OBJECTIVE To investigate the use of drugs and the development of pharmaceutical care in the tight medical alliance （shorted for “medical alliance”） of Wanzhou District of Chongqing， and provide reference for the further construction of the medical alliance. METHODS A survey form was designed and distributed to 21 constituent units （5 leading units and 16 member units） of 5 medical alliances in Wanzhou District of Chongqing. The statistical analysis was conducted in aspects of basic drug allocation and use， pharmaceutical personnel team construction， the development of pharmaceutical care， and rational use of antibiotics. RESULTS Among the 21 constituent units， 4 leading units and 14 member units achieved the target for the proportion of essential drug procurement varieties， with a total compliance rate of 85.71%； 4 leading units and 13 member units achieved the target for the proportion of national essential drug allocation and usage amount， with a total compliance rate of 80.95%. The proportions of personnel with doctoral degrees in the 5 leading units and 16 member units were 1.71% and 0 respectively， and the proportions of personnel with senior professional titles were 8.56% and 1.63%， respectively. A total of 5 pharmacy or pharmaceutical combined outpatient clinics were set up in the 21 medical alliance units， and 5 clinical pharmacy information service platforms were established； all 5 leading units were able to regularly carry out clinical pharmacy projects， while only 4 out of 16 member units had conducted medical order review and evaluation. The proportions of irrational use of antibiotics in outpatient prescriptions and inpatient medical records of the 16 member units （4.81%， 5.21%） were significantly higher than those of the 5 leading units （2.80%， 4.00%）. CONCLUSIONS The allocation and usage of national essential drugs in 21 constituent units from Wanzhou District of Chongqing are both in good standing. However， the data on the allocation of pharmaceutical professionals and the number， qualifications， and job titles of clinical pharmacists in member units are generally low. Moreover， the pharmaceutical service projects and service quality in member units need to be further improved.

Objectives:To investigate the clinical value of contrast echocardiography in the detection of right heart space-occupying lesions. Methods:The imaging and clinical data of 39 patients with right heart space-occupying lesions confirmed by surgery,pathology and clinical treatment in Yanbian University Hospital from January 2019 to January 2023 were retrospectively analyzed.All patients underwent contrast echocardiography and cardiac magnetic resonance(CMR)examinations.The contrast echocardiography features of right heart neoplastic from non-neoplastic occupying lesions were summarized.The diagnostic efficacy of contrast echocardiography and CMR in right heart space-occupying lesions was compared. Results:Among the 39 patients,12 patients(30.8%)were confirmed as thrombus and vegetation,6 patients(15.4%)as benign tumors and 21 patients(53.8%)as malignant tumors.There were 8,4,4 and 17 patients of thrombus,vegetation,benign tumor and malignant tumors located in right atrium,respectively.Contrast echocardiography was used to diagnose thrombus and vegetation in 12 patients(30.8%),benign tumors in 5 patients(12.8%),malignant tumors in 22 patients(56.4%).CMR was used to diagnose thrombus and vegetation in 18 patients(46.2%),benign tumors in 5 patients(12.8%),malignant tumors in 16 patients(41.0%).The Kappa coefficient between contrast echocardiography and clinical diagnosis was 0.956(P<0.001).The Kappa coefficient between CMR and clinical diagnosis was 0.754(P<0.001). Conclusions:Contrast echocardiography can dynamically observe the degree of vascularization in the lesion tissue in real-time,accurately distinguishing the nature of the right heart space-occupying lesions.

The standardization of medical management is critical for facing the challenge of public health emergencies in primary medical and health institutions. During the COVID-19 epidemic a quality standard system for pharmacy management was developed in Shanghai Gubei Community Health Service Center, which included 4 standardized modules: medication management module, pharmacy administration modules, pharmacy service module and specialized disease management module. In this article the author discusses the construction of pharmacy quality management standards, its application and roles in COVID-19 epidemics, to provide reference for quality pharmacy management during public health emergencies in grass-roots medical and health institutions.

