Objective To investigate and analyze the usage of expensive outpatient prescriptions in different hospitals in Longgang area,Shenzhen,and to discuss and provide reference for the rational usage of expensive pre-scriptions.Methods Two primary hospitals,two secondary hospitals and one tertiary hospital in the Longgang area, Shenzhen,were chosen as the research targets.The expensive outpatient prescriptions,defined as the amount of pre-scription was over 150,200 and 300 yuan for primary,secondary and tertiary hospital respectively,were randomly selected and evaluated using international standards for the rational use of drugs.Results The average prescription items for primary,secondary and tertiary hospitals were 2.96,2.61 and 2.61.The largest proportions of prescription costs were 150 to 200 yuan,200 to 250 yuan and 300 to 350 yuan,which were respectively accounted for 49.6%, 56.6% and 37.7%.The frequency of using proprietary Chinese medicine,was 60.08%,68.18% and 41.62%respectively,which was not reasonable.The clinical diagnosis for the prescriptions of primary and secondary hospitals was mainly composed of trauma,bronchitis and vaginitis.The usage of drugs was not reasonable about the use of anti-biotics and infusion.In addition,the clinical diagnosis for the prescription of tertiary hospital was mainly diabetes, hypertension and cerebral infarction,where the abuse of using large dose of adjuvant drug was observed.Conclusion The frequency of using proprietary Chinese medicine is higher at all levels of hospital.In order to reduce the propor-tion of expensive prescription,the medicine institution should establish a sound system for drug use management and strengthen supervision and verification for western medicine physicians using proprietary Chinese medicine in their prescription.Furthermore,we should intervene and restrict the abuse usage of the adjuvant medicine.

Objective To examine the effects of benazepril and losartan on glomerular podocyte autophagy in aged spontaneously hypertensive rats (SHRs) and investigate the underlying mechanisms of renal-protective effects of angiotensin-converting enzyme inhibitors (ACEI)/angiotensin receptor blockers (ARB).Methods Wistar-Kyoto rats (WKYs) were used as the normal control (NORM) group (2 ml physiological saline per day).SHRs were randomly divided into 4 groups:the CTRL group (2 ml physiological saline per day),the ACEI group (10 mg · kg-1 · d-1),the ARB group (30 mg· kg-1 ·d-1) and the combined group (10 mg· kg-1 · d-1 benazepril and 30 mg· kg-1 · d-1),with six 18-month-old make rats in each group.The experiments were conducted during a 4-month period.Blood pressure was monitored regularly.At the end of the experiments,we measured the levels of urine protein,urine creatinine,serum creatinine (SCR),blood urea nitrogen (BUN),and serum and renal cortex angiotensin Ⅱ (AngⅡ).Ultrastructural changes in the kidney were examined under light and transmission electron microscopy.The expressions of nephrin,LC3BⅡ,Atg5 and p62 in the glomerulus were analyzed by Western blot analysis.Results After treatment,the blood pressure and the urine albumin/creatinine ratio of the four SHR groups were still significantly higher than those of the NORM group,but the blood pressure and the urine albumin/creatinine ratio of the ARB group and the combined group were significantly lower than those of the CTRL group (all P＜ 0.05);There were no significant differences in SCR and BUN levels among these five groups (P＞ 0.05);The level of serum AngⅡ of the combined group was significantly higher than that of the CTRL group [CTRL (0.08±0.00) μg/L,Combined (0.12±0.01) μg/L,P＜0.05];The levels of cortex AngⅡ of the four SHR groups were significantly lower than those of the NORM group,while the level of cortex AngⅡ of the ARB group was significantly higher than that of the CTRL group (all P＜0.05);Renal ultrastructural examination revealed shrunken glomeruli,fused or effaced epithelial cell foot processes,and focal atrophy of renal tubules in the four SHR groups.These pathological changes were more serious in the CTRL group but less so in the combined group.There were significantly more autophagosomes in the NORM group and the combined group than in the CTRL group (P＜0.05).Compared with the NORM group,the expressions of nephrin,LC3BⅡ,Atg5 and p62 in the CTRL group were suppressed significantly (P ＜ 0.05).The expressions of nephrin,LC3BⅡ and Atg5 in the ACEI group and the expressions of nephrin,LC3BⅡ,Atg5 and p62 in the ARB group and the combined group were higher than in the CTRL group (P＜0.05).Conclusions ACEI/ARB can decrease the autophagic activity of glomerular podocytes.The renal-protective effects of ACEI/ARB may be mediated by glomerular podocyte autophagy,which is induced by AngⅡ.

