Amid the progress of public hospitals reform,the paper probed into the influences and opportunities of the health reform on the development the hospital pharmacy.They discussed the roles of pharmacists in medical service,and recommended on building the pharmaceutical service system in view of the current caliber of the pharmacists.

Objective To investigate postoperative psychological experiences of patients underwent kidney transplant donated by his/her parent,and to discover mental signs and psychological journey in individual growth.Methods Semi-structured in-depth interviews were conducted among 17 patients underwent kidney transplant donated by his/her parent,and Giorgi analysis method was used to analyze data.Results The postoperative psychological experiences of patients mainly contained 4 aspects:posttraumatic growth,rebuilding meaning of life,being grateful for experience,coexisting of hope and challenge.Conclusion The patients have complex psychological experiences,having positive aspects derived from rehabilitation and improved quality of life,as well as negative aspects derived from concerning health of the donor,fear for complication and rejection,and lack of sound supporting system.Medical staff should guide patients to adjust cognitive and behavioral patterns and face life events directly,integrate medical/social support resources and enhance patients' psychological capital to face future life.

Objective To assess the effects of Jinghou Zengzhi Recipe(JHZZR),a Chinese prescription with the action of tonifying Qi and blood ,on the ovary apoptosis and expression of Bim in ovarian granulosa cells (GCs) of controlled ovarian hyperstimulation(COH) rats , and analyze the possible therapeutic mechanism. Methods A model of COH rats were prepaered and 30 female SD rats were randomly divided into 5 groups , including control group,positive control group,low,medium and high concentration group in six rats in each group. The apoptosis index(AI)in ovarian GCs were detected by TUNEL ,and the expression of Bim by qPCR. Results The AI of ovarian GCs in high and medium concentration group were obviously lower(P < 0.05)than that in the positive control group,and there is no significant differences(P > 0.05)comparing with control group. The mRNA levels of Bim were lower(P<0.05)in all concentration group than those in positive control group ,but still higher(P<0.05)than that in control group. And there is no significant differences(P>0.05)during the three concentration groups in Bim mRNA. Conclusion JHZZR can inhibit the ovarian GCs apoptosis of COH rats through decreasing the expression of Bim mRNA ,which improve the quality of ovarian follicle.

Objective To compare the efficacy of laryngeal mask airway Guardian (GLMA) and laryngeal mask airway Supreme (SLMA) in patients undergoing gynecological surgery. Methods One hundred and twenty ASA Ⅰ or Ⅱ patients aged 19-80 yr weighing 50-70 kg undergoing gynecological surgery were randomly divided into 2 groups: SLMA group (group S, n = 59) and GLMA group (group G, n =61). LMA was inserted after induction of anesthesia with propofol 2.0-2.5 mg/kg, sufentanil 0.2 μg/kg and rocuronium 0.6 mg/kg. All the patients were mechanically ventilated. BP, HR, SpO2, PETCO2 and Ppeak were monitored during operation. The rate of successful placement, placement time, fiberoptic bronchoscope grade, airway sealing pressure, airway pressure during normal ventilation with tidal volume of 8 ml/kg, airway pressure and air leakage during ventilation with large tidal volume of 20 ml/kg, air leakage during opertion, complications, anesthesia time, duration of surgery, extubation time and emergence time were recorded. Results There was no significant difference in the rate of successful placement, placement time, airway pressure during normal ventilation and during ventilation with large tidal volume, blood stain at LMA removal, incidence of sore throat, choking hoarseness and dysphagia, anesthesia time, duration of surgery, extubation time, and emergence time between the two groups (P ＜ 0.05). The BP,HR, SpO2, Ppeak and PETCO2 were within the normal range during operation in both groups. The fiberoptic bronchoscope grade and airway sealing pressure were significantly higher, and the incidence of air leakage during ventilation with large tidal volume and during operation was significantly lower in group G than in group S (P ＜ 0.01).Conclusion GLMA and SLMA can provide adequate ventilation during operation with fewer complications and can be used effectively for gynecological surgery. The efficacy of GLMA is better.

