OBJECTIVE:To promote the development of pharmacists' clinical thinking ability.METHODS:By analyzing the differences between physicians and pharmacists in clinical thinking together with our practical experience,we expounded the key points of pharmacists' clinical thinking,i.e.critical thinking,comprehensive thinking,evidence-based thinking,patient-cored thinking and creative thinking.RESULTS & CONCLUSION:The clinical thinking that is in line with pharmacists' characteristics should be developed with clinical pharmaceutical practice as the core and it can be achieved by enhancing pharmacists' ability to detect and solve the drug related problems.

Objective To establish a method for the determination of bacterial endotoxin in Ilex pubescens compound injection(LPCJ) .Methods According to China Pharmacopoeia (second part,2000),interference test was carried out to detect the endotoxins in LPCJ with limulus lysate agents (?was 0.25 EU/mL).Results Inhibition action was found in bacterial endotoxin test for LPCJ and in the 10-,20-,30-and 40-fold diluted liquid of LPCJ.It was proved that the maximum noninterference concentration was the 50-fold dilution.The inspection results are the same as that of rabbit pyrogen test.Conclusion The 50-fold diluted LPCJ is suitable for the determination of bacterial endotoxin and can be used as the quality control standard for its preparation.

The problems in teaching infectious disease were discussed .The measures should be taken to improve the teaching quality from the varies of aspects, such as the aim and the model of the teaching, the arrangement of curricula, the cultivation of the clinical ability, and the method of examination and the application of multi-media materials.

Objective: To study the chemical constituents from the stems of Daphne acutiloba. Methods: The constituents were separated by column chromatography and their structures were elucidated by spectral data analyses. Results: Fourteen biflavans or biflavons were isolated from the EtOAc fraction of 95% ethanol reflux extract in the stems of D. acutiloba and were identified as daphnodorin A (1), daphnodorin C (2), daphnodorin C' (3), daphnodorin F (4), daphnodorin E (5), wikstrol A (6), daphnodorin K (7), iso-chamaejasmin (8), (+)-chamaejasmin (9), daphnodorin D1 (10), daphnodorin H (11), 3-methoxyl daphnodorin H (12), daphnodorin K' (13), and daphnodorin B (14). Conclusion: All the compounds except 14 are obtained from the stems of this plant for the first time.

Objective To observe the poet-operative clinical inpact on cervical intraepithelial neoplasia surgery by Loop elcctrosurgical excision procedure(LEEP),gelatin paste to improve the healing of the Cut,prevent the post-operative bleeding,and find out effective methods of preventing LEEP complications.Methods 100 patients with cervical intraepithelial neoplasia underwent LEEP in clinic.Divide them into two groups randomly,60 patients were adopted gelatin paste post-LEEP ag the cure group.while 40 patients were adopted as control group.Observation Vaginal bleeding,infection and cervical rear in short-term.Results In 60 patients of cure group,never patients with vaginal bleeding,infection and the cut healing in the short time.In 40 patients of control group,three patients with vaginal bleeding,two patients with infection,and three patients with bad healing.The different between two group with vaginal bleeding,infection and the cut healing time was significant(P＜0.05).Condusion gelatin paste can reduce bleeding.infection and cervical repair bad cmpllcations after cervical intraepithelial neoplasia surgery by LEEP.

Mixed saponin molecules in the extraction of Panax notoginseng(PNE) can be effectively desorpted into the molecular ionization for measurement and analysis by mass analyzer from matrix assisted laser desorption ionization-time of flight-mass spectrometry(MALDI-TOF MS). The saponin samples with chromatography purity were directly analyzed by MALDI-TOF MS, which indicated that the sensitivity of the method was higher than that of RP-HPLC. A technology of MALDI-TOF MS was directly employed to analyze the saponin kinds and their relative contents in Panax notoginseng(PN) while the saponins were perfectly extracted from the Chinese traditional medicine of PN. It was indicated that there were at least 20 saponins consisting of different molecular structure and that the content of both ginsenoside Rg1 and notoginsenoside R1 in PNE was relative high. R1 saponin was extracted and identified to follow its metabolism pathway by both thin layer chromatography and MALDI-TOF MS, respectively. The saponin fingerprinting maps in PNE can be established to evaluate the quality of PE and to study both metabolism pathway and mechanism of extra minim saponins in vivo.