Objective To explore the predictive effect of depression and impulsivity on suicidal ideation in violent criminals.methods 423 violent criminals were assessed by Self-rating Idea of Suicide Scale(SIOSS),Patient Health Questionnaire (PHQ-9) and Barratt Impulsiveness Scale(BIS-11).Result sPeople with suicidal ideation accounted for 17.04% of the total number of violent criminals.The scores of the group with suicidal ideation (respectively (4.95±4.82),(56.79±8.68),(12.95±2.29),(19.03±3.91),(28.81±4.95)) were higher than those without suicidal ideation group (respectively (4.95±4.82),(56.79±8.68),(12.95±2.29),(19.03±3.91),(28.81±4.95)) in depression and every dimension of impulsivity(attentional impulsivity,motor impulsivity and non-planning impulsivity) (t=9.49,t=4.61,t=4.04,t=3.88,t=3.08) (all P<0.01).Positive correlation was observed between suicidal ideation,depression and impulsivity(r=0.156-0.628,P<0.01),while sleeping factor was not associated with non-planning impulsivity.According to the multi-factoral regression module,depression and nonplanning impulsivity scores had positive prediction on suicidal ideation(R2=0.419,SIOSS=-2.471+ 0.192× depression+ 0.149× nonplanning impulsivity).Conclusion There is a close relationship in suicidal ideation,depression and impulsivity,meanwhile depression and nonplanning impulsivity can predict the suicidal ideation.

Objective To study the changes of renal cortex angiotensin Ⅱ (AngⅡ) expression and podocyte autophagy in aging rats with normotension versus hypertension,to further investigate the possible mechanism of renal injury in hypertension during aging.Methods Normotensive Wistar-Kyoto-rats (WKYs) were allocated to three groups by age of 3-month-old group,13-month-old group,22-month-old group.Gender,age and number-matched spontaneously hypertensive rats (SHRs) served as controls.Blood pressure was monitored.Levels of urinary albumin,urinary creatinine,serum creatinine (SCR),blood urea nitrogen (BUN),Ang Ⅱ in serum and in renal cortex were detected.The kidney ultrastructural changes and podocyte autophagosomes were observed under light and transmission electron microscopy.Expressions of nephrin,LC3B Ⅱ,Atg5 and p62 in glomeruli were analyzed by Western blotting.Results Blood pressure was significantly higher in SHRs than in WKYs (P＜0.05).During aging from 3-month-old to 13-month-old and to 22 monthold group,the urinary albumin/creatinine ratio was increased significantly in SHRs with hypertension and in WKYs with normotension [WKY:(0.12±0.01) g/mmol,(0.14±0.04) g/mmol vs.(0.34± 0.05) g/mmol;in SHR:(0.29±0.04) g/mmol,(0.31±0.05) g/mmol vs.(0.72±0.16) g/mmol,P＜0.05],but SCR and BUN levels had no significant difference in SHRs and WKYs during aging (both P＞0.05).And Ang Ⅱ levels in both serum and renal cortex had no significant change in normotension group during aging three time points (both P＞0.05).An age-dependent decrease of Ang Ⅱ level in renal cortex appeared during aging three time points in hypertensive rats [SHR:(0.02 ±0.00) μg/L,(0.02±0.00) μg/L vs.(0.01±0.00) μg/L,P＜0.05],but serum level of Ang Ⅱ had no significant difference during aging three time points (P＞ 0.05) in hypertension group.The structural changes,including glomerulosclerosis,tubular atrophy and interstitial fibrosis were observed during aging three time points both in normotensive and hypertensive rats,but these pathological changes were more serious in hypertensive rats.Autophagosomes relatively accumulated in aging normotensive rats.The protein expressions of LC3B Ⅱ,Atg5 and p62 were increased in normotensive rats during aging (all P＜0.05).While the protein expressions of nephrin,LC3B Ⅱ,Atg5 and p62 were decreased in aging hypertensive rats (all P ＜ 0.05).Conclusions Ang Ⅱ expression level in renal cortex is decreased during aging in hypertensive rats.Podocyte autophagic activity is relatively decreased during aging in normotensive rats,but is relatively increased during aging in hypertensive rats.Ang Ⅱ-induced podocyte autophagy may be involved in the pathogenesis of renal injury in hypertension during aging.

