中国北方典型地区人群活动模式特色数据集

本文介绍了《典型地区活动模式特色数据集》(Typical Regional Activity Patterns,TRAP),此数据集依托于“大气重污染成因与治理攻关项目”。为了探索大气污染与体力活动的交互效应,我们在空气污染物浓度高于周边地区的典型区域(济南市和保定市)收集了9,221名不同职业和生活方式居民连续3天的活动模式数据。TRAP数据集包括人口学指标(人口学、职业信息、个人习惯和居住条件)和体力活动模式数据(活动地点和活动强度)信息。此数据集提供了体力活动模式的暴露测量数据,数据使用者可以根据自己的特定目的将其与各种终点指标匹配。此数据集可为探究中国北方居民活动模式属性提供证据,为跨学科研究人员制定健康教育及健康促进策略和措施提供证据。

含聚硅氧烷链段邻苯二甲腈树脂的制备及性能

以端羟基聚二甲基硅氧烷和4-硝基邻苯二甲腈为原料,在强极性溶剂中进行亲核取代反应合成了含聚硅氧烷链段邻苯二甲腈树脂(SIPH),并利用氨基改性剂(AWL)与该树脂进行反应制备了改性含聚硅氧烷链段邻苯二甲腈树脂预聚物(SIPH-AL)。通过红外光谱和核磁共振表征了SIPH树脂的化学结构;采用差示扫描量热法、红外光谱法、热重分析和动态力学热分析表征了SIPH-AL的固化行为和固化物的耐热性。结果表明,SIPH-AL起始固化温度为207℃,其固化物在空气和氮气中失重5%的温度(T_(d5))及1000℃质量保留率分别是453℃,29%和500℃,77%;石英纤维增强SIPH-AL复合材料室温和600℃时的弯曲强度分别为515.5 MPa和94.5 MPa,玻璃化转变温度(T_(g))高于500℃。

Harness High-Temperature Thermal Energy via Elastic Thermoelectric Aerogels

Despite notable progress in thermoelectric(TE)materials and devices,developing TE aerogels with high-temperature resistance,superior TE performance and excellent elasticity to enable self-powered high-temperature monitoring/warning in industrial and wearable applications remains a great challenge.Herein,a highly elastic,flame-retardant and high-temperature-resistant TE aerogel,made of poly(3,4-ethylene dioxythiophene):poly(styrenesulfonate)/single-walled carbon nanotube(PEDOT:PSS/SWCNT)composites,has been fabricated,displaying attractive compression-induced power factor enhancement.The as-fabricated sensors with the aerogel can achieve accurately pressure stimuli detection and wide temperature range monitoring.Subsequently,a flexible TE generator is assembled,consisting of 25 aerogels connected in series,capable of delivering a maximum output power of 400μW when subjected to a temperature difference of 300 K.This demonstrates its outstanding high-temperature heat harvesting capability and promising application prospects for real-time temperature monitoring on industrial high-temperature pipelines.Moreover,the designed self-powered wearable sensing glove can realize precise wide-range temperature detection,high-temperature warning and accurate recognition of human hand gestures.The aerogel-based intelligent wearable sensing system developed for firefighters demonstrates the desired self-powered and highly sensitive high-temperature fire warning capability.Benefitting from these desirable properties,the elastic and high-temperature-resistant aerogels present various promising applications including self-powered high-temperature monitoring,industrial overheat warning,waste heat energy recycling and even wearable healthcare.

ROS Balance Autoregulating Core-Shell CeO_(2)@ZIF-8/Au Nanoplatform for Wound Repair

Reactive oxygen species(ROS)plays important roles in living organisms.While ROS is a double-edged sword,which can eliminate drug-resistant bacteria,but excessive levels can cause oxidative damage to cells.A core–shell nanozyme,Ce O_(2)@ZIF-8/Au,has been crafted,spontaneously activating both ROS generating and scavenging functions,achieving the multifaceted functions of eliminating bacteria,reducing inflammation,and promoting wound healing.The Au Nanoparticles(NPs)on the shell exhibit high-efficiency peroxidase-like activity,producing ROS to kill bacteria.Meanwhile,the encapsulation of Ce O_(2) core within ZIF-8 provides a seal for temporarily limiting the superoxide dismutase and catalase-like activities of Ce O_(2) nanoparticles.Subsequently,as the ZIF-8 structure decomposes in the acidic microenvironment,the Ce O_(2) core is gradually released,exerting its ROS scavenging activity to eliminate excess ROS produced by the Au NPs.These two functions automatically and continuously regulate the balance of ROS levels,ultimately achieving the function of killing bacteria,reducing inflammation,and promoting wound healing.Such innovative ROS spontaneous regulators hold immense potential for revolutionizing the field of antibacterial agents and therapies.

