OBJECTIVE To investigate the clinical efficacy and safety of rituximab （RTX） followed by belimumab （BLM） in patients with severe systemic lupus erythematosus（SSLE）. METHODS Nine SSLE patients， who were treated with RTX followed by BLM for more than 6 months in the Department of Rheumatology and Immunology of the First Affiliated Hospital of Zhengzhou University from October 2020 to June 2021， were enrolled. Baseline clinical data of patients， laboratory examination results and basic treatment status at weeks 0， 4， 12， and 24 of medication were collected retrospectively. The patients’ systemic lupus erythematosus disease activity index （SLEDAI） score， glucocorticoid dosage and serological indicators （complement C3， complement C4， serum albumin， and 24-hour urine protein quantification） level were analyzed. At the same time， the occurrence of adverse drug reaction was collected. RESULTS All 9 patients completed more than 24 weeks of RTX followed by BLM therapy. All patients suffered from renal impairment， of which 7 （77.8%） had renal pathology support， 3（33.3%） had blood system damage and 2 （22.2%） had nervous system damage. During treatment， with the prolongation of treatment time， the SLEDAI score， 24- hour urinary protein quantification， and glucocorticoid dosage of patients showed a significant downward trend， and ultimately decreased to the normal index level （P＜0.05）； serum albumin， complement C3 and complement C4 all showed a significant upward trend， eventually rose to the normal index level （P＜0.05）. During treatment and follow-up， 1 patient developed herpes zoster， 1 patient developed upper respiratory tract virus infection， and 1 patient developed urinary system bacterial infection. All patients recovered after symptomatic treatment. CONCLUSIONS In sequential use of RTX followed by BLM for SSLE， early administration of RTX can quickly stabilizethe condition， significantly alleviate clinical symptoms， and gradually normalize specific serological indicators； subsequent administration of BLM can reduce the type and dosage of basic treatment drugs； there is no increase in the incidence of adverse drug reactions.

OBJECTIVE To investigate the situation ，influential factors and their re lationship of hospital pharmacy managers ’ servant leadership behavior and hospital pharmacists ’job satisfaction. METHODS The questionnaire survey method was adopted to stratified cluster sampling from primary ，secondary and tertiary hospitals ，five for each in Henan province. The personal basic data scale of pharmacists ，the hospital pharmaceutical service leadership behavior scale and the job satisfaction scale of pharmacists were used to conduct a questionnaire survey among hospital pharmacists. Excel 2019 and SPSS 23.0 software were used for statistical analysis. RESULTS A total of 956 questionnaires were distributed and 882 questionnaires were recovered ，including 841 valid questionnaires，with an effective recovery rate of 95.35％. The reliability coefficients Cronbach’s α of hospital pharmacy managers ’ servant leadership behavior scale and hospital pharmacists ’job satisfaction scale were 0.986 and 0.978，and the validity coefficients KMO were 0.908 and 0.977（P＜0.01）. The total score of hospital pharmacy managers ’servant leadership behavior was （110.73± 18.63）. The total score of hospital pharmacists ’job satisfaction was （126.33±17.79）. Hospital grade ，gender，age，professional title and highest education level all affected pharmacists ’recognition for managers ’servant leadership behavior （P＜0.05）. Hospital grade，age，professional title ，marital status ，highest education level and position all affected job satisfaction （P＜0.05）. The servant leadership behavior of hospital pharmacy managers was positively correlated with the job satisfaction of hospital pharmacists （correlation coefficient r was 0.521-0.698，all P＜0.01）. CONCLUSIONS The promotion and optimization the servant leadership behavior of hospital pharmacy managers can improve the job satisfaction of pharmacists ，stabilize the team of pharmacists ，and provide high-quality pharmaceutical care for patients ，so as to improve the core competitiveness of the hospital.

OBJECTIVE To investigate the working pressure of return-working postpartum hospital pharmacists， analyze the influential factors， and find the suitable strategy to relieve the working pressure of postpartum pharmacists. METHODS By the means of general information questionnaire， working pressure questionnaire and self-rating depression scale， the data of postpartum pharmacists were surveyed with sampling survey to investigate the working-pressure situation. The main influential factors of the postpartum working pressure were analyzed by multiple linear stepwise regression analysis. RESULTS A total of 281 valid questionnaires were collected from 84 different hospitals， with effective rate of 88.64%. The total score of working pressure for 281 postpartum pharmacists who were back to position was （79.80±23.06） （total score of 155）. However， 51.60% of return-working postpartum pharmacists showed depressive state （≥53）. The depression status was positively correlated with working pressure. Family support， frequency of physical exercise， and ideal personnel care were all negatively associated with working pressure. CONCLUSIONS The working pressure of return-working postpartum pharmacists is at a moderate level. Depression， family support， ideal personnel care， and frequency of physical exercise are the main influential factors.

