The chain mediating effect of nursing organization climate perception and professional identity between self-disclosure and transformation impact of new nurses in oncology department / 中国实用护理杂志

Objective:To investigate the current situation and correlation between organizational climate perception, professional identity, self-disclosure and transformation impact of new nurses in oncology department, and explore the chain mediating effect between organizational climate perception and professional identity between self-disclosure and transformation shock, so as to provide basis for further formulating the intervention plan of transformation impact.Methods:This study was a cross-sectional survey. From August 2021 to April 2022, a total of 252 newly graduated nurses in oncology department from nine Class ⅢGrade A hospitals in Henan Province were selected as the research objects by the convenient sampling method. General Information Questionnaire, Transformation of New Nurses Impact Evaluation Questionnaire, Distress Disclosure Index, Nursing Organization Climate Perception Scale, Professional Identity Scale were used for survey. Pearson correlation analysis was performed, and AMOS26.0 software was used to build a chain intermediary model, and the model was tested by Bootstrap method.Results:The total score of the transformation impact of new nurses in the oncology department was (96.51 ± 13.04); the total score of the Distress Disclosure Index was (33.84 ± 7.18); the total score of Nursing Organizational Climate Perception Scale was (99.16 ± 12.97); the total score of the Professional Identity Scale was (91.23 ± 19.92). Self-disclosure, organizational climate perception and professional identity were negatively correlated with transformation impact ( r = - 0.743, - 0.684, -0.631, all P<0.05). The indirect effect of self-disclosure on transformation impact was true, and the total indirect effect was 0.435. The specific mediating effect of nursing organizational climate perception accounted for 51.5% (22.4/43.5) of the total indirect effect and that of professional identity 15.9%(6.9/43.5) of the total indirect effect. The organizational climate and professional identity accounted for 32.4%(14.1/43.5) of the total indirect effects. Conclusions:Self-disclosure, organizational climate perception and professional identity of new nurses in oncology department was negatively correlated with transformation impact. Self-disclosure is positively correlated with organizational climate perception and professional identity, organizational climate perception and professional identity play a chain mediating effect between self-disclosure and transformation impact. It is suggested that managers should adopt positive and effective self-disclosure intervention programs and develop relevant training programs to improve the organizational climate perception and professional identity level of new nurses in oncology department, so as to reduce their transformation impact.

Modulating effects of Astragalus polysaccharide on immune disorders via gut microbiota and the TLR4/NF-κB pathway in rats with syndrome of dampness stagnancy due to spleen deficiency / 浙江大学学报（英文版）（B辑：生物医学和生物技术）

The syndrome of dampness stagnancy due to spleen deficiency (DSSD) is relatively common globally. Although the pathogenesis of DSSD remains unclear, evidence has suggested that the gut microbiota might play a significant role. Radix Astragali, used as both medicine and food, exerts the effects of tonifying spleen and qi. Astragalus polysaccharide (APS) comprises a macromolecule substance extracted from the dried root of Radix Astragali, which has many pharmacological functions. However, whether APS mitigates the immune disorders underlying the DSSD syndrome via regulating gut microbiota and the relevant mechanism remains unknown. Here, we used DSSD rats induced by high-fat and low-protein (HFLP) diet plus exhaustive swimming, and found that APS of moderate molecular weight increased the body weight gain and immune organ indexes, decreased the levels of interleukin-1β (IL-1β), IL-6, and endotoxin, and suppressed the Toll-like receptor 4/nuclear factor-‍κB (TLR4/NF-‍κB) pathway. Moreover, a total of 27 critical genera were significantly enriched according to the linear discriminant analysis effect size (LEfSe). APS increased the diversity of the gut microbiota and changed its composition, such as reducing the relative abundance of Pseudoflavonifractor and Paraprevotella, and increasing that of Parasutterella, Parabacteroides, Clostridium XIVb, Oscillibacter, Butyricicoccus, and Dorea. APS also elevated the contents of short-chain fatty acids (SCFAs). Furthermore, the correlation analysis indicated that 12 critical bacteria were related to the body weight gain and immune organ indexes. In general, our study demonstrated that APS ameliorated the immune disorders in DSSD rats via modulating their gut microbiota, especially for some bacteria involving immune and inflammatory response and SCFA production, as well as the TLR4/NF-κB pathway. This study provides an insight into the function of APS as a unique potential prebiotic through exerting systemic activities in treating DSSD.

Influence of occupational stress on mental health of medical staff: mediating effect of affective commitment and moderating effect of overcommitment / 环境与职业医学

