0.05).Conclusions The expression of myostatin gene mRNA is increased in myotonic dystrophy.Up-regulated expression of myostatin in skeletal muscle might be associated with the mechanism of myotonic dystrophy.

Objective To build a clinical key disciplines evaluation index system for county level hospitals in Chengdu city.Methods Literature meta analysis, focus group discussion, expert consultation method, boundary value method, brainstorming and hierarchy analysis method were comprehensively used.Results The clinical key disciplines evaluation index system for county level hospitals in Chengdu city comprises 5 level-1 indexes,1 6 level-2 indexes,47 level-3 indexes.Among the level-1 indexes,service capacity,medical quality,technical personnel,scientific research and education, and foundation of specialty was 0.474 6,0.202 7,0.148 2,0.097 7,0.076 8 respectively.Conclusion The clinical key disciplines evaluation index system for county level hospitals in Chengdu city is scientific, guiding and practical,which can be used to evaluate the status of the clinical key disciplines for county level hospitals in Chengdu city.

OBJECTIVETo compare the clinical, pathological, laboratory test and follow-up data between familial and sporadic patients with distal myopathy with rimmed vacuoles (DMRV) and discuss the characteristics of this disorder in Chinese population.

METHODSThe clinical and pathological features, laboratory data and follow-up results of 33 sporadic and 4 familial cases of pathologically confirmed DMRV were summarized and compared retrospectively.

RESULTSThe patients age, onset age, or disease duration showed no significant difference between sporadic and familial cases; the onset pattern and affected muscle groups were also similar, but the sporadic cases showed more frequent dysmorphic features than the familial cases. The patients showed mild to moderate elevation of the muscle enzymes by one to three folds, and the familial patients had more significant elevation than the sporadic ones. No correlation was found between the disease duration and the level of muscle enzymes. The pathological findings were similar between the cases, and Gomori staining showed rimmed vacuoles and inclusion bodies without inflammatory cell infiltration. Follow-up results of 29 cases showed no significant difference between the two groups. The disease was slowly progressive and severely affected the quality of life of the patients, but did not produce obvious effect on the life expectancy.

CONCLUSIONThe clinical, pathological and laboratory data of Chinese DMRV patients are basically similar to those of Japanese cases. Sporadic cases tend to show more dysmorphic features than the familial ones, and occasional sporadic cases have early disease onset in early childhood.

Adult ; Asian Continental Ancestry Group ; Distal Myopathies ; classification ; genetics ; pathology ; Female ; Humans ; Inclusion Bodies ; pathology ; Male ; Pedigree ; Retrospective Studies ; Vacuoles ; pathology ; Young Adult

OBJECTIVETo explore the effect of compound qizhu granule (CQG) on cellular immunity of chronic hepatitis B (CHB) patients.

METHODSTotally 103 CHB patients treated with lamivudin (LAM) for 6 months, who had partial virological response (HBeAg positive) were randomly assigned to two groups, 50 in the treatment group and 53 in the control group. All patients took LAM 100 mg (once a day) plus ADV 10 mg (once a day). Patients in the treatment group additionally took CQG, one dose per day. After one-year treatment hepatitis B virus (HBV) DNA negative rates, HBeAg seroconversion, levels of HBV specific cytotoxic T lymphocyte (CTL), non-specific CTL and natural killing (NK) cells were compared between the two groups.

RESULTSAfter 1-year treatment, HBV DNA negative rate of the treatment group was 88: 0% in 44 cases, slightly higher than that of the control group (41 cases, 77.4%), but with no statistical difference (P >0.05). HBeAg seroconversion of the treatment group was 32.0% in 16 cases, higher than that of the control group (8 cases, 15.1%), with statistical difference (P <0.05). Levels of HBV specific CTL (0.79%±0. 07%), non-specific CTL (19.4%±1.8%) and NK cells (14. 1%± 1.5%) of the treatment group were higher than those of the control group (0.58% ± 0.08%, 17.5% ± 1.7%, and 11.1%±1.5%, respectively; allP <0.01).

