Objective:To investigate the application value of shear wave elastography (SWE) in the evaluation of T re-staging after neoadjuvant chemoradiotherapy (nCRT) for locally advanced rectal cancer.Methods:Clinical, endorectal ultrasound (ERUS) and SWE data of 271 patients with locally advanced rectal cancer who underwent nCRT and total mesorectal excision in Fujian Medical University Union Hospital from October 2021 to March 2023 were prospectively collected. The independent predictors for low T staging were analyzed and screened, and the Logistic regression model was constructed. An independent test set was used to validate the prediction performance of the models and compare them with the diagnostic results of sonographers.Results:Binary multivariate Logistic regression analysis showed that Emean of the mesentery around the lesion, thickness, and enlarged lymph nodes around the rectum were the independent predictors for low T staging, and the odds ratios were 1.089, 1.214, 0.183, respectively. The Logistic regression model A established by Emean, thickness and enlarged lymph nodes around the lesion and the Logistic regression model B established by Emean around the lesion had high diagnostic efficiencies (area under the ROC curve were 0.931, 0.918, respectively, the accuracy were 0.888 and 0.887, respectively). There was no significant difference in diagnostic accuracy between the two models ( P=1.000), and both models were significantly higher than that of sonographers (all P<0.001). Conclusions:SWE can effectively predict whether the tumor is of low T staging after nCRT in locally advanced rectal cancer, and can be used as an important supplement to ERUS in evaluating the T re-staging of rectal cancer after nCRT.

Objective: To identify and characterize the 4 strains of Prototheca isolated from the clinical samples of skin or ascites samples in China. Methods: The taxonomic position of 4 yeast-like organisms was revealed by polyphasic taxonomic approach, i.e., cultural and morphologic characteristics, commercial biochemical systems of Vitek 2 (YST kit) and Vitek matrix-assisted laser desorption/ionization time of flight (MALDI-TOF) mass spectrometry (MS) systems in combination with phylogenetic analysis based on the gene sequences of 16S and 28S rRNA. Results: The 4 strains of Prototheca were characterized as cream-white, smooth, moist yeast-like colonies on Sabouraud gentamicin chloramph agar after incubation for 3 days. However, round, oval-shaped or elliptical sporangiums with mulberry-like or strawberry-like endospores were observed by optical microscope, which showed distinct differences from the general yeast species. The 4 isolates were identified as Prototheca wickerhamii with Vitek YST kits by Vitek 2 systems and Vitek MALDI-TOF MS systems. The genome for the 4 isolates was characterized with the existence of the prokaryotic 16S rRNA gene and eukaryotic 28S rRNA gene. The 16S rRNA gene sequence of the 4 strains showed more than 99.7% similarity to that of P. wickerhamii. Sequence analysis of 28S rRNA gene showed that the organisms included multiple copies of different sequences, which showed sequence similarities of 91.9% to 100% even in the same strain. The phylogenetic dendrogram based on 16S rRNA and 28S rRNA gene sequences showed that the 4 strains of Prototheca formed a cluster along with P. wickerhamii. Conclusion The 4 yeast-like organisms could be identified as P. wickerhamii, and 16S rRNA gene should be the suitable molecular target for the identification.

Objective:To establish a calculation model of drug preparation difficulty coefficient for outpatient pharmacy intrave -nous admixture center ( OUIVA) in a children's hospital, and construct the performance model .Methods: All the prescriptions in a week in OUIVA of Shanghai children's medical center were randomly selected .According to the actual difficulty level in the process of outpatient and emergency drug preparation , a basic drug difficulty coefficient and difficulty coefficient addition method was constructed . The difficulty index of every prescription was calculated .All the prescriptions in a week were randomly selected , and according to the difficulty coefficient analysis method , the daily difficulty coefficient of the prescriptions was calculated in order to build a performance model for OUIVA in the hospital .Results:The difficulty coefficient of medicine mainly included four basic difficulty coefficients and nine difficulty addition coefficients .According to the statistics , the average difficulty coefficient of daily prescriptions was (3.83 ± 2.86 )with the highest difficulty coefficient of 35, and the prescription data showed that there was significant difference between outpa -tient and emergency prescriptions and daytime blood tumor prescriptions .Conclusion:A performance model based on the difficulty co-efficient for OUIVA in children ' s hospital is a more scientific reflection to the daily work .

