Objective:To study the impact of clinical pharmacy information management system on antimicrobial stewardship in a general teaching hospital. Methods:The main function, deficiencies and aspects needing improvement of clinical pharmacy information management system, and its influence on antimicrobial stewardship were introduced. Results:The information system had such functions as antimicrobial usage statistics, evaluation of antimicrobial prescription, and the use intensity calculation of antimicrobials. By using the information system, manpower of antimicrobial stewardship was saved, antimicrobial statistics became more comprehensive and objective, and dynamic real-time monitoring of antimicrobial drugs management was realized. However, the system still had some shortcomings needing improvement. Conclusion:Clinical pharmacy information system can promote the implementation and efficiency of antimicrobial stewardship.

Objective To establish a liquid chromatographic-mass spectrometric method ( LC-MS/MS method ) for determination of dextrorphan in human liver microsome. Methods LC-MS/MS was adopted with carbamazepine serving as an internal standard.The separation was performed on Agilent ZORBAX XDB-C18 column (2.1 mm×50 mm, 3.5μm), with mobile phase consisting of 0. 05% formic acid methanol-0. 05% formic acid in gradient elution. Dextrorphan and carbamazepine were detected on multiple reaction monitoring(MRM)mode by transitions from precursor to production(m/z 258.1→199.1, 237.1→194.1). Results The linear range of dextrorphan concentration was 19.22-768 960 ng.L-1(r=0.999 8), and the lowest quantification limit was 19.22 ng.L-1.The relative recoveries were 94.02%-98.74%, and the RSDs of intra-day and inter-day were within 10%.IC50 of psoralen on CYP2D6 was 0.6μmol.L-1. Conclusion The LC-MS/MS method is proved to be rapid, sensitive and reproducible, psoralen is a strong inhibitor of CYP2D6.

Objective To investigate the method of early termination of cesarean scar pregnancy (CSP).Methods Clinical data of 12 patients with CSP were retrospectively analyzed,all patients were treated with mifepristone 25mg in the morning and evening for 3 days,and misoprostol 600μg in the morning at the fourth days.Results Of 12 patients,medical abortion were completely in 4 cases,and 6 cases were failure which were carried out painless abortion with microtubules(disposable suction tube).2 cases were taken curettage because of hemorrhage after incomplete abortion.1 case was improved by massage the uterus,and intramuscular injection of oxytocin 20u in cervix;another one case was taken uterine artery embolization because of postoperative bleeding about 2 000ml with shock symptoms.Conclusion The CSP is complicated,the early prevention and treatment must be taken for it,and once it diagnosed,the termination of pregnancy should be immediately taken,in patients with a history of cesarean section line miscarriage may occur when the hard-to-control bleeding.Uterine artery embolization is an effective treatment method for the first choice.

Objective To evaluate the efficacy and feasibility of ultrasound-guided percutaneous microwave ablation for peripheral lung cancer. Methods Seventeen patients with peripheral lung cancer (23 nodules) were treated with ultrasound-guided microwave ablation. The microwave energy was initially set at 60 W for 100s, and then at 30~40 W for 300~600 s. The treatment was conducted by using multiple simultaneously-powered antennas in lesions ≥3 cm in diameter. Results After the treatment, all the nodules were decreased in size and the blood flow signals inside the nodule disappeared (14 nodules) or weakened (9 nodules). Enhanced CT scanning revealed no enhancement in 16 nodules and partial enhancement in 7. Repeated biopsy in 4 patients showed a complete tumor necrosis. Clinical symptoms disappeared in 8 patients and subsided in 9 patients 1 month after treatment. Follow-up observations in 15 patients for 6~47 months (mean, 23 months) showed 9 survivors, without serious complications. Conclusions Ultrasound-guided percutaneous microwave ablation is an effective, safe, and feasible method for treating peripheral lung cancer.

