OBJECTIVE To ensure the safety of patients’ drug use and control the risk of medical insurance expenditure by upgrading the pre-prescription review system to conduct pre-review on prescriptions from internet hospitals and external prescriptions， as well as to review the payment methods of drugs （including in-hospital and external drug dispensing）. METHODS The data interfaces of prescriptions from internet hospitals and external prescriptions were integrated to achieve real-time rational drug use intervention. Additionally， an intelligent review project for payment method was added to precisely intervene in the medical insurance payment methods of drugs. The effect of the system upgrade was evaluated by comparing the qualification rates of prescriptions from internet hospitals and external prescriptions and the suspected amounts of drug violations from January to April 2025 （before the system upgrade） and May to August 2025 （after the system upgrade）. RESULTS After the upgrade of the pre-prescription review system， the qualification rates of prescriptions from internet hospitals and external prescriptions increased by 3.5% [95% confidence interval （CI）＝0.3%-6.7%， P ＝0.037 ] ； the suspected amounts of drug violations decreased to 52.9% of the pre-upgrade level （95%CI＝31.6%-88.5%， P ＝0.026）， and the average monthly sequential decrease was 29.5% （95%CI＝12.2%-43.4%， P ＝0.012）. Moreover， the addition of the intelligent review project for payment methods promoted the management of off-label drug use in our hospital. After the upgrade， a total of 79 filling valid applications for off-label drug use were received and archived. CONCLUSIONS The upgrade of the pre-prescription review system effectively improves the review qualification rates of prescriptions from internet hospitals and external prescriptions and the accuracy of medical insurance payment for drugs， and strengthens the supervision of off-label drug use， achieving dual guarantees of clinical rationality and medical insurance compliance.

Objective To provide an effective strategy for the prevention and treatment of radiation-induced infections by preparing platelet membrane-modified catalase/silica nanoparticles(PCNP)capable of targeting leukocytes.Methods PCNP and catalase/silica nanoparticles(CNP)were prepared by using platelet membrane,catalase(CAT)and silica,and its biological safety was preliminarily evaluated with cell survival test,hemolysis test and acute toxicity test in mice after tail vein administration;The culture medium,FITC labeled(FITC+)PCNP and FITC labeled(FITC+)CNP were co-incubated with human peripheral blood B lymphocytes(AHH-1)and mouse monocyte macrophages(RAW264.7),respectively.Thus,there were control group,FITC+PCNP group and FITC+CNP group of AHH-1 and RAW264.7 cells.Laser confocal microscopy was used to observe the intracellular fluorescence intensity of PCNP to evaluate the leukocytes targeting function.AHH-1 cells were divided into control,irradiation,platelet membrane,CNP(100 μg/mL)and PCNP(100 μg/mL)groups.After corresponding co-incubation,the cell media were exposed to6 Gy Co60 γ irradiation.The generation of reactive oxygen species(ROS)and cell apoptosis were measured to determine the effect of nanoparticles on reducing radiation injury of leukocytes.Twenty C57BL/6 male mice(weighing 18～20 g)were randomly divided into irradiation group(n=10)and 10 mg/kg PCNP group(n=10).In 2 h after corresponding agents were injected into the mice through tail vein,the mice received whole-body irradiation of 5 Gy Co60 γ ray,and then in 2 h later,they were given intraperitoneal injection of multidrug resistant Acinetobacter baumannii(MDR-AB).The infection inhibitory effect of PCNP after irradiation was evaluated by detecting the bacterial load in main organs.Results The hydration particle of PCNP is 91.3 nm in size,and does not exhibit significant cytotoxicity or hemolytic toxicity at concentrations＜400 μg/mL.Intravenous injection of 20 mg/kg PCNP resulted in normal increase in the body weight but no obvious pathological changes in the major organs such as the heart,liver,spleen,lungs,and kidneys.In AHH-1 and RAW264.7 cells,PCNP showed significant advantages in targeting compared to the FITC+CNP group[(15.45±3.48)%vs(9.33±2.03)%,P＜0.01;(11.25±2.08)%vs(7.06±0.71)%,P＜0.001].PCNP also effectively reduced the generation of ROS[(22.73±3.71)%vs(60.90±9.08)%,P＜0.001]and apoptotic rate[(9.84±0.92)%vs(38.96±3.62)%,P＜0.001]in AHH-1 cells.In in vitro study,bacterial colonization after irradiation showed that there was significantly less MDR-AB colonies in the spleen of mice intervened with PCNP than those of the irradiation group[(17.50±1.38)×104 vs(13.20±2.29)×106 CFU/g,P＜0.001].Conclusion PCNP can effectively inhibit the complications of radiation infection in mice,which is due to its direct protective effect on leukocytes.

