Risk assessment of arrhythmias related to three antiseizure medications: a systematic review and single-arm meta-analysis.

Objective: Antiseizure medications (ASMs) are first line therapy for seizure disorders. Their effects on arrhythmias, especially the risk of arrhythmias associated with lacosamide (LCM), levetiracetam (LEV), and perampanel (PER), have been intensely investigated. Methods: We searched four databases (PubMed, EMBASE, Cochrane Library, and Web of Science) until August 6, 2023. We used a common effects model and reported data as pooled incidence with 95% CIs. Meta-analyses were conducted to elucidate the risk of arrhythmias with different drugs, and Egger's regression was performed to detect publication bias analysis. Results: We included 11 clinical trials with 1,031 participants. The pooled incidence of arrhythmias in the LEV group was 0.005 (95% CI: 0.001-0.013), while it was 0.014 in the LCM group (95% CI: 0.003-0.030). Publication bias analyses indicated no significant bias in the LEV group (t = 0.02, df = 4, p-value = 0.9852) but a significant bias in the LCM group (t = 5.94, df = 3, p-value = 0.0095). We corrected for this bias in the LCM group using the trim-and-fill method, which yielded a similar pooled incidence of 0.0137 (95% CI: 0.0036-0.0280), indicating good reliability. Due to insufficient studies, we could not conduct a meta-analysis for PER, and we analyzed them in our systematic review. Conclusion: The use of LCM significantly elevated the risk of arrhythmias, while LEV had non-significant arrhythmogenic effects. As for the arrhythmogenic effects of PER, more clinical trials are needed in the future.

Predicting long-term time to cardiovascular incidents using myocardial perfusion imaging and deep convolutional neural networks.

Myocardial perfusion imaging (MPI) is a clinical tool which can assess the heart's perfusion status, thereby revealing impairments in patients' cardiac function. Within the MPI modality, the acquired three-dimensional signals are typically represented as a sequence of two-dimensional grayscale tomographic images. Here, we proposed an end-to-end survival training approach for processing gray-scale MPI tomograms to generate a risk score which reflects subsequent time to cardiovascular incidents, including cardiovascular death, non-fatal myocardial infarction, and non-fatal ischemic stroke (collectively known as Major Adverse Cardiovascular Events; MACE) as well as Congestive Heart Failure (CHF). We recruited a total of 1928 patients who had undergone MPI followed by coronary interventions. Among them, 80% (n = 1540) were randomly reserved for the training and 5- fold cross-validation stage, while 20% (n = 388) were set aside for the testing stage. The end-to-end survival training can converge well in generating effective AI models via the fivefold cross-validation approach with 1540 patients. When a candidate model is evaluated using independent images, the model can stratify patients into below-median-risk (n = 194) and above-median-risk (n = 194) groups, the corresponding survival curves of the two groups have significant difference (P < 0.0001). We further stratify the above-median-risk group to the quartile 3 and 4 group (n = 97 each), and the three patient strata, referred to as the high, intermediate and low risk groups respectively, manifest statistically significant difference. Notably, the 5-year cardiovascular incident rate is less than 5% in the low-risk group (accounting for 50% of all patients), while the rate is nearly 40% in the high-risk group (accounting for 25% of all patients). Evaluation of patient subgroups revealed stronger effect size in patients with three blocked arteries (Hazard ratio [HR]: 18.377, 95% CI 3.719-90.801, p < 0.001), followed by those with two blocked vessels at HR 7.484 (95% CI 1.858-30.150; p = 0.005). Regarding stent placement, patients with a single stent displayed a HR of 4.410 (95% CI 1.399-13.904; p = 0.011). Patients with two stents show a HR of 10.699 (95% CI 2.262-50.601; p = 0.003), escalating notably to a HR of 57.446 (95% CI 1.922-1717.207; p = 0.019) for patients with three or more stents, indicating a substantial relationship between the disease severity and the predictive capability of the AI for subsequent cardiovascular inciidents. The success of the MPI AI model in stratifying patients into subgroups with distinct time-to-cardiovascular incidents demonstrated the feasibility of proposed end-to-end survival training approach.

