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.

Clinical application value of therapeutic endoscopic retrograde cholangiopancreatography in super-aged patients / 中国医师进修杂志

Objective@#To evaluate the value and safety of therapeutic endoscopic retrograde cholangiopancreatography (ERCP) in elderly patients.@*Methods@#The clinical data of 377 elderly patients with therapeutic ERCP from January 2010 to September 2017 in Changzhou First People′s Hospital of Jiangsu Province were retrospectively analyzed. Among them, there were 34 patients (observation group) aged ≥ 90 years and 343 patients (control group) aged 75 to 89 years old. The results of ERCP examination, treatment of bile duct stones and related complications were compared between 2 groups.@*Results@#There was no statistical difference in the success rate of ERCP between 2 groups (P>0.05). There were no statistical difference in detection rates of bile duct stones, cholangiocarcinoma and benign biliary stricture between 2 groups (P<0.05); however, the detection rates of duodenal papillary carcinoma and nipple diverticulum in observation group were significantly higher than those in control group: 11.8% (4/34) vs. 2.0% (7/343) and 38.2% (13/34) vs. 18.7% (64/343), and there were statistical differences (χ2 = 10.326 and 7.294, P<0.01). There were 21 patients with bile duct stones in observation group, including 14 patients with multiple stones; there were 241 patients with bile duct stones in control group, including 188 patients with multiple stones. The maximum stone diameter, rate of in-line stent drainage and rate of extracorporeal lithotripsy in multiple stones patients of observation group were significantly higher than those in multiple stones patients of control group: (1.5 ± 0.3) cm vs. (1.2 ± 0.4) cm、9.5% (2/21) vs. 1.7% (4/241), 4.8% (1/21) vs. 0.4% (1/241), and there were statistical differences (P<0.05). There was no statistical difference in incidence of ERCP complications between observation group and control group: 14.7% (5/34) vs. 6.7% (23/343), P>0.05; but the incidence of cardiac accidents in observation group was significantly higher than that in control group: 5.9% (2/34) vs. 1.2% (4/343), and there was statistical difference (χ2 = 4.393, P<0.05). There was no statistical difference in the length of hospital stay between observation group and control group: (11.5 ± 5.0) d vs. (13.2 ± 5.8), P>0.05.@*Conclusions@#Therapeutic ERCP is an important treatment for elderly patients with biliary and pancreatic diseases. For patients over 90 years old, ERCP is safe and reliable, but it is necessary to actively pay attention to comorbidities, especially cardiac function.

Clinical application value of therapeutic endoscopic retrograde cholangiopancreatography in super-aged patients / 中国医师进修杂志

Objective To evaluate the value and safety of therapeutic endoscopic retrograde cholangiopancreatography (ERCP) in elderly patients. Methods The clinical data of 377 elderly patients with therapeutic ERCP from January 2010 to September 2017 in Changzhou First People′s Hospital of Jiangsu Province were retrospectively analyzed. Among them, there were 34 patients (observation group) aged≥90 years and 343 patients (control group) aged 75 to 89 years old. The results of ERCP examination, treatment of bile duct stones and related complications were compared between 2 groups. Results There was no statistical difference in the success rate of ERCP between 2 groups (P＞0.05). There were no statistical difference in detection rates of bile duct stones, cholangiocarcinoma and benign biliary stricture between 2 groups (P﹤0.05); however, the detection rates of duodenal papillary carcinoma and nipple diverticulum in observation group were significantly higher than those in control group: 11.8% (4/34) vs. 2.0% (7/343) and 38.2% (13/34) vs. 18.7% (64/343), and there were statistical differences (χ2=10.326 and 7.294, P﹤0.01). There were 21 patients with bile duct stones in observation group, including 14 patients with multiple stones; there were 241 patients with bile duct stones in control group, including 188 patients with multiple stones. The maximum stone diameter, rate of in-line stent drainage and rate of extracorporeal lithotripsy in multiple stones patients of observation group were significantly higher than those in multiple stones patients of control group: (1.5 ± 0.3) cm vs. (1.2 ± 0.4) cm、9.5% (2/21) vs. 1.7% (4/241), 4.8% (1/21) vs. 0.4% (1/241), and there were statistical differences (P﹤0.05). There was no statistical difference in incidence of ERCP complications between observation group and control group: 14.7% (5/34) vs. 6.7% (23/343), P＞0.05; but the incidence of cardiac accidents in observation group was significantly higher than that in control group: 5.9% (2/34) vs. 1.2% (4/343), and there was statistical difference (χ2=4.393, P﹤0.05). There was no statistical difference in the length of hospital stay between observation group and control group: (11.5 ± 5.0) d vs. (13.2 ± 5.8), P＞0.05. Conclusions Therapeutic ERCP is an important treatment for elderly patients with biliary and pancreatic diseases. For patients over 90 years old, ERCP is safe and reliable, but it is necessary to actively pay attention to comorbidities, especially cardiac function.