Objective To investigate the impulsive traits and their influencing factors in different types of male inmates. Methods A total of 1 206 male inmates in Jiangsu province were assessed by a self-designed questionnaire of detailed criminal records,demographic data,history of substance use and Barratt Impulsiveness Scale (BIS-11).Results ①Significant differences were found between the distribution of age (F＝30.092),educational level(χ2＝84.479),marital status(χ2＝54.386),household registration(χ2＝34.959),smoking history (χ2＝19.047)and drug use history( χ2＝563.144) of male inmates( all P＜0.01).②Difference of impulsivity was found between different types of male inmates,and scores of the impulsivity of the property inmates (total impulsivity (55.92±8.39),attentional impulsiveness (12.70±2.35),motor im-pulsiveness (18.50± 3.88),non-planning impulsivity ( 24.72 ± 4.91)) were significantly lower than other crime types (P＜0.05).③Drug use history had a positive predictive effect on impulsivity of male violent in-mates (B＝4.317,P＜0.01),and educational level(B＝－3.280,P＜0.001),age(B＝－0.094,P＜0.05)and drug use history ( B＝ 3.491, P＜ 0.05 ) had a predictive effect on impulsivity of male property inmates. Conclusion The impulsivity of male property inmates is significantly lower than others and the influence factors of impulsivity among male inmates are age,educational level and drug use history.

Objective: To observe the effect of clean water perineum nursing in preventing urinary catheter-associated urinary tract infection. Methods: From October 2015 to October 2016, 160 patients with indwelling urinary catheter were selected from the first affiliated Hospital of Shantou University Medical College, ICU and neurosurgery ICU. According to the order of admission, the patients were randomly divided into experimental group and control group. A total of 80 patients in the experimental group received clean water perineal nursing, while 80 patients in the control group received routine perineum nursing with 0.5% iodophor. The incidence of urinary tract infection was compared between the two groups on day 3rd, 7th and14th after indwelling urethral catheter. Results: In the control group, the incidence of urinary tract infection on day 3rd, 7th and14th was 0, 1.3%(1/80) and 5.0%(4/80), respectively. In the experimental group, the incidence of urinary tract infection on day 3, 7 and 14 was 0, 2.5% (2/80) and 3.8%(3/80). The difference was not statistically significant (χ²=0.340, 0.149, P> 0.05). Conclusions Using clean water perineum nursing does not increase the incidence of urinary tract infection. This method is simple, effective, and has no adverse reactions. It is worth popularizing in clinic because it can reduce the consumption of iodophor disinfectant and reduce the workload of nurses.

