OBJECTIVE:To explore the ward round model of clinical pharmacists.METHODS:The ward round model of clinical pharmacists was designed and explored based on clinical practice.RESULTS & CONCLUSION:Clinical pharmacists can engage in ward rounds either in cooperation with physicians or alone in special department,or by targeting at those patients using certain drugs.Each model has its distinctive characteristics and clinical pharmacists can choose suitable model based on their own level as well as the conditions in software,hardware and environment so as to facilitate rational administration.

Objective Clinical parenteral nutrition( PN) support still lacks in standards on some degree .This paper was to analyze the clinical application of PN support in our hospital in order to provide the basis for clinical rational drug use . Methods Random weighting method was applied to collect 5% hospitalized patients′information from each patient unit each month from April 2012 to March 2013 in Nanjing Gerneral Hospital of Nanjing Military Region .NRS-2002 nutrition risk screening was applied to eval-uate whether the patient needed PN support .Statistical analysis were carried out on patients supported with parenteral nutrition from department distribution, PN detailed components and distribution intervals of aII in one admixture non-protein calorie and nitrogen ra-tio. Results According to the survey, 393 patients had received PN support, including 217 cases′NRS score <3 and 176 cases′NRS score ≥3.General surgery department ranked the first in the cases of usingall in oneadmixture support.Among 133 cases receiving all in one admixture support, the course of 37 cases(27.82%) <7 d.The aII in one admixture non-protein calorie and ni-trogen ratio(100~150∶1) only took up 28.57%. Conclusion Although PN has got wide application in clinical departments, the rationality of prescription should be strengthened .Pharmacists should help doctors set up appropriate prescription from the aspect of pharmacy.

Objective To approach the clinical value of ultrasound-guided percutaneous transhepatic cholangiographic drainage (PTCD) in the treatment of malignant obstructive jaundice.Methods Twenty-five patients with malignant obstructive jaundice were treated with uhrasound-guided PTCD,and the therapeutic effect and complications were observed.Results All the patients were successfully punctured,and the successful rate of single puncture was 92.00% (23/25) .Jaundice of all the patients decreased 3 to 6 days after PTCD.The serum total bilirubin and the inner diameter of intrahepatic ducts decreased after PTCD.The complications included bile exudation and slight bloody bile (either 1 patient) .Conclusion Ultrasound-guided PTCD is a simple,safe and effective way to reduce jaundice,and can be regarded as the first choice in the treatment of malignant obstructive iaundice.

Objective To investigate the expressions of apoptosis associated protein 3 (APR3) and nuclear factor 3 of activated T-cell (NFAT3) in the tissue of epithelial ovarian tumors and its correlation with the clinicopathological features.Methods 92 patients with epithelial ovarian tumor were collected,23 cases with malignant tumor,24 cases with borderline tumor,45 cases with benign tumor.The expressions of APR3 and NFAT3 were detected by immunohistochemical methods,and the differences of different types of epithelial ovarian tumor were compared.The correlation of the expressions of APR3 and NFAT3 with the clinicopathological features of epithelial ovarian tumor was analyzed.The correlation of the expressions of APR3 with the expressions of NFAT3 in epithelial ovarian tumor was analyzed.Results The positive expression rate of APR3 in patients with malignant epithelial ovarian tumors (78.26％) was significantly higher than borderline tumors (41.67 ％) and benign tumors (22.22 ％),the differences were statistically significant (x2 =5.864,7.632,all P ＜ 0.05).The expression of APR3 in patients with malignant epithelial ovarian tumors was significantly correlated with differentiation,clinical stage,lymph node and abdominal organs metastasis and ascites (x2 =7.425,7.262,8.421,5.031,all P ＜ 0.05).The positive expression rate of NFAT3 in patients with malignant epithelial ovarian tumors (56.52％) was significantly higher than borderline tumors (29.17％) and benign tumors(17.78％),the differences were statistically significant (x2 =6.829,7.547,all P ＜0.05).The expression of NFAT3 in patients with malignant epithelial ovarian tumors was significantly correlated with differentiation,clinical stage,lymph node and abdominal organs metastasis (x2 =5.253,6.367,8.021,all P ＜ 0.05).The expressions of APR3 and NFAT3 in patients with malignant epithelial ovarian tumors were positively correlated (r =0.032,P ＜ 0.05).Conclusion The expressions of APR3 and NFAT3 in the tissue of malignant epithelial ovarian tumor obviously increase,are significantly correlated with differentiation,clinical stage,lymph node and abdominal organs metastasis and are positively correlated,and it may be correlated with the development and progression of malignant epithelial ovarian tumor.

