OBJECTIVE To evaluate the influence of pharmaceutical quality control on the efficiency and outcomes of standardized medication therapy management （MTM） services for patients with coronary heart disease by using Economic， Clinical and Humanistic Outcomes （ECHO） model. METHODS This study collected case data of coronary heart disease patients who received MTM services during January-March 2023 （pre-quality control implementation group， n＝96） and June-August 2023 （post-quality control implementation group， n＝164）. Using propensity score matching analysis， 80 patients were selected from each group. The study subsequently compared the economic， clinical， and humanistic outcome indicators of pharmaceutical services between the two matched groups. RESULTS There were no statistically significant differences in baseline data between the two groups after matching （P＞0.05）. Compared with pre-quality control implementation group， the daily treatment cost （16.26 yuan vs. 24.40 yuan， P＜0.001）， cost-effectiveness ratio [23.12 yuan/quality-adjusted life year （QALY） vs. 32.32 yuan/QALY， P＜0.001]， and the incidence of general adverse drug reactions （2.50% vs. 10.00%， P＝0.049） of post-quality control implementation group were decreased significantly； the utility value of the EuroQol Five-Dimensional Questionnaire （0.74± 0.06 vs. 0.71±0.07， P＝0.003）， the reduction in the number of medication related problems （1.0 vs. 0.5， P＜0.001）， the medication adherence score （[ 6.32±0.48） points vs. （6.10±0.37） points， P＝0.001]， and the satisfaction score （[ 92.56±1.52） points vs. （91.95±1.56） points， P＝0.013] all showed significant improvements. Neither group experienced serious adverse drug reactions. There was no statistically significant difference in the incidence of new adverse reactions between the two groups （1.25% vs. 3.75%， P＝0.310）. CONCLUSIONS Pharmaceutical quality control can improve the quality of pharmaceutical care， and the ECHO model can quantitatively evaluate the effect of MTM services， making pharmaceutical care better priced and more adaptable to social needs， thus being worthy of promotion.

BACKGROUND:As a dominant breed pig in southwest China,the southern Yunnan small-ear pig has been widely used as an experimental animal in the basic research of other disciplines,but there are still no reports on its application in anterior cruciate ligament reconstruction. OBJECTIVE:To establish a large animal model of the southern Yunnan small-ear pig with anterior cruciate ligament with autologous Achilles tendon was established. METHODS:Twenty adult female Yunnan small-ear pigs were equally randomized into two groups.In the autologous Achilles tendon group,the right knee anterior cruciate ligament was reconstructed with autologous Achilles tendon as a graft,while in the sham-operated group,a similar operation was performed on the right knee without any treatment of the anterior cruciate ligament.General conditions of each pig were observed and recorded before and 12 months after surgery.Ligaments and grafts were taken for gross observation and MAS scoring.Hematoxylin-eosin staining was performed to observe morphological characteristics of ligaments.The staining and arrangement of type I and type Ⅲ collagen were evaluated by immunohistochemistry.Transmission electron microscopy was used to observe the type,size,diameter,ratio,and distribution of collagen fibers in ligaments. RESULTS AND CONCLUSION:All animals had normal diet and activity,good wound healing,no obvious inflammatory reaction,no local purulent infection,and no significant changes in mental and urinary conditions compared with those before surgery.The reconstructed cruciate ligament of the knee was intact,with no stiffness and normal range of motion.Both the anterior drawer and Lachman tests were negative.Gross observation of the graft:12 months after surgery,the grafts was in good position,with good integrity,obvious tension,ligament color close to the original anterior cruciate ligament,and complete surface synovial coverage.Most of the intraarticular ligaments in the autologous Achilles tendon group were defined as MAS I type and a few were defined as MAS Ⅱ type.In the sham-operated group,the intraarticular ligament was defined as MAS I type.Hematoxylin-eosin staining indicated that,12 months after surgery,collagen fibers in the autologous Achilles tendon group began to appear bundled,isotropic,and uniformly arranged,with more obvious isotropic corrugations,and the nuclei were mainly linear or spindle-shaped,which were similar to those in normal anterior cruciate ligament tissue of the sham-operated group.Immunohistochemistry results indicated that,12 months after surgery,there was a higher expression of type I collagen and significantly less expression of type Ⅲ collagen in the reconstructed anterior cruciate ligament in the autologous Achilles tendon group.The degree of type I and type Ⅲ staining was similar in the two groups.Under the transmission electron microscope,the diameter,arrangement and density of collagen fibers in the reconstructed anterior cruciate ligament of the autologous Achilles tendon group were similar to those of the original anterior cruciate ligament at 12 months after surgery,indicating that the ligament remodeling process had been basically completed in the autologous Achilles tendon group at 12 months after surgery.Through a comprehensive evaluation of animal general conditions,ligament general view,MAS score,hematoxylin-eosin staining,immunohistochemistry,and transmission electron microscopy observation,we successfully established a large animal model of anterior cruciate ligament reconstruction using autogenous Achilles tendon in southern Yunnan small-ear pigs,with good morphological,histological and ultrastructural results.

