OBJECTIVE:To provide reference for rational use of adjuvant drugs in the clinic.METHODS:By retrospective method,the utilization of top 10 adjuvant in the list of consumption sum and DDDs in our hospital during 2013-2015 were analyzed statistically in respects of consumption sum,DDDs,DDC,B/A,etc.RESULTS:During 2013-2015,the consumption sum of adjuvant drugs in our hospital increased from 32 959 000 yuan to 42 436 500 yuan,and its proportion in total consumption sum increased from 31.28％ to 35.22％.The top 10 adjuvant dosage forms in the list of consumption sum were injection,and varieties included activating blood circulation to dissipate blood stasis,nerve nutrition,immunoregulation drugs.The consumption sum fluctuated but was on the increase in general.Top 10 adjuvant drug types in the list of DDDs were mainly drugs for enhancing tissue metabolism,vitamins,nerve nutrition,activating blood circulation to dissipate blood stasis.In terms of DDC,main dosage form was injection;B/A of these drugs was poor and drug price was in high level.CONCLUSIONS:It is suggested to standardize the utilization of adjuvant drugs,so as to promote the effective,economical and rational use of drugs.

Objective To observe the effect of the compound Qinbudan recipe in treating multi-drug resistant pulmonary tuberculosis (MDR-PTB) of deficiency of both qi and yin. Methods A randomized controlled trial was carried out in 72 MDR-PTB cases, and the patients were divided into treatment group and control group, 36 cases in each group. The treatment group was treated with the compound Qinbudan recipe while the control group was treated with Feitai capsules. After treatment for 3 months, the therapeutic effect, scores of traditional Chinese medical syndromes, and adverse reactions were compared in the two groups. Results ( 1) After treatment for 3 months, the total effective rate of the treatment group was 82.86%, and that of the control group was 25.81%, the difference being significant (P <0.01) . (2) After treatment for 3 months, the total scores of traditional Chinese medical syndromes of the treatment group were lower than those of the control group, and the difference was significant ( P <0.05) . ( 3) At the end of the treatment course, the treatment group showed better effect on relieving shortness of breath, night sweating, spontaneous perspiration, cough with sputum than the control group ( P<0.05 or P <0.01) . The two groups had similar effect on relieving cough, dry throat, tidal fever, and emaciation ( P >0.05) . ( 4) Blood routine examination and hepatorenal function showed no disorders during the treatment. Gastrointestinal disturbance was not found either. Conclusion The compound Qinbudan recipe is effective in treating multi-drug resistant pulmonary tuberculosis of deficiency of both qi and yin, and has better effect on relieving shortness of breath, night sweating, spontaneous perspiration and cough with phlegm than Feitai capsules .

Objective To explore the effect of polypharmacy assessment and intervention on elderly inpatients mainly in both economy and safety. Methods One hundred and forty elderly inpatients were selected. Fifty patients took less than 5 drugs, 75 patients took 5- 9 drugs, and 15 patients took more than 10 drugs. According to medication appropriateness index (MAI) and Beers criteria, the polypharmacy of elderly inpatients was assessed and intervened. The results were compared before and after intervention. Results The discrepancy rate of Beers criteria, incidence of potential risk, total scores of prescription MAI and average daily drug cost after intervention were significantly lower than that before intervention: 7.14% (10/140) vs. 16.43% (23/140), 22.14% (31/140) vs. 90.71%(127/140), 0(0,0)scores vs. 6.00(2.25,10.00)scores and (30.60 ± 19.71) yuan vs. (35.34 ± 26.84) yuan, and there were statistical differences (P<0.01 or <0.05). Conclusions Irregular medication exists widely in elderly patients, and the polypharmacy assessment and intervention can lighten the financial burden of elderly patients and improve the safety of drug therapy.

Objective To investigate the clinical effect of moxibustion and massage combined with psychological intervention on early diabetic foot patients.Methods The control group was treated with traditional Chinese medicine moxibustion and massage on the basis of routine western medicine treatment.The study group was treated with traditional Chinese medicine moxibustion and massage combined with psychological intervention on the basis of routine western medicine treatment.Results After the treatment group compared with before two ABI index improved, better effect of improvement in the study group(P<0.05);after the treatment of group SAS, SDS score improved than before(P<0.05), the control group did not change significantly in negative emotions than before.Conclusion The conventional treatment based on the application, and in patients with early diabetic foot with moxibustion, massage combined with psychological intervention can improve the negative mood, can help patients get more ideal clinical efficacy.

