OBJECTIVE To enhance the training quality of anticoagulation specialty clinical pharmacists， address the resource limitations of a single training base， and promote homogenization of training quality. METHODS A multi-base joint training system for anticoagulation specialty clinical pharmacists in the Beijing area was established. A mixed research method was employed， collecting data through performance comparisons， questionnaires， and qualitative interviews to compare the differences between the joint training model （experimental group， n＝16） and traditional teaching model （the control group， n＝17）. RESULTS The established joint training system encompassed a unified joint training teaching plan， the formation of a joint training teaching team， the establishment of joint theoretical teaching courses， the implementation of joint case discussions and literature presentations， as well as strengthening the assessment throughout the joint training process. Compared to the control group [theoretical assessment of （76.44±3.66） points， case assessment of （84.31±3.27） points]， the experimental group students achieved higher scores in theoretical assessment （[ 79.85±4.64） points] and case assessment （[ 88.70±5.51） points] （P＜0.05）. Through questionnaires and qualitative interviews， the trainees in experimental group were highly satisfied with the joint training model in terms of theoretical learning， communication skills， and teaching interaction. CONCLUSIONS The multi-base collaborative training system for anticoagulation specialty clinical pharmacists can integrate advantageous resources and significantly enhance the training effectiveness of anticoagulation specialty clinical pharmacists， offering value for wider promotion.

OBJECTIVE To evaluate the efficacy ，safety，and economy of selexipag in the treatment of pulmonary arterial hypertension（PAH）. METHODS After literature screening ，data extraction and quality evaluation ，the results of included studies were analyzed descriptively by retrieving PubMed ，Embase，Web of Science ，Cochrane Library ，Epistemonikos，SinoMed， CNKI，VIP，Wanfang data ，CBM，official websites of domestic and foreign health technology assessment institutions and relevant database. RESULTS&CONCLUSIONS A total of 7 literature were included ，involving 6 meta-analysis and 1 pharmacoeconomic study. In terms of efficacy ，selexipag could improve patients ’exercise tolerance and hemodynamic indexes ，and reduced the incidence of clinical worsening events and hospitalization . However，intravenous/subcutaneous administration of prostacyclin analog had better effects in improving WHO functional class and reducing all -cause mortality （P＜0.05）. There were no statistically significant differences in the impact on outcome indexes between selexipag and other targeted agents （P＞0.05）. In terms of safety ， the incidence of adverse drug events and drug withdrawal due to adverse reactions was increased by selexipag （P＜0.05），but there were no significant differences between the effects of selexipag and other targeted drugs on adverse events ，serious adverse events and drug withdrawal due to adverse reactions （P＞0.05）. In terms of economy ，based on the background of Canada ’s health system，it was not economical for selexipag to treat PAH ，and there was a lack of economic research based on China ’s national conditions. Further comparative studies on the efficacy and economics of selexipag and prostacyclins in the real world are needed .

Objective:Three-dimensional speckle tracking echocardiography (3D-STE) was used to evaluate the left ventricular function in patients with triple vessel coronary artery disease without myocardial infarction.Methods:60 patients with three vessel disease of coronary heart disease without myocardial infarction treated in the Second Affiliated Hospital of Dalian Medical University from June 2018 to December 2020 were selected. They were divided into two groups according to the results of coronary angiography. There were 31 cases in group B, and the stenosis rate of all triple vessel coronary artery was 50%-<75%; 29 cases in group C, the stenosis rate of all triple vessel coronary artery was ≥75%; Thirty healthy subjects were recruited as the group A. We measured left ventricular (LV) end-diastolic and end-systolic volume (LVEDV, LVESV) and LV ejection fraction (LVEF) using real-time dynamic three-dimensional echocardiography. The LV strain parameters were acquired by 3D-STE, including global longitudinal strain (GLS), global area strain, global radial strain (GRS) and global circumferential strain (GCS). The correlation between 3D-STE parameters and N-terminal proBNP (NT-proBNP), left ventricular end-diastolic pressure (LVEDP) were analyzed by Pearson linear correlation analysis.Results:The LVEDV and LVESV in group A and B were significantly lower than those in group C (all P<0.05), and the absolute values of LVEF, GLS, GRS, GCS and GAS were higher than those in group C (all P<0.05). There were no significant difference in LVEDV, LVESV and LVEF between group B and group A (all P>0.05), while the absolute values of GLS, GCS and GAS in group B were significantly lower than those in group A (all P<0.05). The absolute values of GLS, GRS, GCS and GAS in group C were negatively correlated with NT-proBNP and LVEDP (all P<0.05). The absolute value of GLS in group B was negatively correlated with NT-proBNP ( P<0.05), and the absolute value of GLS, GRS, GCS and GAS was negatively correlated with LVEDP (all P<0.05). Conclusions:Our study shows that 3D-STE can evaluate the LV function in patients with triple vessel coronary artery disease without myocardial infarction through multiple strain parameters.

