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Objective To investigate the differences in the influencing factors for acute necrotizing pancreatitis (ANP) and infectious pancreatic necrosis (IPN) between Eastern and Western countries, and to provide a theoretical basis for the prediction and prevention of ANP. Methods Databases including PubMed, Embase, the Cochrane Library, and Web of Science were searched for articles on the influencing factors for ANP and IPN published up to January 21, 2021, and a Meta-analysis was performed. Results A total of 59 studies were included, with 22 studies from Eastern countries and 37 studies from Western countries.The Meta-analysis showed that in Eastern countries, male sex (odds ratio[ OR ]=1.51, 95% confidence interval[ CI ]: 1.18-1.91, P < 0.01), C-reactive protein (CRP)(standardized mean difference[ SMD ]=1.39, 95% CI : 1.06-1.71, P < 0.01), D-dimer ( SMD =0.44, 95% CI : 0.07-0.81, P =0.02), Acute Physiology and Chronic Health Evaluation Ⅱ (APACHE-Ⅱ) score (mean difference[ MD ]=3.51, 95% CI : 1.38-5.64, P < 0.01), alcoholic etiology ( OR =3.57, 95% CI : 2.68-4.75, P < 0.01), and biliary etiology ( OR =0.60, 95% CI : 0.46-0.77, P < 0.01) were the influencing factors for ANP, and in Western countries, male sex ( OR =1.63, 95% CI : 1.30-2.05, P < 0.01), CRP ( SMD =2.09, 95% CI : 1.12-3.05, P < 0.01), APACHE-Ⅱ score ( MD =4.28, 95% CI : 2.73-5.83, P < 0.01), Ranson score ( MD =2.99, 95% CI : 2.50-3.47, P < 0.01), and organ failure ( OR =10.87, 95% CI : 2.62-45.04, P < 0.01) were the influencing factors for ANP.In Eastern countries, age ( MD =2.16, 95% CI : 0.43-3.89, P =0.01), body mass index (BMI)( MD =1.74, 95% CI : 1.23-2.25, P < 0.01), albumin level ( SMD =-0.43, 95% CI : -0.75 to-0.12, P < 0.01), CRP ( SMD =0.58, 95% CI : 0.04-1.11, P =0.03), procalcitonin ( SMD =0.80, 95% CI : 0.56-1.04, P < 0.01), D-dimer ( MD =0.23, 95% CI : 0.15-0.31, P < 0.01), APACHE-Ⅱ score ( MD =2.47, 95% CI : 0.73-4.22, P < 0.01), Ranson score ( MD =1.60, 95% CI : 1.46-1.73, P < 0.01), and extent of necrosis ≥30%( OR =2.52, 95% CI : 1.26-5.06, P < 0.01) were the influencing factors for IPN, while in Western countries, age ( MD =4.07, 95% CI : 1.82-6.31, P < 0.01), APACHE-Ⅱ score ( MD =3.28, 95% CI : 1.39-5.17, P < 0.01), Ranson score ( MD =2.18, 95% CI : 1.75-2.62, P < 0.01), SIRS score ( OR =3.88, 95% CI : 1.58-9.51, P < 0.01), alcoholic etiology ( OR =0.61, 95% CI : 0.42-0.87, P < 0.01), and organ failure ( OR =3.63, 95% CI : 1.11-11.92, P =0.03) were the influencing factors for IPN. Conclusion Current evidence shows that biliary etiology and alcoholic etiology are unique influencing factors for ANP in the Eastern population, while Ranson score is a unique influencing factor in the Western population.BMI and extent of necrosis ≥30% are unique influencing factors for IPN in the Eastern population, while alcoholic etiology is a unique influencing factor in the Western population.
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OBJECTIVE To provide suggestions and reference for enriching the selection of anti-infective medicines for children in China and promoting the establishment of the Essential Medicine List for Children in China. METHODS Descriptive analysis method was used to statistically compare the differences and similarities of anti-infective medicines included in the World Health Organization Model List of Essential Medicines for Children （EMLc）， World Health Organization Model List of Essential Medicines （EML） and National Essential Medicine List （NEML） in terms of drug category， variety， dosage form， specification， symbol mark， etc. RESULTS All anti-infective medicines of EMLc were covered by EML （85.3%）. NEML lacked the information of anti-infective medicines relatively， and contained few new categories； for example， the third-generation and above cephalosporins in EMLc were not included， and the drug dosage forms were also relatively limited （mainly tablets， capsules and injections）， but the specifications were relatively rich. CONCLUSIONS With reference to EMLc， the guidance on the use of essential medicines for children in China should be added from the aspects of age， body weight， combined medication， etc.， and the dosage forms suitable for children such as oral liquid preparations and scored tablets should be added to NEML； when updating the NEML the newer drugs suitable for children such as cefixime and dacatavir should be included. Finally， with reference to the continuity of EML and EMLc， the Essential Medicine List for Children in China should be established based on NEML to meet the drug needs of children and promote the safe use of drugs in children.
