OBJECTIVE To reduce dispensing errors in pharmacy intravenous admixture service （PIVAS） of children’s hospitals. METHODS The risk of dispensing procedures in our PIVAS was identified by applying failure mode and effect analysis （FMEA） model. Potential failure modes that might lead to dispensing errors in each link were determined， and failure causes were analyzed. The severity， incidence and detection degree of potential failure modes were quantitatively scored， and their risk priority number （RPN） was calculated to screen failure modes that needed to be improved in priority； the corresponding improvement measures were developed by 6S management method from six aspects， namely， finishing （seiri）， rectifying （seiton）， sweeping （seiso）， sanitation （seiketsu）， literacy （shitsuke） and safety. The effect of intervention before and after rectification was evaluated. RESULTS Based on the RPN， 32 potential failure modes were selected， of which a total of 18 critical failure modes that needed to be improved in priority. After implementing corresponding measures according to 6S management method， the RPN of 18 critical failure modes decreased. The total RPN decreased from 497 to 142 with a decrease rate of 71.43%. The error rates of 15 critical failure modes were significantly lower than before implementation （P＜0.05）. CONCLUSIONS Applying FMEA model and 6S management method to the risk control of all aspects of PIVAS workflow can effectively reduce the risk of PIVAS dispensing errors and ensure the safety of children’s intravenous medication.

Amyloidosis is a rare disease.This paper reports a case of localized secondary hypopharyngeal amyloidosis presenting with pulmonary tuberculosis as the initial symptom.The patient lacked specific clinical manifestations and primarily exhibited symptoms such as cough,sputum production,acid reflux,belching,and abdominal pain.Chest CT indicated bronchiectasis with infection and pulmonary tuberculosis.Digestive endoscopy revealed a white mucosal elevation at the right pyriform sinus of the hypopharynx.Pathological diagnosis confirmed amyloid deposits in the hypopharyngeal mucosal tissue.The patient tested positive for anti-amyloid A antibodies,Congo red staining(+),and periodate Schiff staining(+).Amyloidosis commonly affects the digestive system and may have various etiologies,often presenting with symptoms that overlap with other digestive system diseases,leading to frequent misdiagnosis and missed optimal treatment opportunities.The hypopharynx,a highly folded and narrow chamber that serves as a common passage for the digestive and respiratory tracts,can be effectively evaluated for amyloidosis using digestive endoscopy.

Background Silicosis is an occupational disease mainly characterized by pulmonary progressive fibrosis induced by the accumulation of free silica (SiO₂) in the lungs due to long-term exposure to SiO₂ dust. It has been shown that neutrophil extracellular traps (NETs) are increased in the lung tissues of silicotic mice after 28 d SiO₂ exposure, but it is unclear how the levels of NETs change throughout entire progression of silicosis in mice. Objective To observe the levels of NETs and pathological changes in the lungs of silicotic mice after different duration of SiO₂ exposure, and to confirm the possible role and significance of NETsin the development of SiO₂-induced pulmonary fibrosis. Methods A total of 28 SPF male C57BL/6J mice were randomly divided into a control group, and a model group, and the model group was subdivided into, a 2 d model group, a 7 d model group, and a 28 d model group, with 7 mice in each group. The mice in the model groups were given intratracheal instillation with 10 mg SiO₂ suspension (50 μL), and the mice in the control group were received same volume of saline. Mice were sacrificed and samples were collected at designed time points. The pathological changes of lung tissues of mice were observed after hematoxylin-eosin (HE) and Van Gieson (VG) staining. Immunofluorescence was used to observe the NETs markers citrullination histone H3 (CitH3) and myeloperoxidase (MPO) in bronchoalveolar lavage fluid (BALF), and the percentage of NETs-positive cells was calculated. PicoGreen fluorescent dye kit was used to detect the content of extracelluar DNA (ex-DNA) in mouse BALF, and the expression levels of fibrosis-related proteins α-smooth muscle actin (α-SMA) and fibronectin (FN) and NETs marker CitH3 in lung tissues of mice were detected by Western blot (WB). Results Compared with the control group, inflammatory cells accumulation, alveolar wall thickening, and collagen deposition were obviously observed in the lungs of the silicosis model groups, and a large number of silicone nodules were recorded in the lung tissues in the 28 d group. Compared with the control group, the expressions of α-SMA and FN in the lung tissue of the 28 d group were significantly increased (P<0.05). The percentages of NETs in BALF increased significantly in the 2 d and the 7 d model group, then decreased in the 28 d model group (P<0.05). Compared with the control group (7.434±0.258) ng·mL⁻¹, the ex-DNA levels in BALF of mice in the 2 d [(35.110±6.331) ng·mL⁻¹], the 7 d [(39.491±6.948) ng·mL⁻¹], and the 28 d [(23.360±4.809) ng·mL⁻¹] model groups were increased (P<0.05), and the increase of ex-DNA in the 2 d and the 7 d model groups were statistically significant (P<0.05). In comparison with the control group, the protein level of CitH3 was significantly increased in the lung tissues of mice in the 7 d model group (P<0.05). Conclusion The content of NETs increases significantly and reaches a peak in the early inflammatory stage of silicosis, and decreases as the disease progresses to the fibrotic stage, suggesting that NETs may play a role in early stage of silicosis.

