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The outpatient and emergency electronic medical record system is an important part of the hospital information system. By analyzing the current outpatient and emergency electronic medical record system in hospitals in China, this paper rounded up weaknesses in the development of the outpatient and emergency electronic medical record system in terms of management standards, support, technology bottleneck, data sharing and security. On such basis, the authors suggested to improve the policy standards, clarify the construction objectives, increase the support, optimize the system functions and strengthen the security management, which aimed at promoting the high-quality development of the construction of outpatient and emergency electronic medical record system in China′s hospitals.
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Patient diagnosis and treatment data are scattered in various clinical systems related to electronic medical records(EMR). The data can be better applied to the emergency prevention and control, medical research and government supervision only through unified integration. The authors analyzed the construction level of the EMR system in medical institutions, and sorted out the problems faced by directly extracting the diagnosis and treatment data of patients through the EMR system, including the lack of patient-centered integration of data, insufficient application depth of the EMR system, insufficient data standardization, lack of data and so on. Public health emergencies posed a severe challenge to the extraction of EMR data.For medical institutions with different information construction levels, the authors gave a feasibility analysis of data extraction by classification and time period, and suggested that medical institutions should fundamentally strengthen the understanding of information, establish data standard system and realize data integration and unified management.
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Objective:To analyze the application status and problems of clinical decision support system(CDSS) in medical institutions in China, and put forward corresponding suggestions.Methods:From April to May in 2020, a questionnaire survey was conducted in 1 013 medical institutions in 31 provinces of China. The contents of the questionnaire included the current situation of CDSS installation and deployment, the purpose of establishment, the source of knowledge base, the content to be optimized and the factors hindering the use.Results:199(19.64%) medical institutions had CDSS, among which 123 were used in the whole hospital and 76 in some departments; 426 medical institutions did not use CDSS, but had plans to use it. It was found that the current CDSS system had setbacks, such as big cognitive difference, lack of authority in knowledge, high difficulty in data governance, lack of industry standards and so on.Conclusions:In the future, the standardized use of CDSS in medical institutions could be promoted from the aspects of raising awareness, establishing knowledge authority and establishing standards.
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Pneumoconiosis refers to a spectrum of pulmonary diseases caused by inhalation of mineral dust, usually as the result of certain occupations. The main pathological features include chronic pulmonary inflammation and progressive pulmonary fibrosis, which can eventually lead to death caused by respiratory and/or heart failure. Pneumoconiosis is widespread globally, seriously threatening global public health. Its high incidence and mortality lie in improper occupational protection, and in the lack of early diagnostic methods and effective treatments. This article reviews the epidemiology, safeguard procedures, diagnosis, and treatment of pneumoconiosis, and summarizes recent research advances and future research prospects.
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Humans , Dust , Occupational Diseases , Occupational Exposure , Pneumoconiosis/epidemiology , Pulmonary FibrosisABSTRACT
Traditional Chinese Medicine (TCM) has been extensively used to ameliorate diseases in Asia for over thousands of years. However, owing to a lack of formal scientific validation, the absence of information regarding the mechanisms underlying TCMs restricts their application. After oral administration, TCM herbal ingredients frequently are not directly absorbed by the host, but rather enter the intestine to be transformed by gut microbiota. The gut microbiota is a microbial community living in animal intestines, and functions to maintain host homeostasis and health. Increasing evidences indicate that TCM herbs closely affect gut microbiota composition, which is associated with the conversion of herbal components into active metabolites. These may significantly affect the therapeutic activity of TCMs. Microbiota analyses, in conjunction with modern multiomics platforms, can together identify novel functional metabolites and form the basis of future TCM research.
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OBJECTIVE: To compare the intradermal delivery effects of composite phospholipid liposomes composed of different proportions of soy phospholipids (SPC) and hydrogenated soy phospholipids (HSPC) on the fluorescent modified hydroxypropyl-β-cyclodextrin(HP-β-CD), and to optimize the phospholipid composition with the best skin retention. METHODS: The fluorescent probe, fluorescein isothiocyanate (FITC), was combined with HP-β-CD to prepare fluorescent modified cyclodextrin FITC-HP-β-CD. FITC-HP-β-CD was encapsulated in different composite phospholipid liposomes. The amount of the permeation in the receiving solution and skin retention of the cyclodextrin after 10 h were determined in the in vitro intradermal delivery experiment. RESULTS: The order of cyclodextrin permeation of liposomes in the receiving solution was SPC > S/H (3:1) > S/H (1:1) > S/H (1:3) > HSPC >FITC-HP-β-CD, while the order of cyclodextrin intradermal retention was S/H (1:1) > S/H (1:3) > HSPC > S/H (3:1) > SPC > FITC-HP-β-CD. CONCLUSION: Using SPC to prepare liposomes is more beneficial to promote the permeation of FITC-HP-β-CD into the skin than HSPC, but the addition of HSPC can increase the skin retention of FITC-HP-β-CD. The S/H(1:1) liposomes have the better intradermal delivery effect on the fluorescent modified cyclodextrin, of which the skin retention effect is the best.
