Objective:To understand the usage status of high-alert medicines (HAM) for children in outpatient and emergency prescriptions and inpatient medication orders at department of pediatric.Methods:All outpatient and emergency prescriptions and inpatient medication orders in patients with an age of <18 years between July 1, 2016 and June 30, 2018 in Huairou Maternal and Child Health Hospital Affiliated to Beijing Obstetrics and Gynecology Hospital, Capital Medical University were collected. According to the List of High-Alert Medications for the Chinese Children, the use of HAM for children in prescriptions and medication orders was analyzed retrospectively. Results:A total of 297 968 prescriptions and medication orders were collected in the study, including 270 024 outpatient and emergency prescriptions (90.62%) and 27 944 inpatient medication orders (9.38%). There were 162 521 prescriptions (54.54%) involving male children and 135 447 (45.46%) involving female children with an age of (4±3) years, ranged 0-17 years. The number of drugs included in each prescription was (2±1), ranged 1-9. Of the 297 968 prescriptions and medication orders, 23 476 (7.88%) involved HAM for children. The proportion of prescriptions containing HAM for children in outpatient and emergency prescriptions was significantly higher than that in inpatient medication orders [7.92% (21 381/270 024) vs. 7.50% (2 095/27 944), P=0.013]; the proportion of prescriptions and medication orders containing HAM for children in Surgery Department [32.84% (1 220/3 715)] was significantly higher than that in Medicine Department [8.17% (22 043/269 777)] and other departments [0.87% (213/24 476)], and the difference was statistically significant (all P<0.001). The 23 476 prescriptions involved 13 categories and 42 kinds of HAM for children and the total frequency of HAM for children was 26 084. The top 3 drug categories that most frequently used were traditional Chinese medicine injections (8 694, 33.33%), antipyretic analgesic and anti-inflammatory drugs (7 505, 28.77%), and anti-infective drugs (4 011, 15.38%); the top 10 HAM for children that most frequently used were paracetamol, Yanhuning injection (炎琥宁注射液), Xiyanping injection (喜炎平注射液), vitamin K 1, vidarabine, tetanus antitoxin, penicillins, phenobarbital, promethazine injections, and heparin. Adverse events occurred in 9 children due to medication errors of HAM for children, which were all grade E, and the drugs involved were Xiyanping injection, paracetamol, and vitamin K 1 injection. Conclusions:HAM for children was commonly used, among which the traditional Chinese medicine injection-related HAM was used more, and the proportion of prescriptions containing HAM for children was higher in departments of outpatient, emergency, and surgery. Medication errors related to HAM for children may lead to serious adverse events, so the management of HAM for children should be strengthened.

Objective:To understand the usage status of high-alert medicines (HAM) for children in outpatient and emergency prescriptions and inpatient medication orders at department of pediatric.Methods:All outpatient and emergency prescriptions and inpatient medication orders in patients with an age of <18 years between July 1, 2016 and June 30, 2018 in Huairou Maternal and Child Health Hospital Affiliated to Beijing Obstetrics and Gynecology Hospital, Capital Medical University were collected. According to the List of High-Alert Medications for the Chinese Children, the use of HAM for children in prescriptions and medication orders was analyzed retrospectively. Results:A total of 297 968 prescriptions and medication orders were collected in the study, including 270 024 outpatient and emergency prescriptions (90.62%) and 27 944 inpatient medication orders (9.38%). There were 162 521 prescriptions (54.54%) involving male children and 135 447 (45.46%) involving female children with an age of (4±3) years, ranged 0-17 years. The number of drugs included in each prescription was (2±1), ranged 1-9. Of the 297 968 prescriptions and medication orders, 23 476 (7.88%) involved HAM for children. The proportion of prescriptions containing HAM for children in outpatient and emergency prescriptions was significantly higher than that in inpatient medication orders [7.92% (21 381/270 024) vs. 7.50% (2 095/27 944), P=0.013]; the proportion of prescriptions and medication orders containing HAM for children in Surgery Department [32.84% (1 220/3 715)] was significantly higher than that in Medicine Department [8.17% (22 043/269 777)] and other departments [0.87% (213/24 476)], and the difference was statistically significant (all P<0.001). The 23 476 prescriptions involved 13 categories and 42 kinds of HAM for children and the total frequency of HAM for children was 26 084. The top 3 drug categories that most frequently used were traditional Chinese medicine injections (8 694, 33.33%), antipyretic analgesic and anti-inflammatory drugs (7 505, 28.77%), and anti-infective drugs (4 011, 15.38%); the top 10 HAM for children that most frequently used were paracetamol, Yanhuning injection (炎琥宁注射液), Xiyanping injection (喜炎平注射液), vitamin K 1, vidarabine, tetanus antitoxin, penicillins, phenobarbital, promethazine injections, and heparin. Adverse events occurred in 9 children due to medication errors of HAM for children, which were all grade E, and the drugs involved were Xiyanping injection, paracetamol, and vitamin K 1 injection. Conclusions:HAM for children was commonly used, among which the traditional Chinese medicine injection-related HAM was used more, and the proportion of prescriptions containing HAM for children was higher in departments of outpatient, emergency, and surgery. Medication errors related to HAM for children may lead to serious adverse events, so the management of HAM for children should be strengthened.

