Nephrotic syndrome （NS） is a glomerular disease characterized by massive proteinuria， hypoalbuminemia， edema， and hyperlipidemia. Tripterygium wilfordii exhibits remarkable efficacy in the prevention and treatment of renal diseases； however， its hepatotoxicity， nephrotoxicity， and other factors limit its clinical application. This article systematically reviews the mechanisms of pharmacological effects and detoxification of T. wilfordii and its active ingredients in the treatment of NS. The results show that the main active components of T. wilfordii include tripterygium glycosides， triptolide， and triptriolide， etc. T. wilfordii and its active ingredients exert significant renal protective effects by protecting glomerular podocytes， repairing the glomerular filtration barrier， regulating abnormal immune and inflammatory responses， inhibiting oxidative stress injury， and blocking renal fibrosis， thereby effectively reducing proteinuria， improving renal function， and lowering the recurrence rate of NS. Traditional Chinese medicine compatibility （e.g. T. wilfordii combined with Lysimachia christinae ， Cuscuta chinensis ethanol extract， and Paeonia lactiflora ， respectively） can regulate anti-inflammatory and antioxidant levels and optimize drug metabolic pathways. Combined with modern preparation technologies （e.g.， triptolide self-microemulsion drug delivery system）， these strategies can effectively antagonize the hepatotoxicity， nephrotoxicity， and other factors of T. wilfordii .

Objective:To investigate the etiological characteristics and drug resistance patterns of multidrug-resistant organism (MDRO) infection in patients after cardiac surgery, so as to help clinicians rationally prescribe antimicrobials recommended by guidelines, increase the success rate of empirical antibacterial therapy and improve the prognosis of inpatients.Methods:Clinical data of 409 patients diagnosed with nosocomial infection (NI) after cardiac surgery from January 2018 to October 2021 were retrospectively collected. According to the results of culture, these cases were divided into two groups: MDR bacterial infection group (MDR, n=176) and non-MDR bacterial infection group (non-MDR, n=233). The etiological characteristics of MDRO infection and the patterns of drug resistance to commonly used clinical antibiotics were analyzed. Meanwhile, the etiological distribution, drug resistance and clinical outcome corresponding to different surgical types and clinical infection types were statistically analyzed. Results:A total of 306 strains of MDR bacteria were detected. Among the 176 patients, 97 (55.1%) were infected with more than one kind of MDRO and the mix infections were mainly caused by Klebsiella pneumoniae, Acinetobacter baumannii and/or Pseudomonas aeruginosa. Carbapenem-resistant (CR) bacteria accounted for 69.6% (213/306). Regardless of surgical type and clinical infection type, Acinetobacter baumannii (114/306, 37.3%) was the most common pathogenic bacteria, followed by Klebsiella pneumoniae (72/306, 23.5%) and Pseudomonas aeruginosa (55/306, 18.0%). Most of the clinical specimens were sputum specimens (528/601, 87.9%) and most of the isolated strains were carbapenem resistant, MDR and extensively drug-resistant (XDR). The positive rates of MDR bacteria were 53.7% and 53.1% in patients undergoing coronary artery bypass grafting (CABG) and aortic surgery, respectively, while the positive rates of pandrug-resistant bacteria were relatively low. In vitro drug sensitivity test results showed that MDR bacteria were highly resistant to levofloxacin (64.4%) and cefepime (61.4%), and then to ciprofloxacin (54.6%), ceftazidime (53.9%) and cotrimoxazole (52.4%). However, the resistance rates to polycolistin (5.5%) and amikacin (7.2%) were low. Compared with non-MDR bacteria, MDR bacteria were less susceptible to ceftazidime (χ 2=156.663, P<0.001), ceftriaxone (χ 2=27.844, P<0.001), cefepime (χ 2=210.181, P<0.001), imipenem (χ 2=173.242, P<0.001), levofloxacin (χ 2=201.521, P<0.001), ciprofloxacin (χ 2=180.187, P<0.001), amikacin (χ 2=16.661, P<0.001), gentamicin (χ 2=46.047, P<0.001), tobramycin (χ 2=106.546, P<0.001), piperacillin (χ 2=7.325, P=0.007), ampicillin/sulbactam (χ 2=5.415, P=0.020), piperacillin/tazobactam (χ 2=139.506, P<0.001), cefoperazone/sulbactam (χ 2=102.832, P<0.001), cotrimoxazole (χ 2=121.217, P<0.001), aztreonam (χ 2=6.977, P=0.008) and minocycline (χ 2=53.107, P<0.001). Although there was no significant difference in the detection rates of pathogenic bacteria between patients undergoing different types of surgery or having different types of infection, the mortality rate of NI after cardiac surgery, especially MDR bacterial infection, was as high as 30.0%. Moreover, the mortality rate was closely related to the types of clinical infection. The all-cause mortality of common pulmonary infection and bloodstream infection (BSI) was 10.0% to 20.0%, and once the patient′s condition was not under control and progressed to severe infection or even septic shock, the all-cause mortality would double. Conclusions:MDR bacterial infections would bring great challenges to patients after cardiac surgery, especially gram-negative bacteria (GNB) such as Klebsiella pneumoniae, Acinetobacter baumannii and Pseudomonas aeruginosa. More than half of the patients would have mixed infections caused by carbapenem resistant, XDR or even pandrug-resistant bacteria, resulting in limited choice of anti-infective drugs and poor prognosis in hospitalized patients.

