Pulmonary hypertension （PH） is a severe and rare chronic cardiopulmonary disorder for which existing vasodilator therapies can only alleviate symptoms， rather than target or fundamentally reverse the disease. Additionally， the long-term prognosis remains poor. Recent studies have found that some novel anti-tumor drugs （NADs） can relieve PH， such as imatinib， gefitinib， sorafenib， olaparib， piperacillin， everolimus， rituximab， etc. However， some NADs can induce PH or exacerbate its symptoms， including dasatinib， lorlatinib， carfilzomib， bevacizumab， trastuzumab， nivolumab， etc. The effects of lapatinib， ruxolitinib， and bortezomib on PAH are controversial. Individualized medication should be adopted in clinical practice when using NADs for treatment， with close monitoring being essential.

Objective To investigate the risk factors of pharyngocutaneous fistula(PCF)after total laryngectomy for hypopharyngeal cancer.Methods The clinical data of 89 hypopharyngeal cancer patients,who underwent total laryngectomy in The Affiliated Cancer Hospital of Nanjing Medical University from Jan.2009 to Dec.2019,were retrospectively analyzed.The patients were divided into PCF group and non-PCF group.The risk factors of PCF related to patient,disease,and treatment were analyzed.Results Among the 89 patients,20 cases had postoperative PCF and 69 had no PCF.The overall incidence of PCF was 22.5%.Univariate analysis showed that the proportions of patients with diabetes mellitus(P=0.031),preoperative chemoradiotherapy(P=0.021),preoperative hypoalbuminemia(P=0.008),postoperative hypoalbuminemia(P=0.002),and flap repair(P=0.034)in the PCF group were significantly higher than those in the non-PCF group.Multivariate logistic regression analysis showed that postoperative albumin level was an independent protective factor for PCF(odds ratio=0.174,95%confidence interval 0.048-0.626,P=0.007).Conclusion The hypopharyngeal cancer patients with diabetes mellitus,perioperative hypoalbuminemia,or preoperative chemoradiotherapy are more likely to develop PCF after total larynegctomy.

Traumatic cerebrospinal fluid leakage commonly presents in traumatic brain injury patients, and it may lead to complications such as meningitis, ventriculitis, brain abscess, subdural hematoma or tension pneumocephalus. When misdiagnosed or inappropriately treated, traumatic cerebrospinal fluid leakage may result in severe complications and may be life-threatening. Some traumatic cerebrospinal fluid leakage has concealed manifestations and is prone to misdiagnosis. Due to different sites and mechanisms of trauma and degree of cerebrospinal fluid leak, treatments for traumatic cerebrospinal fluid leakage varies greatly. Hence, the Craniocerebral Trauma Professional Group of Neurosurgery Branch of Chinese Medical Association and the Neurological Injury Professional Group of Trauma Branch of Chinese Medical Association organized relevant experts to formulate the " Chinese expert consensus on the diagnosis and treatment of traumatic cerebrospinal fluid leakage in adults ( version 2023)" based on existing clinical evidence and experience. The consensus consisted of 16 recommendations, covering the leakage diagnosis, localization, treatments, and intracranial infection prevention, so as to standardize the diagnosis and treatment of traumatic cerebrospinal fluid leakage and improve the overall prognosis of the patients.

The transcription factor nuclear factor of kappa-light-chain-enhancer of activated B cells (NF-κB) is expressed in brown adipocytes, but its role remains largely unknown in the cells. This issue was addressed in current study by examining NF-κB in brown adipocytes in vitro and in vivo. NF-κB activity was increased by differentiation of brown adipocytes through elevation of p65 (RelA) expression. The transcriptional activity of NF-κB was induced by the cold stimulation with an elevation in S276 phosphorylation of p65 protein. Inactivation of NF-κB in brown adipocytes made the knockout mice [uncoupling protein 1 (Ucp1)-CreER-p65^f/f, U-p65-KO] intolerant to the cold environment. The brown adipocytes exhibited an increase in apoptosis, a decrease in cristae density and uncoupling activity in the interscapular brown adipose tissue (iBAT) of p65-KO mice. The alterations became severer after cold exposure of the KO mice. The brown adipocytes of mice with NF-κB activation (p65 overexpression, p65-OE) exhibited a set of opposite alterations with a reduction in apoptosis, an increase in cristae density and uncoupling activity. In mechanism, NF-κB inhibited expression of the adenine nucleotide translocase 2 (ANT2) in the control of apoptosis. Data suggest that NF-κB activity is increased in brown adipocytes by differentiation and cold stimulation to protect the cells from apoptosis through down-regulation of ANT2 expression.

