Objective To introduce a traceability closed-loop management system for the entire process of drug dispensing in the inpatient department.Methods In line with the requirements for intelligent healthcare construction and six-level electronic medical records development,a paperless drug dispensing process for the inpatient department was designed.A traceability closed-loop management system was established by improving both hardware equipment and software function.The system's practical effectiveness was evaluated from multiple perspectives.Results With process transformation,the workflow efficiency of doctors,nurses,pharmacists and clinical support staff has been significantly improved.Costs in terms of human resources and materials have been reduced,and the safe and rational use of medication has been promoted.Conclusions The improved process,which is based on the construction of intelligent devices and information technology,achieves a closed-loop and traceable management system for the entire drug dispensing process in the inpatient department.This system offers the benefits of safety,standardization,efficiency,and closed-loop traceability.It reduces the risk of dispensing mistakes,improves the safety of medication and has strong scalability.

Objective:To explore the influence of anxiety on the quality of life and its associated factors in patients with polycystic ovary syndrome (PCOS).Methods:PCOS patients were enrolled in this cross sectional study in Reproductive Endocrinology, Obstetrics and Gynecology Hospital of Fudan University from May 2019 to January 2022. Anxiety and quality of life were scored for patients diagnosed with PCOS. All patients were divided into PCOS with or without anxiety group. The associated factors of PCOS complicated with anxiety were screened from clinical features, endocrine, ovarian reserve function and metabolic status by logistic analysis and receiver operating characteristic (ROC).Results:Totally 125 PCOS patients were enrolled, of whom 44 were complicated with anxiety. The scores for the quality of life in patients with PCOS and anxiety related to obesity (12.7±1.4 vs. 18.8±0.9, P<0.001), abnormal menstruation (17.9±0.9 vs. 23.2±0.6, P<0.001) and PCOS itself (28.3±1.6 vs. 35.0±0.9, P<0.001) were all lower than those in PCOS patients without anxiety. The body mass index (BMI) [(25.74±0.97) kg/m 2vs. (23.46±0.45) kg/m 2, P=0.038] and area of insulin under the curve (IAUC) [(2 844.28±303.61) pmol/L vs. (1 834.28±147.89) pmol/L, P=0.001] of PCOS patients with anxiety were all higher, while sex hormone binding globulin (SHBG) levels [(33.29±6.21) nmol/L vs. (41.94±4.11) nmol/L, P=0.045] were lower than those without anxiety, and the differences were all statistically significant. Logistic regression analysis screened out the most relevant factor with anxiety in PCOS as IAUC ( OR=1.001, 95% Cl=1.000-1.001, P=0.021) and BMI ( OR=1.113, 95% CI=1.016-1.219, P=0.003). ROC analysis showed that IAUC was an associated factor for PCOS complicated with anxiety, and the area under the ROC curve were 0.701 ( P=0.020). Conclusion:The prevalence of anxiety in PCOS patients is higher than that in the general population. The quality of life is lower in PCOS patients with anxiety than those without. Anxiety may be closely related to weight gain and hyperinsulinemia/insulin resistance in PCOS patients.

Objective:To explore the influence of anxiety on the quality of life and its associated factors in patients with polycystic ovary syndrome (PCOS).Methods:PCOS patients were enrolled in this cross sectional study in Reproductive Endocrinology, Obstetrics and Gynecology Hospital of Fudan University from May 2019 to January 2022. Anxiety and quality of life were scored for patients diagnosed with PCOS. All patients were divided into PCOS with or without anxiety group. The associated factors of PCOS complicated with anxiety were screened from clinical features, endocrine, ovarian reserve function and metabolic status by logistic analysis and receiver operating characteristic (ROC).Results:Totally 125 PCOS patients were enrolled, of whom 44 were complicated with anxiety. The scores for the quality of life in patients with PCOS and anxiety related to obesity (12.7±1.4 vs. 18.8±0.9, P<0.001), abnormal menstruation (17.9±0.9 vs. 23.2±0.6, P<0.001) and PCOS itself (28.3±1.6 vs. 35.0±0.9, P<0.001) were all lower than those in PCOS patients without anxiety. The body mass index (BMI) [(25.74±0.97) kg/m 2vs. (23.46±0.45) kg/m 2, P=0.038] and area of insulin under the curve (IAUC) [(2 844.28±303.61) pmol/L vs. (1 834.28±147.89) pmol/L, P=0.001] of PCOS patients with anxiety were all higher, while sex hormone binding globulin (SHBG) levels [(33.29±6.21) nmol/L vs. (41.94±4.11) nmol/L, P=0.045] were lower than those without anxiety, and the differences were all statistically significant. Logistic regression analysis screened out the most relevant factor with anxiety in PCOS as IAUC ( OR=1.001, 95% Cl=1.000-1.001, P=0.021) and BMI ( OR=1.113, 95% CI=1.016-1.219, P=0.003). ROC analysis showed that IAUC was an associated factor for PCOS complicated with anxiety, and the area under the ROC curve were 0.701 ( P=0.020). Conclusion:The prevalence of anxiety in PCOS patients is higher than that in the general population. The quality of life is lower in PCOS patients with anxiety than those without. Anxiety may be closely related to weight gain and hyperinsulinemia/insulin resistance in PCOS patients.

