In February 2023, a 48-year-old male with cough and expectoration was admitted to the Department of Pulmonary and Critical Care Medicine of Peking University People’s Hospital. CT indicated mediastinal soft-tissue mass under the tracheal carina. Meta-genomics next generation sequencing of mediastinal abscess suggested infection with Tropheryma whipplei, which was positive for periodic acid-Schiff staining. The patient had no history of diarrhea, weight loss, or joint pain. The patient was diagnosed with Whipple’s disease and treated with ceftriaxone followed by trimethoprim-sulfamethoxazole therapy. After 1-year post-discharge therapy, the patieny’s symptoms and general condition improved significantly, and remained to follow.

Objective:To analyze the positive detection rate, main genotypes of β-thalassemia in western region of Guangxi Zhuang Autonomous Region (referred to as Guangxi).Methods:Retrospective analysis of 26 189 individuals who underwent gene testing for thalassemia at the Affiliated Hospital of Youjiang Medical University for Nationalities from January 2013 to December 2019. Using the crossing breakpoint PCR (Gap-PCR) and reverse dot blot (RDB) techniques to detect Chinese common type of 7 kinds of α-thalassemia and 17 kinds of β-thalassemia genotypes, high-throughput sequencing(Sanger) was performed for suspected rare β-thalassemia. Gap-PCR was used for suspected deletion β-thalassemia types.Results:β-thalassemia was diagnosed in 4 495 (17.16%) of 26 189 samples. A total of 6 177 alleles of 20 types of β-thalassemia were detected, mainly CD17 (2 712 cases, 43.90%) and CD41-42 (2 240 cases, 36.26%), including 7 rare alleles: Gγ +( Aγδβ) 0, SEA-HPFH, Hb New York, Hb G-Taipei, Hb Hezhou, Hb G-Coushatta and IVS-Ⅱ-81. There were 3 903 case (86.83%) heterozygous, 273 case (6.07%) double heterozygous, and 319 case (7.10%) homozygous among 4 495 β-thalassaemia subjects. A total of 48 genotypes were detected. The two most common genotypes were CD17/β N (1 890 cases, 42.05%) and CD41-42/β N (1 212 cases, 26.96%), accounted for 69.01% (3 102/4 495). Seven rare genotypes were detected: Gγ +( Aγδβ) 0/β N in 3 cases, Hb New York/β N in 3 cases, Hb G-Taipei/β N in 2 cases, SEA-HPFH/β N, Hb Hezhou/β N, Hb G-Coushatta/β N and IVS-Ⅱ-81/β N in 1 case each. A total of 1 041 cases (3.97%, 1 041/26 189) of 116 types of αβ-thalassemia were detected, mainly -- SEA/αα composite CD17/β N (144 cases, 13.83%), followed by -α 3.7/αα composite CD17/β N (112 cases, 10.76%). Conclusions:Western region of Guangxi is a high prevalence area of β-thalassemia, CD17/β N and CD41-42/β N are the main genotypes. The variation spectrum of β-thalassemia is complex and diverse, with rich genotype.