Objective:To investigate the therapeutic value of modified multipoint drainage for biliary complications after liver transplantation.Methods:A total of 125 patients treated by endoscopic retrograde cholangiopancreatography (ERCP) for biliary complications after liver transplantation in Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine from May 2018 to May 2020 were enrolled. Patients were divided into endoscopic retrograde biliary drainage (ERBD) group ( n=67, treated with multiple drainage of bile duct stent) and modified multipoint drainage group [ n=58, treated with ERBD combined with endoscopic nasobiliary drainage (ENBD)] by random number table. Modified multipoint drainage group were further randomly divided into two groups, modification group 1, 31 cases, where nasobiliary ducts were cut proximal to duodenal papilla after one week under endoscopy and modification group 2, 27 cases, where they were cut proximal to duodenal papilla after two weeks under endoscopy. The changes of serological indexes in 2 weeks after the operation in three groups were compared, and the incidence of short-term and long-term complications were analyzed. Results:The serological indexes were improved in patients at 1 d, 7 d and 14 d after ERCP, especially in modified multipoint drainage groups. Two weeks after the operation, the improvement of serological indexes in modification group 2 was better than that in modification group 1. Incidence of recent complications including cholangitis, hyperamylasinemia, and pancreatitis in the ERBD group were higher than those in modification group 1 [32.84% (22/67) VS 12.90% (4/31), 46.27% (31/67) VS 19.35% (6/31), 20.90% (14/67) VS 3.23% (1/31), all P<0.05] and modification group 2 [32.84% (22/67) VS 11.11% (3/27), 46.27% (31/67) VS 22.22% (6/27), 20.90% (14/67) VS 3.70% (1/27), all P<0.05]. ERBD group had a higher incidence of long-term complications including recurrent biliary infection and jaundice than modification group 1 [ 58.21% (39/67) VS 35.48% (11/31), P=0.036; 49.25% (33/67) VS 25.81% (8/31), P=0.027] and modification group 2 [58.21% (39/67) VS 11.11% (3/27), P<0.001; 49.25% (33/67) VS 25.93% (7/27), P=0.038]. The incidence of recurrent biliary infection in modification group 1 was higher than that in modification group 2 [35.48% (11/31) VS 11.11% (3/27), P=0.030]. Conclusion:Multiple drainage with indwelling nasal bile duct by ERCP can effectively reduce the short-term and long-term complications and improve the recovery of serological indexes for patients with biliary complications after liver transplantation. It is suggested that the nasobiliary duct should be retained for 2 weeks and then transformed into a built-in tube to continue drainage.

Objective:To investigate the characteristics of 18F-DCFPyL PET/CT imaging in castration-resistant prostate cancer (CRPC) patients with different PSA levels. Methods:The imaging and clinical data of 50 patients with CRPC who underwent 18F-DCFPyL PET/CT examination in Chinese PLA General Hospital from January 2018 to December 2020 were analyzed retrospectively. The average age was 72 (54-95) years old. Serum total PSA was 92.28(0.36-2000.00) ng/ml. According to the total PSA level, the patients were divided into low PSA group(total PSA ≤ 1 ng/ml, n=9), medium PSA group (1 ng/ml10ng/ml, n=23). According to the standardized evaluation standard of molecular imaging, the suspicious tumor lesions on 18F-DCFPyL PET/CT imaging were scored by molecular imaging PSMA(miPSMA), and the miPSMA score ≥2 was defined as positive lesions. According to the number of lesions displayed by 18F-DCFPyL PET/CT, patients were divided into oligofocal group (the number of lesions ≤3) and multiple lesions group (the number of lesions >3). The imaging characteristics of patients in different groups were summarized. Results:The 18F-DCFPyL PET/CT imaging results of 50 cases in this study were all positive, including oligofocal group (n=27) and multiple lesions group (n=23). Of the 30 patients with unresected prostate, 18 had local recurrence of the prostate, while the other 12 patients with unresected prostate and 20 patients with resected prostate had no signs of local recurrence. The oligofocal group showed local recurrence, regional lymph node metastasis or bone metastasis. Patients with multiple lesions showed multiple lymph nodes and/or bone metastasis with or without local recurrence. There were 9, 18 and 4 patients with oligofoci in low, middle and high PSA groups, respectively.There were 27 patients in the oligonucleogenous group, and 21 of the 22 patients receiving local treatment were effective. All 3 patients treated with systemic treatments were effective. PSA progressed in 2 untreated patients. In the multi-foci group of 23 patients, 6 of 9 patients treated with abiraterone were effective. Two patients treated with enzalumide were ineffective. One of the 4 patients with chemotherapy was effective. One of the two patients treated with 177 Lu-PSMA nuclide was effective. One case did not respond to treatment with 89SrCl 2. Radiotherapy failed in 2 cases. PSA progressed in 3 untreated patients. Conclusions:18F-DCFPyLPET/CT imaging has a high detection rate of lesions in patients with CRPC and has potential guiding significance for follow-up treatment. The number of lesions in CRPC patients with different PSA levels was different, and the patients with low PSA levels were mainly oligofoci.