OBJECTIVE To explore the role of the establishment of the trans-regional review system on rational drug use in second-grade general hospital ，and to promote the rational drug use. METHODS With the administrative support of Jiuquan Health Commission，5 second-grade general hospitals in Jiuquan Medical Association jointly established Jiuquan Rational Drug Use Review Training Center . A trans-regional review system was established to carry out cross-review of prescriptions and medical orders among 5 second-grade general hospitals. Totally 1 500 prescriptions and 900 medical records were collected from 5 second-grade general hospitals before （April to June ，2020）and after （July to September ，2020）the implementation of the project. The changes of rational drug use indicators ，the results of prescriptions and medical order review were investigated before and after the implementation of the project. RESULTS After the implementation of the project ，except for one hospital ，the proportion of drugs in other hospitals decreased to varying degrees with the highest decline rate of 22.56％ . Compared with before the implementation of the project ，reasonable rate of outpatient and emergency prescription review increased by 5.72％ averagely and the reasonable rate of medical order review increased by 10.10％（P＜0.05）. The average utilization rate of antibiotics in outpatients decreased by 14.45％，the average utilization rate of antibiotics in inpatients decreased by 7.98％，and the average use intensity of antibiotics decreased by 25.19％. CONCLUSIONS Through the establishment of trans-regional review system ，medical institutions can be forced to pay more attention to prescription review ，effectively improve the prescription review of pharmacists in medical institutions，and promote the rational use of drugs in medical institutions in the region. However ，there are still some problems ， such as incomplete system coverage ，insufficient work experience ，lagging of informatization ，uneven pharmacist level ，and insufficient assessment and supervision of administrative functional departments.

China ; Esophageal Neoplasms ; Humans ; Length of Stay ; Malnutrition ; Mass Screening ; Postoperative Complications ; ROC Curve ; Sensitivity and Specificity

Objective To explore the feasibility of the deep convolutional neural network (DCNN) judging the indications and prognosis of the total knee arthroplasty based on the trained DCNN computer learning system.Methods C1FAR-10 DCNN model based on TensorFlow (an open source system,Google,USA) optimized by Alex Krizhevsky were constructed.There were 400 cases with knee osteoarthritis from different databases used for analysis.Three hundred patients underwent total knee arthroplasty,while 100 did not.X-ray of 200 preoperative cases from the 400 cases and their enlarged image (50 times) were applied for training DCNN,while the enlarged images from other 200 cases were used to test the DCNN.The correlation and the regression between judgment of the DCNN and clinical truth were analyzed.The clinical truths were rechecked three times and were confirmed by treatment results.Pearson correlation and linear regression analysis were used.The relation test of the software was only used as a reference.Results There was no significant difference between the baseline of cases for learning and test.After learning 200 cases,the DCNN judged the 10 000 cases enlarged from remaining 200 cases.The correlation between the DCNN judgment and the clinical truth was not significant (r=0.000,F=0.001,P=0.970).False positive was observed in 1 681 cases,false negative in 3 296.After enlarged to 10 000 images,the correlation between the two judgments was significant (F=11 228.735,P=0.000,r=0.727 and R2=0.529).The software detection precision was 0.860.Conclusion DCNN can be applied in judging the indications of the total knee arthroplasty.Large sample size can improve the accuracy of the judgment significantly.

Objective To assess the effect of thoracoscopic surgery under laryngeal mask anesthesia and explore the nursing strategies. Methods Thirty-five patients from April to December in 2014 undergoing video-assisted thoracoscopic surgery (VATS) were given intubation anesthesia and another thirty-five ones undergoing the same surgery in 2015 received laryngeal mask anesthesia. The two groups were compared in terms of surgery conditions, surgery complication and ambulation time. Results No significant differences were found in surgery time or blood loss between two groups (P>0.05). The postoperative waking time in the mask anesthesia group was significantly shorter than that of the intubation anesthesia group (P<0.05), and ambulation time was significantly shortened (P<0.05). The rates of throat discomfort, hoarseness and gastrointestinal reactions were significantly lower. Conclusions Laryngeal mask anesthesia used in small thoracoscopic surgery for airway management is safe and feasible. Combined with training in respiration and limb function, better analgesia and nursing, it can keep away complications related to intubation anesthesia, shorten hospital stay and accelerate postoperative rehabilitation.

Objective To investigate the impact of surgical resection on patients with Ⅱ-Ⅲ A stage small cell lung carcinoma (SCLC). Method Data of 61 in-patients who diagnosed as Ⅱ-ⅢA stage SCLC from Jan 1st 2009 to Feb 1st 2014 were analyzed. 23 patients underwent surgical resections were enrolled as the treatment group, while 38 patients without surgical resection were enrolled as the control group. Disease progression was confirmed by monthly examination. The grouping is balanced by propensity score match. The progression-free survival (PFS) time and overall survival(OS) were analyzed with Kaplan-Meier survival method and Cox regression is applied to analyze the covariates. Fisher's exact test was applied to compare one-year survival rate and two-year survival rate. Results The PFS and OS of the treatment group is longer than that of the control group (P < 0.05). Both one-year and two-year survival rates of the treatment group outnumber those of the control group (P < 0.05). Cox regression indicates that surgical resection is an independent prognostic factor (P < 0.05). Conclusion Surgical resection on tolerable patients with stage Ⅱ-Ⅲ A small-cell lung carcinoma is effective on improving the progression-free survival time,one-year and two-year survival rates,and also shows a propensity of a higher overall survival time.

