Objective:To investigate the relationship between the lowest hemoglobin value during hospitalization and the prognosis in patients with extensive burns, in order to explore the hemoglobin warning threshold for blood transfusion in patients with extensive burns.Methods:The research was a retrospective observational study. From October 2012 to October 2022, 288 patients with extensive burns who met the inclusion criteria were admitted to the First Affiliated Hospital of Army Medical University (the Third Military Medical University), including 243 males and 45 females, aged 18 to 65 years. These patients were assigned to the death group ( n=54) and the survival group ( n=234) based on their final prognosis. The clinical data including gender, age, body mass index, total burn area, full-thickness burn area, time of first operation after injury, preoperative prothrombin time (PT) and activated partial thromboplastin time (APTT) and hemoglobin level of the first surgery, complication of inhalation injury, number of surgeries, total surgical area, total surgical time, total length of hospital stay, and highest procalcitonin value, lowest platelet count and hemoglobin values, and occurrence of sepsis during hospitalization were compared between the two groups of patients. According to the lowest hemoglobin value during hospitalization, the patients were assigned to <65 g/L group, ≥65 g/L and <75 g/L group, ≥75 g/L and <85 g/L group, and ≥85 g/L group. The total length of hospital stay, mortality and incidence of sepsis during hospitalization, and mortality within 90 days after injury were compared among the four groups of patients. The relationship between the lowest hemoglobin value during hospitalization and the mortality risk of patients with extensive burns was analyzed using a restricted cubic spline model before and after adjusting covariates. A logistic regression model was adopted to analyze the relationship between the lowest hemoglobin value during hospitalization and the mortality risk of patients with extensive burns after adjusting covariates, with the lowest hemoglobin value during hospitalization as a continuous variable and a categorical variable, separately. Results:Compared with those in survival group, the total burn area, full-thickness burn area, and total surgical area of patients in death group were significantly increased, the preoperative APTT of the first surgery was significantly prolonged, the number of surgeries was significantly reduced, the total length of hospital stay was significantly shortened, the highest procalcitonin value during hospitalization was significantly increased, the lowest platelet count and hemoglobin values during hospitalization were significantly decreased, and the incidence proportion of sepsis during hospitalization was significantly increased (with Z values of -6.72, -5.40, -2.15, -2.99, -2.21, -7.84, -6.23, -7.03, and -3.43, respectively, χ2=161.95, P values all <0.05). There were no statistically significant differences in the other clinical data of patients between the two groups ( P>0.05). There were statistically significant differences in mortality and incidence of sepsis during hospitalization, and mortality within 90 days after injury of patients among the four groups divided according to the lowest hemoglobin value during hospitalization (with χ2 values of 12.12, 15.93, and 10.62, respectively, P<0.05). There was no statistically significant difference in the total length of hospital stay of patients among the four groups ( P>0.05). The restricted cubic spline model analysis revealed an approximately linear relationship between the lowest hemoglobin value during hospitalization and the mortality risk of patients with extensive burns before and after adjusting covariates (with χ2 values of 0.81 and 0.75, respectively, P>0.05). After adjusting covariates, the logistic regression model analysis showed that the mortality risk of patients with extensive burns increased with decreasing hemoglobin when the lowest hemoglobin value during hospitalization was analyzed as a continuous variable (with odds ratio of 0.96, with 95% confidence interval of 0.92 to 0.99, P<0.05). When using the median value of 75.5 g/L as the cut-off value for categorizing the lowest hemoglobin value during hospitalization, there was no statistically significant difference in the mortality risk between patients with hemoglobin <75.5 g/L and those with hemoglobin ≥75.5 g/L ( P>0.05). When the patients were divided into four groups based on the lowest hemoglobin value during hospitalization as above, using ≥85 g/L group as a reference, only patients in <65 g/L group had a significantly increased mortality risk (with odds ratio of 5.37, with 95% confidence interval of 1.57 to 18.29, P<0.05). Conclusions:There is an approximately linear correlation between the lowest hemoglobin value during hospitalization and the mortality risk of patients with extensive burns. When the hemoglobin level drops to 65 g/L or lower, the mortality risk of patients increases significantly, suggesting that a hemoglobin level of 65 g/L could serve as a warning threshold for blood transfusion in patients with extensive burns.

