Construction and effect evaluation of simulation teaching system based on the competency of resident pharmacists / 中国药房

OBJECTIVE To build a standardized simulation teaching system for resident pharmacists and evaluate its effects， and to provide reference for improving the competency of resident pharmacists. METHODS The established simulation teaching system for pharmacy residents’ standardized training in the study included revising the simulation teaching syllabus， setting up simulation teaching courses， implementing the teaching method through “six types of simulations”， applying objective structured clinical examination （OSCE） for assessment， building a simulation teaching team and strengthening the simulation teaching management. The effect evaluation was perfermed with mixed research method， and qualitative and quantitative research methods were used to collect and analyze data and information. RESULTS ＆＆CONCLUSIONS Compared with the traditional teaching system， the passing rate of graduation examination （71.4% vs. 100%） and the score of after-department examination （[ 76.2±7.8） vs. （90.4±4.9）] under the simulation teaching mode were higher； through questionnaire surveys and qualitative interviews， we found that resident pharmacists who went through simulation teaching gave positive feedback on the role and impact of this system. The simulation teaching system can be used with good generalizability for the standardized training of resident pharmacists， and can provide strong basis and support for the high-quality development of hospital pharmacy.

A Multicenter Cross-sectional Survey on the Clinical Characteristics of Patients of Ankylosing Spondylitis with Kidney Deficiency and Stasis Obstruction Syndrome and Damp-heat Stasis Obstruction Syndrome / 中医杂志

ObjectiveTo compare the differences in clinical characteristics between kidney deficiency and stasis obstruction syndrome and damp-heat stasis obstruction syndrome in patients with ankylosing spondylitis （AS）， thereby providing reference for clinical differentiation and treatment. MethodsThe clinical data of 2339 patients with AS were collected， including 1075 cases of kidney deficiency and stasis obstruction syndrome and 1264 cases of damp-heat stasis obstruction syndrome. The basic information including age， gender， course of disease， history of ophthalmia， family history and human leukocyte antigen B27 （HLA-B27） positive history， Bath ankylosing spondylitis disease activity index （BASDAI） score， Bath ankylosing spondylitis functional index （BASFI） score， Bath ankylosing spondylitis measurement index （BASMI） score， Depression Anxiety Stress Scale 21 （DASS-21） score， single symptom score in terms of spinal pain， peripheral joint pain， tendon tenderness， morning stiffness degree and morning stiffness time， patient-reported outcomes including patient global assessment （PGA） score， chronic disease therapy function-fatigue scale （FACIT-F） score and night pain visual analog scale （VAS） score， laboratory indicators including serum C-reactive protein （CRP） and erythrocyte sedimentation rate （ESR）， and CT grading of sacroiliitis were measured and compared between groups. ResultsPatients with kidney deficiency and stasis obstruction syndrome were older and had a longer course of disease （P＜0.01）. The BASDAI， BASFI and BASMI scores of the patients with kidney deficiency and stasis obstruction syndrome were 3.84±1.79， 2.78±2.00 and 3.42±2.36， respectively， while those in patients with damp-heat stasis obstruction syndrome were 4.30±1.99， 3.43±2.12， and 2.92±1.76. The BASDAI score， BASFI score， PGA score， FACIT-F score， spinal pain score， peripheral arthralgia score， tendon tenderness score， morning stiffness degree score， depression score， anxiety score， and stress score in patients with damp-heat stasis obstruction syndrome were all higher than those with kidney deficiency and stasis obstruction syndrome， with longer duration of morning stiffness and higher CRP （P＜0.05 or P＜0.01）. BASMI score and night pain VAS score were more higher in patients with kidney deficiency and stasis obstruction syndrome （P＜0.01）. There was no significant difference in the ESR level and CT grading of the sacroiliac joint between the two groups （P＞0.05）. ConclusionAS patients with kidney deficiency and stasis obstruction syndrome have poorer spinal mobility， while those with damp-heat stasis obstruction syndrome have higher disease activity， poorer physical function， and are more prone to adverse psychological reactions.

Clinical efficacy of flexible ureteroscopic holmium laser lithotripsy combined with cyst wall incision in the treatment of renal calculi with ipsilateral renal cyst / 现代泌尿外科杂志

【Objective】 To investigate the efficacy of flexible ureteroscopic holmium laser lithotripsy combined with cyst wall incision and drainage in the treatment of renal calculi with ipsilateral renal cyst. 【Methods】 A total of 70 patients with renal calculi complicated with ipsilateral renal cyst (cyst diameter >40 mm, maximum diameter of stone 0.05). 【Conclusion】 Flexible ureteroscopic holmium laser lithotripsy combined with cyst incision and drainage has the advantages of short operation time, small trauma, few adverse reactions, good stone clearance effect and satisfactory efficacy. It can be used as a preferred surgical method for renal calculi complicated with ipsilateral renal cyst.

