Objective To investigate the tolerance of chemotherapy based on gemcitabine and cisplatin in elderly patients (> 70 years old) with advanced pancreatic cancer. Methods Retrospective analysis in 34 elderly patients with advanced pancreatic cancer between January 2004 and January 2009 was performed. Results 6 patients had partial remission (PR) and 16 patients had stable diaease (SD). The clinical benefit response (CBR) rate was 64.7%. 18 patients reduced their analgesics dose exceeding 50% , as well as pain intensity descended exceeding 35% , 22 patients had the weight increased more than 7% and had improved general well-being. The incidence rate of nausea and vomiting was 38. 2% (13/34) , 4 patients had worsened liver function and aggravated skin and sclera stained yellow. Incidence of Ⅲ- Ⅳ myelosuppressive was 34. 6% , and there were decrease in the number of white blood cell, hemoglobin, platelets to some extent, the rate of thrombocytopenia was 28. 3% (12/34) , blood routine normalized after using G-CSF. There was no occurrence of peripheral neurotoxicity or chemotherapy-related death. Conclusions Chemotherapy of gemcitabine in combination with cisplatin was tolerable for elderly patients with advanced pancreatic cancer who were in good condition of behavior.

The training of clinical thinking ability is the key point of obstetrical teaching to medical students in eight-year program.Obstetrical department of the third affiliated hospital of Sun Yat-sen university has put forward specific methods of SP inquiring and PBL case analysis teaching.The well-designed teaching methods have an active role in the training of case history collecting ability,diagnosing and treating ability to medical students in eight-year program.

0.05). Conclusion The polymorphism distribution of HLA-B*27 genetic subtypes between unrelated donors and AS patients might have no significant difference.

AIM:To explore the characteristics of hepatitis B virus S gene mutation in the vertical transmission after active and passive vaccination .METHODS:Fifteen cases of immunoprophylaxis failure were enrolled in the study . HBV S gene (including pres-S and S) from the mothers, newborns before active and passive vaccination and 7-month-old infants with immunoprophylaxis failure were detected by PCR amplification .The characteristics of HBV S gene mutation were compared among the 3 groups.RESULTS: The genotype of HBV in the newborns and the infants was the same as that in the mothers .The frequencies of mutation in the 2 fragments of the HBV S gene had no significant difference between the 3 groups.The homology tree model based on HBV S gene was analyzed in the 3 groups, in which every group had their own cluster.There were 15 different mutation sites between 7 pairs of mothers and newborns .There were 3 different muta-tion sites between 3 pairs of newborns and infants (nt273A→A/G, nt512C→C/T and nt1139C→A), among which the first 2 were located in the S gene region but not in the “a” determinant , and the latter was located in the overlap region of S and X genes .There were 25 different mutation sites between 9 pairs of mothers and infants , but only 1 case had a differ-ent mutation site between the mother , newborn and infant .CONCLUSION: The HBV species in newborns and infants with immunoprophylaxis failure were transmitted from the mothers .The mutations in the HBV S gene with immunoprophy-laxis failure happened before and after active and passive vaccination , mainly before vaccination .The relationship between HBV S gene mutations and immunoprophylaxis failure should be further explored .

So in pharmaceutical microbiology teaching, we made education reform according to pharmaceutical characteristics, that is to revise syllabus, update teaching content, reform of teaching methods, use modern means of teaching to train students in innovative spirit and ability. Besides, we strengthen the practice of teaching, conduct comprehensive and applicative experiment, So that our educational content is more in line with teaching objectives of Chinese pharmacy specialty, and help students to engage in basic knowledge of microbiology, experiment skills, capacity to analysis and solve problems.

Objectives:To analyze the clinical characteristics of patients undergoing extracorporeal cardiopulmonary resuscitation (ECPR) and identify the risk factors for death.Methods:The clinical data of 60 patients undergoing ECPR admitted to our hospital and Hangzhou First People's Hospital from September 2014 to September 2019 were retrospectively analyzed. The patients were divided into the survival group and the death group. The clinical data of the two groups were compared to explore the risk factors related to death. COX regression analysis was used to identify the risk factors for death.Results:Sixty patients undergoing ECPR were included in our study, of them, 16 (26.7%) cases were out-of-hospital cardiac arrest (OHCA) and 44 (73.3%) cases were in-hospital cardiac arrest (IHCA). The mortality of OHCA patients was higher than that of IHCA patients (87.5% vs. 56.89%, P < 0.05), and the duration from CPR to ECMO installation in the death group was longer than that in the survival group [(105.4±105.1) min vs. (53.0±28.5) min, P < 0.05]. Compared with the survival group, patients in the death group had higher troponin and glutamic oxalacetic transaminase and lower PH and lactate ( P < 0.05). The median survival time of the 60 patients was 42 days. Out-of-hospital cardiac arrest, high SOFA score before ECMO, high-dose norepinephrine, pulmonary infection during ECMO support and long ECMO support time were independent predictors of patients’ death. Conclusions:Risk factors associated with patients’ death undergoing ECPR are out-of-hospital cardiac arrest, high SOFA score before ECMO, high-dose norepinephrine, long duration from CPR to ECMO installation, pulmonary infection during ECMO support and long ECMO support time.

