Objective To evaluate the clinical value of MRI examination in the diagnosis and guidance of operation complexity a-nal fistula.Methods Preoperative MRI findings of 32 patients with complex anal fistula confirmed by operation were analyzed ret-rospectively,and compared with the operation results.Results The pre-operation MRI results of 32 patients with complex anal fis-tula revealed that there were 43 fistulas,10 anus week abscesses,58 orificium fistulas,comparing the MRI diagnosis with operation results,coincidence rate of fistula,anus week abscesses,orificium fistula was 100.0%,100.0%,89.3%,respectively.MRI manifes-tations of fistula were that T1 WI manifestations of fistula was or low signal,T2 WI and T2 WI fat suppression sequence manifesta-tions of fistula was high signal,fistula presented a tubular shape obviously as T1 WI enhancement scanning,internal opening repre-sented as intensive dot,complicated embranchment,two type signal of fistula appeared at the same time.MRI manifestations of ab-scesses were that circular,ellipse,irregular form and horseshoe-shape,T1 WI manifestations of abscesses was low signal,there was gas in abscess cavity of some patients;intestinal tube surrounding of some patients were involved by abscess cavity,and up through the edge of bladder to the perineum.Conclusion MRI examination could accurately display the number of complex anal fistula,fis-tula walking and branch,the position of internal opening,correlativity between fistula and surrounding muscles,status of abscess, which could provide guidance for anorectal surgery.

Objective　To discuss the technique,advantages and follow-up results of subfascial endoscopic perforator surgery.Methods　Subfascial Endoscopic Perforator Surgery was performed for 23 patients wth chronic venous insufficiency.Over two years postoperative follow-up was done.Results　21 in 23 cases with ulcers healed.Only one case had wound infection.Conclusion　Subfascial Endoscopic Perforator Surgery is a safe and effective procedure in treating venous insufficiency.

Sixty two patients with small bowel bleeding underwent double balloon endoscopy (DBE).Clinical features were compared between patients with positive DBE findings (50 cases) and those with negative findings (12 cases).Results revealed that the causes of melena were discovered in 75.0％(21/28) patients via oral approach,while the lesions were found in 81.8％ (18/22) patients with hematochezia via anal approach ( P ＜ 0.01 ). Duration of bleeding was longer and number of bleeding episodes was higher in patients with positive DBE findings than those with negative findings (P ＜ 0.05 or P ＜ 0.01 ).The time interval between the latest bleeding and DBE was significantly shorter in patients with positive DBE findings (P ＜ 0.05).Positive diagnostic rate was significantly higher in patients with three or more bleeding episodes than those less than three times (92.5％ vs.11.1％,P ＜ 0.01 ).DBE performed within seven days or less increased the positive diagnostic rate significantly than that after seven days (97.1％ vs.59.3％,P＜0.01).

Objective:To study the changes of lymphocytes subpopulation and apoptosis process of lymphocytes in the elderly and to investigate the modulatory effect of BP from Chinese herb on apoptosis.Methods:Lymphocytes phenotype were determinated using indirect immunofluorescence technique.The proliferative responses were measured with MTT method.Apoptosis of lymphocytes was evaluated by flow cytometry and automatic image analysis.Results:The proliferative responses of lymphocytes in the elderly were lower than that of young adults.Decreased CD45RA positive cells and increased CD 45 RO positive cells were found in lymphocytes population of aged people compared to that of young adults. The CD 45 PO positive cells were prone to apoptosis.There is an imhibitory effect of BP on apoptosis of lymphocytes in the elderly.Conclusion:It was implicated that the susceptibility of lymphocyte in the elderly to apoptosis depends on activation,so called activation induced cell death.Present results suggested that apoptosis of lymphocytes of aged people play an important role in the pathogenesis of immunosenescence.The possibility appeared for development of modulatory drugs on apoptosis from Chinese herbs.

Objective:To study the curative efficacy of metformin combined with Jinlida granules in the treatment of gestational diabetes mellitus and its effects on the serum vascular endothelial growth factor (VEGF),adiponectin (APN) and homocysteine(Hcy) levels.Methods:94 patients of gestational diabetes mellitus who were treated from July 2014 to July 2016 in our hospital were selected.According to random number table,those patients were divided into the observation group (n=47) and the control group (n=47).On the basis of routine treatment,such as control diet,reasonable exercise and healthy diet,etc,the control group was treated with metformin,while the observation group was combined with Jinlida granules on the basis of the control group.The changes of blood glucose,blood lipid and serum VEGF,APN and Hcy before and after treatment were compared between the two groups,the incidence of maternal complications and neonatal adverse outcomes were compared.Results:Compared with before treatment,the blood glucose,blood lipid of both groups after treatment were significantly improved (P ＜0.05),the fasting plasma glucose (FBG),postprandial 2h blood glucose (2hPG),glycosylated hemoglobin (HbAlc),total cholesterol (TC),triacylglycerol (TG),low density lipoprotein cholesterol(LDL-C) of observation group were significantly lower than those of the control group,the serum high density lipoprotein cholesterol (HDL-C) level was significantly higher than that of the control group(P＜0.05);after treatment,the serum VEGF,APN and Hcy levels were significantly improved than those before treatment in both groups (P＜0.05),and the serum VEGF,and Hcy levels of observation group were lower than those of the control group,the serum APN level was higher than that of the control group (P ＜ 0.05);the incidence of gestational hypertension,hydramnios,cesarean section and premature delivery of observation group was significantly lower than that of the control group (P ＜0.05);the incidence of giant child,neonatal Jaundice and neonatal respiratory distress in the observation group was significantly lower than that of the control group (P＜0.05).Conclusion:Metformin combined with Jinlida granules was effective for the gestational diabetes mellitus,which could effectively control the blood glucose,blood lipid levels and might be related to the regulation of serum VEGF,APN and Hey levels.

