Objective To discuss on the application of innovative quality control circle in optimizing pharmaceutical care,design pharmaceutical care model according to needs,and improve the quality of pharmaceutical care.Methods Using 10 steps of innovative quality control circle,the quality function development(QFD)was carried out by multidimensional quality tools,and the demand for pharmaceutical services was analyzed in the form of"House of Quality"Combined with PDCA cycle management tool,the situation of pharmaceutical services before and after improvement was analyzed and evaluated.Results After the implementation of the activities,many contents hd been improved,such as the dispensing time for outpatient pharmacy patients decreased from 16 min to 8 min,the finished product infusion configuration time in pharmacy intravenous admixture services decreased from 15 min to 7 min,the surgery pharmacy special management drug report automatically generated number increased from 2 copies to 6 copies,the daily order review time for each department of pharmacy decreased from 80 min to 20 min,the perfection rate of pharmaceutical care digital module increased from 65.23％to 80.34％,and the multidimensional quality tool adoption rate increased from 60.00％to 93.00％.In addition,a number of additional benefits and intangible results were obtained.Conclusion Adopting the management mode of QFD combined with PDCA cycle can effectively reconstruct the management mode of pharmaceutical care,and effectively promote the scientific and fine management of pharmaceutical care.

Objective:To evaluate the safety and clinical efficacy of hypofractionated radiotherapy (HFRT) at 36.5 Gy in 10 fractions for the chest wall and reginal lymph nodes following modified radical mastectomy for breast cancer.Methods:This was a prospective, single-arm, phase Ⅱ clinical study. A total of 85 patients who received HFRT at 36.5 Gy in 10 fractions to the chest wall ± supraclavicular region following modified radical mastectomy for locally advanced breast cancer from March 2014 to December 2015 were included. The primary endpoint was radiotherapy toxicities. The secondary endpoints were locoregional failure-free survival (LRFFS), disease-free survival (DFS), and overall survival (OS).Results:The median follow-up period was 98 (94.0-109.0) months. Radiotherapy toxicities were mild. The incidence rates of grade 1 acute cutaneous and pulmonary toxicities were 52.9% and 40%, and those of grade 1 late cutaneous, pulmonary, and cardiac toxicities and upper extremity edema were 10.6%, 29.4%, 2.4%, and 21.2%, respectively. Only 1 (1.2%) patient suffered from grade 2 radiation-induced brachial plexus injury. Of the 85 patients, one patient had regional recurrence (supraclavicular lymph nodes), six patients had distant metastasis, and six patients died of breast cancer. The 9-year LRFFS, DFS, and OS were 97.7%, 91.8%, and 92.8%, respectively.Conclusions:HFRT at 36.5 Gy in 10 fractions following modified radical mastectomy for breast cancer is associated with mild toxicities. A phase Ⅲ study is necessary for validating HFRT's clinical efficacy.

