Taurine Improved Autism-Like Behaviours and Defective Neurogenesis of the Hippocampus in BTBR Mice through the PTEN/mTOR/AKT Signalling Pathway.

Effective treatment of patients with autism spectrum disorder (ASD) is still absent so far. Taurine exhibits therapeutic effects towards the autism-like behaviour in ASD model animals. Here, we determined the mechanism of taurine effect on hippocampal neurogenesis in genetically inbred BTBR T+ tf/J (BTBR) mice, a proposed model of ASD. In this ASD mouse model, we explored the effect of oral taurine supplementation on ASD-like behaviours in an open field test, elevated plus maze, marble burying test, self-grooming test, and three-chamber test. The mice were divided into four groups of normal controls (WT) and models (BTBR), who did or did not receive 6-week taurine supplementation in water (WT, WT+ Taurine, BTBR, and BTBR+Taurine). Neurogenesis-related effects were determined by Ki67 immunofluorescence staining. Western blot analysis was performed to detect the expression of phosphatase and tensin homologue deleted from chromosome 10 (PTEN)/mTOR/AKT pathway-associated proteins. Our results showed that taurine improved the autism-like behaviour, increased the proliferation of hippocampal cells, promoted PTEN expression, and reduced phosphorylation of mTOR and AKT in hippocampal tissue of the BTBR mice. In conclusion, taurine reduced the autism-like behaviour in partially inherited autism model mice, which may be associa-ted with improving the defective neural precursor cell proliferation and enhancing the PTEN-associated pathway in hippocampal tissue.

Timing of antibiotic prophylaxis in term prelabor rupture of membranes: A retrospective cohort study using propensity-score matching.

OBJECTIVE: To assess whether earlier administration of antibiotic prophylaxis after prelabor rupture of membranes (PROM) at term would decrease the incidence of maternal and neonatal infections. METHODS: This is a retrospective cohort study comparing women with term PROM who were initiated antibiotic prophylaxis within or after 6 h, and within or after 12 h from PROM to delivery during January 2019 to December 2021. Women with term PROM receiving cephalosporin and without contraindications to vaginal delivery or confirmed or suspected infection were included in the study. The primary outcome was puerperal infection, which refers to the reproductive tract infection occurring within 42 days of delivery. The type of pharmacoeconomic evaluation was selected based on the results of compared effectiveness between the early group and the late group. Propensity-score matching (PSM) was used to adjust confounding. Subgroup and sensitivity analyses were used to verify the robustness of results. RESULTS: We enrolled 5353 women with term PROM, including 4331 initiated with antibiotic within 6 h, 1022 after 6 h, 5077 within 12 h, and 276 after 12 h. After PSM, no significant difference was observed in the baseline characteristics of the groups. There was no statistical difference between antibiotic use within 6 h and after 6 h, or within 12 h and after 12 h, in puerperal infection (4.6% vs. 4.3%, P = 0.826; 2.9% vs. 4.6%, P = 0.471, respectively), total maternal infection, neonatal sepsis, and total neonatal infection. Cost-minimization analysis showed there was no significant difference between antibiotic use within 6 h and after 6 h, or within 12 h and after 12 h, in direct medical costs. CONCLUSION: This study showed that there was no statistical difference in the efficacy and economy of antibiotic prophylaxis used within 6-12 h after rupture of membranes versus after 6-12 h in women with term PROM.

Application of FMEA model and 6S management method in reducing dispensing errors in PIVAS of children’s hospitals / 中国药房

OBJECTIVE To reduce dispensing errors in pharmacy intravenous admixture service （PIVAS） of children’s hospitals. METHODS The risk of dispensing procedures in our PIVAS was identified by applying failure mode and effect analysis （FMEA） model. Potential failure modes that might lead to dispensing errors in each link were determined， and failure causes were analyzed. The severity， incidence and detection degree of potential failure modes were quantitatively scored， and their risk priority number （RPN） was calculated to screen failure modes that needed to be improved in priority； the corresponding improvement measures were developed by 6S management method from six aspects， namely， finishing （seiri）， rectifying （seiton）， sweeping （seiso）， sanitation （seiketsu）， literacy （shitsuke） and safety. The effect of intervention before and after rectification was evaluated. RESULTS Based on the RPN， 32 potential failure modes were selected， of which a total of 18 critical failure modes that needed to be improved in priority. After implementing corresponding measures according to 6S management method， the RPN of 18 critical failure modes decreased. The total RPN decreased from 497 to 142 with a decrease rate of 71.43%. The error rates of 15 critical failure modes were significantly lower than before implementation （P＜0.05）. CONCLUSIONS Applying FMEA model and 6S management method to the risk control of all aspects of PIVAS workflow can effectively reduce the risk of PIVAS dispensing errors and ensure the safety of children’s intravenous medication.

