The patient is a female infant who was born at a gestational age of 30⁺⁴ weeks in the breech position and was delivered by assisted vaginal delivery. She was admitted to the neonatal department of Tianjin First Central Hospital for 44 days, during which she had stable respiration, oxygen saturation, and regular weight gain. The patient was discharged home by her family. The infant was readmitted to the hospital due to poor appetite for 15 hours and irregular breathing with weak response for 4 hours at the corrected gestational age of 37⁺² weeks at 47 days after birth. The day before admission, the patient's mother experienced throat discomfort, and on the day of admission, the mother had a fever, with the highest temperature of 37.9 centigrade (she later tested positive for SARS-CoV-2 antigen). About 15 hours before admission, the family noticed that the patient had poor milk intake and weakened suction. About 4 hours before admission, the patient developed irregular breathing and weakened responses. After admission, the patient presented frequent apnea, and it was not relieved by adjusting the respiratory mode and parameters of non-invasive assisted ventilation, as well as caffeine citrate to stimulate the respiratory center. The patient was eventually given mechanical ventilation and other symptomatic support treatments. The pharyngeal swab was positive for COVID nucleic acid testing with a Ct value of 20.1 for the N gene. And the chest X-ray showed multiple patchy shadows in both lungs. The patient was diagnosed with critical coronavirus disease (COVID) caused by the Omicron variant in premature infants. After treatment, the child was clinically cured and discharged 8 days after hospitalization. Symptoms of COVID in premature infants may be atypical, and the condition can deteriorate rapidly. During the Omicron variant epidemic, we should pay more attention to premature infants so as to detect severe and critical cases as early as possible, and treat them actively to improve the prognosis.
Humans ; Female ; Child ; Infant ; Infant, Newborn ; SARS-CoV-2 ; COVID-19 ; Infant, Premature ; Gestational Age

Objective:To study the value of neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) in diagnosing severe Mycoplasma pneumoniae pneumonia (MPP).Methods:A total of 616 cases of MPP patients in the Children′s Hospital of Soochow University from January 2015 to December 2017 were retrospectively analyzed.During the same period, 100 healthy children were selected as the healthy control group.NLR and PLR between MPP group and healthy control group, and those between severe MPP group and ordinary MPP group were compared by t test or rank sum test.Risk factors for severe MPP were identified.Receiver operating characteristic(ROC) curves were plotted to identify the cut-off point of NLR and PLR in distinguishing MPP from healthy subjects. Results:(1)The median of white blood cell count (WBC), neutrophil count (N), platelet count (PLT), NLR, PLR, immunoglobulin M (IgM) and the median percentage of CD3 -CD 19+ , CD 19+ CD 23+ in MPP group were significantly higher than those in healthy control group(8.36×10 9/L vs.7.49×10 9/L, 4.41×10 9/L vs.3.11×10 9/L, 340.92×10 9/L vs.234.00×10 9/L, 1.70 vs.0.91, 112.99 vs.70.34, 1.33 g/L vs.1.29 g/L, 20.95% vs.17.10%, 11.25% vs.9.70%), whereas the median of lymphocyte count (L), IgA and the median percentage of CD3 + , CD3 + CD8 + , and CD3 -CD +(16+ 56) were significantly lower(2.64×10 9/L vs.3.37×10 9/L, 0.86 g/L vs.1.30 g/L, 64.55% vs.68.00%, 23.65% vs.24.90%, 10.50% vs.12.20%)( Z=-3.074, -2.413, -2.972, -1.357, -1.863, -2.251, -4.282, -3.420, -2.221, -4.181, -2.784, -2.024, -2.791, all P<0.05). (2)The median of N, NLR, PLR, IgA, IgG, IgM and the average of percentage of CD3 + , CD3 + CD8 + in severe MPP group were significantly higher than those in ordinary MPP group[5.18×10 9/L vs.3.52×10 9/L, 2.39 vs.1.03, 149.32 vs.94.23, 1.29 g/L vs.0.71 g/L, 9.63 g/L vs.8.19 g/L, 1.40 g/L vs.1.29 g/L, (65.53±9.75)% vs.(62.81±9.89)%, (25.35±6.65)% vs.(23.38±6.91)%], whereas the median of L, the median percentage of CD3 -CD 19+ , and CD 19+ CD 23+ were significantly lower than those of ordinary MPP group(2.02×10 9/L vs.3.25×10 9/L, 17.40% vs.21.50%, 9.00% vs.11.70%)( Z/ t=-7.807, -11.313, -10.452, -8.819, -6.162, -3.047, -3.128, -3.270, -9.402, -5.191, -5.214, all P<0.05). (3)Univariate and multivariate Logistic regression analysis showed that CD3 -CD 19+ was the protective factor for severe MPP, while N, NLR and PLR were the risk factors for severe MPP (all P<0.05), with the risk sequence of NLR>PLR>N.(4)Area under ROC curve analysis of NLR and PLR in the diagnosis of severe MPP: NLR: AUC=0.789, 95% CI: 0.754~0.823, P<0.001; PLR: AUC=0.767, 95% CI: 0.730~0.804, P<0.001; when the critical value of NLR was 1.09, the sensitivity was 98.9%, and the specificity was 70.6%.When the critical value of PLR was 97.47, the sensitivity and specificity were 88.5% and 69.4%. Conclusions:NLR and PLR can be served as independent influencing factors for severe MPP, showing the diagnostic potential in severe MPP.

