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.

Objective To evaluate the effect of remifentanil on cell apoptosis during renal ischemia-reperfusion (I/R) in rats.Methods Seventy-five male Sprague-Dawley rats,weighing 220-250 g,were randomly divided into 3 groups (n =25 each):sham operation group (group S),I/R group,and remifentanil group (group R).Renal ischemia was induced by occlusion of the bilateral renal arteries for 45 min followed by reperfusion in groups I/R and R.Remifentanil was infused at 1.0 μg· kg-1 · min-1 via the caudal vein starting from 15 min before ischemia until 30 min of reperfusion in group R,while the equal volume of normal saline was given instead of remifentanil in groups S and I/R.At 15 min before ischemia (T0) and 3,6,12,24 h of reperfusion (T1-4),5rats were anesthetized and sacrificed,and renal specimens were obtained to detect the apoptotic rate and expression of Bax and Bcl-2 protein (by flow cytometry) and mRNA (by RT-PCR).The ratios between Bcl-2/Bax protein and mRNA expression were calculated.The pathological changes of renal tubules were scored.Results Compared with group S,the pathological scores and apoptotic rate were significantly increased at T1-4,and ratios between Bcl-2/Bax protein and mRNA expression were increased at T1,2,while decreased at T3,4 in groups R and I/R (P ＜0.01).Compared with group I/R,the pathological scores and apoptotic rate were significantly decreased at T1-4,while the ratios between Bcl-2/Bax protein and mRNA expression were increased in group R (P ＜ 0.05 or 0.01).Compared with the baseline value at T0,the pathological scores and apoptotic rates were significantly increased at T1 4,and the ratios of Bcl-2/Bax protein and mRNA expression were increased at T1,2,while decreased at T3,4 in groups R and I/R (P ＜ 0.01).Conclusion Regulation of Bcl-2/Bax expression and inhibition of cell apoptosis in renal tissues are involved in the mechanism by which remifentanil reduces renal I/R injury in rats.

Aim To investigate the effect of Jinlida on cholesterol-related genes in skeletal muscle in fat-in-duced insulin resistance ApoE-/ - mice. Methods Ten male C57 BL/6 J mice were selected as normal group ( NF );50 male ApoE-/ - mice with a high-fat feeding after 16 weeks ( HF) were divided into model group, rosiglitazone ( LGLT ) , Jinlida low dose group ( JLDL, 0. 95 g · kg-1 · d-1 ) , Jinlida medium dose group ( JLDM, 1. 9 g·kg-1 ·d-1 ) , Jinlida high dose group (JLDH, 3. 8 g·kg-1·d-1), which were per-formed intragastric administration for 8 weeks. Oil red O staining of mouse skeletal muscle was used for fat ac-cumulation. Insulin receptor ( INSR) , insulin receptor body substrate-1 ( IRS-1 ) , low-density lipoprotein re-ceptor ( LDLR ) , cholesterol sensor ( SCAP ) mRNA and protein expression in mouse skeletal muscle were measured by quantitative reverse transcription PCR ( RT-PCR ) and Western blot. Results Compared with NF group, fasting blood glucose ( FBG) , choles-terol ( TC ) , triglyceride ( TG ) and low density lipo-protein cholesterol ( LDL-C ) of HF mice were signifi-cantly elevated, while high-density lipoprotein ( HDL-C ) significantly decreased ( P < 0. 05 ) . Compared with HF group, Jinlida group could reduce to varying degrees FBG, TC, TG and LDL-C in mice, and in-crease HDL-C ( P <0. 05 ) . Jinlida could downgrade fasting serum insulin ( FINS ) level, and improve the insulin sensitive index ( ISI ) ( P < 0. 05 ) . Jinlida could obviously improve skeletal muscle fat accumula-tion of mice. Compared with NF group, skeletal mus-cle INSR, IRS-1, LDLR mRNA and protein levels of HF group were significantly decreased ( P <0. 05 ) , while SCAP mRNA and protein level increased signifi-cantly (P<0. 05). Compared with HF group, Jinlida could increase to varying degrees INSR, IRS-1, LDLR mRNA and protein levels ( P < 0. 05 ) , and lower SCAP mRNA and protein levels ( P<0. 05 ) . Conclu-sion Jinlida can alleviate fat-induced insulin resist-ance in ApoE-/ - mice through regulation of cholester-ol-related gene expression.