Exploration of pharmaceutical service model in multidisciplinary diagnosis and treatment of rare diseases in children / 中国药房

OBJECTIVE To explore the pharmaceutical service model in multidisciplinary diagnosis and treatment （MDT） of rare diseases in children. METHODS Clinical pharmacists of West China Second University Hospital （hereinafter referred to as “our hospital”） participated in the process of MDT of children’s rare diseases. Clinical pharmacists took part in the entire diagnosis and treatment process of children and established the MDT pharmaceutical service model of children’s rare diseases by formulating drug treatment plans based on evidence-based practice， improving the accessibility of drugs， pharmaceutical monitoring and drug treatment management. RESULTS From January 2021 to April 2022， clinical pharmacists of our hospital had participated in a total of 39 cases of rare diseases MDT in children， including 21 hospitalized children with rare diseases and 18 outpatient com children with rare diseases， involving a total of 23 rare diseases. Clinical pharmacists completed 45 pharmaceutical zhanglingli@scu.edu.cn rounds and 26 pharmaceutical consultations for rare diseases inpatients， 25 outpatients’ MDT and 5 pharmaceutical outpatient service for outpatients with rare diseases， 38 medication educations for inpatients and outpatients with rare diseases and 25 follow-up services for out-of-hospital patients. There were 24 cases （61.54%） of off-label drug use， involving 13 rare diseases and 16 therapeutic drugs， among which off-label drug use registration of 11 drugs had been completed or was in progress. The temporary purchase evaluations of 3 drugs had been completed； 268 cases of medical insurance drug and high-value drug prescription had been reviewed. CONCLUSIONS Our hospital have primarily established a loop pharmaceutical service model of MDT for children with rare diseases， which covers inpatients and outpatients. The model improves the availability and standardization of clinical application of therapeutic drugs， and diagnosis and treatment level for children with rare diseases in our hospital.

Recommendations for the diagnosis and treatment of maternal SARS-CoV-2 infection / 中华围产医学杂志

The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection has spread worldwide and threatened human's health. With the passing of time, the epidemiology of coronavirus disease 2019 evolves and the knowledge of SARS-CoV-2 infection accumu-lates. To further improve the scientific and standardized diagnosis and treatment of maternal SARS-CoV-2 infection in China, the Chinese Society of Perinatal Medicine of Chinese Medical Association commissioned leading experts to develop the Recommendations for the Diagnosis and Treatment of Maternal SARS-CoV-2 Infection under the guidance of the Maternal and Child Health Department of the National Health Commission. This recommendations includes the epidemiology, diagnosis, management, maternal care, medication treatment, care of birth and newborns, and psychological support associated with maternal SARS-CoV-2 infection. It is hoped that the recommendations will effectively help the clinical management of maternal SARS-CoV-2 infection.

Efficacy of Different Pharmacological Interventions for Cervical High-risk HPV Infection: Bayesian Network Meta-analysis / 肿瘤防治研究

Objective To compare the efficacy of common clinical interventions in the treatment of cervical high-risk (HR) HPV infection based on Bayesian network meta-analysis. Methods Randomized controlled trials (RCTs) about common clinical interventions for cervical HR-HPV infection were searched in PubMed, Web of Science, Embase, The Cochrane Library, CBM, CNKI, Wanfang Data, and VIP databases from inception to July 31, 2021 using specific inclusion and exclusion criteria. The quality of the included studies was evaluated in accordance with the Cochrane systematic review manual. Meta-analysis was performed with Stata16 and RevMan5.3 software. Results Seventy-three RCTs were included, involving 3642 patients and eight treatment methods. Network meta-analysis showed that in the three months after treatment, the negative conversion rate was in the order: PTL > anti-HPV BPD > ALA-PDT > Nr-CWS > BFKS > CSJZS > rhIFNα-2b > FUO. In the six months after treatment, the negative conversion rate was in the order: Nr-CWS > ALA-PDT > PTL > anti-HPV BPD > BFKS > rhIFNα-2b > FUO > CSJZS. In the nine months after treatment, the negative conversion rate was in the order: PTL > ALA-PDT > BFKS > anti-HPV BPD > rhIFNα-2b > FUO. IN the 12 months after treatment, the negative conversion rate was in the order: Nr-CWS > ALA-PDT > anti-HPV BPD > PTL > BFKS > rhIFNα-2b > FUO > CSJZS. Conclusion In terms of HPV negative conversion rate, Nr-CWS and PTL are more effective and currently ideal compared with the other treatments. Owing to the quality of the evidence, the above conclusions must be confirmed by future high-quality studies.

