OBJECTIVE:To provide reference for solving the shortage of national essential medicines in Changchun. METH-ODS:According to preliminary work,a questionnaire was conducted to investigate and statistically analyze the shortage situation of essential medicines in 22 higher than secondary and 50 basic medical and health institutions in Changchun;ABC analysis was used to analyze the national essential medicines in shortage;the bid results and shortage causes of the primary and secondary nation-al essential medicines in shortage were inquired. RESULTS:Totally 72 questionnaire were send out,and 72 were recycled with ef-fective recovery of 100%. The investigation results showed there were 19 shortage breeds(22 dosage forms),which lost the bid-ding,and 99 breeds(111 dosage forms)of national essential medicines in shortage,which won the bidding,including 85 kinds of chemical medicines and biological products,14 kinds of Chinese patent medicine in Changchun. Cardiovascular system drugs shows the largest number in the bid chemical medicines and biological products,and the Chinese patent medicine were mainly Fu-zheng agent and Quyu agent(internal medicine). Results of ABC analysis showed,among the 111 bid shortage dosage forms,17 were primary and 23 were secondary. The main causes for them were price raising in raw materials,lack of production,no produc-ing in manufacturers and purchase price higher than winning bids. CONCLUSIONS:Low accessibility of raw material drugs,low enthusiasm to production,lower drug price than a reasonable level,and small clinical requirements can lead to the shortage of na-tional essential medicines. It is suggested to intensify in supervising the raw materials’marketing,raising the enthusiasm of manu-facturers,perfecting the system of drug bidding,developing fixed-point production and building drug reserve system to guarantee the production and supply of national essential medicines,and satisfy clinical demands.

A new method for the determination of organic acids from mainstream cigarette smoke using ultra low temperature solvent extraction-comprehensive two-dimensional gas chromatography/time-of-flight mass spectrometry(GC×GC-TOF/MS)was established. The mainstream smoke was directly trapped by ethyl ether with ultra low temperature solvent extraction device, and cleaned up with liquid-liquid extraction. The concentrated extracts were further derived by N,O-bis(trimethylsily)trifluoroacetamide (BSTFA). The good separation of silanized product was achieved by the column set of DB-1 (30 m × 0. 25 mm, 1. 0 μm) as the 1st column and DB-wax (1. 5 m × 0. 1 mm, 0. 1 μm) as the 2nd column with modulation period of 6 s and scan range of m/z 45-450 . The results showed that linearity correlation coefficients were larger than 0 . 99 , and the average recoveries were between 80. 17% and 107. 81% with the relative standard deviations (RSD) in the range of 0 . 4%-12 . 1% ( n=5 ) . The detection limit and the quantitation limit were 1 . 3-24 . 5 μg/kg and 4. 1-77. 1 μg/kg, respectively.

Objective To evaluate the effect of early non-liquid diet for patients with mild acute pancreatitis by using Meta-analysis. Methods The randomized controlled trials(RCT) on early non-liquid diet intake for patients with mild acute pancreatitis were collected by computer searching the database of China National Knowledge Infrastructure(CNKI),Wanfang Periodical Database,CBM,Elsevier Scien Direct, cochrane library and PubMed from inception to February 2017, and analyzed by RevMan 5.2 software. Results Five RCTs were included in the study.The Results of Meta-analysis revealed that both the length of hospitalization after eating [MD=-1.48,95%CI-2.50~-0.47, P=0.004] and the total length of hospitalization[MD=-1.99,95%CI-(0.99-2.99),P=0.0001]in liquid diet group were less than that of non-liquid diet group,and the differences were statistically significant.There was no significant difference in the rate of the pain recurrence[RR=1.21,95%CI 0.77-1.91,P=0.40]and the rate of the elimination of oral feeding[RR=1.02,95%CI 0.45-2.30,P=0.96]because of pain,nausea or vomiting after refeeding,although all that rate in non-liquid diet was not lower than that of liquid diet group. Conclusions compared with liquid diet,early non-liquid diet intake for mild acute pancreatitis can shorten their hospitalization time, and it cannot be concluded that the non-liquid diet will increase the pain recurrence rate, and most patients have a better tolerance to non-liquid diet,and non-liquid diet can promote rehabilitation.

This article reports the clinical data, diagnosis and treatment plan and prognosis of 3 patients with breast cancer under 20 years old. The clinical pathological features, treatment and prognosis were discussed in the literature, and compared with the biological characteristics of young (under 35 years old) breast cancer patients, providing a reference for the clinical individualized treatment of the disease.

