Objective To investigate the method of early termination of cesarean scar pregnancy (CSP).Methods Clinical data of 12 patients with CSP were retrospectively analyzed,all patients were treated with mifepristone 25mg in the morning and evening for 3 days,and misoprostol 600μg in the morning at the fourth days.Results Of 12 patients,medical abortion were completely in 4 cases,and 6 cases were failure which were carried out painless abortion with microtubules(disposable suction tube).2 cases were taken curettage because of hemorrhage after incomplete abortion.1 case was improved by massage the uterus,and intramuscular injection of oxytocin 20u in cervix;another one case was taken uterine artery embolization because of postoperative bleeding about 2 000ml with shock symptoms.Conclusion The CSP is complicated,the early prevention and treatment must be taken for it,and once it diagnosed,the termination of pregnancy should be immediately taken,in patients with a history of cesarean section line miscarriage may occur when the hard-to-control bleeding.Uterine artery embolization is an effective treatment method for the first choice.

Objective:To study the impact of clinical pharmacy information management system on antimicrobial stewardship in a general teaching hospital. Methods:The main function, deficiencies and aspects needing improvement of clinical pharmacy information management system, and its influence on antimicrobial stewardship were introduced. Results:The information system had such functions as antimicrobial usage statistics, evaluation of antimicrobial prescription, and the use intensity calculation of antimicrobials. By using the information system, manpower of antimicrobial stewardship was saved, antimicrobial statistics became more comprehensive and objective, and dynamic real-time monitoring of antimicrobial drugs management was realized. However, the system still had some shortcomings needing improvement. Conclusion:Clinical pharmacy information system can promote the implementation and efficiency of antimicrobial stewardship.

Objective To establish a liquid chromatographic-mass spectrometric method ( LC-MS/MS method ) for determination of dextrorphan in human liver microsome. Methods LC-MS/MS was adopted with carbamazepine serving as an internal standard.The separation was performed on Agilent ZORBAX XDB-C18 column (2.1 mm×50 mm, 3.5μm), with mobile phase consisting of 0. 05% formic acid methanol-0. 05% formic acid in gradient elution. Dextrorphan and carbamazepine were detected on multiple reaction monitoring(MRM)mode by transitions from precursor to production(m/z 258.1→199.1, 237.1→194.1). Results The linear range of dextrorphan concentration was 19.22-768 960 ng.L-1(r=0.999 8), and the lowest quantification limit was 19.22 ng.L-1.The relative recoveries were 94.02%-98.74%, and the RSDs of intra-day and inter-day were within 10%.IC50 of psoralen on CYP2D6 was 0.6μmol.L-1. Conclusion The LC-MS/MS method is proved to be rapid, sensitive and reproducible, psoralen is a strong inhibitor of CYP2D6.

Objective To evaluate the efficacy and feasibility of ultrasound-guided percutaneous microwave ablation for peripheral lung cancer. Methods Seventeen patients with peripheral lung cancer (23 nodules) were treated with ultrasound-guided microwave ablation. The microwave energy was initially set at 60 W for 100s, and then at 30~40 W for 300~600 s. The treatment was conducted by using multiple simultaneously-powered antennas in lesions ≥3 cm in diameter. Results After the treatment, all the nodules were decreased in size and the blood flow signals inside the nodule disappeared (14 nodules) or weakened (9 nodules). Enhanced CT scanning revealed no enhancement in 16 nodules and partial enhancement in 7. Repeated biopsy in 4 patients showed a complete tumor necrosis. Clinical symptoms disappeared in 8 patients and subsided in 9 patients 1 month after treatment. Follow-up observations in 15 patients for 6~47 months (mean, 23 months) showed 9 survivors, without serious complications. Conclusions Ultrasound-guided percutaneous microwave ablation is an effective, safe, and feasible method for treating peripheral lung cancer.