Objective:To evaluate the therapeutic effects of sinomenine on T-helper cell type 1-mediated experimental colitis in-duced by 2,4,6-trinitrobenzene sulfonic acid (TNBS) in mice. Methods:Balb/c mice were divided into five groups:ethanol control group, TNBS model group, and sinomenine treatment groups (50, 100 and 200 mg·kg-1 ) with 10 ones in each. Colitis was induced by colonic instillation of TNBS dissolved in 0. 1 ml of 50% ethanol. Seven days after the colonic instillation of TNBS, sinomenine was given by gastric gavage once daily for 21 days. The mice were sacrificed on the 28th day, the injury degree of colonic mucosa was ob-served, the colon myeloperoxidase ( MPO) activity was determined, and the levels of inflammatory cytokines ( TNF-α, IL-17 and IL-23) were determined by ELISA. Results:Compared with those in TNBS model group, the body mass, gross injury score and histologi-cal findings in sinomenine groups at medium dose and high dose were significantly improved (P<0. 05), the activity of MPO signifi-cantly decreased (P<0. 05), and the protein levels of TNF-α, IL-17 and IL-23 in colonic mucosa were lower than those in TNBS group (P<0. 05). Conclusion:Sinomenine has notable therapeutic effect on TNBS-induced chronic colitis in mice, and the mecha-nism is related to the inhibition of Th1 cytokines by sinomenine.

Objective To investigate the clinical and pathological characteristics of bacterial infectious diarrhea.Methods The clinical and pathological characteristics of 2380 cases of bacterial infectious diarrhea in Jinshan Hospital,Fudan University from 1998 to 2007 were analyzed retrospectively.Enumeration data were analyzed by X~2 test.Results Among the 20 169 patients who went to hospital because of diarrhea in 10 years,2380 cases fecal bacterial culture were positive,including Vibrio parahaemolyticus(2247 cases,94.4%),Shigella(99 cases,4.2%),Salmonella (29 cases,1.2%),Vibrio alginolyticus(3 cases),pathogenic Escherichia coli(2 cases).Patients with diarrhea were common from June to 0ctober in each year.The main manifestations of Vibrio parahaemolyticus infection were abdominal pain,diarrhea,nausea,vomit or dehydration.The main manifestations of Shigella infection were fever,abdominal pain and diarrhea.Conclusions The bacterial culture positive rate of stool samples from patients with bacterial infectious diarrhea is not high in Jinshan district.Shanghai.The major pathogens are Wbrio parahaemolyticus and Shigella.

Background Refractive surgery has propelled itself forward to become widely performed surgical procedure nowadays.After the surgery,corneal biomechanics decreases lead to keratoconus and corneal ectasia.Doctors pay more attention to biomechanics changes after refractive surgeries.Objective This clinical study was to investigate the influence of different laser refractive surgeries on corneal biomechanics.Methods A prospective nonrandomized and controlled clinical study was designed.One hundred and sixty-four eyes of 82 patients with moderate myopia were enrolled.The patients were divided into sub-Bowman keratomileusis (SBK) group (60 eyes of 30 patients),laser in situ keratomileusis (LASIK) group (54 eyes of 27 patients) and laser subepithelial keratomileusis (LASEK) group (50 eyes of 25 patients),with the matched demography among the three groups.Corneal hysteresis (CH) and corneal resistance factor (CRF) were detected by ocular response analyzer (ORA) before and 1 week,5 months after refractive surgery.The correlations between stromal ablation depth and postoperative changing values of CH or CRF were analyzed.Results Significant differences were found in CH and CRF at different time points in the three groups (Ftime =41.90,P =0.00;Ftime =49.65,P =0.00),and the CH and CRF values were significantly lower 1 week and 5 months after surgery than those before surgery (all at P =0.00).However,no significant difference of CH or CRF was seen at all time points among the three groups (Fgroup =2.17,P =0.08;Fsroup =2.67,P =0.07).No correlation was found between corneal ablation depth and CH in 1 week and 5 months after surgery (both at R2 =0.000),however,weaker correlations were seen between corneal ablation depth and CRF 1 week and5 months after surgery (Y=3.253+ 0.010X,R2=0.007;Y=1.073+0.021 X,R2=0.004).Conclusions SBK,LASIK and LASEK lead to the change of corneal biomechanics by altering CH and CRF,they play the same influence on cornea.CRF appears to be an useful indicator in evaluating corneal biomechanical changes after laser refractive surgery.

