Objective To analyze the rules and characteristics of cross-allergy cases related to drug-related medical disputes,and to provide reference for the formulation of cross-allergy prescription review strategy.Methods The judgments of cross-allergy related medical damage liability disputes recorded in the legal document database of Beijing Yingke Law Firm and the Chinese Judgment Document Network database from August 2010 to June 2023 were analyzed,the causes of relevant disputes were summarized and analyzed,and more comprehensive response measures were formulated.Results A total of 65 judgments were retrieved,and seven judgments were included.The main drugs causing cross allergy were antibiotics(penicillins,cephalosporins and sulfonamides).Seven cases of medical disputes,all of which were ruled by the court that the medical party had medical errors due to cross-allergies,and had to bear 30％to 80％of the compensation liability.The main reasons for the punishment were that the doctor did not pay enough attention to the patient's past history of allergy and chose unreasonable drugs.Conclusion Medical institutions can reduce the risk of cross-allergy by means of information technology,and play the role of pharmacists in prescription review and pharmaceutical care.Physicians should pay attention to the patient's past history,earnly inquire,strengthen medication education and monitoring,reduce the threat of adverse reactions to the patient's life safety and related drug disputes,and protect the legitimate rights and interests of both doctors and patients.

Objective:To analyze the clinical phenotype, sperm morphological characteristics and assisted reproductive therapy efficiency in patients with total globozoospermia.Methods:Four male patients with total globozoospermia were collected during November 2019 to May 2022 from Reproductive Medical and Genetic Center, the People's Hospital of Guangxi Zhuang Autonomous Region. Peripheral blood samples were collected for genetic detection and the whole exome sequencing to explore the pathogenic genes. Semen characteristics, sperm morphology and ultrastructure were analyzed. Four patients were treated with intracytoplasmic sperm injection (ICSI) combined with artificial oocyte activation (AOA). Conventional ICSI cycles ( n=9) were selected as control group, and the development dynamic parameters were monitored by Time-lapse. The fertilization and embryo development parameters, developmental dynamic parameters and clinical outcomes were analyzed between the two groups. Results:Four patients were complicated with low sperm motility and increased sperm DNA fragmentation. Sperm morphology analysis and acrosome fluorescence staining represented that all the spermatozoas were with a small round head lacked of acrosome. By the transmission electron microscope, it was observed that round-headed spermatozoas were lacked of acrosome completely, loose chromatin structure, vacuolation and other abnormal changes in the head, mitochondrial sheath in neck were reduced arranged in disorder, and the structure of "9+2" of the flagellar axial filament was incomplete. Of the 4 patients, 1 was homozygous deletion of DPY19L2 gene and 1 was homozygous frameshift mutation of DPY19L2 gene. There were no significance differences in fertilization rate, two pronuclei fertilization rate, day 3 high-quality embryo rate, day 6 blastocyst formation rate and day 6 high-quality blastocyst formation rate between total globozoospermia group and control group (all P>0.05). The developmental dynamic parameters as the time at which the second polar body is extruded, the time when both (or the last) PN disappear, two to six discrete cells in the total globozoospermia group were significantly earlier than those in control group, and the difference was statistically significant (all P<0.05). There was no significant difference in the embryo cleavage patterns between the two groups ( P>0.05). Among the 4 patients with total globozoospermia, 2 live births with signal healthy male baby were achieved by fresh embryo transfer, and 2 live births with one signal healthy male baby and one healthy female baby were achieved by frozen-thawed embryo transfer respectively. Conclusion:Abnormal morphology characteristics of spermatozoas from patients with total globozoospermia are obvious, patients with total globozoospermia could have favorable clinical outcomes following ICSI combined with AOA.