Drug-induced gastrointestinal bleeding is caused by drugs acting on the gastrointestinal tract, which damages the gastrointestinal mucosa causing erosion and ulceration. Many drugs can cause gastrointestinal bleeding including non-steroidal anti-inflammatory drugs, antithrombotic drugs, chemotherapy drugs, and antibacterial drugs, drugs induced gastrointestinal bleeding by destroying gastrointestinal mucosal barrier, inhibiting of angiogenesis, destroying coagulation mechanism and there are still few prevention methods. This study focused on the clinical research and mechanism of drugs. The research in recent 5 years were reviewed to illustrate drug-induced gastrointestinal bleeding, so as to illustrate the characteristic actions of drug and provide some references and clues for the prevention of drug-induced gastrointestinal bleeding.

Objective To explore the hemodynamic assessment after radical surgery in children with tetralogy of Fallot (TOF) by both echocardiography and Mostcare monitor. Methods Clinical data of 63 children with TOF who underwent radical surgery in our hospital from February 2016 to June 2018 were retrospectively analyzed, including 34 males and 29 females, aged 6-24 (9.82±5.77) months. There were 19 patients undergoing transannular patch reconstruction of the right ventricular outflow tract (a transannular patch group) while 44 patients retained the pulmonary valve annulus (a non-transannular patch group) . The echocardiography and Mostcare monitor parameters were recorded and brain natriuretic peptide was tested at the time points of 0, 8, 12, 24 and 48 hours after operation (T 0, T 1, T 2, T 4) to analyze their correlations and the change trend at different time points after radical surgery. Results The left ventricular ejection fraction at T 1 (43.49%±3.82%) was lower than that at T 0 (48.29%±4.55%), T 2 (45.83%±3.69%), T 3 (53.76%±4.43%) and T 4 (60.54%±3.23%, P<0.05). The cardiac index at T 1 (1.85±0.35 L·min−1·m−2) was lower than that at T 0 (2.11±0.38 L·min−1·m−2), T 2 (2.07±0.36 L·min−1·m−2), T 3 (2.42±0.37 L·min−1·m−2) and T 4 (2.82±0.42 L·min−1·m−2, P<0.05). The cardiac circulation efficiency at T1 (0.19±0.05) was lower than that at T 0 (0.22±0.06), T 2 (0.22±0.05), T 3 (0.28±0.06) and T 4 (0.34±0.06, P<0.05). The right ventricular two-chambers view fraction area change at T 1 (23.17%±3.11%) was lower than that at T 0 (25.81%±3.74%), T 2 (25.38%±3.43%), T 3 (30.60%±4.50%) and T 4 (36.94%±5.85%, P<0.05). The pulse pressure variability was the highest at T 0 (18.76%±3.58%), followed by T 1 (14.81%±3.32%), T 2 (12.44%±2.94%), T 3 (10.39%±2.96%) and T 4 (9.18%±1.92%, P<0.05). The blood brain natriuretic peptide was higher at T 1 (846.67±362.95 pg/ml) than that at T 0 (42.60±18.06 pg/ml), T 2 (730.95±351.09 pg/ml), T 3 (510.98±290.39 pg/ml) and T 4 (364.41±243.56 pg/ml, P<0.05). There was no significant difference in left ventricular ejection fraction, cardiac circulation efficiency and heart index between the two groups (P>0.05). The right ventricular two-chambers view fraction area change of the transannular patch group was significantly lower than that of the nontransannular patch group at each time point (P<0.05). The blood brain natriuretic peptide and pulse pressure variability of the transannular patch group were significantly higher than those of the non-transannular patch group (P<0.05). Left ventricular ejection fraction was positively correlated with cardiac index (r=0.637, P=0.001) and cardiac circulation efficiency (r=0.462, P=0.001) while was significantly negatively correlated with blood brain natriuretic peptide (r=–0.419, P=0.001). Conclusion Both methods can accurately reflect the state of cardiac function. Mostcare monitor has a good consistency with echocardiography. Using transannular patch to recontribute right ventricular outflow tract in operation has more influence on right ventricular systolic function. The Mostcare monitor can guide the hemodynamic management after surgery in real time, continuously and accurately.

