The construction of a medication safety culture is important for medication safety management and rational drug use.The construction of medication safety culture standards is formulated based on relevant national policies and regulations,accreditation standards for hospitals,expert opinions,the current situation,and the development trend of the healthcare industry.With scientificity,general applicability,instructive guidance,and practicality,they standardized basic requirements,management processes,and improvement of the construction of medication safety culture.To facilitate understanding and the implementation of the standards,we describe the process of standards formulation and explain the key points of the standards.

ObjectiveTo investigate the mechanism of Gegen Qinliantang（GQT） on the intestinal flora of antibiotic-associated diarrhea（AAD） by 16S rRNA sequencing and network pharmacology. MethodSixty SD rats were randomly divided into six groups（n=10）， including blank group， model group， GQT high-， medium- and low-dose groups（10.08， 5.04， 2.52 g·kg^-1） as well as Lizhu Changle group（0.15 g·kg^-1）， except for the blank group， each group was given clindamycin（250 mg·kg^-1） by gavage once a day for 7 consecutive days. After successful modeling， the blank group and the model group were given equal volumes of normal saline by gavage. The other groups were given corresponding doses of drugs by gavage for 14 days. Traditional Chinese Medicine Systems Pharmacology Database and Analysis Platform（TCMSP） was used to screen the active components and targets of GQT， GeneCards， Online Mendelian Inheritance in Man（OMIM） database， Pharmacogenetics and Pharmacogenomics Knowledge Base（PharmGKB）， DrugBank and DisGeNET were used to search for AAD disease targets. The drug-disease common targets were obtained by R software. STRING was applied to analyze the target protein-protein interaction， and Kyoto Encyclopedia of Genes and Genomes（KEGG） pathway enrichment analysis was performed. Then hematoxylin-eosin（HE） staining was used to observe the pathological changes of the colon， and 16S rRNA sequencing of AAD colon content flora structure further verified the results of network pharmacology. ResultThrough network pharmacology， it was found that 238 active components were screened from GQT and acted on 276 component targets， among which quercetin， puerarin， wogonin and apigenin were the main core components of GQT， 1 097 AAD disease targets and 127 drug-disease intersection targets. The protein-protein interaction network mainly included core targets such as protein kinase B1（Akt1）， interleukin（IL）-6 and IL-1β， which were mainly enriched in the IL-17 signaling pathway. It was verified through animal experiments that compared with the blank group， the colon structure of the model group was seriously abnormal， the intestinal epithelial columnar cells were damaged， the goblet cells were reduced， and a large number of inflammatory cells were infiltrated. Compared with the model group， the colon structure of the GQT high-dose group improved， but there were still abnormalities， the colon structure of GQT medium- and low- dose groups and Lizhu Changle group improved significantly and reached the normal level. GQT could improve the structural diversity of AAD intestinal flora. At the phylum level， the abundance of Firmicutes was increased and the abundance of Bacteroidetes was decreased. At the genus level， the abundance of Lactobacillus was increased， and the abundances of Prevotella and Bacteroides were decreased. Among them， Lactococcus could be used as a biomarker for AAD treatment with GQT， and the prediction of functional metabolism of intestinal flora revealed that GQT could promote acetate and lactate metabolic pathways in the intestine. ConclusionGQT may activate IL-17 signaling pathway by acting on the targets of Akt1 and IL-6 through key components such as quercetin and wogonin， and improve the abundance of Lactococcus in the intestinal tract as well as acetate and lactate metabolic pathways， so as to play a role in repairing the intestinal barrier for the treatment of AAD.

Gallstone is a common surgical disease. The factors which related to intestine during the process of gallstone formation have attracted increasing attention. The main factors affecting the formation of cholesterol gallstone including cholesterol absorption, bile acid concentration, gut microbiota changing, are all related to the intestine. A correct understanding of the factors related to intestine during gallstone formation is helpful for the prevention and treatment of gallstone disease. In future, different targets related to intestine may play an important role in both prevention of gallstone disease and post-cholecystectomy management.

