OBJECTIVE: To evaluate the use of Xingnaojing Injection in medical insurance inpatients in Beijing city so as to provide reference for rational drug use and medical insurance billing.METHODS: Inpatient cases using Xingnaojing Injection in 5 Beijing hospitals of different levels were randomly sampled from the 2004 Beijing Medical Insurance Database,and analyzed in terms of indication, dosage, treatment course and ADR.RESULTS: A total of 676 cases were sampled with more than 25 kinds of indications,and among the top 10 indications, 18.0% were inconsistent with the instruction,and 17.5% were in lack of evidence support such as randomized controlled trials.Individual dose of Xingnaojing Injection was(27.9?9.0)mL, which was higher than the usual dose described by the instructions and clinical trials.The mean treatment course of Xingnaojing Injeciton was 14.6 days,with 20.9% exceeding 20 days.Drugs used in combination with Xingnaojing Injection included anti - thrombosis agents( 13.3% ) and traditional Chinese medicines with the action of promoting blood circulation and removing blood stasis (12.7%) .CONCLUSION: The use of Xingnaojing injection in medical insurance patients was not consistant with the instruction or evidence supported by clinical trials.

Objective: To compare the pharmacokinetic c haracteristics of amphoterici n B liposomes injection (LAmB) with market amphotericin B injection (MAmB) in ra bbits by intravenous administration. Methods: LAmB and MAmB wer e intravenously ad ministrated to rabbits at a single dosage of 1 mg*kg －1. The AmB concent rations i n plasma samples were determined by HPLC, and the pharmacokinetic parameters wer e calculated by means of 3P97, and ANOVA were done by means of the Excel softwar e. Results: The concentration- time data of LAmB and MAmB after intravenous administration were best fitted acc ording to three compartment-model with a weight of 1/C and 1 respectively . After a singl e intravenous administra tion, C max　of LAmB and MAmB were 8.4±2.1 and 2.4±0.6 mg*L －1, AUC were 22.5±6.8 and 9.0±1.9 mg*h*L －1, CL were 0.050±0 .024 and 0.114 ±0.022 L*h －1, V c were 0.13±0.04 and 0.46±0.18 L , respectively. Comparing with MAmB, all rabbits showed high plasma levels, large area under the curve values and low cl earance, small apparent volume of distribution of LAmB. Conclusion: There were several striking differences between the pharmacokinetics properties of LAmB and MAmB in jection in rabbits. All changes of the pharmacokinetics properties will be advan tageous to reduce toxicity and improve therapeutic effect.

OBJECTIVE:To promote rational use of Xingnaojing (XNJ) injection in medical insurance patients.METHODS:Clinical trials on indications of XNJ were searched systematically,and clinical evidence that XNJ was applied for different indications were collected and classified.A questionnaire survey was carried out in 20 medical institutions to find out the doctors' attitude and prescribing practice relating to indications,application indications,usage and dosage,timing of application and drug combination of XNJ.The results of above 2 kinds of studies were provided to a group of experts to reach consensus about guideline of XNJ.RESULTS:Guidelines of XNJ,which contained the application indications,timing of medication,dosage,treatment course and drug combination,were developed.The strength and degree of evidence were labeled for each items of recommendation.CONCLUSION:For drugs with low-quality clinical evidence,guideline should be developed according to experts' consensus which is based on evidence-based medicine.

Objective To demonstrate the possibility when discriminating between severe and nonsevere tricuspid regurgitation by E-wave velocity in tricuspid flow.Methods The peak velocity of the tricuspid inflow E-wave was measured in 107 patients,who were divided into mild group(n =39),moderate group(n =42)and severe group(n =26)according to the degree of tricuspid regurgitation(TR).Results Peak E-wave velocity of mild group,moderate group and severe group was (48.6 ±13.8)cm/s,(47.4 ±11.7)cm/s,and (78.3 ±26.1)cm/s, respectively.Mean E-wave velocity of mild group and moderate group were similar,which were lower than that of severe group (P <0.01).A peak E-wave velocity of over 62 cm/s had a sensitivity of 71% and specificity of 92% for the detection of severe TR.Conclusion Increased peak tricuspid E-wave velocity is associated with severe TR and thus can be used as a simple measure of TR grade.

