AIM: To investigate the guiding role of individualized medication adjustment based on CYP2C19 metabolic typing in the treatment of ischemic stroke with clopidogrel, and to provide reference for clinical individualized medication. METHODS: The total of 80 patients with ischemic stroke were divided into the individualized drug instruction group with gene detection (n=40) and the control group without gene detection (n=40) according to whether they received CYP2C19 gene detection. According to the metabolism of CYP2C19, the individualized medication instruction group was divided into slow metabolic type, intermediate metabolic type, fast metabolic type and ultra-fast metabolic type. Patients with fast and ultra-fast metabolites were given clopidogrel dose of 75 mg once a day. Patients with intermediate metabolic type were given double clopidogrel dose of 150 mg once a day. Patients with slow metabolism were given tigrillo dose of 90 mg twice a day or aspirin dose of 100 mg once a day. The control group received 75 mg clopidogrel once a day. All patients enrolled in the groups were followed up for 3 months by outpatients or telephone. The incidence of vascular events and mRS scale scores were compared between the two groups. RESULTS: The incidence of vascular events in the individualized drug instruction group was significantly lower than that in the control group, and the incidence of mRS score(0-1) was significantly higher than that in the control group, with statistically significant differences (P<0.05). CONCLUSION: The individualized medication for patients with ischemic stroke by CYP2C19 gene detection can significantly reduce the incidence of adverse vascular events and improve the prognosis and living ability of patients.

Coronavirus disease 2019(COVID-19)is caused by novel coronavirus(SARS-CoV-2), which is widely prevalent around the world and caused global panic. Evidences show that eye transmission is possible, so the ophthalmic medical staff is more likely to be infected. Ocular manifestations of COVID-19 involve conjunctiva, corneal, sclera, anterior chamber, pupils, retina, optic nerve and visual cortex, extraocular muscles and theirs cranial nerves innervation, orbit and lacrimal system. Viral conjunctivitis is the most common ocular manifestation of COVID-19. In order to protect ophthalmic medical staff from infection and to safely carry out clinical work during the epidemic period of COVID-19, this article summarizes the ocular manifestations of COVID-19, including epidemiology, pathophysiology and clinical manifestation.

OBJECTIVE To provide a reference for the safe use of drugs in patients with complex venous thromboembolism （VTE） and acute renal insufficiency. METHODS Clinical pharmacists participated in the management of anticoagulant therapy for a patient with complex VTE complicated with acute renal insufficiency， and evaluated the patient as high-risk thrombosis and bleeding based on their medical history， laboratory test results， etc.； combined with the complexity of thrombosis and renal insufficiency， clinical pharmacists suggested that enoxaparin sodium should be used in the acute stage of thrombosis （5 to 21 days after onset）， and then warfarin should be adopted for oral anticoagulation treatment. Because the patient’s anticoagulation was not up to the standard （the target range of the international normalized ratio was 2-3）， clinical pharmacists suggested increasing the warfarin dose， detecting the warfarin metabolism genotype， and adjusting the warfarin dose according to the genotype； at the same time， clinical pharmacists developed an anticoagulation monitoring plan to ensure the safety of anticoagulation treatment. RESULTS Doctors had adopted all the recommendations of clinical pharmacists. The patient did not experience adverse events such as bleeding or worsening of thromboembolism during anticoagulation in the hospital. When the anticoagulation met the standards， the patient was allowed to be discharged with medication. CONCLUSIONS By participating in the anticoagulation treatment management of patients with complex VTE and acute renal insufficiency， clinical pharmacists have assisted doctors in formulating personalized anticoagulation plans to promote the compliance with the anticoagulation treatment standard and ensure the safety and effectiveness of medication for patients.

Objective To investigate the phagocytosis function of cigarette smoke extracts (CSE)on the NR8383 cells. Methods The concentration of CSE and the optimal time was defined by cell counting kit-8 assay, Annexin V/PI cell apoptosis assay and CFSE cell proliferation assay. The cell was gained after exposed to the different concentration of CSE for 24 h and mixed with fluorescein-labeled Escherichia coli in 37℃ for 2 h. The fluorescence intensity was used to assay the phagocytosis function of NR8383 cells.Results The phagocytosis function of NR8383 cells may be changed by the concentration of CSE. In the concentration of 100 μg/ml, the phagocytosis function of NR8383 was enhanced 0.5 times than the normal cell when NR8383 cell was exposed to CSE, and the specific activity is the highest. When NR8383 cells were exposed to CSE and LPS, the phagocytosis function of NR8383 cells was enhanced 2 times than the normal cell. In the concentration of 200 μg/ml, the phagocytosis function of NR8383 cells was damaged, the rate of apoptosis is the 54. 1%. Conclusion Low concentration of CSE enhanced the phagocytosis function of NR8383 cells, but high concentration of CSE damaged the phagocytosis function of NR8383 cells. This study reveals a new role of CSE as an activator of macrophage function.

