ObjectiveTo investigate the situation of off-label drug use in dose (OLDUD) of ambroxol hydrochloride injection (AHI) in perioperative period among patients for stanford type A aortic dissection in Guangdong General Hospital, so as to provide references for the rational application of AHI in clinical practice. MethodsAll medical orders of AHI for patients had aortic arch replacement for Stanford type A aortic dissection in Guangdong General Hospital between January 2005 and December 2014 were included. The patients were divided into a mild OLDUD ( < 450 mg) group, a moderate OLDUD (450 mg≤OLDUD < 900 mg) group, and a high OLDUD (≥900 mg)group. The preoperative and postoperative features, incidence of PPCs, mortality, incidence of reintubation, time of mechanical ventilation, time stay in ICU, time stay in hospital and the overall costs among three groups were compared by SPSS 22.0 software. Resultsa) A total of 549 patients were included. The incidence of OLDUD was 99.82%. The most common PMDDs were 450 mg (n=358) and 900 mg (n=88). b) The three groups were well matched for perioperative and operative variables. c) The incidence of preoperative drug use was 8.6%. The incidences (5.5% vs. 7.7% vs. 15.7%, P=0.022) and maximum doses (180 mg vs. 300 mg vs. 450 mg, P=0.014) of preoperative drug use were statistically different in mild OLDUD, moderate OLDUD and high OLDUD groups. The days of preoperative drug use were not different (3 d vs. 2.5 d vs. 2 d, P=0.307). The days of postoperative drug use (9.5 d vs. 13 d vs. 19 d, P < 0.001) and postoperative drug use in maximum doses (7 d vs. 8 d vs. 7 d, P=0.005) were different. d) The incidence of PPCs was 100%, and the mortality (8.2% vs. 6.6% vs. 9.0%, P=0.696) was not statistically different among mild OLDUD, moderate OLDUD and high OLDUD groups. However the incidence of reintubation (14.3% vs. 13.8% vs. 27%, P=0.009), time of mechanical ventilation (37 h vs. 50 h vs. 114 h, P < 0.001), time stay in ICU (138 h vs. 178.5 h vs. 316 h, P < 0.001), time stay in hospital (25 d vs. 27 d vs. 34 d, P=0.001) and the overall costs (￥ 0.17 million vs. ￥ 0.19 million vs. ￥ 0.25 million, P < 0.001) were different among three groups. Moreover, they were all increasing along with the dose of AHI. ConclusionAHI cannot improve the prognosis of patients having aortic arch replacement for Stanford Type A Aortic Dissection in a dose-dependent manner. Further well-designed prospective studies should be conducted to verification or falsification.
Objective To analyze the impact of body mass index (BMI) on tumor characteristics of colorectal patients served by West China Hospital as a regional center in the current version of Database from Colorectal Cancer (DACCA). MethodsThe data of DACCA was updated on October 16, 2021. All data items included BMI, precancerous lesions, cancer family, tumor site, tumor morphology, location, differentiation, pathological properties of tumor, obstruction, overlap, perforation, pain, edema, and bleeding. The patients were divided into lean (BMI<18.5 kg/m2), normal (BMI 18.5–23.9 kg/m2), overweight (BMI 24.0–27.9 kg/m2) and obesity (BMI≥28.0 kg/m2) by Chinese classification methods. ResultsAfter scanning, 5 761 data rows were analyzed. Chi-square test showed that there was significant difference in the type composition ratio of tumor location in colorectal cancer patients under different BMI groups (χ2=31.477, P<0.001). Rank sum test showed that there was significant difference in the degree of obstruction (H=42.490, P<0.001), intussusception (H=8.179, P=0.042), edema (H=14.795, P=0.002), and bleeding (H=9.884, P=0.020) among different BMI groups. ConclusionsThe BMI classification of colorectal cancer patients is related to the location of tumor and the occurrence of some tumor complications. Patients with tumor involving intestinal lumens for one week are more likely to have low BMI. The patients with low BMI are more likely to have severe bleeding, obstruction, intestinal intussusception, and severe intestinal wall edema.
ObjectiveTo summarize the progress of the researches about nano-carbon tattoo in targeted lymph node dissection of breast cancer. MethodThe relevant studies on the application of nano-carbon tattoo to target lymph nodes in the breast cancer at home and abroad were searched and the feasibility and shortcomings of this method were summarized. ResultFrom the studies reported, the nano-carbon tattoo method had a high detection rate (64.0%–100%) and coincidence rate (55.0%–100%), as well as a lower false negative rate (0.0%–9.1%) in the labeling of breast cancer targeted lymph nodes. ConclusionsThe nano-carbon tattoo method is a useful, simple, and safe in the labeling of targeted lymph nodes in breast cancer. But the specific implementation scheme of this method, such as the optimal labeling dosage, the number of labeled lymph nodes, and the improvement of patients’ quality of life are still unclear, which still needs more large-scale prospective research to verify.
