Objective To analyze the unreasonable elements in prescriptions from outpatient department through the intervention of unreasonable prescriptions;To provide evidence for reasonable usage of medicine in outpatient department.Methods Prescriptions were examined by senior pharmacists. If they found any unreasonable elements, they would consult doctors, and record all the unreasonable elements in the prescriptions to avoid unreasonable prescriptions. A total of 663 unreasonable prescriptions from Jan. 2011 to May 2013 were analyzed.Results A total of 709 unreasonable elements were found in these prescriptions. The man elements were following three types:overdose of toxic decoction pieces (73.76%), incompatible prescriptions without signature (12.13%), wrong inputting of prescription and decoction (7.76%).Conclusion With early intervention in prescriptions, the quality of prescriptions and the safety and effectiveness of medication can be improved.

Objective To investigate the clinical significance of the ST segment changing in treadmill exercise test positive for the diagnosis of coronary heart disease. Methods 133 patients (hospitalized from January 2014 to January 2015) with the ST segment depression≥0.1 mm in treadmill exercise test were retrospectively analyzed. Patients were divided into the observation group and the control group according to the coronary angiography (the dividing line is artery stenosis is more than 50% or not ). ST-segment depression margin and recovery time of the two groups were compared. ST-segment depression margin and recovery time of patients with different vascular lesion number were also analyzed. Results In 133 cases, 79 cases of coronary angiography were positive(59.4%). Positive rate of ST segment recovery time(> 90 s) was 76.9% in. The maximal ST-segment depression margin and recovery time in the observation group were more than the control group, the difference was statistically significant (P<0.05). Compared with the maximal ST segment depression margin in single-vessel stenosis group , the difference in the double-vessel and multi-vessel stenosis group was not statistically significant(P > 0.05). But in terms of ST-segment recovery time, the double-vessel and multivessel stenosis group were higher than the single-vessel stenosis group , and the difference was statistically significant (P< 0.05). Conclusion Clinically, patients with TET positive combined the ST segment depression and ST-segment recovery time are important hints for the diagnosis of coronary artery disease , and is worthy of promotion.

BACKGROUND: Tendon injury is a common injury in the department of hand surgery. The postoperative recovery of hand function is always affected by tendon adhesion after tendon repair. To prevent tendon adhesion, especially the adhesion after flexor tendon repair is always the key in the rehabilitation of hand surgery.OBJECTIVE: To investigate the impact of decimeter wave therapy on tendon adhesion and healing after flexor tendon repair.DESIGN: Randomized controlled study based on experimental animal SETTING: Provincial Institute of Orthopaedics.MATERIALS: The study was conducted in Hebei Provincial Institute of Orthopaedics from January 2001 to June 2003. Totally 28 Leghorn chickens were randomly divided into decimeter wave therapy group and operation control group.METHODS: The flexor digitorum profundus tendons of Leghorn chickens were transected and repaired. Decimeter wave therapy was applied to the toes on chickens of decimeter wave therapy group. Animals were executed at week 3 or 6 after operation for macroscopical observation and histological observation under optical and electron microscopes, and biomechanical analysis.MAIN OUTCOME MEASURES: Principle index: results of macroscopical observation and the observatory results under optical and electron microscope, and the results of biomechanics. Secondary index: results of the classification of tendon adhesion and healing.RESULTS: It could be seen under macroscopical and histological observation that the adhesion significantly reduced in decimeter wave therapy group. The protein synthesis of fibroblast was significantly more than that of the control group under electron microscope. As indicated by biomechanical analysis, the tendon gliding distance[ (5.37 ± 1.06) mm at week 3, (6.76 ± 1.52) mm at week 6]and the rehabilitative compliance( 1. 04 ± 0.65 at week 3)of decimeter wave therapy group were bigger than those of the control group respectively [ (4.43 ±1.03) mm, (5.33±1.27)mmand0.63±0.31](P ＜0.05), and the anti-tension strength of decimeter wave in therapy group (N, 26. 93 ± 4. 80,47. 12 ± 7.76) was significantly bigger than that of the control group respectively(21.29 ±4. 88 and 38.96 ±7.52) (P ＜0. 01).CONCLUSION: Decimeter wave therapy can effectively promote tendon healing and reduce tendon adhesions and provide prerequisites for early rehabilitative training after flexor tendon repair. Hence, it is an ideal assistance in the prevention of tendon adhesion.

