OBJECTIVE:To explore the role of clinical pharmacists in the treatment of critical patients at perinatal stage. METHODS:During the treatment process of 4 critical patients at perinatal stage,according to the patients'special pathophysiolog-ic status (such as urea cycle disorder,dyslipidemia,severe infection,can not recover circulating blood volume rapidly,etc.), weighing the order of priority,based on relevant guidelines and literatures,clinical pharmacists provided individual medication ad-vices in respects of drug selection,medication timing,treatment course,drug combination and dosage adjustment,such as using cefuroxime,reduced glutathione,ursodesoxycholic acid,etc.,stopping drugs timely or adjusting antibiotics therapy plan. They al-so provided pharmaceutical care as lab index determination and ADR monitoring. RESULTS:Physicians adopted clinical pharma-cists'advices,and then 4 critical patients were all recovered. CONCLUSIONS:During the treatment course of critical patients at perinatal stage,clinical pharmacists should select safe and effective drugs as much as possible and adjust therapy plan in time ac-cording to clinical symptoms. When the security runs counter to effectiveness,clinical pharmacists should fully weigh the advantag-es and disadvantages and guarantee the maximum safety of pregnant or delivery women and fetuses.

Objective To observe the effect of interventional thrombolytic therapy for central retinal artery occlusion (CRAO) with ipsilateral internal carotid artery occlusion via supratrochlear artery retrogradely or external carotid artery anterogradely.Methods Nine CRAO patients (9 eyes) were enrolled in this study,including 5 males and 4 females.The mean age was (45.2 ± 18.1) years.The mean onset duration was 24 hours.There were 4 eyes with vision of no light perception,3 eyes with light perception and 2 eyes with hand movement.Fundus fluorescein angiography (FFA) examination showed that the retinal artery was filled with delayed fluorescence.The peak of fluorescence was seen in the anterior part of the artery,and some of the eyes showed retrograde filling.The arm-retinal circulation time (A-Rct) was ≥35 s in 4 eyes,≥35 s-＜25 s in 5 eyes.The filling time of retinal artery and its branches (FT) was ≥ 15 s in 2 eyes,≥ 12 s-＜15 s in 3 eyes,≥9 s-＜ 12 s in 4 eyes.All the patients received the treatment of interventional thrombolytic therapy via supratrochlear artery retrogradely (8 eyes) or external carotid artery anterogradely (1 eye) according to the indications and contraindications of thrombolytic therapy in acute cerebral infraction patients.Urokinase (0.4 million U in total) was intermittently injected into the arteries.After artery thrombolysis,the changes of digital subtraction angiography (DSA),filling time of retinal artery and its branches on FFA within 24 hours and the visual acuity were observed.According to the A-Rct and FT on FFA,the therapeutic effects on retinal circulation were defined as effective markedly (A-Rct≤ 15 s,FT ≤2 s),effective (A-Rct was improved but in the range of 16-20 s,FT was in 3-8 s) and no effect (A-Rct was improved but ≥21 s,FT≥9 s).The related local or systemic complications were recorded.Results After the injection ofurokinase into the catheter,the ophthalmic artery and its branches were increased in 6 eyes (66.7％),and the development of the eye ring was significantly more than that of the eyes before thrombolysis.The circulation time in ophthalmic artery was speeded up for 2 s before thrombolysis in 3 eyes,3 s in 3 eyes,and 4 s in 2 eyes.Within 24 hours after thrombolysis treatment,the A-Rct was significantly decreased than that of before interventional therapy.The retinal circulation was effective markedly in 4 eyes (44.4％),effective in 4 eyes (44.4％) and no effect in 1 eyes (11.2％).The vision was improved 3 lines in 4 eyes (44.4％),2 lines in 3 eyes (33.3％),1 line in 1 eye (11.2％) and no change in 1 eye (11.2％).There were no abnormal eye movements,vitreous hemorrhage and incision hematoma,intracranial hemorrhage,cerebral embolism,and other local and systemic adverse effeetives during the follow-up.Conclusions The interventional thrombolytic therapy via supratrochlear artery retrogradely or external carotid artery anterogradely for CRAO with the ipsilateral internal carotid artery occlusion can improve retinal circulation and vision.There are no related local or systemic complications.

ABSTRACT Objective: To investigate the expression and mechanism of microRNA (miRNA)-613 in breast cancer. Methods: A total of 91 specimens of breast cancer tissue were collected from Nanchong Central Hospital between May 2017 and May 2018. Quantitative real-time PCR (qRT-PCR) was used to estimate miRNA-613 expression levels in breast cancer and adjacent tissues and breast cancer ( cells MDA-MB-231, MDA-MB-468, and MCF-7) and normal breast epithelial (HBL-100) cell lines. Based on these data, the relationship between miRNA-613 expression and clinicopathological characteristics and prognosis in breast cancer patients were analyzed using the cancer genome atlas (TCGA) database. A dual-luciferase reporter assay was used to detect the binding of miRNA-613 to the 3'UTR of SOX9. Effects on cell proliferation and cell invasion and migration upon transfection of MDA-MB-231 cells with miRNA-613 mimics were detected by the CCK-8 assay and Transwell invasion and migration assays, respectively. In addition, Western blot was used to estimate the expression levels of SOX9, β-catenin, E-cadherin, and Vimentin in the transfected cells. Results: The expression of miRNA-613 in breast cancer tissues was significantly lower than that in adjacent tissues (P<0.05) and was found to be closely related to TNM stage and lymph node metastasis (P<0.05). TCGA survival data showed that miRNA-613 expression was not related to the overall survival rate of breast cancer patients (P>0.05 ). The expression of miRNA-613 in breast cancer cell lines was significantly lower than that in the normal breast epithelial cell line (P<0.05). Similarly, the expression of miRNA-613 in highly invasive metastatic breast cancer cell lines (MDA-MB-231 and MDA-MB-468) was significantly lower than that in the metastatic breast cancer cell line MCF-7 with lower invasion ability (P<0.05). The dual-luciferase reporter assay showed that miRNA-613 could specifically bind to the 3'UTR of SOX9. Upregulation of miRNA-613 expression could inhibit the proliferation, invasion, and migration of MDA-MB-231 cells (P<0.05). This was associated with the downregulated expression of SOX9, β-catenin, and Vimentin (P<0.05) and upregulation of E-Cadherin expression (P<0.05). Conclusions: The expression of miRNA-613 was decreased in breast cancer tissues and cell lines. MiRNA-613 may inhibit the proliferation, invasion, and metastasis of breast cancer cells and epithelial-mesenchymal transition by regulating the SOX9 and Wnt/β-catenin signaling pathways.

