The effectiveness of dialectical behavior therapy for mental disorders / 中华行为医学与脑科学杂志

Dialectical behavior therapy (DBT), as an important representative of the " third wave" of cognitive behavior therapy (CBT), has been paid more attention. Since the publication of the treatment manual in 1993, DBT has been widely spread in several treatment settings, including outpatient, community, and inpatient settings, and has been applied to the diagnosis and treatment of various mental disorders. In recent years, more and more studies have proved that DBT has a clear effect on a variety of mental disorders and psychological and behavioral problems, especially the clinical problems related to emotion regulation. This article summarizes and evaluates the effectiveness of DBT in the treatment of mental disorders and discusses the limitations of the current research and the future development direction.

Implementation of informatization construction and auxiliary decision-making of COVID-19 designated hospitals based on agile business intelligence system / 中华医院管理杂志

In order to complete the information statistics and submission work of designated hospitals with high quality, a hospital uses the agile business intelligence system to carry out information construction, and realize the statistics, analysis and auxiliary management decision-making of COVID-19 patients′ admission data. Based on the low-load and full-volume data capture mechanism, relevant basic data in the background of the hospital information system was extracted, and the admission information visualization and early warning analysis system was built by establishing data relations, data modeling and other methods. The hospital completed 634 batches of data statistics and reporting tasks of 2 943 patients in a timely and efficient manner, and assisted clinical diagnosis and treatment improvement and hospital leadership decision-making by using data analysis, early warning feedback and other functions.

Current status and countermeasures for the development of occupational health talents in China / 中国职业医学

@#Abstract: Objective ， To analyze the current status and existing problems of occupational health talents in China and put Methods forward development measures and suggestions. The occupational health supervision and management law enforcement officers at the city and county levels in China and occupational health professionals in local occupational disease prevention and control technical support institutions at all levels were selected as the survey subjects using comprehensive survey. The Questionnaire on the Construction Status of Occupational Health Personnel Team in China was used to investigate Results ， theallocation. ByDecember2020 therewere17900occupationalhealthsupervisionandlawenforcementofficersin ， ， cities counties and districts and each occupational health supervision and law enforcement officer in China needed to ， ， supervise and manage 261 enterprises. Among them there are 689 enterprises in Jiangsu Province and 67 enterprises in - - ShanxiProvince.There are 45 200 full time and part time occupationalhealth professionals in occupationaldisease prevention ， and control technical support institutions affiliated to local health systems at all levels. Among them there are 4 900 ， occupationaldiseasepreventionhospitalsatalllevels 20700diseasecontrolcentersatalllevelsand 19600generalhospitals ， - - at all levels. On the distribution of disciplines and specialties there are 22 400 health related majors and 3 200 non health Conclusion ， majors. Thereisalackofpersonnelinoccupationalhealthsupervisionandlawenforcement unevengeographical ， ， distribution few occupational health professionals and imperfect discipline system of occupational health system. There is an ， ， urgent need to strengthen the construction of occupational health personnel team optimize the structure of the team improve ， ， the personnel training mechanism innovate personnel training methods and improve the comprehensive quality and ability of occupationalhealthpersonnel.

Stability Difference Between Ethibond Thread Suture Fixation and Threaded Anchor Fixation for Inferior Pole Fracture of the Patella Using Finite Element Analysis / 医用生物力学

Objective To compare and analyze biomechanical stability of Ethibond thread suture and threaded anchor for fixing inferior pole fracture of the patella using the finite element method. Methods CT images of the knee joint from a healthy adult volunteer were selected and the inferior patella fracture model was established, then the three-dimensional (3D) models of fracture fixation with Ethibond thread suture and threaded anchor were established. Stress and displacement distributions of each fixiation model at different knee flextion angles were analyzed. Results In the range of 0°-90°, as knee flexion angle increased, the maximum stress and maximum displacement also increased. At the same knee flexion angle, threaded anchor fixation had the highest stress level, and Ethibond thread suture had the lowest stress level and the most uniform stress distributions. The displacement deformation of Ethibond thread suture was the largest, and the displacement deformation of threaded anchor fixation was the smallest. Conclusions The maximum displacement of the seam suture around patellar tendon with Ethibond suture is relatively moderate, and its maximum stress is relatively small, which is a reliable method for fixing inferior pole fracture of the patella in clinic.

