OBJECTIVE:To standardize the ward rescue and essential drugs quality management in wards,and reduce the med-ication risk of patients. METHODS:Failure mode and effect analysis(FMEA)was used to analyze the inspection items and failure modes of quality management of ward rescue and essential drugs. According to scoring the possibility,severity and detectability de-gree of the failure modes and calculating the risk priority number(RPN),failure modes that should be given priority improvement were quantified and determined,improvement measures were developed and conducted,and management effects were evaluated af-ter 6 months. RESULTS:12 failure modes were determined,including the residue treatment of narcotic and the first-class psycho-tropic drugs was not recorded,drug storage temperature was not up to standard and drug expired,etc. Improving related systems, enhancing the inspection management,cold chain management,daily management and other measures were implemented and con-ducted. After 6 months,the top 3 items with the highest RPNs were dropped from 320,240,216 score to 16,16,27 scores,re-spectively,all in a relatively low risk area. Numbers of failure mode event were dropped from 1869 to 218,dropping by 88.3%. CONCLUSIONS:According to qualifying the failure modes in ward rescue and essential drugs quality management by using FMEA in our hospital,the management items with the highest risk has determined and improved,the medication risk of patients has significantly reduced.

Objective To evaluate the effect and potential mechanism of Shikonin on hormone-induced osteoporosis in rats.Methods RAW264.7 cell lines were treated with indicated concentrations of Shikonin,and the effects of Shikonin on cell viability were evaluated by CCK8 assay.Then the cells were divided into five groups:control group,dexamethasone(osteoporosis agent)group,dexamethasone + recombinant human parathyroid(anti-osteoporosis agent)group,dexamethasone + Shikonin 0.3 μmol·L-1 group,and dexamethasone + Shikonin 1.2 μmol·L-1 group.The effect of Shikonin on osteoclast function was evaluated by TRAP staining and bone resorption area measurement.The rat model of osteoporosis induced by dexamethasone was established,and divided into five groups(n=8):dexamethasone group,dexamethasone + PTH group,dexamethasone + Shikonin 0.3 μmol·L-1 group and dexamethasone + Shikonin 1.2 μmol·L-1 group,while control group was set up,then each group given separately 0.9%NaCl 6 mL·kg-1,PTH 20 μg·kg-1 3 days,Shikonin 0.5 mg·kg-1 day(0.3 μmol·L-1),Shikonin 2 mg·kg-1 day(1.2 μmol·L-1),and 0.9%NaCl 6 mL·kg-1for 3 weeks.ELISA was used to detect Serum type I collagen(CTX),Cathepsin K(Cathepsin K)and oxidative stress related indicators.HE staining was used to detect the changes of bone structure,and dual-energy X-ray scanning was used to detect the changes of bone density(BMD).Western blot and immunofluorescence were used to detect the effect of Shikonin on NF-κB/MAPKs signaling pathway,Western blot and qRT-PCR were used to detect the expression of RANKL-related proteins and mRNA,and Western blot was used to detect the blocking effect of Shikonin on RANKL/TRAF6.Results 1.2 μmol·L-1 Shikonin had the least damage to cells.Shikonin decreased the number of TRAP positive cells(P<0.05),decreased bone absorption area(P<0.05).and decreased the expression of CTX and Cathepsin K(P<0.05),and in 1.2 μmol·L-1 group decreased more significantly(P<0.05).Shikonin increased rat femur BMD(P<0.05),and increased more significantly in 1.2 μmol·L-1 group(P<0.01).Shikonin reversed the reduction and thinning of bone trabeculae induced by dexamethasone.The expression of SOD and GSH in rats increased(P<0.05),while the expression of MDA decreased(P<0.05).Shikonin inhibited the phosphorylation of NF-κB pathway related proteins in vitro.Shikonin inhibited the expression of RANK,RANKL,TRAF6,c-fos and NFATc1 protein and mRNA.Moreover,Shikonin blocked the expression of TRAF6.Conclusion Shikonin can ameliorate glucocorticoid induced osteoporosis by inhibiting RANKL/RANK/TRAF6 and its mediated NF-κB/MAPKs signaling pathway and oxidative stress.