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Abri Herba,a kind of plant of Leguminosae family,is widely distributed in Guangdong and Guangxi,with rich resources.With a long medication history in China,its whole-plant, apart from plant seeds have been used as medicine, with the effects in removing dampness and removing jaundice, clearing heat and detoxifying,and clearing the liver and relieving pain. By accessing CNKI, Wanfang date,VIP Web, ScienceDirect,FMRS, Pubmed and multiple domestic and foreign databases,recent literatures on chemical constituents and pharmacological action and clinical trials of Abri Herba were collected and summarized in a review.According to a great quantity of relevant domestic and foreign literatures.Abri herba contains abundant chemical constituents, such as betulinic acid and other triterpenoids, catechin and other flavonoids,abrine and other alkaloids, chrysophanol and other anthraquinones, as well as inorganic elements.Abri Herba has a wide range of pharmacological effects due to rich material basis. Abri Herba, as a folk traditional herb, is used to treat jaundice with damp-heat pathogen, distending pain in the stomach, acute mastitisand gall, steatosis hepatis, hepatitis and internal traumatic injury. It also has many other effects in resisting tumor,oxidation,bacteria,virus and inflammation, relieving pain, promoting wound healing and regulating immunity.At present, there is single herb or traditional Chinese medicine compounds of Abri Herba in clinic, and the latter is the majority. Abri Herba can play a better pesticide effect by combining with traditional Chinese medicine. With a wide range of pharmacological effects,cheap price and easy cultivation. Abri Herba has high economic and social benefits, great potential for development and broad market prospects.Based on domestic and foreign studies on Abri Herba in past 30 years, the recent progress in the studies on chemical constituents,biological activities and clinical applications of this plant was reviewed in this paper, in the expectation of providing reference for further development and comprehensive utilization of Abri Herba medicinal resources.
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The open access of electronic health record(EHR) is an important link to promote the construction and application of EHR. Starting with the definition of open data of EHR, the authors discussed the content and form of open data of electronic health records, summarized the advanced experiences of countries with higher openness of EHR in the United States, the United Kingdom and Denmark. This paper combined the current situation that the opening of EHR in China is limited within data access instead of data utilization. It also pointed out such problems in the opening of EHR in China, as unclear data ownership, weak health awareness of residents and lack of unified construction standards.From the point of view of the state and medical institutions, this paper put forward a series of policy suggestions, such as issuing standards to standardize the opening of EHR, implementing patient real-name certification, realizing the overall opening of regional platforms, and linking the scope of application and supervision with the content of data opening.
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The biological relevance of cytokines is known for more than 20 years. Evidence suggests that adipogenesis is one of the biological events involved in the regulation of cytokines, and pro-inflammatory cytokines (e.g., TNFα and IL-1β) inhibit adipogenesis through various pathways. This inhibitory effect can constrain the hyperplastic expandability of adipose tissues. Meanwhile, chronic low-grade inflammation is commonly observed in obese populations. In some individuals, the impaired ability of adipose tissues to recruit new adipocytes to adipose depots during overnutrition results in adipocyte hypertrophy, ectopic lipid accumulation, and insulin resistance. Intervention studies showed that pro-inflammatory cytokine antagonists improve metabolism in patients with metabolic syndrome. This review focuses on the cytokines currently known to regulate adipogenesis under physiological and pathophysiological circumstances. Recent studies on how inhibited adipogenesis leads to metabolic disorders were summarized. Although the interplay of cytokines and lipid metabolism is yet incompletely understood, cytokines represent a class of potential therapeutic targets in the treatment of metabolic disorders.
