OBJECTIVE:To shorten time consuming for dispensing mode of automatic medicine packaging machine(ATC), and improve the efficiency of ATC. METHODS:In the inpatient pharmacy of our hospital,previous dispensing mode that two ATC matched with one tablet case separately was replaced by new mode,i.e. one ATC(another ATC was on standby)matched with two tablet cases(one of them added medicine beforehand),and the information of drug-position coordinate was equipped. The time con-sumed,average daily number of packages,financial expenses and labor costs were recorded and analyzed to evaluated the effect of new mode. RESULTS & CONCLUSIONS:Compared with previous mode,new dispensing mode improve the efficiency of ATC greatly. In previous mode,two ATCs and four pharmacists work simultaneously and spend 4.5 hours for 3 850 bags of medicine, which cost 4 400 000 yuan;in new mode,only one ATC and three pharmacists work simultaneously,and spend 3.0 hours for 4 015 bags of medicine,which cost 2 350 000 yuan. Therefore,double-universal tablet cases greatly improves the efficiency of ATC and reduce the financial expenses as machine maintenance and labor cost.

Objective:To investigate the clinical features of placental thrombosis complicated with fetal growth restriction(FGR),and to analyze its diagnosis and treatment methods. Methods:Combined with reviewing the relevant literatures, the clinical data of a case of placental thrombosis complicated with FGR was retrospectively analyzed. The patient with 32 1/7 weeks of gestation was hospitalized due to placental blood sinus found one month ago;at the same time FGR was found by ultrasound examination. The patient was intravenously given nutritional support treatment such as amino acid and glucose.At the same time, the patient was continuously given low-flow oxygen. Results:The patient received cesarean section at 35 2/7 weeks of gestation and a baby girl with 1 280 g weight and 32 cm length was gained;many blood sinus in the maternal surface of placenta were seen with the largest diameter of 3-4cm;the placenta was hypertrophic, weighted 540 g .After operation,the newborn was transferred to Department of Neonatology and followed up for 1 month.1 month later, the infant could eat by herself, other physical examinations were finished without any obvious abnormal findings and the newbron discharged from hospital after recovery. Conclusion:Placental thrombosis complicated with FGR is very common in clinic and this disease severely endangers the neonatal health. Early diagnosis and reasonable treatment can improve the pregnancy outcomes.

Objective:To evaluate the changes of left ventricular (LV) myocardial systolic strain and twist motion including global longitudinal strain(GLS), global circumferential strain(GCS), global radial strain(GRS), global area strain(GAS), LV basal segment rotation angle (Rotation-basal), LV apical segment rotation angle (Rotation-apical), LV twist angle (Twist), LV torsion(Torsion) by three-dimensional speckle tracking imaging(3D-STI) in adult patients with hypertrophic cardiomyopathy (HCM), and further to analyze the correlations between LV twist and its morphology and global systolic function.Methods:A total of 45 patients with HCM from the General Hospital of Ningxia Medical University from September 2017 to June 2019 were enrolled. In addition, 50 healthy subjects were recruited as a control group. Left atrial dimension(LAD), interventricular septal end-diastole dimension(IVSD), LV posterior wall end-diastole dimension (LVPWD), LV mass index(LVMI) and other parameters were respectively measured by conventional two-dimensional transthoracic echocardiography. LV end-diastole volume(EDV), LV end-systole volume(ESV), calculated stroke volume(SV) and LV ejection fraction (LVEF) were respectively measured by 3D transthoracic echocardiography. Full-volume 3D dynamic images were performed using matrix transducer X5-1. LV Rotation-basal, Rotation-apical, Twist and Torsion, GLS, GCS, GRS and GAS were respectively analyzed by off-line TomTec software. The differences of those parameters between the two groups were compared. The correlations between 3D-Torsion parameters and those parameters by two-dimensional echocardiography was further analyzed.Results:Compared with control group, LAD, IVSD, LVPWD and LVMI of HCM group were increased(all P<0.01), EDV, ESV, SV, LVEF and E/A were decreased(all P<0.01). Compared with control group, GLS, GCS and GRS of HCM group were decreased(all P<0.01). Rotation-basal, Rotation-apical, Twist and Torsion were increased(all P<0.01), and there was no significant difference of GAS between the two groups( P>0.05). In HCM group, IVSD was not correlated with Rotation-basal ( P>0.05), but negatively correlated with Rotation-apical, Twist and Torsion ( r=-0.327, -0.439, -0.374; all P<0.05); LVEF and LVMI were not correlated with Rotation-basal, Rotation-apical, Twist and Torsion (all P>0.05). Conclusions:①3D-STI can detect the earlier subtle changes of left ventricular three-dimensional systolic strain in HCM patients; ②LV three-dimensional Twist inereases considerably in HCM patients; ③LV Twist, Torsion and Rotation-apical are significantly decreased with the increase of IVSD in HCM patients; However, LVEF and LVMI are not significantly correlated with Rotation-basal, Rotation-apical, Twist and Torsion.

