Objective To realize the utilization of antibacterial drugs in pediatric inpatients in Children's Hospital for clinical reference of rational use of drugs. Methods By a retrospective study, 180 cases in pediatric inpatients were randomly sampled in Children's Hospital from July to December 2012, and were analyzed in utility rate, antibiotics varieties, administrational frequency,single dose,combination use,prophylaxis time,courses of drug use,etc. Results The use of antibacterial drugs in pediatric inpatients was 110 cases (61.1%) and used in combination was 55 cases (50%) . Leading the list in terms of DDDs was cephalosporins,followed byβ-lactam and its enzyme inhibitor complex preparations. The improper medications frequency was 12 cases (10.9%), irrational single dose was 7 cases (6.4%), and irrational course of treatment was 9 cases (8.2%) . Conclusion The utilization of antibacterial drugs in Children's Hospital is basically rational, but there still exist some irrational drug uses,such as antibiotics varieties,no indication, irrational dosage,long duration and irrational combination. So, it is necessary to enhance the administration of antibiotics use and improve the level of clinical reasonable application of antibiotics.

Objective To study the effects of ghrelin on action potential (AP) and transient outside K+ current (Ito) in ventricular myocytes of diabetic cardiomyopathy (DCM) rats.Methods A rat model of DCM was established by single intraperitoneal injection of streptozotocin (STZ, 60mg/kg), and whole cell patch-clamp technique was used to record the effects of 10-7mmol/L ghrelin on AP and Ito current density in the DCM rat ventricular myocytes.Results Compared to DCM group, Ghrelin of 10-7mmol/L could significantly prolong APD50 [(12.49±2.32)％;n=7, P=0.037] and APD90 [(26.29±5.13)％;n=7, P=0.006] and decrease Ito current peak value [(23.14±3.07)％;n=9, P=0.021] in DCM rat ventricular myocytes.Conclusion Exogenous ghrelin is involved in the electrophysiological reconstruction of the heart of diabetic rats by decreasing Ito current and prolonging APD in STZ-induced DCM rat ventricular myocytes.

Objective:To prepare and identify the mouse anti-human monoclonal antibodies ( mAbs) using leukocytes as im-munogens. Methods: The mice were immunized using human peripheral blood leukocytes. Then, use of B lymphocyte hybridoma technology preparation of mAbs,followed screening by immunocytochemistry and limited dilution. The secreted mAbs were identified by immunoprecipitation,mass spectrometry,Western blot,ELISA and immunohistochemistry. Results:The 35 positive polyclonal cells were obtained,of which 11 strains secreted mAbs against S100A9. And one strain was used to prepare monoclonal antibody. The purified mAb against S100A9 were purified and identified as IgG1 subtype,with the titer,purity and affinity constant was 1∶3. 18×105,95% and 3. 54×108 L/mol,respectively. This mAb generally had 0. 12% crossed reactivity to S100A8 ,and showed little or no cross reactivity to S100A12 and S100A13. The prepared monoclonal antibodies can specifically recognizes the S100A9 antigen in human breast cancer tissues. Conclusion:Successful preparation of mAb against S100A9,which can secrete specific mAb against S100A9 protein with high titers and specificity have been established successfully,which laid the foundation for the immunology application.

Objective:To evaluate the correlation between the timed up and go(TUG)test and fall risks in elderly frail patients.Methods:From July to September 2019, elderly frail patients who were treated at the cardiovascular department of our hospital were enrolled.Basic clinical data and fall-related information of patients were collected.Patients were divided into the fall group and the non-fall group.Results on the body mass index(BMI), TUG, 4-meter maximum walking speed(4 m MWS)and Barthel index were compared between the two groups.The correlation between TUG and each indicator was examined.Multivariate Logistic regression analysis was used to analyze the correlation between the TUG and falls in elderly patients.Results:A total of 96 eligible patients were enrolled, including 35 in the fall group and 61 in the non-fall group.The average TUG time was longer in the fall group than in the non-fall group(16.45±6.44 s vs.10.17±2.91 s, t=-6.556, P<0.001). The correlation analysis results showed that the TUG was correlated with falls and 4 m MWS( r=0.582 and 0.875, both P<0.001). Multivariate Logistic regression analysis showed that the TUG( OR=1.201, 95% CI: 1.111-1.470, P=0.004)and 4 m MWS( OR=1.146, 95% CI: 1.063-1.244, P=0.015)were risk factors for falls. Conclusions:The TUG is correlated with fall risks in elderly frail patients and should be recommended as a routine test in clinical practice.

