Application of cocrystal separation technology in the separation and purification of genistein-puerarin-daidzein ternary system / 药学学报

Cocrystal separation technology is a technology that utilizes coformers to selectively form cocrystals with target compounds and separate them from mixed systems. Our study used puerarin (PUE), daidzein (DDZ), and genistein (GEN) as model drugs, which have similar structures and are the main isoflavones in Pueraria lobata root. The separation and purification processes in the modern traditional Chinese medicine (TCM) of these three components use conventional column chromatography, recrystallization, and other technologies, which have the issues of lengthy separation cycles, high solvent consumption, and inefficient preparation. Different with existing separation technology, our team used the early-found cocrystal separation method to design a step-by-step extraction and separation experiment of GEN-PUE-DDZ ternary mixture. Caffeine and L-proline were added to the mixed system in turn, GEN-caffeine cocrystal and PUE-proline cocrystal were prepared by suspension method. The cocrystals precipitated out of the solution. The purities of the GEN-caffeine cocrystal and the PUE-proline cocrystal could achieve 93% (the purity of GEN) and 99% (the purity of PUE). Besides, the purity of DDZ could also be increased by 6.76 times. This study proposed a simple operating, low cost and wide application range separation method different from the traditional separation method and realized the separation of structurally similar chemical components in TCM, laying a foundation for the application of cocrystal technology in the separation and refining of TCM.

Budget impact analysis of treatment for pulmonary arterial hypertension included in special and chronic disease outpatient reimbursement policy / 中国药房

OBJECTIVE To evaluate the budget impact on medical insurance fund upon the treatment of pulmonary arterial hypertension（PAH）included in the outpatient special and chronic disease management policy （hereinafter refer to as the Policy ）， so as to provide reference for medical insurance reimbursement decision-making. METHODS Based on the perspective of medical insurance payer ，a budget impact model with 10 million people was built to calculate the budget impact on the medical insurance fund in the next three years （2021-2023）after PAH treatment included in the Policy. The measured cost mainly included the cost of medicine，outpatient registration ，examinations，hospitalizations，and death events. RESULTS A total of 34-36 patients with PAH per year were expected to use targeted therapy during 2021-2023. For cities with outpatient costs not covered by the pooling fund of basic medical insurance ，upon the treatment of PAH included the Policy ，the annual expenditure of the medical insurance fund increased by about 40 000 yuan，i.e. an increase of about 1 000 yuan per patient. For cities with outpatient costs covered by the pooling fund ，the annual expenditure of the medical insurance fund increased by about 80 000 yuan，which was equal to 2 000 yuan increase per patient. The increment of above cost decreased year by year. CONCLUSIONS The incremental expenditure of the medical insurance fund is controllable after the treatment of PAH included the Policy ；with the implementation of the Policy ，the incremental expenditure of the medical insurance fund will be reduced year by year.

Rapid identification of phthalides and organic acids in Angelica sinensis based on UPLC-Q-TOF/MS / 中国药房

OBJECTIVE To establish a comprehensive and rapid m ethod for the a nalysis of chemical constituents as phthalides and organic acids in Angelica sinensis ，and to provide scientific reference for the quality evaluation and pharmacodynamic substance research of A. sinensis . METHODS The 70％ ethanol extract of A. sinensis was analyzed by ultra high performance liquid chromatography-quadrupole-time of flight tandem mass spectrometry （UPLC-Q-TOF/MS）. The determination was performed on ACQUITY UPLC BEH-C 18 column with mobile phase consisted of 0.1％ formic acid solution- acetonitrile（gradient elution ）at the flow rate of 0.3 mL/min. The column temperature was set at 30 ℃，and sample size was 2 µL. The ion source was an electrospray ion source ，using positive ion scanning mode ，and the mass scanning range was m/z 50-1 000. Capillary voltage was 4 000 V； atomizer pressure was 35 psi；cracking voltage was 135 V and the taper hole voltage was 65 V；the temperature of dry gas was 320 ℃；the flow of dry gas was 10 L/min and the flow of sheath gas was 11 L/min；collision energy were 20 and 40 V. Qualitative Analysis 10.0 software was used to obtain the retention time of compounds ，the accurate mass number of excimer ion peaks and secondary fragments. The compounds were analyzed by comparing with the mass spectra of the reference substance ，combined with relevant literature ，mass spectrometry cleavage law and database such as Chemspider ，MassBank，PubChem. RESULTS A total of 72 compounds were identified or deduced from A. sinensis ，including 55 phthalides，13 organic acids and 4 other constituents. CONCLUSIONS The established method is rapid and accurate for the identification of chemical constituents from A. sinensis ，such as organic acids and phthalides ，which provides an efficient and rapid analytical method for the comprehensive characterization of its chemical constituents.

