OBJECTIVE:To establish a method for simultaneous determination of 5 effective components in Luohua zizhu dry extract. METHODS:UPLC-MS/MS was conducted. The separation was performed on an Zorbax Eclipse Plus C18 column with mo-bile phase of acetonitrile-water(gradient elution)at the flow rate of 0.3 mL/min. The column temperature was set at 40℃and sam-ple size was 2 μL. The analytes were detected in the multiple reaction monitoring(MRM)mode. Nitrogen was used as drying gas and atomized gas. The temperature and flow rate of drying gas were 325 ℃ and 6 L/min. The pressure of atomized gas was 45 psi. The temperature and flow rate of sheath gas were 350℃and 12 L/min. The voltage of capillary were 4000 V(+)and 3500 V(-). The voltage of nozzle was 500 V. RESULTS:The linear ranges of luteoloside,acteoside,quercetin,luteolin and rutin were 0.5048-252.4 ng/mL(r=0.9999),0.7124-356.2 ng/mL(r=0.9990),0.5094-254.7 ng/mL(r=0.9962),0.3030-151.5 ng/mL(r=0.9998) and 0.6022-301.1 ng/mL(r=0.9996),respectively. RSDs of precision,stability and reproducibility tests were all less than 3.0%. The limit of quantitation were 0.42,0.87,0.33,0.12,0.76 ng/mL. The recoveries were 97.99%-101.20%(RSD=1.3%,n=6), 96.50%-101.20%(RSD=1.7%,n=6), 94.81%-99.34%(RSD=1.7%,n=6), 97.54%-100.51%(RSD=1.2%,n=6), 93.37%-98.70%(RSD=1.9%,n=6),respectively. CONCLUSIONS:The method is simple,precise,stable and reproducible, and can be used for simultaneous determination of 5 effective components in Luohua zizhu dry extract.

Objective To investigate the causes, diagnosis, treatment and prognosis of misdiagnosing metastatic liver cancer as liver abscess. Methods Clinical data of 4 patients with metastatic liver cancer misdiagnosed as liver abscess in Department of General Surgery, the Third Hospital of Shenzhen from April 2012 to April 2013 were retrospectively analyzed. The informed consents of all patients were obtained and the ethics committee approval was received. There were 1 male and 3 females with age ranging from 44 to 67 years old and a median age of 54 years old. All the patients received tests such as blood routine, liver function, alpha fetoprotein (AFP), carcinoembryonic antigen (CEA), carbohydrate antigen 19-9 (CA 19-9) and so on, and examinations of hepatobiliary ultrasonography, computed tomography (CT) scan of the upper abdomen, gastroscope and colonoscope after admission to hospital. Results The mean temperature of patients was (37.8±0.8)℃when admitted in hospital. Two cases got fever and shivering, and 4 cases suffered upper abdominal pain or discomfort. There were 2 cases with increasing white blood cell (WBC) and increasing alkaline phosphatase (ALP), 3 cases with increasing CA19-9, 2 cases with increasing CEA and 1 case with increasing AFP. By ultrasound examination and CT , multiple lesions were observed in 3 cases and single lesion in 1 case, including 2 cases of cystic lesions. Obvious edge enhancement was found in 3 cases by CT scan, heterogeneous internal enhancement in 2 cases, no internal enhancement in 2 cases, and 3 cases were found with lymphadenectasis in the porta hepatis or retroperitoneum. By pathological examination, 2 cases were diagnosed with liver metastasis of colon cancer, 1 case with liver metastasis of gastric cancer. And 1 case was clinically diagnosed with liver metastasis of gastrointestinal tract or extrahepatic bile duct cancer. Two cases received anti-infection treatment after admission to hospital. One case received liver tumor biopsy+catheter drainage of liqueifed necrotic tissues, and 1 case received colon cancer resection for intestinal obstruction. All the 4 patients received chemotherapy. One case died of multiple organ failure 3 months after being diagnosed and 1 case who had undergone colon cancer resection still received chemotherapy and lived well till the date of paper submission. The other 2 cases were in poor condition. Conclusions Some patients with metastatic liver cancer are usually misdiagnosed as liver abscess because of the untypical clinical features. The tumor marker detection is helpful for the differential diagnosis. Comprehensive treatments with the main of surgical resection should be employed in the patients but the prognosis is poor.

