Objective: To characterize perioperative dynamic changes in immune-cell phenotypes and inflammatory cytokines in patients undergoing CPB (cardiopulmonary bypass) cardiac surgery, and to explore their associations with postoperative outcomes. Methods: In this prospective cohort study, 120 adult patients who underwent elective cardiac surgery under CPB at West China Hospital from May 2022 to March 2023 were enrolled. Perioperative immune-cell phenotypes and concentrations of 40 inflammation-related cytokines were measured. The primary outcomes were the sequential organ failure assessment (SOFA) score at 24 h after surgery and ΔSOFA (the peak SOFA score within 48 h after surgery minus the preoperative SOFA score). Secondary outcomes included major adverse cardiovascular events (MACE), acute kidney injury (AKI), respiratory failure, severe liver injury, and infection. Results: The mean age of enrolled patients was 57±10 years. Of these, 52% (62/120) were male and 90% (108/120) underwent valve surgery. During the rewarming to the end of CPB, neutrophil counts rapidly increased (7.39×10 /L vs preoperative 3.07×10 /L, P<0.001), with significant upregulation of CD11b (7.30×10 /L vs preoperative 3.05×10 /L, P<0.001) and CD54 (7.15×10 /L vs preoperative 2.99×10 /L, P<0.001). Lymphocyte counts increased at the end of CPB (1.75×10 /L vs preoperative 1.12×10 /L, P<0.001) but decreased significantly at 24 h after surgery (0.59×10 /L vs preoperative 1.12×10 /L, P<0.001). Plasma analysis showed that multiple pro-inflammatory cytokines increased during CPB and remained elevated up to 24 h after surgery; five chemokines and the anti-inflammatory cytokine IL-10 peaked at the end of CPB. The SOFA score increased from 1 (1, 2) preoperatively to 7 (5, 10) at 24 h after surgery, with a ΔSOFA of 6 (4, 8). Within 30 days after surgery, 48 patients (40.0%) developed AKI, 17 (14.2%) developed infection, 4 (3.3%) developed severe liver injury, 3 (2.5%) developed respiratory failure, and 3 (2.5%) experienced MACE. During the 2-year follow-up, 8 patients (6.7%) experienced MACE and 5 (4.2%) died. Conclusion: Multi-organ dysfunction is common after cardiac surgery under CPB (median ΔSOFA, 6), accompanied by perioperative activation of multiple immune-cell subsets and upregulation of pro-inflammatory, anti-inflammatory, and chemotactic mediators. This study provides data-driven evidence and research clues for further investigation of the associations between CPB-related immune perturbations and postoperative organ dysfunction and clinical outcomes.

Objective:To explore solutions to the "grey zone" of activated partial thromboplastin time (APTT) mixing study, and establish the clinical application pathway of it.Methods:Patients treated in West China Hospital of Sichuan University from January 1, 2018, to December 31, 2019, with a prolonged APTT were included in this study. The ROC curve was used to analyze the"cut-off"of different methods and explore solutions to the "grey zone" by combination of the 1∶1 and 4∶1 mixing study. Similar samples from January 1, 2020 to December 31, 2020 were included to verify the diagnostic efficiency of the clinical application pathway.Results:The traditional Rosner index criterion had a low diagnostic accuracy in differentiating factor deficiencies from inhibitors. A total of 49 cases (15%) in the establishment group and validation group were located in the "grey zone". The optimal cut-off value of the Rosner index in our 1∶1 mixing study for determining factor deficiency was 5.0%, and inhibitor was 9.1%. The sample between 5.0% and 9.0% needed 4∶1 mixing studies, which could significantly improve the detection sensitivity of inhibitors. The percentage of extended time after incubation-P (1∶1 mixing>10.8% and 4∶1 mixing>13.5%) was better than the traditional criterion mentioned by"consensus"in determining whether the inhibitor was time-dependent. The sensitivity, specificity, positive predictive value and negative predictive value of combined the 1∶1 and 4∶1 mixing study in differentiating factor deficiencies from inhibitors all attained more than 90%. Only 7% (3/43)of inhibitors were incorrectly classified into the factor deficiency group by the combination, which was 20.9% (9/43) by traditional criterion. The specificity for detecting time-dependent inhibitor was increased from 54.2% to 100%, and accuracy was increased from 63.3% to 97.4%.Conclusions:The combination of 1∶1 and 4∶1 mixing study can better resolve the "grey zone". The established clinical application pathway is beneficial for the further promotion and clinical application of APTT mixing study.

Malaria still threatens global health seriously today. While the current discoveries of antimalarials are almost totally focused on single mode-of-action inhibitors, multi-targeting inhibitors are highly desired to overcome the increasingly serious drug resistance. Here, we performed a structure-based drug design on mitochondrial respiratory chain of

Objective    To investigate the effect of different administration methods of tranexamic acid on postoperative pulmonary inflammation response during cardiopulmonary bypass (CPB). Methods    A total of 64 SD rats were included in the study. They were randomly divided into eight different groups. CPB model was established for the operation groups. The rats in the operation groups were given tranexamic acid at low (25 mg/kg), medium (50 mg/kg) or high (100 mg/kg) concentrations before or after the CPB. Blood cells count and coagulation function were assessed 1 hour after surgery. The concentration of interleukin (IL)-1β、IL-6 and tumor necrosis factor (TNF)-α in blood and lung lavage fluid were measured. The infiltration of inflammatory cells in lungs was observed by hematoxylin-eosin (HE) staining. Results    The concentration of inflammatory cells in the operation groups was higher than that in the control group (P<0.05). The use of tranexamic acid inhibited the increase of IL-6 and TNF-α in whole blood and lung lavage fluid due to CPB (P<0.05), but there was no significant difference among the experimental groups (P>0.05). Tranexamic acid could reduce the exudation of inflammatory cells in the lungs. Conclusion    The use of tranexamic acid can effectively reduce the release of inflammatory factors and reduce acute lung injury caused by CPB in rat models. But simply increasing the dose or changing the timing of administration is not more effective in reducing the intensity of the inflammatory response.