Background Occupational stress has been shown to be an important factor affecting the mental health of workers. The role of affective commitment to the organization and overcommitment to work cannot be ignored. However, there is a lack of research on this topic in China. Objective To explore a potential mediating effect of affective commitment on how occupational stress affects the mental health of medical staff and a potential moderating effect of overcommitment on the mediating effect of affective commitment. Methods A total of 1372 health care workers in a tertiary Grade A hospital in Lanzhou City were selected as study subjects for a cross-sectional survey. The occupational stress, emotional commitment, and psychological distress of the subjects were evaluated by the Effort-Reward Imbalance Scale, Affective Commitment Scale, and Kessler 10 Scale. SPSS 26.0 was used for correlation analysis, mediation analysis, and moderated mediation analysis. Common method bias wasevaluated by Harman one-factor test. Results A total of 1372 questionnaires were distributed, of which 1277 valid questionnaires were returned, with a valid recovery rate of 93.08%. The mean occupational stress score was 1.14±0.23, the mean overcommitment score was 20.26±3.21, the mean affective commitment score was 20.25±3.34, and the mean psychological distress score was 26.26±7.90. The Spearman correlation analysis results showed that occupational stress among medical staff was positively correlated with overcommitment and psychological distress (r=0.153, 0.410, P＜0.01) and negatively correlated with affective commitment (r=−0.341, P＜0.01); overcommitment was negatively related to affective commitment and positively related to psychological distress (r=−0.107, 0.312, P＜0.01); affective commitment was negatively related to psychological distress (r=−0.464, P＜0.01). The positive effect of occupational stress on psychological distress of medical staff was significant (b=0.41, t=15.42, P<0.001); affective commitment presented a partial mediating effect on the relationship between occupational stress and psychological distress (effect value=0.13), accounting for 31.71% of the total effect; overcommitment moderated the process of occupational stress-affective commitment-psychological distress (P＜0.01). Conclusion Affective commitment of medical staff has a partial mediating effect on the relationship between occupational stress and psychological distress, and overcommitment plays a significant role in moderating the process of occupational stress-affective commitment-psychological distress.

Factors associated with overweight or obesity in community patients with schizophrenia in Shanghai / 上海预防医学

ObjectiveTo investigate the prevalence of overweight or obesity in community patients with schizophrenia in Shanghai and to explore the related factors. MethodsStratified cluster sampling method was used and the general condition， physical examination and laboratory examination data of patients with schizophrenia who voluntarily participated in 2020 free health examination of National Basic Public Health Service were analyzed. ResultsA total of 3 200 patients were included into the study ，and the prevalence of overweight and obesity was 36.75% and 17.19%， respectively. Multivariate logistic regression analysis indicated that age between 40 and 60 （OR=1.333， 95%CI： 1.030‒1.724）， intake of first-generation antipsychotics （OR=1.413， 95%CI： 1.112‒1.796）， intake of second-generation antipsychotics （OR=1.573， 95%CI： 1.288‒1.921）， high-normal blood pressure （OR=1.549， 95%CI： 1.245‒1.927）， high-abnormal blood pressure （OR=2.824， 95%CI： 2.204‒3.619）， elevated ALT （OR=1.874， 95%CI： 1.386‒2.535）， elevated FBG （OR=1.270， 95%CI： 1.066‒1.513）， and elevated TG （OR=1.652， 95%CI： 1.335‒2.044） were the related factors that associated overweight or obesity in patients with schizophrenia. ConclusionOverweight and obesity are highly prevalent among community patients with schizophrenia in Shanghai. Age between 40 and 60， taking first-generation and second-generation antipsychotics， blood pressure higher than 120/80 mmHg， elevated ALT， elevated FBG， and elevated TG are associated with overweight or obesity in patients with schizophrenia. To provide personalized health guidance， medical staff in primary health care institutions should pay more attention to high-risk groups of overweight and obesity in schizophrenia patients at annual physical examination.

Neonatal D-bifunctional protein deficiency: a report of two cases and literature review / 中华围产医学杂志

Objective:To summarize the clinical characteristics and genetic etiology of infants with D-bifunctional protein deficiency (DBPD).Methods:This study involved two DBPD newborns who were hospitalized in the Second Affiliated Hospital of Wenzhou Medical University in August 2020 and November 2020. Clinical data including manifestations, radiographic findings and genetic testing results were retrospectively analyzed. Relevant articles up to November 2022 were retrieved from various databases including CNKI, Wanfang, CQVIP, Online Mendelian Inheritance in Man and PubMed using the terms of "D-bifunctional protein deficiency" and " HSD17B4" in both Chinese and English. Clinical data of the cases diagnosed with DBPD by genetic testing within two years of age were collected. Clinical features and genetic etiology of the children with DBPD were summarized by descriptive statistical analysis. Results:Both neonates in this report presented with dyspnea, hypotonia, intractable epilepsy, poor response, absence of primitive reflexes, and craniofacial malformation. Whole-exome sequencing revealed that patient 1 carried heterozygous variations of c.972+1G>T and c.727T>A (p.W243R) in the HSD17B4 gene, which were inherited from his father and mother, respectively. A homozygous variation of c.1333+4A>G in the HSD17B4 gene was identified in patient 2. All these mutations were pathogenic. Thirteen papers (12 in English and one in Chinese) involving 19 patients from 16 pedigrees were retrieved. Altogether 21 patients (eight males and 13 females) were included, and among them, four from two pedigrees were born to consanguineous parents. There were 21 patients with hypotonia, 20 with epileptic seizures (17 presenting with epileptic seizures within 5 d after birth) and 12 with craniofacial deformities including high forehead, long philtrum and high palatine arches. Genetic tests showed that 13 patients carried compound heterozygous variations in the HSD17B4 gene and eight patients had homozygous variations. Twenty-six variations in the HSD17B4 gene were detected, including 16 missense mutations, seven splicing mutations, two nonsense mutations and one frameshift mutation. Conclusion:DBPD should be considered and genetic tests should be given when newborns have dystonia and intractable epilepsy complicated by appearance deformity.