3,3',4,4'-联苯四胺改性邻苯二甲腈树脂及其复合材料性能

采用3,3',4,4'-联苯四胺(LBS)与联苯型邻苯二甲腈树脂(BPh)进行预聚反应制备改性联苯型邻苯二甲腈树脂预聚物(BLBS)。利用红外光谱法、差示扫描量热仪、旋转流变仪和热重分析对BLBS的固化行为、流变性能和耐温性能进行研究。结果表明,BLBS最低可在240℃前开始固化,但仍需要较高的温度才能固化完全;BLBS-3固化物在氮气和空气氛围中的质量损失5%时的温度(Td5)分别为549.4℃和555.6℃。石英纤维增强BLBS复合材料(QF/BLBS)具有优异的力学性能和耐热性能,玻璃化转变温度(T_(g))大于500°C,室温弯曲强度和层间剪切强度分别为711.5 MPa和48.5 MPa,400℃热处理2 h后弯曲强度和层间剪切强度分别为680.5 MPa和31.3 MPa。

Strong shock propagation for the finite-source circular blast in a confined domain

The circular explosion wave produced by the abrupt discharge of gas from a high-temperature heat source serves as a crucial model for addressing explosion phenomena in compressible flow.The reflection of the primary shock and its propagation within a confined domain are studied both theoretically and numerically in this research.Under the assumption of strong shock,the scaling law governing propagation of the main shock is proposed.The dimensionless frequency of reflected shock propagation is associated with the confined distance.The numerical simulation for the circular explosion problem in a confined domain is performed for validation.Under the influence of confinement,the principal shock wave systematically undergoes reflection within the domain until it weakens,leading to the non-monotonic attenuation of kinetic energy in the explosion fireball and periodic oscillations of the fireball volume with a certain frequency.The simulation results indicate that the frequency of kinetic energy attenuation and the volume oscillation of the explosive fireball align consistently with the scaling law.

High Hydrostatic Pressure Exacerbates Bladder Fibrosis through Activating Piezo1

Objective Bladder outlet obstruction(BOO)results in significant fibrosis in the chronic stage and elevated bladder pressure.Piezo1 is a type of mechanosensitive(MS)channel that directly responds to mechanical stimuli.To identify new targets for intervention in the treatment of BOO-induced fibrosis,this study investigated the impact of high hydrostatic pressure(HHP)on Piezo1 activity and the progression of bladder fibrosis.Methods Immunofluorescence staining was conducted to assess the protein abundance of Piezo1 in fibroblasts from obstructed rat bladders.Bladder fibroblasts were cultured under normal atmospheric conditions(0 cmH_(2)O)or exposed to HHP(50 cmH_(2)O or 100 cmH_(2)O).Agonists or inhibitors of Piezo1,YAP1,and ROCK1 were used to determine the underlying mechanism.Results The Piezo1 protein levels in fibroblasts from the obstructed bladder exhibited an elevation compared to the control group.HHP significantly promoted the expression of various pro-fibrotic factors and induced proliferation of fibroblasts.Additionally,the protein expression levels of Piezo1,YAP1,ROCK1 were elevated,and calcium influx was increased as the pressure increased.These effects were attenuated by the Piezo1 inhibitor Dooku1.The Piezo1 activator Yoda1 induced the expression of pro-fibrotic factors and the proliferation of fibroblasts,and elevated the protein levels of YAP1 and ROCK1 under normal atmospheric conditions in vitro.However,these effects could be partially inhibited by YAP1 or ROCK inhibitors.