Characteristics of cervical lesions in 1 080 patients with abnormal colposcopic biopsies of TCT and HPV double screening in Shihezi region / 中国医师杂志

Objective:To explore the characteristics of cervical lesions in female patients in the Shihezi region of Xinjiang in the past two years and provide guidance for clinical work and local cervical cancer screening.Methods:The clinicopathological data and characteristics of 1 080 patients with abnormal double screening of human papilloma virus (HPV) and cervical exfoliative cell test (TCT) and vaginal mirror cervical tissue biopsy in the gynecology department of the First Affiliated Hospital of Medical College of Shihezi University from May 2017 to March 2019 were analyzed retrospectively. The influencing factors of cervical lesions were analyzed by logistic regression.Results:(1) Uneducated [odds ratio ( OR)=2.267], irregular vaginal bleeding ( OR=3.275) and number of sexual partners ≥3 ( OR=3.052) were independent risk factors for cervical lesions. (2) Cervical intraepithelial neoplasia (CIN) was detected most frequently in the 30-39 age group (57.54%), and cervical cancer was detected most frequently in the ≥60 age group (14.15%), followed by the 40-49 age group (2.20%). (3) The proportion of HPV positive and the positive rate of high-risk HPV16/18 in the 40-49 age group were the highest, 33.18% and 39.38% respectively. There was no statistically significant difference in HPV viral load between the different age groups ( P>0.05). (4) The detection rates of CIN3 and cervical cancer were higher in the HPV16/18-positive group than in the HPV-positive and TCT≥atypical squamous epithelial cells of undermined significance (ASC-US) group (18.34% vs 11.33%, 4.30% vs 1.82%), with statistically significant difference (all P<0.05), respectively. The detection rate of CIN2 was higher in the high-load group (28.44%) than in the medium-load group (25.32%) and the low load group (15.79%). (5) The detection rate of CIN3 in the HPV-positive TCT for the ASC-US populations was significantly higher in the HPV16/18-positive group than in the other subtypes of HPV-positive group (21.43% vs 8.33%, P<0.05). Conclusions:During cervical cancer screening in Shihezi region, we should strengthen the publicity of elderly women and uneducated people. CIN and cervical carcinoma in Shihezi region are closely associated with high-risk HPV infection, especially HPV16/18 infection. HPV-positive age is mainly concentrated in the age group of 40-49 years, and the detection rate of CIN and cervical cancer is the highest in the age group of 30-39 years and ≥60 years, respectively. The detection rate of ≥CIN2 in HPV16/18 fraction and high viral load population is higher than that of other HPV subtypes positive and low to medium load populations. How to effectively shunt HPV positive TCT is an important problem in ASC-US population, which needs further research.

MR metal artifact reduction in patients with anterior cruciate ligament reconstruction: comparison of MAVRIC-SL with conventional FSE sequences / 中华放射学杂志

Objective:To explore the value of metal artifact reduction in oblique sagittal multi-acquisition with variable resonance image combination slab selectivity (MAVRIC-SL) inversion recovery (IR) sequence compared with conventional fast spin-echo (FSE) fat saturation (FS)-T 2WI and proton density weighted imaging (PDWI) on the postoperative review of patients with metal-fixed anterior cruciate ligament reconstruction (ACLR) at 3.0 T MR. Methods:From June to November 2018, 27 patients with metal fixtures in ACLR were prospectively recruited in the First Hospital of China Medical University. The FSE sequences (FS-T 2WI and PDWI) and the MAVRIC-SL IR were performed at 3.0 T MRI system. The maximum artifact slice was selected and ROI was drawn, then the implant and artifact area and the number of artifact-influence slices were recorded. Image signal-to-noise ratio (SNR) was calculated. The degree of image artifacts (artifact degree of spiked ligament staple and its influence on the diagnosis of surrounding structures), measurability (measurability of distance between the upper edge of the staple and the lower edge of the graft entrance on tibia), and other degree of artifacts (whether there were metal artifacts other than implants that affect the observation of other structures within the scanning range) were scored. The Friedman M test and pairwise comparison were used to compare and analyze the quantitative and qualitative data. Results:The differences in artifact area, the number of artifact-influence slices and SNR among FS-T 2WI, PDWI and MAVRIC-SL IR images were statistically significant (all P<0.001). Pairwise comparison analysis suggested that the metal implant artifact area and the number of artifact-influence slices in the MAVRIC-SL IR image were smaller, and the SNR was higher than those of FS-T 2WI and PDWI (all P<0.05 after correction). The differences of the three scores among FS-T 2WI, PDWI and MAVRIC-SL IR were statistically significant (all P<0.001). Pairwise comparison analysis suggested that the degree of image artifacts score of MAVRIC-SL IR sequence was lower, and the measurability and other degree of artifacts scores were higher than FS-T 2WI and PDWI (all P<0.05 after correction). Conclusion:MAVRIC-SL can significantly reduce the metal artifacts and improve image quality in the postoperative MRI review of the patients with metal-fixed ACLR. Therefore, oblique sagittal MAVRIC-SL IR sequence can be used for assisting the diagnosis of conventional FS-T 2WI and PDWI.