Objective:To evaluate the therapeutic effects of sinomenine on T-helper cell type 1-mediated experimental colitis in-duced by 2,4,6-trinitrobenzene sulfonic acid (TNBS) in mice. Methods:Balb/c mice were divided into five groups:ethanol control group, TNBS model group, and sinomenine treatment groups (50, 100 and 200 mg·kg-1 ) with 10 ones in each. Colitis was induced by colonic instillation of TNBS dissolved in 0. 1 ml of 50% ethanol. Seven days after the colonic instillation of TNBS, sinomenine was given by gastric gavage once daily for 21 days. The mice were sacrificed on the 28th day, the injury degree of colonic mucosa was ob-served, the colon myeloperoxidase ( MPO) activity was determined, and the levels of inflammatory cytokines ( TNF-α, IL-17 and IL-23) were determined by ELISA. Results:Compared with those in TNBS model group, the body mass, gross injury score and histologi-cal findings in sinomenine groups at medium dose and high dose were significantly improved (P<0. 05), the activity of MPO signifi-cantly decreased (P<0. 05), and the protein levels of TNF-α, IL-17 and IL-23 in colonic mucosa were lower than those in TNBS group (P<0. 05). Conclusion:Sinomenine has notable therapeutic effect on TNBS-induced chronic colitis in mice, and the mecha-nism is related to the inhibition of Th1 cytokines by sinomenine.

Objective To understand the clinical features of candidemia.Methods A retrospective analysis was performed based on the data of 88 candidemia cases treated in Huashan Hospital during the period from 2007 to 2012.The clinical data were re-viewed in terms of species distribution,underlying diseases,clinical manifestations,treatment and outcomes.The prognostic factors were analyzed by chi-square test or Fisher exact probability test.Multivariate analysis was conducted by multiple Logis-tic regression.Results Candida albicans (40/88,45.5%)was the most common pathogen isolated from these candidemia ca-ses,followed by Candida tropicalis (20/88,22.7%),Candida parapsilosis (17/88,19.3%),Candida glabrata (10/88, 11 .4%),and Candida krusei (1/88,1 .1 %).Solid malignancy,diabetes,and surgical procedure were the most frequently identified underlying diseases.Fatal or deteriorative outcome was reported in 28 cases.The attributable mortality was 18.2%. Multivariate prognostic analysis indicated that presence of central venous catheter (OR:6.322,95% CI :1 .055-37.891 ,P =0.044)was independently correlated to increased mortality.Appropriate antifungal therapy was an independent predictor of de-creased overall mortality (OR:0.137,95% CI :0.039-0.480,P =0.002).Conclusions The pathogen distribution of candi-demia has changed slightly.Appropriate antifungal therapy plays a key role in the treatment of candidemia.

The clinical data were retrospectively analyzed for 21 cases of liver neoplasms undergoing laparoscopic hepatectomy from December 2007 to October 2012.Among 11 cases of borderline hepatocellular carcinoma (HCC) (1.0-9.0 cm),6 of them were of micro hepatocellular carcinoma (MHCC) with a diameter ≤2 cm.There were 10 cases of borderline hepatic benign tumor,including liver hemangioma (n =7),hepatic adenoma (n =1),liver lymphoma (n =1) and liver focal necrosis (n =1).According to Couinaud's liver segmentation method,neoplasm was located on segment Ⅲ (n =13),segment Ⅳ (n =6),segment Ⅴ (n =1) and segment Ⅵ (n =1).Laparoscopic hepatectomy was successful in all patients.There was neither conversion into open approach nor postoperative complications of bile leakage,air embolism or perioperative mortality,etc.The mean operative duration was (120 ± 30) minutes,average hemorrhagic volume (165-±79) ml and normal diet & ambulation at Day 1-2 post-operation.The average postoperative hospitalization stay was (16 ± 10)days and l-year survival rate 100％.The parameters of leucocyte,liver enzymes,albumin and bilirubin returned to normal at Week 1 post-operation.Once a reasonable surgical indication is selected,laparoscopic resection is both safe and effective for peripheral micro hepatocellular carcinoma.