Objective:To explore the application effect of Jiankuai psychosomatic active therapy in the elderly perioperative patients.Methods:From March 2018 to December 2019, 387 elderly patients in the urology department of the First People′s Hospital of Lianyungang City, Jiangsu Province were selected. According to the patients in two medical groups in the same ward, 193 patients in one medical group were divided into the experimental group and 194 patients in two medical groups as the control group. The experimental group was intervened by routine perioperative nursing combined with simple and fast psychosomatic active therapy, while the control group was only intervened by routine perioperative nursing. Self rating Anxiety Scale (SAS), Rosenberg Self-confidence Scale and General Self-efficacy Scale (GSEs) were used as the evaluation indexes before and after the implementation of the two groups.Results:The SAS score of the experimental group was 31.13 ± 3.64 and that of the control group was 48.45 ± 7.72 on the 7th day after operation. The difference between the two groups was statistically significant ( t value was 16.36, P < 0.05). The effective rate of self-confidence was 98.4% (190/193) and 94.8% (183/193) in the experimental group and 86.6% (168/194) and 85.1% (165/194) in the control group on the first day and the seventh day after operation, respectively. The difference between the two groups was statistically significant ( Z values were - 3.27 and 14.66, all P < 0.05). The GSEs score of the patients in the experimental group was 26.79 ± 2.17 and that of the control group was 16.86 ± 1.90. The difference between the two groups was statistically significant ( t value was 10.19, P < 0.05). Conclusions:The application of Jiankuai psychosomatic active therapy can effectively reduce the tension and anxiety of the elderly patients during the perioperative period, increase their self-confidence and self-efficacy, effectively improve the communication efficiency between doctors and patients, and promote rehabilitation.

Objective To compare the predictive value of radiomics signature extracted from MRI plain and enhancement sequence for the disease-free survival (DFS) of rectal cancer. Methods We retrospectively analyzed fifty-one patients with rectal adenocarcinoma confirmed by biopsy from October 2010 to December 2013 in Cancer Hospital Chinese Academy of Medical Sciences.All patients underwent neoadjuvant chemotherapy(nCRT)followed total mesorectal excision(TME),and MRI scans were performed before nCRT.Follow-up time for the survival patients were more than 3 years.The image segmentation was performed on the T2WI sequence of the small FOV and the multi-phase enhancement sequence venous phase,respectively.Least absolute shrinkage and selection operator(LASSO)Cox regression was applied to extract radiomics features and the imaging signature was constructed. According to the radiomics score of each patient,the patients were divided into the high risk group with shorter DFS and the low risk group with longer DFS. A 3-year DFS was calculated for radiomics signature using the Kaplan-Meier product limit method with univariate log-rank analysis testing for differences in the training and validation cohort, respectively. And the predictive ability of the model was evaluated by concordance index (C-index). Results The training set and the validation set were 36 and 15 cases, respectively. During follow-up 32 patients experienced relapse(26 distant,3 local and 3 both),and 19 cases were censored.Twelve features were extracted in the enhanced sequence.The radiomics signatures were significant for DFS in the training set and the validation set(P=0.000 2 and 0.009 1,respectively).The C-index of the model were 0.904 and 0.700 in the training set and the validation set, respectively. The model has the better ability to predict survival.Two features were extracted in the plain sequence.The radiomic signature was significant for DFS in the training set(P=0.005 0),while the radiomics signature was not significant for DFS in the validation set (P=0.767 0). The C-index of the model were 0.711 and 0.500 in the training set and the validation set, respectively.Conclusions Radiomics signature extracted from MRI venous phase enhancement sequence superior to plain sequence for predicting the DFS of rectal cancer before nCRT.

OBJECTIVETo study the expression of EpCAM and E-cadherin in papillary thyroid carcinoma and to analyze its correlation with various clinicopathologic parameters.

METHODSImmunohistochemical study for EpCAM and E-cadherin was carried out in 91 cases of papillary thyroid carcinoma. Twenty-four cases of papillary hyperplasia of thyroid were used as controls.