Objective:To analyze the clinical phenotype, sperm morphological characteristics and assisted reproductive therapy efficiency in patients with total globozoospermia.Methods:Four male patients with total globozoospermia were collected during November 2019 to May 2022 from Reproductive Medical and Genetic Center, the People's Hospital of Guangxi Zhuang Autonomous Region. Peripheral blood samples were collected for genetic detection and the whole exome sequencing to explore the pathogenic genes. Semen characteristics, sperm morphology and ultrastructure were analyzed. Four patients were treated with intracytoplasmic sperm injection (ICSI) combined with artificial oocyte activation (AOA). Conventional ICSI cycles ( n=9) were selected as control group, and the development dynamic parameters were monitored by Time-lapse. The fertilization and embryo development parameters, developmental dynamic parameters and clinical outcomes were analyzed between the two groups. Results:Four patients were complicated with low sperm motility and increased sperm DNA fragmentation. Sperm morphology analysis and acrosome fluorescence staining represented that all the spermatozoas were with a small round head lacked of acrosome. By the transmission electron microscope, it was observed that round-headed spermatozoas were lacked of acrosome completely, loose chromatin structure, vacuolation and other abnormal changes in the head, mitochondrial sheath in neck were reduced arranged in disorder, and the structure of "9+2" of the flagellar axial filament was incomplete. Of the 4 patients, 1 was homozygous deletion of DPY19L2 gene and 1 was homozygous frameshift mutation of DPY19L2 gene. There were no significance differences in fertilization rate, two pronuclei fertilization rate, day 3 high-quality embryo rate, day 6 blastocyst formation rate and day 6 high-quality blastocyst formation rate between total globozoospermia group and control group (all P>0.05). The developmental dynamic parameters as the time at which the second polar body is extruded, the time when both (or the last) PN disappear, two to six discrete cells in the total globozoospermia group were significantly earlier than those in control group, and the difference was statistically significant (all P<0.05). There was no significant difference in the embryo cleavage patterns between the two groups ( P>0.05). Among the 4 patients with total globozoospermia, 2 live births with signal healthy male baby were achieved by fresh embryo transfer, and 2 live births with one signal healthy male baby and one healthy female baby were achieved by frozen-thawed embryo transfer respectively. Conclusion:Abnormal morphology characteristics of spermatozoas from patients with total globozoospermia are obvious, patients with total globozoospermia could have favorable clinical outcomes following ICSI combined with AOA.

Objective:To explore the effects of "5-moment method" on antivirus medication compliance and revisit rate among patients with chronic hepatitis B.Methods:From January 2019 to June 2019, this study selected 120 chronic hepatitis B patients with antivirus therapy in the First Affiliated Hospital of Wenzhou Medical University as subjects by convenience sampling. All patients were divided into control group and observation group according to wards, 60 cases in each group. Control group carried out the traditional intervention including the routine medication education, hepatitis B information push by WeChat and discharged telephone follow-up. Observation group implemented the "5-moment" intervention involving the "5-moment" medication education, guiding patients to actively participate the safe and antiviral self-management through "5-moment" medication knowledge, applying "5-moment method" medication management in family medication management by informationization continuing service. This study compared the medication knowledge and compliance of patients with the self-designed Chronic Hepatitis B Antivirus Medication Knowledge Questionnaire and Morisky Medication Adherence Scale-8 (MMAS-8) as well as the revisit rate between two groups. There were 4 cases loss to follow-up in control group and no case loss to follow-up in observation group. A total of 116 subjects were included.Results:The awareness rate of antivirus medication knowledge and score of MMAS-8 of patients in observation group 6 months after intervention were (76.79±6.57) % and (7.17±0.78) respectively higher than those in control group with statistical differences ( t=19.883, 4.382; P<0.01) . The revisit rates of observation group and control group 6 months after intervention were 88.33% (53/60) and 55.36% (31/56) respectively with a statistical difference (χ 2=15.768, P<0.01) . Conclusions:The "5-moment method" can effectively improve the cognition of chronic hepatitis B patients on antivirus therapy, antivirus medication compliance of patients and revisit rate which is worthy of popularization in antivirus therapy management.