Multicenter study on the etiology characteristics of neonatal purulent meningitis / 中华传染病杂志

Objective:To study the distribution and antibiotics resistance of the main pathogens of neonatal purulent meningitis in different regions of China.Methods:A retrospective descriptive clinical epidemiological study was conducted in children with neonatal purulent meningitis which admitted to 18 tertiary hospitals in different regions of China between January 2015 to December 2019. The test results of blood and cerebrospinal fluid, and drug sensitivity test results of the main pathogens were collected. The distributions of pathogenic bacteria in children with neonatal purulent meningitis in preterm and term infants, early and late onset infants, in Zhejiang Province and other regions outside Zhejiang Province, and in Wenzhou region and other regions of Zhejiang Province were analyzed. The chi-square test was used for statistical analysis.Results:A total of 210 neonatal purulent meningitis cases were collected. The common pathogens were Escherichia coli ( E. coli)(41.4%(87/210)) and Streptococcus agalactiae ( S. agalactiae)(27.1%(57/210)). The proportion of Gram-negative bacteria in preterm infants (77.6%(45/58)) with neonatal purulent meningitis was higher than that in term infants (47.4%(72/152)), and the difference was statistically significant ( χ2=15.54, P=0.001). There were no significant differences in the constituent ratios of E. coli (36.5%(31/85) vs 44.8%(56/125)) and S. agalactiae (24.7%(21/85) vs 28.8%(36/125)) between early onset and late onset cases (both P>0.05). The most common pathogen was E. coli in different regions, with 46.7%(64/137) in Zhejiang Province and 31.5%(23/73) in other regions outside Zhejiang Province. In Zhejiang Province, S. agalactiae was detected in 49 out of 137 cases (35.8%), which was significantly higher than other regions outside Zhejiang Province (11.0%(8/73)). The proportions of Klebsiella pneumoniae, and coagulase-negative Staphylococcus in other regions outside Zhejiang Province (17.8%(13/73) and 16.4%(12/73)) were both higher than those in Zhejiang Province (2.9%(4/137) and 5.1%(7/137)). The differences were all statistically significant ( χ2=14.82, 12.26 and 7.43, respectively, all P<0.05). The proportion of Gram-positive bacteria in Wenzhou City (60.8%(31/51)) was higher than that in other regions in Zhejiang Province (38.4%(33/86)), and the difference was statistically significant ( χ2=6.46, P=0.011). E. coli was sensitive to meropenem (0/45), and 74.4%(32/43) of them were resistant to ampicillin. E. coli had different degrees of resistance to other common cephalosporins, among which, cefotaxime had the highest resistance rate of 41.8%(23/55), followed by ceftriaxone (32.4%(23/71)). S. agalactiae was sensitive to penicillin, vancomycin and linezolid. Conclusions:The composition ratios of pathogenic bacteria of neonatal purulent meningitis are different in different regions of China. The most common pathogen is E. coli, which is sensitive to meropenem, while it has different degrees of resistance to other common cephalosporins, especially to cefotaxime.

Clinical analysis of 33 cases with purulent meningitis complicated with hydrocephalus in neonates / 中华传染病杂志

Objective:To study the clinical characteristics of purulent meningitis complicated with hydrocephalus in neonates, and to analyze the risk factors of the disease.Methods:Neonates diagnosed with purulent meningitis complicated with hydrocephalus who hospitalized in the department of neonatology of the Second Affiliated Hospital of Wenzhou Medical University from January 2002 to August 2021 were selected as the case group. Neonates with positive pathogen cultures but no hydrocephalus during the same period were assigned by random number table method as the control group. The ratio of the control group and the case group was 2 ∶1. The clinical data such as bacteria distribution, cranial imaging, therapy and prognosis were compared between the two groups. The risk factors for hydrocephalus were predicted. Statistical analysis was conducted using chi-square test and multiple logistic regression analysis.Results:There were 33 cases in the case group and 66 cases in the control group. A total of 27 cases had confirmed pathogen results, of which 20 cases (74.1%) were Gram-negative bacteria and seven cases (25.9%) were Gram-positive bacteria. The time of diagnosis for hydrocephalus were 13.0(5.5, 28.5) days after the onset. Twenty-six cases received non-surgical treatment, while seven cases received surgery. The cure rate of case group was 42.4%(14/33), which was lower than that of control group (72.7%, 48/66), and the difference was statistically significant ( χ2=8.63, P=0.003). Univariate analysis showed that the incidences of protein>3 g/L in cerebrospinal fluid, glucose<2 mmol/L in cerebrospinal fluid, convulsions, central respiratory failure, intracranial hemorrhage and encephalomalacia in the case group were all higher than those in the control group, with statistical significance ( χ2=19.72, 12.04, 19.04, 5.73, 11.85 and 17.48, respectively, all P<0.050). Multivariate logistic regression analysis showed that convulsions (odds ratio ( OR)=4.476, 95% confidence interval ( CI) 1.091 to 18.363, P=0.037), intracranial hemorrhage ( OR=8.031, 95% CI 1.894 to 34.059, P=0.005) and encephalomalacia ( OR=35.189, 95% CI 2.954 to 419.150, P=0.005) were risk factors for neonatal purulent meningitis complicated with hydrocephalus. Conclusions:Gram-negative bacteria are common pathogen of neonatal purulent meningitis complicated with hydrocephalus. Convulsions, intracranial hemorrhage and encephalomalacia are important predictors for neonatal purulent meningitis complicated with hydrocephalus.