Objective To investigate the effects of ulinastatin pretreatment on oxidative stress response and hepatocyte growth factor (HGF) after hepatectomy in rats.Methods One hundred and twelve pathogen-free male Sprague-Dawley rats,aged 3 months,weighing 230-280 g,were randomly divided into 2 groups (n=56 each): group hepatectomy (group H) and group ulinastatin pretreatment (group U).Left and median lobe resection was performed and then liver ischemia was induced by blood flow occlusion of right and caudate lobes for 30 min,followed by perfusion in both groups.Ulinastatin 50 000 U/kg was injected intravenously at 5 min before occlusion in group U.Eight rats in each group were chosen and the blood samples were taken from the inferior vena cava for measurement of serum ALT and AST activities and HGF concentration before ischemia and at 1,6,12,24and 48 h of reperfusion.Then the right lobe were removed for determination of apoptosis,SOD and myeloperoxidase (MPO) activities,MDA content,expression of proliferating cell nuclear antigen (PCNA) and liver regeneration.Apoptotic index was calculated.Another 8 rats in each group were chosen and the 7 day survival rate was recorded.Results Compared with group H,the levels of ALT,AST,MPO aud MDA and apoptotic index were significantly decreased,and the levels of HGF and SOD,PCNA expression and liver regeneration were significantly increased at different time points in group U (P ＜ 0.05).There was no significant difference in 7 day survival rate between group H and group U (P＞ 0.05).Conclusion Ulinastatin pretreatment can strengthen liver regeneration after hepatectomy in rats,the underlying mechanism may be related to inhibition of oxidative stress response and increase in HGF production.

Objective To explore the application value of comparative imaging combined with multimedia teaching in the five-year undergraduate intemship teaching of nuclear medicine.Metbods 70 undergraduates internship in the nuclear medicine department of our hospital from June 2017 to February 2018 were divided into the control group and experimental group,35 in each group.The control group adopted traditional teaching method,and the experimental group adopted comparative imaging combined with multimedia teaching for internship teaching.The theoretical test scores,the evaluation of the self-perception of the teaching process and the teaching feedback of the two groups were compared.Results The theoretical test scores of the experimental group students were significantly higher than those of the control group,including the noun explanation [(26.60 ± 0.51) vs.(22.20 ± 0.58)],the short-answer question [(26.80 ± 0.37) vs.(22.40 ± 0.60)],the essay question [(36.00 ± 0.71) vs.(27.40 ± 1.03)] and total score [(92.40 ± 0.93) vs.(71.80 ± 0.37)].The satisfactions with the evaluation of the self-perception in the teaching process and the teaching feedback in the experimental group were also much better than those of the control group.Conclusion The application of comparative imaging combined with multimedia teaching in the practice teaching for undergraduate students in nuclear medicine could effectively improve the clinical practice teaching quality and actively promote the development of the teaching of nuclear medicine.

OBJECTIVE：To explore refined management mode of outpatient pharmacy ，and to improve the efficiency and quality of outpatient pharmacy service. METHODS ：From the hospital information and big data center of our hospital ，the outpatient pharmacy prescription data under the traditional management mode were collected ；fish bone analysis was used to find out the factors that may affect the waiting time of patients ，the work efficiency and quality of pharmacy ；4M1E method was adopted to improve the related problems and implement refined management. The prescription data of 10 working days before improvement，stage 1 and stage 2 of refined management were selected. The work efficiency of pharmacists ，average waiting time of patients ，dispensing errors and inventory errors before and after the improvement were compared and analyzed to evaluate the effects of refined management. RESULTS ：By fishbone diagram ，the factors influencing the waiting time of patients ，the work efficiency and quality of outpatient pharmacy service in our hospital included personnel factors ，machine factors ，material factors ， method factors ，environmental factors ，such as the number of personel and time alloction was unreasonable ，the machine was aging，etc. After the implementation of refined management ，the outpatient pharmacy of our hospital had taken a variety of measures，such as adjusting the staff working time and refining the performance rew ard scheme ，maintaining the automatic dispensing machine and updating the prescription scanning equipment，setting up temporary drug containers and opti- mizing the location number ，strengthening drug management and relevant personnel training ， openning the window ofcharacteristic single variety dispensing. The statistical results com showed that in the first stage of fine management ，the number of dispensing prescriptions and the number of p rescription items in the outpatient pharmacy of our hospital increased slightly in 10 working days. Due to the decrease of the number of on-the-job staff and the change of the number and time of open windows ，the cumulative working hours of on-the-job staff decreased from 1 680 hours to 1 440 hours；the number of dispensing prescriptions and prescription items per hour per capita increased from 52.0 pieces，58.7 to 65.1 pieces，69.6（P＜0.05）；the number of dispensing errors decreased from 30 to 5；there was no significant change in waiting time of patients and inventory errors. In the second stage of fine management ，when the amount of dispensing prescriptions in outpatient pharmacy of our hospital was similar ，the number of dispensing prescriptions and the number of prescription items per hour per capita increased from 52.0 pieces，58.7 to 59.9 pieces，67.3，respectively（P＜0.05）；the average waiting time of patients decreased from 9.30 min to 7.32 min（P＜0.05）. After further refining the error data collection method and adjusting the performance incentive scheme ，the number of dispensing errors in outpatient pharmacy increased to 75，and the number of inventory errors decreased from 5 to 0. CONCLUSIONS ：By 4M1E method，outpatient pharmacy of our hospital carry out refined management ，to achieve the improvement of work efficiency and quality，shorten the waiting time of patients