Objective:To establish a technical system for early judgment and rescue artificial oocyte activation of oocytes after fertilization failed, intracytoplasmic sperm injection (ICSI) and to explore the activation efficiency and application value.Methods:Firstly, a retrospective analysis was performed in 150 ICSI cycles cultured by Time-lapse system during January 2017 to March 2018 from Reproductive Medical and Genetic Center, the People's Hospital of Guangxi Zhuang Autonomous Region, the time distribution of the second polar body (Pb2) exclusion and its relationship with fertilization and embryo development outcomes, the feasibility of Pb2 exclusion as an early indicator of fertilization failure in ICSI was discussed. Secondly, 225 fertilization failed oocytes from 93 ICSI cycles during March 2018 to June 2019 were collected for randomized controlled trials according to different artificial activation modes. They were divided into three groups including non-activation group (NAOA group), rescue activation group (RAOA group) and late activation group (LAOA group). At the same time, the rest of injected oocytes from ICSI cycles include in this study were used as control group. Fertilization and embryo development parameters were used to explore the efficiency and application value of rescue artificial activation for after fertilization failure oocytes ICSI.Results:Time-lapse monitoring showed that the fertilization rate and 2PN fertilization rate were 99.91% and 97.76% in the Pb2-exclusion group, 0.03% and 0% in the without Pb2-exclusion group after ICSI, with significant differences between the two groups ( P<0.001); the exclusion time of Pb2 after ICSI was (3.04±1.45) h, and the distribution and proportion of Pb2 exclusion time were 0-3 h (58.00%), 3-5 h (36.29%), 5-8 h (3.92%) and >8 h (1.21%). The Pb2 exclusion rate, the fertilization rate and the 2PN fertilization rate in NAOA group were all 0%, and the 2PN fertilization rate (36.00%), day 3 (D3) high-quality embryo rate (8.00%), day 5 (D5) blastocyst formation rate (0%) and D5 high-quality blastocyst formation rate (0%) in LAOA group were significantly lower than those in RAOA group (60.00%, 44.19%, 51.16%, 25.58%) ( P=0.005, P=0.002, P<0.001, P=0.005), and also in control group (97.63%, 48.62%, 63.23%, 37.94%) ( P<0.001); the Pb2 exclusion rate (84.00%), the fertilization rate (81.33%), the 2PN fertilization rate (60.00%) and the 2PN cleavage rate (95.56%) in RAOA group were significantly lower than those in control group (100.00%, 99.68%, 97.63%, 99.51%) ( P<0.001, P<0.001, P<0.001, P=0.04). However, there was no significant difference in D3 high-quality embryo rate, D5 blastocyst formation rate and D5 high-quality blastocyst formation rate between the two groups ( P>0.05). Conclusion:Time-lapse monitoring of the Pb2 exclusion can be used as an early judgment indicator of fertilization failure in ICSI cycles. Rescue artificial activation of fertilization failed oocytes in 5 h after ICSI can achieve normal fertilization and acceptable embryo development outcomes.

Objective:To establish a technical system for early judgment and rescue artificial oocyte activation of oocytes after fertilization failed, intracytoplasmic sperm injection (ICSI) and to explore the activation efficiency and application value.Methods:Firstly, a retrospective analysis was performed in 150 ICSI cycles cultured by Time-lapse system during January 2017 to March 2018 from Reproductive Medical and Genetic Center, the People's Hospital of Guangxi Zhuang Autonomous Region, the time distribution of the second polar body (Pb2) exclusion and its relationship with fertilization and embryo development outcomes, the feasibility of Pb2 exclusion as an early indicator of fertilization failure in ICSI was discussed. Secondly, 225 fertilization failed oocytes from 93 ICSI cycles during March 2018 to June 2019 were collected for randomized controlled trials according to different artificial activation modes. They were divided into three groups including non-activation group (NAOA group), rescue activation group (RAOA group) and late activation group (LAOA group). At the same time, the rest of injected oocytes from ICSI cycles include in this study were used as control group. Fertilization and embryo development parameters were used to explore the efficiency and application value of rescue artificial activation for after fertilization failure oocytes ICSI.Results:Time-lapse monitoring showed that the fertilization rate and 2PN fertilization rate were 99.91% and 97.76% in the Pb2-exclusion group, 0.03% and 0% in the without Pb2-exclusion group after ICSI, with significant differences between the two groups ( P<0.001); the exclusion time of Pb2 after ICSI was (3.04±1.45) h, and the distribution and proportion of Pb2 exclusion time were 0-3 h (58.00%), 3-5 h (36.29%), 5-8 h (3.92%) and >8 h (1.21%). The Pb2 exclusion rate, the fertilization rate and the 2PN fertilization rate in NAOA group were all 0%, and the 2PN fertilization rate (36.00%), day 3 (D3) high-quality embryo rate (8.00%), day 5 (D5) blastocyst formation rate (0%) and D5 high-quality blastocyst formation rate (0%) in LAOA group were significantly lower than those in RAOA group (60.00%, 44.19%, 51.16%, 25.58%) ( P=0.005, P=0.002, P<0.001, P=0.005), and also in control group (97.63%, 48.62%, 63.23%, 37.94%) ( P<0.001); the Pb2 exclusion rate (84.00%), the fertilization rate (81.33%), the 2PN fertilization rate (60.00%) and the 2PN cleavage rate (95.56%) in RAOA group were significantly lower than those in control group (100.00%, 99.68%, 97.63%, 99.51%) ( P<0.001, P<0.001, P<0.001, P=0.04). However, there was no significant difference in D3 high-quality embryo rate, D5 blastocyst formation rate and D5 high-quality blastocyst formation rate between the two groups ( P>0.05). Conclusion:Time-lapse monitoring of the Pb2 exclusion can be used as an early judgment indicator of fertilization failure in ICSI cycles. Rescue artificial activation of fertilization failed oocytes in 5 h after ICSI can achieve normal fertilization and acceptable embryo development outcomes.