Objective:To investigate the diagnostic value of a single hydrogen-methane breath test (SHMBT) for small intestinal bacterial overgrowth (SIBO).Method:The current investigation was a cross-sectional study. Questionnaires and SHMBTs were administered to 162 patients with gastrointestinal symptoms (case group) and 69 healthy volunteers (control group). Differences in SHMBT results between the two groups were assessed,and cut-off values of CH 4 (methane) and H 2 (hydrogen) were analyzed via receiver operating characteristic (ROC) curves. Lastly,archived SHMBT data from 2 655 patients with gastrointestinal symptoms (validation set) were used to evaluate the diagnostic value of the SHMBT with respect to SIBO. The Chi-square test,the Mann-Whitney U test,Spearman′s Rank correlation analysis,and the Z test were used for statistical analysis. Results:Based on the international recommended diagnostic criteria for SIBO,which are fasting CH 4 ≥10 ppm (parts per million) or H 2 ≥20 ppm,the SHMBT-positive rate in the case group was significantly higher than that of control group (35.2% vs. 21.7%, χ2=4.08, P=0.043). Levels of CH 4 and H 2 were higher in the case group than in the control group [CH 4: 3(2,7) vs. 3(1,3) ppm, H 2: 11(4,22) vs. 10(5,15) ppm],and the difference in CH 4 levels was statistically significant ( Z=6.22, P=0.001). ROC curves were generated based on whether the subjects had gastrointestinal symptoms. The areas under the ROC curves were 0.633 for CH 4 alone,0.531 for H 2 alone, and 0.620 for CH 4 combined with H 2. The cut-off values were fasting CH 4≥4 ppm,fasting H 2≥13 ppm,and fasting CH 4 ≥5 ppm (or CH 4≥4 ppm and H 2≥24 ppm),respectively. Measuring CH 4 alone and CH 4 combined with H 2 was effective for determining the presence of gastrointestinal symptoms ( P<0.05). When CH 4 alone or CH 4 combined with H 2 were used as diagnostic indicators of SIBO, the respective SHMBT-positive rates in the validation set were 34.2% and 30.4%. These rates did not significantly differ from the SIBO-positive rate of 32.0% obtained via the international recommended diagnostic criteria ( P>0.05). The specificity of CH 4 alone was 79.9%,and the accuracy of CH 4 alone was 68.8%. The specificity of CH 4 combined with H 2 was 85.0%,and the accuracy of CH 4 combined with H 2 was 71.7%. Conclusion:Rapid one-time determination of CH 4 and H 2 in exhaled breath may a viable diagnostic method for SIBO, and using CH 4 combined with H 2 ( i.e.,fasting CH 4≥5 ppm, or CH 4 ≥4 ppm and H 2 ≥24 ppm) as cutoff values may be feasible.

OBJECTIVE To study the anti-inflammatory immune response effects of lactoferrin in the treatment of periodontitis and its mechanism. METHODS One hundred SD rats were randomly divided into blank control group, model group, lactoferrin administration group low, medium, high dose group(1, 2, 3 g·kg-1), metronidazole positive control group (0.02 g·kg-1), PDTC group(200 mg·kg-1), lactoferrin+PDTC group(2 g·kg-1, 200 mg·kg-1), MCC950 group(1 mg·kg-1) and lactoferrin+MCC950 group(2 g·kg-1, 1 mg·kg-1), 10 rats in each group. Silk thread ligation combined with 10% sucrose drinking water was used to establish the model, and then the drug was administered orally once a day. The blank control group and the model group were administered orally with 0.9% NaCl. The rats in each group were sacrificed after one month of continuous administration. The contents of IL-1b, IL-8 and IL-10 were detected by ELISA kit, and the expressions of TLR2-NF-κB pathway and NLRP3 inflammasome related proteins were detected by Western blotting. HE staining was used to observe the pathological changes of the periodontal tissues of the rats in each group. RESULTS Compared with the model group, the symptoms of periodontitis in each dose group of lactoferrin were significantly improved. HE staining showed that the infiltration of inflammatory cells was reduced, and the proliferation of fibroblasts was active. The protein expressions of TLR2, NF-κB, NLRP3, Caspase-1 p20 and GSDMD-N decreased, the content of pro-inflammatory factor IL-8 and IL-1b decreased, and the content of anti-inflammatory factor IL-10 increased. CONCLUSION Lactoferrin may play a role in the regulation of inflammatory immune response in the treatment of periodontitis by down-regulating the protein expression of TLR2-NF-κB-NLRP3 pathway, reducing the initiation of inflammatory response and the release of inflammatory factors, so as to achieve the purpose of anti-inflammatory.

