OBJECTIVE To analyze the metabolites of Zhideke granules and speculate its metabolic pathway in rats in vivo. METHODS Male SD rats were randomly divided into blank group and administration group （Zhideke granules， 9.45 g/kg）； they were given ultrapure water or relevant medicine， twice a day， every 6-8 h， for 3 consecutive days. Serum， urine and feces samples of rats were collected， and their metabolites were identified by UPLC-Q-Exactive-MS technique after intragastric administration of Zhideke granules； their metabolic pathways were speculated. RESULTS After intragastric administration of Zhideke granules， 16 prototype components （i.g. irisflorentin， baicalin， chlorogenic acid） and 11 metabolites （i.g. hydration products of kaempferol or luteolin， methylation products of chlorogenic acid， and hydroxylation products of baicalin） were identified in serum， urine and feces of rats. Among them， 8 prototype components and 4 metabolites were identified in serum samples； 10 prototype components and 7 metabolites were identified in urine samples； 8 prototype components and 5 metabolites were identified in the fecal samples. CONCLUSIONS The metabolites of Zhideke granules in rats mainly include baicalin， irisflorentin，chlorogenic acid， and the main metabolic pathways included methylation， hydroxylation， glucuronidation.

Objective:To retrieve, evaluate and summarize the relevant evidence of subcutaneous injection in patients to reduce pain at the injection site, so as to provide reference for clinical practice.Methods:According to the evidence pyramid "6S" model, all evidence on subcutaneous injection and injection site pain, including guidelines, expert consensus, summary of evidence, clinical decision, systematic review, etc were retrieved from domestic and international guideline networks and databases. The search period was from database establishment to October 2, 2022. The literature quality evaluation and evidence grading system of Joanna Briggs Institute (JBI) Evidence-based Health Care Center was used to evaluate the literature quality and classify the evidence level.Results:A total of 12 articles were included, including 2 expert consensus, 6 systematic reviews, 2 best evidence summaries and 2 clinical guidelines. A total of 21 pieces of best evidence were summarized from 8 aspects, including pre-subcutaneous injection assessment, injection site, injection needle, injection position, injection method, precautions, personnel training and health education.Conclusions:This study summarized a comprehensive and practical subcutaneous injection method. Clinical practitioners can use evidence to administer subcutaneous injection to patients, reduce pain and improve patients ′ comfort.

【Objective】 To investigate the influence of different packaging methods on the volume of low-dose(0.5 U) suspended leucocyte depleted red blood cells(SLD RBC) and provide reference for accurate labeling. 【Methods】 Bags of SLD RBC in 1.5 U and 2 U were randomly sampled to measure the weight and specific gravity of each bag, so as to estimate the blood volume.The relationship between the weight and volume of 0.5 U blood, split from different parent bags, was analyzed and the linear regression equation was put forward.The regression equation was used to calculate and analyze the difference in the volume of 0.5 U SLD RBC prepared by three different packaging methods (A: manual multi-bag average packing; B: instrument multi-bag average packing; C: manual single-bag packing) in actual work. 【Results】 The specific gravity of 1.5 U (38 bags) and 2 U SLD RBC (39 bags) were (1.090±0.011) g/mL and (1.097±0.013) g/mL, respectively, and the difference was statistically significant (P<0.05). After the 0.5 U subsidiary bags were split from the parent bags(1.5 U or 2 U), the regression equations for the volume (Y) of 0.5 U and gross weight (X) of the whole bag were respectively: Y1.5 U packing=0.902 7X-12.52 (P<0.05) and Y2 U packing=0.905 6X-13.15(P<0.05). In actual blood packaging, the average blood volume of 0.5 U subsidiary bags split from 1.5 U bag, using method A and B, were smaller than those split from 2 U bag [(62.12±5.38) mL and (62.50±6.77) mL vs (67.72±3.81) mL and(68.39±6.44)mL] (P<0.05), with the deviation of low-dose blood volume from 5.593 mL to 5.887 mL.The volume deviation by method B (10.84% and 9.42%) were greater than that by method A (8.67% and 5.63%). The average volume of 0.5 U subsidiary bags split from 1.5 U and 2 U by method C were (65.49±1.72) mL and (64.99±1.91) mL (P>0.05), with volume deviation at 2.63% and 2.94%, respectively.The mean volume value of overall 0.5 U blood (n=483) was (65.35±5.34) mL. 【Conclusion】 For packaging 0.5 U subsidiary bags, the instrument multi-bag packaging showed the largest volume deviation, followed by the manual multi-bag packaging and the single-bag packaging.The volume labeling of low-dose SLD RBC should be established, according to the specifications of parent bags and specific gravity.

