Objective To study the photodynamic performance and the killing effect of photodynamic therapy on lung cancer of novel chlorin compounds 2-（4-（5,15,20-triphenyl-7H,8H-porphyrin-10-yl） phenoxy） acetic acid（D1）and 4-（4-（5,15,20-triphenyl-7H,8H-porphyrin-10-yl） phenoxy） butanoic acid （D2）. Methods The ultraviolet visible absorption spectrum and fluorescence spectrum of D1 and D2 were determined. The singlet oxygen generation capacity of D1 and D2 was measured by using DPBF as singlet oxygen capture agent. Fluorescence assay was used to detect the cellular phagocytosis rate of the compounds in A549 cells, and MTT assay was used to detect their dark toxicity and phototoxicity. A nude mouse model of lung cancer was established to investigate the antitumor activity of the compounds mediated photodynamic action in vivo, and the blood concentration of D2 in nude mice, its distribution in tumor tissue and skin tissue were further detected. Results D1 and D2 had strong absorption at 652 nm with the best excitation wavelength at 429 nm and 427 nm, and the optimal emission wavelength was at about 659 nm. They also had a higher singlet oxygen generation rate than the control drug m-THPC. D1 and D2 had no dark toxicity at concentrations below 10 μmol/L, and could be ingested by A549 cells, basically reaching saturation in 18~24 hours. After laser irradiation at 650 nm wavelength, D1 and D2 showed significant antitumor activity in vivo and in vitro （P<0.01）. However, D2 could selectively accumulate in tumor tissues after administration, and the optimal treatment time was less than 30 min after administration. Conclusion D2 had excellent photodynamic antitumor activity and could selectively aggregate in tumor tissues, which had the potential to be a candidate drug for photosensitizer and treatment of lung cancer with independent intellectual property rights, and was worth further research.

Background: Data on the efficacy and incidence of adverse effects associated with dexmedetomidine (DEX) as a local anesthetic adjuvant for patient-controlled epidural analgesia (PCEA) are inconclusive. This meta-analysis assessed the efficacy and risks of DEX for PCEA using opioids as a reference. Methods: Two researchers independently searched PubMed, Embase, Cochrane Library, and China Biology Medicine for randomized controlled trials comparing DEX and opioids as local anesthetic adjuvants in PCEA. Results: In total, 636 patients from seven studies were included in this meta-analysis. Postoperative patients who received DEX had lower visual analog scale (VAS) scores than those who received opioids at 4–8 h (mean difference [MD]: 0.61, 95% CI [0.45, 0.76], P < 0.001, I2 = 0%), 12 h (MD: 0.85, 95% CI [0.61, 1.09], P < 0.001, I2 = 0%), 24 h (MD: 0.59, 95% CI [0.06, 1.12], P = 0.030, I2 = 82%), and 48 h (MD: 0.54, 95% CI [0.05, 1.02], P = 0.030, I2 = 91%). Additionally, patients who received DEX had a lower incidence of itching (odds ratio [OR]: 2.86, 95% CI [1.18, 6.95], P = 0.020, I2 = 0%) and nausea and vomiting (OR: 6.83, 95% CI [3.63, 12.84], P < 0.001, I2 = 24%). In labor analgesia, no significant differences in neonatal (pH and PaO2 of cord blood, fetal heart rate) or maternal outcomes (duration of labor stage, mode of delivery) were found between the DEX and opioid groups. Conclusions Compared with opioids, using DEX as a local anesthetic adjuvant in PCEA improved postoperative analgesia and reduced the incidence of itching and nausea and vomiting without increasing the incidence of adverse events.