Objective To investigate the effect of acupuncture at Yangming meridian combined with modified Buyang Huanwu Decoction on hemiplegia,hemorheology and neurotrophic factors in pa-tients with cerebral infarction differentiated as type of Qi deficiency and blood stasis.Methods A to-tal of 84 hospitalized patients with cerebral infarction differentiated as type of Qi deficiency and blood stasis from March 2018 to June 2023 were selected as research objects,and they were randomly divid-ed into observation group and control group,with 42 cases in each group.The control group was con-ducted with acupuncture and routine treatment,while the observation group was conducted with modi-fied Buyang Huanwu Decoction on the basis of the control group.Clinical efficacy after 2 weeks of treatment as well as the scores of main symptoms,neurological function,limb function,hemorheologi-cal indicators and levels of neurotrophic factors before and after treatment were compared between two groups.Results After 2 weeks of treatment,the total effective rate of the observation group was sig-nificantly higher than that of the control group(P＜0.05);after treatment,the scores of symptoms such as hemiplegia,deviated mouth and awkward speech in both groups decreased significantly when compared to those before treatment,and these scores in the observation group were significantly lower than those in the control group(P＜0.05).After treatment,the score of the National Institutes of Health Stroke Scale(NIHSS)in both groups decreased significantly when compared to that before treat-ment,and the score in the observation group was significantly lower than that in the control group(P＜0.05);the score of the Motor Function Assessment Scale(Fugl-Meyer)after treatment in both groups was significantly higher than that before treatment,and the observation group was significant-ly higher than that in the control group(P＜0.05).After treatment,the plasma viscosity,red blood cell aggregation index,whole blood high shear viscosity and whole blood low shear viscosity in both groups decreased significantly when compared to those before treatment,and these indexes in the observation group were significantly lower than those in the control group(P＜0.05).After treatment,the levels of serum brain derived neurotrophic factor(BDNF),nerve growth factor(NGF)and glial cell line-derived neurotrophic factor(GDNF)in both groups increased significant-ly when compared to those before treatment,and the levels of these indexes in the observation group were significantly higher than those in the control group(P＜0.05).Conclusion Acupuncture at Yangming meridian combined with modified Buyang Huanwu Decoction can enhance the therapeutic effect for patients with cerebral infarction differentiated as type of Qi deficiency and blood stasis,im-prove clinical symptoms,repair nerve damage,and promote the recovery of limb function.

Objective To investigate the effect of acupuncture at Yangming meridian combined with modified Buyang Huanwu Decoction on hemiplegia,hemorheology and neurotrophic factors in pa-tients with cerebral infarction differentiated as type of Qi deficiency and blood stasis.Methods A to-tal of 84 hospitalized patients with cerebral infarction differentiated as type of Qi deficiency and blood stasis from March 2018 to June 2023 were selected as research objects,and they were randomly divid-ed into observation group and control group,with 42 cases in each group.The control group was con-ducted with acupuncture and routine treatment,while the observation group was conducted with modi-fied Buyang Huanwu Decoction on the basis of the control group.Clinical efficacy after 2 weeks of treatment as well as the scores of main symptoms,neurological function,limb function,hemorheologi-cal indicators and levels of neurotrophic factors before and after treatment were compared between two groups.Results After 2 weeks of treatment,the total effective rate of the observation group was sig-nificantly higher than that of the control group(P＜0.05);after treatment,the scores of symptoms such as hemiplegia,deviated mouth and awkward speech in both groups decreased significantly when compared to those before treatment,and these scores in the observation group were significantly lower than those in the control group(P＜0.05).After treatment,the score of the National Institutes of Health Stroke Scale(NIHSS)in both groups decreased significantly when compared to that before treat-ment,and the score in the observation group was significantly lower than that in the control group(P＜0.05);the score of the Motor Function Assessment Scale(Fugl-Meyer)after treatment in both groups was significantly higher than that before treatment,and the observation group was significant-ly higher than that in the control group(P＜0.05).After treatment,the plasma viscosity,red blood cell aggregation index,whole blood high shear viscosity and whole blood low shear viscosity in both groups decreased significantly when compared to those before treatment,and these indexes in the observation group were significantly lower than those in the control group(P＜0.05).After treatment,the levels of serum brain derived neurotrophic factor(BDNF),nerve growth factor(NGF)and glial cell line-derived neurotrophic factor(GDNF)in both groups increased significant-ly when compared to those before treatment,and the levels of these indexes in the observation group were significantly higher than those in the control group(P＜0.05).Conclusion Acupuncture at Yangming meridian combined with modified Buyang Huanwu Decoction can enhance the therapeutic effect for patients with cerebral infarction differentiated as type of Qi deficiency and blood stasis,im-prove clinical symptoms,repair nerve damage,and promote the recovery of limb function.