【Objective】 To retrospectively analyze the clinical use of low-dose blood components in Dongguan and the trend of clinical pediatric blood use, so as to provide reference for better preparation and inventory management of low-dose blood components in blood centers. 【Methods】 The clinical consumption of RBCs, platelets and plasma of Dongguan Blood Center from 2015 to 2020 was counted. The compositions and changes of low-dose blood components by specifications (0.25 U, 0.5 U), years and hospitals (public grade A general hospital, public grade A specialized hospital, private grade A hospital, private hospital equivalent to grade A, regional central hospital, public township hospital, small private hospital) were analyzed. 【Results】 The cumulative growth rates of low-dose RBCs, platelets, and plasma in 6 years were 10.78%, 1 098.55% and -29.41%, respectively, and the compound annual growth rates were 2.07%, 64.34% and -6.73%, respectively. The composition of low-dose blood components in RBCs, platelets and plasma was different (P<0.05) in different levels of hospitals, among which RBCs and plasma were the mostly used in public grade A specialized hospital, accounting for 45.08% (7 272 /16 133) and 53.18% (7 199/13 373) respectively, while platelets were the mostly used in private grade A management hospitals, accounting for 77.38% (3 393/4 385), dominated by apheresis platelets 53.84% (1 144/2 125) and irradiated apheresis platelets 99.51% (2 249/2 260). The composition ratios of 0.25 U and 0.5 U RBCs used in different hospitals were significantly different (P<0.05). The 0.25 U RBCs were used mostly in public grade A hospitals (62.60%, 3 502/5 594) and 0.5 U RBCs in public grade A specialized hospitals (62.09%, 6 544/10 539). 【Conclusion】 The total consumption of low-dose blood components in clinical pediatrics from 2015 to 2020 were as follows: platelets had increased significantly year by year, RBCs had increased steadily and with fluctuation, plasma had a downward trend year by year. The consumption volume and varieties used in different levels of hospitals were uneven, which may be related to the development of pediatrics departments in hospitals and their capabilities to conduct new business. Regular monitoring of the trend of low-dose blood component consumption is of great significance to guarantee the pediatric clinical blood supply.

Objective To analyze the monitoring results of external exposure dose of interventional radiology staff in a tertiary general hospital in Beijing, China, 2018—2020, and to provide a basis for safe guarding staff health and hospital radiation protection management. Methods A total of 321 interventional radiology staff in a hospital in Beijing were selected to collect information on the types of interventional work, positions, and personal dose monitoring results in 2018—2020. The dose monitoring results were analyzed using SPSS 22.0. Results The effective monitoring rate for the three years was 78.82%, 81.65%, and 96.85%, respectively, showing an increasing trend (χ² _trend = 16.134, P < 0.001). The annual dose equivalent per capita was 0.142, 0.142, and 0.265 mSv, respectively. The annual dose equivalent per capita in 2020 was significantly higher than those in 2018 (H = 24.562, P < 0.001) and 2019 (H = 39.378, P < 0.001). The annual dose equivalent per capita in 2020 was in the order of interventional clinician > interventional nurse > technician (H = 10.699, 6.562, P < 0.01). The annual dose equivalent per capitain 2020 was higher in the cardiology interventional department than in the comprehensive interventional, neuro interventional, and vascular surgery departments (H = 35.530, 37.614, 35.496, P < 0.001). Conclusion The number of interventional radiology staff monitored from 2018 to 2020 increased year by year, so did the effective monitoring rate.The external exposure dose was at low levels, which generally meets the requirements of national occupational exposure limits. Training on radiation protection for interventional radiology staff should be further strengthened to raise awareness of radiation protection.