Three cancers in the renal pelvis,bladder,and colon:A case report

BACKGROUND Multiple primary cancers are rare occurrences that can involve either metachronous or synchronous development.It is particularly rare for an individual to have more than two primary cancers.In this report,we present a case study of an elderly man who was diagnosed with three heterochronous cancers in the renal pelvis,bladder,and colon.CASE SUMMARY On December 30,2014,a 51-year-old Chinese man was admitted to our hospital with complaints of intermittent painless gross hematuria for the preceding week.A computed tomography(CT)scan revealed wall thickening in the left ureter’s upper segment,while a CT urography revealed a left renal pelvis tumor.A successful laparoscopic radical resection of the left renal pelvis tumor was subsequently performed at Shanghai Zhongshan Hospital in January 2015.The pathological findings after the surgery revealed a low-grade papillary urothelial carcinoma of the renal pelvis.The final pathological tumor stage was pT1N0M0.After surgery,this patient received 6 cycles of intravenous chemotherapy with gemcitabine and carboplatin,as well as bladder infusion therapy with gemcitabine.On December 18,2017,the patient was admitted once again to our hospital with a one-day history of painless gross hematuria.A CT scan showed the presence of a space-occupying lesion on the posterior wall of bladder.Cystoscopic examination revealed multiple tumors in the bladder and right cutaneous ureterostomy was performed under general anesthesia on December 29,2017.The postoperative pathological findings disclosed multifocal papillary urothelial carcinoma of the bladder(maximum size 3.7 cm×2.6 cm).The bladder cancer was considered a metastasis of the renal pelvis cancer after surgery.The pathological tumor stage was pT1N0M1.The patient refused chemotherapy after surgery.After another six years,the patient returned on February 28,2023,complaining of periumbilical pain that had lasted six days.This time,a CT scan of the abdomen showed a tumor in the ascending colon,but a subsequent colonoscopy examination indicated a tumor in the descending colon.On March 12,2023,a subtotal colectomy and an ileosigmoidal anastomosis were carried out under general anesthesia.Postoperative pathological findings revealed that all three tumors were adenocarcinomas.The final pathological tumor stage was pT3N0M0.The patient had an uneventful postoperative recovery and was discharged without complications.CONCLUSION The case of this elderly man presents a rare occurrence of metachronous primary cancers in the renal pelvis and colon.Bladder cancer is considered a metastasis of renal pelvis cancer after surgery.Optimal treatment can be implemented by evaluating the patient’s histological features,clinical history,and tumor distribution correctly.

KnowledgeMapping of Hybrid Solar PV andWind Energy Standalone Systems: A Bibliometric Analysis

Renewable energy is becoming more attractive as traditional fossil fuels are rapidly depleted and expensive,and their use would release pollutants.Power systems that use both wind and solar energy are more reliable and efficient than those that utilize only one energy.Hybrid renewable energy systems(HRES)are viable for remote areas operating in standalone mode.This paper aims to present the state-of-the-art research on off-grid solar-wind hybrid energy systems over the last two decades.More than 1500 published articles extracted from the Web of Science are analyzed by bibliometric methods and processed by CiteSpace to present the results with figures and tables.Productive countries and highly cited authors are identified,and hot topics with hotspot articles are shown in landscape and timeline views.Emerging trends and new developments related to techno-economic analysis and microgrids,as well as the application of HOMER software,are predicted based on the analysis of citation bursts.Furthermore,the opportunities of hybrid energy systems for sustainable development are discussed,and challenges and possible solutions are proposed.The study of this paper provides researchers with a comprehensive understanding and intuitive representation of standalone solar-wind hybrid energy systems.

Habitat heterogeneity and biotic interactions mediate climate influences on seedling survival in a temperate forest

Seedling stage has long been recognized as the bottleneck of forest regeneration,and the biotic and abiotic processes that dominate at seedling stage largely affect the dynamics of forest.Seedlings might be particularly vulnerable to climate stress,so elucidating the role of interannual climate variation in fostering community dynamics is crucial to understanding the response of forest to climate change.Using seedling survival data of 69 woody species collected for five consecutive years from a 25-ha permanent plot in a temperate deciduous forest,we identified the effects of biotic interactions and habitat factors on seedling survival,and examined how those effects changed over time.We found that interannual climate variations,followed by biotic interactions and habitat conditions,were the most significant predictors of seedling survival.Understory light showed a positive impact on seedling mortality,and seedling survival responded differently to soil and air temperature.Effects of conspecific neighbor density were significantly strengthened with the increase of maximum air temperature and vapor pressure deficits in the growing season,but were weakened by increased maximum soil temperature and precipitation in the non-growing season.Surprisingly,seedling survival was strongly correlated with interannual climate variability at all life stages,and the strength of the correlation increased with seedling age.In addition,the importance of biotic and abiotic factors on seedling survival differed significantly among species-trait groups.Thus,the neighborhood-mediated effects on mortality might be significantly contributing or even inverting the direct effects of varying abiotic conditions on seedling survival,and density-dependent effects could not be the only important factor influencing seedling survival at an early stage.