Objective:To evaluate the laparoscopic sleeve gastrectomy combined with hiatal hernia repair surgery for weight loss and antireflux.Methods:This study included 21 obese patients with gastroesophageal reflux who underwent laparoscopic sleeve gastrectomy at the Weight Loss Metabolism Center of the Department of Hepatobiliary and Pancreatic Surgery of Zhejiang Provincial People's Hospital from Dec 2019 to Dec 2020. Patients were divided into simple bariatric surgery group (9 cases) and simultaneous combined surgery group (12 cases).Results:In the combined surgery group, 1 case had postoperative gastric leakage. The postoperative body weight, waist circumference, and BMI indexes of the two groups showed a downward trend ( F=5.154, P=0.013; F=14.319, P<0.001; F=6.725, P=0.004). There was a statistically significant difference in the excess weight loss in both the two groups at 6 months after the operation compared to 1 month after the operation ( t=8.927, P<0.001; t=8.926, P<0.001). There was no statistically significant difference in postoperative lower esophageal sphincter resting pressure and Gerd symptom score in the bariatric surgery group compared with preoperative ( t=-0.891, P=0.507; t=0.629, P=0.298). The postoperative Gerd symptom score of the patients in the combined surgery group was significantly lower than that before the operation, and the resting pressure of the lower esophageal sphincter was significantly higher than that before the operation, ( t=-10.539, P<0.001; t=5.066, P=0.038). Conclusion:Combined surgery have the same weight loss effect as in simple bariatric surgery in obese patients with gastroesophageal reflux, in addition to stronger anti-reflux effect.

Objective:To evaluate the efficacy and safety of drospirenone and ethinylestradiol tablets (Ⅱ) in Chinese women with dysmenorrhea.Methods:This was a single-arm, open-label, interventional, multicenter, post-authorization safety/effectiveness study of drospirenone and ethinylestradiol tablets (Ⅱ) across 6 treatment cycles, a total of 526 patients were included in the dysmenorrhea subgroup. Visual analog scale (VAS) was used to assess the severity of menstrual pain. Secondary outcomes included unintended pregnancies, bleeding pattern, cycle control and safety.Results:After treated with drospirenone and ethinylestradiol tablets (Ⅱ), VAS of pain had decreased significantly compared with baselines [(49.5±23.7) vs (32.3±24.9) vs (20.7±19.4) vs (18.4±18.7) mm, P<0.01]. From the second cycle to the fifth cycle, the incidence of scheduled bleeding increased from 93.9% (450/479) to 96.4% (431/447). The duration of scheduled bleeding decreased from (5.7±2.7) to (5.4±1.8) days. The incidence of intermenstrual bleeding decreased from 9.0% (43/479) to 5.6% (25/447). 17.5% (92/526) patients reported adverse drug reactions, most frequently reported adverse events were breast pain, nausea, breast swelling, headache, and uterine bleeding. No death occurred during the study. Conclusion:Drospirenone and ethinylestradiol tablets (Ⅱ) is effective for the treatment of dysmenorrhea and has good safety.

Objective To compare the research status and hotspots of immunotherapy for liver cancer at home and abroad. Methods Papers about immunotherapy for liver cancer published from the establishment to 2019 were searched in PubMed database and Chinese database. Information were extracted and sorted by BICOMB-2 software, and then we created the word matrix and co-occurrence matrix of high-frequency subject headings. The cluster analysis of subject headings was conducted by gCLUTO 1.0. NetDraw 2.089 was used to draw social network diagrams, UCINET 6.212 was used to conduct the centrality analysis. Results There were 2 081 foreign literatures and 901 Chinese literatures, involving 655 foreign periodicals and 275 Chinese periodicals. Four themes of immunotherapy for liver cancer were determined: the correlation between the immune inoculation of hepatitis B patients and the occurrence of liver cancer, the study between dendritic cells and immunotherapy for liver cancer, the study of the combination of radiotherapy and immunotherapy on liver cancer, and related research of natural killer cells and liver cancer immunotherapy. Conclusion The number of researches on immunotherapy for liver cancer have shown an increasing trend year by year. We can learn from the international research status and hotspots to create a new way for liver cancer treatment.

