OBJECTIVE To establish a pharmaceutical management model for infusion safety in hospitalized inpatients and ensure the safety of drug use. METHODS Our hospital established the standardized management process for infusion scheme， formulated rules for compatibility contraindications in drug combinations. In the form of embedded hospital official account, the infusion scheme and medication guidance WeChat developed by pharmacists are pushed to the mobile phone of inpatients, providing electronic medication guidance services for patients, and forming a pharmaceutical management model for infusion safety of inpatients. RESULTS Our hospital provided a total of 45 291 inpatients with pharmaceutical services including the formulation of individualized infusion scheme and WeChat push infusion scheme and medication guidance as of December 2023. After the implementation of the management model， the intervention rate of pharmacists on the compatibility contraindications in drug combination of long-term medical orders for inpatients increased from 18.25% before implementation to 90.58% （P＜0.01）， and the satisfaction rate of inpatients increased from 87.50% to 94.50% （P＜0.05）. CONCLUSIONS The pharmaceutical management model for infusion safety of hospitalized patients integrates pharmaceutical services throughout the entire process of intravenous medication treatment. Pharmacists can participate in the management of infusion usage while providing qualified finished infusion products, achieving closed-loop management of pharmaceutical services, improving the hospital’s pharmaceutical service capabilities and patient satisfaction, and providing guarantees for the safety and effectiveness of patient medication.

Objective:The differentially expressed genes(DEGs)and activated signaling pathways in systemic sclerosis(SSc)were screened by bioinformatics methods,and Chinese medicines for potential treatment of SSc were explored,providing a new theoretical basis for the study of SSc and the screening of potential markers.Methods:The data sets GSE58095,GSE130953,GSE33463 and GSE58613 were selected from GEO database and divided into skin group and peripheral blood group according to the sample source.The DEGs of SSc patients was analyzed by R language,and the Wayne diagram was drawn to take the intersection of the two groups.Metascape was used for GO enrichment analysis and KEGG pathway enrichment analysis,and STRING and Cytoscape were used for protein interaction network analysis to find key pathways and hub genes.The core genes were mapped to the medical on-tology information retrieval platform,and related Chinese medicines for SSc treatment were screened.The effective components of Chi-nese medicines were obtained through TCMSP and HERB databases,and the target letters of active ingredients were obtained through swiss database.The"drug-active ingredient-target"network was constructed by Cytoscape.Results:Total 218 DEGs were identified from the skin group of patients with SSc,and 283 DEGs were screened from peripheral blood of patients with SSc.Among them,there were 7 DEGs co-upregulated in skin and peripheral blood,namely ISG15,LGALS3BP,BST2,C1QB,IFI27,CEACAM1 and FBP1.CAMK2N1 was up-regulated in skin but down-regulated in peripheral blood,ARG1 was down-regulated in skin but up-regulated in pe-ripheral blood.GO and KEGG analysis of SSc DEGs showed that these genes were significantly enriched in inflammatory response,he-moglobin complex,immune receptor activity and extracellular matrix.The results of protein interaction network suggest that more than 10 genes such as COL1A1,CTGF12,IL1B,IFNG and JUN may be potential markers of SSc and core genes of therapeutic targets.The potential Chinese medicines screened for SSc treatment include ginseng,sanguisorba,convolvula,wolfberry,safflower,etc.The main components of these herbs were β-sitosterol,quercetin,kaempferol,stigmasterol,luteolin,sitosterol,Spinasterol,and the target were AKR1B1,AR,CYP1B1,XDH,etc.Conclusion:This study uses bioinformatics to screen out core genes that may be potential markers and therapeutic targets for SSc,which is expected to be a new target for the early diagnosis and mechanism research of SSc.Meanwhile,the mapped Chinese medicine and its effective components can provide ideas for the research and development of Chinese medicine compounds for the treatment of SSc.

