Objectives To evaluate the effects of hypertonic-hyperoncotic solution (HHS) on cardiac function and extravascular lung water in children after open-heart surgery for congenital cardiac disease. Methods 50 children with congenital cardiac disease were randomly assigned to 2 groups. The HHS group received HHS (7.5% sodium chloride with 6% hydroxyethyl-stareh 200 kDa). The ISS group received isotonic saline solution (ISS 0.9% sodium chloride). Cardiac index (CI), extravascular lung water index (ELWI), stroke volume index (SVI), mean arterial pressure (MAP), and systemic vascular resistance index (SVRI) were measured. Immediately after sur-gery, patients were loaded either with HHS or with ISS (4 ml/kg). Sodium concentration, osmolality, thrombocyte count(TC), fibrinogen, and arterial blood gases were detected before operation, immediately after loading, 15 minutes, 1,4, 12, and 24 hours after the end of vol-ume loading. Hemodynamic parameters were recorded at the same time. The total amount of dobutamine required was documented. Results In HHS group, MAP, SVI and CI increased, and SVRI decreased significantly after the administration of HHS, compared with ISS group and before administration(P<0.01 or 0.05). Both CVP and HR were unchanged in both groups. In HHS group, ELWI decreased signifi-cantly, compared with before volume administration. But ELWI increased directly and remained elevated for 60 minutes after the administra-tion of ISS. Sodium concentration increased immediately after infusion of HHS. The postoperative need for infused dobutamine in the patients in HHS group was decreased, compared with ISS group (P<0.05). All patients left the hospital in a clinically sufficient state. Condu-sions A single infusion of HHS after cardiac surgery is safe. After cardiopuimonary bypass surgery, the administration of HHS increased CI by elevating SVI in combination with a decreased SVRI. ELWI significantly decreased, which suggest that HHS effectively counteracts, the capillary leakage.

Objective To investigate the expression of CD14/CD16 by monocytes and the anti-inflammatory effects of hypertonic saline plus dextran (HSD) in adult blunt trauma patients in hemonhagic shock. Method A total of 30 adult patients were eligible for inclusion in the study if they sustained blunt trauma from March to October 2007 and had at least one recorded episode of hypotension (systolic blood pressure ≤ 90 mm Hg) with clear evidence of blood loss (external or internal including the thorax, abdomen or retroperitoneum). Patients were excluded if they refused to participate, were admitted ≥ 6 hours after injury, were pregnant, or had chronic disease. The enrolled patients were randomly divided in a double-blinded manner into an HSD group which was administered 7.5% Nad plus 6% dextran - 70, and a control group which was administered 0.9% NaCl. A single 250 ml dose of either HSD or NaO was immediately administered to the patients in each of the two groups while they were in the emergency room. The primary outcomes were to measure the changes in CD4/CD16 expression by monocytes and the levels of anti-inflammatory cytokines, including tumor necrosis factor-alpha (TNF-α), interleukin (IL)-lra and IL-10. Patient demographics, fluid requirements, organ dysfunction, infection and death were recorded. Results A total of 28 patients were enrolled with no significant differences in their clinical measurements. Hyperosmolarity was modest and transient. HSD altered the shock-induced monocyte redistribution pattern by reducing the drop in the "classic" CD14 ++ subset and remarkably affecting the expansion of the "pro-inflammatory" CD14+CD16+ subsets. In parallel, HSD significamly reduced pro-inflammatory TNF-α production while increasing anti-inflammatory IL-lra and IL-10 production. Conclusions This human trial demonstrates that HSD has anti-inflammatory and immunologic properties for trauma patients in hemorrhagic shock. HSD exerts profound immunomodulatory effects, promoting more balanced pro-/anti-inflammatory responses and reducing post-traumatic complications. Therefore, it could be useful in attenuating post-trauma multiorgan dysfunction (MOD).

Pulmonary hypertension has a high mortality rate,and although targeted therapy is available,it is still incurable,and the long-term prognosis for patients is poor.As a tyrosine kinase inhibitor,imatinib was approved for marketing in China in 2002 for the treatment of chronic myelogenous leukemia and other tumor diseases.In addition to the antitumor effects,imatinib was found to improve hemodynamics and exercise tolerance in patients with severe pulmonary arterial hypertension,but the safety was suboptimal.With the emergence of new formulations of imatinib targeted at the lungs,it is expected to become a new targeted drug for pulmonary arterial hypertension.

As medical advances and surgical techniques have improved the survival rates of children with congenital heart disease (CHD), more and more studies have begun to focus on the quality of survival and long-term development of children with CHD. Cognitive and psychological developmental deficits in children with CHD have been well documented. With the development of brain function assessment and neuroimaging techniques in recent years, it has become possible to elucidate the mechanisms of neurocognitive impairment in patients with CHD from a brain science perspective. Providing targeted early follow-up interventions for the population with CHD and promoting their social adaptation have a great clinical significance. This review summarized recent research findings on neurocognitive developmental outcomes in children with CHD from the perspective of behavioral medicine and brain science. This paper focuses on reviewing the mechanisms of brain microstructure damage and brain network dysfunction which may explain neurocognitive impairment in children with CHD, and further explores the early monitoring and intervention programs suitable for clinical development, aiming to suggest possible directions for improving long-term neurocognitive developmental outcomes for CHD population.