CONCLUSIONTreating CHB patients with partial virological response by ADV plus CQG could improve specific and non-specific cellular immunity, thereby elevating HBeAg seroconversion rate.

Drugs, Chinese Herbal ; therapeutic use ; Hepatitis B e Antigens ; immunology ; Hepatitis B virus ; genetics ; Hepatitis B, Chronic ; drug therapy ; immunology ; Humans ; Immunity, Cellular ; immunology ; T-Lymphocytes, Cytotoxic ; drug effects

OBJECTIVE:To evaluate the effects of the implementation of National Essential Medicine System on the utilization rate of hormone drugs in primary medical institutions in China systematically.METHODS:Retrieved from CJFD,Wanfang database and VIP,the literatures about the use of hormone drugs were collected before and after the implementation of National Essential Medicine System.Meta-analysis was performed by using Stata 13.0 software after utilization rate dam extraction and quality evaluation with Cochrane system evaluator manual 5.1.0.RESULTS:A total of 20 literatures were included.Results of Meta-analysis showed that utilization rate of hormone drugs after the implementation of National Essential Medicine System was significantly lower than before implementation,with statistical significance [RD =-0.03,95 ％ CI (-0.05,-0.02),P＜ 0.001].Results of subgroup Meta-analysis of utilization rate of hormone drugs in different areas before and after the implementation of National Essential Medicine System showed that the utilization rate of hormone drugs in eastern areas was significantly lower after the implementation of National Essential Medicine System than before [RD=-0.06,95％ CI(0.09,-0.03),P=0.001] with statistical significance.There was no statistical significance in the utilization rate of hormone drugs in middle area [RD=-0.02,95 ％ CI(0.06,0.02),P=0.235] or western area [RD=-0.01,95％ CI (-0.02,0),P=0.122] before and after the implementation of National Essential Medicine System.CONCLUSIONS:The implementation of National Essential Medicine System reduces the utilization of hormone drugs in primary medical institutions.The effect of the eastern area is more obvious than in middle and western area.

OBJECTIVEThis study aimed to explore the impact of specimen collection and storage consumable products on trace element quantitative analysis.

METHODSDevices and consumable products of different brands used in specimen collection or storage were selected and treated separately as below:urine collection and storage tubes (Brand A, B, C and D, 2 samples for each brand) were treated with 1% of HNO(3) volume fraction for 2 - 4 h; blood taking device (Brand O, P and Q, 3 samples for each brand) were used for ultra-pure water samples collecting as simulation of blood sampling;dust sampling filters (Brand X, Y and Z, 2 samples for each brand) were cold digested by nitric acid for 12 h, followed by microwave digestion. Then cadmium, cobalt, chromium, copper, iron, manganese, molybdenum, nickel, lead, selenium, stannum, titanium, vanadium and zinc concentrations in the solutions obtained during the course of collect or storage were quantified by inductively coupled plasma mass spectrometer.

RESULTSFor the urine collection and storage consumable products, background values of elements were described as mean of parellel samples. The consentration of 14 quantified elements were relatively low for 5 ml cryogenic vials (brand B) with background values range of 0.001 - 0.350 ng/ml. The background values of copper of 50 ml centrifuge tubes (brand A), chromium of 5 ml cryogenic vials (brand C) and zinc of 1.5 ml centrifuge tubes (brand D) were relatively high, which were 1.900, 1.095 and 1.368 ng/ml, respectively. Background values of elements in blood sampling devices were described as x(-) ± s. Background values of chromium for brand O, P and Q were (0.120 ± 0.017), (0.337 ± 0.093) and (0.360 ± 0.035) ng/ml; for copper were (0.050 ± 0.001), (0.017 ± 0.012) and (0.103 ± 0.015) ng/ml; for lead were (0.057 ± 0.072), (0.183 ± 0.118) and (0.347 ± 0.006) ng/ml; for titanium were (7.883 ± 0.145), (8.863 ± 0.190) and (8.613 ± 0.274) ng/ml; zinc were (2.240 ± 0.573), (42.140 ± 22.756) and (8.850 ± 3.670) ng/ml. There were statistically differences of background values for chromium, copper, lead, titanium and zinc among the above three brands of blood sampling devices (all P values < 0.05). For air sampling filters, background values of elements were described as mean of parellel samples. Background values of chromium and nickel of sampling filters (brand X) were lowest, which were 17.000 and 15.400 ng per piece, respectively; while background values for other elements were relatively high, the quantification of cadmium, cobalt, copper, iron, manganese, molybdenum, lead, selenium, stannum, titanium, vanadium and zinc were 0.250, 0.550, 48.500, 690.000, 25.500, 0.900, 6.500, 10.550, 7.950, 10.500, 0.850, 370.000 ng per piece, respectively. Background values of chromium and nickel of sampling filters (brand Z) were highest, which were 171.000 and 29.850 ng per piece.

