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.

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 investigate the effect of Jianpi Yangzheng(JPYZ)formula regulating tumor-associated macrophage(TAM)exosomes on anoikis in gastric cancer and its mechanism.METHODS TAM model was established by inducing human mononuclear THP-1 cells in vitro;M0,TAM and TAM+JPYZ formula exosomes were extracted by ultracentrifugation and co-incuba-ted with gastric cancer cells.Flow cytometry was used to detect the effect of exosomes in each group on anoikis in gastric cancer cells.A BALB/c transplanted tumor mouse model was constructed,and the expression level of apoptotic proteins in transplanted tumors was detected by Western blot.Label-free mass spectrometry proteomics and bioinformatics were used to analyze the differential proteins in gastric cancer cells before and after intervention;Western blot and qPCR experiments were used to detect the expression level of dif-ferential protein isocitrate dehydrogenase 1(IDH1),and ubiquitination experiments were used to detect the ubiquitination level of IDH1;kits were used to detect the levels of α-ketoglutarate(α-KG),NADPH/NADP+,glutathione(GSH/GSSG)and reactive oxy-gen species(ROS)content.RESULTS The anoikis rate of gastric cancer cells was reduced after TAM exosomes intervention(P<0.05,P<0.01),while it was significantly increased after TAM+JPYZ exosomes intervention(P<0.05,P<0.01).In the in vivo mouse experiment,the ratio of Cleaved Caspase-3/Caspase-3 in the tumor of the TAM exosome group was reduced(P<0.05),while the ra-tio was significantly increased after TAM+JPYZ exosome intervention(P<0.05).Proteomic analysis showed that IDH1 was significant-ly different after intervention,and was related to tricarboxylic acid cycle metabolism.Compared with the M0 group,the IDH1 ubiquiti-nation level of gastric cancer cells in the TAM group with exosome intervention was increased,the levels of α-KG,NADPH/NADP+and GSH/GSSG were significantly increased,and the ROS content was reduced(P<0.05),while TAM+JPYZ exosomes could reverse the above phenomenon.CONCLUSION JPYZ Formula can regulate TAM exosomes to cause ubiquitin degradation of IDH1 in gas-tric cancer cells,reduce the level of tricarboxylic acid cycle metabolism in gastric cancer cells,promote ROS accumulation,induce anoikis in gastric cancer,and thus inhibit the development of gastric cancer.

The quality of recovery after surgery not only affects patient's satisfaction degree, but also affects patient's prognosis. With the goal of promoting early recovery, the potential advantages of amide local anesthetic lidocaine in perioperative intravenous application have attracted much attention. Intravenous infusion of lidocaine has many benefits, such as analgesia, anti-inflammatory, anti-tumor, and organ protection, and can effectively improve patient's prognosis. This study reviewed the current status of lidocaine in clinical intravenous application, explored its advantages in promoting patient's recovery, and briefly described the relevant mechanisms and safety of its application in the perioperative period.

DNMT3A encodes a DNA methyltransferase involved in development, cell differentiation, and gene transcription, which is mutated and aberrant-expressed in cancers. Here, we revealed that loss of DNMT3A promotes malignant phenotypes in lung cancer. Based on the epigenetic inhibitor library synthetic lethal screening, we found that small-molecule HDAC6 inhibitors selectively killed DNMT3A-defective NSCLC cells. Knockdown of HDAC6 by siRNAs reduced cell growth and induced apoptosis in DNMT3A-defective NSCLC cells. However, sensitive cells became resistant when DNMT3A was rescued. Furthermore, the selectivity to HDAC6 inhibition was recapitulated in mice, where an HDAC6 inhibitor retarded tumor growth established from DNMT3A-defective but not DNMT3A parental NSCLC cells. Mechanistically, DNMT3A loss resulted in the upregulation of HDAC6 through decreasing its promoter CpG methylation and enhancing transcription factor RUNX1 binding. Notably, our results indicated that HIF-1 pathway was activated in DNMT3A-defective cells whereas inactivated by HDAC6 inhibition. Knockout of HIF-1 contributed to the elimination of synthetic lethality between DNMT3A and HDAC6. Interestingly, HIF-1 pathway inhibitors could mimic the selective efficacy of HDAC6 inhibition in DNMT3A-defective cells. These results demonstrated HDAC6 as a HIF-1-dependent vulnerability of DNMT3A-defective cancers. Together, our findings identify HDAC6 as a potential HIF-1-dependent therapeutic target for the treatment of DNMT3A-defective cancers like NSCLC.