Objective: To investigate the antitumour activity of ginsenoside Rh2 against human leukemia KG1α cells through apoptosis and autophagy pathway. Methods: CCK-8 assay was used to screen the most effective ingredient on the proliferations among ginsenoside Rh2 in leukemia KG1α cell line; FCM detected cell apoptosis; Hoechst staining observed the cell morphological changes of apoptosis; Acridine staining detected Rh2 effected on autophagy; Western blotting and RT-PCR detected the expression levels of the proteins closely associated with autophagy and apoptosis. After joining autophagy inhibitors, using CCK-8 to test the proliferation activity of cells, cell apoptosis was measured by FCM. Results: CCK-8 indicated that Rh2 could inhibit the proliferation of KG1α cells significantly with dose- and time-dependent manners; FCM indicated that Rh2 induced apoptosis; Hoechest staining showed that KG1α cells had typical apoptotic morphological changes by treated Rh2; Acridine staining revealed that Rh2 cause increase in the number of acidic autophagy vesicles in cells, causing cell autophagy levels increased; Western blotting and RT-PCR results showed that Rh2 increased the expression of Beclin-1, LC3A, and LC3B, activated Caspase-3 and Bax/Bcl-2 rates, and MAPK, ATK, and ERK signaling pathway; After using autophagy inhibitors (3-MA), autophagy crippled that Rh2 inhibited the proliferation and induced apoptosis in KG1α cells. Conclusion: Ginsenoside Rh2 could significantly enhance autophagy through activated MAPK, ATK, and ERK signaling pathway, and then inhibit the proliferation and induce apoptosis in KG1α cells.

OBJECTIVE： To investigate the protective effects of anemarsaponin B on hypoxia/reoxygenation injury astrocytes and its possible mechanism. METHODS： The primary astrocytes of neonatal SD rats were cultured and identified， and then randomly divided into normal group， model group， positive control group （nimodipine， 10 μmol/L）， anemarsaponin B low-dose， medium-dose and high-dose groups （1， 10， 100 μmol/L）， respectively. Normal group and model group were given complete medium 1 000 μL. Administration group was given complete medium with relevant medicine 1 000 μL. Except for normal group， hypoxia/reoxygenation injury model was established by oxygen-glucose deprivation/reperfusion in other groups. After reoxygenation， relative release rate of lactate dehydrogenase （LDH） in cell was detected by colorimetry. MTT assay was used to detect the relative viability of the cells. The contents of aquaporin 4 （AQP-4）， IL-6， IL-1β and TNF-α in cell were measured by ELISA. RESULTS： Compared with normal group， relative release rate of LDH， the contents of AQP-4， IL-6， IL-1β and TNF-α in cell were increased significantly in model group， while relative viability of the cells were decreased significantly （P＜0.01）. Compared with model group， relative release rate of LDH， the contents of AQP-4， IL-6， IL-1β and TNF-α in cell were decreased significantly in administration groups， while relative viability of the cells were increased significantly （P＜0.05 or P＜0.01）. CONCLUSIONS： Anemarsaponin B can significantly decrease cell injury degree， strengthen cell viability and protect hypoxia/reoxygenation injury astrocytes to certain extent. The effect may be related to the down-regulation of the secretion of AQP-4， IL-6， IL-1β and TNF-α.

