OBJECTIVE:To discuss the application practice of PIVAS standardization in pharmacy intravenous admixture ser-vice(PIVAS)of our hospital. METHODS:Based on JCI,the design concept and management mode of PIVAS were analyzed and summarized from PIVAS design,management,job and medical order time arrangement,staff management,infusion quality or fault emergency plan,etc. RESULTS:After introducing JCI standards,the improvement was conducted in respects of management system and work flow design,purification system and logistics division design,information system design,etc. Working hour was arranged according to the workload or work flow and the actual needs of clinical departments. Medical orders,1 batch per hour,24 batches one day,were delivered to clinical departments according the time point. The positivity of the staff had been improved, and work quantization and performance appraisal had been achieved. Those improvement optimized drug dispensing process, cleared the responsibility of information management and guaranteed the quality of infusion. Work error analysis and summary were monthly conducted;the number of work error decreased from 562 cases before JCI introduction(2013)to 264 cases after JCI intro-duction (2014),decreasing by 112.87% annually. CONCLUSIONS:JCI standard is of significance to the promotion of PIVAS management,work level and quality,and safe and rational use of drugs in the clinic.

Glycosylation, one of the most common and important reactions in biological systems, results in diverse functions and is often found in biologically active small-molecule natural products produced by microorganisms. Furthermore, sugar moieties are generally critical for their activities. Alternating the sugar structures thus provides the potentials for enhancing the biological activities of natural products, which evokes researchers to study the sugar biosynthetic machinery and its application in the modification of sugar moieties with an aim of generating unnaturally glycosylated natural product drugs with better activities. This review will briefly outline current studies on sugar biosynthesis and glycosyltransferase, with a few selected experiments designed to alter natural-product sugar structures.

A novel near-infrared (NIR) diffuse correlation spectroscopy (DCS) has recently been developed for noninvasive monitoring of tumor blood flow during photodynamic therapy (PDT).DCS offers several attractive new features for tumor blood flow measurement such as noninvasiveness,portability,low cost,high temporal resolution and relatively large penetration depth.DCS technology has been utilized for continuous measurement of tumor blood flow before,during and after PDT in both animals and humans.The ultimate goal is to predict treatment outcomes from the measured tumor hemodynamic responses to PDT.

Objective To evaluate the relationship between the lung volume (LV) in inspiration and expiration,pulmonary function tests(PFT),and other CT measurements of emphysema index (EI) and mean lung density (MLD) in patients with chronic obstructive pulmonary disease (COPD).Methods Seventy-six patients with COPD were included.Three-dimension analysis was performed to obtain the following CT parameters on the inspiratory and expiratory phases:EI,MLD,LV.The ratios and differencesof MLD and LV between the two phases were calculated(ΔMLD,ΔLV,MLDex/in,LVexin).Not only the linear correlations between the lung volume parameters and PFT but also the correlations of lung volume parameters with the other CT parameters were tested by the Spearman rank correlation test and multivariant step wise regression.Results LVex/in had negative correlations with forced expiratory volume in 1 second ％ predicted [FEV1 ％,(54.32 ± 7.11)] and the ratio of forced expiratory volume in 1 second to forced vital capacity [FEV1/FVC,(49.12 ±8.01)％] (r =-0.69,-0.56,P ＜0.01),but it had the positive correlation with the ratio of residual volume to total lung capacity [RV/TLC,(58.03 ± 8.55) ％,Spearman coefficients 0.66,P ＜ 0.01].LV/exin (0.67 ± 0.12) was positively correlated with MLDex/in (0.89 ± 0.04,r =0.88,P ＜0.01).The further multivariate step wise regression denonstrated that EI,LV and MLD could introduce a regression equation with R2 =0.77 and 0.73,respectively (P ＜ 0.01).Conclusions There is an association between LVex/in and the parameters of routine PFT,which can reflect the collapsibility of lung.Moreover,LVex/in can be considered to be equivalent to MLDex/in.Taking into account the impact of scanning parameters on MLDex/in,LVex/in may play a complementary role in the assessment of pulmonary function.