Objective: Comparing the benefit of Abidor, lopinavir/ritonavir and recombinant interferon α-2b triple combination antiviral therapy and lopinavir/ritonavir and interferon dual combination antiviral therapy to hospitalized novel coronavirus pneumonia 2019 in Zhejiang province. Methods: A multi-center prospective study was carried out to compare the effect of triple combination antiviral therapy with dual combination antiviral therapy in 15 medical institutions of Zhejiang Province. All patients were treated with recombinant interferon α-2b (5 million U, 2 times/d) aerosol inhalation. 196 patients were treated with abidol (200 mg, 3 times/d) + lopinavir / ritonavir (2 tablets, 1 time/12 h) as the triple combination antiviral treatment group. 41 patients were treated with lopinavir / ritonavir (2 tablets, 1 time/12 h) as the dual combination antiviral treatment group. The patients who received triple combination antiviral therapy were divided into three groups: within 48 hours, 3-5 days and > 5 days after the symptom onset. To explore the therapeutic effects of triple combination antiviral drugs and dual combination antiviral drugs, as well as triple combination antiviral drugs with different antiviral initiate time. SPSS17.0 software was used to analyze the data. Results: The time of virus nucleic acid turning negative was (12.2 ± 4.7) days in the triple combination antiviral drug group, which was shorter than that in the dual combination antiviral drug group [(15.0 ± 5.0) days] (t = 6.159, P < 0.01 ). The length of hospital stay [12 (9, 17) d] in the triple combination antiviral drug group was also shorter than that in the dual combination antiviral drug group [15 (10, 18) d] (H = 2.073, P < 0.05). Comparing the antiviral treatment which was started within 48 hours, 3-5 days and > 5 days after the symptom onset of triple combination antiviral drug group, the time from the symptom onset to the negative of viral shedding was 13 (10,16.8), 17 (13,22) and 21 (18-24) days respectively (Z = 32.983, P < 0.01), and the time from antiviral therapy to the negative of viral shedding was (11.8±3.9) , (13.5±5.1) and (11.2±4.3) d. The differences among the three groups were statistically significant (Z=32.983 and 6.722, P<0.01 or<0.05). Conclusions The triple combination antiviral therapy of Abidor, Lopinavir/Litonavir and recombinant interferon α-2b showed shorter viral shedding time and hospitalization time compared with the dual combination antiviral therapy. The earlier the time to initiate triple antiviral treatment, the shorter the time of virus shedding.