Hymenopteran insect stings are a risk factor that cannot be ignored for the people allergic to hymenopteran venoms.In China,the current diagnostic tools cannot provide accurate information to identify sen-sitized insects,thus affecting clinical diagnosis and treatment.Honeybee is a common hymenopteran insect.Due to its wide distribution,large number,and complex venom composition,researchers have carried out recombi-nation schemes for the main allergens of honeybee venom,laying a theoretical foundation for the detection of al-lergens.The development of diagnostic technologies for allergen components can accurately detect bee venom aller-gens,providing a new set of clinical diagnosis and treatment schemes for the population allergic to bee venom.

Objective:To investigate the application effect of problem-based learning (PBL) combined with case-based learning (CBL) in standardized training of traditional Chinese medicine (TCM) clinical pharmacists.Methods:A total of 40 TCM clinical pharmacists who received the standardized training of TCM clinical pharmacy in Chongqing Traditional Chinese Medicine Hospital from August 2020 to July 2021 were enrolled as subjects and were randomly divided into research group (PBL combined with CBL) and control group (traditional teaching). The two groups were compared in terms of theoretical knowledge, practical skills, and the degree of satisfaction with training. SPSS 23.0 was used to perform the t-test and the chi-square test. Results:Compared with the control group, the research group had significantly higher scores of theoretical knowledge [(49.45±5.52) vs. (40.54±5.65), P<0.05] and practical skills [(48.65±5.23) vs. (41.53±4.41), P<0.05]. As for the degree of satisfaction with training, the questionnaire survey showed that compared with the control group, the research group had significantly better results in strong ability to analyze and solve clinical issues, strong learning initiative and enthusiasm, teachers' willingness to interact with students, teaching and learning benefiting each other, and satisfaction with this assessment method ( P<0.05). Conclusion:The combined teaching model of PBL and CBL can help to improve the teaching quality of standardized training for TCM clinical pharmacists and cultivate the good learning habits, independent thinking ability, and clinical thinking ability of pharmacists, and therefore, it is beneficial to cultivating high-quality TCM clinical pharmacists.

Objective:The preseason prophylactic treatment of seasonal allergic rhinitis (AR) caused by pollens could alleviate AR symptoms during the pollen season. This study aimed to evaluate the effect of prophylaxis usage of suplatast tosilate on the life quality of AR patients in the pollen season, and investigate the potential mechanism of action through transcriptomic analysis.Methods:This is a randomized controlled study. AR patients allergic to weed pollens were recruited from Allergy Clinic of Peking Union Medical College Hospital from January 2020 to June 2020, and divided into prophylactic group who started to take suplatast tosilate as prophylaxis 2 weeks before the spread of weed pollens[n=10, 4 men and 6 women with age range of (34±6) years old] and control group who did not use any prophylactic treatment[n=24, 12 men and 12 women with age range of (33±9) years old]. The differences of age ( t=0.381, P=0.706) and gender ( χ2=0.595, P=0.715) distribution between the patients of two groups were not statistically significant. All the subjects filled in the rhinoconjunctivitis quality of life questionnaire (RQLQ) while onset of AR symptoms, and peripheral blood was drawn for transcriptomic analysis 1 month before and during the pollen season. Differences between groups were statistically analyzed through chi-square test and t test. Results:There was no significant difference in visual analogue scale of rhinitis symptom in the last pollen season between prophylactic group and control group[ 8.0 (6.4, 9.3) vs 7.3 (6.1, 8.0), Z=1.180, P=0.254]. The RQLQ score of prophylactic group was superior to that of control group in the weed pollen season (2.9±0.9 vs 3.7±0.9, t=-2.438, P=0.026). 210 differentially expressed genes of fold change ≥2 were identified, with 147 genes upregulated and 63 genes downregulated in the prophylactic group compared to the control group. Gene Ontology annotation showed that IL-12 and IL-23 related pathways were downregulated in prophylactic group ( P=0.006 48). Polymerase Chain Reaction (PCR) verification of differentially expressed genes indicated that the relative expression level of HLA-G in prophylactic group was significantly lower than that in control group (0.23±0.19 vs 1.00±0.49, t=4.016, P=0.006). Conclusion:The prophylactic treatment of suplatast tosilate showed some benefit to the life quality of seasonal AR patients during the pollen season, and the potential mechanism might be related with the downregulation of IL-12 and IL-23 pathways and decreased expression of HLA-G.

