Objective To investigate and assess the risk signals of adverse drug events(ADEs)associated with the post-marketing 4 long-acting anticholinergic antagonists(LAMA),including adionium bromide,glycopyrronium bromide,umeonium bromide,and tiotropium bromide,to provide references for clinically safe prescribing practices.Methods Four LAMA drugs-related ADE records were selected by searching the FAERS database from the first quarter of 2004 to the first quarter of 2024 and standardizing the drug name of adionium bromide,glycopyrronium bromide,umeonium bromide,and tiotropium bromide,with the primary suspected drug as a restriction.Potential ADE signals were mined using the reporting odds ratio(ROR)method,medicines and healthcare products regulatory agency(MHRA)method and Bayesian confidence propagation neural network(BCPNN)method,and Medical Dictionary for Drug Regulatory Activities 26.1 was used to classify the results systematically.Results A total of 80 680 reports of four LAMA drugs-related ADE were collected,including 4 287 reports for aclidinium bromide,3 584 reports for glycopyrronium bromide,3 084 reports for umeclidinium bromide and 69 725 reports for iotropium bromide.The reports predominantly involved female patients(47 725 cases,59.15％)over male patients(27 525 cases,34.11％).The United States emerged as the principal reporting country,with consumers,pharmacists,and physicians as the primary reporters.Serious ADE outcomes included life-threatening conditions,hospitalizations,disabilities,deaths.A total of 902 signals were identified,mainly affecting 27 systems or organs.Specifically,aclidinium bromide(180 signals),glycopyrronium bromide(210 signals),umeclidinium bromide(142 signals),and tiotropium bromide(370 signals)exhibited signals predominantly in the respiratory,thoracic and mediastinal disorders,investigations,injury,poisoning and procedural complications,eye and organ diseases cgastrointestinal disorders.Conclusion When using LAMA drugs for respiratory conditions,clinicians should implement preventive measures to monitor respiratory diseases,thoracic and mediastinal diseases,eye and organ changes and various laboratory examination indicators,to reduce the risk of medication.

【Objective】 To investigate the main causes of blood donor deferral in domestic blood center. 【Methods】 The causes of donor deferral were classified into 12 categories as previous medical history, drug use, alcohol consumption, menstrual period, underweight, abnormal blood pressure, abnormal body temperature, abnormal hemoglobin (Hb), lipemic blood, positive hepatitis B surface antigen (HBsAg), elevated alanine aminotransferase (ALT) and others according to the comparison indicators of Asia-Pacific Blood Network (APBN) and the national standard Blood Donor Health Examination Requirements. The relevant data of the top 3 causes of donor deferral, voluntarily reported by the members of Practice Comparison Working Group of China’s Mainland Blood Collection and Supply Institutions from 2014 to 2019, were collected and a histogram was generated. 【Results】 The median donor deferral rate of 20 domestic blood centers from 2014 to 2019 was 12.14%, with the lowest at 0.18% and highest at 32.32%, respectively. The top three causes for donor deferral were elevated ALT, abnormal Hb and abnormal blood pressure in year 2014, 2015, 2018 and 2019; elevated ALT, lipemic blood and abnormal blood pressure in 2016; elevated ALT, abnormal Hb, and lipemic blood in 2017. 【Conclusion】 The main causes of donor deferral were elevated ALT, abnormal Hb, abnormal blood pressure and lipemic blood.

Nonalcoholic fatty liver disease (NAFLD) is a disease caused by multiple factors and can progress to liver cirrhosis and hepatocellular carcinoma. At present, the pathogenesis of NAFLD remains unclear and there are still no effective therapeutic drugs in clinical practice; therefore, it is particularly important to search for new therapeutic drugs that have few side effects and can effectively delay or reverse disease progression. Some studies have shown that related hormones produced by gastric tissue have a variety of effects in the regulation of energy homeostasis and obesity, and the expression level of inflammation-related genes in gastric fundus is consistent with the severity of liver disease; thus we have reason to believe that the stomach is one of the important participants in NAFLD. This article summarizes the role of ghrelin and obestatin produced by the stomach in the progression of NAFLD, which provides a new idea for the pathogenesis of NAFLD and a new direction for treatment.

