ObjectiveThis study aims to investigate the effects of different sizes of seedlings and melatonin treatment on physiological and biochemical indicators and bolting-related gene expression in Angelica sinensis， find substances related to early bolting， and elucidate the inhibitory mechanism of melatonin on bolting. MethodsSpectrophotometry was used to detect the related enzyme activities of A. sinensis leaves. The contents of endogenous hormones and polyamines were detected using ultra-high performance liquid chromatography-tandem mass spectrometry. Real-time polymerase chain reaction （Real-time PCR） was used to detect the expression levels of bolting-related genes. Inter-group differential indicator analysis， orthogonal partial least squares discriminant analysis， and principal component analysis were comprehensively applied to identify factors related to early bolting. ResultsEndogenous jasmonic acid and melatonin were identified as the most important factors affecting early bolting. Secondly， the activity of antioxidant enzymes， abscisic acid content， gibberellin content， and the expression levels of CO3， HD3A， and FD genes had important effects on the bolting process. Compared with small seedlings， exogenous melatonin treatment mainly inhibited early bolting by increasing endogenous melatonin content， reducing gibberellin content， and decreasing the expression levels of SOC1 and FD genes. ConclusionExogenous melatonin can inhibit early bolting in A. sinensis by regulating its physiological， biochemical， and gene expression levels.

ObjectiveThis study aims to investigate the effects of different sizes of seedlings and melatonin treatment on physiological and biochemical indicators and bolting-related gene expression in Angelica sinensis， find substances related to early bolting， and elucidate the inhibitory mechanism of melatonin on bolting. MethodsSpectrophotometry was used to detect the related enzyme activities of A. sinensis leaves. The contents of endogenous hormones and polyamines were detected using ultra-high performance liquid chromatography-tandem mass spectrometry. Real-time polymerase chain reaction （Real-time PCR） was used to detect the expression levels of bolting-related genes. Inter-group differential indicator analysis， orthogonal partial least squares discriminant analysis， and principal component analysis were comprehensively applied to identify factors related to early bolting. ResultsEndogenous jasmonic acid and melatonin were identified as the most important factors affecting early bolting. Secondly， the activity of antioxidant enzymes， abscisic acid content， gibberellin content， and the expression levels of CO3， HD3A， and FD genes had important effects on the bolting process. Compared with small seedlings， exogenous melatonin treatment mainly inhibited early bolting by increasing endogenous melatonin content， reducing gibberellin content， and decreasing the expression levels of SOC1 and FD genes. ConclusionExogenous melatonin can inhibit early bolting in A. sinensis by regulating its physiological， biochemical， and gene expression levels.

Objective To discuss on the application of innovative quality control circle in optimizing pharmaceutical care,design pharmaceutical care model according to needs,and improve the quality of pharmaceutical care.Methods Using 10 steps of innovative quality control circle,the quality function development(QFD)was carried out by multidimensional quality tools,and the demand for pharmaceutical services was analyzed in the form of"House of Quality"Combined with PDCA cycle management tool,the situation of pharmaceutical services before and after improvement was analyzed and evaluated.Results After the implementation of the activities,many contents hd been improved,such as the dispensing time for outpatient pharmacy patients decreased from 16 min to 8 min,the finished product infusion configuration time in pharmacy intravenous admixture services decreased from 15 min to 7 min,the surgery pharmacy special management drug report automatically generated number increased from 2 copies to 6 copies,the daily order review time for each department of pharmacy decreased from 80 min to 20 min,the perfection rate of pharmaceutical care digital module increased from 65.23％to 80.34％,and the multidimensional quality tool adoption rate increased from 60.00％to 93.00％.In addition,a number of additional benefits and intangible results were obtained.Conclusion Adopting the management mode of QFD combined with PDCA cycle can effectively reconstruct the management mode of pharmaceutical care,and effectively promote the scientific and fine management of pharmaceutical care.