Objective To investigate the efficacy and safety of modified endoscopic submucosal dissection (ESD) and rubber band ligation assisted endoscopic dissection for treatment of small gastric submucosal tumors (SMT) originating from the muscularis propria layer. Methods A total of ninety-two patients diagnosed as gastric SMT (6 mm≤diameter≤13 mm) originating from the muscularis propria layer by EUS in our hospital were enrolled in this study. With intravenous anesthesia and tracheal intubation in all patients, modified ESD was performed firstly to stripe the small tumors. After being exposed to a certain extent, the tumors were ligated by rubber band and snared for endoscopic dissection. The situation of bleeding, perforation in both intraoperative and postoperative, the integrity and size of the resected specimens were observed and recorded. The resected specimens were identified with histopathological detection and immunohistochemistry assay. At the 6-month and 12-month after the operation, all patients were reviewed by gastroscopy and EUS in our hospital. Results All the 92 tumors were resected completely and successfully. The mean operating time was (19.2±2.3) min and the mean blood loss in operation was (2.6±0.5) mL. Perforation after resection occurred in 3 cases, which were closed with metal hemostatic clips and nylon ropes. No delayed bleeding and perforation occurred in one week after the operation. The tumor sizes ranged from 6 mm × 5 mm to 13 mm × 12 mm. Seventy-three gastric stromal tumors (risk classification:all were very low risk), 18 gastric leiomyomas and 1 gastric neurofibroma were identified. There were no residue or recurrence in all cases during the 12-month follow-up period. Conclusion The modified ESD and rubber band ligation assisted endoscopic dissection are effective and safe for treatment of small gastric submucosal tumors originating from the muscularis propria layer. The tumors are resected completely and successfully, showing certain significance to assess the nature, degree of malignancy of the tumor and prognosis of the patients.

OBJECTIVE:To explore the working model of developing pharmacovigilance in our hospital. METHODS:179 ADR cases reported in our hospital in 2008 were analyzed and the measures to carry out pharmacovigilance were introduced. RESULTS:Due to the practice of pharmacovigilance,the incidence of serious ADRs in our hospital was lowered significantly,down to 0 case in 2008 from 8 cases during 2005～2007; the proportion of rational drug use increased and the ADR reporting rate increased. CONCLUSION:To maintain high level of rational drug use,it is imperative to develop pharmacovigilance in our hospital.