Objective:To investigate the knowledge of Sixth Chinese national consensus report on the management of Helicobacter pylori infection ( treatment excluded) (hereinafter referred to as sixth national consensus) and 2022 Chinese national clinical practice guideline on Helicobacter pylori eradication treatment (hereinafter referred to as the guideline)among medical staff from general hospitals in Hainan. Methods:From February 20 to May 7, 2023, a questionnaire survey on the diagnosis and treatment of Helicobacter pylori ( H. pylori) infection was conducted among 1 463 medical staff from 15 general hospitals in Hainan Province. The questionnaire was drawn up according to the sixth national consensus and the guideline, covering knowledge of 6 sections, induding H. pylori related diseases, detection of H. pylori, eradication, prevention and influence factors of eradication of H. pylori, etc. Chi-square test was used for statistical analysis. Results:A total of 1 463 valid questionnaires were collected with the effective responsive rate of 100.00%.The 1 463 subjects included 225 gastroenterologists and 1 238 other medical staff(including 503 physicians from other departments, 264 surgeons and 471 medical technologists and pharmacists). About 78.67%(177/225)of gastroenterologists agreed that the overall infection rate of H. pylori in China was more than 20%, the awareness rate was higher than that of other medical staff (physicians from other departments 65.41%(329/503), surgeons 61.74%(163/264), medical technologists and pharmacists 60.30%(284/471); the following datas were sorted by this position), and the difference was statistically significant ( χ2=30.97, P<0.001). About 51.11%(115/225) of gastroenterologists considered that H. pylori serological antibody test could not be used as a diagnostic method for current infection, the awareness rate was higher than that of other medical staff(22.07%(111/503), 14.02%(37/264), 12.31%(58/471)), and the difference was statistically significant( χ2 =152.66, P<0.001). Proton pump inhibitor and potassium-competitive acid blocker should be discontinued for 2 weeks, and antibiotics and bismuth should be discontinued for 4 weeks before urea breath test, and the awareness rates of gastroenterologists were higher than those of other medical staff (38.67%(87/225) vs. 23.26%(117/503), 19.70%(52/264), 18.47%(87/471); 60.89%(137/225) vs. 26.64%(134/503), 25.76%(68/264), 23.78%(112/471)), and the differences were statistically significant ( χ2 =133.70 and 165.51, both P<0.001). For refractory H. pylori infection, 98.67%(222/225)of gastroenterologists agreed with the individualized diagnosis and treatment of H. pylori infection should be guided by bacterial culture, antibiotic susceptibility test or drug resistance gene test, and the awareness rate was higher than that of other medical staff (91.85%(462/503), 93.56%(247/264), 93.21%(439/471)), and the difference was statistically significant( χ2=20.55, P=0.002). About 70.67% (159/225) of gastroenterologists recommended a bismuth containing quadruple regimen, 80.44% (181/225) supported a 10 to 14 day H. pylori eradication course, and the awareness rates were higher than other medical staff (46.92%(236/503), 33.33%(88/264), 32.91%(155/471); 67.20%(338/503), 59.09%(156/264), 53.93%(254/471)), and the differences were statistically significant ( χ2=111.25 and 59.99, both P<0.001). The understanding rates of the sixth national consensus and the guideline in gastroenterologists was 85.33% (192/225), which was higher than that of other medical staff (64.21%(323/503), 66.67%(176/264), 57.96%(273/471)), and the difference was statistically significant ( χ2=85.47, P<0.001). Conclusions:Gastroenterologists from general hospitals in Hainan Province have a better understanding of the sixth national consensus and the guideline than other medical staff. However, there is still a lack of deep understanding of the sixth national consensus and the guideline, and it is necessary to further strengthen the learning and application of the sixth national consensus and the guideline.