BACKGROUND: Intensive phototherapy (IPT) and exchange transfusion (ET) are the main treatments for extreme hyperbilirubinemia. However, there is no reliable evidence on determining the thresholds for these treatments. This multicenter study compared the effectiveness and complications of IPT and ET in the treatment of extreme hyperbilirubinemia. METHODS: This retrospective cohort study was conducted in seven centers from January 2015 to January 2018. Patients with extreme hyperbilirubinemia that met the criteria of ET were included. Patients were divided into three subgroups (low-, medium-, and high- risk) according to gestational week and risk factors. Propensity score matching (PSM) was performed to balance the data before treatment. Study outcomes included the development of bilirubin encephalopathy, duration of hospitalization, expenses, and complications. Mortality, auditory complications, seizures, enamel dysplasia, ocular motility disorders, athetosis, motor, and language development were evaluated during follow-up at age of 3 years. RESULTS: A total of 1164 patients were included in this study. After PSM, 296 patients in the IPT only group and 296 patients in the IPT plus ET group were further divided into the low-, medium-, and high-risk subgroups with 188, 364, and 40 matched patients, respectively. No significant differences were found between the IPT only and IPT plus ET groups in terms of morbidity, complications, and sequelae. Hospitalization duration and expenses were lower in the low- and medium-risk subgroups in the IPT only group. CONCLUSIONS In this study, our results suggest that IPT is a safe and effective treatment for extreme hyperbilirubinemia. The indication of ET for patients with hyperbilirubinemia could be stricter. However, it is necessary to have a contingency plan for emergency ET as soon as IPT is commenced especially for infants with risk factors. If IPT can be guaranteed and proved to be therapeutic, ET should be avoided as much as possible.
Child, Preschool ; Exchange Transfusion, Whole Blood/adverse effects* ; Humans ; Hyperbilirubinemia, Neonatal/therapy* ; Infant ; Infant, Newborn ; Kernicterus/therapy* ; Phototherapy/methods* ; Retrospective Studies

Objective To evaluate the effect of Ulinastatin injection on inflammation, hemodynamics, oxygenation index (PaO₂/FiO₂) and prognosis in patients with septic shock. Methods A retrospective analysis was performed on clinical data of 109 patients with septic shock from January 2017 to December 2019. Patients were divided into observation group (n=73) and routine group (n=54) according to the treatment regimens. The two groups were given anti-shock treatment according to the relevant guidelines, and observation group was additionally given Ulinastatin. The inflammatory factors, hemodynamic parameters and PaO₂/FiO₂ and recovery were compared between the two groups before and after treatment. Results The levels of IL-6, TNF-α and PCT at 7 d of treatment were significantly decreased in the two groups (P<0.05), and the levels of IL-6, TNF-α and PCT of observation group were lower than that of routine group (P<0.05). At 12 h, 24 h and 72 h of treatment, the MAP, CI and PaO₂/FiO₂ were significantly increased in the two groups (P<0.05) while the EVLWI and SVRI were significantly decreased (P<0.05), and the MAP and PaO₂/FiO₂ of observation group at the same time were higher than that of routine group while the EVLWI was lower than that routine group (P<0.05). At 7 d of treatment, the APACHE-II score, mechanical ventilation time and ICU stay time of observation group were lower than that of routine group, and the incidence rates of MODS in the two groups were 4.11% and 14.81% respectively (P<0.05), and the mortality rates were 1.37% and 7.41% respectively (P>0.05). Conclusion Ulinastatin could be beneficial in septic shock, which could reduce inflammatory response, improve hemodynamic parameters and microcirculation perfusion, and put a positive effect on promoting rehabilitation and improving prognosis.

Objective:To explore the application effect of respiratory rehabilitation nursing led by respiratory rehabilitation nursing group in patients with acute exacerbation of chronic obstructive pulmonary disease.Methods:Using the convenient sampling method, a total of 124 patients with acute exacerbation of chronic obstructive pulmonary disease who were admitted to Department of Respiratory Medicine of China-Japan Friendship Hospital from June 2018 to June 2020 were selected as the research objects. Among them, 62 cases admitted to the hospital from June 2018 to June 2019 were set as the control group and 62 cases admitted to the hospital from July 2019 to June 2020 were set as the observation group. The control group was given routine nursing, while the observation group was given respiratory rehabilitation nursing by the respiratory rehabilitation nursing group. The differences in body mass index, airflow obstruction, dyspnea, and exercise capacity index (BODE) index, Chinese version of COPD Assessment Test (CAT) scale, activity of daily living (ADL) , self-efficacy and self-management ability were compared between the two groups before and after the intervention.Results:Finally, 58 patients in the control group and 61 patients in the observation group completed the study. After the intervention, the BODE index and CAT score of the observation group were lower than those before the intervention, and the scores of ADL, self-efficacy and self-management ability were increased, and they were all higher than those of the control group, and the differences were statistically significant ( P<0.05) . Conclusions:In the respiratory rehabilitation nursing of patients with acute exacerbation of chronic obstructive pulmonary disease, a special respiratory rehabilitation nursing group can relieve the symptoms of dyspnea and improve the ADL, self-efficacy and self-management ability of patients, which is worthy of promotion.