Objective To investigate the regulatory mechanism of activated hepatic stellate cell (aHSC) in the microvascular generation of hepatocellular carcinoma (HCC). Methods Tissue samples of 25 patients with HCC who underwent liver resection in Department of Hepatobiliary Surgery, the Third Afifliated Hospital of Sun Yat-sen University from January to December 2013 were collected. The informed consents of all patients were obtained and the ethical committee approval was received. There were 21 males and 4 females with age ranging from 29 to 75 years old and the median age of 54 years old. The HCC tissues (HCC group) and peri-cancer tissues (peri-cancer group) were collected and normal liver tissues of 21 cases were collected as control group. The expressions of smooth muscle actin (SMA), angiogenin (Ang-1), and cluster of differentiation (CD) 34 were detected by immunohistochemistry. The expression level of Ang-1 was detected by Western blot. The high expression of SMA in HCC tissues was regarded as a marker of aHSC. The differences of 3 groups were compared using one-way analysis of variance and LSD-t test. Spearman correlation analysis was used to analyze the correlations between different proteins expression. Results The mean of optical densities of SMA in HCC, peri-cancer, control group were (4.56±0.64)×104, (2.71±0.37)×104, (2.25±0.48)×104 respectively, which was signiifcantly higher in HCC group than those in peri-cancer group and control group (LSD-t=7.09, 7.42;P<0.05). The optical densities of Ang-1 in 3 groups were (3.11±0.27)×105, (2.28±0.20)×105, (1.26±0.15)×105 respectively, which was significantly higher in HCC group than those in peri-cancer group and control group (LSD-t=3.00, 3.14; P<0.05). The relative gray values of Ang-1 expression in 3 groups were 4.33±1.17, 1.62±0.33, 1.60±0.38 respectively, which was significantly higher in HCC group than those in peri-cancer group and control group (LSD-t=2.71, 2.74; P<0.05). The optical intensities of CD34 in 3 groups were (18.3±0.36)×103, (5.75±1.17)×103, (2.75±0.72)×103 respectively, which was signiifcantly higher in HCC group than those in peri-cancer group and control group (LSD-t=3.21, 3.36;P<0.05). There were positive correlations between SMA, Ang-1, CD34 (r=0.442, 0.449, 0.582;P<0.05). Conclusions High expressions of SMA, Ang-1 and CD34 can be observed in HCC group and closely related with each other. SMA marked aHSC can be observed in the HCC tissues. The aHSC may promote the microvascular generation of HCC by secreting Ang-1.

Objective:To explore the application of Sojump in clinical teaching assessment of nursing students in operating room and to evaluate its effect.Methods:The graduation examination results of nursing students in clinical practice in the operating room of Second Affiliated Hospital of Medical College of Shantou University from 2017 to 2019 were collected, the results of 2017-2018 as the control group, and those of 2018-2019 as the observation group. The control group took the paper handwriting test, and the observation group took the electronic Sojump test, and the two-year graduation examination results were compared. A questionnaire survey was conducted to investigate the nursing students' satisfaction with the teaching work of the teachers in 2018-2019, and the teachers' feelings of the teachers' training was investigated with the questionnaire. SPSS 22.0 was used for t test. Results:The graduation examination scores of all educational levels in the observation group were higher than those in the control group, with statistical differences between the two groups ( P<0.05). The satisfaction rate of nursing students who did not understand the contents of the questionnaire and studied again was 98.19%, and the teachers' satisfaction rate of automatic marking of Sojump test was 100%. Conclusion:Sojump is easily and efficiently operational, paperless, targeted teaching, which can promote teaching by evaluation, and reach high satisfaction of nursing students and teachers, worthy of promotion in clinical teaching.