Application value of transrectal multimodal ultrasound in evaluating the efficacy of endocrine therapy for prostate cancer / 中华超声影像学杂志

Objective:To explore the value of transrectal multimodal ultrasound parameters in monitoring and evaluating the efficacy of endocrine therapy for prostate cancer.Methods:Thirty patients with prostate cancer confirmed by pathology and treated with endocrine therapy in Inner Mongolia Autonomous Region People′s Hospital from November 2019 to May 2021 were selected. The levels of serum prostate specific antigen (PSA), prostate volume, color Doppler parameters, elasticity index and contrast-enhanced ultrasound parameters were measured and recorded before treatment, 1 month and 3 months after treatment. The parameters before and after treatment were statistically analyzed. The correlation between the changes of each index and PSA was analyzed by Spearman correlation analysis.Results:Total prostate specific antigen, free prostate specific antigen, and prostate volume were significantly different before treatment, and 1 month and 3 months after treatment( P<0.05), and the values showed a downward trend with increase of treatment time. There was no significant difference in resistance index before and 1 month after treatment( P>0.05), but decreased significantly 3 months after treatment( P<0.05). The values of elasticity index, peak intensity, area under curve and gradient at 1 month and 3 months after treatment were lower than those before treatment, while the arrival time and rising time at 1 month and 3 months after treatment were significantly higher than those before treatment( P<0.05). Spearman correlation analysis showed that there was no correlation between the changes of quantitative parameters and PSA value before and after treatment( P>0.05). Conclusions:Prostate volume, color Doppler parameters, elasticity index, and contrast-enhanced ultrasound parameters change in the early stage of endocrine therapy for prostate cancer, which can be used as a useful supplement to PSA for prostate cancer, and can be used to evaluate the efficacy of clinical prostate cancer endocrine therapy.

Metformin inhibits proliferation and promotes apoptosis of HER-2 positive breast cancer cells possibly through the Hippo-YAP pathway / 南方医科大学学报

OBJECTIVE@#To investigate the effect of metformin on the proliferation and apoptosis of HER-2-positive breast cancer cell line SKBR3 and explore the possible mechanism of its action.@*METHODS@#SKBR3 cells were treated with different concentrations (20-120 μmol/L) of metformin, and the changes in cell proliferation and colony formation ability were assessed using CCK-8 assay and crystal violet staining, respectively. Flow cytometry was performed to analyze cell apoptosis and cell cycle changes. Real-time fluorescent quantitative PCR (qRT-PCR) was used to detect mRNA expressions of YAP, TAZ, EGFR, CTGF, CYR61, E-cadherin, N-cadherin, vimentin and fibronectin in the treated cells, and the protein expressions of YAP and TAZ were detected using Western blotting; immunofluorescence assay was used to observe YAP/TAZ nuclear translocation in the cells.@*RESULTS@#Metformin treatment significantly inhibited the proliferation of SKBR3 cells (P < 0.05) in a concentration- and time-dependent manner. The results of flow cytometry showed that metformin significantly promoted apoptosis and caused cell cycle arrest at G1 phase in SKBR3 cells. Metformin treatment significantly down-regulated the mRNA expressions of YAP, TAZ, EGFR, CTGF and CYR61, N-cadherin, vimentin and fibronectin (P < 0.05) and up-regulated the expression of E-cadherin (P < 0.05); Western blotting results showed that YAP and TAZ protein expressions were significantly down-regulated in the cells after metformin treatment (P < 0.05). Immunofluorescence assay revealed that metformin treatment caused the concentration of YAP and TAZ in the cytoplasm, and significantly reduced their amount in the cell nucleus.@*CONCLUSION@#Metformin can inhibit proliferation and promote apoptosis and epithelal-mesenchymal transition of HER-2 positive breast cancer cells possibly by that inhibing YAP and TAZ expression and their nuclear localization.

Preliminary clinical experience of the novel transcatheter aortic valve system Prizvalve® for the treatment of severe aortic stenosis / 中华心血管病杂志

