OBJECTIVE To improve the efficiency and quality of dispensed oral drug management in the inpatient pharmacy， and ensure the safety of drug use in patients. METHODS SWOT （strength， weakness， opportunity， threat） analysis method was used to analyze the internal strengths and weaknesses， as well as the external opportunities and threats in the construction of a closed-loop management system for dispensed oral drugs in the inpatient pharmacy of our hospital， and propose improvement strategies. RESULTS & CONCLUSIONS A refined， full-process， closed-loop traceability management system for dispensed oral drugs in the inpatient pharmacies was successfully established， which is traceable in origin， trackable in destination， and accountable in responsibility. After the application of this system， the registration rate of dispensed drug information and the correctness rate of registration content both reached 100%. The proportion of overdue drug varieties in the same period of 2024 decreased by 77.78% compared to March 2020， the inventory volume decreased by 29.50% compared to the first quarter of 2020， the per-bed medication volume decreased by 32.14% compared to the first quarter of 2020； the average workload per post in the same period of 2023 increased by 49.09% compared to 2019， the dispensing accuracy rate reached 100%， and the improvement rate of quality control problem increased by 25.25% compared to 2021. This system effectively improves the safety and accuracy of dispensed oral drug management in the inpatient pharmacy.

The clinical data of one child with metanephric stromal tumor (MST) and BRAF V600E gene mutation admitted to the First Affiliated Hospital of Zhengzhou University in June 2022 was analyzed retrospectively.Literature was reviewed.The patient, a 2-year-old girl, was diagnosed with a tumor in the left abdomen.The maximum diameter of the tumor was 10.5 cm.A radical nephrectomy was performed on the left kidney, and postoperative pathology revealed MST.Microscopically, the tumor had no envelope and exhibited expansive growth.The tumor cells were fusiform or stellate, and nuclear division was visible in the cell-rich region.Dysplastic blood vessels were seen inside the tumor.The tumor cells around the blood vessels and invaginated renal tubules were arranged like onion skin.CD34 was detected positive by immunohistochemical staining, and BRAF V600E mutation was also detected positive by fluorescent polymerase chain reaction.A total of 21 relevant case reports were retrieved, including 16 in English and 5 in Chinese.Fifty-eight MST patients, including the one in this report were analyzed.These patients were aged 2 days to 15 years, with a median age of 2 years.Except for 2 patients with unknown sex, the ratio of male to female was about 1.4∶1.0.Most MST patients were asymptomatic, with an average tumor size of 5.3 cm.The tumor cell CD34 showed positive expression in different degrees.Eight patients received the BRAF V600E mutation detection, and the results were all positive.Fifty-eight patients underwent nephrectomy and were followed up for 0-156 months, of which 7 patients were assisted with radiotherapy and chemotherapy.During the follow-up, 1 patient died, and 1 patient had a relapse.MST is a rare benign renal stromal tumor. BRAF V600E mutations are detected in a variety of malignancies.This paper is the first to report MST with BRAF V600E mutation in China and points out the importance of molecular detection of BRAF mutation for accurate diagnosis of MST.

OBJECTIVE To analyze the impurities in cetirizine hydrochloride oral solution, and explore the existing problems of the production process, and provide a reference for improvement of the product quality. METHODS The related substances of 3 manufactures’ cetirizine hydrochloride oral solution were determined by HPLC. The main impurities were studied qualitively and quantitatively. The chromatographic separation was performed on a CAPCELL PAK C18 (4.6 mm×250 mm, 5 μm) column with a mixture of acetonitrile-water(17 : 83)(phosphoric acid adjusted to pH 1.5) and acetonitrile-water(35 : 65)(phosphoric acid adjusted to pH 1.5) as mobile phase by gradient elution. Detection wavelength was set at 230 nm. The confirmatory structure of the main impurities was determined by chromatography-mass spectrometry, the compatibility test between raw materials and pharmaceutical excipients was established to determine the pathway of impurities. The chromatographic separation was performed on an ACQUITY UPLC HSS-C18(150 mm×2.1 mm, 1.7 μm) column with 20 mmol·L–1 ammonium acetate(with 0.1% acetic acid)-methanol as mobile phase by gradient elution. RESULTS There might be 5 impurities in cetirizine hydrochloride oral solution. The two main related substances detected in cetirizine hydrochloride oral solution from 3 enterprises were cetirizine propylene glycol esters(a pair of diastereomers) and cetirizine glycerides(a pair of diastereomers). The emergence of impurities was highly relater to the formulation process. CONCLUSION The formulation technology of cetirizine hydrochloride oral solution need to be improved, and the active ingredients are incompatible with excipients. The related substances of cetirizine hydrochloride oral solution should be controlled from formulation design to improve the quality.