Dose-response Relationship of Dexmedetomidine Combined with Sufentail for Postoperative Intravenous Analgesia in Video-assisted Thoracoscopic Surgery / 中国医学科学院学报

Objective To investigate the 50% effective dose(ED)and 95% effective dose(ED)of dexmedetomidine(DEX)combined with 0.032 μg/(kg·h)sufentanil as well as its analgesic effect for patient-controlled intravenous analgesia(PCIA)after video-assisted thoracoscopic surgery(VATS).Methods Totally 25 patients undergoing elective VATS were enrolled. DEX and 0.032 μg/(kg·h)sufentanil were used for postoperative PCIA. The loading dose of DEX was 0.048 μg/(kg·h),and the dose difference between two adjacent patients was 0.008 μg/(kg·h). The DEX dose of a current patient was determined by whether the previous patient was satisfied with postoperative analgesic effect. If the previous patient was satisfied with postoperative analgesic effect,the DEX dose of the current patient was decreased by 0.008 μg/(kg·h);and if the previous analgestic effect was not satisfactory,DEX dose of the current patient was increased by 0.008 μg/(kg·h). The study endpoint was dexmedetomidine dose was<0.008 μg/(kg· h) within 7 upper and lower cycles in 7 consecutive cases. Finally,the probability unit regression was used to estimate the ED and ED of DEX and their 95% .Results When DEX combined with 0.032 μg/(kg·h) sufentanil was used for postoperative PCIA in young patients undergoing VATS,the ED and EDof DEX were 0.0346 μg/(kg· h)[95%:0.0283-0.0408 μg/(kg·h)] and 0.0459 μg/(kg·h)[95%:0.0400-0.0880 μg/(kg·h)],respectively. No adverse reaction such as vomiting,respiratory depression,or bradycardia occurred. The average Visual Analogue Scale(VAS)scores at rest(=-5.128,=0.000)and cough(Z=-6.642,=0.000)and the Ramsay sedation score(Z=-2.335,=0.020)within 6 hours after surgery were higher than those after 6 hour.Conclusion DEX combined with 0.032 μg/(kg·h) sufentanil are effective for postoperative PCIA in patients undergoing VATS when the ED and ED are 0.0346 μg/(kg·h)and 0.0459 μg/(kg·h),respectively.

GRACE Score on Prognosis of ST-segment Elevation Myocardial Infarction in Patients Elder Than 75 Years With Primary Percutaneous Coronary Intervention / 中国循环杂志

Objective: To explore GRACE (global registry of acute coronary events)score on short term prognosis of ST-segment elevation myocardial infarction (STEMI)in patients elder than 75 years with primary percutaneous coronary intervention(PCI). Methods: A total of 104 STEMI patients elder than 75 years with primary PCI in our hospital from 2011-11 to 2014-01 were studied. Based on GRACEscore at admission, the patients were divided into 2 groups: Lower/mid risk group, n=72 patients with GRACEscore at 112-154 (136.5±10.6) and High risk group, n=32 patients with GRACE score at 155-202(167.8±12.3). The baseline condition and outcomes were compared between 2 groups and the primary endpoint was 1 year mortality. Predictive value of GRACEscore on 1 year mortality was evaluated by ROC curve, the relationships between Lower/mid risk group, High risk group and clinical outcomes were assessed by log-ranksurvive curve andunivariate Cox regression analysis. Results: The area under ROC curve for GRACEscore predicting 1 year mortality was 0.788 with the sensitivity at 70.0%and specificity at 84.0 %.Univariate Cox regression analysis indicated that compared with Lower/mid risk group, High risk group had the higher risk of 1-year death (HR=5.75, 95% CI 1.486-22.256, P=0.0113); log-rank survive curve presented that High risk group had the higher 1 year mortality (21.9% vs 4.2%, P=0.0039). Conclusion: GRACE score may further distinguish the lower/mid risk and high risk populations in elder STEMI patients; it may also predict 1 year clinical prognosis.