Objective: To evaluate the safety and efficacy of transcatheter aortic valve implantation (TAVI) with the novel Prizvalve® system in treating severe aortic stenosis. Methods: This is a single-center, prospective, single-arm, observational study. A total of 11 patients with severe aortic stenosis with high risk or inappropriate for conventional surgical aortic valve replacement (SAVR) were included, and TAVI was achieved with the Prizvalve® system between March 2021 and May 2021 in West China Hospital. Transthoracic echocardiography (TTE) was performed immediately after prosthesis implantation to evaluate mean transaortic gradient and maximal transaortic velocity. The device success rate was calculated, which was defined as (1) the device being delivered via the access, deployed, implanted and withdrawn, (2) mean transaortic gradient<20 mmHg (1 mmHg=0.133 kPa) or a maximal transaortic velocity<3 m/s post TAVI, and without severe aortic regurgitation or paravalvular leak post TAVI. TTE was performed at 30 days after the surgery, and all-cause mortality as well as the major cardiovascular adverse events (including acute myocardial infarction, disabling hemorrhagic or ischemic stroke) up to 30 days post TAVI were analyzed. Results: The age of 11 included patients were (78.1±6.3) years, with 8 males. A total of 10 patients were with NYHA functional class Ⅲ or Ⅳ. Devices were delivered via the access, deployed, implanted and withdrawn successfully in all patients. Post-implant mean transaortic gradient was (7.55±4.08) mmHg and maximal transaortic velocity was (1.78±0.44) m/s, and both decreased significantly as compared to baseline levels (both P<0.05). No severe aortic regurgitation or paravalvular leak was observed post TAVI. Device success was achieved in all the 11 patients. No patient died or experienced major cardiovascular adverse events up to 30 days post TAVI. Mean transaortic gradient was (9.45±5.07) mmHg and maximal transaortic velocity was (2.05±0.42) m/s at 30 days post TAVI, which were similar as the values measured immediately post TAVI (both P>0.05). Conclusions: TAVI with the Prizvalve® system is a feasible and relatively safe procedure for patients with severe aortic stenosis and at high risk or inappropriate for SAVR. Further clinical studies could be launched to obtain more clinical experience with Prizvalve® system.

Advances in transcatheter aortic valve replacement for pure aortic regurgitation / 中国胸心血管外科临床杂志

@#Transcatheter aortic valve replacement (TAVR) for aortic stenosis has been confirmed to be safe and efficient, and its status has gradually increased with the continuous updating of guidelines. But for severe pure aortic valve regurgitation, it has long been considered a relative contraindication to TAVR. However, many elderly, high-risk patients with pure aortic regurgitation have also been treated with TAVR and prognosis was improved through off-label use of transcatheter heart valves due to contraindications to surgery or intolerance. But because of the complexity and challenging anatomic features, high technical requirements, limited device success rate, high rate of complications, and lack of randomized controlled studies to confirm its safety and efficacy, TAVR treatment of pure aortic regurgitation has been evolving in a debate. In recent years, with the application of new-generation valves and an increasing number of studies, some new insights have been gained regarding TAVR for severe aortic regurgitation, and this article will review the progress of research on TAVR for severe pure aortic regurgitation.

Clinical analysis of 53 children with connective tissue disease complicated with interstitial lung disease / 中华实用儿科临床杂志

Objective:To investigate the clinical manifestations, characteristics of chest high-resolution computed tomography (HRCT), and prognosis of connective tissue disease (CTD) complicated with interstitial lung disease (ILD) in children.Methods:The clinical data of 53 children with CTD-ILD who were admitted to the Department of Rheumatology and Immunology, Affiliated Xi′an Children′s Hospital of Xi′an Jiaotong University from October 2013 to October 2019 were retrospectively analyzed, including clinical manifestations, blood gas analysis, chest HRCT and prognosis.Results:As for these 53 children with CTD-ILD, the ratio of male to female was 1.0∶1.4, the average age was (7.50±3.34) years, and the course of disease was 2.00 (0.85, 7.50) months.Among them, there were 25 cases (47.2%) of juvenile idiopathic arthritis (JIA), 15 cases (28.3%) of systemic lupus erythematosus (SLE), 11 cases of polymyositis / dermatomyositis (PM/DM) (20.7%), 1 case of overlap syndrome (OS) (1.9%), and 1 case of allergic granulomatosis with polyangiitis (AGPA) (1.9%). Although cough (39.6%) was the most common symptom of respiratory system in these children with CTD-ILD and fever(66.0%) was the most common symptom in the systemic features.Blood gas analysis appeared abnormal in 17 cases, including 10 cases of hypoxemia (18.9%) and 7 cases of type Ⅰ respiratory failure (13.2%). HRCT chest showed ground glass shadow, strip shadow, subpleural spot shadow, grid shadow, pleural thickening, consolidation shadow, nodular shadow and cystic low-density shadow, with the proportion of 52.8%, 26.4%, 22.6%, 18.9%, 11.3%, 7.5%, 1.9% and 1.9%, respectively; nonspecific interstitial pneumonia (NSIP)(39.6%) was the most common type of imaging classification.After the combined treatment with glucocorticoids, immunosuppressive agents and biological agents, HRCT chest showed remarkably improvement in 36 cases (67.9%), while no change in 8 cases (15.1%). A total of 75.0%(33 cases) of 44 cases were infected in the course of combined treatment.In addition, 9 cases (17.0%) died from acute respiratory distress syndrome (ARDS), among which 4 cases exacerbated to rapid progressive luge disease and 5 cases aggravated secondary ARDS due to infection.Conclusions:Only a small number of children with CTD-ILD have respiratory symptoms and signs.HRCT chest contributes to the early diagnosis of CTD-ILD, and its imaging manifestations are diverse.Blood gas analysis and HRCT chest play an important role in the disease evaluation and treatment planning.Moreover, it is the direction for further research to develop effective methods to prevent and control secondary infection so as to improve the survival rate and reduce the mortality rate during the active treatment of primary diseases.