Objective To observe the clinical efficacy of moxibustion plus tuina in treating 0-grade diabetic foot.Method Seventy patients with 0-grade diabetic foot were randomized into a treatment group and a control group, 35 cases in each group. The control group was intervened by conventional medication, while the treatment group was by moxibustion plus tuina in addition to the interventions given to the control group. The Ankle Brachial Index (ABI) was observed before intervention and after 2 treatment courses, and the clinical efficacies were compared between the two groups.Result The ABI scores were changed significantly after intervention in both groups (P<0.05). After intervention, there was a significant difference in comparing the ABI score between the two groups (P<0.05). The total effective rate and recovery rate were respectively 94.3% and 71.4% in the treatment group, versus 74.3% and 20.0% in the control group, and the differences were statistically significant (P<0.05).Conclusion Moxibustion plus tuina is an effective approach in treating 0-grade diabetic foot.

Objective To evaluate and intervene polypharmacy in multimorbid elderly patients in order to explore the application effects and reliability of Beers criteria and medication appropriateness index(MAI)and improve the safety,rationality and feasibility of drug use through the whole process of pharmaceutical directions. Methods This study included 191 patients with multimorbidity.Based on the Beers criteria and MAI,enrolled elderly patients with multimorbidity were evaluated and intervened.Moreover,based on the efficacy,safety and suitability,clinical pharmacists and geriatricians made new medication strategy,and undertook a follow up study every month after discharge.After six months,all patients were evaluated again.All data were recorded before and 6-months after intervention. Results After versus before intervention,the potentially inappropriate polypharmacy was decreased[21 cases(10.99%)vs.98 cases(51.31%),χ2 = 65.154,P< 0.05]in multimorbid elderly patients.Moreover,the MAI score was significantly decreased after the intervention(6.35 ± 5.25 to 0.75 ± 1.81,Z= - 10.549,P< 0.05). Conclusions Through the whole process of pharmaceutical directions of clinical pharmacists,the Beers Criteria- and MAI-based assessment and intervention could improve the safety,rationality and efficiency of drug therapy in multimorbid elderly patients.

Objective To explore the risk factors of osteoporosis in elderly patients with ischemic stroke by intracranial atherosclerotic stenosis(ICAS). Methods 342 elderly patients(≥ 65 year)with ischemic stroke by ICAS were divided into osteoporosis group and non-osteoporosis group,multivariate unconditional Logistic re-gression analysis was used to analyze the risk factors for elderly patients with ischemic stroke by ICAS. Results Univariate analysis shows that female,unilateral anterior circulation infarct,involvement of vessels of more than two branches,complete paralysis,delayed paralysis,BI index were significantly associated with osteoporosis in el-derly patients with ischemic stroke by ICAS between the two groups(all P < 0.05). Multiple Logistic regression analysis revealed that gender,disease duration,involvement of cerebral circulation,paralysis degree,muscle ten-sion state were independent risk factors for the development of osteoporosis in elderly patients with ischemic stroke by ICAS(OR = 3.459,2.486,4.540,3.819,3.699,P < 0.05). Conclusions Gender,disease duration,in-volvement of cerebral circulation,paralysis degree,muscle tension state are independent risk factors of osteoporo-sis in elderly patients with ischemic stroke by ICAS,provides a theoretical basis for the prevention of osteoporosis in elderly patients with ischemic stroke by ICAS.

OBJECTIVE: To explore the method and effect of the midfacial degloving approach and modified hemifacial degloving approach associated with nasal endoscopic surgery in the treatment of the nasal diseases. METHOD: Thirty patients with nasal diseases were treated with nasal endoscopic surgery by midfacial degloving approach and modified hemifacial degloving approach. Four cases underwent midfacial degloving approach with standard method, three cases were underwent by hemifacial degloving approach and our modified hemifacial degloving approach associated with nasal endoscopic surgery were performed in twenty-three cases. We used Caldwell-Luc's approaches which located mainly in affected-side, and modified bilateral intercartilaginous incision, which at first peeled off integrality healthy-side cutis and mucosa of nasal septum as well as periosteum of basis nasi. With preserving the integrality of the healthy-side nasal cavity parenchyma, the pyriform aperture incisions extending to the healthy-side vestibule wasn't been cut. With the incisions of septal cartilage of nasal and disease- side cutis and mucosa of nasal septum as well as the pyriform aperture incisions extending to the affected-side vestibule, the lesion were cleared away completely by modified midfacial degloving approach associated with nasal endoscopic surgery. RESULT: All cases cuts achieved primary healing. One of four cases with midfacial degloving approach suffered from straightness of nasal vestibule. One of three cases with hemifacial degloving approach was led to perforation of nasal septum. In 23 cases operated hy modified hemifacial degloving approach, no straightness of nasal vestibule and no perforation of nasal septum was happened. CONCLUSION The midfacial degloving approach and modified hemifacial degloving associated with endoscopic surgery can achieve the advantages of a widely exposed field for operation, no facial scar, making tumour resection easier, and also no nasal- stuffed in healthy nasal cavity as well as no straightness of nasal vestibule after modified approach.
Adolescent ; Adult ; Aged ; Child ; Child, Preschool ; Endoscopy ; methods ; Face ; surgery ; Female ; Humans ; Infant ; Male ; Middle Aged ; Nasal Septum ; surgery ; Nose ; surgery ; Nose Diseases ; surgery ; Otorhinolaryngologic Surgical Procedures ; methods ; Young Adult