Objective:To investigate the effect of mindfulness-based cognitive therapy (MBCT) on mindfulness attention awareness, experiential avoidance, and cognitive fusion in individuals with general anxiety disorder(GAD).Methods:A total of 53 patients aged 18-60 years who met the GAD diagnostic criteria of DSM-5 were selected from the Seventh People's Hospital of Hangzhou from May 2021 to September 2022.After receiving routine treatment, patients were randomly assigned to two groups: MBCT group( n=26) for an 8-week mindfulness cognitive therapy and health education group( n=27) for an 8-week health education program. Participants were evaluated using the generalized anxiety disorder scale(GAD-7), acceptance and action questionnaire-2nd edition(AAQ-Ⅱ), cognitive fusion questionnaire(CFQ), and mindful attention awareness scale (MAAS) before and after the intervention.Data were analyzed using SPSS 26.0 software, with the chi-square test, independent sample t-test, and paired sample t-test. Results:(1)There was no significant difference in MAAS score between the two groups before the intervention (42.63±10.18, 47.67±9.52, t=-1.55, P=0.13). However, after the intervention, the MAAS score in MBCT group was significantly higher than that in the health education group(54.42±9.87, 47.83±7.59, t=-2.27, P=0.03). (2) No significant difference was observed in CFQ score between the two groups before the intervention (57.11±15.97, 53.50±12.01, t=-0.77, P=0.45). However, after the intervention, the CFQ score in the MBCT group was significantly lower than that in the health education group(38.32±10.31, 47.11±10.66, t=-2.51, P<0.01). (3) There was no significant difference in AAQ-Ⅱ scores between the two groups before the intervention(33.79±7.90, 30.00±7.23, t=1.52, P=0.14). After the intervention, the AAQ-Ⅱ score in the MBCT group was significantly lower than that in the health education group(21.89±8.69, 30.22±8.68, t=-3.51, P<0.01) . Conclusion:MBCT has a positive effect on enhancing mindfulness attention awareness, reducing cognitive fusion, and mitigating experiential avoidance in GAD patients.

Qi-Yu-San-Long decoction(QYSLD)is a traditional Chinese medicine that has been clinically used in the treatment of non-small-cell lung cancer(NSCLC)for more than 20 years.However,to date,metabolic-related studies on QYSLD have not been performed.In this study,a post-targeted screening strategy based on ultra-performance liquid chromatography coupled with quadrupole time-of-flight full infor-mation tandem mass spectrometry(UPLC-QTOF-MSE)was developed to identify QYSLD-related xeno-biotics in rat urine.The chemical compound database of QYSLD constituents was established from previous research,and metabolites related to these compounds were predicted in combination with their possible metabolic pathways.The metabolites were identified by extracted ion chromatograms using predicted m/z values as well as retention time,excimer ions,and fragmentation behavior.Overall,85 QYSLD-related xenobiotics(20 prototype compounds and 65 metabolites)were characterized from rat urine.The main metabolic reactions and elimination features of QYSLD included oxidation,reduction,decarboxylation,hydrolysis,demethylation,glucuronidation,sulfation,methylation,deglycosylation,acetylation,and associated combination reactions.Of the identified molecules,14 prototype compounds and 58 metabolites were slowly eliminated,thus accumulating in vivo over an extended period,while five prototypes and two metabolites were present in vivo for a short duration.Furthermore,one pro-totype and five metabolites underwent the process of"appearing-disappearing-reappearing"in vivo.Overall,the metabolic profile and characteristics of QYSLD in rat urine were determined,which is useful in elucidating the active components of the decoction in vivo,thus providing the basis for studying its mechanism of action.