Objective:To investigate the application effect of case-based learning (CBL) based on the clinical case library of stomatology in standardized residency training for comprehensive stomatology.Methods:A total of 52 residents in Department of Stomatology, Chongqing Medical University, were given CBL teaching based on the clinical case library of comprehensive stomatology, and a questionnaire survey was performed to evaluate the teaching effect. Theoretical and skill assessments were performed before and after CBL teaching, and a comparative analysis was performed. SPSS 19.0 software was used for the t-test. Results:The questionnaire survey showed that CBL teaching based on the clinical case library of stomatology effectively improved the ability of independent learning [92.31% (48/52)], the interest in learning [88.46% (46/52)], and the ability for case diagnosis and the accuracy of investigation and judgment [94.23% (49/52)]. This method helped with the mastery and understanding of the theoretical knowledge in stomatology [96.15% (50/52)] and improved the abilities for expression and communication [84.62% (44/52)] and the ability to find and solve problems [94.23% (49/52)]. It also helped to stimulate the interest in scientific research and teaching [82.69% (43/52)] and create an active classroom atmosphere [82.69% (43/52)]. Among these residents, 94.23% (49/52) liked CBL teaching, and 88.64% (46/52) thought the setting of the case library was reasonable. After the application of CBL teaching, there were significant increases in theoretical score [from (66.74±4.25) points to (81.44±7.16) points] and skill examination score [from (64.00±3.14) points to (81.96±7.50) points].Conclusions:CBL teaching based on the case library of stomatology has a good teaching effect in the standardized residency training for comprehensive stomatology and can not only improve the theoretical and skill assessments of residents, but also improve their learning interest and clinical thinking ability.

Objective:To investigate the clinical characteristics and interventions associated with drug-induced anaphylaxis in the emergency infusion room.Methods:Bases on the adverse drug reaction database from the emergency medicine center of the First Affiliated Hospital of Nanjing Medical University, clinical data of patients who experienced drug-induced anaphylaxis in the emergency infusion room between November 2019 and November 2023 were collected, including gender, age, history of previous adverse drug reactions, allergy history, Charlson comorbidity index, medication details, information related to drug-induced anaphylaxis (onset time, clinical manifestations), interventions, outcomes, and follow-up. The clinical characteristics and interventions in these patients were analyzed.Results:During the study period, a total of 398 772 patients in the emergency infusion room in our hospital received intravenous infusion of drugs. Of them, 625 cases developed adverse drug reactions (ADRs) and 75 cases developed drug-induced anaphylaxis, accounting for 0.02% (75/398 772) of the total infusion patients and 12.0% (75/625) of all ADR cases. Of the 75 patients with anaphylaxis, 30 cases (40%) were classified as grade Ⅱ, and 45 cases (60%) as grade Ⅲ, with no grade Ⅳ cases. The most common drugs involved in 75 cases of anaphylaxis were anti-infective drugs (41 cases, 54.7%). Drug-induced anaphylaxis exhibited diverse clinical manifestations, with cardiovascular symptoms being the most common, primarily varying degrees of transient hypotension (67 cases, 89.3%), followed by systemic and neurological symptoms, including profuse sweating (31 cases, 41.3%) and dizziness (28 cases, 37.3%). All 75 patients with anaphylaxis were treated with measures such as discontinuation of medication, replacement of infusion sets, rapid assessment of circulation and respiration, and monitoring of vital signs, of which 65 (86.7%) received rapid intravenous infusion for volume expansion, 6 (8.0%) received intravenous injection of glucocorticoids, 3 (4.0%) received intramuscular injection of 0.5 mg epinephrine, and 2 (2.7%) received antihistamines. All 75 patients showed improvement in symptoms, and no sequelae or deaths were found.Conclusions:In the emergency infusion room, the severity of anaphylaxis is mainly grade Ⅱ and Ⅲ with a good prognosis after timely intervention. The treatment measures mainly focus on rapid intravenous infusion for volume expansion, and the use of epinephrine is relatively low.

Objective:To explore the clinical characteristics of adverse reactions induced by levofloxacin in the emergency infusion unit.Methods:The study was designed as a single center prospective cohort study. Data of adverse drug reaction (ADR) in the Infusion Unit of Emergency Medicine Center of First Affiliated Hospital of Nanjing Medical University was managed, recorded and collected according to the pre-formulated "emergency infusion unit drug adverse reaction management process" and "strengthening the reporting of observational studies in epidemiology (STROBE)". The incidence, severity, clinical characteristics, intervention measures, outcomes, and follow-up of adverse reactions induced by levofloxacin from November 2019 to October 2022 was summarized and analyzed.Results:A total of 426 cases of ADR occurred within the set time period, of which 62 (14.55%) were related to levofloxacin, involving 27 males (43.55%) and 35 females (56.45%) with a median age of 39 years. Among the 62 levofloxacin-related ADRs, 96.77% (60/62) occurred within 2 hours of intravenous infusion of levofloxacin; the severity of 44 (70.97%), 10 (16.13%) and 8 (12.90%) cases of ADRs was classified as grade 1, 2, and 3, respectively, and no grade 4 ADRs occurred. The most common clinical symptoms were skin and mucosa reactions, including rash and itching, followed by cardiovascular system and nervous system manifestations, including hypotension, palpitation, and dizziness. The skin and mucosa manifestations were more common in patients with severity grade 1 ADRs, while the cardiovascular, digestive, respiratory nervous system and systemic manifestations were more common in those with severity grade 2 and 3 ADRs; the differences were statistically significant (all P<0.05). After the occurrence of ADRs, levofloxacin was withdrawn in all the 62 patients, the infusion set was replaced, and infusion of 0.9% sodium chloride injection were used to flush the tube. Additionally, 24 patients (38.71%) were given drug intervention, including epinephrine in 2 patients. After the above intervention, the symptoms of all patients were relieved, with a median response time of 49 minutes. Conclusions:Levofloxacin was one of the common drugs causing ADR in the emergency infusion unit. The clinical manifestations were mainly rashes and itching, most of which were mild in severity. Timely discontinuation of levofloxacin and drug interventions often help get a good prognosis. However, the treatment procedure of severe ADRs remain to be standardized.

