OBJECTIVE To improve the efficiency and quality of dispensed oral drug management in the inpatient pharmacy， and ensure the safety of drug use in patients. METHODS SWOT （strength， weakness， opportunity， threat） analysis method was used to analyze the internal strengths and weaknesses， as well as the external opportunities and threats in the construction of a closed-loop management system for dispensed oral drugs in the inpatient pharmacy of our hospital， and propose improvement strategies. RESULTS & CONCLUSIONS A refined， full-process， closed-loop traceability management system for dispensed oral drugs in the inpatient pharmacies was successfully established， which is traceable in origin， trackable in destination， and accountable in responsibility. After the application of this system， the registration rate of dispensed drug information and the correctness rate of registration content both reached 100%. The proportion of overdue drug varieties in the same period of 2024 decreased by 77.78% compared to March 2020， the inventory volume decreased by 29.50% compared to the first quarter of 2020， the per-bed medication volume decreased by 32.14% compared to the first quarter of 2020； the average workload per post in the same period of 2023 increased by 49.09% compared to 2019， the dispensing accuracy rate reached 100%， and the improvement rate of quality control problem increased by 25.25% compared to 2021. This system effectively improves the safety and accuracy of dispensed oral drug management in the inpatient pharmacy.

OBJECTIVE To analyze the influential factors for clinical efficacy of polymyxin B combined with other antibiotics in the treatment of carbapenem-resistant Acinetobacter baumannii （CRAB） pulmonary infection. METHODS A retrospective analysis was conducted on the clinical data of patients with CRAB pulmonary infection in our hospital from May 2021 to October 2024. Information such as age， gender， admitting department， infection status， underlying medical conditions， mechanical ventilation time， combination anti-infective treatment regimens， and the Acute Physiology and Chronic Health Evaluation Ⅱ （APACHE-Ⅱ） score 24 h before medication was compiled. Based on the effectiveness of the treatment， patients were divided into treatment-effective group and treatment-ineffective group. Univariate analysis and multivariate Logistic regression analysis were employed to identify independent factors influencing clinical efficacy. RESULTS A total of 156 patients were included， and 108 patients were treated effectively， with an effective rate of 69.23%. The results of univariate analysis indicated that there were statistically significant differences between 2 groups in terms of the duration of mechanical ventilation time， APACHE-Ⅱ score 24 h before medication， the number of complication types， the proportion of abnormal coagulation function， anti-infective treatment course， and hospital stay before medication （P＜0.05）. The results of multivariate Logistic regression analysis showed that APACHE-Ⅱ score≥15 points 24 h before medication [OR＝2.965， 95%CI （1.284， 6.845）， P＝0.020]， mechanical 20251606） ventilation time≥10 d [OR＝3.577， 95%CI （1.185， 10.793）， P＝0.037] and hospital stay≥14 d before medication [OR＝2.422， 95%CI （1.036， 5.654）， P＝0.041] were independent 15120420253@139.com risk factors， and anti-infective treatment course＞7 d was a protective factor [OR＝0.445， 95%CI （0.221， 0.895）， P＝0.043]. CONCLUSIONS This study shows that the effective rate of polymyxin B combined with other antibiotics in the treatment of CRAB pulmonary infection is less than 70%. The mechanical ventilation time≥10 d， APACHE-Ⅱ score≥15 points 24 h before medication， and hospital stay≥14 d before medication may lead to treatment failure， whereas anti-infective treatment course＞7 d may be associated with treatment success.