PURPOSE: To explore whether there is matching relation between the length and the tilting angle of terminal implants in the All-on-Four protocol by studying the effects of different implant configurations on stress distributions of implant, bone, and framework. MATERIALS AND METHODS: Four implants were employed to support a full-arch fixed prosthesis and five three-dimensional finite element models were established with CT images, based on the length (S and L) and distal tilt angle (0degrees, 30degrees and 45degrees) of terminal implants for an edentulous mandible, which named: Tilt0-S, Tilt30-S, Tilt30-L, Tilt45-S and Tilt45-L. An oblique 240 N was loaded at second molar. The von Mises Stresses were analyzed. The implants were consecutively named #1 to #4 from the loading point. RESULTS: 1) Tilt0-S had the greatest stress on the implants, with the other groups exhibiting variable reductions; the four implants of Tilt45-L demonstrated the greatest reduction in stress. 2) Tilt0-S had the greatest stress at bone around #1 implant neck, and Tilt45-L exhibited the least stress, which was a 36.3% reduction compared to Tilt0-S. 3) The greatest stress in the framework was found on the cantilevers distal to #1 implant. Tilt45-S exhibited the least stress. CONCLUSION: Matching different length and tilting angle of the terminal implants led to variable stress reductions on implants, bone and the superstructure. By optimizing implant configuration, the reduction of stress on implants and surrounding bone could be maximized. Under the present condition, Tilt45-L was the preferred configuration. Further clinical testings are required.
Finite Element Analysis* ; Mandible ; Molar ; Neck ; Prostheses and Implants

Objective To systematically review the efficacy and safety of denosemab and zoledronic acid in patients with solid tumors bone metastases and multiple myeloma.Methods Pubmed,Embase,Cochrane Library,Web of Science,CNKI,WanFang Data and VIP databases were electronically searched for randomized controlled trials(RCTs)related to denosemab and zoledronic acid in the solid tumors bone metastases and multiple myeloma from inception to November 21,2023.Two reviewers independently screened literature,extracted data and assessed the risk of bias of included studies,and Meta-analysis was performed by using RevMan 5.3 software.Results A total of 5 RCTs,involving 8 957 patients were included.The results of Meta-analysis showed that denosumab was effective in delaying the time to first bone-related event(SRE)(HR=0.85,95％CI 0.80 to 0.92,P＜0.001)and the time to first and subsequent SRE time(HR=0.87,95％CI 0.79 to 0.96,P=0.004)were superior to zoledronic acid.Denosumab had lower incidence of nephrotoxicity(RR=0.70,95％CI 0.58 to 0.85,P＜0.001),acute phase response(RR=0.46,95％CI 0.40 to 0.51,P＜0.001),anemia(RR=0.91,95％CI 0.85 to 0.98,P=0.008)and appetite decreased/anorexia(RR=0.89,95％CI 0.81 to 0.98,P=0.02),but the incidence of hypocalcemia was higher(RR=1.72,95％CI 1.49 to 1.99,P＜0.001).There were no significant differences between denosumab and zoledronic acid in terms of overall survival,time to disease progression,incidence of adverse events and serious adverse events(P＞0.05).Conclusion Current evidence shows that compared with zoledronic acid,denosemab can significantly delay SREs induced by solid tumors bone metastases and multiple myeloma.In terms of safety,the risk of denosemab-induced nephrotoxicity,acute phase reactions,anemia and decreased appetite/anorexia are lower,but the risk of denosemab-induced hypocalcemia is higher.