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Tripterygium wilfordii multiglycoside( GTW),an extract derived from T. wilfordii,has been used for rheumatoid arthritis and other immune diseases in China. However its potential hepatotoxicity has not been investigated completely. Firstly,the content of triptolid( TP) in GTW was 0. 008% confirmed by a LC method. Then after oral administration of GTW( 100,150 mg·kg-1) and TP( 12 μg·kg-1) in female Wistar rats for 24 h,it was found that 150 mg·kg-1 GTW showed more serious acute liver injury than 12 μg·kg-1 TP,with the significantly increased lever of serum ALT,AST,TBA,TBi L,TG and bile duct hyperplasia even hepatocyte apoptosis. The expression of mRNA and proteins of liver bile acid transporters such as BSEP,MRP2,NTCP and OATP were down-regulated significantly by GTW to inhibit bile acid excretion and absorption,resulting in cholestatic liver injury. Moreover,GTW was considered to be involved in hepatic oxidative stress injury,although it down-regulated SOD1 and GPX-1 mRNA expression without significant difference in MDA and GSH levels. In vitro,we found that TP was the main toxic component in GTW,which could inhibit cell viability up to 80% in Hep G2 and LO2 cells at the dose of 0. 1 μmol·L-1. Next a LC-MS/MS method was used to detect the concentration of triptolid in plasma from rats,interestingly,we found that the content of TP in GTW was always higher than in the same amount of TP,suggesting the other components in GTW may affect the TP metabolism. Finally,we screened the substrate of p-glycoprotein( p-gp) in Caco-2 cells treated with components except TP extrated from GTW,finding that wilforgine,wilforine and wilfordine was the substrate of p-gp. Thus,we speculated that wilforgine,wilforine and wilfordine may competitively inhibit the excretion of TP to bile through p-gp,leading to the enhanced hepatotoxity caused by GTW than the same amount of TP.
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Animals , Female , Humans , Rats , Caco-2 Cells , Chemical and Drug Induced Liver Injury , Pathology , Chromatography, Liquid , Diterpenes , Toxicity , Drugs, Chinese Herbal , Toxicity , Epoxy Compounds , Toxicity , Glycosides , Toxicity , Liver , Phenanthrenes , Toxicity , Plant Extracts , Toxicity , Rats, Wistar , Tandem Mass Spectrometry , Tripterygium , ToxicityABSTRACT
An introduction is made to the experiences and trends of EMR-based evaluation of medical care quality in developed countries. The authors held that electronic medical records(EMR)are key technical means and supporting tool for medical care quality management, and quality data source for such evaluation. They recommended that China adapt to international standards in the design and choice of evaluation indicators of medical care quality and engage in international comparisons; integrate various data collection modalities to minimize workload of hospitals in data reporting, and keep elevating hospitals′informationization competence centering on electronic medical records.
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Described in the paper are the outcomes and progress of the MEG standards in six years, along with the imperativeness and revision pathways of the standards for the purpose of further promoting the level of HIT development in China.
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Objective To investigate the effect of knockout of IgG receptor( FcγRIIB) on systemic and adipose tis-sue inflammation and fat tissue lipid metabolism treated with high-fat diet ( HFD) . Methods We used 10 male mice with IgG receptor FcγRIIB knockout ( FcγRIIB-/-) and another 10 male FcγRIIB+/+mice as control, and trea-ted them with HFD. At the end of the 17th week, mice were weighed, the blood was taken by cardiac puncture af-ter sacrifice. Adipose tissue was collected to measure inflammation and lipid metabolism. Results Compared with FcγRIIB+/+mice, FcγRIIB-/-mice had significantly increased levels of inflammatory cytokines, IL-6, TNF-α, and IFN-γ in the serum, and increased macrophage infiltration in adipose tissue. M1 polarization gene MCP-1 and TNF-α increased ( P＜0.05) and M2 polarization gene ARG and IL-10 did not differ significantly. However, there was no significant difference in body mass, adipocyte size and expression of lipid metabolism related genes PPARG, CEBPα, FASn, HSL, ATGL, UCP-1 and GLUT4. Conclusions Under HFD treatment, knocking out the IgG re-ceptor FcγRIIB aggravates the inflammatory response of the whole body and adipose tissue, but cannot influence lipid metabolism of adipose tissue and body weight.