OBJECTIVE: To evaluate the effectiveness of the single-stage anterior eccentric kyphotic distraction reduction technique (EKD-RT) for treating lower cervical dislocation with locked facet joints, assessing its reduction success rate, neurological improvement, and safety. METHODS: A retrospective analysis was conducted on 67 patients with lower cervical dislocation and locked facet joints (21 unilateral, 46 bilateral) treated between January 2015 and January 2024. There were 39 males and 28 females, with an average age of 49.5 years (range, 22-75 years). The injured segments included C _{3, 4} in 4 cases, C _{4, 5} in 13 cases, C _{5, 6} in 22 cases, and C _{6, 7} in 28 cases. The interval between injury and admission ranged from 2 hours to 2 days (mean, 5.6 hours). Preoperative Frankel grading included grade A in 9 cases, grade B in 28 cases, grade C in 17 cases, grade D in 11 cases, and grade E in 2 cases. Japanese Orthopaedic Association (JOA) score was 7.0±1.4. All patients underwent single-stage anterior cervical discectomy and fusion. Following discectomy at the dislocated level, the EKD-RT was applied to unlock and reduce the locked facet joints, followed by internal fixation. Operation time, blood loss, reduction success rate, and complications were recorded. Interbody fusion status was evaluated using Bridwell criteria. Neurological status was assessed pre- and post-operatively using Frankel grading. Spinal cord function was scored using the 17-point JOA score, and the improvement rate was calculated. RESULTS: Successful reduction of the locked facet joints achieved in all cases. The operation time was 41-85 minutes (range, 63.3 minutes), and intraoperative blood loss was 50-360 mL (range, 125.0 mL). Complications included cerebrospinal fluid leakage in 2 cases; no severe complications such as major vascular injury or recurrent laryngeal nerve injury occurred. All patients were followed up 12-24 months (mean, 17.9 months). At last follow-up, radiological examination confirmed interbody fusion in all patients, with no implant failure or migration. The Frankel grading included grade A in 3 cases, grade B in 9 cases, grade C in 13 cases, grade D in 16 cases, and grade E in 26 cases; the JOA score reached 13.7±2.3; all of which significantly improved compared to preoperative levels ( P<0.05). The improvement rate of JOA score was 66.1%±24.7%. CONCLUSION The EKD-RT is an effective surgical approach for lower cervical dislocation with locked facet joints. It enables safe and efficient reduction of the locked facet joints via a single incision, resulting in significant neurological improvement with a low complication rate.
Humans ; Male ; Middle Aged ; Female ; Cervical Vertebrae/diagnostic imaging* ; Retrospective Studies ; Adult ; Aged ; Zygapophyseal Joint/injuries* ; Joint Dislocations/diagnostic imaging* ; Treatment Outcome ; Spinal Fusion/methods* ; Young Adult ; Kyphosis/surgery*

Breast cancer (BC) is one of the most prevalent malignant tumors affecting women worldwide, with its incidence rate continuously increasing. As a result, treatment strategies for this disease have received considerable attention. Research has highlighted the crucial role of the Hedgehog (Hh) signaling pathway in the initiation and progression of BC, particularly in promoting tumor growth and metastasis. Therefore, molecular targets within this pathway represent promising opportunities for the development of novel BC therapies. This study aims to elucidate the therapeutic mechanisms by which natural compounds modulate the Hh signaling pathway in BC. By conducting a comprehensive review of various natural compounds, including polyphenols, terpenes, and alkaloids, we reveal both common and unique regulatory mechanisms that influence this pathway. This investigation represents the first comprehensive analysis of five distinct mechanisms through which natural compounds modulate key molecules within the Hh pathway and their impact on the aggressive behaviors of BC. Furthermore, by exploring the structure-activity relationships between these compounds and their molecular targets, we shed light on the specific structural features that enable natural compounds to interact with various components of the Hh pathway. These novel insights contribute to advancing the development and clinical application of natural compound-based therapeutics. Our thorough review not only lays the groundwork for exploring innovative BC treatments but also opens new avenues for leveraging natural compounds in cancer therapy.

Objective:To investigate the correlation between CHA 2DS 2-VASC score and the recurrence risk of paroxysmal atrial fibrillation after radiofrequency ablation. Methods:It was a retrospective cohort study. A total of 150 patients who underwent radiofrequency ablation for paroxysmal atrial fibrillation in Xingtai People′s Hospital from January 2017 to January 2021 were consecutively included in the study. According to the preoperative CHA 2DS 2-VASC score, patients were divided into high score group (≥3 points, n=90) and low score group (<3 points, n=60). Baseline clinical data was collected. All patients underwent circumferential pulmonary vein isolation, and those with atrial flutter before ablation also underwent tricuspid isthmus isolation. Holter and electrocardiogram examinations were performed at 3, 6 months and 1 year after ablation to evaluate whether there was recurrence of atrial fibrillation. Univariate and multivariate Cox regression was used to analyze the risk factors for recurrence of atrial fibrillation after radiofrequency ablation. Results:Among 150 patients 90 were males and 60 were females with a mean age of (64.0±3.6) years. There were no significant differences in age, sex, and proportion of hypertension, diabetes, chronic heart failure and stroke or transient ischemic attack (TIA), medication of antiarrhythmic and anticoagulant drugs between the two groups (all P>0.05). The longest duration of atrial fibrillation in the high score group was significantly longer than that in the low score group (26.0±6.1) hours vs. (10.0±2.1) hours, P<0.05). There were no patients with cardiac tamponade, atrial esophageal fistula and severe vascular puncture complications in the two groups. During the follow-up period, the recurrence rate in the high score group was significantly higher than that in the low score group (16.7% (15/90) vs. 8.3% (5/60), P<0.05). Multivariate Cox regression analysis showed that CHA 2DS 2-VASC score≥3 was an independent risk factor for atrial fibrillation recurrence in patients with paroxysmal atrial fibrillation after radiofrequency ablation ( HR=3.84, 95% CI: 1.87-7.89, P=0.02). Conclusion:CHA 2DS 2-VASC score≥3 is an independent risk factor for atrial fibrillation recurrence in patients with paroxysmal atrial fibrillation after radiofrequency ablation.

