Objective To observe effect of Dermlin and silver zinc emulsion in treatment of phase Ⅱ and Ⅲ pressure ulcer, and explore a new method which is easy to operate, safe and easily accepted by elderly patients. Methods 38 elderly patients with pressure ulcer from July, 2007 to June,2010 were selected and divided into the treatment group and the control group with 19 patients in each group. The treatment group adopted Dermlin and silver zinc emulsion, while the control group used Comfeel dressing. The treatment effect and cure time of the two groups were compared. Results The treatment effect of the treatment group was better than that of the control group, time used to achieve significant effect was also less in the treatment group. Conclusions Application of Dermlin and silver zinc emulsion in treatment of phase Ⅱ and Ⅲ pressure ulcer can achieve better effect than comfeel dressing, besides it is easy to operate and worthy of clinical practice.

This paper reports the nursing experience of 5 cases of Charcot's arthropathy undergoing rotating hinge prosthesis knee replacement. The nursing care focused on psychological nursing, preoperative examinations, control of blood glucose and treatment of syphilis during preoperative period, as well as wound care, management of drainage tube, prevention of complications and early functional exercise during the postoperative period. All cases were followed up through 6 to 60 months. The short-term outcomes were satisfying. One patient suffered from periprosthetic femoral fracture at 23-month after the operation, and healed up eventually after open reduction and internal fixation.

Objective To measure the setup errors in thoracic esophageal carcinoma treated with intensity modulated radiotherapy (IMRT) using kilo-voltage cone-beam CT (kV-CBCT),and to evaluate the impact of the setup errors on the dose distributions in tumor target volume and the peripheral normal tissues.Methods Twenty-one patients with thoracic esophageal carcinoma undergoing image guided IMRT (IG-IMRT) were included in this study. Using kV-CBCT,173 setup errors of these patients were acquired before treatment.By shifting the isocenters,these setup errors were simulated in the 3-dimentional treatment planning system and the corresponding impact of the dose distribution in tumor target volume and peripheral organs were evaluated.Results The translational deviations of lateral,longitudinal and vertical directions were ( 2.73 ± 1.85 ),( 3.19 ± 2.71 ),and ( 2.35 ± 1.71 ) mm,respectively.The dose of gross tumor volume (GTV) was not impacted significantly by the setup errors. However,comparing with the standard plan without setup errors,the setup errors in the simulated plan reduced the dose of 95％ planning target volume (PTV) by 3.38 Gy.The dose to PTV Dmin and PTV Dmean were also reduced by 9.83 Gy and 0.65 Gy respectively. The correction of setup errors improved the conformity index (CI) and the homogeneity index (HI) for PTV.The C1 and HI for the standard plan were 0.74 ± 0.10 and 1.07 ±0.02, respectively. The C1 and H1 for the simulated plan were 0.69 ± 0.08 and 1.13 ± 0.07,respectively.Statistically significance was observed in these differences ( t =3.43 and -3.91 respectively,P ＜ 0.05 ). No statistical significance was observed in the dose differences in lungs,spinal cord and heart between the two plans ( P ＞ 0.05).The mean maximum dose of the spinal cord was (42.20 ± 4.97 ) Gy in the simulation plan,which was (41.37 ± 2.75 ) Gy in the standard plan.For some patients,the maximum dose of the spinal cord exceeded the tolerance level of 45 Gy in the simulation plan,and one case even reached 52.8 Gy.Conclusions Using the image guidance of kV-CBCT,the setup errors can be reduced significantly for patients with esophageal carcinoma receiving IG-IMRT.The correction of setup errors can increase the treatment precision and enhance the dose in PTV.No significant dose changes were observed in the lung,spinal cord and heart as a result of setup error correctio.

To explore and discuss the application of case teaching method for pharmaceutical administration science according to the actual teaching situation and the teaching experience of the authors. The teaching effects can be improved by the method, which is worthy of promotion and popularization.

Objective To investigate the safety and clinical outcome of total body irradiation (TBI) and the real-time in vivo dosimetry with semiconductor dosimeter in hematogenous stem cell transplantation (HSCT). Methods Fifty-seven patients requiring HSCT were treated with TBI. The TBI was given with the semi-sitting or standing position or lateralcumbent posture, using 6 MV X-ray beams and opposed parallel fields technique (two or four fields, AP/PA fields) in a single fraction or multiple fractions. The real-time in vivo dosimetry was performed with six diodes positioned on the surface of patients to adjust the dose homo-geneity of the midplane using the different thickness lead sheets. Results Mild to moderate nausea, vomi-ting and swollen parotid occurred in 41 patients after TBI, which were relieved after allopathy therapy. No radiation-induced interstitial pneumonia was observed. All patients fulfilled the HSCT. The homogeneity of relative dose (normalize to umbilicus dose) in the different positions accorded with the requirement of the prescription dose. Conclusions The opposed parallel radiation, with the semi-sitting or standing positions or lateralcumbent posture, combined with the real-time in vivo dosimetry with semiconductor dosimeter is an effective and safe technique for TBI.

Objective:To provide some thoughts for pharmaceutical treatment and care for the patients with pulmonary infection af-ter renal transplantation. Methods:Clinical pharmacists participated the whole treatment process of one case of pulmonary infection af-ter renal transplantation. According to the literatures combined with medical history, clinical symptoms and lab results, the drug treat-ment process of the patient was analyzed, and the key points of the optimized pharmaceutical care were summarized. Results: The pharmaceutical care included the dose adjustment of immunosuppressants at the early phase of the disease and after the improvement of clinical symptoms, attention paid to the interactions between multiple anti-infective drugs and immunosuppressive agents, dosage ad-justment based on the renal function of the patient, monitoring adverse drug reactions and drawing up personalized regimen. Conclu-sion:Through comprehensive medication monitoring, clinical pharmacists can help physicians develop timely and effective treatment programs and provide professional and effective pharmaceutical care for patients.

