OBJECTIVE:To investigate the status of the use of angiotensin Ⅱ receptor blocker(ARB)in the outpatient of our hospital,and provide reference for the clinical rational drug use. METHODS:Totally 2 460 prescriptions of hypertension treated by ARB drugs in the outpatient of our hospital in 2013 were statistically collected,and the use of such drugs were comprehensively an-alyzed. RESULTS:The ratio of ARB in the treatment of hypertension in the outpatient of our hospital in 2013 was 36.22%,and the common ARB drugs were Irbesartan tablets,Irbesartan and hydrochlorothiazide tablets,Valsartan capsules and Telmisartan tab-lets. The prescriptions of hypertension in our hospital were mostly two-drug combination,the common combination of ARB drugs were ARB+calcium channel blocker(CCB)and ARB+potassium-sparing diuretics;the three-drug combination of ARB drugs were ARB+β-receptor blockers (β-RB)+CCB and ARB+CCB+potassium-sparing diuretics. Among 2 460 prescriptions of hypertension treated by ARB drugs,1 103 prescriptions were irrational,accounting for 44.84%;77 prescriptions were ARB combined with po-tassium-sparing diuretics with no clear indication,accounting for 6.98%;39 prescriptions were ARB combined with ACEI with no clear indication,accounting for 3.54%;330 prescriptions were ARB combined with β-RB with no clear indication,accounting for 29.92%;617 prescriptions had inappropriate frequency of ARB use,accounting for 55.94%;and 40 prescriptions were other irra-tional use,accounting for 3.63%. CONCLUSIONS:ARB drugs are commonly used for hypertension patients in outpatient of our hospital. However,there are still many problems of irrational use in clinical treatment. Therefore,hospital should take appropriate interventions to promote the rational drug use through the joint efforts of physicians,pharmacists and hospitals.

Objective To investigate the blood conservation techniques during orthotopic liver transplantation(OLT). Methods Thirty-eight patients undergoing OLT without veno-venous bypass under general anesthesia were studied. During operation, the blood conservation measures such as controlled blood loss and blood coagulation, etc. were implemented. The input and output of liquid, blood component transfusion in preanhepatic, anhepatic and reperfusion phases was analyzed. The blood samples from central vein were collected, plasma creatinine, hemoglobin and albumin were determined after anesthesia, 1 h after preanhepatic phase, 20 min after anhepatic phase and 1 h after reperfusion phase, and the central venous pressure and Sonoclot data were measured.Results The total volume of whole blood transfusion was about ( 816? 86.3) ml and that of red blood cells ( 962? 55.3) ml during operation. Two patients had no blood transfusion. The normal urinary output was maintained during preanhepatic, anhepatic and reperfusion phases. The central venous pressure at three phases was significantly decreased compared to that after anesthesia (P 0.05). The plasma creatinine was significantly increased at reperfusion phase (P

Objective To observe the effect of drug pairs of extracts from Rhizoma Chuanxiong(RC)and Radix Paeoniae Rubra(RPR)in different proportions on promoting blood circulation and removing blood stasis in rats and to find the optimal proportion between the two extracts.Methods The Wistar rat models of blood stasis were established by injection of adrenalin.The changes of the platelet aggregation and adhesiveness and erythrocyte aggregation were observed.Results Blood vessel contraction increased,the platelet aggregation and erythrocyte aggregation increased,erythrocyte deformation occurred and the blood viscosity increased in the model rats.The drug pairs could reduce blood viscosity,ameliorate erythrocyte ability of deformation,reduce erythrocyte aggregation and inhibit platelet aggregation.The effects were obvious especially in the groups of RC and RPR in the proportions of 0.45 g to 0.45 g,0.21 g to 0.45 g.Conclusion The drug couples from RC and RPR in different proportions could improve the blood rheology,the effect being obvious in the groups of RC and RPR in the proportions of 0.45 g to 0.45 g,0.21 g to 0.45 g.