Smallholder oil palm plantation sustainability assessment using multi-criteria analysis and unmanned aerial vehicles.

Oil palm agriculture has caused extensive land cover and land use changes that have adversely affected tropical landscapes and ecosystems. However, monitoring and assessment of oil palm plantation areas to support sustainable management is costly and labour-intensive. This study used an unmanned aerial vehicles (UAV) to map smallholder farms and applied multi-criteria analysis to data generated from orthomosaics, to provide a set of sustainability indicators for the farms. Images were acquired from a UAV, with structure from motion (SfM) photogrammetry then used to produce orthomosaics and digital elevation models of the farm areas. Some of the inherent problems using high spatial resolution imagery for land cover classification were overcome by using texture analysis and geographic object-based image analysis (OBIA). Six spatially explicit environmental metrics were developed using multi-criteria analysis and used to generate sustainability indicator layers from the UAV data. The SfM and OBIA approach provided an accurate, high-resolution (~5 cm) image-based reconstruction of smallholder farm landscapes, with an overall classification accuracy of 89%. The multi-criteria analysis highlighted areas with lower sustainability values, which should be considered targets for adoption of sustainable management practices. The results of this work suggest that UAVs are a cost-effective tool for sustainability assessments of oil palm plantations, but there remains the need to plan surveys and image processing workflows carefully. Future work can build on our proposed approach, including the use of additional and/or alternative indicators developed through consultation with the oil palm industry stakeholders, to support certification schemes such as the Roundtable on Sustainable Palm Oil (RSPO).

Prompt diagnosis of a wild-type transthyretin cardiac amyloidosis: Role of multimodality imaging.

Amyloidosis cardiomyopathy is a rare and underdiagnosed disease characterized by amyloid fibril deposition in the myocardium. The diagnosis of cardiac amyloidosis is often delayed due to a lack of awareness and the necessity of biopsy to confirm the diagnosis. Recent advances in cardiovascular imaging modalities have enhanced earlier recognition of this disease. A 66-year-old man experiences progressive shortness of breath for two weeks. Laboratory testing was significant for an elevation of cardiac biomarkers (creatine kinase: 522 U/L, troponin I: 0.10 ng/mL) and NT-pro-BNP (5074 pg/mL). He was diagnosed with acute coronary syndrome and received stent deployment. Nonetheless, progressive shortness of breath recurred in 2 months. Transthoracic echocardiography (TTE) demonstrated an increased left ventricular (LV) wall thickness with apical sparing. Cardiac magnetic resonance (CMR) imaging demonstrated high native T1 value, increased extracellular volume fraction as well as diffused subendocardial late gadolinium enhancement. Technetium-99m pyrophosphate (99mTc-PYP) scintigraphy, endomyocardial biopsy (EMB), and the genetic study confirmed the diagnosis of wild-type transthyretin amyloidosis (ATTRwt). The nonspecific clinical manifestations, lack of diagnostic biomarkers, and the rarity of systemic amyloidosis usually lead to delayed diagnosis and treatment. Our objective is to emphasize the role of multimodalities imaging in reducing delays to the diagnosis of cardiac amyloidosis.

Risk of Ischemic Bowel Disease in Patients With Atrial Fibrillation Receiving Warfarin or Non-vitamin K Antagonist Oral Anticoagulants.

