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OBJECTIVE To analyze the effects of the national centralized drug procurement （NCDP） policy on drug availability and the structure of drug use in public hospitals. METHODS Using hypoglycemic， lipid-lowering， antiviral drugs， and psychiatric drugs for the treatment of mental illness and depression as objects， the interrupted time series model was used to quantitatively evaluate the changes in consumption sum of drugs， consumption amount and daily cost of the target drugs in national sample hospitals as well as the changes in per capita medication frequency， outpatient prescription amount， and medical insurance surplus of target drugs in a third grade class A hospital before and after the implementation of NCDP policy. RESULTS After the implementation of the NCDP policy， the volume for the four bid-winning drugs increased significantly （P＜0.01 for the remaining three categories except for hypoglycemic drugs）， but DDDc （P＜0.01） and the amount of related drugs （P＜0.001） decreased significantly. The volume for the non-winning drugs （except for lipid-lowering drugs） decreased significantly （P＜0.05）， and DDDc also decreased significantly （P＜0.05 for other 3 categories except for psychiatric drugs）； the volume （P＜0.01） and DDDc （P＜0.01 only for psychiatric drugs） for alternative drugs all increased except for antiviral drugs. The structure of drug use for different drugs was affected differently by the NCDP policy，and that of hypoglycemic drugs was affected obviously； the proportion of alternative drugs increased after centralized procurement. The outpatient prescription amount of each hospital significantly decreased after centralized procurement，and the decrease in the cost paid by the patients using lipid-lowering and antiviral drugs related to centralized procurement was greater than 0.60； the remaining medical insurance amount for bid-winning drugs was approximately 1.252 5 million yuan. CONCLUSIONS NCDP policy effectively alleviates the burden of medical expenditure and also drives the structure changes of drug use such as the substitution of generic drugs for original drugs， the growth of the volume of alternative drugs.
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Objective To explore the physician-pharmacist joint outpatient service mode of chronic obstructive pulmonary disease ( COPD) and asthma. Methods Cases of COPD or asthma patients who visited the joint outpatient department from June 2021 to December 2021 were collected in our hospital, the inhaler usage score，compliance ( MMAS-8) score，clinical control efficacy，incidence of adverse reactions and patient satisfaction were evaluated before and after pharmaceutical care intervention and statistically analyzed．Results The inhaler usage score，MMAS-8 score，and the Asthma Control Test（ACT）/COPD Assessment Test（CAT） score had been changed significantly after the intervention (P<0.05). Patient satisfaction with pharmaceutical care was basically above 94.75%．Conclusion Pharmaceutical care provided by joint outpatient department in our hospital could help COPD and asthma patients to use inhaler device correctly，resulting in improving compliance of inhaler usage, better disease control，and reducing the occurrence of adverse drug reactions, which could be a positive attempt and exploration of standardized pharmaceutical care model for patients with COPD and asthma．
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Chronic refractory wound (CRW) is one of the most challengeable issues in clinic due to complex pathogenesis, long course of disease and poor prognosis. Experts need to conduct systematic summary for the diagnosis and treatment of CRW due to complex pathogenesis and poor prognosis, and standard guidelines for the diagnosis and treatment of CRW should be created. The Guideline forthe diagnosis and treatment of chronic refractory wounds in orthopedic trauma patients ( version 2023) was created by the expert group organized by the Chinese Association of Orthopedic Surgeons, Chinese Orthopedic Association, Chinese Society of Traumatology, and Trauma Orthopedics and Multiple Traumatology Group of Emergency Resuscitation Committee of Chinese Medical Doctor Association after the clinical problems were chosen based on demand-driven principles and principles of evidence-based medicine. The guideline systematically elaborated CRW from aspects of the epidemiology, diagnosis, treatment, postoperative management, complication prevention and comorbidity management, and rehabilitation and health education, and 9 recommendations were finally proposed to provide a reliable clinical reference for the diagnosis and treatment of CRW.