Objective To evaluate curative effects of treatment of malignant biliary and gastric outlet-duodenal obstruction with endoscopically placed self-expandable metal stents.Methods A retrospective analysis was performed in 17 patients who underwent enteral stenting after placement of the biliary stent.The success rate of insertion,the effective palliation of biliary and duodenal obstruction,the rate of complication,recurrent stent obstruction and the median patency were observed.Results In 17 patients,biliary stenting were all performed for obstructive jaundice and then enteral stents were inserted.The levels of tatal billirubin [from (263.4 ± 62.5) μmol/L to (157.6 ± 25.1) μmol/L],direct billirubin [from (1233.2 ±66.5) μmol/L to (130.9 ± 27.7) μmol/L] and alkaline phosphatase [from (233.2 ± 66.5) IU/L to (130.9 ±27.7)IU/L] decreased significantly (P ＜0.01),and the gastric outlet score increased significandy [from (0.9 ± 1.1) points to (2.1 ±0.7) points] (P ＜0.01).No serious complication in all patients.Lifetime of patients ranged from 70 days to 332 days,and the median survival time was 192 day.Conclusion Combined biliary and enteral stenting is an effective method for palliation of malignant biliary and gastric outlet-duodenal obstruction.

Objective To explore the diagnostic value of alcohol fixation and liquid-based cytology method for malignant stricture of common bile duct and to study the interval time between sampling and fixation for procedure of alcohol fixation.Methods Data of 82 patients were retrospectively studied,who were suspected of having malignant stricture of common bile duct underwent brushing through endoscopic retrograde cholangiopancreatography (ERCP),and were confirmed by follow-up for 2 years or pathology after surgery from October 2008 to June 2013.These patients were randomly divided into alcohol fixation group (n =30),liquid-based cytology group (n =28) and conventional cytology group (n =24).The positive diagnostic rates of brush cytology in each group were compared.The alcohol fixation group were randomly divided into 2-minute group and 5-minute group according to the interval time between sampling and fixation.Positive diagnostic rates were also compared.Results The positive rates were 73.33％ (alcohol fixation group,22/30),75.00％ (liquid-based cytology group,21/28) and 20.83％ (conventional cytology group,5/24),respectively.The positive rate of conventional cytology group was obviously lower than alcohol fixation group (x2 =21.525,P=0.000) and liquid-based cytology group (x2 =22.208,P =0.000) with statistical significance.But the positive rate of alcohol fixation group was similar to the liquid-based cytology group (x2 =0.683,P =0.898).In alcohol fixation group,the positive rate of 2-min group (88.24％,15/17) was significantly higher than the 5-min group (53.85％,7/13) with statistical significance (x2 =4.535,P =0.033).Conclusion Compared with conventional fixation,alcohol fixation and liquid-based cytology can improve positive diagnostic rate of brushing during ERCP.The alcohol fixation is more simple in procedure and low in cost than liquid-based cytology.The interval time between sampling and fixation should be reduced to no more than 2 minutes.

Objective To investigate the clinical and pathological characteristics of bacterial infectious diarrhea.Methods The clinical and pathological characteristics of 2380 cases of bacterial infectious diarrhea in Jinshan Hospital,Fudan University from 1998 to 2007 were analyzed retrospectively.Enumeration data were analyzed by X~2 test.Results Among the 20 169 patients who went to hospital because of diarrhea in 10 years,2380 cases fecal bacterial culture were positive,including Vibrio parahaemolyticus(2247 cases,94.4%),Shigella(99 cases,4.2%),Salmonella (29 cases,1.2%),Vibrio alginolyticus(3 cases),pathogenic Escherichia coli(2 cases).Patients with diarrhea were common from June to 0ctober in each year.The main manifestations of Vibrio parahaemolyticus infection were abdominal pain,diarrhea,nausea,vomit or dehydration.The main manifestations of Shigella infection were fever,abdominal pain and diarrhea.Conclusions The bacterial culture positive rate of stool samples from patients with bacterial infectious diarrhea is not high in Jinshan district.Shanghai.The major pathogens are Wbrio parahaemolyticus and Shigella.