BACKROUND:Corneal hemangiogenesis occurs in 40%-60%patients after keratoplasty.Blood vessel is one of the high risk factors for corneal immunological rejection.To inhibit corneal hemangiogenesis would prolong the survival time of the grafts and promote the successful rate of the keratoplasty.OBJECTIVE:To explore the inhibitive effects of doxycycline on corneal angiogenesis after keratoplasty.DESIGN,TIME AND SETTING:A randomized controlled animal experiment was performed at the State Key Laboratory of Ophthalmology(No.2006DA105054),Zhongshan Ophthalmic Center,Sun Yat-sen University from March to August 2007.MATERIALS:A total of 48 healthy dean Sprague Dawley rats served as recipients(right eye)and 24 Wistar rats as donors(both eyes).CD31-PEfluorescent antibody was obtained from Sigma,USA.Sandwich enzyme-linked immunosorbent assay(ELISA)kit for vascular endothelial growth factor(VEGF)was brought from RapidBio,USA.METHODS:Corneal allogenic transplantation models were established in rats.Recipients were equally and randomly divided into 2 groups:saline control group and doxycycline group.Twenty minutes prior to surgery,mydriasis was performed using 1%atropine,with a diameter of 2.75 mm of implant and 2.5 mm of implant bed.In the saline control group,conjunctiva of the right eye received saline,three times a day,following surgery.In the doxycycline group,conjunctiva of the right eye received 1%doxycycline,three times a day,till 30 days following surgery.MAIN OUTCOME MEASURES:The following parameters were measured:corneal angiogenesis using immunofluorescence,expression of VEGF protein by using ELISA.RESULTS:Compared with the survival time of saline control group[(9.67±2.73)days],the mean survival time of doxycycline group[(20.67±3.01)days]was significantly prolonged(P＜0.01).The mean percentages of neovascularized corneal area in the saline control group were(4.00±1.00)%,(14.33±4.04)%,(31.33±3.51)%at 3,7 and 14 days after keratoplasty,respectively.The mean percentages of neovascularized corneal area in the doxycycline group were(1.67±1.15)%,(4.67±1.53)%,(18.33±1.53)%at the same time point respectively.Compared with the saline control group,the mean percentages of neovascularized corneal area of the doxycycline group was significantly reduced at 7 and 14 days after keratoplasty(P ＜0.05).The expression of VEGF in the saline control group was(541.00±75.44)pg/mg,(960.00±90.14)pg/mg,(976.00±130.41)pg/mg at 3,7 and 14 days after keratoplasty,respectively,while expression of VEGF in the doxycycline group was(115.33±9.29)pg/mg,(239.00±41.62)pg/mg,(361.00±65.20)pg/mg,respectively.The difference of VEGF expression at all time points between the two groups was significant (P＜0.05).CONCLUSION:Doxycycline has a significant effect in inhibiting corneal angiogenesis and prolonging survival time of implants after keratoplasty.