Objective:To evaluate the relationship between dexmedetomidine-induced reduction of sevoflurane-induced neurotoxicity and cation-chloride cotransporters Na + -K + -2Cl --1 (NKCC1) /K + -2Cl --2 (KCC2) in neonatal rats. Methods:Eighty healthy male Sprague-Dawley rats at postnatal day 7 were divided into 4 groups ( n=20 each) using a random number table method: control group (group C), sevoflurane anesthesia group (group S), dexmedetomidine group (group D), and sevoflurane and dexmedetomidine group (group SD). Rats were exposed to 2.5% sevoflurane for 6 h to establish the model of sevoflurane anesthesia in group S. Dexmedetomidine 1.0 μg/kg was intraperitoneally injected, and then sevoflurane anesthesia was performed in group SD.The expression of cleaved caspase-3, NKCC1 and KCC2 was detected by Western blot at 24 h after the end of anesthesia.At 35 days after the end of anesthesia, the cognitive function was assessed using the Y maze test, and the neurons in the hippocampal CA1 area were counted using the Nissan staining method. Results:Compared with group C, the percentage of time spent in novel arm and the number of neurons in hippocampal CA1 area were significantly decreased, the expression of cleaved caspase-3 and NKCC1 was up-regulated, the expression of KCC2 was down-regulated, and the ratio of NKCC1/KCC2 was increased in S and SD groups ( P<0.05), and no change was found in the above indicators in group D ( P>0.05). Compared with group S, the percentage of time spent in novel arm and the number of neurons in hippocampal CA1 area were significantly increased, the expression of cleaved caspase-3 and NKCC1 was down-regulated, the expression of KCC2 was up-regulated, and the ratio of NKCC1/KCC2 was decreased in group SD ( P<0.05). Conclusion:The mechanism of dexmedetomidine attenuating sevoflurane-induced neurotoxicity may be related to maintaining the relatively stable expression of NKCC1/KCC2 in neonatal rats.

Objective    To investigate the effectiveness and safety of totally endoscopic transmitral myectomy (TETM) for hypertrophic obstructive cardiomyopathy (HOCM), comparing with traditional sternotomy modified Morrow procedure (SMMP). Methods    Thirty-eight patients with HOCM who needed surgical intervention were selected from our hospital in 2019, including 14 males and 24 females, with an average age of 56 (44-68) years. According to the operation method, they were divided into a TETM group (n=18) and a SMMP group (n=20). Appropriate patients  were screened by propensity matching scores. Finally, the clinical data of two matched groups were compared and

OBJECTIVE: To analyze the clinical presentation and gene of 2 pedigrees with suspected oculocutaneous albinism(OCA), and provide basis for clinical classification, genetic counseling and prenatal diagnosis. METHODS: Variants were identified using next-generation sequencing(NGS) and confirmed by Sanger sequencing in 2 pedigrees with suspected OCA. The pathogenicity of the variants was analyzed according to the American College of Medical Genetics and Genomics (ACMG) standard. RESULTS: Two compound heterozygous mutations of TYR and OCA2 genes were identified respectively in 2 pedigrees with suspected OCA. The mutation of c.819+3insATATGCC in TYR and the mutation of c.1870G>C in OCA2 are first reported in this study. The pathogenicity analysis shows that two novel mutations are likely pathogenic by combination of prediction of SIFT, Polyphen-2 and Human Splicing Finder. CONCLUSION The findings of this study expand the mutational spectrum of OCA. Compound heterozygous mutations in the TYR and OCA2 gene may be responsible for clinical manifestations of 2 pedigrees with suspected OCA.
Albinism, Oculocutaneous ; DNA Mutational Analysis ; Female ; High-Throughput Nucleotide Sequencing ; Humans ; Membrane Transport Proteins ; Monophenol Monooxygenase ; Mutation ; Pedigree ; Pregnancy

