#Female students and medical students can be inclined to self-injurious behavior. Parental rearing styles were related to the self-injurious behaviors of college students. Strengthening interaction between students and parents, providing appropriate emotional warmth as well as encouraging the establishment of a good family atmosphere may reduce the occurrence of self-injurious behavior in current college students.

Clinical value of cardiac ultrasound in the diagnosis of segmental ventricular wall motion abnormalities of coronary heart disease / 中国基层医药

Objective To explore the application value of cardiac ultrasound in the diagnosis of segmental ventricular wall motion abnormality of coronary heart disease (CHD),and to continuously improve the diagnosis and treatment quality of CHD.Methods From January 2015 to April 2017,200 CHD patients with segmental ventricular wall motion abnormalities(the echocardiographic diagnosis) in the Fourth People~ Hospital of Datong were selected in the research.Before treatment,the patients received cardiac ultrasound examination,checked out the segmental ventricular wall motion abnormalities,the coronary artery angiography was used for further identification.The cardiac ultrasound detection rate was calculated.The adverse reactions after coronary angiography were recorded.Results Echocardiography showed normal results in 16 cases(8.00％) and 184 cases(92.00％).And 184 cases(92.00％) were diagnosed with segmental wall motion abnormality by coronary angiography,that is,the disease detection rate of cardiac ultrasonic examination was 92.00％.No adverse reactions were found after receiving cardiac ultrasound examination.After coronary angiography examination,there were allergic reactions,nausea and other discomfort reactions,but the difference was not statistically significant(x2 =26.64,P ＞0.05).Conclusion In the diagnosis of segmental ventricular wall motion abnormality of CHD,coronary angiography has high accuracy but it is expensive,and cardiac ultrasound examination is highly accurate and non-invasive,and can be selected by grassroots hospitals without the conditions of coronary angiography.

Clinical effects of application of antibiotic bone cement in wounds of diabetic foot ulcers / 中华烧伤杂志

Objective@#To explore the clinical effects of antibiotic bone cement in the treatment of diabetic foot ulcers.@*Methods@#According to the treatment methods, 18 patients with diabetic foot ulcers (11 males and 7 females, aged 53-79 years), who were conformed to the study criteria and admitted to our hospital from January 2016 to January 2017, were enrolled in traditional group; 18 patients with diabetic foot ulcers (11 males and 7 females, aged 55-80 years), who were conformed to the study criteria and admitted to our hospital from February 2017 to February 2018, were enrolled in bone cement group. Wounds of patients in traditional group were treated with vacuum sealing drainage after conventional debridement. Wounds of patients in bone cement group were covered with antibiotic bone cement after conventional debridement. The number of patients with positive bacterial culture in wound exudate in the 2 groups on admission and 3, 6, 9, and 15 days after surgery, the length of hospital stay, the number of operation, and the wound complete healing time were retrospectively recorded. Data were processed with Fisher′s exact probability test and independent sample t test.@*Results@#Compared with (29±10) d and (4.6±1.2) times of patients in traditional group, the length of hospital stay [(9±3) d] of patients was obviously shortened, the number of operation [(1.3±0.6) times] of patients was obviously reduced, the number of patients with positive bacterial culture in wound exudate at each time point post surgery was obviously reduced (t=8.177, 9.896, P<0.05 or P<0.01) in bone cement group. There were no statistically significant differences in the number of patients with positive bacterial culture in wound exudate on admission and wound complete healing time between patients in the 2 groups (t=0.175, P>0.05).@*Conclusions@#The antibiotic bone cement treatment of diabetic foot ulcers can reduce the number of patients with positive bacterial culture in wound exudate and the number of operation, as well as shorten the length of hospital stay.

Study on the diagnosis of pulmonary aspergillosis in patients with non-granulocyte deficiency by GM detection of bronchial alveolar lavage / 中国医师杂志