OBJECTIVE:To provide reference for exploring the way to improve the ability of pharmaceutical care in primary pharmaceutical staff. METHODS:Questionnaire survey was conducted among pharmaceutical staff(including head of pharmacy department),director/vice-director of hospital in charge of pharmacy,medical staff and patients from primary medical institutions in 9 provinces(regions,cities). The results of investigation were analyzed statistically. RESULTS:A total of 77 primary medical institutions involved in the survey. Totally of 2 273 questionnaires were sent out,and 2 248 effective questionnaires were collected with effective recovery rate of 98.9%. Among effective questionnaires,278 questionnaires were filled out by pharmaceutical staff (68 by head of pharmacy department),48 by director/vice-director of hospital in charge of pharmacy,771 by medical staff and 1 151 by patients. Results of survey showed that only 140 pharmaceutical staff had obtained pharmacy practice qualification,accounting for 50.4%. The surveyed primary medical institutions provided limited pharmaceutical care projects,and the projects with high proportion were medication explanation(85.7%)and medication consultation(84.4%). The establishment of Health Service Record Card in elderly patients(19.5%),the development of chronic disease management(23.4%)and the development of chronic disease related pharmaceutical knowledge publicity at the primary level(37.7%)took up low proportion relatively. Overall satisfaction of surveyed medical staff to pharmaceutical care of pharmaceutical staff was general(77.2%). Surveyed patients greatly satisfied with the attitude of pharmaceutical staff(85.5%)but overall satisfaction of them to professional knowledge of pharmaceutical staff(78.2%)was general. Surveyed pharmaceutical staff training needs in descending order were medication explanation(74.5%),medication counseling(71.9%)and providing pharmaceutical information(64.0%). However,the projects which had low proportion of training needs included chronic disease management(22.3%)and lifestyle guidance (27.0%),etc. The more favorite training forms in descending order were further study in medical institution at higher level(65.4%),expert lectures(60.1%)and training in the training base (57.9%). CONCLUSIONS:The primary medical institutions provided limited pharmaceutical care. It is necessary to further explore and standardize pharmaceutical care criteria. The overall satisfaction of medical staff and patients on pharmaceutical care of pharmaceutical staff is not high in primary institutions,and it needs to be further improved. The related pharmacy training for primary pharmaceutical staff still needs to be strengthened,and can be conducted according to the favorite form of training so as to improve the ability of pharmaceutical care.