Objective: To evaluate the clinical effects of troponin alone and troponin combining copeptin in early diagnosis of Non-ST segment elevation myocardial infarction (NSTEMI) by meta-analysis. Methods: We searched Medline, EMBASE, Cochrane, Pubmed, CNKI and Wanfang database (1995-01 to 2015-10) for the publications of troponin alone and troponin combining copeptin in early diagnosis of NSTEMI. Based on inclusion and exclusion criteria, we screened the literatures and evaluated their quality by QUADAS items. Manager 5.2 and Meta-DiSc 1.4 software were used to study the pooled sensitivity and speciifcity for troponin alone and troponin combining copeptin in NSTEMI early diagnosis, and to calculate the summary receiver operating characteristic curve (SROC) with the area under curve (AUC). Results: There were 11 articles including 1 Chinese article enrolled. For NSTEMI diagnosis, compared with troponin alone, troponin combining copeptin showed the higher sensitivity (90% vs 75%), but lower speciifcity (60% vs 87%). For SROC, both AUC were > 0.7, while the AUC of troponin combining copeptin was even lower (0.805 vs 0.891). Conclusion: Combination of troponin and copeptin had the better sensitivity for NSTEMI early diagnosis, although it with lower speciifcity while increased copeptin level might suggest the patients associated with other clinical conditions such as heart failure or stroke which were important in clinical practice.

Objective To evaluate the impact of positive end-expiratory pressure (PEEP) on hemodynamic variables including central venous pressure (CVP),mean arterial pressure (MAP) and heart rate (HR) in patients with central respiratory failure treated by mechanical ventilation.Methods Thirty two neurosurgical patients with central respiratory failure,male 19,female 13,mean age (58.8 ± 13.9)years,GCS ≤ 8 points,were enrolled in this prospective,self-control study between June 1,2009,and May 31,2011.Patients were excluded in cases of severe cardiopulmonary disorders,pericardial diseases,person machine confrontation,administration of vasoactive drugs,and hypervolemia or hypovolemia.On admission to neurosurgical intensive care unit,all patients were mechanically ventilated in the mode of synchronized intermittent mandatory ventilation.Hemodynamic effects of six randomly set levels of end-expiratory pressures (0,3,6,9,12,15 cm H2O,every 10 min,1cm H2O =0.098 kPa) were studied in all patients.CVP,MAP and HR were recorded at each of the six end-expiratory pressure levels.One-way analysis of variance and simple linear regression model were used for data analysis.Results The levels of central venous pressure were elevated with increase in end-expiratory pressures.CVP levels were positively correlated with the levels of PEEP (R =0.468,P =0.000),with a simple linear regression equation expressed as:CVP (cm H2O) =7.870 +0.344 ×PEEP (cm H2O),The levels of MAP showed no statistically significant changes at different PEEP levels (F =1.390,P =0.227).No linear correlation between MAP,HR and PEEP levels was found (R =0.042 and 0.160,P =0.413 and 0.002).Conclusions CVP values would be overestimated during mechanical ventilation at different PEEP levels in mechanically ventilated patients due to central respiratory failure,positive correlation existed between CVP values and PEEP levels,whereas MAP was unaffected by different PEEP levels.This study could probably offer a quantitative reference for correct assessment of such a hemodynamic variable as CVP for mechanically ventilated patients without discontinuance of PEEP.Further studies are needed to determine whether these findings could be confirmed in a prospective manner.

Objective To exam the exposure status to tobacco advertisement and promotion programs in Chinese middle school students.Methods Stratified multi-stage cluster sampling was used to select participated grade 7-9 middle school students in 31 provinces (n=155 117).A self-administrated questionnaire was used in which questions related to behavior on tobacco use,exposure to second-hand smoking (SHS),access to tobacco products and prices,tobacco control advocacy,exposure to tobacco advertisement,and promotion as well as attitude and knowledge towards tobacco,etc.Data was weighted and analyzed,using the complex survey module of SAS 9.3 software.Results In the past 30 days,48.5％ of the students had a chance to see advertisement or promotion programs on tobacco.Tobacco advertisement or promotion were most frequently seen on TV (21.3 ％) among students,followed by outdoor billboard (20.1％),at the stands for sale (17.5％),and Internet (15.6％).In addition,4.6％ of the students reported having kept the items related to brand logos of tobacco products; 2.0％ reported having been offered a free tobacco product by tobacco company representatives; 69.7％ reported having seen scenes related to smoking on TV/videos/movie screens.Twenty five point two percent of the student smokers reported buying individual sticks at last purchase.Among those students who had never been exposed to tobacco,the ones who had been exposed to tobacco advertisement and promotion programs reported that they were more likely to feel smoking attractive than those who had not.They also reported that if a cigarette was offered by friends,they might try to smoke within the next 12 months,feeling that smoking would make him/her comfortable,and finally to feel that they might enjoy smoking (P＜0.000 1).Conclusion Adolescents had been heavily exposed to tobacco advertisement and promotion programs in China.Students who had been exposed to tobacco advertisement or promotions were more likely to express positive attitude to tobacco use.It is urgent to make amendments to China's Advertising Law to completely prohibit tobacco advertisement,promotion and sponsorship programs,to keep the young people away from tobacco.