BACKGROUND: Cervical lymph nodes are draining region of cornea. It is believed that aqueous fluid goes through a minor pathway named uveoscleral drainage, which will allow passage of antigen-presenting cells (APC) directly to the draining lymph nodes and induce allograft rejection after keratoplasty.OBJECTIVE: To explore the inhibitory effects of cervical lymphadenectomy in alkali induced high-risk corneal transplantation.DESIGN: A randomized controlled animal experiment.SETTING: State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University.MATERIALS: The experiment was performed in the State Key Laboratory of Ophthalmology (No. 2006DA105054), Zhongshan Ophthalmic Center, Sun Yat-sen University from May 2005 to February 2007. 144 male animals (1-2 months old) including 104 SD rats and 40 Wistar rats were provided by the animal experimental center of Sun Yat-sen University. Sandwich enzyme-linked immunosorbent assay (ELISA) kits for interleukin-2 (IL-2) and interferon-γ (IFN-γ) were brought from BioSource International company (USA). The animal treatment in the experiment was accorded with the statement in Association for Research in Vision and Ophthalmology (ARVO) for animals.METHODS: With the SD rats as recipients, and Wistar rats as donors, all rats were subjected to corneal allografting. The recipient rats were randomly divided into 4 groups (n=20): group A (control group) which underwent corneal transplantation; group B which was subjected to bilateral cervical lymphadenectomy; group C, corneal transplantation 21 days after the alkali burn injury; group D, cervical lymphadenectomy following group C. The immune rejection of grafts was evaluated by detecting the expression of IFN-γ and IL-2 using ELISA. The time when allograft rejection occurred was recorded and mean survival time (MST) was compared among the groups. The development of corneal inflammation and new vessels was examined by slit lamp microscope and histopathological examination.MAIN OUTCOME MEASURES: ①The development of corneal inflammation after corneal alkaline burns. ②MST of rats in each group following transplant. ③The expression of IL-2 and IFN-γ in grafts of each group. RESULTS: ①Normal rat cornea was transparent without inflammation or neovascularization. There were many inflammatory cells invading to stroma on day 3 after burn. Then, the inflammation of cornea resolved gradually 3 weeks after the burn, but corneal neovascularization reached the peak at that time. Corneal blood vessels regressed completely at the end of 8 weeks after the burn. ②The MST of group A, B, C, and D was (10.40±1.14), (46.30±9.46), (7.00±1.58), and (15.00±3.39) days, respectively. Compared with the group A, the MST of group B was significantly longer (P < 0.05), and the MST of grafts in group D was also significantly longer than group C (P < 0.05). ③The expression of IFN-γ and IL-2 proteins was absent in group B. Compared with group C, the expression of IL-2 and IFN-γ proteins in group D significantly decreased on days 3, 7, 10, and 14 after keratoplasty (P < 0.05). CONCLUSION: Cervical lymphadenectomy therapy can effectively inhibit corneal allograft rejection in normal and high-risk corneal beds after alkali burn injury.

Objective To investigate the effect of Treg cells and Th17 cells on the pathogenesis of SLE in patients with SLE,by detecting levels of serum IL-10 and IL-17 in patients with systemic lupus erythematosus (SLE).Methods Selected 54 patients with SLE diagnosed in Suzhou Municipal Hospital Affiliated to Nanjing Medical University from July 2013 to July 2015 as subjects,and 19 healthy persons were selected as control group.Using double antibody sandwich method (ELISA) to detect the levels of IL-10 and IL-17 in two groups.Using indirect immunofluorescence and western blot method to detect ANA,dsDNA,RNP,Sm,SSA and SSB in patients with SLE.Then compared and correlation analysed the level of IL-10 and IL-17,the levels of IL-10 and IL-17 in ANA,RNP,Sm,SSA and dsDNA groups were analyzed simultaneously.Results The level of IL-10 and IL-17 in SLE were 63.7±89.0 pg/ml and 87.7±123.0 pg/ml,and control group were 20.8±8.9 pg/ml and 18.5 ± 111.6 pg/ml,with the statistically significant difference (trL10 =3.484,tIL-17 =4.076,P＜0.01).The level of positive group in SLE were 176.5±93.2 pg/ml and 237.2±107.5 pg/ml,and negative group were 16.2±5.7 pg/ml and 12.9 ±8.3 pg/ml,with the statistically significant difference (tIL-10 =6.875,tIL-17 =8.843,P＜0.01).The level of IL-10 was positively correlated with IL-17 level in SLE (r=0.96,P＜0.05).The level of IL-10 and IL-17 in ANA high titer group were 91.8±100.8 pg/ml and 135.5±140.9 pg/ml,ANA low titer group were 44.5±76.7 pg/ml and 54.4±98.5 pg/ml,with the statistically significant difference (tIL10 =2.215,tIL-17 =2.345,P＜0.05).The level of IL-10 and IL-17 in anti ds-DNA antibody positive group were 87.1 ± 101.1 pg/ml and 122.4 ± 137.1 pg/ml,negative group were 27.4± 50.1 pg/ml and 28.6 ± 61.6 pg/ml,with the statistically significant difference (tIL-10 =2.904,tIL-17 =3.443,P＜0.05).Conclusion The levels of IL-10 and IL-17 were significantly increased and there was positive correlation.It was explained that the anti-inflammatory and pro-inflammatory response existing at the same time in SLE patients and Treg cell and Th17 cell may also play an important role in the occurrence and development in SLE.

