The infection caused by pseudomonas aeruginosa biofilm has becoming one of the most urgent problems in hospital.Recent reports of possible mechanism of iron in biofilm formation were reviewed in this paper.The possible effects of iron on adsorption,microcolony formation,mature of colony and desorb were explained,and the prospect of clinical use of local iron or chelator spray was also reviewed here.

In order to solve the problem of selection and in vivo delivery problem in siRNA treatment, hepatitis B virus (HBV) HBx gene which could be targeted by siRNA was studied. The siRNA expression plasmid which specific inhibits HBx expression was obtained by in vitro selection via a dual-luciferase plasmid including HBx-Fluc fusion protein expression domain. The selected siRNA expression plasmid was then encapsulated in PEG-modified cationic liposome, which was devoted into pharmacodynamic studies at both cellular and animal level. The results illustrated that the cationic liposome which encapsulated siRNA expression plasmid could effectively inhibit HBx gene expression both in vitro and in vivo.

To investigate whether accelerated blood clearance (ABC) phenomenon could be induced after repeated injection of mitoxantrone thermosensitive liposomes, LC-MS/MS and enzyme linked immunosorbent assay (ELISA) were used to measure the concentration of mitoxantrone and the anti-polyethylene glycol (PEG) IgM levels in rat plasma, separately. The drug was rapidly cleared away after the second administration. The anti-PEG IgM was detected after the first dose which was neutralized quickly after the second dose. It is proved that repeated administration of mitoxantrone thermosensitive liposomes in rat caused the ABC phenomenon.

OBJECTIVE To study the in virto interaction of allicin combined with cefoperazone against clinical isolates of Pseudomonas aeruginosa.METHODS The protocol was designed by checkerboard method and the MICs of allicin combined with cefoperazone against the 17 strains of sensitive and 14 strains of drug-resistant P.aeruginosa were determined by broth dilution method,the FIC index was calculated according to MIC results.The combined effects were confirmed by FIC index.RESULTS The percentage of the FIC index less than 0.5,from 0.5 to 1,from 1 to 2,and more than 2 was 41.2-64.3% 35.7-41.2% 0-17.6%,and 0%,respectively.CONCLUSIONS Synergism and additivity of allicin combined with cefoperazone against P.aeruginosa are their main action,there are little autonomy and no antagonism.Allicin can significantly improve the antibacterial activity of cefoperazone against drug-resistant P.aeruginosa.

OBJECTIVE:To provide reference for improving the service quality of PIVAS in our hospital. METHODS:Satis-faction questionnaire was designed by us. The survey was conducted among clinical nurses from 40 wards of our hospital about their satisfactory degree to pharmaceutical care of PIVAS and related influential factors. The survey data were analyzed statistically. RESULTS:A total of 280 questionnaires were sent out,and 271 effective questionnaires were collected with effective recovery of 96.79%. The overall satisfaction degree of nurses to PIVAS services was higher [(4.31±0.89)points]. The top 3 items were"drug admixture correction rate""infusion order rationality"and"drug packing quantitative accuracy rate rate",scored (4.57 ± 0.70), (4.56 ± 0.73) and (4.50 ± 0.76),respectively;the last 3 items of satisfaction were"timeliness of telephone answering service""timeliness of temporary medical orders'distribution"and"serviceable time for temporary medical orders'admixture",scored (3.73 ± 1.16),(3.75 ± 1.03) and (3.96 ± 1.01),respectively. The univariate analysis and multivariate analysis showed that there were statistical differences in the satisfaction score among nurses with different ages from different departments(P<0.01). The nurs-es in cardiovascular medicine department and ICU showed lowest satisfaction on service effect,and the nurses aged 20-29 years old showed highest satisfaction on service effect. There was no statistical significance in satisfactory degree among nurses with different gender,nursing ages,education background and professional titles(P>0.05). CONCLUSIONS:The overall satisfaction of clinical nurses to PIVAS service is favorable. The items of temporary medical orders-related service score the lowest,and service effect is related to nurses'departments and age. It is necessary to combine the shortage of work and the demand of clinical services to strengthen the management and promote the continuous improvement of PIVAS service quality.

