OBJECTIVE:To explore the intervention effects by clinical pharmacist on the use of antibacterials during periopera-tive period of hysteroscopic surgery. METHODS:250 medical records of hysteroscopic surgery were collected from July to Septem-ber in 2014(before intervention)and from October to December in 2014(after intervention). The rationality of antibacterials dur-ing perioperative period was retrospectively analyzed before and after intervention. RESULTS:After intervention by clinical pharma-cists,the antibacterial use density decreased from 47.02 DDDs/(100 persons·day)to 23.30 DDDs/(100 persons·day),and the rate of perioperative use of antibacterial decreased from 82.40% to 57.20%,with significant difference(P<0.01). The rationality of medication indicators for perioperative application of antibacterials for hysteroscope increased from 56.80%to 82.52%;the rational-ity of medication duration increased from 49.51% to 79.02%,with significant difference(P<0.05). CONCLUSIONS:Clinical pharmacist's intervention is effective and feasible to perioperative application of antibacterials for hysteroscopic surgery. It could ef-fectively promote the rational use of antibacterials.

OBJECTIVE:To provide reference for the clinical rational application and preventing the adverse reactions of hy-droxyethyl starch(HES). METHODS:The HES application of inpatients in a hospital in Jul. 2014 were retrospectively analyzed, the usage and dosage,indications,and the changes of renal functions and blood coagulation function before and after HES treat-ment were detected,and the application rationality was evaluated. RESULTS:The usage of HES in the hospital was hydroxyethyl starch 200/0.5 and Sodium chloride injection,which was the second generation of HES. In the 347 patients,295 patients had moni-tored the renal functions before the HES treatment,the result was normal;and 21 patients had monitored the renal functions after HES treatment,the result was normal. Meanwhile,326 patients had monitored the blood coagulation functions before and after HES treatment,the results were normal. HES was not used for the patient of severe sepsis,renal dysfunctions and coagulopathy in this hospital. CONCLUSIONS:The application of HES can induce renal damage and coagulation disorder,so relevant indicators should be closely monitored before and after treatment to prevent the incidence of adverse reactions;further more,clinicians should strictly handle indications,usage and dosage and precautions during the clinical application;in addition,it is suggested to replace the second generation of HES by the third generation,which is more safer.

Objective To assess the memory function of hyperthyroid patients at different disease durations and investigate the value of cerebral blood flow (CBF) imaging in the detection of memory dysfunction in related regions.Methods Thirty-seven hyperthyroid patients (10 males,27 females; mean age (39.27± 10.58) years) and 28 healthy volunteers (8 males,20 females; mean age (35.80±9.41) years) were enrolled into this prospective study.The patients were divided into two subgroups: short duration group (duration ≤ 6 months; n =15),long duration group (duration ＞6 months ; n =22).Wechsler memory scale was used for memory assessment,and cancellation test was used for attention assessment.Self-rating depressions scale (SDS) and self-rating anxiety scale (SAS) were used for mood disorder assessment.99Tcm-ECD SPECT CBF imaging was performed at rest for all patients and controls on the same day.SPM 2.0 was used to investigate the differences of rCBF between the two groups.Two independent samples t test was used for the comparisons of memory and attention scores between patients and controls,also between patients with short and long disease durations.Multiple stepwise regression was used for factor analysis of memory state.Results Scale total score (92.27±17.50 vs 101.75±11.70; t=-2.476)and memory quotient (91.32±17.76 vs 100.29±9.43 ; t =-2.421) were significant different between patients and controls (both P＜0.05).The scale total score and memory quotient in patients with long disease duration were significant lower than those of controls(88.77±16.69 vs 101.75±11.70,t=-3.231; 86.18±16.73 vs 100.29±9.43,t=3.770,both P＜0.05).The memory quotient was significant lower in patients with long disease duration than those with short disease duration(86.10± 17.13 vs 98.87± 17.00; t =2.212,P＜0.05).There was no significant difference in memory quotient and scale total score between short duration group and controls (t=-0.754,0.910,both P＞0.05).CBF was reduced in the limbic system of hyperthyroid patients and the involved area was larger in patients with long disease duration.Age,attention score,serum FT4 level and reduced CBF in left pulvina nuclei,left lateral geniculate body and right amygdale were the statistically significant factors for impaired memory function in hyperthyroid patients (b=-0.393-0.685,all P＜0.05).Conclusions Memory impairment could be significant in hyperthyroid patients with long disease duration.CBF imaging could reflect the degree of dysfunction at specific brain regions responsible for memory impairment in these patients.