Subclinical seizures (SCS) are paroxysmal electroencephalogram (EEG) events that do not accompany obvious subjective or objective behavioral changes. They are not uncommon in EEG monitoring, with an intracranial EEG detection rate of about 50%-60%, significantly higher than the scalp EEG detection rate of about 10%. SCS most frequently occur in patients with temporal lobe epilepsy. In terms of EEG characteristics, SCS often remain confined to the epileptogenic zone but can also spread outside of it. Their value in localizing the epileptogenic zone is comparable to that of clinical seizures (CS). Additionally, the concordance between SCS and CS localization is associated with favorable surgical outcomes, indicating the significant value of SCS in focal epilepsy. A systematic review of domestic and international research on SCS is provided in this paper, aiming to enhance understanding in this area.

OBJECTIVE To evaluate the effectiveness， safety， economy， innovation， suitability and accessibility of recombinant Mycobacterium tuberculosis fusion protein （EC）， and to provide evidence for selecting skin detection methods for tuberculosis infection diagnosis and auxiliary diagnosis of tuberculosis. METHODS The effectiveness and safety of EC compared with purified protein derivative of tuberculin （TB-PPD） were analyzed by the method of systematic review. Cost minimization analysis， cost-effectiveness analysis and cost-utility analysis were used to evaluate the short-term economy of EC compared with TB-PPD， and cost-utility analysis was used to evaluate the long-term economy. The evaluation dimensions of innovation， suitability and accessibility were determined by systematic review and improved Delphi expert consultation， and the comprehensive score of EC and TB-PPD in each dimension were calculated by the weight of each indicator. RESULTS The scores of effectiveness， safety， economy， innovation and suitability of EC were all higher than those of TB-PPD. The affordability scores of the two drugs were consistent， while the availability score of EC was lower than those of TB-PPD. After considering dimensions and index weight， the scores of effectiveness， safety， economy， innovation， suitability， accessibility and the comprehensive score of EC were all higher than those of TB-PPD. CONCLUSIONS Compared with TB-PPD， EC performs better in all dimensions of effectiveness， safety， economy， innovation， suitability and accessibility. However， it is worth noting that EC should further improve its availability in the dimension of accessibility.

Objective:Childhood traumatic experiences greatly influenced the brain network activities of patients with depression,and there is an urgent need to explore the temporal dynamics for these changes.This study aims to investigate the abnormalities of resting-state electroencephalogram(EEG)microstates in eye-open state of depressed adolescents and to explore the correlations between their EEG microstates and the childhood traumatic experience. Methods:Using resting-state EEG microstate analysis,we explored the temporal dynamics of brain activity in patients with adolescent depression.This study selected 66 adolescents with depression as a patient group,and 27 healthy adolescents as a healthy control group.A modified k-means clustering algorithm was used to classify the 64-channel resting-state EEG data into different microstates.Independent sample t-tests were used to compare the microstate parameters between the 2 groups and further assciations between these parameters and childhood traumatic experience in patients were explored via using Spearman correlation. Results:In this study,significant differences were observed in the occurrence and transition probabilities of EEG microstates between the healthy control and the patient group.Notably,there was a statistically significant difference(P＜0.05)in the occurrence of microstate A across 2 groups,exhibiting a negative correlation with the emotional abuse component within the childhood trauma scores(Spearman's rho=-0.31,P=0.013).Furthermore,patient-specific,non-random transitions from microstate B to A(Spearman's rho=-0.30,P=0.015)and C to A(Spearman's rho=-0.31,P=0.013)were inversely associated with the scores of emotional abuse factors from childhood trauma in the patient group,showing statistically significant differences when comparing to the healthy controls(P＜0.05).Upon stratification into quartiles based on the emotional abuse factor scores,the occurrence of microstate A,as well as the transition rates from microstates B to A and C to A,retained statistical significance following adjustment for multiple comparisons(all P＜0.05). Conclusion:The abnormal temporal dynamics in brain networks of adolescents with depression are linked to childhood emotional abuse.Those who have suffered severe emotional abuse may show greater impairments in the brain's visual and central executive networks.EEG microstate analysis could be a potential tool for detecting adolescent depression with severe childhood trauma.