Clinical comprehensive evaluation of recombinant Mycobacterium tuberculosis fusion protein / 中国药房

OBJECTIVE To evaluate the effectiveness， safety， economy， innovation， suitability and accessibility of recombinant Mycobacterium tuberculosis fusion protein （EC）， and to provide evidence for selecting skin detection methods for tuberculosis infection diagnosis and auxiliary diagnosis of tuberculosis. METHODS The effectiveness and safety of EC compared with purified protein derivative of tuberculin （TB-PPD） were analyzed by the method of systematic review. Cost minimization analysis， cost-effectiveness analysis and cost-utility analysis were used to evaluate the short-term economy of EC compared with TB-PPD， and cost-utility analysis was used to evaluate the long-term economy. The evaluation dimensions of innovation， suitability and accessibility were determined by systematic review and improved Delphi expert consultation， and the comprehensive score of EC and TB-PPD in each dimension were calculated by the weight of each indicator. RESULTS The scores of effectiveness， safety， economy， innovation and suitability of EC were all higher than those of TB-PPD. The affordability scores of the two drugs were consistent， while the availability score of EC was lower than those of TB-PPD. After considering dimensions and index weight， the scores of effectiveness， safety， economy， innovation， suitability， accessibility and the comprehensive score of EC were all higher than those of TB-PPD. CONCLUSIONS Compared with TB-PPD， EC performs better in all dimensions of effectiveness， safety， economy， innovation， suitability and accessibility. However， it is worth noting that EC should further improve its availability in the dimension of accessibility.

CHINA PH ARMACY Volume 33，Number 7，April 15，2022 Semimonthly Table of Contents Drug selection guideline for medical institutions / 中国药房

In order to promote the standardization of drug selection in medical institutions ，enhance the level of pharmaceutical affairs management of medical institutions and promote the safe ，effective，economical and appropriate use of drugs in the treatment of diseases ，the Drug Selection Guideline for Medical Institutions （hereinafter refer to as the Guideline ）is formulated. The development of the Guideline for medical institutions is following the latest definition of Institution of Medicine （IOM）， National Academy of Sciences and based on the methodology of WHO handbook for guideline development. During the construction of the Guideline ，the research points of the Guideline are constructed on the basis of Delphi method ；a drug selection and evaluation system with 10 primary indicators and 30 secondary indicators as the core is also designed. The evaluation indexes can be divided into research indexes and policy indexes according to their attributes and main sources of evidence. The GRADE method is used to evaluate the quality of the evidence system for research indexes ，while the policy indexes are graded according to the Legislation Law of the People ’s Republic of China . On this basis ，the evaluation methods of those indexes are constructed by using evidence-based medicine method ，the recommendation is formed through expert consensus method ，and finally a standard guideline for drug selection in medical institutions is formed.

Co-regulation of circadian clock genes and microRNAs in bone metabolism / 浙江大学学报（英文版）（B辑：生物医学和生物技术）

Mammalian bone is constantly metabolized from the embryonic stage, and the maintenance of bone health depends on the dynamic balance between bone resorption and bone formation, mediated by osteoclasts and osteoblasts. It is widely recognized that circadian clock genes can regulate bone metabolism. In recent years, the regulation of bone metabolism by non-coding RNAs has become a hotspot of research. MicroRNAs can participate in bone catabolism and anabolism by targeting key factors related to bone metabolism, including circadian clock genes. However, research in this field has been conducted only in recent years and the mechanisms involved are not yet well established. Recent studies have focused on how to target circadian clock genes to treat some diseases, such as autoimmune diseases, but few have focused on the co-regulation of circadian clock genes and microRNAs in bone metabolic diseases. Therefore, in this paper we review the progress of research on the co-regulation of bone metabolism by circadian clock genes and microRNAs, aiming to provide new ideas for the prevention and treatment of bone metabolic diseases such as osteoporosis.