Comparative analysis of different surgical methods for patients with moderate to severe uterine prolapse without conserving fertility / 中国医师杂志

Objective:To compare the efficacy of three different surgical methods in the treatment of patients with pelvic organ prolapse (POP)-Q grade Ⅱ-Ⅲ uterine prolapse (UP).Methods:The clinical data of 100 patients with pelvic organ prolapse quantitative (POP-Q) grade Ⅱ-Ⅲ UP treated in the First Affiliated Hospital of Medical College of Shihezi University from November 2015 to April 2019 were analyzed retrospectively. According to the operation method, they were divided into vaginal total hysterectomy group (TVH group, n=46), laparoscopic total hysterectomy + vaginal stump Y-patch sacral fixation group (LSC group, n=34) and transabdominal total hysterectomy + vaginal stump abdominal transverse fascia and round ligament suspension group (AFS group, n=20). The age, body mass index, delivery times, operation time and intraoperative bleeding of the three groups were compared. POP-Q scale, visual analogue scale (VAS) and Pelvic Floor Impact Questionnaire (PFIQ-7) were used to evaluate the objective cure, subjective satisfaction, preoperative and postoperative quality of life, and the recurrence rate of postoperative prolapse was compared. Results:Among the three groups, the TVH group had the shortest operation time and the LSC group had the least intraoperative blood loss ( P<0.05). The postoperative PFIQ-7 score improved the quality of life in the AFS group significantly better than the other two groups ( P<0.05). The postoperative POP-Q indicator points of the three groups were significantly improved than before ( P<0.05). Postoperative prolapse recurred in 8 cases (17.4%) in TVH group, 3 cases (8.8%) in LSC group and 1 case (5.0%) in AFS group, with no significant difference in recurrence rate among the three groups ( P>0.05). Conclusions:These three surgical treatments are all safe and effective for the treatment of moderate to severe uterine prolapse. Various factors should be considered comprehensively to develop individualized surgical plans for patients.

Evaluation of lumbar intervertebral disc degeneration with synthetic MRI / 中华放射学杂志

Objective:To investigate the value of synthetic MRI for evaluating lumbar intervertebral disc degeneration.Methods:A total of 414 lumbar intervertebral discs from 85 patients were included prospectively from September 2018 to February 2019 in First Affiliated Hospital of China Medical University. The T 1, T 2 and proton density (PD) mapping were generated from synthetic MRI. Two doctors measured the T 1, T 2 and PD values to evaluate intraobserver agreement by using ICC. For Pfirrmann grade comparisons, the variables with normal distribution were analyzed with the one-way analysis of variance, whereas those with skewed distribution were analyzed with the Kruskal-Wallis H test. Furthermore, the ROC curves were used on significant parameters to evaluate their diagnostic efficacy. The Z test was used to compare the differences of area under the ROC curves (AUC). Results:The color of the quantitative mapping changed along with the increase of the Pfirrmann grade of the intervertebral discs, which corresponded to the decrease of the T 2WI signal intensity. The ICC values of the quantitative values of nucleus pulposus indicated excellent agreement (ICC>0.900), followed by anterior annulus fibrosus (ICC>0.700) and then the posterior annulus fibrosus (ICC>0.600). The results of the adjacent Pfirrmann grade comparisons were as follows: between Pfirrmann grade Ⅰ and Ⅱ, the differences of T 2 and PD values of nucleus pulposus were statistically significant ( P=0.004 and P<0.001, respectively); between Pfirrmann grade Ⅱ and Ⅲ, the differences of T 1, T 2 and PD values of nucleus pulposus were statistically significant (all P<0.001); between Pfirrmann grade Ⅲ to Ⅳ, the T 1, T 2 and PD values of nucleus pulposus (all P<0.001) and the T 1 and PD values of posterior annulus fibrosus ( P=0.025, P<0.001, respectively) had statistically significant differences; between Pfirrmann grade Ⅳ to Ⅴ, the difference of T 2 values of nucleus pulposus were statistically significant ( P=0.031). The AUC of T 2 values of nucleus pulposus between Pfirrmann grade Ⅱ to Ⅲ and grade Ⅳ to V were higher than those of the PD values ( Z=2.443, 3.591 and P=0.015,<0.001). Conclusions:Synthetic MRI can quantitatively evaluate lumbar disc degeneration, in which the T 2 value of nucleus pulposus may be the most effective parameter with high repeatability.