Short‐term and long‐term memory self‐attention network for segmentation of tumours in 3D medical images

Tumour segmentation in medical images(especially 3D tumour segmentation)is highly challenging due to the possible similarity between tumours and adjacent tissues,occurrence of multiple tumours and variable tumour shapes and sizes.The popular deep learning‐based segmentation algorithms generally rely on the convolutional neural network(CNN)and Transformer.The former cannot extract the global image features effectively while the latter lacks the inductive bias and involves the complicated computation for 3D volume data.The existing hybrid CNN‐Transformer network can only provide the limited performance improvement or even poorer segmentation performance than the pure CNN.To address these issues,a short‐term and long‐term memory self‐attention network is proposed.Firstly,a distinctive self‐attention block uses the Transformer to explore the correlation among the region features at different levels extracted by the CNN.Then,the memory structure filters and combines the above information to exclude the similar regions and detect the multiple tumours.Finally,the multi‐layer reconstruction blocks will predict the tumour boundaries.Experimental results demonstrate that our method outperforms other methods in terms of subjective visual and quantitative evaluation.Compared with the most competitive method,the proposed method provides Dice(82.4%vs.76.6%)and Hausdorff distance 95%(HD95)(10.66 vs.11.54 mm)on the KiTS19 as well as Dice(80.2%vs.78.4%)and HD95(9.632 vs.12.17 mm)on the LiTS.

Influence of Li^(+)/Al^(3+) on the corrosion behavior of Li-Al layered double hydroxides(LDHs) film on LA51 magnesium alloys

A hierarchical superhydrophobic Al-Li layered double hydroxide(LDH)films with different Li^(+)/Al^(3+)molar ratios of 1:1,1:2,2:1,p H value of 11.5 and reaction temperature of 125°C,have been fabricated on the surface of Mg-5Li-1Al(LA51)alloys by hydrothermal method following the characteristics of controllable cation structure and exchangeable anion between layers.The properties of the films were investigated by X-ray diffractometer(XRD),scanning electron microscope(SEM)and energy dispersive spectrometer(EDS).XRD and SEM results indicate that the Al-Li LDH films are successfully prepared on LA51 alloys.The contact angle(CA)was measured to be about100.7°,indicating that the surface wettability of the film converted from hydrophilic to hydrophobic by surface modification.The corrosion resistance of Al-Li LDH films was evaluated by Tafel polarization curve and electrochemical impedance spectroscopy(EIS).Surprisingly,Tafel polarization curve and EIS test reveal that the Al-Li LDH films prepared at the molar ratio of Li^(+)/Al^(3+)1:2,p H 11.5 and temperature125°C have better corrosion resistance in 0.1 M Na Cl neutral solution.In addition,the formation mechanism and corrosion mechanism of the films on the surface of LA51 alloy are also proposed.It provides innovative synthetic materials and novel design ideas for the preparation of high-efficiency anti-corrosion coatings on LA51 alloys,whose application can be extended in industrial fields.

High-sensitivity phase imaging eddy current magneto-optical system for carbon fiber reinforced polymers detection

This paper proposed a high-sensitivity phase imaging eddy current magneto-optical (PI-ECMO) system for carbon fiber reinforced polymer (CFRP) defect detection. In contrast to other eddy current-based detection systems, the proposed system employs a fixed position excitation coil while enabling the detection point to move within the detection region. This configuration effectively mitigates the interference caused by the lift-off effect, which is commonly observed in systems with moving excitation coils. Correspondingly, the relationship between the defect characteristics (orientation and position) and the surface vertical magnetic field distribution (amplitude and phase) is studied in detail by theoretical analysis and numerical simulations. Experiments conducted on woven CFRP plates demonstrate that the designed PI-ECMO system is capable of effectively detecting both surface and internal cracks, as well as impact defects. The excitation current is significantly reduced compared with traditional eddy current magneto-optical (ECMO) systems.

Driver-Centric Velocity Prediction With Multidimensional Fuzzy Granulation

Dear Editor,This letter deals with a real-world problem regarding chaotic time series prediction, where a driver-centric velocity prediction model is presented for vehicle intelligent control and advanced driver assistance,i.e., multi-dimension fuzzy predictor. Inspired by fuzzy granulation technology, a finite-state Markov chain(MC) is reinforced to capture probabilities of the transitions between velocity and acceleration and present signals that vary in a continuous range.