Objective:The preseason prophylactic treatment of seasonal allergic rhinitis (AR) caused by pollens could alleviate AR symptoms during the pollen season. This study aimed to evaluate the effect of prophylaxis usage of suplatast tosilate on the life quality of AR patients in the pollen season, and investigate the potential mechanism of action through transcriptomic analysis.Methods:This is a randomized controlled study. AR patients allergic to weed pollens were recruited from Allergy Clinic of Peking Union Medical College Hospital from January 2020 to June 2020, and divided into prophylactic group who started to take suplatast tosilate as prophylaxis 2 weeks before the spread of weed pollens[n=10, 4 men and 6 women with age range of (34±6) years old] and control group who did not use any prophylactic treatment[n=24, 12 men and 12 women with age range of (33±9) years old]. The differences of age ( t=0.381, P=0.706) and gender ( χ2=0.595, P=0.715) distribution between the patients of two groups were not statistically significant. All the subjects filled in the rhinoconjunctivitis quality of life questionnaire (RQLQ) while onset of AR symptoms, and peripheral blood was drawn for transcriptomic analysis 1 month before and during the pollen season. Differences between groups were statistically analyzed through chi-square test and t test. Results:There was no significant difference in visual analogue scale of rhinitis symptom in the last pollen season between prophylactic group and control group[ 8.0 (6.4, 9.3) vs 7.3 (6.1, 8.0), Z=1.180, P=0.254]. The RQLQ score of prophylactic group was superior to that of control group in the weed pollen season (2.9±0.9 vs 3.7±0.9, t=-2.438, P=0.026). 210 differentially expressed genes of fold change ≥2 were identified, with 147 genes upregulated and 63 genes downregulated in the prophylactic group compared to the control group. Gene Ontology annotation showed that IL-12 and IL-23 related pathways were downregulated in prophylactic group ( P=0.006 48). Polymerase Chain Reaction (PCR) verification of differentially expressed genes indicated that the relative expression level of HLA-G in prophylactic group was significantly lower than that in control group (0.23±0.19 vs 1.00±0.49, t=4.016, P=0.006). Conclusion:The prophylactic treatment of suplatast tosilate showed some benefit to the life quality of seasonal AR patients during the pollen season, and the potential mechanism might be related with the downregulation of IL-12 and IL-23 pathways and decreased expression of HLA-G.

OBJECTIVE：To investiga te main risk factors for adverse drug reactions （ADR）of skin by intravenous injection of iodine contrast agent. METHODS ：From Jan. 2009 to Apr. 2020，the patients suffering from skin ADR after enhanced CT with iodine contrast agent were collected from our hospital. The basic information ，laboratory test results before using iodine contrast agent and ADR related information were collected through hospital information system （HIS）. The use of iodine contrast agent ，main manifestations of skin ADR and drug combination were analyzed statistically. Taking the sex ，age，body mass index （BMI），the dosage of iodine contrast agent ，length of stay ，laboratory examination ，tumor history ，basic disease ，allergy history ，drinking history as independent variables ，the incidence of skin ADR related to iodine contrast agent was analyzed by single factor analysis ，and the variables with statistically significant were selected for multivariate Logistic stepwise regression analysis. RESULTS ：There were 157 cases of skin ADR ，involving 79 males（50.3％）and 78 females（49.7％）. The age ranged from 19 to 86 years old ，being（52.68± 18.73）years old in average. BMI was 14.6-40.7 kg/m2，being（22.5±3.7） kg/m2. 67 cases（42.68％）were treated with iprodione ，34 cases（21.66％）with iodixanol ，31 cases（19.74％）with iohexol and 25 cases（15.92％）with iopamidol ；the dose of iodine contrast agent were 50-100 mL，being（73.06±13.29）mL in average. There was no significant difference among different dosage of 4 kinds of iodine contrast agents （P≤0.05）. Among 4 kinds of iodine contrast agents ，the incidence of skin ADR induced by iopromide was the highest（0.197％）. The skin ADR related to iodine contrast agent was mainly acute （89.2％），the severity was mild （75.2％），and urticaria（38.9％）was the most common. After symptomatic treatment ，135 cases were cured ，13 cases were improved and 9 cases were not improved. Among the patients with iodine contrast agent related skin ADR ，the incidence of ADR induced by combined use of anti infective drugs was the highest （33.1％）；however，the combined use of anti-tumor drugs was the main cause of severe skin ADR. The length of stay ｛11～20 d[OR＝1.21，95％CI（1.07，1.20），P＝0.042]、21～30 d[OR＝1.39，95％CI（1.12，1.52），P＝0.035]、31～40 d[OR＝1.15，95％CI（1.03，1.37），P＝0.008]、＞40 d[OR＝1.33，95％CI（1.28，1.53），P＝0.003]｝，respitatory and circulatory system tumor history[OR ＝1.51，95％CI（1.35，1.61），P＝0.037]，injection allergy history[OR ＝1.50，95％CI（1.37，1.59），P＝0.005] can significantly increase the incidence of iodine contrast agent related skin ADR. CONCLUSIONS ：The main manifestation of skin ADR related to iodine contrast agent was urticaria. The main risk factors of skin ADR related to iodine contrast agent were length of stay （＞ 10 d），respiratory and circulatory system tumor history and injection allergy history.