Objective To investigate the effects of Xuanfeitongfufang Decoction on expressions of MD-2, NF-κB protein and its mRNA in lung of the rats with acute lung injury caused by LPS. Methods Wistar rats were randomly divided into normal group, model group, dexamethasone group and Xuanfeitongfufang Decoction large-, medium-, small-dose group, each group had eight rats. The ALI rat model was established by LPS tail-intravenous injection (6 mg/kg). The rats in Xuanfeitongfufang Decoction groups were pretreated by Xuanfeitongfufang Decoction (15.12, 7.56, 3.78 g/kg) for 3 days before LPS induced ALI. The rats in dexamethasone group were pretreated by dexamethasone (5 mg/kg). MD-2, NF-κB protein and its mRNA were measured by immunohistochemistry and PCR. The histopathology of the lung injury was observed by light microscope. Results Compared with normal group, the expression of MD-2, NF-κB protein and its mRNA were obviously increased in model group (P<0.01). Compared with model group, the expression of MD-2, NF-κB protein and its mRNA were obviously decreased in Xuanfeitongfufang Decoction groups and dexamethasone group (P<0.01), and there was no obvious difference between Xuanfeitongfufang Decoction groups and dexamethasone group. Light microscope observation indicates that there were large areas of pulmonary hemorrhage and necrosis in model group. While in Xuanfeitongfufang Decoction group and dexamethasone group, the pathological manifestations were much more ameliorated than those of the model group. The lung bronchiale inflammation appeared occasionally, and the edema was lightly. Conclusion Xuanfeitongfufang Decoction can lessen the injury of lung tissue and has protective effects on rats with ALI, the mechanism is possibly related to the inhibition of the expressions of MD-2 and NF-κB protein and its mRNA in injured lung tissues.

Objective To investigate the changes of Treg cells,Th17 cells and related cytokines in pe?ripheral blood of patients with severe hand?foot?mouth disease( HFMD) in the initial stage of infection caused by Enterovirus 71 virus. Methods Thirty?five cases of severe HFMD children in the Fifth Hospital of Shijiazhuang from May 2013 to December 2013 were selected as the research subjects,including 27 cases of severe formed group and 8 cases of danger severe formed group. The frequencies of Th17 cells ( CD3+CD8?IL?17+) and Treg cells( CD4+CD25+Foxp3+) in peripheral blood were detected by flow cytometry in patients with severe HFMD and 31 healthy children(control group). Moreover the serum levels of interleukin 6(IL?6),interleukin 17(IL?17) ,interleukin 10( IL?10) ,interleukin 23( IL?23) ,and human transforming growth factorβ1 ( TGF?β1) were measured by ELISA. Results As compared with those in control group,the frequencies of Treg cells,ratio of Treg/Th17,serum levels of TGF?β1, IL?10 in severe HFMD groups were significantly decreased ( F=23. 23, 30. 88,10. 766,11. 680 respectively;P<0. 05) . However the frequency of Th17 cells,serum levels of IL?6,IL?17,IL?23 in severe HFMD groups were significantly increased( F=646. 81,5. 904,10. 557,3. 490 respectively;P<0. 05) . Conclusion The changes of Treg and Thl7 cells and related cytokines appear in peripheral blood of patients with HFMD in the initial stage of infection caused by Enterovirus 71 virus. The frequency of Treg cell is decreased,however,the frequency of Thl7 cells frequency is increased,as a result,which may spread inflammato?ry reaction and cause complication.

OBJECTIVE:To study the bioequiavailability of two sertraline hydrochloride formulations in healthy volunteers.METHODS:A randomized, crossover study of 22 healthy volunteers receiving single oral dose of 50mg sertraline hydrochloride solution(test preparation) or sertraline hydrochloride tablets(comparator preparation) was conducted and the blood concentrations determined by LC/MS/MS.RESULTS: The pharmacokinetic parameters for the test sertraline and the comparator sertraline were as follows:t1/2 were (27.3?5.2)h and (26.3?3.0)h,respectively;Cmax were(9.56?2.49)?g?L-1 and(9.43?2.91)?g?L-1,respectively;tmax were(5.18?1.47)h and(6.00?1.07)h,respectively;AUC0～108 were(329?112)?g?h?L-1 and (297?111)?g?h?L-1,respectively;AUC0～∞ were(354?127)?g?h?L-1 and (316?122)?g?h?L-1,respectively.There were no significant differences in main pharmacokinetics parameters between the 2 preparations,except in tmax from analysis of variance and one-side & two-sides t tests.The relative bioavailability of the test sertraline was(115.5?26.7)%.CONCLUSION:These two sertraline hydrochloride formulations are bioequivalent.

OBJECTIVE: To study the bioequivalence of tegaserod maleate dispersible tablets in healthy volunteers.METHODS: A single oral dose of 6mg test or reference preparations of tegaserod maleate was given to 22 healthy volunteers in a randomized crossover study.The plasma concentrations of tegaserod were determined by LC/MS/MS assay.RESULTS: The main pharmacokinetic parameters of test and reference products were as follows: tmax(0.86? 0.22) and(1. 01? 0.24) h;Cmax(2.21? 0.69) and(2.05? 0.64) ng? mL1;AUC0～ 17(6.35? 2.48) and(6.47? 1.99) ng? h? mL-1,AUC0～ ∞(6.69? 2.59) and(6.70? 2.03) ng? h? mL-1,respectively.The relative bioavailability of test to reference preparation was(98.2? 22.1) %.CONCLUSION: The reference preparation and the test preparation are bioequivalent.