OBJECTIVE To build a new workflow of pharmacy intravenous admixture services （PIVAS）， effectively connect intelligent equipment， and promote the intelligent development of PIVAS. METHODS Based on intelligent auxiliary equipment， PIVAS workflow was optimized， and a process-oriented model was established. This model integrated intelligent prescription review （automatic prescription review+manual intervention mode）， intelligent labeling， intelligent allocation， intelligent sorting， and finished infusion quality inspection system. Furthermore， an assessment was conducted to examine unreasonable medical order rate of intelligent prescription review， the working efficiency and error rate of intelligent labeling machine and intelligent sorting machine， and the dispensing efficiency and accuracy of intelligent dispensing robot. RESULTS Under the intelligent prescription review mode， the rate of unreasonable medical orders decreased from 0.157% to 0.050% （P＜0.05）； automatic labeling efficiency reached 21.7 sheets/min， surpassing the manual labeling efficiency of 13.8 sheets/min （P＜0.05）， and the daily labeling error rate decreased from 6.1‰ to 2.5‰ （P＜0.05）. Simultaneously operating two dispensing robots significantly improved the efficiency of batch dispensing and reduced the residual amount of liquid medicine （P＜0.05）； additionally， a quality testing system for finished infusion was established， involving appearance， Tyndall effect， insoluble particles， turbidity， absorbance， pH and osmotic pressure， to ensure the quality of finished infusion and reduce the risk of infusion. CONCLUSIONS The new process of PIVAS connected with intelligent devices in our hospital can improve work efficiency， reduce dispensing errors， ensure the quality of finished infusion， and improve the level of pharmaceutical care.

Objective:To explore the preliminary results of using the UreteroPyeloVisClear Catheter (VCC) in the treatment of ureteral stones.Methods:A retrospective analysis was conducted on the clinical data of 18 patients with ureteral stones who underwent treatment with VCC at Beijing Tsinghua Changgung Hospital from November 2023 to March 2024. The cohort consisted of 15 men and 3 women, with a mean age of 53 years (range: 27-75 years). The preoperative CT measurements showed that the mean maximum stone diameter was 9 mm (range: 3-18 mm), and the mean maximum CT value of the stones was 870 HU (range: 260-1 480 HU). The distribution of stones was as follows: 3 cases in the upper ureter, 8 in the middle ureter, and 7 in the lower ureter. Gravity-assisted perfusion was used, and all patients underwent VCC combined with Holmium laser lithotripsy, with flexible ureteroscopy used if necessary. A ureteral stent was routinely placed for 2 weeks postoperatively. Perioperative conditions and complications were analyzed.Results:All 18 patients successfully underwent VCC lithotripsy, with one patient experiencing stone migration during the procedure. The average operation time was 53 minutes (range: 20-100 minutes), and the average lithotripsy time was 25.5 minutes (range: 6–60 minutes). There were no significant changes in serum creatinine or hemoglobin levels on the first postoperative day. The average hospital stay was 2 days (range: 1–3 days). One patient experienced a fever (maximum temperature of 38.5℃), which resolved with antibiotic treatment. The visual analogue scale (VAS) scores on postoperative day 1 were 0 for 15 patients, 2 for 1 patient, 3 for 1 patient, and 4 for 1 patient. No complications of Clavien-Dindo grade Ⅱ or higher were observed. At 1-month follow-up, the stone-free rate (SFR) was 100%(18/18), and no hydronephrosis was observed in the affected kidney.Conclusions:The results of this study indicates that VCC is a safe and effective method for treating ureteral stones, with a low incidence of postoperative complications and a high stone clearance rate.

