In this paper,we study on turbidity-toxin from the connotation,the pathological characteristics and process of diabetes,and explored the relationship of type 2diabetes with abnormal lipid metabolism and lipid toxicity.We found that insulin resistance,apoptosis of Islet,cell and various complications caused by abnormal lipid metabolism and lipid toxicity had signifi cant correlation with the process of the generation and variation of turbidity-toxin:it was argued that blood turbidity and its subsequent toxin accumulation were the pathogenic basis of the formation,combing with the turbidity-toxin,phlegm and blood stasis,then various complications occurred.So it provided a good theoretical and practical foundation for further treatment of type 2 diabetes associated with abnormal lipid metabolism by removing turbidity and detoxication.

Objective To observe the therapeutic effect of tumor necrosis factor inhibitor (Etanercept) on intractable ankylosing spondylitis (AS) related hip joint lesion. Methods Thirty-five patients with AS with unilateral or bilateral hip joints pain and limitation of joint motion were included into this study. The patients' conditions were not controlled under standard treatment by non-steroidal anti-inflamma-tory drug and antirheumatic medications. The clinical trial was designed as a prospectiveopen study, 35 pati-ents received Etanercept 50 mg once a week for 12 weeks, combined with methotrexate (MTX) 10 mg once a week. Parameters including Harris hip score, Bath ankylosing spondylitis radiologic index-hip (BASRI-hip), Bath ankyiosing spondylitis disc.use activity index (BASDAI), Bath ankylosing spondylitis functional index (BASFI), Erythrocyte sedimentation rate (ESR), and C-reactive protein (CRP) were evaluated and side effects were observed before and after the treatment. Results Fifty-five hip joints were involved in 35 patients, in which unilateral hip involvement in 15 patients and bilateral in 20 patients. Harris score of the hips iner-eased significantly from 51±4 before treatment to 86±5 (P=0.000) after treatment ; Before and after treatment, BASDAI changed from 6.4±1.2 to 4.4±0.8 (P=0.000), BASFI was changed from 6.3±1.1 to 3.4±0.8 (P=0.000), before and after treatment ESR was changed from (68±28) mm/l h to (25±6) mm/l h (P=0.001), CRP changed from (59.1±22.3) mg/l, to (6.9±1.1) mg/L (P=0.000) before and after treatment respectively, but BASRI-hip was not changed obviously before and after treatment. No tuberculosis and serious side effects was observed during the treatment and follow-up period. Conclusion Etanercept, when combined with methotrexate, could be used to treatintractahle AS-related hip joint lesions. This regimen could improve the hip joint function and control the disease activity without serious side effects.

Objective:To investigate the rationality of off-label use of tacrolimus combined with Wuzhi capsules in a membranous nephropathy patient. Methods:Based on the related literatures, the application rationality of tacrolimus combined with Wuzhi capsules in a membranous nephropathy patient was analyzed. Results:The combination of tacrolimus and Wuzhi capsules against membranous nephropathy was an off -label drug use, however, it showed certain clinical rationality and economic efficiency. Conclusion:Off-label drug use commonly exists in clinics. Clinical pharmacists should provide evidence support for off-label drug use through searching and analyzing clinical evidences and closely monitoring therapeutic outcome.

Objective To investigate the resting?state functional alteration in posterior cingulate cortex ( PCC) in Type 2 diabetes ( T2DM) patients with cognitive impairment and to determine the relation?ship of rs?fMRI changes with cognitive decline. Methods Resting?state functional magnetic resonance ima?ging was performed T2DM patients with impaired cognition ( n=19) and healthy control subjects ( n=20) . The amplitude of low frequency fluctuations ( ALFF) and regional homogeneity ( ReHo) values were calcu?lated in left PCC to represent the spontaneous brain activity. Using left PCC as a seed region,the functional connectivity of the whole brain was mapped. In addition,correlation analysis was conducted among ALFF,Re?Ho,and neuropsychological test scores. Results The ALFF values of left PCC (0.72±0.37) was decreased compared with the control group(1.09±0.46),but the ReHo value(1.12±0.10)was not significantly changed compared with control group (1.14±0.11). The functional connectivity was decreased with the left medial temporal lobe,left superior and middle temporal gyrus,right superior frontal gyrus,and right supplementary motor area ( SMA) ,while it was increased with the left middle frontal gyrus,inferior frontal gyrus and right cerebella. MoCA scores were positively correlated with the ALFF values of left PCC. Conclusion In resting state,the spontaneous activity and functional connectivity of PCC is altered in T2DM patients with cognitive impairement;and the function of PCC contributes to the cognitive decline associated with T2DM.The decrease of ALFF value of PCC may help to detect the cognitive decline of T2DM.