Objective:To analyze the status quo of intelligent health management services in health examination institutions in Shanxi Province.Methods:This study is a cross-sectional study. In October 2023, 292 health examination institutions in 11 cities of Shanxi Province were surveyed by convenient sampling with the help of “Questionnaire star” to investigate the health examination (management) institutions to carry out smart health management services from January to December 2022. It was mainly divided into three aspects: pre-inspection, in-inspection and post-inspection, including 6 dimensions, with a total of 21 items. A total of 300 questionnaires were distributed in this survey, and 292 were effectively collected, with an effective recovery rate of 97.33%. The 292 questionnaires were divided and compared according to four regions: the north of Shanxi Province, the middle of Shanxi Province, the south of Shanxi Province and the southeast of Shanxi Province.Results:The health examination (management) institutions were distributed in 11 prefectures and cities in Shanxi Province, and there were 56 (19.2%) tertiary health examination (management) institutions. There were 178 government organizations (61.0%) and 114 social organizations (39.0%). There were 256 (87.7%) that carried out smart health management services; among them, 229 (78.4%) had smart management service systems, and 58 (19.9%) had physical examination centers with smart health management clinics. A total of 108 institutions (36.99%) carried out follow-up visits after intelligent screening. The prevalence of intelligent referrals were 63.3%, 59.6%, 78.0% and 85.2% in the north of Shanxi Province, the middle of Shanxi Province, the south of Shanxi Province and the southeast of Shanxi Province, respectively ( χ2=14.02, P<0.05). The prevalence of self-service in the north of Shanxi Province, the middle of Shanxi Province, the south of Shanxi Province and the southeast of Shanxi Province were 39.2%, 52.3%, 62.0% and 37.0%, respectively ( χ2=9.75, P<0.05). Conclusions:The development of intelligent health management in health examination (management) institutions in Shanxi Province is good, and the service scale continues to grow, but the problem of uneven development among regions is severe. In addition, the proportion of institutions providing services through information technology is not high, and the rate of intelligent management outpatient service, intelligent post-examination follow-up and intelligent physical examination service satisfaction is low.

Objective:To explore the relationship between psychological capital, career decision-making difficulties, and employment anxiety among undergraduate nursing students, in order to help them improve their employability and mental health.Methods:From December 2022 to January 2023, a cross-sectional survey was conducted on 543 undergraduate nursing students from five medical colleges in Shanxi Province interning at the First Hospital of Shanxi Medical University, selected through convenience sampling method, using a General Information Questionnaire, Psychological Capital Scale, College Student Career Decision-making Difficulties Scale, and College Student Employment Anxiety Scale. Spearman correlation analysis was used to explore the relationship among them, and hierarchical model was used to explore the predictive ability of undergraduate nursing students ′ psychological capital and career decision-making difficulties on their employment anxiety by stratified regression analysis. Results:The score of College Student Employment Anxiety Scale of 543 undergraduate nursing students was 36(30, 44). The results of correlation analysis showed that employment anxiety was negatively correlated with psychological capital and its four dimensions (self-efficacy, hope, resilience and optimism), while employment anxiety was moderately correlated with career decision-making difficulties and its three dimensions (lack of preparation, difficulty in information exploration and conflict)( r values were -0.291 to 0.564, all P<0.05). The hierarchical model showed that psychological capital and career decision-making difficulties independently explained the 46.1% variation of employment anxiety after controlling the influence of general data. Conclusions:The score of employment anxiety of undergraduate nursing students is in the middle level, and the difficulty of career decision-making has a positive impact, while the psychological capital has a negative impact. College educators can continuously monitor the psychological capital and provide career development counseling for undergraduate nursing students through positive psychological intervention and effective management measures, so as to reduce the degree of employment anxiety of undergraduate nursing students.