Objective: To establish a hypertension risk assessment model among the middle-aged and elderly populations based on residents' electronic healthcare records of the basic public health service program, so as to provide insights into prevention of hypertension. Methods: Demographic features and physical examinations were collected among residents at ages of 40 years and older from residents' electronic healthcare records of the basic public health service program in a county of Zhejiang Province from 2019 to 2020. The risk factors of hypertension were identified using a multivariable logistic regression model, and the odds ratio (OR) for each risk factor was transformed into approximate relative risk (RR), which was included in the formula for calculation of the disease risk proposed by Harvard School of Public Health to create a hypertension risk assessment model. The predictive value of the model was evaluated using a receiver operator characteristic (ROC) curve. Results: Totally 7 275 subjects were enrolled, with a mean age of (66.15±7.91) years, and the participants included 3 189 males and 4 086 females, with a male-to-female ratio of 0.78∶1. There were 190 cases with new-onset hypertension (2.61%). Multivariable logistic regression analysis revealed that overweight, obesity, central obesity, borderline high triacylglycerol (TG), elevated TG, abnormal fasting plasma glucose (FPG), prehypertension and family history of hypertension were included in the hypertension risk assessment model, with approximate RR values of 1.66, 1.96, 1.54, 1.17, 1.64, 1.45, 1.69 and 1.11. The area under the ROC curve (AUC) of the model was 0.678 (95%CI: 0.641-0.715, P<0.001), and the optimal positive cut-off was 0.899. The model predicted 139 subjects with RR>0.899 for hypertension, with a sensitivity of 73.16% and specificity of 55.79%. Conclusions The hypertension risk assessment model created in this study is feasible to predict the RR for developing hypertension among the middle-aged and elderly populations, which has a predictive value in healthcare management.

Objective:To investigate the relationship between plasma levels of complements before treatment and the clinicopathological feathers and prognoses of diffuse large B-cell lymphoma (DLBCL) patients treated with Rituximab (R)-CHOP or R-CHOP-like therapy.Methods:The clinicopathological data of 105 DLBCL patients treated in cancer Hospital of Chinese Academy of Medical Sciences from 2010 to 2016 were collected. The plasma samples from 105 DLBCL patients treated with R-CHOP or R-CHOP-like therapy and 80 healthy controls were used to detect 34 complement levels before treatment by utilizing antibody microarray. The relationship between plasma levels of complements and the clinicopathological feathers and prognosis of DLBCL patients were analyzed.Results:The signal values of C1QA and CR1L in patients with international prognostic index (IPI) scores of 3-5 were 1 261.43±138.9 and 2 214.69±98.58, respectively, higher than 950.79±80.19 and 984.67±121.79 in patients with IPI scores of 0~2 (both P<0.05). The levels of C1QA and CR1L in the non-complete response (CR) group were 1 165.43±98.56 and 2 263.13±145.63, respectively, higher than 914.70±100.77 and 1 821.34±84.68 in the CR group (both P<0.05). Cox regression analysis showed that elevated C1QA signal value was associated with poor progression-free survival (PFS) and poor overall survival (OS) (PFS: HR=2.063, 95% CI: 1.220-3.489, P=0.007; OS: HR=2.23, 95% CI: 1.036~4.798, P=0.040). After IPI correction by Cox multivariate model, the elevated C1QA signal value was still correlated with poor PFS ( HR=1.765, 95% CI 1.034~3.013, P=0.037). Conclusions:The baseline plasma levels of C1QA and CR1L are correlated with IPI scores and therapeutic effects of DLBCL patients treated with R-CHOP. The baseline plasma level of C1QA has a certain predictive value for the prognostic evaluation of DLBCL.