Objective:To investigate the effect and possible mechanism of curcumin on the growth and invasion of thyroid carcinoma papillary K1 cells.Methods:K1 cells were randomly divided into control group, solvent control group, and curcumin group with 10, 30 and 50 μmol/L. The control group was only added with fresh medium, the solvent control group was added with dimethyl sulfoxide medium, and the 10, 30, 50 μmol/L curcumin groups were added with 10, 30 and 50 μmol/L curcumin respectively. The effects of curcumin on the growth of thyroid cancer papillary carcinoma K1 cells were observed by MTT assay. PI and Hochest3342 double staining were used to detect cell death. Transwell chamber was used to verify the effect on cell invasion. Western blot was used to observe the effects of curcumin on expression of Vimentin and E-cadherin.Results:Compared to the control group and solvent control group, the cell survival rate significantly decreased and the cell death rate of 10, 30, 50 μmol/L curcumin groups significantly increased ( P<0.05). The cell invasion rate (80.12% ± 3.43%, 65.59% ± 4.11%, 30.32% ± 4.67% vs. 100.00% ± 2.81%, 98.82% ± 2.18%) of 10, 30, 50 μmol/L curcumin groups significantly decreased ( P<0.05). The expression of E-cadherin (0.41 ± 0.12, 0.63 ± 0.14, 0.70 ± 0.13 vs. 0.34 ± 0.10, 0.35 ± 0.11) of 10, 30, 50 μmol/L curcumin groups significantly increased ( P<0.05), and the expression of Vimentin (0.70 ± 0.11, 0.22 ± 0.10 vs. 0.87 ± 0.12, 0.87 ± 0.13) of 10, 30, 50 μmol/L curcumin groups significantly decreased ( P<0.05). Conclusions:Curcumin can inhibit the proliferation and invasion of papillary thyroid carcinoma K1 cells and accelerate cell death.

The rotation of clinical pharmacists in anti-infection specialty is an important part of standardized training. In view of the poor foundation of imaging diagnosis ability, short rotation time and unsystematic training scheme, the quality of standardized training has been significantly improved through strict management system, strengthening entrance education, reforming academic lecture mode, setting up tutorial system for training students and refining assessment system. It's of great significance for clinical pharmacists in the direction of anti-infection to understand systemic infection.

