Objective To discuss the correlation of serum visceraladiposetissue-derived serineproteinase inhibitor(vaspin)and atrial fibrosis biochemical markers in atrial fibrillation(AF)patients.Methods The subjects were selected from inpatients in Shanghai Putuo District People's Hospital during January 2021 to October 2022.Enzyme linked immunosorbent assay(ELISA)was used to determine the levels of serum vaspin,C-terminal propeptide of prollagen type Ⅰ(PⅠCP),matrix metalloproteinase-1(MMP-1),N-terminal type Ⅲ collagen peptide(PⅢNP),tissue matrix metalloproteinase inhibitory factor-1(TIMP-1)of paroxysmal atrial fibrillation(PAF)group,persistent atrial fibrillation(PeAF)group,and control group.The correlation between serum vaspin and the above serum biochemical markers was analyzed.Results ①Levels of serum vaspin(9.51±1.47)ng/ml,PⅠCP(704.83±120.45)ng/ml,MMP-1(5.92±0.73)ng/ml,PⅢNP(63.34±12.24)ng/ml,and TIMP-1(7.56±0.90)ng/ml in PeAF group were significantly higher than those of PAF group and control group(P<0.05);②vaspin was significantly and positively correlated with PⅠCP,MMP-1,PⅢNP,TIMP-1 in PAF group and PeAF group.Conclusion Serum vaspin level of AF patients were significantly high and positively correlated with atrial fibrosis biochemical markers,which indicated that serum vaspin level might be closly related to atrial fibrosis in AF patients.It may be a potential marker to identify the degree of fibrosis in atrial fibrillation.

Objective To analyze the residual status,transfer behavior,and risk of paclobutrazole in the national mar-ket of Shenmai granules.Methods GC-MS/MS determined the residual amount of paclobutrazol in Shenmai granules,and ANOVA analyzed the distribution characteristics of sample residuals.The transfer rule of paclobutrazol from Ophiopogonis Radix to Shenmai granules was investigated by simulating the production process,and chronic exposure assessment was performed using the point evaluation model.Results The established method can accurately determine the residual amount of paclobutrazol in Shenmai granules.The residual amount of paclobutrazol in 85 batches of Shenmai granules ranged from 0.001 3 to 0.015 8 mg·kg-1,and there was a statistical difference in the residual amount among different enterprise samples.The transfer rate of paclobutrazol from decoction pieces to preparations was 29.8%.The chronic risk quotient(HQc)of paclobutrazol residues in Shenmai granules was 0.000 7%,far lower than 1.Conclusion There is a general presence of paclobutrazol residues in Shenmai granules.The risk assessment results show that the normal dosage of Shenmai granules does not pose an unacceptable risk to the general population.The residual distribution characteristics and process transfer rules can provide a reference for safety risk control in production enterprises.

Objective:To investigate the efficacy and prognosis of CLAG±DAC (Clofarabine, Cytarabine, G-CSF±Decitabine) chemotherapy in patients with relapsed/refractory acute myeloid leukemia (R/R AML) .Methods:Continuous cases of R/R AML treated with the CLAG+DAC protocol or CLAG alone at the First Affiliated Hospital of Soochow University from January 2017 to December 2021 were retrospectively analyzed. The baseline characteristics, individual treatment regimen, treatment effect, disease progression, and survival status of patients were recorded. The factors influencing the efficacy of the CLAG±DAC chemotherapy regimens were analyzed, and the overall survival (OS) time after reinduction was calculated using the Kaplan-Meier method.Results:This study included a total of 53 patients, with 33 male patients and an average age of 40.6 years. Thirty-three patients achieved complete remission (CR+CRi) of the disease after the CLAG±DAC chemotherapy regimen and six patients achieved partial remission (PR), while 14 did not. Thirty-two patients eventually underwent hematopoietic stem cell transplantation, and the median OS of the patients was 55.9 months until follow-up. Patients with disease remission after the application of the CLAG±DAC chemotherapy had a significantly longer survival time than those without remission ( P<0.001). The results of the multifactorial analysis have revealed that combined DAC ( OR=4.60, 95% CI 1.14-23.5, P=0.04) and DNMT3A mutation ( OR=0.14, 95% CI 0.01-0.89, P=0.05) were the factors influencing the efficacy of the CLAG±DAC chemotherapy regimen. The remission rate was relatively higher in patients with R/R AML combined with FLT3-ITD mutation by applying the DAC+CLAG regimen ( OR=10.84, 95% CI 1.48-288.50, P=0.04) . Conclusion:The CLAG±DAC regimen is considered effective in patients with R/R AML, whereas decitabine combined with the CLAG regimen is more suitable for patients with R/R AML combined with FLT3-ITD mutation.