Objective To explore the effects of self-management education on sharp instruments operation behavior of nursing staff. Methods Form January to June 2017, 231 nurses were given the self-management education on sharp instruments operation. The general self-efficacy, the self-management ability and the accuracy of sharp instruments operation behavior of nurses were compared before and after the education. Results After the self-management education, the general self-efficacy, the total score of self-management ability in sharp instruments operation, the control operation, the emotion management, the operation information management, occupational health management, the operation environment management and the accuracy of sharp instruments operation behavior of nurses also improved apparently than before, and the differences were statistically significant (P< 0.05). Conclusions The self-management education can improve the self-management ability and the accuracy of sharp instruments operation behavior of nurses.

Objective To explore the effects of self-management intervention on medical waste disposal for patients with viral hepatitis at home.Methods Totally 116 patients with infectious hepatitis who used home injection were selected and divided into the control group (n=54) and the observation group (n=62) according to the order of admission. Patients in the control group were given routine education, while patients in the ob-servation group were given self-management intervention on the basis of routine education. Patients' knowledge about medical waste and self-management status about medical waste disposal in two groups were compared. Results Three months after intervention, the awareness rate of patients on medical waste in the observation group was (13.21±5.31) point and (7.52±3.80) point in the control group (t=6.547,P<0.01). The self-man-agement of medical waste disposal in the observation group was better than that of the control group (χ2=6.640, P<0.01).Conclusions Self management intervention is helpful in improving the standard of medical waste disposal in patients with viral hepatitis at home.

ObjectiveTo study the effects of quality control circle (QCC) activities on improving the revisiting rate in discharged patients with chronic hepatitis B,so as to supervise patients to return visit regularly and improve medical compliance.Methods To investigate the revisiting situation of chronic hepatitis B patients discharged from infection department from January to March 2016 through QCC activities,in which the causes of the missing revisits were analyzed,and goals for improvement and corresponding measurements were set up. Corresponding measures were taken from April to October,2016. Statistical analysis was made to compare the revisiting rate before and after QCC activities.Results After taken the measures,the revisiting rate of discharged chronic hepatitis B patients was raised from 30.56% to 63.22%.Conclusions QCC activity can improve the revisiting rate and satisfaction of discharged patients with chronic hepatitis B.

Objective To investigate the effects of nursing intervention on self-management ability and quality of life of patients with chronic hepatitis B in antiviral treatment. Methods A total of 160 patients with chronic hepatitis B antiviral treatment were randomly divided into control group and observation group on average. The patients of control group were given routine care based on their own condition, while the patients of intervention group were assessed their self-management ability and quality of life by the self-management scale and quality of life evaluation questionnaire, and they were given specific nursing intervention based on the analysis of assessment, and then completed one year follow-up after discharge. Results The self-management ability of patients in the intervention group was higher than that of control group, while quality of life score in the intervention group was (66.43 ±5.94) compared (62.45 ±6.89) in the control group (t=2.48,P<0.05). Conclusions Nursing intervention can improve patients′self-management ability as well as quality of life.