This paper summarizes the main achievements and the existing problems of clinical pharmacy in China since establishing the discipline. The cause which accounts for the occurrence of these problems is briefly analysed. On the basis, we suggest the way to develope clinical pharmacy in the future. The following three topics are discussed in detail:establishing related rules and regulations, trainning qualified personnel, and encouraging pharmaceutists to contact clinical work.

OBJECTIVE: To provide reference for the further implementation of national essential drug system in China. METHODS: The establishment of national essential drug system in China was reviewed to find out the problem in the implementation process. Related solutions were proposed. RESULTS & CONCLUSION: The implementation of essential drugs in China demand clarifying the legal status of essential drugs, strengthening popularity of essential drugs, improving awareness of medical staff and the public about essential drugs. Moreover, patients can be benefited in the medical institutions where essential drug system has been carried out to improving the dependence of the public to essential medicines.

Ten cases of gastrointestinal adenocarcinomas were histochemically investigated for their lectin receptors by avidin-biotin-peroxidase complex (ABC) method. Results showed that gastric adenocarcinomas expressed more types of lectin receptors than large bowel adenocarcinomas. Positive rates of G1c/Man-and GlcNAc-specific lectin receptors in those tumors were higher than those of Gal/GalNAc- and Fuc-specific lectin receptoes. From the stomach to rectum, the spectrum of the lectin receptors in pericarcinomatous tissues gradually changed from the gastric type to rectal type. The expression of lectin receptors in gastrointestinal adenocarcinomas was obviously different from that in their corresponding pericarcinomatous tissues. The increase and decrease of lectin receptor expression, the appearance and disappearance of some types of lectin receptors as well as the change of the receptor distribution are indirectly regulated by cellular genome.

Glycophorin A(GPA)of human erythrocyte membrane is closely related with the invasion of erythrocytes by Plasmodium falciparum. Under the condition of the in vitro culture, the effects of GPA, anti-GPA-IgG, ?1-acid glycoprotein, wheat germ agglutinin, etc. on the invasion of erythrocytes by Plasmodium falciparum were observed in the research. The results showed that the combination of GPA with Plasmodium falciparum merozoites has high specificity, high affinity and a tendency to saturation, and produces specific biological effects. These confirm for the first time from the characteristics of the ligand-receptor interaction that GPA is a recptor recognized and bound by Plasmodium falciparum merozoites.

Wheat germ agglutinin(WGA)with a higher activity of hemagglutination was purified from wheat germ by a modified method of ovomucoid-Sepharose 4B affinity chromatography.The average yield of purified WGA from 100g wheat germ acetone powder was 58.74?6.56mg. WGA showed a single band on sodium dodecyl sulfate-polyacrylamide gel electrophoresis with an apparent molecular weight of 34400.The specific haptens of WGA- were N-acetylglucosamine and sialic acid.

The high affinity interaction of avidin-biotin in immunoenzyrnatic techniques has provided a simple and sensitive method to localize antigens in formalin-fixed and paraffin-embedded tissues.The distribution of lectin receptors in primary hepatocellular carcinoma, int-ahepatic cholangiccarcinorria an.i cavernous hemangi-oma was studied for the first time by avidin-biotin-peroxidase complex (ABC) method.The results show that the method was simple, highly sensitive, and had gcod reproducibility and specificity as well as higher value of practical use.

Receptors of wheat germ agglutinin (WGA) in liver tumors, such as hepatocellular carcinoma (HCC), intrahepatic cholangiocellular carcinoma(ICC) and so on, were histologically localized by avidin-biotin-peroxidase complex (ABC) method. Normal, cirrhostic and pericarcinomatous liver tissues were used as controls. The result showed that WGA receptors in HCC were irregularly distributed, which was significantly different to the band-like distribution of WGA receptors in the controls and to the distribution in ICC. After the treatment with neuraminidase, the distributions of WGA receptors changed apparently. It is suggested that the characteristics of WGA receptor distributions in cells could be helpful to the diagnosis and differential diagnosis of liver tumors.