Objective: To investigate the application value of magnetic resonance imaging (MRI) in the classification diagnosis of rectal mucinous adenocarcinoma. Methods: The retrospective and descriptive study was conducted. The clinical data of 74 patients with rectal mucinous adenocarcinoma who were admitted to Chongqing Traditional Chinese Medicine Hospital from July 2009 and February 2019 were collected. There were 40 males and 34 females, aged (46±8)years, with a range from 32 to 82 years. Among the 74 patients, 41 were simple mucinous adenocarcinoma, 26 were partial mucinous adenocarcinoma, and 7 were focal or small foci mucinous adenocarcinoma. All patients underwent MRI plain scan and dynamic enhanced scan. Observation indicators: (1) morphology of rectal mucinous adenocarcinoma; (2) the lesion margin of rectal mucinous adenocarcinoma; (3) the value of apparent diffusion coefficient (ADC) of rectal mucinous adenocarcinoma; (4) internal enhancement features of rectal mucinous adenocarcinoma; (5) timesignal intensity curve of rectal mucinous adenocarcinoma. Measurement data with normal distribution were represented as Mean±SD, and count data were described as absolute numbers. Results: (1) Morphology of rectal mucinous adenocarcinoma: 74 patients had different morphological changes. Among the 41 cases of simple mucinous adenocarcinoma, 22 were oval, 8 were round, and 11 were irregular. Among the 26 patients with partial mucinous adenocarcinoma, 15 were oval, 8 were round and 3 were irregular. Among the 7 patients with focal or small foci mucinous adenocarcinoma, 2 were oval, 1 was round and 4 were irregular. (2) The lesion margin of rectal mucinous adenocarcinoma: the lesion margin of 74 patients was mainly unclear and irregular. Among the 41 cases of simple mucinous adenocarcinoma, 32 had unclear and irregular margin, 7 had clear margin, and 2 had unclear margin combined with fissure. Among the 26 cases of partial mucinous adenocarcinoma, 20 had unclear margin combined with fissure, 5 had unclear margin and irregular margin, and 1 had clear margin. Among the 7 patients with focal or small foci mucinous adenocarcinoma, 5 had unclear or irregular margin, 1 had unclear or irregular margin, and 1 had clear margin. (3) The value of ADC of rectal mucinous adenocarcinoma: diffusion weighted imaging of 74 patients showed diffused limited changes. The average ADC value was (1.24±0.23)×10^-3 mm²/s of 41 patients with simple mucinous adenocarcinoma, (0.91±0.42)×10^-3 mm²/s of 26 patients with partial mucinous adenocarcinoma, and (1.07±0.24)×10^-3 mm²/s of 7 patients with focal or small mucinous adenocarcinoma. (4) Internal enhancement features of rectal mucinous adenocarcinoma: 74 patients showed delayed heterogeneous enhancement and marginal enhancement. Among 41 cases of simple mucinous adenocarcinoma, 24 showed delayed heterogeneous enhancement, 17 showed marginal enhancement, and none showed homogeneous enhancement. Among 26 patients with partial mucinous adenocarcinoma, 20 showed marginal enhancement, 6 showed homogeneous enhancement, and none showed heterogeneous enhancement. All the 7 cases of focal or small foci mucinous adenocarcinoma showed heterogeneous enhancement. (5) Timesignal intensity curve of rectal mucinous adenocarcinoma: 74 patients showed mainly outflow type in the timesignal intensity curve. Among the 41 cases of simple mucinous adenocarcinoma, 22 presented progressive curve, 12 presented platform type, and 7 presented outflow type. Among the 26 patients with partial mucinous adenocarcinoma, 17 presented outflow type, 8 presented platform type, and 1 presented progressive type. Among the 7 patients with focal and small forci mucinous adenocarcinoma, 4 presented outflow type, 2 presented platform type, and 1 presented progressive type. Conclusions MRI findings show different results for different types of rectal mucinous adenocarcinoma. A correct understanding of the MRI features of different types of rectal mucinous adenocarcinoma is helpful for the classification diagnosis of rectal mucinous adenocarcinoma.

OBJECTIVE: To explore the role of clinical pharmacists in anti-infective treatment for the patient with septic shock induced by intrauterine infection. METHODS: Clinical pharmacists participated in anti-infective treatment for a patient with septic shock induced by intrauterine infection, and assisted physicians to formulate empirical anti-infective treatment, determine that Escherichia coli was pathogenic bacteria and analyze the causes of fluctuations in body temperature. According to the patient's disease condition and results of assistant examination, clinical pharmacists suggested using Imipenem and cilastatin sodium for injection 1. 0 g, ivgtt, q6 h, stopping Teicoplanin for injection, de-escalation using Cefoxitin sodium for injection 2. 0 g, ivgtt, q8 h for anti-infective treatment, with oral sequential therapy. RESULTS: Physicians adopted most advice of pharmacists. After 30 d anti-infective and symptomatic treatment, the patients symptoms were better than before, and discharged from the hospital. CONCLUSIONS: Clinical pharmacists participate in formulating individual anti-infective treatment regimen, so as to promote the rational use of antibiotics and improve the response rate and success rate of treatment.