Application and Effect Evaluation of 4M1E Refined Management Method in Optimizing Outpatient Pharmacy Service in Our Hospital / 中国药房

OBJECTIVE：To explore refined management mode of outpatient pharmacy ，and to improve the efficiency and quality of outpatient pharmacy service. METHODS ：From the hospital information and big data center of our hospital ，the outpatient pharmacy prescription data under the traditional management mode were collected ；fish bone analysis was used to find out the factors that may affect the waiting time of patients ，the work efficiency and quality of pharmacy ；4M1E method was adopted to improve the related problems and implement refined management. The prescription data of 10 working days before improvement，stage 1 and stage 2 of refined management were selected. The work efficiency of pharmacists ，average waiting time of patients ，dispensing errors and inventory errors before and after the improvement were compared and analyzed to evaluate the effects of refined management. RESULTS ：By fishbone diagram ，the factors influencing the waiting time of patients ，the work efficiency and quality of outpatient pharmacy service in our hospital included personnel factors ，machine factors ，material factors ， method factors ，environmental factors ，such as the number of personel and time alloction was unreasonable ，the machine was aging，etc. After the implementation of refined management ，the outpatient pharmacy of our hospital had taken a variety of measures，such as adjusting the staff working time and refining the performance rew ard scheme ，maintaining the automatic dispensing machine and updating the prescription scanning equipment，setting up temporary drug containers and opti- mizing the location number ，strengthening drug management and relevant personnel training ， openning the window ofcharacteristic single variety dispensing. The statistical results com showed that in the first stage of fine management ，the number of dispensing prescriptions and the number of p rescription items in the outpatient pharmacy of our hospital increased slightly in 10 working days. Due to the decrease of the number of on-the-job staff and the change of the number and time of open windows ，the cumulative working hours of on-the-job staff decreased from 1 680 hours to 1 440 hours；the number of dispensing prescriptions and prescription items per hour per capita increased from 52.0 pieces，58.7 to 65.1 pieces，69.6（P＜0.05）；the number of dispensing errors decreased from 30 to 5；there was no significant change in waiting time of patients and inventory errors. In the second stage of fine management ，when the amount of dispensing prescriptions in outpatient pharmacy of our hospital was similar ，the number of dispensing prescriptions and the number of prescription items per hour per capita increased from 52.0 pieces，58.7 to 59.9 pieces，67.3，respectively（P＜0.05）；the average waiting time of patients decreased from 9.30 min to 7.32 min（P＜0.05）. After further refining the error data collection method and adjusting the performance incentive scheme ，the number of dispensing errors in outpatient pharmacy increased to 75，and the number of inventory errors decreased from 5 to 0. CONCLUSIONS ：By 4M1E method，outpatient pharmacy of our hospital carry out refined management ，to achieve the improvement of work efficiency and quality，shorten the waiting time of patients

Effects of N-methyl-D-aspartate Receptor in Keratinocyte on TypeⅠComplex Regional Pain Syndrome / 中国医学科学院学报

To observe the cell origin of N-methyl-D-aspartic acid(NMDA)receptor expression in skin after chronic ischemic pain modeling in rats and explore the role of NMDA receptor in type Ⅰ complex regional pain syndrome. Forty-two adult male Sprague-Dawley rats were randomly divided into five groups:sham operation group(=12),chronic post ischemia pain(CPIP)group(=12),CPIP+normal saline(NS)group(=6),CPIP+NMDA group(=6),and CPIP+MK801 group(=6).Six rats in the sham operation group and CPIP group were sacrificed under deep anesthesia one day after modeling.The plantar skin and L3-L5 spinal cord tissue were used for NR1(NMDA receptor)subunit immunofluorescence detection and for Western blotting of NR1,interleukin(IL)-1β,and tumor necrosis factor(TNF)-α.For the remaining rats,the mechanical withdrawal threshold(MWT)values on the 2nd,6th,10th and 14th day after ischemia were recorded,and the corresponding drugs were injected subcutaneously from the 6th day after ischemia.The skin and L3-L5 spinal cords were collected on the 14th day,and the same detection methods were applied. Compared with the sham operation group,the CPIP group had significantly higher expressions of NR1(1.708±0.064;=12.120, <0.001),IL-1β(2.575±0.305;=5.158, =0.003),and TNF-α(2.691±0.217;=7.786, <0.001)in the skin on the first day after modeling.After intervention with NMDA and MK801,the MWT value was [(20.37±0.95)g] in the CPIP+NS group,which was significantly higher than that in CPIP+NMDA group [(15.85±1.09)g;=10.920, <0.001] but significantly lower than that in CPIP+MK801 group[(22.95±0.96)g;=6.421, <0.001] 10 days after modeling.On the 14th day,compared with the MWT of the CPIP+NS group [(21.57±0.96)g],the CPIP+NMDA group had significantly decreased MWT value [(16.53±1.63)g;=12.190, <0.001],and the CPIP+MK801 group had significantly increased MWT value [(23.27±1.28)g;=4.094, =0.025].Compared with the sham operation group,the CPIP group had significantly increased NR1 expression(1.708±0.064;=10.910, <0.001)and the CPIP+NS group had significantly increased expressions of IL-1β(2.518±0.147;=11.010, <0.001)and TNF-α(1.949±0.184;=10.870, <0.001).Compared with the CPIP+NS group,the CPIP+NMDA group had significantly increased expressions of IL-1β(4.816±0.607;=16.670, =0.003)and TNF-α(2.629±0.349;=7.790, <0.001)and the CPIP+MK801 group had significantly decreased expressions of IL-1β(1.048±0.257;=10.660, =0.003)and TNF-α(0.790±0.165;=13.280, <0.001). NMDA receptor activation in skin keratinocytes after chronic ischemia in rats hinders the expression of inflammatory cytokines such as IL-1β and TNF-α,which may be involved in central sensitization and pain conduction of type Ⅰ complex regional pain syndrome.