Background: Although atrial fibrillation (AF) is a risk factor for ischemic bowel disease, data regarding the incidence of ischemic bowel disease in patients with anticoagulated AF were limited. Methods: The present study used the Taiwan NHIRD and included newly diagnosed patients with AF aged ≥ 20 years without ischemic bowel disease from 2012 to 2018. A total of 69,549 patients taking warfarin or non-vitamin K antagonist oral anticoagulants (NOACs) constituted the final study group. We aimed to study the incidence of ischemic bowel disease in patients with AF receiving warfarin or NOACs. Secondary endpoints were also analyzed, including ischemic stroke, systemic embolism, myocardial infarction, mortality, intracranial hemorrhage (ICH), major bleeding, and composite adverse events (ischemic bowel disease or ICH or major bleeding). Results: There were 43,787 patients taking NOACs and 25,762 patients taking warfarin. The overall incidence rate of ischemic bowel disease was 0.036% per year and increased with the CHA2DS2-VASc scores [0.013% for patients with a CHA2DS2-VASc score of 0 (men) or 1 (women), 0.022% for those with a CHA2DS2-VASc score of 1 (men) or 2 (women), and 0.039% for those with a CHA2DS2-VASc score ≥ 2 (men) or ≥ 3 (women)]. The risk of ischemic bowel disease was similar between NOAC and warfarin groups (0.036%/year vs. 0.037%/year; adjusted hazard ratio 0.802, p = 0.430), whereas the NOAC group had a significantly lower risk of secondary endpoints compared to the warfarin group. Conclusion: We reported the incidence of ischemic bowel disease in patients with anticoagulated AF from a nationwide cohort database and observed a positive correlation between the increase of CHA2DS2-VASc scores and the incidence rate. Moreover, NOAC was as effective as warfarin for the risk of ischemic bowel disease.

Catalytic Performance of Li/Mg Composites for the Synthesis of Glycerol Carbonate from Glycerol and Dimethyl Carbonate.

A series of Li/Mg composites were synthesized by the coprecipitation method using magnesium and lithium nitrates, and then used for the synthesis of glycerol carbonate (GC) from glycerol and dimethyl carbonate (DMC). The experimental results indicated that Li/Mg composites were prospective catalysts for GC synthesis. 92.05% glycerol conversion and 90.61% GC yield were obtained after reacting at 80 °C for 2 h in the presence of Li/Mg composites. The structure and properties of Li/Mg composites were characterized by X-ray diffraction (XRD), Fourier transform infrared (FT-IR), Brunauer-Emmett-Teller (BET), and CO2-temperature-programmed desorption (TPD) techniques. It was inferred that the basic strength and basicity of Li/Mg composites were improved with increase in Li content. It was concluded that Li2CO3 was the main reactive species. A too-strong basic strength of Li/Mg composites could facilitate the glycerol conversion but impair GC selectivity.

Optimal anticoagulation in elderly patients with atrial fibrillation: Which drug at which dose?

Aging is an important risk factor for adverse events in elderly patients with atrial fibrillation (AF) and complicates the management of anticoagulation. Underuse of oral anticoagulants (OACs) is common in elderly patients because of comorbidities, the altered physiological function of multiple organs, frailty, risk of falls, and the lack of randomized controlled trials (RCTs) specifically for elderly patients. Nevertheless, current data still support OACs use for reducing ischemic stroke with positive net clinical benefits. Sub-analyses of RCTs and real-world cohort studies showed that non-vitamin K antagonist OACs (NOACs) would be more favorable choices compared to warfarin for stroke prevention in the elderly. This review will discuss important data on stroke prevention and the use of NOACs in elderly AF patients.

Prolonged sitting time links to subclinical atherosclerosis.