Safety and effectiveness of the SAPIEN 3 transcatheter heart valve in the treatment of severe aortic stenosis: Early clinical outcomes of a multicenter study in China / 中国胸心血管外科临床杂志

@#Objective     To evaluate the safety and efficacy of transcatheter aortic valve replacement (TAVR) using the SAPIEN 3 system. Methods    This was a prospective, multicenter, single arm study in 4 centers in China. The clinical data of 50 patients with high-risk symptomatic severe aortic stenosis who underwent TAVR using the SAPIEN 3 system from June 2017 to June 2019 were analyzed, including 27 males and 23 females aged 76.8±6.1 years. Results    The Society of Thoracic Surgeon score was 6.0%±2.8%. Totally, 20.0% of patients had severe bicuspid aortic stenosis. The operation time was 41.8±16.5 min and the hospital stay time was 8.5±5.0 d. At the postoperative 30-day follow-up, no all-cause mortality occurred and the device success rate was 89.5%. Major vascular complications occurred in one (2.0%) patient,  stroke in one (2.0%) patient, new pacemaker implantation in one (2.0%) patient, as well as coronary artery obstruction in one (2.0%) patient. There was no moderate or moderate/severe paravalvular leak. The aortic pressure gradient was decreased from 49.2±16.2 mm Hg before the operation to 12.4±4.6 mm Hg at the postoperative 30-day follow-up, and the valvular area was increased from 0.6±0.3 cm2 to 1.3±0.3 cm2 (P<0.01). Moreover, the New York Heart Association classification in 83.7% of the patients was improved during the follow-up. Conclusion    This pre-marketing multicenter study has demonstrated the safety and effectiveness of transfemoral TAVR with the SAPIEN 3 transcatheter valve system in Chinese aortic stenosis patients at high risk for surgery.

The construction of public sports service guarantee system in a healthy community in the background of public health / A construção de um sistema de garantia de serviço desportivo público em uma comunidade saudável no contexto da saúde pública / Construcción de un sistema de garantía de servicios deportivos públicos en comunidades urbanas saludables en el contexto de la salud pública

ABSTRACT Community sports are a very important part of urban public service. It directly affects the quality of life of residents and plays an important role in improving the health level of the masses. However, there are still many problems in the current public sports service system, which hinders the provision of public health. In order to ensure the effectiveness of the indicators of community sports service guarantee system, this study uses the fuzzy analytic hierarchy process to construct the community public sports service guarantee system, and verifies the effectiveness of the system constructed by this method through an example application. The results show that the weight of each index from large to small is service effectiveness > residents' demand > service capacity > service content; the weight of service effectiveness is 48.46%, which is an important indicator of service guarantee system. In addition, the effectiveness of the community sports service system was verified, and the CR value of the evaluation index system was greater than 0.1, which showed that the consistency of the evaluation index system met the requirements. The public sports service guarantee system constructed by the research institute has good applicability and high practical value. I hope that the research results can provide some reference for the improvement of grass-roots sports service construction, and provide some theoretical support for the construction of grass-roots service evaluation system.

RESUMO O desporto comunitário é uma parte muito importante do serviço público urbano. Afeta diretamente a qualidade de vida da população e desempenha um papel importante na melhoria do nível de saúde das massas. No entanto, ainda há muitos problemas no atual sistema de serviço público de desporto comunitário, o que dificulta a prestação da saúde pública. A fim de garantir a eficácia dos indicadores do sistema de garantia do serviço desportivo, este estudo utiliza o processo hierárquico analítico difuso para construir o sistema de garantia do serviço desportivo público e verifica a eficácia do sistema construído por este método através de uma aplicação dada como exemplo. Os resultados mostram que o peso de cada índice, de alto para baixo, é a eficácia do serviço > demanda da população > capacidade de serviço > conteúdo de serviço; o peso da eficácia do serviço é 48.46%, que é um importante indicador do sistema de garantia do serviço. Além disso, a eficácia do sistema de serviços desportivos foi verificada, e o valor CR do índice de avaliação do sistema foi superior a 0.1, o que mostrou que a consistência do sistema de índice de avaliação satisfazia os requisitos. O sistema público de garantia do serviço desportivo construído pelo instituto de pesquisa tem boa aplicabilidade e elevado valor prático. Espero que os resultados da investigação possam servir de referência para a melhoria da construção de serviços desportivos de base e proporcionar algum apoio teórico à construção de um sistema de avaliação de serviços de base.