The aim of this study was to investigate the effects of high-intensity interval training(HIIT)on lipopolysaccharide(LPS)-induced septic myocardial injury in mice and the roles of NLRP3 inflammasome and macrophage M1 polarization in the process.C57BL/6 male mice were randomly divided into 4 groups:control(CON)group,LPS(L)group,HIIT+saline injection(E)group,and HIIT+LPS(EL)group.Six weeks of HIIT intervention was followed by intraperitoneal injection of LPS,and cardiac function indexes were measured by echocardiography 12 hours post the injection.Hematoxylin-eosin(HE)staining was used to evaluate the morphology and pathological characteristics of myocardium for assessing myocardial damage score;enzyme-linked immunosorbent assay(ELISA)was used to test the content of myocardial damage indicators(AST,CK-MB,LDH);RT-PCR was used to detect the relative mRNA levels of NLRP3 inflammasome(NLRP3,Caspase-1),atrial natriuretic peptide(ANP),brain natriuretic peptide(BNP),myeloperoxidase(MPO)and macrophage M1-associated inflammasome factors(IL-1β,TNF-α,IL-6);Western blot was applied to measure the protein expression of inducible nitric oxide synthase(iNOS)and apoptosis-associated speck-like protein containing a caspase recruitment domain(ASC)in cardiac tissues;immunofluorescence staining was used to detect the protein expression of NLRP3 inflammasome,ASC,IL-18 and iNOS.Compared with the CON group,mice in the LPS group showed obvious decrease in body weight,a significant decrease in EF and FS,a significant increase in LVESD and LVEDD,obvious pathological damage in myocardial tissue,a significant increase in myocardial damage fraction,a significant increase in serum myocardial damage indexes,and a significant increase in the expression levels of BNP,MPO,NLRP3 inflammasome,iNOS,IL-1β,IL-6 and TNF-α.HIIT treatment could reverse these changes mentioned above in model mice.In conclusion,6 weeks of HIIT inhibits the activation of LPS-induced NLRP3 inflammasome and suppressed macrophage M1-type polarization,thereby combating septic myocardial injury.

Objective:To investigate the status quo of continuing education and training needs among general practitioners in Pudong New Area of Shanghai.Methods:An online questionnaire survey was conducted among general practitioners registered in the community health service center of Shanghai Pudong New Area in September 2019. The questionnaire included items of general information, the status quo of continuing education, the training needs and demands, and the knowledge and skills to be improved.Results:There were total 1 824 general practitioner in Pudong New Areal, 861 participated in the survey with a participant rate of 47.2%. A total of 861 valid questionnaires retrieved with a response rate of 100.0%. Among all participants, 79 (9.18%) thought that continuing education was very useful for improving or developing their professional ability, 564 (65.51%) thought it was useful, and 41 people (4.76%) thought it was almost useless. There were significant different in views on the roles of continuing education among participants with different ages, types of registration, and working years (χ2=15.544, 15.382, 21.979; P<0.05). There are 112 participants (13.01%) who spend less than 1 day in continuing education each month, and 224 (26.02%) who spent more than 3 days a month in continuing education, the times of attending continuing education was related to the taking administrative duty for general practitioners (χ2=9.551, P<0.05). When general practitioners choose continuing education programs, the first consideration was the practicability of the contents [772 (31.94%)], followed by the form of teaching [541 (22.38%)]. The three most recognized forms of continuing education courses were online learning (28.22%), training and off-line teaching (25.58%) and special lectures (24.69%) The three most required knowledge and skills to be improved through continuing education were the endocrine system, respiratory system, and blood circulation system. Conclusions:The survey shows the current status and traing needs of continuing education among general practitioners in Shanghai Pudong New Area, which indicates that it is necessary to take the job competence as the core and carry out various activities of continuing education for general practitioners in community health service centers.

Objective:To study the effect of atractylodes lactideⅠ,Ⅱand Ⅲ on the expression of cytokines by inducing M1 type macrophage model. Methods:Apoptotic macrophages were induced by sodium thioglycolate, and then the rat peritoneal inflammatory macrophages were purified by a differential adherence method. The expression of macrophage marker antigen (ED1) was identified by flow cytometry macrophages. Tumor necrosis factor ( TNF-α) , proinflammatory cytokines ( IL-1β) and interleukin-6 ( IL-6 ) were measured by ELISA in vitro. The levels of expression of arginase 1, inducible nitric oxide synthase (iNOS), inflammatory cytokines (IL-1β) chemokine (CCL22) and transforming growth factor (TGF-β) in inflammatory macrophages were determined by RT-PCR. Results:As for the purification of cultured rat inflammatory macrophage expressing ED1, atractylenolideⅠand Ⅲ could reduce the ex-pression levels of iNOS and IL-1βand increase the expression levels of arginase1 CCL22 and TGF-β. The release of inflammatory fac-tor IL-1β decreased, and the release levels of TGF-β and chemokines CCL22 were promoted(P<0. 05). Atropine lactoneⅠ and Ⅲ had significant inhibitory effects on TNF-α, IL-1β and IL-6 in macrophages(P<0. 05). Conclusion: Atractylodes lactone Ⅰand Ⅲ with anti-inflammatory activity can promote the expression of cytokines in inflammatory macrophages, while the change induced by at-ractylaxanthin Ⅱ is not obvious.