Objective To evaluate the clinical efficacy of traditional Chinese medicine turbid phlegm obstructing lung decoction on patients with acute exacerbation of chronic obstructive pulmonary disease(AECOPD)and its influence on laboratory indexes.Methods A total of 191 patients with AECOPD who were hospitalized in the First People's Hospital of Changde from January 2021 to December 2022 were selected.Patients were divided into observation group(96 cases)and control group(95 cases)according to their treatment intention.The control group received conventional treatment of western medicine,and the observation group received oral administration of traditional Chinese medicine turbid phlegm obstructing lung decoction for one week.TCM symptom scores,COPD assessment test(CAT),lung function,laboratory indicators and efficacy were compared between two groups.Results The total effective rate of observation group was significantly higher than that of control group(χ2=4.573,P=0.030).After treatment,TCM symptom score,CAT score,hypersensitive C-reaction protein(hsCRP)and interleukin-6(IL-6)of patients in both groups were significantly lower than before treatment,percentage of forced vital capacity to predicted value(FVC%)and percentage of forced expiratory volume in one second to predicted value(FEV1%)were significantly higher than before treatment(P<0.05),arterial partial pressure of carbon dioxide(PaCO2)of observation group was lower than before treatment,and arterial partial pressure of oxygen(PaO2)was higher than before treatment(P<0.05).The TCM symptom score,CAT score,hsCRP and IL-6 of observation group were significantly lower than those of control group,while FVC%,FEV1%and PaO2 were significantly higher than those of control group(P<0.05).Conclusion On the basis of western medicine treatment,traditional Chinese medicine turbid phlegm obstructing lung decoction can more effectively improve clinical symptoms of AECOPD patients,relieve the inflammation in the body,contribute to the recovery of lung function and improve the quality of life of patients.

To investigate the alleviating effect of glycyrrhizic acid(GA)on chronic toxicity of afla-toxin B1(AFB1)in ducklings.Eighty 4-day-old ducklings were randomly divided into 4 groups,with 20 ducklings in each group,including a blank group,a model group(100 μg/kg AFB1),a high-concentration GA group(100 μg/kg AFB1+100 mg/kg GA),and a low-concentration GA group(100 μg/kg AFB1+50 mg/kg GA),with a trial period of 18 days.At the end of the experi-ment,the body weight of the ducklings in each group,AFB1-DNA content in the liver and liver tis-sues index,the biochemical indicators of liver function,and the pathological changes in liver tissues were examined.Additionally,the oxidative damage status of the liver tissues was eval-uated,and the mRNA expression levels of mitochondria-related apoptosis genes was detected.Com-pared with the control group,the body weight of ducklings in the model group decreased signifi-cantly(P＜0.01),AFB1-DNA content in the tissues increased significantly(P＜0.05),liver swell-ing and yellowing were observed,the liver index increased significantly(P＜0.01),as did the levels of aspartate aminotransferase(AST)and alanine aminotransferase(ALT)(P＜0.01).The AST/ALT levels also increased significantly(P＜0.01),while the serum total protein(TP)content de-creased significantly(P＜0.01).The liver tissues showed a large amount of inflammatory cell infil-tration,vacuolar degeneration,fibrotic changes and apoptosis.The activities of catalase(CAT),glutathione S-transferase(GST),the total antioxidant capacity(T-AOC)of the duckling liver all decreased significantly(P＜0.01)and the mRNA expression of mitochondria-related apoptosis genes Bax,Cyt-c,Caspase-3,and Caspase-9 significantly increased(P＜0.01).Compared with the model group,GA treatment significantly increased the body weight of the model ducklings(P＜0.01),reduced AFB1-DNA content in the tissue,significantly reduced their liver index(P＜0.05),visibly restored the liver's apparent status,effectively reversed the abnormal changes in serum liver function indicators,improved the pathological changes in liver tissue histology,enhanced liver an-tioxidant function,significantly decreased expression of Bax,Cyt-c,Caspase-3,and Caspase-9 mR-NA(P＜0.05).Further correlation analysis showed that mRNA expression levels of Bax,Cyt-c,Caspase-3,and Caspase-9 in duck liver tissues were positively correlated with liver index,AFB1-DNA content,AST content,ALT content,AST/ALT ratio,and MDA content,and negatively cor-related with body weight,TP content,SOD activity,CAT activity,GST activity,and T-AOC activi-ty in ducklings.In conclusion,GA may alleviate liver damage to relieve duckling AFB1 chronic tox-icity by inhibiting the mitochondrial pathway of apoptosis.