CONCLUSIONBackground values of trace elements varied among products of different brands, and the most noticable differences were found in chromium, manganese, nickel, lead, stannum and zinc.

Environmental Monitoring ; methods ; Quality Control ; Specimen Handling ; methods ; Trace Elements ; analysis

OBJECTIVETo investigate the relationship between hepatitis B virus (HBV) genotype and therapeutic efficacy during the early phase of lamivudine treatment.

METHODSTotally 595 patients with chronic hepatitis B were treated with lamivudine 100 mg/day for 12 months. HBV genotypes, contents of HBV DNA, HBeAg/anti-HBe and YMDD mutation after lamivudine treatment for 12 months were determined. The data were analyzed with SPSS software.

RESULTSIn 595 patients, 8 (1.4%) were genotype A; 53 (8.9%) genotype B; 360 (60.5%) genotype C; 112 (18.8%) were coinfection of genotype B and C; 14 (2.4%) of A and C; 15 (2.5%) A and B; 6 (1.0%) of A, B, and C, and remaining 27 (4.5%) were unspecified. Patients were treated with lamivudine 100 mg/day for 12 months. Genotype B with HBV DNA levels turned to be negative (HBV DNA < 0.1 ng/L) was 87.2%, genotype C was 89.51%, coinfection of genotype B and C was 93.04% (P > 0.05). HBeAg seroconversion of genotype B was 11.65%, of genotype C was 20.64%, and of coinfection of genotype B and C was 18.57% (P > 0.05). All 69 strains of YMDD mutation were detected after lamivudine treatment for 12 months, in which genotype B was in 16.98%, genotype C in 15.38%, and coinfection of genotype B and C was in 13.86% (P > 0.05).

CONCLUSIONThere was no difference in HBV genotypes and the rate of development of YMDD mutations, HBeAg seroconversion, descending of HBV DNA level in Chinese patients with chronic hepatitis B.

China ; Genotype ; Hepatitis B e Antigens ; blood ; Hepatitis B virus ; drug effects ; genetics ; immunology ; Hepatitis B, Chronic ; drug therapy ; virology ; Humans ; Lamivudine ; therapeutic use ; Reverse Transcriptase Inhibitors ; therapeutic use ; Treatment Outcome

BACKGROUNDTo explore the cut-off period of subclassification and pathological features of severe hepatitis (SH).

METHODSBased on combined clinical and pathological analyses, the complete clinical and biopsy or autopsy liver tissues data from 196 cases of patients with severe hepatitis were investigated. Meanwhile, proliferative hepatocytes, cholangioepithelia and collagens were identified by a panel of monoclonal antibodies such as those against albumin, cytokeratin 18,19 and collagen I, III with immunohistochemical method.