Objective:To compare the effect of F7.5 ureteroscope and other types of ureteroscope (F8.5, F9.0, F9.2, F9.6) in the control of intrapelvic pressure during operation.Methods:F7.5 super thin flexible ureteroscope and other 4 kinds of disposable flexible ureteroscopes (F8.5, F9.0, F9.2, F9.6) were combined with 3 kinds of ureteral guidance sheaths to form 15 endoscope-sheath combinations. The real outer diameter of each flexible ureteroscope was measured and the effective ratio of endoscope-sheath diameter was calculated. The real outer diameter of each soft mirror was measured and the effective sheath ratio was calculated. The irrigation during lithotripsy was simulated in a 3D printed kidney model, the irrigation pressure of 50-500 cmH 2O was set, and the stable intrapelvic pressure and flow rate were measured. The line chart was drawn and the relationship between intrapelvic pressure and irrigation pressure was analyzed by linear regression. The intrapelvic pressure between different endoscope-sheath combinations and different endoscope groups were compared respectively. Results:The ratio of endoscope-sheath diameter for all combinations ranges from 0.62 to 0.92, with 0.75, 0.68 and 0.62 for the F7.5 flexible ureteroscopes and F10/12, F11/13 and F12/14 sheath combinations respectively. Intrapelvic pressure and flow rate showed an approximately linear relationship with irrigation pressure in all groups. The F7.5 flexible scope with the F10/12, F11/13 and F12/14 sheaths all provided intrapelvic pressures below 40 cmH 2O. The F12/14 sheath-F7.5 scope combination produced the lowest intrapelvic pressure of 1.47 cmH 2O at 50 cmH 2O irrigation pressure and the highest flow rate of 74.24 ml/min at 500 cmH 2O irrigation pressure. When combined with the F10/12 sheath, only the F7.5 flexible scope was able to maintain a safe intrapelvic pressure of only 25.90 cmH 2O throughout. Analysis of the variability of intrapelvic pressure using the combination of instruments as the grouping variable suggested a significant overall difference( P<0.05). Analysis of the variability between groups using the different flexible scope as the grouping variable showed that the F7.5 scope group had significantly lower intrapelvic pressure compared to the other four groups( P<0.05). Conclusions:The F7.5 super thin flexible scope has the best intrapelvic pressure control of the five flexible scopes due to the significantly reduced ratio of endoscope-sheath diameter for the instrument combination and the ability to fit a thinner guide sheath while maintaining safe pelvic pressure.

Objective To investigate the effects and related molecular mechanisms of glutathione S-transferase pi 1 (GSTP1) on the inflammasome activation of astrocytes.Methods A model of epilepsy was established in 10-week-old male SD rats by intraperitoneal injection of lithium chloride (n=8),and brain tissues were collected from the hippocampus.Rat primary astrocytes were treated with different concentrations of lipopolysaccharide (0 μg/ml,0.1 μg/ml,1 μg/ml,10 μg/ml and 100 μg/ml) for 48 h.The protein levels of GSTP1,JNK and p-JNK in tissues and cells were measured by Western blotting.The levels of TNF-α,IL-1β,IL-6 were detected by enzyme-linked immunosorbent assay.The levels of glutamate (Glu) were detected by high pressure liquid chromatography.The lipopolysaccharide-induced astrocytes were transiently transfected with GSTP1 overexpression vector and were treated with Anisomycin (JNK activator),and the inflammatory activation of astrocytes was observed.Results The protein levels of GSTP1 were lower in the hippocampal brain tissues of epileptic rats than those in normal rats,while the protein levels of p-JNK and the levels of TNF-α,IL-1β,IL-6 and Glu were higher in epileptic rats than those in normal rats (P<0.05).GSTP1 was negatively correlated with p-JNK protein expression level (P<0.05).Lipopolysaccharide-induced inflammasome activation in astrocytes,as evidenced by a dose-dependent decrease in the protein expression levels of GSTP1 and a dose-dependent increase in the protein levels of p-JNK and the levels of TNF-α,IL-1β,IL-6 and Glu (P<0.05).Overexpression of GSTP1 inhibited lipopolysaccharide-induced inflammasome activation of astrocytes,while Anisomycin partially reversed the inhibitory effect of GSTP1. Conclusion GSTP1 inhibits inflammasome activation of astrocytes in the hippocampus of epileptic rats,and its molecular mechanism is related to JNK pathway inhibition.

