OBJECTIVE To address the management challenges encountered by inpatient pharmacy of our hospital in undertaking “internet-based medicine delivery” （IMD） services， and to improve service efficiency and medication safety. METHODS SWOT analysis method was applied to systematically examine both internal and external factors， formulate comprehensive management strategies， and restructure the service processes. Process optimization included： establishing a closed-loop process for dispensing and returning drugs based on the drug traceability codes； unifying the drug inventory of the inpatient pharmacy with that of IMD， optimizing the management of storage locations； improving the inventory management function of the hospital information system， and adjusting the inventory counting plan and shift scheduling rules. The indicators of the inpatient pharmacy， including inventory structure， dispensing efficiency， inventory checks accuracy rate， the rationality rate of prescription， and consistency rate of human-machine review， were compared before and after the implementation of the strategies to evaluate the implementation effects. RESULTS After implementation， the structure of the drug inventory was significantly optimized. The proportion of drugs approaching their expiration dates decreased by 35.55%， the proportion of unsold drugs decreased by 64.52%， and the proportion of drugs that had been accumulated for more than 4 weeks decreased by 33.26%. The speed of prescription dispensing increased by 34.92%， and the daily drug requisition time was shortened by 62.03%. The accuracy rate of inventory checks rose from 86.33% to 90.33%， while the rationality rate of prescriptions and the consistency rate of human-machine review rose from 86.00% and 89.33% to 95.00% and 97.00% respectively. Furthermore， the launch of the drug traceability system reduced external dispensing errors from 4 to 1. CONCLUSIONS The comprehensive management strategy based on SWOT analysis can effectively improve the quality of drug management in the inpatient pharmacy and the operational efficiency of IMD， ensuring timely and safe medication for patients.

ObjectiveTo explore the mechanism through which Gantou Fumu decoction （GDFMT）-containing serum inhibits the activation of hepatic stellate cells. MethodsSerum pharmacology techniques were employed to prepare GDFMT-containing serum samples. Rat hepatic stellate cells （HSCT6） were randomly allocated into three groups： Control， penicillamine （90 mg·kg^-1）， and GDFMT （6.8 g·kg^-1）. Cell viability was assessed by the cell counting kti-8 （CCK-8） assay， intracellular ROS levels were determined by flow cytometry using the DCFH‑DA fluorescent probe and while extracellular collagen Ⅰ （ColⅠ） levels were quantified via enzyme linked immunosorbent assay （ELISA）. Intracellular α-smooth muscle actin （α-SMA） expression was visualized through immunofluorescence staining. Real-time polymerase chain reaction（Real-time PCR） and Western blot were performed to evaluate alterations in the expression of nuclear factor-erythroid 2-related factor 2 （Nrf2）， glutamate cysteine ligase， catalytic （GCLC）， glutamate-cysteine ligase， modifier subunit （GCLM）， Kelch-like ECH-associated protein 1 （Keap1）， NAD（P）H：Quinone oxidoreductase 1 （NQO1）， and heme oxygenase-1 （HO-1）. Genetic knockdown of Nrf2 was achieved through small interfering （siRNA） transfection to validate pathway specificity. ResultsCCK-8 data indicated that under the selected experimental conditions， culturing HSCT6 cells with 10% （volume fraction） GDFMT-containing serum for 48 h demonstrated equivalent effect in inhibiting HSCT6 cell proliferation compared with culturing HSCT6 cells with 10% （volume fraction） penicillamine-containing serum for 36 h， with no statistically significant difference between the two groups. After treatment of HSCT6 cells with siRNA-mediated Nrf2 gene transfection technique， the inhibitory effect of GDFMT on the activation process of HSCT6 cells was significantly weakened. After HSCT6 cells were cultured with GDFMT-containing serum for 48 h， the flow cytometry with a fluorescence probe showed that the content of reactive oxygen species （ROS） in the cells was significantly reduced. After the expression level of the Nrf2 gene in HSCT6 cells was knocked down by siRNA transfection， the content of ROS increased （P<0.01）， indicating that GDFMT significantly reduced the ROS level in activated HSCT6 cells， and this effect strictly depended on the integrity of the Nrf2 pathway. Quantitative analysis by ELISA showed that the synthesis of ColⅠ in the HSCT6 cell culture system treated with GDFMT-containing serum for 48 h was lower than that in the control group （P<0.01）. After the Nrf2 gene level of HSCT6 cells was knocked down by siRNA transfection， the ColⅠ concentration in the culture supernatant increased （P<0.01）. The results of α-SMA detection by IF method showed that compared with the normal group， GDFMT-containing serum reduced the expression of α-SMA （P<0.01） and the protein level of α-SMA in HSCT6 cells was increased （P<0.01） after siRNA-mediated Nrf2 silencing， suggesting that Nrf2 signaling pathway may be involved in regulating the phenotypic transformation process of the cells. Real-time PCR and Western blot results showed that GDFMT-containing serum reduced the protein level of α-SMA （P<0.01） and enhanced the gene and protein levels of Nrf2 in the nucleus and GCLC， HO-1， Keap1， GCLM， and NQO1 in the cytoplasm of HSCT6 cells （P<0.05， P<0.01）. After the Nrf2 gene level of HSCT6 cells was knocked down by siRNA transfection， the protein level of α-SMA was increased （P<0.01）， and the levels of GCLC， GCLM， Keap1， NQO1， and HO-1 were decreased （P<0.05， P<0.01）. These results indicated that GDFMT-containing serum successfully triggered the Nrf2 signaling pathway of HSCT6 cells. ConclusionThe anti-hepatic fibrosis effect of 10%GDFMT was equivalent to that of penicillamine. In addition， GDFMT can inhibit HSC activation and reduce oxidative stress damage by activating the Nrf2/antioxidant response element （ARE） pathway， as manifested by the up-regulated expression of Nrf2 and downstream antioxidant genes （GCLC， GCLM， HO-1， Keap1， and NQO1） and reduced secretion of ROS， α-SMA， and ColⅠ.