Objective To establish a method for the determination of related substances in foscarnet sodium by HPLC.Methods The chromatography separation was performed on a CAPCELL PAK C18 chromatography column(250 mm×4.6 mm,5 μm)with mobile phase of a mixture of solution[Solution A:dissolve 3.2 g of sodium sulfate decahydrate in water,add 3 mL of glacial acetic acid and 6 mL of 0.1 mol·L-1 sodium pyrophosphate,dilute with water to 1 000 mL.Solution B:dissolve 3.2 g of sodium sulfate decahydrate in water,add 6.8 g of sodium acetate and 6 mL of 0.1 mol·L-1 sodium pyrophosphate,dilute with water to 1000mL.Solution A and Solution B(70∶30)(the pH of this mixture is about 4.4).To 1 000 mL of this solution add 0.25 g of tetrahexylammonium hydrogen sulfate and 100 mL of methanol]at a flow rate of 1.0 mL·min-1.The column temperature was 35℃.The detection wavelength was 230 nm and the injection volume was 50 μL.Results Under the chromatography conditions,the peaks of foscarnet sodium,impurityⅠ,impurity Ⅱ and other individual impurities were separated effectively.The foscarnet sodium and impurity Ⅱ showed good liner relationships(r=0.999 9)in the range of 5-248 μg·mL-1 and 1.6-9.1 μg·mL-1,respectively.The limits of detection(LODs)of foscarnet sodium and impurity Ⅱ were 23 ng and 62 ng respectively.The average recovery of impurity Ⅰ was 100.8%,RSD= 2.0%(n= 6).The average recovery of impurity Ⅱ was 98.6%,RSD=2.7%(n=12).Conclusion The method is simple,sensitive and accurate.It is suitable for the determination of related substances in foscarnet sodium.

Objective:To investigate the status of corneal epithelial remodeling and changes in corneal aberration after femtosecond laser-assisted laser in situ keratomileusis (FS-LASIK) and FS-LASIK combined with corneal collagen cross-linking (FS-LASIK Xtra), and to analyze the relationship between corneal epithelial thickness (CET) and corneal aberration.Methods:A cohort study was conducted.A total of 172 patients (172 eyes) who underwent FS-LASIK at Yinhai Eye Hospital of Chengdu University of Traditional Chinese Medicine were enrolled from June 2021 to February 2022.The 172 eyes were divided into FS-LASIK group (94 eyes) and FS-LASIK Xtra group (78 eyes) according to the surgical procedure, with a total follow-up of 6 months.The cornea was divided into a central 2-mm ring and a ring of 2-5 mm centered on the central cornea.CET at 9 regions in the central 0-5 mm area was measured by OCT before and at 1, 3 and 6 months after surgery, and the corneal higher-order aberration (HOA) was measured by the iTrace visual function analyzer.The main outcomes were the increase in CET (ΔCET), and corneal HOA at 6 months after surgery.The relationship between central corneal ΔCET and corneal aberration was analyzed.This study adhered to the Declaration of Helsinki.The study protocol was approved by the Ethics Committee of Yinhai Eye Hospital of Chengdu University of Traditional Chinese Medicine (No.2021yh-009). Written informed consent was obtained from each subject.Results:At 1, 3 and 6 months after surgery, the central, superior, superior nasal, nasal, inferior nasal, inferior, inferior temporal, temporal and superior temporal ΔCET were significantly smaller in FS-LASIK Xtra group than in FS-LASIK group (all at P<0.05). In FS-LASIK Xtra group, 6-month postoperative central, superior, superior nasal, inferior and inferior temporal ΔCET were significantly larger than those at 1 month after surgery, and 3- and 6-month postoperative temporal ΔCET were significantly larger than that at 1 month after surgery, and 6-month postoperative superior temporal ΔCET was significantly larger than those at 1 and 3 months after surgery (all at P<0.05). In FS-LASIK group, 3- and 6-month postoperative central, superior, inferior and inferior temporal ΔCET were significantly larger than those at 1 month after surgery, and 6-month postoperative superior nasal ΔCET was significantly larger than that at 3 months after surgery, and 6-month postoperative nasal, inferior nasal, temporal, superior temporal ΔCET were significantly larger than those at 1 and 3 months after surgery (all at P<0.05). There was no significant difference in vertical trefoil, vertical and horizontal coma changes at different time points after surgery between both groups (vertical trefoil: χ2group=4.27, P=0.118; χ2time=0.01, P>0.05.vertical coma: χ2group=5.74, P=0.057; χ2time=0.08, P=0.957.horizontal coma: χ2group=3.97, P=0.137; χ2time=0.51, P=0.773). The tilted trefoil changes at 1, 3 and 6 months after surgery of FS-LASIK Xtra group were significantly larger than those of FS-LASIK group (all at P<0.05). The 6-month spherical aberration change in FS-LASIK Xtra group was significantly higher than that at 1 month after surgery, and the 6-month spherical aberration change in FS-LASIK group was significantly higher than that at 1 and 3 months after surgery (all at P<0.05). The 6-month total HOA change in FS-LASIK group was significantly lower than that at 1 and 3 months after surgery (all at P<0.05). In FS-LASIK group, central corneal ΔCET was weakly positively correlated with spherical aberration at 1 and 6 months after surgery ( rs=0.257, P=0.008; rs=0.244, P=0.012), and was weakly positively correlated with total HOA ( rs=0.253, P=0.009; rs=0.279, P=0.004). Conclusions:The postoperative ΔCET after FS-LASIK Xtra is smaller than that after FS-LASIK, but the homogeneity of ΔCET in each region is similar between the two groups.The changes in corneal HOA after surgery are similar in both groups, and there is a certain association between the overall epithelial distribution and corneal aberration.