OBJECTIVETo explore the effects of acupuncture on the expression of protein kinase B (PKB/AKT) in lung tissues of asthma rats.

METHODSForty SPF male SD rats were randomly divided into a blank group, a model group, an acupuncture group and a blocker group, 10 rats in each one. The rat model of asthma was established by egg albumin stimulation in the model group, acupuncture group and blocker group. Since the establishment of rat model, the rats in the acupuncture group were treated with acupuncture at "Dazhui" (GV 14), "Feishu" (BL 13) and "Fengmen" (BL 12) before atomization; the rats in the blocker group were treated with intervention of blocker LY294002, once every two days, for 7 times. There was no treatment in the blank group and model group. HE staining was applied to observe the morphologic changes of lung tissues; the immunohistochemical method was applied to test the protein expression of AKT in lung tissue.

RESULTSHE staining indicated the infiltration and aggregation of a variety of inflammatory cells around airways, as well as bronchial smooth muscle spasm and confined lumen in the model group; in the acupuncture group and blocker group the inflammatory cells were less and confined lumen was relieved. Compared with the blank group, the protein expression of AKT was higher in the model group (<0.05); compared with the model group, the protein expression of AKT in the acupuncture group and blocker group was reduced (both<0.05); the differences between the acupuncture group and blank group, blocker group were not significant (both>0.05).

CONCLUSIONSAcupuncture could reduce the protein expression of AKT in lung tissue in asthma rats, leading to relieved inflammation reaction and airway remodeling.

OBJECTIVETo explore the regulation of acupuncture for transforming growth factor β1 (TGF-β1) expression in the lung tissues of bronchial asthmatic rats.

METHODSForty SPF male SD rats were randomly divided into a blank group, a model group, an acupuncture group and a shallow fast acupuncture group, 10 rats in each group. Asthma model was established in the model, acupuncture, and shallow fast acupuncture groups, and no intervention was applied in the blank and model groups. Before atomization excitation, 20 min acupuncture was applied at "Dazhui" (GV 14) "Feishu" (BL 13) "Fengmen" (BL 12) in the acupuncture group. Acupuncture only into skin without needle retained at the above acupoints was used in the shallow fast acupuncture group before atomization excitation from the day of model established. All the treatment was given 7 times, once the other day. The pathological lunge tissues of rats were observed by HE staining; the protein expression of TGF-β1 in the lung tissues was examined by immunohistochemical staining and immunofluorescence staining. The TGF-β1 expressions in bronchoalveolar lavage fluid (BALF) and serum were showed by ELISA.

RESULTSThere were changes in the lung tissues in the model group, including mucus plug in the bronchial lumen, irregular bronchial epithelium, thick airway smooth muscle, local break, narrow lumen, a large number of inflammatory cell infiltration. The phenomena in the acupuncture group were improved and those in the shallow fast acupuncture group were not apparently changed compared with those in the model group. The IOD value of TGF-β1 expression in the model group increased compared with that in the blank group (<0.05); the positive expression in the acupuncture group was lower than those in the model and shallow fast acupuncture groups (both<0.05). The contents of TGF-β1 in BALF and serum of the acupuncture group were lower than those in the model and shallow fast acupuncture groups (all<0.05).

CONCLUSIONSAcupuncture may improve airway inflammatory response and remolding of asthma by inhibiting TGF-β1 expression.

Nitric oxide(NO)is a vital signal messenger in human and generated by nitric oxide synthase including endothelial nitric oxide synthase(eNOS), inducible nitric oxide synthase(iNOS)and neuropathic nitric oxide synthase(nNOS). NO has important regulatory function on the immune system, nervous system and many other physiological systems. Endogenous NO can enhance the function of the vascular system and endothelial cell survival, and inhibit platelet accumulation and leukocyte infiltration. Excessive production of NO may damage tissues by cytotoxic and cytostatic effects. Thus, NO plays a dual role in physiology and pathology. This paper gives a brief review on regulatory effects of NOS-NO system by traditional Chinese medicine during the recent five years, so as to provide some clues or references for the treatment of related diseases and scientific evidene for reasonable and effective clinical application.