Interpretation for Evidence-based Practice Guideline of Medication Therapy of High-dose Methotrexate in China / 中国药房

Evidence-based Practice Guideline of Medication Therapy of High-dose Methotrexate in China was published in the British Journal of Clinical Pharmacology in February 2022. The guideline followed the latest definition of clinical practice guideline and the methodology specification for the guideline development of WHO. The Grading of Recommendations Assessment ， Development，and Evaluation （GRADE）approach was applied to rate the quality of evidence and determine the strength of recommendations. Finally ，this guideline presents 28 recommendations covering the whole process of clinical medication of high-dose methotrexate ，involving evaluation prior to administration （liver and renal function ，pleural effusion and ascites ， comedication，genetic testing ），pre-treatment and routine dosing regimen （pretreatment of hydration and alkalization ，urine alkalization，routine dosing regimen ），therapeutic drug monitoring （necessity，method，timing，target concentration ），leucovorin rescue（rescue timing ，rescue regimen ，rescue dose optimization ），and management of toxicities （liver and kidney function monitoring，supportive treatment ，blood purification treatment ）. This article aims to summarize and interpret the recommendations of this guideline ，so as to promote the better promotion and implementation of this guideline and provide comprehensive technical support and suggestions for whole-course individualized administration of high-dose methotrexate in China.

An overview of the characteristics and quality assessment criteria in systematic review of pharmacoeconomics.

BACKGROUND: The systematic review of economic evaluations plays a critical role in making well-informed decisions about competing healthcare interventions. The quality of these systematic reviews varies due to the lack of internationally recognized methodological evaluation standards. METHODS: Nine English and Chinese databases including the Cochrane Library, PubMed, EMbase (Ovid), NHS economic evaluation database (NHSEED) (Ovid), Health Technology Assessment (HTA) database, Chinese National Knowledge Infrastructure (CNKI), WangFang, VIP Chinese Science & Technology Periodicals (VIP) and Chinese Biomedical Literature Database (CBM) were searched. Two reviewers independently screened studies and extracted data. The methodological quality of the literature was measured with modified AMSTAR. Data were narrative synthesized. RESULTS: 165 systematic reviews were included. The overall methodological quality of the literature was moderate according to the AMSTAR scale. In these articles, thirteen quality assessment tools and 32 author self-defined criteria were used. The three most widely used tools were the Drummond checklist (19.4%), the BMJ checklist (15.8%), the Consolidated Health Economic Evaluation Reporting Standards (CHEERS) statement (12.7%). Others included the Quality of Health Economic Studies (QHES), the Consensus on Health Economic Criteria (CHEC), the checklist of Center for Reviews and Dissemination (CRD), the Philips checklist, the World Health Organization (WHO) checklist, the checklist of Critical Appraisal Skills Program (CASP), the Pediatric Quality Appraisal Questionnaire (PQAQ), the Joanna Briggs Institute (JBI) checklist, Spanish and Chinese guidelines. The quantitative scales used in these literature were the QHES and PQAQ. CONCLUSIONS: Evidence showed that pharmacoeconomic systematic reviews' methodology remained to be improved, and the quality assessment criteria were gradually unified. Multiple scales can be used in combination to evaluate the quality of economic research in different settings and types.

Microalbuminuria level in patients with rheumatoid arthritis and its correlation with disease activity / 中华风湿病学杂志