RESULTSIn all of the 24 cases of papillary hyperplasia, EpCAM was located on the cell membrane, while in the 91 cases of papillary thyroid carcinoma studied, EpCAM was located within the cytoplasm, with 36.3% (33/91) showing nuclear localization as well. In all the papillary hyperplasia cases studied, E-cadherin showed membranous expression. E-cadherin expression was reduced in 84.6% (77/91) of papillary thyroid carcinoma, as compared with the surrounding native thyroid parenchyma. Amongst the 33 cases of papillary thyroid carcinoma which showed nuclear localization of EpCAM, 30 cases also showed reduced E-cadherin expression. There was a positive correlation between nuclear expression of EpCAM and loss of E-cadherin expression (P = 0.000; Spearman correlation coefficient = 0.857). Nuclear expression of EpCAM correlated with follicular variant of papillary thyroid carcinoma and presence of extrathyroidal extension ( P = 0.037 and 0.033, respectively). Loss of E-cadherin expression correlated with age of patients and presence of lymph node metastasis (P = 0.018 and 0.010, respectively).

CONCLUSIONSE-cadherin expression is reduced in papillary thyroid carcinoma, as compared with native thyroid parenchyma and papillary hyperplasia. Papillary thyroid carcinoma shows loss of EpCAM membranous expression and increased cytoplasmic/nuclear accumulation. Detection of these two markers may provide a valuable reference in defining the biologic behaviors of papillary thyroid carcinoma, including extrathyroidal extension and lymph node metastasis.

Antigens, Neoplasm ; metabolism ; Cadherins ; metabolism ; Carcinoma, Papillary ; metabolism ; secondary ; Cell Adhesion Molecules ; metabolism ; Cell Membrane ; metabolism ; Cytoplasm ; metabolism ; Epithelial Cell Adhesion Molecule ; Humans ; Lymphatic Metastasis ; Neoplasm Proteins ; metabolism ; Thyroid Neoplasms ; metabolism ; pathology

Objective To compare the effect of procedure prolapse hemorrhoids (PPH)and traditional milligan morgan hemorrhoidectomy in treatment of circumferential mixed hemorrhoids. Methods All 60 cases annular mixed hemorrhoid patients were randomly divided into observation group and control group,each group 30 cases, observation group un-derwent the procedure for prolapse and hemorrhoids,the control group underwent milligan morgan hemorrhoidectomy,op-erative time, bleeding, hospitalization time, VAS, complications were compared between two groups. Results The mean operative time, hospitalization time of observation group was significantly shorter than the control group,intra-operative bleeding volume was less than the control group (P<0.05), after operation 24 h, VAS of observation group decreased more significantly than the control group(P<0.05),the complication rate in the observation group was 13.3%,was lower than the control group 40.0%(P<0.05). Conclusion The procedure for prolapse and hemorrhoids than tradi-tional milligan morgan hemorrhoidectomy has advantages of less bleeding, shorter operative time, less postoperative complications,less pain,worthy of promotion and application.

Objective To study the expression of EpCAM and E-cadherin in papillary thyroid carcinoma and to analyze its correlation with various clinicopathologic parameters.Methods Immunohistochemical study for EpCAM and E-cadherin was carried out in 91 cases of papillary thyroid carcinoma.Twenty-four cases of papillary hyperplasia of thyroid were used as controls.Results In all of the 24 cases of papillary hyperplasia, EpCAM was located on the cell membrane, while in the 91 cases of papillary thyroid carcinoma studied, EpCAM was located within the cytoplasm, with 36.3% ( 33/91 ) showing nuclear localization as well.In all the papillary hyperplasia cases studied, E-cadherin showed membranous expression.E-cadherin expression was reduced in 84.6% ( 77/91 ) of papillary thyroid carcinoma, as compared with the surrounding native thyroid parenchyma.Amongst the 33 cases of papillary thyroid carcinoma which showed nuclear localization of EpCAM, 30 cases also showed reduced E-cadherin expression.There was a positive correlation between nuclear expression of EpCAM and loss of E-cadherin expression ( P=0.000; Spearman correlation coefficient=0.857).Nuclear expression of EpCAM correlated with follicular variant of papillary thyroid carcinoma and presence of extrathyroidal extension (P=0.037 and 0.033, respectively).Loss of E-cadherin expression correlated with age of patients and presence of lymph node metastasis ( P=0.018 and 0.010, respectively).Conclusions E-cadherin expression is reduced in papillary thyroid carcinoma, as compared with native thyroid parenchyma and papillary hyperplasia.Papillary thyroid carcinoma shows loss of EpCAM membranous expression and increased cytoplasmic/nuclear accumulation.Detection of these two markers may provide a valuable reference in defining the biologic behaviors of papillary thyroid carcinoma, including extrathyroidal extension and lymph node metastasis.