A nested case-control study on association between self-reported occupational sulfur dioxide exposure and hypertension / 环境与职业医学

Background Current evidence on whether occupational sulfur dioxide (SO2) exposure affects the risk of hypertension is still limited, and the research results of the effect of environmental SO2 exposure on risk of hypertension remain inconsistent. Objective To analyze the association between self-reported occupational exposure to SO2 and the risk of hypertension, and the potential dose-response relationship between the years of exposure to SO2 and the risk of hypertension. Methods Based on the Jinchang cohort, a nested case-control study design was adopted. A total of 841 newly diagnosed hypertension patients were followed up as the case group, and the control group was selected with 1∶1 individual matching based on non-occupational factors and occupational factors, respectively. The former matching conditions included age ±2 years old, same gender, working age ±2 years, and home address in the same sub-district. The latter was limited to working in the same workshop on the basis of the former conditions. Finally, the former included 717 controls and the latter included 488 controls. A unified questionnaire was used to collect general demographic characteristics, lifestyle habits, history of diabetes, family history of hypertension, and information on occupational exposure to SO2 (self-reported history of occupational exposure to SO2 and years of exposure to SO2). Conditional logistic regression model was used to analyze the association between occupational exposure to SO2 and hypertension, and the dose-response relationship between the years of SO2 exposure and the risk of hypertension. Results In the nested case-control study matching with the non-occupational factors, the OR of hypertension in workers with self-reported occupational exposure to SO2 was 2.39 (95%CI: 1.68-3.39); while when matching with the occupational factors, the OR of hypertension in workers with self-reported occupational exposure to SO2 was 1.48 (95%CI: 1.04-2.12). The results of the dose-response relationship showed that as the SO2 exposure years increased from 1-9 years, 10-19 years, 20-29 years, and 30 years and above, in the nested case-control study matching with non-occupational factors, the ORs of hypertension were 1.85 (95%CI: 0.68-5.08), 1.46 (95%CI: 0.58-3.67), 1.64 (95%CI: 1.00-2.67), and 4.95 (95%CI: 2.63-9.31), respectively; in the nested case-control study matching with occupational factors, the ORs of hypertension were 0.98 (95%CI: 0.40-2.41), 1.84 (95%CI: 0.72-4.70), 1.37 (95%CI: 0.82-2.29), and 2.44 (95%CI: 1.37-4.35), respectively. The two dose-response relationships were positive by χ2 trend test (Ptrend<0.05). Conclusion Self-reported occupational exposure to SO2 is associated with the risk of hypertension in the study population, and the hypertension risk increases with the increase of SO2 exposure years.

The correlation between pulmonary surfactant protein B gene polymorphism and susceptibility to respiratory distress syndrome in Uyghur newborns / 中国新生儿科杂志

Objective:To study the relationship between the 1580 locus (rs1130866) gene polymorphism of pulmonary surfactant protein B (SP-B) gene and susceptibility of neonatal respiratory distress syndrome (RDS) in Uygur newborns.Methods:From June 2019 to May 2020, Uyghur premature infants admitted to the Department of Neonatology of our hospital were prospectively enrolled and assigned into RDS group and control group according to their diagnosis. The genotype and allele distribution of SP-B gene 1580 locus were examined using polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) analysis technology. The genotype and allele frequency of SP-B gene 1580 locus in RDS infants among Uyghur, Mongolian and Han nationality were compared.Results:A total of 160 infants were enrolled, including 80 in the RDS group and 80 in the control group. Three genotypes (TT, TC and CC) were detected in both groups. The frequencies of the three genotypes in the RDS group were 18.8%, 53.8% and 27.4%, respectively, with T allele frequency 45.6% and C allele frequency 54.4%. The frequencies of the three genotypes in the control group were 22.5%, 52.5% and 25.0%, respectively, with T allele frequency 48.8% and C allele frequency 51.3%. No significant differences existed in genotype frequency and allele frequency distribution between the two groups ( P>0.05). The CC genotype frequency of SP-B gene 1580 locus in Uyghur was significantly different from Mongolian and Han nationality ( P<0.05). Significant difference existed in C allele frequency between Uyghur and Han nationality ( P<0.05), while no significant difference existed in allele frequency between Uyghur and Mongolian nationality ( P>0.05). Conclusions:No correlation exists between the polymorphism of SP-B gene 1580 locus (rs1130866) and RDS in Uygur premature infants. Different ethnic groups have different SP-B gene 1580 locus polymorphism.

Characteristics of pelvic floor structure and electrophysiology of pelvic floor muscle in female patients with stroke / 中国康复理论与实践

ObjectiveTo investigate the characteristics of pelvic floor structure and electrophysiology in female patients with stroke. MethodsFrom June to December, 2020, 21 female inpatients with stroke in Zhongda Hospital, Southeast University (stroke group) were divided into urinary incontinence (UI) group (n = 6) and non-urinary incontinence (NUI) group (n = 15), and other 20 healthy subjects were as control group. They were observed with pelvic floor ultrasonography and pelvic floor surface electromyogram. ResultsAverage electromyography, integral electromyography, root mean square, mean power frequency and median frequency decreased in UI and NUI groups compared with those of the control group (P < 0.05), but there was no significant difference between UI group and NUI group (P > 0.05). Bladder neck position, bladder neck angle, bladder neck mobility, urethral rotation angle; and anteroposterior diameter, left-right diameter and area of levator ani muscle hiatus after Valsalva's action were all not different among three groups (F < 2.484, P > 0.05). ConclusionThe activities of pelvic floor muscles decrease in female patients with stroke, without obvious changes of pelvic floor supporting structures, whatever UI.