Objective To elucidate the interaction between osteoblast of bone marrow microenvironment and leukemia cells,and to investigate the role of osteoblast in the leukemia cells survival and apoptosis and the influence of leukemia cells on the osteoblast.Methods Leukemia cells from AML1-ETO9a-Rac1 mouse leukemia model and osteoblast cells were used.The ratio of GFP+ leukemia cells that co-cultured with or without osteoblast was detected by FACS.In addition,the apoptosis level of leukemia cells was detected by flow cytometry by PI and Annexin Ⅴ labeling.Activation level of PARP was determined by Western-blot.Real-time PCR (RT-PCR) was utilized to detect the mRNA level of TPO,N-cadherin,OPN and Ang1 in osteoblast which was separated from leukemic mice.Results The ratio of GFP+ cells in AE9a-Rac1 leukemia cells co-cultured with osteoblast cell was significantly higher than that of AE9a-Rac1 leukemia cells cultured alone.The apoptotic level of AE9a-Rac 1 leukemia cells cultured alone was significant higher than that of AE9a-Rac 1 leukemia cells in co-culture system.Western blot showed that activated level of PARP in AE9a-Rac1 leukemia cells co-cultured with osteoblast was lower than that cultured alone.RT-PCR result showed that TPO and N-cadherin mRNA levels in primary osteoblast separated from leukemic mice were higher than that from normal mice.Ang1 and OPN mRNA levels of osteoblast from leukemia mice were lower.Conclusion Osteoblast cell can support the survival and inhibit the apoptosis of leukemia cells.Leukemia cells can influence the functions of osteoblast by microenvironment associated cytokines production.

AIM: To observe the expression of fractalkine, and its receptor, CX3CR1, in renal tissues of patients with diffuse proliferative lupus glomerulonephritis (WHO class IV), minimal glomerular abnormalities, and normal kidney. Meanwhile, the correlation among the expression of fractalkine, CX3CR1 and CD68-positive macrophages was investigated, and the role of fractalkine and CX3CR1 in the pathogenesis of lupus nephritis was discussed. METHODS: The expressions of fractalkine, CX3CR1 and CD68 were detected immunohistochemically in kidney tissue sections obtained from twenty-one patients with WHO class IV lupus nephritis, eighteen cases with minimal glomerular abnormalities, and eight normal kidneys which were no abnormality under light microscope. RESULTS: (1) Fractalkine was generally indistinguishable in tissue sections from normal kidney and minimal glomerular abnormalities. CX3CR1-positive cells and CD68-positive macrophages were sparsely detected in the glomeruli and in the cortical interstitium. (2) There were considerable CX3CR1-positive cells and macrophages in both the glomeruli and the interstitium in sections from class IV lupus nephritis. The number of CX3CR1-positive cells significantly correlated with the number of macrophages in the glomeruli and in the interstitium respectively (r=0.956, P

Objective To investigate the effect of anti-syphilis treatment on the perinatal outcomes and neonatal prognosis in pregnant women complicated with syphilis.Methods One hundred and ninety eight pregnant women complicated with syphilis were collected from Chengdu Hospital of Infectious Diseases during January 2010 and January 2012,including 98 cases received standard treatment,59 cases received nonstandard treatment and 41 cases did not receive treatment.Pearson x2 and partition of chi-square were used for the comparison of pregnant outcomes,neonatal prognosis and negative rates of rapid plasma circle card test (RPR) among 3 groups.Results The incidence of adverse pregnancy outcomes,including miscarriage,prematurity,still birth and congenital malformation were 4.08％,27.12％ and 63.41％ in three groups,respectively.The incidence of congenital syphilis,low birth weight,asphyxia in infants and neonatal death raised in from standard-treatment group,nonstandard-treatment group to untreated group.Congenital syphilis rates were 2.04％,18.75％ and 35.29％ in three groups,respectively.RPR titers in newborns from mothers with high RPR titer (≥ 1 ∶ 8) in standard-treatment group were significantly lower than those in nonstandard-treatment group and untreated group (x2 =37.122,P ＜ 0.01).RPR negative rates were 100.00％,59.26％ and 25.00％ in three groups,respectively (x2 =18.839,P ＜ 0.01).Conclusion Standard anti-syphilis treatment can improve pregnant outcome,neonatal prognosis and reduce the incidence of congenital syphilis.