Objective:To investigate the diagnostic value of serum CircRNA_0048211 expression level in postmenopausal osteoporosis (PMOP) and its correlation with bone-specific alkaline phosphatase (BALP), osteopontin (OPN), procollagen type I N-terminal propeptide (PINP) and β-crosslaps (β-CTX). Methods:Data of postmenopausal women who underwent physical examination in our hospital from January 2019 to December 2021 were collected. All subjects were measured bone mineral density (BMD) by dual-energy X-ray absorptiometry and divided into PMOP group, decreased bone mass group and normal bone mass group according to BMD level. The serum CircRNA_0048211, BALP, OPN, PINP and β-CTX levels were compared in each group. Binary logistic regression was used to analyze the risk factors of PMOP, the receiver operating characteristic curve (ROC) was drawn to analyze the diagnostic value of CircRNA_0048211, BALP, OPN, PINP and β-CTX on PMOP. The correlation between CircRNA_0048211 expression level and BALP, OPN, PINP and β-CTX was analyzed by Pearson correlation analysis. Results:A total of 218 patients were included in this study. Age is 60.52±6.83 years (range, 47-76 years), body mass index is 24.27±2.28 kg/m 2 (range, 22.18-25.73 kg/m 2) and menopausal time is 10.16±4.25 years (range, 2.30-21.80 years). There were 40 cases in PMOP group, 97 cases in osteopenia group and 81 cases in normal bone mass group. The serum CircRNA_ 0048211, BALP, OPN, PINP and β-CTX was significantly different between PMOP group, osteopenia group and normal group ( F=21.15, P<0.001; F=12.52, P<0.001; F=17.86, P<0.001; F=14.32, P<0.001; F=15.52, P<0.001). The serum CircRNA_0048211 level in PMOP group (0.37±0.08) were significantly lower than that of osteopenia group (1.05±0.46) and normal bone mass group (1.73±0.81), the difference was statistically significant ( P<0.05). The levels of BALP (28.42±7.35 μg/L), OPN (17.28±7.30 ng/ml), PINP (58.40±14.37 ng/ml) and β-CTX (1.52±0.28 μg/L) in PMOP group were significantly higher than those in osteopenia group (22.61±5.93 μg/L, 11.95±5.64 ng/ml, 49.16±11.24 ng/ml, 0.81±0.17 μg/L) and normal bone mass group (16.30±4.18 μg/L, 7.62±3.25 ng/ml, 35.48±7.12 ng/ml, 0.37±0.10 μg/L), the difference was statistically significant ( P<0.05). Binary logistic regression analysis showed that decreased CircRNA_0048211 expression level [ OR=3.53, 95% CI (2.73, 10.32)] was a risk factor for the occurrence of PMOP ( P<0.001). ROC curve showed that CircRNA_0048211≤0.76 has a diagnostic significance on PMOP, and its combination of BALP, OPN, PINP and β-CTX has the highest AUC [0.95, 95% CI (0.89, 1.00)] in diagnosing PMOP. Correlation analysis showed that CircRNA_0048211 expression level were negatively correlated with BALP, OPN, PINP and β-CTX ( r=-0.46, P<0.001; r=-0.80, P<0.001; r=-0.81, P<0.001; r=-0.69, P<0.001). Conclusion:The CircRNA_0048211 showed low expression in PMOP, which was negatively correlated with BALP, OPN, PINP and β-CTX. The combination of these five factors has certain clinical value in the diagnosis of PMOP.