ABSTRACT OBJECTIVE To investigate the current situation of pediatric pharmacist-managed clinic in China, and to provide reference for pediatric pharmacist-managed clinic construction and improvement. METHODS Domestic Children's hospitals, Women's & Children's Hospital, and general hospitals with pediatric unit were selected as the survey objects, questionnaires were distributed through the Wenjuanxing Application, and SPSS 26.0 was used to describe the data. The development of pediatric pharmacist-managed clinic, the qualification of visiting pharmacists, the situation of post training and training needs were analyzed. RESULTS A total of 101 valid questionnaires were collected. Pediatric pharmacist-managed clinics had been set up in 55(54.5%) hospitals, of which 35 were independent pharmacists' clinics, and most had well medical document and patient management processes. However, about 70% of hospitals did not charge registration fees, and more than half of hospitals had fewer than 5 patient-visits per day. 85.5% of the hospitals were visited by clinical pharmacists, and about half of them were senior clinical pharmacists with more than 10 years of working experience. But only 3.6% of visiting pharmacists had the right of specific prescription. In 101 hospitals relevant post training for pharmacists had been carried out in 36 hospitals, of which 25 hospitals had set up pharmacist-managed clinic. In addition to pharmaceutical expertise, more than 50% of pharmacists had a strong demand for the improvement of physician-patient communication and problem-solving ability, and 30%-40% of the demand was focused on the collection of medication history, psychological counseling ability, and case-based learning in the pharmacist-managed clinic. CONCLUSION At present, the domestic pediatric pharmacist-managed clinic shows a vigorous development trend, however, there are insufficient registration fees, visits, and post training. Appropriate service methods of pediatric pharmacist-managed clinic should be actively explored, and a pediatric specialized training system for should be well constructed to improve the competency.

Abstract OBJECTIVE To analyze the drug-drug interaction during the use and treatment of nirmatrelvir/ritonavir tablets in children, and to provide reference for rational drug use in clinical practice. METHODS All hospitalized pediatric patients with using nirmatrelvir/ritonavir tablets from December 23, 2022 to February 8, 2023 in Children's Hospital, Zhejiang University School of Medicine were collected. The use of nirmatrelvir/ritonavir was analyzed, and the combination drugs were classified. The potential clinical drug-drug interactions of nirmatrelvir/ritonavir were analyzed through micromedex drug interaction database and the severity was graded. RESULTS A total of 48 patients using nirmatrelvir/ritonavir tablets were collected, with a median age of 6.71 years old(87 d-17.75 years old). The usage departments were mainly in the departments of hematology, ICU, infectious disease, and general internal medicine, and the main underlying disease being tumors. The median fever-reducing time after medication was 3 d. Many drugs were combined during medication period. A total of 15 potential drug-drug interaction drugs of nirmatrelvir/ritonavir tablets were collected, and potential drug interaction with antifungals should be considered. CONCLUSION The department with more usage of nirmatrelvir/ritonavir tablets in children is hematology, and the main underlying disease is tumors. When nirmatrelvir/ritonavir tablets are used in combination with potential drug-drug interaction drugs, attention should be paid to monitoring the efficacy and adverse reactions.

Objective:To explore the analgesic methods in ambulatory laparoscopic cholecystectomy (LC) patients.Methods:Three hundred patients were randomly divided into six groups receiving different analgesic regimen. VAS scores, postoperative blood pressure, CRP, IL-6, and the occurrence of postoperative adverse effects were recorded at 2, 4, 8, and 12 h postoperatively.Results:The success rate of ambulatory LC in this study was 66.22%. The dynamic VAS scores of patients in each group gradually decreased with time elapsing, with groups B and C being significantly lower than group A at 2 h and 4 h postoperatively ( P<0.05). Groups D, E and F were significantly different from group A at all postoperative time points ( P<0.05). There was a statistically significant difference at 8 h and 12 h postoperatively in group B vs. group D and group C vs. group E (all P<0.05). There was significant difference at the 12 h postoperatively between groups (B and C) compared to group F ( P<0.05). There was a significant difference in CRP and IL-6 between the groups (all P<0.05). Postoperative dizziness, nausea and delayed discharge were significantly higher in patients using analgesic pumps ( P<0.05). Conclusion:Local infiltration of ropivacaine combined with postoperative parecoxib sodium drip is a recommended analgesic regimen.

