OBJECTIVE To optimize the drug placement layout， reduce pharmacists’ dispensing time， and improve the work efficiency of the inpatient pharmacy. METHODS An ABC-CVA classification method was constructed. The ABC classification was first employed to categorize drugs into three groups [A （high frequency)， B （medium frequency）， and C （low frequency）] based on drug usage frequency. Subsequently， the CVA （Critical Value Analysis） method was applied to further classify drugs with low frequency （mainly category C） but requiring urgent use （e.g.， emergency drugs） or occupying large space. RESULTS After optimizing the drug placement layout based on this method， the average daily dispensing time for long-term prescriptions across three major wards （internal medicine， surgery， and intensive care unit） was shortened by （14.7±4.9） min. The optimized average daily dispensing time in each ward was significantly lower than that before optimization， and all differences were statistically significant （ P ＜0.001）. CONCLUSIONS The established ABC-CVA classification method can precisely facilitate the optimization of drug layout in inpatient pharmacies， significantly improve pharmacists’ dispensing efficiency， and enhance the service quality of inpatient pharmacies.

BACKGROUND:Crosslinked sodium hyaluronate gel has good mechanical property,biocompatibility,and biodegradability,and can be used as an isolated protective material in tumor radiation therapy to protect endangered organs from damage caused by excess radiation dose. OBJECTIVE:To investigate the safety and efficacy of crosslinked sodium hyaluronate gel in reducing the dose of radiation to dangerous organs during brachytherapy. METHODS:A total of 16 specific pathogen-free Kunming mice of the same age and similar body weight were selected as experimental subjects and divided into experimental group and control group by the random number table method,with 8 mice in each group.125I seeds were implanted subcutaneously in the back of mice in the experimental group,and then crosslinked sodium hyaluronate gel was injected around the radioactive particles.Only 125I seeds were implanted subcutaneously in the back of mice in the control group.After injection,the distance between the radioactive particles and the epidermis was measured by spiral CT scan,and the surface radiation dose was measured by radiation dosimeter.Within 10 weeks after injection,the growth state,survival rate,skin radiation damage,and gel retention of mice were observed. RESULTS AND CONCLUSION:(1)Spiral CT scan showed that the implanted gel was relatively concentrated and created an effective distance between the radioactive seeds and the epidermis.The body surface radiation dose of the experimental group was significantly lower than that of the control group(P<0.01).(2)During the experimental observation period,mice in both groups survived;mice in the control group showed obvious irritability and other unstable behavior in the late experimental period,and some mice in the experimental group showed similar behavior.The daily food intake of mice in the two groups had no significant change,and the body mass showed the same increasing trend.After implantation of radioactive seeds,the two groups of mice showed different degrees of radioactive skin injury.From day 23 after injection to the end of the experiment,the skin radiation injury score of the experimental group was lower than that of the control group(P<0.01).At week 10 after implantation,6 mice in the experimental group had no obvious gel residue under their skin,and 2 mice had a very small amount of scattered gel-like samples under their skin.(3)Therefore,the crosslinked sodium hyaluronate injection technique can increase the space between the radioactive target area of 125I seeds and the organ at risk outside the target through physical space occupying,which can effectively reduce the dose of the organ at risk,and play a role in the isolation and protection of the organ at risk.