With the perspective of evidence-based medicine, this review aims to investigate the effectiveness and safety of off-label drug use of bevacizumab for eye disease, and explore the barriers to further study. And then, suggestions for the supported evidence and clinical use of off-label drug use will be provided based on this case.
Objective To investigate the off-label prescriptions in pediatrics in West China Second University Hospital and to analyze the reasons and performance, so as to provide the baseline data for improving the rationality drug use in pediatrics in China. Methods The prescriptions of pediatrics outpatient department were randomly selected from May 2008 to April 2009; and the off-label use was analyzed according to the package inserts in the following aspects, the types of off-label use, the rate of off-label use in different age groups and categories of medicine. Results Of the total 2 400 prescriptions, 1 398 (58.25%) involving off-label use. All sample prescriptions contained 6028 records, 1 923 (31.90%) involving off-label use. The problems such as dosage (45.98%), frequency (21.17%) and age (18.19%) were the top-three types of off-label use. The rate in different age groups ranked as the top-three were school-age (61.56%), followed by preschool (60.77%) and infants (57.56). The top-five categories of medicines in off-label use were anti-allergy drugs (49.45%), digestive system drugs (49.32%), externally applied drugs (41.49%), Chinese patent drugs (34.60%) and nervous system drugs (33.78%). Conclusion The off-label drug use is widespread in pediatrics outpatient department. It is an effective approach to reduce off-label use and improve drug safety through strictly abiding by the instruction of usage and dosage as well as selecting a suitable dosage form.
The cold chain safety of vaccines is a global issue. The electronic vaccine vial monitor (eVVM) label can monitor the temperature of vaccines in real time and provide “early warning” prompts. In order to comprehensively evaluate the monitoring efficiency of eVVM, this study selected 75 eVVM labels and distributed them with a total of 600 vaccine vial monitor (VVM) labels of four different types in different experimental environment (2?8℃, ?20℃ and 40℃), and used a temperature recorder as “gold standard”. The results showed that the accuracy of the eVVM labels and VVM labels in high temperature environment was as same as that of the temperature recorder (P = 0.195). The accuracy of low temperature anomalies report and high temperature anomalies report of eVVM labels was 100%, which was better than those reported by VVM labels. Therefore, eVVM labels have high monitoring accuracy, which is suitable not only for ordinary environments, but also for severe temperature environments. It should be helpful for the improvement of the efficiency and accuracy of cold chain monitoring.
Objective The combined appl ication of green fluorescent protein (GFP) and confocal laser scanning microscope three-dimensional reconstruction (CLSM-3DR) were used to monitor the construction and in vivo transplantation of tissue engineered bone (TEB), to provide for technology in selection of scaffolds and three-dimensional constructional methods. Methods After bone marrow mesenchymal stem cells (BMSCs) were isolated from a 2-year-old green goat by a combination method of density gradient centrifugation and adherent culture, and the expressions of CD29, CD60L, CD45, and CD44 in BMSCs were detected by flow cytometry. Plasmid of pLEGFP-N1 was ampl ified, digested by enzymes (Hind III, BamH I, Sal I, and Bgl II), and identified. Transfection of pLEGFP-N1 into PT67 cells was performed under the help of l iposome. Positive PT67 cells were picked out with G418, and prol iferated for harvesting virus. Based on the titre of virus, after BMSCs were infected by virus containing pLEGFP-N1, GFP positive BMSCs were collected and prol iferated for seeding cells. TEB was fabricated by GFP positive BMSCs and decalcified bone matrix (DBM) and observed by CLSM-3DR for the evaluation of the distribution and prol iferation of seeding cells. After TEB was transplanted in the defect of goat femur, CLSM was used for observing the survival and distribution of GFP positive cells in the grafts. Results The isolated cells were fibroblast-l ike morphous, with the positive expression of CD29 and CD44, and negative expression of CD60L and CD45. The digested production of pLEGFP-N1 was collected for ionophoresis, whose results showed the correct fragment length (6 900 bp). The virus of pLEGFP-N1 was harvested by transfection of pLEGFP-N1 into PT67 cells and used for further infection to obtain GFP positive BMSCs. The prol iferated GFP positive BMSCs and DBM were used for fabrication of TEB. The distribution, prol iferation, and migration of BMSCs in TEB were observed by CLSM-3DR. GFP positive cells also were observed in images of TEB graft in goat femur 28 days after transplantation. Conclusion The BMSCs labeled by GFP in three-dimensional scaffold in vivo were monitored well by CLSM-3DR. It suggests a wide use potency in monitoring of three-dimensional cultured TEB.