Objective To explore the effect of medical and nursing integration notification on the truth knowing rate,anxiety,depression and quality of life in cancer patients undergoing chemotherapy. Meth-ods From February to March 2017,34 patients for the first time needing chemotherapy were included as control group,using normal disclosure.From June to July 2017,35 cases for the first time needing chemother-apy were included as the experimental group. The experimental group was informed of the medical and nurs-ing integration notification. The truth knowing rate,anxiety,depression and quality of life were compared be-fore and after three cycles of chemotherapy. Results After three cycles of chemotherapy,the truth knowing rate of patients in the experimental group (completely 57.14%,partly 34.29% and none 8.57%) was signifi-cantly different with the control group (completely 29.42%,partly 35.29% and none 35.29%,P＜0.01). The scores of anxiety and depression in the experimental group(39.43±4.60,41.86±5.23) were significantly low-er than those before chemotherapy(42.37±4.76,45.69±5.49,P＜0.01). The scores of anxiety and depression in the control group (45.74±5.20,49.74±5.42) were significantly higher than those before chemotherapy (42.77±5.62,45.56±6.27,P＜0.01).After three cycles of chemotherapy,the scores of anxiety and depression in the experimental group were lower than the control group (P＜0.01). After three cycles of chemotherapy, the total health status,body function,role function,emotional function,cognitive function,social function,fa-tigue,nausea and vomiting,and loss of appetite were statistically significant between the experimental group and control group (P＜0.05). Conclusion The medical and nursing integration notification has a positive effect on the truth knowing rate,anxiety,depression and quality of life in cancer patients undergoing chemo-therapy.

As an assistant examination method,medical imaging can help clinicians diagnose Parkinson's disease (PD),help them select treatment methods and evaluate the prognoses.Conventional structural MR imaging can display the brain structure changes of some PD patients by using its high resolution advantages on soft tissues,and diffusion MR imaging is widely used in the study of brain microstructure.This article focuses on the recent research progress of structural MR imaging and diffusion MR imaging in PD.

PURPOSE: The aim of this study was to evaluate the effects of reflective trainings for nursing students on their critical thinking disposition. METHODS: A total of 157 senior undergraduate nursing students sampled from Hainan Medical University in China participated in this study in 2014. They were randomly divided into experimental and control groups. The experimental group students were provided the reflective training during their entire 12-month clinical internship, whereas students in the control group were requested to keep their reflective diaries but without a formal training. Before and after the intervention, nursing students' critical thinking disposition was rated using the Chinese version of Critical Thinking Disposition Inventory (CTDI-CV). RESULTS: Before the start of the intervention, the critical thinking disposition scores of the two groups had no significant differences. At the end of the intervention, it was found that the experimental students performed better in each subscale of CTDI-CV. These include the search for truth, open mind, analytical ability, systematic ability, critical thinking, self-confidence, curiosity, and cognitive maturity. By summing the scores of all categories, the results showed that the experimental group had a significantly higher total score than that of the control group (p ≤ .044). Evaluating the score difference in each function indicated that there was a range of improvements on the critical thinking disposition because of the reflective training intervention. CONCLUSION: Reflective training during the internship period improves nursing students' disposition of critical thinking and promotes their readiness for their clinical practices in the rapidly increasing demands of the healthcare field.
Asian Continental Ancestry Group ; China* ; Delivery of Health Care ; Education, Nursing ; Exploratory Behavior ; Humans ; Internship and Residency ; Nursing* ; Students, Nursing* ; Thinking*

Recent studies have found that inflammatory response is positively associated with the progression of liver cirrhosis,acute-on-chronic liver failure,and primary liver cancer and can affect their prognosis,and as a marker for inflammatory response,neutrophil/lymphocyte ratio (NLR) is easy to calculate,has good repeatability,and holds promise for prognostic evaluation.This article introduces the research advances in the association of NLR with the prognosis of liver cirrhosis,acute-on-chronic liver failure,and primary liver cancer and points out that NLR plays an important role in evaluating the prognosis of liver cirrhosis,acute-on-chronic liver failure,and primary liver cancer.However,there are still controversies over the selection of optimal cut-off values for different diseases,and further studies are needed.

Truth disclosure of cancer patients is becoming more and more recognized in the world.Truth disclosure is usually regarded as the doctor's responsibility.However,the nurse has become an active participant in the truth disclosure of cancer patients both intentionally and inadvertently.This article systematically reviewed the role of nurses at home and abroad in informing patients with cancer the truth so as to provide guidance for the clinical practice.In April 2017,we retrieved articles in Pubmed,Chinese CNKI,Wanfang database,VIP database,and retrieval time is not restricted.A total of 92 literatures were retrieved and 8 articles were retrieved by manual searching.Finally,23 articles were included.Through systematic review of the literature,nurses are found to play an important role in informing cancer patients the truth.Compared with physicians,nurses have a more positive attitude for truth disclosure.Nurses have the most contact with patients and family members,if the nurses have plans to communicate with the families on telling the truth to cancer patients,there will be a positive impact on the truth disclosure attitude of family members.It is necessary to explore the strategy of truth disclosure for cancer patients with integrated medical staff in the future.

