OBJECTIVE To evaluate the influence of pharmaceutical quality control on the efficiency and outcomes of standardized medication therapy management （MTM） services for patients with coronary heart disease by using Economic， Clinical and Humanistic Outcomes （ECHO） model. METHODS This study collected case data of coronary heart disease patients who received MTM services during January-March 2023 （pre-quality control implementation group， n＝96） and June-August 2023 （post-quality control implementation group， n＝164）. Using propensity score matching analysis， 80 patients were selected from each group. The study subsequently compared the economic， clinical， and humanistic outcome indicators of pharmaceutical services between the two matched groups. RESULTS There were no statistically significant differences in baseline data between the two groups after matching （P＞0.05）. Compared with pre-quality control implementation group， the daily treatment cost （16.26 yuan vs. 24.40 yuan， P＜0.001）， cost-effectiveness ratio [23.12 yuan/quality-adjusted life year （QALY） vs. 32.32 yuan/QALY， P＜0.001]， and the incidence of general adverse drug reactions （2.50% vs. 10.00%， P＝0.049） of post-quality control implementation group were decreased significantly； the utility value of the EuroQol Five-Dimensional Questionnaire （0.74± 0.06 vs. 0.71±0.07， P＝0.003）， the reduction in the number of medication related problems （1.0 vs. 0.5， P＜0.001）， the medication adherence score （[ 6.32±0.48） points vs. （6.10±0.37） points， P＝0.001]， and the satisfaction score （[ 92.56±1.52） points vs. （91.95±1.56） points， P＝0.013] all showed significant improvements. Neither group experienced serious adverse drug reactions. There was no statistically significant difference in the incidence of new adverse reactions between the two groups （1.25% vs. 3.75%， P＝0.310）. CONCLUSIONS Pharmaceutical quality control can improve the quality of pharmaceutical care， and the ECHO model can quantitatively evaluate the effect of MTM services， making pharmaceutical care better priced and more adaptable to social needs， thus being worthy of promotion.

This study was performed to screen the sequence of specific nanobody targeting SARS-CoV-2 S protein,and to express and purify recombinant anti-SARS-CoV-2 nanobodies,and evaluate their characteristics and application potential.Based on the previously constructed natural bacteriophage nanobody display library,the anti-SARS-CoV-2 S protein nanobody sequences were screened,with biotinylated SARS-CoV-2 S protein receptor-binding domain antigen as target,by biotin-streptavidin liquid phase screening method,phage-ELISA and sequencing.Recombinant anti-SARS-CoV-2 S protein nanobody expression vectors were constructed,the protein was induced by IPTG and then purified,and their characteristics and application potential were analyzed by SDS-PAGE,Westem blot and ELISA methods.Two anti-SARS-CoV-2 S protein nanobody sequences were successfully obtained,and the corresponding prokaryotic expression bacteria were constructed.The recombinant anti-SARS-CoV-2 S protein nanobody was expressed and purified successfully,which can specifically bind to SARS-CoV-2 S protein.In conclusion,the recombinant anti-SARS-CoV-2 S protein nanobodies have screened and expressed successfully,which provides a basis for its application in SARS-CoV-2 detection and treatment,and facilitates related researches.