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As the National Health Commission changes the management of novel corona virus infection, the situation and preventive policies for controlling the epidemic have also entered a new stage in China. Perioperative care strategies for orthopedic trauma such as designated isolation and nucleic acid test screening have also been adjusted in the new stage. Based on the perioperative work experiences in the new stage of epidemic from the frontline anti-epidemic staff of orthopedics in domestic hospitals and combined with the literature and relevant evidence-based medical data in perioperative care of orthopedic trauma patients under the current anti-epidemic policies at home and abroad, Chinese Orthopedic Association and Chinese Society of Traumatology organized relevant experts to formulate the Guideline for clinical perioperative care of orthopedic trauma patients in the new stage of novel corona virus infection ( version 2023). The guideline summarized 16 recommendations from the aspects of preoperative diagnosis and treatment, infection prevention, emergency operation and postoperative management to systematically standardize the perioperative clinical pathways, diagnosis and treatment processes of orthopedic trauma in the new stage of novel corona virus infection, so as to provide a guidance and reference for hospitals at all levels to carry out relevant work in current epidemic control policies.
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During coronavirus disease 2019 epidemic, the treatment of severe trauma has been impacted. The Consensus on emergency surgery and infection prevention and control for severe trauma patients with 2019 novel corona virus pneumonia was published online on February 12, 2020, providing a strong guidance for the emergency treatment of severe trauma and the self-protection of medical staffs in the early stage of the epidemic. With the Joint Prevention and Control Mechanism of the State Council renaming "novel coronavirus pneumonia" to "novel coronavirus infection" and the infection being managed with measures against class B infectious diseases since January 8, 2023, the consensus published in 2020 is no longer applicable to the emergency treatment of severe trauma in the new stage of epidemic prevention and control. In this context, led by the Chinese Traumatology Association, Chinese Trauma Surgeon Association, Trauma Medicine Branch of Chinese International Exchange and Promotive Association for Medical and Health Care, and Editorial Board of Chinese Journal of Traumatology, the Chinese expert consensus on emergency surgery for severe trauma and infection prevention during coronavirus disease 2019 epidemic ( version 2023) is formulated to ensure the effectiveness and safety in the treatment of severe trauma in the new stage. Based on the policy of the Joint Prevention and Control Mechanism of the State Council and by using evidence-based medical evidence as well as Delphi expert consultation and voting, 16 recommendations are put forward from the four aspects of the related definitions, infection prevention, preoperative assessment and preparation, emergency operation and postoperative management, hoping to provide a reference for severe trauma care in the new stage of the epidemic prevention and control.
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Oxalicine B ( 1) is an α-pyrone meroterpenoid with a unique bispirocyclic ring system derived from Penicillium oxalicum. The biosynthetic pathway of 15-deoxyoxalicine B ( 4) was preliminarily reported in Penicillium canescens, however, the genetic base and biochemical characterization of tailoring reactions for oxalicine B ( 1) has remained enigmatic. In this study, we characterized three oxygenases from the metabolic pathway of oxalicine B ( 1), including a cytochrome P450 hydroxylase OxaL, a hydroxylating Fe(II)/α-KG-dependent dioxygenase OxaK, and a multifunctional cytochrome P450 OxaB. Intriguingly, OxaK can catalyze various multicyclic intermediates or shunt products of oxalicines with impressive substrate promiscuity. OxaB was further proven via biochemical assays to have the ability to convert 15-hydroxdecaturin A ( 3) to 1 with a spiro-lactone core skeleton through oxidative rearrangement. We also solved the mystery of OxaL that controls C-15 hydroxylation. Chemical investigation of the wild-type strain and deletants enabled us to identify 10 metabolites including three new compounds, and the isolated compounds displayed potent anti-influenza A virus bioactivities exhibiting IC50 values in the range of 4.0-19.9 μmol/L. Our studies have allowed us to propose a late-stage biosynthetic pathway for oxalicine B ( 1) and create downstream derivatizations of oxalicines by employing enzymatic strategies.