目的观察多功能微晶疤痕治疗仪配合曲安缩松局部注射治疗瘢痕疙瘩的疗效。方法 80例瘢痕疙瘩患者随机分为多功能微晶疤痕治疗仪配合曲安缩松瘢痕组织内注射组与单纯曲安缩松注射组各40例,比较两组的疗效。结果多功能微晶疤痕治疗仪配合曲安缩松局部注射的疗效明显优于单纯曲安缩松注射(P<0.01)。结论多功能微晶疤痕治疗仪负压探头能软化瘢痕,利于曲安缩松药物充盈,从而使其更好地发挥抑制成纤维细胞增生的作用。

Objective To investigate the clinical value of serum endocan and procalcitonin (PCT) in early diagnosis and prognosis evaluation of sepsis.Methods The patients with systemic inflammatory response syndrome (SIRS,n = 26) and sepsis (n = 78) admitted to intensive care unit (ICU) of the Third Hospital of Hebei Medical University from December 2014 to December 2016 were enrolled. According to the severity of disease, the sepsis patients were divided into general sepsis group (n = 20), severe sepsis group (n = 24), and septic shock group (n = 34). The cases were divided into survival group (n = 55) and non-survival group (n = 23) according to 28-day mortality. The serum endocan, PCT, acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ) score, and sequential organ failure assessment (SOFA) score were recorded when the patients were admitted into ICU. The differences in endocan, PCT, APACHE Ⅱ, SOFA score between SIRS and sepsis groups and within sepsis subgroups were compared. Spearman correlation analysis was used to analyze the correlation between the indexes of sepsis patients. Receiver operation characteristic curve (ROC) was used to evaluate the value of endocan and PCT for the diagnosis and prognosis of sepsis.Results ① Serum endocan, PCT, APACHE Ⅱ, SOFA score and 28-day mortality in the sepsis group were significantly higher than those in the SIRS group [endocan (μg/L): 4.28 (10.64) vs. 1.03 (0.69), PCT (μg/L): 3.94 (10.75) vs. 0.43 (0.39), APACHE Ⅱ:18.81±9.17 vs. 9.35±3.78, SOFA: 9.00 (7.20) vs. 4.50 (1.50), 28-day mortality: 29.49% vs. 11.54%, allP < 0.01]. The area under the ROC curve (AUC) of endocan, PCT, APACHE Ⅱ, SOFA score for sepsis diagnosis were 0.887, 0.842, 0.822, 0.835, respectively. When the cut-off value of endocan was 1.26μg/L, the sepsis diagnostic sensitivity was 87.2% and specificity was 81.8%. When the cut-off value of PCT was 0.75μg/L, the sepsis diagnostic sensitivity was 85.9% and specificity was 81.8%. ② With the severity of the disease increased, the index showed an increasing trend in patients with sepsis. Serum endocan, PCT, APACHE Ⅱ, SOFA score and 28-day mortality in septic shock group were significantly higher than those in severe sepsis group or general sepsis group [endocan (μg/L): 13.02 (6.70) vs. 3.33 (3.05), 1.60 (0.98); PCT (μg/L): 8.10 (17.68) vs. 5.47 (8.92), 1.57 (2.78); APACHE Ⅱ: 25.00 (9.50) vs. 18.00 (9.00), 9.50 (5.75); SOFA: 13.00 (4.50) vs. 8.00 (3.00), 5.00 (3.50); 28-day mortality: 52.94% vs. 20.83%, 0%; allP < 0.01]. There was a significantly positive correlation between endocan, PCT, APACHE Ⅱ, SOFA, indicating that the endocan and PCT can be used to assess the severity of sepsis. ③ Serum endocan, PCT, APACHE Ⅱ and SOFA score in non-survival group were significantly higher than those in the survival group [endocan (μg/L): 15.05 (9.23) vs. 2.32 (4.81), PCT (μg/L):18.40 (16.99) vs. 3.10 (6.67), APACHE Ⅱ: 28.13±7.56 vs. 14.91±6.64, SOFA: 14.70±3.65 vs. 7.38±3.26, allP < 0.01]. The AUC of endocan, PCT, APACHE Ⅱ, SOFA score for the prediction of non-survival sepsis were 0.915, 0.763, 0.899, 0.930. When the cut-off value of endocan was 4.37μg/L, the septic death prediction sensitivity was 95.7% and specificity was 70.9%. When the cut-off value of PCT was 7.68μg/L, the septic death prediction sensitivity was 65.2% and specificity was 78.2%.Conclusions Serum endocan is more clinically valuable than PCT in early diagnosis and prognosis assessment of sepsis.