Objective To observe the effects of electro-acupuncture on the expression and inhibition of DNA binding protein 2 (Id2) and myelin basic protein (MBP),and to explore the mechanism of remyelinization after compressive spinal cord injury (CSCI) in rats.Methods Fifty-four SD rats were randomly divided into a control group and a treatment group,and each was further subdivided into 3 time point subgroups:3,7 and 14 days.There were 9 rats in each subgroup.The CSCI models were made with a self-designed method.The acupuncture points Jiaji (EX-B2),bilateral Zusanli (ST36) and Taixi (KI3) were selected for treatment.Electro-acupuncture (continuous wave,2 Hz,1.5 V)was applied to the bilateral Zusanli (ST36) and Taixi (KI3) points.The control group received the injury but no treatment.The changes in the ultrastucture of the nerve fibers＇ white matter were de-termined by transmission electron microscopy (TEM).The alterations in the expression of MBP and Id2 were observed by double labeled immunofluorescence and Western blotting on the 3rd,7th and 14th day after the injury.Results TEM showed that the myelin sheaths in the control group had degenerated,swollen,and even broken down after CSCI.Changes to the myelin sheaths in the treatment group were milder than those in the control group.The immunofluorescence results showed the amount of Id2-immunoreactive oligodendrocytes in the control group to be (20 ±2) on the 3rd day after CSCI,becoming (16 ± 1) on the 14th day.The differences among the 3 control subgroups were not statistically significant.The amount of Id2-immunoreactive oligodendrocytes in the treatment group was (13 ± 1) on the 3rd day,reaching a minimum the 14th day.The differences among the 3 treatment groups were statistically significant.The differences compared with the control group at the same time points were also statistically significant.Western blotting showed that the expression of Id2 in the contrast and treatment groups was (1.12 ±0.12) and (0.67 ±0.01) respectively on the 3rd day after CSCI,and both decreased with time.The expression of Id2 in both groups reached their minima ((0.86 ±0.02) and (0.25 ±0.01) respectively) on the 14th day.The difference between the treatment groups and the contrast group was statistically significant at each time point.The expression of MBP in the contrast and treatment groups at day 3 was (0.44 ± 0.02) and (0.67 ± 0.04) respectively,and these increased with time.The expression of MBP in both groups peaked at the 14th day (at (0.95 ± 0.04) and (1.74 ± 0.09) respectively).These differences were again statistically significant.Conclusion Electro-acupuncture can regulate the expression of Id2 and MBP after CSCI.The down-regulation of Id2 which controls MBP negatively and the up-regulation of MBP may contribute to remyelination in the injured spinal cord.

OBJECTIVE:To study the protective effect of butylphthalide on the apoptosis of human umbilical vein endothelial cells (HUVECs) induced by Aβ1-42 and its mechanism. METHODS:HUVECs were divided into normal control group,Aβ1-42 group,TAK242 group(10 nmol/L),DMSO group(1‰DMSO)and butylphthalide low-concentration,medium-concentration and high-concentration groups (40,80,160 μg/L). Except for normal control group and DMSO group,other groups were given 50 μmol/L Aβ1-42 to culture HUVECs for 24 h. TAK242 group,DMSO group and butylphthalide low-concentration,medium-concentra-tion and high-concentration groups were given relevant concentration of drugs for 30 min,with 3 holes for each concentration. The cell viability was determined by CCK-8 assay;cell apoptosis was observed by Hochest 33342/PI double staining;the cell apoptotic rate was detected by AnnexinⅤ-fluorescein isothiocyanate (FITC) flow cytometry;the protein expression of TLR-4 and COX-2 were determined by Western blot assay;the contents of IL-1 and TNF-α were detected by ELISA. RESULTS:Compared with nor-mal control group,cell viability of HUVECs were decreased in Aβ1-42 group;while apoptotic rate,protein expression of TLR4 and COX-2,the contents of IL-1 and TNF-α were increased. Compared with Aβ1-42 group,cell viability of HUVECs were increased in TAK242 group and butylphthalide low-concentration,medium-concentration and high-concentration groups;while apoptotic rate, protein expression of TLR4 and COX-2,the contents of IL-1 and TNF-α were decreased,with statistical significance(P<0.05 or P<0.01). CONCLUSIONS:Butylphthalide can reduce HUVECs apoptosis induced by Aβ1-42,which may be related with inhibiting the expression of TLR4,COX-2 and inflammatory factors.

Objective To investigate the feasibility and plan quality of the image-guided volumetric modulated arc therapy (VMAT) based voluntary deep exhale breath-holding technique in the stereotactic ablative body radiotherapy (SABR) for liver tumors.Methods Fifteen patients with liver tumors were involved in this study.All patients were immobilized with voluntary deep exhale breath hold (vDEBH) combined with real-time position management (RPM) respiratory gating system.Treatment was planned using VMAT with 2 modified partial arc and re-planned using intensity modulated radiation therapy (IMRT) technique for comparison.Dosimetric parameters were calculated for plan quality assessment.Quality assurance studies included absolute dose and multiple planar dose verifications,total monitor units and delivery time analysis.Daily cone beam computed tomography imaging was used to verify the motions.Results There were no significant dosimetric differences between VMAT and conventional IMRT plans (P ＞0.05).Both techniques were able to minimize doses to organs at risk including normal liver,kidneys,spinal cord,and stomach.However,the average monitor units with VMAT were significantly lower 28.1％ than those with IMRT(t =3.064,P ＜0.05).The average beam-on time in VMAT plans was 31.6％ shorter than that in IMRT plans(t =2.278,P ＜ 0.05).Conclusions The utilization of VMAT in the treatment planning of SABR for liver tumors under breath control mode has better dosimetrics.In comparison to conventional IMRT plans,VMAT plans have higher efficiency and feasibility.

OBJECTIVE:Probe into the procedures and contents of pharmaceutical care in department of gastroenterology. METHODS:The feasibility,requirement and our specialty of pharmaceutical care were systematically analyzed in department of gastroenterology through a special - purpose study and discussion, and a detailed design was instituted, then the four faces were established.RESULTS: Clinical pharmacists should bring their pharmaceutical specialty into full play, and worked smoothly with clinicians and nurses by aiming directly at kinds of clinical requirement .An initial effect of pharmaceutical care was shown in department of gastroenterology .CONCLUSION: Young clinical pharmacists should adopt a scientific analysis and normative procedure to work smoothly with clinical partners as quickly as possible at the beginning of their clinical pharmacy work and strive hard to be one of the important person in multidisciplinary treatment teams.