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Chest trauma accounts for 10%-15% of total trauma and is responsible for approximately 25% of trauma-related deaths. Standard and accurate assessment of trauma severity is the basis for effective treatment. The application of chest trauma scoring systems to evaluate the severity of trauma is of great significance to prediction of complication and prognosis, clinical decision making and treatment optimization. The chest trauma scoring systems are varied with different functions and characteristics. When performing injury evaluation, an appropriate chest trauma scoring system should be selected according to the injury mechanism, injury site and needs of diagnosis and treatment. The authors review the application scope, scoring methods and research status of different chest trauma scoring systems, in order to provide references for more rational use of trauma scoring systems in clinical evaluation and treatment of chest trauma.
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Objective:To analyze the tendency of road traffic injuries (RTIs) among different age groups in China from 2004 to 2018 so as to provide a reference for targeted prevention of RTIs.Methods:Based on the annual traffic accident report data from the Ministry of Public Security of China and the China Statistical Yearbook, the age was divided into four groups: 0-14 years, 15-34 years, 35-59 years and ≥60 years. The total number of accidents, number of fatalities, number of injuries and age composition ratio of RTIs in different age groups were calculated from 2004 to 2018, and the mortality and disability rates of RTIs in different age groups were also calculated. The annual percent change (APC) and average annual percent change (AAPC) of the total number of accidents, number of fatalities, mortality rate, number of injuries and disability rate of RTIs among different age groups in China were measured by Joinpoint regression so as to analyze development trend of RTIs.Results:From 2004 to 2018, the age distribution concerning the number of accidents, deaths and injuries of RTIs were mainly among 15-34 years and 35-59 years, with the composition ratio greater than 40%. The composition ratio of people aged ≥60 years was small, but was increased gradually. The fitted value of the segmented regression model had a small relative error with the actual value, showing good fitting effect. From 2004 to 2018, the total number of accidents, number of fatalities, mortality rate, number of injuries and disability rate of RTIs in China were all statistically descended (AAPC=-5.53， P<0.01；AAPC=-3.64， P<0.01；AAPC=-4.19, P<0.01; AAPC=-5.13, P<0.01, AAPC=-5.65, P<0.01). Total number of accidents, number of fatalities and mortality rate of RTIs in China showed a notable upward trend instead after 2016 (APC=8.15, P=0.03; APC=2.10, P<0.01, APC=1.55, P<0.05). From 2004 to 2018, the total number of accidents, number of fatalities, mortality rate，number of injuries and disability rate of RTIs among people aged 15-34 years and 35-59 years were statistically descended (AAPC<0, P<0.05), while the total number of accidents, number of fatalities, mortality rate, number of injuries, and disability rate of RTIs among people aged ≥ 60 years showed a notable upward trend instead (AAPC=7.13, P<0.01; AAPC=6.64, P<0.01; AAPC=3.37, P<0.05; AAPC=8.85, P<0.01; AAPC=5.83, P<0.01). Conclusions:From 2004 to 2018, the total number of accidents, number of fatalities, mortality rate, number of injuries and disability rate of RTIs present a decrease trend in China and among people aged 15-34 years and 35-59 years, while an upward trend in those aged ≥60 years. In particular, the RTIs among people aged ≥60 years in China show an increase significantly since 2016, so the education of traffic safety awareness for the elderly should be strengthened to prevent their occurrence of RTIs.
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Lower extremity deep vein thrombosis (DVT) is one of the main complications in patients with traumatic fractures, and for severe patients, the DVT can even affect arterial blood supply, resulting in insufficient limb blood supply. If the thrombus breaks off, pulmonary embolism may occur, with a high mortality. The treatment and rehabilitation strategies of thrombosis in patients with lower extremity fractures have its particularity. DVT in traumatic fractures patients has attracted extensive attention and been largely studied, and the measures for prevention and treatment of DVT are constantly developing. In recent years, a series of thrombosis prevention and treatment guidelines have been updated at home and abroad, but there are still many doubts about the prevention and treatment of DVT in patients with different traumatic fractures. Accordingly, on the basis of summarizing the latest evidence-based medical evidence at home and abroad and the clinical experience of the majority of experts, the authors summarize the clinical treatment and prevention protocols for DVT in patients with traumatic fractures, and make this consensus on the examination and assessment, treatment, prevention and preventive measures for DVT in patients with different fractures so as to provide a practicable approach suitable for China ′s national conditions and improve the prognosis and the life quality of patients.