Objective:To investigate the change of microalbuminuria (MA) in patients with RA and its clinical significance.Methods:From January 2018 to December 2019, data of 75 cases of RA patients were collected from outpatient and inpatient wardsof our hospital, and the data of 75 cases of physical examination wascollected as control. Erythrocyte sedimentation rate (ESR), C-reactive protein (CRP) anti-cyclic citrullinated peptide (CCP) antibody, blood lipid, Homeostasis model assessment for insulin resistance (HOMA-IR), rheumatoid factor (RF), anti-CCP antibodyand MA levels were measured respectively. RA patients were obtained by ultrasound Carotid intima-media thickness (cIMT) and brachial artery flow mediated diastolic function (FMD) were measured. The statistical analysis was carried out with independent t-test, analysis of variance, Pearson correlation analysis and multiple stepwise regression. Results:The MA level of RA patients was significantly higher than that of the healthy control group [(31±5) mg/L vs (25±4) mg/L, t=5.982, P<0.05]. In RA patients, MA level was positively correlated with course of disease ( r=0.327, P=0.015), HOMA-IR ( r=0.576, P<0.01], CRP ( r=0.212, P=0.027), RF ( r=0.585, P<0.01), disease activity score in 28 joints (DAS28) ( r=0.472, P=0.013), cIMT ( r=0.611, P<0.01) and duration of nonsteroidal anti-inflammatory drugs (NSAIDs) use ( r=0.274, P<0.01), and urineMA level( OR=1.763, P<0.01) were independent correlation factors affecting cIMT. Conclusion:The level of MA in RA patients is significantly higher than that in normal controls, and is correlated with disease activity and subclinical atherosclerosis, which could be another important predictor of disease follow-up and early screening of subclinical atherosclerosis in RA patients.

Evidence-based study on rehabilitation program and empirical study of patients with anterior cruciate ligament reconstruction / 中国实用护理杂志

Objective:To construct the rehabilitation strategy of anterior cruciate ligament reconstruction based on the evidenced method and evaluate the effectiveness in clinic.Methods:The rehabilitation strategy was firstly built based on evidenced method. And then 80 patients from Department of Sports Medicine and Adult Reconstructive Surgery, Nanjing University Medical School Affiliated Drum Tower Hospital from January to August, 2019 were randomly and equably sent to experiment group and control group. Patients in experiment group or control group were accepted the evidenced method or regular method as treatment strategy, respectively. The visual analogue scale (VAS), thigh circumference, motion range of knee joint and Lysholm score were recorded before and after surgery.Results:Six papers met the inclusion criterion and were been screen out from 1 535 papers, and then the evidenced rehabilitation strategy of anterior cruciate ligament reconstruction was made. The VAS scores in 12 and 24 h were 1(0-2), 1(1-3) in experiment group and 2(1-3), 3(1-3)in control group, the differences were significant between two groups( Z values were 4.955, 6.489, P<0.001). The motion ranges of knee joint in 2, 4, 6, 12 weeks after operation were (61.6±5.1)°, (85.3±6.6)°, (114.6±5.2)°, (127.6±3.4)° in experiment group and(54.9±4.6)°, (71.0±8.8)°, (105.1±5.9)°, (115.8±4.0) °in control group, the differences were significant between two groups( t values were 6.209-14.138, P<0.001). The Lysholm scores at 6,8,12 weeks after operation were 58.8±3.7, 71.1±3.1, 84.3±3.7 in experiment group and 56.0±3.4, 65.4±4.3, 75.6±3.0 in control group, the differences were significant between two groups( t values were 3.511, 6.867, 11.439, P<0.001). Conclusions:This evidenced rehabilitation strategy of anterior cruciate ligament reconstruction in this study was helpful to alleviating the pain, improving motion range of knee joint after anterior cruciate ligament reconstruction.

Research and Development Status Quo of Respiratory Inhalation Preparations ：A Systematic Review / 中国药房

OBJECTIVE：To systematically evaluate the research and development status quo of respiratory inhalation preparations. METHODS ：Related literatures or data about R&D status quo of domestic and foreign respiratory inhalation preparations were retrieved from 5 databases（PubMed，Embase，CNKI，Wanfang database and VIP ），4 clinical trial registration platforms，15 national/regional drug administration platforms and yaozhi.com . The status quo of related studies was analyzed by descriptive analysis. RESULTS & CONCLUSIONS ：A total of 27 second literatures were included. The information of respiratory inhalation preparations approved by European Union ，the United States ，Canada，Japan and China was collected ，and the information of related drugs under registration and approval in China was also collected. The market situation of respiratory inhalation preparations was analyzed from the perspective of dosage form ：powder aerosols accounted for 46％，aerosols account ed for 32％，and atomized inhalation solutions accounted for 22％ in the global consumption sum of each dosage form. From the perspective of market share ，companies such as AstraZeneca in the UK ，Boehringer Ingelheim in Germany and GlaxoSmithKline in the UK had a total market share of about 70％. At present ，there were 39 kinds of respiratory inhalation preparations on the market in European Union ，121 kinds in the United States ，111 kinds in Canada ，37 kinds in Japan ，69 kinds of domestic inhalation preparations and 80 kinds of imported inhalation preparations in China. Respiratory inhalation preparations were undergoing clinical trials with 511 cases abroad and 69 cases in China. The barriers to the imitation of respiratory inhalation preparations mainly included research and development ，clinical trial ，approval and production barriers. At present ，the support is provided for 0035） domestic drug innovation and localization of medical devices in China through a series of policies ，which is helpful to promote the localization research and development of inha led preparations. Future research and development can pay more cn attention to combination ，indication，dosage and device of inhalation preparation.