Continuing professional development model of Japanese pharmacists and its enlightenment / 中国药房

OBJECTIVE To provide reference and ideas for optimizing the continuing education system of pharmacists in China. METHODS By introducing the continuing professional development （CPD）model of pharmacists in Japan ，the current situation and existing problems for continuing education of pharmacists in China were analyzed to puts forward some suggestions. RESULTS & CONCLUSIONS The continuing education system of CPD model for pharmacists in Japan included five continuous cycle processes ：self-assessment，making plan ，implementing plan ，learning record and result evaluation. It emphasized the autonomy and sustainability of pharmacists ’learning and promoted the sustainable development of pharmacists ’career. The education and training of pharmacists in Japan were subject to the certification system ，and a diversified implementation organization composed of industry associations ，colleges and universities and commercial education institutions had been formed. After continuous reform ，Japan had established a relatively mature and perfect sustainable career development model for pharmacists. Our country can refer to the CPD model of Japanese pharmacists ，promote the legislation of pharmacists ，explore the unified management model （the unity of hospital pharmacists and licensed pharmacists ），explore the construction of pharmacists ’ continuing education certification mechanism ，carry out refined continuing education for pharmacists in different practice fields ， improve the enthusiasm of industry associations ，and add practical content to pharmacists ’continuing education projects.

Neonatal lateral meningocele syndrome: report of a case and literature review / 中华围产医学杂志

Objective:To investigate the clinical characteristics and pathogenic gene mutation of lateral meningocele syndrome(LMS).Methods:We retrospectively collected the clinical manifestations, laboratory examination, imaging examinations, and genetic analysis of a neonate with LMS which was diagnosed at the Department of Neonatology of the Second Affiliated Hospital of Wenzhou Medical University in May 2020. Relevant literature up to February 2021, retrieved from PubMed, OMIM, CNKI, Wanfang, and CQVIP database with the terms of "lateral meningocele syndrome", " NOTCH3", were reviewed to summarize the clinical characteristics, pathogenesis, and genetic etiology of this disease. Results:A full-term male newborn was admitted to our hospital due to feeding difficulty 7 d after birth. The clinical characteristics included hypotonia, dysphagia, hypertension, lateral spinal meningocele, craniofacial anomaly, and cryptorchidism. Abnormal spinal MRI and brainstem evoked potential were also observed. Whole exome sequencing revealed a heterozygous frameshift variation c.6667_6686del(p.Ala2223Profs*12) of NOTCH3 gene located in 19p13.12, which was not detected in the parents. Only 12 English literature were retrieved, with 17 patients from 15 pedigrees. Out of the 18 patients including the index case, 10 were genetically diagnosed as LMS. The age at diagnosis ranged from 15 d to 55 years. Regarding the clinical features, multiple lateral thoracolumbar spinal meningoceles (18/18) was the most common one, followed by retrognathia and low-set ears (16/18), eyelid ptosis and down slanting palpebral fissures (15/18), hypotonia (13/18), hypertension (11/18), developmental delay (9/18), mixed or conductive hearing loss (9/18), cardiovascular dysplasia (7/18), and cryptorchidism (7/10). A total of nine NOTCH3 gene variants were detected, all were heterozygous variants, including six frameshift and three nonsense variants. Conclusions:LMS is caused by NOTCH3 gene mutation with the clinical characteristics including multiple lateral thoracolumbar spinal meningoceles, craniofacial dysmorphisms, hypotonia, hypertension, developmental delay, difficulty in feeding, cryptorchidism, etc.

Development and Enlightenment of Clinical Pharmaceutical Accreditation in Japan / 中国药房

OBJECTIVE：To provi de reference for improvin g the quality assurance system of clinical pharmaceutical talent training and promoting the development of clinical pharmaceutical education in China. METHODS ： The background of pharmaceutical education reform and accreditation in Japan was introcuded ；the development of clinical pharmaceutical professional accreditation standards in Japan and the main changes of current standards were analyzed so as to put forward the enlightenment to the development of clinical pharmaceutical education in China. RESULTS & CONCLUSIONS ：Japan officially started the six-year clinical pharmaceutical education in 2006，which stipulated that only graduates of six-year clinical pharmaceutical education can be qualified to participate in the national examination for pharmacists. Japan Accreditation Borad of Pharmaceutical Education （JABPE）is responsible for the professional accreditation of clinical pharmacy in Japan. Its accreditation standards experienced the development of three versions in 2006，2012 and 2018. The main changes in the latest accreditation standards in Japan （2018 edition）are reflected in the innovation of index system framework ，accreditation concept and training requirements. For example ， its system framework integrates 57 benchmarks and 176 viewpoints in 2012 edition of accreditation standard into 19 benchmarks and 53 viewpoints in 2018 edition of accreditation standard ，with prominent focus ，clarity and simplification. Our country should learn from the development experience of clinical pharmaceutical professional accreditation in Japan ，perfect laws and regulations to ensure the healthy and orderly development of accreditation system ；establish an independent third-party certification body ；explore the mechanism of organic connection between professional certification and professional qualification ；attach importance to the application of self-evaluation and qualitative indicators ； explore and construct a training mode of clinical pharmaceutical talents based on national conditions and in line with international standards.