Objective:To investigate the differences in terms of blood cerebrospinal fluid barrier immune surveillance injury by lead acetate and nano-lead sulfide exposure in order to provide basis for the study of their mechanism of nerve injury caused by exposure to lead and nano lead.Methods:In June 2015, forty-five SPF SD male rats were randomly divided into control group, lead acetate group (20 mg/kg) and nano-lead sulfide group (20 mg/kg), with 15 rats in each group. The rats were intragastric five times a week, for nine weeks. The numbers of CD4 + T lymphocytes in blood and cerebrospinal fluid were detected by flow cytometry. The levels of interleukin-4 (IL-4) and interferon-γ (IFN-γ) in serum and cerebrospinal fluid were detected by ELISA. The expressions and distribution of intercellular cell adhesion molecule-1 (ICAM-1) and CD4 + T lymphocytes in choroid plexus were detected by laser confocal fluorescence immunoassay. The mRNA expression levels of IL-4, IFN-γ and ICAM-1 in the choroid plexus were detected by real-time PCR. Results:Compared with the control group, the proportion of CD4 + T lymphocytes in blood of rats in lead acetate group was increased, the proportions of CD4 + T lymphocytes in cerebrospinal fluid of rats in lead acetate group and nano-lead sulfide group were increased, the contents of IL-4 and IFN-γ in serum of rats in lead acetate group and nano-lead sulfide group were increased, the content of IL-4 in cerebrospinal fluid of rats in lead acetate group and the contents of IL-4 and IFN-γ in cerebrospinal fluid of rats in nano-lead sulfide group were increased, the differences were statistically significant ( P<0.05). The fluorescence intensity of ICAM-1 and CD4 + T lymphocytes in choriochoroid plexus of rats in lead acetate group and nano-lead sulfide group were stronger than those in control group, and the fluorescence intensity of CD4 + T lymphocytes of rats in nano-lead sulfide group was weaker than that in lead acetate group. Compared with the control group, the mRNA expression levels of ICAM-1, IL-4 and IFN-γ in choriochoroids plexus of rats in lead acetate group and nano-lead sulfide group were increased, and the mRNA expression levels of ICAM-1 and IL-4 in nano-lead sulfide group were higher than those in lead acetate group, while the mRNA expression level of IFN-γ in nano-lead sulfide group was lower than that in lead acetate group ( P<0.05) . Conclusion:Exposure to lead and nano-lead sulfide can cause the increase of CD4 + T lymphocytes, IL-4, IFN-γ and ICAM-1, which may be related to the damage to the immune surveillance of the blood cerebrospinal fluid barrier. And there is a difference in the injury caused by lead and nano-lead sulfide exposure.

Objective:To investigate the differences in terms of blood cerebrospinal fluid barrier immune surveillance injury by lead acetate and nano-lead sulfide exposure in order to provide basis for the study of their mechanism of nerve injury caused by exposure to lead and nano lead.Methods:In June 2015, forty-five SPF SD male rats were randomly divided into control group, lead acetate group (20 mg/kg) and nano-lead sulfide group (20 mg/kg), with 15 rats in each group. The rats were intragastric five times a week, for nine weeks. The numbers of CD4 + T lymphocytes in blood and cerebrospinal fluid were detected by flow cytometry. The levels of interleukin-4 (IL-4) and interferon-γ (IFN-γ) in serum and cerebrospinal fluid were detected by ELISA. The expressions and distribution of intercellular cell adhesion molecule-1 (ICAM-1) and CD4 + T lymphocytes in choroid plexus were detected by laser confocal fluorescence immunoassay. The mRNA expression levels of IL-4, IFN-γ and ICAM-1 in the choroid plexus were detected by real-time PCR. Results:Compared with the control group, the proportion of CD4 + T lymphocytes in blood of rats in lead acetate group was increased, the proportions of CD4 + T lymphocytes in cerebrospinal fluid of rats in lead acetate group and nano-lead sulfide group were increased, the contents of IL-4 and IFN-γ in serum of rats in lead acetate group and nano-lead sulfide group were increased, the content of IL-4 in cerebrospinal fluid of rats in lead acetate group and the contents of IL-4 and IFN-γ in cerebrospinal fluid of rats in nano-lead sulfide group were increased, the differences were statistically significant ( P<0.05). The fluorescence intensity of ICAM-1 and CD4 + T lymphocytes in choriochoroid plexus of rats in lead acetate group and nano-lead sulfide group were stronger than those in control group, and the fluorescence intensity of CD4 + T lymphocytes of rats in nano-lead sulfide group was weaker than that in lead acetate group. Compared with the control group, the mRNA expression levels of ICAM-1, IL-4 and IFN-γ in choriochoroids plexus of rats in lead acetate group and nano-lead sulfide group were increased, and the mRNA expression levels of ICAM-1 and IL-4 in nano-lead sulfide group were higher than those in lead acetate group, while the mRNA expression level of IFN-γ in nano-lead sulfide group was lower than that in lead acetate group ( P<0.05) . Conclusion:Exposure to lead and nano-lead sulfide can cause the increase of CD4 + T lymphocytes, IL-4, IFN-γ and ICAM-1, which may be related to the damage to the immune surveillance of the blood cerebrospinal fluid barrier. And there is a difference in the injury caused by lead and nano-lead sulfide exposure.