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To compare the penetration-enhancing effect of cinnamon oil and its main components (cinnamaldehyde) on ibuprofen and their self-percutaneous absorption behavior in vitro. Firstly, cinnamon oil was extracted by steam distillation, then the compositions were analyzed by gas chromatography mass spectrometry (GC-MS) and the cinnamaldehyde content in cinnamon oil was determined by high performance liquid chromatography (HPLC). With azone as positive control, ibuprofen as model drug, cinnamon oil and cinnamaldehyde as penetration enhancers (PE) were prepared and administered to the SD rat's abdominal skin. The penetration-enhancing effects of cinnamon oil and cinnamaldehyde and their own transdermal absorption properties were compared. The results showed that yield of cinnamon oil was (3.55±0.36)% (=3), and the cinnamaldehyde content in cinnamon oil was (73.48±0.21)% (=3). As compared with blank group, the enhancing rate (ER) of cinnamon oil, cinnamaldehyde, and azone was 3.56, 1.13, 2.47 respectively. The cumulative penetration rate of cinnamaldehyde in cinnamon oil and cinnamaldehyde monomer in 24 h was (63.30±0.98)%, (51.03±3.34)% (=4) respectively. The penetration-enhancing effect of cinnamon oil was significantly better than that of cinnamaldehyde, indicating the existence of muti-component synergy. The penetration rate of cinnamaldehyde in cinnamon oil was higher than that of cinnamaldehyde monomer, suggesting that a "pull effect" may be present.
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Objective To observe the clinical efficacy of cupping in intervening non-alcoholic fatty liver disease (NAFLD), and further explore the possible mechanism. Method Fifty NAFLD patients were randomized into two groups: a treatment group (25 cases, intervened by cupping, Chinese medication, diet control and kinesiotherapy) and a control group (25 cases, intervened by Chinese medication, diet control and kinesiotherapy). They were observed for 6 months. Body weight, body mass index (BMI), abdomen circumference, hip circumference, arm circumference, thigh circumference, blood lipids [including total cholesterol (TC) and triglyceride (TG)], hepatic enzymes [including aspartate transaminase (AST) and alanine transaminase (ALT)], and B-scan ultrasound of liver were recorded before and after the treatment for statistical analysis. Result After 6-month treatment, the body weight, BMI, abdomen circumference, hip circumference, arm circumference, and thigh circumference were significantly improved in the two groups (P<0.05); some patients had their TC, TG, AST and ALT levels descended to the normal range and B-scan ultrasound of liver turned negative; the reduction of abdomen circumference in the treatment group was more significant than that in the control group (P<0.05). Conclusion Cupping plus Chinese medication, diet control and exercises can effectively improve clinical observation indexes of NAFLD, especially for those with central obesity.
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OBJECTIVE:To introduce the research and application of sentinel hospital pharmacovigilance system,and provide technical reference for hospital pharmacovigilance working in China. METHODS:A sentinel hospital pharmacovigilance system based on hospital information system was established,the architecture and functionality were introduced and its effects were ana-lyzed. RESULTS:The sentinel hospital pharmacovigilance system formed by hospital business information management platform and data center. Its main functions included drug data arrangement,the auxiliary reporting of ADR,active monitoring,pharmaco-vigilance information inquiry,monitoring and warning and statistical analysis,which successfully achieved the rapid reporting and active monitoring of hospital ADR. The system had applied in 20 sentinel hospitals,and the ADR reporting quantity was obviously increased after applying the system. Compared with 2015,ADR reporting in a sample sentinel hospital was increased 120.6％ since it used the system in early 2016. Besides,the system had improved the ADR reporting process,operation and input standard for the ADR reporter,shortened the reporting time and improved the efficiency of the reporting staff. CONCLUSIONS:The establish-ment and application of sentinel hospital pharmacovigilance system has greatly improved the hospital ADR monitoring management level,and it is of great significance to further strengthen the pharmaovigilance in China.
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OBJECTIVE:To evaluate the research and application situation of Sunshine Medicine Electronic Monitoring Data Analysis System. METHODS:The Sunshine Medicine Electronic Monitoring data Analysis System based on business intelligence technology was introduced in respects of design process,development,implementation and application example. RESULTS:The whole architecture of the system mainly includes hospital business platform,data integration platform,information processing plat-form and application service platform;the functions of the system include medicine homepage show,single species analysis,antimi-crobial agent analysis,national essential medicine analysis,injection analysis and sunshine medicine analysis. It can monitor the drug utilization in multi-angle and multi-level manners by building data center and creating multidimensional models. Besides,the sys-tem could solve thedrugs unified coding and information controlproblems,data collection and information integrationprob-lems in different hospital,andthe efficient calculation and analysis of a large number of drug use data. It can realize drug analy-sis and monitoring in the hospital,analysis and online monitoring of drugs prescribed by the doctor,finding,warning and evaluat-ing abnormal phenomenon of drug use in the medical institutions,so that it is better for the supervisors to monitor the usage of drugs. CONCLUSIONS:The system with easy operation,flexible monitoring,rich chart shows,comprehensive monitor index has a positive effect on rational medication level.