ObjectiveTo investigate the efficacy and mechanism of Polygoni Cuspidati Rhizoma et Radix （Huzhang） in treating respiratory syncytial virus（RSV） infection by regulating pulmonary surfactant lipid homeostasis through lipidomics. MethodsSixty BALB/c mice were randomly divided into the blank group， model group， positive group（ribavirin group， 46 mg·kg^-1）， and low- and high-dose Huzhang groups（0.75， 2.25 g·kg^-1）， with 12 mice in each group. Except for the blank group， all other groups were infected with RSV via intranasal instillation. The drug intervention groups were given corresponding doses of drug by gavage for 3 consecutive days， while normal saline was used in the blank and model groups. Hematoxylin-eosin（HE） staining was used to observe pathological changes in mouse lung tissue. Real-time fluorescence quantitative polymerase chain reaction（Real-time PCR） was employed to detect viral loads［RSV-nucleoprotein（N） and RSV-glycoprotein（G） mRNA］ and inflammatory factor levels［interleukin（IL）-1β and tumor necrosis factor（TNF）-α mRNA］ in the lung tissue. Mouse bronchoalveolar lavage fluid was collected to detect the levels of pulmonary surfactant lipids through ultra-high performance liquid chromatography-quadrupole-electrostatic field orbitrap high-resolution mass spectrometry（UPLC-Q-Exactive Orbitrap-MS）， followed by principal component analysis and differential lipid identification. ResultsCompared with the blank group， the model group exhibited extensive inflammatory cell infiltration， congestion， and tissue damage in the lungs， and the pathological score and lung index of lung tissue significantly increased（P<0.01）， along with significantly elevated mRNA expressions of RSV-N， RSV-G， IL-1β， and TNF-α（P<0.01）. Compared with the model group， different doses of Huzhang and ribavirin significantly reduced the pathological scores of the lung tissue and lung index（P<0.01）. In addition， the mRNA levels of RSV-N， RSV-G and TNF-α in the lungs significantly decreased in the Huzhang high dose group（P<0.01）. Lipidomics analysis identified multiple significantly changed differential metabolites. Compared with the blank group， the model group showed obvious abnormal lipid metabolism， which was manifested by the elevated levels of prostaglandin（PG）， ceramide（Cer）， phosphatidylcholine（PC）， phosphatidylethanolamine（PE）， phosphatidylinositol（PI）， sphingomyelin（SM）， and the decreased levels of diglycerides（DG） and acylethanolamine（NAE）. After the intervention of low dose of Huzhang， the above lipid metabolites showed a significant reversal trend， while the intervention of high dose of Huzhang could regulate levels of PI lipids， PG lipids and PC lipids. ConclusionHuzhang can significantly reduce the viral load of lung tissue and improve lung inflammation in RSV-infected mice. The underlying mechanism may be related to the maintenance of homeostasis in pulmonary surfactant lipids such as PI and PG.

ObjectiveTo investigate the efficacy and mechanism of Polygoni Cuspidati Rhizoma et Radix （Huzhang） in treating respiratory syncytial virus（RSV） infection by regulating pulmonary surfactant lipid homeostasis through lipidomics. MethodsSixty BALB/c mice were randomly divided into the blank group， model group， positive group（ribavirin group， 46 mg·kg^-1）， and low- and high-dose Huzhang groups（0.75， 2.25 g·kg^-1）， with 12 mice in each group. Except for the blank group， all other groups were infected with RSV via intranasal instillation. The drug intervention groups were given corresponding doses of drug by gavage for 3 consecutive days， while normal saline was used in the blank and model groups. Hematoxylin-eosin（HE） staining was used to observe pathological changes in mouse lung tissue. Real-time fluorescence quantitative polymerase chain reaction（Real-time PCR） was employed to detect viral loads［RSV-nucleoprotein（N） and RSV-glycoprotein（G） mRNA］ and inflammatory factor levels［interleukin（IL）-1β and tumor necrosis factor（TNF）-α mRNA］ in the lung tissue. Mouse bronchoalveolar lavage fluid was collected to detect the levels of pulmonary surfactant lipids through ultra-high performance liquid chromatography-quadrupole-electrostatic field orbitrap high-resolution mass spectrometry（UPLC-Q-Exactive Orbitrap-MS）， followed by principal component analysis and differential lipid identification. ResultsCompared with the blank group， the model group exhibited extensive inflammatory cell infiltration， congestion， and tissue damage in the lungs， and the pathological score and lung index of lung tissue significantly increased（P<0.01）， along with significantly elevated mRNA expressions of RSV-N， RSV-G， IL-1β， and TNF-α（P<0.01）. Compared with the model group， different doses of Huzhang and ribavirin significantly reduced the pathological scores of the lung tissue and lung index（P<0.01）. In addition， the mRNA levels of RSV-N， RSV-G and TNF-α in the lungs significantly decreased in the Huzhang high dose group（P<0.01）. Lipidomics analysis identified multiple significantly changed differential metabolites. Compared with the blank group， the model group showed obvious abnormal lipid metabolism， which was manifested by the elevated levels of prostaglandin（PG）， ceramide（Cer）， phosphatidylcholine（PC）， phosphatidylethanolamine（PE）， phosphatidylinositol（PI）， sphingomyelin（SM）， and the decreased levels of diglycerides（DG） and acylethanolamine（NAE）. After the intervention of low dose of Huzhang， the above lipid metabolites showed a significant reversal trend， while the intervention of high dose of Huzhang could regulate levels of PI lipids， PG lipids and PC lipids. ConclusionHuzhang can significantly reduce the viral load of lung tissue and improve lung inflammation in RSV-infected mice. The underlying mechanism may be related to the maintenance of homeostasis in pulmonary surfactant lipids such as PI and PG.