BACKGROUND: Studies have shown that the incidence and severity of corona virus disease 2019 (COVID-19) in patients with lung cancer are higher than those in healthy people. At present, the main anti-tumor treatments for lung cancer include surgery, immunotherapy, chemotherapy, radiotherapy, targeted therapy and anti-angiogenesis therapy. While the effects of different anti-tumor treatments on the occurrence and severity of COVID-19 pneumonia are not uniform. Therefore, we aimed to describe clinical characteristics and antitumor therapy of patients with lung cancer and COVID-19 pneumonia, and examined risk factors for severity in this population. METHODS: From December 1, 2022 to February 15, 2023, a retrospective study was conducted in 217 patients diagnosed with COVID-19 and pathologically confirmed lung cancer in the Jinling Hospital. We collected data about patients' clinical features, antitumor treatment regimen within 6 months, and the diagnosis and treatment of COVID-19. Risk factors for occurrence and severity of COVID-19 pneumonia were identified by univariable and multivariable Logistic regression models. RESULTS: (1) Among the 217 patients included, 51 (23.5%) developed COVID-19 pneumonia, of which 42 (82.4%) were classified as medium and 9 (17.6%) were classified as severe; (2) Univariate and multivariate analysis revealed overweight (OR=2.405, 95%CI: 1.095-5.286) and intrapulmonary focal radiotherapy (OR=2.977, 95%CI: 1.071-8.274) are risk factors for increasing occurrence of COVID-19 pneumonia, while other therapies are not; (3) Chronic obstructive pulmonary disease (COPD) history (OR=7.600, 95%CI: 1.430-40.387) was more likely to develop severe pneumonia and anti-tumor therapies such as intrapulmonary focal radiotherapy, chemotherapy, targeted therapy and immunotherapy did not increase severity. CONCLUSIONS Intrapulmonary focal radiation therapy within 6 months increased the incidence of COVID-19 pneumonia, but did not increase the severity. However, there was no safety concern for chemotherapy, targeted therapy, surgery and immunotherapy.
Humans ; COVID-19 ; Retrospective Studies ; Lung Neoplasms/drug therapy* ; Incidence ; Pneumonia/etiology*