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<p><b>BACKGROUND</b>Thrombosis following plaque rupture is the main cause of acute coronary syndrome, but not all plaque ruptures lead to thrombosis. There are limited in vivo data on the relationship between the morphology of ruptured plaque and thrombosis.</p><p><b>METHODS</b>We used optical coherence tomography (OCT) to investigate the morphology of plaque rupture and its relation to coronary artery thrombosis in patients with coronary heart disease. Forty-two patients with coronary artery plaque rupture detected by OCT were divided into two groups (with or without thrombus) and the morphological characteristics of ruptured plaque, including fibrous cap thickness and broken cap site, were recorded.</p><p><b>RESULTS</b>The fibrous cap of ruptured plaque with thrombus was significantly thinner compared to caps without thrombus ((57.00 ± 17.00) µm vs. (96.00 ± 48.00) µm; P = 0.0076).</p><p><b>CONCLUSIONS</b>Plaque rupture associated with thrombosis occurs primarily in plaque covered by a thin fibrous cap. Thick fibrous caps are associated with greater stability of ruptured plaque.</p>
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Adult , Aged , Female , Humans , Male , Middle Aged , Acute Coronary Syndrome , Diagnostic Imaging , Coronary Angiography , Plaque, Atherosclerotic , Diagnostic Imaging , Rupture, Spontaneous , Tomography, Optical Coherence , MethodsABSTRACT
<p><b>BACKGROUND</b>Combination therapy is an effective method to reduce the blood pressure (BP) for patients with hypertension. This study was performed to evaluate the efficacy and safety of benazepril/lercanidipine compared with benazepril alone in patients with mild-to-moderate hypertension.</p><p><b>METHODS</b>One hundred and eighty-one patients with mild-to-moderate primary hypertension were assigned in this randomized, single-blind, parallel-group study and were randomly divided into group A (benazepril 10 mg/lercanidipine 10 mg) and group B (benazepril 10 mg) for 8 weeks. At 4 weeks, the dosage of Benazepril was titrated up to 20 mg if the diastolic blood pressure (DBP) remained ≥ 90 mmHg. BP control and side effects were evaluated at the end of 1, 4 and 8 weeks.</p><p><b>RESULTS</b>The baseline characteristics of the two groups were similar. The BP in both groups decreased from the baseline (P < 0.05). At the end of 4 and 8 weeks, Benazepril/Lercanidipine produced greater BP reduction than Benazepril alone (P < 0.05). The comparison of the rate of BP control for the benazepril/lercanidipine and benazepril groups at the end of 1, 4, and 8 weeks were 41.2% vs. 37.6% (P > 0.05), 67.1% vs. 44.7% (P < 0.05), and 71.8% vs. 45.9% (P < 0.05). There was no significant difference of side effects between the two groups.</p><p><b>CONCLUSION</b>The benazepril/lercanidipine combination is more effective in reducing BP than benazepril alone, while it does not increase the incidence of side effects.</p>
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Aged , Female , Humans , Male , Middle Aged , Angiotensin-Converting Enzyme Inhibitors , Therapeutic Uses , Benzazepines , Therapeutic Uses , Blood Pressure , Calcium Channel Blockers , Dihydropyridines , Drug Therapy, Combination , Hypertension , Drug Therapy , Single-Blind MethodABSTRACT
<p><b>BACKGROUND</b>Edge dissections after coronary stent implantation are associated with increased short-term risk of major adverse cardiovascular events. The incidence and outcome of edge dissections after coronary stent implantation were reportedly different using different imaging techniques. We used optical coherence tomography (OCT) to assess the incidence, morphological findings and related factors of edge dissections after drug-eluting stent (DES) implantation.</p><p><b>METHODS</b>Totally 42 patients with 43 de novo lesions in 43 native arteries undergoing DES implantation with OCT imaging were enrolled in this study.</p><p><b>RESULTS</b>Nine edge dissections were detected in 43 arteries after DES implantation. There were four morphological patterns of stent edge dissections indentified in this study: (1) superficial intimal tears (n = 3), (2) subintimal dissections (n = 4), (3) split of media (n = 1), (4) disruption of the fibrotic cap of plaque (n = 1). Stent edge expansion and stent expansion were both higher in the group with dissections than those in the group without dissections (1.682 ± 0.425 vs. 1.229 ± 0.285, P = 0.0290; 1.507 ± 0.445 vs. 1.174 ± 0.265, P = 0.0072).</p><p><b>CONCLUSIONS</b>The incidence of stent edge dissections detected by OCT was 21%. Stent edge dissection is related with stent edge expansion and stent expansion.</p>