Objective To investigate the expression level of fibroblast activation protein(FAP)in esophageal squamous cell carcinoma(ESCC)and its prognostic implications,and to further explore the role of FAP expression in cancer-associated fibro-blasts(CAFs)in driving the malignant progression of ESCC.Methods The expression levels of FAP in tumor and adjacent tis-sues of 31 types of tumors were assessed by utilizing the TCGA database,followed by an analysis of its influence on the progno-sis of ESCC.Fresh tumor and normal tissue samples were acquired from ESCC patients in high-incidence regions for extracting and purifying primary CAFs and normal fibroblasts(NFs).Phenotypic identification and functional analyses were conducted via qRT-PCR,Western blot,and immunofluorescence.Supernatants from NFs,CAFs,and CAFs treated with the FAP inhibitor(FAPi)were collected to establish an in vitro co-culture model with KYSE150 cells.The impact of differential FAP expression levels on the malignant progression of KYSE150 cells,encompassing proliferation,invasion,and migration were assessed by u-sing EdU assay,CCK-8 assay,colony formation assay,Transwell assay,and scratch assay.The in vivo expression of FAP in CAFs was detected in a subcutaneous tumor model of esophageal cancer in mice to elucidate its role in the malignant progression of ESCC.Results In 10 types of malignant tumors,including ESCC,the expression of FAP was markedly elevated in tumor tissues compared to adjacent non-tumorous tissues.Moreover,elevated FAP expression in ESCC was associated with a poor prognosis and may serve as an independent prognostic risk factor for ESCC patients.Primary CAFs and NFs were effectively isolated from ESCC tumor and adjacent tissues,and their phenotypic characteristics were precisely characterized.The results of co-culture experiments indicated that,in comparison to NFs and untreated cells,CAFs with elevated FAP expression markedly enhanced the proliferation,invasion,and migration of KYSE150 cells.Conversely,FAPi treatment significantly suppressed these malignant behaviors.In vivo experiments had demonstra-ted that the deactivation treatment of FAPi and CAFs exerted a significant inhibitory effect on tumor growth in tumor-bearing mice.Conclusion In ESCC,the high expression of FAP is positively correlated with the activation of CAFs and the poor prognosis of patients,thereby promoting the malignant progression of the tumor.