Objective:To investigate the relationship between plasma levels of complements before treatment and the clinicopathological feathers and prognoses of diffuse large B-cell lymphoma (DLBCL) patients treated with Rituximab (R)-CHOP or R-CHOP-like therapy.Methods:The clinicopathological data of 105 DLBCL patients treated in cancer Hospital of Chinese Academy of Medical Sciences from 2010 to 2016 were collected. The plasma samples from 105 DLBCL patients treated with R-CHOP or R-CHOP-like therapy and 80 healthy controls were used to detect 34 complement levels before treatment by utilizing antibody microarray. The relationship between plasma levels of complements and the clinicopathological feathers and prognosis of DLBCL patients were analyzed.Results:The signal values of C1QA and CR1L in patients with international prognostic index (IPI) scores of 3-5 were 1 261.43±138.9 and 2 214.69±98.58, respectively, higher than 950.79±80.19 and 984.67±121.79 in patients with IPI scores of 0~2 (both P<0.05). The levels of C1QA and CR1L in the non-complete response (CR) group were 1 165.43±98.56 and 2 263.13±145.63, respectively, higher than 914.70±100.77 and 1 821.34±84.68 in the CR group (both P<0.05). Cox regression analysis showed that elevated C1QA signal value was associated with poor progression-free survival (PFS) and poor overall survival (OS) (PFS: HR=2.063, 95% CI: 1.220-3.489, P=0.007; OS: HR=2.23, 95% CI: 1.036~4.798, P=0.040). After IPI correction by Cox multivariate model, the elevated C1QA signal value was still correlated with poor PFS ( HR=1.765, 95% CI 1.034~3.013, P=0.037). Conclusions:The baseline plasma levels of C1QA and CR1L are correlated with IPI scores and therapeutic effects of DLBCL patients treated with R-CHOP. The baseline plasma level of C1QA has a certain predictive value for the prognostic evaluation of DLBCL.

[Abstract] Objective: To investigate the short-term clinical efficacy and safety of intraperitoneal perfusion of natural killer (NK) cells in the treatment of ovarian cancer with ascites. Methods: The clinical data of 15 ovarian cancer patients with ascites effusion, who received NK cell perfusion in the Qinhuai Medical District of the General Hospital of Eastern Theater Command from November 2016 to January 2019, were analyzed. The peripheral blood was collected to isolate the peripheral blood mononuclear cells, and to further obtain the NK cells after culture. NK cell suspension was intraperitoneally perfused into the abdominal cavity (no less than 2×109 cells/ time). The volume of peritoneal effusion, the level of serum tumor marker CA-125, the level of serum cytokines IL-2, INF-γ and TNF-α as well as the changes in peripheral blood lymphocyte subsets were detected before and after the treatment; Moreover, the clinical efficacy and adverse reactions were observed. Results: The effective rate of intraperitoneal perfusion of NK cells was 66.7%, and there were no obvious treatment-related adverse reactions. Compared with before treatment, the serum tumor marker CA-125 level significantly decreased after treatment (P<0.05), and the levels of IL-15, IFN-γ and TNF-α increased significantly (P<0.05 or P<0.01), while there was no significant changes in peripheral blood lymphocyte subsets (all P>0.05). Conclusion: Intraperitoneal infusion of NK cells in the treatment of ovarian cancer associated peritoneal effusion has a good short-term clinical efficacy with little adverse reactions, which is a promising method for the treatment of cancerous peritoneal effusion.