Objective:To explore the classification of bilobar anterolateral thigh perforator flaps assisted by color Doppler ultrasonography and its impact on their donor sites.Methods:A retrospective analysis was conducted of the data of 67 patients with large soft tissue defects who had been repaired with anterolateral thigh perforator flaps at Department of Orthopaedics, The Hospital Affiliated to The Second Medical University of Shandong, Department of Orthopaedics, The 80th Group Army Hospital of the People's Liberation Army, and Department of Orthopaedics, Weifang Traditional Chinese Medicine Hospital. The patients were divided into 2 groups according to their flaps used: a unilobar group and a bilobar group. In the unilobar group, 36 cases [25 males and 11 females with an age of (40.3±8.3) years] were repaired with a unilobar anterolateral thigh perforator flap from March 2015 to April 2019. In the bilobar group, 31 cases [22 males and 9 females with an age of (38.9±7.4) years] were repaired with a bilobar anterolateral thigh perforator flap from May 2019 to August 2023. Color Doppler ultrasonography was used to classify the bilobar flaps into 4 types according to the different distributions of perforating vessels: common trunk type, separate trunks type, fascia dependent type, and composite mixed type. The number of perforating vessels and type of perforator flap found by preoperative color Doppler ultrasound were compared with the intraoperative findings in the bilobar group. One year after operation, recovery rate of donor muscle strength, rate of skin paresthesia, scar length at the donor site, the widest scar width and motor function were compared between the 2 groups.Results:The number of perforating vessels and type of perforator flap found by preoperative color Doppler ultrasound were consistent with the intraoperative findings ( P<0.05). There was no significant difference in the preoperative general data between the 2 groups, indicating comparability ( P>0.05). One year after operation in the bilobar group, the recovery rate of donor muscle strength was 96.8% (30/31), significantly higher than that in the unilobar group [77.8% (28/36)], the rate of skin paresthesia 6.5% (2/31), significantly lower than that in the unilobar group [27.8% (10/36)], the scar length at the donor site (22.18±5.02) cm, significantly longer than that in unilobar group [(17.35±3.11) cm], the widest scar width (7.26±1.58) mm, significantly narrower than that in the unilobar group [(43.72±9.81) mm], and the scores of Vancouver Scar Assessment Scale and Fugl-Meyer lower limb motor function scale were (1.95±0.57) points and (8.39±2.17) points, respectively, significantly lower than those in the unilobar group [(6.38±1.72) points and (14.02±3.54) points] ( P<0.05). Conclusions:Preoperative classification of bilobar anterolateral thigh perforator flaps assisted by color Doppler ultrasonography may provide guidance for flap harvesting and lobe layout of the flap. Compared to traditional unilobar flaps, bilobar ones may minimize tissue damage at a donor site.

