OBJECTIVE:To refine the quality standard of pharmacy intravenous admixture service(PIVAS),and provide refer-ence for improving the work quality of PIVAS. METHODS:Through establishing quality management organization and developing quality standard rules,quality control system for PIVAS in our hospital was constructed and total quality management was conduct-ed. Numbers of quality problems before(Jul. 2013-Jun. 2014)and after(Jul. 2014-Jun. 2015)its implementation were compared, and the effects were evaluated. RESULTS:117 management systems and 14 link quality standards and rules were made,including staff behavior standards,quality standards for drug management,supervision and inspection of quality standards,etc. Numbers of quality problems dropped from 358 to 177 after the implementation,the ratio of dispensing errors accounted for the total dispensing declined from 0.35? to 0.17?(P<0.05). CONCLUSIONS:The construction of quality control system and the implementation of quality control standards and rules in PIVAS of our hospital has improved the quality of PIVAS work.

Objective To investigate the genotype and drug resistance of extended-spectrum beta-lac-tamases(ESBLs) -producing Shigella in pediatric patients.Methods A total of 59 strains of Shigella were isolated from stool specimens of hospitalized children with shigellosis in Beijing Children's Hospital from January 2004 to December 2008.Phenotypic confirmatory test,which is based on Clinical and Laboratory Standards Institute(CLSI),was used to detect the ESBLs-producing strains.Agar dilution method was used to determine the minimal inhibitory concentration (MIC).PCR amplification was performed for ESBLs producers to determine the genotype.PCR product was sequenced and then analyzed to confirm the subtype of ESBLs.Results Of the 59 isolates,21 (35.6%) strains were identified as ESBLs producers.The 21 strains of ESBLs-producing Shigella all carried the genes of CTX-M as shown by PCR,and CTX-M-1,CTX-M-9 accounted for 6,15,respectively.Among the 21 CTX-M producers,there were 4 strains accompanied by TEM-type and 6 strains accompanied by OXA-type.Nucleotide sequence analysis showed that there were CTX-M-3 (n = 1),CTX-M-15 (n = 2),CTX-M-57(n =3) of the 6 CTX-M-1-producing isolates.The subtypes of CTX-M-9,TEM,OXA were all CTX-M-14,TEM-1,OXA-1,respectively.The sensitive drugs to ESBLs producers were imipenem,meropenem,piperacillin/tazobactam,cefoperazone/sulbactam and cefoxitin,with resistance rate all less than 15%.The resistance to ceftazidime was remarkably variable among different CTX-M producers.Conclusion The prevalence of ESBLsproducing Shigella is in a high level in pediatric patients in this area.The genotypes of ESBLs are all CTX-M.Most of them are CTX-M-14,but some are CTX-M-3,CTX-M-15 and CTX-M-57.Most ESBLs-producing strains are multidrug resistant.Carbopenems should be the first choice for ESBLs producers.

OBJECTIVE:To provide reference for standardizing dispensing and use of intravenous drug. METHODS:266 piec-es of intravenous drug instructions were collected in PIVAS of our hospital,and then the labeling information were statistically ana-lyzed,including dispensing method,diluted or dissolved solvent before preparation and storage time after preparation. RESULTS:Among 266 intravenous drug instructions,there were 45 kinds of finished product infusion varieties and 221 kinds of drugs needing to be prepared. Among these,there were only 30 pieces of drug instructions with labeling dispensing method,accounting for 13.57%;195 pieces of drug instructions stated solvent for dilution and 22 stated solvent for dissolution before preparation,account-ing for 88.24% and 19.13%;69 pieces of drug instructions stated storage time,accounting for 31.22%. CONCLUSIONS:The la-bel information of dispensing method and storage time in intravenous drug instructions is markedly insufficient or not clear. Drug ad-ministration departments are suggested to strengthen the instruction standardization management. Meanwhile,manufacturers should specify the relevant information in intravenous drug instructions.