A Conditionally Anonymous Linkable Ring Signature for Blockchain Privacy Protection

In recent years,the issue of preserving the privacy of parties involved in blockchain transactions has garnered significant attention.To ensure privacy protection for both sides of the transaction,many researchers are using ring signature technology instead of the original signature technology.However,in practice,identifying the signer of an illegal blockchain transaction once it has been placed on the chain necessitates a signature technique that offers conditional anonymity.Some illegals can conduct illegal transactions and evade the lawusing ring signatures,which offer perfect anonymity.This paper firstly constructs a conditionally anonymous linkable ring signature using the Diffie-Hellman key exchange protocol and the Elliptic Curve Discrete Logarithm,which offers a non-interactive process for finding the signer of a ring signature in a specific case.Secondly,this paper’s proposed scheme is proven correct and secure under Elliptic Curve Discrete Logarithm Assumptions.Lastly,compared to previous constructions,the scheme presented in this paper provides a non-interactive,efficient,and secure confirmation process.In addition,this paper presents the implementation of the proposed scheme on a personal computer,where the confirmation process takes only 2,16,and 24ms for ring sizes of 4,24 and 48,respectively,and the confirmation process can be combined with a smart contract on the blockchain with a tested millisecond level of running efficiency.In conclusion,the proposed scheme offers a solution to the challenge of identifying the signer of an illegal blockchain transaction,making it an essential contribution to the field.

含多黏菌素B抗菌方案治疗多重耐药革兰阴性菌HAP/VAP的贝叶斯网状Meta分析

目的采用贝叶斯网状Meta分析方法比较含多黏菌素B的抗菌方案与其他抗菌方案治疗多重耐药革兰阴性菌医院获得性肺炎/呼吸机相关性肺炎(HAP/VAP)的临床疗效。方法计算机检索PubMed、EMbase、The Cochrane Library、Web of Science、CNKI、SinoMed、ChiCTR、WanFang Data和VIP数据库,搜集含多黏菌素B的抗菌方案治疗多重耐药革兰阴性菌HAP/VAP的临床对照研究,检索时限均从建库到2022年10月15日。由2位研究员独立筛选文献、提取资料并评估纳入研究的偏倚风险后,采用Stata 17.0和R 4.1.2软件进行贝叶斯网状Meta分析。结果共纳入1个随机对照试验(RCT)和10项观察性研究,共1385例患者,涉及8种治疗方案。贝叶斯网状Meta分析结果表明,在临床有效率方面,8种用药方案组间差异无统计学意义(P>0.05),累积排序概率曲线下面积(SUCRA)显示多黏菌素B静脉滴注联合多黏菌素B雾化吸入方案的临床有效率高于多黏菌素B静脉滴注单用或其联合替加环素等方案;在病死率方面,文中涉及的4种用药方案中,SUCRA显示多黏菌素B静脉滴注联合多黏菌素B雾化方案的病死率较低,低于多黏菌素B静脉滴注、替加环素单用或两者联用等方案,其中多黏菌素B静脉滴注联合多黏菌素雾化吸入方案的病死率低于多黏菌素B静脉滴注联合替加环素方案,且差异有统计学意义[OR=0.21,95%CrI(0.05,0.94),P<0.05],其余涉及的治疗方案组间差异无统计学意义(P>0.05);在细菌清除率方面,涉及的4种用药方案组间差异无统计学意义(P>0.05)。结论现有证据表明,就生存获益而言,推荐使用多黏菌素B静脉滴注联合多黏菌素B雾化吸入方案治疗多重耐药革兰阴性菌HAP/VAP。受纳入研究数量和质量限制,上述结论尚待更多大样本、高质量、多中心的RCT予以验证。

First Report of a Postharvest Fruit Rot on Apple Caused by <i>Diaporthe phaseolorum</i>var. <i>caulivora</i>in China: A Note

Brown rots of Red Fuji apples were observed in Hangzhou city (Zhengjiang Province, China). The causal agent was isolated and identified in both morphological and molecular genetic levels. The phenotype and phylogenetic analysis revealed that the isolate was Diaporthe phaseolorum var. caulivora, and its pathogenicity on apple fruit was confirmed by re-inoculation experiment. To our knowledge, this is the first report of D. phaseolorum var. caulivora causing postharvest fruit rot on apple in China.