Objective To evaluate the impact of cigarette excise tax up-regulation on the retail price of cigarettes in 2015.Methods Nominal and real price of selected cigarette varieties were calculated with data from Tobacco Retail Price Monitoring Project,which was conducted in 10 cities of China from 2013 to 2015.The trend of the cigarette prices changing was analyzed with annual data.Results A total of 352 varieties of cigarettes were surveyed during the three years.The nominal price of these cigarettes did not change significantly from 2013 to 2014.Compared with nominal price of 2014,the price of 286 varieties increased and the price of 10 most popular varieties increased from 0.6％ to 7.4％ after cigarette excise tax increased,but the actual prices had both rise and fall compared with 2013.Conclusions Cigarette excise tax raise in 2015 had influence on the retail price of cigarettes.But the increase in retail price was very limited,if factors including inflation and purchasing power are taken into consideration.Therefore,the influence of 2015 cigarette excise tax raise on tobacco control needs further evaluation.

Objective To investigate the changes of serum corticosterone and inflammatory factors in rats with different burn degrees. Methods One hundred and fifty male healthy Wistar rats were randomly divided into normal control group, moderate and severe burn hormone treatment groups, and moderate and severe burn physiological saline treatment groups, each group with 30 rats. After anesthesia, the rat models with burn Ⅱ,Ⅲ degrees of 30% back surface area were replicated; the burn, fluid infusion and steroid therapy were not carried out in the normal control group. After modeling, the moderate and severe burn hormone treatment groups were given intra-abdominal cavity injection of hydrocortisone 200 mg/d; while in the moderate and severe burn normal saline treatment groups, normal saline 4 mL·kg-1·d-1 was injected into the abdominal cavity. The dynamic changes of serum corticosterone, tumor necrosis factor-α(TNF-α), and interleukin-6 (IL-6) levels were detected at 1, 4, 12 hours and 1, 3 and 7 days after burn injury in each group. Results The levels of serum corticosterone at different time points after moderate and severe burn injury treatment were higher than those in normal control group, the degree of increase at 4 hours after injury in severe burn saline treatment group was more significant than that in moderate and severe burn hormone treatment groups and moderate burn saline treatment group (ng/L: 200.45±2.63 vs. 110.56±9.23, 146.02±3.28, 160.02±8.22). Except the level at 1 hour after injury in the moderate and severe burn hormone treatment groups, the TNF-αlevels in all the other groups at different time points were significantly higher than those in the normal control group (all P < 0.05); the IL-6 levels in various treatment groups were all higher than the IL-6 level in the normal control group, moreover, the increase degree on 1 day after injury in the severe burn saline treatment group was more obvious than the degrees in the moderate and severe burn hormone treatment groups and the moderate burn saline treatment group [TNF-α(ng/L): 39.78±4.30 vs. 15.99±1.40, 20.58±2.10, 25.98±1.60, IL-6(ng/L): 210.20±6.70 vs. 125.45±3.10, 149.81±4.20, 161.40±3.80, all P < 0.05]. Conclusion The burn stress may lead to the significant increase of serum corticosterone level in rats, and the stress dose of hydrocortisone has a certain regulatory effect on serum corticosterone and inflammatory factors in rats after different degrees of burn.

Objective To discuss the diagnosis and treatment of non-specific ureteritis. Methods Considered by the Court left pelvis area occupying one case, and there are special non-specific symptoms in patients with treatment ureteritis recalled while literature and discuss the effective non-specific ureteritis diagnosis and treatment. Results Surgery did not undergo resection of the left kidney ureter, only stripping, removal of parcels renal pelvis, ureter choco-late-like substance. Conclusion Patients with a lower back pain, clinical history of macroscopic haematuria, imag-ingstudies revealed hydronephrosis, renal pelvis and ureter wall thickening, irregular, or beaded change, ureteral peri-stalsis is poor, should be carefully and spontaneous perirenal hemorrhage, ureteral cancer identification, If by related tests, imaging examination and cytological examination failed to diagnose patients, feasible with bilateral renal pelvis ureter surgical exploration, avoid blindly kidney ureteral resection.

Objective:To explore the safety and efficacy of immune checkpoint inhibitors(ICI)for patients with tumor recurrence after liver transplantation(LT).Methods:A single-center retrospective study was conducted for 6 recipients of tumor recurrence after LT on a therapy of ICI admitted into Shulan(Hang Zhou)Hospital from September 2015 to June 2018.The authors examined the occurrences of graft rejection and clinical outcomes of overall response rate, progression-free survival and overall survival after dosing of PD-1/PD-L1 inhibitors.Results:Six patients enrolled with tumor recurrence on a therapy of ICI undergoing LT due to hepatocellular carcinoma (HCC). Nivolumab (n=4) and duvalizumab (n=2) were administrated.The median session of treatment was 8.3(2-31) cycles.The disease outcomes were stable (3/6, 50%) and progressive (3/6, 50%), The progression-free survival time of 3 disease-controlled patients was 1.5, 16.2 and 18 months and the median survival time after recurrence was 19.75(10.8-37.8) months.Rejection occurred in 1 patients (1/6, 16.7%) and the occurring time of rejection was 28 days after PD-1 inhibitor dosing.After acute rejection, high-dose corticosteroids and immunoglobulin were ineffective and the patient died from acute rejection related liver failure.Conclusions:ICI may be employed as a salvage treatment for tumor recurrence after LT for HCC.Due to a possibility of severe acute rejection, usage should be cautious under close monitoring of liver function.