Objective:To investigate the clinical characteristics and interventions associated with drug-induced anaphylaxis in the emergency infusion room.Methods:Bases on the adverse drug reaction database from the emergency medicine center of the First Affiliated Hospital of Nanjing Medical University, clinical data of patients who experienced drug-induced anaphylaxis in the emergency infusion room between November 2019 and November 2023 were collected, including gender, age, history of previous adverse drug reactions, allergy history, Charlson comorbidity index, medication details, information related to drug-induced anaphylaxis (onset time, clinical manifestations), interventions, outcomes, and follow-up. The clinical characteristics and interventions in these patients were analyzed.Results:During the study period, a total of 398 772 patients in the emergency infusion room in our hospital received intravenous infusion of drugs. Of them, 625 cases developed adverse drug reactions (ADRs) and 75 cases developed drug-induced anaphylaxis, accounting for 0.02% (75/398 772) of the total infusion patients and 12.0% (75/625) of all ADR cases. Of the 75 patients with anaphylaxis, 30 cases (40%) were classified as grade Ⅱ, and 45 cases (60%) as grade Ⅲ, with no grade Ⅳ cases. The most common drugs involved in 75 cases of anaphylaxis were anti-infective drugs (41 cases, 54.7%). Drug-induced anaphylaxis exhibited diverse clinical manifestations, with cardiovascular symptoms being the most common, primarily varying degrees of transient hypotension (67 cases, 89.3%), followed by systemic and neurological symptoms, including profuse sweating (31 cases, 41.3%) and dizziness (28 cases, 37.3%). All 75 patients with anaphylaxis were treated with measures such as discontinuation of medication, replacement of infusion sets, rapid assessment of circulation and respiration, and monitoring of vital signs, of which 65 (86.7%) received rapid intravenous infusion for volume expansion, 6 (8.0%) received intravenous injection of glucocorticoids, 3 (4.0%) received intramuscular injection of 0.5 mg epinephrine, and 2 (2.7%) received antihistamines. All 75 patients showed improvement in symptoms, and no sequelae or deaths were found.Conclusions:In the emergency infusion room, the severity of anaphylaxis is mainly grade Ⅱ and Ⅲ with a good prognosis after timely intervention. The treatment measures mainly focus on rapid intravenous infusion for volume expansion, and the use of epinephrine is relatively low.

Objective:To explore the clinical characteristics of adverse reactions induced by levofloxacin in the emergency infusion unit.Methods:The study was designed as a single center prospective cohort study. Data of adverse drug reaction (ADR) in the Infusion Unit of Emergency Medicine Center of First Affiliated Hospital of Nanjing Medical University was managed, recorded and collected according to the pre-formulated "emergency infusion unit drug adverse reaction management process" and "strengthening the reporting of observational studies in epidemiology (STROBE)". The incidence, severity, clinical characteristics, intervention measures, outcomes, and follow-up of adverse reactions induced by levofloxacin from November 2019 to October 2022 was summarized and analyzed.Results:A total of 426 cases of ADR occurred within the set time period, of which 62 (14.55%) were related to levofloxacin, involving 27 males (43.55%) and 35 females (56.45%) with a median age of 39 years. Among the 62 levofloxacin-related ADRs, 96.77% (60/62) occurred within 2 hours of intravenous infusion of levofloxacin; the severity of 44 (70.97%), 10 (16.13%) and 8 (12.90%) cases of ADRs was classified as grade 1, 2, and 3, respectively, and no grade 4 ADRs occurred. The most common clinical symptoms were skin and mucosa reactions, including rash and itching, followed by cardiovascular system and nervous system manifestations, including hypotension, palpitation, and dizziness. The skin and mucosa manifestations were more common in patients with severity grade 1 ADRs, while the cardiovascular, digestive, respiratory nervous system and systemic manifestations were more common in those with severity grade 2 and 3 ADRs; the differences were statistically significant (all P<0.05). After the occurrence of ADRs, levofloxacin was withdrawn in all the 62 patients, the infusion set was replaced, and infusion of 0.9% sodium chloride injection were used to flush the tube. Additionally, 24 patients (38.71%) were given drug intervention, including epinephrine in 2 patients. After the above intervention, the symptoms of all patients were relieved, with a median response time of 49 minutes. Conclusions:Levofloxacin was one of the common drugs causing ADR in the emergency infusion unit. The clinical manifestations were mainly rashes and itching, most of which were mild in severity. Timely discontinuation of levofloxacin and drug interventions often help get a good prognosis. However, the treatment procedure of severe ADRs remain to be standardized.

