OBJECTIVE:To provide reference for the development of clinical pharmacists’career and the establishment of le-gal system in China. METHODS:The background,progress and situation of applying for“pharmacists’health care provider sta-tus”in the United States were introduced. The reasons for achieving provider status in California,Washington,and Oregon were summed up in aspects of politics,economics and education. The chance and challenge for achieving provider status at federal level were also discussed. Based on the development of clinical pharmacists in China,the suggestions were put forward for the improve-ment of legal system of clinical pharmacists in China. RESULTS & CONCLUSIONS:“Health care provider status”in the United Stated were recognised by 3 states with local developed economics,high-level education,and collective efforts of pharmacy organi-zations. Multiple national pharmacy organizations as American Pharmacists Association,American Society of Health-System Phar-macists and American Pharmacy College Society are working together toward provider status at the federal level. Our country should pay attention to related legal system construction,establish perfect and definite clinical pharmacists legal system as soon as possible to provide legal guarantee for career development of clinical pharmacists in China.

Objective China is experiencing increasing disease burden and economic burden of acute myocardial infarction(AMI),while the healthcare resources are limited and unevenly distributed.Hospitalization duration is an important measure of health resource utilization index.This study aims to describe the time trend of Length of stay(LOS) for AMI inpatient care in eastern urban areas of China,and to identify potential hospital-level factors associated with the LOS,which is an important indicator of resource utilization.Methods The study randomly selected a representative sample of patients admitted for AMI in 2001,2006 and 2011,from urban hospitals in eastern China.After central data abstraction from medical records,patients' characteristics,treatments and outcomes were compared between 3 hospital groups that were divided according to their median of LOS.Results Five thousand and forty-seven AMI cases were included in the analyses.The average LOS were (15.3±10.2),(13.5±8.7) and (12.2±7.8) d in 2001,2006 and 2011 respectively,with a decreasing trend(F=10.93,P<0.001).After adjusted for patients' characteristics,there were no significant different in LOS between years.Patients' characteristics were similar between high-,middle-and low-LOS hospitals,however,in high-LOS hospitals,use rates of aspirin,clopidogrel and statins were even lower(P≤0.001).LOS were longer 1.9 d in the hospitals with relatively small AMI inpatient treatment volumes(30-80 annually,t=2.97,P<0.01).Conclusions The average LOS for AMI in eastern urban areas of China is much longer than in western countries.Conclusion between hospitals have highlighted the gaps in care quality and efficiency.Standardized clinical pathways and hierarchical medical system are essential strategies in the new healthcare reform.

Adult ; Histiocytosis, Langerhans-Cell ; surgery ; Humans ; Mandibular Condyle ; surgery

Objective:To investigate the clinical efficacy of reconstruction of the mandibular defect in patients with osteoradionecro-sis using submental artery island flap and reconstructive Ti-plate.Methods:20 cases with mandible osteoradionecrosis underwent par-tial mandibulectomy.The submental artery island flap and reconstructive Ti-plate were used to reconstruct the mandibular defects and adjacent soft tissue defects.The post-operative effects and flap successful rate were evaluated with a follow-up period of 6 to 1 8 months.Results:1 9 flaps were well survived,local necrosis in the remote end was observed in 1 flap,but survived by hyperbaric ox-ygen therapy and iodoform gauze dressing,no plate exposure was found after operation in the follow up period.All patients were satis-factory with the outlook.Conclusion:Submental artery island flap combined with reconstructive Ti-plate is feasible in the treatment of osteoradionecrosis.