Objective:To explore the preliminary results of using the UreteroPyeloVisClear Catheter (VCC) in the treatment of ureteral stones.Methods:A retrospective analysis was conducted on the clinical data of 18 patients with ureteral stones who underwent treatment with VCC at Beijing Tsinghua Changgung Hospital from November 2023 to March 2024. The cohort consisted of 15 men and 3 women, with a mean age of 53 years (range: 27-75 years). The preoperative CT measurements showed that the mean maximum stone diameter was 9 mm (range: 3-18 mm), and the mean maximum CT value of the stones was 870 HU (range: 260-1 480 HU). The distribution of stones was as follows: 3 cases in the upper ureter, 8 in the middle ureter, and 7 in the lower ureter. Gravity-assisted perfusion was used, and all patients underwent VCC combined with Holmium laser lithotripsy, with flexible ureteroscopy used if necessary. A ureteral stent was routinely placed for 2 weeks postoperatively. Perioperative conditions and complications were analyzed.Results:All 18 patients successfully underwent VCC lithotripsy, with one patient experiencing stone migration during the procedure. The average operation time was 53 minutes (range: 20-100 minutes), and the average lithotripsy time was 25.5 minutes (range: 6–60 minutes). There were no significant changes in serum creatinine or hemoglobin levels on the first postoperative day. The average hospital stay was 2 days (range: 1–3 days). One patient experienced a fever (maximum temperature of 38.5℃), which resolved with antibiotic treatment. The visual analogue scale (VAS) scores on postoperative day 1 were 0 for 15 patients, 2 for 1 patient, 3 for 1 patient, and 4 for 1 patient. No complications of Clavien-Dindo grade Ⅱ or higher were observed. At 1-month follow-up, the stone-free rate (SFR) was 100%(18/18), and no hydronephrosis was observed in the affected kidney.Conclusions:The results of this study indicates that VCC is a safe and effective method for treating ureteral stones, with a low incidence of postoperative complications and a high stone clearance rate.

Objective To investigate the physical compatibility of admixture of cisplatin injection with 6 proton pump inhibitors.Methods At room temperature,cisplatin solutions at low,medium and high prepared concentrations(0.06,0.09,0.12 mg·mL-1)were mixed with the same volume of injection solutions of pantoprazole sodium,esomeprazole sodium,omeprazole sodium,rabeprazole sodium,lansoprazole sodium and ilaprazole sodium infusion,respectively.The changes of appearance,Tyndall effect,pH value,turbidity,the number of insoluble particles and UV absorbance of the admixtures were investigated within 8 h.Results The admixtures of cisplatin with pantoprazole sodium,esomeprazole,omeprazole sodium and rabeprazole sodium were clear and transparent within 8 h,and the change of pH value,turbidity changes,insoluble particles,UV absorbance value changes met the requirements.The combination of low concentration cisplatin and lansoprazole sodium was physically compatible and stable within 8 h.The number of insoluble particles in medium did not meet the requirements when high concentration cisplatin combined with lansoprazole sodium.All the indexes did not meet the requirements when cisplatin were combined with ilaprazole sodium.Conclusions Low concentration cisplatin is compatible with Lansoprazole sodium within 4 h at room temperature.Low,medium and high concentrations of cisplatin were compatible with pantoprazole sodium,esomeprazole sodium,omeprazole sodium and rabeprazole sodium within 8 h.High concentrations of cisplatin is incompatible with lansoprazole sodium.Cisplatin with low,medium and high concentrations are incompatible with iprrazole sodium.