Objective:To compare the treatment effect of venous-arterial extracorporeal membrane oxygenation (VA-ECMO) patients in the prophylactic distal perfusion catheter (DPC) and the non-prophylactic DPC.Methods:A prospective randomized controlled trial (RCT) was conducted. Patients who received VA-ECMO treatment were reviewed at Affiliated Jinhua Hospital, Zhejiang University School of Medicine from January 2019 to June 2020 were divided into two groups, the prophylactic DPC group (DPC placed immediately after the patient VA-ECMO) and the non-prophylactic DPC group (the DPC was placed after the early limb ischemic signs by using evaluation of the lower extremity perfusion assessment table). Comparing the differences of clinical data of two group patients. Pearson correlation analysis was used to analyze the correlation between peak velocity of dorsalis pedis artery and peak velocity of posterior tibial artery and transcutaneous oxygen partial pressure (TcPO 2). Results:A total of 62 patients were included in the analysis, with 31 cases in prophylactic DPC group and another 31 cases in non-prophylactic DPC group. There were no significant differences in sex, age, body mass index (BMI), smoking index, underlying disease, catheterization site, recovery time before on machine, extracorporeal membrane oxygenation (ECMO) operation time, mechanical ventilation time, length of stay in intensive care unit (ICU), mortality rate in hospital, and acute physiology and chronic health evaluationⅡ(APACHEⅡ) between the preventive DPC group and the non-preventive DPC group. There was no significant difference in ECMO indications, ECMO intubation location and pipeline type. The bleeding in the non-prophylactic DPC group was lower than that in the non-prophylactic DPC group [6.5% (2/31) vs. 29.0% (9/31), P < 0.05]. There were no significant differences in limb complications such as cyanosis, necrosis, amputation, compartment syndrome, arterial thrombosis, vascular reconstruction and repair, pseudoaneurysm, limb ischemic or limb infection. During the ECMO operation, except the blood stream infection in the non-prophylactic DPC group was lower than that in the non-prophylactic DPC group [3.2%(1/31) vs. 19.4% (6/31), P < 0.05], there was no other statistical difference in complications between the two groups. The peak velocity of dorsalis pedis artery in the preventive DPC group was significantly higher than that of the non-preventive DPC group (cm/s: 19.30±10.85 vs. 17.85±8.55, P < 0.05), and the peak velocity of posterior tibial artery was significantly lower than that of the non-preventive DPC group (cm/s: 19.90±10.94 vs. 21.58±9.77, P < 0.05). Pearson correlation analysis showed that the peak velocity of dorsalis pedis artery and peak velocity of posterior tibial artery of the preventive DPC group and the non-preventive DPC group were positively correlated with TcPO 2 ( r values were 0.747, 0.856, 0.850, 0.813, respectively, and P values were all 0.000). Conclusions:For patients with VA-ECMO treatment, the incidence of blood stream infection and bleeding during ECMO operation in non-prophylactic DPC implantation patients is lower than that of prophylactic DPC implantation patients. TcPO 2 is positively correlated with peak velocity of posterior tibial artery and dorsal foot artery in the cannulated limb. In patients with VA-ECMO undergoing femoral artery and vein puncture, in addition to judging the blood supply of lower limbs according to symptoms and signs, ultrasound and TcPO 2 monitoring can also be used as effective monitoring methods.