Novel Coronavirus Infection Response ：Prevention and Control Strategies Based on Drug ，Material Supply and Emergency Management / 中国药房

OBJECTIVE：To provide drug ，material supp ly and emergency management reference for novel coronavirus （SARS-CoV-2）infection in pharmacy staff in hospital. METHODS ：The method of 5M1E was used to analyze the six main factors，including man ，machine，material，method，environment and measurement of drug ，material supply and emergency management. The relevant prevention and control strategies were put forward. RESULTS & CONCLUSIONS ：In the drug ，material supply and emergency management of epidemic prevention and control ，the man factors were involved ，such as mainly pharmacists from pharmacy departments of medical institutions. At the same time ，the management also involved machine factors such as drug storage，cleaning and disinfection ；material factors such as emergency drugs ，disinfection products ，in vitro diagnostic reagents ， the guarantee of medicine materials for medical team ，investigational products ；methods factors such as relevant management measures；environmental factors such as storage environment and facilities ；measurement factors such as drug use ，drug and substance reserve. In view of the above factors ，it is suggested to strengthen the professional knowledge and communication skills training of pharmacists ，and strengthen humanistic care ，so as to improve their post competency ，communication in emergency response and psychological tolerance. Equipment and materials management shall be strengthened ，and equipment maintenance and disinfection shall be done well to ensure normal use of equipment. According to the evidence-based method ，the emergency drug list should be established. According to the disinfection protection requirements ，the disinfection products should be reasonably selected and their quality and sufficient inventory should be ensured. The qualified in vitro diagnostic reagents should be purchased in time. The investigational products should be managed reasonably according to the relevant requirements of clinical trials ，to ensure the drug and material supply of medical team members. Emergency plans and standard operating procedures shall be formulated，the principle of sympathetic drug use shall be followed ，and the management of off-label drug use and early warning of drug and material shortage shall be done well. Reasonable storage space should be reserved to strengthen environmental monitoring and disinfection. We should strengthen the monitoring and reporting of daily data ，strengthen the quality monitoring ， and accept the independent audit of the third party. Above strategies are helpful to improve the ability of drug supply risk identification and response ability ，and cooperate with the medical team to timely rescue patients.

Interpretation of Novel Coronavirus Infection ：Expert Consensus on Guidance and Prevention Strategies for Hospi tal Pharmacists and the Pharmacy Workforce / 中国药房

OBJECTIVE：To provid e reference for pharmaceutical workers to better understand Novel Coronavirus Infection ： Expert Consensus on Guidance and Prevention Strategies for Hospital Pharmacists and the Pharmacy Workforce （hereinafter referred to as “expert consensus ”），and to apply and practice in specific work ，so as to give full play to the role of pharmacists to help fight the epidemic.METHODS ：The background of the formulation and revision of the expert consensus were introduced ，and its main contents and viewpoints were interpreted. RESULTS & CONCLUSIONS ：The text of expert consensus is divided into 8 parts，mainly including disease diagnosis and treatment [SARS-CoV- 2 infection related background ，clinical manifestations and diagnosis， treatment]，hospital pharmacy （prevention and control strategy ，work guidance ），drug and facility support management（key drug/facility/equipment support ，management and use of the drug in special circumstances ），information sources and related resources ，etc.，which comprehensively and detailedly provide information ，guidance and strategies for coronavirus SARS-CoV-2 infection prevention and control to play the role of pharmacists in hospital pharmacy well ，do well in the protection of staff in different pharmaceutical posts ，drug security work in response to epidemic situation ，and develop pharmaceutical care. So far，the understanding of SARS-CoV- 2 in the pharmaceutical industry is relatively limited. Based on the accumulated experience and progress in epidemic prevention and control ，the expert consensus will be updated and improved continuously ，so as to provide guidance and help for hospital pharmaceutical personnel.