Health risk assessment of heavy metals in direct drinking water among middle and primary schools in Huangpi District of Wuhan / 中国学校卫生

Objective@#To analyze heavy metal health risks of direct drinking water in primary and secondary schools in Huangpi District, Wuhan, so as to provide reference basis for ensuring drinking water safety of teachers and students.@*Methods@#Cadmium (Cd), Plumbum (Pb) and arsenic (As) in water samples from primary and secondary schools were detected in accordance with the GB/T 5750-2006 "Standard Examination Methods for Drinking Water", water quality was evaluated based on the Quality Standard for Fine Drinking Water(CJ 94-2005). Health risk assessment model was used to evaluate the potential risk of heavy metals in direct drinking water in primary and secondary schools.@*Results@#The unqualified rates of Pb, Cd and As were 0.95%, 1.22% and 0 in 66 primary and secondary schools in Huangpi District, Wuhan. The risk of noncarcinogens related to the direct drinking water of heavy metals (Pb, Cd, As) were less than 1. The range of carcinogenic risks related to the direct drinking water was within the range of 1.07×10 -8 /year -5.58×10 -6 /year which were both within the acceptable level.@*Conclusion@#Concentrations of cadmium, plumbum and arsenic were not found to be significantly elevated as compared to "Quality Standard for Fine Drinking Water" in Huangpi District of Wuhan. Pb and Cd slightly exceeded the standard, with no significant health risk. Water quality and health risk assessment should be strengthened to ensure the safety of drinking water for teachers and students.

Cardiac operation and interventional therapy during pregnancy： an analysis of outcome / 中华妇产科杂志

Objective:To explore the efficacy and safety of open cardiac operation and interventional therapy in pregnant patients and describe the feto-neonatal and maternal outcomes.Methods:A retrospective study of 39 cases of women undergoing open cardiac operation or interventional therapy during pregnancy was conducted in Guangdong Provincial People′s Hospital from Jan. 2014 to Oct. 2019.Results:The age of 39 pregnant women with gestational heart disease was (30±6) years old (21-43 years old). Among them, 37 cases were single and 2 cases were twin pregnancy. Modified World Health Organization (mWHO) pregnancy risk classification were all level Ⅳ. There were 22 women receiving cardiac operation under cardiopulmonary bypass during pregnancy, 14 patients undergoing percutaneous balloon mitral valvuloplasty, 2 patients accepting percutaneous balloon pulmonary valvuloplasty, and 1 case receiving atrial septal defect occluder with ultrasound guidance. Three were no maternal deaths during and after the operation. One patient had an inevitable abortion. Four fetuses died in the uterine after open cardiac surgery. There patients chose termination of the pregnancy after cardiac operation. There were 31 live birth, in which 7 cases were preterm live birth and 24 patients were term live birth. The total number of newborns were 33. Two fetuses suffered neonatal intracranial hemorrhage and died after birth. Thirty-one fetuses were alive and born without any abnormity.Conclusion:For pregnant women with high risk of cardiovascular disease and classified as mWHO pregnancy risk level Ⅳ, cardiopulmonary bypass and interventional therapy during pregnancy could be used as an alternative for better materal and fetal outcomes.

Analysis on risk factors for deep venous thrombosis of lower extremities after hip fracture / 中华创伤杂志

Objective@#To investigate the risk factors of deep venous thrombosis (DVT) of lower extremities after hip fracture and provide reference for the prevention of DVT.@*Methods@#A retrospective case-control study was conducted to analyze the clinical data of 167 patients with hip fracture admitted to Daping Hospital of Army Medical University from January 2016 to December 2016, including 75 males and 92 females, aged 18.7-90.3 years [(70.4±17.7)years]. Using the positive results of ultrasound as the standard for confirming the diagnosis of DVT, 79 patients (47.3%) were assigned to the DVT group, and 88 patients (52.7%) to the non-DVT group. Patients' age, gender, body mass index (BMI), smoking history, D-dimer level, osteoporosis, venous thrombosis risk stratification score (RAPT), coronary heart disease, hypertension, diabetes history, anesthesia method (general anesthesia or nerve blocking), type of surgery (joint replacement or internal fixation), operation time were included in the analysis. The correlation between DVT and the above indices was explored through univariate analysis, followed by logistic regression analysis to determine the risk factors of lower extremities DVT after hip fracture.@*Results@#The univariate analysis showed that smoking history, D-dimer level, BMI, RAPT score, hypertension, diabetes, coronary heart disease, anesthesia method and operation time were significantly associated with lower extremities DVT after hip fracture. According to the logistics regression analysis, smoking (OR=9.403, P<0.05). D-dimer (OR=0.999, P<0.01), BMI(OR=0.603, P<0.01), RAPT score (OR=0.499, P<0.05), hypertension (OR=28.965, P<0.01), diabetes(OR=6.948, P<0.05), coronary heart disease (OR=17.185, P<0.01), operation time (OR=36.830, P<0.01) were significantly correlated with newly formed lower extremities DVT after hip fracture.@*Conclusions@#Smoking, D-dimer level, obesity (BMI≥25 kg/m2), RAPT score, hypertension, diabetes, coronary heart disease and operation time (≥150 minutes) are independent risk factors for lower extremities DVT after hip fracture. D-dimer level detection shows early diagnostic value for hip fracture with DVT. RAPT score can effectively evaluate DVT in trauma patients, thus guiding and preventing the occurrence of DVT.