Objective:The differentially expressed genes(DEGs)and activated signaling pathways in systemic sclerosis(SSc)were screened by bioinformatics methods,and Chinese medicines for potential treatment of SSc were explored,providing a new theoretical basis for the study of SSc and the screening of potential markers.Methods:The data sets GSE58095,GSE130953,GSE33463 and GSE58613 were selected from GEO database and divided into skin group and peripheral blood group according to the sample source.The DEGs of SSc patients was analyzed by R language,and the Wayne diagram was drawn to take the intersection of the two groups.Metascape was used for GO enrichment analysis and KEGG pathway enrichment analysis,and STRING and Cytoscape were used for protein interaction network analysis to find key pathways and hub genes.The core genes were mapped to the medical on-tology information retrieval platform,and related Chinese medicines for SSc treatment were screened.The effective components of Chi-nese medicines were obtained through TCMSP and HERB databases,and the target letters of active ingredients were obtained through swiss database.The"drug-active ingredient-target"network was constructed by Cytoscape.Results:Total 218 DEGs were identified from the skin group of patients with SSc,and 283 DEGs were screened from peripheral blood of patients with SSc.Among them,there were 7 DEGs co-upregulated in skin and peripheral blood,namely ISG15,LGALS3BP,BST2,C1QB,IFI27,CEACAM1 and FBP1.CAMK2N1 was up-regulated in skin but down-regulated in peripheral blood,ARG1 was down-regulated in skin but up-regulated in pe-ripheral blood.GO and KEGG analysis of SSc DEGs showed that these genes were significantly enriched in inflammatory response,he-moglobin complex,immune receptor activity and extracellular matrix.The results of protein interaction network suggest that more than 10 genes such as COL1A1,CTGF12,IL1B,IFNG and JUN may be potential markers of SSc and core genes of therapeutic targets.The potential Chinese medicines screened for SSc treatment include ginseng,sanguisorba,convolvula,wolfberry,safflower,etc.The main components of these herbs were β-sitosterol,quercetin,kaempferol,stigmasterol,luteolin,sitosterol,Spinasterol,and the target were AKR1B1,AR,CYP1B1,XDH,etc.Conclusion:This study uses bioinformatics to screen out core genes that may be potential markers and therapeutic targets for SSc,which is expected to be a new target for the early diagnosis and mechanism research of SSc.Meanwhile,the mapped Chinese medicine and its effective components can provide ideas for the research and development of Chinese medicine compounds for the treatment of SSc.

Objective To investigate the value of wrist MRI in bone age estimation for male adoles-cents in Shanghai,Zhejiang and Jiangsu.Methods A total of 124 Han male adolescents aged 6.0 to 18.0 years from Shanghai,Zhejiang and Jiangsu were selected as subjects.Their weight and height were measured,and T1WI and T2WI sequences of the wrist were scanned.The distal ends of the ra-dius and ulna,and the first to five metacarpal epiphyses and corresponding metaphyses were selected as observational indexes after MRI images of the wrist were obtained.The development of each index was classified(0-2 grades)by a deputy senior imaging expert,then the maximum width of each in-dex was measured by another deputy senior expert.Height,weight,classification and maximum width of indexes were used as input variables,and age was used as the target variable.Support vector ma-chine,random forest,current reality tree,and linear regression models were established to estimate the bone age,and the model with the highest accuracy was selected.Results The height,weight,classifica-tion of wrist bone epiphysis development,maximum width of each bone metaphysis and epiphysis were all correlated with age(P<0.05).The accuracies of the support vector machine were the highest when the differences between bone age and actual chronological age were within 1.0 and 1.5 years(88.7%and 96.0%,respectively).Conclusion It is feasible to estimate bone age by using MRI images.Quantifying the maximum width of the epiphysis and corresponding metaphysis of bone and combining it with MRI image classification can effectively reduce the estimation error.

Objective To investigate the risk factors for the clinical outcomes of patients with bloodstream infections in emergency in-tensive care unit(EICU)and provide a basis for clinical treatment.Methods The medical records and blood culture records of 141 patients with bloodstream infections in the EICU of our hospital from January 2019 to April 2023 were retrospectively collected.The risk factors leading to patients′death were analyzed by the Logistic regression and the relationships between these factors and patients′sur-vival time and outcomes were evaluated by the Cox regression.Results Among the 141 patients with bloodstream infections in the EICU,the mixed bloodstream infections of two or more bacteria(odds ratio[OR]=5.68,95%confidence interval[CI]:1.20-26.98,P＜0.05)and bloodstream infections of multidrug-resistant bacteria(OR=6.39,95%CI:2.78-14.67,P＜0.01)were significantly cor-related with the patients′death.Whether to adjust medication in a timely manner based on drug sensitivity results(hazard ratio[HR]=0.47,95%CI:0.30-0.74)and bloodstream infections of multidrug-resistant bacteria(HR=2.02,95%CI:1.28-3.20)were the risk factors leading to the death of patients with bloodstream infections in the EICU(P＜0.01).Conclusion Early blood culture to identify the pathogenic bacteria and precise medication to control infection can effectively reduce the mortality of patients with bloodstream in-fections in the EICU.