Objective:To investigate the overall drug resistance, drug resistance trend and distribution of drug resistance mutation sites in human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS) patients with antiviral therapy failure in Yunnan Province.Methods:The demographic data and genotype drug resistance of HIV/AIDS population with antiviral therapy failure in Yunnan Province from January 2021 to December 2023 were collected and analyzed by cross-sectional investigation. Statistical analyses were performed using chi-square test.Results:Among 15 159 HIV/AIDS patients, 12 215 cases tested positive by amplification. The circulating recombinant form (CRF) 08_BC was the predominant genetic subtype, accounting for 54.97%(6 714/12 215), followed by CRF01_AE (16.14%(1 972/12 215)) and CRF07_BC (14.48% (1 769/12 215)). When the viral load was ≥200 to <1 000 copies/mL, the incidence of drug resistance was 21.48%(99/461). When it was ≥1 000 to <10 000 copies/mL, the incidence was 51.29%(2 867/5 590). When it was ≥10 000 to <100 000 copies/mL, the incidence was 69.39% (3 979/5 734). When it was ≥100 000 copies/mL, the incidence was 81.86%(352/430). A total of 7 297 drug resistant cases were detected, with a drug resistance rate of 59.74% (7 297/12 215), thus the estimated drug resistance incidence rate among the antiviral treated population in Yunnan Province was 2.00% (7 297/364 238). From 2021 to 2023, the annual drug resistance rates among patients were 60.71%(2 554/4 207), 60.28%(1 671/2 772), and 58.67% (3 072/5 236), respectively, with no statistically significant difference ( χ2=4.47, P=0.107). Among the population with antiviral therapy failure, the drug resistance rates of non-nucleoside reverse transcriptase inhibitor (NNRTI), nucleoside reverse transcriptase inhibitor (NRTI), and protease inhibitor (PI) were 93.70%(6 837/7 297), 44.10%(3 218/7 297) and 5.15%(376/7 297), respectively. The mutation sites with the highest frequencies among the three classes of drugs including NRTI, NNRTI and PI were M184V/I (46.13%(2 123/4 602)), K103N/S (37.14%(2 648/7 129)), L33F (15.50%(82/529)) and M46I/L (15.50%(82/529)), respectively. Analysis of the degree of drug resistance showed that among NNRTI drugs, nevirapine (49.01%(5 987/12 215)) and efavirenz (48.00%(5 863/12 215)) had the highest drug resistance rates, followed by emtricitabine (23.59%(2 882/12 215)) and lamivudine (23.58%(2 881/12 215)) among NRTI drugs. Conclusions:Among HIV/AIDS patients with antiviral therapy failure in Yunnan Province from 2021 to 2023, CRF08_BC is the main genetic subtype. The drug resistance rate of patients increases with the increase of HIV-1 viral load. There is no significant change in the drug resistance rate from 2021 to 2023. NNRTI has the highest drug resistance rate, followed by NRTI, and PI has the lowest. The main mutation sites are M184V/I for NRTI, K103N/S for NNRTI, and M46I/L and L33F for PI. The drug resistance rates of nevirapine, efavirenz, emtricitabine and lamivudine are relatively high.

Objective:To investigate the overall drug resistance, drug resistance trend and distribution of drug resistance mutation sites in human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS) patients with antiviral therapy failure in Yunnan Province.Methods:The demographic data and genotype drug resistance of HIV/AIDS population with antiviral therapy failure in Yunnan Province from January 2021 to December 2023 were collected and analyzed by cross-sectional investigation. Statistical analyses were performed using chi-square test.Results:Among 15 159 HIV/AIDS patients, 12 215 cases tested positive by amplification. The circulating recombinant form (CRF) 08_BC was the predominant genetic subtype, accounting for 54.97%(6 714/12 215), followed by CRF01_AE (16.14%(1 972/12 215)) and CRF07_BC (14.48% (1 769/12 215)). When the viral load was ≥200 to <1 000 copies/mL, the incidence of drug resistance was 21.48%(99/461). When it was ≥1 000 to <10 000 copies/mL, the incidence was 51.29%(2 867/5 590). When it was ≥10 000 to <100 000 copies/mL, the incidence was 69.39% (3 979/5 734). When it was ≥100 000 copies/mL, the incidence was 81.86%(352/430). A total of 7 297 drug resistant cases were detected, with a drug resistance rate of 59.74% (7 297/12 215), thus the estimated drug resistance incidence rate among the antiviral treated population in Yunnan Province was 2.00% (7 297/364 238). From 2021 to 2023, the annual drug resistance rates among patients were 60.71%(2 554/4 207), 60.28%(1 671/2 772), and 58.67% (3 072/5 