Postal distribution of anthrax spores in 2001 in the USA has raised public health concern about terrorist attack using biological agents. The attack challenged medical preparation and scientific understanding of the epidemiology of biothreat agents. There is an urgent need for public health and medical personnel to have a clear understanding of the possible agents and appropriate therapy or prophlaxis. This article provides a brief overview of the definition and nature of bioterrorism, the list of pathogens likely to be used by bioterrorists to adversely affect human health, the characteristics of category A agents including bacillus anthrax, Yersinice pestis, smallpox virus, hemorrhagic fever virus, botulinum toxin and appropriate measures to prevent bioterrorism or to limit its consequences.

Objective To investigate the effect of four integrated care model of physical,mental,social and spirit on the quality of life of patients with breast cancer.Methods 100 cases of postoperative breast cancer patients were randomly divided into the intervention group and the control group with 50 cases in each.The control group received routine nursing care; the intervention group was given four integrated care model of physical,mental,social and spirit by specialized trained nurses,including systematic psychological counseling,rehabilitation knowledge of health education and behavior intervention on the patients themselves and their family members.Before intervention and 3 months after the intervention,the quality of life of patients after operation was surveyed by the FACT quality of life questionnaire.Results 3 months after the intervention the quality of life score of the intervention group was significantly higher than that of the control group.Conclusions To strengthen postoperative patients of breast cancer with targeted and personalized four integrated care model of physical,mental,social and spirit,can significantly improve the quality of life of patients,help to improve their physical and mental health and alleviate psychological reaction of depression.

Objective To observe the value of epiglottis and sternohyoid myofascial flap in laryngeal function reconstruction after partial laryngectomy.Methods Seven cases of subtotal laryngectomy were reviewed for analysis.The choice of surgical procedure was decided on pathologic conditions,the laryngeal function was reconstructed using epiglottis and sternohyoid myofascial flap.Results All patients rehabilitated deglutition in 10 to 12 days after surgery.None presented complication of aspiration.Conclusion The epiglottis and sternohyoid myofascial flaps are appropriate for reconstruction of surgical defect in laryngeal carcinoma.

To identify the pathogen of severe acute respiratory syndrome (SARS ), suckling mice and Vero E6 cells were inoculated with the lung samples from autopsied patients with SARS. The tissues obtained from mice were examined with light microscopy and electron microscope(TEM). The infected cells and supernatants were also examined under TEM. The primary hiatopathological leisions in the lungs were wall of lung alveolies thickened and alveolar cavities narrowed. The hepatocytes were swollen and undergone vacuolar and hydropic degeneration. A large quantity of coronavirus like particles could be observed in the infected cells and supernatants and also in mouse pneumocytes under TEM. The viruses are round with diameters 80～120nm.The isolated coronavirus was associated with the current SARS epidemics.

OBJECTIVE:To analyze the clinical characteristics of cefepime-induced neurotoxicity and to provide reference for rational use of cefepime.METHODS:Medical records of cefepime-induced neurotoxicity were collected from medical literatures from 1997 to 2009.Age and gender of 46 patients,primary diseases,drug usage,onset time of ADR,clinical symptom and prognosis were analyzed.RESULTS:Of 46 patients,25 cases were male and 21 female.Their average age was (59.56?18.84) years old (unknown age of 1 case).38 cases received cefepime alone and 8 cases cefepime combined with other drugs.All patients were administered by intravenous infusion.Of 46 patients,32 patients suffered from chronic renal failure,among which 10 patients received overdosage of medicine (unknown dosage of 1 case).Clinical symptoms of cefepime-induced neurotoxicity were encephalopathy,myoclonus and epilepsy.The occurrence time of neurotoxicity was (4.39?2.18)d (unknown occurrence time of 2 cases).The symptoms of 36 cases were relieved and cured after drug withdrawal and treatment with mean cure duration of (2.67?2.64)d.CONCLUSION:Great importance should be attached to the antibacterial effects of cefepime and cefepime-induced neurotoxicity.