Objective:To explore the quality improvement in the organization structure and management model of the integrated community child health services.Methods:This was a qualitative study, including two parts: cause analysis and service improvement suggestions. In the analysis part the data mining was conducted to identify valuable patterns and relationships in the comprehensive child health services. Semi-structured interviews were conducted with 12 relevant department heads and health workers of the comprehensive child health service team at Gumei Community Health Service Center in December 2023, and the causes of the key problems were explored. In the service improvement part, focus group discussions were held to propose suggestions, then improvement measures were formulated to address the identified problems.Results:Through data mining and semi-structured interviews, the key problems were identified: information isolation among multiple departments and lack of coordination mechanism in the comprehensive child health service team. A team organizational structure based on the "three definite" principle was established. The organizational structure should include the pediatric family doctor team, general practitioner management team and departments of pediatrics, maternal and child health care, immunization and child rehabilitation; the management model should include a cross-department resource and information sharing mechanism, the pediatric family doctor model, optimization and integration of physical space, and enhancement of publicity activities for the comprehensive child health services.Conclusion:Based on the analysis in Gumei health service center, this study identified key problems in community integrated child health services, and proposes the quality improvement measure in the organizational structure and management model of the service team.

Objective To explore the clinical effect of different doses of alfentanil combined with low-dose propofol in painless colonoscopy in elderly patients.Methods A total of 120 elderly patients undergoing elective painless colonoscopy from January to March 2022,aged 65 to 80 years,gender unlimited,body mass index(BMI)18-28kg/m2,American Society of Anesthesiologists(ASA)grade Ⅰ～Ⅱ.Patients were included in the three groups by random number tables:alfentanyl 5μg/kg(N1),alfentanyl 7.5μg/kg(N2),and alfentanyl 10μg/kg(N3),40 patients in each group.Record the heart rate,mean arterial pressure,and oxygen saturation were recorded before anesthesia(T1),after anesthesia induction(T2),colonoscopy(T3),colonoscopy reaching the ileocecum(T4),and at the end of examination(T5).The success rate of anesthesia sedation,dosage of propofol,sedative induction time,colonoscopy time,sedative recovery time,use of vasoactive drugs and physician satisfaction of the three groups were recorded.The incidence of intraoperative hypoxemia,hypotension,spontaneous ycardia,bradycardia,postoperative nausea and dizziness,and postoperative fatiguesyndrome(POFS)and the occurrence of adverse reactions.Results Compared with T1,the mean arterial pressure in T2-T5 patients decreased significantly(P＜0.05),and the heart rate at T3 increased significantly(P＜0.05)in N1,the total dosage,induction time,induction time,awakening time and vasoactive drug use were decreased in N2 and N3,and the success rate of anesthesia sedation was significantly increased(P＜0.05).Comparing the N2 group,physician satisfaction decreased in the N1 and N3 groups(P＜0.05).The incidence of intraoperative hypotension and postoperative POFS decreased in the N2 and N3 groups(P＜0.05)and in the N1 and N2 groups(P＜0.05).Conclusion Afunentanil 7.5pg/kg compound propofol can be used safely and effectively for painless colonoscopy in elderly patients,and the incidence of adverse reactions is low,which improves the quality of postoperative recovery of patients,and is worthy of clinical promotion and application.

Objective:To explore the relevancy between the uridine diphosphate-glucuronylgly-cosyltransferase 1A1 (UGT1A1) gene mutation and the phenotype of indirect hyperbilirubinemia in children.Methods:Sixteen cases with indirect hyperbilirubinemia who visited the Department of Gastroenterology, Children's Hospital of Nanjing Medical University from July 2013 to November 2019 were retrospectively analyzed and were divided into Gilbert syndrome (GS), Crigler-Najjar syndrome type II (CNS-II), and indirect hyperbilirubinemia groups unexplained by UGT1A1 gene mutations. The differences in gene mutation site information and general clinical data were compared. The association between gene mutation spectrum and bilirubin level was explored by t-test analysis.Results:Ten of the sixteen cases with indirect hyperbilirubinemia had GS, three had CNS-II, and three had indirect hyperbilirubinemia unexplained by UGT1A1 gene mutations. A total of six mutation types were detected, of which c.211G?>?A accounted for 37.5% (6/16), c.1456T?>?G accounted for 62.5% (10/16), and TATA accounted for 37.5% (6/16), respectively. Compared with the GS group, the CNS group had early disease onset incidence, high serum total bilirubin ( t ?=?5.539, P ??0.05) and age of onset ( t ?=?0.3611, P ?>?0.05) between the two groups. There was no significant correlation between the number of UGT1A1 gene mutations and serum bilirubin levels. Children with c.1456T?>?G homozygous mutations had the highest serum bilirubin levels. Conclusion:The common pathogenic variants of the UGT1A1 gene sequence are c.1456T?>?G, c.211G?>?A, and TATA, indicating that these site mutations are related to the occurrence of indirect hyperbilirubinemia and have important guiding significance for the etiological analysis of indirect hyperbilirubinemia in children.

