Objective To investigate the efficacy of laparoscopic cholecystectomy (LC) for the treatment of patients with cholelithiasis complicating liver cirrhosis. Methods The clinical data of 50 patients with cholelithiasis complicating liver cirrhosis were analyzed retrospectively, who received LC (LC group,23 cases) or open cholecysteetomy (OC group,27 cases). Summarized and compared with operation time, blood loss,length of stay and complications of two groups. Results Operation time,blood loss and length of stay in LC group [(43.2 ± 15.6) min, ( 78.3 ± 22.5 ) ml, (5.7 ± 2.5 ) d] were significantly less than those in control group [(77.4 ±21.2) min, (195.7 ±32.4) ml, (9.3 ±3.2) d.], the differences were statistically significant (P ＜ 0.05). The mainly post-operative complications were dehydration and urinary tract infection, but the incidence rate had no statistically significant difference between two groups (P ＞ 0.05 ).There was no other severe complications and death case occurred postoperation in two groups. Conclusion For patients with cholelithiasis complicating liver cirrhosis in Child-Pugh A and B class, LC is a safe and feasible minimally invasive surgery, it is worthy to be popularized.

Objective To optimize the extracting process of alkaloid from Nelumbo nucifera leaves by multi-stage countercurrent extraction.Methods The spectrophotometry was used to determine the alkaloids.The extracting process of alkaloid was optimized by L16(44) to observe the effect of extraction time,extraction temperature,solid to liquid ratio,and ethanol concentration,respectively.Results The optimum extraction parameters were extraction time 25 min,extraction temperation 90 ℃,solid to liquid ratio 1∶50,and ethanol concentration 70%.Conclusion The multi-stage countercurrent extraction is used to the extracting process of alkaloid from N.nucifera leaves.

Objective: To evaluate the diagnostic efficacy of DWI based on monoexponential and biexponential models in differential diagnosis of benign and malignant lung lesions. Methods: Studies related to diagnosis of benign and malignant lung lesions by DWI based on monoexponential and biexponential models were retrieved from Embase, Pubmed, Cochrane Library, CNKI, Wanfang Med Online and VIP databases which were performed up to December, 2018. The studies that meet the inclusion criteria were evaluated with quality assessment of diagnostic accuracy studies. Meta-Disc version 1.4 and STATA 15.0 software were used for statistics analysis. Results: Totally 10 studies (5 English, 5 Chinese), including a total of 695 lesions in 672 patients were enrolled. The sensitivity of ADC value and D value in differential diagnosis of benign and malignant lung lesions was 0.78 (95%CI [0.73, 0.83]), 0.90 (95%CI [0.87, 0.93]), specificity was 0.71 (95%CI [0.64, 0.78]), 0.64 (95%CI [0.57, 0.70]), the diagnostic odds ratio was 12.59 (95%CI [4.93, 32.11]), 19.58 (95%CI [7.06, 54.29]), and the AUC of summary ROC curve was 0.848 9, 0.885 1, respectively. Conclusion: ADC value and D value both have good diagnostic efficacy in distinguishing benign and malignant lung lesions, and the diagnostic efficacy of D value is better than ADC value.

Objective To observe the inhibitory effect of Tirofiban on different shear-induced platelet aggregation, and to provide medication suggestions for the treatment of thrombosis in different hemodynamic environment. Methods Polydimethylsiloxane ( PDMS)-glass microchannel chips were fabricated by soft lithography. The whole blood of healthy volunteers anticoagulated with sodium citrate was collected and incubated with different concentrations of Tirofiban in vitro. The blood flowed through the straight microchannel or channel with 80% narrow for 150 seconds at the speed of 11 μL/ min and 52 μL/ min, respectively. The wall shear stress rates in straight channel at 11 μL/ min and 52 μL/ min were 300 s-1 and 1 500 s-1, respectively. The maximum wall shear rates in the channel with 80% occlusion at 11 μL/ min and 52 μL/ min were 1 600 s-1 and 7 500 s-1, respectively. The adhesion and aggregation images of fluorescent labeled platelets on glass surface were photographed with the microscope, and the fluorescent images were analyzed with Image J. The platelet surface coverage ratio was used as a quantitative index of platelet aggregation behavior, and the IC50 of Tirofiban for platelet inhibition was calculated under different shear rates. Flow cytometry was used to detect the platelet activation index (CD62P, PAC-1) in the whole blood at 52 μL/ min in channel with 80% occlusion. Results Tirofiban inhibited platelet aggregation in a dose-dependent manner, and the inhibitory effect was related to the shear rate. Under the shear rates of 11 μL/ min and 52 μL/ min, the aggregation was almost completely inhibited when the concentration in straight channel reached 100 nmol / L. When the concentration in channels with 80% occlusion reached 1 μmol / L, the aggregation was almost completely inhibited. IC50 values at 11 μL/ min and 52 μL/ min in straight channel were 2. 3 nmol / L and 0. 5 nmol / L, respectively. IC50 values at 11 μL/ min and 52 μL/ min in channels with 80% occlusion were 20. 73 nmol / L and 4. 5 nmol / L. Pathologically high shearforce induced an increase in platelet activation, which could be inhibited by Tirofiban. Conclusions Tirofiban can effectively inhibit shear-induced platelet aggregation, and different concentrations of Tirofiban should be given according to the thrombus formed in different shear force environment in clinic practice