RESULTSThe clinical and pathological analyses indicated the cut-off periods of acute, subacute and chronic SH (ASH,SSH and CSH) were (13.4+/-7.2) d, (77.4+/-69.3) d and (80.5+/-63.2) d, respectively. Among all SH cases, one case of ASH patient presented clinical manifestation and pathological changes of ASH for 21 days, however, one patient with SSH was demonstrated 12 day course by histological examination. The time of cut-off period between ASH and SSH in child cases was shorter than that in adult cases. Histologically, ASH liver tissues showed massive and/or submassive necrosis caused by one attack, with congestive sinusoid frameworks and proliferative cholangioepithelium-like hepatocytes, while SSH liver tissues presented combined fresh and old submassive or massive necrosis caused by multiple attacks, accompanied by obviously proliferative bile ducts and sinusoid framework collapse.However, the pathological changes of CSH showed ASH- or SSH-like lesions on the background of chronic liver injury.

CONCLUSIONOur data indicated that the cut-off period between ASH and SSH is in accordance with the Scheme of Viral Hepatitis Prevention and Therapy, China, published in 2000, but excluded a part of child SH cases. In our study, the authors found a few pathological features in ASH and SSH.

Adolescent ; Adult ; Aged ; Aged, 80 and over ; Child ; Collagen ; metabolism ; Female ; Hepatitis ; classification ; metabolism ; pathology ; Humans ; Keratins, Type I ; metabolism ; Liver ; pathology ; Male ; Middle Aged ; Young Adult

OBJECTIVE：To investig ate the application and trend o f tranexamic acid in the orthopedic inpatient ，and to provide reference for rational drug use. METHODS ：The consumption of tranexamic acid ，the distribution of orthopedics diseases using tranexamic acid and route of administration were analyzed in 3 sub-departments （joint surgery department ，spinal surgery department，orthopedic trauma department ）from 4 third-grade class-A hospitals of Chongqing during 2017 to 2020. RESULTS ： The total consumption of tranexamic acid used in orthopaedic department had increased year by year in the past 4 years，with increase of 6.2％-52.2％，and the consumption of tranexamic acid in various departments also increased year by year ；from 2017 to 􀤂􀤂􀤂􀤂􀤂􀤂􀤂􀤂􀤂􀤂􀤂􀤂􀤂􀤂􀤂􀤂􀤂􀤂􀤂􀤂􀤂􀤂􀤂􀤂􀤂􀤂􀤂􀤂􀤂􀤂􀤂􀤂􀤂􀤂􀤂􀤂􀤂􀤂􀤂􀤂􀤂􀤂􀤂􀤂􀤂􀤂􀤂􀤂􀤂􀤂􀤂􀤂􀤂􀤂􀤂􀤂􀤂􀤂􀤂􀤂􀤂􀤂􀤂􀤂 书辅料标明情况及风险控制建议 [J].中国药师，2018，21 中华中医药杂志，2018，33（6）：2225-2229. （18）：2020-2022. [10] 孟菲，李学林.中成药说明书中规格项存在的问题与探 [ 7 ] 国家药典委员会.中华人民共和国药典：二部[S]. 2010年 讨[J].当代医学，2015，21（12）：14-15. 版.北京：中国医药科技出版社，2010：1014. [11] 国家食品药品监督管理局 .中成药规格表述技术指导原 [ 8 ] 孟菲，李学林.中成药说明书中功能主治项表述方法的探 则：征求意见稿 [EB/OL].（2017-10-11）[2020-12-20]. 讨[J].中医药临床杂志，2015，27（1）：111-112. https：//www.nmpa.gov.cn/xxgk/zhqyj/zhqyjyp/20171011- [ 9 ] 田硕，郭晖，苗明三.中成药说明书完善的思考及实践[J]. 151401184.html. [12] 王裴芳.我国中成药说明书中老年人用药项的调查分 Δ基金项目：重庆市科技计划项目-技术预见与制度创新项目（No. 析[J].中国药房，2015，26（29）：4055-4057. cstc2018jsyj-zdcxX0052）；重庆市社会科学规划项目（No.2019QNGL31） [13] 林志健，周伟龙，张冰，等.中成药说明书中儿童用药信息 ＊硕士研究生 。研究方向 ：社会医学 、卫生事业管理 。电话： 023-68485178。E-mail：351389583@qq.com 的修订完善思考 [J].药物流行病学杂志 ，2018，27（4）： # 通信作者：教授，硕士生导师，硕士。研究方向：医事法学、卫生 244-248. 政策、卫生事业管理。电话：023-68485178。E-mail：puchuan68@sina. （收稿日期：2021-01-07 修回日期：2021-05-26） com （编辑：罗 瑞） ·1622· China Pharmacy 2021Vol. 32 No. 13 中国药房 2021年第32卷第13期 2019，joint surgery department accounted for the largest prop ortion（59.2％ ，53.5％ ，47.2％）to use tranexamic acid ，and orthopedic trauma department accounted for the largest proportion （39.2％）in 2020. On the whole ，top 4 orthopedic diseases in the list of the consumption of tranexamic acid were joint replacement （25.5％-29.6％），hip fracture （19.3％-23.6％），diaphysis fracture （13.5％-18.6％）and pelvic and acetabular fracture （8.2％-14.0％）. The route of administration for tranexamic acid in spinal surgery department ，joint surgery department and orthopedic trauma department was mainly intravenous application every year （accounting for 55.1％-81.0％，46.9％-77.1％，49.3％-73.3％，44.9％-71.5％）. CONCLUSIONS ：The consumption of tranexamic acid in orthopedic inpatients is increased year by year ，and is dominated by joint surgery department and orthopedic trauma department. The route of tranexamic acid is still mainly intravenous administration ，which is safe and reliable.

