OBJECTIVE:To prepare risperidone injectable biodegradable implants and study its in vitro release. METHODS: Polylactide-co-glycolide copolymer(PLGA)was chosen for carrier and N-Methyl pyrolidone(NMP)as solvent to prepare risperidone injectable biodegradable implants. The percentage of accumulative drug release within 30 days,the change in molecular weight of copolymer and superficial opening diameters of copolymer in function time were observed. RESULTS:Drug release curve of risperidone injectable biodegradable implants for 30 days was stable with small burst. The percentage of accumulative drug release was 89.01% and the percentage of burst accounted for 13.8% at the first 24 hours. The average molecular weight of copolymer decreased to about 10 000 from 43 000 after 30 days and the size of the superficial openings became larger and larger. CONCLUSION:Risperidone injectable biodegradable implants can release continuously and stably in vitro for 30 days.

Objective To investigate the diagnostic value of EUS with miniprobe on upper gastrointestinal tract mesenchymal tumor(GIMT).Methods The EUS features of 38 patients with GIMT who underwent EUS with miniprobe were studied retrospectively,and the results were compared with the postoperative pathological findings.Results Among 38 GIMT cases detected by EUS,there were 25 cases of gastrointestinal stromal tumor,11 cases of leiomyoma,and 2 cases of leiomyosarcoma.Postoperative histopathological and immunohistochemical examinations confirmed 28 cases of stromal tumor.In which 6 cases were high-risk GIST,8 cases were leiomyoma,1 case was leiomyosarcoma,and 1 case was neurofibroma.The accuracy of diagnosis with EUS was 89%.Conclusion EUS is an accurate method in diagnosis of submucosal tumors,which can make better differentiation diagnosis between GIMT and other submucosal tumors.

Objective To evaluate the effects of different doses of dexmedetomidine on median effective end-tidal concentration of sevoflurane (EC50) inhibiting responses to tracheal intubation in pediatric patients.Methods Sixty-seven ASA physical status Ⅰ or Ⅱ patients,aged 3-8 yr,with body weight not exceeding 150％ of the ideal weight,scheduled for elective surgery under general anesthesia,were randomly divided into 3 groups using a random number table:control group (group C,n =22) and different doses of dexmedetomidine groups (group D1,n =23 ; group D2,n =22).Before induction of anesthesia,dexmedetomidine 1.0 and 2.0 μg/kg was infused intravenously over 10 min followed by infusion at a rate of 0.5 and 1.0 μg·kg-1 ·h-1 in D1 and D2 groups,respectively.Anesthesia was induced with inhalation of 5 ％ sevoflurane.After eyelash reflex disappeared,the end-tidal sevoflurane concentration was adjusted to achieve the target concentration and maintained at this level for 15 min.Tracheal intubation was then performed and the response to intubation was scored.The initial end-tidal sevoflurane concentration was 3.5％,2.5％ and 1.5％ in C,D1 and D2 groups,respectively.Up-and-down sequential trial was used to determine the EC50.Each time the concentration of sevoflurane increased/decreased in the next patient depending on whether or not the response to intubation was positive.The positive response to intubation was defined as intubation score ＞ 1.The ratio of concentrations between the two consecutive patients was 1.2.The EC50 and 95％ confidence interval of sevoflurane were calculated.The development of adverse cardiovascular events was recorded after dexmedetomidine administration.Results The adverse cardiovascular events were not observed in D1 group.The incidence of hypotension and brachycardia was 14％ and 9％ in D2 group.The EC50 (95％ confidence interval) of sevoflurane was 3.54％ (3.39％-3.69％),2.37％ (2.24％-2.46％) and 1.41 ％ (1.37％-1.46 ％) in C,D1 and D2 groups,respectively.Compared with group C,the EC50 of sevoflurane was significantly decreased in D1 and D2 groups (P ＜ 0.01).Compared with group D1,the EC50 of sevoflurane was significantly decreased in group D2 (P ＜ 0.01).Conclusion The optimum dose of dexmedetomidine is 1.0 μg/kg (loading dose) and 0.5 μg· kg-1 · h-1 (maintenance dose) when combined with sevoflurane for induction of anesthesia in pediatric patients.