Objective Using abandoned white cells separated from preparation of blood products to cultivate NK cells in vitro, and to optimize the method of cultivation of allogeneic NK cells for clinical application.Methods Abandoned white cells separated from blood production were collected from 15 healthy donors.PBMCs were isolated from the abandoned white cells and cultured for 17 days using culture bottles as previously coated antibodies (group CD3 mAb was coated with CD3 mAb, group CD 16mAb was coated with CD16mAb, and group CD3mAb +CD16 mAb was coated with CD3 mAb and CD16 mAb).Flow cytometry was used to determine the ratio of CD3-CD56+cells, expression of activated cell surface receptors, and secretion of IFN-γ.The anti-tumor cytotoxicity against K562 and Raji cells was determined using LDH cytotoxicity assay and flow cytometry.Results After expansion for 17 days, the proportions of CD3-CD56+cells was (15.19±12.22)% in the group CD3 mAb, (83.63±10.63)% in the group CD16 mAb, (49.40± 12.64)% in the group CD3mAb +CD16 mAb, and it was (16.34±10.51)% before expansion.The total number of NK cells was more than 10 9 .The expression ratios of NK cell surface activated receptors NKp30 and NKp46 were significantly increased, while that of the NKG2D was not significantly changed.The NK cells after expansion showed high cytotoxicity activity against K562 cells, reaching up to(76.97±3.16)%when effector-cell-to-target-cell ratio (E ∶T ratio) was 40 ∶1.Conclusions NK cells can be obtained from abandoned white cells after cultivation for 17 days, with a purity up to 90% and total cell number of more than 10 9 .Their activity was reinforced, the anti-tumor cytotoxicity activity was increased, and may meet the standard of clinical therapeutic application.

Objective Using abandoned white cells separated from preparation of blood products to cultivate NK cells in vitro, and to optimize the method of cultivation of allogeneic NK cells for clinical application.Methods Abandoned white cells separated from blood production were collected from 15 healthy donors.PBMCs were isolated from the abandoned white cells and cultured for 17 days using culture bottles as previously coated antibodies (group CD3 mAb was coated with CD3 mAb, group CD 16mAb was coated with CD16mAb, and group CD3mAb +CD16 mAb was coated with CD3 mAb and CD16 mAb).Flow cytometry was used to determine the ratio of CD3-CD56+cells, expression of activated cell surface receptors, and secretion of IFN-γ.The anti-tumor cytotoxicity against K562 and Raji cells was determined using LDH cytotoxicity assay and flow cytometry.Results After expansion for 17 days, the proportions of CD3-CD56+cells was (15.19±12.22)% in the group CD3 mAb, (83.63±10.63)% in the group CD16 mAb, (49.40± 12.64)% in the group CD3mAb +CD16 mAb, and it was (16.34±10.51)% before expansion.The total number of NK cells was more than 10 9 .The expression ratios of NK cell surface activated receptors NKp30 and NKp46 were significantly increased, while that of the NKG2D was not significantly changed.The NK cells after expansion showed high cytotoxicity activity against K562 cells, reaching up to(76.97±3.16)%when effector-cell-to-target-cell ratio (E ∶T ratio) was 40 ∶1.Conclusions NK cells can be obtained from abandoned white cells after cultivation for 17 days, with a purity up to 90% and total cell number of more than 10 9 .Their activity was reinforced, the anti-tumor cytotoxicity activity was increased, and may meet the standard of clinical therapeutic application.

Objective To compare the pregnancy outcome of mother and infant through the analysis of clinical data of patients with preeclampsia. Methods Clinical data of 237 cases with preeclampsia from March 2013 to March 2014 in the department of obstetrics were analyzed retrospectively. 237 patients with preeclampsia were assigned to two groups according to different gestational weeks, group A (gestational weeks <34 weeks) and group B (gestational weeks ≥34 weeks). Complications as well as the incidence of outcome of perinatal fetus were compared between groups. Results Complications of patients with preeclampsia and incidence of the pregnancy outcome of perinatal fetus in different ges-tational weeks were different. Incidence rate of complications in the two groups was 64.2% and 38.8% respectively;neonatal asphyxia rate was 13.4% and 6.5% respectively; mortality rate of perinatal fetus was 37.3% and 3.6%. Con-clusion Patients with early-onset of preeclampsia have severe conditions, and the prognosis of perinatal fetus is unfa-vorable. Cases of disease should be strictly selected and standardized treatment should be carried out. Conditions of mother and infants should be closely monitored, so as to control disease progression effectively and terminate the preg-nancy at appropriate times.