Objective:To evaluate the impact of self-crosslinked hyaluronic acid (SCH) gel on endometrium recovery after artificial abortion.Methods:A multicenter, prospective randomized controlled trial was conducted across 18 hospitals from December 2021 to February 2023, involving 382 women who underwent artificial abortion. Participants were randomly allocated to receive either treatment with SCH gel (SCH group) or no treatment (control group) in a 1∶1 ratio. The primary outcome was endometrium thickness in 14 to 18 days after the first postoperative menstruation. Secondary outcomes included changes in menstrual volume during the first postoperative menstruation, menstruation resumption within 6 postoperative weeks, time to menstruation resumption, duration of the first postoperative menstruation, and incidence of dysmenorrhea.Results:Baseline characteristics of participants were comparable between the two groups (all P>0.05), with 95.3% (182/191) in SCH group and 92.7% (177/191) in the control group completed the study. The postoperative endometrial thickness in SCH group was significantly greater than that in the control group [(9.78±3.15) vs (8.95±2.32) mm; P=0.005]. SCH group also had significantly fewer participants with reduced menstrual volume [23 cases (12.6%, 23/182) vs 31 cases (17.5%, 31/177); P=0.038]. Although SCH group experienced less dysmenorrhea during the first postoperative menstrual period, this difference was not statistically significant [28.5% (51/179) vs 37.1% (65/175); P=0.083]. Outcomes were similar between SCH group and the control group regarding the proportion of participants who resumed menstruation within 6 weeks postoperatively, time to menstruation resumption, and duration of the first postoperative menstruation ( P=0.792, 0.485, and 0.254, respectively). No serious adverse events were observed during the study period, and no adverse events were attributed to SCH gel treatment. Conclusion:The application of SCH gel after artificial abortion is safe and might aid in the recovery of the endometrium.

Objective:To retrieve, evaluate and integrate the best evidence of blood glucose management in hemodialysis patients with end-stage diabetic kidney disease, so as to provide a basis for clinical evidence-based nursing practice.Methods:BMJ Best Clinical Practice, Cochrane, OVID, Scopus, UpToDate, CNKI, Wanfang Database, Medical Pulse database, and other guideline networks and professional association websites and databases were searched for blood glucose management in hemodialysis patients with end-stage diabetic kidney disease. The search time limit was from the establishment of the database to May 10, 2023.Results:A total of 14 articles were included, including 1 clinical decision, 5 guidelines, 6 systematic reviews, 1 randomized controlled trial, and 1 expert consensus. The best evidences for blood glucose management in hemodialysis patients were summarized, including 8 aspects of pre-dialysis assessment, pre-dialysis blood glucose management, blood glucose management during dialysis, blood glucose management during dialysis interval, diet and nutrition, exercise management, lifestyle intervention and health education, with 25 pieces of evidence.Conclusions:This study summarizes the best evidence of blood glucose management in hemodialysis patients with end-stage diabetic kidney disease, and provides evidence-based basis for clinical practice for medical staff.