Objective:To analyze the dosage distribution and the frequency of each dosage of high-risk tablets in the hospitalized patients in a children's hospital,and study whether the existing specifications of high-risk tablets meet the pediatrics clinical needs. Methods:All the prescriptions including high risk tablets were analyzed from 2014 to 2016 in Shanghai children's medical center. The frequency of every dosage of every drug was analyzed,and the current specifications were judged according to the frequency. New specifications were proposed when the existing specifications did not match the clinical needs. The new frequency of the proposed speci-fications was re-accounted for all the three-year prescriptions in order to evaluate whether the proposed new specifications met the clini-cal needs. Results:Among the five kinds of high-risk oral tablets,methotrexate tablets and vitamin A acid tablets were in accordance with the actual clinical requirements. Mercaptopurine tablets should add two specifications including 12.5 mg and 17 mg,and warfarin sodium tablets should add one specification(1.25 mg). Hydroxyurea tablets(250 mg) and warfarin sodium tablets(1 mg) were rec-ommended used in the children's hospital. Conclusion:The existing specifications of high-risk oral tablets can't fully meet the clini-cal needs,therefore,specifications still needs to be adjusted.

Objective:To analyze the safety of generics and lactation of commonly used drugs in outpatient and emergency department of a children's hospital in Shanghai to formulate the related high-risk medicines list. Methods:According to the drug directory for outpatient and emergency department in the sample hospital,the medication assistant software was used to check the safety level of the related drugs used during pregnancy and lactation. Drugs with pregnancy safety grade D or X,and the lactation safety grade L4 or L5 involved in the high-risk pregnancy or breast-feeding drug list. Results:Of the 151 kinds of infusion medicines commonly used in outpatient and emergency department in the sample hospital, a total of 118 kinds were with a specified level of pregnancy safety,which accounted for 78.15%,and a total of 86 kinds were with a clear indication of the safety level of lactation,which accounted for 56.95% of the total number of medicines. A total of 25 kinds of drugs labeled pregnancy safety grade D or X, which accounted for 16.56%, and 21 species were with lactation safety L4 or L5, which accounted for 13.90% of the total number of drugs. The drugs with high pregnancy or lactation risk in the outpatient and emergency department of the sample children's hospital were anti-tumor drugs,anti-infective drugs,some cardiovascular drugs and central nervous system drugs. Conclusion:There are still many deficiencies in the information about the safety of pregnancy or breast-feeding in the existing medicines used in the sample hospital,which need to be improved.

Objective: To analyze the common dosage of oral liquid preparations used in a children's hospital in order to provide reference for the best drug specifications for children's medicines. Methods: The prescription data of patients containing oral liquid preparations were collected from January 2014 to December 2016 and used for the analysis in the sample hospital. The most commonly used doses were compared with the existing specifications to provide suggestions on the best specifications for children. Results: There were 11 kinds of oral liquid preparations commonly used in the children's hospital. Only 4 kinds of drugs met with the best drug speci-fications for children, and the others were not able to meet the clinical needs in the children's hospital. Conclusion: The best specifi-cations of children's medicines need to be readjusted.