Objective To preliminarily understand the infection of Chikungunya virus (CHIKV) in Cangyuan County, a southern border area of Yunnan Province, and provide a reference basis for the prevention and control of Chikungunya fever. Methods In April 2020, a total of 400 serum samples from individuals seeking medical care at the People's Hospital of Cangyuan County in Yunnan Province were collected. Among these, 121 samples were from healthy individuals undergoing physical examinations, and 279 samples were from patients with fever. The serum samples collected underwent CHIKV neutralizing antibody testing using a serum micro-neutralization assay. Real-time fluorescence quantitative RT-PCR was used to detect CHIKV nucleic acid in the samples, followed by analysis of the test results. Results The results of neutralizing antibodies showed that 18 of the 400 human serum samples were positive for neutralizing antibodies against CHIKV, with an overall positivity rate for serum samples of 4.5% (18/400). Among the 279 serum samples collected from patients with fever, 18 were positive for neutralizing antibodies against CHIKV, with a positive rate of 6.45% (18/279), and the neutralizing antibody titers ranged from 1∶10 to 1∶320. The results of 121 healthy human serum samples were negative for neutralizing antibodies against CHIKV. The results of real-time fluorescence quantitative RT-PCR showed that 3 of the 400 human serum samples were positive for CHIKV nucleic acid, and the positive rate was 0.75% (3/400). Among the 279 serum samples collected from patients with fever, 3 samples were positive for CHIKV nucleic acid, with a positive rate of 1.08% (3/279), and Ct values ranged from 36.58 to 37.74. While all healthy human serum samples were negative for CHIKV nucleic acid. Conclusions The findings indicate that infection of CHIKV exists in the population of Cangyuan County, a southern border area of Yunnan Province, and an outbreak of the disease is occurring. Therefore, it is necessary to strengthen the monitoring, prevention, and control of CHIKV in this area.

Objective : To investigate the expression of class A scavenger receptor 1(MSR1) in the lungs of silico⁃ sis mice and its role in inflammation and lipid metabolism mediated by mouse mononuclear macrophages (RAW264. 7) . Methods : 24 C57BL/6 male mice were randomly divided into control group , exposed 7 d group , exposed 14 d group , exposed 28 d group , with 6 mice in each group. RAW264. 7 cells were divided into control group , siRNA⁃MSR1 group , SiO2 group and siRNA⁃MSR1 + SiO2 stimulation group. The pathological changes of lung tissue in mice were observed by HE and VG staining. Lipid accumulation was observed under oil red O staining microscope. Immunohistochemical staining (IHC) was used to detect the expression and localization of MSR1 . The expression of MSR1 , tumor necrosis factor (TNF) Ⅳα , interleukin (IL) Ⅳ6 and IL⁃1β were detected by Western blot. Results : Compared with the control group , HE and VG staining results showed that inflammatory cells gathered and collagen distribution increased in the lung tissue of silicosis mice. Oil red O staining showed that a large number of orange⁃red lipid droplets appeared in the lung tissue of mice. IHC results showed that the expression of MSR1 was up⁃regulated in silicosis inflammation stage. Western blot results showed that the expression of MSR1, TNF⁃α , IL⁃6 and IL⁃1β was up⁃regulated in silicosis inflammation stage (P < 0. 05) . The expression of MSR1 in the SiO2 cell stimulation group was up⁃regulated ( P < 0. 05 ) , and the expression of MSR1 in the siRNA⁃MSR1 group decreased (P < 0. 05) , and lipid droplets also appeared in the SiO2 cell stimulation group. The accumulation of lipid droplets in siRNA⁃MSR1 + SiO2 stimulation group was lower than that in SiO2 group (P < 0. 01) . ELISA results showed that the expression of TNF⁃α , IL⁃6 and IL⁃1β in SiO2 cell stimulation group was up⁃regulated ( P <0. 05) . Compared with SiO2 group , the expression of TNF⁃α , IL⁃6 and IL⁃1β in siRNA⁃MSR1 + SiO2 stimulation group was down⁃regulated (P < 0. 05) . Conclusion MSR1 is involved in the regulation of lipid components and the release of inflammatory factors in lung tissue and cells of silicosis mice. Inhibition of MSR1 expression can an⁃ tagonize the inflammatory response and abnormal lipid accumulation in macrophages. MSR1 may be a potential therapeutic target for future intervention in the progression of silicosis.