Objective:To investigate the value of chromosomes 7 and 8 polysomy in circulating tumor cells (CTCs) for the diagnosis of non-small cell lung cancer, and the correlation of CTCs with clinical pathological characteristics and epidermal growth factor receptor (EGFR) mutations in cancer tissue.Methods:Fifty-seven patients with non-small cell lung cancer and 21 patients with benign lung diseases were enrolled at Beijing Chaoyang Hospital, Capital Medical University, Beijing, China from November 2017 to October 2020. Negative enrichment combined with immunofluorescence in situ hybridization (imFISH) was used to identify CTCs polysomy on chromosomes 7 and 8. EGFR mutations in 56 lung cancer patients was detected using ARMS-PCR.Results:CTCs were detected in 93.0% (53/57) of non-small cell lung cancers and 28.6% (6/21) benign lung lesions. The difference between lung cancer patients and the control cohort was statistically significant ( P<0.01). Receive operator curve (ROC) analyses showed that, when the cut-off value was 1 cell/3.2 mL, Youden index had the highest sensitivity of 93.0% and specificity of 71.4% (AUC=0.906, 95% CI:0.833-0.980, P<0.01). The positive rate of CTCs in stage Ⅲ-Ⅳ cancers was significantly higher than that in stage Ⅰ-Ⅱ ( P=0.023). No significant correlation was observed between positive rate of CTCs or chromosome polysomy and age, gender, smoking status, pathologic types and EGFR mutation status. The number of CTCs in EGFR mutated group was higher than that in the non-mutated group (6.5±1.1 vs. 3.7±0.7, P=0.045). The detection rate for CTCs ≥5 in the EGFR mutated group was also higher than the EGFR non-mutated group (52.0% vs. 19.4%, P=0.010). Conclusion:Detection of CTCs with chromosomes 7 and 8 polysomy has potential value in auxiliary diagnosis of non‐small cell lung cancer, and the number of CTCs is correlated to TNM stage and EGFR gene mutation status.

Objective: To summarize the clinical features of 7 rare cases of hemolytic disease of newborn (HDN), and to improve the understanding of rare HDN. Methods: Data of clinical information, laboratory findings, treatments and outcomes were collected and analyzed for four cases with HDN due to anti-M, two cases due to anti-Kidd, and one case due to anti-Duffy. All of them were admitted to the Department of Neonatology, Beijing Children's Hospital Affiliated to Capital Medial University from July 2007 to June 2017. Results: Among the four MN hemolytic babies, two were males and two were females. Jaundice was found in three cases. Two cases had hyperbilirubinemia, one of them had severe hyperbilirubinemia. All the four cases developed anemia, including severe anemia in three cases. Two cases of Kidd hemolytic disease and 1 case of Duffy hemolytic disease had jaundice and anemia, but did not reach the level of severe hyperbilirubinemia and severe anemia. MN hemolytic disease babies got negative results in direct antiglobulin test, whereas the Kidd and Duffy hemolytic disease babies had positive findings in direct antiglobulin test. None of the babies had blood transfusion, and they were discharged from the hospital. Conclusions Without maternal and fetal blood group incompatibility (ABO or Rh blood-group system), for early onset of jaundice, severe jaundice or anemia, antiglobulin test to mother and child earlier should be administered, and MN, Kidd, Duffy and other rare hemolytic disease of the newborn should be pay attention to.

Objective To investigate the effect of 17β-estradiol on the pain threshold in neuropathic rats.Methods Fifty fe-male SD rats were divided into five groups by adopting the random number table method,the sham operation group(separating and exposing the left sciatic nerve without ligation and giving the saline injection),the other four groups were established as chronic compression injury(CCI)model of sciatic nerve:CCI group(saline injection),estradiol group(17β-estradiol injection),antagonist group(AP-5 injection)and composite group(17β-estradiol and AP-5 injection),10 cases in each group.The rat mechanical pain threshold value was examined by adopting the paw withdrawal mechanical threshold(PWMT),the rat thermal threshold was exam-ined by adopting the paw withdrawal thermal latency(PWTL),and the expression of NMDAR1 protein was determined by immuno-histochemistry and Western blot.Results Compared with the sham operation group,PWM T in the CCI group and estradiol group was decreased(P<0.05)and PWTL was shortened(P< 0.05),while the expression of NMDAR1 protein was significantly in-creased(P<0.05).Compared with the CCI group,PWMT in the estradiol group was decreased(P<0.05)and PWTL was short-ened(P<0.05),while the expression of NMDAR1 protein was significantly increased(P<0.05).Conclusion 17β-estradiol can de-crease the pain threshold of the neuropathic pain rats by increasing the NMDAR1 expression.