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Blast injury of the chest injury is the most common wound in modern war trauma and terrorist attacks, and is also the most fatal type of whole body explosion injury. Most patients with severe blast injury of the chest die in the early stage before hospitalization or during transportation, so first aid is critically important. At present, there exist widespread problems such as non-standard treatment and large difference in curative effect, while there lacks clinical treatment standards for blast injury of the chest. According to the principles of scientificity, practicality and advancement, the Trauma Society of Chinese Medical Association has formulated the guidance of classification, pre-hospital first aid, in-hospital treatment and major injury management strategies for blast injury of the chest, aiming to provide reference for clinical diagnosis and treatment.
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Objective:To investigate the pain level of lumbar puncture and family anxiety of hospitalized children, and analyze the influencing factors of family anxiety.Methods:A multi-center cross-sectional survey was used to enroll 190 children and their families who underwent lumbar puncture in 4 hospitals of Jiangsu Province from July 2018 to December 2019. The FLACC scale and face pain scale (WONG-BAKER scale) were adopted. The visual analogue scale (VAS) was used to investigate the pain level, and the anxiety state-trait questionnaire (STAI) was used to investigate the anxiety level.Results:The pain level scores before and after lumbar puncture were (2.86 ± 1.08) and (6.24 ± 1.59) scores respectively, and the difference was statistically significant ( t = 24.241, P<0.001). The total anxiety level of the children′s family members was (73.78 ± 4.67) scores, which was affected by factors such as the pain score, the age of the child, the number of lumbar punctures, the success rate of a lumbar puncture, the level of the hospital, the family status, and the education level of the family (adjusted R2 = 0.574, F = 29.784, P = 0.001). Conclusions:The pain in children is at a high level, and the anxiety level of their family members is also at a high level and is affected by many factors. Clinical medical staff can stratify the children and their families, and adopt targeted methods to relieve the pain of the children and the anxiety of the family members and promote the smooth development of the lumbar puncture.
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The efficient production of lignocellulolytic enzyme systems is an important support for large-scale biorefinery of plant biomass. On-site production of lignocellulolytic enzymes could increase the economic benefits of the process by lowering the cost of enzyme usage. Penicillium species are commonly found lignocellulose-degrading fungi in nature, and have been used for industrial production of cellulase preparations due to their abilities to secrete complete and well-balanced lignocellulolytic enzyme systems. Here, we introduce the reported Penicillium species for cellulase production, summarize the characteristics of their enzymes, and describe the strategies of strain engineering for improving the production and performance of lignocellulolytic enzymes. We also review the progress in fermentation process optimization regarding the on-site production of lignocellulolytic enzymes using Penicillium species, and suggest prospect of future work from the perspective of building a "sugar platform" for the biorefinery of lignocellulosic biomass.
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Biomass , Cellulase/metabolism , Fermentation , Fungi/metabolism , Lignin/metabolism , PenicilliumABSTRACT
According to the pathological characteristics of symptomatic chronic thoracic and lumbar osteoporotic vertebral fracture (SCOVF), the different clinical treatment methods are selected, including vertebral augmentation, anterior-posterior fixation and fusion, posterior decompression fixation and fusion, and posterior correction osteotomy. However, there is still a lack of a unified understanding on how to choose appropriate treatment method for SCOVF. In order to reflect the new treatment concept and the evidence-based medicine progress of SCOVF in a timely manner and standardize its treatment, the clinical guideline for surgical treatment of SCOVF is formulated in compliance with the principle of scientificity, practicability and advancement and based on the level of evidence-based medicine.
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TSCI have dyskinesia and sensory disturbance that can cause various life-threaten complications. The patients with traumatic spinal cord injury (TSCI), seriously affecting the quality of life of patients. Based on the epidemiology of TSCI and domestic and foreign literatures as well as expert investigations, this expert consensus reviews the definition, injury classification, rehabilitation assessment, rehabilitation strategies and rehabilitation measures of TSCI so as to provide early standardized rehabilitation treatment methods for TSCI.