Objective To investigate the plastic surgery of facial soft tissue for improvement of facial contour. Methods Botulinum toxin type A was injected into hypertrophied masseter to make it atrophy and attenuation; meanwhile, buccal fat lining was partly resected by intra-oral approach. Buc-cal liposuction was performed if necessary. Results 36 cases got satisfactory face thinning results af-ter treatment. The facial contour of all patients was markedly improved. Following up for 6 - 12 months showed that the effect was stable. Conclusion Plastic repair of facial soft tissue for improve-ment of facial contour is a simple approach, with mild injury, quick recovery, safe and effective.

Objective To investigate the effects of minimally invasive intracranial hematoma clearance on the perihematomal glutamate(Glu) level,permeability of blood-brain barrier(BBB) and brain edema.Methods Thirty rabbits with body weight of 2.80-3.40 kg were used to established the model of spontaneous intracerebral hemorrhage(ICH) and randomly divided into the minimally invasive group(MI) and control group(MC) after the model was prepared successfully.The MI group underwent minimally invasive procedures for removing intracranial hematoma by stereotactic instrument within 6 h after establishing the ICH model.The brain tissue was extracted on postoperative 1,3,7 d,and the perihematomal brain tissues were taken to detect the Glu level,BBB permeability and water content of brain tissue,which were compared with those in the control group.Results The Glu level,BBB permeability and brain water content on 1,3,7 d in the MI group were lower than those in the MC group,and the differences were statistically significant(P＜0.05).Conclusion The minimally invasive surgery for removing intracranial hematoma is helpful to reduce perihematoma Glu level,BBB permeability and brain water content.

OBJECTIVE:To investigate the role of clinical pharmacists in the treatment for patients with chronic renal failure. METHODS:Clinical pharmacists participated in the treatment process for a patient with chronic renal failure during uremia period;assisted physicians to optimize and improve therapy plan from correcting anemia,controlling blood pressure,improving heart func-tion and regulating ion disorder,etc.;suggested adding dosing frequence of Felodipine sustained-release tablet,Metoprolol tartrate tablet and Shenqiong glucose injection,and giving Benazepril hydrochloride tablet and Isosorbide 5-mononitrate sustained-release tablet. They also suggested adjusting the dosage of rhEPO and the dosage form of ferralia,increasing the dosage of Calcitriol cap-sule and Calcium carbonate tablet,decreasing dosing frequence of 5% Glucose injection and Levocarnitine for injection,and giv-ing Vitamine B12 tablet. Therapeutic efficacy and ADR should be observed closely during treatment,and medication education should be performed for the patient. RESULTS:Physicians adopted the suggestions of clinical pharmacists. The patient was im-proved and discharged from hospital with drugs 28 days later. CONCLUSIONS:Clinical pharmacists participate in the individual-ized treatment for patients with chronic renal failure and assist physicians to optimize therapy plan,which promote the clinical effec-tiveness and safety of drug treatment.