Comparison of effect of total intravenous anesthesia with propofol and combined intravenous-inhalational anesthesia with sevoflurane on postoperative sleep quality in elderly female patients / 中华麻醉学杂志

Objective@#To compare the effect of total intravenous anesthesia with propofol and combined intravenous-inhalational anesthesia with sevoflurane on postoperative sleep quality in elderly female patients.@*Methods@#One hundred and twenty patients, aged 65-80 yr, with body mass index of 18.5-25.0 kg/m2, of American Society of Anesthesiologists physical status Ⅰ-Ⅲ, scheduled for elective gynecological laparoscopic operation, were divided into 2 groups (n=60 each) by a random number table method: total intravenous anesthesia with propofol group (group P) and combined intravenous-inhalational anesthesia with sevoflurane group (group S). Anesthesia was induced with intravenous etomidate 0.2-0.3mg/kg, sufentanil 0.2-0.4 μg/kg and cisatracurium 0.10-0.15 mg/kg.Anesthesia was maintained as follows: propofol was given by target-controlled infusion with the target plasma concentration set at 2-4 μg/ml in group P, 1.2-2.3% sevoflurane was inhaled in group S, and sufentanil 0.2-0.3 μg/kg and cisatracurium 0.04-0.06 mg/kg were intermittently injected in two groups.The patients were followed up at 7-8 a. m.on the day of hospitalization, the day of operation and 1, 3, 7 and 30 days after operation.The Pittsburgh Sleep Quality Index (PSQI) was recorded, PSQI > 7 points was considered as sleep disorders, and the occurrence of sleep disorders was recorded.The morning urine was collected at the time points mentioned above, and the concentrations of melatonin sulfate and free cortisol were determined by enzyme-linked immunosorbent assay.@*Results@#Compared with group S, the PSQI was significantly decreased on 3 and 7 days after operation, the incidence of sleep disorder was decreased on 7 days after operation, the concentrations of melatonin sulfate in urine were increased (P<0.05), and no significant change was found in free cortisol in urine in group P (P>0.05).@*Conclusion@#The effect of total intravenous anesthesia with propofol on postoperative sleep quality is less than that of combined intravenous-inhalational anesthesia with sevoflurane in elderly female patients.

Comparison of effect of total intravenous anesthesia with propofol and combined intravenous-inhala-tional anesthesia with sevoflurane on postoperative sleep quality in elderly female patients / 中华麻醉学杂志

Objective To compare the effect of total intravenous anesthesia with propofol and com-bined intravenous-inhalational anesthesia with sevoflurane on postoperative sleep quality in elderly female patients.Methods One hundred and twenty patients,aged 65-80 yr,with body mass index of 18.5-25.0 kg/m2,of American Society of Anesthesiologists physical status Ⅰ-Ⅲ,scheduled for elective gyne-cological laparoscopic operation,were divided into 2 groups(n＝60 each)by a random number table meth-od: total intravenous anesthesia with propofol group(group P)and combined intravenous-inhalational anes-thesia with sevoflurane group(group S).Anesthesia was induced with intravenous etomidate 0.2-0.3 mg/kg,sufentanil 0.2-0.4 μg/kg and cisatracurium 0.10-0.15 mg/kg.Anesthesia was maintained as fol-lows: propofol was given by target-controlled infusion with the target plasma concentration set at 2-4 μg/ml in group P,1.2-2.3％sevoflurane was inhaled in group S,and sufentanil 0.2-0.3 μg/kg and cisatracuri-um 0.04-0.06 mg/kg were intermittently injected in two groups.The patients were followed up at 7-8 a.m.on the day of hospitalization,the day of operation and 1,3,7 and 30 days after operation.The Pittsburgh Sleep Quality Index(PSQI)was recorded,PSQI> 7 points was considered as sleep disorders,and the oc-currence of sleep disorders was recorded.The morning urine was collected at the time points mentioned a-bove,and the concentrations of melatonin sulfate and free cortisol were determined by enzyme-linked immu-nosorbent assay.Results Compared with group S,the PSQI was significantly decreased on 3 and 7 days after operation,the incidence of sleep disorder was decreased on 7 days after operation,the concentrations of melatonin sulfate in urine were increased(P＜0.05),and no significant change was found in free cortisol in urine in group P(P>0.05).Conclusion The effect of total intravenous anesthesia with propofol on postoperative sleep quality is less than that of combined intravenous-inhalational anesthesia with sevoflurane in elderly female patients.

