Objective:To investigate the thoughts and the methods of clinical pharmacists in the individual continuous renal re-placement therapy ( CRRT) anticoagulation treatment for severe patients. Methods:Clinical pharmacists participated in the CRRT anti-coagulation treatment for one patient with severe thrombocytopenia after aortic dissection surgery. Clinical pharmacists analyzed the cau-ses of thrombocytopenia and the coagulation function of the patient to exclude heparin-induced thrombocytopenia, and developed the treatment of supplementing platelets and regional citrate anticoagulation as the way of CRRT. Results:Three days after the treatment, the patient was changed to the general ward with normal renal function. Conclusion:Clinical pharmacists should participate in clinical treatment comprehensively and perform individual treatment for patients in order to ensure the effect and safety of medication.

BACKGROUND:Cannulated screw tension band combined with wire fixation is most commonly used for treatment of patel a fractures.
OBJECTIVE:To evaluate the clinical outcomes of combination of cannulated screw tension band and wire fixation in the treatment of patel a fractures.
METHODS:A literature search method was employed to retrieve relevant articles addressing cannulated screw tension band and wire fixation of patel a fractures. In-depth analysis of literatures meeting the study criteria was carried out. Patients with patel a fractures who received cannulated screw tension band and wire fixation were fol owed up to evaluate the postoperative fracture healing, complications and functional recovery of the knee joint at the injury side. Then, the clinical efficacy of cannulated screw tension band combined with wire fixation was analyzed.
RESULTS AND CONCLUSION:After treatment with cannulated screw tension band and wire fixation, patients with patel a fractures exhibited good fracture healing and low probability of complications, including screw or wire loosening, broken, and shedding. Functional recovery of the affected knee was up to 90%. Clinical case analysis showed that cannulated screw tension band combined with wire fixation achieved good outcomes in the treatment of patel a fracture, with over 90%functional recovery of the affected knee, which is consistent with the reported results. It indicates that the cannulated screw tension band combined with wire fixation is one of the ideal and reliable methods in use for internal fixation of patel a fractures.

Objective To investigate the analgesic efficacy of ultrasound guided transversus abdominis plane block and to compare the efficacy of posterior approach and medial approach of ultrasound guided transversus abdominis plane block (TAPB) in providing postoperative analgesia after children laparoscopic groin surgery.Methods Eligible children 2 ～ 4 years old (n =60),American society of anesthesiologists (ASA) I,undergoing elective laparoscopic unilateral groin surgery were randomly assigned into posterior approach group (Group P),medial approach group (Group M) and control group (Group C).Many parameters were measured and recorded during the study,including funk sedation scores,intraoperative circulation monitoring at time points of T1 (before induction),T2 (skin incision) and T3 (skin closure),length of surgery,the time from post anesthesia care unit (PACU) arrival to the first obtainable pain score,length of PACU stay,modified-children's hospital of eastern ontario pain scale(m-CHEOPS),pediatric anesthesia emergence delirium (PAED) scores,number of children with sufentanil administered in PACU,number of people occurred nausea and vomiting,and satisfaction of parents.Results There were no statistically significant difference in general characteristics,basic emotion score,duration of surgery,the time from PACU arrival to first obtainable score,haemodynamic parameter at T1 and satisfaction of parents among groups P,M,and C.However,the m-CHEOPS scores at the time points of first obtainable,10 min,the number of children received sufentanil administration,PAED scores and haemodynamic parameter at T2 and T3 were significantly lower in groups P and M than in group C.There were no significant difference in parameters mentioned above between groups P and M.Conclusions Ultrasound guided transversus abdominis plane block could provide efficient and secure postoperative analgesia for children undergoing laparoscopic groin surgery.Both posterior approach and medial approach are ideal options.