Objective　To investigate the role and molecular mechanism of long intergenic non-coding RNA 1116 (LINC01116) in hippocampal astrocytes of acute ischemic stroke (AIS).Methods　The expressions of LINC01116 and miR-203 in serum of 131 AIS patients before and after thrombolysis were detected by real-time fluorescence quantitative PCR.The regulatory effect of LINC01116 on miR-203 was detected by dual-luciferase reporter gene and RNA-binding protein immunoprecipitation assay.Human hippocampal astrocytes (hHA) were applied to establish an oxygen-glucose deprivation/reoxygenation (OGD/R) model and were treated with LINC01116 interference and LINC01116 combined with miR-203 interference.The changes of cell proliferation,cell apoptosis,production of reactive oxygen species (ROS),activity of lactate dehydrogenase (LDH),and inflammatory factors were detected by CCK-8,TUNEL and Western blotting,ROS assay,LDH assay,and enzyme-linked immunosorbent assay,respectively.Results　The expressions of LINC01116 and miR-203 in serum after thrombolysis were higher and lower than those before thrombolysis,respectively,and the expressions of LINC01116 and miR-203 were negatively correlated (P<0.05).LINC01116 inhibited miR-203 expression by sponge of miR-203 (P<0.05).LINC01116 interference alleviated the OGD/R-induced injury of hHA cells,which manifested as elevated cell proliferation ability,decreased cell apoptosis rate,decreased protein expressions of cleaved caspase-3 and Bax but raised protein expression of Bcl-2,reduced ROS production,decreased LDH activity,and downregulated TNF-α,IL-1β and IL-6 concentrations but upregulated IL-4,IL-10 and IL-13 concentrations (P<0.05).miR-203 interference reversed the protective effect of LINC01116 interference on the OGD/R-induced injury of hHA cells (P<0.05).Conclusions　LINC01116 promotes the OGD/R-induced injury of hHA cells by targeting miR-203,suggesting that the LINC01116/miR-203 pathway might be a potential therapeutic target for AIS.

Objective To investigate the occurrence factors of duodenobiliary reflux (DBR) after endoscopic sphincterotomy (EST ) .Methods A total of 198 patients with choledocholithiasis hospitalized in the digestive department of the hospital from Sep-tember 2012 to February 2016 were selected and given duodenal papilla EST .The DBR occurrence was judged and the occurrence factors were investigated ,meanwhile the Oddi sphincter function was measured and long term complications were followed up .Re-sults All patients successfully completed EST ,the average common bile duct diameter in 198 cases was (2 .24 ± 0 .24)cm ,the aver-age common bile duct stones number was 3 .63 ± 1 .12 ;the maximum diameter of common bile duct stones was (1 .02 ± 0 .19)cm . There were 12 cases of DBR after EST ,the occurrence rate was 6 .1% ,the average radioactivity was (3 .39 ± 0 .89)MBq .The post-operative Oddi sphincter systolic peak and contraction frequency were (31 .49 ± 4 .22)mm Hg and (3 .78 ± 0 .53) times /min ,which were significantly lower than those before operation (P<0 .05);and the postoperative Oddi sphincter basic pressure and common bile duct pressure were (8 .23 ± 1 .03)mm Hg and (3 .32 ± 0 .45)mm Hg respectively ,which had no statistical difference compared with preoperation (P>0 .05) .The Logistic regression analysis showed that complicating gallbladder stone ,diameter of common bile duct ,frequency difference of Oddi sphincter contraction before and after operation ,number of stones and maximum diameter of stone were the main risk factors for postoperative DBR occurrence (P<0 .05) .All cases were followed up for 6 months ,18 cases developed long term complications ,the incidence rate was 9 .1% ,including 4 cases of reflux cholangitis ,6 cases of bile duct stric-ture ,4 cases of papillary stenosis and 4 cases of recurrence .Conclusion DBR after duodenal papilla EST is common ,which can re-sult in the Oddi sphincter function decrease and increase of long-term complications ,and needs to actively strengthen prevention and management .