Objective To investigate the expression level of fibroblast activation protein(FAP)in esophageal squamous cell carcinoma(ESCC)and its prognostic implications,and to further explore the role of FAP expression in cancer-associated fibro-blasts(CAFs)in driving the malignant progression of ESCC.Methods The expression levels of FAP in tumor and adjacent tis-sues of 31 types of tumors were assessed by utilizing the TCGA database,followed by an analysis of its influence on the progno-sis of ESCC.Fresh tumor and normal tissue samples were acquired from ESCC patients in high-incidence regions for extracting and purifying primary CAFs and normal fibroblasts(NFs).Phenotypic identification and functional analyses were conducted via qRT-PCR,Western blot,and immunofluorescence.Supernatants from NFs,CAFs,and CAFs treated with the FAP inhibitor(FAPi)were collected to establish an in vitro co-culture model with KYSE150 cells.The impact of differential FAP expression levels on the malignant progression of KYSE150 cells,encompassing proliferation,invasion,and migration were assessed by u-sing EdU assay,CCK-8 assay,colony formation assay,Transwell assay,and scratch assay.The in vivo expression of FAP in CAFs was detected in a subcutaneous tumor model of esophageal cancer in mice to elucidate its role in the malignant progression of ESCC.Results In 10 types of malignant tumors,including ESCC,the expression of FAP was markedly elevated in tumor tissues compared to adjacent non-tumorous tissues.Moreover,elevated FAP expression in ESCC was associated with a poor prognosis and may serve as an independent prognostic risk factor for ESCC patients.Primary CAFs and NFs were effectively isolated from ESCC tumor and adjacent tissues,and their phenotypic characteristics were precisely characterized.The results of co-culture experiments indicated that,in comparison to NFs and untreated cells,CAFs with elevated FAP expression markedly enhanced the proliferation,invasion,and migration of KYSE150 cells.Conversely,FAPi treatment significantly suppressed these malignant behaviors.In vivo experiments had demonstra-ted that the deactivation treatment of FAPi and CAFs exerted a significant inhibitory effect on tumor growth in tumor-bearing mice.Conclusion In ESCC,the high expression of FAP is positively correlated with the activation of CAFs and the poor prognosis of patients,thereby promoting the malignant progression of the tumor.

OBJECTIVE To explore the safety， effectiveness and cost-effectiveness of a multimodal analgesic regimen in patients who underwent laparoscopic sleeve gastrectomy under the guidance of enhanced recovery after surgery principles. METHODS Data from weight loss patients who underwent laparoscopic sleeve gastrectomy at our hospital were retrospectively collected. The trial group patients received a multimodal analgesic regimen， which included the use of 0.375% ropivacaine for local infiltration of the surgical incision before the end of surgery； intravenous infusion of flurbiprofen axetil 50 mg twice daily； intravenous infusion of methylprednisolone 40 mg once daily and oral administration of extended-release hydrocodone hydrochloride tablets 10 mg twice daily after surgery. The control group patients received a conventional analgesic regimen， which included intravenous infusion of flurbiprofen axetil 100 mg twice daily， with a daily dose twice that of the trial group； and intravenous injection of dexamethasone 5 mg once daily. Propensity score matching was used to balance the baseline data between the two groups. Then the pain scores during movement and at rest at 2， 12， 24 and 36 hours postoperatively， as well as the length of postoperative hospital stay， total length of hospital stay， time to first ambulation after surgery， adverse reactions during hospitalization， total drug costs， and costs of antimicrobial drugs during hospitalization were compared between the two groups. RESULTS The trial group had significantly lower pain scores during movement at 2， 24 and 36 hours postoperatively， and at rest at 2， 12 and 24 hours postoperatively compared to the control group （P＜0.05）. The time to first ambulation after surgery， total length of hospital stay， and length of postoperative hospital stay were significantly shorter in the trial group compared to the control group （P＜0.05）. The incidence of shoulder and back soreness， and costs of antimicrobial drugs were significantly lower in the trial group compared to the control group （P＜0.05）. No statistically significant differences were observed in the total incidence of drug-related adverse reactions and total drug costs during hospitalization between the two groups （P＞0.05）. CONCLUSIONS The multimodal analgesic regimen provides marked pain relief， demonstrates good safety profiles， and has a more economic advantage than the conventional analgesic regimen.