RESUMEN Los deportes comunitarios son una parte muy importante del servicio público urbano. Afecta directamente la calidad de vida de los residentes y juega un papel importante en la mejora del nivel de salud de las masas. Sin embargo, todavía existen muchos problemas en el actual sistema público de servicios deportivos, lo que dificulta la prestación de servicios de salud pública. Con el fin de asegurar la efectividad de los indicadores del sistema de garantía del servicio deportivo comunitario, este estudio utiliza el proceso de jerarquía analítica difusa para construir el sistema de garantía del servicio público deportivo comunitario, y verifica la efectividad del sistema construido por este método a través de una aplicación de ejemplo. Los resultados muestran que el peso de cada índice, de mayor a menor, es la eficacia del servicio> la demanda de los residentes> la capacidad del servicio> el contenido del servicio; el peso de la efectividad del servicio es del 48,46%, lo que es un indicador importante del sistema de garantía del servicio. Además, se verificó la efectividad del sistema de servicios deportivos comunitarios y el valor de RC del sistema de índice de evaluación fue mayor a 0.1, lo que mostró que la consistencia del sistema de índice de evaluación cumplió con los requisitos. El sistema de garantía del servicio público de deportes construido por el instituto de investigación tiene una buena aplicabilidad y un alto valor práctico. Espero que los resultados de la investigación puedan proporcionar alguna referencia para la mejora de la construcción de servicios deportivos de base y proporcionar algún apoyo teórico para la construcción de un sistema de evaluación de servicios de base.

Valve in Valve transcatheter mitral valve replacement by a transvenous, transseptal access: A case report / 中国胸心血管外科临床杂志

@#Reoperation due to degenerated bioprostheses is an important factor of high-risk thoracic surgeries. In 2020 ACC/AHA guideline, Valve in Valve (ViV) was recommended for high-risk patient instead of surgical mitral valve replacement. This report described a 77-year-old male patient with a failed mitral bioprosthetic valve, evaluated at high risk of surgery, received a transvenous, transseptal transcatheter mitral valve replacement (TMVR). Tracheal intubation was removed at CCU 3 h after surgery without discomfort such as polypnea. The patient was transferred out of the CCU and discharged on the 3rd day. Compared with transapical access, transvenous transseptal access was less invasive, with shorter duration in CCU and hospitalization.

Iguratimod inhibits transforming growth factor-β 1 induced human lung fibroblast activation and collagen secretion via the Smad3/p300 pathway / 中华风湿病学杂志

Objective:To investigate the effect of iguratimod (IGU) on transforming growth factor-β 1 (TGF-β 1)-induced primary human lung fibroblasts (pHLFs) activation and collagen secretion. Methods:Mice pulmonary fibrosis (PF) models were established in vivo and were divided into three groups: the control group (CTR group), the Bleomycin (BLM) group and the BLM+IGU group, hematoxylin-eosin (HE) staining was used to observe lung morphology, and Masson staining was used to observe the degree of collagen accumulation in lung. Fibronectin and smooth muscle 22 (SM22) were detected by immunofluorescence, and the content of hydroxyproline in lung tissue was detected by chloramine-T method. In vitro, pHLFs were used to assess the effect of IGU on TGF-β 1 stimulation in four groups: CTR group, IGU group, TGF-β 1 group and TGF-β 1+IGU group, the apoptosis of cells was detected by flow cytometry, and the mRNA expression of collagen type Ⅰ (COL-Ⅰ) and collagen type Ⅲ (COL-Ⅲ) was detected by quantitative real-time polymerase chain reaction (qRT-PCR). The protein levels of α-smooth muscle actin (α-SMA), fibronectin, p-Smad2, p-Smad3 and transcription coactivator p300 were detected by Western blot and immunofluorescence. One-way ANOVA was used for all data, and LSD- t test or Kruskal-Wallis test was used for pair comparison. Results:The content of hydroxyproline in CTR group, the BLM group and the BLM+IGU group was (0.552±0.075) μg/mg, (1.293±0.081) μg/mg and (0.833±0.053) μg/mg ( F=169.672, P<0.01) respectively. IGU reduced the content of hydroxyproline in the lung tissue of mice, reduced the accumulation of collagen in the lung, and thus reduced the degree of BLM-induced pulmonary fibrosis, and improved the pathological changes in the lung of mice. In cell experiments, IGU had no significant effect on apoptosis ( F=0.83, P=0.54). The relative expression levels of COL-Ⅰ mRNA in the CTR group, TGF-β 1 group and TGF-β 1+IGU group were (100.4±1.2), (299.0± 13.0) and (202.5±7.0) respectively ( F=468.7, P<0.01). The relative expression levels of COL-Ⅲ mRNA in the CTR group, TGF-β 1 group and TGF-β 1+IGU group were (99.8±1.9), (350.6±8.0) and (220.3±9.9) respectively ( F=468.7, P<0.01). The relative expression levels of α-SMA protein were (0.193±0.038) in CTR group, (0.530±0.061) in TGF-β 1 group, and (0.410±0.065) in TGF-β 1+IGU group ( F=35.620, P<0.01); The relative expression levels of fibronectin in CTR group, TGF-β 1 group, and TGF-β 1+IGU group were (0.200±0.020), (0.700±0.020) and (0.410±0.066) respectively ( F=123.326, P<0.01). The relative expression levels of p-Smad3 protein in CTR group, TGF-β 1 group, and TGF-β 1+IGU group were (0.120±0.020), (0.573±0.586) and (0.327±0.252) respectively( F=92.987, P<0.01); The relative expression levels of p300 in CTR group, TGF-β 1 group and TGF-β 1+IGU group were (0.180±0.055), (0.923±0.025) and (0.650±0.050) respectively ( F=207.676, P<0.01). IGU significantly decreased the mRNA expression levels of COL-Ⅰ and COL-Ⅲ induced by TGF-β 1, inhibited the protein expression levels of α-SMA, fibronectin, p300, and phosphorylation of Smad2/3. Conclusion:Our results revealed the beneficial effect of IGU on the inhibition of TGF-β 1-mediated pHLFs activation and collagen secretion via the Smad3/p300 pathway, thus suggest that it might act as an effective anti-fibrotic agent in preventing the progression of PF.

