Objective To set up the quality standard of Shiwei Shujin Huoluo Powder. Methods Rhizoma Polygoni cuspidati and Cortex Cinnamomi, the main ingredients of the powder, were identified by thin layer chromatography ( TLC) , and the content of emodin in the powder was detected by high performance liquid chromatography (HPLC) . Results The spots showed by TLC were clear without interference of the negative control. HPLC results showed that linear range of emodin was 9.30 ~ 46.52 μg·mL-1, the recovery of emodin was 96.22%, and RSD was 1.76% ( N=6) . Conclusion The established method is reliable and accurate, and can be used for quality control of Shiwei Shujin Huoluo Powder.

Objective To explore the levels and the significance of IL-11 and soluble glycoprotein 130(sgp130) in the treatment of new-diagnosed acute leukemia(AL) during the induced remission. Methods The levels of IL-11 and sgpl30 in 47 patients with acute leukemia were determined by ELISA respectively before treatment and after completed remission(CR), and the number of white blood cell (WBC) and platelet (Plt) were valued by hametometry. Results Plasma IL-11 level of AL patients was significantly lower than normal (P ＜0.05), and increased obviously to the normal level when complete remission was achieved. And it correlated with PLT counts. While sgp130 level was higher than normal (P＜0.05),and declined after CR and correlated with WBC counts. Conclusion The plasma IL-11 and sgp130 levels can be helpful for confirming the diagnosis,evaluating the efficiency and predicting the prognosis of AL.

Objective To measure the present situation of medical students' learning adaptability and find the influencing factors in order to revise Learning Adaptability Scale for medical students.Methods A stratified sampling method was used to collect 1 180 medical students from Harbin Medical University.Using the internal consistency reliability test,the reliability of the revised student learning adaptability scale was verified.Five common factors were extracted by the exploratory factor analysis of the principal analysis method,and Logistic regression was used to analyze the influencing factors of medical student learning adaptability.Results The revised Student Learning Adaptability Scale (Cronbach's Alpha=0.914) consists of 27 measurement items.It includes five dimensions,namely self-directed learning,information utilization,environment choice,stresses response and goal orientation.The results showed that the adaptability of medical students was moderate (3.28 ± 0.52),and the influencing factors included job position (OR =1.496,95％ CI=1.114-2.009),academic achievement (OR =1.638,95 ％ CI=1.386-1.936),satisfaction with learning (OR=2.160,95％CI=1.745-2.673),professional satisfaction (OR=1.369,95％CI=1.092-1.718),professional interest (OR =1.426,95％ CI=1.186-1.715) and employment prospects (OR =1.526,95％ CI=1.251-1.862).Conclusion The reliability and validity of the Student Learning Adaptability Scale is appropriate.Medical students' learning adaptability is influenced by many factors.

Innovative self-efficacy is the degree of self-confidence in the individual's ability to per-form innovative activities. Although the theory of innovation self-efficacy is shorter, but as an important indicator of innovation ability measurement, it has been accepted by scholars in various countries, and innovative self-efficacy provides a new perspective for the cultivation of innovative talents. The research of innovation self-efficacy is still the initial stage. Chinese and foreign scholars have made some progress in measuring tools, antecedents, aftereffect and development, but there are still obvious differences and defi-ciencies,and the research results are not abundant.The future research will focus on the measurement tools, influencing factors and research direction of three aspects of systematic research to improve the theory of innovation self-efficacy.