Comprehensive analysis of differential methylation genes in cholangiocarcinoma and identification of prognosis-related genes glucosaminyl (N-acetyl) transferase 1 and neurotrophic receptor tyrosine kinase 3 / 肿瘤研究与临床

Objective:To identify and screen the differential methylation genes in patients with cholangiocarcinoma and to predict the prognosis of patients with CCA.Methods:Cholangiocarcinoma tissues and paracancerous tissues of 8 patients with cholangiocarcinoma in Fujian Provincial Hospital from October 2019 to May 2020 were selected for 850K methylation sequencing analysis to obtain differentially methylated genes. The 2018 genome-wide methylation data and clinical information of 36 patients with cholangiocarcinoma were download from The Cancer Genome Atlas (TCGA) database, the 2012 cholangiocarcinoma methylation data (GSE32879) were download from the Gene Expression Omnibus (GEO) database, and the 2018 TCGA database differential survival genomic data of overall survival (OS) and disease-free survival (DFS) of cholangiocarcinoma were download from the GEPIA2 database. The differentially methylated positions (DMP) and differentially methylated regions (DMR) results of 850K methylation sequencing analysis of submitted samples, methylated genes in TCGA and GEO databases, and cholangiocarcinoma survival genes of samples were jointly submitted for testing, multi-data set analysis was performed by the Sangerbox VENN tool, and common differentially methylated genes were obtained by intersection screening. The minimum P value method was used to determine the cut-off value of gene expression in Sangerbox, and the patients were divided into high and low expression groups of differentially methylated genes. The OS, DFS, disease-specific survival (DSS), disease-free interval (DFI) and progression-free interval (PFI) of cholangiocarcinoma patients were compared between the two groups. Gene Ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) enrichment analyses were performed. Results:A total of 121 954 DMP were identified by 850K methylation sequencing of cholangiocarcinoma tissues and paracancerous tissues of 8 patients; a total of 1 399 differentially methylated genes were identified in DMR, and the common prognosis related genes glucosaminyl (N-acetyl) transferase 1 (GCNT1) and neurotrophic receptor tyrosine kinase 3 (NTRK3) were identified by intersection identification. The expression of GCNT1 in the cholangiocarcinoma tissues was higher than that in the paracancerous tissues, and the difference was statistically significant ( P = 0.040). The expression of NTRK3 in cholangiocarcinoma tissues was higher than that in the paracancerous tissues, but the difference was not statistically significant ( P = 0.790). The minimum P value method was used to predict the prognosis of patients with cholangiocarcinoma based on the combined expression of GCNT1 and NTRK3, and the order was based on the sum of the expression levels of the two genes. When 30% of the ranking was taken as the cut-off value, the difference in DFS between the high expression group and the low expression group in cholangiocarcinoma was the most significant ( P < 0.001); there was no significant difference in OS between the two groups ( P = 0.065). The results of GO functional analysis showed that GCNT1 was involved in protein glycosylation, macromolecule glycosylation, glycosylation, glycoprotein biosynthetic process, glycoprotein metabolic process, transferase activity and transferring glycosyl groups, protein O-linked glycosylation, O-glycan processing, etc., and NTRK3 was involved in neurotrophin signaling pathway, Ras signaling pathway, EGFR tyrosine kinase inhibitor resistance, ErbB signaling pathway, phospholipase D signaling pathway, central carbon metabolism in cancer, natural killer cell mediated cytotoxicity, etc. The results of KEGG analysis showed that GCNT1 was mainly associated with system functions such as mucin-type O-glycan biosynthesis and metabolic pathways, and NTRK3 was mainly associated with cell surface receptor pathways, intracellular signal transduction, positive regulation of stimulatory responses, transmembrane receptor protein tyrosine kinase signaling pathway, enzyme-linked receptor protein signaling pathway, MAPK signaling pathway cascade and regulation, protein phosphorylation signal transduction and other system functions. Conclusions:The expressions of differentially methylated genes GCTNT1 and NTRK3 in cholangiocarcinoma have certain predictive effects on the prognosis of patients with cholangiocarcinoma.