Objective:To investigate the risk factors of atrial fibrillation (AF) in patients with typical atrial flutter after radiofrequency ablation.Methods:This study was a case-control study. The clinical data of 120 patients with typical atrial flutter who underwent radiofrequency ablation in Xingtai People′s Hospital from January 2017 to January 2021 were retrospectively analyzed. Patients were followed up every 3-6 months for a period of 2 years, and AF occurred in 30 patients (25.0%). The risk factors of AF were analyzed with univariate and multivariate logistic regressions.Results:The mean age of patients was (62.0±6.5) years and 64(53.3%) were males. No patients in the two groups had complications such as cardiac tamponade, pulmonary embolism and cerebral infarction after radiofrequency ablation. Compared with non-AF patients, patients in AF group had older age and higher CHA 2DS 2-VASC score ( P<0.001). Multivariate regression analysis showed that age ( HR=1.09, 95% CI:1.01-1.17) and CHA 2DS 2-VASC score ( HR=3.84, 95% CI:1.87-7.89) were independent risk factors for the occurrence of atrial fibrillation after radiofrequency ablation in patients with atrial flutter. Conclusion:After radiofrequency ablation of typical atrial flutter, nearly 25% of patients will relapse into AF, old age and higher CHA 2DS 2-VASC score increase the risk of AF recurrent.

Objective:To study and analyze the status quo and influencing factors of breast cancer patients′ concern about the upbringing of their minor children, and to provide a reference for clinical improvement of the level of breast cancer patients′ concern about parenting.Methods:A total of 247 breast cancer patients in the daytime ward of Tianjin Medical University Cancer Hospital from March to May 2023 were selected by convenience sampling. The General Information Questionnaire, Parenting Concerns Questionnaire, Parenting Sense of Competence Scale were selected for cross-sectional investigation. The multiple linear regression model was used to analyze the influencing factors of breast cancer patients′ worries about the upbringing of their minor children.Results:Finally, 240 valid questionnaires were ultimately collected. There were 12 patients with breast cancer aged 20-29 years old, 76 patients aged 30-39 years old, 117 patients aged 40-49 years old, and 35 patients aged ≥50 years old. The total score of breast cancer patients′anxiety about minor children′s rearing was (37.34 ± 2.56) points. The scores of each dimension were in order of (15.14 ± 1.02) worry about the actual impact on children, (11.15 ± 0.83) worry about the emotional impact on children, and (11.05 ± 0.71) worry about the parents of children. The total score of parenting competence (66.54 ± 11.68) points. Multiple linear regression analysis showed that parenting competence, educational level, number of underage children, per capita monthly income of families, and TNM stage (T: tumor primary lesion; N: regional lymphnode involvement; M: remote metastasis situation) affected parenting anxiety ( t values were -15.24-8.56, all P<0.05), which could explain 81.2% of the total variation in parenting anxiety level. Conclusions:Breast cancer patients′ concern about the upbringing of minor children is at a medium level, so medical staff should give relevant intervention measures to breast cancer patients with different characteristics, in order to provide reference for reducing the level of concern about the upbringing of minor children.