Objective : To explore the clinical application value of reflectance confocal microscopy(RCM) in the diagnosis of actinic cheilitis(AC). Methods: After approval by the hospital ethics committee and informed consent given by the patients, from October 2020 to July 2022, 17 patients who were diagnosed with actinic cheilitis in the Ninth People's Hospital affiliated with Shanghai Jiao Tong University School of Medicine were retrospectively analyzed. The white keratotic lesions of the lips were scanned with reflectance confocal microscopy, and the image characteristics were summarized and analyzed, including epithelial hyperplasia/atrophy, hyperkeratosis, inflammatory cell infiltration, blood vessel dilatation, solar elastosis, atypical keratinocytes, widening of intercellular spaces, degeneration of basal cell layer, and pigmentation. We used the sample compliance rate to measure the correlation between RCM parameters and histopathological diagnostic criteria for AC and kappa concordance analysis to calculate the concordance between RCM and pathological diagnosis. Results: Under RCM, the sample correct rates for epithelial hyperplasia/atrophy, hyperkeratosis, inflammatory cell infiltration, vasodilation, and solar elastosis were 76.5%, 100%, 100%, 64.7%, and 70.6%, the sample accuracy compared with pathological diagnosis was 82.4%, 47.1%, 94.1%, 88.2% and 76.5%, respectively. We also observed that 100%, 88.2%, 76.5%, and 88.2% of AC patients showed RCM features of atypical keratinocytes, widening of intercellular spaces, degeneration of the basal cell layer, and pigmentation, respectively. The kappa value of hyperkeratosis and inflammatory cell infiltration was 1. The kappa value of blood vessel dilatation was 0.645. Conclusion Reflectance confocal microscopy is noninvasive and versatile and has clinical application value in the diagnosis of actinic cheilitis.

OBJECTIVE：To stu dy the improvement effects o f Trillium tschonos kii total sapo nins（TTM）on adjuvant-induced arthritis model rats and its mechanism. METHODS ：SD rats were randomly divided into model group （n＝44）and blank group （n＝6）. Model group was given Complete Freund ’s adjuvant to induce the adjuvant-induced arthritis model ；blank group was given constant volume of normal saline with same method. Model group were divided into model group ，Tripterygium wilfordii polyglycoside tablets group （40 mg/kg），TTM low-dose ，medium-dose and high-dose groups （50，100，200 mg/kg），with 6 rats in each group. Administration groups were given relevant medicine intragastrically ；blank group and model group were given normal saline intragastrically ，once a day ，for consecutive 9 days. After last intragastric administration ，the body weight and foot swelling degree （bilateral）were detected ，and arthritis score was performed. The contents of tumor necrosis fator α（TNF-α）， interleukin 1β（IL-1β）and IL- 6 were detected ；the pathomorphological changes of rat ankle were observed ；protein expression of NOD-like receptor protein 3 （NLRP3），apoptosis associated spot-like protein （ASC），caspase-1 were detected ；the protein expression of NLRP 3 in synovial tissue of ankle joint were also determined. RESULTS ：Compared with blank group ，foot swelling degree，serum contents of TNF-α，IL-1β and IL-6，the protein expression of NLRP 3，ASC and caspase- 1 in knee tissue as well as the protein expression of NLRP 3 in synovial tissue of ankle joint were increased significantly in model group （P＜0.05 or P＜ 0.01），while the body weight was decreased significantly （P＜0.05）. The obvious proliferation of synovial cells ，the congestion and inflammatory cell infiltration of synovial tissue were all observed. Compared with model group ，most of the above indexes were all reversed significantly in TTM groups （P＜0.05 or P＜0.01）；the pathological changes such as synovial cell proliferation ， congestion of synovial tissue and chondrocyte destruction were all relieved ，and inflammatory cell infiltration was alleviated.CONCLUSIONS：TTM can improve rheumatoid arthritis of rats， the mechanism of which may be associated with 用。E-mail：yulingling@ctgu.edu.cn inhibiting the activity of NLRP 3/caspase-1 signaling pathway and decreasing the expression of inflammatory factors TNF-α，IL-1β，IL-6.