Efficacy of posaconazole in preventing invasive fungal disease in hematologic patients with neutropenia / 中国感染控制杂志

Objective To evaluate the prophylactic efficacy and safety of posaconazole against invasive fungal disease(IFD)in hematologic patients with neutropenia.Methods Medical records of 18 hematologic patients with neutropenia received posaconazole for preventing IFD in a Beijing hospital between 2014 and 2015,the efficacy and safety was evaluated.Results There was no clinical diagnosis or confirmed diagnosis of IFD among 18 patients during posaconazole prophylaxis period,none of patients stopped posaconazole due to severe adverse reaction.Two patients with acute myeloid leukemia(AML) died of pulmonary infection,1 of whom isolated Stenotrophomonas maltophilia from sputum culture on the 12th day of posaconazole prophylaxis,the other isolated Escherichia coli from sputum culture on the 14th day of posaconazole prophylaxis.Other patients all adherence to posaconazole prophylaxis until granulocyte count recovered,patients were followed up until 100 days medication,no death occurred.The lowest peripheral neutrophil count was(0.00-0.27) x 109/L during posaconazole prophylaxis period,with the median of 0.02 x 109/L;the duration of posaconazole prophylaxis was 8-27days,with the median of 16 days;among patients without IFD breakthrough or received systemic use of other antifungal agents,there were 2 (11.1％) all-cause death within 100 days;there were no adverse reaction,such as liver function abnormalities≥grade 2 and kidney function abnormalities≥grade 2,as well as QTc prolongation.Conclusion Posaconazole is effective for preventing IFD in hematologic patients with neutropenia,adverse reaction is rare.

The impact of cigarette cessation intervention on mental state of patients with coronary heart disease / 中华内科杂志

Objective This study was designed to observe the impact of cigarette cessation on anxiety and depression in patients with coronary heart disease (CHD).Methods A total of 690 cigarette smoking patients with CHD identified by coronary angiography (CAG) were included and analyzed in the study.The mental state were scored with Hamilton anxiety (HAMA) and depression (HAMD) scale both on admission and at 6-month follow-up.The patients were divided into two groups based on the cigarette cessation.The score of mental state between the two groups were compared.The patients were treated with percutaneous coronary intervention (PCI),coronary artery bypass grafting (CABG),or medicine therapy (MT).Results The clinic data and score of mental state were similar at the time of admission (HAMA:10.66±5.53 vs 11.09 ±5.61,P =0.311;HAMD:29.81 ± 10.13 vs 28.94 ± 10.22,P =0.266 4) between the two groups.After 6 months,the proportions of subjects in smoking cession group with anxiety (24.2％ vs 32.3％,P ＜0.05),depression (18.0％ vs 27.5％,P ＜0.05),and anxiety and depression (7.0％ vs 16.2％,P ＜0.001) decreased significantly compared with those in smoking group irrespective of the treatment strategy.Both the HAMA and HAMD scores were lower in smoking cessation group (HAMA:9.83±3.40;HAMD:24.91 ±7.90) than in smoking group (HAMA:10.98 ±4.87;HAMD:27.70 ± 11.16) (all P ＜ 0.001).Conclusions Smoking cessation is good for the relief of anxiety and depression in CHD patient.

Suppressive effect of exogenous carbon monoxide on abnormal platelet exocytosis and its molecular mechanism in sepsis / 中华危重病急救医学