Objective To observe and study the late effects of intrauterine exposure to irradiation.Methods A 16-year-old girl,borne by a woman exposed to 60Co irradiation during the Xinzhou radiation accident 16 years ago underwent inquiry,general medical examination.Conventional chromosome aberration analysis and fluorescence in situ hybridization (FISH) were used to examine non-stability and stability chromosome aberrations,and China revised Wechsler Intelligence Scale for Children (C_WISC)was used to detect IQ level.Results Inquiry revealed no history of carcinoma and no family history of hereditary diseases.The girl often caught cold when she was a child,but she hadn' t any other diseases.Menarche occurred when she was 12 years old,and she had not suffered from dysmenorrhea.Her development of body frame constitution was normal.She could not carry out addition and subtraction,but she could make simple verbal communication,writing and even reciting text.The results of the routine lab examination were within the normal range.Unstable chromosome aberrations were not shown,and the chromosome translocation rate was 2.3%.The dose that induced the chromosome injury was deduced as 0.81 Gy.The biological dose of the radiation that she was exposed to was inferred to be 1.85 Gy when she was in ther mother's uterus.Ultrasonic sound showed nodular goiter and no malignant change.China's revised Wechsler Intelligence Scale for Children (C_WISC) test results showed that speech,operation and full-scale IQ was 51,50,and 46 respectively.The total intelligence was better than 0.01% ,and worse than 99.90% of the population.Conclusions Exposure in utero does not affect the body frame constitution development after birth of the fetus,but mental retardation is clear.No evidence of any tumor can be found for the children exposed to radiation before their birth.

Objective To investigate the late effect of radiation on child-bearing women,through observing "Fang",a 19-week-pregnant woman at age of 23,who was exposed to 60Co radiation in Shanxi Xinzhou radiation accident in November,1992 and diagnosed as moderate bone marrow type acute radiation sickness and recovered after 16 year of follow-up treatment.Methods Clinical data including medical history,physical examination,laboratory data,imaging findings and consulting relevant departments were reviewed.Results The followed-up woman "Fang" often felt weak and caught cold after recovery.When she was 32 years old (9 years after radiation),her hair turned grey,but without hair loss.Her menstrual quantity was lessened since 31 years old (8 years after radiation).She was remarried and pregnant twice in the same year.At the first time she underwent artificial abortion and the second child suffered from intrauterine death after 6 months of pregnancy.The physical examination found bilateral degree Ⅰ thyroid enlargement and sparse armpit hair.The laboratory test showed the increased levels of triiodothyronine,thyroxine and anti-thyroid peroxidase antibody (TMAb) and the decreased thyroid stimulating hormone (TSH).Unstable chromosome aberrations were totally lost and stable aberrations in chromosomes were detected by fluorescence in situ hybridization (FISH).The dose estimated with the residue chromosome aberration was 0.76 Gy.Other laboratory results were normal.Ultrasonic test showed diffuse lesion in bilateral thyroid and multiple cystic nodules in right lobe of thyroid,which was considered to be nodular goiter.The examination of bone mineral density (BMD) showed osteoporosis from the second to the fourth lumber vertebra.There were no diseases associated with radiation based on the consultation from related departments.Conclusions Intrauterine death after 6 months of pregnancy might be associated with the previous exposure.There is no evidence of malignant tumor,but non-cancerous diseases are obvious.

Objective To reconstruct the absorbed dose for the individual who was accidentally exposed in uterus 16 years ago.Methods Peripheral blood samples were taken from the victim and her mother.The dicentric and centric ring chromosome aberrations were analyzed with conventional method,the micronucleus was observed with cytokinesis-block micronucleus method,and fluorescence in situ hybridization (FISH) with chromosomes 1,2 and 4 painting probes were used for translocation detection.Dose was estimated according to the standard dose-response curves previously established.Results No unstable chromosome aberrations and normal micronucleus frequencies were observed in two persons 16years after the accident.Against the established dose-response curves with FISH,the doses to the mother and her daughter were 0.76 Gy (95% GI 0.41-1.00 Gy) and 0.61 Gy (95% CI 0.44-0.86 Gy),respectively.Because the biological dose estimated for the mother 1 month after the accident was 2.30 Gy (95% CI 2.07-2.50 Gy),the dose correction factor was 3.03 for dose estimation 16 years later.The estimated dose in uterus to the victim was 1.85 Gy (95% CI 1.33-2.61 Gy).Conclusions The estimated dose to the individual accidentally exposed in uterus 16 years ago can be obtained according to the dose correction factor of the mother with FISH method.