Factors related to post-operative delirium in middle-aged and elderly patients in intensive care unit and risk prediction model / 中国康复理论与实践

@#Objective To analyze the influencing factors of post-operative delirium (POD) in middle-aged and elderly patients in intensive care unit (ICU) and construct risk prediction model for it.Methods A total of 112 middle-aged and elderly postoperative patients in the ICU of Lu'an Hospital of Anhui Medical University from January, 2018 to February, 2021 were selected. On the second day after the operation, they were transferred to ICU, and assessed with the Confusion AssessmentMethod for Intensive Care Unit (CAM-ICU). The patients were divided into delirium group (n = 52) and non-delirium group (n = 60) according to assessment. Univariate analysis was used to compare the differences in clinical data between the two groups, and multivariate Logistic regression analysis was used to screen the independent influencing factors to construct risk prediction model. Receiver operating characteristic (ROC) curve was used to evaluate prediction performance. Results Multivariate logistic regression analysis showed Acute Physiology and Chronic Health Evaluation II score (APACHE II score) (OR = 1.424, 95%CI 1.204 to 1.685, P < 0.001), ICU sleep quality score (OR = 1.432, 95%CI 1.159 to 1.770, P < 0.001), and postoperative oxygenation index ≤ 300 (OR = 4.485, 95%CI 1.644 to 12.240, P = 0.001) were independent influencing factors of postoperative delirium in ICU. The prediction model was: logit(P) = -11.381+0.354X1 (APACHE II score, cut-off value 16)+0.359X2 (ICU sleep quality score, cut-off value 13)+1.501X3 (postoperative oxygenation index ≤ 300), with the sensitivity and specificity of 79.2% and 79.7% respectively. The area under the ROC curve was 0.866 (95%CI 0.801 to 0.930), more than those of the factors alone (P < 0.05). Conclusion The prediction model based on Logistic regression can predict the occurrence of postoperative delirium in middle-aged and elderly patients in ICU.

Endoscopic ultrasound features of distal biliary stricture / 临床肝胆病杂志

Objective To investigate the endoscopic ultrasound (EUS) features of distal biliary stricture (DBS), and to provide a clinical basis for the evaluation of DBS by EUS. Methods Related clinical data were collected from 175 patients with DBS who underwent EUS examination in The First Affiliated Hospital of Anhui Medical University from April 2016 to March 2020 to analyze their clinical manifestation, laboratory examination results, imaging findings, and EUS findings, and the patients were followed up to summarize the EUS features of DBS. The chi-square test was used for comparison of categorical data between groups, and the t -test was used for comparison of continuous data between groups. Results Among the 175 patients with DBS, 85(48.57%) had benign DBS and 90(51.43%) had malignant DBS. Compared with the patients with benign DBS, the patients with malignant DBS had a significantly longer length of stricture on EUS (14.1±3.0 mm vs 7.9±3.0 mm, t =13.358, P < 0.001) and significantly higher incidence rates of the characteristic changes on EUS such as hypoechoic space-occupying lesions in lumen (57.8% vs 34.1%, χ 2 =9.843, P =0.002), peripheral lymph node enlargement (26.7% vs 12.9%, χ 2 =5.147, P =0.023), and pancreatic duct dilatation (51.1% vs 28.2%, χ 2 =9.532, P =0.002). EUS combined with magnetic resonance cholangiopancreatography had a sensitivity of 70.6% in the diagnosis of benign DBS and a sensitivity of 92.2% in the diagnosis of malignant DBS. Conclusion The characteristic EUS features of DBS, such as long length of stricture, hypoechoic lesion, peripheral lymph node enlargement, and pancreatic duct dilatation, may help with the differential diagnosis of DBS in clinical practice.

Influence of indometacin on the level of platelet microparticles in patients with post-endoscopic retrograde cholangiopancreatography pancreatitis / 中华消化内镜杂志

To observe the effect of indomethacin suppository 100 mg before endoscopic retrograde cholangiopancreatography (ERCP) on the level of platelet microparticles (PMPs) in patients with post-ERCP pancreatitis (PEP). A total of 191 patients receiving ERCP were collected from June 2019 to October 2020 in the First Affiliated Hospital of Anhui Medical University and were randomly divided into the indometacin group ( n=96) and the control group ( n=95) by random number table method. The indometacin group received 100 mg indometacin suppositories before ERCP and the control group received placebo of equal quality. Levels of PMPs before operation, 3 hours and 24 hours after operation were measured by flow cytometry. The levels of IL-1, IL-6 and TNF-α in the plasma before ERCP, 3 hours and 24 hours after ERCP were also detected. The incidence of PEP in the indometacin group was 5.21% (5/96), which was significantly lower than that in the control group [13.68% (13/95), P=0.044]. The preoperative PMPs level in the indometacin group (1 910.01/μL) was slightly lower than that in the control group (2 351.87/μL) with no significant difference ( P>0.05). The PMPs levels in the indometacin group 3 hours and 24 hours after ERCP (1 671.47 /μL, 862.74/μL) were significantly lower than those of the control group (2 443.75/μL, 2 536.76/μL, both P<0.05). Inflammatory cytokines including IL-1, IL-6 and TNF-α showed the same tendency. Indometacin can reduce the incidence of PEP, for the reason that indometacin may decrease the levels of PMPs.