Objective To evaluate the effects of levosimendan on hemodynamics and cardiac function in patients with septic shock. Methods A prospective single-center randomized controlled trial was conducted. The patients with septic shock admitted to the Department of Critical Care Medicine of the Third Hospital of Hebei Medical University from June 2011 to October 2013 were enrolled. The patients with septic shock received the conventional treatment according to international guidelines for management of severe sepsis and septic shock. Thirty-six patients received the examination of echocardiography and left ventricular ejection fraction (LVEF)≤0.45 after fluid resuscitation were enrolled the study ,who were divided into two groups according to random number table ,with 18 cases in each group. After the conventional treatment,the patients in dobutamine group received intravenous injection of 5μg·kg-1·min-1 dobutamine for 48 hours immediately after fluid resuscitation,and those in levosimendan group received a 24-hour infusion of 5μg·kg-1·min-1 dobutamine followed by a 24-hour infusion of 0.2μg·kg-1·min-1 levosimendan. The hemodynamics and cardiac function were evaluated by pulse indicator continuous cardiac output (PiCCO) and ultrasound during treatment. Results Compared with dobutamine group,after the treatment in the levosimendan group,stroke volume index (SVI),cardiac index (CI)and left ventricular stroke work index(LVSWI) were significantly increased〔SVI(mL/m2):39.8±5.4 vs. 37.5±4.5,t=-2.762,P=0.020;CI(L·min-1·m-2):4.6± 0.7 vs. 3.6±0.7,t=-9.829,P=0.000;LVSWI (kg·min-1·m-2):33.7±2.4 vs. 28.2±1.2,t=-6.307,P=0.000〕, and central venous pressure (CVP),intrathoracic blood volume index (ITBVI)and extravascular lung water index (EVLWI)were significantly decreased〔CVP(mmHg,1 mmHg=0.133 kPa):8.2±0.9 vs. 12.1±0.8,t=3.928,P=0.002;ITBVI (mL/m2):820±42 vs. 978±69,t=9.472,P=0.000;EVLWI (mL/kg):6.1±1.6 vs. 8.9±1.7,t=4.467,P=0.001〕. Cardiac ultrasound showed that compared with dobutamine group,in the levosimendan group,left ventricular end-systolic volume (LVESI) and end-diastolic volume (LVEDI) were significantly lowered〔LVESI (mL/m2):32.7±9.2 vs. 48.2±13.4,t=0.882,P=0.000;LVEDI (mL/m2):61.7±11.4 vs. 78.6±13.6,t=2.453, P=0.032〕,and the LVEF was significantly increased (0.463 ±0.068 vs. 0.383 ±0.085,t=-2.439,P=0.035). Levosimendan also could decrease the lactic acid(mmol/L:3.4±1.1 vs. 5.2±1.2,t=3.346,P=0.007),and increase the lactate clearance rate(mL/min:73.2±13.5 vs. 47.6±11.8,t=-4.079,P=0.002),24-hour urinary output(mL:2 213.4±354.0 vs. 1 533.8±402.0,t=6.342,P=0.000)and 24-hour cumulative intake (mL:5 746.6±420.0 vs. 4 156.7 ±215.0,t=7.126,P=0.000). There were no significant differences in total volume of norepinephrine, mortality in intensive care unit (ICU)and 28-day mortality between two groups. Conclusion Levosimendan can increase cardiac ejection function,reduce the heart blood and vascular preload,intrathoracic lung water,improve heart function and systemic hemodynamic indexes of patients with septic shock.