Objective: To understand the occupational hazard and distribution of silica dust (free SiO₂≥10%) in the workplace environment of the enterprises in Fengxian District, and to provide scientific basis for improving the working environment and protecting the physical and mental health of the workers. Methods: Individual sampling monitoring and on-site labor hygiene investigation were conducted on 421 workers involved in 87 silicon dust enterprises in the jurisdiction from 2014 to 2018, and measured concentration-time weighted average (C_TWA) . Results: The results showed that the range of the C_TWA was (0.021~17.000) mg/m³, the median was 1.600 mg/m³, and the qualified rate of 30.88%. The difference of total dust concentration was statistically significant in different years (Z=38.831, P<0.05) . The qualified rate of small-scale enterprises is higher than that of medium-scale enterprises (χ²=9.472, P<0.05) . The qualified rate of other domestic enterprises is higher than that of private enterprises and foreign enterprises (χ²=10.089, P<0.05) . The acceptance rate of metal products manufacturing is lower than that of general equipment manufacturing and other manufacturing enterprises (χ²=64.626, P<0.05) . The qualification rate of natural ventilation is higher than that of mechanical ventilation (χ²=6.278, P<0.05) . Conclusion The enterprises involved in silicon production in Fengxian District need to further strengthen the production process reform and improve the ventilation and dust removal protection measures. Widely carry out the publicity of occupational disease prevention and control law, conduct targeted pre-job training, improve workers' awareness of self-protection, and protect the occupational health of workers in many ways.

Objective To explore the factors that contribute to the anxiety and depression in obstructive sleep apnea hypopnea syndrome (OSAHS) patients in terms of excessive daytime sleepiness (EDS) and sleep quality.Methods A total of 196 OSAHS patients,including 103 severe patients and 93 mild-moderate patients,were enrolled.Polysomnography was carried on at the sleep center of the First Hospital of China Medical University between May 2013 and November 2015.According to the Epworth sleepiness scale (ESS) and the subject daytime sleepiness symptom,all patients were divided into EDS group and non-EDS group.The patients' general information and subjective symptoms were recorded.Emotional states were assessed with self-rating anxiety scale (SAS) and self-rating depression scale (SDS).Sleep quality was evaluated with Pittsburgh sleep quality index (PSQI).The anxiety and depression related factors were studied by regression analysis.Results (1) In severe OSAHS group,the patients with EDS showed higher PSQI(6.22± 2.57 vs.4.05± 3.72,P＜0.01) and oxygen desaturation index(ODI)[(57.70±17.53) events/h vs.(48.23 ± 22.01)events/h,P＜0.05] when compared with those without EDS.(2) In both severe and mild-moderate OSAHS groups,the patients with EDS presented higher SAS scores (severe:33.86±7.60 vs.28.95 ± 4.71,mild-moderate:37.46± 10.68 vs.33.40± 11.07,P＜0.05)and SDS scores(severe:32.81 ± 8.36 vs.28.90±4.53,mild-moderate:36.98± 12.77 vs.31.70±10.94,P＜0.05)when compared with those without EDS.(3) The multiple regression analysis showed that the SAS scores were related to ESS,PSQI,insomnia and nasal obstruction (R2=0.356,P＜0.05),and the SDS scores were related to ESS,PSQI and insomnia(R2=0.344,P＜0.05).Conclusions The anxiety and depression of OSAHS patients are closely related to the severity of EDS and sleep quality.Both severe and mild-moderate OSAHS patients with EDS have worse anxiety and depression scores.