During coronavirus disease 2019 epidemic, the treatment of severe trauma has been impacted. The Consensus on emergency surgery and infection prevention and control for severe trauma patients with 2019 novel corona virus pneumonia was published online on February 12, 2020, providing a strong guidance for the emergency treatment of severe trauma and the self-protection of medical staffs in the early stage of the epidemic. With the Joint Prevention and Control Mechanism of the State Council renaming "novel coronavirus pneumonia" to "novel coronavirus infection" and the infection being managed with measures against class B infectious diseases since January 8, 2023, the consensus published in 2020 is no longer applicable to the emergency treatment of severe trauma in the new stage of epidemic prevention and control. In this context, led by the Chinese Traumatology Association, Chinese Trauma Surgeon Association, Trauma Medicine Branch of Chinese International Exchange and Promotive Association for Medical and Health Care, and Editorial Board of Chinese Journal of Traumatology, the Chinese expert consensus on emergency surgery for severe trauma and infection prevention during coronavirus disease 2019 epidemic ( version 2023) is formulated to ensure the effectiveness and safety in the treatment of severe trauma in the new stage. Based on the policy of the Joint Prevention and Control Mechanism of the State Council and by using evidence-based medical evidence as well as Delphi expert consultation and voting, 16 recommendations are put forward from the four aspects of the related definitions, infection prevention, preoperative assessment and preparation, emergency operation and postoperative management, hoping to provide a reference for severe trauma care in the new stage of the epidemic prevention and control.

Objective:To study the effect of duodenal papillary morphology on selective biliary cannulation (SBC).Methods:Data of 912 patients with biliopancreatic diseases treated with endoscopic retrograde cholangiopancreatography (ERCP) at the Department of Gastroenterology, Affiliated Hospital of Northwest Minzu University from January 2018 to January 2020 were retrospectively analyzed. Duodenal papillary morphology of patients was classified into 4 types by using Haraldsson's endoscopic classification. The success rate of SBC, the pre-incision rate, the difficult intubation rate and the incidence of post-ERCP pancreatitis (PEP) of different papillary types were analyzed.Results:A total of 912 patients were enrolled in this study, and 86.95% (793/912) duodenal papilla conformed to one type of the classification, of which 77.18% (612/793) were regular type (type Ⅰ), 10.21% (81/793) small nipple type (type Ⅱ), 8.58% (68/793) protruding or drooping type (type Ⅲ), and 4.04% (32/793) wrinkled or ridged type (type Ⅳ). The success rates of SBC in four types of duodenal papilla were 98.86% (605/612), 90.12% (73/81), 88.24% (60/68) and 96.60% (28/32) respectively. The success rate of SBC of type Ⅰ was higher than those of type Ⅱ-Ⅳ (all P<0.008) and there was no significant difference between those of type Ⅱ and type Ⅲ ( P> 0.008). The pre-incision rate in the four types of duodenal papilla were 7.84% (48/612), 32.10% (26/81), 50.00% (34/68) and 25.00% (8/32) respectively. The pre-incision rate of type Ⅰ was lower than those of type Ⅱ-Ⅳ (all P<0.008), and there was no significant difference between those of type Ⅱ and type Ⅲ ( P>0.008). The difficult intubation rate in the four types of duodenal papilla were 12.42% (76/612), 39.51% (32/81), 58.82% (40/68) and 28.12% (9/32) respectively .The difficult intubation rate of type Ⅰ was lower than those of type Ⅱ and type Ⅲ (both P<0.001), and that of type Ⅲ was higher than that of type Ⅳ ( P=0.004) . There was no significant difference between those of type Ⅰ and type Ⅳ or type Ⅱ and type Ⅲ (both P>0.008). The incidences of PEP of the four types were 2.61% (16/612), 12.35% (10/81), 5.88% (4/68) and 6.25% (2/32) respectively. The incidences of PEP of type Ⅱ was higher than that of type Ⅰ ( P<0.001) , and there was no significant difference between those of type Ⅰ and type Ⅳ or type Ⅱ and type Ⅲ (both P>0.008). Conclusion:SBC is affected by duodenal papilla morphology, easiest for type Ⅰ and hard for type Ⅱ and Ⅲ. Attention should be paid to risk of PEP in SBC of type Ⅱ.