OBJECTIVE:To evaluate the economics of azithromycin vs. amocillin clavulante in the treatment of lower respirato-ry tract infections. METHODS:System evaluation was adopted to retrieve the randomized controlled trials(RCT)about azithromy-cin(test group)vs. amoxicillin clavulanate(control group)in the treatment of lower respiratory tract infections. Information was col-lected and Meta-analyses were performed. On this basis and short-term decision tree model,cost factors were added to conduct the pharmacoeconomics by the principle of PICO of Treeage Pro 2011 edition software. RESULTS:Totally 18 RCT were enrolled,in-volving 3 365 patients. Results of Meta-analysis showed that there were no significant differences in the effective rate [RR=0.93, 95%CI(0.55,1.55),P=0.77] and incidence of adverse reactions [RR=0.79,95%CI(0.62,1.0),P=0.05] between 2 groups. The av-erage treatment cost in test group and control group was respectively 790.4 yuan and 884.4 yuan,and cost-effectiveness ratio was respectively 216.0 and 245.7,and the incremental cost-effectiveness ratio(ICER)was -1 392.59. CONCLUSIONS:Azithromycin has similar efficacy and safety to amoxicillin clavulanate in the treatment of lower respiratory tract infection,however,azithromy-cin has better cost-effectiveness.

Objective To investigate clinical effects of early postoperative oral enteral nutrition on immune function for colorectal cancer patients,to provide a reference for clinical treatment.Methods We selected 90 colorec-tal cancer surgery patients from January 2012 to April 2015,and they were divided into two groups by random number method.50 cases in the study group were given early oral enteral nutrition,and 40 patients in the control group were given postoperative parenteral nutrition.Before and after treatment,the quality of life,complications,immunology indi-cators,nutrition indicators were compared in two groups.Results In the observation group,the postoperative fever, exhaust time,hospital stay,hospital costs,quality of life scores were (54.29 ±5.76)h,(57.89 ±5.95)h,(10.48 ± 1.63)d,(41 432.85 ±2 165.46)RMB,(79.23 ±5.17)points,which were significantly lower than those in the con-trol group,the differences were statistically significant (t =8.69,P =0.00;t =8.61,P =0.00;t =9.49,P =0.00;t =5.54,P =0.00;t =4.16,P =0.01);7d after the treatment,the IgA,IgG,IgM,CD +4 ,CD +4 /CD +8 in observation group were (1.92 ±0.49)g/L,(11.31 ±2.24)g/L,(0.99 ±0.21)g/L,(41.21 ±5.51)%,(1.72 ±0.32),which were better than those in the control group,the differences were statistically significant (t =2.05,P =0.04;t =2.11, P =0.04;t =2.12,P =0.04;t =3.64,P =0.01;t =2.23,P =0.03).In observation group,postoperative 7d Hb, TRF,ALB,PAB were (113.28 ±13.36)g/L,(3.02 ±0.39)mg/L,(38.97 ±3.15)g/L,(333.15 ±18.35)mg/L, which were better than those in the control group,the differences were statistically significant (t =3.45,P =0.01;t =2.18,P =0.03;t =2.32,P =0.04;t =3.21,P =0.01).7d after operation,the CRP level of observation group was(7.29 ±2.05)mg/L,which was significantly lower than that of the control group,the difference was statistically sig-nificant (t =4.22,P =0.01 ).The incidence rate of postoperative complications in the observation group was 26.00%,that of the control group was 40.00%,the difference was statistically significant (χ2 =4.52,P =0.01). Conclusion Early oral enteral nutrition in patients with colorectal cancer will help to improve immune function, nutritional support,reduce the inflammatory response,which will help postoperative recovery.