Objective:To discuss the onset and development pattern and characteristics of refeeding syndrome (RFS) induced by nutrition support and to provide reference for rational drug use in parenteral nutrition management.Methods:Case reports of RFS from CNKI, Wanfang, VIP database and Pubmed from 2000 to 2020 were retrieved. The clinical data were collected and statistically analyzed.Results:A total of 17 reports, including 17 cases, were included in the analysis. Patients were 6 males(35.29%) and 11 females (64.71%). The distribution of age was from 29 weeks in a premature neonate to 87 years old. 12 cases (70.59%) of RFS occurred within 3 days after starting the nutrition support. The most common clinical manifestation were cardiovascular system symptoms (88.23%), with dyspnea as the most reported symptom (41.17%). 15 patients (88.23%) recovered after appropriate intervention and 2 patients died(11.76%).Conclusions:Refeeding syndrome is a potentially fatal condition. The risk of RFS should be assessed before initiating nutrition support. Patients at risk of RFS must be monitored closely at the early stage of nutritional support.

Objective To explore the mechanism of human umbilical cord mesenchymal stem cell (HUC-MSC) alleviating ischemia-reperfusion injury (IRI) of liver cells through mitochondrial transfer. Methods Normal human liver cell line L02 was divided into the blank control group, oxygen-glucose deprivation (OGD) group, experimental control group, and L02 and HUC-MSC co-culture group (L02+HUC-MSC group). L02+HUC-MSC group was further divided into 10:1 co-culture subgroup (group A), 4:1 co-culture subgroup (group B), 2:1 co-culture subgroup (group C), 1:1co-culture subgroup (group D) and 1:2 co-culture subgroup (group E) according to different co-culture ratio of L02 and HUC-MSC. The apoptosis rate and relative reactive oxygen species (ROS) level of L02 cells were detected by flow cytometry. The MitoTracker positive rate of L02 cells was detected by flow cytometry. The mitochondrial transfer from HUC-MSC to L02 cells was observed by laser confocal microscope. Results The apoptosis rate and relative ROS level of L02 cells in the OGD group were significantly higher than those in the blank control group (both P < 0.05). Compared with the OGD group, the apoptosis rates of L02 cells in group B, C, D and E were significantly decreased (all P < 0.05), and the relative ROS level of L02 cells in group E was significantly declined (P < 0.05). The MitoTracker positive rate of L02 cells did not significantly differ between group A and experimental control group (P>0.05), whereas the MitoTracker positive rates of L02 cells in group B, C, D and E were significantly higher than that in the experimental control group in a concentration-dependent manner (all P < 0.05). Under the laser confocal microscope, mitochondrial transfer fromHUC-MSC to L02 cells could be observed through tunneling nanotube (TNT). Conclusions HUC-MSC may alleviate cell apoptosis and reduce ROS level of liver cells after IRI via direct mitochondrial transfer between cells.

Objective To investigate the value of the difference between peripheral arterial and venous blood gas analysis for the prognosis of patients with septic shock after resuscitation.Methods Patients with septic shock aged 18 to 80 years admitted to intensive care unit (ICU) of Affiliated Hospital of Integrated Traditional Chinese and Western Medicine, Nanjing University of Chinese Medicine from May 2016 to December 2017 were enrolled. The peripheral arterial blood and peripheral venous blood gas analysis were measured simultaneously after the early 6 hours resuscitation, including pH, partial pressure of oxygen (PO2), partial pressure of carbon dioxide (PCO2), base excess (BE), bicarbonate (HCO3-) and lactate (Lac) level, and the difference values between peripheral arterial and venous blood were calculated. According to the 28-day survival, the patients were divided into survival group and death group. Multiple Logistic regression analysis was used to analyze the risk factors of death, and the receiver operating characteristic curve (ROC) was used to analyze the prognostic value of blood gas analysis parameters for prognosis.Results A total of 65 patients with septic shock resuscitation were enrolled in the study, 35 survived while 30 died during the 28-day period. ① There was no significant difference in gender, age, and mean arterial pressure (MAP), central venous pressure (CVP), central venous oxygen saturation (ScvO2) and norepinephrine (NE) dose between the two groups.② The arterial and venous Lac, the difference of Lac (ΔLac) and PCO2 (ΔPCO2) between arterial and venous blood in death group were significantly higher than those in survival group [arterial Lac (mmol/L): 7.40±3.10 vs. 4.82±2.91, venous Lac (mmol/L): 9.17±3.27 vs. 5.81±3.29, ΔLac (mmol/L): 1.77±0.54 vs. 0.99±0.60, ΔPCO2 (mmHg, 1 mmHg =0.133 kPa): 9.64±5.08 vs. 6.70±3.71, allP < 0.01], and there was no significant difference in the other arterial and venous blood gas analysis index and its corresponding differential difference between two groups. ③ Multiple Logistic regression analysis showed that ΔPCO2 [β = 0.247, odd ratio (OR) = 1.280, 95％ confidential interval (95％CI) = 1.057-1.550,P = 0.011], and ΔLac (β = 2.696,OR = 14.820, 95％CI = 2.916-75.324,P = 0.001) were the independent risk factors for the prognosis of septic shock. ④ It was shown by ROC curve analysis that arterial blood Lac, ΔLac andΔPCO2 had predictive value on prognosis of septic shock, the area under ROC curve (AUC) was 0.792, 0.857, 0.680, respectively (allP < 0.05). When the best cut-off value of arterial Lac was 4.00 mmol/L, the sensitivity was 100％, and the specificity was 62.86％ for predictor of death in 28-day; when the best cut-off value of ΔLac was 1.25 mmol/L, the sensitivity was 93.33％, and the specificity was 68.57％ for predictor of death in 28-day; when the best cut-off value of ΔPCO2 was 4.35 mmHg, the sensitivity was 83.33％, and the specificity was 37.14％ for predictor of death in 28-day.Conclusions Compared to other parameters, the difference between peripheral arterial and venous blood gas analysis, ΔPCO2 and ΔLac had the best correlation with the prognosis of septic shock. The ΔPCO2 and ΔLac are the independent prognostic predictors for 28-day survival.

