Objective Irrational pharmacotherapy is a common and severe phenomenon which happened in elderly people, it easily induces adverse outcomes, for example, increasing adverse drug reaction, mortality in hospital and the cost of drugs.The geriatric irrational pharmacotherapy are caused by lots of factors, and it is a challenge to clinical works in rational and optimized pharmacotherapy because of elderly complications and multiple pharmacotherapy which faced to doctors.Practical and effective treatment strategies and interventions are keys to geriatric rational pharmacotherapy.This paper will propose various of pharmacotherapy strategies in order to promote rational pharmacotherapy for the elderly patients.

Objective To evaluate the reliability and validity of Chinese multi-dimensional health assessment questionnaire (MDHAQ-C) in patients with systemic lupus erythematosus (SLE) in China.Methods One hundred and twelve SLE patients were recruited in the evaluation.The reliability of the questionnaire was tested by intra-class coefficient (ICC) and Cronbach's alpha.Convergent validity and divergent validity were assessed by Spearman correlation coefficient of MDHAQ-C with health assessment questionnaire (HAQ),the 36-item short-form health survey (SF-36) and the hospital anxiety and depression scales(HAD).Discriminant validity was tested in groups of patients with varied disease activities and status of damage.Results The Cronbach's alpha was 0.886 in the function scale (FN) and 0.774 in the scale of psychological status (PS).The corrected item-total correlation ranged from 0.409-0.866.The ICC was 0.615-0.920(P＜0.05).MDHAQ-C correlated with the questionnaires satisfyingly in most scales (from P＜0.5 to P＜0.001).The scores of MDHAQ-C could discriminate different groups of patients (P＜0.05).Conclusion MDHAQ-C is a reliable,valid instrument for functional measurement and quality of life assessment in Chinese SLE patients.

This study discussed problems in consistency assessment of generic drugs and analyzed effect of polymorphs on drug quality and its influence on consistency of curative efficiency.Relationship between evaluation method of polymorphs and curative efficiency was investigated.It showed that establishment of curative efficiency related evaluation indicators was necessary and improvment of techniques was important.Drug quality criteria should be added with requirement of curative efficiency control.Related information based on polymorphs could be provided for technical research in consistency assessment.

Objective To investigate the protective effect and possible mechanisms of erythropoietin (EPO) on myocardial ischemia-reperfusion injury(MIRI) in rats.Methods Ninety male SD rats were randomly divided into three groups,the sham operation group (n =20),I/RI group (n =20),and EPO treatment combined I/RI group (n =20).The left anterior descending coronary artery was ligated for 30min utes and then loosed for 150min utes to establish the rat model of MIRI.Rats of EPO + I/RI group were injected with EPO(5000u/kg) in abdominal cavity,the others were injected with nomal sodium.The serum MDA content was determined in a method of the thiobarbituric (TBA),the cardiac injury markers(cTn Ⅰ,CK,CK-MB) contents were determined by ELISA.Results The serum MDA and MPO levels of the I/RI group were significantly higher than the sham group,difference was significant(t =10.445,9.848,all P ＜ 0.05) ; Intervention by EPO,the serum MDA and MPO levels of the EPO + I/RI group were significantly lower than the I/RI group,the difference was significant (t =5.087,6.683,all P ＜ 0.05).The serum cTn Ⅰ,CK and CK-MB levels of the I/RI group were significantly higher than the sham group,the difference was significant (t =8.153,5.411,3.729,P ＜ 0.05) ; Intervention by EPO,the serum cTn Ⅰ,CK and CK-MB levels of the EPO+ I/RI group were significantly lower than the I/RI group,the difference was significant(t =4.808,4.089,3.002,all P ＜0.05).Conclusion EPO has protective effect on MIRI,the effect may be through EPO's antioxidant,antiinflammatory and protective effect on myocardial cells in the MIRI rats.