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Objective:To explore the peer support experience of newly graduated nurses during standardized training period.Methods:Using phenomenological qualitative research methods and purposive sampling, from April to December 2020, 32 new nurses who participated in the standardized training peer support program in the Affiliated Hospital of Yangzhou University were selected. Semi-structured interview was conducted and Claizzi content analysis method was used to analyze the data.Results:Peer support during the standardized training of new graduated nurses could be summarized into four major themes and eleven sub-themes. Theme 1: cognition and attitude (emotional security, adaptive guidance, recognition of the value of peer support, positive intention to support). Theme 2: peer support needs (department-related information needs; knowledge and skills experience needs; emotional communication needs; career growth support needs). Theme 3: peer support experience (adaptive behavior changes, cognitive and emotional changes, differences in perceived expectations of supporters and support effects).Conclusions:During the standardized training, we should attach importance to the important supporting role of peer support for new nurses. By building a peer support platform for new nurses and broadening experience exchange channels, we can enhance the positive experience of peer support, so as to promote the role adaptation and career growth of new nurses.
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OBJECTIVE： To introduce the pharmaceutical care for refractory mycoplasma pneumoniae （MP） pneumonia combined with cerebral infarction in child by clinical pharmacist， and to improve further understanding of MP-induced cerebral infarction and the management level of the clinical pharmacist. METHODS： Clinical pharmacist provided whole course pharmaceutical care for a child case of refractory PM pneumonia complicated with cerebral infarction admitted to the Children’s Hospital of Fudan University in Oct. 2018. The drug use in anti-infection， anti-inflammatory， treatment of cerebral infarction， possible drug interactions and suspected ADR were analyzed during treatment. RESULTS： The child admitted to the hospital for treatment due to MP pneumonia. During the treatment， the child suffered from cerebral infarction symptoms. The child was given a series of treatment programs， such as Azithromycin for injection for anti-infection， Methylprednisolone sodium succinate for injection for anti-inflammation， Nadroparin calcium injection for anticoagulation， Mannitol injection for reducing intracranial pressure， Dextran 40 glucose injection anti-thrombosis， Compound glycyrrhizin injection for protecting liver function， Hydrotalcite tablets for protecting gastric mucosa， intravenous immunoglobulin symptomatic supportive treatment. During the treatment， due to the poor therapeutic effect of Azithromycin for injection， it was considered that the patient may have cerebral infarction caused by refractory MP infection， so the patient’s prognosis was good when Azithromycin injection was replaced with Levofloxacin hydrochloride injection for anti-infection. For the increase of liver enzyme during the treatment， clinical pharmacist suggested that anti-infection combined with liver protection was provided for the child and then the liver enzyme returned to normal. During the treatment， clinical pharmacist mainly monitored the interaction and possible adverse reactions among anticoagulants， glucocorticoids， liver protecting drugs， drugs for reducing cranial pressure， antipyretic and analgesic drugs， and at the same time， made medication publicity and education for the family members of the child， and inform them of the adverse reactions of drugs to be paid attention to and the precautions for taking stomach protecting drugs， glucocorticoids and other drugs. CONCLUSIONS： Cerebral infarction caused by refractory MP pneumonia in children is because of excessive immune response directly or indirectly mediated by MP. The principle of treatment is to inhibit the inflammatory response， to solve the primary disease， and symptomatic supportive treatment. Multi-drug combination is needed in the course of treatment， so it is more necessary for the clinical pharmacist to participate in the whole process and to manage the drug refinement and ensure the safety of drug use.