Objective:To investigate the serotype distribution, drug resistance and the virulence gene profiles of clinical isolates of Salmonella in Zhejiang Province. Methods:A retrospective study of 463 clinical isolates of Salmonella in nine regions of Zhejiang Province from 2010 to 2017 was conducted. Their serotypes were detected using the Kauffmann-White scheme based on serological detection. Antibiotics susceptibility tests were carried out using K-B disk diffusion method. Eleven virulence genes were detected by polymerase chain reaction. Results:A total of 35 serotypes were identified among the 463 strains of Salmonella. The dominant serotypes were Salmonella typhimurium (41.90%(194/463)) and Salmonella enteritis (22.25%(103/463)). The resistance rate of Salmonella to ampicillin was the highest (66.52%(308/463)), followed by ampicillin/sulbactam (46.87%(217/463)), while low resistance rate to piperacillin/tazobactam was observed (3.24%(15/463)). All strains were sensitive to imipenem and meropenem. Finally, 188 strains (40.60%) of multi-drug resistance were found. The virulence genes hilA, ssrB, marT, siiD, sopB and pagN were found in all Salmonella strains. The virulence gene vexA was found only in Salmonella typhi and Salmonella Dublin; virulence gene icmF was mainly found in Salmonella enteritis. The virulence plasmid gene spvB and pefA were mainly found in Salmonella enteritidis and Salmonella typhimurium and invariably appeared in pairs. The virulence gene cdtB was mainly found in Salmonella typhi and Salmonella paratyphi A. Conclusions:Salmonella typhimurium and Salmonella enteritis are the main clinically isolated Salmonella strains in Zhejiang Province. The situation of multi-drug resistance is severe and a variety of virulence genes are highly detected.

AIM: To study the inhibitory and scavenging effects of ambroxol combined with levofloxacin on the bacterial biofilm of Klebsiella pneumoniae, and to provide a new strategy to treat and antagonize the formation of the biofilm. METHODS: We collected Klebsiella pneumoniae of different resistance and divided them into sensitive group (wild bacteria group), ESBLs group and CRKP group with 15 strains in each group and performed biological semi-quantitative detection of its biofilm by crystalline violet staining method. After selecting 3 strains with similar membrane yields from each group, we determined the minimum inhibitory concentration (MIC) of ambroxol and levofloxacin against Klebsiella pneumoniae by micro broth dilution method.In addition, we determined the effects of ambroxol in different concentrations on the MIC of levfloxacin by the micrdilution checkerboard techniques and calculated the partial inhibitory concentration index (FIC) to determine the joint effect and select the best synergistic concentration. Finally, the effects of ambroxol and levofloxacin in different concentrations on the inhibition formation test and removal test of Klebsiella pneumoniae biofilm were observed by crystal violet method combined with confocal laser scanning microscopy. RESULTS: We found that all three groups of bacterial biofilms became mature on the 5th day, and the sensitive group was easier to form and produce biofilm more than the ESBLs and CRKP groups (F=3.725, P=0.032). It was showed that the geometric average of levofloxacin MIC value in the three groups decreased significantly. And the selected strains all showed a synergistic effect on the two-drug combination.In the biofilm test, as the concentration of ambroxol increased, its inhibition rate reached more than 75%, but its biofilm removal rate did not reach 70%. CONCLUSION: Our study support that ambroxol combined with levofloxacin can inhibit the bacterial biofilm of Klebsiella pneumoniae early, and its optimal synergistic concentration is 0.49 mg/mL (ambroxol) + 4 μg/mL (levofloxacin).