Objective To investigate the effects of Gualou Guizhi Granules on excitatory toxic damage of PC12 induced by glutamate; To primarily explore the involved protective mechanism of Gualou Guizhi Granules. Methods Excitatory toxic damage of PC12 induced by glutamate was used to establish models. Cells were divided into normal group, glutamate group, and Gualou Guizhi Granules low- (200 μg/mL), medium- (400 μg/mL) and high-dose (800 μg/mL) groups. MTT and LDH assay methods were used to detect PC12 activity; Caspase-3 activity detection method and Annexine V/PI double staining method were used to detect cell apoptosis; Western blot and RT-PCR were used to detect Bcl-2, Bax protein and mRNA expression. Results Compared with glutamate group, MTT showed that all Gualou Guizhi Granules groups could improve PC12 activity, and LDH showed that cell activity in all Gualou Guizhi Granules groups decreased; Annexine V/PI double staining method showed that all Gualou Guizhi Granules groups could decrease the PC12 apoptosis; Caspase-3 activity detection method showed that all Gualou Guizhi Granules groups could decrease the activity of Caspase-3; Western blot and RT-PCR showed that all Gualou Guizhi Granules groups could reduce Bax expression and increase Bcl-2 expression. Conclusion Gualou Guizhi Granules have certain protective effects on excitatory toxic damage of PC12 induced by glutamate, which may be related to its anti-apoptotic activity.

Objective To investigate the impact of trigger refinement on adverse drug event (ADE) detection efficiency through applying Global Trigger Tool (GTT).Methods The sample of medical records of patients discharged from Xuanwu Hospital of Capital Medical University from January 1st to June 30th 2014, and from July 1st 2014 to June 30th 2015 were selected randomly.The medical records of former period were reviewed by using unrefined ADE triggers (including 30 items) and refined triggers (including 8 items), respectively.The medical records of latter period were reviewed by using refined ADE triggers.All medical records were reviewed manually.The medical records were checked thoroughly in order to identify ADEs after detecting trigger.The classification of the severity of ADE was categorized by the National Coordinating Council for Medication Error Reporting and Prevention index of E to I.The ADE detection rate and positive predictive value (PPV) of ADE in the medical records in different period using unrefined triggers and/or refined triggers were compared.Results Four hundreds and eighteen medical record samples from January to June 2014 were reviewed using unrefined ADE triggers.ADE occurred in 38 of the 418 cases.The ADE detection rate was 9.1%.Fifty-three ADEs were identified to be associated with 38 patients.The top 3 ADEs were abnormal hepatic function, diarrhea, and rash.Fifty ADEs were classified as E (94.3%), and 3 ADEs were classified as F(5.6%).The top 3 drugs caused ADE were antibiotics (15 cases), antineoplastics (6 cases), and hormone and related drugs (6 cases).Twenty-three triggers could be detected from 30 triggers.The times of positive detecting of triggers were 552.The 35 ADEs were identified.The PPV was 6.3% (35/552).The 30 triggers were refined based on the above-mentioned results.There were 8 refined triggers by deleting undetected triggers and removing the triggers which could be detected, but it was difficult to judge the causality with drugs.The same 418 records were reviewed again by applying the refined triggers.ADE occurred in 33 patients.The ADE detection rate was 7.9%.Forty-four ADEs were identified to be associated with the 33 patients.The top 3 events were diarrhea, abnormal hepatic function, and rash.Forty-one ADEs were classified as E (93.2%), and 3 ADEs were classified as F (6.8%).The top 3 most commonly implicated drug classes were antibiotics (13 cases), central nervous system drugs (5 cases), and hormone and related drugs (4 cases).All 8 triggers could be detected.A total of 120 times of detections were checked.Twenty-five ADEs were identified.The overall PPV was 20.8%.The difference of PPC between the refined triggers and the unrefined triggers was statistically significant (P<0.05).Eight hundreds and thirty-seven medical records sample from July 2014 to June 2015 were reviewed by using refined ADE triggers.ADE occurred in 60 of 837 cases.The ADE detection rate was 7.2%.Seventy-four ADEs were identified to be associated with the 60 patients.The top 3 events were rash, vomiting, and abnormal hepatic function/diarrhea/nausea.Seventy ADEs were classified as E (94.6%) and 4 ADEs were classified as F (5.4%).The top 3 most commonly implicated drug classes were antibiotics (14 cases), antineoplastics (9 cases), and central nervous system drugs (9 cases).All 8 triggers could be detected.A total of 252 times of detections were checked.Twenty-five ADEs were identified.The overall PPV was 9.9%.The difference of PPC between the refined triggers and the unrefined triggers was not statistically significant (P>0.05).Conclusions The refined triggers can improve the efficacy of ADE detection of GTT and increase the PPV.Decrease of the number of triggers has no effect on confirming the categories and severities of ADE and can be easily implemented.