Objective:To investigate the diagnosis and clinical characteristics of five elderly patients with Chlamydia psittaci-caused severe pneumonia.Methods:Through retrospective analysis, diagnosis and treatment process and clinical characteristics of five elderly inpatients with severe pneumonia caused by Chlamydia psittaci were summarized in the Department of Critical Care Medicine, Quanzhou First Hospital East Street Branch Area, affiliated to Fujian Medical University between January to June 2021.Results:Five patients with severe pneumonia caused by Chlamydia psittaci were aged from 64 to 74 years, with various underlying diseases such as coronary heart disease, chronic heart failure, chronic obstructive pulmonary disease, etc.All patients had an established history of poultry exposure.These cases had high fever, cough, spitting, and dyspnea as the main clinical manifestations.Some of them also had systemic symptoms or weakness of the limbs as the prodromal symptoms.The disease progressed rapidly, with severe respiratory failure, acute kidney injury, and shock appearing soon, accompanied by different degrees of muscle injury, and damage to the heart, liver, blood coagulation, and immune systems at the same time.Laboratory examination showed that levels of inflammatory indicators were increased: at 3, 5, 7 d after admission, the level of C reactive protein was 214.6(153.9-256.3)mg/L, 199.2(115.8-333.8)mg/L, 151.0(11.19-173.7)mg/L, respectively; and interleukin 6 level was 1 241.0(912.1-6822.0)ng/L, 779.1(451.2-7122.0)ng/L, 631.2(7.0-4 321.0)ng/L, respectively.And monitoring results of nutritional index indicated a high metabolic state.The imaging examinations showed that consolidation and ground-glass shadows spreaded to both lungs, may accompany the miliary and nodular shadows, and may also involve pleural which caused pleural effusion.After the clinical use of metagenomic next-generation sequencing(mNGS), mNGS has been confirmed as an important method for the diagnosis of Chlamydia psittaci infection.The disease course and prognosis were related to the severity of the disease, advanced age, underlying diseases, and timely diagnosis and effective treatment.Conclusions:The progression of Chlamydia psittaci pneumonia to severe disease may be related to advanced age, more basic diseases such as chronic cardiopulmonary disease, smoking, and timely diagnosis and treatment.Generally, laboratory and imaging examinations have no diagnostic specificity, but mNGS is of great significance for early diagnosis, transition to target treatment and improvement of prognosis.

Objective To investigate the effect of glutamine (GLN) treatment on neurobehavioral outcome,brain edema and inflammatory response in rats after traumatic brain injury (TBI),and to find out the role played by autophagic response in this effect.Methods Rat models with TBI in this study were established using Feeney's method.One hundred healthy male SD rats were randomly divided into five groups (n =20) to receive sham operation (group Sham),TBI (group TBI),TBI and glutamine treatment (group TBI+GLN),TBI amd autophagy inhibitor 3-methyladenine (group TBI+ 3-MA),and TBI,GLN and autophagy inhibitor (group TBI+GLN+3-MA).We measured the rats' behavioral outcomes by modified neurologic severity score (mNSS) tests at day 1,3,7 and 14 after intervention.Brain water content was measured with wet-dry weight method.The serum levels of tumor necrosis factor-α (TNF-ct),interleukin (IL)-1 and IL-4 were tested using enzyme linked immunosorbent assay.The expressions of autophagy-related factors (LC3-Ⅱ,Beclin-1) in TBI cerebral cortex were tested with Western blot.Results Compared with the Sham group,the other four groups had significantly increased levels of brain edema,mNSS,serum inflammatory factors and cerebral LC3-Ⅱ and Beclin-1 (P=0.00).Compared with the TBI group,the TBI+GLN group had less severe brain edema and improved mNSS,lower levels of TNF-α [(57.71 ±9.69) pg/ml vs.(83.37± 12.81) pg/ml,P=0.01] and IL-1 [(39.46±8.60) pg/ml vs.(69.04± 10.48) pg/ml,P=0.00],higher levels of IL-4 [(68.72± 11.18) pg/ml vs.(35.75 ± 8.40) pg/ml,P =0.04],and upregulated expressions of LC3-Ⅱ and Beclin-1 (P=0.01).Compared with the TBI+GLN group,the TBI+GLN+3-MA group had severer neurofunctional impairment,brain edema and inflammation (P＜ 0.05).Conclusions Treatment with GLN markedly reduced brain edema and improved neurobehavioral outcomes in rats with TBI by inhibiting inflammatory response in the central nervous system.The mechanism might have been the activation of the autophagic response.