Objective:To investigate the clinical efficacy of ear acupoint pressing beans combined with escitalopram tablets in the treatment of depression.Methods:A total of 100 patients with depression who received treatment in the Department of Psychiatrics, The Third People's Hospital of Yongkang from October 2021 to February 2023 were included in this randomized controlled study. These patients were randomly divided into a control group and an observation group, with 50 patients in each group, using a random number table method. The control group was treated with escitalopram tablets, while the observation group was treated with ear acupoint pressing beans combined with escitalopram tablets. The two groups were treated for 8 weeks. Hamilton Depression Scale (HAMD), traditional Chinese medicine syndrome scores, Pittsburgh Sleep Quality Index (PSQI), serotonin levels, clinical efficacy, and adverse reactions were recorded in each group.Results:After treatment, the HAMD scores in each group were significantly decreased compared with those before treatment (both P < 0.001). After treatment, the HAMD scores in the observation group were significantly lower than those in the control group [(15.89 ± 1.08) points vs. (19.24 ± 1.27) points, t = 14.21, P < 0.001]. After treatment, the traditional Chinese medicine syndrome scores in each group were significantly lower than those before treatment (both P < 0.001). After treatment, the traditional Chinese medicine syndrome scores in the observation group were significantly lower than those in the control group [(6.83 ± 1.24) points vs. (9.78 ± 1.80) points, t = 9.54, P < 0.001]. After treatment, the PSQI scores in each group were significantly decreased compared with those before treatment (both P < 0.001). After treatment, the PSQI scores in the observation group were significantly lower than those in the control group [(7.00 ± 1.34) points vs. (9.48 ± 1.82) points, t = 7.76, P < 0.001]. After treatment, the levels of serotonin in each group were significantly decreased compared with those before treatment (both P < 0.001). The levels of serotonin in the observation group were significantly higher than those in the control group [(40.65 ± 5.37) μg/L vs. (32.52 ± 4.20) μg/L, t = 8.43, P < 0.001]. The total effective rate in the observation group was significantly higher than that in the control group [94% (47/50) vs. 80% (40/50), χ2= 4.33, P = 0.037]. The incidence of adverse reactions in the observation group was significantly lower than that in the control group [8% (4/50) vs. 10% (5/50), χ2= 0.12, P = 0.727]. Conclusion:The combination of ear acupoint pressing beans and escitalopram tablets shows good clinical efficacy in the treatment of depression. This combined therapy can reduce symptoms, improve sleep quality, increase serotonin levels and also has fewer adverse reactions, making it a worthy candidate for clinical promotion.