Objective To study the effect of implant number and inclination on stress distribution in implant and its surrounding bone with three-dimensional finite element analysis.Methods A special denture was made for an edentulous mandible cast to collect three-dimensional finite element data.Three threedimensional finite element models were established as follows.Model 1∶6 paralleled implants; model 2∶4 paralleled implants; model 3∶4 implants,the two anterior implants were parallel,the two distal implants were tilted 30° distally.Results Among the three models,the maximum stress values found in anterior implants,posterior implants,and peri-implant bone were modle 3 ＜ modle 1 ＜ modle 2 in turn.The effect of implant numbers on stress distribution was as follow:the maximum stress value of the anterior and posterior implant,and the peri-implant bone of model 2 were 126.8,267.4,and 40.0 MPa,which was 35.8％,3.8％ and 7.8％ higher than those in model 1 (93.4,257.7,37.1 MPa) respectively.The impact of implant inclination on stress distribution was as follow:when the distal implant titled 30° in model 3,the maximum stress value of the anterior and posterior implant,and the peri-implant bone were 82.0,239.5 and 28.7 MPa,which was 35.4％,10.5％ and 28.2％ lower than those in model 2 respectively.Conclusions Within the limitation of this study,when implants are placed parallel,the maximum stress of the distal implant can be reduced by increasing the number of implant.When the number of implant was decreased from six to four,the maximum stress around the implant can be reduced by tilting the distal implant.This design will provide a better prostheses effect than the design with six implants does.

Objective:To explore the effect of immersive mindfulness travel system in patients undergoing breast biopsy.Methods:This study adopted a randomized controlled study design. From February to July 2022, convenience sampling was used to select 94 patients who underwent breast biopsy in the Breast Surgery of Beijing Hospital as the research subject. The patients were randomly divided into an experimental group and a control group by segmented randomization, with 47 cases in each group. The experimental group implemented the immersive mindfulness travel system model, while the control group patients wore headphones to listen to light music and received verbal comfort and support. We compared the anxiety, fear scores and satisfaction with nursing services between two groups of patients.Results:There was a statistically significant difference in the scores of the State-trait Anxiety Inventory and the modified Surgical Fear Questionnaire for Breast Biopsy Patients between the two groups of patients before and after intervention ( P<0.05). The satisfaction score of nursing services in the experimental group was higher than that in the control group, and the difference was statistically significant ( P<0.01) . Conclusions:Immersive mindfulness travel system makes up for some deficiencies of existing intraoperative virtual reality intervention. It is superior to light music therapy in alleviating intraoperative anxiety and fear of breast biopsy patients and improving nursing service satisfaction, and has good clinical application prospects.

