Objective To discuss the pharmaceutical care protocol and methods for clinical pharmacists taking part in cancer pain management. Methods A patient developed delirium and drowsiness after using oxycodone hydrochloride prolonged-release tablet ( OXYCONTIN) and morphine hydrochloride tablet for pain titration treatment. The clinical pharmacist analyzed the reasons of delirium and drowsiness,and suggested a dose reduction of OXYCONTIN or converting OXYCONTIN to another opioid analgesic. Results The suggestion of the clinical pharmacist was partly accepted. After adjusting the treatment, the delirium and drowsiness disappeared gradually, and the pain was well controlled. Conclusion In clinical practice, especially when faced with a rare adverse drug reaction, clinical pharmacists are helpful for ensuring the safety and effectiveness in pain management, as well as improving the level of the treatment, by the implementation of individualized drug therapy.

Objective To study the setup errors in three-dimensional conformal radiotherapy (3DCRT) for thoracic esophageal carcinoma using electronic portal imaging device(EPID) and calculate the margins from CTV to PTV. Methods Forty-one patients with thoracic esophageal carcinoma who received 3DCRT were continuously enrolled into this study. The anterior and lateral electronic portal images (EPI) were aquired by EPID once a week. The setup errors were obtained through comparing the difference between EPI and digitally reconstructed radiographs(DRR). Then the setup margins from CTV to PTV were calculat-ed. By using self paired design,22 patients received definitive radiotherapy with different margins. Group A: the margins were 10 mm in all the three axes;Group B: the margins were aquired in this study. The differ-ence were compared by Paired t-test or Wilcoxon signed-rank test. Results The margins from CTV to PTV in x,y and z axes were 8.72 mm, 10.50 mm and 5.62 mm, respectively. Between the group A and group B, the difference of the maximum dose of the spinal cord was significant(4638.7 cGy±1449.6 cGy vs. 4310.2 cGy±1528.7 cGy; t=5.48, P=0.000), and the difference of NTCP for the spinal cord was also significant (4.82%±5.99% vs. 3.64%±4.70%;Z=-2.70,P=0.007). Conclusions For patients with tho-racic esophageal carcinoma who receive 3DCRT in author's department,the margins from CTV to PTV in x, y and z axes were 8.72 mm, 10.50 mm and 5.62 mm, respectively. The spinal cord could be better protected by using these setup margins than using 10 mm in each axis.

Objective To investigate the relationship of sperm morphology with seminal plasma zinc and sperm acrosin activity in male infertile patients.Methods 455 patients with male infertility were divided into 5 groups and 8 groups according to age and sperm morphology respectively.The sperm morphology,seminal plasma zinc and sperm acrosin activity were detected by the Diff-Quik stain,modified 5-Br-PAPS and modified Kennedy methods respectively.Results The percentages of morphologically normal sperm and seminal plasma zinc concentration in the infertile men groups were not different in various age groups(P >0.05 ).The sperm acrosin activity in the age group of 36-50 years was remarkably decreased (P <0.05),while which in other age groups had no statistical difference(P >0.05).Seminal plasma zinc concentration in the infertile men groups were not different in the 8 groups (P >0.05 ).Sperm acrosin activity was decreased with the percentage decrease of morphologically normal sperm (r =0.93,P <0.01).Conclusion The percentage of morphologically normal sperm is not affectd by the age and the seminal plasma zinc,which is positively correlated with the sperm acrosin activity.

OBJECTIVE To investigate the knowledge of Helicobacter pylori infection among outpatients,analyzing the data and providing useful information and measures for H.pylori infected and uninfected patients. METHODS Questionnaires about the knowledge of H.pylori were operated on 286 patients randomly selected from patients taking gastrointestinal endoscopy in October,2005. RESULTS Among 286 patients investigated,177 cases(61.9%) took the examination for diagnosis,while 157 cases(54.9%) had upper abdominal symptom more than 12 months.There were 60% patients investigated who knew only 2 items from total(7 items) about H.pylori in the questionnaires,while 46.7% patients wanted to obtain the knowledge of the disease and instructions on health care from medical professionals.In addition,it showed that there was no close relation between education level and knowledge of the disease. CONCLUSIONS Investigating the knowledge of special disease,which mastered by the patients,will help to identify patients blind to the disease they have,and patients who are in need of health-care instructions.