Serum lipid level of patients with branch retinal vein occlusion / 中华眼底病杂志

Objective To observe the serum lipid level of patients with branch retinal vein occlusion (BRVO).Methods A total of 71 BRVO patients (BRVO group) were enrolled in this study.The patients included 31 males and 40 females,with an average age of (52.75 ± 10.2) years.All the patients were examined for visual acuity,slit lamp ophthalmoscopy combine with preset lens,fundus color photography and fundus fluorescein angiography (FFA) examination.Seventy-two age-and sex-matched normal subjects were enrolled in this study as control group.The subjects included 32 males and 40 females,with an average age of (53.10±9.5) years.The BRVO and control group were divided into four subgroup which including age with ＜40 years,40-49 years,50-59 years and ≥60 years.The plasma cholesterol and triglyceride level of BRVO group,control group,and age subgroups of BRVO and control group were comparatively analyzed.Results The average plasma cholesterol levels were (4.529±0.100) and (4.274±0.106) mmol/L in BRVO and control group,respectively.There was no difference between two groups (t=-1.738,P＞0.05).The average triglyceride levels were (1.500±0.129) and (1.319±0.095) mmol/L in BRVO and control group,respectively.There was no difference between two groups (t=-1.135,P＞0.05).There was no difference of average plasma cholesterol (t=-1.755,1.850,-1.892,-0.507) and triglyceride (t=0.846,-0.074,-1.288,-1.887) level in age subgroups of BRVO and control subgroup (P＞0.05).Conclusion There is no significant difference of serum lipid level between BRVO patients and controls.

Study on the Yersinia pestis plasmid along the Qinghai-Tibet Railway / 中国地方病学杂志

Objective To detect the Yersinia pestis plasmid and molecular weight along the Qinghai-Tibet Railway.Methods Yersinia pestis plasmids molecular weight detected and analyzed using alkaline lysis,phenol-chloroform extraction of Yersinia pestis plasmid by agarose gel electrophoresis.Results The 18 Yersinia pestis strains of Qinghai-Tibet Railway contained 6×106,45×106,52×106,65×106,92×106plasmid,varing in the range of the 52×106-92×106.Conclusions The Yersinia pestis of Qinghai-Tibet Railway has a standardplasmid graphics,with the biggest Yersinia pestis plasmid changing in a certain regular degree,which providessignificance in the study of plague natural foci of the spatial structure and the genetic.characteristics of Yersiniapestis.

The quality specification of grape seed extract / 中国中药杂志

This paper reiviewed the current situation of quality control of grape seed extract in domestic and international market. Considering the fact that there is no national or industrial technical specifications established for the extract product, the authors suggested that two sets of quality specifications should be established for the grape seed extract. The two sets of specifications are: the high purity grape seed extract should contain polyphenol NLT 95%, monomer NLT 10%; and the grape seed extract with ordinary quality should have a procyanidolic value NLT 95, and monomer NLT 6%.

Quality control of plant extract / 中国中药杂志

The current situation of plant extract in domestic and international market was analyzed in the paper. The quality control of 20 plant extracts which have reasonably good sales in USA market was compared and analyzed. The analysis of the quality control of six plant extracts indicated that there were two main reasons leading to the varied quality specifications among different suppliers. One reason was that the plant species utilized by different companies were different. The other reason was that the extraction processes were different among different production plants. Comparing with the significant international suppliers of plant extracts, the product quality of Chinese companies were not satisfactory. It was suggested that chromatography and chromatographic fingerprint techniques should be applied to improve the quality control standard of plant extract in our country.