236), respectively, with no statistically significant difference ( χ2=4.47, P=0.107). Among the population with antiviral therapy failure, the drug resistance rates of non-nucleoside reverse transcriptase inhibitor (NNRTI), nucleoside reverse transcriptase inhibitor (NRTI), and protease inhibitor (PI) were 93.70%(6 837/7 297), 44.10%(3 218/7 297) and 5.15%(376/7 297), respectively. The mutation sites with the highest frequencies among the three classes of drugs including NRTI, NNRTI and PI were M184V/I (46.13%(2 123/4 602)), K103N/S (37.14%(2 648/7 129)), L33F (15.50%(82/529)) and M46I/L (15.50%(82/529)), respectively. Analysis of the degree of drug resistance showed that among NNRTI drugs, nevirapine (49.01%(5 987/12 215)) and efavirenz (48.00%(5 863/12 215)) had the highest drug resistance rates, followed by emtricitabine (23.59%(2 882/12 215)) and lamivudine (23.58%(2 881/12 215)) among NRTI drugs. Conclusions:Among HIV/AIDS patients with antiviral therapy failure in Yunnan Province from 2021 to 2023, CRF08_BC is the main genetic subtype. The drug resistance rate of patients increases with the increase of HIV-1 viral load. There is no significant change in the drug resistance rate from 2021 to 2023. NNRTI has the highest drug resistance rate, followed by NRTI, and PI has the lowest. The main mutation sites are M184V/I for NRTI, K103N/S for NNRTI, and M46I/L and L33F for PI. The drug resistance rates of nevirapine, efavirenz, emtricitabine and lamivudine are relatively high.

Objective:To explore the classification of bilobar anterolateral thigh perforator flaps assisted by color Doppler ultrasonography and its impact on their donor sites.Methods:A retrospective analysis was conducted of the data of 67 patients with large soft tissue defects who had been repaired with anterolateral thigh perforator flaps at Department of Orthopaedics, The Hospital Affiliated to The Second Medical University of Shandong, Department of Orthopaedics, The 80th Group Army Hospital of the People's Liberation Army, and Department of Orthopaedics, Weifang Traditional Chinese Medicine Hospital. The patients were divided into 2 groups according to their flaps used: a unilobar group and a bilobar group. In the unilobar group, 36 cases [25 males and 11 females with an age of (40.3±8.3) years] were repaired with a unilobar anterolateral thigh perforator flap from March 2015 to April 2019. In the bilobar group, 31 cases [22 males and 9 females with an age of (38.9±7.4) years] were repaired with a bilobar anterolateral thigh perforator flap from May 2019 to August 2023. Color Doppler ultrasonography was used to classify the bilobar flaps into 4 types according to the different distributions of perforating vessels: common trunk type, separate trunks type, fascia dependent type, and composite mixed type. The number of perforating vessels and type of perforator flap found by preoperative color Doppler ultrasound were compared with the intraoperative findings in the bilobar group. One year after operation, recovery rate of donor muscle strength, rate of skin paresthesia, scar length at the donor site, the widest scar width and motor function were compared between the 2 groups.Results:The number of perforating vessels and type of perforator flap found by preoperative color Doppler ultrasound were consistent with the intraoperative findings ( P<0.05). There was no significant difference in the preoperative general data between the 2 groups, indicating comparability ( P>0.05). One year after operation in the bilobar group, the recovery rate of donor muscle strength was 96.8% (30/31), significantly higher than that in the unilobar group [77.8% (28/36)], the rate of skin paresthesia 6.5% (2/31), significantly lower than that in the unilobar group [27.8% (10/36)], the scar length at the donor site (22.18±5.02) cm, significantly longer than that in unilobar group [(17.35±3.11) cm], the widest scar width (7.26±1.58) mm, significantly narrower than that in the unilobar group [(43.72±9.81) mm], and the scores of Vancouver Scar Assessment Scale and Fugl-Meyer lower limb motor function scale were (1.95±0.57) points and (8.39±2.17) points, respectively, significantly lower than those in the unilobar group [(6.38±1.72) points and (14.02±3.54) points] ( P<0.05). Conclusions:Preoperative classification of bilobar anterolateral thigh perforator flaps assisted by color Doppler ultrasonography may provide guidance for flap harvesting and lobe layout of the flap. Compared to traditional unilobar flaps, bilobar ones may minimize tissue damage at a donor site.

