Objective To explore the effect of management model of clinical pharmacists participating in multidisciplinary collaborative diagnosis and treatment(MDT)for new anti-tumor drugs in the national medical insurance drug negotiation(hereinafter referred to as"national negotiation"),including efficacy,safe-ty,economy and rationality.Methods The medical records of 326 cases using novel anti-tumor drugs by na-tional negotiation and conforming to the including and excluding standards in this hospital from July 2018 to June 2023 were retrospectively analyzed.The patients were divided into the MDT group(n=122)and non-MDT group(n=204).The patients diagnosed as non-small cell lung cancer(NSCLC)in the two groups were extracted and defined as the MDT-NSCLC subgroup(n=41)and non-MDT-NSCLC subgroup(n=77).The progression-free survival(PFS),overall survival(OS),disease control rate(DCR)and the indexes such as survival quality and medical quality control were compared between the groups.Results The median PFS in the two groups was 12.7 months and 8.0 months,the median OS was 75.2 months and 56.3 months,DCR was 96.72％and 81.86％respectively,and the differences were statistically significant(P＜0.05).The COX multivariate regression analysis indicated that the HR value of clinical pharmacists participating in MDT was higher than the other influencing factors.The median PFS time in the MDT-NSCLC subgroup and non-MDT-NSCLC subgroup was 10.5 months and 6.7 months,DCR was 97.30％and 75.64％respectively,and the differences were statistically significant(P＜0.05),the median OS time was 55.1 months and 40.3 months respectively,and the difference was statistically significant(P＞0.05).The COX multivariate regression anal-ysis indicated that the HR value with clinical pharmacists participating in MDT was higher than the other in-fluencing factors;The adverse reaction occurrence rate in the MDT group and non-MDT group was 45.9％and 58.3％respectively,and the difference was statistically significant(P＜0.05).The KPS score after treatment in the MDT group was higher than that in the non-MDT group,and the difference was statistically significant;in the aspect of medical quality control,the average drug proportion in the MDT group and non-MDT group was 63.93％and 64.54％respectively,the rational drug rate of comments on prescription was 98.36％and 88.73％respectively,the patient satisfaction average value was 90.69 points and 87.36 points respectively and the differences were statistically significant(P＜0.05).Conclusion Clinical pharmacists participating in MDT related to novel anti-tumor drugs by national negotiation is beneficial to improve the therapeutic effects,living quality and patient satisfaction,also benefit to management and control of off-label drug use and medical quality control indexes.

Objective:To summarize treatment strategies and outcomes of patient suffer from acute Stanford type A aortic dissection(ATAAD) with mesenteric malperfusion.Methods:We collected 13 patients with mesenteric malperfusion among 321 ATAAD patients underwent surgery at Nanjing First Hospital during January 2019 to September 2022. Characteristics of these patients were recorded. We analyzed their early and late clinical outcomes.Results:Two patients underwent revascularization-first strategy in hybrid operation room had no in-hospital mortality or complication related to mesenteric ischemia. There were 11 patients with central repair-first strategy. Eight patients appeared mesenteric complications and 2 of them needed extra gastrointestinal surgery. Six in-hospital mortality were recorded in central repair-first patients.Conclusion:We recommended revascularization-first strategy with followed central repair in hybrid operation room for patients suffered from ATAAD with mesenteric malperfusion. Those who underwent central repair-first strategy because of coronary artery or cerebral malperfusion and unstable hemodynamic needed percutaneous angiography of mesenteric artery.

Objective: To investigate the mental health status of female migrant workers in a city. Methods: From August to December, 2016, cluster random sampling was used to select female migrant workers aged 16-60 years from 10 districts of this city, and Symptom Checklist-90 (SCL-90) and a questionnaire on general status were used. Results: Among these female migrant workers, the detection rates of obsessive-compulsion, hostility, and depression were 6.62%, 4.18%, and 4.10%, respectively. There was a significant difference in the detection rate of mental health issues between the female migrant workers from different districts, with different occupations, or with different education levels (P<0.05) . Districts, occupation, and education level were associated with mental health issues, after adjustment for age (P<0.05) . Conclusion Although female migrant workers in this city have a high mental health level, the issues such as obsessive-compulsion, hostility, and depression should be taken seriously. Targeted mental health surveys and comprehensive interventions should be implemented to improve the mental health level of female migrant workers.