Objective:To study the relationship between maternal hemoglobin concentration, anemia rate in the third trimester and the altitudes, pregnancy outcomes among pregnant women in Tibet rural areas.Methods:This prospective study collected clinical and laboratory data of 390 Tibetan pregnant women who delivered after 28 gestational weeks at Chaya People's Hospital, Changdu city, Tibet autonomous region, from May 2020 to March 2021. Blood routine examination was performed at admission and 24-72 h postpartum using an automatic hematologic analyzer. According to the hemoglobin standard adjusted for altitude by World Health Organization (WHO), the association between pregnancy outcomes and maternal hemoglobin levels and anemia rate before and after adjustment were analyzed using Mann-Whitney U one-way analysis of variance, Chi-square, Pearson correlation, and Spearman correlation tests. Results:(1) In these women, the mean actual hemoglobin concentration in the third trimester was (121±16) g/L, and the prevalence of anemia and microcytic hypochromic anemia was 23.8% (93/390) and 20.3% (79/390), respectively. (2) After adjustment, the mean hemoglobin concentration was (93±17) g/L, and the prevalence of anemia and microcytic hypochromic anemia was 84.4% (329/390) and 30.5% (119/390), respectively. (3) Actual hemoglobin levels showed an increasing tendency as the altitude rose. At the altitude of 3 000-3 500 m, >3 500-4 000 m, and >4 000 m, the mean hemoglobin levels were (118±15) g/L, (119±17) g/L, and (124±16) g/L, respectively ( Ftrend=7.38, P=0.007). However, the prevalence of anemia and microcytic hypochromic anemia did not differ significantly between different altitude ( P>0.05). (4) Corrected hemoglobin levels were negatively associated with the altitude ( r=－0.31, P<0.001). At the altitude of 3 000~3 500 m, 3 500~4 000 m and >4 000 m, the mean corrected hemoglobin levels were (100±15) g/L, (92±17) g/L, and (87±18) g/L, respectively ( Ftrend=30.36, P<0.001). The prevalence of anemia increased with altitude ( χ2trend=15.44, P<0.001), but no association was observed between microcytic hypochromic anemia and altitudes ( P>0.05). (5) No association was found between actual or corrected anemia in the third trimester and adverse pregnancy outcomes, nor the hemoglobin level before or after adjustment and neonatal birth weight. Conclusions:In Tibet rural areas, the mean actual hemoglobin level in pregnant women tends to increase with the altitude. However, the prevalence of anemia and microcytic hypochromic anemia remains high and more attention should be paid to iron supplementary during pregnancy. After adjusting hemoglobin concentration based on WHO standard, more women were diagnosed as having anemia during pregnancy in this area, and the applicability of the diagnostic criteria for Tibetan residents requires further investigations.

Objective:to apply Fuzhengkangai AIDS particles combined therapy with effective antiretroviral therapy (HAART) at the beginning of the HIV/AIDS (human immunodeficiency virus/acquired immunodeficiency syndrome) patients,observe its clinical curative effect and improve the related adverse reactions.Methods:a multicenter,randomized,double-blind,placebo-controlled clinical research method,divided into experimental group and the control group (n =57),experimental group to "Fuzhengkangai particles" joint efficient antiretroviral therapy (HAART) antiviral treatment,control group to "Fuzhengkangai particles" placebo (5％ low dose) joint efficient antiretroviral therapy (HAART) antiviral treatment,treatment for 3 months.Two groups of patients with simultaneous liver and kidney function,blood routine,CD4 + T lymphocyte count,the observation of TCM symptoms and signs,survival quality of integral.Results:after 12 weeks of treatment,the control group and experimental group,the experimental group significantly elevated levels of peripheral blood RBC,lower levels of CR,reduce the signs and symptoms (total score,fatigue,stay,and spontaneous perspiration)integral,higher levels of CD4 + T lymphocyte count and survival quality score,the difference had statistical significance (p ＜ 0.05).Conclusion:Fuzhengkangai particles joint efficient antiretroviral therapy (HAART) antiviral treatment,can improve HAART after initial treatment of the patient's clinical symptoms,blood toxicity,the quality of survival,reduce the antiviral treatment of adverse reactions,combination drug alone can significantly increase the CD4 + T lymphocytes,so as to improve clinical curative effect.

Polymeric hydrogels have been widely researched as drug delivery systems, wound dressings and tissue engineering scaffolds due to their unique properties such as good biocompatibility, shaping ability and similar properties to extracellular matrix. However, further development of conventional hydrogels for biomedical applications is still limited by their poor mechanical properties and self-healing properties. Currently, nanocomposite hydrogels with excellent properties and customized functions can be obtained by introducing nanoparticles into their network, and different types of nanoparticles, including carbon-based, polymer-based, inorganic-based and metal-based nanoparticle, are commonly used. Nanocomposite hydrogels incorporated with polymeric micelles can not only enhance the mechanical properties, self-healing properties and chemical properties of hydrogels, but also improve the
Biocompatible Materials ; Hydrogels ; Micelles ; Nanocomposites ; Polymers