Objective:To investigate the correlations of myasthenia gravis (MG) susceptibility with STAT3 (rs744166 and rs1053005) and STAT4 (rs7574865) gene polymorphisms. Methods:A total of 149 MG patients admitted to Department of Neurology, Second Affiliated Hospital of Harbin Medical University from September 2019 to June 2022 were selected as MG group, and 148 subjects accepted physical examination in our hospital at the same period were selected as control group. Peripheral venous blood of all subjects was collected. Improved multiplex ligation detection reaction (imLDR) assay was used to detect the STAT3 (rs744166 and rs1053005) and STAT4 (rs7574865) gene polymorphisms. Differences in polymorphisms of various gene loci were compared between the MG group and control group, among subjects with different gender or age, between MG patients with and without thymoma, between AChR-Ab positive and AChR-Ab negative MG patients, and between patients with eye muscle MG and systemic MG. Results:(1) Compared with the control group, the MG group had significantly increased GT and TT genotype and T allele frequencies (37.2% vs. 57.0%; 10.1% vs. 11.4%; 28.7% vs. 39.9%), and decreased GG genotype and G allele frequencies (52.7% vs. 31.5%; 71.3% vs. 60.1%) at rs7574865 locus in STAT4 gene ( P<0.05). (2) Compared with male subjects in the control group, the male patients in MG group had significantly increased GT and TT genotype and T allele frequencies, and decreased GG genotype and G allele frequencies at rs7574865 locus in STAT4 gene ( P<0.05); compared with female subjects in the control group, the female patients in MG group had significantly increased GT and TT genotype frequencies and decreased GG genotype frequency at rs7574865 locus in STAT4 gene ( P<0.05). Compared with subjects≤50 years old in the control group, patients≤50 years old in the MG group had significantly increased GT and TT genotype and T allele frequencies, and decreased GG genotype and G allele frequencies at rs7574865 locus in STAT4 gene ( P<0.05); compared with subjects>50 years old in the control group, patients>50 years old in the MG group had significantly increased GT genotype frequency and decreased GG and TT genotype frequencies at rs7574865 locus in STAT4 gene ( P<0.05). (3) No significant differences in genotype and allele frequencies were noted between MG patients with and without thymoma, between AChR-Ab positive and AChR-Ab negative MG patients, or between patients with eye muscle MG and systemic MG ( P>0.05). Conclusion:MG susceptibility is associated with rs7574865 polymorphism of STAT4 gene; the male subjects or subjects≤50 years old with GT/TT genotype or T allele are susceptible to MG.

This paper summarized professor WANG Shouchuan's experience in differentiating and treating children epistaxis from the perspective of "four excess and three deficiency". It is believed that the pathogenesis of children epistaxis is concluded as "four excess and three deficiency"， of which the four excess syndromes are exuberant heat in the lung channel， intense stomach fire， heart fire hyperactivity， and liver fire flaming upward， while the three deficiency syndromes include qi， yin and yang deficiency. Seven methods for treating children epistaxis are summarized. For exuberant heat in the lung channel syndrome， it is recommended to clear lung and direct qi downward， using self-made Xiebai Zhiniu Decoction （泻白止衄汤）. For intense stomach fire syndrome， the method of clearing stomach and draining fire can be used with self-made Qingwei Zhiniu Decoction （清胃止衄汤）. In terms of heart fire hyperactivity syndrome， it is better to clear heart and drain fire， using self-made Daochi Zhiniu Decoction （导赤止衄汤）. For liver fire flaming upward syndrome， it is advised to clear liver and drain fire， using self-made Yimu Zhiniu Decoction （抑木止衄汤）. In terms of qi deficiency syndrome， the method of fortifying spleen and boosting qi and containing blood should be used with self-made Futu Zhiniu Decoction （扶土止衄汤）. If there is yin deficiency syndrome， it is advised to supplement kidney， enrich yin and clear heat， using self-made Zishui Zhiniu Decoction （滋水止衄汤）. If there is yang deficiency syndrome， the method of boosting qi， warming yang and nourishing blood can be used， using self-made Wenpi Zhiniu Decoction （温脾止衄汤）.