Objective To investigate the suppressive effect of exogenous carbon monoxide (CO) on abnormal platelet exocytosis and its possible molecular mechanism. Methods Venous blood was collected from healthy volunteers. Platelet-rich plasma (PRP) was isolated from the blood by differential centrifugation. The PRP was randomly divided into five groups by random number table, namely normal control group, lipopolysaccharide (LPS) group (challenged with 10 mg/L LPS), inactively exogenous carbon monoxide releasing molecule 2 (iCORM-2) group (given 10 mg/L LPS + 50 μmol/L iCORM-2 for intervention), exogenous carbon monoxide releasing molecule 2 (CORM-2) 10 μmol/L and 50 μmol/L groups (given 10 mg/L LPS + CORM-2 10 μmol/L or 50 μmol/L for intervention). After 30 minutes, enzyme linked immunosorbent assay (ELISA) was used to determine the platelet-derived growth factor BB (PDGF-BB) and matrix metalloproteinase 2 (MMP-2). Chemical fluorescein method was used to determine the platelet adenosine triphosphate (ATP). Flow cytometer was used to determine the expression of P-selectin. The expressions of Toll-like receptor 4 (TLR4), phosphorylation of protein kinase Cθ (PKCθ) and syntaxin binding protein 1 (STXBP-1) were determined by Western Bolt. The soluble N-ethylmaleimide-sensitive factor-attachment protein receptors (SNAREs) complex formation [syntaxin 2-synaptosomal-associated protein 23-vesicle associated membrane protein 8 (STX2-SNAP23-VAMP8)] mediated by STXBP-1 was determined by immunoprecipitation. Results ① Compared with normal control group, the platelet release of PDGF-BB, MMP-2 and ATP was significantly increased after LPS challenge, and the P-selectin expression of platelet was also obviously up-regulated [PDGF-BB (μg/L): 127.53±1.78 vs. 94.35±5.84, MMP-2 (ng/L): 51.87±9.20 vs. 35.83±3.17, ATP (μmol/L): 1.288±0.056 vs. 0.975±0.010, P-selectin: (3.93±0.19)% vs. (0.44±0.10)%, all P < 0.05]. The increases in platelet release of PDGF-BB, MMP-2 and ATP were suppressed by 10 μmol/L or 50 μmol/L CORM-2 administration, as well as high-expression of P-selectin in a dose-dependent manner [PDGF-BB (μg/L): 114.68±1.35, 97.08±6.14 vs. 127.53±1.78, MMP-2 (ng/L): 32.67±8.00, 24.63±1.63 vs. 51.87±9.20, ATP (μmol/L): 0.999±0.015, 0.965±0.008 vs. 1.288±0.056, P-selectin: (1.95±0.27)%, (0.94±0.11)% vs. (3.93±0.19)%, all P < 0.05]. ② Compared with normal control group, LPS challenge resulted in a significant increase in the expression of TLR4 and the phosphorylation of PKCθ and STXBP-1 [TLR4 (gray value): 1.21±0.38 vs. 0.67±0.06, p-PKCθ (gray value): 1.36±0.20 vs. 0.44±0.03, p-STXBP-1 (gray value): 1.13±0.06 vs. 0.59±0.04, all P < 0.05]. The increases in above parameters were suppressed by 10 μmol/L or 50 μmol/L CORM-2 administration in a dose-dependent manner [TLR4 (gray value): 0.76±0.05, 0.65±0.04 vs. 1.21±0.38; p-PKCθ (gray value): 0.71±0.07, 0.47±0.10 vs. 1.36±0.20; p-STXBP-1 (gray value): 0.56±0.02, 0.48±0.01 vs. 1.13±0.06, all P < 0.05]. ③ Compared with normal control group, the SNAREs proteins in platelet that combined with STXBP-1, including STX2, SNAP23 and VAMP8, were obviously increased after LPS challenge [STX2 (gray value): 1.35±0.06 vs. 0.57±0.04, SNAP23 (gray value): 0.97±0.04 vs. 0.30±0.12, VAMP8 (gray value): 1.37±0.12 vs. 0.77±0.10, all P < 0.05]. The increases in SNAREs complex formation were suppressed by 10 μmol/L or 50 μmol/L CORM-2 administration in a dose-dependent manner [STX2 (gray value): 0.77±0.02, 0.39±0.03 vs. 1.35±0.06, SNAP23 (gray value): 0.41±0.03, 0.22±0.08 vs. 0.97±0.04, VAMP8 (gray value): 0.85±0.07, 0.66±0.07 vs. 1.37±0.12, all P < 0.05]. There was no significant difference in the above mentioned parameters between iCORM-2 group and LPS group. Conclusions LPS-induced abnormal secretion of platelet was suppressed by CORM-2 administration. The mechanism may involve the TLR4/PKCθ/STXBP-1 signaling pathway activation and the SNAREs complex formation.

Interactions between endothelial cells and smooth muscle cells of blood vessels in sepsis / 中华危重病急救医学

Vascular endothelial cells (EC) and smooth muscle cells (SMC) are target and effecter cells of inflammation, and they play an important role in inflammatory responses. The abnormal structure and function of EC and SMC play a significant role in microcirculation disturbance in septic shock and multiple organ dysfunction. This review was meant to discuss the changes in structure and function of EC and SMC and their bidirectional regulation. The cellular linkage of EC and SMC is essential for the interactions between them, and it contributes to the course of sepsis. Paracrine and autocrine as produced by EC and SMC constitute a network for mutual adjustment. Replication of the interaction between EC and SMC facilitates the potential to support hemodynamics, tissue perfusion and cellular metabolism, thereby lower the mortality rate of sepsis. However, the detailed and specific mechanisms remain to be disclosed.