Poor awareness of preventing aspirin-induced gastrointestinal injury with combined protective medications

AIM:To investigate prescribing pattern in low-dose aspirin users and physician awareness of preventing aspirin-induced gastrointestinal(GI) injury with combined protective medications.METHODS:A retrospective drug utilization study was conducted in the 2nd Affiliated Hospital,School of Medicine,Zhejiang University.The hospital has 2300 beds and 2.5 million outpatient visits annually.Data mining was performed on all aspirin prescriptions for outpatients and emergency patients admitted in 2011.Concomitant use of proton-pump inhibitors(PPIs),histamine 2-receptor antagonists(H2RA) and mucoprotective drugs(MPs) were analyzed.A defined daily dose(DDD) methodology was applied to each MP.A further investigation was performed in aspirin users on combination use of GI injurious medicines [non-steoid anti-inflammatory drugs(NSAIDs),corticosteroids and clopidogrel and warfarin] or intestinal protective drugs(misoprostol,rebamipide,teprenone and gefarnate).Data of major bleeding episodes were derived from medical records and adverse drug reaction monitoring records.The annual incidence of major GI bleeding due to low-dose aspirin was estimated for outpatients.RESULTS:Prescriptions for aspirin users receiving PPIs,H2RA and MPs(n = 1039) accounted for only 3.46% of total aspirin prescriptions(n = 30 015).The ratios of coadministration of aspirin/PPI,aspirin/H2RA,aspirin/MP and aspirin/PPI/MP to the total aspirin prescriptions were 2.82%,0.12%,0.40% and 0.12%,respectively.No statistically significant difference was observed in age between patients not receiving any GI protective medications and patients receiving PPIs,H2RA or MPs.The combined medication of aspirin and PPI was used more frequently than that of aspirin and MPs(2.82% vs 0.40%,P < 0.05) and aspirin/H2RA(2.82% vs 0.12%,P < 0.05).The values of DDDs of MPs in descending order were as follows:gefarnate,hydrotalcite > teprenone > sucralfate oral suspension > L-glutamine and sodium gualenate granules > rebamipide > sucralfate chewable tablets.The ratio of MP plus aspirin prescriptions to the total MP prescriptions was as follows:rebamipide(0.47%),teprenone(0.91%),L-glutamine and sodium gualenate granules(0.92%),gefarnate(0.31%),hydrotalcite(1.00%) and sucralfate oral suspension(0.13%).Percentages of prescriptions containing aspirin and intestinal protective drugs among the total aspirin prescriptions were:rebamipide(0.010%),PPI/rebamipide(0.027%),teprenone(0.11%),PPI/teprenone(0.037%),gefarnate(0.017%),and PPI/gefarnate(0.013%).No prescriptions were found containing coadministration of aspirin and other NSAIDs.Among the 3196 prescriptions containing aspirin/clopidogrel,3088(96.6%) prescriptions did not contain any GI protective medicines.Of the 389 prescriptions containing aspirin/corticosteroids,236(60.7%) contained no GI protective medicines.None of the prescriptions using aspirin/warfarin(n = 22) contained GI protective medicines.Thirty-five patients were admitted to this hospital in 2011 because of acute hemorrhage of upper digestive tract induced by low-dose aspirin.The annual incidence rates of major GI bleeding were estimated at 0.25% for outpatients taking aspirin and 0.5% for outpatients taking aspirin/warfarin,respectively.CONCLUSION:The prescribing pattern of low-dose aspirin revealed a poor awareness of preventing GI injury with combined protective medications.Actions should be taken to address this issue.

Drug-induced liver injury in hospitalized patients with notably elevated alanine aminotransferase