Prediction Model of Steady-state Dose of Warfarin in Patients with Renal Insufficiency Based on Gene Polymorphism / 中国药房

OBJECTIVE： To establish the prediction model of steady-state dose of warfarin in patients with renal insufficiency on the basis of CYP2C9＊3（1075A＞C） and VKORC1-1639G＞A gene polymorphism. METHODS： The clinical data of 103 patients with renal dysfunction （involving primary glomerulonephritis， chronic pyelonephritis， hypertensive renal arteriosclerosis， diabetic nephropathy， secondary glomerulonephritis， tubulointerstitial lesions， hereditary kidney diseases） who took warfarin and whose INR was stable at 1.5-3.0 were collected from nephrology department of the First Affiliated Hospital of Xi’an Jiaotong University during Jun. 2016 to Jun. 2019. The CYP2C9＊3（1075A＞C） and VKORC1-1639G＞A genotypes were detected by fluorescence staining in-situ hybridization. The relationship of genotype， gender， age， body mass index （BMI） and glomerular filtration rate （eGFR） with steady-state dose of warfarin were analyzed. The multiple linear regression method was used to establish the prediction model for steady-state dose of warfarin in patients with renal insufficiency. Other 25 patients were involved in validation. RESULTS： The frequencies of CYP2C9＊3（1075A＞C） and VKORC1-1639G＞A genes in 103 patients were in accordance with Hardy-Weinberg equilibrium. The average steady-state dose （3.20±0.88） mg/d of warfarin in CYP2C9＊3 （1075A＞C） AA genotype was significantly higher than that （2.17±0.13） mg/d in CYP2C9＊3 （1075A＞C） AC genotype （P＜0.05）； average steady-state dose （2.89±0.08） mg/d of warfarin in VKORC1-1639G＞A AA genotype was significantly lower than that （4.01±0.17） mg/d in VKORC1-1639G＞A GA genotype （P＜0.05）； steady-state dose of warfarin in male patients （3.16±0.11） mg/d was higher than that in female patients （3.07±0.13） mg/d （P＞0.05）. Age was negatively correlated with steady-state dose of warfarin （P＜0.05）； eGFR was positively correlated with steady-state dose of warfarin （P＜0.05）. BMI had no significant correlation with steady-state dose of warfarin （P＞0.05）. The prediction model for steady-state dose of warfarin included steady-state dose of warfarin＝3.057－0.73* VKORC1-1639G＞A+0.08*eGFR－0.013* age+0.565* CYP2C9＊3（1075A＞C） [VKORC1-1639G＞A：AA＝1，GA＝0，GG＝0；CYP2C9＊3（1075A＞C）：AA＝1，AC＝0；the age was years old； the unit of eGFR was mL/（min·1.73 m2）] （R2＝0.502）. There was no statistical significance between the dose （3.12±0.56） mg/d of prediction model and actual steady-state dose （3.06±0.93） mg/d in 25 validation patients （P＞0.05）. CONCLUSIONS： There are significant differences in steady-state dose of warfarin among different genotype patients with CYP2C9＊3（1075A＞C） AA and VKORC1-1639G＞A. The prediction model of warfarin steady-state dose in patients with renal insufficiency is established successfully.

Relevant factors of successful surgery in the basic type of intermittent exotropia / 中华实验眼科杂志

Objective To explore the relevant factors of functionally healing the basic type of intermittent exotropia.Methods A prospective observation study was designed.One hundred and thirty-two cases with basic type of intermittent exotropia in Tianjin Eye Hospital from August 2015 to March 2016.Pre-and post-operation examinations to each patient,including the tests of ocular alignment,Worth four-dot test at 2 m and 33 cm,Titmus,functional visual analyzer (FVA),Frisby Davis distance (FD2) were used to explore the influencing factors of postoperative eye position and stereoscopic reconstruction,and to find the cutoff point of surgery.This study followed the Declaration of Helsinki.This study protocol was approved by Ethic Committee of Tianjin Eye Hospital (No.YKLL-2015-8-21).Written informed consent was obtained from each patient or guardian prior to entering study cohort.Results At 6 months postoperatively,there were 84 cases of orthopedic position,4 cases of overcorrection and 44 cases of undercorrection.The success rate was 63.6％.The deviation at day 1 and peripheral fusion function were statistically significant to postoperative eye position (b =-0.093,P =0.037;b =0.725,P =0.017).The area under the receiver operating characteristic (ROC) curve was 0.645,which showed that the result of Worth four-dot test at 33 cm had lower diagnostic value.Seventy-two cases with eye position between 0 and +10 PD at 1 day postoperatively were all successful in eye position at 6 months postoperatively.The postoperative eye position was the influencing factor for postoperative distance stereo with FVA (x2 =4.036,P =0.045).The age of onset and the preoperative distance stereoacuity with FD2 were the influencing factors of postoperative distance stereo reconstruction (b =-0.213,P =0.023;b =0.021,P =0.036).The area under the ROC curve of the age of onset and the preoperative distance stereoacuity with FD2 was 0.257 and 0.752,respectively.The former had no diagnostic value,and the latter had a medium diagnostic value.The best cutoff point was 22.5" with FD2 at 6 m.Conclusions Success rate of postoperative eye position is affected by the postoperative deviation at day 1.The optimal deviation at post-operation day 1 is 0-10 PD.Postoperative distance stereopsis is improved well and the surgery should be done before the distance stereoacuity is decreased to 22.5" with FD2 at 6 m.