Objectives To identify the Francisella strain isolated from blood of a patient with drowning-associated pneumonia.Methods The whole genome of the strain,designated Wenzhou1,was sequenced using the high throughput sequencing technology by 2000/miSeq system of Illumina platform,and the obtained genome draft was assembled by MicrobeTrakr Plus software.The phylogenetic neighbors of Wenzhou1 were obtained by NCBI BLAST analysis from GenBank database for the gene sequences of 16S rRNA,malate dehydrogenase(mdh),DNA-directed RNA polymerase subunit beta (rpoB) and succinate dehydrogenase subunit alpha (sdhA).The average nucleotide identity(ANI) between Wenzhou1 and its phylogenetic neighbors was analyzed by the software OrthoANI using NCBI BLAST search under the Java Runtime Environment Version 8.Results The genome size of Wenzhou1 was 1.96 × 106 bp,containing 74 contigs.The genomic G + C mol％ of Wenzhou1 was 32.1％,which was similar to the other species of genus Francisella and Allofranicella.Based on the analysis of NCBI BLAST of GenBank for the similarities of 16S rRNA gene,mdh gene,rpoB gene and sdbA gene sequences,Wenzhou1 was most closely related to F.hispaniensis FSC454 and Francisella cf.novicida 3523.The ANI of Wenzhou1 was 97.8％ to F.hispaniensis FSC454,97.5％ to 97.6％ to Francisella cf.novicida 3523,but only 91.3％ to 91.5％ to the four subspecies of F.tularensis.Conclusion ANI analysis based on whole genome sequence should be an accurate,effective method for bacterial identification.Wenzhou1 could be identified as F.hispaniensis by ANI with high-throughput whole genome sequencing technology.

Objective: To study the dosages of capsules commonly used in children to provide reference for the addition of capsule specification for children.Methods: According to the application situation of capsule dosages commonly used for the inpatients in one children's hospital from January 1, 2013 to September 1, 2016, and combined with the usage rates of various drugs with different dosages, the addition of the minimum dosage of capsules was proposed.Results: Totally 10 species of commonly used capsules were selected from the children's hospital, and among them, 4 ones met the requirements of clinics, and the other 8 ones needed the specification addition, including clostridium butyricum capsules (210 mg) and polysaccharide ferric complex capsules (25 mg).Conclusion: The existing capsule specification can not fully meet the clinical requirements in the children's hospital.Therefore, appropriate dosage adjustments are still needed.

Objective: To establish the standardized management mode for emergent medicines of inpatient area based on JCI. Methods:The expiry verification data of emergent medicines in hospital wards were collected from 2013 to 2015. The number and the amount of emergent medicines expired in the last three months in each calendar month during the three years were analyzed, the exist-ing problems in the management mode were found out and gradually optimized using PDCA cycle. Results:From 2013 to 2015, the re-placement amount of emergent medicines expired in the next month was 3497. 37 yuan. The number of emergent medicines expired in current month was 62. A total of 420 times of emergent medicines didn' t meet the requires of expiry verification from 2013 to 2015. After the check-in form redesign for emergent medicines and the standardization of replacement process, the number of expired medi-cines in the rescue carts was reduced, and the validity and quantity of drugs in all the rescue vehicles could be clearly shown in the new form. Conclusion:The standardization of emergent medicine management model can guarantee the safety of emergent medicines used in patients.

Objective To explore the influence of various concentrations of amino acid on the stability of neonatal parenteral nutrition solutions .Methods Five formulations were designed with 5 different amino acid concentrations containing the same components .The final amino acid concentrations of admixtures were 0%, 1%, 2%, 3%, and 3.5%, respectively .The appearance , pH, and osmolality were observed or meas-ured after preparation (0 hour) and at 12, 24, 48 and 72 hours after preparation.The average size and the size distribution of the lipid globules were also evaluated by laser nanometer particle size analyzer .Results There was no observable alteration in color , phase separation , precipitate , and flocculation in any admixture at any of the observation time points.The mean pH values for all groups were between (5.49 ±0.01) to (6.19 ±0.01) within 72 hours.The mean osmolalities for all groups were between (774 ±3) to (1106 ±13) mOsm/kg.The mean diameters of lipid globules for all groups were between (280.6 ±0.7 ) mm to (332.2 ±2.0 ) nm.The mean polydispersity for all groups were between (0.200 ±0.011) to (0.245 ±0.012).The enrichment of ami-no acid concentration was linked to lower pH ( P=0.000 ) , higher osmolality ( P=0.000 ) and larger average lipid globules size ( P=0.000 ) .However , there was no distinct linear dependence between amino acid concen -tration and polydispersity value ( P=0.628 ) .Conclusion After 72 hours of storage at room temperature , the appearance, pH, osmolality, and the average lipid globules diameter of the parenteral nutrition solutions are within the safe range when the amino acid is not contained or the concentrations are no more than 3.5%.