BACKGROUND: This study investigates the association between daily sitting time and subclinical atherosclerosis by using coronary computed tomography angiography (CCTA). METHODS: The study enrolled 203 subjects (age 57.6 ± 8.8 years) who underwent CCTA at annual medical checkups. Sitting time was categorized as < 5 hours/day (short), 5 to 9 hours/day (moderate) and ≥10 hours/d (long). We analyzed the coronary calcium score, plaque characteristics, and severity of coronary artery stenosis, including the segment involvement score (SIS) and segment stenosis score (SSS). RESULTS: Subjects with longer sitting times tended to be male gender and have lower levels of high-density lipoprotein cholesterol (p for trend < 0.05). In addition, those with longer sitting time had higher SIS (1.2 ± 1.5 vs. 1.6 ± 2.1 vs. 2.3 ± 2.0 for short, moderate, and long sitting time, respectively) (p for trend = 0.015) and SSS (1.4 ± 2.0 vs. 1.9 ± 2.7 vs. 2.7 ± 2.6) (p for trend = 0.015), suggesting longer sitting time-correlated with the severity of coronary atherosclerosis. When considering the coronary plaque patterns, subjects with shorter sitting time (<5 hours/d) tended to have more calcified plaque and subjects with longer sitting time (≥10 hours/d) had more mixed plaque (p for trend = 0.018). After adjusting for age, gender, comorbidities, body mass index, and lipid profiles, increased sitting time was independently associated with the presence of mixed plaque, suggesting longer sitting time may be associated with higher risk of the formation of vulnerable plaque. CONCLUSION: Longer sitting time was linked to the severity of subclinical atherosclerosis and the presence of high-risk vulnerable plaque in the general population.

Experimental Determination of Molecular Weight-Dependent Miscibility of PBAT/PLA Blends.

Blends of poly(butylene adipate-co-terephthalate) (PBAT) and polylactide (PLA) have attracted the attention of academia and industry as a sustainable material. Unfortunately, this combination results in problems related to poor miscibility on the molecular level. This study mainly aims to determine the influence of molecular weights on the miscibility of PBAT/PLA blends. First, polymers with various molecular weights were obtained by the hydrolysis of PBAT and methanolysis of PLA. Second, the two components were solution-blended with different molecular weights and weight ratios. Third, each blend was heated to the molten state and subsequently stored at room temperature. Finally, the samples were tested using DSC and SEM. The thermal analysis indicated that the difference in glass transition temperature between both components decreased from about 91 °C to 57 °C and 0 °C, as the number-average molecular weights (Mn) decreased from 52/127 to 9.4/9 and 6.3/6.6 kg/mol. Moreover, the morphology changed from phase-separated with dispersed large particles gradually to uniform and homogeneous. This experimental work validated the trends predicted in the previous study, namely that PBAT/PLA blends changed the state from immiscible to partially miscible to fully miscible with decreasing Mn values. Moreover, we discussed the influencing factors such as weight ratio, temperature, and molecular structure on the miscibility. Based on the results, this work contributes to developing partially miscible and compatible blends without additives.

Prediction of the Miscibility of PBAT/PLA Blends.

Designing polymer structures and polymer blends opens opportunities to improve the performance of plastics. Blending poly(butylene adipate-co-terephthalate) (PBAT) and polylactide (PLA) is a cost-effective approach to achieve a new sustainable material with complementary properties. This study aimed to predict the theoretical miscibility of PBAT/PLA blends at the molecular level. First, the basic properties and the structure of PBAT and PLA are introduced, respectively. Second, using the group contribution methods of van Krevelen and Hoy, the Hansen and Hildebrand solubility parameters of PBAT and PLA were calculated, and the effect of the molar ratio of the monomers in PBAT on the miscibility with PLA was predicted. Third, the dependence of the molecular weight on the blend miscibility was simulated using the solubility parameters and Flory-Huggins theory. Next, the glass transition temperature of miscible PBAT/PLA blends, estimated using the Fox equation, is shown graphically. According to the prediction and simulation, the blends with a number-average molecular weight of 30 kg/mol for each component were thermodynamically miscible at 296 K and 463 K with the possibility of spinodal decomposition at 296 K and 30% volume fraction of PBAT. This study contributes to the strategic synthesis of PBAT and the development of miscible PBAT/PLA blends.

Modified Taiwan Atrial Fibrillation Score for the Prediction of Incident Atrial Fibrillation.