Medical big data analysis of the clinical off-label use of proton pump inhibitors / 药学实践杂志

Objective To explore the main causes of the overuse of proton pump inhibitor (PPIs) in domestic hospitalized patients. Methods The electronic medical records of patients in 20 general hospitals from January 1, 2015 to March 31, 2018 were analyzed. The distribution of indications of PPIs, the distribution of different uses of PPIs, the most often diseases of patients using the off-label medications, surgeries and combined medication, etc. were analyzed. Results The number one indication of PPIs was the prevention of NSAIDs-related ulcer, which accounted for 40.9% of the patients and 34.2% of them was off-label users. Among the off-label patients, lansoprazole was the most highly used, which accounted for 48.1%. The most often diseases, surgeries and combined medications of the patients using PPIs were the diseases of esophagus, stomach and duodenum, gallbladder and biliary surgery and mineral supplement. Conclusion The prevention of drug-induced ulcers and the off-label use is the main reasons for the huge amount of PPIs usage. The application of lansoprazole is not standardized; The main causes of the off-label PPIs usage are gastrointestinal discomfort, fasting, surgery and glucocorticoids.

Design and Upgrading of Finished Infusion Label in PIVAS of Our Hospital / 中国药房

OBJECTIVE：To design and upgrade the finished infusion label in P IVAS of Hefei Binhu hospital ，so as to improve the safety and effectiveness of intravenous medication. METHODS ：By investigating the experience and suggestions about the use of infusion labels by pharmacists and clinical nurses in PIVAS ，taking clear ，concise，focused，rational layout ，comprehensive information as improving principle ，the infusion label was designed and upgraded. The effect of upgrading were evaluated by the recognition rate of label scanning ，scanning time and rate on label （94 701，113 759 groups，respectively），and the correct rate ， time and rate of drug delivery checking in 30 days before and after upgrading ，as well as satisfaction degree ，which made among PIVAS pharmacists （30），nurses（50）and patients （49）. RESULTS ：The upgraded label simplified part of the content and optimized the layout structure ，removed redundant content ，focused on the patient safety information that nurses needed to pay attention to when checking ，and added the marking of infusion sequence and precautions. By changing the barcode into two-dimensional code and adding hidden display function ，more information about drugs and rational drug use related to the infusion of patients was provided. Compared with original label ，after upgrading ，the recognition rate of new label scanning increased from 99.27％ to 99.96％，the scanning time reduced from 3 518.75 s/d to 2 110.10 s/d，and the scanning rate increased from 0.57 group/s to 0.95 group/s；the correct rate of drug delivery checking increased from 99.73％ to 99.91％，the time of drug delivery checking decreased from 5 423.55 s/d to 4 818.85 s/d，and the speed of drug delivery checking increased from 0.36 group/s to 0.41 group/s. The satisfaction degree of pharmacists ，nurses and patients were increased from 70.00％ to 93.33％，from 62.00％ to 90.00％，from 20.40％ to 89.80％，respectively. CONCLUSIONS：The design and upgrading of infusion labels can improve the working efficiency of staff ，and improve the quality of pharmaceutical care and nursing care ， and satisfaction， promote the improvement on the safety and effectiveness of intravenous medication for patients.

