Objective To apply the BestSeqTM new generation pathogenic gene detection technology to perform the genetic detec‐tion in the patients with progressive muscular dystrophy (PMD) validating its sensitivity and specificity .Methods The BestSeqTM new generation pathogenic gene detection technology was used to perform the gene sequencing in 2 cases of limb‐girdle muscular dystrophy(LGMD) and 6 cases of Dunchenne′s muscular dystrophy(DMD) ,and the found point mutations were confirmed by the Sanger sequencing method .Results This study completed the genetic detection in above 8 cases ,2 cases of large fragment deletion and 10 cases of micromutations were detected ,in which 8 micromutations were the new mutation discovered ffor the first time and verified by the Sanger sequencing .Conclusion The BestSeqTM new generation pathogenic gene detection technology greatly increa‐ses the detection efficiency by using the high density imbricate type probe and multiple tag technology ,and has the better clinical ap‐plication prospects .

Objective:To investigate the effect of the use of medial calcar screws on the treatment of Neer type Ⅲ proximal humeral fracture with Multiloc intramedullary nailing.Methods:A retrospective study was conducted to analyze the data of 36 patients with Near type Ⅲ fracture of the proximal humerus who had received Multiloc intramedullary nailing at Department of Upper Limbs, Sichuan Orthopedic Hospital from January 2016 to December 2021. There were 6 males and 30 females with an age of (63.9±5.3) years. They were divided into 2 groups according to whether medial calcar screws had been used or not. There were 17 cases in the group without medial calcar screws and 19 cases in the group with medial calcar screws. The 2 groups were compared in terms of flexion and lifting, external rotation, internal rotation and back touch, visual analogue scale (VAS), American Shoulder and Elbow Surgeons (ASES) score, Constant-Murley score for shoulder function (Constant score), neck shaft angle, and incidence of complications at the last follow-up.Results:There were no statistically significant significances in the preoperative general data between the 2 groups, indicating comparability between the groups ( P>0.05). The 36 patients were followed up for 13.5(12.0,19.8) months after surgery. The flexion and lifting, external rotation, internal rotation and back touch, VAS, ASES score, Constant score, neck shaft angle at the last follow-up in the group without medial calcar screws were, respectively, 134.1°±8.4°, 32.1°±5.3°, 14.0 (13.0, 15.5) , 0.0 (0.0, 1.0), 78.2±5.2, 78.0±5.8, and 137.6°±8.1°, insignificantly different from those in the group with medial calcar screws [134.7°±6.1°, 35.0(30.0, 35.0)°, 14.0(13.0, 15.0), 1.0 (0.0, 1.0), 78.2±5.4, 76.7±4.5, and 136.9°±6.4°] ( P>0.05). Postoperative complications occurred in 6 patients in each group, showing no statistically significant difference between the 2 groups ( P=1.000). Conclusion:The use of medial calcar screws has no significant impact on the postoperative shoulder function and incidence of complications in the treatment of Neer type Ⅲ fractures of the proximal humerus with Multiloc intramedullary nailing.

Objective:To investigate the clinical efficacy of botulinum toxin A in the treatment of hand hyperhidrosis.Methods:One hundred patients with hand hyperhidrosis were treated with botulinum toxin A (BTXA, Lanzhou Biotechnology Development Co., Ltd., Botulinum Toxin Type A for Injection Hengli) injection, a total of 200 U. Each hand was injected with 100 U respectively. The curative effect was evaluated by self-made questionnaire. The scores of the two were added. The subjective and objective evaluation were carried out before and after injection, and the patients were rechecked 2 weeks, and 1, 4 and 6 months after injection. Efficacy, patient satisfaction and adverse reactions were evaluated.Results:Compared with before treatment, the effective rate increased 2 weeks after injection, 1 month after injection, 4 months after injection and 6 months after injection, and the difference was statistically significant (Chi-square value was 31.54, 36.33, 28.34, 25.23, respectively, P<0.05). After 6 months of follow-up, the effect gradually decreased, and the curative effect could be maintained for about 10 months. After recurrence, the symptoms of hand sweating were still reduced. Satisfaction 96%; Adverse reactions were mild, subcutaneous blood stasis, 27% hand muscles were slightly weak, and returned to normal after 2-3 weeks. Conclusions:Botulinum toxin A injection has certain curative effect, high safety and less adverse reactions. It is an ideal method for the treatment of hand hyperhidrosis.