To investigate collagen protein expressions in ischemic myocardium of rats with acute myocardial infarction (AMI) and the effects of qi-tonifying, yin-tonifying and blood-activating herbs and detoxifying and blood-activating herbs.

To observe the D-dimer levels and the numbers of micro-embolic signals (MES) in atrial fibrillation patients with different thromboembolic risk scores. A total of 216 persistent atrial patients were classified according to their different scores with a range of 0 -6.They were also divided into two groups by ≥2 or ＜ 2 according to the CardiacFailure,Hypertension,Age,Diabetes,Stroke 2 (CHADS2) point system.D-dimer levels and the numbers of MES were detected in all patients.A rising trend of D-dimer level and the number of MES was observed with the increases of CHADS2 score. D-dimer level and the number of MES in group 0 or 1 score were significantly lower than those in other high score groups (P ＜ 0.05).And the number of MES in group 5 or 6 score was significantly higher than those in other low score groups (P ＜ 0.05).D-dimer level and the number of MES in the group of ≥ 2 score were significantly higher than those in group ＜ 2 score ( P ＜ 0.01 ).It suggests that D-dimer level and the nunber of MES may reflect the thromboembolic risks in atrial fibrillation patients.

Objective To investigate the appropriate cross-matching methods for the direct antiglobulin test (DAT)positive patients.Methods The DAT was used to screen the irregular antibodies on the surface of erythrocytes.The microcolumn gel test was used for blood identification.The antiglobulin test and manual polybrene test were used for cross-matching.Re-sults A total of five DAT positive cases were collected in study.The blood groups of each case were detected,including A-DCcEe,O-DCCee,O-DCcee,A-DCCee and A-DCcee.The donor samples with corresponding blood-antigen negative were cho-sen for cross-matching,and the agglutination intensity of each cross-matching tube was weaker than the control.The transfu-sion of washed red blood cells was suggested.Finally,each transfusion was safe and efficient.Conclusion The infusion of the washed red blood cells with corresponding blood-antigen negative could efficiently ensure the safety of blood transfusion.

Objective To investigate the reliability of intramyocardial electrogram (IMEG) in monitoring acute rejection after human heart transplantation. Methods From June 2004 to March 2009, 32 patients underwent orthotopic heart transplantations. During the operation telemetric pacemakers were placed under the skin of the body with connected bipolar electrodes implanted into epimyocardium. Postoperative IMEGs, including the autonomous IMEG and ventricular evoked response (VER) were recorded routinely. The endomyocardium biopsy (EMB) was taken routinely and performed once again when positive IMEG results or other positive signs were observed. Results Totally 523 IMEGs has been produced, 41 of VERs were recorded together with autonomous IMEGs and EMBs, in which 17 EMB specimens were confirmed positive and 24 negative. AUC of QRS was 0.7537, Se was 88.24%, Sp was 62. 50%; AUC of Tslew was 0. 9081, Se was 94. 12%, Sp was 87. 50%. QRS and Tslew had significant difference in AUC of ROC, with x2 = 4. 22, P＜0. 05; AUC of combined diagnostic index (positive when either QRS or Tslew is positive and negative when both values are negative) was 0. 7917, Se was 100.00%, Sp was 58. 33%. Conclusion QRS amplitude of the autonomous IMEGs, Tslew of VERs and combined diagnostic index are reliable indexes for monitoring acute allograft rejection after human heart transplantation. Furthermore, Tslew has a better prognostic value than QRS.