Background::Heterogeneity of tumor cells and the tumor microenvironment (TME) is significantly associated with clinical outcomes and treatment responses in patients with urothelial carcinoma (UC). Comprehensive profiling of the cellular diversity and interactions between malignant cells and TME may clarify the mechanisms underlying UC progression and guide the development of novel therapies. This study aimed to extend our understanding of intra-tumoral heterogeneity and the immunosuppressive TME in UC and provide basic support for the development of novel UC therapies.Methods::Seven patients with UC were included who underwent curative surgery at our hospital between July 2020 and October 2020. We performed single-cell RNA sequencing (scRNA-seq) analysis in seven tumors with six matched adjacent normal tissues and integrated the results with two public scRNA-seq datasets. The functional properties and intercellular interactions between single cells were characterized, and the results were validated using multiplex immunofluorescence staining, flow cytometry, and bulk transcriptomic datasets. All statistical analyses were performed using the R package with two-sided tests. Wilcoxon-rank test, log-rank test, one-way analysis of variance test, and Pearson correlation analysis were used properly.Results::Unsupervised t-distributed stochastic neighbor embedding clustering analysis identified ten main cellular subclusters in urothelial tissues. Of them, seven urothelial subtypes were noted, and malignant urothelial cells were characterized with enhanced cellular proliferation and reduced immunogenicity. CD8 + T cell subclusters exhibited enhanced cellular cytotoxicity activities along with increased exhaustion signature in UC tissues, and the recruitment of CD4 + T regulatory cells was also increased in tumor tissues. Regarding myeloid cells, coordinated reprogramming of infiltrated neutrophils, M2-type polarized macrophages, and LAMP3 + dendritic cells contribute to immunosuppressive TME in UC tissues. Tumor tissues demonstrated enhanced angiogenesis mediated by KDR + endothelial cells and RGS5 +/ACTA2 + pericytes. Through deconvolution analysis, we identified multiple cellular subtypes may influence the programmed death-ligand 1 (PD-L1) immunotherapy response in patients with UC. Conclusion::Our scRNA-seq analysis clarified intra-tumoral heterogeneity and delineated the pro-tumoral and immunosuppressive microenvironment in UC tissues, which may provide novel therapeutic targets.

Objective:To establish an in vivo infection model of West Nile virus (WNV) pseudovirus and evaluate the neutralizing activity of antibody WNV-XH1.Methods:A stable cell line that can package the WNV pseudovirus was established in the early stage to prepare the pseudovirus supernatant. The supernatant was concentrated and infected BHK21 cells to detect the titer of the pseudovirus. After intraperitoneal injection of the pseudovirus into C57BL/J mice, bioluminescence imaging was performed to observe the infection status of the pseudovirus in the mice. After simultaneous infection, blood was collected and ELISA was used to detect NS1 levels in mouse serum. The in vivo functional activity of antibody WNV-XH1 was evaluated using the established mouse infection model.Results:Fluorescence was detected in C57BL/J mice infected with WNV pseudovirus, and the NS1 levels in the peripheral blood serum of mice infected with pseudovirus were significantly higher than those of non infected mice (1.453±0.09vs0.305±0.018). After intravenous administration of WNV-XH1 antibody before the attack, the fluorescence signal in the mice decreased and the serum NS1 level decreased (0.384±0.015).Conclusions:A successful in vivo infection model of WNV pseudovirus was established, and it was confirmed that the antibody WNV-XH1 had a protective effect against WNV pseudovirus infection in vivo.