Objective:To study the effects of early breastfeeding volume on neonatal necrotizing enterocolitis (NEC) and feeding intolerance in very low birth weight infants.Methods:This study retrospectively analyzed the clinical data of 275 cases of very low birth weight infants (birth weight<1 500 g) born in Shenzhen Maternity & Child Healthcare Hospital from June 2017 to May 2018. Based on whether breastfeeding or not and the ratio of breast milk intake over the total volume of intake within two weeks after birth, they were divided into three groups: breast milk intake>50% group (>50% group, n=199), breast milk intake≤50% group (≤50% group, n=55) and formula group ( n=21). Differences in the incidence of NEC and feeding intolerance among the three groups were analyzed using Chi-square test (or Fisher's exact test). Effects of breast milk intake on the incidence of NEC and feeding intolerance were evaluated using univariate and multivariate logistic regression analysis. Results:The incidence of NEC in the >50% group, ≤50% group and formula group was 1.5% (3/199), 27.3% (15/55) and 9.5% (2/21), respectively ( P<0.01), and the incidence of feeding intolerance was 17.6% (35/199), 56.4% (31/55) and 28.6% (6/21), respectively ( χ2=34.826, P<0.01). Univariate logistic regression analysis showed that compared with the >50% group, the risk of NEC in the≤50% and formula group increased ( OR=24.500, 95% CI: 6.755-85.594; OR=6.877, 95% CI: 1.081-43.744); that of feeding intolerance increased in the≤50% group ( OR=6.316, 95% CI: 3.293-12.113). Multivariate logistic regression analysis showed that compared with the >50% group, the risk of NEC in the≤50% and formula groups increased ( OR=28.452, 95% CI: 7.280-111.195; OR=8.610, 95% CI: 1.262-58.766); that of feeding intolerance increased in the≤50% group ( OR=7.207, 95% CI: 3.601-14.425). Conclusions:Breastfeeding accounting for more than half of the total volume of intake within two weeks after birth may reduce the incidence of feeding intolerance and NEC in very low birth weight infants.

Objective To investigate the causes and treatments of severe complications after laparoscopic surgery. Methods Clinical data of 7 cases with severe complications after laparoscopic surgery in the Third People’s Hospital of Shenzhen from January 2008 to January 2013 were analyzed retrospectively. The informed consents of all patients were obtained and local ethical committee approval had been received. There were 3 males and 4 females with the age ranging from 6 to 67 years old and median of 40 years old. The diagnosis, treatments clinical data of the patients were collected, and the causes, treatments and prevention measures of the complications were summarized. Results Five cases underwent laparoscopic cholesystectomy (LC), 4 of which suffered bile duct injury for severe abdominal adhesion and unclear anatomy of the Calot triangle and 1 case suffered strangulated intestinal obstruction after operation because the hepatic falciform ligament was ruptured when puncturing below the xiphoid. One case underwent laparoscopic high ligation of hernial sac for indirect inguinal hernia and suffered strangulated intestinal obstruction after operation because part of the small intestine ran out of the peritoneum through the port site below the umbilicus. One case underwent laparoscopic tension-free repair for indirect inguinal hernia and suffered ischemic necrosis of the left testis possibly because of testicular torsion when stretching the tissue. The 4 cases with bile duct injury received primary drainage, 3 of which underwent secondary Roux-en-Y cholangiojejunostomy for severe biliary stricture and all recovered well after operation, and the other case underwent endoscopic biliary stent implantation 3 months after operation. The 2 cases with strangulated intestinal obstruction underwent emergent partial resection and end-to-end anastomosis of small intestine and recovered well after operation. The case with necrosis of testis underwent testicular excision. Conclusions The main causes of severe complications after laparoscopic surgery probably are the unclear local anatomy and failing to convert surgical procedure timely, etc. Early diagnosis, comprehensive evaluation and proper surgical interventions are the important measures for improving the prognosis of these patients.