AIM： To identify the proportion, causes and the nature of drug-induced liver injury （DILI） in patients with no- tably elevated alanine aminotransferase （ALT）. METHODS： All the inpatients with ALT levels above 10 times upper limit of normal range （ULN） were ret- rospectively identified from a computerized clinical laboratory database at our hospital covering a 12-mo period. Relevant clinical information was obtained from medical records. Alternative causes of ALT eleva- tions were examined for each patient, including bili- ary abnormality, viral hepatitis, hemodynamic injury, malignancy, DILI or undetermined and other causes. All suspected DILI cases were causality assessed usingthe Council for International Organizations of Medical Sciences scale, and only the cases classified as highly probable, probable, or possible were diagnosed as DILI. Comments related to the diagnosis of DILI in the medical record and in the discharge letter for each case were also examined to evaluate DILI detection by the treating doctors. RESULTS： A total of 129 cases with ALT 〉 i0 ULN were identified. Hemodynamic injury （n = 46, 35.7%）, DILl （n = 25, 19.4%） and malignancy （n = 21, 16.3%） were the top three causes of liver injury. Peak ALT val- ues were lower in DILI patients than in patients with hemodynamic injury （14.5 5.6 ULN vs 32.5 ：I： 30.7 ULN, P = 0.001）. Among DILI patients, one （4%） case was classified as definite, 19 （76%） cases were clas- sified as probable and 5 （20%） as possible according to the ClOMS scale. A hepatocellular pattern was ob- served in 23 （92%） cases and mixed in 2 （8%）. The extent of severity of liver injury was mild in 21 （84%） patients and moderate in 4 （16%）. Before discharge, 10 （40%） patients were recovered and the other 15 （60%） were improved. The improved patients tended to have a higher peak ALT （808 ＋ 348 U/L vs 623 ＋ 118 U/L, P = 0.016） and shorter treatment duration before discharge （8 ＋ 6 d vs 28 ~ 12 d, P = 0.008） compared with the recovered patients. Twenty-two drugs and 6 herbs were found associated with DILl. Antibacterials were the most common agents causing DILI in 8 （32%） cases, followed by glucocorticoids in 6 （24%） cases. Twenty-four （96%） cases received treatment of DILl with at least one adjunctive drug. Agents for treatment of DILI included anti-inflammatory drugs （e.g., glycyr- rhizinate）, antioxidants （e.g., glutathione, ademetionine 1,4-butanedisulfonate and tiopronin）, polyene phospha- tidyl choline and herbal extracts （e.g., protoporphyrin disodium and silymarin）. Diagnosis of DILl was not mentioned in the discharge letter in 60% of the cases. Relative to prevalent cases and cases from wards of internal medicine, incident cases and cases from surgi- cal wards had a higher risk of missed diagnosis in dis- charge letter [odds ratio （OR） 32.7, 95%CI （2.8-374.1）,CONCLUSION： DILI is mostly caused by use of anti- bacterials and glucocorticoids, and constitutes about one fifth of hospitalized patients with ALT 〉 10 ULN. DILI is underdiagnosed frequently.

Drug utilization of clarithromycin for gastrointestinal disease treatment

AIM： To evaluate the patterns of use of clarithromycin for gastrointestinal disease treatment and promote its rational use.METHODS： Using a structured pro forma, we conducted a two-month survey of the electronic prescriptions containing immediate-release （IR） or sustained-release （SR） product of clarithromycin for outpatients with gastrointestinal diseases in a 2200-bed general hospital. Suitability of the prescription was audited retrospectively. RESULTS： One hundred and sixty-four prescriptions of SR product and 110 prescriptions of IR product were prescribed for gastrointestinal disease treatment. Among prescriptions for anti-Helicobacter pylori （H pylori） therapy, triple therapy take the dominant position （91.8%）, followed by quadruple therapy （4.3%） and dual therapy （3.9%）. Amoxicillin was the most frequently co-prescribed antibiotic.Furazolidone and levofloxacin are used more widely than metronidazole or tinidazole. Clarithromycin SR was administered at inappropriate time points in all prescriptions. Fifty percent of all prescriptions of clarithromycin SR, and 6.4% of prescriptions of clarithromycin IR, were prescribed at inappropriate dosing intervals. Surprisingly, disconcordance between diagnoses and indications was observed in all prescriptions of clarithromycin SR which has not been approved for treating Hpy/ori infection although off-label use for this purpose was reported in literature. On the contrary, only one prescription （0.9%） of clarithromycin IR was prescribed for unapproved indication （i.e. gastro-oesophageal reflux disease）. 1.4% of prescriptions for chronic gastritis or peptic ulcer treatment were irrational in that clarithromycin was not co-prescribed with gastric acid inhibitors. Clinical significant CYP3A based drug interactions with clarithromycin were identified. CONCLUSION： There is a great scope to improve the quality of clarithromycin prescribing in patients with gastrointestinal disease, especially with regard to administration schedule, concordance between indications and diagnoses and management of drug interactions.