Objective:To conduct a survey on major surgeon′s mental trauma caused by iatrogenic biliary injury (IBI) during laparoscopic cholecystectomy (LC), and explore its influencing factors.Methods:The retrospective cross-sectional survey was conducted. Surgeons who have registered in Chinese College of Surgeons of Chinese Medical Doctor Association and Chinese Surgical Society of Chinese Medical Association were recruited to participate as respondents between December 1, 2018 and January 1, 2019. The survey was conducted by the questionnaires of influencing factors for surgeon′s mental trauma caused by IBI during LC. The questionnaires were distributed to participants via WeChat on the Wenjuanxin platform. Observation indicators: (1) results of questionnaire survey; (2) analysis of influencing factors for severe mental trauma of major surgeons caused by IBI during LC. Measurement data with normal distribution were expressed as Mean± SD, and count data were expressed as absolute numbers or percentages. The chi-square test was used for univariate analysis. Factors with P<0.10 in the univariate analysis were included in multivariate analysis, and Logistic regression model was used for multivariate analysis. Results:(1) Results of questionnaire survey. A total of 606 questionnaires were retrieved. ① Basic information of major surgeons: of the 606 major surgeons, there were 596 males and 10 females, aged (41±7)years, with a range from 18 to 62 years. Of the 606 major surgeons, 59.24%(359/606) came from non-teaching hospitals, and 64.03%(388/606) encounted the most impressive case of IBI during LC when they were in the primary or intermediate professional title. For 76.24%(462/606) of the major surgeons, the first case of IBI during LC was the most impressive case, and 69.80%(423/606) believed that careful operation during LC could avoid IBI. ② Patient information: of the patients with the most impressive IBI during LC in each major surgeon′s memory, there were 400 females and 206 males. The proportion of patients younger than 35 years old, in 35-65 years old and older than 65 years old was 9.57%(58/606), 65.51%(397/606), and 24.92%(151/606), respectively. ③ IBI related information: 57.43%(348/606) of the major surgeons indicated that they could receive help from senior surgeons in time for the occurrence of IBI during LC, and 78.88%(478/606) of the major surgeons invited senior surgeons to participate in the initial repair. For the most impressive case of IBI during LC, 66.83%(405/606) of the primary repair surgeries were performed during LC, 11.06%(67/606) were performed within postoperative 3 days and 22.11%(134/606) were performed after 3 days. The main repair methods included local repair, bile duct to end anastomosis, and bilioenteric anastomosis, accounting for 24.92%(151/606), 30.20%(183/606), 33.17%(201/606), respectively. The proportion of patients requiring partial hepatectomy, with perioperative death, and requiring multiple repair was 2.48%(15/606), 2.15%(13/606), and 9.24%(56/606), respectively. ④ Subsequent processing on major surgeons: after the occurrence of IBI during LC, 64.85%(393/606) of the major surgeons gained the understanding of patients and their families, 35.15%(213/606) of the major surgeons were involved in medical disputes, 15.68%(95/606) of the major surgeons received administrative punishment from the hospital. About the compensation, 14.36%(87/606) of the major surgeons had to pay for the compensation by themselves, and only 6.77%(41/606) of the major surgeons had medical liability insurance. There were 9.24%(56/606) of the major surgeons invloved in violent conflicts during the medical disputes. ⑤ Psychology-related information of major surgeons: of the 606 major surgeons, 544 had mental trauma including 279 with severe mental trauma. After the occurrence of IBI during LC, 82.01%(497/606) of the major surgeons experienced anxiety and/or depression for more than one month; 63.37%(384/606) of the major surgeons expected to avoid LC or showed tension during LC; 44.72%(271/606) of the major surgeons had a physiological response when recalling the case; 36.14%(219/606) of the major surgeons initiated the idea of not being a surgeon; 6.44%(39/606) of the major surgeons asked psychologists for help; and 5.61%(34/606) of the major surgeons had taken psychiatric drugs such as antianxiety and anti-depression drugs for more than one month. (2) Analysis of influencing factors for severe mental trauma of major surgeons caused by IBI during LC. Results of univariate analysis showed that the hospital type of the major surgeons, participation of senior surgeons in the repair, surgical method of the primary repair, IBI requiring repeated repair, medical disputes, administrative punishment from the hospital, compensation paid by the major surgeon, having medical liability insurance, violent conflicts in medical disputes were related factors for severe mental trauma of the major surgeons caused by IBI during LC ( χ2=7.688, 3.932, 19.764, 13.837, 61.488, 24.904, 30.976, 5.344, 26.285, P<0.05) . Results of multivariate analysis showed that the surgical method of the primary repair, IBI requiring repeated repair, medical disputes, administrative punishment from the hospital, compensation paid by the major surgeon, violent conflicts in medical disputes were independent risk factors for severe mental trauma caused by IBI during LC of the major surgeons ( odds ratios=1.203, 2.198, 2.922, 1.830, 2.405, 2.171, 95% confidence interval: 1.033-1.402, 1.143-4.226, 1.944-4.391, 1.083-3.093, 1.076-5.375, 1.002-4.702, P<0.05). Having medical liability insurance was an independent protective factor for severe mental trauma of the major surgeons caused by IBI during LC ( odds ratios=0.336, 95% confidence interval: 0.126-0.896, P<0.05). Conclusions:Most surgeons in China are troubled by IBI during LC, and nearly half of them suffer from severe mental trauma. Surgical method of the primary repair, IBI requiring repeated repair, medical disputes, administartive punishment from the hospital, compensation paid by the major surgeon, and violent conflicts in medical disputes are independent risk factors for severe mental trauma of major surgeons caused by IBI during LC. Having medical liability insurance is an independent protective factor for severe mental trauma of major surgeons caused by IBI during LC.