To analyze the clinical and image features for 12 patients of cerebral autosomal dominant arteriopathy with subcortical infarct and leucoencephalopathy (CADASIL).
 Methods: A total of 12 CADASIL patients were collected in Xiangya Hospital of Central South University from January 2013 to December 2018. The clinical manifestation, risk factors, MRI imaging data and NOTCH3 mutations were analyzed retrospectively.
 Results: The mean age of 12 patients was (47.25±9.49) years. The clinical manifestation was most common in cognitive impairment (75%) and stroke events (58.3%), and 2 cases showed cerebral hemorrhage. Migraine was only seen in 25% patients. All MRI showed white matter hyperintensity (WMH), lacune and enlarged perivascular space (PVS). WMH mainly occurred in the frontal parietal lobe (100%), temporal lobe (83.3%), external capsule (66.7%), occipital lobe (41.6%), callosum 41.6% and the temporal pole (33.3%), while lacune mainly appeared in frontal lobe (91.6%), parietal lobe(83.3%), temporal lobe(66.7%), basal ganglia (66.7%), brain stem (41.6%), occipital lobe (33.3%), cerebellum (8.3%). Enlarged PVS located in the basal ganglia (100%), partly under the cortex (45.4%). WMH of the patient with intracerebral hemorrhage was mild (Fezakas score 1-2), which was not found in external capsule. 16.7% of the patients had intracranial arterial stenosis. In 12 patients, 8 different Notch3 mutations were detected. The c1013G>c p.(Cys338Ser) located in exon 6, which was a new pathogenic mutation of CADASIL.
 Conclusion: The patients with cerebral hemorrhage have mild WMH and specific genotype, indicating that the clinical characteristics of CADASIL with cerebral hemorrhage may be related to image features and genotype.
Adult ; CADASIL ; Cerebral Infarction ; Humans ; Leukoencephalopathies ; Middle Aged ; Retrospective Studies ; Temporal Lobe

Objective To evaluate the effect of sevoflurane combined with propofol anesthesia on the postoperative expression of nuclear heterogeneous ribonucleoprotein A2 (hnRNPA2) in brain tissues of rats with mild cognitive impairment (MCI).Methods Male Sprague-Dawley rats,aged 16-18 months,were anesthetized with pentobarbital sodium.MCI was induced by ligation of bilateral common carotid arteries after anesthesia.Forty-eight rats with MCI were divided into 4 groups (n =12 each) using a random number table method:sham operation group (SH group),sevoflurane anesthesia group (S group),propofol anesthesia group (P group),and sevoflurane combined with propofol anesthesia group (SP group).Group S inhaled 3％ sevoflurane.Propofol was intravenously infused at a rate of 40 mg · kg-1 · h-1 in group P.In group SP,1.7％ sevoflurane was inhaled,and propofol 20 mg· kg-1 · h-1 was intravenously infused.The anesthesia time was 3 h in the three groups.After disappearance of eyelash reflex,open reduction and internal fixation was performed after tibial fracture was induced.Y-maze test was performed at 7 days after operation,and the percentage of time of staying at novel arm was calculated.The open field test was performed,and the total activity distance and time of staying at the central region were recorded.Then the rats were sacrificed,and brain tissues were obtained for determination of the expression of hnRNAP2 and γ-aminobutyric acid receptor A1 subunit (GABAA-α1) in hippocampus by immunofluorescence and Western blot,respectively.Results Compared with SH group,the percentage of time of staying at novel arm was significantly decreased,the expression of hnRNPA2 in the hippocampus was up-regulated,and the expression of GABAA-α1 was down-regulated in S and P groups,and the expression of hnRNPA2 in the hippocampus was up-regulated (P＜0.05),and no significant change was found in the percentage of time of staying at novel ann or expression of GABAA-α1 in SP group (P＞ 0.05).Compared with S group or P group,the percentage of time of staying at novel arm was significantly increased,the expression of hnRN-PA2 in the hippocampus was down-regulated,and the expression of GABAA-α1 was up-regulated in SP group (P＜0.05).There was no significant difference in the total distance or time of staying at the central region among the four groups (P＞ 0.05).Conclusion The mechanism by which sevoflurane combined with propofol anesthesia does not aggravate the postoperative cognitive dysfunction may be related to up-regulating the expression of hnRNPA2 in brain tissues and maintaining GABAA-α1 stable in rats with MCI.