Objective To establish a UPLC-MS/MS method to measure the content of monoester-alkaloids(benzoylmesaconine,benzoylaconine,benzoylhypaconine)and diester-alkaloids(mesaconitine,hyp-aconitine,aconitine)in Fengshiantai tablets.To provide a basis for quality control by conducting chemometric analysis and risk assessment on the measurement results.Methods The components were separated on Waters BEH C18 column(2.1 mm×100 mm,1.7 μm)with methanol and 0.1%formicacid aqueous solution as the mobile phase by gradient elution at a flow rate of 0.3 mL·min-1.The column temperature was set at 35℃.The injection volume was 1 μL.The detection was carried out by electrospray ionization(ESI),and electron spray ionization source was adopted in positiveion detection with multiple reaction monitoring mode(MRM).Results Six components showed good linear relationships within their own ranges(r≥0.9990),whose average recovery rate of samples were 90.3%-107.6%with the RSD of 0.9%-1.8%.In 23 batches of tested samples,the diester-alkaloids contents ranged from 1.35 to 19.49 μg per tablet,which indicated low risk of drug safety;the monoester-alkaloids contents ranged from 20.17-99.55 μg per tablet.The results of chemometrics showed that 23 batches of samples were classify into four categories,and there were certain differences in sample quality among different production enterprises.Conclusion The established method is stable and reliable,and can be used for quality control of Fengshi Antai tablets.

Objective To explore the establishment of a new model of informational drug treatment pathway management.Methods The orthopedic drug treatment pathways was developed through multidisciplinary diagnosis and treatment(MDT),and the pathway management was implemented with the help of an information systems to implement refined control rules.Cases before the implementation of the management pathway(January to May 2022)were selected as the control group,and cases after the implementation of the management pathway(June to December 2022)were selected as the improvement group to evaluate the management effectiveness.Results After establishing drug treatment pathways for 8 major types of surgeries,maintaining 990 medical prescriptions for recommended drugs in the HIS system,and 176 control rules in the MINDS system.There was a significant improvement in the orthopaedic department's indexes of antimicrobial drug use rate,antibacterial drug use intensity,average inpatient medication cost,and percentage of the amount of basic medication after applying a new model of drug treatment pathway management.According to the case analysis before and after the implementation of the pathway,the rational rate of using orthopedic antibiotics,analgesics,fluid replacement and volume expansion drugs,acid inhibiting and stomach protecting drugs,blood activating and swelling-reducing proprietary Chinese medicines were increased by 21.6%,12.7%,23.3%,32.1% and 27.1%,respectively.The average drug costs was reduced by 111.51 yuan,15.33 yuan,49.84 yuan,42.29 yuan and 14.23 yuan,respectively.Conclusion The management mode of drug treatment pathway based on MDT established by our hospital is practical and effective,and the relevant experience may provide valuable insights for pharmaceutical peers.

