Objective To investigate the entry points for clinical work of intensive care unit (ICU) pharmacists.Methods Through combination with daily work and referring the domestic and foreign literature,the characteristics of ICU medications were discussed to find out the entry point for clinical work of ICU pharmacists.Results ICU patients particularly need individualized pharmaceutical care because of the special pathophysiological characteristics and medicine use.Conclusion ICU pharmacists should provide pharmaceutical care based on Pharmacokinetics/pharmacodynamics knowledge and focus on the drug dosage adjustment,drug interactions and adverse event prevention.

BACKGROUND:Titanium implants as a safe biological material have been used to produce the artificial Russian titanium cornea, but complications stil exist, including artificial cornea shift, leakage, corneal tissue melting and artificial cornea discharge.
OBJECTIVE:To evaluate in vivo biocompatibility of hydroxyapatite modified titanium skirt for keratoprosthesis in alkali burn cornea.
METHODS:A total of 30 alkali burned New Zealand white rabbit corneas were divided into three group groups. Hydroxyapatite modified titanium skirt (experimental group) and titanium skirt (control group) were respectively inserted into the corneal stroma of rabbits. In the blank control group, only a lamel ar corneal incision was made.
RESULTS AND CONCLUSION:Al skirts were stable without necrosis, melting and exclusion during the observation period. The number of inflammatory cells in the experimental and control groups was significantly higher than that in the blank control group at 2 and 8 weeks postoperatively (P<0.05), but there was no difference in inflammatory cellinfiltration among different groups by the 16th week. The number of corneal fibroblasts increased significantly in the experimental group compared with the control and blank control group after 2, 8, 16 weeks (P<0.05). The extracellular matrix deposited on the surface of hydroxyapatite modified titanium skirt was denser and tighter than that on the surface of titanium skirt. It indicates that hydroxyapatite modified titanium skirt for keratoprosthesis can promote the interfacial biointegration of skirt and host cornea.

Objective To compare the efficacy of patient-controlled intravenous analgesia (PCIA),patient-controlled paravertebral block (PCPB) and patient-controlled epidural analgesia (PCEA) in patients after lobectomy performed via video-assisted thoracoscope (VAT).Methods Forty-eight ASA Ⅰ or Ⅱ patients,aged 50-64 yr,with a body mass index of 20-25 kg/m2,undergoing elective lobectomy via VAT,were randomly divided into 3 groups ( n =16 each):PCIA group,PCPB group and PCEA group.PCIA solution contained sufentanil 2 μg/kg in 100 ml of normal saline,The PCA pump was set up with a 2 ml bolus dose,a 15 min lockout interval and background infusion at a rate of 2 ml/h.PCPB solution contained 0.75％ ropivacaine 60 ml in 250 ml of normal saline and the pump was set up with a 5 ml bolus dose,a 15 min lockout interval and background infusion at a rate of 5 ml/h.The PCEA solution contained 0.75％ ropivacaine 50 ml and sufentanil 1 μg/kg in 250 ml of normal saline.The PCEA pump was set up to deliver a 5 ml bolus dose with a 15-min lockout interval and background infusion at 5 ml/h.VAS score was maintained ≤3.Peripberal venous blood samples were obtained before operation ( baseline),and at 24 and 48 h after operation for determination of the plasma cortisol concentration.The side effects were recorded.Results The plasma cortisol concentration and incidence of Somnolence were significantly lower in groups PCPB and PCEA than in group PCIA ( P ＜ 0.05 ).The plasma cortisol concentration was significantly lower in group PCEA than in group PCPB ( P ＜ 0.05).Compared with the baseline value,the plasma cortisol concentrstion was significantly higher after operation in groups PCIA and PCPB ( P ＜ 0.05),while no significant change was found in group PCEA ( P ＞ 0.05).Conclusion Compared with PCIA,PCEA can inhibit the stress response,while PCPB can reduce the stress response with good safety in patients after lobectomy performed via VAT if they can provide the equivalent postoperative analgesia.

Objective To compare the cerebral protective effect of propofol and sevoflurane combined with sufentanil anesthesia in the patients undergoing valvular surgery under cardiopulmonary bypass (CPB).Methods Sixty American Society of Anesthesiologists physical status Ⅱ or Ⅲ patients, aged 60-70 yr, scheduled for elective valvular surgery under CPB, were randomly divided into either propofol-based anesthesia group (group PA) or sevoflurane-based anesthesia group (group SA) , with 30 patients in each group.From induction of anesthesia to the end of surgery, group P received targetcontrolled infusion of propofol 0.5-2.0 μg/ml, and group S continuously inhaled 0.5％-2.5％ sevoflurane.Bispectral index value was maintained at 45-55.Immediately after induction (T0), at the end of surgery (T1) , and at 6, 12 and 24 h after surgery (T2-4) , the superior vena cava was retrogradely cannulated for blood sampling, and the concentrations of plasma S-100β protein and neuron-specific enzyme were determined using enzyme-linked immunosorbent assay.Results Compared with group SA, the plasma S-100β concentrations at T1,2 and neuron-specific enzyme concentrations at T1-3 were significantly decreased in group PA.Conclusion The cerebral protective effect of propofol combined with sufentanil anesthesia is superior to that of sevoflurane combined with sufentanil anesthesia in the patients undergoing valvular surgery under CPB.