ObjectiveTo investigate the possible mechanism of Ruyi Heibai Power （如意黑白散， RHP） in the treatment of vitiligo. MethodsTwenty-four C57BL/6 mice were randomly divided into blank group， model group， high-dose and low-dose RHP groups， with 6 mice in each group. Model group， high- and low-dose RHP groups were all applied hydroquinone to establish vitiligo animal model. After modeling， High- and low-dose RHP groups were given 7.02 g/kg and 2.34 g/kg of RHP by gavage， respectively， while the blank group and model group were intragastrically given 10ml/kg of normal saline， once a day for 36 days. After administration， the skin lesions were observed with naked eye， and HE staining was used to observe the melanin content of the skin lesions. Immunohistochemistry was used to determine the expression of CD3⁺ and CD8⁺ T cells in skin tissue. Immunofluorescence staining was used to measure the expression of programmed death receptor 1 （PD-1） in the skin lesion tissue. RT-PCR was used to detect programmed cell death ligand 1 （PD-L1） mRNA expression. ELISA was used to detect serum superoxide dismutase （SOD）， tumor necrosis factor （TNF-α）， and tyrosinase （TYR） levels. ResultsCompared to those in the blank group， the skin of the mice in the model group was pale， and the melanin content was significantly reduced under the microscope after HE staining； the rate of excellent and good skin lesions decreased， and the melanin granules in the cells around the epidermis and hair follicles decreased significantly； the expression of CD3⁺ and CD8⁺ T cells in skin tissue increased significantly， and the expressions of PD-L1 mRNA and PD-1 decreased； the content of TYR decreased， while the content of SOD and TNF-α increased （P＜0.05）. Compared to those in the model group， the skin color of high- and low-dose RHP groups were deepened， and the melanin content increased； the rate of excellent and good skin lesions increased， as well as the melanin granules in the spinous cell layer， basal cells and hair follicles； the expression of CD3⁺ and CD8⁺ T cells in the skin lesions decreased， while PD-L1 mRNA and PD-1 expression increased； the content of TYR increased， while the content of SOD and TNF-α decreased （P＜0.05）. Compared to the low-dose RHP group， the high-dose group had a larger pigment recovery area in the modeling area， an increased rate of excellent and good skin lesions， an increase in spinous cell layer， basal cells， and hair follicle melanin granules， a decrease in CD3⁺ and CD8⁺ T cells expression， an increase in the expression of PD-L1 mRNA and PD-1， an elevated TYR content， and decreased SOD and TNF-α contents （P＜0.05）. ConclusionRHP can increase skin melanin content of vitiligo mice.The mechanism of action may be related to activating the PD-1/PD-L1 signaling pathway， and then reducing the destruction of melanocytes by T cell-mediated autoimmunity.

Objective To establish the drug use evaluation(DUE)standard of bivalirudin for injection,and to evaluate the use of the drug by weighted TOPSIS method,so as to provide a reference for rational use of bivalirudin.Methods Based on the package insert,clinical guidelines and consensus of experts of bivalirudin,the DUE standards were developed,and the weighted TOPSIS method was used to evaluate the rationality of the discharge medical records of Shanxi Bethune Hospital from January 1st to June 30th in 2022.Results Incorporating 108 medical records involving the use of bivalirudin for injection,88 cases(81.48％)exhibited a high degree of adherence(Ci≥0.8)between the prescribed drug regimens and the optimal recommendations,which is considered reasonable.Additionally,19 cases(17.59％)fell within the range of 0.6＜Ci＜0.8,indicating a generally reasonable adherence.Only one case(0.93％)had a Ci＜0.6,suggesting an unreasonable level of adherence.The irrational situations about various evaluation indicators in the DUE were mainly manifested in the inappropriate dosages of administration(12.04％),inappropriate disposal of adverse reactions(11.11％),using medicine with contraindications(3.70％),using medicine without indication(1.85％),inappropriate monitoring of adverse reactions(0.93％),etc.Conclusion The established DUE standards for bivalirudin are intuitive and comprehensive,and the evaluation results show that there are some unreasonable situations in the use of bivalirudin in the hospital,and it is necessary to standardize the use of bivalirudin in terms of dosages,disposal of adverse reactions,indication and contraindication.

Objective:To investigate the popularization of non-iodized salt among residents in water-borne high iodine areas and the iodine nutrition status of key populations in Shandong Province.Methods:In 2021, monitoring was conducted on a county-by-county basis in 47 counties (cities, districts, hereinafter referred to as counties) in 9 cities of Shandong Province, in accordance with the newly designated high iodine areas in the "Definition of Water Source High Iodine Areas and High Iodine Disease Areas" (GB/T 19380-2016) and historical high iodine areas. In each monitoring county, administrative villages with a median water iodine level greater than 100 μg/L were sorted by water iodine value, and a systematic sampling method was used to select 5 administrative villages as monitoring sites to investigate the water improvement situation and the iodine level of residents' drinking water. Totally 40 non boarding students aged 8 to 10 from one primary school and 20 pregnant women were selected in each village location to collect household edible salt samples and random urine samples for testing salt iodine and urine iodine levels, and the B-ultrasound method was used for thyroid examination in children.Results:A total of 364 high iodine administrative villages had been monitored, all of which had completed water improvement with a water improvement rate of 100.0%. The median iodine content in residential drinking water was 20.3 μg/L, ranging from 0.1 to 869.1 μg/L; and 11 464 edible salt samples were collected from residents' homes, with a non-iodized salt rate of 82.7% (9 481/11 464). A total of 9 197 urine samples from children and 2 335 urine samples from pregnant women were tested, with median urinary iodine levels of 219.0 and 139.0 μg/L, respectively. A total of 9 197 children were examined for thyroid, with 262 cases detected and a goiter rate of 2.8%.Conclusions:The rate of non-iodized salt in high iodine areas of Shandong Province still needs to be improved. Children's iodine nutrition is above the appropriate level, while pregnant women are at an iodine deficiency level.