Analysis of the Effect of Intelligent Regulation of Infusion Sequence on Promoting Intravenous Rational Drug Use / 中国药房

OBJECTIVE：To evaluate th e eff ects of infusion sequence regulation on the promotion of intravenous rational drug use. METHODS ：The intelligent control of infusion sequence was realized with Markov chain machine learning method on the basis of intelligent reminder manual labeling infusion sequence. Selected from Binhu Hospital of Hefei during Jan. to Sept. 2017， 164 800 inpatients’medication orders were collected as data before intelligent control of infusion sequence ，and 264 600 inpatients’ medication orders were collected as data after intelligent control of infusion sequence. The correct rate of incompatibility ，storage time limit ，administration frequency ，chronopharmacology，preventive drugs ，drug interaction ，auxiliary drugs and infusion sequence for intravenous irritant drugs were compared before and after regulation ；the times of flushing tube ，the cost of flushing tube infusion and the change of liquid property in the infusion tube were compared before and after regulation. RESULTS ：The correct rate of incompatibility ，storage time limit ，administration frequency ，chronopharmacology，drug interaction and infusion sequence for auxiliary drugs after regulation were significantly higher than before regulation ；the correct rate of infusion sequence for preventive drugs and intravenous irritant drugs ，the times of flushing tube ，the cost of flushing tube infusion and the case number of the liquid change （proportion） in infusion tube were significantly lower than before regulation （P＜0.001）. CONCLUSIONS：Intelligent regulation of infusion sequence can improve the rationality of intravenous medication sequence to a certain extend.

Cognitive impairment in patients with intracranial aneurysm / 国际脑血管病杂志

In addition to causing high disability and high fatality rates, ruptured intracranial aneurysms can also cause cognitive impairment. Although preventive surgical treatment can avoid intracranial aneurysm rupture and bleeding, patients may still have a certain degree of cognitive impairment, even in patients with good clinical recovery after surgery. There is no systematic review on the effect of different surgical methods on cognitive function, and the best surgical method is still inconclusive. This article reviews the cognitive impairment in patients with intracranial aneurysm, hoping to provide a basis for clinical treatment decisions.

Angiographic characteristics of acute myocardial infarction with myocardial bridging / 中华急诊医学杂志

Objective Myocardial bridging is a congenital anomaly.However,little data is available for patients with myocardial bridging (MB) associated with acute myocardial infarction (AMI).The goals of this study are to evaluate characteristics of MB in patients with AMI.Methods From March 1999 to February 2006,137 patients with both MB and AMI,were identified by coronary angiography,including 117 men and 20 women with an average age of 60.77±12.01 years (range 30-83 years) were enrolled in the present study.Results There were 119 patients with MB at the middle segment of left anterior descending artery (LAD),15 patients at distal segment of LAD,2 patients at middle segment of left circumflex (LCX),and 1 at the proximal segment of the obtuse marginal branch (OM) of LCX.There are 36 patients with non-ST elevation acute myocardial infarction (NSTEAMI),38 patients with anterior ST elevation AMI (STEAMI),40 patients with inferior STEAMI and 23 patients with inferior-posterior STEAMI.Risk factors such as hypertension,diabetes,hyperlipidemia and smoking were not different among four groups.Patients with anterior AMI included 8 patients who showed no stenosis at the segment of MB.Conclusion Patients with MB and ST elevation AMI were mainly inferior AMI.MB might be one of the causes of AMI.

Study the mechanism of tantalum particles on the proliferation of osteoblasts / 实用医学杂志

Objective To investigate the effect of tantalum particles on the proliferation of osteoblasts and explore its mechanism. Methods Mouse osteoblasts MC3T3-E1 were co-cultured with micro-tantalum particles (micro-Ta)and Nano-tantalum particles(nano-Ta)of different concentrations respectively. CCK-8 assay was used to measure the cell viability at 6,12,24 and 48 h. According to the result of CCK-8 the group with the most prolif-erative effect was screened and the level of autophagy was detected by using Western blot,laser confocal microsco-py and transmission electron microscopy(SEM). Finally,to verify the role of autophagy in pro-proliferation effect of nano-Ta,the OD value was measured repeatedly in combination with autophagy inducer and inhibitor. Results 100 ng/mL micro-Ta treated groups had obvious proliferative effect but autophagy was not detected. 20 μg/mL nano-Ta treated groups had obvious proliferative effect and autophagy was detected. CCK-8 assay revealed that autophagy inhibitor can significantly inhibited cell proliferation of nano-Ta treated group. Conclusion Nano-Ta could pro-mote cell proliferation by inducing autophagy,and micro-Ta may promote osteoblast proliferation through other non-autophagy pathway.