12.08g herbs/kg.The overall effective rate for coronary heart disease was86.8%.CONCLUSION:Danzhisuxin capsule is appropriate in formulation and feasible in preparation technique.The method of quality control is reli?able.No toxic reactions were found and the clinical effect was satisfactory.

Objective To investigate the clinical characteristics of methylmalonic academia in adolescence cases. Methods 4 cases were diagnosed methylmalonic academia by gas chromatography- masss pectrogram whose clinical, manifestations and treatment process were analyzed. Results The main clinical manifestations in 4 cases with methylmalonic academia were intellect impairment,epilepsy, pyramid signs; 2 of them suffered with hypopsia and optic atrophy, one of them suffered with papilledema. Symptoms were improved after treated with cobamamide and L-carnitine in all the 4 cases 1 months later. Conclusions The main clinical characteristics of methylmalonic academia in adolescence were intellect impairment, epilepsy and pyramid signs. The symptoms could be improved after treatment.

Objective To investigate the prenatal emotional disorder of the primipame and the related factors,and to analyze its influence on the delivery mode.Methods In the prospective cohort study,590 healthy primiparase were asked to complete a self-compiled questionnaires for their general social mental state,state-trait anxiety inventory(STAI)and self-rating depression scale(SDS).Results Questionnaires of 159 patients were selected and these patients were divided into the anxiety group(114 cases)and the control group(455 cases),the depression group(159 cases)and the control group(410 cases).The ratio of selective cesarean section in the anxiety group was significantly higher(45.61%,32.53%,X2=6.85,P＜0.01),while the successful trial of labor were less than that of the control group(19.35%,47.88%,X2=26.30,P＜0.01).The ratio of selective cesarean section in the depression group was significandy higher than that of the control group(46.54%,31.95%,X2=10.21,P＜0.01),while the successful trial of labor were less than that of the control group(31.76%.46.59%,X2=9.13,P＜0.01).Single-factor analysis showed that prenatal anxiety related to the following factors:fear of childbirth,worried about their children,knowledge for childbirth,high economic status,maternal age and their own economic situation.Conclusions Higher incidence and risk factors of anxiety or depression before delivery,such as advanced delivery age,bad economic condition,weak family support,worrying about the safety of babies and themselves,are found in our study.Prenatal emotional disorder would affect the quality of labor and delivery options,and lead the high risk of cesarean section.

Objective To evaluate the feasibility of an in-room automated volumetric arc therapy (VMAT) planning engine based on dose volume histogram (DVH) prediction model in RayStation treatment planning system.Methods A total of 4,0 VMAT plans of cervix cancer,planned by experts,were chosen to build DVH estimation model by principal component regression analytic method.An in-room automated VMAT planning program based on IroPython scripting language combined with DVH prediction model was performed in RayStation treatment planning system.The DVH estimation model was applied to Another 10 testing cases of cervical cancer and the feasibility was evaluated by comparing the automatic plans with manual plans.Results The predicted DVH of organs at risk showed a good fit with real DVH in the ten testing cases.There were no statistically significant differences between manual and automatic plans in PTV conformal index (CI) and homogeneity index (HI) (P ＞ O.05).V40 and V50 of bladder were significantly decreased by 4.3％ and 1.6％ in automatic plans (t =2.75,5.26,P ＜ 0.05).V30,V40 and Vs0 of rectum were also decreased by 6.8％,5.8 ％ and 2.1％ (t =2.26,3.55,5.19,P ＜ 0.05).Both left and right femoral heads were better spared in automatic plans with average doses decreased by 380 and 322 cGy(t =5.55,7.25,P ＜ 0.05).The time of creating a treatment plan was 36 min for automatic plan and 53 min for manual plan.Conclusions The fully automated VMAT treatment plan program can create a VMAT plan of cervix cancer with high efficiency and good quality.