Objective: To summarize the experience of diagnosis and treatment of superior mesenteric artery compression syndrome (SMACS) secondary to chronic constipation according to the concept of Lee′s triad syndrome. Methods: The concept of Lee′s triad syndrome: (1) clinical symptoms: triad of constipation, malnutrition, upper gastrointestinal obstruction (vomiting, difficulty in eating); (2) anatomical manifestations: with triple anatomy anomaly of transverse colon sagging, elevated spleen flexure, and mesentery arterial compression; (3) treatment: with triple treatment of enteral nutrition support, chest-knee posture and fecal microbiota transplantation. A descriptive cohort study was performed. According to Lee′s triad syndrome criteria, clinical data of 78 patients with superior mesenteric artery compression syndrome secondary to chronic constipation in the Tenth People′s Hospital of Tongji University and General Hospital of Eastern Theater Command from June 2004 to November 2018 were prospectively collected, including basic information, symptoms and signs, imaging findings, nutritional indicators, gastrointestinal quality of life index (GIQLI) and Wexner defecation score. The above parameters based on Lee′s triad syndrome criteria were followed up and recorded at 1, 3, 6, 12 months after comprehensive treatment. Results: All the patients had Lee′s triple symptoms of constipation, malnutrition, upper gastrointestinal obstruction (vomiting, eating difficulties), and triple anatomy anomaly of transverse colon sagging, elevated spleen curvature, and mesentery arterial compression before treatment. After triple treatment of enteral nutrition support, chest-knee posture, and fecal microbiota transplantation, 69 (88.5%) patients had a significant improvement of symptoms, and 9 patients had no significant improvement of symptoms and then eventually received surgery. The 69 cases without operation received follow-up for 12 months. All the patients eventually returned to normal eating, and upper gastrointestinal angiography and superior mesenteric artery imaging showed duodenal compression disappeared. After 1 month, the constipation-related indexes were improved. After 12 months, the number of autonomous defecation per week increased from 1.0±0.8 to 5.0±1.6 (P<0.001). The GIQLI score increased from 52.7±8.5 to 93.2±7.5 (P<0.001), and the Wexner score decreased from 19.1±2.5 to 6.2±2.1 (P<0.001). After 1 month, nutritional indexes were improved gradually. After 12 months, the BMI increased from (17.9±1.8) kg/m² to (21.0±1.3) kg/m², total protein increased from (65.2±5.7) g/L to (68.3±4.2) g/L, albumin increased from (32.1±5.1) g/L to (40.4±3.0) g/L, prealbumin increased from (163.2±53.7) mg/L to (259.1±45.6) mg/L, fibrinogen increased from (1.9±0.5) g/L to (2.4±0.5) g/L, whose differences were statistically significant (all P<0.001). Upper gastrointestinal angiography and superior mesenteric artery imaging showed duodenal compression were relieved. The angle between superior mesenteric artery and abdominal aorta increased from (17.4±3.8)° to (37.8±5.8)° (t=-22.26, P<0.001). Conclusion When patients with SMACS secondary to chronic constipation have Lee′s triple symptoms and triple anatomy anomaly, the triple combination treatment of enteral nutrition support, chest-knee posture and fecal microbiota transplantation should be applied.

Objective:To compare the efficacy of the combination of abidol, lopinavir/ritonavir plus recombinant interferon α-2b (rIFNα-2b) and the combination of lopinavir/ritonavir plus rIFNα-2b for patients with COVID-19 in Zhejiang province.Methods:A multicenter prospective study was carried out to compare the efficacy of triple combination antiviral therapy and dual combination antiviral therapy in 15 medical institutions of Zhejiang province during January 22 to February 16, 2020. All patients were treated with rIFNα-2b (5 million U, 2 times/d) aerosol inhalation, in addition 196 patients were treated with abidol (200 mg, 3 times/d) + lopinavir/ritonavir (2 tablets, 1 time/12 h) (triple combination group) and 41 patients were treated with lopinavir/ritonavir (2 tablets, 1 time/12 h) (dual combination group). The patients who received triple combination antiviral therapy were further divided into three subgroups: <48 h, 3-5 d and >5 d according the time from the symptom onset to medication starting. The therapeutic efficacy was compared between triple combination group and dual combination group, and compared among 3 subgroups of patients receiving triple combination antiviral therapy. SPSS 17.0 software was used to analyze the data.Results:The virus nucleic acid-negative conversion time in respiratory tract specimens was (12.2±4.7) d in the triple combination group, which was shorter than that in the dual combination group [(15.0±5.0) d] ( t=6.159, P<0.01). The length of hospital stay in the triple combination group [12.0 (9.0, 17.0) d] was also shorter than that in the dual combination group [15.0 (10.0, 18.0) d] ( H=2.073, P<0.05). Compared with the antiviral treatment which was started within after the symptom onset of in the triple combination group, the time from the symptom onset to the viral negative conversion was 13.0 (10.0, 17.0), 17.0 (13.0, 22.0) and 21.0 (18.0, 24.0) d in subgroups of 48 h, 3-5 d and >5 d, respectively ( Z=32.983, P<0.01), while the time from antiviral therapy to viral negative conversion was (11.8±3.9), (13.5±5.1) and (11.2±4.3) d, respectively( Z=6.722, P<0.05). Conclusions:The triple combination antiviral therapy of abidol, lopinavir/litonavir and rIFNα-2b shows shorter viral shedding time and shorter hospitalization time, compared with the dual combination antiviral therapy; and the earlier starting triple combination antiviral therapy will result in better antiviral efficacy.