Objective To determine the optimum dose of dexmedetomidine administered locally through evaluating the effects of different doses of dexmedetomidine on the median effective concentration (EC50) of ropivacaine for brachial plexus block.Methods American Society of Anesthesiologists physical status Ⅰ or Ⅱ patients of both sexes, aged 19-50 yr, weighing 50-80 kg, scheduled for elective ulna and radius fracture open reduction and internal fixation, requiring ultrasound-guided axillary brachial plexus block, were randomly assigned into 4 groups using a random number table: control group (group C) and dexmedetomidine 0.4, 0.6 and 0.8 μg/kg groups (D1 , D2 and D3 groups).Axillary brachial plexus block was performed only with ropivacaine in group C.In D1-3 groups, axillary brachial plexus block was performed with the mixture of ropivacaine and dexmedetomidine 0.4, 0.6 and 0.8 μg/kg, respectively.The effective block was defined as complete loss of pain sensation in the areas innervated by the brachial plexus.The volume of local anesthetics was 40 ml.The concentration of ropivacaine was determined by up-and-down technique.The initial concentration was 0.4％ and the ratio between the two successive concentrations was 1.0.If the block was effective, the next patient received a lower dose of ropivacaine;or conversely if ineffective, a higher dose was given in the next patient.At least 7 independent crossover pairs were observed in each group.The EC50 of ropivacaine was the mean of the concentration of ropivacaine of each crossover pair.The occurrence of brachial plexus block-related adverse events, adverse cardiovascular events and over-sedation was recorded.Results In C, D1, D2 and D3 groups, 20, 22, 24 and 19 patientswere enrolled, respectively.Compared with group C, the EC50 of ropivacaine was significantly decreased in D2 and D3 groups, and no significant change in the EC50 of ropivacaine was found in group D1.No patients developed adverse events in group D1.The incidence of bradycardia was 17％, but it was transient in group D2.In group D3, the incidence of bradycardia and hypotension was 58％ and 32％, respectively, and they required special treatment, and the incidence of over-sedation was 10％.Conclusion The optimum dose of dexmedetomidine is 0.6 μg/kg when mixed with ropivacaine for brachial plexus block.

Objective To explore impact of BMI on the clinical efficacy of treatment of type 2 diabetes mellitus after the laparoscopic gastric bypass. Methods Twenty patients were randomly selected from type 2 diabetes mellitus patients with BMI of 25 ~28 kg/m2 after laparoscopic gastric bypass surgery in our hospital from 2010 to 2013,20 patients from type 2 diabetes mellitus patients with BMI of 28~35 kg/m2 and 20 patients from type 2 diabetes mellitus patients with BMI≥35 kg/m2 . Accordingly,the total of 60 patients were divided into low BMI group,middle BMI group and high BMI group. The difference of the rate of blood glucose control and other indicators between three groups were compared and analyzed. Results The rate of blood glucose control in low BMI group was 75%,middle BMI group was 85%, and high BMI group was 90%. There was no statistical difference of the rate of blood glucose control between three groups at 12 months after laparoscopic gastric bypass surgery. The blood glucose and weight obviously improved in all patients,and fasting insulin and postprandial ser-um insulin decreased at 12 months after laparoscopic gastric bypass surgery. Conclusion All the patient of type 2 diabetes mellitus with dif-ferent BMI in three group can acquire satisfying clinical therapeutic effect after the laparoscopic gastric bypass.

