Objective To investigate the impact of multi-drug transporters including P-glycoprotein (PGP) and multi-drug resistance associated protein (MRP) on concentration of lamotrigine in the extracellular fluid in hippocampus of epilepsy rat models induced by pilocarpine, and to deduce the multi-drug resistance mechanisms in refractory epilepsy. Methods The epilepsy rat models were established by repeated administration (by ip) of pilocarpine. A microdialysis probe was placed into the hippocampus of the epileptic rats and dialysate was collected at five time-points from 30--150 minutes after systemic injections of lamotrigine (10 mg/kg). The concentration of lamotrigine in the extracellular fluid in the hippocampus was determined by high-performance liquid chromatography (HPLC). Then PGP inhibitor verapamil and MRP inhibitor probenecid was added individually through microdialysis probe and the concentration of lamotrigine was detected again. Results Compared with control group (0. 41 ± 0. 10 in 60 minutes, 0. 50 ±0.04 in 90 minutes, 0. 39 ±0. 09 in 120 minutes and 0. 30±0.06 in 150 minutes), verapamil significantly increased the concentration of lamotrigine in extracellular fluid of the hippocampus 60--150 minutes (0. 65 ±0. 11, 0. 84 ± 0. 09, 0. 70± 0. 09 and 0. 58 ± 0. 08 respectively) after injection (F value were 5.01, 8.61, 10. 23 and 7.89, all P < 0. 05) and probenecid also enhanced the concentration of lamotrigine 90--150 minutes (0. 75 ± 0. 09, 0. 58±0. 10 and 0. 49±0. 07) after injection (F = 6. 58, 4. 56, 4. 75, all P < 0. 05). Conclusions Penetration of lamotrigine through blood-brain barrier in pilocarpine induced epilepsy rats is restricted by PGP and MRP, resulting in decreased concentration of lamotrigine in the extracellular fluid of the hippocampus. Therefore, increasing expression of PGP and MRP in brains of epilepsy patients might be an important mechanism involved in multi-drug resistance in refractory epilepsy.

Objective To investigate the influence of irbesartan taken before bedtime on morning blood pressure surge and urine microalbuminuria in elderly patients with essential hypertension. Methods Ninety-two patients with uncontrolled hypertension were recruited in this study and their 24-hour ambulatory blood pressure monitoring profiles were collected for analysis. After irbesartan taken before bedtime, its influence on general blood pressure, morning blood pressure surge and urine microalbuminuria was observed. Results Before irbesartan treatment,the average 24-hour ambulatory blood pressure was(140.1 ± 12. 7)mm Hg, the morning blood pressure surge was (45.6 ± 10.8) mm Hg, urine microalbuminuria level was (58.6 ± 3.7) mg/L. After irbesartan treatment,the average 24-hour ambulatory blood pressure decreased to (129. 5 t 11.8) mm Hg (t = 3.18, P ＜ 0.05), the morning blood pressure surge decreased to(14. 2 ±4. 1)mm Hg(t =5.74,P ＜0.01) ,urine microalbuminuria level decreased to(31.7±3.1)mg/L(t =5.24,P＜0.01).Conclusions Irbesartan can effectively reduce the peak morning blood pressure,improve achievement ratio of blood pressure control, decrease urine microalbuminuria level in elderly patients essential hypertension.

Objective To investigate the present situation and to analyze related factors of nursing practice environment among 22 public hospitals in Shanghai area.Methods We investigated 1 600 nurses from the 22 hospitals with general information questionnaire and the Chinese version of Practice Environment Scale,and also analyzed related factors by single and multiple factor analysis.Results 1 582questionnaires were taken back.49％ were dissatisfied with their working environment,and 28.1％ were evaluated to have nice practice conditions.Nurse concerned with workforce management and adequate resources were widespread.Logistic analysis indicated that hospital's level,the nurse's age,educational background and seniority were main factors influencing nurses' satisfaction.Nurse work in tertiary hospitals reported lower satisfaction.Conclusions More attention should be paid on improving nursing practice environment.

Objective To study the effect of inhibitors of the multidrug transporters including P-glycoprotein (PGP)and multi-drug resistance-associated protein(MRP)on the regulation of concentration of oxcarbazepine in the extra-cellular fluid of the hippocampus after pilocarpine induced seizures in rats.To investigate whether oxcarbazepine are sub-strate for PGP and MRP and whether brain expressions of PGP and MRP are involved in muhidrug resistance mechanisms of refractory epilepsy.Methods The epileptic rats model were established by repeated peritoneal injection treatment with pi-locarpine.Thirty-two Wistar rats were divided into four groups:control group,pilocarpine epileptic model group,verapamil treated group and probenecid treated group.At 30,60,90,120 and 150 min following systemic injection of oxcarbazepine (80 mg/kg),dialysate was collected and the concentration of oxcarbazepine in the extracellular fluid of hippocampus was determined by microdialysis and high-performance liquid chromatography technique.Results After systemic injection of oxcarbazepine,the concentration of oxcarbazepine in extracellular fluid of the hippocampus during 90～150 min(1.26±0.09、0.93±0.10)were much higher in verapamil treated group than in pilocarpine epileptic model group(0.87±0.06、0.66±O.04)(P<0.05)and the concentration of oxcarbazepine in the hippocampus during 60～150 min(1.07 4±0.11、1.32±O.13、1.02±0.10、0.87±0.08)were higher in probenecid treated group than in pilocarpine epileptic model group (0.81±0.08、0.87±0.06、0.66.4±0.04、0.58±0.06)(P<0.05).Conclusions Oxcarbazepine are substrates for PGP and MRP and,penetration of oxcarbazepine through blood-brain barrier are restricted by PGP and MRP.Increased expres-sions of PGP and MRP in brain maybe involved in the mechanisms of multidrug resistance of refractory epilepsy.