Objective:To investigate the clinical efficacy of butylphthalide combined with hyperbaric oxygen therapy on post-stroke cognitive impairment in patients with acute ischemic stroke.Methods:A total of 90 patients with post-stroke cognitive impairment who were hospitalized within 72 hours of onset in Suining County People's Hospital from December 2019 to November 2020 were included in this study. They were randomly divided into a control group and an observation group ( n = 45/group). The control group was given conventional treatment and the observation group was given butylphthalide combined with hyperbaric oxygen therapy in addition to conventional treatment. The National Institutes of Health Stroke Scale score, Montreal Cognitive Assessment score, and Activities of Daily Living score were compared between the two groups before and after treatment. Results:Before treatment, there were no significant differences in the National Institutes of Health Stroke Scale score, Montreal Cognitive Assessment score, and Activities of Daily Living score between the two groups (all P > 0.05). At 14 days and 1 month after surgery, the National Institutes of Health Stroke Scale scores in the observation group were (4.02 ± 2.18) points and (3.21 ± 2.03) points, which were significantly lower than (5.21 ± 2.24) points and (4.62 ± 2.68) points in the control group ( t =2.55, 2.81, both P < 0.05). At 1 and 3 months after treatment, the Montreal Cognitive Assessment score in the observation group were (19.79 ± 5.67) points and (23.69 ± 2.67) points, which were significantly higher than (16.88 ± 5.12) points and (19.74 ± 2.29) points in the control group ( t = 2.56, 7.53, both P < 0.05). At 1 and 3 months after treatment, Activities of Daily Living scores in the observation group were (54.85 ± 5.69) points and (74.38 ± 4.98) points, which were significantly higher than (46.78 ± 6.24) points and (63.21 ± 5.24) points in the control group ( t = 6.41, 9.76, both P < 0.05). Conclusion:Butylphthalide combined with hyperbaric oxygen therapy for the treatment of post-stroke cognitive impairment in patients with acute ischemic stroke can alleviate neurologic deficits, and improve cognitive function and the ability of daily life.

Objective:To construct a machine-learning model for predicting the progression of pancreatic cystic lesions (PCLs) based on clinical and CT features, and to evaluate its predictive performance in internal/external testing cohorts.Methods:Baseline clinical and radiological data of 200 PCLs in 177 patients undergoing abdominal thin slice enhanced CT examination at Peking Union Medical College Hospital from July 2014 to December 2022 were retrospectively collected. PCLs were divided into progressive and non-progressive groups according to whether the signs indicated for surgery by the guidelines of the European study group on PCLs were present during three-year follow-up. 200 PCLs were randomly divided into training (150 PCLs) and internal testing cohorts (50 PCLs) at the ratio of 1∶3. 15 PCLs in 14 patients at Jinling Affiliated Hospital of Medical School of Nanjing University from October 2011 to May 2020 were enrolled as external testing cohort. The clinical and CT radiological features were recorded. Multiple feature selection methods and machine-learning models were implemented and combined to identify the optimal machine-learning model based on the 10-fold cross-validation method. Receiver operating characteristics (ROC) curve was drawn and area under curve (AUC) was calculated. The model with the highest AUC was determined as the optimal model. The optimal model's predictive performance was evaluated on testing cohort by calculating AUC, sensitivity, specificity and accuracy. Permutation importance was used to assess the importance of optimal model features. Calibration curves of the optimal model were established to evaluate the model's clinical applicability by Hosmer-Lemeshow test.Results:In training and internal testing cohorts, the progressive and non-progressive groups were significantly different on history of pancreatitis, lesions size, main pancreatic duct diameter and dilation, thick cyst wall, presence of septation and thick septation (all P value <0.05) In internal testing cohort, the two groups were significantly different on gender, lesion calcification and pancreatic atrophy (all P value <0.05). In external testing cohort, the two groups were significantly different on lesions size and pancreatic duct dilation (both P<0.05). The support vector machine (SVM) model based on five features selected by F test (lesion size, thick cyst wall, history of pancreatitis, main pancreatic duct diameter and dilation) achieved the highest AUC of 0.899 during cross-validation. SVM model for predicting the progression of PCLs demonstrated an AUC of 0.909, sensitivity of 82.4%, specificity of 72.7%, and accuracy of 76.0% in the internal testing cohort, and 0.944, 100%, 77.8%, and 86.7% in the external testing cohort. Calibration curved showed that the predicted probability by the model was comparable to the real progression of PCLs. Hosmer-Lemeshow goodness-of-fit test affirmed the model's consistency with actual PCLs progression in testing cohorts. Conclusions:The SVM model based on clinical and CT features can help doctors predict the PCLs progression within three-year follow-up, thus achieving efficient patient management and rational allocation of medical resource.