Objective To explore and analyze the clinical characteristics and treatment strategy of severe complications caused by childrenˊs foreign bodies in esophagus.Methods The clinical data of 71 ca-ses of esophageal foreign bodies in children with ENT admitted to our hospital were analyzed retrospectively from Jan 2009 to Dec 2014.Results Esophageal foreign bodies in children with 71 cases,of whom 42 males and 29 females;aged from 2 months to 14 years old,highest incidence of 1 to 3 years old.Foreign bodies in esophagus lasted 2 h to 15 d.Ingestion of metallic foreign bodies in 43 cases,12 cases of plant-based foreign body,9 cases of animal foreign bodies,7 cases of chemical foreign bodies.Foreign bodies located in the upper esophageal was 51 cases,9 cases of the middle and 7 cases of the under section,3 cases of esophageal en-trance,1 case of falling into the stomach.In children with 71 cases,9 cases had complications,69 cases were cured,improved in two cases,and the cure rate was 97.2%,the average healing time was 4 d.Conclusion Early diagnosis and treatment,avoid esophageal perforation are the key to avoid the emergence of the compli-cations in children with esophageal foreign bodies,timely and accurate treatment of esophageal perforation and other complications are the effective measures to improve the cure rate.

Objective To investigate changes of N-methyl-D-aspartic acid receptor 2B(NR2B) level and calcium/calmodulin-dependent protein kinase Ⅱ(CaMK Ⅱ) activities in the hippocampus of vascular dementia(VD) rats and the intervention effects of Memantine.Methods The VD rat models were established by permanent,bilateral occlusion of the common carotid arteries.The rats were randomly divided into VD group and Memantine-treated group.At 4,8,12,16 weeks after operation,the water maze test was performed to detect the ability of learning and memory of the rats.The changes of NR2B level were measured by RT-PCR.The changes of the CaMK Ⅱ activities were determined by incorporation of 32P into histone.The resoults were compared with the sham-operated group.Results Compared with the sham-operated group,the ability of learning and memory of VD group rats at each time point after operation decreased significantly(all P

Objective To investigate the preventive effect of the artificial nerve canal on irritating neuralgia after neurilemmoma resection.Methods Thirty patients diagnosed as neurilemmoma were divided into artificial nerve group and control group at randomly.There were 15 patients in each group.The nerves in artificial nerve group were enclosed using the artificial nerve besides neurilemmoma resection.The nerves in control group only had neurilemmoma resection.All patients were assessed with VAS for the degree of irritating neuralgia at 3 time points after operation.Calculate the incidence of irritating neuralgia and analyze the data using statistical methods.Results In control group,the VAS scores were 7.5,5.1,2.8,and the incidences of irritating neuralgia were 80％,67％,40％,respectively.In artificial nerve group,the VAS scores were 3.2,1.5,0,and the incidences of irritating neuralgia were 33％,13％,0.The VAS scores and the incidences of irritating neuralgia of two groups had significant difference by statistical analysis (P ＜ 0.05).Conclusion The artificial nerve canal can relieve the degree and decrease the incidence of irritating neuralgia after neurilemmoma resection,which is a useful method to prevent irritating neuralgia in clinic.

Objective For an analysis and evaluation of the technical efficiency of tertiary hospitals in Tianjin.Methods Data Envelopment Analysis of different combinations of indicators and Spearman Rank Correlation Analysis were used for a study of the relative efficiency between 28 tertiary hospitals and the correlation between the indictors.Results The study showed that 12 hospitals reached DEA efficient,effective rate of 42.86%,and there is a correlation between the five sets of indicators. Conclusion Regulators of Tianjin hospitals should pay attention to efficiency calculations,make full use of medical resources,strengthen scientific management,and enhance the competitiveness of the hospital.