Objective To investigate the characteristics of notifiable infectious diseases reported from a hospital during 2014-2018,and to provide a scientific basis for the epidemic management and department management in the hospital.Methods The descriptive epideniological method was used to analyze the information on notifiable infectious diseases in the China Information System for Disease Control and Prevention,which was reported from the general hospital during 2014-2018.Results During 2014-2018,the number of reported infectious disease cases reached the peak during June to August every year,and the most common diseases were hand,foot and mouth disease,bacillary dysentery,and other infectious diarrhea.There were more male than female cases,with the former accounting for 56.9％.The proportion of children aged 0-14 years was the highest among all age groups.The reported cases were mainly from the enteric diseases clinic,emergency department,and pediatric department.Conclusions Infectious diseases have seasonality in occurrence.During 2014-2018,intestinal infectious diseases were most common among all reported infectious disease cases;the number of cases of respiratory infectious diseases showed an increasing trend;the proportion of cases with viral infectious diseases increased.Much attention should be paid to the monitoring and control of infectious diseases in children.

Objective:To investigate the effect of different fecal bacterial preservation time on the efficacy and complications of FMT.Methods:A retrospective cohort study was carried out. Clinical data of 483 patients with slow transit constipation undergoing voluntary FMT at Intestinal Microecology Diagnosis and Treatment Center from August 2017 to October 2019 were retrospectively collected. According to the storage time of fecal bacterial samples used in FMT treatment, the cases were divided into fresh bacterial solution ( n=29), bacterial solution stored at -80℃ for 1 week ( n=187), 1 month ( n=121), 3 months ( n=89), 6 months ( n=38), and 12 months (n=19). The total number of complete bowel movement, Wexner constipation score, gastrointestinal quality of life index (GIQLI), FMT satisfaction score and related adverse reactions were summarized and compared among groups 1 week and 1 month after FMT treatment. Results:There were no statistically significant differences in the baseline data of patients among different bacterial solution storage time (all P>0.05). After 1 month of treatment, the overall frequency of defecation of all the patients was (3.83 ± 1.22) times/week, Wexner constipation score was (6.74 ± 3.56) points, GIQLI score was (108.76 ± 15.38) points, clinical cure rate was 57.8% (279/483). The improvement rate was 66.3% (320/483), and the treatment satisfaction was (3.85 ± 0.93) points. No severe FMT-associated complication and death were observed during treatment and follow-up period. FMT-related adverse events occurred in 115 cases (23.8%), including nausea in 25 cases (5.2%), vomiting in 13 (2.7%), diarrhea in 21 (4.3%), abdominal pain in 16 (3.3%), abdominal distension in 33 (6.8%), sore throat in 56 (11.6%) and fever in 16(3.3%), all of which relieved after symptomatic treatment. There were no statistically significant differences in the number of defecations, Wexner constipation scores, and GIQLI scores before FMT, 1 week and 1 month after FMT treatment among different bacterial solution storage groups (all P>0.05). Differences of clinical cure rate, clinical improvement rate, and treatment satisfaction of patients 1 week and 1 month after treatment were not statistically significant (all P>0.05). Among the groups, differences in the overall complications and types of complications after FMT treatment were not statistically significant (all P>0.05). Conclusions:FMT is safe and effective in the treatment of slow transit constipation. Fresh fecal bacterial samples or fecal bacterial samples frozen at -80℃ for 1 year can be safely applied to FMT for the treatment of slow transit constipation, with stable short-term efficacy and without serious adverse reactions.