Optimization of Ultrafiltration Technology of Enzymatic Hydrolysate from Eucommia ulmoides Peel / 中国药房

OBJECTIVE：To optim ize the ultrafiltration technology of enzymatic hydrolysate from Eucommia ulmoides peel. METHODS：The single factor test was adopted to investigate the effects of molecular weight of ultrafiltration membrane ，liquid temperature，operating pressure ，operating frequency ，membrane filtration time ，liquid concentration and pH on transfer rates of aucubin，geniposide and chlorogenic acid as well as solid removal rate in enzymatic hydrolysate from E. ulmoides peel. Setting the molecular cut off of fixed ultrafiltration membrane of 100 000，liquid concentration of 7 g/L，and pH value of 7，the ultrafiltration technology was optimized by Box-Behnken design response-surface methodology and validated with liquid temperature ，operating pressure，operating frequency and membrane passing time as factors ，using comprehensive scores calculated from transfer rates of aucubin，geniposide and chlorogenic acid as well as solid removal rate as indexes. RESULTS ：The optimal ultrafiltration technology of enzymatic hydrolysate from E. ulmoides peel was as follows as liquid temperature of 35 ℃，operating pressure of 0.5 MPa，operating frequency of 35 Hz and membrane passing time of 42 min. Results of validation tests showed that the comprehensive scores of the transfer rates of aucubin ，geniposide and chlorogenic acid as well as solid removal rate in enzymatic hydrolysate from E. ulmoides peel was 78.06％（RSD＝1.43％，n＝3），and its relative error with the predicted value （77.18％） was 1.14％. CONCLUSIONS ：The optimized ultrafiltration technology is stable and reliable ，and can be used for the ultrafiltration purification of enzymatic hydrolysate from E. ulmoides peel.

Long non-coding RNA regulates bone metabolism via Wnt/β-catenin signaling pathway / 生物工程学报

The balance of bone metabolism depends on the dynamic balance between bone formation and bone resorption. Wnt/β-catenin signaling pathway is involved in the regulation of bone resorption and bone formation, and plays an important role in maintaining the balance of bone metabolism. Recently, long non-coding RNA (lncRNA) is shown to play an essential role in different process of bone metabolism. LncRNA can also regulate the balance of bone metabolism via Wnt/β-catenin signaling pathway. Few studies report that lncRNA regulates bone metabolism via Wnt/β-catenin signaling pathway. Therefore, we summarize here the role of lncRNA in bone metabolism from the perspective of Wnt/β-catenin signaling pathway. LncRNA indirectly regulates Wnt/β-catenin signaling pathway by targeting miRNAs as well as activating or inhibiting Wnt/β-catenin signaling pathway via targeting the key molecules of Wnt/β-catenin signaling pathway, thus to regulate bone metabolism. These findings provide new ideas and directions for the study of the mechanism whereby lncRNA regulates bone metabolism.