Objective:To investigate the effect of salvianolic acid on depressive behavior in depression model rats induced by chronic mild stress (CMS) and its mechanism.Methods:Fifty healthy male clean grade Sprague-Dawley(SD) rats were divided into five groups according to a random number table with 10 in each group: control group (nCMS+ Nal group), CMS+ normal saline group (CMS+ Nal group), CMS+ fluoxetine group (CMS+ Flu group), CMS+ salvia acid group (CMS+ Sal group), CMS+ fluoxetine+ Salvia acid group (CMS+ Flu+ Sal group). Except the control group, the rats in the other four groups were all received CMS modeling for 21 days. Twenty-one days after CMS modeling, rats were intraperitoneally injected with 0.9% normal saline (10 mg·kg -1·d -1), fluoxetine (20 mg·kg -1·d -1), salvia acid(40 mg·kg -1·d -1), fluoxetine(20 mg·kg -1·d -1)+ salvia acid(40 mg·kg -1·d -1)for 21 days. During the administration period, rats in the other four groups continued to receive CMS intervention for 21 days. Forced swimming test and sucrose preference test were conducted at baseline (day 0), after modeling (day 21) and after intervention (day 42) so as to evaluate depression like behavior. Then the rats were sacrificed and the hippocampus and prefrontal cortex were taken. The mRNA levels of Toll like receptor 4 (TLR4) and myeloid differentiation primary response 88 (MyD88) were detected by RT-qPCR. The cytokines including interleukin-1β(IL-1β), interleukin-2(IL-2), interferon-γ (IFN-γ) and tumor necrosis factor-α (TNF-α) were detected by Luminex technique.SPSS 21.0 was used for statistical analysis.Repeated measurement ANOVA was used for behavioral data analysis, one-way ANOVA was used for molecular index data analysis, and Spearman was used for correlation analysis. Results:The results of repeated measurement ANOVA showed that the interaction effects between group and time of body mass, sucrose preference, forced swimming immobility time were significant at baseline, after modeling and after intervention ( F=18.238, 6.921, 7.591, all P<0.05). After modeling, compared with nCMS+ Nal group, the rats in CMS+ Flu group, CMS+ Sal group, CMS+ Flu+ Sal group and CMS+ Nal group had lower body weight, lower sucrose preference rate and longer forced swimming immobility time (all P<0.05). After intervention, compared with CMS+ Nal group(body weight (350.15±41.65)g, sucrose preference(52.95±11.13)%, static time(91.40±15.22)s), the body weight((378.21±30.78)g, (385.12±43.19)g, (391.41±31.21)g, (402.33±18.67)g, all P<0.05) and sucrose preference((69.30±15.56)%, (68.12±10.99)%, (71.18±9.51)%, (75.47±11.55)%, all P<0.05) of CMS+ Flu group, CMS+ Sal group, CMS+ Flu+ Sal group and nCMS+ Nal group were all increased, while the forced swimming immobility time ((68.81±21.74)s, (66.10±25.51)s, (63.53±22.32)s, (71.21±21.41)s, all P<0.05) were shorter (all P<0.05). After intervention, among the body weight, sucrose preference and the immobility time of CMS+ Flu group、CMS+ Sal group and CMS+ Flu+ Sal group, there were no differences between each two groups(all P>0.05). After intervention, the levels of TLR4 mRNA and MyD88 mRNA in prefrontal cortex and hippocampus of CMS+ Flu group, CMS+ Sal group, CMS+ Flu+ Sal group and nCMS+ Nal group were all lower than those in CMS+ Nal group (all P<0.05). In prefrontal cortex, the levels of TLR4 mRNA (0.715±0.358) and MyD88 mRNA (0.739±0.233) in CMS+ Flu+ Sal group were lower than those in CMS+ Sal group (1.943±0.606, 1.815±0.897) (both P<0.05). The level of TLR4 mRNA in prefrontal cortex and hippocampus of rats were positively correlated with the level of MyD88 mRNA and TNF-α level and forced swimming immobility time and negatively correlated with sucrose preference rate (prefrontal cortex r=0.915, 0.041, 0.027, -0.178, all P<0.05; hippocampus r=0.810, 0.070, 0.011, -0.153, all P<0.05). Conclusion:The antidepressant effect of salvianolic acid is presumedly achieved by inhibiting the immunoinflammatory response mediated by the TLR4/Myd88 signaling pathway in CMS rats.

Objective: To explore the application of the 3D precise digital technology in restoring structural defects of the orbital region. Methods: Structural defects of the orbital region concerning on osseous structure and soft tissue were restored in one stage or stages using EH composite artificial bone prosthesis with complex three-dimensional structure. The fabrication of EH composite artificial bone prosthesis was based on CT scanning and 3D reconstruction of the skull with computer aided data analysis and design. The appearance, degree of satisfaction and the complications were evaluated in postoperative regular follow-up. Results: Five cases of structural defects in the orbital regions presenting bone defect and soft tissue abnormality, received treatments in the department from January 2016 to September 2017. The cases consist of one patient with dysplasia following surgical treatment, three with post-traumatic and one with Treacher-Collins syndrome. With the application of individualized EH composite artificial bone fabricated by aforementioned method, all the repair materials presented the ideal three-dimensional structure and coincided well with the defects, and soft tissue restoration of 2 cases was performed in one stage or by stages. Appearance and symmetry of the 5 cases was significantly improved, without complications of infection, rejection, exposure or graft tissue necrosis. All the patients were satisfied with the results. Conclusions In consideration of the capacity to fabricate accurate individualized repair materials, the three-dimensional digital technology plays an important role in the treatment of structural defects in the orbital region, especially the reconstruction of the bony contour. The simple orbital deformities can be treated with the repair materials and correction of soft tissue. For special orbital deformities, attention should be paid to bone structure repair, eye socket reconstruction and filling of orbital contents sequentially.