Two hundred and fourteen patients with non-ST-segment elevation acute coronary syndrome (NSTEACS) underwent percutaneous coronary intervention (PCI).Serum ischemic modified albumin (IMA) levels were measured in patients at admission.The major adverse cardiac events (MACE),including cardiac death,nonfatal myocardial infarction (MI) and recurrent ischemia leading to urgent revascularization were observed during 1-y period of follow-up.Receiver operating characteristic (ROC) curves,Kaplan-Meier analysis and Cox regression were used to assess the prognostic value of IMA for 1-y MACE.Twenty one patients experienced major adverse cardiac events during 1-y follow up period,including 6 cases of cardiac death,8 cases of new or recurrent MI,7 cases of target vessel/lesion revascularization or coronary artery bypass grafting (CABG).ROC showed that the area under the ROC curve (AUC) was 0.667,and when IMA was used to predict 1-y major adverse cardiac events,the cut-off value of 65.3 kU/L was most effective.Kaplan-Meier analysis showed that IMA was significantly correlated with the occurrence of 1-y MACE(P ＜ 0.01).But Cox regression model showed that IMA levels were not independent risk factor for 1-y MACE in NSTEACS patients,when adjusted with other risk factors.

Cell senescence is a basic cell response triggered by various stimuli and is a basic characteristic of living organism. Liver fibrosis refers to the pathological process of diffuse excessive deposition of extracellular matrix in the liver caused by abnormal proliferation of connec-tive tissue due to various pathogenic factors and can progress to liver cirrhosis and liver cancer. Studies have shown that cell senescence is closely associated with the progression of liver fibrosis. This article reviews the regulatory effect of different types of cell senescence on liver fibrosis.

ObjectiveTo investigate the effect and significance of cyclooxygenase-2 (COX-2) inhibitors on the expression of the Acsl gene family in the ileum of rats with nonalcoholic fatty liver disease (NAFLD). MethodsA total of 45 Sprague-Dawley rats were randomly divided into normal control group (15 rats given normal diet), NAFLD model group (15 rats given high-fat diet), and nimesulide group (15 rats given high-fat diet and nimesulide). All rats were sacrificed after 12 weeks of feeding, and then blood samples were collected from the inferior vena cava to measure total cholesterol (TC) and triglyceride (TG). HE staining and oil red O staining were performed for the liver to evaluate the degree of hepatic steatosis in each group, and quantitative real-time PCR was used to measure the mRNA expression of the Acsl family genes in the ileum. An analysis of variance was used for comparison of continuous data between multiple groups, and the least significant difference t-test was used for further comparison between two groups. ResultsCompared with the normal control group, the NAFLD model group had significant increases in serum TC and TG and marked hepatic steatosis (all P＜0.05); compared with the NAFLD model group, the nimesulide group had significant reductions in serum TC and TG and degree of hepatic steatosis (all P＜0.05). Compared with the normal control group, the NAFLD model group had a significant increase in the expression of COX-2 in the ileum (P＜0.05), and compared with the NAFLD model group, the nimesulide group had a significant reduction in the expression of COX-2 in the ileum (P＜005). Compared with the normal control group, the NAFLD model group had significant increases in the mRNA expression of Acsl3 and Acsl5 in the ileum (both P＜0.05), and compared with the NAFLD model group, the nimesulide group had significant reductions in the mRNA expression of Acsl3 and Acsl5 (both P＜0.05). ConclusionThe COX-2 inhibitor nimesulide can regulate the expression of the Acsl gene family in the ileum of rats with NAFLD, suggesting that COX-2 inhibitors may inhibit the progression of NAFLD through the Acsl gene.