BACKGROUND: We have proposed the Taiwan AF score consisting of age, male sex, hypertension, heart failure, coronary artery disease, end-stage renal disease, and alcoholism to predict incident atrial fibrillation (AF) in Asian population. We hypothesized that the modified Taiwan AF score (mTaiwan AF score) excluding alcoholism remained useful for predicting new onset AF. METHODS: A total of 7,220,654 subjects aged ≥ 40 years without a past history of cardiac arrhythmia were identified from a national cohort, and 438,930 incident AF occurred during a 16-year follow-up with an incidence of 0.42 per 100 person-years. The mTaiwan AF score ranging between -2 and 14 and its predictive accuracy of incident AF was analyzed. RESULTS: The areas under the receiver operating characteristic curve (AUCs) of the mTaiwan AF scores in predicting AF are 0.861 for 1-year follow-up, 0.829 for 5-year follow-up, 0.795 for 10-year follow-up, and 0.751 for 16-year follow-up. The risk of incident AF increased from 0.05%/year for patients with a score of -2 to 6.98%/year for those having a score of 14. Patients were classified into three groups based on the tertile values of the mTaiwan AF scores-group 1 (score -2-3), group 2 (score 4-9) and group 3 (score 10-14). The annual risks of incident AF were 0.20, 1.33, and 3.36% for group 1, 2, and 3, respectively. Compared to patients in group 1, the hazard ratios of incident AF were 5.79 [95% confidence interval (CI) 3.75-7.75] for group 2 and 8.93 (95% CI 6.47-10.80) for group 3. CONCLUSIONS: We demonstrated that the mTaiwan AF score based on age and clinical comorbidities could be used to predict incident AF in Asian population.

Uncompatibilized PBAT/PLA Blends: Manufacturability, Miscibility and Properties.

Polymer blends of poly(butylene adipate-co-terephthalate) (PBAT) and polylactide (PLA) have been drawn attention due to the application potential as packaging or agricultural films. This study aims to determine the manufacturability, miscibility and mechanical properties of uncompatibilized PBAT/PLA blends prepared using different techniques. First, PBAT and PLA are melt-blended in a wide range of ratios from 90/10 to 10/90. The compounds are then processed into pressed panels, flat films and blown films. Finally, the thermal, morphological, rheological and mechanical properties of these blends are investigated. PBAT/PLA blends have a small difference of solubility parameters, predicting theoretically good miscibility. However, they show two almost unchanged glass transition temperatures in the DSC, phase separation in SEM and two relaxation mechanisms in the Cole-Cole plot. The phase morphology varies depending on both the blend ratios and the preparation techniques. Tensile tests indicate that with increasing PLA content the elongation at break decreases. A good correlation between the elongation at break and the tear propagation resistance is found. Furthermore, the trouser tear method is proven to be more applicable to differentiate highly extensible blown films compared with the Elmendorf tear method.

Microbiota Regulates Dentine Mineralisation and Differentiation of Dental Pulp Stem Cells.

OBJECTIVE: To investigate the role of microbiota in dentine formation and the characteristics of dental pulp stem cells (DPSCs) in mouse incisors. METHODS: The influence of microbiota on dentine was detected via microcomputed tomography (microCT), microhardness testing and haematoxylin-eosin (HE) staining in incisors from germ-free (GF), specific pathogen-free (SPF) and conventionalised (ConvD) mice. Cell Counting Kit-8 (CCK-8) assay, alizarin red staining and expression of dentine sialophosphoprotein (DSPP), alkaline phosphatase (ALP) and bone sialoprotein (BSP) via real-time polymerase chain reaction (PCR) were used to evaluate the biological characteristics of DPSCs derived from mice of different microbiota status. RESULTS: MicroCT showed that the incisors in the GF and ConvD groups had comparable dentine thickness to those in the SPF group. Microhardness testing showed a lower dentine hardness value in GF incisors compared to SPF, while HE staining showed that GF incisors exhibited thicker predentine than SPF incisors. There was no difference between the ConvD and SPF groups. DPSCs from GF mice showed no significant difference in proliferation rate to SPF and ConvD DPSCs. DPSCs from GF mice formed less mineral deposition and expressed lower levels of osteo-/odontogenic differentiation-related genes including ALP, BSP and DSPP than SPF and ConvD DPSCs. The absence of microbiota in GF mice resulted in a lower dentine hardness value, thicker predentine and impaired osteo-/odontogenic differentiation capacity. CONCLUSION: The absence of microbiota impaired the dentine mineralisation and osteo-/odontogenic differentiation abilities of DPSCs.