Objective: To analyze the interactions between different structural types of volatile oil components (VOCs) and skin lipid molecules, and investigate the mechanism of volatile oil in Chinese materia medica (VOCMM) as penetration enhancers. Methods: In this study, 210 different structural types of VOCs were selected from the VOCMM penetration enhancer database, and the molecular docking experiments were conducted with three main lipid molecules of skin: ceramide 2 (CER2), cholesterol (CHL), and free fatty acid (FFA). Each VOC was docked individually with each lipid molecule. Cluster analysis was used to explore the relationship between the binding energy of VOCs and their molecular structures. Nine specific pathogen-free (SPF) Sprague Dawley (SD) rats were randomly divided into Control, Nootkatone, and 3-Butylidenephthalide groups for in vitro percutaneous experiments, with three rats in each group. The donor pool solutions were 3% gastrodin, 3% gastrodin + 3% nootkatone, and 3% gastrodin + 3% 3-butylidenephthalide, respectively. The penetration enhancing effects of VOCs with higher binding energy were evaluated by comparing the 12-hour cumulative percutaneous absorption of gastrodin (Q12, µg/cm²). Result: (i) Most of the VOCs were non-hydrogen bonded to the hydrophobic parts of CHL and FFA, and hydrogen bonded to the head group of CER2. Among them, sesquiterpene oxides showed the most pronounced binding affinity to CER2. The VOCs with 2 − 4 rings (including carbon rings, benzene rings, and heterocycles) demonstrated stronger binding affinity for three skin lipid molecules compared with the VOCs without intramolecular rings (P < 0.01). (ii) According to the cluster analysis, most of the VOCs that bond well to CER2 had 2 − 3 intramolecular rings. The non-oxygenated VOCs were bonded to CER2 in a hydrophobic manner. The oxygenated VOCs were mostly bonded to CER2 by hydrogen bonding. (iii) The results of Franz diffusion cell experiment showed that the Q12 of Control group was 260.60 ± 25.09 µg/cm2, and the transdermal absorption of gastrodin was significantly increased in Nootkatone group (Q12 = 5 503.00 ± 1 080.00 µg/cm², P < 0.01).  The transdermal absorption of gastrodin was also increased in 3-Butylidenephthalide  group (Q12 = 495.40 ± 56.98 µg/cm², P > 0.05). (iv) The type of oxygen-containing functional groups in VOCs was also an influencing factor of binding affinity to CER2. Conclusion The interactions between different types of VOCs with different structures in the VOCMM and three skin lipid molecules in the stratum corneum were investigated at the molecular level in this paper. This research provided theoretical guidance and data support for the screening of volatile oil-based penetration enhancers,  and a simple and rapid method for studying the penetration-enhancing mechanism of volatile oils.

OBJECTIVE To develop a whole-process intelligent model of pharmaceutical care for peritoneal dialysis （PD） patients， and to provide a reference for clinical pharmacists to provide standardized PD pharmaceutical care. METHODS The pharmaceutical care mode of PD patients at home and abroad was investigated and analyzed. Based on the actual situation of the First Affiliated Hospital of Soochow University （hereinafter referred to as “our hospital”）， with “home→PD center outpatient→ inpatient department” as the main node， the recycling process of medication reconciliation was optimized. The whole-process intelligent pharmaceutical care model of PD was illustrated by improving the Chinese version of the drug-related problems （DRPs） classification tool， developing the corresponding pharmaceutical care process， and presenting specific cases. RESULTS Based on the medication therapy management （MTM） platform， our hospital had built a closed-loop PD whole-process intelligent pharmaceutical care model of “in-hospital pharmaceutical care （building document）-PD outpatient MTM-home pharmaceutical care （online App management）”. A “double cycle” workflow of “admission→discharge→outpatient” medication reconciliation cycle and “discovery-analysis-intervention-follow-up-record-evaluation” DRPs cycle was formed. CONCLUSIONS The establishment of the whole-process intelligent pharmaceutical care model for PD in our hospital provides experience for standardizing pharmaceutical care for PD patients， and can reduce DRPs.