Objective To investigate the risk factors of atrial fibrillation (AF) in hyperthyroidism patients.Methods The clinical data of 557 patients with hyperthyroidism receiving 131I treatment from January 2015 to May 2018 were enrolled in the study.There were 50 cases with AF and 507 patients without AF before the treatment.Univariate and multivariate logistic regression were applied to analyze the risk factors of AF in hyperthyroidism patients.Results Compareded to non-AF patients,AF patients had older age [(59.1±10.6) vs.(41.9±13.7) years,t=6.75,P＜0.01],more males[42.0％(21/50] vs.19.7％(100/507),x2=14.11,P＜0.01],longer duration of hyperthyroidism [66.0 (6.8,120.0) vs.12.0(3.0,72.0) months,Z=2.83,P=0.02],higher prevalence of coronary artery disease [16.0％(8/50) vs.2.6％(13/507)] and hypertension[30.0％(15/50) vs.9.3％(47 / 507)],higher serum creatinine (SCr) [51.5(46.0,64.3) vs.42.0(35.0,51.0) μmol / L,Z=4.62,P＜0.01],serum uric acid (SUA) [(360.6±90.3) vs.(313.4±80.3)μmol/L,t=3.76,P＜0.01]and gamma-glutamy transpeptidase (GGT)[72.1 (38.0,97.0)vs.42.2(17.0,48.8) U/L,Z=4.97,P＜0.01] and total bilirubin (TBIL) (21.3±8.8) vs.(13.8±7.7) U/L,t=5.26,P＜0.01],direct bilirubin(DBIL)[12.6(7.9,17.4) vs.5.5(4.1,7.9)μmol/L,Z=6.62,P=0.00)]and lower blood platelet (PLT) [(188.5±60.8) × 109/L vs.(241.0±65.1)× 109/L,t=4.52,P＜0.01].And there were no significant differences in thyroid hormone level and thyroid autoimmune antibody levels.Univariate and multivariate analysis showed that the age (OR=1.23,95％CI:1.09-1.38,P＜0.01),SUA (OR=1.01,95％CI:1.00-1.20,P=-0.05),DBIL (OR=1.65,95％CI:1.01-2.72,P=0.05),GGT (OR=1.04,95％CI:1.01-1.08,P=0.01) were risk factors for AF in patients with hyperthyroidism.Conclusion Older age,abnormal serum SUA,DBIL and GGT are risk factors for atrial fibrillation in patients with hyperthyroidism,to timely control hyperthyroid and to give symptomatic treatment for those patients are necessary.

Objective To discuss the application of blending learning based on MOOC in Histology and Embryology, so as to improve students' learning effectiveness. Methods Nursing undergraduates in class one of 2017 grade were randomly selected as experimental group (n=47) , and nursing undergraduates in class two as control group (n=48), with blending learning and traditional teaching model adopted, respec-tively. SPSS 19.0 was applied to processing the data and T test were used to compare the results of the final exam of this course and the evaluation scale of students' independent learning ability in two groups. Results The experimental scores [(24.22±5.08) vs. (18.49±4.65)], paper test scores [(52.37±6.24) vs. (47.15± 5.99)], and total score [(76.61±7.22) vs. (62.83±7.36)], which shows the scores of experimental group were statistically higher than those of the control group. According to the evaluation scale of students' inde-pendent learning ability, the self-learning ability of the experimental group was better than that of the control group, with significant differences (P<0.05). Conclusion Blending learning can be applied to the teaching of Histology and Embryology, which can effectively improve learning quality, with satisfactory teaching effects to both teachers and students.