OBJECTIVE To systematically review the effects of body weight on the efficacy and safety of novel oral anticoagulants （NOACs） or aspirin for the prevention of venous thromboembolism （VTE） after total hip arthroplasty and total knee arthroplasty （hereinafter referred to as “hip and knee arthroplasty”）. METHODS Retrieved from PubMed， Embase and Cochrane library， randomized controlled trial （RCT） and non-RCT about the effectiveness and/or safety of NOACs， aspirin and low- molecular heparin by subgrouping according to body weight or body weight index [BMI 18.5-＜25 kg/m2 as normal body mass， BMI 25-30 kg/m2 as overweight， and BMI＞30 kg/m2 as obesity （of them， BMI＞40 kg/m2 as morbid obesity）] were collected from the inception to June 30， 2022. After literature screening and data extraction， the quality of RCT was evaluated with bias risk assessment tool RoB 2.0 recommended by Cochrane system evaluator manual. The Newcastle-Ottawa scale was used to evaluate the quality of non-RCT. Meta-analysis was performed by using RevMan 5.4 software. RESULTS A total of 6 literatures， containing 3 series of RCT pooled studies and 3 non-RCTs were included. The results of meta-analysis showed that among different BMI subgroups， there was no statistical significance in reducing major VTE and VTE-related mortality of patients with normal body mass patients [OR＝0.63， 95%CI（0.26，1.51），P＝0.30]， overweight patients [OR＝0.48，95%CI（0.22，1.04），P＝0.06] and obese patients [OR＝0.70，95%CI（0.40，1.25），P＝0.23] by NOACs， compared with enoxaparin. The safety of NOACs was comparable to that of enoxaparin in different BMI subgroups in terms of the incidence of major bleeding events and major+clinically relevant non- major bleeding events （P＞0.05）. There was no statistical significance in the incidences of total VTE [OR＝1.28， 95%CI （0.68，2.40）， P＝0.45]， symptomatic VTE and all-cause mortality [OR＝1.26， 95%CI （0.81，1.95）， P＝0.30] and major bleeding [OR＝0.79， 95%CI （0.58，1.08）， P＝0.14] in obese/morbidly obese patients using NOACs and aspirin， compared with normal/overweight patients. CONCLUSIONS The impact of body weight on the efficacy and safety of NOACs and aspirin for the prevention of VTE after hip and knee arthroplasty is not significant， and this study supports that overweight and obese patients receive NOACs or aspirin for VTE prevention.

Ceftazidime-avibactam （CAZ/AVI）is a novel β-lactam antibiotic with broad-spectrum antibacterial activity and good tolerability. However， the physiological and pathological differences in special populations [e.g. augmented renal clearance （ARC） patients， undergoing continuous renal replacement therapy （CRRT） patients， neonates and children， obese patients， undergoing extracorporeal membrane oxygenation （ECMO） patients， elderly patients and liver dysfunction patients] may affect the pharmacokinetic （PK） properties of CAZ/AVI， leading to treatment failure. At present， there is currently a lack of corresponding guidelines or consensus on dose adjustment of CAZ/AVI in special populations. This article summarizes the research on PK/ pharmacodynamic （PD） characteristics and dose adjustment of CAZ/AVI in special populations and recommends the following dosing regimens： for ARC patients， the recommended dose is 2.5 g， q8 h； for undergoing CRRT patients with infections caused by sensitive strains （i.e. MIC＜4 mg/L） and infections at sites where hydrophilic antibiotics distribute well， a dose of 1.25 g， q8 h may be used； for undergoing CRRT patients with less sensitive strains or sites with poorer drug distribution， a dose of 2.5 g， q8 h or continuous infusion may be considered； for children aged 6 months to ＜18 years with normal or mildly impaired renal function， a dose of 62.5 mg/kg， q8 h is infused for 2 h （maximum dose not exceeding 2.5 g per dose）； for infants aged 3～6 months with normal or mildly impaired renal function， a dose of 50 mg/kg， q8 h is infused for 2 h； for obese patients， the recommended dose is 2.5 g， q8 h， with therapeutic drug monitoring recommended；undergoing ECMO patients， elderly patients， and those with impaired liver function may also use the recommended dose of 179368757@qq.com 2.5 g， q8 h.