The presence of physiological barriers in the eye （both external and internal） makes conventional ophthalmic medications （eye drops， ointments， gels， etc.） less bioavailable and difficult to reach the posterior segment of the eye. Although intravitreal injection can deliver drugs to the posterior segment of the eye， it has disadvantages such as infection， injury， and poor tolerance. Ophthalmic microneedle breaks through the intra- and extra-ocular barriers， enabling the drug to reach the target site accurately and to be released continuously greatly avoiding intraocular infections and injuries， and improving the bioavailability of the drug， which has obvious advantages as an ophthalmic drug delivery tool. Ophthalmic microneedle can be classified into hollow microneedle， dissolving microneedle， and coated microneedle according to the usage methods. Each type of microneedle has its own advantages and has shown satisfactory performance in the treatment of diseases such as bacterial and fungal keratitis， glaucoma， exudative age-related macular degeneration， diabetic macular edema， non-infectious uveitis， corneal neovascularization， and even choroidal melanoma.

OBJECTIVE To provide reference for the management of antithrombotic therapy in thrombocytopenia patients with atrial fibrillation and atherosclerosis. METHODS The clinical pharmacist participated in the treatment of a thrombocytopenia patient with atrial fibrillation and atherosclerosis， and analyzed the causes of thrombocytopenia according to the patient’s medical history and laboratory examination results. At the same time， the risk of thrombosis-bleeding was evaluated according to the relevant guidelines， and the clinicians were assisted in formulating individual antithrombotic therapy plan and pharmaceutical care plan for the patient. The literature on antithrombotic therapy related to thrombocytopenia was collected and analyzed by retrieving CNKI. RESULTS Thrombocytopenia was considered as primary thrombocytopenia in this patient， and the main risk of bleeding was age ≥65 years old， bleeding tendency， and combined use of antithrombotic drugs. After the clinical pharmacist assessed the risk of thrombosis and bleeding， the clinician was recommended to give full dose of Bemiheparin sodium injection + Dronedarone hydrochloride tablets + Metoprolol succinate sustained-release tablets. In view of thrombocytopenia， the clinician gave Compound zaofan pill， Caffeic acid tablet and Sheng xuexiaoban capsule， but the patient developed diarrhea after the medication. The clinical pharmacist suggested stopping Sheng xuexiaoban capsule， and the clinician adopted the clinical pharmacist’s suggestion. When the patient was discharged from hospital， the clinical pharmacist suggested that the antithrombotic therapy plan for discharge was anticoagulation alone or selective anticoagulation. The clinician chose selective anticoagulation treatment considering that the patient’s current thrombocytopenia， urinary occult blood （+） and fecal occult blood were weakly positive， and ordered the patient to take Metoprolol succinate sustained-release tablets + Atorvastatin calcium tablets at discharge. Literature analysis showed that the causes of thrombocytopenia of patients with thromboembolism mainly included heparin induced-thrombocytopenia， immune thrombocytopenia， etc. All patients were improved after symptomatic treatment. CONCLUSIONS By participating in the management of antithrombotic therapy for the thrombocytopenia patient with atrial fibrillation and atherosclerosis， clinical pharmacists can help effectively control the patient’s condition and ensure the safety and effectiveness of drug use.

Objective To analyze and summarize the changes of the bronchus and vessels of right B2 downwards-shift. Methods The 5 280 patients who underwent three-dimensional computed tomography bronchography and angiography between January 2019 and January 2022 were screened. Based on the opening position of B1+3, we classified bronchial variations into a normal type, over type, and tracheal-bronchus type. Results Finally 6 patients were included with 1 male and 5 females, aged 29 to 71 years. According to our bronchial classification, there were 4 (66.7%) patients of the normal type in this group, 1 (16.7%) of over type, and 1 (16.7%) of tracheal-bronchus type. About arteries, 4 (66.7%) patients was the trunk superior (Tr.sup)+posterior artery (A.post) type and 2 (33.3%) Tr.sup+trunk inferior (Tr.inf)+A.post type. About veins, 2 (33.3%) patients were the Ⅰab+right upper lobe vein posterior to the bronchus intermedius (UVPBI) type, 1 (16.7%)Ⅰb+UVPBI type, 1 (16.7%) anterior+UVPBI type, 1 (16.7%) central+UVPBI type and 1 (16.7%) central type. Conclusion In the right B2 downwards-shift, A.post exists, and the posterior oblique fissure is poorly developed (RS2 and RS6 are interconnected). Therefore, it is easier for us to dissect and disconnect B2 intraoperatively, but it is necessary to be vigilant for vascular damage caused by opening the posterior oblique fissure.

Humans ; Immune Checkpoint Inhibitors/therapeutic use* ; Prospective Studies ; HIV Infections/drug therapy* ; Anti-HIV Agents/therapeutic use* ; Comorbidity