Objective : To explore the regulatory role of microRNA⁃455 ⁃3p ( miR⁃455 ⁃3p) in lymphangiogenesis of rat silicosis model , and to investigate the effect of miR⁃455 ⁃3p targeted regulation of vascular endothelial growth factor C (VEGF⁃C) on the tubular structure formation of human lymphatic endothelial cells ( HLECs) . Methods: The rats were randomly divided into the silicosis model group and the normal control group. The silicosis model group were injected with silicon dioxide (SiO2 )dust suspension , and the control group was injected with the same amount of normal saline. HE , Masson and immunohistochemistry staining were used to observe the pathological changes and lymphangiogenesis of lung tissue. The expression levels of miR⁃455 ⁃3p and VEGF⁃C in lung tissues of rats were detected by Quantitative real⁃time PCR ( RT⁃qPCR) and Western blot; The miR⁃455 ⁃3p inhibitors and negative controls ( NC) were transfected into HLECs , and the expression levels of miR⁃455 ⁃3p and VEGF⁃C in cells were detected by RT⁃qPCR and Western blot. The migration ability of HLECs was detected by scratch test , the ability of tubular structure formation was detected by matrigel tube formation test , and dual luciferase experiments were used to verify the targeting relationship between miR⁃455 ⁃3p and VEGF⁃C. Results : Compared with the normal control group , in the silicosis model group , a large number of inflammatory cells gathered and collagen gradually deposited in the pulmonary interstitium , and there was lymphatic hyperplasia in the lung. The expression of miR⁃455 ⁃3p in the lung tissue was lower than that in the control group , and the expression of VEGF⁃C was higher than that in the control group ; After transfection with HLECs , compared with the NC group , the expression of miR⁃455 ⁃3p in the cells of the Inhibitors group decreased , the expression of VEGF⁃C increased , and the ability of cell migration and tubular structure formation increased(P < 0. 05) ; VEGF⁃C was confirmed as a target gene of miR⁃455 ⁃3p by the dual luciferase experiments. Conclusion miR⁃455 ⁃3p can affect the tubular structure formation ability of HLECs and regulate lymphangiogenesis by targeting the expression of VEGF⁃C.

Objective:To explore the research hotspots and trends of risk prediction models in nursing at home and abroad.Methods:The visual analysis software CiteSpace was used, and the Web of Science was used as the data source. The publication situation of the risk prediction model in nursing was visually analyzed, mainly including time distribution, country/research institution cooperation network, journal collinear network, co-citation, keywords and emerging words.Results:A total of 684 articles were included. The number of publications on the risk prediction in nursing was on the rise. The United States was the country that contributed the most to the number of publications, and China ranked second. The Journal of Advanced Nursing was the most published journal. In terms of institutions and authors, the cooperation was not close. Research hotspots mainly focused on pressure injuries, falls, and nurses' burnout. Adverse event prediction, patient prognosis and intelligent data mining were the key research directions. Conclusions:Compared with international ones, the research on nursing risk prediction in China still needs to be strengthened. Future research can broaden the direction, perfect the existing model and carry out verification and improvement, so as to provide a good reference for nursing work.