Objective To compare the effects of different oral motor interventions,including non-nutritive sucking (NNS) and acupuncture point stimulation of oral and cheek combined with NNS,on oral feeding of prematures.Methods A total of 164 prematures were randomly divided into three groups. Group A (n=53) received routine feeding nursing care;Group B (n=54) were given non-nutritive sucking for 3 minutes before and after feeding,with 8 times per day;Group C (n=57) were given acupuncture point stimulation of oral and cheek for 17 minutes and non-nutritive sucking for 3 minutes before feeding,with twice per day.Results There was no significant difference between group B and C on the transitional time from the initiation of oral feeding to full oral feeding (P>0.05). Transitional time of both groups were significant shorter than that of group A (P<0.05). Feeding performance of prematures from the initiation of oral feeding to full oral feeding in group C was significant better than group A and B (P<0.05). There was significant difference in the feeding performance of prematures at the initiation of oral feeding between A and B group (P<0.05),but no significant differences between two groups after full oral feeding (P>0.05).Conclusions Different oral motor interventions including NNS and acupuncture point stimulation of oral and cheek combined with NNS can reduce the time of achieving full oral feeding in prematures. Acupuncture point stimulation of oral and cheek combined with NNS performs better than only NNS on feeding in prematures.

Objective:To summarize the best evidence of chronic pain management in the elderly, and to provide reference for the clinical practice of chronic pain management in the elderly.Methods:Focusing on the problem of chronic pain in the elderly, evidence-based nursing method was used to search the relevant literature in domestic and foreign databases from the establishment of the database to June 2, 2020. Two researchers evaluated the quality of various studies and level of evidence recommendation by the JBI evidence-based health care center's literature quality evaluation standard and evidence recommendation system, and extracted evidences from the literature meeting the inclusion criteria.Results:A total of 20 articles were included with 8 guides, 3 systematic reviews, 3 expert consensus, 1 best decision, 1 position statement and 4 evidence summaries. Finally, 20 pieces of best evidence were formed, including general principles of pain management, pain assessment, intervention strategies, self-management, education and training.Conclusions:This study summarizes the current literature on chronic pain in the elderly, which provides evidence-based basis for the management of chronic pain in the elderly. Clinicians should use the evidence according to the best clinical evidence and the actual medical conditions of the hospital, in order to improve the quality of nursing.

Objective To systematically review the risk prediction models for postoperative pancreatic fistula(POPF)after pancreaticoduodenectomy(PD),and to provide a reference for the clinical screening and application of POPF-related risk models.Methods This study was conducted according to the PRISMA guidelines,with a PROSPERO registration number of CRD42023437672.PubMed,Scopus,Embase,Web of Science,the Cochrane Library,CNKI,VIP,Wanfang Data,China Medical Journal Full-text Database,and CBM were searched for studies on establishing risk prediction models for POPF after PD published up to April 26,2024.The PROBAST tool was used to assess the quality of articles,and RevMan 5.4 and MedCalc were used to perform the Meta-analysis.Results A total of 36 studies were included,involving 20 119 in total,and the incidence rate of POPF after PD was 7.4%—47.8%.A total of 55 risk prediction models were established in the 36 articles,with an area under the receiver operating characteristic curve(AUC)of 0.690-0.952,among which 52 models had an AUC of>0.7.The quality assessment of the articles showed high risk of bias and good applicability.MedCalc was used to perform a statistical analysis of AUC values,and the results showed a pooled AUC of 0.833(95%confidence interval:0.808-0.857).The Meta-analysis showed that body mass index,amylase in drainage fluid on the first day after surgery,preoperative serum albumin,pancreatic duct diameter,pancreatic texture,fat score,tumor location,blood loss,sex,time of operation,main pancreatic duct index,and pancreatic CT value were predictive factors for POPF(all P<0.05).Conclusion The risk prediction models for POPF after PD is still in the exploratory stage.There is a lack of calibration methods and internal validation for most prediction models,and only the univariate analysis is used to for the screening of variables,which leads to the high risk of bias.In the future,it is necessary to improve the methods for model establishment,so as to develop risk prediction models with a higher prediction accuracy.