Recently, the incidence rate of infertility has been increasing year by year. Lesions of the female reproductive system are the most important causes of infertility, such as premature ovarian failure, polycystic ovary syndrome, pelvic inflammatory disease, endometriosis, recurrent abortion, etc. However, the specific pathogenesis of infertility needs to be further studied. Gene editing is a technical method to change the sequence of deoxyribonucleic acid (DNA) in biological cells, which is an indispensable tool for studying gene function and disease pathogenesis. In this research, we review the recent progress in studying the pathogenesis of female infertility related diseases through gene editing technology, so as to explore a new direction for the clinical diagnosis and treatment of infertility.

Objective:To explore the effect of narrative nursing in patients with retinal detachment undergoing surgery.Methods:From February 2020 to August 2021, 40 patients with retinal detachment who underwent surgical treatment in the Department of Geriatrics and Ophthalmology of Beijing Tongren Hospital, Capital Medical University were selected as the research object by the convenient sampling method. According to the random number table method, the patients were divided into the observation group and the control group, 20 cases in each. The patients in the control group were given routine nursing, and the patients in the observation group received narrative nursing on this basis. Before and after the intervention, Self-Rating Anxiety Scale (SAS) , Self-Rating Depression Scale (SDS) , Memorial University of Newfoundland Scale of Happiness (MUNSH) , and Generic Quality of Life Inventory-74 (GQOLI-74) were used to investigate the two groups of patients. The hospitalization time and complications of the two groups of patients were recorded.Results:At discharge, the SAS and SDS scores of the observation group were lower than those of the control group, the GQOLI-74 and MUNSH scores of the observation group were higher than those of the control group, and the differences were statistically significant ( P<0.01) . The hospitalization time of the observation group was shorter than that of the control group, and the difference was statistically significant ( P<0.05) . There was no significant difference in the number of cases of postoperative intraocular hypertension between the two groups ( P>0.05) . Conclusions:Narrative nursing can effectively relieve anxiety and depression in patients with retinal detachment surgery, improve patients' well-being and quality of life, and shorten hospitalization time.

With the continuous elucidation of the molecular mechanism of primordial follicle activation, clinical in vitro activation (IVA) has gradually become a clinical treatment for premature ovarian insufficiency (POI) and reduced ovarian reserve (DOR). This article will review the mechanism of phosphatase and tensin homolog (PTEN)/phosphatidylinositol-3-kinase (PI3K), hippo signal and mammalian target of rapamycin complex 1 (mTORC1) signal involved in the activation of primordial follicles, and the application of IVA in patients with POI and DOR.

Objective:To study the effectiveness of noninvasive embryo chromosome screening (NICS) based on blastocyst culture medium and cystic fluid in preimplantation genetic detection (PGT) of embryos in different age groups.Methods:A retrospective analysis of 62 couples who underwent PGT assisted pregnancy in Shenzhen Hospital of Peking University from January 2019 to June 2021. A total of 310 blastocysts were biopsied. At the same time, D3-6 blastocyst culture medium and blastocyst cavity fluid were collected for NICS. According to the age of the patients, they were divided into three groups: <35 years old group, 35≤age<40 years old group and ≥40 years old group. The results of NICS were compared with those of embryonic trophoblast (TE) biopsy in each group, and the consistency, sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) were calculated. Then the consistency, sensitivity, specificity, positive predictive value and negative predictive value of NICS and TE among the three age groups were statistically analyzed.Results:There was no statistically significant difference in the consistency rate of NICS and TE among the three age groups ( P>0.05), but there was an upward trend in the elderly group (35≤age<40 years and ≥40 years). There was no statistically significant difference in specificity, sensitivity and PPV among the three age groups ( P>0.05). There was significant difference in NPV between the ≥40 years group and the other two groups ( P<0.05). Conclusions:There was no statistical difference in the effectiveness of NICS among different age groups, However, there was an increasing trend in people ≥35 years of age.