Objective To investigate the relationship between resting heart rate (RHR)and carotid artery structure in young hypertensive patients.Methods A total of 663 primary hypertensive patients aged between 18 and 45 (38.01 ± 5.78) were chosen from the First Affiliated Hospital of Xinjiang Medical University from January,2009 to January,2012.Patients under this study were divided into three groups according to their RHRs:group A (RHR＜70 bpm,n=163),group B(70 bpm≤RHR＜80 bpm,n=268),group C (RHR≥80 bpm,n=232).Data on bilateral carotid artery intima-media thickness,common carotid artery diameter were detected by carotid ultra-sonography.Indexes of carotid artery were analyzed by both variance and bi-variate correlation analysis.Results 1)Differences in the blood pressure among three groups showed statistical significance (P＜0.01),with diastolic pressure in group A higher than in group B (P＜0.05),while both systolic and diastolic pressure in group C higher than in group B (P＜0.01).2)In group A,the right carotid artery diameter was higher than in group C(P＜0.05) and the left carotid artery diameter higher than in group B(P＜ 0.05) with the left carotid artery diameter higher than in group C (P＜0.05).3) Significant positive correlations were found between RHR and blood pressure (r =0.112,0.118) and negative correlation between RHR and left carotid artery diameter (r=-0.89).However,correlation between RHR and right carotid artery diameter was not significant (r=-0.075,P=0.068).Conclusion When blood pressure had an increase,we found that the carotid artery diameter was decreasing along with the increasing RHR among the young hypertensive patients.

Objective To reduce the dose to organ at risk ( OAR) by script-based optimizing the gantry angles of tangential beams for forward-planned intensity-modulated breast radiotherapy ( fIMRT ) plans. Methods A total of 46 patients with breast cancer (26 in left and 20 in right) after conservative surgery who were treated with manually planned fIMRT were retrospectively re-planned using a script to place the tangential beams automatically. The script program was developed using Pinnacle3 scripting language as imbedded in the Pinnacle3 treatment planning system, and the Python scripting language. Dosimetric indices, including V20 of the ipsilateral lung, D1 of the contralateral breast and V10 of the heart were extracted by the script for plans of different gantry angles. Then the optimal tangential angles were selected by a penalty function. Results For the 26 left breast cancer cases, V20 of the ipsilateral lung for manual and script were (18.2 ±3.4)% and (18.1 ±3.4)%, respectively(P>0.05), while D1 of the contra-lateral breast(249. 2 ± 88. 4) cGy and (230. 4 ± 80. 2) cGy, respectively( t=2. 27, P<0. 05), V10 of the heart (13. 7 ± 5. 7)% and (13. 1 ± 5. 7)%(t=2. 82, P<0. 05). The V20 of the ipsilateral lung of the 20 right breast cancer cases were (19. 8 ± 3. 8)% and (19. 8 ± 3. 9)%, respectively(P>0. 05). The script plans achieved better V10 of the heart[(298. 0 ± 239. 7) cGy] than the manual plans[(340. 0 ± 286. 2) cGy] (t =2. 53, P <0. 05). Conclusions Compared with the manualmethod, the script can assess of the impact of tangential beam angles on the OAR dose, patient-specifically and quantitatively, hence make better trade-offs and improve the plan quality.