Objective To design a pocket diary for cancer pain patients, to explore the effect on improving their knowledge about pain control, and make them actively participate in cancer pain control activities. Methods The study was performed in Sichuan Cancer Hospital, it was conducted on 299 cancer patients, who were randomly divided into the experimental group ( 156 cases ) and the control group (143 cases), undergoing moderate-to-severe cancer pain in six standardized pain control demonstration wards. Patients from the experimental group recorded their adverse reactions and general routine care, with a cancer pain pocket diary, and the patients in the control group only got the general routine care. A questionnaire was used to test their level of cancer pain knowledge and degree of satisfaction before discharge. Results There was no significant difference in the pain assessment and drug use between the two groups (P>0. 05). The scores of adverse reactions prevention, adverse reactions report and misunderstanding identification of the experimental group were (15. 84 ± 1. 70), (15. 84 ± 1. 70) and (18. 52 ± 1. 16), respectively, which were significantly higher than those in the control group (t =5. 25, 2. 38, 13. 53, respectively;P<0. 05). In the experimental group, 98 patients were quite satisfied, 55 patients were satisfied, 3 patients were not satisfied. There was a significant difference between the two groups (Z =8. 87,P <0. 05). Conclusions The cancer pain pocket diary could improve the cancer patients′ knowledge about pain control, and make them actively participate in cancer pain control activities.

Objective To investigate the expression of serum CC chemokine ligand 2(CCL2),CX3C chemokine ligand 1(CX3CL1)and CXC chemokine ligand 10(CXCL10)in postmenopausal osteoporosis(PMOP)patients and the value of combination with fracture risk assessment tool(FRAX)in predicting fracture occurrence.Methods A total of 120 patients with PMOP admitted to Hainan West Central Hospital from January 2022 to June 2023 were selected,and they were divided into fracture group(n=52)and non-fracture group(n=68).According to the FRAX score examination,they were divided into a high-risk fracture group(n=73)and a low-risk fracture group(n=47).The levels of serum CCL2,CX3CL1 and CXCL10 in each group were compared.Multivariate Logistic regression was used to analyze the fracture risk factors in PMOP patients.ROC curve was drawn to analyze the value of CCL2,CX3CL1 and CXCL10 combined with FRAX score in predicting fracture of PMOP.Results The levels of serum CCL2(134.98±32.24 pg/ml),CX3CL1(186.25±41.60 pg/ml)and CXCL10(223.47±56.43 pg/ml)in the fracture group were higher than those in the non-fracture group(82.26±17.30 pg/ml,105.23±23.78 pg/ml,151.47±43.14 pg/ml),and the differences were statistically significant(t=11.503,13.452,7.923,all P＜0.001).The levels of serum CCL2(119.70±37.56 pg/ml),CX3CL1(161.43±53.79 pg/ml)and CXCL10(204.06±61.41pg/ml)in the high-risk group for fractures were higher than those in the low-risk group(82.43±17.23 pg/ml,107.55±24.75 pg/ml,149.45±42.50pg/ml),and the differences were statistically significant(t=6.377,6.436,5.327,all P＜0.001).Multivariate Logistic regression analysis showed that elevated levels of serum CCL2,CX3CL1 and CXCL10 were risk factors for fractures in PMOP patients.The ROC curve showed that the combination of CCL2,CX3CL1 and CXCL10 combined with FRAX scores predicted the highest AUC(95％CI)for PMOP fractures[0.951(0.892～0.993)],with sensitivity and specificity of 98.2％and 85.6％,respectively.Conclusion The increased levels of serum CCL2,CX3CL1 and CXCL10 are risk factors for fracture in PMOP patients,and the combination with FRAX score has a good predictive value for fracture.