Objective To observe the effect of Xuebijing on coagulation function in patients with sepsis. Methods Sixty-two patients with severe sepsis were admitted to Department of Emergency and Intensive Care Unit (ICU) of Kunming Municipal Hospital of Traditional Chinese Medicine from February 2015 to June 2017, and they were divided into Xuebijing group and routine treatment control group according to the random number table method, 31 cases in each group. Both groups were treated with symptomatic supportive therapy, and the Xuebijing group was treated with Xuebijing injection 50 mL intravenous drip on the basis of routine treatment, twice a day for consecutive 7 days. The differences in platelet count (PLT), 5 items of coagulation: D-dimer, fibrinogen (Fib), activated partial thromboplastin time (APTT), prothrombin time (PT), thrombin time (TT) and acute physiology and chronic health evaluationⅡ (APACHE Ⅱ) score were compared between the two groups before and after treatment. Results After treatment, in both groups, the levels of PLT and Fib were significantly higher than those before treatment, the level of D-dimer, APACHE Ⅱ were obviously lower than those before treatment, APTT, PT and TT were significantly shorter than those before treatment, and the changes in Xuebijing group were more marked than those in the routine treatment control group [PLT (×109/L):186.63±45.29 vs. 119.96±59.76, Fib (g/L): 3.88±1.82 vs. 2.33±1.33, D-dimer (mg/L): 0.40±0.11 vs. 0.65±0.14, APTT (s): 30.95±8.48 vs. 42.25±7.73, PT (s): 10.97±1.51 vs. 13.16±2.22, TT (s): 16.17±1.28 vs. 18.98±1.12, APACHE Ⅱ score: 6.62±2.91 vs. 12.87±4.54, all P ＜ 0.05]. Conclusion Xuebijing can regulate coagulation disorder in patients with severe sepsis, ameliorate the disease condition of patients, block the deterioration of disease development, and improve the prognosis of patients.

OBJECTIVETo establish a novel method to determine specific type of amyloidosis through laser microdissection and mass spectrometry (LMD/MS) based proteomic analysis.

METHODSThere were 138 formalin-fixed and paraffin-embedded (FFPE) biopsy samples of patients who were diagnosed as systemic amyloidosis used in this study. For each case, a 10 μm section stained with congo-red and positive amyloid deposits were identified under fluorescent light, followed by micro-dissection and mass spectrometry analysis. The amyloidosis subtype was confirmed based on the most abundant amyloid protein.

RESULTSThe tissue types of 138 specimens were as following: subcutaneous abdominal fat accounted for 26%, tongue for 19%, gingiva for 11%, kidney for 9%, intestine for 9%, heart for 6% and others for 20%. Specific types of amyloid were accurately detected in 121 cases, including 106 (87.6%) amyloid light chain (AL) type, 7 (5.8%) amyloid trans-thy-retin (ATTR), 2 (1.7%) amyloidogenic protein A (AA), 2 (1.7%) amyloid heavy chain (AH)/AL+AH, 2 (1.7%) fibrinogen alpha chain (AFib), 1(0.8%) amyloid apolipoprotein A-type II (AApoA-II) and one (0.8%) amyloid lysozyme (ALys). Diagnosis of amyloidosis was excluded in 5 cases. The types of twelve cases were indeterminate by LMD/MS. On the whole, LMD/MS reached 91.3% accuracy rate in amyloid typing. Commonly involved organs (for example, heart, kidney and liver) turned out to be suitable sources of FFPE samples with typing success rate of almost 100%. In contrast, MS analysis was successful in only 83.3% of subcutaneous abdominal fat samples.

CONCLUSIONLMD/MS method provided a more direct technique for accurate typing of amyloidosis in a single procedure.