Objective To investigate the influences of Xuebijing injection on organs' ultra-microstructure in septic shock rats. Methods Fifteen male Sprague-Dawley (SD) rats of clean grade were selected. According to the method of random digits table, all of them were divided into three groups: sham operation group, model group and Xuebijing treated group, 5 rats being in each group. Cecal ligation and puncture (CLP) was adopted to reproduce abdominal cavity infection leading to sepsis model formation. While the rats in sham operation group just underwent abdominal median incision, abdominal exploration and closure of abdominal wall after flipping retrocecal region. In the Xuebijing treated group, within 1 hour after the operation, Xuebijing injection (4 mL/kg) was transfused through the catheter inserted in the femoral vein, and then normal saline (2 mL·kg-1·h-1) was continuously transfused until the rat being sacrificed. In the sham operation group and model group, equal volume of normal saline was given after operation. The blood pressure of all the rats was monitored continuously by a pressure device connected with a catheter inserted in the right carotid artery. The rats were observed for 12 hours, afterwards they were sacrificed, the samples of heart, lung, kidney and liver were taken, and their ultrastructural changes were observed under an electron microscope. Results The blood pressure of sham operation group was decreased a little with time extension, but within normal limits. The mean arterial pressure (MAP) of model group and Xuebijing treated group developed into a state of sepsis shock at 9 hours and 10 hours after operation respectively, and MAP were lower than 70 mmHg (1 mmHg=0.133 kPa). The MAP levels of model and Xuebijing groups at 11 hours after operation were lower significantly than those of sham operation group (mmHg:58.7±7.0, 58.7±8.3 vs. 91.0±8.2, both P<0.01), and they were persistently decreased at 12 hours after operation;the MAP in Xuebijing group was a little higher than that of model group at the same period (mmHg:55.4±4.0 vs. 48.8±12.9, P>0.05). The results of the observation with electron microscope:the structures of heart, lung, liver and kidney in sham operation group were basically normal;all the organs of model group appeared different degrees of structural damage. Compared with model group, the injury of heart and lung in Xuebijing treated group was milder, especially, the changes of cellular mitochondria were obvious;however, there was no significant difference in injury of kidney and liver between the model and Xuebijing treated groups. Conclusion Xuebijing injection can play a certain role in stabilizing the circulatory system in rats with septic shock, and can possibly ameliorate the heart and lung damage caused by infection and shock.

Objective To explore the risk factors of the chronic subdural hematoma(CSDH) drilling drainage recurrence.Methods The clinical data of 252 CSDH patients were retrospectively analyzed.All patients underwent trephination and drainage treatment,there were 40 cases with postoperative recurrence of hematoma.Multivariate logistic analysis of linear regression was used to analyze the risk factors for postoperative hematoma recurrence.Results In this study,of 252 CSDH patients received trepanation and hematoma,the probability of recurrence was 15.9 ％ (40/252).Single factor analysis showed that the size of hematoma,CT shows the density of hematoma,postoperative drainage volume,operation time,review the CT intracranial pneumatosis,age,hematoma midline shift could increase the recurrence possibility.Logistic multivariate analysis showed that he size of hematoma,CT shows the density of hematoma,postoperative drainage volume,age were independent risk factors of recurrence of hematoma drainage in patients with CSDH after drilling.Conclusion The influence factor of recurrence of hematoma in CSDH patients received trepanation and drainage is complex,we should strengthen the intraoperative,postoperative nursing and operation to reduce postoperative recurrence of CSDH.

Objective To investigate the expressions of microRNA-21,microRNA-143,and microRNA-145 in the sera of patients with nasopharyngeal carcinoma (NPC),and their assessment vales in the recurrence,metastasis,and prognosis of NPC patients.Methods From January 2012 to January 2014,80 NPC patients in our hospital Department of Internal Medicine and Head and Neck Surgery was used as tumor group,80 cases of healthy volunteers as control.The real-time fluorescence quantitative polymerase chain reaction (RT-PCR) was used to detect the expression levels of microRNA-21,microRNA-143,and microRNA-145 in the sera.Results Expression of microRNA-21 in NPC patients was significantly higher than that in healthy control group with statistically significant difference (P ＜ 0.05).The expressions of microRNA-143 and microRNA-145 in NPC patients was significantly lower than those in healthy control group with significant difference (P ＜ 0.05).At the same time,those microRNAs were significantly associated with tissue differentiation,invasion,and metastasis.Conclusions Increased microRNA-21 expression level in NPC patients,and decreased expression of microRNA-143 and microRNA-145 in NPC patients play an important role in differentiation,invasion,and metastasis in the development process of NPC.microRNAs can be used as a new index in the auxiliary diagnosis of NPC and the evaluation of recurrence,metastasis,and prognosis evaluation.