Objective To investigate the impact of trigger refinement on adverse drug event (ADE) detection efficiency through applying Global Trigger Tool (GTT).Methods The sample of medical records of patients discharged from Xuanwu Hospital of Capital Medical University from January 1st to June 30th 2014, and from July 1st 2014 to June 30th 2015 were selected randomly.The medical records of former period were reviewed by using unrefined ADE triggers (including 30 items) and refined triggers (including 8 items), respectively.The medical records of latter period were reviewed by using refined ADE triggers.All medical records were reviewed manually.The medical records were checked thoroughly in order to identify ADEs after detecting trigger.The classification of the severity of ADE was categorized by the National Coordinating Council for Medication Error Reporting and Prevention index of E to I.The ADE detection rate and positive predictive value (PPV) of ADE in the medical records in different period using unrefined triggers and/or refined triggers were compared.Results Four hundreds and eighteen medical record samples from January to June 2014 were reviewed using unrefined ADE triggers.ADE occurred in 38 of the 418 cases.The ADE detection rate was 9.1%.Fifty-three ADEs were identified to be associated with 38 patients.The top 3 ADEs were abnormal hepatic function, diarrhea, and rash.Fifty ADEs were classified as E (94.3%), and 3 ADEs were classified as F(5.6%).The top 3 drugs caused ADE were antibiotics (15 cases), antineoplastics (6 cases), and hormone and related drugs (6 cases).Twenty-three triggers could be detected from 30 triggers.The times of positive detecting of triggers were 552.The 35 ADEs were identified.The PPV was 6.3% (35/552).The 30 triggers were refined based on the above-mentioned results.There were 8 refined triggers by deleting undetected triggers and removing the triggers which could be detected, but it was difficult to judge the causality with drugs.The same 418 records were reviewed again by applying the refined triggers.ADE occurred in 33 patients.The ADE detection rate was 7.9%.Forty-four ADEs were identified to be associated with the 33 patients.The top 3 events were diarrhea, abnormal hepatic function, and rash.Forty-one ADEs were classified as E (93.2%), and 3 ADEs were classified as F (6.8%).The top 3 most commonly implicated drug classes were antibiotics (13 cases), central nervous system drugs (5 cases), and hormone and related drugs (4 cases).All 8 triggers could be detected.A total of 120 times of detections were checked.Twenty-five ADEs were identified.The overall PPV was 20.8%.The difference of PPC between the refined triggers and the unrefined triggers was statistically significant (P<0.05).Eight hundreds and thirty-seven medical records sample from July 2014 to June 2015 were reviewed by using refined ADE triggers.ADE occurred in 60 of 837 cases.The ADE detection rate was 7.2%.Seventy-four ADEs were identified to be associated with the 60 patients.The top 3 events were rash, vomiting, and abnormal hepatic function/diarrhea/nausea.Seventy ADEs were classified as E (94.6%) and 4 ADEs were classified as F (5.4%).The top 3 most commonly implicated drug classes were antibiotics (14 cases), antineoplastics (9 cases), and central nervous system drugs (9 cases).All 8 triggers could be detected.A total of 252 times of detections were checked.Twenty-five ADEs were identified.The overall PPV was 9.9%.The difference of PPC between the refined triggers and the unrefined triggers was not statistically significant (P>0.05).Conclusions The refined triggers can improve the efficacy of ADE detection of GTT and increase the PPV.Decrease of the number of triggers has no effect on confirming the categories and severities of ADE and can be easily implemented.