OBJECTIVE:To provide reference for rational use of antibiotics in terminal stage patients with malignant tumor. METHODS:The inpatients with malignant tumor who died in the department of medical oncology of our hospital from Mar. 2013 to Mar. 2016 were analyzed retrospectively in respects of general situation,infection situation and antibiotics use. RESULTS:Among 149 inpatients,a total of 129 infection cases were found in 113 patients(75.8%). The most frequent sites of infection were lung(65.9%),followed by digestive tract/abdomen(13.2%),and skin/wound(6.2%). 100 patients (67.1%)received antibiot-ics,61.1% of which were empiric treatment. β-lactam/β-lactam lactamase inhibitor(41.8%),fluoroquinolone(21.7%)and cepha-losporin(16.9%)were the top 3 frequently prescribed antibiotics. The effective rate of antibiotics treatment was as low as 15.8%, which was believed to be linked with the survival duration since infection occurred (P<0.001),the Karnofsky performance scale (KPS)score when infection occurred(P<0.001)and the duration of antibiotics treatment(P=0.025). CONCLUSIONS:Terminal stage patients with malignant tumor are vulnerable to infections,especially to pulmonary infection. The empirical broad-spectrum an-tibiotics are widely used in terminal patients with malignant tumor,but the effectiveness rate of antibiotic treatment is in low level. For those terminal stage patients with malignant tumor and with KPS score<60 points,when futile antibiotics treatment last for more than 7 days,timely termination of antibiotics treatment is a better choice.

AIM: To investigate the influences of native and oxidized lipoprotein(a) on human arterial smooth muscle cell (SMC) proliferation, change of intracellular free calcium concentration ([Ca 2+ ] i) and the protective effect of sodium ferulate(SF). METHODS: Lp(a) was oxidized by Cu 2+ and the extent of oxidation was assessed by the MDA content.Human SMC were incubated in culture media with SF for 12 h, then exposed to Lp(a) and oxidized-Lp(a), respectively. MTT colorimetry and flow cytometry were used to evaluated the proliferation of SMC and flurorescent indicator Fura-2/AM was used to determined [Ca 2+ ] i. RESULTS: ox-Lp(a) significantly promoted proliferation of SMC and increased[Ca 2+ ] i compared with Lp(a). SF(40,80 mg/L) remarkedly inhibited SMC proliferation and decreased the rising of [Ca 2+ ] i induced by ox-Lp(a) in a dose-dependent manner, but no effect on SMC proliferation and the increase in [Ca 2+ ] i induced by Lp(a).CONCLUSION: ox-Lp(a) induces the strong growth-promoting effect in SMC through increasing in [Ca 2+ ] i, which might be one of the cellular mechanisms responsible for the higher atherogenic potential of ox-Lp(a) compared with Lp(a), and this process can be prevented by inhibiting of oxidation by SF.

Objective To understand the clinical features of candidemia.Methods A retrospective analysis was performed based on the data of 88 candidemia cases treated in Huashan Hospital during the period from 2007 to 2012.The clinical data were re-viewed in terms of species distribution,underlying diseases,clinical manifestations,treatment and outcomes.The prognostic factors were analyzed by chi-square test or Fisher exact probability test.Multivariate analysis was conducted by multiple Logis-tic regression.Results Candida albicans (40/88,45.5%)was the most common pathogen isolated from these candidemia ca-ses,followed by Candida tropicalis (20/88,22.7%),Candida parapsilosis (17/88,19.3%),Candida glabrata (10/88, 11 .4%),and Candida krusei (1/88,1 .1 %).Solid malignancy,diabetes,and surgical procedure were the most frequently identified underlying diseases.Fatal or deteriorative outcome was reported in 28 cases.The attributable mortality was 18.2%. Multivariate prognostic analysis indicated that presence of central venous catheter (OR:6.322,95% CI :1 .055-37.891 ,P =0.044)was independently correlated to increased mortality.Appropriate antifungal therapy was an independent predictor of de-creased overall mortality (OR:0.137,95% CI :0.039-0.480,P =0.002).Conclusions The pathogen distribution of candi-demia has changed slightly.Appropriate antifungal therapy plays a key role in the treatment of candidemia.