Objective: To study status of social support and its influencing factors in female migrant workers. Methods: Study participants were selected with a random cluster design from participants 16-60 years old in non-registered residents from 10 districts in one city. Social support revalued scale and general questionnaire were used to survey social support status of female migrant workers in August-December of 2016. Results: There was statistic difference in social support among different districts, occupations, and income of female migrant workers (P<0.05) . Results of multiple linear regression demonstrates that districts, occupations, and income of female migrant workers were associated with social support scale (district standarized β=0.03, occupations standarized β=-0.03, incorue standarized β=0.10, P<0.05) . Conclusion We should be attentive to self-employed and Low-income participants among female migrant workers.

Objective To investigate the effects of Mycobacterium tuberculosis heparin-binding he-magglutinin (HBHA) on the polarization of mouse bone marrow-derived macrophages (BMDM) and a mu-rine macrophage cell line(Raw264.7 cells). Methods After HBHA was confirmed to be able to enter into macrophages by immunofluorescence, mouse BMDM and Raw264. 7 cells were treated with LPS (100 ng/ml)+IFN-γ (2.5 ng/ml),IL-4 (20 ng/ml),HBHA (1 μg/ml,3 μg/ml,6 μg/ml,10 μg/ml) and ESAT-6 (5 μg/ml),respectively. IL-6,IL-12 and TNF-α in the supernatants of cell culture were measured by ELISA. RT-PCR was performed to detect the expression of molecular markers of macrophage polarization [inducible nitric oxide synthase (iNOS), TNF-α, Arg-1 and CD206] at mRNA level. Western blot assay was used to detect the expression of iNOS and Arg-1 at protein level. Results Increased secretion of IL-6, IL-12 and TNF-α in the supernatants of cell culture and enhanced expression of iNOS and TNF-α at mRNA level were observed after treating BMDM with Mycobacterium tuberculosis HBHA. Similarly,in HBHA-trea-ted Raw264.7 cells,the secretion of IL-6 and the expression of TNF-α were also up-regulated. Mycobacteri-um tuberculosis HBHA and ESAT-6 had similar effects on murine macrophages. Neither of them could in-crease the expression of Arg-1,a molecular marker of M2 macrophages,in BMDM at protein level,but both enhanced the expression of iNOS,a molecular marker of M1 macrophages,in BMDM and Raw264.7 cells. Conclusion Mycobacterium tuberculosis HBHA can induce the polarization of murine macrophages to M1 phenotype.

Objective To investigate the molecular epidemiological characteristics and homology of Staphylococcus aureus (S. aureus)isolated from patients in intensive care units (ICUs)of a hospital,so as to provide laboratory basis for the effective control of healthcare-associated infection(HAI). Methods 62 S. aureus strains isolated from various specimens from ICU patients with infection in March-August 2013 were collected,7 housekeeping genes were amplified with polymerase chain reaction (PCR),the amplified products were sequenced,ST typing of strains was performed by multilocus sequence typing (MLST ), phylogenetic analysis of ST typing was conducted. Results 62S. aureus strains were amplified specific product of 7 housekeeping genes;there were 10 ST genotypes, in which 2 ST genotypes(STn1and STn2)were first discovered,1 ST genotype(ST675)was first discovered domes-tically. ST239 was the main ST type of S. aureus from ICU patients in this hospital,accounting for 74.20% ,which distributed in 6 ICUs,ST5 distributed in 3 ICUs. 62 strains formed 7 main branches in the phylogenetic tree,55 (88.71% )MRSA strains were detected. Conclusion S. aureus isolated from hospital ICUs has some homology, and the small number of types showed the trend of concentrated distribution.