Evaluation of the inpatient usage of intravenous infusion in 156 hospitals / 药学实践杂志

Objective To investigate the usage of intravenous infusion and the antibiotic intravenous infusion in different hospitals nationwide ,and to evaluate the influence of the hospital bed number ,hospital area and hospital grade on the clinical application of intravenous infusion .Methods Intravenous infusion volume ,rate and other related indexes were analyzed based on the inpatient information obtained from the regional medical big data net for 156 hospitals .Results 1323852 inpatients were included in this study .93 .13％ of those patients received intravenous infusion therapy .The average daily infusion volume was 782 .67 ml per bed .The average infusion time was 7 .39 days per patient .44 .78％ of inpatients received intravenous antibi-otic treatment .The average daily antibiotic infusion volume was 92 .48 ml per bed .Conclusion Generally ,the inpatient per-centage of intravenous infusion was getting higher in China .The greater infusion volume in larger hospitals suggested that the patient′s condition is relatively more serious in the larger hospital .The higher grade hospitals used smaller antibiotic infusion rate and volume ,indicating the antibiotic use in high grade hospitals is relatively more standardized .

Study on the use of antimicrobial agents in hospitalized trauma patients based on medical big data / 药学实践杂志

Objective To investigate the relationship between the trauma severity and the usage of antibacterial drugs and to provide reference for standard protocol of proper antibiotic use in wound care.Methods ICD-10 and AIS were used to set up the relationship and to analyze the use of antibiotics in patients with different trauma score.Results 25 035 trauma patients were enrolled in this study.Those patients were divided into five groups according to the AIS score with least severe as group 1 to most severe as group 5.The patient percentage in group 1 to 5 was 21.92％,67.73％,8.86％,0.97％ and 0.52％ respectively.The five most frequently used antibiotic classes are second generation cephalosporins,third generation cephalosporins,first generation cephalosporins,fluoroquinolones and penicillin/beta lactamase inhibitor combination, accounted for 29.69％,22.57％,20.33％,4.66％ and 4.47％ of total DDDs of antibacterial drugs.Individually, the top 10 antibiotics are cefuroxime (12.21％), cefazolin (8.31％), ceftriaxone (7.74％), cefathiamidine (7.34％), cefotiam (4.87％), ceftazidime (3.68％), amoxicillin/clavulanic acid (3.63％), levofloxacin (3.59％), cefoxitin (3.56％), flucloxacillin (3.52％);gentamicin (2.27％), ornidazole (2.00％) and cefoperazone/tazobactam (1.44％) were used most in their categories respectively.The variety and quantity of antibacterial drugs used for different trauma patients were different.Conclusion The trauma score based on ICD-AIS can reflect the severity of trauma.The use of antibiotics in patients with different trauma score can provide reference for the clinical applications of antibiotics in wound care.

Analysis of Clinical Features of Alprostadil Lipid-micro Injection from 159 Hospitals of China / 中国药房

OBJECTIVE:To provide evidence for rational use and clinical monitoring of Alprostadil lipid-micro injection (Li-po-PGE1). METHODS:Adult inpatients receiving Lipo-PGE1 from hospital information system(HIS)of 159 hospitals were select-ed as research subject. Based on frequency statistics,population,clinical diagnosis,and average daily dose of Lipo-PGE1 were all studied. RESULTS:A total of 71687 adult inpatients were included,and the male was more than female,mostly aged 61-75. The hospitalization duration was 8-14 d(45.01%),most of patients were recovered(68.20%). Lipo-PGE1 was wildly used in the clin-ic,and was used for 871 kinds of clinical diseases in total;top 3 diseases were cerebral infarction(9.06%),non-insulin dependent diabetes mellitus (8.65%) and chronic ischemic heart disease (8.08%). The average daily dose of different diseases and different hospitals were significantly different,mostly≤12.5μg. CONCLUSIONS:As adjuvant drug,medical institutions and related super-vision departments should formulate reasonable monitoring index and strengthen medication guidance and evaluation of Lipo-PGE1.

