ObjectiveTo explore the application value of CT pulmonary angiography (CTPA) in assessing the severity of acute pulmonary embolism (APE) and right heart function in rehabilitation patients. MethodsFrom January, 2013 to January, 2020, 133 inpatients (94 positive and 39 negative) who underwent CTPA examination in Beijing Bo'ai Hospital were involved. Positive patients were further divided into mild, moderate and severe groups based on the pulmonary artery obstruction index (PAOI). The clinical parameters and right heart function indicators were compared. Spearman correlation analysis was used to analyze the correlation between PAOI, and clinical parameters and right heart function indicators, and Logistic regression analysis was used to predict the risk factors of APE. ResultsThere was significant difference in lower extremity venous thrombosis, D-dimer, oxygen partial pressure, PAOI and left process of interventricular septum among four groups (H ≥ 12.350, P < 0.01). PAOI was moderately positively correlated with D-dimer (r = 0.443, P < 0.001) and left process of interventricular septum (r = 0.520, P < 0.001), and was weakly positively correlated with lower extremity venous thrombosis (r = 0.399, P < 0.001), left pulmonary artery diameter (r = 0.213, P = 0.014) and inferior vena cava regurgitation (r = 0.229, P = 0.008). Lower extremity venous thrombosis (OR = 7.708, P < 0.001) and left process of interventricular septum (OR = 3.641, P = 0.008) were independent risk factors for the onset of APE. The combination of the two indicators was effective for diagnosis of APE, and AUC was 0.795 (95% CI 0.715 to 0.874). ConclusionCTPA may be applied to evaluate the severity of APE and right heart function in rehabilitation patients.

In order to make the shared traditional Chinese medicine （TCM） pharmacy develop more efficiently and normatively at the grass-roots level， using the “shared TCM pharmacy” as the retrieval word， this paper uses the literature research method to retrieve the reports， documents and policies from CNKI， the websites of people’s governments at all levels， the official websites of the State Administration of Traditional Chinese Medicine， people.com， China News Network， Xinhua News and other platforms before May 20， 2022， sort out the development mode and history of two “Internet plus” TCM pharmacies， namely “shared TCM pharmacies” and “smart TCM pharmacies”， and compare them with each other. Combined with the actual work of community hospitals and community service centers （stations）， the necessity and advantages （such as reducing the costs of the intermediate links of drug circulation and standardizing the grass-roots drug use process） of the development of “shared TCM pharmacy” are obtained from the perspective of primary medical care. Combined with the current situation of the promotion and application of shared TCM pharmacy in county medical communities， it is concluded that the shared TCM pharmacy should be further constructed from four aspects： improving the work process of drug centralized procurement under the background of normalization， improving the compatibility and synchronization of the whole process dispensing information system module， unifying pharmaceutical services and personnel training， defining the authority of data query and clarifying the boundaries of patient privacy to further build a shared TCM pharmacy. Finally， it integrates information technology， summarizes the definition of shared TCM pharmacy and its future construction direction， and provides reference for the next development of shared TCM pharmacy at the grass-roots level.

Animals ; SARS-CoV-2 ; Antibodies, Neutralizing ; Macaca mulatta ; COVID-19/prevention & control* ; Antibodies, Viral ; Vaccines

Objective:To analyze the expression and clinical significance of serum microRNA-221 (miR-221) and microRNA-127 (miR-127) levels in children with severe pneumonia.Methods:151 children with severe pneumonia treated in Handan Central Hospital from January 2017 to December 2019 were prospective selected as severe pneumonia group. According to the prognosis of children in hospital, they were divided into death group (16 cases) and survival group (135 cases). Another 80 healthy children who underwent physical examination in our hospital during the same period were selected as normal control group. Microarrays were used to analyze the expression of miRNAs in the severe pneumonia group and the normal control group, and the miRNAs with the most significant up-regulation or down-regulation (based on the difference expression change ≥2 times threshold and P<0.05) were selected. The serum miR-221, miR-127 and inflammatory factor [C-reactive protein (CRP), calcitonin (PCT) and interleukin 6 (IL-6), interleukin 8 (IL-8), tumor necrosis factor-α (TNF-α)] levels were detected in the enrolled subjects. The correlation between serum miR-221 and miR-127 and the above inflammatory indicators in severe pneumonia group were analyzed. The diagnostic value and prognostic value of miR-221 and miR-127 in severe pneumonia were analyzed by receiver operating characteristic (ROC) curve. Results:The serum levels of miR-221 and miR-127 in severe pneumonia group were lower than those in normal control group, while the serum levels of CRP, PCT, IL-6, IL-8 and TNF-α were higher than those in the normal control group (all P<0.05). Serum miR-221 was negatively correlated with CRP, PCT, TNF-α (all P<0.05); Serum miR-127 was negatively correlated with CRP, PCT, IL-6 and IL-8 (all P<0.05). The serum levels of miR-221 and miR-127 in the death group were lower than those in the survival group ( P<0.05). The area under the curve (AUC) of miR-221 and miR-127 for the combined diagnosis of severe pneumonia was 0.871, and the AUC for the prognosis of severe pneumonia was 0.851. Conclusions:The serum levels of miR-221 and miR-127 in children with severe pneumonia decreased, which was negatively correlated with the levels of some inflammatory factors. The combined detection of miR-221 and miR-127 has high clinical value in the diagnosis and prognosis prediction of severe pneumonia.