Diabetic retinopathy is a common blinding complication in diabetic patients. Compared with conventional fundus color photography, fundus fluorescein angiography can dynamically display retinal vessel permeability changes, offering unique advantages in detecting early small lesions such as microaneurysms. However, existing intelligent diagnostic research on diabetic retinopathy images primarily focuses on fundus color photography, with relatively insufficient research on complex lesion recognition in fluorescein angiography images. This study proposed an adaptive multi-label classification model (D-LAM) to improve the recognition accuracy of small lesions by constructing a category-adaptive mapping module, a label-specific decoding module, and an innovative loss function. Experimental results on a self-built dataset demonstrated that the model achieved a mean average precision of 96.27%, a category F1-score of 91.21%, and an overall F1-score of 94.58%, with particularly outstanding performance in recognizing small lesions such as microaneurysms (AP = 1.00), significantly outperforming existing methods. The research provides reliable technical support for clinical diagnosis of diabetic retinopathy based on fluorescein angiography.
Objective lt;brgt;To investigate the feasibility of labeling iris pigment epithelial（IPE）cells of rabbits with 5（and 6）carboxyfluorescein diacetate succinimidyl ester（CFSE）. lt;brgt; lt;brgt;Methods lt;brgt;Enzyme-assisted microdissection was used to isolate the cultured rabbitprime;s IPE cells.The third or forth subcultured IPE cells were incubated with 2.5，5，10，20，and 40 mu;mol/L of CFSE for 1，5，and10min respectively.The fluorescence intensity was detected by flow cytometry，and the leakage of CFSE and its dyeing were observed by fluorescence antibody labeling. lt;brgt;Results lt;brgt;Incubation with 20 mu;mol/L CFSE under 37℃for1minute was the most optimal condition for IPE cells labeling.The coloration of IPE cells stained by CFSE lasted 4 weeks.There was no leakage of dye from labeled rabbit IPE cells to non-labeled human IPE cells in mixed culture process. lt;brgt; lt;brgt;Conclusion lt;brgt;With the advantages of high rate of dyeing，long time of tracing，safety and convenience，CFSE can be used as a new method to label the rabbitprime;s IPE cells. lt;brgt; lt;brgt;(Chin J Ocul Fundus Dis, 2006, 22: 261-264)
ObjectiveTo retrospectively analyze off-label drug use (OLDU) situation of ambroxol hydrochloride injection (AHI) among inpatients in the Guangdong General Hospital in 2012, so as to provide references for AHI OLDU. MethodsAll medical orders of AHI for inpatients in the Guangdong General Hospital in 2012 were included, and OLDU was judged according to drug labels. We summarized situation of drug use in all departments, analyzed OLDU incidence in administration path and in dose, calculated prescribed daily dose (PDD) and utilization index (DUI) in each department to evaluate the degree of OLDU in dose. Resultsa) A total of inpatients 138 227 patient-days who used AHI were included. OLDU occurred in all departments in this hospital and the total OLDU incidence was 67.06%. b) OLDU in dose occurred in 71.43% of the departments (25/35) with an incidence of 29.53%; the top 4 departments were cardiac surgery intensive care unit department (CICU) (97.74%), cardiac surgery department (97.51%), pediatric cardiac surgery department (72.30%) and pediatric intensive care unit department (PICU) (70.28%) in order. c) The PDDs in CICU department, cardiac surgery department, PICU departments, pediatric cardiac surgery department, oncological surgery ward, neurosurgery ward and intensive care unit (ICU) were higher than the defined daily dose (DDD), of which, the DUI/cDUI in CICU, cardiac surgery department, PICU and pediatric cardiac surgery department were 1 to 3 times higher than normal level. d) No relevant adverse drug reaction/adverse event (ADR/AE) reports were received in this hospital in 2012. ConclusionAHI is widely used in the Guangdong General Hospital, and AHI OLDU is commonly-seen. Further studies should be conducted to analyze the influence factors of AHI OLDU in dose and to evaluate the rationality of its application.