Association of variability in uric acid and future clinical outcomes of patient with coronary artery disease undergoing percutaneous coronary intervention.

BACKGROUND AND AIMS: Hyperuricemia is independently associated with cardiovascular disease (CVD) and is considered to be one of the major risk factors for CVD. However, the impact of inter-visit uric acid (UA) variability on cardiovascular risk remains undetermined. METHODS: We enrolled 3202 patients with coronary artery disease (CAD), who received successful coronary intervention, in a cohort from Taipei Veterans General Hospital from 2006 to 2015. All post-baseline visits UA measurements using standard deviation (SD) were analyzed to correlate with long-term outcome. The primary outcome was the composite of cardiac death, nonfatal MI, nonfatal stroke (MACE). The secondary event was MACE and hospitalization for heart failure. RESULTS: During an average 65.06 ± 32.1-month follow-up, there were 66 cardiovascular deaths, 175 nonfatal myocardial infarctions, 64 nonfatal strokes, 287 hospitalizations for heart failure, and 683 revascularization procedures. There was a linear association between high UA SD and future adverse events. Compared to the lowest quartile SD, subjects in the highest quartile SD had a higher risk of MACE (HR: 2.53, 95% CI: 1.78-3.59), myocardial infarction (HR: 2.43, 95% CI: 1.53-3.86), cardiovascular death (HR: 6.45, 95% CI: 2.52-16.55), heart failure-related hospitalization (HR: 3.43, 95% CI: 2.32-5.05), and total major CV events (HR: 2.72, 95% CI: 2.09-3.56). Furthermore, compared to the average achieved on-treatment UA value, increasing UA SD had a stronger association of higher risk of developing MACE (HR: 1.51, 95% CI: 1.36-1.68), myocardial infarction (HR: 1.37, 95% CI: 1.38-1.68), ischemic stroke (HR: 1.43, 95% CI: 1.13-1.82), CV death (HR: 1.77, 95% CI: 1.50-2.11), HF (HR: 1.43, 95% CI: 1.29-1.58), and total major CV events (HR: 1.46, 95% CI: 1.34-1.58). CONCLUSIONS: High UA variability is associated with a higher risk of developing future cardiovascular events, suggesting the importance of maintaining stable serum UA levels and avoiding large fluctuations in CAD patients after percutaneous coronary intervention (PCI).

Erratum: Wang, Y. et al., A Privacy Preserving Scheme for Nearest Neighbor Query. Sensors 2018, 18, 2440.

The authors wish to make the following erratum to this paper [...].

Polylactide (PLA) and Its Blends with Poly(butylene succinate) (PBS): A Brief Review.

Polylactide (PLA), poly(butylene succinate) (PBS) and blends thereof have been researched in the last two decades due to their commercial availability and the upcoming requirements for using bio-based chemical building blocks. Blends consisting of PLA and PBS offer specific material properties. However, their thermodynamically favored biphasic composition often restricts their applications. Many approaches have been taken to achieve better compatibility for tailored and improved material properties. This review focuses on the modification of PLA/PBS blends in the timeframe from 2007 to early 2019. Firstly, neat polymers of PLA and PBS are introduced in respect of their origin, their chemical structure, thermal and mechanical properties. Secondly, recent studies for improving blend properties are reviewed mainly under the focus of the toughness modification using methods including simple blending, plasticization, reactive compatibilization, and copolymerization. Thirdly, we follow up by reviewing the effect of PBS addition, stereocomplexation, nucleation, and processing parameters on the crystallization of PLA. Next, the biodegradation and disintegration of PLA/PBS blends are summarized regarding the European and International Standards, influencing factors, and degradation mechanisms. Furthermore, the recycling and application potential of the blends are outlined.