Objective:To explore the current situation of maternal childbirth readiness and analyze its influencing factors, providing a basis for improving maternal childbirth readiness.Methods:From March to July 2023, convenience sampling was used to select 355 pregnant women who visited Obstetrics Clinic in three Class Ⅲ Grade A hospitals in Chengde City, Hebei Province as participants. Participants were surveyed using the self-designed General Information Questionnaire, Childbirth Readiness Scale, Perceived Social Support Scale, Family APGAR Index, and Childbirth Self-efficacy Inventory 32. LASSO regression and random forest importance ranking were used to select characteristic variables, and multiple linear regression was combined to enhance interpretability, so as to explore the important factors affecting maternal childbirth readiness.Results:The total score of the Childbirth Readiness Scale for 355 pregnant women was (74.41±7.09), and the mean score of each item was (4.13±0.39). The random forest algorithm showed that when the lambda (λ) value was 0.167 7, the error was minimized, and the corresponding number of influencing factors was six. The top six independent variables in importance ranking were perceived social support, childbirth self-efficacy, gestational week, primiparous status, participation in maternity school, and place of residence. Multiple linear regression analysis showed that perceived social support, childbirth self-efficacy, whether primigravida, gestational week, and participation in maternity school were important influencing factors of maternal childbirth readiness ( P<0.05) . Conclusions:The childbirth readiness of pregnant women is above the middle level. Medical and nursing staff can start with factors that affect the childbirth readiness of pregnant women, adopt personalized nursing measures for pregnant women with different characteristics, and encourage family members to provide sufficient family support to improve the readiness of pregnant women for childbirth.

Objective:To explore the current situation of maternal childbirth readiness and analyze its influencing factors, providing a basis for improving maternal childbirth readiness.Methods:From March to July 2023, convenience sampling was used to select 355 pregnant women who visited Obstetrics Clinic in three Class Ⅲ Grade A hospitals in Chengde City, Hebei Province as participants. Participants were surveyed using the self-designed General Information Questionnaire, Childbirth Readiness Scale, Perceived Social Support Scale, Family APGAR Index, and Childbirth Self-efficacy Inventory 32. LASSO regression and random forest importance ranking were used to select characteristic variables, and multiple linear regression was combined to enhance interpretability, so as to explore the important factors affecting maternal childbirth readiness.Results:The total score of the Childbirth Readiness Scale for 355 pregnant women was (74.41±7.09), and the mean score of each item was (4.13±0.39). The random forest algorithm showed that when the lambda (λ) value was 0.167 7, the error was minimized, and the corresponding number of influencing factors was six. The top six independent variables in importance ranking were perceived social support, childbirth self-efficacy, gestational week, primiparous status, participation in maternity school, and place of residence. Multiple linear regression analysis showed that perceived social support, childbirth self-efficacy, whether primigravida, gestational week, and participation in maternity school were important influencing factors of maternal childbirth readiness ( P<0.05) . Conclusions:The childbirth readiness of pregnant women is above the middle level. Medical and nursing staff can start with factors that affect the childbirth readiness of pregnant women, adopt personalized nursing measures for pregnant women with different characteristics, and encourage family members to provide sufficient family support to improve the readiness of pregnant women for childbirth.