OBJECTIVE：To explore the role of pharmacists i n developi ng the outpatient and emergency prescription pre-audit with the help of rational drug use software. METHODS ：With the help of rational drug use software ，outpatient and emergency prescription pre-aduit was conducted during Jan.-Apr. 2020；the intervention effects of irrational prescriptions were analyzed. The prescriptions from Sept. to Dec. in 2019 were included in the control group （only for post review ），and the prescriptions from Jan. to Apr. in 2020 were included in the intervention group （pre-audit and post review ）；the unreasonable prescriptions were compared before and after the intervention. The prescriptions intercepted by the software system from Nov. to Dec. in 2019 were further selected as the interception control group ，and the prescriptions intercepted from Jan. to Feb. in 2020 were selected as the interception intervention group ；the interception situation of prescriptions before and after the intervention was compared ，and the influence of pre-audit on physicians ’prescription behavior was evaluated. In addition ，108 992 prescriptions in Apr. 2020 were selected for post review using the traditional model （i.e. complete manual audit ）and the information model （i.e. software-assisted manual audit ）respectively；the effects of two models were compared. RESULTS ：From Jan. to Apr. in 2020，a total of 2 393 prescriptions were pre-audited by pharmacists ，among which 1 387 prescriptions were reasonable （57.96％）and 1 006 prescriptions were unreasonable and intervened （42.04％）. After pharmacist intervention ，983 prescriptions were modified by doctors ，and the success rate of intervention was 97.71％ . Compared with control group ，unreasonable rate of outpatient and emergency prescriptions，that of each type of prescriptions were all decreased significantly （P＜0.001）. Compared with interception control group（1 402 pieces），the number of intercepted prescriptions （721 pieces）was significantly reduced in interception intervention group （P＜0.001）. Compared with traditional model ， the number of prescriptions requiring manual post review and E-mail：xss306@126.com “false positive ” prescriptions were decreased significantly # under information model ， and the number of discovered unreasonable prescriptions were increased significantly （P＜ 0.001）. CONCLUSIONS ：With the help of rational drug use software ，prescription pre-audit by pharmacists can significantly improve reasonable rate of outpatient and emergency prescriptions. The work intensity of pharmacists in post review of prescriptions can be reduced and the accuracy of prescription review can be improved in the information mode.

OBJECTIVE：To summarize and analyze t he clinical characteristics of acarbose-induced skin ADR ，and to provide reference for its therapy. METHODS ：Clinical pharmacists participated in the treatment of a patient with acarbose-induced skin ADR. The patient developed erythema multiforme several days after oral administration of Acarbose tablets （100 mg/d）. After consultation by dermatology and clinical pharmacy ，considering that the adverse reaction was related to acarbose ，clinical pharmacists suggested to stop the drug. Based on the above cases ，clinical pharmacists searched Wanfang database ，CNKI， PubMed，Embase and other databases to collect case reports of skin ADR caused by acarbose ，summarize its general situation （gender，age，usage and dosage ，etc.），latency，ADR（diagnosis and manifestation ），intervention and outcome ，etc. RESULTS ： The doctor adopted the pharmacist s’advice，stopped the use of acarbose ，and gave symptomatic treatment as Methylprednisolone sodium succinate for injection 40 mg（intravenous injection ，qd）+Medloratadine tablets 8.8 mg（oral administration ，qd）+Calamine lotion（for external use ）. The patient improved and was discharged after 10 days. A total of 12 literatures involving 12 patients were retrieved. Among the 13 patients included in the analysis （including the above clinical case and 12 literature cases ），there were 8 males and 5 females，and 8 patients of them aged 50 and over；the dosage of acarb ose in most patients was within the requirements of the drug instructions. The primary diseases of 12 patients were diabetes mellitus. The latency of skin ADR in 11 patients was within 6 days of administration. Among the 13 patients，the ADR were diagnosed as rash in 4 cases，pustulosis in 3 cases， erythema multiforme in 2 cases， urticaria in 2 cases， maculopapular rash in 1 case and lip swelling in 1 case. The ADR of 1 patient improved after drug withdrawal ，and 12 patients also improved after drug withdrawal and symptomatic treatment such as glucocorticoid or antihistamine. Acarbose was re-used in 2 patients after the improvement of first skin ADR ，and skin ADR occurred again ，and the ADR were improved after drug withdrawal and symptomatic treatment. CONCLUSIONS ：Skin ADR are acarbose-induced rare ADR ，mostly within 6 days of medication ，and are more likely to occur in middle-aged and older men. When the patients suffer from ADR ，the drug should be stopped in time and given glucocorticoids or antihistamines for symptomatic treatment. Clinical pharmacists should do a good job in drug publicity and education ，remind patients to closely monitor relevant indicators and ensure drug safety.

Small for gestational age (SGA) infants are more likely to experience neurocognitive impairments compared to appropriate for gestational age (AGA) infants. This paper reviews recent research on the neurocognitive development of SGA children. SGA can lead to a "brain-sparing effect" due to growth restriction, which may affect cerebral blood flow and brain structure. However, this does not guarantee normal brain development. Restrictive blood flow can result in changes in brain structure, such as reduced total white matter and gray matter volume in various brain regions, including the cerebral cortex, hippocampus and cerebellum, ultimately leading to decreased head circumference. SGA children also exhibit lower scores in all neurocognitive domains, including intelligence, attention, memory, and executive function. This may result in poor academic performance and an increased risk of social, behavioral, and neurological problems, such as cerebral palsy, epilepsy, visual and hearing impairments, as well as comorbidities like attention deficit hyperactivity disorder(ADHD), autism spectrum disorder(ASD), anxiety, depression, and schizophrenia. Several risk factors for SGA-related neurocognitive impairments have been identified, including gestational hypertension, abnormal gestational weight, smoking, and catch-up growth. Studies have shown that the best interventions to improve cognitive dysplasia include nutrient supplementation, continued breastfeeding, high-quality education, and appropriate early intervention (responsive parenting) are effective in improving cognitive outcomes for SGA children.