Objective:To construct a risk prediction model for infection with Klebsiella pneumonia (KP) for patients with severe acute pancreatitis (SAP).Methods:Retrospective analysis was done on the clinical data of 109 SAP patients who were admitted to Shanghai General Hospital, between March 2016 and December 2021. Patients were classified into infection group ( n=25) and non-infection group ( n=84) based on the presence or absence of KP infection, and the clinical characteristics of the two groups were compared. The least absolute shrinkage and selection operator (LASSO) algorithm was used to reduce the dimension of the variables with statistical significance in univariate analysis. A nomogram prediction model was created by incorporating the optimized features from the LASSO regression model into the multivariate logistic regression analysis. Receiver operating characteristic curve (ROC) was drawn and the area under curve (AUC) was calculated; and consistency index (C-index) were used to assess the prediction model's diagnostic ability. Results:A total of 25 strains of KP were isolated from 109 patients with SAP, of which 21(84.0%) had multi-drug resistance. 20 risk factors (SOFA score, APACHEⅡ score, Ranson score, MCTSI score, mechanical ventilation time, fasting time, duration of indwelling of the peritoneal drainage tube, duration of deep vein indwelling, number of invasive procedures, without or with surgical intervention, without or with endoscopic retrograde cholangiopancreatography (ERCP), types of high-level antibiotics used, digestion disorders, abnormalities in blood coagulation, metabolic acidosis, pancreatic necrosis, intra-abdominal hemorrhage, intra-abdominal hypertension, length of ICU stay and total length of hospital stay) were found to be associated with KP infection in SAP patients by univariate analysis. The four variables (APACHEⅡ score, duration of indwelling of the peritoneal drainage tube, types of high-level antibiotics used, and total length of hospital stay) were extracted after reduced by LASSO regression. These four variables were found to be risk factors for KP infection in SAP patients by multiple logistic regression analysis (all P value <0.05). Nomogram prediction model for KP infection in SAP was established based on the four variables above. The verification results of the model showed that the C-index of the model was 0.939, and the AUC was 0.939 (95% CI 0.888-0.991), indicating that the nomogram model had relatively accurate prediction ability. Conclusions:This prediction model establishes integrated the basic clinical data of patients, which could facilitate the risk prediction for KP infection in patients with SAP and thus help to formulate better therapeutic plans for patients.