The development of metagenomics revealed a novel role of microorganism in lots of diseases.Emerging researches at home and abroad illustrated that microbiome changes from nasopharynx, oropharynx and/or lung in quality and/or quantity exist in many respiratory diseases including chronic obstructive pulmonary disease, asthma, cystic fibrosis, pneumonia as well as upper respiratory infection, which play an important role in immune system, metabolism and neuroregulation.These research results may provide us new strategy for the diagnosis, therapy, surveillance and prognosis of respiratory diseases.

Objective To study the characteristics of antimicrobial resistance and molecular epidemiology of Staphylococcus aureus (S .aureus)in the intensive care units(ICUs)of a hospital.Methods Clinical isolates of S .aureus collected from ICUs between January and December 2014 were identified and performed antimicrobial susceptibility testing,then typed by staphylococcal protein A (spa)typing and multilocus sequence typing (MLST) methods.Results Of 160 isolates of S .aureus ,120 (75.00%)were methicillin-resistant S .aureus (MRSA). Resistance rates of MRSA to erythromycin,clindamycin,and levofloxacin were all > 80%;methicillin-sensitive S .aureus (MSSA)were sensitive to cefazolin,resistance rates to erythromycin,clindamycin,and levofloxacin were 62.50%,35.00%,and 10.00% respectively.spa typing and MLST results showed that the main types of 120 isolates of MRSA were ST239-t030,ST239-t037,and ST5-t2460,the major epidemic strains were ST239-t030 (n=105,87.50%),and were isolated from 8 ICUs;MSSA had more types,ST59-t437 were detected only from depart-ment of neurology(n =8)and department of digestive diseases(n =2),ST6-t701 ,ST398-t3625,ST398-t1793,and ST121-t2092 were isolated from departments of neurology(n=7),anesthesiology(n=5),neurosurgery(n=4),and cardiac surgery(n=4)respectively.Conclusion Isolation rate of MRSA in ICUs in this hospital is high,ST239-t030 is the main type,which prevailed in hospital;different types of MSSA have epidemic trends in various departments.

Objective To express recombinant HBHAΔC and HBHAΔN protein,and compare the HBHA series protein activity with each other.It will be provide a experimental basis for the research on clinical diagnostic of HBHA.Methods The HBHAΔC and HBHAΔN gene fragments were cloned and expressed by transforming E.coli BL-21.Test the protein heparin binding ability by CL-6B column.And then added protein to the BCG 7H9 culture medium,to observe the induced BCG aggregation.Results nHB-HA,rHBHA and HBHAΔN protein have heparin binding ability.Meanwhile nHBHA,rHBHA and HBHA Δ C protein have in-duced BCG aggregation effect.Conclusion The HBHAΔC and HBHAΔN protein were successfully obtained.It was proved that the HBHA C-terminal could be combined with heparin and the N-terminal involved could induce the aggregation of BCG.This results provide a basis for further study on molecular mechanism of TB infection and clinical application.

ObjectiveTo screen out the two-component system associated with drug resistance of Mycobacterium tuberculosis by detecting the differential expression of two-component system regulator genes between multidrug resistant Mycobacterium tuberculosis strains and drug sensitive strains. MethodsTotal RNA of MTB was extracted from cultured MTB during the logarithmic phase in the 7H9 brook medium, and then its purity was identified. Reverse transcription was further completed. The expressing levels of TCS response regulators were quantified using SYBR Green I qRT-PCR, which aimed at finding the differential expressions between multidrug resistant strains and sensitive strains. Finally, all of differentially expressed TCS were screened out under the stress of INH, SM and LFA. Results Compared with sensitive strains,multidrug resistant strains of Rv0491, Rv3133c, Rv3143 and Rv3246c were up-regulated 1. 03, 7.11,3.48and 1.37 folds, respectively (t/t' =5. 623, -4. 196, -3. 559 and -3. 016, respectively, P ＜0. 01 ). The expressing level of other regulators had no statistical significance between muhidrug resistant strains and drug sensitive strains. Under the antibiotic pressure, the expression of Rv1027c, Rv3246c and Rv3143 showed significant changes compared with no antibiotic group. ConclusionRv3246c and Rv3143 may be associated with MTB drug resistance and the differentially expressed genes in multi-drug resistant strains may be used as potential drug targets against drug resistant tuberculosis.