OBJECTIVE：To systematically evaluat e the efficacy and safety of different regimens in the treatment of refractory Kawasaki disease ，and to provide evidence-based reference for clinical treatment. METHODS ：Retrieved from PubMed ，Embase， Cochrane Library ， CNKI， VIP， Wanfang database ，randomized controlled trials （RCTs）and cohort studies about different therapeutic regimens in the treatment of refractory 84206032。E-mail：liuyingzryy@163.com Kawasaki disease were collected during the inception to March 2021. After selecting the literature and extracting the data ，the quality of RCT was evaluated by modified Jadad scale ，and the quality of cohort st udy was evaluated by NOS scale. Network Meta-analysis was performed by using Stata 16.0 software. RESULTS ：A total of 29 literatures were included ，involving 15 RCTs and 14 cohort studies. A total of 3 112 patients and 12 therapeutic regimens were involved ，including twice IVIG ，twice IVIG+hormone，twice IVIG+ulinastatin ，first IVIG ，first time IVIG+hormone ，first time IVIG+cyclosporine ，first time IVIG+ etanercept，hormone，hormone+ulinastatin，ulinastatin，infliximab and placebo. The results of network Meta-analysis showed that in terms of the incidence of coronary artery injury （CAL），twice IVIG+hormone was significant lower than hormone ，and first time IVIG +etanercept was significant lower than first time IVIG （P＜0.05）. The sorting results of network Meta-analysis showed that area under cumulative ranking curve of CAL incidence in ascending order was hormone ＜ulinastatin＜twice IVIG ＜first time IVIG＜first IVIG+hormone ＜twice IVIG+hormone ＜infliximab＜first time IVIG+cyclosporin ＜first time IVIG+etanercept. In terms of the incidence of ADR ，compared with twice IVIG+ hormone and hormone ，twice IVIG and first time IVIG+etanercept were decreased significantly ；infliximab was significantly lower than hormone （P＜0.05）. The sorting results of network Meta-analysis showed that area under cumulative ranking curve of ADR incidence in ascending order was hormone ＜twice IVIG+hormone ＜first time IVIG+hormone ＜first time IVIG+cyclosporin ＜first time IVIG ＜twice IVIG ＜first time IVIG+etanercept ＜infliximab. In terms of the serum level of CRP ，compared with twice IVIG ，twice IVIG+hormone ，twice IVIG+ulinastatin and hormone were decreased significantly；twice IVIG+hormone was significantly lower than first time IVIG ；twice IVIG+ulinastatin were all significantly lower than twice IVIG+hormone ，hormone，hormone+ulinastatin，first time IVIG ，first time IVIG+hormone and ulinastatin （P＜0.05）. The sorting results of network Meta-analysis showed that area under cumulative ranking curve of serum CRP level in ascending order was first time IVIG ＜first time IVIG+hormone ＜twice IVIG ＜hormone+ulinastatin＜ulinastatin＜infliximab＜hormone＜twice IVIG+hormone＜twice IVIG+ulinastatin. In terms of improving persistent fever duration ，there was no statistical difference between pairwise treatment measures （P＞0.05）. The sorting results of network Meta-analysis showed area under cumulative ranking curve of persistent fever time in ascending order was first time IVIG ＜placebo＜first time IVIG+cyclosporine ＜hormone＜twice IVIG+ hormone＜twice IVIG ＜ulinastatin＜infamliximab. CONCLUSIONS ：The first time IVIG+etanercept has the best effect in reducing the incidence of CAL. Infliximab possesses a relatively low incidence of ADR and the best antipyretic effect. Twice IVIG + ulinastatin has the best anti-inflammatory effect.

OBJECTIVE：To interpret the key points in local standard Specification for Pharmacy Intravenous Centralized Admixture（DB11/T 1701-2019）（Beijing Local Standard for short ）in Beijing ，and to provide guidance and reference for managers of medical institutions and staff of PIVAS to deeply understand the standard and further improve the quality of PIVAS in medical institutions. METHODS ：The background and main content of Beijing Local Standard were interpreted in detail ，and then compared with Quality Specification of Pharmacy Intravenous Admixture （National Specification for short ）promulgated by Chinese National Ministry of Public Health and Quality Specification of Pharmacy Intravenous Admixture Services of Guangdong Provincial （Trial）（Specification of Guangdong Province for short ）promulgated by Guangdong Pharmaceutical Association. RESULTS & CONCLUSIONS：Beijing Local Standard had been promulgated and implemented by Beijing Municipal Administration for Market Regulation on April 1st，2020. The text of Beijing Local Standard is divided into 7 parts，mainly including the scope of application，normative references ，terms and definitions ，basic requirement ，environmental requirements （design，location， layout），equipment and facilities （ventilation system and console ，operation and maintenance ），and admixture requirements. Beijing Local Standard further refines the relevant contents on the basis of following the requirements of National Specification . Like Specification of Guangdong Province ，the applicability and operability of the standard are enhanced by combining their local characteristics and practice status. As the first local standard in this domain ，the local standard is expected to promote the improvement of the working quality of PIVAS in Beijing ，enable the PIVAS of proposed construction ，under construction and operation maintenance to meet uniform standards and reduce the failure of acceptance or reconstruction after completion.