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OBJECTIVE： To improve the quality of pediatric clinical trials， and establish the clinical trial training system for pediatric. METHODS： By consulting the literature， referring to the clinical research and training system of the United States and the European Union （mainly including initiators， training objects， training contents and time， training methods and assessment methods）， and combining with the characteristics of pediatric clinical trials in China， the pediatric clinical trial training system was built. RESULTS & CONCLUSIONS： The training system of clinical drug trials in the United States and the European Union is relatively perfect. Taking the United States as an example， clinical drug trials in the United States were initiated by the National Institutes of Health （NIH）， mainly for clinical researchers and other health technicians engaged in clinical research. The training contents included pharmacology， clinical research principle and practice， bioethics， etc. The training time was usually not indicated. The main methods included distance education and online network training， and assessment through online network examination. The author suggests that a collaborative network of pediatric clinical trials should be established in China. For clinical researchers， training courses should be developed at different levels （e.g. basic classes， promotion classes， advanced classes） and corresponding time should be set up （e.g. 2， 3， 4 d）. Various training methods should be set up （e.g. online， face-to-face， assignment， etc.） and assessment methods should changed （be changed to face-to-face assessment and formulate unified assessment criteria）. The training system of pediatric drug clinical trials in China can be gradually built and improved through the above ways.
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Objective To investigate the effect of Clostridium butyricum on the intestinal permeability and expression of tight junction proteins in rats with intrahepatic cholestasis.Methods Forty SD rats were random-ly divided into normal control group(Con),model group(Mod),group with low(CBL)and high dose(CBH)of Clostridium butyricum. Animal models of intrahepatic cholestasis were induced by alpha-naphthylisothiocyanate. Then different drugs were administrated via oral gavage for 7 days after modeling.After the last administration,the activities of serum alanin aminotransferase(ALT),aspartate aminotransferase(AST),diamineoxidase(DAO)and the contents of total bilirubin(T-BIL)in serum were detected. Pathological changes of liver tissue were observed. The expression level of Occludin and ZO-1 in small intestine was analysed by Western blot. Results Compared with the normal control group,the levels of ALT,AST,DAO,and T-BIL in mordel group were significantly in-creased. The expression of Occludin and ZO-1 in small intestine was reduced(P < 0.05). Compared with the mordel group,the levels of ALT,AST,DAO,and T-BIL and the expression of Occludin and ZO-1 decreased sig-nificantly(P<0.05)and the liver pathologic changes were improved in CBL and CBH group.Conclusions Clos-tridium butyricum can protect the liver and improve the intestinal permeability in rats with intrahepatic cholestasis, and he mechanism may be related with upregulation of Occludin and ZO-1.
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BACKGROUND: Placenta mesenchymal stem cells have become hot spots in stem cells study in recent years because of its advantages. OBJECTIVE:To analyze the biological characteristics of amniotic mesenchymal stem cells and amnion epithelial cells, and to explore the feasibility of amniotic mesenchymal stem cells and amnion epithelial cells applied as seed cells in three-dimensional liquid culture to construct the tissue-engineered skin. METHODS:The amniotic mesenchymal stem cells and amnion epithelial cells were obtained by using multi-step digestion with trypsin and col agenase;then the flow cytometry, reverse transcription-PCR and immunofluorescent staining techniques were adopted to identify the surface molecular markers, stem cellcharacteristics and keratinocytes similarity respectively. Based on these data, amniotic mesenchymal stem cells and amnion epithelial cells used as seed cells together with rat type Ⅰ col agen matrix were adopted for three-dimensional liquid culture. RESULTS AND CONCLUSION:Flow cytometry test showed that amniotic mesenchymal stem cells and amnion epithelial cells cultured in vitro could highly express CD90, CD73 and CD105, and could not express the hemopoietic stem cellmarker of CD34 and MHC-class Ⅱ molecular HLA-DR. Reverse transcription-PCR results detected that amniotic mesenchymal stem cells could express stem cellcharacteristic genes CMCY and NANOG;amnion epithelial cells could express stem cellcharacteristic genes CMCY and KLF4, showing that both amniotic mesenchymal stem cells and amnion epithelial cells have stem cellproperties. Reverse transcription-PCR results showed that amniotic mesenchymal stem cells could express keratinocytes characteristic genes K19,β1-integrin and K8;amnion epithelial cells could express K19,β1-integrin, K5 and K8. Immunofluorescence staining results showed amnion epithelial cells could express keratinocytes proliferation related protein K14, which revealed that there was certain similarity in the mRNA expression between keratinocytes and amnion epithelial cells, and indicating that it has the potential to differentiate into keratinocytes. Tissue-engineered skin was successful y constructed by using amniotic mesenchymal stem cells and amnion epithelial cells, hematoxylin-eosin staining section showed that it has certain skin structure, and amnion epithelial cells had a preliminary differentiation. Al these prove that it is feasible to construct human skin tissues with amniotic mesenchymal stem cells and amniotic epithelial cells through the three-dimensional culture.