Traditional Chinese herb compound is a prescription formulated according to the theory of Chinese medicine, and it is a commonly used method of Chinese medicine. As one of the main active ingredients, the extraction methods of polysaccharides from traditional Chinese herb compound include solvent extraction, ultrasonic assisted extraction, microwave assisted extraction and microbial fermentation extraction. The traditional Chinese herb compound polysaccharide has antitumor, immunoregulatory, intestinal mucosa repair, hypoglycemic, antiviral, antioxidant and other pharmacological activities. In this paper, the extraction methods of polysaccharides from traditional Chinese herb compound and its pharmacological activities were summarized, so as to provide scientific evidence for a better development and utilization of traditional Chinese herb compound polysaccharide.

Objective: To explore the effect of PDCA nursing model combined with token reward on the compliance and negative emotions of children with hypospadias. Methods: A total of 120 children with hypospadias who were admitted to Children′s hospital affiliated to Zhengzhou University from February 2017 to December 2017 were selected as study subjects. According to the time of admission, they were divided into observation group and control group, with 60 cases in each group. The control group was given routine nursing care, the observation group was given PDCA nursing mode combined with token rewards intervention on the basis of routine care. The self-made children's behavioral compliance assessment table was used to compare the compliance of the two groups of children. Achenbach Child Behavior Check List (CBCL) scores were performed before and after the intervention. The hospitalization time and the incidence of complications were calculated. Results: There was no significant difference in CBCL scores between the two groups at admission (t=0.965, P=0.102). The scores of compliance and CBCL scores of the observation group were (43.12±3.99) points and (17.62±7.30) points respectively, the scores of control group were (30.67±4.53), (24.23±6.67), the difference was statistically significant (t=15.977, 5.184, P<0.01). The hospitalization time and complication rate of the observation group were (18.73±0.84)d, 15.00% (9/60), which were significantly lower than (20.92±1.90) d, 31.67% (19/60) of the control group, and the difference was statistically significant (t=8.166, χ²=4.658, P<0.01 or 0.05). Conclusions The PDCA nursing model combined with token reward can improve the compliance of children with hypospadias and improve their negative emotions.

Objective: To explore the subunit strategy for perineal defect reconstruction and flap selection. Methods: This is a respective study of 21 patients, with perineal defect, during January 2008 to December 2018. All patients were admitted to the fifth section of Burn and Plastic Surgery in the Fourth Medical Center of the People′s Liberation Army General Hospital. There were 10 males and 11 females, aged from 4 to 68 years old, with the mean age of 26.4 years. The causes of injury included burn (n=11), trauma (n=2), Paget′s disease (n=2), Brown′s disease (n=2), perineal squamous cell carcinoma (n=3)and hemangioma (n=1). The perineum is divided into 4 subunits, according to the anatomical structure: a front area monsveneris or pubic symphysis, 2 middle areas (labia or scrotum) and a posterior area (anal). The defects ranged 23 cm×11 cm-5 cm×3 cm after perineal lesions were removed. Appropriate flaps were selected based on tissue defect. Results: Nine patients were repaired with superficial inferior epigastric artery flap, 3 patients were repaired with superficial circumflex iliac artery flap, and 2 patients were repaired with combined superficial inferior epigastric artery flap and superficial circumflex iliac artery island flap. Internal pudendal arterial perforator flap was performed in 5 patients, and anterolateral thigh perforator flap in 2 patients. The size of flap was 25 cm×12 cm-6 cm×3 cm. All flaps survived, and incisions were primary healing. Patients were followed up for 6 months to 9 years, with an average of 13 months. The patients were satisfied with the appearances and functions of the recipient and doner sites. Scars were concealed well. Conclusions Appropriate flap can be chosen to repair perineal defects, based on the subunit principle in perineum, in order to restore function and appearance, and achieve satisfactory clinical outcomes.