AIM: Given the biofilm formation abili- ty of different ST-type Klebsiella pneumoniae, our study was aimed at exploring the inhibitory and clearance of azithromycin combined with levofloxacin on the biofilm of Klebsiella pneumoniae of different ST-types and providing a new strategy for the prevention of biofilm formation in the treatment of post-infectious Klebsiella pneumoniae. METHODS: 9 strains of Klebsiella pneumoniae from all susceptibility groups, 19 strains of Klebsiella pneumoniae producing extended-spectrum β - lactamases (ESBLs), and 37 strains of Carbapenem-resistant Klebsiella pneumoniae (CRKP) were randomly collected from the samples of patients hospitalized in the First Affiliated Hospital of Wannan Medical College from August 2019 to November 2021. The isolates were identified using VITEK MS IVD KB V3.2 and VITEK 2-Compact 60. Multilocus sequence typing (MLST) was performed to analyze the homology of each strain; crystal violet staining was used for semi -quantitative detection of biofilm to compare the differences in biofilm formation ability between different ST-type Klebsiella pneumoniae. Different ST-type strains were selected, and the partial inhibitory concentration index (FICI) was calculated by micro broth dilution method to judge the combination effect and select the optimal combination concentration; crystalline violet staining method was used to investigate the inhibition and clearance effect of azithromycin combined with levofloxacin on the biofilm of different ST-type Klebsiella pneumoniae; laser scanning confocal fluorescence microscopy was used to observe the structural changes of the biofilm of Klebsiella pneumoniae before and after the effect of the antibacterial drugs. RESULTS: MLST typing results showed that the sensitive group of Klebsiella pneumoniae strains had 8 sequences such as ST86, ST727, etc., the ESBLs group strains belonged to 14 sequence types such as ST15, ST37, ST11, etc., of which ST15 accounted for 26.32% (5 / 19). The CRKP group strains belonged to 9 sequence types such as ST11, ST15, ST656, etc., of which ST11 accounted for 48.65% (18/37), ST15 accounted for 27.03% (10/37); ST15 (ESBLs), ST11 (CRKP), ST15 (CRKP) type Klebsiella pneumoniae biofilms all reached maturity on the 5th day, the ST15 (ESBLs) group had a stronger ability to produce material to be membranous than the ST15 (CRKP) group. The ST11 (CRKP) group had a stronger ability to produce material to be membranous than the ST15 (CRKP) group (P<0.01); the results of azithromycin combined with levofloxacin drug sensitivity showed that it had an additive effect on different ST-type Klebsiella pneumoniae bacteria; in the inhibition of biofilm formation and clearance test, the 2×MIC azithromycin group and the combined concentration group had a stronger inhibition of biofilm formation of different ST-type Klebsiella pneumoniae bacteria, and the inhibitory ability of the combined group was better than that of the single-drug group, and the highest inhibition rate could reach 89.93%; the clearance effects were all combined drug group>azithromycin>levofloxacin, and the highest clearance rate was 44.79%. CONCLUSION: There are differences in biofilm formation ability between different ST-type Klebsiella pneumoniae, and azithromycin combined with levofloxacin has a better inhibitory effect on different ST-type Klebsiella pneumoniae biofilm, conbined application can be used in the treatment of biofilm infections early stage.

OBJECTIVE：To evaluate th e effectiveness ，safety and economy of albu min-bound paclitaxel （nab-PTX）in the treatment of breast cancer by using rapid health technology assessment （HTA），and to provide evidence-based reference for drug selection. METHODS ：Retrieved from PubMed ，the Cochrane Library ，CNKI，Wangfang database and other databases ，systematic evaluation/Meta-analysis，HTA and pharmacoeconomic studies about nab-PTX in the treatment of breast cancer were included ；the conclusions were classified and analyzed by using descriptive analysis. RESULTS ：A total of 5 systematic reviews/Meta-analysis ， 8 pharmacoeconomic studies were included in this study. Compared with conventional taxanes ，nab-PTX increased pathological complete response （pCR）rate [OR ＝1.39，95％CI（1.16，1.67），P＜0.001] and event-free survival （EFS）[HR＝0.69，95％CI（0.57， 0.85），P＜0.001] in neoadjuvant chemotherapy （NAC）-treated breast cancer patients. However ，there were no significant differences in overall survival （OS），progression-free survival （PFS），objective response rate （ORR）and disease control rate （DCR）in metastatic breast cancer （MBC）patients between 2 groups. In the terms of safety ，nab-PTX increased the incidence of grade 3-4 sensory neuropathy [OR ＝1.89，95％CI（1.36，2.61），P＜0.001] in MBC patients ，and increased the incidence of neutropenia [OR ＝ 1.52，95％CI（1.23，1.88，P＜0.001]，sensory neuropathy [OR ＝ 2.17，95％CI（1.38，3.40），P＜0.001]，rash [OR ＝1.46，95％CI mei1213@163.com （1.18，1.80），P＜0.001] and fatigue [OR ＝1.28，95％CI（1.04， 1.56）， P＝0.02] in NAC -treated breast cancer patients.Pharmacoeconomic studies showed that nab-PTX could improve the quality adjusted lif e years of MBC patients compared with traditional taxanes ，and it was a economical option. CONCLUSIONS：Nab-PTX enhances pCR in NAC-treated breast cancer patients ，but has no significant advantage in the effectiveness of MBC patients ，and increases the occurrence of ADR. Nab-PTX may have a cost-utility advantage over conventional taxanes for MBC.