A study on the influence of situational simulation training combined with Miller pyramid teaching on emergency response ability and nursing skills of operating room nurses / 中华医学教育探索杂志

Objective:To explore the effect of situational simulation training combined with Miller pyramid teaching on emergency response ability and nursing skills of specialized nurses in operating room.Methods:A total of 56 disaster nursing trainees who received specialized nurse training in the operating room of Mianyang Central Hospital from June 2019 to June 2020 were selected in the study, and they were divided into control group and research group in average according to the order of training time. The control group adopted clinical one-to-one teaching, while the research group adopted situational simulation training combined with Miller pyramid teaching. After the training, the teaching effect of specialized nurse training was evaluated by their professional theoretical knowledge and nursing skill operation results, and self-designed assessment scale was used to evaluate the emergency response ability and satisfaction with the training effect of the nurses. SPSS 22.0 was used for t test and chi-square test. Results:The results of theoretical knowledge and nursing skills operation of specialize nurses in operating room in the research group were significantly higher than those in the control group, and the differences were statistically significant ( P<0.001). The scores of emergency capability assessment in the research group were significantly higher than those in the control group, with statistical significance ( P<0.001). The study group was better than the control group in 7 aspects of satisfaction, such as the improvement of the operation level of emergency ability, team cooperation ability, analysis and problem solving ability, clinical nursing decision-making ability, independent thinking ability and nurse-patient communication ability, with significant differences ( P<0.05). Conclusion:Situational simulation training combined with Miller pyramid teaching can significantly improve the emergency response ability, nursing skill operation and training satisfaction of operating room nurses, which is better than the traditional clinical teaching method, and is worthy of application and promotion in clinical nursing teaching.

Clinical characteristics of cranial imaging abnormalities in children with systemic lupus erythematosus in children at the initial diagnosis / 中华实用儿科临床杂志

Objective:To investigate the incidence and clinical characteristics of cranial imaging abnormalities in children with systemic lupus erythematosus (SLE) at the initial diagnosis.Methods:The clinical data of 74 children with SLE admitted to the Department of Rheumatology in Children′s Hospital Affiliated to Xi′an Jiaotong University for the initial diagnosis from January 2012 to May 2019 were subject to retrospective analysis.They were divided into the cranial imaging abnormality group and the cranial imaging non-abnormality group according to the imaging.A description and statistical analysis were carried out for both groups with respect to the course before initial diagnosis, gender, rash, arthralgia, hair loss, pulmonary lesions, white blood cells (WBC), hemoglobin (Hb), platelets (PLT), erythrocyte sedimentation rate (ESR), serum ferritin (FER), serum complement values (C 3 and C 4), anticardiolipin antibody (ACA), alanine aminotransferase (ALT), aspartate transaminase (AST), triglyceride (TG), high-density lipoprotein (HDL), low-density lipoprotein (LDL), and total cholesterol (TC). Results:Seventy-four children with SLE underwent a cranial imaging exa-mination at the initial diagnosis, including 52 cases for magnetic resonance imaging (MRI) and 22 cases for CT.There were 36 abnormal cases (48.6%), including 27 cases (51.9%) in MRI and 9 cases (40.9%) in CT.Among 36 cases of abnormal cranial imaging in children with SLE, MRI abnormalities were mainly demyelinating lesions and sulcus widening (brain atrophy), while CT abnormalities were mainly sulcus widening (brain atrophy). There were 21 cases presenting with neurological symptoms, including 17 cases of headache, 11 cases of dizziness, 3 cases of convulsions, and 1 case of coma.There were no significant differences between both groups in the course before initial diagnosis, gender, rash, arthralgia and hair loss.Among the 36 cases of SLE with cranial imaging abnormalities, 20 cases presented with interstitial pulmonary lesions, of which 4 cases presented with pulmonary hemorrhage; Among 38 cases of SLE without cranial imaging abnormality, 8 cases presented with interstitial pulmonary lesions, which indicated that there were statistical differences between both groups; within terms of the laboratory test items, there were significant differences in PLT between both groups, and there was no significant difference in WBC, Hb, ESR, FER, C 3, C 4, ACA, ALT, AST, TG, HDL, LDL and TC. Conclusions:The cranial imaging abnormalities in children with SLE, especially the earlier occurrence in MRI, may occur before the manifestation of clinical symptoms of the nervous system.They were also associated with other important organ damages, such as abnormal blood system and lung lesions.Early detection may contribute to the short-term prognosis.