Objective To investigate the consistency in 18F-deoxyglucose positron emission tomography (18F-FDG PET-CT) examination and histopathological analyses in the diagnoses of resectable lung tumors. Methods Retrospective reviews over the clinical data of lung tumor patients by preoperative PET-CT diagnosis and postoperative histopathological diagnosis were conducted to investigate the effects of the two diagnostic methods in terms of lung tumor properties , mediastinal lymph node metastasis , and pulmonary hilar lymph node metastasis. Results The diagnoses by preoperative PET-CT was consistent in differentiation of non-malignancy and malignancy of pathologic lung tumors by 87.3%, at a medium level (κ = 0.401, P < 0.001). McNemar test showed P = 0.508, indicating the two diagnostic methods were insignificantly different in the diagnosis of pulmonary tumors. The preoperative PET-CT was consistent in the diagnosis of the metastasis of pathologic mediastinal lymph node by 85.9%, at a medium level (κ = 0.697, P < 0.001). McNemar test showed P =0.754, indicating no significant difference between the diagnostic methods. The preoperative PET-CT was consistent with postoperative pathological examinations in the differentiations of the metastasis of pulmonary and hilar lymph node by 77.4%, at a medium level (κ=0.523, P < 0.001). McNemar test showed P = 0.454, indicating the two diagnostic methods were no significantly different. Conclusion Preoperative PET-CT and histopathologic examinations may be consistent in lung tumor diagnosis , which provides a basis for a certain significance in the surgical options.

Objective To observe the therapeutic effect ofYiqi-Fumai injection andShenshao capsule in the treatment of angina pectoris and the influence on vascular endothelial cell function and serum MPO. Methods 90 cases of angina pectoris of coronary heart disease were randomly divided into a treatment group and a control group. 50 cases in the treatment group were treated withYiqi-Fumai injection and Shenshao capsule; 40 cases in the control group were treated with Plavix and metoprolol; clinical symptoms were observed before and after treatment, the indexes of endothelial cell function and electrocardiogram blood serum nitric oxide (NO), endothelin (ET), NOS and serum MPO, SOD, GSH changes were compared.Results The content of nitric oxide (NO), 6-keto-PGFLa and NOS of the treatment group were increased than the control group, while ET was reduced. In the treatment group, NO was (78.09 ± 88.71)μmol/L 6-keto-PGFL was 32.04 ± 25.82 pg/ml and NOS was 27.88 ± 9.08 U/MI before the treatment,; after the treatment, the NO was 127.11 ± 103.60μmol/L, 6-keto-PGFLa was 50.03 ± 60.87 pg/ml and NOS was 35.12 ± 22.18 U/MI. In the control group, NO was 96.98 ± 82.45μmol/L, 6-keto-PGFLa was 40.31 ± 51.92 pg/ml and NOS was 28.12 ± 5.11 U/MI before the treatment; After the treatment, NO was 95.62 ± 6.31μmol/L, 6-keto-PGFLa was 29.09 ± 42.01 pg/ml and NOS was 30.11 ± 7.51 U/MI. In the treatment group, ET was 58.81 ± 33.18 pg/ml before the treatment and 42.47 ± 40.5 pg/ml. after the treatment. In the control group, ET was 56.81 ± 32.76 pg/ml before the treatment and 60.67 ± 12.81 pg/ml after the treatment. In terms of resistance to oxidative stress and MPO, the SOD ,GSH and MPO improvement rate of the treatment group was significantly better than the control group (P<0.05). In the treatment group, SOD was 48.36 ± 17.38 U/MI, GSH was 126.68 ± 19.93 g/L and MPO was 57.33 ± 8.34 mmol/L before the treatment, after the treatment, SOD was 62.45 ± 15.76 U/MI, GSH was 135.98 ± 28.99 g/L and MPO was 17.11 ± 3.60 mmol/L. In the control group, SOD was 48.44 ± 19.37 U/MI, GSH was 29.44 ± 21.66 g/L and MPO was 56.35 ± 14.44 mmol/L before the treatment, after the treatment, SOD was 57.35 ± 14.44 U/MI, GSH was 28.56 ± 24.06 g/L and MPO was 48.62 ± 6.31 mmol/L.ConclusionYiqi-Fumai injection combined with Shenshao capsule has curative effect on angina pectoris of coronary heart disease, being worth of clinical use.