Objective:To explore the effectiveness of application of the internet of things in respiratory rehabilitation nursing for patients with chronic obstructive pulmonary disease (COPD) .Methods:Using the convenient sampling method, a total of 96 patients who were admitted to the Department of Respiration and Critical Care Medicine in the Center of Respiratory Medicine of China-Japan Friendship Hospital from January to December 2019 were selected as research objects. Patients were selected according to their willingness to use the internet of things devices for respiratory rehabilitation. Voluntary users were included in the observation group, while unwilling users were included in the control group, with 48 cases in each group. The control group received routine respiratory rehabilitation nursing, while the observation group received the internet of things scheme on the basis of the control group. The maximum inspiratory pressure (MIP) , activity of daily living (ADL) , rehabilitation exercise compliance and satisfaction were compared between the two groups before and after the intervention.Results:There were significant differences in the MIP and ADL between the two groups before and after the intervention ( P< 0.01) . After the intervention, the MIP, ADL, rehabilitation exercise compliance and satisfaction of patients in the observation group were higher than those in the control group, and the differences were statistically significant ( P<0.05) . Conclusions:The application of the internet of things in respiratory rehabilitation nursing of COPD patients can improve the MIP, ADL, rehabilitation exercise compliance and satisfaction of patients, which is worthy of clinical application and promotion.

ated acute peritonitis induced by LPS in rats.

Objective To investigate the role of rat organic anion transporter 1 (OAT1, SLC22A6) in the renal cellular uptake of AA Ⅰ and its impact on cellular toxicity. Methods HEK-293 cells were transfeeted with rat OAT1 cDNA or empty vectors. The over-expression of rOAT1 was confirmed by Western blot analysis and its activity was validated by using para-aminohippurate (PAH) as a probe. Cellular apoptosis was examined by flow cytometery using propodium iodode (PI) and annexin V-FITC staining. Results Concentration-and time-dependent intracellular accumulation of AA Ⅰ was observed in rOATl-transfected HEK-293 cells. After treatment with AA Ⅰ at the concentrations of 40 mg/L, 80 mg/L, 120 mg/L and 160 mg/L,respectively, for 45 min, the intracellular concentrations of AA Ⅰ in rOAT1-transfected HEK-293 cells were higher than those in controls (P<0.05). After treatment with AA Ⅰ (120 mg/L for 30 min, 60 min, 90 min and 120 min, respectively, the intracellular concentrations of AA Ⅰ in rOAT1-transfected HEK-293 cells were higher than those in controls (P<0.05). PAH significantly reduced the intracellular accumulations of AA Ⅰ in rOAT1-transfected HEK-293 cells. After treatment with AA Ⅰ at the concentrations of 40 mg/L, 80 mg/L, 120 mg/L and 160 mg/L respectively for 35 min, the intracellular accumulations of AA Ⅰ in rOAT1-transfected HEK-293 cells that treated with PAH were lower than those that were not treated by PAH. Cellular apoptosis and caspase-3 expression in rOAT1-transfeeted HEK-293 cells were significantly up-regnlated as compared to controls (P<0.05). Conclusion rOAT1 is involved in the cellular uptake of AA Ⅰ which leads to increased epithelial apoptosis. Further studies are suggested to investigate the role of human OAT in the disposition of AA and its toxicological consequences.

Objective To report a Chinese boy suffering from nephrotic syndrome associated with Schimke immuno-osseous dysplasia (SIOD). Methods The clnical data and pathological changes of renal biopsy were analyzed and associated literatures were reviewed. The clinicopathological features and diagnosis of SIOD were discussed. Results The first symptom of the patient was recurrent infections. Growth retardation, spondyloepiphyseal dysplasia accompanied by nephrotic syndrome and defective cellular immunity were seen as clinical features in this patient. Renal pathology showed focal segmental glomerulosclerosis. Conclusion Combining the clinical manifestation with renal pathology, the case is diagnosed as Schimke immuno-osseous dysplasia.