Cohort Study on the Effectiveness and Safety of Tiapride Combined with Clonidine versus Tiapride and Clonidine Alone for Children with Tic Disorders / 中国药房

OBJECTIVE：To compa re the effectiveness and safety of three regimens of tiapride ，clonidine and tiapride combined with clonidine in the treatment of tic disorder （TD）in children. METHODS ：A sequential collection of 312 children with TD from the outpatient department of West China Second Hospital of Sichuan University were conducted during Jan.-Dec. 2019. They were divided into clonidine group ，tiapride group ，tiapride combined with clo nidine group ，with 104 cases in each group. Tiapride group was given Tiapride hydrochloride tablets with initial dose of 50-100 mg per day ，and the dose was gradually increased to 150-500 mg per day according to tolerance and clinical experience. Clonidine group was given Clonidine transdermal patches ，once a week ，with initial dose of 1 mg each week ，maintenance dose of 1-2 mg each week ，once a week. Tiapride combined with clonidine group was given Tiapride hydrochloride tablets （same usage and dosage as tiapride group ）+ Clonidine transdermal patches （same usage and dosage as clonidine group ）. The treatment course of 3 groups was 3 months. After the treatment ，they were followed up every 3 months（the following were expressed as 24，36 and 48 weeks after treatment ）. Yale global tie severity scale （YGTSS）scores of 3 groups were observed before treatment ，after 4，8，12，24，36，48 weeks of treatment，and the occurrence of ADR was recorded at different follow up time points. RESULTS ：Before treatment ，there was no statistical significance in YGTSS scores among 3 groups（P＞0.05）. After 4，8，12，24，36 and 48 weeks of treatment ，YGTSS scores of 3 groups were significantly lower than those before treatment （P＜0.05）. After 4，8 and 12 weeks of treatment ，YGTSS scores of tiapride combined with clonidine group were significantly lower than tiapride group and clonidine group （P＜0.05），while there was no statistical significance between tiapride group and clonidine group （P＞0.05）. At 24 weeks of treatment ，YGTSS score of children in tiopride combined with clonidine group was significantly lower than tiopride group （P＜0.05），but there were no significant differences between tiopride combined with clonidine group and tiopride group ，and between tiopride group and clonidine group （P＞0.05）. After 36 and 48 weeks of treatment ，there was no significant difference in YGTSS scores among 3 groups（P＞0.05）. After 12 weeks of treatment ，the results of P value corrected by Bonferroni method showed that YGTSS score of tiopride combined with clonidine group was significantly lower than those of tiopride group and clonidine group （P＜0.016 7）， while there was no statistical significance in the difference between tiopride group and clonidine group （P＞0.016 7）. There was no statistically significant difference in the total incidence of ADR among 3 groups（P＞0.05）. CONCLUSIONS ：Clonidine，tiapride and tiapride combined with clonidine can significantly improve the tic symptoms of TD children with good safety .

Study on the Medication Compliance of Children with Tic Disorder Based on the Theory of Protective Motivation / 中国药房

OBJECTIVE：To study the current status and influencing factors of medication compliance in children with tic disorder（TD），and to provide reference for improving medication compliance in TD children. METHODS：The questionnaire was designed according to the protection motivation theory. The cross-sectional study was adopted to conduct questionnaire survey among TD children in West China Second Hospital of Sichuan University from Jan. 2018 to Dec. 2019. The structural equation model was established according to the theoretical assumptions，and the maximum likelihood method was used to estimate the model；multiple linear regression analysis was carried out for the factors with significant influence in the single factor analysis，and path analysis and intermediary effect test were carried out. RESULTS：A total of 317 patients with TD were included，the mean age was（8.38±2.54）years，and the mean course of disease was（3.19±2.46）years. Average medication compliance scores was （5.70±1.69），among which 15.1％ was low compliance，37.5％ moderate compliance，and 47.3％ high compliance. Multivariate linear regression analysis showed that comorbidities（β＝0.124，SE＝0.167，P＝0.011），education level of the main guardian（β＝ 0.236，SE＝0.110，P＜0.001），quality of life（β＝0.399，SE＝0.112，P＜0.001）and the types of drugs taken（β＝0.166，SE＝ 0.047，P＝0.001）were the factors affecting medication compliance of children with TD. Structural equation model analysis showed that severity（β＝0.295，95％CI：0.103-0.493），external return（β＝0.830，95％CI：0.662-1.002），self-efficacy（β＝0.200，95％CI： 0.057-0.353），susceptibility（β＝0.220，95％CI：0.084-0.352）and quality of life（β＝0.353，95％CI：0.211-0.500）had a direct positive impact on medication compliance. Quality of life mediated between external returns and compliance variables（intermediary effect accounted for 13.9％ of the total effect value）. CONCLUSIONS：Children with TD have low medication compliance. It is recommended that pediatricians in medical institutions at all levels to manage the medication compliance of patients with TD from the severity，susceptibility，external returns and self-efficacy，so as to improve patients and guardians’awareness of the severity and susceptibility of disease and medication non-adherence，weaken external returns and increase self-efficacy，and ultimately improve medication compliance of patients