Objective:To investigate and compare the clinical effectiveness and efficacy of cannulated screws and suture anchors in assistance of locking plates reinforcement for enhancing fixation in the treatment of proximal humeral fractures.Methods:A retrospective analysis was conducted on the data of 121 patients with proximal humeral fractures who were treated by locking plates reinforcement at Hainan Western Central Hospital from January 2018 to January 2020.Based on the intraoperative method of auxiliary reinforcement for the greater tuberosity of humerus,the patients were divided into cannulated screw group(62 cases)and suture anchor group(59 cases).The Disabilities of the Arm,Shoulder and Hand(DASH)score,Constant-Murley Shoulder Score and Neer Shoulder Function(Neer)Score pre surgery,the 3rd month and 12th month after surgery were recorded and compared between the two groups,so as to assess the changes in shoulder function.Results:The time of operation,the intraoperative bleeding volume,the length of stay and the follow up time of cannulated screw group were respectively(94.7±13.4)min,(230.5±39.2)ml,(9.2±1.3)d and(15.3±4.2)months,and the differences of them between two groups were no significant(P>0.05).All patients were satisfactory for the postoperatively proximal humeral fractures and the reduction of greater tuberosity,and there was no acromial impingement.The DASH scores of two groups at the 12th month after surgery were lower than those at the 3rd month after surgery,and the Constant-Murley scores and Neer scores of two groups at the 12th month after surgery were higher than those at the 3rd month after surgery,and the differences of them were significant(t=12.069,11.446,15.553,14.879,16.223,18.209,P<0.05),respectively.There were no statistically significant differences in DASH score,Constant-Murley score and Neer score at 3rd month and 12th month after surgery between the two groups(P>0.05).Conclusion:During surgical treatment for proximal humeral fractures,both cannulated screws and suture anchors can effectively assist to lock plate for strengthening fixation of the greater tuberosity,and maintaining anatomical reduction of the greater tuberosity,and promoting recovery of the function of shoulder joint.

Objective: To investigate the diagnostic value of serum complement level and lipid metabolism level detection in senile osteoporosis. Methods: A total of 215 elderly people who underwent physical examination and bone mineral density test in Beijing Jishuitan Hospital from January 2016 to June 2016 were divided into osteoporotic group(74) and non-osteoporotic group (141) according to bone mineral density classification. The relationship between serum complement C3, complement C4, low density lipoprotein cholesterol (LDL), high density lipoprotein cholesterol (HDL), triglyceride (TG), total cholesterol (CHO) and bone mineral density were analyzed. The data were analyzed by t-test, non-parametric test, binary Logistic regression and the receiver operating characteristic (ROC) curve. Results: The age and CHO,LDL, HDL, complement C3 and C4 in the osteoporosis group[(80.6±8.2)years, (4.43±1.25)mmol/L, (2.27±0.73) mmol/L, (1.33±0.39) mmol/L, (1.12±0.22) g/L, (0.29±0.09)g/L], were significantly higher than those in the non-osteoporosis group[(77.5±8.3)years,(4.04±1.02)mmol/L,(1.97±0.59)mmol/L,(1.19±0.32)mmol/L,(0.86±0.25)g/L,(0.21±0.06)g/L,t-value were 2.571,-3.848,-4.483,-3.951,-1.249,-1.185,P<0.05], and the the BMI bone mineral density T-Score value of DXA and in the osteoporosis group were significantly lower than those in the non-osteoporosis group[(22.33±3.8)kg/m², -2.74±0.78 and (25.03±4.2)kg/m², 0.14±0.9, while the t value was 6.151 and 4.624, respectively, P<0.05]. The level of TG in osteoporotic group was significantly lower than that in non-osteoporotic group[the median (quartile) was 1.21(0.67,1.44)mmol/L and 1.37(0.86,1.67)mmol/L, respectively, Z=-2.51, P<0.01].Gender and serum levels of HDL, LDL, C3 and C4 were independent risk factors for senile osteoporosis(OR=2.476,P=0.004;OR=1.305,P=0.038;OR=1.564,P=0.028; OR=1.018, P=0.025; OR=1.023, P=0.015, respectively). The risk of osteoporosis in women was 2.476 times higher than that in men of the same age. The corresponding risk of osteoporosis increased by1.305,1.564, 1.018 and 1.023 times as HDL, LDL, C3 and C4 increased by one unit. The areas under the ROC curve detected separately by HDL, LDL, C3 and C4 were 0.623,0.595,0.673 and 0.731 respectively, and the area under the ROC curve of the four items was 0.864. Conclusions The levels of blood lipids and complements play a great role in bone metabolism. The combined detection of blood lipid metabolism and complement can improve the diagnostic efficacy of senile osteoporosis.