Nonalcoholic steatohepatitis (NASH) is a spectrum of chronic liver disease characterized by hepatic lipid metabolism disorder. Recent reports emphasized the contribution of triglyceride and diglyceride accumulation to NASH, while the other lipids associated with the NASH pathogenesis remained unexplored. The specific purpose of our study was to explore a novel pathogenesis and treatment strategy of NASH via profiling the metabolic characteristics of lipids. Herein, multi-omics techniques based on LC-Q-TOF/MS, LC-MS/MS and MS imaging were developed and used to screen the action targets related to NASH progress and treatment. A methionine and choline deficient (MCD) diet-induced mouse model of NASH was then constructed, and Schisandra lignans extract (SLE) was applied to alleviate hepatic damage by regulating the lipid metabolism-related enzymes CES2A and CYP4A14. Hepatic lipidomics indicated that MCD-diet led to aberrant accumulation of phosphatidylethanolamines (PEs), and SLE could significantly reduce the accumulation of intrahepatic PEs. Notably, exogenous PE (18:0/18:1) was proved to significantly aggravate the mitochondrial damage and hepatocyte apoptosis. Supplementing PE (18:0/18:1) also deteriorated the NASH progress by up regulating intrahepatic proinflammatory and fibrotic factors, while PE synthase inhibitor exerted a prominent hepatoprotective role. The current work provides new insights into the relationship between PE metabolism and the pathogenesis of NASH.

Objective:To investigate the levels of sex hormone and fertility in female patients after hematopoietic stem cell transplantation (HSCT), as well as their correlation with conditioning regimens, and analyse the effect of hormone replacement therapy (HRT) in young women after HSCT.Methods:Retrospective case series study. The clinical data of 147 women who underwent HSCT in the First Affiliated Hospital of Soochow University from January 2010 to January 2021 were retrospectively analyzed. The sex hormone levels were measured and followed-up, and the survival, menstrual fertility and the use of HRT of the patients were also followed-up. The sex hormone levels were measured after transplantation, and the ovarian function was evaluated. Independent sample t test and χ2 test were used for comparison between the two groups. Results:The median age of the 147 patients was 26 (range, 10-45) years. Of them, 135 patients received allogeneic HSCT and 12 patients received autologous HSCT. Furthermore, 129 patients received myeloablative conditioning, and 18 patients received reduced conditioning dose. The median follow-up time was 50 months (range, 18-134 months). Five patients died of disease recurrence during follow-up. Of the 54 patients with subcutaneous injection of zoladex, three recovered menstruation spontaneously after transplantation, and all of them were myeloablative conditioning patients, one patient gave birth to twins through assisted reproductive technology. Ninety-three patients did not use zoladex before conditioning, two patients with aplastic anemia with non-myeloablative transplantation resumed menstruation spontaneously, and conceived naturally. The level of follicle stimulating hormone after transplantation in patients receiving myeloablative conditioning regimen was significantly higher than that in patients receiving reduced-dose conditioning regimen [(95.28±3.94) U/L vs. (71.85±10.72) U/L, P=0.039]. Among 147 patients, 122 patients developed premature ovarian failure, 83 patients received sex hormone replacement therapy after transplantation, and 76 patients recovered menstruation and improved endocrine function. Conclusions:The incidence of premature ovarian failure is high in female patients after HSCT, and patients have a chance at natural conception. Reducing the dose of conditioning regimen and the application of zoladex before transplantation can reduce ovarian of conditioning drugs. HRT after transplantation can partially improve the endocrine function of patients.

Objective:To investigate the survival and prognosis of B-lineage acute lymphoblastic leukemia (B-ALL) patients with TP53 mutation.Methods:The clinical data of 479 newly diagnosed B-ALL patients treated in the First Affiliated Hospital of Soochow University from January 2016 to December 2019 were retrospectively analyzed.Results:Among 479 B-ALL patients, 34 cases (7.1%) were positive for TP53 gene mutation, and a total of 36 TP53 mutations were detected, including 10 frameshift gene mutations (27.8%) , 23 missense mutations (63.9%) and 3 nonsense mutations (8.3%) . A total of 34 (94.4%) mutations were located in the DNA binding domain (exons 5-8) .The average number of mutated genes in patients with TP53 gene mutation (2.3) and the group without TP53 gene mutation (1.1) were statistically different ( P<0.001) . The proportion of Ph positive and Ph-like positive patients in the TP53 gene mutation negative group was significantly higher than that of the TP53 mutation positive group, and the difference was statistically significant ( P<0.001) . The 3-year OS and EFS rates of the TP53 gene mutation negative group were significantly higher than those of the TP53 gene mutation positive group. The differences in OS and EFS rates between the two groups were statistically significant ( χ2= 4.694, P = 0.030; χ2= 5.080, P= 0.024) . In the multivariate analysis, failure to achieve remission (CR) after one course of induction chemotherapy was an independent adverse prognostic factor affecting OS.Of the 34 patients with TP53 mutation, 16 underwent allogeneic hematopoietic stem cell transplantation (allo-HSCT) in the CR 1 state, and 2 patients with recurrence after transplantation obtained CR 2 after infusion of donor-derived anti-CD19 chimeric antigen receptor T (CAR-T) cells. Among the 11 patients with TP53 gene mutation who relapsed during consolidation chemotherapy, 6 received anti-CD19 CAR T cell therapy, 4 patients achieved remission and minimal residual disease (MRD) turned negative, followed by bridging allo-HSCT, and 2 of them sustained CR. Conclusion:Missense mutations are the most common in B-ALL patients with TP53 gene mutation, and the majority of mutations were located in the DNA binding domain. B-ALL patients with TP53 gene mutation should undergo allo-HSCT as soon as possible after CAR-T cell therapy has cleared the MRD after recurrence. B-ALL patients with TP53 gene mutation still have a higher recurrence rate after allo-HSCT, and the infusion of donor-derived CAR-T cells can achieve better sustained remission.