Objective To evaluate the value of bone marrow imaging by third-generation dual-source dual-energy CT(DSDECT) using virtual noncalcium(VNCa) technique for the assessment of diffuse infiltrative lesions of multiple myeloma(MM). Methods From December 2015 to June 2016,31 patients with plasma disorders at our center were prospectively recruited and received whole-body imaging with third-generation DSDECT and MRI. CT numbers of vertebrae were measured on VNCa images as well as regular CT images. Correlation between VNCa CT numbers and MRI signal intensities of the vertebrae was evaluated. The diagnostic ability of VNCa for MM infiltrative lesions was assessed by ROC analysis,using MRI as the reference standard. Results The mean VNCa CT numbers of vertebrae with MM diffuse infiltration (n=62) were (-13.27±18.96)HU,which were significantly higher than those of non-infiltrated vertebrae[(-63.31±26.75)HU,(n=117)] (Z=-9.731,P=0.000). VNCa CT numbers of vertebrae were negatively correlated with T1WI signal intensity normalized by non-degenerative vertebral discs (r=-0.592,P=0.000). ROC analysis showed the area under the curve of VNCa for the diagnosis of infiltrative lesions was 0.943. With the cut-off value of-37 HU,the sensitivity and specificity of VNCa were 90.32% and 87.18%,respectively. Conclusion Bone marrow imaging by third-generation DSDECT using VNCa technique is a valuable tool for assessing diffuse infiltrative lesions of MM.
Bone Marrow ; diagnostic imaging ; Humans ; Magnetic Resonance Imaging ; Multiple Myeloma ; diagnostic imaging ; ROC Curve ; Sensitivity and Specificity ; Spine ; diagnostic imaging ; Tomography, X-Ray Computed ; methods

Objective To evaluate the image quality and radiation exposure in multidetector computed tomography (MDCT) with automated topogram-based tube potential selection,compared to fixed tube potential,in patients with solid pancreatic lesions. Methods The preoperative pancreatic dual-source CT images of 113 patients who were confirmed as solid pancreatic lesions by postoperative pathology in the Peking Union Medical College Hospital from January 2014 to August 2016 were retrospectively analyzed.Among them,53 patients were examined on fixed tube potential at 120 kV,and tube current was automatically modulated (group 1). Sixty patients underwent topogram-based automatic tube potential selection (Tube voltage step:90,100 kV) and automated mA modulation (group 2). Two experienced radiologists measured the body sizes,assessed subjective and objective image quality of arterial phase and portal phase,and recorded radiation parameters including CT dose index volume (CTDI) and dose-length product (DLP). Results Of 60 patients in group 2,45 patients were scaned at 90 kV,15 patients were scaned at 100 kV.The average body diameter [(287±24) mm] in 90 kV group was significantly lower than that [(328±22) mm] in 100 kV group(t=0.731,P=0.0008). The mean CTDI[(3.9±1.0) mGy] in group 2 was significantly lower than in group 1 [(9.0±1.9) mGy],reduced by 56.7% (t=17.5,P=0.0003). The average DLP [(109±38) mGy·cm] in group 2 was significantly lower than that in group 1 [(276±83) mGy·cm],reduced by 60.5% (t=14.0,P=0.0007). In group 2,the standard deviations of images background noise in arterial and portal phase were (6.4±0.9) and (6.4±1.0)HU,respectively,which were significantly higher than those in group 1 [(5.6±1.4)HU,t=-3.757,P=0.0003;(5.5±1.4)HU,t=-3.828,P=0.0006]. In group 2,the signal to noise ratios of pancreatic lesions, abdominal aorta in arterial phase and pancreatic lesions, the portal vein in portal phase were 18.8±9.3,76.0±19.3 and 17.4±6.7,33.1±7.2,which were significantly higher than those in group 1 (13.1±8.7,t=-3.379,P=0.001;56.5±22.6,t=-2.268,P=0.025;14.1±8.1,t=-2.283,P=0.024;28.9±8.8,t=-2.613,P=0.009). Conclusion Compared with fixed tube voltage on the second-generation dual-source CT techniques,topogram-based automatic tube potential selection on third-generation dual-source CT can reduce radiation dose without decreasing image quality in imaging solid pancreatic lesions.
Humans ; Multidetector Computed Tomography ; methods ; Pancreas ; diagnostic imaging ; pathology ; Radiation Dosage ; Retrospective Studies ; Signal-To-Noise Ratio