ObjectiveTo evaluate the effect of laparoscopic cholecystectomy (LC) combined with intraoperative cholangiography (IOC) and intraoperative endoscopic sphincterotomy (IOEST) for the diagnosis and treatment of choledocolithiasis. Methods Statistical analysis was carried out for 106 patients with cholecystocholedocolithiasis diagnosed and treated by LC-IOC-IOEST. Results Sixty-four (60.4%, 64/106 ) patients with preoperative diagnosis of simple gall stone were found with complicated choledocholithisis; LC-IOC -IOEST was successfully performed in 99(93.4%, 99/106) cases. Six cases (6.1%) suffered from mild postoperative acute pancreatitis. Duodenal perforation, bile leakage, peumothorax (0.9%) developed in one each. Duodenal adenocarcinoma was overlooked in one case, and 2 cases (1.8%) suffered from gastric paralysis. Conclusion LC combined with IOC and IOEST was a safe, effective approach to the diagnosis and minimally invasive treatment of choledocholithiasis.

Objective To optimize the formulation of the sunscreen used in military training.Methods The different formulations of sunscreen were prepared according to the orthogonal design,and then applied on 3M adhesive tape posted on the color dish with a certain amount;the absorbance in 280 nm-320 nm and 320 nm-400 nm of them were measured and the arithmetic mean (A) was concluded.By comparing A,the protective effect and the main factors affecting preventive bask were determined.The preventive bask test of the optimum formula was carried out in human trials using the method of multi point increasing ultraviolet irradiation.Results OMC,TinosorbTM M,rutin,pearl powder and baicalin all had significant effects in preventing UVA.OMC had a significant effect in preventing UVB.The formula 1 (containing the five materials mentioned above) had the best effects in preventing both UVA (SPF 18) and UVB (PA+).Conclusions The formula 1 has the best effects in preventing both UVA and UVB.

OBJECTIVE: To explore the role of clinical pharmacists in anti-infective treatment for the patient with septic shock induced by intrauterine infection. METHODS: Clinical pharmacists participated in anti-infective treatment for a patient with septic shock induced by intrauterine infection, and assisted physicians to formulate empirical anti-infective treatment, determine that Escherichia coli was pathogenic bacteria and analyze the causes of fluctuations in body temperature. According to the patient's disease condition and results of assistant examination, clinical pharmacists suggested using Imipenem and cilastatin sodium for injection 1. 0 g, ivgtt, q6 h, stopping Teicoplanin for injection, de-escalation using Cefoxitin sodium for injection 2. 0 g, ivgtt, q8 h for anti-infective treatment, with oral sequential therapy. RESULTS: Physicians adopted most advice of pharmacists. After 30 d anti-infective and symptomatic treatment, the patients symptoms were better than before, and discharged from the hospital. CONCLUSIONS: Clinical pharmacists participate in formulating individual anti-infective treatment regimen, so as to promote the rational use of antibiotics and improve the response rate and success rate of treatment.

Objective:To investigate the application effect of problem-based learning (PBL) combined with case-based learning (CBL) in standardized training of traditional Chinese medicine (TCM) clinical pharmacists.Methods:A total of 40 TCM clinical pharmacists who received the standardized training of TCM clinical pharmacy in Chongqing Traditional Chinese Medicine Hospital from August 2020 to July 2021 were enrolled as subjects and were randomly divided into research group (PBL combined with CBL) and control group (traditional teaching). The two groups were compared in terms of theoretical knowledge, practical skills, and the degree of satisfaction with training. SPSS 23.0 was used to perform the t-test and the chi-square test. Results:Compared with the control group, the research group had significantly higher scores of theoretical knowledge [(49.45±5.52) vs. (40.54±5.65), P<0.05] and practical skills [(48.65±5.23) vs. (41.53±4.41), P<0.05]. As for the degree of satisfaction with training, the questionnaire survey showed that compared with the control group, the research group had significantly better results in strong ability to analyze and solve clinical issues, strong learning initiative and enthusiasm, teachers' willingness to interact with students, teaching and learning benefiting each other, and satisfaction with this assessment method ( P<0.05). Conclusion:The combined teaching model of PBL and CBL can help to improve the teaching quality of standardized training for TCM clinical pharmacists and cultivate the good learning habits, independent thinking ability, and clinical thinking ability of pharmacists, and therefore, it is beneficial to cultivating high-quality TCM clinical pharmacists.

The rotation of clinical pharmacists in anti-infection specialty is an important part of standardized training. In view of the poor foundation of imaging diagnosis ability, short rotation time and unsystematic training scheme, the quality of standardized training has been significantly improved through strict management system, strengthening entrance education, reforming academic lecture mode, setting up tutorial system for training students and refining assessment system. It's of great significance for clinical pharmacists in the direction of anti-infection to understand systemic infection.