AIM: To establish HPLC fingerprint for the identification of Hydrocotyle sibthorpioides and its adulterants. METHODS: The chromatographic seperation was performed on a Diamonsil C_(18) (250 mm×4.6 mm,5 μm)with a mobile phase consisting of acetonitrile-0.1% phosphoric acid, gradient eluent, at the flow rate of 1.0 mL/min. The UV detection was set at 340 nm. RESULTS: There was an apparent difference in fingerprint between Hydrocotyle sibthorpioides and its adulterants. CONCLUSION: The method is stable and reliable with a good reproducibility andprovides a reference standard for identifying Hydrocotyle sibthorpioides and its adulterants.

To investigate the mechanism of macrophages apoptosis induced by stressed Salmonella typhi,macrophages were co-cultivate with inhibitors caspase 3,8,9 and anti-TNF-α antibody and then S.typhi was added to construct the infection model..The rate of macrophage apoptosis was assayed by flow cytometry and the contens of caspase 3.8 ,9 and anti-TNF-α antibody as well as NO were then determined respectively.It was found that the apoptotic rates of macrophages were significantly inhibited by caspase 3 and caspase 8 inhibitors and antibody against TNF-α respectively (P<0.01).A significantly enhanced generation of caspase 3 and caspase 8 activities during macrophage apoptosis induced by S.typhi correlated with the increased generation of TNF-αand NO (P<0.01).These results indicate that the inactive NO and TNF-α mediated inhibitors caspase 3 and caspase 8 participate the exogenous apoptotitic pathway of macrophages induced by S.typhi.

AIM: To establish HPLC fingerprint for the identification of Hydrocotyle sibthorpioides and its adulterants. METHODS: The chromatographic seperation was performed on a Diamonsil C_18(250 mm?4.6 mm,5 ?m)with a mobile phase consisting of acetonitrile-0.1% phosphoric acid,gradient eluent,at the flow rate of 1.0 mL/min.The UV detection was set at 340 nm. RESULTS: There was an apparent difference in fingerprint between Hydrocotyle sibthorpioides and its adulterants. CONCLUSION: The method is stable and reliable with a good reproducibility and provides a reference standard for identifying Hydrocotyle sibthorpioides and its adulterants.

Objective To understand the awareness of children snoring disease knowledge and demand of health education and appropriate health education methods from the parents whose children were in hospital by snoring, and provide basis for health education in clinic. Methods On the basis of literature search and expert consultation, 276 parents whose children in hospital by snoring were investigated by self-designed questionnaire. The questionnaire included the awareness of children snoring disease knowledge and demand of health education and appropriate health education methods were carried out. Results The awareness rate of children snoring disease knowledge was 2.54%-55.07% in parents whose children in hospital by snoring. The average demand rate of health education surpass 80%, major reason and symptom and main therapy and surgical outcomes of snoring were more concerned with 100.00%(276/276). The average demand rate of the impact on the intelligence was 96.38%(266/276). Acceptable methods of health education from high to low were as follows, consulting a doctor was 93.48%(258/276), posting publicity column in the halls or ward hallway was 74.28% (205/276), attending health education lecture was 66.30% (183/276), through QQ group or micro letter platform was 61.96%(171/276), through community healthy knowledge publicity column was 56.52%(156/276), through broadcast radio and television programs when see a doctor or in hospital was 53.62%(148/276), through telephone counseling was 36.96%(102/276), through hospital health prescription was 36.23% (100/276), through audiovisual teaching materials was 32.25% (89/276), communication between parents was 7.97%(22/276). Conclusions The awareness rate of children snoring disease knowledge from the parents whose children in hospital by snoring is low, the medical staff need take various ways of health education to improve snoring children′s parents′overall understanding level of children sleep apnea, effectively prevent various influencing factors of sleep apnea and snoring related complications, to reduce the dangers caused by snoring.

Intellectual property in medical institutions has been getting more attention in research activity.Large general hospitals have made significant achievements in intellectual property,and the management of intellectual property right has also gradually become the norm.This article discussed the possibility to carry out the intellectual property management in the primary health care sector,based on their current status and characteristics,proposed an evaluation system which suitable for the primary health care sector.We described the structure and method of this system,explored a standardized intellectual property management process used in primary health care institutions.

OBJECTIVE:To investigate the role of clinical pharmacists in the treatment for patients with chronic renal failure. METHODS:Clinical pharmacists participated in the treatment process for a patient with chronic renal failure during uremia period;assisted physicians to optimize and improve therapy plan from correcting anemia,controlling blood pressure,improving heart func-tion and regulating ion disorder,etc.;suggested adding dosing frequence of Felodipine sustained-release tablet,Metoprolol tartrate tablet and Shenqiong glucose injection,and giving Benazepril hydrochloride tablet and Isosorbide 5-mononitrate sustained-release tablet. They also suggested adjusting the dosage of rhEPO and the dosage form of ferralia,increasing the dosage of Calcitriol cap-sule and Calcium carbonate tablet,decreasing dosing frequence of 5% Glucose injection and Levocarnitine for injection,and giv-ing Vitamine B12 tablet. Therapeutic efficacy and ADR should be observed closely during treatment,and medication education should be performed for the patient. RESULTS:Physicians adopted the suggestions of clinical pharmacists. The patient was im-proved and discharged from hospital with drugs 28 days later. CONCLUSIONS:Clinical pharmacists participate in the individual-ized treatment for patients with chronic renal failure and assist physicians to optimize therapy plan,which promote the clinical effec-tiveness and safety of drug treatment.