Characteristics and outcomes following transcatheter aortic valve replacement in China: a report from China aortic valve transcatheter replacement registry (CARRY) / 中华医学杂志(英文版)

BACKGROUND@#The past decade has witnessed an ever-increasing momentum of transcatheter aortic valve replacement (TAVR) and a subsequent paradigm shift in the contemporary management of severe aortic stenosis (AS). We conducted a multi-centric TAVR registry based on Chinese patients (the China Aortic valve tRanscatheter Replacement registrY [CARRY]) to delineate the clinical characteristics and outcomes of Chinese patients who underwent TAVR and compare the results between different valve types in different Chinese regions.@*METHODS@#CARRY is an all-comer registry of aortic valve disease patients undergoing TAVR across China and was designed as an observational study that retrospectively included all TAVR patients at each participating site. Seven hospitals in China participated in the CARRY, and 1204 patients from April 2012 to November 2020 were included. Categorical variables were compared using the chi-squared test, and continuous variables were analyzed using a t test or analysis of variance (ANOVA) test. The Kaplan-Meier curve was used to estimate the risk of adverse events during follow-up.@*RESULTS@#The mean age of the patients was 73.8 ± 6.5 years and 57.2% were male. The median Society of Thoracic Surgeon-Predicted Risk of Mortality score was 6.0 (3.7-8.9). Regarding the aortic valve, the proportion of bicuspid aortic valve (BAV) was 48.5%. During the hospital stay, the stroke rate was 0.7%, and the incidence of high-degree atrioventricular block indicating permanent pacemaker implantation was 11.0%. The in-hospital all-cause mortality rate was 2.2%. After 1 year, the overall mortality rate was 4.5%. Compared to patients with tricuspid aortic valve (TAV), those with BAV had similar in-hospital complication rates, but a lower incidence of in-hospital mortality (1.4% vs. 3.3%) and 1 year mortality (2.3% vs. 5.8%).@*CONCLUSIONS@#TAVR candidates in China were younger, higher proportion of BAV, and had lower rates of post-procedural complications and mortality than other international all-comer registries. Given the use of early generation valves in the majority of the population, patients with BAV had similar rates of complications, but lower mortality than those with TAV. These findings further propel the extension of TAVR in low-risk patients.@*TRIAL REGISTRATION@#https://www.chictr.org.cn/ (No. ChiCTR2000038526).

Efficacy and safety of a parylene-coated occluder for atrial septal defect: a prospective, multi-center, randomized controlled clinical trial / 中华医学杂志(英文版)

BACKGROUND@#Nitinol-containing devices are widely used in clinical practice. However, there are concerns about nickel release after nitinol-containing device implantation. This study aimed to compare the efficacy and safety of a parylene-coated occluder vs. a traditional nitinol-containing device for atrial septal defect (ASD).@*METHODS@#One-hundred-and-eight patients with ASD were prospectively enrolled and randomly assigned to either the trial group to receive a parylene-coated occluder (n = 54) or the control group to receive a traditional occluder (n = 54). The plugging success rate at 6 months after device implantation and the pre- and post-implantation serum nickel levels were compared between the two groups. A non-inferiority design was used to prove that the therapeutic effect of the parylene-coated device was non-inferior to that of the traditional device. The Cochran-Mantel-Haenszel chi-squared test with adjustment for central effects was used for the comparison between groups.@*RESULTS@#At 6 months after implantation, successful ASD closure was achieved in 52 of 53 patients (98.11%) in both the trial and control groups (95% confidence interval (CI): [-4.90, 5.16]) based on per-protocol set analysis. The absolute value of the lower limit of the 95% CI was 4.90%, which was less than the specified non-inferiority margin of 8%. No deaths or severe complications occurred during 6 months of follow-up. The serum nickel levels were significantly increased at 2 weeks and reached the maximum value at 1 month after implantation in the control group (P  0.05).@*CONCLUSIONS@#The efficacy of a parylene-coated ASD occluder is non-inferior to that of a traditional uncoated ASD occluder. The parylene-coated occluder prevents nickel release after device implantation and may be an alternative for ASD, especially in patients with a nickel allergy.