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Since December 2019, corona virus disease 2019 (COVID-19) has been reported in Wuhan, Hubei Province, and spreads rapidly to all through Hubei Province and even to the whole country. The virus is 2019 novel coronavirus (2019-nCoV), never been seen previously in human, but all the population is generally susceptible. The virus spreads through many ways and is highly infectious, which brings great difficulties to the prevention and control of COVID-19. Based on the needs of emergency surgery for orthopedic trauma patients and review of the latest diagnosis and treatment strategy of COVID-19 and the latest principles and principles of evidence-based medicine in traumatic orthopedics, the authors put forward this expert consensus to systematically standardize the clinical pathway and protective measures of emergency surgery for orthopedic trauma patients during prevention and control of COVID-19 and provide reference for the emergency surgical treatment of orthopedic trauma patients in hospitals at all levels.
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With the spread of corona virus disease 2019 (COVID-19) in December 2019, the management and rehabilitation of elderly patients with hip fractures and protection of medical staff face new challenges, and need to be adjusted appropriately under this very circumstances. Hip fractures in the elderly account for more than half of osteoporotic fractures. Expert group formulate this consensus to make better decision against this epidemic and protect patients and medical staff. This consensus elaborates not only epidemic condition of COVID-19, but also general principles of medical admission, treatment and protection for both medical staff and patients, so as to provide some reference and promote the standardization of clinical diagnosis and treatment of elderly patients with hip fractures under the condition of COVID-19.
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There published 186 papers in Chinese Journal of Trauma in 2019.The yearly monographic topic was concentrated in spine and spinal cord injuries,involving 54 papers covering basic,clinical and rehabilitative studies.The columns mainly included Forum for Academician,Consensus and Guidelines,Trauma Center Construction,Special Monograph for 70th Anniversary of the Founding of People's Republic of China,Spine and Spinal Cord Injuries,Posttraumatic Bone Infection,Trauma Nursing and Basically Scientific Research.The authors introduce the key contents so as to help readers deepen their understanding of the publication and academic orientation of the Chinese Journal of Trauma.
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Since December 2019, novel coronavirus pneumonia (NCP) has been reported in Wuhan, Hubei Province, and spreads rapidly to all through Hubei Province and even to the whole country. The virus is 2019 novel coronavirus (2019-nCoV), never been seen previously in human, but all the population is generally susceptible. The virus spreads through many ways and is highly infectious, which brings great difficulties to the prevention and control of NCP. Based on the needs of orthopedic trauma patients for emergency surgery and review of the latest NCP diagnosis and treatment strategy and the latest principles and principles of evidence-based medicine in traumatic orthopedics, the authors put forward this expert consensus to systematically standardize the clinical pathway and protective measures of emergency surgery for orthopedic trauma patients during prevention and control of NCP and provide reference for the emergency surgical treatment of orthopedic trauma patients in hospitals at all levels.
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With the spread of novel coronavirus pneumonia (NCP) in December 2019, the management and rehabilitation of elderly patients with hip fractures and protection of medical staff face new challenges, and need to be adjusted appropriately under this very circumstances. Hip fractures in the elderly account for more than half of osteoporotic fractures. Expert group formulate this consensus so as to make better decision against this epidemic and protect patients' families and medical staff. This consensus elaborates not only epidemic condition of NCP, but also general principles of medical admission, treatment and protection for both medical staff and patients, in order to provide some reference and promote the standardization of clinical diagnosis and treatment of elderly patients with hip fractures under the condition of NCP.
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There published 186 papers in Chinese Journal of Trauma in 2019. The yearly monographic topic was concentrated in spine and spinal cord injuries, involving 54 papers covering basic, clinical and rehabilitative studies. The columns mainly included Forum for Academician, Consensus and Guidelines, Trauma Center Construction, Special Monograph for 70th Anniversary of the Founding of People's Republic of China, Spine and Spinal Cord Injuries, Posttraumatic Bone Infection, Trauma Nursing and Basically Scientific Research. The authors introduce the key contents so as to help readers deepen their understanding of the publication and academic orientation of the Chinese Journal of Trauma.