BACKGROUND:The majority of rheumatoid arthritis treatment is chronic anti-arthritis drugs, biological agents and plant drugs. Among them, plant drugs have been widely concerned due to low cost and few adverse effects. OBJECTIVE:To observe the expression of tumor necrosis factor-α(TNF-α) and interleukin-1β(IL-1β) in the
synovium of col agen-induced arthritis rats, and explore the effect of Aconitum leucostomum Worosch. on the expression.
METHODS:Forty-five rats were randomly divided into normal control group (8 rats) and model group (37 rats). The col agen-induced arthritis model was established with the injection of type II bovine col agen into the end of the tail and paws. After the success of modeling, the 24 successful model rats were randomly selected and divided into model group (8 rats), Tripterygium wolfprdi polyglycoside group (8 rats) and Aconitum leucostomum Worosch. group (8 rats). The arthritis index of the rats in the three intervention groups and one control group were evaluated weekly. After treated by intragastric administration for 4 weeks (Tripterygium wolfprdi polyglycoside group and Aconitum leucostomum Worosch. group were taken by the corresponding drug solution, model group and normal control group were taken by the same volume of physiological saline), the expressions of TNF-αand IL-1βin the synovium were tested by immunohistochemistry.
RESULTS AND CONCLUSION:Compared with the model group, the arthritis index of mice in Tripterygium wolfprdi polyglycoside group and Aconitum leucostomum Worosch. group was decreased significantly after treatment (P<0.05). The expression levels of TNF-αand IL-1βin the synovium of model group were significantly higher than those of the normal control group (P<0.05). After treatment with Aconitum leucostomum Worosch. and Tripterygium wolfprdi polyglycoside, the expression levels of TNF-αand IL-1βin the synovium was decreased compared with the model group (P<0.05). Experimental findings indicated that, the mechanism that Aconitum leucostomum Worosch. treats rheumatoid arthritis is related to the inhibition of TNF-αand IL-1β.

Objective To investigate the correlation between stroke volume variation (SVV) and blood volume during hypovolemia.Methods Twenty ASA Ⅰ or Ⅱ patients,aged 20-64 years,with body mass index (BMI) of 20-30 kg/m2,scheduled for elective orthopedic operation were enrolled in this study.Anesthesia was induced with dexamethasone,midazolam,propofol,fentanyl and cisatracurium,and maintained with sevoflurane,fentanyl and cisatracurium.Then the patients received endotracheal intubation and mechanical ventilation.Heart rate (HR),mean arterial blood pressure (MAP),central venous pressure (CVP),arterial pressure-based cardiac output (APCO),SW,systemic vascular resistance (SVR) and cardiac index (Cl) were recorded 5 minutes after endotracheal intubation.Blood was taken from the central vein at a rate of 30-50 ml/min and the volume was 5％ of the whole blood volume,and then haemodynamic parameters mentioned above were recorded after the haemodynamics were kept stable for 5 minutes.Blood was taken again with the method mentioned above and the haemodynamic parameters were recorded.Then 6％ hydroxyethyl starch (HES) 130/0.4 was infused at 50-70 ml/min via the right internal jugular vein,and the volume was equal to 5％ of the whole blood volume,and then haemodynamic parameters were recorded after the haemodynamics was kept stable for 5 minutes.Fluid replacement was performed again using the method mentioned above and the haemodynamic parameters were recorded.Linear correlation of the changes in blood volume (difference between the blood volume at each time point and the baseline value) with dSVV (difference between the value monitored at each time point and the baseline value) was analyzed.Results Significant changes were found in SW,APCO and Cl after each change in blood volume (P ＜ 0.05 or 0.01),while no significant changes were found in HR,MAP,CVP and SVR after each change in blood volume.The change in blood volume was negatively correlated with dSVV (r =-0.875,P ＜ 0.01).Conclusion There is high correlation between SVV and blood volume during hypovolemia.And SVV can reflect the changes in blood volume accurately and can be used for volume therapy during hypovolemia.