Background: Mental stress-induced myocardial ischemia (MSIMI) is closely associated with adverse cardiac events in patients with coronary artery disease (CAD) and we aimed to determine whether biomarkers and blood pressure could be potential predictors of MSIMI. Methods: This study enrolled 82 patients with documented CAD between June 1, 2017 and November 9, 2017. Patient blood samples were obtained at resting period and at the end of mental arithmetic. Then, patients were assigned to MSIMI positive group and MSIMI negative group. The main statistical methods included linear regression, receiver operating characteristic (ROC) curves, and logistic regression. Results: Patients with CAD with MSIMI had significantly greater median resting N-terminal pro-brain natriuretic peptide (NT-proBNP, 141.02 [45.85–202.76] pg/mL vs. 57.95 [27.06–117.64] pg/mL; Z = -2.23, P = 0.03) and mean systolic blood pressure (SBP) (145.56 ± 16.87 mmHg vs. 134.92 ± 18.16 mmHg, Z = -2.13, P = 0.04) when compared with those without MSIMI. After 5-min mental stress task, those who developed MSIMI presented higher elevation of median post-stressor high sensitivity cardiac troponin I (hs-cTnI, 0.020 [0.009–0.100] ng/mL vs. 0.009 [0.009–0.010] ng/mL; Z = -2.45, P = 0.01), post-stressor NT-proBNP (138.96 [39.93–201.56] pg/mL vs. 61.55 [25.66–86.50] pg/mL; Z = -2.15, P = 0.03) compared with those without MSIMI. Using the ROC curves, and after the adjustment for basic characteristics, the multiple logistic regression analysis showed that patients presenting a post-stressor hs-cTnI ≥ 0.015 ng/mL had seven-fold increase in the risk of developing MSIMI (odds ratio [OR]: 7.09; 95% confidence interval [CI]: 1.65–30.48; P = 0.009), a rest NT-proBNP ≥ 80.51 pg/mL had nearly eight-fold increase (OR: 7.85; 95% CI: 1.51–40.82; P = 0.014), a post-stressor NT-proBNP ≥ 98.80 pg/mL had 35-fold increase (OR: 34.96; 95% CI: 3.72– 328.50; P = 0.002), a rest SBP ≥ 129.50 mmHg had 11-fold increase (OR: 11.42; 95% CI: 1.21–108.17; P = 0.034). Conclusions The present study shows that CAD patients with higher hs-cTnI level, and/or greater NT-proBNP and/or SBP are at higher risk of suffering from MSIMI when compared with those without MSIMI, indicating that hs-cTnI, NT-proBNP, SBP might be potential predictors of MSIMI.