Objective To evaluate the diagnostic effect of galactomannan (GM) on bronchial alveolar lavage in patients with non-granulocyte deficiency.Methods 64 patients with suspected invasive pulmonary aspergill were enrolled in our hospital from May 2016 to May 2017.According to the relevant diagnostic criteria,they were divided into the diagnosis group (n =3),the clinical diagnosis group (n =20),the proposed group (n =14) and non-fungal infection group (n =27).All subjects underwent bronchial alveolar lavage and GM testing.Results When the GM value of bronchoalveolar lavage fluid and serum GM value increased from 0.5 to 1,the sensitivity decreased,while the specificity and positive predictive value increased.The sensitivity,positive predictive value and negative predictive value of GM detection method for bronchial alveolar lavage fluid were significantly higher than that of serum GM (P ＜ 0.05) at the same GM boundary value,and the specificity was significantly lower than that of serum GM (P ＜ 0.05).When the GM boundary value of bronchial alveolar lavage fluid was ≥ 0.86,the diagnostic efficiency of invasive pulmonary aspergillosis was the highest,the sensitivity and specificity reached 80.26％,75.15％,and the area under the curve was 0.945 (95％ CI:0.782-0.986).Conclusions GM detection of bronchial alveolar lavage fluid is more helpful for the diagnosis of invasive pulmonary aspergillosis in patients with non-granulocyte deficiency than serum GM.The optimal threshold is 0.86.

Effect of rosuvastatin on C-reactive protein and vascular cell adhesion molecule 1 in patients with acute cerebral infarction / 中国基层医药

Objective To observe the effect of rosuvastatin on vascular cell adhesion molecule-1 (VCAM -1),C-reactive protein (CRP),TG,TC and LDC in patients with acute cerebral infarction at the early stage.Methods According to the random number expression method,90 patients with acute cerebral infarction were divided into rosuvastatin treatment group and control group,with 45 cases in each group.The course of treatment was 21 days.The control group was given conventional western medicine (aspirin,mannitol etc.),the treatment group received rosuvastatin on the basis of the control group.Before and after treatment,the plasma VCAM-1,CRP,TG,TC,LDLch levels,clinical efficacy,efficacy of regulating dyslipidemia and drug safety were compared.Results After treatment,the CRP levels in the two groups were improved.After treatment for 7 days,14 days,the CRP levels of the treatment group were (23.68 ± 5.23) mg/L,(16.68 ± 6.76) mg/L,respectively,which improved more significantly than those of the control group [(30.12 ± 6.68) mg/L,(21.12 ± 6.35) mg/L],the differences were statistically significant (t =5.092,3.230,all P ＜ 0.05).After 21 days of treatment,the CRP of treatment group was better than the control group,but the difference was not statistically significant (P ＞ 0.05).The VCAM-1 levels of the two groups after treatment were improved.After treatment for 7 days,14 days,the VCAM-1 levels of the treatment group were (1 205.1 ±61.8)mg/L,(852.1 ± 60.2)mg/L,respectively,which were improved more significantly than those of the control group[(1 415.6 ± 62.9) mg/L,(963.1 ± 53.3) mg/L],there were statistically significant differences between the two groups (t =21.815,9.261,all P ＜ 0.05),21 days after treatment,there was no statistically significant difference (P ＞ 0.05).The levels of TG,TC,LDC in the two groups were all decreased after treatment for 7 days,14 days and 21 days,and the improvement in the treatment group was more obvious,the differences between the two groups were statistically significant (t =5.219,7.303,4.044,2.232,4.336,3.612,2.689,7.817,11.057,all P ＜0.05).Conclusion Compared with the conventional western medicine treatment,rosuvastatin can decrease the plasma levels of CRP,VCAM-1,TG,TC,LDC,further improve the pathological basis of ischemic cerebrovascular disease,eliminate the risk factors,it is more conducive to the prognosis of acute cerebral infarction.

Exploration of "curriculum design" in biochemistry teaching / 中华医学教育探索杂志

The "student-centered" concept highlights the dominant position of students in the teaching process and makes up for the deficiency of traditional teaching mode.Based on the above idea,the teaching team of the author's department tried to improve teaching effect through effective teaching design in biochemistry.Firstly,the teaching goal (the goal of knowledge,ability and emotion) and the important situational factors the learning situation analysis,the characteristics of the course and the class,etc)should be identified.suitable teaching strategies he inspiration strategy,exploration strategy and problem solution strategy,etc.),teaching method (discussion,case study,problem based learning,etc.) and proper assessment (such as the summative assessment with formative evaluation) should be determined to organize classroom teaching.At the end of the class the timely feedback and the teaching reflection should be carried outto extend classroom teaching to extra-curricular class.The results showed that effective teaching designismore likely to stimulate students' learning enthusiasm,promote students' deep learning and achieve better teaching effects.