Objective:To investigate the effect of T-lymphocyte and subpopulation counts on the prognosis of severe acute pancreatitis (SAP) patients.Methods:The clinical data of 90 patients with SAP diagnosed at the Shanghai General Hospital between January 2019 and June 2022 were retrospectively analyzed, and the patients were divided into good prognosis and poor prognosis group according to whether they were diagnosed for 28 d. The general information of the patients was recorded, including blood-related immunological indicators within 24 h of diagnosis, including leukocytes, neutrophils, lymphocytes, monocytes, CD 3+ , CD 4+ , CD 8+ T-lymphocyte count and CD 4+ /CD 8+ T-lymphocyte ratio, IgG4 level; blood inflammation index procalcitonin, albumin level and APACHEⅡ score at admission; survival and complication status of patients at 28 d of diagnosis. Non-parametric Mann-Whitney U test was used to analyze the correlation between each index and the prognosis of the patients. The subject operating characteristic curve (ROC) of patients was plotted, and area under curve (AUC) was calculated to assess the value of CD 3+ and CD 4+ T-lymphocytes in predicting the prognosis of SAP. Results:The majority of SAP patients were male (65.6%). The main cause of SAP was gallstone (56.7%), followed by hyperlipidemia (35.6%). At 28 days after diagnosis, 85(94.4%) patients survived, and 39 of them were cured and included in the good prognosis group. Forty-six cases were complicated with infection, multiple organ dysfunction syndrome (MODS) and local pancreatic complications, and 5 cases (5.56%) died; and a total of 51 cases were included in the poor prognosis group. Compared with the good prognosis group, the number of CD 3+ T-lymphocytes [366(268, 498) cells /μl vs 709(578, 999) cells /μl], CD 4+ T-lymphocytes [209(120, 298) cells /μl vs 486(303, 548) cells /μl] and albumin level (33.9 g/L vs 35.9 g/L) within 24 hours in the poor prognosis group were significantly lower, while the level of procalcitonin (1.02 ng/ml vs 0.43 ng/ml) and APACHEⅡ score [7(4, 10) vs 5(3, 8)] were significantly increased, and all the differences were statistically significant (all P value <0.05). ROC curve analysis showed that the AUC values for CD 3+ and CD 4+ T-lymphocyte counts within 24 hours for predicting poor prognosis of SAP were 0.857 (95% CI 0.696-1.000) and 0.867 (95% CI 0.708-1.000), respectively. The cut-off values were 524 cells /μl and 301 cells /μl, the sensitivity were both 85.7%, and the specificity were 78.6% and 85.7%, respectively. Conclusions:The significant decrease of peripheral blood CD 3+ and CD 4+ T-lymphocyte count within 24 h of SAP diagnosis has a certain predictive value for the prognosis of patients with SAP.

Objective:To evaluate the clinical efficacy of continuous renal replacement therapy (CRRT) with adsorptive filter oXiris in the treatment of severe acute pancreatitis (SAP).Methods:The clinical data of 5 SAP patients who received the treatment of absorptive filter oXiris in Department of Critical Care Medicine of Shanghai General Hospital from February 2021 to February 2022 were collected. The changes of inflammatory indicators, hemodynamics, acid-base balance indicators and organ function indicators were compared before and 24 h after treatment.Results:Before the treatment of oXiris, 3 patients had pancreatic necrotic infection, and all the five patients had systemic inflammatory response syndrome(SIRS), acute respiratory and circulatory failure and acute renal injury. At 24 h after the treatment with oXiris, the levels of inflammatory indicators such as white blood cell count [(13.4±5.0)×10 9/L vs (25.8±10.0)×10 9/L), CRP [(149.6±68.3)mg/L] vs (289.0±129.4)mg/L] and procalcitonin [3.7(1.4, 17.7)ng/ml vs 12.2(3.2, 62.9)ng/ml] in the blood samples from the patients were greatly decreased. Hemodynamics were obviously improved; heart rate [(107.4±9.5)bpm/min vs (143.4±9.7)bpm/min] was decreased, and the mean artery pressure [(87±5)mmHg vs (73±13)mmHg], 1 mmHg=0.133 kPa] tended to be stabilized. Metabolic acidosis was significantly improved; pH value (7.4±0.0 vs 7.2±0.1) and base excess (-2.1±2.5 vs -14.5±6.1) were increased, while lactic acid [(2.6±1.2)mmol/L vs (10.62±6.55)mmol/L] was decreased. Organ dysfunctions were improved; PaO 2/FiO 2 value (241.7±58.5 vs 115.9±53.6) was increased, while serum creatinine [(148.0±42.5)μmol/L vs (232.8±77.4)μmol/L], intra-abdominal pressure [(18.6±4.5)mmHg vs (24.2±4.0)]mmHg, modified Marshall score [3(3.0, 4.0) vs 6(5.5, 9.0)] and APACHEⅡ score (17.6±2.9 vs 26.0±5.2) were decreased. All the differences above were statistically significant (all P value <0.05). Conclusions:It is safe and feasible to treat SAP patients with CRRT by using oXiris in clinical practice, which may have the functions of clearing inflammatory mediators, stabilizing hemodynamics and acid-base balance and improving organ function.