ObjectiveTo compare the effects of airway humidification by atomization humidifier and heated humidifier on ICU patients with tracheotomy. Methods? Totally 57 patients who received tracheotomy and did not need mechanical ventilation from the Department of Critical Care Medicine of Yixing No.2 People's Hospital between December 2014 and November 2017 were selected by convenient sampling and divided into the control group (n=28) which received airway humidification by atomization humidifier and the observation group (n=29) which received airway humidification by heated humidifier according to the random number table. The differences in sputum quantity, number of daily sputum suction, sputum viscosity and blood gas analysis index were compared between the two groups. Results? The number of daily sputum suction, sputum volume and viscosity of sputum of the observation group were less than that of the control group (P＜0.05). The observation group showed better blood gas analysis results than the control group on day 7 (P＜0.05). Conclusions? The heated humidifier is better for dilution and drainage of sputum. It can effectively improve the oxygenation of ICU patients with tracheotomy, maintain better acid-base balance, lessen sputum suction procedures which would be repeated and time-consuming in clinical nursing care, reduce damage to patients' airway mucosa, and improve the quality of airway management, which is worth promoting in clinical practice.

Objectives To investigate the closing time of patent foramen ovale in newborns and infants in order to provide appropriate follow-up time points.Methods From September 1,2010 to April 30,2011,131 of l 202 full-term infants with patent foramen ovale were finished follow up at 3,6 and 12 months of age in Beijing Children's Hospital,Capital Medical University.If the foramen ovale was not closed at 12 months of age,the patients were followed up until two years of age.The closing time and the effects of complicated patent ductus arteriosus (PDA) were analyzed statistically using two independent t test,Chi-square and trend Chi square tests.Results Of the 131 full-term infants with patent foramen ovale,72 were males,and 59 were females.The foramen ovale size in neonatal period was not statistically different between males and females [(2.94 ±0.86) vs (2.95 ± 0.92) mm,t=0.641,P=0.964].The foramen ovale closing rate at 3 months was 21.4％ (28/131),67.9％ (89/131) at 6 months,and 95.4％ (125/131) at 12 months.The rate of foramen ovale closing decreased with larger foramen ovale at 3,6 and 12 months of age (x2trend were 42.930,101.050 and 63.260,all P＜0.05).Six patients with patent foramen ovale at 12 months of age were followed up until 2 years of age:two cases with foramen ovale ＜5.0 mm in the neonatal period were closed,one of two cases with foramen ovale ≥5.0 but ＜6.0 mm was closed,and one of two cases with foramen ovale ≥ 6.0 mm was closed.Of the 131 cases,121 were simple patent foramen ovale,and l0 were complicated with PDA.There were no significant difference in neonatal foramen ovale size between children with simple patent foramen ovale and those with PDA [(2.95 ±0.88) vs (2.82±0.83) mm,t=0.782,P=0.649].The closing rates in the simple patent foramen ovale group at 3,6,and 12 months of age were 21.5％ (26/121),57.9％ (55/95) and 87.5％ (35/40),respectively,and showed no significant difference from those with PDA (2/10,6/8 and 1/2,x2=0.012,0.946 and 1.536,all P＞0.05).In the simple patent foramen ovale group,the closing rate at 3 months was less than that at 6 months and 12 months 0x2 were 10.410 and 62.515,both P＜0.01).There was no difference in the closing rate in patients with PDA at 3,6 and 12 months (x2=5.748,P＞0.05).Conclusions Asymptomatic patent foramen ovale with a foramen ovale ＜5.0 mm may not require follow-up.But patients with a foramen ovale ≥ 5.0 mm,even asymptomatic,should be followed up using thoracic echocardiography at 2 years,and further follow-up is required if unclosed.