ObjectiveTo analyze the genetic characteristics of the hemagglutinin （H） gene of measles virus （MeV） in Shanghai， 2001‒2018. MethodsNasopharyngeal swab specimens were collected from suspected measles cases reported in Shanghai from 2001 to 2018， and the isolation of measles virus was conducted with Vero/hSLAM cell line. RT-PCR amplification and sequencing were conducted after RNA extraction to analyze the genetic characteristics of the complete H gene. ResultsIn total， 5 665 nasopharyngeal swab samples were collected by suspected measles case surveillance from 2001 to 2018， and 1 394 measles virus strains were isolated. The homology of nucleotide acid and amino acid among 349 representative measles virus isolates was 87.4%‒100.0% and 85.1%‒100.0%， respectively. The homology of nucleotide acid and amino acid between representative measles virus isolates and China vaccine strain （S191） was 85.7%‒100.0% and 84.1%‒100.0%， respectively. All the sub-genotype H1a MeV isolates had an amino acid substitution （Ser240Asn）， which removed a predicted N-linked glycosylation site. ConclusionMost of the MeV isolates are sub-genotype H1a analyzed based on H gene， which are identical to those of the N gene. The predicted amino acid sequences of the H protein are relatively conserved at most of the functionally significant amino acid positions.

【Objective】 To explore the effect of Genistein on the proliferation and cell cycle regulation of ovarian cancer cells. 【Methods】 Ovarian cancer OVCAR-5 cells were treated with Genistein. Cell counting and MTS assays were performed to determine the alterations of cell proliferation. Real-time PCR and Western blotting were conducted to examine the expression changes of key cell cycle regulators. 【Results】 Genistein significantly promoted the proliferation and viability of OVCAR-5 cells. After Genistein treatment, cellular mRNA and protein expression levels of cell cycle activators such as PCNA, Cyclin D1 and CDK4 were increased, but those of cell cycle inhibitors such as p21 and p27 were decreased. 【Conclusion】 Genistein can upregulate the proliferation and G1-S transition of ovarian cancer OVCAR-5 cells. The discrepancy may be caused by diverged experimental conditions and/or different ER expression patterns of cell lines. The findings may provide basic information for in-depth analysis of the role(s) and mechanisms by which genistein confers its effect on ovarian cancer cells.

Objective:To confirm the Sigma N transcription factor activity of a gene product encoded by LA2404 gene of Leptospira interrogans ( L. interrogans) and to identify the target genes of Sigma N signaling system. Methods:L. interrogans LA2404 gene and its regulated target genes were predicted using bioinformatic analysis according to the promoter sequence signature in Sigma N-regulated genes. A LA2404 gene-knockout (ΔLA2404) strain of L. interrogans was constructed based on homologous sequence recombinant of suicide plasmid. Real-time fluorescent quantitative RT-PCR (qRT-PCR) was used to detect the changes in the expression of target genes at mRNA level in the ΔLA2404 mutant. A prokaryotic expression system for LA2404 gene was established and the target recombinant protein rSigma N was extracted by Ni-NTA affinity chromatography. Gel electrophoresis mobility shift assay (EMSA) was used to screen out the target genes regulated by rSigma N. Results:Pathogenic L. interrogans serogroup Icterohaemorrhagiae serovar Lai strain Lai carried one Sigma N gene and 22 Sigma N promoter sequence-containing target genes. Qualitative examination of the ΔLA2404 mutant by microscopy revealed no defect in motility and appearance. Expression of LA1188, LA2306, LA3426, LA1968, LA1313, LA3806 and LA0773 genes at mRNA level in the ΔLA2404 mutant was significantly down-regulated ( P<0.05), but no significant changes in the expression of other target genes at mRNA level were detected. EMSA results confirmed that rSigma N could bind to the promotor sequences of the target genes mentioned above. Conclusions:Sigma N transcription factor was encoded by LA2404 gene. LA1188, LA2306, LA3426, LA1968, LA1313, LA3806 and LA0773 genes contained Sigma N promoter sequence and the expression of them was regulated by Sigma N signaling system.