OBJECTIVE： To evaluate the clinical efficacy and economics of α-lipoic acid injection alone or combined with Mecobalamin injection versus Mecobalamin injection in the adjunctive treatment of diabetic peripheral neuropathy （DPN）. METHODS： Retrieved from PubMed， Cochrane Library， Embase， CNKI， VIP， CBM and Wanfang database， using “mecobalamin” “α-lipoic acid” and“diabetic peripheral neuropathy”as Chinese retrieval words， “Thioctic acid” “α-lipoic acid” “Methylcobal” “Mecobalamin” “Diabetic peripheral neuropathy” as English retrieval words， relevant randomized controlled trials （RCTs） were collected during the date of database establishment to Aug. 30th， 2018. Meta-analysis was conducted for total response rate. From the perspective of health care providers， cost-effectiveness analysis was used for economic evaluation and sensitivity analysis was conducted by a 15％ fluctuation of cost and total response rate. RESULTS： Totally 13 RCTs were included， involving 1 131 patients. The results of Meta-analysis showed that the total response rate of two-drug combination therapy in the treatment of DPN was higher than that of mecobalamin alone [RR＝1.41， 95％CI（1.28， 1.55）， P＜0.000 01]； that of α-lipoic acid injection alone in the treatment of DPN was higher than that of mecobalamin injection alone [RR＝1.35， 95％CI（1.25，1.47）， P＜0.000 01]， with statistical significance. Results of cost-effectiveness analysis showed that the cost-effectiveness ratio （CER） of Mecobalamin injection was 211.38 yuan， and CER of two-drug combination and α-lipoic acid injection alone were 1 484.42 and    1 383.49 yuan， respectively. The incremental cost-effectiveness ratio （ICER） were 4 589.52 and 4 638.82 yuan， which were all lower than per capita GDP in 2017. Sensitivity analysis showed that the cost-effectiveness analysis results kept stable. CONCLUSIONS： Compared with Mecobalamin injection， α-lipoic acid injection combined with Mecobalamin injection in the adjunctive treatment of DPN show high total response rate and economics.

OBJECTIVE：To study the potential ris k of Chinese patent medicine for the treatment of stable chronic obstructive pulmonary disease （COPD），and to provide reference for the safety of clinical drug use. METHODS ：Retrieved from Chinese journal full-text database ，CBM，Wanfang database and VIP ，using“stable”“Chronic obstructive pulmonary disease ”“COPD” “Chinese patent medicine ”as retrieval words ，relative literatures about Chinese patent medicine in the treatment of stable COPD were retrieved ，and retrieval time limitation was from their establishment to Sept. 2019. The type and components of Chinese patent medicine were collected. The potential risk of Chinese patent medicine was analyzed in terms of the contraindications of traditional Chinese medicines ，the interaction between traditional Chinese medicines and chemical medicines ，and its effects on stable COPD with other common chronic diseases. RESULTS ：Eleven related studies covering 29 kinds of Chinese patent medicines for the treatment of stable COPD were included in this study. There were several incompatibility between two Chinese patent medicines containing Aconitum carmichaelii and eleven Chinese patent medicines containing “Pinellia ternata ，Trichosanthes kirilowii ， Bolbostemma paniculatum ，Ampelopsis japonica ，Bletilla striata ”as an ancient rule of traditional Chinese medicine incompatibility “Eighteen antagonisms ”and“Nineteen mutual ”inhibitors. Meanwhile ，it should be avoided that four Chinese patent medicines containing ephedra combined with β2 receptor agonists or theophylline. Moreover ，oral antibiotics and 14 kinds of Chinese patent medicine containing licorice would reduce the curative effect. In addition ，patients with stable COPD who also had hypertension ， hyperlipidemia or diabetes should be careful to use Chinese patent medicines containing ingredients such as Glycyrrhiza uralensis ， A. carmichaelii ，Ephedra sinica ，Citrus aurantium ，Cornus officinalis ，Fritillaria cirrhosa ，Panax ginseng （Panax notoginseng ）. CONCLUSIONS：There are many potential risks （such as combined use ，compatibility）in the use of Chinese patent medicines for stable COPD. It is suggested to comprehensively evaluate the patient ’s previous medical history and medication before using Chinese patent medicines ，so as to provide scientific guide for clinical rational medication.