Objective To investigate the effect of three different routes of administration of analgesic on gastrointestinal function in delivery women with cesarean section.Methods From June 2016 to January 2017,90 delivery women cesarean section were treated in our hospital aged 23-35 years with body mass index (BMI) 25-35 kg/m2,ASA physical status Ⅰ or Ⅱ.Parturients were randomly divided into three groups:intravenous analgesia pump group (group J),skin implanted analgesia pump group (P group) and epidural analgesia pump group (group Y).Group J received postoperative intravenous infusion of sufentanil 5 μg and analgesia pump (3 μg/kg sufentanil+ 100 ml saline)connected with venous channels;group P received postoperative Bipi injection of sufentanil 5 μg introcarplaced in the subcutaneous and connected with analgesia pump (3 μg/kg sufentanil+ 100 ml saline);group Y was given epidural injection of 1％ ropivacaine and 0.5％ lidocaine mixture 4 ml,the analgesia pump (0.15％ ropivacaine+50 μg sufentanil+100 ml saline) was connected with epidural catheter.The recovery time of bowel sounds,the time of firstly anal exhaust,48 hours after surgery,the incidence of nausea,vomiting and bloating were recorded.Results The recovery time of bowel sounds [(14.6±2.3) h] and the time of firstly exhaust time [(20.5±7.9) h] in group Y was significantly earlier than in group J [(18.3±3.6) h and (28.7±8.2) h] and group P [(18.8±4.1) h and (27.9±9.3) h] (P＜0.05).The incidence of nausea (17％),and abdominal distention (20.0％) was significantly lower in group Y than in group J (36.7％ and 47.0％) and group P (33.3％ and 43.0％) (P＜0.05).Conclusion Postoperative analgesia pump of epidural pathway is beneficial to restore the gastrointestinal function on the basis of postoperative analgesia.

ObjectiveTo analyze the clinical manifestation of hemolytic disease of the newborn (HDN) due to anti-M and Rhesus system.MethodsClinical information was collected and analyzed for three cases with HDN due to anti-M and 64 with Rhesus hemolytic disease, who were admitted to Department of Neonatology, Beijing Children's Hospital Affiliated to Capital Medical University from February 2011 to January 2015, as well as another 28 cases of HDN due to anti-M with complete information retrieved from literature in Wanfang and China National Knowledge lnfrastructure (CNKI) Database from 1992 to 2014.Chi-square test was performed for statistical analysis.ResultsTwo out of the 64 Rh hemolytic babies gave up therapy due to kernicterus and another two out of the 31 MN hemolytic babies, obtained from literature, died 24 h after birth because of anemia or edema, while the rest survived. Although more babies were the first child of the family in HDN due to anti-M than those of Rh hemolytic disease [26%(8/31) vs 9%(6/64),χ2=4.487, P=0.034], but lower incidence of jaundice [81%(25/31) vs 98%(63/64),χ2=9.686,P=0.002], less proportion of presentation of jaundice within 24 h after birth [29% (9/31) vs 64%(41/64),χ2=10.279,P=0.001] and lower positive rate of direct antiglobulin test [39%(12/31) vs 100%(64/64), Fisher exact test,P=0.000] were shown in HDN due to anti-M. No significant difference was found in the incidences of hyperbilirubinemia [58%(18/31) vs 66%(42/64),χ2=0.513], severe hyperbilirubinemia [23%(7/31) vs 36%(23/64),χ2=1.724], anemia [81%(25/31) vs 89%(57/64),χ2=1.253] and severe anemia [29%(9/31) vs 34%(22/64),χ2=0.271] between HDN due to anti-M and Rh hemolytic babies (allP>0.05).ConclusionsHDN due to anti-M and Rhesus hemolytic disease can cause severe pathological jaundice and/or anemia in newborns. Indirect antiglobulin test should be offered when direct antiglobulin test is negative which is helpful in the diagnosis of HDN due to anti-M.