Objective To evaluate the effect of dexmedetomidine on the expression of NR1 subunit-containing NMDA receptors and GIuR2 subunit-containing AMPA receptors during hypoxic injury to rat hippocampal neurons.Methods The hippocampal neurons were isolated from Wistar rats within 24 h after birth and divided into 3 groups (n=24 each) using a random number table:control group (group C),hypoxia group (group H) and dexmedetomidine group (group D).The cells were subjected to hypoxia for 6 h to establish the model of neuronal hypoxic injury in H and D groups.In group D,0.1 μmol/L dexmedetomidine was added at 6 h of hypoxia and neurons were incubated for 3 h,and then the culture medium was replaced with a normal medium and neurons were incubated for 24 h.The neuronal viability was measured by CCK-8 assay,the leakage of LDH was detected,and the leakage rate was calculated.The expression of NR1 subunits-containing NMDA receptors and GluR2 subunits-containing AMPA receptors was detected by Western blot.The concentration of calcium ion in cytoplasm was measured using Fluo-3AM.Results Compared with group C,the neuronal viability was significantly decreased,the LDH leakage rate was increased,the expression of NR1 subunits-containing NMDA receptors in the membrane was up-regulated,the expression of GluR2 subunits-containing AMPA receptors was down-regulated,and the concentration of calcium ion in cytoplasm was increased in H and D groups (P＜0.05).Compared with group H,the neuronal viability was significantly increased,the LDH leakage rate was decreased,the expression of NR1 subunits-containing NMDA receptors in the membrane was down-regulated,the expression of GluR2 subunitscontaining AMPA receptors was up-regulated,and the concentration of calcium ion in cytoplasm was decreased in group D (P＜0.05).Conclusion The mechanism by which dexmedetomidine reduces hypoxic injury to rat hippocampal neurons may be related to inhibiting up-regulation of the expression of NR1 subunits-containing NMDA receptors in the membrane and down-regulation of the expression of GluR2 subunitscontaining AMPA receptors.

Objective To evaluate the effects of different ratios of medicine dosage for propofol and sevoflurane on postoperative cognitive function in elderly patients with mild cognitive impairment.Methods Ninety-six patients of both sexes,aged 65-75 yr,weighing 60-80 kg,of American Society of Anesthesiologists physical status Ⅰ or Ⅱ,scheduled for elective lower limb fracture operation under general anesthesia,with mild cognitive impairment before surgery,were assigned into 4 groups (n =24 each) using a random number table:propofol group (group P),sevoflurane group (group S) and different ratios of medicine dosage for propofol and sevoflurane groups (group PS1 and group PS2).Montreal Cognitive Assessment (MoCA) and Mini-Mental State Examination (MMSE) were used to evaluate the cognitive function of patients at 1 day before operation (T0) and 7 days after operation (T1).Venous blood samples were collected at T0 and T1 for determination of the concentrations of plasma apolipoprotein J (ApoJ) and soluble CD14 (sCD14) by enzyme-linked immunosorbent assay.Results Compared with group S,MMSE and MoCA scores were significantly increased and plasma concentrations of ApoJ and sCD14 were decreased at T1,and the incidence of postoperative cognitive dysfunction was decreased in P,PS1 and PS2 groups (P＜0.05).Compared with group PS1,MMSE and MoCA scores were significantly decreased and the plasma concentrations of ApoJ and sCD14 were increased at T1,and the incidence of postoperative cognitive dysfunction was increased in P and PS2 groups (P＜0.05).MMSE and MoCA scores were significantly lower and plasma concentrations of ApoJ and sCD14 were higher at T1 than at T0 in S,P and PS2 groups (P＜0.05),and there was no significant difference in the parameters mentioned above between T1 and T0 in group PS1 (P＞0.05).Conclusion Combination of propofol 1.2 μg/ml given by target-controlled infusion and 0.7-1.2％ sevoflurane inhalation for maintenance of anesthesia does not aggravate the postoperative cognitive dysfunction in elderly patients with mild cognitive impairment.