Objective To investigate the effect of statin on trabecular bone microstructure by using trabecular bone score (TBS), a new type of bone microstructure evaluation index. Methods A total of 253 middle and aged patients hospitalized in the First Affiliated Hospital of Nanjing Medical University between January 2014 and March 2016 were retrospectively analyzed. According to whether statin was used or not, patients were divided into two groups: 90 patients in the statin use group (statin was use for more than 1 year) and 163 in the control group (not taken any statin). Serum biochemical indicators, such as triacylglycerol, total cholesterol, high density lipoprotein cholesterol, low density lipoprotein cholesterol, alkaline phosphatase, fasting blood glucose and 25 hydroxy vitamin D, were compared between the two groups. Dual energy X-ray absorptiometry (DXA) was used to measure the bone mineral density (BMD) of lumbar spine and femoral neck. TBS was calculated with TBS iNsight? software, and the DXA image of lumbar spine were analyzed. Results Values of total cholesterol and low density lipoprotein cholesterol were significantly lower in statin group compared with those of control group (P<0.001), while no significant differences in other biochemical indicators between two groups (P>0.05). There was higher lumbar spine BMD statin group compared to that of control group (g/cm2:1.04 ± 0.19 vs. 0.96 ± 0.14, P<0.01). There was higher lumbar spine BMD and higher TBS (1.31±0.09 vs. 1.26±0.09, P<0.01) in statin group than that of control group. There was no difference in the femoral neck BMD between the two groups (P>0.05). Conclusion Statin increases lumbar spine BMD and improves trabecular bone microstructure in middle and aged people.

Objective:To verify the revised method of cerium sulfate catalytic spectrophotometry for iodide index of "Standard Examination Methods for Drinking Water-Nonmetal Parameters" (GB/T 5750.5-2006).Methods:From July to September 2019, the Laboratory of Department for Endemic Disease Prevention and Control of Qinghai Institute for Disease Prevention and Control verified the revised method (determination of iodide in drinking water by cerium sulfate catalytic spectrophotometry) of cerium sulfate catalytic spectrophotometry (hereinafter referred to as original method) in "Standard Examination Methods for Drinking Water-Nonmetal Parameters" (GB/T 5750.5-2006). The revised method was verified according to the requirements of "Standard Examination Methods for Drinking Water-Water Analysis Quality Control" (GB/T 5750.3-2006), including standard curve, detection limit, precision, accuracy and actual sample determination.Results:The linear range of the revised method was 0 - 20.0 μg/L, the correlation coefficient was - 0.999 4 - 0.999 8, and the detection limit was 0.231 μg/L. The relative standard deviation ( RSD) of low, medium and high iodine water samples of 6 times detection ranged from 1.4% to 9.6%, and the recoveries of low and medium water samples ranged from 89.0% to 108.0%. The detection results of national first-class reference materials for iodine composition analysis in water were within the range of standard value ± uncertainty. There was no significant difference in the test of results of 12 tap water samples between the revised method and the original standard method ( t = - 0.075, P > 0.05). Conclusion:The revised method has a good linear relationship of standard curve, high precision and accuracy, and good reproducibility, is simple and easy to operate, and is suitable for promotion and application.

Objective To understand the molecular epidemiology of norovirus from 5 outbreaks of gastroenteritis during Dec.2012 to Jan.2013 in Guangzhou.Methods Epidemiologic data and specimens were collected from 5 gastroenteritis outbreaks in Guangzhou.274 specimens were detected for norovirus by RT-PCR methods and PCR products were sequenced.Sequence alignment and phylogenetic analysis were performed by using Clustal X 1.83 and MEGA 5.05 programs.Statistical analysis was performed by using SPSS 17.0 program.Results The total positive rate of norovirus was 20.07％ (55/274).The positive rate was 8.70％ (2/23) in University A,36.36％ (8/22) in Kindergarten B,36.07％ (22/61) in University C,100％ (5/5) in community health service center D,11.04％ (18/163) in University E.The positive rate was 100％ (6/6) among age group ≥ 60 years old,47.37％ (9/19) among 10-19 age group and 36.36％ (8/22) among age group ＜ 10 years old.Phylogenetic analysis showed that 33 samples were infected by the new variant-Sydney 2012 of norovirus GⅡ.4.Conclusion Norovirus was one of the main pathogens causing acute gastroenteritis outbreaks and GⅡ.4 Sydney 2012 variant was identified as the predominant strain in Guangzhou.

Objective: To evaluate the effect of tumor shape and location on pulmonary dose-volume parameters by intensity-modulated radiation therapy (IMRT) in patients with non-small cell lung cancer (NSCLC), aiming to provide a reference basis for establishing limits of the pulmonary dose-volume parameters during IMRT. Methods: Clinical data of 208 NSCLC patients undergoing radical IMRT from June 2009 to June 2016 were retrospectively analyzed. According to the tumor shape and location, 208 cases were divided into the vertical bar group (n=127) and the horizontal bar group (n=81), the superior lung group (n=103) and the inferior lung group (n=105). Regression model curve was used to evaluate the effect of tumor shape and location upon the common pulmonary dose-volume parameters(V₅, V₂₀, MLD, AVS₅ and AVS₂₀). Results: In all groups, the fitting curves of V₅, V₂₀ and MLD were manifested in the quadratic equation pattern, and AVS₅ and AVS₂₀ in the logarithmic equation manner. In the vertical bar group, the V₅(P=0.015), V₂₀(P=0.047) and MLD (P=0.012) were significantly higher, whereas the AVS₅(P=0.044) was significantly lower compared with those in the horizontal bar group. No statistical significance was observed in AVS₂₀ between two groups (P=0.490). The tumor location exerted significant effect upon V₅ alone (P=0.009). Conclusions When the tumors presents in the vertical bar shape, the limits of the common lung dose-volume parameters are likely to exceed those of tumors in the vertical bar shape. Lung tumors located in the inferior lobe exerts a more significant effect upon the low-dose region volume compared with the tumors in the superior lobe.