Objective To compare main adverse cardiac events of patients with coronary heart disease and diametes,but normal lipids after statin on lowering lipids , and to bring out necessity of early lowering lipids . Methods A total of 324 patients with coronary heart disease and diametes were enrolled ,LDL-C was measured in-hospital for all patients and LDL-C<3.36mmol/L suitable for the experiment .They were divided into statin group (n=176,rosuvastatin 10 mg/d)and control group(n=148)randomly,all patients received second prevention for cor-onary heart disease including anti-platelet,anti-myocardial ischemia,smoke quitting,adjust diets and exercise,the CAG or PTCA(and stent implanting),CABG.the end events were main adverse cardiac events (cardiac events,recur-rent angina and target vessel reconstruction ).The mean follow-up time was(13 ±6)months.Results The fasting plasma glucose,LDL-C,hs-CRP in statin group were all significantly lower than those of control group [FPG:(5.3 ± 0.9)vs.(6.7 ±1.2)mmol/L,P=0.042;LDL-C:(1.7 ±0.6)mmol/Lvs.(3.9 ±1.6)mmol/L,P<0.01;hs-CRP:(1.4 ±0.5)mmol/L vs.(3.8 ±1.2)mg/L,P <0.01],MACE were less(15.6% vs.37.1%,P =0.032). Conclusion Early statin on patient with coronary heart disease and diametes ,though normal lipids ,which can down-regulate main adverse cardiac events significantly .

ObjectiveTo investigate the effects of astragalin on pulmonary edema after acute cervical spinal cord injury in rats.MethodsA total of 200 adult Wistar rats weighing 240-250 g were randomly divided into five groups:astragalin group,low concentration astragalin group,physiological saline group,blank group and sham group,with 40 rats in each group.The rats with cervical spinal cord injury were induced at C7 by modified Allen' s method,with the dropping weight of 10 × 2.5 g · cm.In the sham group,the laminas were removed only,leaving spinal cord at the C7 intact.Each group was further divided into four time points:24 hours,3 days,1 week and 2 weeks after the modeling,with 10 rats in each time point,according to the specimen collection time.Rats were sacrificed at different time points to observe the pathological change of the lung tissue using optical microscope,measure the lung wet/dry weight ratio (W/D) and protein concentrations of the serum and bronchoalveolar lavage fluid and calculate the lung W/D and lung permeability index (LPI).ResultsAt the same instant,the W/D and LPI in the astragalin group and low concentration astragalin group were lower than those in physiological saline group and blank group,with the lowest value in the astragalin group at day 3 after injury ( P ＜0.05 ).ConclusionsRats with acute cervical spinal cord injury may cause pulmonary edema,which can be efficiently alleviated through early use of astragalin.

Objective To compare the effects of propofol-and sevoflurane-based anesthesia on postoperative cognitive dysfunction in elderly patients undergoing cardiac valve operation under cardiopulmonary bypass (CPB).Methods Eighty patients of both sexes,of American Society of Anesthesiologists physical status Ⅱ or Ⅲ,aged 65-72 yr,weighing 60-80 kg,scheduled for elective cardiac valve operation under CPB,were randomly divided into 2 groups (n =40 each) using a random number table:propofol-based anesthesia group (group P) and sevoflurane-based anesthesia group (group S).In group P,propofo] was given by target-controlled infusion with the target plasma concentration of 0.5-2.0 μg/ml to maintain anesthesia.In group S,0.5％-2.5％ sevoflurane was inhaled for maintenance of anesthesia.Immediately after induction of anesthesia,at the end of operation,and at 6,12 and 24 h after operation,blood samples were taken from the superior vena cava for determination of plasma matrix metalloproteinase-9,S100β protein and neuron-specific enolase concentrations.Cognitive function was assessed at 1 day before operation,and at 3,7 and 30 days after operation.Results Compared with group P,the plasma matrix metalloproteinase-9,S100β protein and neuron-specific enolase concentrations at the end of operation and at 6 h after operation and incidence of postoperative cognitive dysfunction were significantly increased in group S (P ＜ 0.05).Conclusion Propofol-based anesthesia provides better cerebral protection than sevoflurane-based anesthesia,and the development of postoperative cognitive dysfunction is decreased in elderly patients undergoing cardiac valve operation under CPB.