Objective:To analyze the short-term effect of targeted drugs on quality of life in patients with radioactive iodine-refractory differentiated thyroid cancer (RAIR-DTC).Methods:From February 2020 to April 2022, 19 RAIR-DTC patients (10 males, 9 females; age (54.5±14.5) years) who received targeted drugs therapy (sorafenib, lenvatinib or anlotinib) in Tianjin Medical University General Hospital were prospectively enrolled. The thyroglobulin (Tg) levels prior and 1, 3, 6 months post the targeted treatment, and the adverse events were measured and recorded. Response evaluation criteria in solid tumors (RECIST) 1.1 version was used to evaluate the treatment response. The quality of life based on five-level EuroQol five-dimensional questionnaire (EQ-5D-5L) was monitored prior and 3 months post the targeted treatment, and the prevalence rates of mobility, self-care, usual activities, pain/discomfort, and anxiety/depression were analyzed, and the scores of health assessment were assessed. Paired t test, Kruskal-Wallis rank sum test and χ2 test were used to analyze data. Results:The prevalence rates of mobility (8/19), self-care (6/19), usual activities (10/19), pain/discomfort (10/19), and anxiety/depression (12/19) in 3 months post treatment were higher than those prior treatment (1/19, 1/19, 1/19, 2/19, 2/19; χ2 values: 4.38-11.31, all P<0.05). The score of health assessment prior treatment was (84.37±6.25), which was higher than that at 3 months post treatment (71.63±9.14; t=5.02, P=0.001). After targeted treatment, 10 patients were with skin toxicity, 8 patients were with hypertension, 8 patients were with weight loss, 7 patients were with diarrhea, 6 patients were with fatigue, 5 patients were with hepatic dysfunction, 2 patients were with proteinuria, 2 patients were with muscle pain and 1 patient was with oral ulcer. Of 19 patients, 17 insisted on continuing treatment, and the other two stopped treatment. The Tg levels at 1, 3 and 6 months post treatment were 56.26(44.60, 210.50), 53.36(41.25, 203.07) and 54.35(34.71, 223.52) mg/L, respectively, which were lower than the level prior treatment with no significant difference (110.16(49.63, 294.50) mg/L; H=2.42, P=0.490). After 3 months of targeted treatment, the progression-free survival (PFS) rate was 16/17, including 7 patients with partial response (PR), 9 patients with stable disease (SD), and 1 patient with progression of disease (PD). After 6 months of targeted treatment, the PFS rate was 10/17, including 5 patients with PR, 5 patients with SD, and 7 patients with PD. Conclusion:After 3-6 months of targeted treatment, the tumor markers of most patients are decreased with metastases improved, but the adverse events of targeted drugs have a great impact on quality of life in patients with RAIR-DTC.

Objective:To investigate the predictive value of early thyroid function changes on the efficacy of patients with Graves′ disease (GD) after 131I therapy. Methods:Data of patients with GD (59 males, 214 females; age (37.4±11.4) years) who underwent single therapy of 131I in Tianjin Medical University General Hospital from November 2017 to January 2019 were retrospectively analyzed. Symptoms, signs and laboratory tests (serum free triiodothyronine (FT 3) and serum free thyroxine (FT 4)) of patients were observed to assess the efficacy of 131I treatment. Efficacy was divided into complete remission (CR), partial remission (PR), non-remission (NR) or relapse. The changes of thyroid function (ΔFT 3=FT 3 before treatment-FT 3 after treatment)/FT 3 before treatment×100%; ΔFT 4=FT 4 before treatment-FT 4 after treatment)/FT 4 before treatment×100%) 1 month after 131I therapy in each efficacy group and differences among them were compared by using independent-sample t test, χ2 test, one-way analysis of variance and the least significant difference t test. ROC curves were drawn to analyze the predictive values of early thyroid function changes on the efficacy of 131I treatment for GD. Logistic regression analyses were performed to identify the influencing factors for the efficacy of 131I therapy. Results:CR rate and total effective rate of 273 GD patients after single therapy of 131I were 67.03%(183/273) and 92.67%(253/273), respectively. After 1 month, CR rate of euthyroidism group ( n=95) was significantly higher than that of hyperthyroidism group ( n=178; 81.05%(77/95) vs 59.55%(106/178); χ2=4.60, P=0.032). ΔFT 3 and ΔFT 4 at the first month were statistically significant and decreased sequentially in the CR group ( n=183), PR group ( n=70), NR or relapse groups ( n=20; F values: 15.40, 12.54, both P<0.001). ROC curve analysis showed that patients with ΔFT 3≥73.64% and (or) ΔFT 4≥59.03% had a higher probability of achieving CR, with sensitivities of 84.3% and 86.7%, and specificities of 62.6% and 62.6%, respectively. Logistic regression analysis showed that 24 h radioactive iodine uptake (odds ratio ( OR)=1.095, 95% CI: 1.031-1.139), dose of 131I given per gram of thyroid tissue ( OR=1.562, 95% CI: 1.321-1.694), ΔFT 3 ( OR=1.354, 95% CI: 1.295-1.482), ΔFT 4 ( OR=1.498, 95% CI: 1.384-1.608) were factors affecting the outcome of patients with GD treated with 131I treatment (all P<0.05). Conclusion:Effects of 131I treatment can be predicted based on the change of the thyroid function at the first month after 131I treatment in patients with GD.