To investigate the alleviating effect of glycyrrhizic acid(GA)on chronic toxicity of afla-toxin B1(AFB1)in ducklings.Eighty 4-day-old ducklings were randomly divided into 4 groups,with 20 ducklings in each group,including a blank group,a model group(100 μg/kg AFB1),a high-concentration GA group(100 μg/kg AFB1+100 mg/kg GA),and a low-concentration GA group(100 μg/kg AFB1+50 mg/kg GA),with a trial period of 18 days.At the end of the experi-ment,the body weight of the ducklings in each group,AFB1-DNA content in the liver and liver tis-sues index,the biochemical indicators of liver function,and the pathological changes in liver tissues were examined.Additionally,the oxidative damage status of the liver tissues was eval-uated,and the mRNA expression levels of mitochondria-related apoptosis genes was detected.Com-pared with the control group,the body weight of ducklings in the model group decreased signifi-cantly(P＜0.01),AFB1-DNA content in the tissues increased significantly(P＜0.05),liver swell-ing and yellowing were observed,the liver index increased significantly(P＜0.01),as did the levels of aspartate aminotransferase(AST)and alanine aminotransferase(ALT)(P＜0.01).The AST/ALT levels also increased significantly(P＜0.01),while the serum total protein(TP)content de-creased significantly(P＜0.01).The liver tissues showed a large amount of inflammatory cell infil-tration,vacuolar degeneration,fibrotic changes and apoptosis.The activities of catalase(CAT),glutathione S-transferase(GST),the total antioxidant capacity(T-AOC)of the duckling liver all decreased significantly(P＜0.01)and the mRNA expression of mitochondria-related apoptosis genes Bax,Cyt-c,Caspase-3,and Caspase-9 significantly increased(P＜0.01).Compared with the model group,GA treatment significantly increased the body weight of the model ducklings(P＜0.01),reduced AFB1-DNA content in the tissue,significantly reduced their liver index(P＜0.05),visibly restored the liver's apparent status,effectively reversed the abnormal changes in serum liver function indicators,improved the pathological changes in liver tissue histology,enhanced liver an-tioxidant function,significantly decreased expression of Bax,Cyt-c,Caspase-3,and Caspase-9 mR-NA(P＜0.05).Further correlation analysis showed that mRNA expression levels of Bax,Cyt-c,Caspase-3,and Caspase-9 in duck liver tissues were positively correlated with liver index,AFB1-DNA content,AST content,ALT content,AST/ALT ratio,and MDA content,and negatively cor-related with body weight,TP content,SOD activity,CAT activity,GST activity,and T-AOC activi-ty in ducklings.In conclusion,GA may alleviate liver damage to relieve duckling AFB1 chronic tox-icity by inhibiting the mitochondrial pathway of apoptosis.

OBJECTIVE To analyze the implementation of insulin centralized volume-based procurement policy （hereinafter referred to as “centralized procurement”） in our hospital and its effect on the use of insulin products in clinical. METHODS The manufacturer， specifications， usage， sales amount and agreed purchase volume of insulin products in our hospital before （July 4， 2021 to January 3， 2022） and after （July 4， 2022 to January 3， 2023） the centralized procurement were collected. The defined daily dose （DDD） method was used to calculate defined daily doses （DDDs）， defined daily cost （DDC）， the progress of procurement completion and actual cost saving. RESULTS After the centralized procurement， the number of insulin products had increased from 20 to 29 in our hospital； except for the Insulin degludec/aspart injection in our hospital’s original insulin catalog that had not been centrally purchased， all other existing varieties had been included in centralized procurement catalog. The use of Insulin aspart 30 injection produced by Novo Nordisk （China） Pharmaceutical Co.， Ltd. always ranked the first place in the list of usage and DDDs before and after the centralized procurement. The sales amount of Insulin glargine injection produced by Ganli Pharmaceutical Co.， Ltd. and Tonghua Dongbao Pharmaceutical Co.， Ltd. increased significantly due to the significant increase in usage. The centralized procurement of Degu insulin injection from Novo Nordisk （China） Pharmaceutical Co.， Ltd. had achieved a relatively high completion rate in our hospital’s original insulin catalog， while the completion rate for new varieties was low. After the centralized procurement， our hospital actually saved a total of 1 388 582.66 yuan in expenses. CONCLUSIONS After the centralized procurement， the selection and usage of insulin varieties in our hospital are reasonable， which saves patients’ insulin treatment costs， and reduces economic pressure on patients and society.

Objective To explore the therapeutic effects of estrogen-intervened endothelial progenitor cells( EPCs) transplantation on diabetic ischemic stroke rats. Methods PKH26-labeled diabetic EPCs and estrogen-intervened diabetic EPCs were injected into rats via the tail vein 24 h after cerebral ischemia. Cerebral ischemic volume, behavioral changes, ischemic site vascularization and homing of EPCs were measured 3 d after EPCs injection. Results Compared with diabetic ischemic rats, estrogen-intervened EPCs transplantation had reduced infarct volumes, improved behavioral scores and ischemic site revascularization and promoted homing of EPCs to sites of injury(P<0.05). Conclusion Estrogen-intervened EPCs transplantation had a better therapeutic effect on diabetic ischemic stroke by promoting EPCs homing to injury site and EPCs-medicated neovascularization .