Effects of exogenous carbon monoxide-releasing molecule 2 intervention in vitro on formation of human neutrophil extracellular traps stimulated by endotoxin/lipopolysaccharide and its mechanism / 中华烧伤杂志

<p><b>OBJECTIVE</b>To explore the effects of exogenous carbon monoxide-releasing molecule 2 (CORM-2) on formation of human neutrophil extracellular traps (NETs) stimulated by endotoxin/lipopolysaccharide (LPS) and its relevant mechanism.</p><p><b>METHODS</b>Venous blood samples were collected from a healthy adult volunteer to isolate neutrophils. The neutrophils were divided into normal control (NC) group, LPS group, LPS+ 10 μmol/L CORM-2 group, LPS+ 50 μmol/L CORM-2 group, and LPS+ inactive CORM-2 (iCORM-2) group according to the random number table. No treatment was given to the neutrophils in NC group. The neutrophils in LPS group underwent LPS stimulation (1 μL, 1 μg/mL). The neutrophils in LPS+ 10 μmol/L CORM-2 group, LPS+ 50 μmol/L CORM-2 group, and LPS+ iCORM-2 group underwent the same LPS stimulation as that in LPS group and treatment of 10 μmol/L CORM-2, 50 μmol/L CORM-2, and 50 μmol/L iCORM-2, respectively, with the volune of 1 μL. After conventional culture for 1 h, the number of NETs was determined with propidium iodide staining method; the early cell apoptosis rate was determined with flow cytometer; the generation level of reactive oxygen species (ROS) was assessed with dihydrogenrhodamine 123 fluorescent probe staining method (denoted as mean fluorescence intensity); the expression level of phosphorylated extracellular regulated kinase 1/2 (p-ERK1/2) was determined by Western blotting. The sample numbers of each group in the 4 experiments were all 5. Data were processed with one-way analysis of variance and SNK test.</p><p><b>RESULTS</b>(1) The numbers of NETs per 400-time visual field in cells of LPS and LPS+ iCORM-2 groups were close to the number in NC group (with P values above 0.05). The number of NETs per 400-time visual field was significantly larger in cells of LPS+ 10 μmol/L CORM-2 and LPS+ 50 μmol/L CORM-2 groups than in NC and LPS groups (with P values below 0.05). The number of NETs per 400-time visual field in cells of LPS+ iCORM-2 group was close to that of LPS group (P>0.05). (2) The early cell apoptosis rate was significantly increased in LPS, LPS+ 10 μmol/L CORM-2, LPS+ 50 μmol/L CORM-2, and LPS+ iCORM-2 groups than in NC group (with P values below 0.05). The early cell apoptosis rates in LPS+ 10 μmol/L CORM-2, LPS+ 50 μmol/L CORM-2, and LPS+ iCORM-2 groups were close to the rate in LPS group (with P values above 0.05). (3) The generation level of ROS was significantly higher in cells of LPS, LPS+ 10 μmol/L CORM-2, and LPS+ iCORM-2 groups than in NC group (with P values below 0.05). The generation level of ROS in cells of LPS+ 50 μmol/L CORM-2 group was close to that of NC group (P>0.05). The generation level of ROS was lower in cells of LPS+ 10 μmol/L CORM-2 and LPS+ 50 μmol/L CORM-2 groups than in LPS group (with P values below 0.05), while the generation level of ROS in cells of LPS+ iCORM-2 group was close to that of LPS group (P>0.05). (4) The expression levels of p-ERK1/2 in cells of LPS and LPS+ iCORM-2 groups (respectively 0.0311±0.001 and 0.0309±0.0018) were close to the level in NC group (0.0304±0.0046, with P values above 0.05). The expression level of p-ERK1/2 was significantly higher in cells of LPS+ 10 μmol/L CORM-2 and LPS+ 50 μmol/L CORM-2 groups (respectively 0.7891±0.0201 and 1.2970±0.0056) than in NC group (with P values below 0.05). The expression level of p-ERK1/2 was significantly higher in cells of LPS+ 10 μmol/L CORM-2 and LPS+ 50 μmol/L CORM-2 groups than in LPS group (with P values below 0.05). The expression level of p-ERK1/2 in cells of LPS+ iCORM-2 group was close to that of LPS group (P>0.05).</p><p><b>CONCLUSIONS</b>CORM-2 can obviously increase the production of NETs in LPS-induced neutrophils, and it might be attributable to the promotion of inhibition of ROS generation and phosphorylation of ERK1/2.</p>

Experiments about Effect of Diabetes Mellitus on Function of Astrocyte (review) / 中国康复理论与实践

@# Diabetes mellitus can cause central nervous system dysfunction. Astrocyte, as an important part of the central nervous system,is affected by diabetes, which involve the volume of astrocyte, intercellular gap junctions, the expression of protein, glycogen storage and so on.

Experiments about Effect of Diabetes Mellitus on Function of Astrocyte (review) / 中国康复理论与实践

Diabetes mellitus can cause central nervous system dysfunction. Astrocyte, as an important part of the central nervous sys-tem, is affected by diabetes, which involve the volume of astrocyte, intercellular gap junctions, the expression of protein, glycogen storage and so on.