Objective To investigate the characteristics and related risk factors associated with tuberculosis(TB) in patients with systemic lupus erythematosus (SLE) who received glucocorticoid and immunosuppressive therapy. Methods Among the 452 SLE patients underwent the treatment of glucocorticoid and immunosuppressive agent, the clinical data was reviewed and summarized retrospectively.Results 42 of 452(9.29% ) patients were diagnosed as TB infection. 11 patients (23.81% )had exudative pulmonary tuberculosis and 31 patients(73.81% ) had extra-plumonary TB. Statistics of the 31 patientsshowed that 8 patients( 19.05% ) had hematogenous disseminated pulmonary tuberculosis;6 (14.29%) had tuberculo-meningitis ;2 (4.76%) had thoracic cavity TB; 2 ( 4.76% ) had abdominal cavity TB; 1 ( 2.38% )had crewels ; 1 ( 2.38% ) had bone tuberculosis and 1 (2.38%) had nephronophthisis. The focus of infection was not found in 10 patients. Of all 42 patients with TB infection, 38 cases suffered form lupus nephritis, 40 with hypoalbuminosis, 10 with TB history, 14 had leucocytopenia or hyperglycaemia, respectively. The effect of antiTB therapy started up at least 7 days, or in 4 weeks as longest. 2 patients died of hematogenous disseminated pulmonary tuberculosis. Conclusion Under the treatment of glucocorticoid and immunosuppressive agent ,TB incidence in patients with SLE is obviously higher than that of common people.Extra-pulmonary rib and serious infection are more frequently. It is shown that those who had lupus nephritis or TB history are more susceptible to TB.

OBJCETIVE:To investigate the role of clinical pharmacists in medication reconciliation. METHODS:Totally 200 inpatients admitted or transferred to nephrology department of our hospital during Aug.-Oct. 2015 were selected. Within 48 h after admission,1-year medication history were collected by reviewing electronic medical records,consultation,querying self-prepared drugs and medical history;and then medication reconciliation was conducted by clinical pharmacists. RESULTS:Among drug lists collected by clinical pharmacists,there were 987 kinds of drugs,but only 9.63%(95 kinds) drugs were recorded in the medical records. There were 5 cases of ADR in total,and only 40.00% of them (2 cases) were recorded in the medical records. Among 200 patients,medication reconciliation was needed in 45 cases with reconciliation rate of 22.50%. Among 492 medical orders of 200 patients,medication errors were found in 103 medical orders;the number of medication errors per case was (2.3 ± 1.8), mainly including wrong dose,repeated medication,wrong solvent,drug interactions;the potential risk degree was mainly degree 1 (53 orders,51.46%). Among 103 medication reconciliation orders,main plans were drug withdrawal (78 cases,75.73%), followed by drug change(17 cases,16.50%)and drug supplement(8 cases,7.77%). A total of 90 reconciled medical orders were adopted by physicians,with success rate of 87.38%. CONCLUSIONS:Compared with physicians,clinical pharmacists can obtain more detailed and accurate drug list. It can reduce medication error and guarantee the safety of drug use to maximum extent that clinical pharmacists conduct medication reconciliation.

Objective To evaluate the role of extracellular signal-regulated kinase (ERK) signaling pathway in inhibition of oxygen-glucose deprivation and restoration (OGD/R)-induced apoptosis in rat cortical neurons by sevoflurane and the relationship with mitochondrial permeability transition pore (mPTP).Methods The rat cortical neurons were cultured in vitro and seeded in 6-well or 12-well culture plates.The neurons were randomly divided into 4 groups (n =18 each) using a random number table:control group (group C);OGD/R group (group O);sevoflurane group (group OS);sevoflurane + ERK1/2 inhibitor PD98059 group (group OSP).The neurons were subjected to O2-glucose deprivation for 90 min followed by restoration of O2-glucose supply for 24 h in group O.The neurons were incubated with 2％ sevoflurane for 2 h after OGD/R in group OS.OGD/R was performed at 1 h after ERK1/2 inhibitor PD98059 30 μmol/L was added,and the neurons were incubated with 2％ sevoflurane for 2 h after OGD/R in group OSP.At 24 h of restoration of O2-glucose supply,the expression of phosphorylated ERK1/2 (p-ERK1/2) in neurons was measured by Western blot,the neuronal apoptosis was detected using Annexin V-FITC/PI double staining combined with flow cytometry,and the opening of mPTP was determined through measuring the optical density at 540 nm.The apoptosis rate was calculated.Results Compared with group C,the expression of p-ERK1/2 in neurons was significantly up-regulated,and the apoptosis rate and mPTP opening were significantly increased in group O (P＜0.05).Compared with group O,the expression of p-ERK1/2 in neurons was significantly up-regulated,and the apoptosis rate and mPTP opening were significantly decreased in group OS (P＜0.05).Compared with group OS,the expression of p-ERK1/2 in neurons was significantly down-regulated,and the apoptosis rate and mPTP opening were significantly increased in group OSP (P＜0.05).Conclusion The mechanism by which sevoflurane inhibits OGD/R-induced apoptosis in rat cortical neurons is related to inhibition of mPTP opening after activation of ERK signaling pathway.