AIM To compare the in vivo pharmacokinetics of paeoniflorin,paeoniflorin,liquiritin,isoliquiritin,liquiritigenin and glycyrrhizic acid from Shaoyao Gancao Decoction in normal and gastric ulcer rats.METHODS Six rats were randomly assigned into two groups,after which the 75%ethanol-induced gastric ulcer model was established,the gastric tissues were collected.Twelve rats were randomly assigned into two groups and given intragastric administration(9.9 g/kg),after which blood collection was made at different time points,UPLC-MS/MS method was adopted in the determination of plasma concentrations,and main pharmacokinetic parameters were calculated.RESULTS Prolonged Tmax(P＜0.05,P＜0.01)of various active constituents,prolonged T1/2,MRT0-t(P＜0.05,P＜0.01),increased Cmax,AUC(P＜0.05,P＜0.01)and decreased Vd/F,CL/F(P＜0.05,P＜0.01)of paeoniflorin,increased Cmax,AUC(P＜0.05,P＜0.01)and decreased CL/F(P＜0.05)of albiflorin,prolonged MRT(P＜0.05),increased AUC(P＜0.05)and decreased CL/F(P＜0.01)of liquiritin,prolonged MRT(P＜0.05,P＜0.01)and decreased Vd/F(P＜0.05)of isoliquiritin,no obviously changed pharmacokinetic parameters(except for Tmax)of liquiritigenin(P＞0.05),and prolonged T1/2,MRT0-∞(P＜0.05,P＜0.01),increased Cmax,AUC(P＜0.05,P＜0.01)and decreased CL/F(P＜0.01)of glycyrrhizic acid were observable in the model group as compared with those in the normal group.CONCLUSION Gastric ulcer exhibits certain influences on the velocities and degrees of in vivo absorption and metabolism of active constituents from Shaoyao Gancao Decoction.

Objective To explore medium and long term efficacy of oblique lateral interbody fusion(OLIF)in treating lumbar specific infection.Methods From October 2017 to January 2021,24 patients with lumbar specific infection were treated by OLIF combined with vertebral screw internal fixation,including 15 males and 9 females,aged from 27 to 61 years old with an average of(43.0±15.0)years old;the courses of disease ranged from 6 to 24 months with an average of(14.0±7.0)months;7 patients with L2-L3,12 patients with L3-L4 and 5 patients with L4-L5;19 patients with tuberculosis infection and 5 patients with brucella infection.The amount of intraoperative blood loss,operative time and complications were recorded,and erythro-cyte sedimentation rate(ESR),C-reactive protein(CRP),visual analogue scale(VAS),Japanese Orthopaedic Association(JOA)score and American Spinal Injury Association(ASIA)rating were compared before and one month after opertaion.Re-sults All patients were followed up from 9 to 24 months with an average of(13.0±6.0)months.Operative time was(132.5±21.4)min,and intraoperative blood loss was(227.3±43.1)ml.ESR and CRP were decreased from(82.34±18.62)mmol·h-1 and(53.08±21.84)mg·L-1 before operation to(33.52±17.31)mmol·h-1 and(15.48±8.36)mg·L-1 at one month after opera-tion,respectively(P＜0.05).VAS was decreased from(7.52±1.36)before opertaion to(1.74±0.87)at one month after opera-tion(P＜0.05).JOA was increased from(17.86±3.95)before operation to(24.72±3.19)at one month after operation(P＜0.05).Four patients had neurological symptoms before operation,and were classified to grade D according to ASIA classifica-tion,who were recovered to grade E at 1 month after operation.One patient was suffered from psoas major muscle injury after operation,and returned to normal at 3 weeks.One patient was suffered from abdominal distension and difficulty in defecation,and relieved after gastrointestinal decompression and enema.No complications such as abdominal organ injury and poor wound healing occurred in all patients.Conclusion OLIF combined with vertebral screw internal fixation is a new minimally invasive surgical method for the treatment of lumbar specific infection,especially the lesion located on the middle lumbar vertebra.It has advantages of less trauma,short operation time,less blood loss,convenient operation,complete removal of the lesion,safety and effectiveness,and has good medium-and long-term efficacy for lumbar specific infection.