Objective:To measure the retinal structural and functional parameters of adult Macaca fascicularis, and explore the similarity of the retinal structural and functional parameters between non-human primates and normal human retinas.Methods:Six eyes of 3 5-year-old adult Macaca fascicularis were examined by in vivo detection including color fundus photography, retinal optical coherence tomography (OCT) and electroretinogram (ERG) to determine the thickness of the inner/outer retina at the fovea and 1 000/2 000 μm away from the nasal, temporal, superior and inferior regions of the fovea, the thickness of the retinal nerve fiber layer (RNFL), the area of optic disc, the area of optic cup, the area ratio of cup to disc and the biological parameters of flash ERG.Differences in the above parameters between left and right eyes were analyzed.The similarity of parameters between Macaca fascicularis and human was compared with reference to published literature.The use and care of animals complied with the Regulation on the Management of Experimental Animals.The study protocol was approved by the Institutional Animal Care and Use Committee of Hubei Topgene Biotechnology (NO.IACUC-2019-012). Results:The foveal thickness, optic disc area, cup-disc area ratio, and average RNFL thickness in normal adult Macaca fascicularis were (252.31±4.79)μm, (1.89±0.05)mm 2, 0.14±0.01, and (103.53±0.58)μm, respectively.The b-wave amplitude of dark-adapted 0.01 ERG was (66.75±7.29)μV.The a- and b-wave amplitudes of dark-adapted 3.0 ERG response were (57.15±15.01) and (122.10±25.51)μV, respectively.The a- and b-wave amplitudes, the amplitude of oscillation potentials, and the latency of dark-adapted 10.0 ERG response were (72.98±20.14)μV, (131.67±13.78)μV, (49.98±10.08)μV, and (30.02±5.76)ms, respectively.The a- and b-wave amplitudes of light-adapted 3.0 ERG were (9.16±2.75) and (40.43±5.57)μV, respectively.The latency and the amplitude of the light-adapted 30 Hz flicker was (26.61±1.19)ms and (24.72±5.10)μV, respectively.There was no significant difference in the parameters between left and right eyes (all at P>0.05). The retinal thickness in central fovea, mean RNFL thickness, waveform and amplitude of ERG of Macaca fascicularis were similar to normal human. Conclusions:The structure and function of the retina of adult Macaca fascicularis are similar to those of normal humans.As a laboratory animal for preclinical drug research, in vivo studies of Macaca fascicularis can refer to normal human retinal parameters.

ObjectiveTo determine the antibody levels of varicella-zoster virus （VZV） in healthy individuals aged 1 to 30 years in Songjiang District of Shanghai， and to provide evidence for further development of varicella immunization strategies for healthy population. MethodsSix village committees were selected in Songjiang District through multi-stage stratified random sampling method from July to September 2022. Healthy individuals aged 1 to 30 years old in these villages were recruited and 3‒5 mL of venous blood was collected. Anti-VZV IgG antibody was tested by ELISA. Positive rate of anti-VZV IgG antibody and geometric mean concentration （GMC） were determined. ResultsA total of 315 healthy individuals aged （10.97±8.38） years were included in this study， of which 165 were males aged （11.00±8.52） years and 150 were females aged （10.96±8.25） years. Blood samples were collected and tested for anti-VZV IgG antibody， with the overall positive rate of 55.24% （174/315）. The GMC was calculated to be 99.73 mIU·mL^-1， with the GMC in those tested positive for anti-VZV IgG antibody of 413.11 mIU·mL^-1. The positive rate of anti-VZV IgG antibody and GMCs across age groups ranged between 13.33%‒86.67% and 16.36‒355.14 mIU·mL^-1， respectively. The highest GMC was found in the group of 20‒30 years old （355.14 mIU·mL^-1）， followed by 132.41 mIU·mL^-1 in the group of 5‒ years old and 138.12 mIU·mL^-1 in the group of 15‒ years old. Moreover， the positive rate was 38.47% in the group with 1-dose varicella vaccine and 63.49% in the group with 2 doses， while the GMC were 53.28 mIU·mL^-1 and 130.79 mIU·mL^-1 in these two groups， respectively. Multivariable analysis revealed that occupation was a risk factor associated with anti-VZV IgG antibody （OR=2.540）. Stratified analysis by varicella immunization history showed that among 2-dose vaccination group， time interval since the last dose was a protective factor （OR=0.315）. ConclusionsThe overall positive rate of anti-VZV IgG antibody in healthy population in Songjiang District of Shanghai remains low. The 2-dose varicella vaccination should be strengthened to improve the coverage in susceptible population.