Objective:To investigate the correlation between intrahepatic triglyceride content (IHTC) and glucose metabolism in patients with non-alcoholic fatty liver disease (NAFLD) diagnosed by proton magnetic resonance spectroscopy ( 1H-MRS). Methods:A total of 239 subjects without diabetes mellitus were previously enrolled and underwent 1H-MRS scans. Anthropometric indexes including height, weight, waist and blood pressure, and laboratory findings as plasma glucose (PG), insulin (INS), C-peptide (CP), liver enzymes [alanine aminotransferase (ALT), aspartate transaminase (AST), γ-glutamyl transpeptidase (GGT)] and lipid profiles were collected. According to IHTC levels, participants were divided into three groups: the non-NAFLD group (IHTC<5.56%), the mild NAFLD group (IHTC 5.56%-<33%), and the moderate and severe NAFLD group (IHTC ≥ 33%). The clinical characteristics of each group were analyzed, and the correlation between IHTC and glucose metabolism were assessed. Results:Compared with those in the non-NAFLD group, male proportion, waist, 120 min postprandial PG (PG120), CP, liver enzymes and total cholesterol (TC) levels were greater in the NAFLD group, whereas insulin sensitivity index-Cederholm (ISI-Cederholm) and high density lipoprotein cholesterol (HDL-C) levels were lower in the NAFLD groups. Subjects in the moderate and severe NAFLD group had higher levels of 120 min postprandial INS (INS120) and Stumvoll indexes, and lower ISI-Cederholm than those in the mild NAFLD group [80.37 (57.68, 112.70) mU/L vs.110.50(71.78, 172.80)mU/L, 1453(1178, 1798)vs.1737(1325, 2380), 358(297, 446) vs.441(318, 594), 2.27(2.01, 2.53) vs.2.06(1.81, 2.39), respectively, all P<0.05]. Correlation analyses showed that IHTC was significantly positively correlated with waist hip ratio (WHR), PG120, INS120, HOMA insulin resistance (HOMA-IR), Stumvoll 1st-insulin secretion, Stumvoll 2nd-insulin secretion, ALT, AST, GGT and TC ( r=0.197, 0.274, 0.334, 0.162, 0.199, 0.211, 0.406, 0.361, 0.215, and 0.196, respectively, all P<0.05), and negatively correlated with ISI-Cederholm and HDL-C ( r=-0.334, and-0.237, respectively, all P<0.05). Furthermore, a multiple linear stepwise regression analysis indicated that ISI-Cederholm (Standardized β =-0.298, P<0.001) and Stumvoll 1st insulin secretion (Standardized β = 0.164, P = 0.024) were independent factors of IHTC. Conclusions:Peripheral insulin resistance occurs in the early stage of NAFLD and becomes worse with the progression of the disease. IHTC was independently associated with insulin sensitivity and first-phase insulin secretion.

OBJECTIVE：To understand the current management situation and problems of residual drugs in medical institutions in China ，evaluate the practice effect of corresponding control mode of our hospital and to explore the countermeasures to reduce the production of residual drugs and standardize its management. METHODS ：By random sampling ，30 third-level hospitals and 20 second-level hospitals in different regions were selected respectively during May 1st to 31st in 2019. For the pharmaceutical personnel，doctors，nurses and other non-pharmaceutical personnel ，a self-designed questionnaire on the status quo of residual drugs in medical institutions was issued. Excel 2010 software was used to count basic data of valid questionnaire ，and the causes ， management status ，disposal status and possible hazards of residual drugs in medical institutions were analyzed. A management mode of residual drugs was established and implemented （involving reducing the generation of sources ，implementing process management，and strictly implementing disposal ）. The effects of the model were evaluated ，then the countermeasures and suggestions were put forward . RESULTS & CONCLUSIONS：A total of 400 questionnaires were sent out ，and 311 valid questionnaires were collected with effective recovery rate of 77.75％. The causes of drug residual were complicated ，which included the“combination”of the same drugs ，the pre-order dispensing ，adverse drug reactions ，poor compliance of patients ，wrong order imput，sudden transfer ，discharge or death of patients ，wrong dispensing or nurse check error ，etc. The management status of residual drugs was chaotic ，the disposal methods lacked of standardization ，which may lead to harm such as deterioration ，illegal Δ 基金项目：重庆市技术预见与制度创新项目（No.cstc2018jsyj- recycling and pollution . The established whole-link residual zdcxX0093） drug management model in our hospital ，mainly included ＊主管药师 ，硕士。研究方向 ：药事管理 、抗肿瘤药理 。电话： measures of introducing Clinical Departments Residual Drug 023-68774769。E-mail：513293274@qq.com Safety Management Regulations to clarify the responsibilities # 通信作者：主任药师，博士生导师，博士。研究方向：药事管理、 of management group ， clinical department ， pharmacy 临床药学。电话：023-68755580。E-mail：zrcq73@163.com department； using rational medication control software to 中国药房 2020年第31卷第8期 China Pharmacy 2020Vol. 31 No. 8 ·897· reduce prescription error ；increasing the frequ ency of drug inventory ；introducing Drug Withdrawal and Refund Management to clear out drug withdrwal process ；independently researching and developing “Residual Drug Recovery Management System ”to standardize and simplify the recovery process ；bringing the residual drugs into special fund project management for medical assistance. According to the operation management practice from Jan. to Oct. 2018，a total of more than 1 million yuan worth of residual drugs were recovered. The residual drugs that did not meet the recovery conditions should be destroyed according to the specified process ，and the case number of non-standard notification of ward management would significantly reduced. The whole-link mode management established by our hospital can effectively reduce the production of residual drugs and standardize their management and disposal. It is suggested that the state or province should issue special regulations on the management of residual drugs in medical institutions ，and each medical institution should formulate specific management measures suitable for its own unit. Meanwhile ，the management of residual drugs in medical institutions should be further standardized systematically by actively exploring the ways to reduce residual drugs ，formulating the corresponding financial account processing standards ， supporting incentive mechanism and other measures.