Objective : To explore the effects of Blonanserin on hippocampal neurons damage and PI3K / AKT / GSK3 β signaling pathways in rats with MK-801 induced schizophrenia． Methods : The schizophrenia models were induced by one-time intraperitoneal injection of MK-801．A total of 48 SD rats were randomly divided into normal group，model group，Blonanserin group ( 1 mg / kg Blonanserin) and risperidone group (0. 54 mg / kg risperidone) ， with 12 cases in each group．The behaviors of rats were observed by stereotyped behavior assay，open field test and Morris water maze．The pathological damage of hippocampus was observed by HE staining，which was scored．The levels of serum glucose-lipid metabolism indexes were detected．The mRNA and proteins of phosphatidylinositol 3- kinase (PI3K) ，protein kinase B (AKT) and glycogen synthase kinase 3 β ( GSK3 β) in hippocampal tissues were detected by real-time fluorescent quantitative PCR and Western blot. Results : Compared with model group，scores of stereotyped behaviors，total distance in open field test，escape latency and score of pathological damage in hippo- campus decreased in Blonanserin group and risperidone group，while times of crossing platform original site，levels of PI3K，AKT and GSK3 β mRNA，and phosphorylation levels of PI3K，AKT and GSK3 increased (P ＜0. 05) . However，there was no significant difference in the above indexes between Blonanserin group and risperidone group．The differences in levels of fasting blood glucose ( FPG) ，glycosylated hemoglobin ( HbA1c) ，triglyceride (TG) ，total cholesterol (TC) ，high-density lipoprotein (HDL) and low-density lipoprotein (LDL) among normal group，model group and Blonanserin group was not statistically significant．However，levels of FPG，HbA1c，TG and TC in risperidone group were higher than those in the other three groups (P＜0. 05) ，and there was no signifi- cant change in HDL or LDL． Conclusion Blonanserin may protect schizophrenia rats from hippocampal neurons damage，improve cognitive function，learning and memory ability by activating PI3K / AKT / GSK3 β signaling path- ways.

Objective: To describe the clinicopathological features of synchronous mucinous metaplasia and neoplasia of the female genital tract (SMMN-FGT). Methods: The sample consisted of 7 cases of SMMN-FGT recorded from November 2014 to September 2017 at Obstetrics and Gynecology Hospital, Fudan University.PAP method was used in immunohistochemistry.Clinical histories were retrieved and pathological slides were reviewed. Results: The patients were 37 to 70 years old(mean 54 years old). All patients showed endometrial mucinous lesions associated with cervical lesions. Three cases were an admixture of minimal deviation adenocarcinoma(MDA) and gastrictype adenocarcinoma(GAS). Three cases were an admixture of lobular endocervical glandular hyperplasia (LEGH), atypical LEGH and focal gastrictype adenocarcinoma in situ, one of which had early invasive gastrictype adenocarcinoma.Endometrium showed a structure of LEGH in one patient with focal simple gastric mucinous metaplasia in her cervix. Gastric mucinous differentiation was found in unilateral fallopian tube in 6 patients. Ovarian mucinous lesions were found in 3 patients. p16 was negative staining in 6 cases and positive in 1 case. CK7 was diffusely positive in all lesions. CK20 and CDX2 were negative or only focally positive.The expression of MUC6 was strongly positive staining or focal staining. p53 in GAS and GAS in situ had mutant expression, but wild expression in MDA region. Patients were followed up for 2 to 34 months and no recurrence was found. Conclusions SMMN-FGT is a series of rare mucinous lesions involving multiple areas of the female genital tract, including benign or malignant lesions with gastric differentiation. It is not related to infection with high-risk human papilloma virus. When cervical gastrictype lesions are found, SMMN-FGT should be considered and should be differentiated from metastatic mucinous adenocarcinoma.