Objective To evaluate the effect of sevoflurane preconditioning on the expression of metabotropic glutamate receptor type Ⅱ( mGluRⅡ) during focal cerebral ischemia-reperfusion ( I∕R) in rats. Methods Forty-eight clean-grade healthy male Sprague-Dawley rats were divided into 3 groups (n＝16 each) using a random number table method: sham operation group ( group S), cerebral I∕R group (group I∕R) and sevoflurane preconditioning group (group Sev). Rats were anesthetized with 10% chloral hydrate 3 ml∕kg. Focal cerebral I∕R was produced by occlusion of the right middle cerebral artery for 2 h fol-lowed by 24 h reperfusion. In group Sev, 2. 7% sevoflurane was inhaled for 1 h and 24 h later focal cerebral I∕R was produced. At 24 h after reperfusion, neurological deficit was scored, the cerebral infarct size was determined by TTC staining, the cell apoptosis in ischemic penumbra was observed by TUNEL, IκB-α ex-pression was detected by Western blot, and mGluRⅡexpression was determined by immunofluorescent stai-ning. The apoptosis rate was calculated. Results Compared with group S, the neurological deficit score, cerebral infarct size and apoptosis rate were significantly increased, the expression of mGluRⅡwas up-regu-lated, and the expression of IκB-α was down-regulated in I∕R and Sev groups ( P＜0. 05). Compared with group I∕R, the neurological deficit score, cerebral infarct size and apoptosis rate were significantly de-creased, the expression of mGluRⅡwas down-regulated, and the expression of IκB-α was up-regulated in group Sev (P＜0. 05). Conclusion Sevoflurane preconditioning reduces focal cerebral I∕R injury through inhibiting the expression of mGluRⅡ in rats.

Objective:To investigate the intervention effect of topical shikonin on an imiquimod-induced psoriasis-like mouse model and its effect on expression of CCAAT enhancer binding protein δ (CEBPD) .Methods:Twenty specific pathogen-free BALB/c male mice were randomly and equally divided into model group, shikonin 1 group, shikonin 2 group and blank control group by using simple random sampling. Mice in the model group, shikonin 1 group and shikonin 2 group were topically treated with 50 mg of 5% imiquimod cream every day on the shaved back to establish the psoriasis-like mouse model. After 6-hour treatment, mice in the shikonin 1 group and shikonin 2 group were treated with 0.5 ml of shikonin at concentrations of 0.576 and 5.76 g/L respectively in the modeling area for 8 consecutive days; the blank control group received no treatment. Changes in the skin lesions of these mice were observed by naked eyes every day, and evaluated by using psoriasis area severity index (PASI) ; after 8-day treatment, the mice were sacrificed by cervical dislocation, the dorsal skin tissues were resected, and immunohistochemical study and Western blot analysis were performed to determine the expression of CEBPD in the mouse epidermis. Statistical analysis was carried out with SPSS 16.0 software by using one-way analysis of variance for comparisons of observation indices among different groups, as well as least significant difference- t test for multiple comparisons. Results:On day 8, the mice in the model group presented with obvious erythema, scales, and infiltrative and thickened skin lesions; compared with the model group, the skin lesions were markedly improved in the shikonin 1 group and shikonin 2 group, and the improvement was more obvious in the shikonin 2 group. On day 8, the PASI score significantly differed among the blank control group, model group, shikonin 1 group and shikonin 2 group (0, 11.0±1.22, 8.6±0.55, 5.8±1.30 points, respectively; F=128.21, P<0.01) , and there were significant differences between any two groups (all P < 0.01) . Immunohistochemical study showed a significant difference in the expression of CEBPD ( A value) among the model group, shikonin 1 group, shikonin 2 group and blank control group (0.072±0.026, 0.177±0.036, 0.290±0.062, 0.407±0.051, respectively; F=48.895, P < 0.01) , and there were also significant differences between any two groups (all P < 0.01) . Western blot analysis showed that the CEBPD expression in the mouse epidermis was highest in the blank control group, followed in descending order by the shikonin 2 group, shikonin 1 group and model group, and significantly differed among the above 4 groups ( F=10.237, P<0.05) ; moreover, there were significant differences in the CEBPD expression between the model group and blank control group, as well as between the shikonin 1 group and blank control group (both P<0.05) , while no significant difference was observed between the shikonin 2 group and the blank control group ( P > 0.05) . Conclusion:Topical shikonin could effectively interfere with the development of imiquimod-induced psoriasis-like mouse model; CEBPD expression decreased in the psoriasis-like mouse model, and could be markedly upregulated by topical application of shikonin.