Objective To compare the application of evidence-based medical education and traditional medical education in the general practitioners' standardized training.Methods 80 students accepting general practitioners' standardized training were researched to compare the teaching effect of evidence-based and traditional medical education.Results Application of evidence-based medical education help to improve learning interests and learning abilities subjectively,and it helps improve exam results objectively.Conclusions Application of evidence-based medical education in the general practitioners' standardized training receives good learning effect and can help achieve the learning goal.

Objective To observe the effects of propofol intervention on renal ischemia-reperfusion injury on the expression of Cx43 in rat renal interlobar artery.Methods Male SD rats were randomly divided into control 4h and 24h groups (control), sham operation 4h and 24h groups (sham), ischemia reperfusion 4h and 24h groups (I/R), propofol 4h and 24h groups (propofol), and fat emulsion 4h and 24h groups (intralipid).Ischemia/reperfusion model was prepared by resection of right kidney and noninvasive arterial occlusion of left kidney, with renal ischemia for 45min and reperfusion for 4h or 24h depending on different group.Serum urea nitrogen (BUN) and creatinine (Cr) were detected by automatic biochemical analyzer.HE staining was used to observe the pathological changes of renal tissue.The changes of renal artery systolic and diastolic lobes were examined by pressure myographic technique.The expression of Cx43 protein in renal interlobar artery was analyzed by Western blot.Results The concentrations of serum BUN and Cr in sham group did not differ significantly from those in the blank control group.Renal HE staining showed no significant lesions;the pressure myogram of motor renal interlobar artery contraction rate showed no significant difference.The expression of Cx43 protein did not change significantly.Compared with sham operation group, the concentrations of serum BUN and Cr in ischemia-reperfusiongroup were significantly increased.HE slices kidney showed that the pathological changes of renal tissue became obvious;pressure motor indicated renal interlobar artery contraction rate was decreased;the expression of Cx43 protein was increased significantly (P<0.05).Compared with ischemia-reperfusion group, the concentrations of serum BUN and Cr in propofol group were decreased;renal HE slices showed reduced renal tissue lesions, increased renal interlobar artery contraction rate, and decreased expression of Cx43 protein (P<0.05).Conclusion Propofol can change renal ischemia-reperfusion injury by reducing the expression of Cx43 protein in vasomotor in renal interlobar artery.

Objective To prepare and identify monoclonal antibody against LRR-WSC domain of polycystin-1 and to investigate the distribution of polycystin-1 in kidney tissues and kidney cell lines. Methods BALB/c mice were immunized with fusion protein PC1-e of polycystin-1 LRR-WSC domain. The splenocytes were fused with myeloma cells by PEG 4000 and the hybridomas were selected in HAT medium. The hybridoma clones secreting antibodies against polycystin-1 LRR-WSC domain were detected by enzyme-linked immunosorbent assay ( ELISA) and cloned by limiting dilution. The specificity of anti-polycystin-1 LRR-WSC domain monoclonal antibody from hybridoma was verified by ELISA and Western blot. The distribution of polycystin-1 in tissues and cells was detected by immunohistochemical method. Results One cell line of hybridoma secreting monoclonal antibody against polycystin-1 was established. Western blot analysis showed that the monoclonal antibody reacted strongly and specifically to polycystin-1 LRR-WSC domain. Distribution of polycystin-1 in fetal kidney was localized in tubular epithelium. In normal adult kidney tissues, our study showed that polycystin-1 was mainly expressed in the medullary collecting ducts and distal convoluted tubules. Positive staining was also found in the majority of cyst-lining epithelial ceEs of cystic tissue from autosomal dominant polycystic kidney disease ( ADPKD) patients. Expressions of polycystin-1 were found in either ADPKD cyst-lining epithelia cell line and LLC-PK1, clearly plasma membrane and intracytoplasmic staining of polycystin-1 were observed. Conclusion Specific monoclonal antibody against polycystin-1 LRR-WSC domain were obtained. The antibody is important to researching the mechanism of ADPKD. The distribution of polycystin-1 in kidney tissues and cells show that polycystin-1 was important in tubular elongation and the maintenance of tubular architecture.