Objective To obtain monoclonal antibodies ( mAbs ) against neutrophil gelatinase-associated lipocalin ( NGAL ) and a chemiluminescense immune quantification assay based one paired mAbs.Methods Six-to-eight weeks old female BALB/c mice were immunized with the purified recombinant human NGAL antigen( rhNGAL) that was produced by the Escherichia coil expression system.The spleen was fused with hybridoma for screening anti-NGAL monoclonal antibodies by indirect ELISA.Western blot was implemented to identify the reactivity with native NGAL. Results The rhNGAL antigen was found to form disulfide cross-linked dimers and present excellent immunogenicity.The reaction titer of the immune serum of NGAL immunized mice was about 106.Thirty mAbs were screened by indirect ELISA, hereinto;the EC50 values of mAb23C12 and 38D10 were 0.034 g/mL, 0.022 g/mL respectively.The antibodies pair, 38D10/23C12-SAE labeled with AcridiniumEster(AE), were shown to work well in chemiluminescense immune response quantitative detection which was screened by NGAL standardand clinical urine samples.This detection can resolve positive and negative samples with a statistically significant difference (P<0.0001).And the correlation coefficient R2between NGAL quantitative results and that of the Abbott's NGAL chemiluminescence immune assay kit was greater than 0.97.The detection linear range was 10-1500 ng/mL, analytical sensitivity of the method was 0.63 ng/mL.Conclusion Highly purified rhNGAL antigen and specific anti-NGAL monoclonal antibodies are generated in this study.The detection capability of method is comparable with that of the international commercial kit.

Objective:To investigate the feasibility of ultrasound-guided percutaneous endomyocardial septal cryoablation of in vitro porcine hearts and to compare its effect with the percutaneous endomyocardial radiofrequency ablation.Methods:Experiment 1: Six in vitro porcine hearts were divided into 1 min ( n=2), 3 min ( n=2) and 5 min ( n=2) groups according to the cryoablation time, and all were subjected to ultrasound-guided percutaneous intra-myocardial septal cryoablation at 100% power respectively. After cryoablation, ultrasound images, the size of the solid dissection of the ice ball, and the size of the necrotic area after melting of the frozen ice ball were measured. Experiment 2: The in vitro porcine hearts were divided into cryoablation group ( n=3) and radiofrequency ablation group ( n=3), and ultrasound-guided percutaneous endomyocardial septal cryoablation and radiofrequency ablation were performed with 100% cryo power and 40 W radiofrequency power, and the extent of complete necrotic area and incomplete necrotic area were compared between the two ablation methods after 1 min. Results:Experiment 1: In the 1 min cryoablation time group ( n=2), the short diameter of the puck measured by ultrasound was (8.00±0.84)mm, the short diameter of the puck measured by solid was (8.38±1.19)mm, and the short diameter of the necrotic zone measured by solid was (8.35±0.83)mm; in the 3 min group ( n=2), the short diameter of the puck measured by ultrasound was (19.4±0.28)mm, and the short diameter of the puck measured by solid was (19.03±0.33)mm, solid measurement of the short diameter of the necrotic zone was (19.16±0.25)mm; in the 5 min group ( n=2), the short diameter of the puck measured under ultrasound was (26.4±2.54)mm, solid measurement of the short diameter of the puck was (26.01±0.24)mm, and solid measurement of the short diameter of the necrotic zone was (24.82±0.25)mm. Randomized blocks analysis of variance was performed on this data and the difference of block Factor b (freezing time: 1 min, 3 min, 5 min) among the three groups was statistically significant( F=505.884, P<0.001). The SNK- q test showed that all three groups differed from each other(all P<0.05). The analysis results for the treatment factors K (measurement modality-ultrasound image measurements, solid anatomical measurements of the puck, and measurements of the necrotic area after melting of the frozen puck) was not statistically significant ( F=0.470, P=0.635). Experiment 2: In the RF ablation group ( n=3), the ratio of incomplete necrotic zone to the radius of the RF ablation area was 0.64±0.01; in the cryoablation group ( n=3), the ratio of incomplete necrotic zone to the radius of the ablation area was 0.26±0.02. The difference was statistically significant( P=0.002) and it can be considered that the incomplete necrotic zone of cryoablation was smaller than that of RF ablation. Conclusions:Percutameous intramyocardial septal cryoablation is controllable in scope, ultrasound image evaluation of ablation area is more accurate and incomplete necrosis area is small, which may have potential applications in cardiac ablation.