Objective To explore the relevance of high density lipoprotein cholesterol (HDL-C) level and resistance of epidermal growth factor receptor-tyrosine kinase inhibitor (EGFR-TKI) in advanced non-small cell lung cancer (NSCLC).Methods In a total of 87 NSCLC patients harboring EGFR mutation treated with EGFR-TKI, the correlations of pre-treatment levels of soluble HDL-C between efficacy and resistance of EGFR-TKI were analyzed by Kaplan-Meier method and Cox proportional hazard model.Results Patients with normal HDL-C (≥0.94 mmol/L) had a better disease control rate (DCR) than those with low HDL-C (＜0.94 mmol/L) [94.5 ％ (52/55) vs 65.7 ％ (21/32), P ＜ 0.001].The results of univariate analysis showed that patients with normal HDL-C had longer progress free survival (PFS) (HR =0.27, 95 ％ CI 0.164-0.444, P ＜ 0.001).The results of multivariate Cox proportional hazard model analysis with sex, pathologic histology, smoking history and mutation type showed that only HDL-C group had a significant difference (P ＜ 0.001).The same results were showed when stratified by sex and smoking history (female: P ＜ 0.001, male: P =0.002;Smoker: P ＜ 0.001, non-smoker: P =0.014).Conclusion Normal pre-treatment serum levels of HDL-C are associated with a better outcome and longer progression-free survival in NSCLC patients treated with EGFR-TKI, which may be a predictive marker for a better response.

Objective To investigate the effects of dexmedetomidine pretreatment on lung injury for patients after liver surgery. Meth-ods Sixty patients who had liver surgery in our hospital from August 2009 to February 2014 were equally divided into the treatment group and the control group, with 30 patients in each group. Both of the two groups were given one-lung ventilation anesthesia. Patients in the treatment group were given continuous intravenous infusion of dexmedetomidine after induction of anesthesia while paitents in the control group were not. In the time of before induction of anesthesia (T0), closed chest (T1), immediately after surgery (T2), all patients were given the gas analysis, expression of inflammatory cytokines and lung function testing and analysis. Results The diastolic blood pressure and heart rate at time points of T0, T1 and T2 in the two groups showed no significant difference (P> 0. 05). And the expression of TNF-αand SP-D at time points of T1 and T2 in the two groups were significantly higher than those at T0 (P<0. 05);while the expression of TNF-αand SP-D in the treatment group were significantly lower than those in the control group at time points of T1 and T2 (P<0. 05). The plateau air-way pressure and airway resistance in the treatment group at T2 and T3 were significantly lower than that at T1 (P<0. 05), and there were statistically significant differences compared with the control group (P<0. 05). Conclusion The dexmedetomidine pretreatment for the liver surgery patients can inhibit the inflammatory response, while improve lung airway plateau pressure and airway resistance. It has no significant effect for blood, so it can play a protective role for lung function.

Objective To investigate the clinical characteristics and therapeutic plan of Miller Fisher syn-drome( MFS) complicated with Guillain-Barrésyndrome( GBS) .Methods The clinical data of one patient of MFS complicated with GBS was reviewed retrospectively,and analysis combined with literature review was given.Results The patient had infectious history before the onset of MFS and GBS.Clinical manifestations included MFS triad,bulbar paralysis,bilateral facial paralysis,protein-cell dissociation of cerebrospinal fluid and neurogenic damages in electro-myography.Plasm exchange and adrenocortical hormones treatment were effective.Conclusion MFS complicated with GBS is an independent disease which is different from MFS or GBS.It has its distinct clinical features which should apply appropriate treatment.