OBJECTIVE： To explore the management model of smart pharmacy under the background of “Internet+TCM”， and to promote the improvement of the work and service quality of smart pharmacy. METHODS： The information platform and internal organization of smart pharmacy in our hospital were combined； the supervision and management of smart pharmacy and the establishment of quality control system in smart pharmacy were summarized and the development and supervision effectiveness of smart pharmacy in our hospital were evaluated. RESULTS： Our hospital established the information platform on the basis of the “Internet+TCM”. Hospital information setting were divided into online and offline. The prescriptions that were not suitable for online handling decoction and distribution service were clearly defined and the system locking settings were set up to realize effective information transmission from hospital to smart pharmacy. The service platform of smart pharmacy were set up including electronic prescription circulation system， whole-course prescription barcode recognition management system， electronic prescription audit and dispensing system， intelligent decoction control management system， smart pharmacy distribution management system， etc. It had realized seamless connection of information between smart pharmacy and patients. The internal organization included six departments： prescription audit center， dispensing center， decoction center， individualized preparation production center， logistics center and customer service center. Our hospital conducted daily supervision and management of the entire work process of the smart pharmacy from aspect of hospital management and pharmacy management. The internal service quality of smart pharmacy could be controlled by quality control system of prescription reviewing center， dispensing center， decocting center， individualized preparation center， logistics center and customer service center and pharmaceutical personnel training mechanism in smart pharmacy. Since the start of the smart pharmacy in June 2015， the number of people receiving the services of smart pharmacy had increased significantly， and the types of services and service opportunities for patients had added； the distribution service had added， and the service of individualized preparation processing and distribution had also added. Moreover， the service capacity of smart pharmacy far exceeded the demand of our hospital， and other medical institutions could share the platform of smart pharmacy. By simply counting the situation in our hospital， the average number of daily prescription increased from 387 in Jun.-Dec. of 2015 to 1 433 in 2018； the error rate showed a downward trend， among which the abnormal rate of prescription reviewing， the dispensing error rate， the decoction error rate and customer service complaints rate decreased from 2.10％， 0.13％， 0.52％， 0.13％ in Jun.-Dec. of 2015 to 0.45％， 0.05％， 0.27％， 0.04％ in 2018； total timely investment rate in logistics increased from 93.20％ in Jun.-Dec. of 2015 to 97.06％ in 2018. At present， the existing information platform， internal organization， quality control system and supervision system could ensure the orderly operation of smart pharmacy and could ensure the quality of drugs， decoction and distribution. CONCLUSIONS： However， the development of smart pharmacy in our hospital is still in its infancy. In the future， it is still necessary to strengthen the construction of information software and hardware， standardize the operation of various links， strengthen personnel training， establish an effective quality control system and explore more objective supervision mechanisms.

OBJECTIVES: Genetic mutation is one of the important causes for tumor genesis and development, but genetic mutation in nasopharyngeal carcinoma (NPC) has rarely been reported. This study explored the role of phosphatidylinositol 3 kinase-protein kinase B (PI3K-Akt), mammalian target of rapamycin (mTOR), and adenosine 5'-monophosphate (AMP)-activated protein kinase (AMPK) signaling pathway in the efficacy and prognosis in patients with NPC. METHODS: A total of 31 patients with advanced NPC, who came from the Affiliated Cancer Hospital of Xiangya School of Medicine of Central South University/Hunan Provincial Cancer Hospital, were enrolled. All of the exons of 288 genes, introns of 38 genes and promoters or fusion breakpoint regions from the nasopharyngeal biopsy tissues before treatment were detected by the gene sequencing platform Illumina NextSeq CN500. The coding regions of 728 genes were carried out a high-depth sequencing of target region capture, and the 4 variant types of tumor genes (including point mutations, insertion deletions of small fragments, copy number variations, and currently known fusion genes) were detected. All of 31 patients received platinum-based induction chemotherapy combined with concurrent chemoradiotherapy and were followed up for a long time. RESULTS: The 3-year regional failure-free survival (RFFS) and disease-free survival (DFS) in patients with PI3K-Akt pathway mutation were significantly lower than those in unmutated patients (χ²=6.647, P<0.05). The 3-year RFFS and DFS in patients with mTOR pathway mutations were significantly lower than those in unmutated patients, and there was significant difference (χ²=5.570, P<0.05). The rate of complete response (CR) in patients with unmutated AMPK pathway was significantly higher than that in patients with mutation at 3 months after treatment (P<0.05), and the 3-year RFFS and DFS in patients with AMPK pathway mutation were significantly lower than those in unmutated patients (χ²=4.553, P<0.05). PI3K-Akt/mTOR/AMPK signaling pathway mutations and pre-treatment EB virus DNA copy numbers were independent prognostic factors for 3-year RFFS and DFS in patients with NPC (both P<0.05). CONCLUSIONS The NPC patients with PI3K-Akt/mTOR/AMPK signaling pathway mutation have poor prognosis, and the detection of PI3K-Akt, mTOR, AMPK driver genes and signaling pathways by next-generation sequencing is expected to provide new idea for basic research and targeted therapy of NPC.
AMP-Activated Protein Kinases/metabolism* ; DNA Copy Number Variations ; Humans ; Mutation ; Nasopharyngeal Carcinoma/genetics* ; Nasopharyngeal Neoplasms/metabolism* ; Phosphatidylinositol 3-Kinases/metabolism* ; Prognosis ; Proto-Oncogene Proteins c-akt/metabolism* ; Signal Transduction ; Sirolimus ; TOR Serine-Threonine Kinases/metabolism*