Objective:To observe the pathological changes of levator palpebrae superiors muscle in patients with different severities of simple congenital ptosis (SCP).Methods:Levator palpebrae superiors muscle specimens from 102 eyes of 68 patients with SCP who received levator palpebrae superiors muscle shortening surgery at Wuhan Aier Hankou Eye Hospital from August 2018 to October 2019 were collected as the observation group.According to the severity of ptosis, the specimens were divided into three groups, coverage ≤4 mm group (n=35), coverage >4 mm to ≤6 mm group (n=30), and coverage >6 mm group (n=37). Fresh levator palpebrae superiors muscle tissues from 8 normal donors in Aier Eye Bank of Wuhan Red Cross were selected as the control group.All specimens were performed with Masson trichrome staining and immunohistochemical staining for α-smooth muscle actin (α-SMA), and ImageJ software was used to measure the collagen fiber area ratio, skeletal muscle fiber area ratio and the integrated absorbance (IA) value of α-SMA.Seventeen specimens (2 from the control group, 5 from coverage ≤4 mm group/coverage >4 mm to ≤6 mm group/coverage >6 mm group) were observed with a transmission electron microscope (TEM). This study protocol adhered to the Declaration of Helsinki and was approved by an Ethics Committee of Wuhan Aier Hankou Eye Hospital (No.HKAIER2018IRB-005-01). All patients and their legal guardians were well informed about the treatment method and the purpose of sampling and voluntarily signed informed consent.Results:Compared with the control group, the skeletal muscle fiber was reduced in number and was in disordered arrangement, and the striation of some muscle fibers disappeared, and hyperplastic fibrous connective tissue was found in intercellular substances in the observation group.The collagen fiber area ratio of the coverage ≤4 mm group, coverage >4 mm to ≤6 mm group, coverage >6 mm group were significantly higher than that of the control group, and the skeletal muscle fiber area ratio of the three groups was significantly lower than that of the control group (all at P<0.008 3). There were more smooth muscle fibers and positive expression of α-SMA found in the specimens of the observation group.The IA value of α-SMA of the coverage ≤4 mm group, coverage >4 mm to ≤6 mm group, coverage >6 mm group was 7 195.28(5 935.69, 14 058.29), 55 584.18(33 861.88, 80 419.32), 166 507.76(119 121.95, 187 890.86), respectively, which were all higher than 5 543.03(4 867.67, 8 312.02) of the control group, among which, there were statistically significant differences between the control group and the coverage >4 mm to ≤6 mm group, coverage >6 mm group (both at P<0.008 3). Abundant organelles and some damaged mitochondria were found in smooth muscle cytoplasm in the observation group with a TEM.But no characteristic structure of smooth muscle cells such as dense patch and dense body was detected.Conclusions:There are abnormal smooth muscle cells in the levator palpebrae superiors muscle of SCP patients, and the dysgenesis of the levator palpebrae superiors muscle may be related to this abnormal muscle cell.

OBJECTIVE： To explore the management model of smart pharmacy under the background of “Internet+TCM”， and to promote the improvement of the work and service quality of smart pharmacy. METHODS： The information platform and internal organization of smart pharmacy in our hospital were combined； the supervision and management of smart pharmacy and the establishment of quality control system in smart pharmacy were summarized and the development and supervision effectiveness of smart pharmacy in our hospital were evaluated. RESULTS： Our hospital established the information platform on the basis of the “Internet+TCM”. Hospital information setting were divided into online and offline. The prescriptions that were not suitable for online handling decoction and distribution service were clearly defined and the system locking settings were set up to realize effective information transmission from hospital to smart pharmacy. The service platform of smart pharmacy were set up including electronic prescription circulation system， whole-course prescription barcode recognition management system， electronic prescription audit and dispensing system， intelligent decoction control management system， smart pharmacy distribution management system， etc. It had realized seamless connection of information between smart pharmacy and patients. The internal organization included six departments： prescription audit center， dispensing center， decoction center， individualized preparation production center， logistics center and customer service center. Our hospital conducted daily supervision and management of the entire work process of the smart pharmacy from aspect of hospital management and pharmacy management. The internal service quality of smart pharmacy could be controlled by quality control system of prescription reviewing center， dispensing center， decocting center， individualized preparation center， logistics center and customer service center and pharmaceutical personnel training mechanism in smart pharmacy. Since the start of the smart pharmacy in June 2015， the number of people receiving the services of smart pharmacy had increased significantly， and the types of services and service opportunities for patients had added； the distribution service had added， and the service of individualized preparation processing and distribution had also added. Moreover， the service capacity of smart pharmacy far exceeded the demand of our hospital， and other medical institutions could share the platform of smart pharmacy. By simply counting the situation in our hospital， the average number of daily prescription increased from 387 in Jun.-Dec. of 2015 to 1 433 in 2018； the error rate showed a downward trend， among which the abnormal rate of prescription reviewing， the dispensing error rate， the decoction error rate and customer service complaints rate decreased from 2.10％， 0.13％， 0.52％， 0.13％ in Jun.-Dec. of 2015 to 0.45％， 0.05％， 0.27％， 0.04％ in 2018； total timely investment rate in logistics increased from 93.20％ in Jun.-Dec. of 2015 to 97.06％ in 2018. At present， the existing information platform， internal organization， quality control system and supervision system could ensure the orderly operation of smart pharmacy and could ensure the quality of drugs， decoction and distribution. CONCLUSIONS： However， the development of smart pharmacy in our hospital is still in its infancy. In the future， it is still necessary to strengthen the construction of information software and hardware， standardize the operation of various links， strengthen personnel training， establish an effective quality control system and explore more objective supervision mechanisms.