Study on the Distribution ，Drug Supply and Quantity of Licensed Pharmacists in Retail Pharmacies around 5 Third Grade Class A Hospitals from Beijing / 中国药房

OBJECTIVE： To investigate the distribution， drug supply and quantity of licensed pharmacists in retail pharmacies around Third Grade Class A Hospitals， and to provide reference for decision-making of related management departments. METHODS： Field investigation and questionnaire survey were used to investigate the distribution， type， operating area， annual turnover， drug type， ranking of consumption sum， daily prescription amount and pharmacist allocation of 5 Third Grade Class A Hospitals in Beijing and general information of 100 surveyed pharmacists in 2017. RESULTS： There were 43 retail pharmacies in total within 1 km of 5 Third Grade Class A Hospitals， with an average of 8.60 retail pharmacies for each hospital. The number of retail pharmacies with distance between 200-400 m and 800-1 000 m was the largest （11）， of which 21 （48.84％） were chain drugstores. The operating area of 38 pharmacies （88.37％） was in the range of 100-175 m2， mainly ranging 100-125 m2 （16 pharmacies， 37.21％）. The annual turnover of 40 pharmacies were counted and ranged 50-10 000 ten thousand yuan， among which the pharmacies 0-200 m away from the hospital had the highest annual turnover. The average variety of drugs （prescription drugs and over-the-counter drugs） was 2 511 kinds. 34 pharmacies （79.07％） had more varieties of over-the-counter drugs than prescription drugs， and the consumption sum of over-the-counter drugs was higher than that of prescription drugs in 26 pharmacies （60.47％）. Top 3 drugs in the list of consumption sum were antineoplastic drugs， cardiovascular drugs and anti-infective drugs. Average daily prescriptions of 28 drugstores （65.11％） were less than 10 pieces； average daily prescription were more than 20 pieces in only 7 pharmacies （16.28％）. On average， each pharmacy had 7.4 staff members and 1.37 licensed pharmacists. 58 staff members’ first degree was junior college （58％）， 38 staff members’ first degree was technical secondary school or high school （38％）， and only 3 （3％） staff members’ first degree was undergraduates or above. CONCLUSIONS： With the gradual promotion of “health care policy” and the outflow of more hospital prescriptions， the retail pharmacies around hospitals should increase their numbers， expand the operating area， accelerate the construction of licensed pharmacists and improve the education level of pharmacists so as to improve the pharmaceutical care ability.

A Privacy Preserving Scheme for Nearest Neighbor Query.

In recent years, location privacy concerns that arise when using the nearest neighbor query services have gained increasing attention, as such services have become pervasive in mobile social networks devices and the IoT environments. State-of-the-art privacy preservation schemes focus on the obfuscation of the location information, which has suffered from various privacy attacks and the tradeoff of the quality of service. By noticing the fact that the user's location could be replaced by their surrounding wireless sensor infrastructures in proximity, in this paper, we propose a wireless sensor access point-based scheme for the nearest neighbor query, without using the location of the user. Then, a noise-addition-based method that preserves user's location privacy was proposed. To further strengthen the adaptability of the approach to real-world environments, several performance-enhancing methods are introduced, including an R-tree-based Noise-Data Retrieval Algorithm (RNR), and a nearest neighbor query method based on our research. Both performance and security evaluations are conducted to validate our approach. The results show the effectiveness and the practicality of our work.