OBJECTIVE：To study the pr otective effect of schisandrin A （SA）on CCl 4-induced liver fibrosis model mice and its mechanism. METHODS ：Mice were randomly divided into blank control group ，model group ，silymarin group （positive control，100 mg/kg），SA low-dose and high-dose groups （20，40 mg/kg），with 10 mice in each group. Except for blank control group，other groups were given CCl 4 subcutaneously to induce liver fibrosis model. After successful modeling ，administration groups were given relevant medicine intragastrically ，once a day ，for consecutive 6 weeks；blank control group and model group were given constant volume of 0.5％sodium carboxymethyl cellulose solution intragastrically by the same way. HE staining was used to observe the pathological changes of liver tissue in mice. UV spectrophotometry and ELISA assay were adopted to detect the serum levels of liver injury indexes （ALT and AST ）and the contents of inflammatory factors （TNF-α，IL-1β，IL-6）. Western blotting assay was used to detect the expression of NOD like receptor protein 3（NLRP3）/NF-κB and TGF-β/Smad signaling pathway protein. RESULTS ：Compared with blank control group ，obvious pathological changes of liver fibrosis were observed in model group. The serum levels of liver injury indexes and contents of inflammatory factors were significantly increased （P＜0.01）. The expression of NLRP 3，apoptosis associated spot-like protein ，Caspase-1 and IL- 1β，TGF-β1 and ratios ofp-NF-κB p65/NF-κB p65，p-IκBα/IκBα，p-Samd3/Smad3 were increased significantly （P＜0.01）. Compared with model group ，SA could significantly relieve hepatic fibrosis in mice ，reduce serum levels of liver injury indexes and contents of inflammatory factors ，as well as the expression of NLRP 3/NF-κB and TGF-β/Smad signaling pathway protein and phosphorylation level（P＜0.01）. CONCLUSIONS ： SA can effectively relieve liver injury and inflammation of CCl 4-induced hepatic fibrosis model mice ，which may be through the regulation of NLRP 3/NF-κB and TGF-β/Smad3 signaling pathways ，thus inhibiting the process of liver fibrosis.

OBJECTIVE：To establis h the evaluation model of hospital pharmacist post value of dispensing department ，and to provide scientific basis for optimizing the performance management of pharmacists in despensing department in hospital. METHODS：Based on factor counting method ，combined with questionnaire ，Delphi expert correspondence method and so on ，the hospital pharmacist post value evaluation model was established. Based on this ，the relative value scores of the pharmacists in the dispensing department was determined. RESULTS ：Hospital pharmacist post value evaluation model was established with 5 evaluation dimensions （knowledge，skills，responsibility，work autonomy ，work environment and intensity ，of which the first level weight coefficients were 0.194，0.166，0.365，0.216 and 0.058，respectively）and 31 evaluation elements. The above 5 evaluation dimensions contained 5，8，9，3，6 evaluation elements ，respectively，and the corresponding second-level weights were 0.052-0.431 （for example ，responsibility dimension with the highest weight ，including quality and safety control ，decision responsibility，responsibility for finance and assets ，the corresponding second-level weight coefficients were 0.279，0.140，0.132， respectively）. The relative value scores of 13 pharmacist post were 342.9-840.4 in the dispensing department of our hospital with this model ，among which the department responsible person had the highest score （840.4）and the prescription post score was the lowest（342.9）. CONCLUSIONS ：The hospital pharmacist post value evaluation model constructed by factor counting method can provide a scientific and reliable theoretical basis for realizing the rewards of different positions in the dispensing department.

Background and Objectives: Adipose tissue-derived mesenchymal stem cells (ASCs) are recognized as an advantaged source for the prevention and treatment of diverse diseases including type 2 diabetes mellitus (T2DM). However, alterations in characteristics of ASCs from the aforementioned T2DM patients are still obscure, which also hinder the rigorous and systematic illumination of progression and pathogenesis. Methods: and Results: In this study, we originally isolated peripancreatic adipose tissue-derived mesenchymal stem cells from both human type 2 diabetic and non-diabetic donors (T2DM-ASCs, ND-ASCs) with the parental consent, respectively. We noticed that T2DM-ASCs exhibited indistinguishable immunophenotype, cell vitality, chondrogenic differentiation and stemness as ND-ASCs. Simultaneously, there’s merely alterations in migration and immunoregulatory capacities in T2DM-ASCs. However, differing from ND-ASCs, T2DM-ASCs exhibited deficiency in adipogenic and osteogenic differentiation, and in particular, the delayed cell cycle and different cytokine expression spectrum. Conclusions The conservative alterations of T2DM-ASCs in multifaceted characteristics indicated the possibility of autologous application of ASCs for cell-based T2DM treatment in the future.

Objective: To investigate the effect factors of liver enzymes elevation by monitoring the liver function changes before and after intraportal islet transplantation. Methods: 16 diabetic patients who received intraportal islet transplantation in our hospital were analyzed. The levels of aspartic aminotransferase (AST), alanine aminotransferase (ALT)and total bilirubin (TBil)were monitored after islet transplantation. Results: Among those 16 diabetic patients who received intraportal islet transplantation, 11 patients showed an increased AST and 8 patients showed an increased ALT, among which a 2.5-fold increase in AST was observed in 4 patients and over 1.5-fold elevation of ALT was observed in 3 patients. The level of TBil were in the normal range before and after transplantation in all patients. Transplanted tissue volume of islet was the main factor for significantly increased AST (P<0.05) in this study. It is also shown that the change in portal pressure is related to the AST elevation after islet transplantation. Conclusions The amount of transplanted islet tissue volume is related to the liver enzymes elevation after intraportal islet transplantation. Therefore, the improvement of the purity of islet to reduce the amount of transplanted tissue could be benefit to prevent the liver injury after islet transplantation. Meanwhile, the purified islets should be injected as slowly as possible to maintain a stable portal pressure.