Combined with the development of modem hospital pharmacy,in light of the present condition of the continuing education for the hospital pharmacists,based on the continuing education mode and method of the affiliated provincial hospital of Anhui medical university pharmacists,from the establishment of continuing education's goal and mode,the construction of hierarchical continuing education system,and education content integration aspects,this paper expounds the role and influence of the pharmacist professional skill contest.Through pharmacist professional skill contest,pharmacist can test and evaluate the hospital pharmacist professional ability,gradually improve pharmaceutical service level and quality of pharmacists.By introducing the pharmacist professional skill contest,pharmacist can not only timely adjust the continuing education's plan and ways,better coordinate with the development of hospital pharmacists,but also provide important technical support and talent reserves for the pharmacist professional skill contest.

Developing the clinical thinking ability and therefore improving the clinical practice ca-pacity are the core of the quality-oriented education and in the current medical education reforms. The rea-sons for retarding the development of clinical thinking ability in dental clinical probation were herein dis-cussed. According to the similarity between mind mapping and clinical thinking, drawing mind map was used in the creation of the clinical knowledge system; various teaching techniques were used and classical clinical cases were shown; role playing as dentist and patient was used to mimic the clinical circumstance;dentist-patient communication was emphasized and methods to evaluate the clinical thinking ability were also developed. These strategies effectively developed the clinical thinking ability of the dental students.

Objective To investigate the knowledge regarding the diabetic retinopathy among patients from Quzhou city, and to explore individualized health guidance countermeasures. Methods From January 2012 to March 2014,diabetic retinopathy scale was used to analyze the situation of the disease knowledge mastery among 297 inpatients with diabetes from Department of Endocrinology of People′s Hospital of Quzhou. Results 42. 42% of the total 297 patients had not participated in any forms of study concerning the knowledge of diabetic retinopathy. 38. 38% of the participants visited ophthalmologist once every 1 -6 month, while 42. 76% of them made the interval over six months. 65. 32% of the participants could follow the doctor′s advice to have their fundus examination and only 30. 97% of participants could have the regular fundus examination annually. Conclusions The level of knowledge regarding the diabetic retinopathy and self-care behavior among diabetic patients are medium and low level. The related health education should be further performed to improve the situation of prevention and treatment for diabetic retinopathy.

Objective To compare the early diagnostic value of between transabdominal color Doppler ultra-sound(TACDS)and transvaginal color Doppler ultrasound(TVCDS)in tubal pregnancy.Methods Clinical data of 112 cases which were diagnosis of tubal pregnancy by operation and postoperative pathologic examination were retro-spectively ananlyzed.The accuracy of clinical diagnosis of tubal ectopic pregnancy were compared between TACDS group and TVCDS group.Results 75 cases and 108 cases were diagnosed of tubal pregnancy in TACDS group and TVCDS group,respectively.The diagnostic accuracy were 66.96% and 96.43%,respectively.There was evident difference between the TACDS group and TVCDS group(χ2 =32.511 8,P =0.000).Conclusion Compared with TACDS,TVCDS has high accurate for early diagnosis of tubal pregnancy,which can provide characteristic images and objective basis for the diagnosis and treatment of tubal ectopic pregnancy.

Objective To measure the total β radioactive background level in the urine of normal adults,and to establish the method which can be universally used and satisfy the needs of rapid screening of samples in large batch.Methods A total of 83 urine samples from healthy adults were prepared by evaporation.And the gross β activity in urine was detected by using low background measuring instrument.Results The optimal experimental conditions were in place.The sampled volume was 200 ml,and the samples were turned to nitric acid salinization,ashed at 300℃ for 2 h,and the measured time was 1000 min.To get a more stable result,the urine residues were put aside for 24 h before measurement.The radioactivity in urine of healthy adults was between 9.40-55.92 Bq/L,and showed no correlation with age and sex.Conclusions When the radioactivity in urine is detected under the conditions mentioned above,the sample preparation process is simple and quickly,which can satisfy the needs of large batch sample screening.

Objective To investigate the effect of the histological changes on rat dorsal root ganglia (DRG) after 125I seed brachytherapy.Methods Twelve adult male Sprague-Dawley rats ( 150-180g each) were randomly divided into 6 groups,125I seeds with different activities of 0 (Titanium shell),14.8,18.5,22.2,25.9 and 29.6 MBq were implanted to 6 groups of rats respectively and the behavioral changes of rats were observed.The rats were killed in different periods after implantation,the morphological changes in DRG and surrounding muscle tissue were observed with an Olympus BX51 optical microscope and then the irradiation doses were estimated.Results After 125I seed implantation,the movement function of rats was not affected and the weight of rats gained after 7 days.After the titanium shell implantation,very few mild swelling was induced in neuroganglion cells that still had clear nucleolus and normal cytoplasm.At 14 days after 18.5 MBq seed implantation,cell swelling was more serious and cell dehydrating,nuclear condensation and nuclear fragmentation appeared after 30 days.At 60 days after 29.6 MBq of seed implantation,nuclear dissolution and cytoplasmic shrinkage were induced in a large number of cells.In general,the severity of fibrosis was aggravated with the time post-irradiation and the dose in the muscles around the ganglion.Conclusions After 125I seed implantation,the injury degree of DRG tissue is dose-dependent,and the 125I seed irradiation would have analgesic effect on releasing intractable pain.