Objective To investigate the mechanism of Qinggan-Huoxue recipe in the treatment of alcoholic liver disease by observing its function on alcoholic liver disease rat fibroblast growth factor -21 (FGF21). Methods The rats were randomly divided into the blank group (n=10), the carbon tetrachloride group (n=10), the model group (n=11), the Qinggan-Huoxue recipe group (n=10), the Qinggan recipe group (n=9) and the Huoxue recipe group (n=10). Except for the blank group and the carbon tetrachloride group, the other rats were given 10 ml/kg alcohol, corn oil and pyrazole mixture (4.5 ml: 2 ml: 25 mg), once a day, 0.3 ml/kg carbon tetrachloride olive oil solution (carbon tetrachloride: olive oil =1: 3) intraperitoneally, and twice a week for 12 weeks to prepare the alcoholic liver disease model. In the ninth week, the Qinggan-Huoxue recipe group was treated with 4.75 g/kg of Qinggan-Huoxue recipe, the Qinggan recipe group was treated with 1.5 g/kg of Qinggan recipe, and the Huoxue recipe group was treated with 3.25 g/kg of Huoxue recipe, once a day, and 28 d for continuous administration. The pathological changes of liver tissue were observed by HE staining and Masson staining. The serum levels of AST and ALT were detected in rats. The changes of FGF21 protein and mRNA expression were detected by immunohistochemistry, Western blotting and fluorescence quantitative PCR. Results Compared with the model group, the liver weight and liver body ratio in the Qinggan recipe group, Qinggan-Huoxue recipe group and Huoxue recipe group were significantly lower (P<0.01). Compared with the model group, the serum ALT (41.95 ± 26.78 U/L, 46.63 ± 21.00 U/L, 37.57 ± 27.85 U/L vs. 138.34 ± 43.35 U/L), AST (102.74 ± 23.55 U/L, 111.50 ± 21.26 U/L, 83.72 ± 37.57 U/L vs. 257.41 ± 162.31 U/L) in the Qinggan recipe group, Qinggan-Huoxue recipe group and Huoxue recipe group significantly decreased (P<0.01 or P<0.05). Compared with the model group, the expression of FGF21 protein (1.19 ± 0.07, 1.24 ± 0.12 vs. 0.92 ± 0.04) in Qinggan recipe group and Qinggan-Huoxue recipe group significantly increased (P<0.05), and the expression of FGF21 mRNA (1.25 ± 0.08 vs. 0.95 ± 0.05) in Qinggan-Huoxue recipe group significantly increased (P<0.05). Conclusions FGF21 plays an important role in the alcoholic liver disease. During the process of liver injury, FGF21 increases continuously. Qinggan-Huoxue recipe can improve the content of FGF21 in the treatment of alcoholic liver disease.

Objective:To explore the application and practice of "flipped classroom" in the teaching of general surgery interns.Methods:A total of 20 internship groups (3 to 5 people in each group) were randomly selected from the general surgery practice group in the Department of General Surgery of the Second Clinical Medical College of North Sichuan Medical College. They were randomly divided into the flipped group (45 people) and the traditional group (40 people), with 10 subgroups in each group. The flipped group adopted the flipped classroom teaching mode (students' self-study by handing out materials before class, students and teachers' discussion in class, and students and teachers' evaluation after class), while the control group adopted the current conventional teaching mode (students' preview before class, teachers' explanation in class, and teachers' question answering after class). At the end of the teaching, a questionnaire was used to evaluate the participation and completion of each student. The teaching effect was evaluated by medical history collection and case analysis. The participation, completion, and teaching effect between the two groups were compared and analyzed. SPSS 23.0 software was used for t-test and Chi-square test. Results:The participation of the flipped group was better than that of the traditional group [(17.45±1.83) vs. (15.57±1.52)], and the difference was statistically significant ( P < 0.05). There was no statistically significant difference between the flipped group and the traditional group. There was no significant difference in medical history collection scores between the two groups. The case analysis of the flipped group was better than that of the traditional group [(87.30±6.06) vs. (81.50±5.88), P < 0.05]. The questionnaire shows that about 90% of the students think that flipped classroom can improve their interest in learning [96% (43/45)], improve their autonomous learning ability [89% (40/45)], and have better learning effect. At the same time, 78% (35/45) of students think that learning time is too long. Conclusion:The flipped classroom teaching model can improve the teaching participation of general surgery students, improve students' interest in learning, improve their self-learning ability, and improve students' thinking ability of medical record analysis.