Objective:To systematically evaluate the clinical outcomes of hemihepatic inflow occlusion(HHO)and total hepatic inflow occlusion(THO)in liver resection surgery.Method:Re-trieve the Cochrane Library,PubMed,EMbase,Ovid,Web of Science,CNKI,and WanFang Data databases,and search for journal articles published from January 1,2000 to January 31,2023,on randomized controlled trials(RCTs)comparing the effects of HHO and THO in liver resection.At the same time,two researchers independently screened literature based on inclusion and exclusion cri-teria,conducted meta-analysis using RevMan 5.4 and State17PM software.Result:Fifteen RCTs were ultimately included,including 624 patients.The meta-analysis results showed that HHO re-duced serum AST(MD=-104.75,95％CI:-134.45-75.06,P＜0.05),ALT(MD=-155.37,95％CI:-182.90-127.85,P＜0.05),and TBIL(MD=-6.28,95％CI:-8.07-4.48,P＜0.05)on postoperative days 1,3,and 7 Compared to THO,the elevation of blood levels and reduction of intraoperative bleeding(MD=-66.21,95％CI:-116.49-15.94,P＜0.05)were superior.THO is superior to HHO in shortening surgical time(MD=13.94,95％CI:4.77-23.12,P＜0.05).There was no significant differ-ence between the two methods in hospital stay,hospital death rate and complication rate(P＞0.05).Conclusion:compared with THO,the application of HHO in hepatectomy has less damage to liver function and less intraoperative bleeding,but the two methods have the similar effect in terms of hospitalization time,hospital mortality rate and complication rate.

Objective:To systematically evaluate the clinical outcomes of hemihepatic inflow occlusion(HHO)and total hepatic inflow occlusion(THO)in liver resection surgery.Method:Re-trieve the Cochrane Library,PubMed,EMbase,Ovid,Web of Science,CNKI,and WanFang Data databases,and search for journal articles published from January 1,2000 to January 31,2023,on randomized controlled trials(RCTs)comparing the effects of HHO and THO in liver resection.At the same time,two researchers independently screened literature based on inclusion and exclusion cri-teria,conducted meta-analysis using RevMan 5.4 and State17PM software.Result:Fifteen RCTs were ultimately included,including 624 patients.The meta-analysis results showed that HHO re-duced serum AST(MD=-104.75,95％CI:-134.45-75.06,P＜0.05),ALT(MD=-155.37,95％CI:-182.90-127.85,P＜0.05),and TBIL(MD=-6.28,95％CI:-8.07-4.48,P＜0.05)on postoperative days 1,3,and 7 Compared to THO,the elevation of blood levels and reduction of intraoperative bleeding(MD=-66.21,95％CI:-116.49-15.94,P＜0.05)were superior.THO is superior to HHO in shortening surgical time(MD=13.94,95％CI:4.77-23.12,P＜0.05).There was no significant differ-ence between the two methods in hospital stay,hospital death rate and complication rate(P＞0.05).Conclusion:compared with THO,the application of HHO in hepatectomy has less damage to liver function and less intraoperative bleeding,but the two methods have the similar effect in terms of hospitalization time,hospital mortality rate and complication rate.

Multi-leaf collimators are devices to block rays from medical linear accelerators, which directly affect doses to targets and organs at risk by adjusting field shape and dose distribution in radiation therapy. As multi-leaf collimators are diversified in structure, there has been growing research on dosimetric comparison of various multi-leaf collimators. In this paper, we introduced the classifications of multi-leaf collimators according to their basic components, as well as the hardware structure and design features of the products of main accelerator manufacturers, including Varian’s Millennium MLC, HD120 MLC, and Halcyon, Elekta’s MLCi/i2 and Agility, and Accuray’s InCise 2 MLC and TomoTherapy. In terms of clinical application evaluation, focusing on radiotherapy plans for nasopharyngeal carcinoma, we reviewed comparative studies on the dosimetry performance of multi-leaf collimators and the effects of relevant parameters on dose distribution. We hope this review on the design and application evaluation of multi-leaf collimators can provide a reference for more innovative design and accelerator selection and parameter setting in clinical individualized treatment.