Objective To investigate the clinical efficacy of acupuncture plus TDP in treating stageⅡ-Ⅲ pressure sore.Methods Thirty-three patients with pressure sore meeting the inclusion criteria were randomly allocated to treatment and control groups, 17 cases each. Both groups were first given routine clean care. The control group received routine surgical asepsis dressing change and the treatment group, fire needling, surrounding electroacupuncture and TDP irradiation to the affected part. The pressure sore area was observed and the PUSH score was recorded in the two groups before and after treatment. The clinical therapeutic effects were compared between the two groups of patients. Results The total efficacy rate was 88.0% in the treatment group and 71.0% in the control group; there was no statistically significant difference between the two groups (P>0.05). The total efficacy rate was 88.0% in the treatment group and 71.0% in the control group; there was no statistically significant difference between the two groups (P>0.05). The cure and marked efficacy rate was 58.8% in the treatment group and 23.5% in the control group; there was a statistically significant difference between the two groups (P<0.05). There was a statistically significant pre-/post- treatment difference in the pressure sore area in the two groups at one, two and three weeks after treatment (allP<0.05). There was a statistically significant difference in the pressure sore area between the two groups at two and three weeksafter treatment (bothP<0.05). There was a statistically significant pre-/post-treatment difference in the PUSH score in the two groups at two and three weeks after treatment (bothP<0.05). There was a statistically significant difference in the PUSH score between the two groups at three weeks after treatment (P<0.01).Conclusions Acupuncture plus TDP can markedly relieve the clinical symptoms and accelerate the sore healing in treating stageⅡ-Ⅲ pressure sore.

Objective To investigate the expressions of IL-8,MCP-1 and MIP-1? and their biological significance in pancreatic carcinoma and chronic pancreatitis, and investigate the relationships of their expressions in pancreatic cancer tissues.Methods Immunohistochemical method of avidin-biotin complex was used to examine surgically removed specimens from 51 cases of pancreatic carcinoma and 10 cases of chronic pancreatitis. Results The positive rates of expression and the scorings of IL-8,MCP-1,MIP-1? were significantly higher in pancreatic carcinoma than that in chronic pancreatitis(P

Aim To assess the impact of morin and acetyl-resveratrol on the oral bioavailability and pharmacokinetics of saquinavir (SQV), a substrate of P-glycoprotein (P-gp), in rats.Methods Twenty rats were randomized into four groups of equal size, including a control group, two intervention groups and a positive control group, and administered orally 30 mg·kg-1 SQV with or without 40 mg·kg-1 morin or acetyl-resveratrol or verapamil (as positive control).The plasma concentrations of saquinavir were determined using a high-performance liquid chromatography-tandem mass spectrometry (HPLC-MS/MS) method, and the PK of SQV was assessed using non-compartmental analysis.Results The PK parameters values of SQV, SQV+morin, SQV+acetyl-resveratrol, SQV+verapamil were as follows: AUC0-t, 381.53 μg·h·L-1,185.53 μg·h·L-1, 360.43 μg·h·L-1, 529.95 μg·h·L-1;AUC0-∞, 409.48 μg·h·L-1, 228.52 μg·h·L-1,446.67 μg·h·L-1, 552.41 μg·h·L-1;Cmax, 110.80 μg·L-1, 86.44 μg·L-1, 139.84 μg·L-1, 423.60 μg·L-1;Tmax, 0.25 h, 0.25 h, 0.25 h, 0.50 h;T1/2, 5.72 h, 5.94 h, 6.78 h, 3.78 h;MRT0-∞, 10.30 h, 9.61 h, 12.30 h, 4.89 h;CL/F, 7.59 mL·kg-1·h-1, 13.88 mL·kg-1·h-1, 7.28 mL·kg-1·h-1, 5.52 mL·kg-1·h-1.Conclusions Multiple peak phenomenon can be observed in the plasma SQV profiles.Morin can significantly reduce the SQV oral bioavailability and affect SQV PK profiles while acetyl-resveratrol cannot significantly affect the SQV oral bioavailability and SQV PK profiles in rats.