Objective To develop and validate the Knowledge-Attitude-Practice Scale for Prevention of Occupational Low Back Pain for Nurses (hereinafter referred to as KAP). Methods Based on the knowledge, attitudes and practice theory, a list of 48 potential items were developed by reviewing literatures related to the prevention of occupational low back pain in nurses. The Delphi expert consultation method was used to conduct two rounds of consultation on the items, and the KAP (draft) with 31 items was formed. A total of 269 nurses in a hospital in Guangdong Province were selected as study subjects by convenience sampling method and investigated with the KAP (draft). The list was selected and its validity tested using SPSS 25.0 software. Results The authority degrees of two rounds of expert consultation were 0.919 and 0.922. All of the recovery rates of valid questionnaires were >80.0%, with the coefficients of variation ranged from 0.07 to 0.40 and 0.05 to 0.28. The Kendall's concordance coefficients were 0.198 and 0.274, respectively (all P<0.05). After item selection, five items were removed, resulting in the KAP with 28-item including three dimensions： knowledge, attitude and behavior. The scale-level content validity index/average was 0.976, and the item-level content validity index ranged from 0.833 to 1.000, as assessed by experts. The scale demonstrated 100.0% for convergent and discriminative validity of the three dimensions. The exploratory factor analysis revealed three factors with a cumulative variance contribution rate of 51.0%. Cronbach's alpha coefficients for the overall scale and knowledge, attitude, and behavior dimensions were 0.880, 0.878, 0.895, and 0.877, respectively. Split-half reliability coefficients were 0.922, 0.863, 0.852, and 0.820, respectively. Conclusion The KAP shows good reliability and validity and can be used to assess knowledge, attitude and practice levels related to occupational low back pain prevention among nurses.

Objective To provide reference for clinical pharmacists to participate in rational drug use through case study. Methods Clinical pharmacists participated in the optimization of treatment plan and performed pharmaceutical care for the patients according to their own characteristics, drug interactions, compatibility contraindications and adverse drug reactions. Results Clinical pharmacists provided pharmaceutical care for the patients with cerebrovascular diseases, Parkinson's disease, encephalitis and other diseases in the Department of Neurology by using pharmaceutical expertise, retrieved evidence-based support from literature and participating in the formulation of treatment plans. Those achieved individualized drug treatment, improve patient compliance, reduced the occurrence of unreasonable usage and dosage, inappropriate drug combination and improper drug selection, the treatment of adverse drug reactions, drug safety, and rational drug use. Conclusion Clinical pharmacists need to use their sound professional ability and good communication skills to help doctors make individualized drug delivery plans to ensure the safety, effectiveness and economy of drug treatment.

Objective:To determine the influences of structural changes after valgus impacted femoral neck fracture on hip range of motion (ROM) so as to provide evidence for clinical judgment of whether reduction is necessary or not in the internal fixation of such fractures.Methods:1. 3D reconstructions of the CT hip scans were performed for the 73 patients who had been treated at Department of Orthopaedic Surgery, Shanghai Sixth People’s Hospital Affiliated to Shanghai Jiao Tong University for valgus impacted femoral neck fractures from January 2019 to April 2019.The femoral neck-shaft angle, anteversion angle, femoral offset, axial alpha angle, lateral center edge angle (LCEA), anterior center edge angle (ACEA) and center displacement were measured and compared between the affected and healthy sides to determine the influences of the fracture on the above indexes. 2. Hip motions (flexion and MIR-90°) were simulated on bilateral sides to determine the influences of structural changes after fracture on hip ROM using stepwise regression and Logistic regression. 3. The distribution of femoral-acetabular contact points on the femoral side was observed in simulation of hip flexion to detect the potential area for femoracetabular impingement (FAI) induced by the fracture displacement.Results:1. The valgus impacted femoral neck fractures had significant influences on femoral neck-shaft angle, anteversion angle, femoral offset and axial alpha angle. Compared with the healthy side, on average, the femoral neck-shaft angle increased by 5.1°, anteversion angle decreased by 6.5°, femoral offset decreased by 8.2 mm and axial alpha angle increased by 9.7° on the affected side, showing significant differences ( P<0.05).The displacements of the femoral head center averaged 9.2 mm. There was no significant difference in LCEA or ACEA between the affected and healthy sides ( P>0.05). 2. Compared with the healthy side, on average, the simulated hip flexion decreased significantly by 27.0° and the hip MIR-90° decreased significantly by 20.3° on the affected side after fracture ( P<0.05). Regression analysis showed that femoral anteversion angle, ACEA and displacement of the femoral head center had a significant influence on hip ROM, especially the anteversion angle. When the anteversion angle decreased by more than 7.1°, the hip flexion would decrease by at least 20%. 3. The points of FAI distributed more widely on the fracture side. Compared with the healthy side, the impact points extended outward and upward in hip flexion and extended inwardly in hip MIR-90° on the affected side. Conclusions:After a valgus impacted femoral neck fracture, if the femoral anteversion angle has been decreased by more than 7.1°, the hip ROM can be greatly influenced and the points of FAI can be distributed more widely. Therefore, reduction should be recommended before internal fixation of the fracture.