Objective To compare the fetal and maternal outcomes of labor undergoing epidural block anesthesia with and without using hand-and-knee position in the second stage of labor.Methods A total of 1,158 subjects were included in the study.There were 560 subjects in the study group and 598 cases in the control group.All the subjects were divided into study and control group according to the randomized numbers.Both groups underwent epidural block anesthesia and used the same labor way in stage I and stage 3.In the study group,the hand-and-knee position was used for 15～30 minutes combined with uterine contractions and the delivery was done in the lithotomy position.In the control group,the gradidea took the semi-recumbent position with bent knees and bed elevated 40°,combined with uterine contractions until the delivery was done in the lithotomy position.The labor time of stage1,stage2,stage3 and all abor,labor way,perinaueum,complications and newborns were compared.Results The average time of the second stage labor and all labor in the observation group were significantly shorter than those of the control group (P＜0.05).The labor ways in the observation group was better than that of the control group (P＜0.05).The incidence of postpartum urinary retention in the observation group was significantly lower than that of the control group (P＜0.05).The differences of labor time for stage 1,stage2,perinaueum,blood loss rate,newboms' s tomor and neonatal asphyxia between two groups were not statistically significant (P＞0.05).Conclusions Under continuous epidural block anesthesia,the use of the hands-and-knees position in the second stage of labor can reduce the incidence of operative delivery,shorten the labor process,and reduce maternal complications.The method is worthy of promotion.

Objective By using optical coherence tomography (OCT) to evaluate the vascular neointimal hyperplasia and the stent strut coverage degree in patients with acute myocardial infarction (AMI) and in patients with stable angina (SA) one year after receiving drug-eluting stent (DES) implantation, and to compare the clinical results between the two groups. Methods A total of 39 patients, who received DES implantation due to coronary heart disease, including AMI (n=16, AMI group) and SA (n=23, SA group), during the period from March 2011 to July 2012, were enrolled in this study. One year after DES implantation, coronary angiography and OCT reexaminations were performed in all patients. The neointimal hyperplasia (NIH) thickness, NIH area, NIH volume, strut coverage and apposition rate were determined with OCT. The results were compared between the two groups. Results OCT measuring results showed that the mean NIH thickness of AMI group and SA group was ( 66 . 8 ± 20 . 7 ) mm and ( 121 . 6 ± 135 . 7 ) mm respectively (P=0.022); the NIH volume ratio were 5.66%±3.18% and 11.88%±8.22% respectively (P=0.005); the percentage of cross-section with NIH thickness over 100 μm was 22.56%±23.99% and 40.14%± 30.01% respectively (P=0.034); and the percentage of overall stent strut coverage was 89.27%±6.40% and 93.42%±7.03% respectively (P=0.007). All the above mentioned data of AMI group were obviously lower than those of SA group. Conclusion After DES implantation, the intimal repair, intimal hyperplasia and stent strut coverage in AMI patients are poorer.