A method was developed for the determination of tetrodotoxin in marine organisms by high perfor-mance liquid chromatography-mass spectrometry with immunoaffinity column. The samples were extracted with 1% acetic acid methanol solution and diluted with phosphate buffer at pH 7-8. After cleaned up by immuno-affinity column, the samples were analyzed by LC-MS/MS and quantitatively determined by external standard method. The chromatographic separation was performed on an ACQUITY UPLC BEH Amide column with gradient elution by using acetonitrile and 5 mol/L ammonium acetate solution containing 0. 1% formic acid as mobile phase. Detection was carried out by electrospray positive ionization mass spectrometry in the multiple reaction monitoring mode. Linear ranges of TTX was in the range of 0. 3 -20. 0 μg/L with correlation coeffi-cient more than 0. 997. The quantification limit of the method was 0. 3 μg/kg. The recoveries of standard addition for tetrodotoxin were 88. 7%-102. 3%, and the relative standard deviation was 2. 0%-6. 4%. The method could be used to identify and quantify tetrodotoxin in marine organisms with satisfactory reproducibility and sensitivity.

Objective: To evaluate the safety and efficacy of DSA-guided percutaneous application of ethanol sclerotherapy combined with lauromacrogol foam sclerotherapy for the treatment of hyper-backflow venous malformations. Methods: The clinical data of 72 cases of hyper-backflow venous malformation of head and neck from August 2012 to June 2016 by DSA-guided percutaneous puncture sclerotherapy were analyzed retrospectively. Based on the method of sclerotherapy, the patients were divided into group A and B. Group A was treated with ethanol combined with lauromacrogol foam, and Group B was treated with lauromacrogol foam alone. All patients were followed up for 12-24 months (mean 14.3 months). The curative effects and postoperative adverse responses were analyzed by comparision.SPSS 19.0 software was applied, effective rate and adverse reaction rate were examined by chi square test.P<0.05 was considered as statistically significant. Results: Group A(37 cases), cure was achieved in 10, basic cure in 21 and effective response in 3, ineffective response in 3, with a total efficiency of 91.9%(34/37). There were 3.2 average injections. The mean dose of sclerosant foam used in each patient was 220 mg and ethanol 13.6 ml. Group B(35 cases), cure was achieved in 5, basic cure in 15 and effective response in 4, ineffective response in 11, with a total efficiency of 68.6%(24/35). There were 4.8 average injection times. The mean dose of sclerosant foam used in each patient was 322 mg. There was statistically significant difference in total efficiency of 2 groups (χ²=6.245, P<0.05). The main adverse effect were tissue necrosis, nerve injury and limitation of mouth opening. There was no statistically significant difference in adverse effect of 2 groups (P>0.05). Conclusions DSA-guided percutaneous application of ethanol sclerotherapy combined with lauromacrogol foam sclerotherapy for the treatment of hyper-backflow venous malformations is safe and effective with fewer complications.This technique is especially useful for the hyper-backflow type of venous malformations.

In the past decades,numerous chemical analysis studies have identified numerous compounds in tobacco smoke,and the number is increasing,as of 2013,9582 compounds have been identified in tobacco smoke,including nicotine,tobacco smoke-specific nitrosamines,benzo[alpha]pyrene and other substances,as well as cotinine,4-(methylnitrosamine)-1-(3-pyridyl)-1-butanol and other products that are metabolized in the body.The products of metabolic transformation,such as cotinine and 4-(methylnitrosamine)-1-(3-pyridyl)-1-butanol,can target the heart,lungs and other organs,inducing chronic obstructive pulmonary disease,coronary heart disease,lung cancer,esophageal cancer and other types of cancer.Chinese medicine's understanding of"toxicity"originates from the Nei Jing,which believes that"poisonous evil"can be an external pathogenic factor,but can also cause the five organs to lose harmony and produce phlegm and stagnation and other pathological products that accumulate into internal toxicity.The modern medical understanding of tobacco smoke toxic substances and their metabolites is quite consistent with the understanding of"external toxicity"and"internal toxicity"in Chinese medicine,so the author intends to explore the main components and pathogenic mechanisms of tobacco smoke harmful substances and their metabolites.To clarify the etiological characteristics and pathogenic transformation characteristics of"internal"and"external"tobacco smoke toxicity,so as to explore the modernization of"tobacco smoke toxicity"and the combination of tobacco smoke pathogenesis and TCM theory for TCM.Theoretical foundation is laid.