Objective To compare the diagnostic values of γ-glutamyl transpeptidase-to-platelet ratio index (GPRI) ,aspartate aminotransferase-to-platelet ratio index (APRI) and fibrosis index based on the four factors (Fib-4) for chronic hepatitis B (CHB) fibrosis and cirrhosis .Methods According to the Metavir score ,262 CHB patients were divided into F0 — F1 group (n= 131) ,F2 — F3 group (n= 102) and F4 group (n = 29 ) . The age , gender , alanine aminotransferase (ALT ) , aspartate aminotransferase (AST ) ,γ-glutamyl transpeptidas (γ-GT ) and platelet count were recorded .GPRI ,APRI ,Fib-4 scores were calculated separately .Statistical analysis was performed by t test ,Kruskal-Wallis H test ,and χ2 test .The correlations between serum models and liver fibrosis stages were analyzed using the Spearman test .Results The scores of GPRI in F0 — F1 group ,F2 — F3 group and F4 group were 0 .39 (0 .21 , 0 .95) ,1 .05 (0 .38 ,2 .39) and 2 .11 (1 .12 ,3 .33) ,respectively .The difference was statistically significant (χ2 = 40 .645 ,P< 0 .01) .APRI scores in the three groups were 0 .49 (0 .32 ,0 .97) ,0 .77 (0 .52 ,1 .52) and 1 .12 (0 .77 ,2 .50) ,respectively .The difference was statistically significant (χ2 = 32 .636 , P < 0 .01) . Fib-4 scores in the three groups were 1 .36 (0 .92 ,2 .05) ,2 .34 (1 .28 ,4 .35) and 3 .86 (3 .03 ,8 .99) , respectively .The difference was statistically significant (χ2 = 48 .943 , P< 0 .01) .Age ,γ-GT ,AST and liver fibrosis were all positively correlated with liver fibrosis (r = 0 .322 ,0 .301 and 0 .199 ,respectively , all P< 0 .05) .Platelet was negatively correlated with liver fibrosis (r = — 0 .455 , P< 0 .05) ,while ALT was not significantly associated with hepatic fibrosis (r= 0 .111 ,P= 0 .073) .GPRI ,APRI and Fib-4 were positively correlated with liver fibrosis (r = 0 .625 ,0 .417 and 0 .399 ,respectively ,all P < 0 .05) .The areas under the operating characteristic curve of GPRI for significant hepatic fibrosis , advanced liver fibrosis and cirrhosis were 0 .818 ,0 .864 and 0 .837 ,respectively .APRI for significant hepatic fibrosis , advanced liver fibrosis and cirrhosis were 0 .694 ,0 .766 and 0 .722 ,respectively ,while Fib-4 were 0 .696 , 0 .770 and 0 .724 ,respectively .The low cutoff values of GPRI for various stages of liver fibrosis were 0 .99 ,1 .04 and 1 .06 ,respectively ,and the sensitivity ,specificity ,positive predictive value (PPV ) and negative predictive value (NPV) were all higher than those of APRI and Fib-4 .The high cutoff values of GPRI for liver fibrosis at each stage were 2 .49 ,3 .69 and 6 .77 , respectively , and the sensitivity , specificity ,PPV and NPV of the diagnosis were all higher than those of APRI and Fib-4 .Conclusion The diagnostic value of GPRI for CHB liver fibrosis is higher than those of APRI and Fib-4 .

Early and accurate diagnosis of hepatic fibrosis and application of antiviral therapy are the key to improving the prognosis of patients with chronic hepatitis B (CHB).Liver biopsy and transient elastography cannot be widely used for the diagnosis of hepatic fibrosis in clinical practice,and therefore,the serological diagnostic model has become a hot research topic in recent years.This article introduces a new serological diagnostic model,γ-glutamyl transpeptidase-to-platelet ratio (GPR),which has a high value in the diagnosis of hepatic fibrosis in CHB patients;however,the accuracy of GPR varies between different populations and different areas.GPR is also an excellent predictor for the prognosis of hepatitis B-associated liver cancer.It is pointed out that GPR has a promising future in the diagnosis of hepatic fibrosis in CHB patients,but due to a lack of clinical research data on GPR,further studies are needed to support its application in China.