Effects of abdominal obesity on cognitive status in patients with moderate to severe of obstructive sleep apnea syndrome / 中华老年医学杂志

Objective:To observe the effects of abdominal obesity on cognitive status in patients with obstructive sleep apnea syndrome(OSAS).Methods:150 cases with moderate to severe OSAS patients were enrolled in this prospective case-control study in the Department of Neurology of Beijing Luhe Hospital Affiliated to Capital Medical University from June 2016 to September 2020.According to whether abdominal obesity was complicated, the patients were divided into non-abdominal obesity group(n=31)and abdominal obesity group(n=119). The cognitive function of the patients was evaluated by Montreal Cognitive Assessment(Mo-CA)scale and Symbol Digit Modalities Test(SDMT)in the two groups, and the independent influencing factors of each cognitive function were determined by linear regression.Two factors Analysis of Variance(ANOVA)was used to analyze the main effects and interactions of Apnea Hypopnea Index(AHI)and abdominal obesity on various cognitive functions.Results:Compared with the non-abdominal obesity group, the body mass index, neck circumference, waist circumference, hip circumference, AHI, minimum oxygen saturation and oxygen de-saturation index(ODI)were significantly higher in the abdominal obesity group(all P<0.01). Before correction for any factors, the total score of Mo-CA, visual space and executive score and language score were lower in abdominal obesity group than in non-abdominal obesity group( P<0.01). After adjusting for gender, age, years of education, smoking history, drinking history, AHI and other factors, there were still significant differences in visual space, executive score and language score between the two groups( P<0.05), but there was no significant difference in the total score of Mo-Ca( P>0.05). The correct number of SDMT(40.4±14.5)was lower in non-abdominal obesity group than in abdominal obesity group(44.4±9.0), but the difference was not statistically significant( t=1.887, P>0.05). After adjusting for gender, age, years of education, smoking history, and drinking history, there was still no significant difference in AHI and other factors between the two groups( P>0.05). Regression analysis results showed that independent influencing factors of the total Mo-CA score were age, education, abdominal obesity, and AHI>30( β=-0.174, 0.213, 0.011, 0.158, respectively all P<0.05); the independent influencing factors of visual space and execution ability were the years of education and the abdominal obesity( β=0.182, -0.038, P<0.01); the independent influence factors of naming were gender( β=-0.176, P<0.01); independent influencing factors of attention were age( β=-0.159, P<0.01); independent influencing factors of language were abdominal obesity( β=-0.203, P<0.01); independent influences factors for abstract thinking ability were the length of education( β=0.204, P<0.01); independent influencing factors for delay recall were age, years of education and AHI>30(βvalues were -0.206, -0.125, and -0.174, respectively, all P<0.05, respectively); independent influencing factors for SDMT correct number were age, years of education(β values were -0.177, 0.153, respectively, all P<0.01, respectively). Interaction analysis results showed that there was an interaction between AHI and abdominal obesity in language score( P<0.05). Conclusions:Abdominal obesity can impair the visuospatial and executive abilities as well as language ability in moderate to severe obstructive sleep apnea patients.And there is an interaction between apnea-hypopnea index and MO-CA scores in language ability.

An instrument for evaluating the clinical applicability of guidelines.

OBJECTIVE: To establish an instrument for evaluating the clinical applicability of guidelines from the guideline-users' perspective. METHODS: We established this instrument through forming a working group, forming an initial list of items based on a qualitative systematic review, establishing initial instrument via two rounds of modified Delphi surveys, and external review the initial instrument. RESULTS: The results of modified Delphi surveys establishing appraisal aspects, appraisal items, general information of the evaluator met the preset requirements. The instrument includes three parts: general information of the evaluator (12 items), evaluation of clinical applicability (12 items, including items on the availability, readability, acceptability, feasibility, and overall applicability of guideline), and scoring scheme. CONCLUSIONS: The instrument for evaluating the clinical applicability of guidelines from the guideline-users' perspective provides criteria and methods for improving the clinical applicability of guidelines during development and updating.