Objective To probe into the varying efficiency of public hospitals and recommend on efficiency improvement.Methods By means of DEA method including CCR model,BCC model and Malmquist index,to study the static and dynamic changes of operating efficiency of hospitals in Tianjin from 2008 to 2012.Results The overall efficiency of these 24 hospitals is not high,and the efficiency of the tertiary hospitals (0.900)is higher than the second-level hospitals(0.828).There exist problems that the size of the second-level hospitals is either too big or too small,a lot of health resources can be saved by managing the non-DEA efficient hospitals.The trends of the total factor productivity of 24 hospitals in Tianjin from 2008 to 2012 are increased.Thanks to the advanced technology and innovation, the overall efficiency of tertiary hospitals is improved.Through improving organizational management level,the overall efficiency of second-level hospitals is improved.Conclusion Hospital managers should introduce the high-level medical workers,enhance technological innovation,improve and standardize the hospital management and service system,optimize the allocation of medical resources and select the appropriate size of the hospital with the hospital's own situation to improve the operating efficiency of the public hospitals.

Objective To retrospectively analyze the perioperative complications of posterior lumbar interbody fusion (PLIF) for recurrent lumbar disc herniation and identify potential risk factors that correlate with those complications.Methods All of 71 patients with recurrent lumbar disc herniation were treated surgically with PLIF,discharged from our department between January 2008 and December 2014.Demographic and operation data were collected and perioperative complications were recorded.We analyzed whether the clinical factors (age,gender,BMI,co-morbidity,smoking,time of recurrence,blood loss,operation segment,operation time) were in correlation with perioperative complication by univariate analysis.Then we integrated the statistically significant indicators into Logistic regression equation to determine the related risk factors for complication.Results The study group consisted of 71 cases,including 42 males and 29 females.The age was 19 to 64 years old with an average of 50.6 years old,and the average BMI was 23.6 kg/m2.26 cases had perioperative complications,while there were two or more complications in 5 patients,and no mortalities.Neurologic deterioration or neuropathic pain (10 cases,14.1％) and dural tears (6 cases,8.5％) were the most common intraoperaitive complications.The other complications included nerve root or cauda equine injury,deep or superficial wound infection,urinary tract infection,respiratory system complication,cardio-vascular complication and delirium.Univariate analysis suggested that age,gender,co-morbidity,smoking,time of recurrence,operation segment,operation time were not associated with perioperative complication.The multivariate Logistic regression analysis showed BMI and blood loss were closely related to perioperative complication.Conclusion Complications of posterior spinal fusion surgery for recurrent lumbar disc herniation are affected by many factors.The most common complications are transient neurologic deterioration or neuropathic pain and dural tears.BMI and blood loss are independent risk factors.

Objective To systematic evaluation the antiepileptic drug valproic acid and topiramate effects on body weight and plasma leptin levels.Methods By searching the Cochrane Library,PubMed,EMBASE,CNKI,VIP Chinese Scientific Journals Database and Articles Database (from building a database to August 1,2014),qualified RCT was chosen from those articles according to inclusion and exclusion criterias and evaluated their quality.Then the meta-analysis was performed by Rev Man 5.3.Results (1) A total of 70 documents retrieved for the evaluation,12 of the literatures could be incorporated into the Meta-analysis,including a total of 634 participants,9 literatures using valproate to treat epilepsy,4 literatures used topiramate.(2)Meta-analysis:compared with other drugs,valproic acid treatment increased body mass index and leptin level in patients with epilepsy,BMI combined MD=0.88(95％ CI:0.45-1.31),leptin level in the combined MD=0.58(95％ CI:0.07-1.09);compared with other drugs,topiramate affect body mass index and leptin level in patients with epilepsy had no statical difference,BMI combined MD=-0.02 (95％ CI:-0.62-0.58),leptin levels in the combined MD =-0.05(95％ CI:-0.31-0.20).Conclusion Antiepileptic drug valproic acid may increase patients' BMI and serum leptin levels,yet topiramate in do not have influence in patients BMI and serum leptin levels;more basic and clinical researches are needed to explore serum leptin levels and the exact therapy mechanisms of antiepileptic drugs for clinicians to select antiepileptic drugs.