To understand the pathogenicity,virulence genes,drug resistance genes,and drug resistance of Staphylococcus aureus isolated from yaks in some areas of Lhasa and Nagqu City,55 yak nasal swab samples were analyzed for S.aureus in this study.The cocci were isolated and identified,and the carriage of virulence genes and drug resistance genes,as well as the pathogenicity and drug sensitivity of the isolated S.aureus strains,were detected with PCR,artificially infected mice,and the K-B drug susceptibility disk method.Seven strains of S.aureus were isolated from the 55 yak nasal swab samples,with an iso-lation rate of 12.73％.The isolated strains were all pathogenic to mice,with a fatality rate exceeding 60％.These seven strains of S.aureus carried three drug resistance genes(tetM,tet,and mecA)and six virulence genes(seb,sec,clfA,hla,hlb,and nuc).The detection rate of the three drug resistance genes was 100％,whereas the detection rate of the six virulence genes in the isolates ranged from 83.33％to 100％.The resistance rates of the isolated strains to penicillin,ampicillin,and cotrimox-azole reached 85.71％-100％,whereas the resistance rates to tetracycline and ceftazidime were both 28.57％.Thus,yaks in Lhasa and Nagqu cities were found to be infected by S.aureus strains carrying various drug-resistance genes and virulence genes.These strains were highly pathogenic and showed sensi-tivity to most antibacterial drugs.These findings may serve as a reference for treating S.aureus infection in yaks in the cities of Lhasa and Nagqu.

OBJECTIVE：To establish the quality standard of the Tibetan medicine Ma lus Fructus （known as the fruit of Ese ）， and to provide scientific reference for quality control and utilization of resource. METHODS ：The qualitative analysis of 20 batches of Malus Fructus with different producing areas and different origins was carried out by morphological observation ，microscopic and TLC identification. According to the method stated in 2015 edition of Chinese Pharmacopoeia ，water content ，total ash content and extract content were determined. HPLC method was used to determine the contents of 6 kinds of flavones （chlorogenic acid ， hyperin，isoquercitrin，quercitin，phloridzin，quercetin）in Malus Fructus. RESULTS ：The properties of this medicinal material were obovate ，spheroidal or oval ，its surface was reddish brown to dark red ，with slight shrinkage. Its taste was sweet ，sour and slightly astringent. The microscopic characteristics of the powder were clear ，the stone cells were scattered individually or clustered，and the pulp parenchyma cells contained calcium oxalate cube crystal and cluster crystal. The results of TLC showed that there were fluorescent spots of the same color in the chromatogram of the tested product and the corresponding position of the reference substance （ursolic acid ）. The content ranges of moisture ，total ash and extracts were 9.02％-11.39％，2.29％-3.35％， 37.12％-58.41％ respectively. The linear ranges of chlorogenic acid ，hyperin，isoquercitrin，，quercetin phlorizin and quercetin were 3.12-50，1.25-20，1.25-20，3.12-50，18.7-300，0.5-8 μg/mL（all r were not less than 0.999 7）. RSDs of prescision ，stability and reproducibility tests were all lower than 3.0％（n＝6）. The average recoveries were 97.56％，98.28％，106.14％，103.74％， 98.37％，98.76％；RSDs were 1.57％，1.62％，1.38％，1.99％，2.15％，2.31％（n＝6）. The content ranges of the above six components in 20 baches of samples were 0.001 5％-0.028 8％，0.005 9％-0.022 0％，0.008 7％-0.030 4％，0.019 4％- 0.048 5％，0.068 5％-0.199 8％ and 0.005 1％-0.081 4％. CONCLUSIONS ：Established method is accurate and stable ，and can be used for quality control of Malus Fructus. It is preliminarily Δ 基金项目：四川省科技计划项目（No.2020YFS0495）；“杏林学 proposed that moisture and total ash content should not exceed 者”学科人才科研提升计划（No.CXTD2018016） 12％ and 3.5％，and extract （by dry product ）and phlorizin ＊硕士研究生 。研究方向 ：中药品种 、质量与资源 。E-mail： content should not be less than 40％ and 0.1％ respectively. 1159020313@qq.com # 通信作者：教授。研究方向：中药品种、质量与资源。E-mail：