Objective To investigate the clinical significance of the serum sialic acid (SA) detection for the diagnosis and therapy monitoring in liver cancer patients.Methods Patients and healthy people of Chinese academy of medical science cancer hospital from January 2011 to October 2012,were enrolled,including 221 liver cancer patients (183 primary hepatic carcinoma patients and 38 metastatic hepatic carcinoma patients),117 benign liver disease patients and 150 healthy people.The concentration of serum SA were tested by ROCHE P800.The intra-assay and inter-assay coefficient of variation (CV) of SA kit were evaluated by use of low and high concentration samples,measured for 5 days and 4 times each day.Receiver operating characteristic (ROC) curve were used to determine the cut-off of SA using data of 183 cases of primary liver cancer and 150 healthy controls.The area under the curve (ROC-AUC) were used to evaluate the diagnostic value of SA.The changes of serum SA level in 103 cases of primary hepatic carcinoma patients were monitored before therapy and at the 1 st day,7 th day,14 th day,1 st month,3rd month,6 th month and 9 th month after treatment.SPSS16.0 was used to analyse the results.Results The intra and inter-day CVs for low level sample were 2.4％ and 3.2％ respectively,and for high level sample were 2.2％ and 3.1％.The cut-off value of the serum SA was 659 mg/L for liver cancer,the sensitivity and specificity was 63.4％ (1 16/183) and 94.7％ (142/150) respectively.The serum SA level of liver cancer group [(726 ± 173) mg/L] was higher than that of liver benign disease patients group [(552 ± 128) mg/ L] and healthy controls group [(599 ± 62) mg/L,U values were 1832.52 and 887.00,P ＜ 0.01].The serum SA level were tracked in 103 cases of primary hepatic carcinoma patients during therapy period.The serum level of SA elevated to [(817 ± 193) mg/L,t =-3.272,P ＜ 0.05] at I st week after treatment and kept at high level until late in 1st month after treatment [(782 ±173) mg/L,t =-2.694,P＜0.05].In the 3rd month,the SA level decreased to that of pretreatment [(662 ± 138) mg/L,t =1.225,P ＞ 0.05].In the 6th months,the SA level declined to [(615 ± 144) mg/L,t =1.999,P ＜0.05],as well as the level of healthy control group.There were 85 cases of hepatic carcinoma patients with decreased SA level compared with that of pretreatment,and the coincidence rate was 82.5％ (85/103),the Kappa value was 0.79.There were 5 cases of patients with hepatic carcinoma relapse after treatment in 9 th months and the SA levels increased significantly to (939 ± 175) mg/L.Conclusion The serum SA has significant values possibly in the diagnosis and therapy monitoring in liver cancer patients.

Objective To evaluate the efficacy of the RevoLix 70 Watt 2 micron continuous wave laser vaporesection for treatment of large volume benign prostatic hyperplasia(BPH,＞80 g).Methods Forty-five patients with obstructive BPH were treated with 2 micron continuous wave laser vaporesection.The age ranged from 57 to 88 years with a mean of 69 years.Nine patients had acute urinary retention.Mean prostatic volume was(96±1 3)ml(ranged from 80 to 128 m1).Eight cases were given suprapubic puncture.All cases were successfully anesthetized by using epidural anesthesia.At the beginning of the operation,the distal resection border close to the verumontanum was marked and laser incisions were performed at 5 and 7 o'clock lithotomy position.Firstly,median lobe was vaporeseeted closely along capsule from bladder neck to verumontanum.Secondly,prostate at 12 o'clock was vaporesected until the capsule was reached,and both lateral lobes were dissected downward.Thirdly,the apical position was enucleated by sheath,and then prostate was vaporesected from the tissue in 12 o'clock position to the tissue at 6.It was important to follow the 2 principles:inner to extra,up to down.Transfusion rate,resection time,time of indwelling catheter,improvement in urinary flow rate(Qmax),international prostate symptom score(IPSS)and quality of life(QOL)were measured.Results AIl cases were successfully operated.except one whose left lateral lobe was left due to heavy fluctuation of heart rate and blood pressure in operation.The mean operation time was (104±12)min.Transfusions were not necessary in any patients.The catheter was indwelled for 3 to 5 d postoperatively.One case had urethral stricture 3 weeks after operation,and urinated free after 22 times urethral sounding disj unctively.All cases were followed up for 3-1 2 months.All patients were satisfied with voiding outcome,none had incontinence.Mean Qmax increased from(3.3±0.5)ml/spreoperatively to(16.5±1.5)ml/s postoperatively.IPSS decreased from 28.6±5.5 to 8.3±2.3 and QOL score decreased from 4.5±0.4 to 2.7±0.2.respectively(P＜0.01).No hemorrhage occurred after the operation.Conclusion RevoLix 2 micron continuous wave laser vaporesection for treatment of large volume BPH is a safe and effective relief therapy,and that in combination with enucleation could improve the efficiency of vaporesection.