Establishment of a Novel Mouse Model of Coronary Microembolization / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Coronary microembolization (CME) has been frequently seen in acute coronary syndromes and percutaneous coronary intervention. Small animal models are required for further studies of CME related to severe prognosis. This study aimed to explore a new mouse model of CME.</p><p><b>METHODS</b>The mouse model of CME was established by injecting polystyrene microspheres into the left ventricular chamber during 15-s occlusion of the ascending aorta. Based on the average diameter and dosage used, 30 C57BL/6 male mice were randomly divided into five groups (n = 6 in each): 9 μm/500,000, 9 μm/800,000, 17 μm/200,000, 17 μm/500,000, and sham groups. The postoperative survival and performance of the mice were recorded. The mice were sacrificed 3 or 10 days after the surgery. The heart tissues were harvested for hematoxylin and eosin staining and Masson trichrome staining to compare the extent of inflammatory cellular infiltration and fibrin deposition among groups and for scanning transmission electron microscopic examinations to see the ultrastructural changes after CME.</p><p><b>RESULTS</b>Survival analysis demonstrated that the cumulative survival rate of the 17 μm/500,000 group was significantly lower than that of the sham group (0/6 vs. 6/6, P = 0.001). The cumulative survival rate of the 17 μm/200,000 group was lower than those of the sham and 9 μm groups with no statistical difference (cumulative survival rate of the 17 μm/200,000, 9 μm/800,000, 9 μm/500,000, and sham groups was 4/6, 5/6, 6/6, and 6/6, respectively). The pathological alterations were similar between the 9 μm/500,000 and 9 μm/800,000 groups. The extent of inflammatory cellular infiltration and fibrin deposition was more severe in the 17 μm/200,000 group than in the 9 μm/500,000 and 9 μm/800,000 groups 3 and 10 days after the surgery. Scanning transmission electron microscopic examinations revealed platelet aggregation and adhesion, microthrombi formation, and changes in cardiomyocytes.</p><p><b>CONCLUSION</b>The injection of 500,000 polystyrene microspheres at an average diameter of 9 μm is proved to be appropriate for the mouse model of CME based on the general conditions, postoperative survival rates, and pathological changes.</p>

Coronary Microembolization with Normal Epicardial Coronary Arteries and No Visible Infarcts on Nitrobluetetrazolium Chloride-Stained Specimens: Evaluation with Cardiac Magnetic Resonance Imaging in a Swine Model

OBJECTIVE: To assess magnetic resonance imaging (MRI) features of coronary microembolization in a swine model induced by small-sized microemboli, which may cause microinfarcts invisible to the naked eye. MATERIALS AND METHODS: Eleven pigs underwent intracoronary injection of small-sized microspheres (42 microm) and catheter coronary angiography was obtained before and after microembolization. Cardiac MRI and measurement of cardiac troponin T (cTnT) were performed at baseline, 6 hours, and 1 week after microembolization. Postmortem evaluation was performed after completion of the imaging studies. RESULTS: Coronary angiography pre- and post-microembolization revealed normal epicardial coronary arteries. Systolic wall thickening of the microembolized regions decreased significantly from 42.6 +/- 2.0% at baseline to 20.3 +/- 2.3% at 6 hours and 31.5 +/- 2.1% at 1 week after coronary microembolization (p < 0.001 for both). First-pass perfusion defect was visualized at 6 hours but the extent was largely decreased at 1 week. Delayed contrast enhancement MRI (DE-MRI) demonstrated hyperenhancement within the target area at 6 hours but not at 1 week. The microinfarcts on gross specimen stained with nitrobluetetrazolium chloride were invisible to the naked eye and only detectable microscopically. Increased cTnT was observed at 6 hours and 1 week after microembolization. CONCLUSION: Coronary microembolization induced by a certain load of small-sized microemboli may result in microinfarcts invisible to the naked eye with normal epicardial coronary arteries. MRI features of myocardial impairment secondary to such microembolization include the decline in left ventricular function and myocardial perfusion at cine and first-pass perfusion imaging, and transient hyperenhancement at DE-MRI.

Comparison of the medicine treatment level of military in patients in military hos-pital before and after the adjustment of the policy of military reasonable medicine treatment / 药学实践杂志

Objective To assess differences between the medicine treatment level of military inpatients in military hospi-tal in 2009 and 2011 ,provide references for reasonable adjustments of health policy in future .Methods Medicine treatment da-ta from acute simple appendicitis ,coronary heart disease ,chronic bronchitis and type 2 diabetes from 16 military hospitals were excavated and analyzed by statistical methods to provide a comparative study of the medicine treatment level in 2009 and 2011 . Results 3748 cases from 16 hospitals showed the significant difference in the level of the medicine treatment in 2009 and 2011 , such as medicine cost ,medicine varieties ,primary medicine costs ,hospital daily medication cost ,and the date in 2011 is higher than 2009 .Conclusion It was showed that the medicine treatment level in four common multiple diseases in the military in 2009 and 2011 was changed .A long-term stability mechanism should be established for the evaluation of military medicine sup-port level ,which could provide strong evidence for future medicine policy adjustment .