Objective To investigate the feasibility of detecting adverse drug event( ADE)using Global Trigger Tool( GTT)in Chinese medical institutions. Methods Discharged patients' records of the Xuanwu Hospital of Capital Medical University from January 1st to December 31st 1013 were collected. After sorting by discharged date,30 cases were selected in a half month period by a random sampling tool of Microsoft Excell1007 software. Unqualified cases were eliminated according to the inclusion criteria( patients aged 18 and over,one time admission in 1013,and hospitalization for more than 1 day)and exclusion criteria( patients in the Department of Obstetrics,Family Planning,Rehabilitation,Oncology,Pediatrics, and day-care ward). The 10 cases were reviewed every half a month in sequence of random sampling using 35 triggers,including laboratory indexes,antidotes,clinical symptoms,and treatment measures,that were identified by GTT recommendation,relevant foreign researches,and self-experience of Xuanwu Hospital of Capital Medical University. All cases were enrolled if the number of cases which met the inclusion criteria was less than 10. The cases in whom triggers could be detected were marked as the cases with positive triggers. The cases with positive triggers-related situations were further reviewed in order to identify or exclude ADE and then the identified ADEs were classified. The positive triggers and ADEs were analyzed by Microsoft Excell1007 software and the positive predictive values of positive triggers were calculated. Results Totally 465 cases were reviewed. Of them,156 were male and 109 female with the mean age of 57(19~91)years. The time of hospital stay was 1 to 37 days with the mean hospital stay of 10 days. Of the 465 patients,in 108 patients(44. 7%)positive triggers could be detected. Of all the 35 triggers,11 triggers(61. 9%)were positive referring to 341 times. There were 18 ADEs identified involving 16 patients and the detectable rate was 3. 4%(16/465). Of the 18 ADEs,13 ADEs had their corresponding triggers containing 8 triggers. The overall positive predictive value of 11 positive triggers was 3. 8%. The 18 ADEs included pneumonia (1 ADEs),liver injury(1 ADEs),chill(1 ADEs),skin rash(1 ADEs),antibiotic-associated diarrhea (1 ADE),headache(1 ADE),dizziness(1 ADE),nausea and vomiting(1 ADE),hypoglycemia (1 ADE),over-sedation(1 ADE),delirium(1 ADE),bleeding(1 ADE),leucopenia(1 ADE),and excitation(1 ADE). There were 14 ADEs of class E and 4 ADEs of class F in the 18 ADEs which referred to 11 drugs including 5 kinds of antibacterial agents, 3 kinds of blood system drugs, 3 kinds of psychotherapeutic agents,1 kinds of cardiovascular drugs,1 kinds of hormone drugs,1 kinds of Chinese patent medicines,1 kind of lipid drug,1 kind of drug acting bone metabolism,1 kind of antipyretic analgesic,and 1 kind of anesthetic. Conclusions GTT could help to early detect the signals of ADEs and provide the reference evidence of preventing drug risk. It is valuable that GTT is popularized and used in Chinese medical institutions.

Objective To investigate the feasibility of detecting adverse drug event( ADE)using Global Trigger Tool( GTT)in Chinese medical institutions. Methods Discharged patients' records of the Xuanwu Hospital of Capital Medical University from January 1st to December 31st 1013 were collected. After sorting by discharged date,30 cases were selected in a half month period by a random sampling tool of Microsoft Excell1007 software. Unqualified cases were eliminated according to the inclusion criteria( patients aged 18 and over,one time admission in 1013,and hospitalization for more than 1 day)and exclusion criteria( patients in the Department of Obstetrics,Family Planning,Rehabilitation,Oncology,Pediatrics, and day-care ward). The 10 cases were reviewed every half a month in sequence of random sampling using 35 triggers,including laboratory indexes,antidotes,clinical symptoms,and treatment measures,that were identified by GTT recommendation,relevant foreign researches,and self-experience of Xuanwu Hospital of Capital Medical University. All cases were enrolled if the number of cases which met the inclusion criteria was less than 10. The cases in whom triggers could be detected were marked as the cases with positive triggers. The cases with positive triggers-related situations were further reviewed in order to identify or exclude ADE and then the identified ADEs were classified. The positive triggers and ADEs were analyzed by Microsoft Excell1007 software and the positive predictive values of positive triggers were calculated. Results Totally 465 cases were reviewed. Of them,156 were male and 109 female with the mean age of 57(19~91)years. The time of hospital stay was 1 to 37 days with the mean hospital stay of 10 days. Of the 465 patients,in 108 patients(44. 7%)positive triggers could be detected. Of all the 35 triggers,11 triggers(61. 9%)were positive referring to 341 times. There were 18 ADEs identified involving 16 patients and the detectable rate was 3. 4%(16/465). Of the 18 ADEs,13 ADEs had their corresponding triggers containing 8 triggers. The overall positive predictive value of 11 positive triggers was 3. 8%. The 18 ADEs included pneumonia (1 ADEs),liver injury(1 ADEs),chill(1 ADEs),skin rash(1 ADEs),antibiotic-associated diarrhea (1 ADE),headache(1 ADE),dizziness(1 ADE),nausea and vomiting(1 ADE),hypoglycemia (1 ADE),over-sedation(1 ADE),delirium(1 ADE),bleeding(1 ADE),leucopenia(1 ADE),and excitation(1 ADE). There were 14 ADEs of class E and 4 ADEs of class F in the 18 ADEs which referred to 11 drugs including 5 kinds of antibacterial agents, 3 kinds of blood system drugs, 3 kinds of psychotherapeutic agents,1 kinds of cardiovascular drugs,1 kinds of hormone drugs,1 kinds of Chinese patent medicines,1 kind of lipid drug,1 kind of drug acting bone metabolism,1 kind of antipyretic analgesic,and 1 kind of anesthetic. Conclusions GTT could help to early detect the signals of ADEs and provide the reference evidence of preventing drug risk. It is valuable that GTT is popularized and used in Chinese medical institutions.