Objective:To compare the operation time,peroperative and long-term postoperative complications of percutaneous tracheotomy with or without the guidance by fiberoptic broncho-scopy in intensive care unit(ICU).Methods:The clinical data of 73 patients who were performed percutaneous tracheotomy in ICU of Changshu First People's Hospital from Nov 2010 to Jan 2014 were retrospectively analyzed.Forty-three patients who accepted percutaneous tracheotomy guided by fiberoptic bronchos-copy were assigned to Group A,while the other 30 patients were assigned to Group B.The status of intraoperative and short-term and long-term postoperative complications were compared between the two groups.Results:The operation time had no significant difference between the two groups(P >0.05).Four cases(9.3%)in Group A got perioperative complications,inclu-ding 1 case of postoperative bleeding >48 h,1 case of wound infection and 2 cases of subcutaneous emphysema.Fifteen cases (50%)in Group B got perioperative complications,including 1 case of wound infection,1 case of pneumothorax,3 cases of postoperative bleeding >48 h,5 cases of subcutaneous emphysema,and 5 cases of tracheal damage on posterior wall or side wall.The differences in rate of complications between the two groups were statistically significant(P <0.05).Among the 73 patients,33 cases had be followed up,2 cases from the 18 cases who had be followed up in Group A had complications,inclu-ding 1 case of hoarseness,1 case of foreign body sensation in the throat.Two cases from the 15 cases who had be followed up in Group B had complications,including 1 case of hoarseness,1 case of dysphagia.The long-term complications rates had no significant difference between the two groups(P > 0.05).Conclusions:The percutaneous tracheotomy guided by fiberoptic bronchoscopy does not increase operation time,but can reduce the incidence of perioperative complications.

Objective To evaluate the utility of multi-slice computed tomography (MSCT) in assessing acute non-reperfused myocardial infarct size. Methods Seven domestic pigs (mean weight 17.3 ± 1.9 kg) underwent ligation of the distal left anterior descending artery to establish a model of acute myocardial infarction (MI). MSCT and triphenyltetrazolium chloride (TTC) staining were performed two hours later. The following data were acquired and analyzed:MI volume (%), CT values of the infarcted region, left ventricular cavity and normal cardiac tissue at various scanning time-points (1, 5, 10, 15, 20 min after contrast injection). Results Using MSCT, the overall MI volume showed a time-dependent decrease, with a reduction of 28.87%after 20 min. The greatest reduction occurred at the 5 min time-point. In TTC staining, MI volume was 9.87%± 2.44%. When MI size, as determined by MSCT, was compared with that by TTC staining in Bland-Altman plots, there was a better agreement at 5, 10, and 15 min time-points at 1 and 20 min. Conclusions The study indicates that double-phase scanning examination using MSCT is a useful tool to assess MI size, and the optimal late-phase scanning time-point set within 5-15 min of contrast injection.

Objective: To study the optimal combined ratio of baicalin, icariin and Astragalus saponin I from a Chinese herbal compound Biminne. Methods: Firstly, a mouse model of allergic rhinitis was established by intraperitoneal injection of ovalbumin (OVA) and aluminum hydroxide gel suspension, and the effective dose range of baicalin, icariin and Astragalus saponin I was detected by 2,3-bis(2-methoxy-4-nitro-5-sulfophenyl)-2H-tetrazolium-5-carboxanilide inner salt method. Secondly, 10 groups of combinations of baicalin, icariin and Astragalus saponin I assembled by U*(10)(10(8)) form were employed to determine the optimal combination by means of analyzing of the inhibitory effect on the splenocyte proliferation. Finally, the effects of each effective ingredient and the optimal combination were compared by observing the splenocyte proliferation, the contents of interleukin-4 (IL-4), IL-5, interferon-gamma (IFN-gamma) in supernatant of the splenocyte cultures and the ratio of IL-4 to IFN-gamma in order to verify the result. Results: Baicalin or icariin at concentrations ranging from 2 to 10 mumol/L, and Astragalus saponin I from 1 to 10 mumol/L effectively suppressed the splenocyte proliferation. When the proportion of baicalin, icariin and Astragalus saponin I was 1:2.14:2.65, the inhibitory effect was most remarkable. Further research confirmed the rationality of the optimal combination. Conclusion: An optimal combination of the major effective ingredients from Chinese herbal compound Biminne most effectively suppresses the proliferation of splenocytes from sensitized mice and regulates the cytokine secreting.