Objective:To investigate the content and mode of pharmaceutical care for the patients with severe burn and promote the rational use of drugs. Methods:Taking the treatment for one patient with severe burn as example,pharmacists provided pharmaceu-tical care in respects of anti-infection therapy,organ preservation,nutritional support, drug interactions, drug precautions, drug incom-patibility, adverse drug reactions and the effect evaluation . Results:The program of rational drug use was provided for clinics through the implementation of pharmaceutical care. The vital signs of the patient were stable, and then the patient left on pass and continued to be treated with rehabilitation therapy. Conclusion:It is necessary for clinical pharmacists to perform pharmaceutical care for the pa-tients with severe burn,reduce the abuse of drugs and improve the medication safety and effectiveness. Meanwhile, the collaborative service of doctors,pharmacists,nurses and inspectors to patients reflects the value of clinical pharmacists.

Objective To identify the accurate measurement of glomerular filtration rate (GFR) in chronic glomerulonephritis (CGN)patients. Methods Forty-two patients were enrolled in the study, including 15 females with age from 18 to 73 years old (mean 46 years old) and 27 males with age from 20 to 77 years old (mean 48 years old). The methods used for measuring GFR were classical dual plasma sample clearance method (tGFR), considered to be the gold standard,renal dynamic imaging method (dGFR), 24-hour creatinine clearance method (24hCcr). The difference and correlation amony them were analyzed. When the difference was significant, Pearson correlation and linear regression analysis were further performed. The difference of GFR detected by dGFR between left and right kidney of patients was compared simultaneously. A two-sided P value＜0.05 was considered as statistically significant. Results Either dGFR or 24hCcr was statistically different from tGFR, but had excellent correlation with tGFR, and the coefficient was 0.916 (P=0.000) and 0.957 (P=0.000) respectively. The linear regressions correlation existed and the regression equations were tGFR=0.936 dGFR-4.648 (F=208.941, P=0.000), tGFR =0.887 24hCcr+2.919 (F=376.513, P=0.000) respectively. Difference had not statistically significance between left and right kidney of patients (P=0.591). Conclusions Neither dGFR nor 24hCcr can substitute tGFR, but both can reflect the GFR of the CGN patients safely and effectively. The decrease of GFR is homochronous for left and right kidney of CGN patients. Therefore, the 24hCcr can be chosen to evaluate the GFR in the hospitals without SPECT.

OBJECTIVETo develop a GC-FID method for the determination of borneol concentration in rat plasma and to investigate the pharmacokinetics after injection of novel-Xingnaojing.

METHODNovel-Xingnaojing was injected via by caudal vein injection. The blood samples were collected by posterior orbital venous plexus approach at 0.5, 1, 3, 5, 8, 12, 20, 30, 45 min. The drug in plasma was extracted with ethyl acetate and then detected by GC-FID, octadecane was used as the internal standard. The pharmacokinetic parameters were calculated by the software of Kinetica.

RESULTThe calibration curve was good linear in the range of 1.67-16.67 mg x L(-1). The extraction recoveries of low, medium and high concentration were (92.81 +/- 1.11)%, (85.38 +/- 0.86)% and (84.58 +/- 0.58)%, respectivley. And the RSDs of within-day and between-day were below 3.00%. Plasma concentration of borneol was consistent with the two-compartment open model. The pharmacokinetic parameters were that the t1/2alpha was (1.18 +/- 0.20) min, the t1/2beta was (22.27 +/- 6.85) min, the C(max)(Calc) was (18.76 +/- 2.10) mg x L(-1), the MRT was (23.84 +/- 7.67) min(-1), and the AUC was (100.00 +/- 15.85) mg x min x L(-1).

CONCLUSIONThe GC-FID method developed can be applied to determination and pharmacokinetics. The borneol in novel-Xingnaojing is distributed and metabolized fast after being administrated.

Animals ; Bornanes ; pharmacokinetics ; Drugs, Chinese Herbal ; pharmacokinetics ; Flame Ionization ; methods ; Male ; Rats ; Rats, Sprague-Dawley