Objective:To evaluate the effect of regulation of zinc finger protein 281 (ZNF281) expression by miR-203 on the proliferation and migration of melanoma cell lines.Methods:The human vascular endothelial cell line ECV304, as well as human melanoma cell lines A375, M14, SK-MEL-28 and SK-MEL-2 were subjected to conventional culture. Real-time fluorescence-based quantitative PCR was performed to measure the miR-203 expression, and Western blot analysis to determine the ZNF281 protein expression in the above cell lines. Both A375 and M14 cells were divided into 5 groups: control group (normally cultured) , miR-203 mimic control group transfected with the miR-203 mimic negative control, miR-203 inhibitor control group transfected with the miR-203 inhibitor negative control, miR-203 mimic group transfected with a miR-203 mimic, miR-203 inhibitor group transfected with a miR-203 inhibitor. Real-time fluorescence-based quantitative PCR was conducted to measure intracellular miR-203 expression, cell counting kit (CCK) -8 assay to assess cellular proliferation activity, Transwell assay to determine the number of migratory cells, and Western blot analysis to measure the protein expression of ZNF281 in A375 and M14 cells in the above groups. Dual-luciferase reporter assay was conducted to verify the targeting relationship between miR-203 and ZNF281. One-way analysis of variance was used for comparison of multiple groups, and the Student-Newman-Keuls- q (SNK- q) test for multiple comparisons. Results:Lower miR-203 expression and higher ZNF281 protein expression were observed in the melanoma cell lines A375, M14, SK-MEL-28, SK-MEL-2 compared with the vascular endothelial cell line ECV304 (all P < 0.05) . Compared with the control group, miR-203 mimic control group and miR-203 inhibitor control group, the miR-203 mimic group showed significantly increased miR-203 expression in A375 and M14 cells ( F = 487.632, 68.454, respectively, both P < 0.05) , significantly decreased number of migratory A375 and M14 cells (both P < 0.05) , and significantly decreased ZNF281 protein expression (both P < 0.05) , while the miR-203 inhibitor group showed significantly decreased miR-203 expression in A375 and M14 cells (both P < 0.05) , significantly increased number of migratory A375 and M14 cells (both P < 0.05) , significantly increased ZNF281 protein expression in A375 cells ( P < 0.05) , significantly increased proliferative activity of A375 cells at 36, 48, 60 and 72 hours (all P < 0.05) , and significantly increased proliferative activity of M14 cells at 24, 36, 48, 60 and 72 hours (all P < 0.05) . Dual-luciferase reporter assay showed interaction sites between miR-203 and ZNF281. Conclusion:Up-regulating the miR-203 expression can inhibit the proliferation and migration of melanoma cell lines, and vice versa, likely by regulating the expression of ZNF281.

Objective To investigate the application effect of the sandwich teaching method in the course of Surgical Nursing . Methods Two classes of the students majoring in nursing were randomly divided into control group and observation group, with 36 students in each group. The students in the control group received the traditional teaching method, and those in the observation group received the sandwich teaching method . The teaching effect was compared between the two groups by theoretical assessment and questionnaire survey. SPSS 24.0 was used for analysis of variance and the t-test. Results Compared with the control group, the observation group had significantly higher scores of course assessment, learning atmosphere, and learning initiative. The observation group also had significantly higher good rates of learning atmosphere and learning initiative than the control group(P<0.05). Conclusion The sandwich teaching method can significantly improve students' abilities of communication and problem solving, arouse their enthusiasm of learning, and increase the interestingness of classroom, and therefore, it has a practical value in teaching.