Progress of donor selection of haploidentical hematopoietic stem cell transplantation / 白血病·淋巴瘤

Haploidentical hematopoietic stem cell transplantation (HID-HSCT) is increasingly used worldwide as an important treatment for hematopoietic diseases. Thanks to the improvements in new treatment regimens and drugs, more patients with hematopoietic disorders can benefit from it. Selecting the appropriate donor is good to optimize clinical outcomes. Many factors need to be taken into consideration when choosing the optimum donor, such as donor-specific antibodies, donor age, genetic relationship, gender and ABO compatibility, human lymphocyte antigen (HLA) mismatch, natural killer cell alloreactivity, and serum status of donor cytomegalovirus. This article reviews the new progress of donor selection of HID-HSCT.

Druggability enhancement by modification of physicochemical properties of drugs via crystal engineering / 药学学报

The solubility/dissolution, hygroscopicity and mechanical properties of drug candidates have a profound effect on oral bioavailability, processability and stability. The physicochemical properties of crystalline drug are closely related to inner crystal structure. Crystal engineering technologies, as strategies of altering the crystal structure and tailoring physicochemical properties at molecular level, possess the potential of enhancing the pharmaceutical performance of product. The current article reviewed the modification of drug solubility/dissolution, hygroscopicity and mechanical properties by crystal engineering technologies through polymorphic selection, amorphization/co-amorphization, as well as co-crystallization, which provided a reference for the applications of pharmaceutical crystallography in improving physicochemical properties and druggability.

The value of the prominent hypointense vessels sign in acute ischemic stroke / 中华神经科杂志

Susceptibility-weighted imaging (SWI) is a tool that uses the intrinsic nature of local magnetic fields to enhance image contrast in order to improve the visibility of various susceptibility sources. SWI has blood oxygen levels dependent effect and is sensitive to the change of the cerebral oxygen saturation. This imaging method is applied to various diseases with abnormal deoxyhemoglobin concentration, such as ischemic stroke and cerebral arteriovenous malformation. Patients with acute ischemic stroke have elevated levels of deoxygenated hemoglobin in the affected area, so the ischemic area can show abnormal venous imaging on SWI images. SWI could recognize penumbra and guide the management of patients with acute stroke. Besides, SWI also could evaluate the severity of symptoms, predict prognosis and future surviving state. This paper reviews the research progress of the prominent hypointense vessels sign and its application in acute ischemic stroke.

Proventive and Therapentic Effects of Endothelial Progenitor Cells on Monocrotaline-Induced Hepatic Vein Occlusion Disease / 中国实验血液学杂志

OBJECTIVE@#To investigate the preventive and therapeutic effects of endothelial progenitor cells on monocrotaline-induced hepatic vein occlusion disease in mice.@*METHODS@#C57BL/6 mice were randomly divided into 3 groups: saline group (n=15), monocrotaline group (n=15), and endothelial progenitor cell infusion group (n=15). Liver function (TBIL, ALT, AST), liver index, and serum levels of TNF-α and IL-6 were measured on the 8 day after intragastric administration. Hepatic sinusoidal endothelial cells, hepatic central venous endothelial cells and hepatocytes were observed by both HE and immunohistochemical staining. Hepatic fibrosis was observed by Masson's trichrome staining.@*RESULTS@#By the light microscopy, the liver of the monocrotaline group showed moderate to the severe injuries of hepatic sinusoidal and central venous endothelial cells, and hepatic venous congestion. Masson staining showed moderate to severe hepatic fibrosis of central vein and hepatic sinus. In the endothelial progenitor cell group, hepatic sinusoidal and central venous endothelial cell injuries, and the fibrosis of central hepatic vein and hepatic sinus were mild to moderate. Hepatic venous congestion was reduced in comparison with that in the mice of the monocrotaline group. Compared with the endothelial progenitor cell group, the liver index was higher, the liver function was more abnormal, and the serum expression levels of TNF-α and IL-6 were higher in the monocrotaline group.@*CONCLUSION@#The monocrotaline-induced damage of hepatic sinusoidal and central venous endothelial cells is an linitiating factor for hepatic vein occlusive disease. Infusion of endothelial progenitor cells can play a role in preventing and treating hepatic vein occlusion.