ObjectiveTo investigate the impacts of portal vein arterializations (PVA) on the liver regeneration in rats with liver cirrhosis.MethodsFifty rats with liver cirrhosis model were randomly divided into PVA group (n=40) and control group (n=10) according to the random number table method. Rats in PVA group underwent PVA+portocaval shunt. Rats in control group received no treatments. The ratio of hepatic wet weight to body weight, the hepatocyte percentage of positive proliferating cell nuclear antigen (PCNA) and hepatocyte percentage in DNA synthesis phase (S phase) in each group were measured at the time of 1 week (T1), 2 weeks (T2), 4 weeks (T3) and 8 weeks (T4) after operation or enrolling in the group. Parameters of every time points inside the group were compared by one-way analysis of variance and pairwise comparison was conducted by LSD-t test. Comparison between groups was conducted byt test.Results The ratio of hepatic wet weight to body weight at T1,T2,T3,T4 in PVA group [(3.72±0.26)%, (3.81±0.27)%, (3.83±0.31)%, (3.78±0.31)%] were signiifcantly increased compared with that in control group [(2.84±0.37)%] (t=6.11,6.64,6.49,6.17;P<0.05). The hepatocyte percentage of positive PCNA at T1, T2, T3, T4 in PVA group [(76±6)%, (69±8)%, (20±5)%, (15±4)% ] were signiifcantly increased compared with that in control group [(11±2)%] (t=34.48, 22.87,5.69,2.93;P<0.05). The hepatocyte percentage of positive PCNA at different time points inside the PVA group decreased gradually as time extended, where signiifcant difference was observed (F=316.20,P<0.05). The hepatocyte percentage in S phase at T1, T2, T3, T4 in PVA group [(27.0±1.2)%, (20.5±1.4)%, (16.2±1.3)%, (13.5±1.3)%] were signiifcantly increased compared with that in control group [(11.6±1.9)%] (t=21.97, 12.15, 6.30, 2.68;P<0.05). The hepatocyte percentage in S phase at different time points inside the PVA group decreased gradually as time extended, where signiifcant difference was observed (F=208.00,P<0.05).ConclusionsPVA can effectively promote liver regeneration in rats with liver cirrhosis and the effect declines as time extends.

Background and objective Platinum plus a third-generation agent doublet chemotherapy is the stan-dard regimen and ifrst-line chemotherapy for the treatment of advanced non-small cell lung cancer (NSCLC). hTe aim of this study is to evaluate the effcacy and safety of docetaxel plus platinum (DP) compared with vinorelbine plus platinum (VP) regimens in patients with advanced NSCLC. Methods We searched the PubMed, EMBASE, Cochrane Library, CNKI, CBM, VIP, and WanFang databases for randomized controlled trials (RCTs), in which DP regimen was compared with VP regimen. A quality assessment of qualiifed RCTs was performed according to Cochrane Handbook 5.1.0, and Stata 12.0 was used to per-form meta-analysis. Results Seven RCTs involving 2,318 patients were included. Meta-analysis results indicated that the DP regimen increased the two-year survival rate (HR=0.887, 95%CI:0.810-0.972, P=0.010), response rate (RR=1.276, 95%CI:1.107-1.450, P=0.001), and diarrhea rate (RR=3.134, 95%CI:1.918-5.121, P<0.001) compared with the VP regimen. Anemia rate was also reduced (RR=0.386, 95%CI:0.311-0.478, P<0.001). No statistical differences were observed between DP and VP regimens in terms of one-year survival rate, leukopenia, neutropenia, thrombocytopenia, anorexia, nausea, and vomiting. Conclusion DP regimen reduced the rate of anemia and increased the rate of diarrhea, two-year survival rate, and response rate. hTerefore, DP regimen may be a more effective option as a ifrst-line treatment for advanced NSCLC compared with VP regimen.

OBJECTIVETo summarize our experience with video-assisted thoracoscopic (VATS) removal of esophageal leiomyoma located with endoscopy during operation.

METHODSBetween January 2006 and December 2010, 55 patients with esophageal leiomyoma underwent VATS enucleation. The surgical procedure was similar to that of open thoracotomy with intraoperative endoscopic location of the tumor and examination of the mucosal integrity especially for tumors less than 1 cm in diameter.

RESULTSOf the 55 patients undergoing VATS tumor removal, 54 patients completed the procedures smoothly, and 1 patient experienced ventricular fibrillation during the operation to require an open thoracotomy. Endoscopy was used in 38 patients during the operation. VATS enucleation differed significantly from open thoracotomy in the volume of bleeding, postoperative fasting days and postoperative hospital stay (P<0.05). The symptoms were completely relieved after the operation without postoperative complications. The patients were followed up for 8 to 59 months (mean 23.0 months) and no recurrence was found.

CONCLUSIONVATS removal of esophageal leiomyomas is minimally invasive, safe and effective and can serve as the primary option for surgical removal of esophageal leiomyomas.

Adolescent ; Adult ; Aged ; Esophageal Neoplasms ; surgery ; Female ; Gastroscopy ; methods ; Humans ; Leiomyoma ; surgery ; Male ; Middle Aged ; Thoracic Surgery, Video-Assisted ; methods ; Thoracoscopy ; Thoracotomy ; Treatment Outcome ; Young Adult