OBJECTIVE To investigate the association between the functional GLCCI1 gene rs37973 polymorphism and inhaled corticosteroids （ICSs） response in patients with asthma-chronic obstructive pulmonary disease overlap （ACO）. METHODS Totally 173 newly diagnosed ACO patients were recruited from Shanghai Pudong New Area People’s Hospital during April 1st， 2019 to December 31st， 2020. All patients were treated with Salmeterol fluticasone inhalation powder， twice a day， for 24 weeks. The genotype of rs37973 locus was determined， and lung function indicators [forced expiratory volume in one second （FEV1）， FEV1/forced vital capacity （FVC）， the percentage of FEV1 to expected value （FEV1%pred）]， and lung function improvement （ΔFEV1 and ΔFEV1%pred） were all detected. RESULTS Totally 111 patients completed the whole 24-week follow-up and lung function detection. Among them， there were 42 cases of AA genotype， 52 cases of AG genotype， and 17 cases of GG genotype. After 12， 24 weeks of treatment， lung function indexes of patients were significantly better than baseline lung function indexes before treatment （P＜0.05）. After 24 weeks of treatment， ACO patients with AA and AG genotypes showed significantly better lung function improvement than GG genotype， and ΔFEV1%pred of AA genotype was significantly better than AG genotype （P＜ 0.05）. After 12， 24 weeks of treatment， the improvement of lung function in patients with a smoking history ≤20 pack year was significantly better than those with a smoking history ＞20 pack year， and among patients with a smoking history ≤20 pack year， only AA genotype had significantly better FEV1%pred than AG genotype （P＜0.05）. After 12 weeks of treatment， among patients with a smoking history ＞20 pack year， the improvement of lung function in AA genotype and AG genotype was significantly better than GG genotype， and the FEV1%pred in AA genotype was significantly better than AG genotype （P＜0.05）. After 24 weeks of treatment， the improvement of lung function of AA genotype and AG genotype was significantly better than GG genotype （P＜0.05）. CONCLUSIONS GG genotype of GLCCI1 gene rs37973 locus is associated with the poor treatment response to ICSs in patients with ACO， especially in patients with smoking history ＞20 pack year.

Objective To explore the effect and mechanism of estrogen on endothelial progenitor cells（EPCs）function in diabetic rats. Methods EPCs were isolated from bone marrow of rats and characterized by fluorescence microscopy and flow cytometry. Rat diabetic model was established via streptozotocin induction. The bone marrow was taken to culture EPCs. EPCs of diabetes were incubated with Estrogen 10 nmol/L for 24h. The functions and proliferation of EPCs in vitro were detected. The levels of MnSOD and NO in EPCs and TSP-1 in supernatant were assayed. Results Compared with control group, EPCs proliferation, adhesion and angiogenesis functions were impaired in diabetic rats. The level of MnSOD and NO in diabetic EPCs were significantly decreased, while TSP-1 protein level in the supernatant increased. The above changes can be reversed with estrogen incubation. Conclusion Estrogen improved the EPCs migration and tubule formation in diabetic rats. The mechanism may be related to the reduction of oxidative stress and downregulation of TSP-1 expression in diabetic EPCs.

Objective To explore the effect of the intervention of clinical pharmacists on the rational use of piperacillin-tazobactam by using PDCA cycle, in order to provide reference for rational drug use. Methods The problems of piperacillin-tazobactam in our hospital was analyzed. PDCA cycle was used to manage the problems. Then, the data before and after PDCA cycle was compared and analyzed. Results After using PDCA cycle, the irrational use rate of piperacillin-tazobactam gradually decreased, from 9% in February 2018 to 2% in February 2019; the doses decreased from 4380 in February 2018 to 3346 in February 2019; and the frequency of usage decreased from 391 DDDs in February 2018 to 298 DDDs in February 2019. The effectiveness and continuous improvement of PDCA cycle in managing piperacillin-tazobactam were significant. Conclusion PDCA cycle can effectively improve the management effectiveness of piperacillin-tazobactam administration.