Objective To investigate the fine management in the role of infection control management and the effect evaluation in pharmacy intravenous admixture services. Methods From July 2013 to June 2016, infection control management were reviewed retrospectively in pharmacy intravenous admixture services:routine management (from July 2013 to December 2014) and fine management (from January 2015 to June 2016). The settlement of air bacteria formation rate, hand hygiene compliance and accuracy of drug-care workers, and worker′s hand colonization monitoring data before and after the fine management were compared. Results After the implementation of fine management, the settlement of air bacteria formation rate was reduced from 10.42%(120.0/1152) to 4.45%(51.3/1152); there was significant differences (t=3.417, P<0.01).The hand hygiene compliance of drug-care workers increased from 81.50%(1172/1438) to 95.56%(1314/1375), the difference was statistically significant (χ2=1.353, P<0.01);the accuracy rate increased from 86.09%(1109/1172) to 95.13%(1250/1314), the difference was statistically significant (χ2=60.975, P<0.01); workers′ hands colonies number after fine management decreased than before, and there was significant differences (χ2=41.163, P<0.01). Conclusions The fine management has a higher application value in the infection control management of pharmacy intravenous admixture services, which can reduce the settlement of air bacteria formation rate, workers′ hands colonies number, improve hand hygiene compliance and accuracy of drug-care workers, further standardize the worker′s behavior, provide a more secure configuration environment, and guarantee the quality of drug configuration.

OBJECTIVE：To explore the key factors affecting the sustainable development of pharmacy intravenous admixture service（PIVAS），and to provide theoretical basis for the healthy development of PIVAS. METHODS ：Retrieved from PubMed ， CNKI，Wanfang database and VIP ，literatures related to the development of PIVAS. Combining with the actual operation and development of PIVAS in China in recent 20 years，based on actual experience of PIVAS in our hospital in recent 10 years，the key factors affecting the sustainable development of PIVAS were analyzed by retrospective method from five aspects ，i.e. drug management，quality control ，pharmacists’professional quality improvement ，pharmaceutical care extension ，cost and benefit. RESULTS & CONCLUSIONS ：The key elements of PIVAS drug management included drug inventory ，expiration date ，daily inventory，high-warning drug ，drug damage ，slack demand of drug and drug shortage. The key elements of PIVAS quality control included personnel quality control ，environment quality control and quality control of finished infusion. Improving the professional ability and communication service ability of pharmacists were the key factors to improve the professional quality of pharmacists. The establishment and application of medication order review and accurate flushing database based on PIVAS prescription audit system，professional drug consultation and clinical education ，whole pharmaceutical care of cytotoxic drugs and PIVAS adverse drug reaction monitoring were the key elements of pharmaceutical service extension. It can promote the sustainable and healthy development of PIVAS to improve pharmacists ’professional ability and communication ability ，strictly drug management and quality control ，continously extend pharmaceutical care ，improve professional influence and expand social influence and formulate reasonable charging mechanism.

【Objective】 To study the distribution and haplotype polymorphism of HLA-A, -B, -C, -DRB1, -DQB1 alleles in Anhui Han population. 【Methods】 The HLA-A, -B, -C, -DRB1 and -DQB1 genotyping of 3 169 random unrelated stem cell donors was performed by PCR-SBT. The allele frequency, haplotype frequency and linkage imbalance parameters were calculated by counting method, maximum expectation algorithm and PyPop software. 【Results】 A total of 411 HLA alleles were detected in the population, of which 67, 143, 65, 75 and 64 alleles were detected for HLA-A, -B, -C, -DRB1 and -DQB1, respectively. The alleles with frequency >0.1 were HLA-A^*11∶01, A^*11∶01, A^*24∶02, A^*02∶01, C^*01∶02, C^*07∶02, C^*06∶02, DRB1^*09∶01, DRB1^*15∶01, DRB1^*07∶01, DQB1^* 03∶01, DQB1^* 03∶03, and DQB1^*02∶01. 1426 HLA-A~HLA-B, 1 772 HLA-B~HLA-DRB1, 798 HLA-B~HLA-C, and 446 HLA-DRB1~HLA-DQB1 haplotypes were detected. The haplotypes showed linkage imbalance, and 19 of them showed strong linkage imbalance (RLD>0.80). 【Conclusion】 The frequency and haplotype distribution of HLA-A, -B, -C, -DRB1 and -DQB1 alleles in Anhui Han population were obtained. The distribution of those alleles and haplotypes have their own characteristics.