A 76-year-old male patient received an IV infusion of micafungin 50 mg in 0. 9% sodium chloride 100 ml once daily for pulmonary infection. Ninety minutes after the first infusion,the patient presented with chills,fever and dark brown urine. Laboratory testing showed the following levels:white blood cells count 25. 2 × 109/L,hemoglobin 73 g/L,platelet count 179 × 109/L,blood urea nitrogen 6. 4 mmol/L,serum creatinine 96 μmol/L,procalcitonin 14. 13 ng/ml,prothrombin time 17 s,activated partial thromboplastin time 44 s,D-dimer 8. 7 mg/L,and routine urine tests showed white blood cells( +++), urine occult blood test( +++),urobilinogen( +++),urine ketones( +++),urine protein( +++) and nitrite positive. The patient was considered as acute hemolysis. Micafungin was stopped. He was given an IV injection of methylprednisolone 40 mg and hydration and urinary alkalinization. However,his urine volume was reduced from 100-150 ml/h to 10-20 ml/h in 4 hours and developed dark urine. The following day,his white blood cells count was 18. 6 × 109/L,red cells count was 1. 7 × 1012/L,hemoglobin was 57 g/L,platelet count was 116 × 109/L,reticulocytes was 0. 05,albumin was 25 g/L,indirect bilirubin was 20. 4 μmol/L,aspartate transaminase was 108 U/L,alanine aminotransferase was 42 U/L,blood urea nitrogen was 17. 9 mmol/L,serum creatinine was 230μmol/L,and direct antiglobulin test was positive. He was considered to have acute kidney failure. The patient received anti-infective treatment,continuous renal replacement therapy,and infusion of erythrocyte suspension and plasma. Ten days later,the patient was still anuric and presenting worsening jaundice,family members gave up treatment.

A 76-year-old male patient received an IV infusion of micafungin 50 mg in 0. 9% sodium chloride 100 ml once daily for pulmonary infection. Ninety minutes after the first infusion,the patient presented with chills,fever and dark brown urine. Laboratory testing showed the following levels:white blood cells count 25. 2 × 109/L,hemoglobin 73 g/L,platelet count 179 × 109/L,blood urea nitrogen 6. 4 mmol/L,serum creatinine 96 μmol/L,procalcitonin 14. 13 ng/ml,prothrombin time 17 s,activated partial thromboplastin time 44 s,D-dimer 8. 7 mg/L,and routine urine tests showed white blood cells( +++), urine occult blood test( +++),urobilinogen( +++),urine ketones( +++),urine protein( +++) and nitrite positive. The patient was considered as acute hemolysis. Micafungin was stopped. He was given an IV injection of methylprednisolone 40 mg and hydration and urinary alkalinization. However,his urine volume was reduced from 100-150 ml/h to 10-20 ml/h in 4 hours and developed dark urine. The following day,his white blood cells count was 18. 6 × 109/L,red cells count was 1. 7 × 1012/L,hemoglobin was 57 g/L,platelet count was 116 × 109/L,reticulocytes was 0. 05,albumin was 25 g/L,indirect bilirubin was 20. 4 μmol/L,aspartate transaminase was 108 U/L,alanine aminotransferase was 42 U/L,blood urea nitrogen was 17. 9 mmol/L,serum creatinine was 230μmol/L,and direct antiglobulin test was positive. He was considered to have acute kidney failure. The patient received anti-infective treatment,continuous renal replacement therapy,and infusion of erythrocyte suspension and plasma. Ten days later,the patient was still anuric and presenting worsening jaundice,family members gave up treatment.