The diagnostic reference level (DRL) for adults radiation dose in CT examination based on a large-scale national survey data is released in the form of national health industry standards (WS/T 637-2018) after more than ten years of exploration by radiologists, imaging technologists, radiation protection specialists and radiographers. Its principles and method are in line with international practices and the actual situation in China, which basically cover frequently-used CT examination items for adults. Compared with DRL in several other countries or organizations, radiation exposure to the patients as a whole is at a reasonably low level. The 50^th percentile (achievable dosimetry levels) and 25^th percentile (indicative level of unusually low dosimetry) are given as additional tools for radiation dose optimization guidance. In daily activities of radiological diagnosis, the radiation dose should be matched with image quality and clinical diagnostic tasks, and the frequency of unjustifiable high or low radiation dose should be reduced.

Objective:To deliver understanding of the latest research progress on clinical trials and approval of dermatological drugs in China in 2020.Methods:A registration and information disclosure platform for drug clinical studies and a query system for domestic and imported drugs in the National Medical Products Administration of China were searched for registered clinical trials and approved dermatological drugs, respectively. The number and stages of clinical trials, indications and classification of involved products, and listed dermatological drugs in 2020 were summarized and depicted.Results:There were 157 dermatological drug trials registered in China in 2020, accounting for 6.16% of all the 2 548 clinical drug trials, including 127 (80.9%) initiated by Chinese pharmaceutical enterprises and 25 (15.9%) international multicenter trials. Among the 127 drug trials initiated by Chinese pharmaceutical enterprises, bioequivalence trials were mostly common, accounting for 55.9% (71/127) . Compared with global pharmaceutical enterprises, domestic pharmaceutical companies initiated significantly decreased proportions of international multicenter trials (1.9% [3/157] vs. 14.0% [22/157], P < 0.001) , but significantly increased proportions of phaseⅠclinical trials and bioequivalence trials (24.4% [31/127] vs. 10.0% [3/30], 55.9% [71/127] vs. 0, respectively, both P < 0.001) . Totally, 90 kinds of dermatological drug were involved in all the trials, psoriasis, atopic dermatitis and melanoma were the most common indications, and innovative drugs accounted for 53.3% (48/90) ; the proportion of innovative drugs was significantly lower in domestic pharmaceutical companies than in global pharmaceutical companies (43.2% [32/74] vs. 16/16, P < 0.001) . In addition, 28 dermatological drugs developed by 22 pharmaceutical companies were approved in China in 2020, of which 21 drugs were developed by domestic pharmaceutical companies. Conclusion:Clinical drug trials carried out by domestic pharmaceutical companies mostly focus on generic drugs, and it is still necessary for domestic pharmaceutical companies to further improve the innovation ability.