Objectives To analyze the impact of glucose-insulin metabolism during pregnancy onβ-cell function in premature infant, and to explore biomarkers for monitoringβ-cell function in preterm infant. Methods Eighty-two premature infants admitted to NICU from March to December 2012 were divided into 2 groups, a group with abnormal maternal glucose metabolism during pregnancy (35 cases) and another group with normal maternal glucose metabolism during pregnancy group (47 cases). Fasting blood glucose, insulin, C-peptide and proinsulin at 1 hour after birth and 7 days postpartum were measured respectively, and relevant indices ofβ-cell function were compared in premature infants. Results Maternal pre-pregnancy and prenatal body mass index, weight and head circumference of preterm infants at birth were signiifcantly different between two groups (P<0.05) except for maternal weight gain in pregnancy (P>0.05). The differences in levels of proinsulin at birth, C-peptide and proinsulin at postnatal day 7 were signiifcantly different between the two groups (P<0.05). There was no signiifcant diffe-rence in insulin resistance, fastingβcell function index and insulin sensitivity index between two groups (P>0.05). Conclusions Abnormal maternal glucose metabolism in pregnancy has no effect on early pancreatic islet function in premature infant, how-ever, proinsulin secretion has been affected.

OBJECTIVEThe optimum conditions of SFE-CO2 extraction of Plantaginis Semen oil (SPO), the composition of SPO and its antioxidant activities of SPO were all investigated in this paper.

METHODResponse surface method (RSM) was used to establish the mathematical model of SFE-CO2 extraction of SPO to obtain the optimum conditions based on Single factor experiments. Fatty acid compositions and contents of SPO were tested by GC-MS, and antioxidant activities of SPO were studied by DPPH and ABTS free radical elimination method.

RESULTThe optimum conditions obtained through RSM analysis were as follows: extraction tempreture 70 degrees C, extraction pressure 30 MPa, extraction time 120 min and flow rate 30 L x h(-1). Under the optimal condition, predicted value was 35.91%, while the experimental value was 35.07%. The experimental values agree with the predicted from the regression model with a relative error less than 5%. The main components of SPO were 9,12,15-octadecatrienoic acid, 8,11-octadecadienoic acid, octadecanoic acid and hexadecanoic acid. Most of the fatty acids were polyunsaturated fatty ones, whose quantities were obtained more than 88%. The IC50DPPH and IC50ABTS were 1.13, 3.57 g x L(-1) respectively in DPPH and ABTS assay.

CONCLUSIONOptimization of the extraction process by RSM of SPO is convenient and feasible. SPO has good antioxidant activity and is worth to develop for application.

Antioxidants ; chemistry ; isolation & purification ; Carbon Dioxide ; chemistry ; Chromatography, Supercritical Fluid ; methods ; Cupressaceae ; chemistry ; Gas Chromatography-Mass Spectrometry ; Plant Oils ; chemistry ; isolation & purification