Objective To evaluate the clinical outcome in the treatment of humerus shaft comminuted fractures using limited open reduction and internal fixation combined with an external fixator.Methods Data of 80 patients with comminuted humerus shaft fractures treated from January 2005 to January 2013 were analysed retrospectively.All the patients underwent limited open reduction and internal fixation combined with an external fixator (treatment group) and open reduction and plate fixation (control group) according to the random number table.In the treatment group,there were 40 patients (28 males,12 females),at mean age of 33.5 years (range,21-54 years),with causes of injury including traffic accidents in five patients,falls in nine,crashes in seven and others in six.There were seven patients with open fractures and 33 with closed fractures.In the control group,there were 40 patients (25 males,15 females),at mean age of 32.9 years (range,19-55 years),with causes of injury including traffic accidents in 16 patients,tumbling in seven,crush in seven and others in ten.There were eight patients with open fractures and 32 with closed fractures.The operation time,intraoperative blood loss,bone union time and complications in both groups were recorded.Clinical efficacy was evaluated using the Stewart and Hundley standard.Results Mean follow-up was 19 months (range,15-24 months).Treatment and control groups showed significant differences in operation time [(55.5 ± 10.3) minutes vs.(120.5 ± 15.3) minutes],intraoperative blood loss [(120.4 ± 20.7) ml vs.(245.4 ± 26.7) ml] and bone union time [(11.6 ± 1.3) weeks vs.(14.9 ± 2.3) weeks] (P ＜ 0.05).Rate of incision infection was 8％ (3/40) in treatment group and 10％ (4/40) in control group (P ＞ 0.05).In treatment group the results were excellent in 31 patients and good in nine.In control group the results were excellent in 27 patients,good in nine,fair in one and poor in three.One patient with radial nerve injury after a second surgery for implant removal and two patients with osteomyelitis or bone nonunion were noted in control group.Conclusion Limited open reduction and internal fixation in combination with an external fixator is associated with small trauma,easy operation,short operation time,few bleeding,rigid fixation,early functional exercises and reduced bone nonunion for treatment of comminuted humerus shaft fractures,which exhibits great clinical value.

Objective To study the subject domain knowledge of clinical education of pediatrics in our country with multivariate statistical analysis and social network study,research on the domain subject distribution and knowledge cluster,and then built visualized knowledge-mapping,so as to predict and guide the developmental trend in this field.Methods We searched the CNKI with MESH keywords (pediatrics OR children OR infants) AND clinical education OR bedside education OR interview of clinics in March,2013.679 articles were enrolled in and then imported into Bicomb.After core keywords had been identified by Bicomb,a word text matrix and co-occmrence matrix of words to articles were built.Systemic clustering of the co-occmrence matrix was finished by SPSS 20.0,leading the strategic plot to be built.Then draw visualized network in Ucinet 6.0.Results Totally 679 articles about pediatrics education were included.The number of core keywords was 66,and the lowest frequency of core keywords was 5.With multivariate statistical analysis and social network study,the visualized domain knowledge-mapping was successfully built,and it directly reflected the structure of subject knowledge-mapping of pediatric clinical education in our country,and then key clusters were formed,in which the clusters of participation model of clinical education and applications of clinical education had been well developed,and had been the dominant subject in pediatric clinical education.Whereas the unbalanced developed cluster of Exploration in refommtion of clinical education was now in rapid development with the introduction of new technology and innovative teaching model.At the same time,the nursing clinical education cluster has been separate cluster,but needed further and enhanced research.Conclusion The well developed subjects of participation model of clinical education applications of clinical education stood in the center of the subject do main knowledge-mapping,and with several clusters following.And the study of refomation of clinical education makes a great contribution to the progress of the subject.The nursing teaching needed balanced development.

Objective To assess the efficacy of 308 nm excimer laser irradiation for the treatment of guinea pig model of vitiligo and its immunoregulatory effect on Treg cell and Th17 cell.Methods Vitiligo was induced in guinea pigs by hydroquinone bleaching,and they were randomly divided into an experimental group and a control group.There was also a normal control group.The experimental group was treated with a 308 nm excimer laser at the nidus of vitiligo; the two control groups were given no intervention.After 8 weeks of treatment,leukasmus of the different groups were compared.The mRNA expression of Foxp3 and IL-17 were measured by real-time fluorescence quantitative (RTFQ-PCR) and the expression of Foxp3 and IL-17 in the lesions were measured by immunohistochemistry staining.Results The effectiveness rate was 100％ in the experiment group.The results of RTFQ-PCR showed that the mRNA expression of Foxp3 in the experimental group and the vitiligo control group was significantly higher than the healthy control group (all P ＜ 0.05),being 0.33 ± 0.03 and 0.02 ±0.07 respectively,as was the mRNA expression of IL-17,being 0.21 ± 0.05 and 0.94 ± 0.06 accordingly; and the mRNA expression of IL-17 in the experimental group was significantly lower than the vitiligo control group(P ＜ 0.05).The immunohistochemical staining showed that Foxp3 and IL-17 protein was scattered in the lesions of the experimental group,while they were crowded in those of the vitiligo control group.Conclusion Laser irradiation might contribute to a therapeutic effect on vitiligo through modulating the balance of Treg and Th17 cells,at least in guinea pigs.