Objective To examine the antiplatelet effect of ticagrelor by microfluidic chip and flow cytometry under shear stress in vitro. Methods Microfluidic chip was used to examine the effect of ticagrelor on platelet aggregation at the shear rates of 300/s and 1500/s.We adopted the surface coverage of platelet aggregation to calculate the half inhibition rate of ticagrelor.The inhibitory effect of ticagrelor on ADP-induced platelet aggregation was verified by optical turbidimetry.Microfluidic chip was used to construct an in vitro vascular stenosis model,with which the platelet reactivity under high shear rate was determined.Furthermore,the effect of ticagrelor on the expression of fibrinogen receptor (PAC-1) and P-selectin (CD62P) on platelet membrane activated by high shear rate was analyzed by flow cytometry. Results At the shear rates of 300/s and 1500/s,ticagrelor inhibited platelet aggregation in a concentration-dependent manner,and the inhibition at 300/s was stronger than that at 1500/s (both P<0.001).Ticagrelor at a concentration ≥4 μmol/L almost completely inhibited platelet aggregation.The inhibition of ADP-induced platelet aggregation by ticagrelor was similar to the results under flow conditions and also in a concentration-dependent manner.Ticagrelor inhibited the expression of PAC-1 and CD62P. Conclusion We employed microfluidic chip to analyze platelet aggregation and flow cytometry to detect platelet activation,which can reveal the responses of different patients to ticagrelor.
Humans ; Ticagrelor/pharmacology* ; Platelet Aggregation Inhibitors/pharmacology* ; Flow Cytometry/methods* ; Microfluidics ; Platelet Aggregation

OBJECTIVE To eval uate the cost-util ity of regimen containing bortezomib in the treatment of newly diagnosed multiple myeloma in China. METHODS From the perspective of China ’s health system ，Markov model was constructed based on SWOG S 0777 clinical trial. The simulation time limit was 10 years，and the cycle was set with reference to the treatment cycle. Taking quality adjusted life years （QALYs）as the utility index ，the utility and cost were discounted at a discount rate of 5％；the willingness to pay （WTP）threshold was set to be 3 times of China ’s per capita gross domestic product （GDP）in 2021（242 928 yuan/QALY）. The incremental cost-utility ratio （ICER）of dexamethasone combined with bortezomib and lenalidomide （VRD） versus dexamethasone combined with lenalidomide （RD）were compared with cost-utility analysis. The sensitivity analysis was performed for the uncertainty of the model. RESULTS Results of baseline analysis showed that VRD regimen could obtain 0.65 more QALYs than RD scheme ，but its treatment cost was 135 782.77 yuan more than RD regimen ，ICER was 206 623.35 yuan/ QALY，which was lower than the WTP threshold set in this study ，VRD regimen was cost-effective. Single factor sensitivity analysis showed that the health utility value in progressive free survival had the greatest impact on the results ，the decrease of utility value would make the ICER higher than the WTP threshold ，and VRD regimen would no longer have advantages. Under the WTP threshold of 3 times of China ’s per capita GDP in 2021，the probability of VRD regimen being cost-effective was 86.5％； with the increase of WTP threshold ，the possibility of VRD regimen becoming more cost-effective than RD regimen would increase. CONCLUSIONS Under the WTP threshold of 3 times of China ’s per capita GDP in 2021，compared with RD regimen，VRD regimen is cost-effective in the treatment of newly diagnosed multiple myelo ma in China.