Objective To investigate the immunological pathogenesis of immune reconstitution inflammatory syndrome (IRIS) during highly active antiretroviral therapy( HAART), in this prospective cohort study we analyzed the lymphocyte subsets, lymphocyte activation, changes in regulatory T cells, and levels of Th1 and Th2 cytokines in both IRIS and non-IRIS groups. Methods Two hundred and thirty-eight AIDS patients received HAART and participated prospective research cohort for 24 weeks follow-up. Forty-seven IRIS cases and 191 non-IRIS cases were enrolled in the IRIS group or non-IRIS group respectively. Blood samples were collected in both groups at pre- and post-HAART 12 weeks, 24 weeks. Using flow cytometer to detect the immunophenotypes of lymphocyte subsets (CD4 + CD45RA+ CD62L+, CD8+ CD45RA+ CD62L+naive T cells; CD4+ CD45RO+, CD8+ CD45RO+ memory T cells), activated T lymphocytes (CD4+CD38 +, CD8 + CD38 + cells), and regulatory T cell ( CD4 + CD25 + Foxp3 + ). Blood samples collected at pre-and post-HAART4 weeks, 12 weeks, 24 weeks and used ELISA to detect IL-2, IFN-γ, IL-4, IL-10and IL-7 cytokine serum levels. Results The percentages of CD4 + and CD8 + naive T cells and mlemory T cells exhibited no significant differences at the baseline, 12 weeks, 24 weeks of HAART initiation between both groups, but CD4 + and CD8 + memory T cells were demonstrated a trend towards to increase while compared to baseline during HAART. The percentages of CD4 + and CD8 + activated T cells are significantly higher at the baseline while compared to normal control and demonstrated a downward trend, but between both groups showed no significant difference. The percentages of CD4 + regulatory T cell was lower in IRIS group than non-IRIS group at the baseline, 12 weeks, 24 weeks and the onset of IRIS. Th1 cytokines, IL-2 and IFN-γshowed an upward trend during HAART at the levels of IRIS group had significantly increased at 4 weeks and the onset of IRIS. Th2 cytokines, IL-4 and IL-10 showed a downward trend during HAART,and the levels of IL-10 in IRIS group had significantly decreased at 4 weeks and the onset of IRIS. IL-7 was higher than normal control at the baseline in two groups and showed a downward trend during HAART. The level of IL-7 was higher than non-IRIS group at all follow-up points. Conclusion Memory T cells appear rapid increase in the early stage of HAART and may play a significant role in the inflammatory response of IRIS. CD4 + and CD8 + naive T cells, memory T cells and activated T cells showed no significant difference between IRIS and non-IRIS group within 24 weeks after HAART started. There was a significant reduction in the frequency of regulatory T cells in IRIS group without obvious upward trend during HAART, suggesting that the immune suppression function of regulatory T cells in IRIS was impaired. IL-2 and IFN-γ significantly increased while IL-10 significantly decreased at 4 weeks post-HAART initiation and onset of IRIS in IRISgroup than non-IRIS group, suggested that IRIS was related to cytokines environment disorder. That is, a significant increase in inflammatory cytokines, while the relative lack of non-inflammatory cytokines. The level of IL-7 decreased gradually after HAART started, and it was higher in IRIS group when compared to non-IRIS group in the first 24 weeks after HAART started. Also IL-7 may play a role in the pathogenesis of IRIS.

Now the visiting physicians are usually trained without effective supervision and guidance mechanism.Since 2017,the Emergency Department of Peking University Third Hospital has adopted the training model under tutor system for visiting physicians.Tutors and visiting physicians are matched 1∶1.Personalized training program is made by tutors and visiting physicians depending on the level of the hospital where visiting physicians practice in,educational background,clinical experience,length and the goal of study.The training plan is refined according to the timeline in order to facilitate the tutor and training physician's own precise management.Since implementation of this training model,the visiting physicians say they are more efficient to complete the training program and learned more than before.The teaching ability of tutors has further been enhanced.