Objective:To optimize the clinical dosage regimen of amoxicillin and clavulanate potassium extended release ( ER) tablets based on the PK/PD parameters. Methods:Totally 30 healthy subjects ( half male and half female) were randomly divided into three groups, and orally administered the ER tablets respectively under fasting condition, before the meal and after the meal, and the optimal administration time was determined by comparing the pharmacokinetic characteristics. The subjects in the three groups were ad-ministered the ER tablets respectively at low, medium and high dosage, and the optimal dosage and dosing interval were determined based on the PK/PD parameters. Results:Under fasting condition, the AUC of amoxicillin [(32.2 ±15.0) μg·h·ml-1] was sig-nificantly lower than that before the meal [(41.7 ±1.92) μg·h·ml-1] and that after the meal [(42.6 ±17.7) μg·h·ml-1]. In contrast, the AUC of clavulanate acid after the meal [(1.89 ±0.54) μg·h·ml-1] was significantly lower than that under fasting condition [(2.55 ±0.76) μg·h·ml-1] and that before the meal [(2.58 ±0.76) μg·h·ml-1] (P<0.05). Amoxicillin and clavulanic acid displayed linear pharmacokinetics within the range of 1000-4000 mg and 62. 5-250 mg, respectively. After a single o-ral administration of amoxicillin and clavulanate potassium ER tablets at low, medium and high dose, the duration of blood concentra-tion above the minimum inhibitory concentration (MIC, 2. 0 μg·ml-1) (T> MIC) in 12 h was 5. 5, 7 and 10 h, and the percentage was 46%, 58% and 83%, respectively, and T> MIC in 12 h was 4. 5, 6 and 8 h, and the percentage was 38%, 50% and 67%, re-spectively when MIC was 4. 0μg·ml-1 . Conclusion:It is suggested that amoxicillin and clavulanate potassium ER tablets be taken at the start of a standard meal, 2 tablets per time, twice daily, which is sufficient to achieve T> MIC of 40% -50%.

Objective To observe the effect of levosimendan in the treatment of pulmonary heart disease patients with heart failure.Methods 60 patients were randomly divided into treatment group and control group.The treatment group used levosimendan.The control group used digitalis.We observed the NT -PROBNP, echocardio-graphic and clinical efficacy.Adverse drug reactions were observed too.Results The significantly effect of the treat-ment group was 22 cases(73%),and effective was 8 cases (27%).The significant effect of the control group was 14 cases (43%),and effective was 16 cases (57%).The levels of NT-PROBNP and pulmonary artery pressure in the treatment group were ( 416 ±311 ) pg/mL, ( 51 ±9 ) mmHg after 1 month treatment, which in the control group were (1 516 ±250) ng/mL,(57 ±10) mmHg.The efficacy of the treatment group was better than the control group (χ2 =4.44,P<0.05),the levels of NT-PROBNP and pulmonary artery pressure were lower(t=15.10,2.44,all P<0.05).Conclusion The levosimendan had effects on the pulmonary heart disease patients with heart failure.

Objective To establish an analytical method for assessing acetylcysteine in human plasma and study the relative bioavailability and bioequivalence of acetylcysteine granules in Chinese healthy volunteers. Methods In the randomized crossover study, 24 healthy male volunteers received a single oral dose of 0. 6 g test acetylcysteine granules, reference acetylcysteine granules or no medication. The plasma concentration of acetylcysteine was determined by LC-MS/MS. Pharmacokinetic parameters were calculated and bioequivalence of two preparations were evaluated by DAS3. 0 software. Results The main pharmacokinetic parameters of the test and reference preparations were as follows:AUC0→t was (8 547. 64± 2 860.04) and (8 783.07±4 042. 10) μg·h·L-1, respectively; AUC0→∞ was (9 481. 64±3 444. 76) and (9 540. 51± 4 239. 30) μg·h·L-1, respectively;Cmax was (1 994. 39±726. 42) and (2 090. 27±885. 46) μg·L-1, respectively;tmax was (1.18±0. 60) and (1. 13±0. 53) h, respectively; t1/2 was (8. 60±3. 76) and (7. 75±5. 01) h, respectively. The relative bioavailability F0→t and F0→∞ was ( 107. 0 ± 43. 3 )% and ( 106. 5 ± 40. 1 )%, respectively. Conclusion The results of statistical analysis indicate that the test and reference formulations are bioequivalent.

Objective To investigate the therapeutic mechanism of umbilical cord mesenchymal stem cell(UC-MSCs)trans-plantation for the graves disease(GD)mice .Methods Thirty two mice were divided into 3 groups as following :normal control group (G0) ,GD control group (G1) ,UC-MSCs group(G2) .Enzyme linked immunosorbent assay(ELISA)was used to measure the level of TSAb in blood serum and the expression of FT4 was measured by chemiluminescence .Thyroid sections were stained with hema-toxylin and eosin(HE)for histological examination .Splenocytes were stained with multicolor immunofluorescence and detected by flow cytometry to analyze the percentages of CD1dhiCD5+CD19+ regulatory B cells(Bregs) .Expressions of IL-10 and TGF-βmR-NA in spleen organization were measured by Real-time PCR .Results At 26 weeks ,the level of TSAb in blood serum in G2 was more significantly decreased than in G1(P<0 .05) ,and the level of CD19+ B in spleen in G2 was also more significantly decreased than in G1(P<0 .05) ,however ,the percentage of CD1dhiCD5+CD19+ Bregs splenocytes and the levels of IL-10 and TGF-βmRNA in spleen organization were more significantly increased than in G1(P<0 .05) .The concentration differences of TSAb in serum was negatively correlated with the percentage differences of CD1dhi CD5+ CD19+ Bregs ,however ,positively correlated with the expres-sion differences of IL-10 and TGF-βmRNA in spleen before and after transplantation .Conclusion Activation of Bregs may be one of the mechanisms of UC-MSCs therapeutic effect on GD mice .