【Objective】 To study the status and conduct effect evaluation of blood donation recruitment of blood services in Chongqing, and explore its influencing factors, so as to provide reference for the regional homogenization of blood services in Chongqing. 【Methods】 19 blood services in Chongqing were investigated by questionnaire in terms of the input in human resources and funds, recruitment methods, document construction and effect evaluation. The statistical analysis was conducted. 【Results】 The average number of blood donors per 1 000 population in 19 blood services in Chongqing was 9.35±3.35. Among the 19 blood services, blood inventory warning occurred in 18, 6 of them reached Level 2 and 1 of them was Level 1. The number of blood donations per 1 000 population in blood banks with no more than 5 recruits or with less than 100 000 yuan/year recruitment fund was significantly lower than that in blood banks with more than 5 recruits or with more than 100 000 yuan/year recruitment fund(P<0.05). SMS and telephone recruitment were most commonly used in blood donation recruitment. Most blood banks have established corresponding system documents, but only one has established the method to evaluate the effect of blood donation recruitment. 【Conclusion】 The number of blood donations per 1 000 population in 19 blood services in Chongqing varies greatly, and the pressure of blood inventory warning is widespread. The input of human resources and financial fund have a certain impact on the number of blood donations per 1000 population, but not the alone factor. The recruitment method is a little bit more on the traditional side, and the blood donation recruitment and efficacy evaluation is in lack of documentary supporting. Regional homogenization should be achieved by integrating the resources of blood services, establishing the document framework of blood donation recruitment and effect evaluation, clarifying the evaluation content and unifying the evaluation standard.

OBJECTIVE：To compare the protective effects model mice between the aboveground and underground parts of Astragalus membranaceus on immunosuppression ，and to provide reference for further utilization and development of A. membranaceus. METHODS ：A total of 240 ICR mice were divided into 4 batches，60 mice in each batch ，with half male and half female. Each batch of mice were randomly divided into blank group ，model group ，A. membranaceus aboveground part and undergroud part low-dose and high-dose groups （3，6 g/kg，by crude drug ）according to body weight and sex ，with 10 mice in each group. Blank group and model group were given normal saline intragastrically. A. Membranaceus groups were given corresponding concentration of drug intragastrically ，10 mL/kg，once a day ，for consecutive 30 days. Except for blank group ， other groups were intraperitoneally injected with cyclophosphamide 40 mg/（kg·d）for consecutive 3 days，since 24th day of treatment，to establish immunosuppression model. The levels of serum immunoglobulin （IgG，IgM，IgA），inflammation factors [nitric oxide ，interleukin-2（IL-2），IL-6，tumor necrosis factor-α] and half hemolysis value were detected in each group. Body weight ，thymus index ，spleen index ，phagocytic index ，activity of natural killer （NK）cell，splenic lymphocyte proliferation ability，dinitrofluorobenzene-induced delayed metamorphosis reaction in mice （by weight difference between left and right ears ） and the number of hemolytic plaque were determined. RESULTS ： Compared with blank group ， the serum levels of immunoglobulin，body weight ，thymus index ，spleen index ，phagocytic index ，NK cell activity ，the proliferation ability of splenic lymphocyte，the number of hemdytic plaque and half hemolysis value were decreased significantly in model group （P＜0.05）， while inflammation factor level as well as weight difference between left and right ears were increased significantly （P＜0.05）. Compared with model group ，above indexes of mice in A. membranaceus groups were improved significantly ，in dose-dependent manner（P＜0.05）. Compared with A. membranaceus undergroud part group ，above indexes of A. membranaceus aboveground part group were improved significantly （P＜0.05）. CONCLUSIONS ：Aboveground and underground part of A. membranaceus both have pretective effect on immunosuppression model mice ，and the effect of aboveground part of A. membranaceus is stronger than underground part of A. membranaceus .

Polymyxin B, which is a last-line antibiotic for extensively drug-resistant Gram-negative bacterial infections, became available in China in Dec. 2017. As dose adjustments are based solely on clinical experience of risk toxicity, treatment failure, and emergence of resistance, there is an urgent clinical need to perform therapeutic drug monitoring (TDM) to optimize the use of polymyxin B. It is thus necessary to standardize operating procedures to ensure the accuracy of TDM and provide evidence for their rational use. We report a consensus on TDM guidelines for polymyxin B, as endorsed by the Infection and Chemotherapy Committee of the Shanghai Medical Association and the Therapeutic Drug Monitoring Committee of the Chinese Pharmacological Society. The consensus panel was composed of clinicians, pharmacists, and microbiologists from different provinces in China and Australia who made recommendations regarding target concentrations, sample collection, reporting, and explanation of TDM results. The guidelines provide the first-ever consensus on conducting TDM of polymyxin B, and are intended to guide optimal clinical use.
Humans ; Anti-Bacterial Agents/therapeutic use* ; China ; Drug Monitoring/methods* ; Polymyxin B ; Practice Guidelines as Topic