OBJECTIVE:To evaluate the effects of PDCA cycle management on standardizing rational use of ribavirin in children,and to investigate the effectiveness and safety of ribavirin in children. METHODS:By adopting 4 times of PDCA cycle, clinical pharmacists conducted continuous intervention to ribavirin use in pediatric department;authoritative guideline and evidence-based evidence were reviewed;List of Antiviral Therapy Plans in Qutpatient Department of Prediatrics was formulated in our hospital,which provided antiviral therapy plan of common pediatric infectious disease. By compared the rationality of ribavirin prescription in the pre and post PDCA cycle management(intervention group and non-intervention group)to evaluate the effects of standard management. RESULTS & CONCLUSIONS:After 4 times of PDCA cycle,the consumption amount of ribavirin both reduced significantly. The proportion of ribavirin prescriptions decreased from 3.10％ to 0.80％(P<0.01);the proportion of suitable medication indication prescriptions increased from 56.14％ to 90.30％(P<0.01);diagnosed disease types of commonly prescribed ribavirin prescriptions decreased from 26 to 5;the proportion of suitable administration route prescriptions increased from 73.43％ to 93.75％. The proportion of ribavirin combined with antibiotics prescriptions decreased from 59.74％ to 12.91％(P<0.01). PDCA is an effective and feasible method for pediatric medication management by clinical pharmascits. Ribavirin is not recommended as routine antiviral drug for children due to its unclear clinical benefit and distinct toxicity.

Objective To analyze the clinical features and prognosis of radiotherapy associated sarcoma (RAS) in the head and neck following radiotherapy for nasopharyngeal carcinoma (NPC).Methods The clinicopathologic data,diagnosis,treatment and follow-up results of 11 patients with RAS diagnosed between January 1995 and December 2011 at Zhejiang Cancer Hospital were analyzed retrospectively.Among these patients,6 were males and 5 were females.Patients' ages ranged from 33 to 66 years (median 50 years).The latency period for development of the RAS was between 3 years and 23 years (median 7 years) after irradiation.Overall survival rate was calculated using the Kaplan-Meier method and Log rank test.Results All cases underwent surgery,of them 6 casesachieved radical resection3 cases left with microscopic positive resection margins and 2 caseshad palliative surgery.Among 11 patients,4 had resurgery after recurrence,including 1 case had repeated surgeries followed by chemotherapy and radioactive seed implantation.Follow-up time ranged from 2 to 102 months,andeight patients died The 2-year,3-year and 5-year cumulative survival rateswere 45.5％,30.3％ and 15.2％,respectively.The median survival time was 15 months.Surgical resection with clear margins achieved significantly better prognosis (P =0.04).Conclusions The incidence of RAS after radiation of NPC is generally low,but the treatment of RAS is very difficult,with poor prognosis.

Objective To explore the clinical significance of integrated screening of RET in a Chinese multiple endocrine neoplasia type 2A(MEN 2A)family and to evaluate the feasibility and effectiveness of prophy-lactic total thyroidectomy to MEN 2A-related medullary thyroid carcinoma ( MTC).Methods Medical history was obtained from 10 family members in a 3-generation south China family .Systemic investigations including bio-chemical tests, imaging examinations and germline RET screening were performed .3 asymptomatic mutation car-riers underwent prophylactic total thyroidectomy .Results RET screening showed a heterozygous missense muta-tion of TGC to CGC at codon 634 on exon 11 in 6 members(p.C634R), which was completely consistent with the clinical manifestations.There were 4 males and 2 females.The initial mean diagnostic age of 33.5 years(ranging from 19 years to 65 years) and the mean maximum diameter of MTC was 2.3 cm(ranging from 0.7 cm to 5.2 cm). Among them 3 members had palpable neck masses (1 case with diarrhea).Right total thyroidectomy +right level Ⅵlymph-node dissection with modified right neck dissection in one case , and bilateral total thyroidectomy +bilat-eral level Ⅵlymph-node dissection in 2 were performed .In other 3 asymptomatic mutation carriers , prophylactic total thyroidectomy +bilateral level Ⅵ lymph-node dissection were also performed .Among them, 1 case of a-symptomatic pheochromocytom ( PHEO) underwent cortical-sparing adrenalectomy before MTC .After the first op-eration, 4 patients still presented a high value of calcitonin , among whom 1 patient( T3N 1bM 0-1) underwent re-operation for 3 times after the initial operation and presented metastasis to bone after 130 months, taking vandet-anib orally up to now;2 patients underwent reoperation at 6 and 7 months after initial operation respectively (T1N 1bM0 and T2N 1bM0), and the other one patient was closely monitored and followed up for 22 months(T2N 1b M0).Moreover, The calcitonin levels dropped to normal in the other 2 asymptomatic cases(T1N0M0) who were followed up for 20 months.Conclusions Pedigree screening can work up an early diagnosis and improve the prognosis of MEN 2A.Integrated screening of RET and pre-operative calcitonin level measurement and prophylac-tic thyroidectomy for asymptomatic RET mutation carriers are reasonable and effective .