Objective To strengthen the standardized management of totally implanted vascular access devices (TIVAD) in order to prevent and reduce the complications.Methods The unified TIVAD maintenance record form was adopted.The form contained the embedded and maintenance information.The maintenance and propaganda handbooks were handed out to the patients.The incidence of complications between before and after the application of the maintenance record form was analyzed statistically.Results The incidence of infection and obstruction fell from 2.1％(20/942) and 8.3％(78/942) to 1.0％(13/1 258) and 2.8％(35/1 258),the difference was statistically significant.Conclusions The application of TIVAD maintenance record form can reduce the occurrence of complications and prolong the service life of TIVAD.

Objective To explore the effect of rehabilitation training start time after mastectomy on the recovery of the affected limb function. Methods 90 patients who received modified radical mastectomy were divided into groups A, B and C randomly. All the patients accepted the unified rehabilitation program, but started 1, 3 and 10 d after the operation respectively. They were evaluated with the Japanese Orthopaedics Association (JOA) assessment for affected shoulder 1, 3 and 6 months after operation. Results The score of JOA was the least in the group C (P<0.01) 1 month after operation, and was the most in the group A 3 months after operation (P<0.01). At the end of the 6th month, there was no difference among these groups (P>0.05). Conclusion The rehabilitation training can be started as early as possible.

Objective To analyze the reasons of catheter fracture of implantable vascular access devices and to explore the prevention and handling measures. Methods A retrospective analysis was carried in 3 887 adult patients with implantable vascular access devices and 13 had catheter fracture. The clinical features and causes were analyzed and the successful handling measures were summarized. Results Of 3 887 cases, a total of 13 (0.33%) catheter fracture occurred. The incidence rate of catheter fracture via subclavian jugular venipuncture was 3.70%,(6/162) , via internal jugular venipuncture was 0.18% (7/3 725), via internal jugular venipuncture was significantly lower than that via the subclavian venipuncture (χ2=47.505,P=0.000). There had no statistical differences between the left and right of the two puncture ways(P=0.707,0.682). Conclusions Catheter fracture is one of the serious complications in the process of use and maintenance of implantable vascular access device. Choosing appropriate surgical method, strengthen maintenance education, specificating the operation procedure, closing observation and other measures can not only reduce the occurrence of the catheter fracture, but also can dealt with catheter fracture in time, which could ensure the safety of patients' life.

Objective To explore the role of pharmaceutical care in the treatment of patients with pulmonary infection secondary to suppurative thrombophlebitis. Methods The treatment of a patient diagnosed with pulmonary metastatic infection secondary to suppurative thrombophlebitis and the whole process of clinical pharmacists participating in the monitoring were analyzed retrospectively. The use of antibiotics was evaluated, and the experience of coagulation management in suppurative thrombophlebitis was explored. Results Based on the infection site, characteristics of septic thrombus, monitoring of vancomycin blood concentration, pharmacokinetics and pharmacodynamics characteristics of antibiotics, clinical pharmacists provided comprehensive pharmaceutical services for clinicians and patients in terms of anti-infection scheme adjustment, optimization of vancomycin individualized treatment, anticoagulant timing. Patient’s systemic infection and septic thrombus can be effectively controlled and which promotes the treatment of patients with suppurative thrombophlebitis. Conclusion Clinical pharmacists can play an important role in the treatment team of severe patients to improve the rational use of antibiotics.

Background and Objectives: Psoriasis is a chronic inflammatory skin disease, which the mechanisms behind its initiation and development are related to many factors. DMSCs (dermal mesenchymal stem cells) represent an important member of the skin microenvironment and play an important role in the surrounding environment and in neighbouring cells, but they are also affected by the microenvironment. We studied the glucose metabolism of DMSCs in psoriasis patients and a control group to reveal the relationship among glucose metabolism, cell proliferation activity，and VEC (vascular endothelial cell) differentiation in vitro, we demonstrated the biological activity and molecular mechanisms of DMSCs in psoriasis. Methods: and Results: We found that the OCR of DMSCs in psoriatic lesions was higher than that in the control group, and mRNA of GLUT1 and HK2 were up-regulated compared with the control group. The proliferative activity of DMSCs in psoriasis was reduced at an early stage, and mRNA involved in proliferation, JUNB and FOS were expressed at lower levels than those in the control group. The number of blood vessels in psoriatic lesions was significantly higher than that in the control group (p＜0.05), which the mRNA of VEC differentiation, CXCL12, CXCR7, HEYL and RGS5 tended to be increased in psoriatic lesions compared to the control group, in addition to Notch3. Conclusions We speculated that DMSCs affected local psoriatic blood vessels through glucose metabolism, and the differentiation of VECs, which resulted in the pathophysiological process of psoriasis.

Objective:To culture and identify dermal mesenchymal stem cells (DMSCs) in skin lesions of patients with psoriasis, and to determine the expression of hairy and enhancer of split-1 (HES1) and chemokine ligand 6 (CXCL6) in DMSCs.Methods:DMSCs were isolated from skin lesions of 15 patients with psoriasis and normal skin tissues of 18 healthy controls, and then subjected to culture. Cell phenotypes were identified by flow cytometry, and mRNA and protein expression of HES1 and CXCL6 was determined by real-time fluorescence-based quantitative PCR (RT-PCR) and Western blot analysis respectively. Comparisons were performed between 2 groups by using t test. Results:There was no difference in the morphology of DMSCs between the psoriasis group and control group. The mRNA expression of HES1 and CXCL6 in the psoriasis group was 3.56 and 3.44 times that in the control group respectively, and there was a significant difference between the two groups (both P < 0.05) . The protein expression of HES1 and CXCL6 in DMSCs was significantly higher in the psoriasis group than in the control group (both P < 0.05) . Conclusion:The high expression of HES1 and CXCL6 in DMSCs from lesions may be involved in the occurrence of psoriasis.

Objective To investigate the role of clinical pharmacists in identifying adverse drug reactions (ADR), to draw clinical attention to the possibility of drug-induced lung injury caused by rhG-CSF, and distinguish them from infectious diseases. Methods A case of rhG-CSF induced acute lung injury was analyzed. After analyzing the relationship between rhG-CSF and acute eosinophilic pneumonia, exploring the possible mechanism, in combination with the patient's condition, the clinical pharmacist put forward the suggestion for the treatment of the disease. Results After receiving rhG-CSF, the patient's eosinophils increased, the pneumonia was aggravated, and the effect of anti-infection treatment was poor. Eosinophils pneumonia associated with rhG-CSF was considered. The patient's pulmonary symptoms improved after treatment with glucocorticoid in combination with withdrawal of antibiotics and antiviral drugs, and eosinophil returned to normal. Conclusion rhG- can cause rare eosinophilic pneumonia. The clinical pharmacist's participation in clinical treatment can help to identify drug-induced diseases, reorient the direction of treatment and ensure the success of clinical therapy.

OBJECTIVETo summarize the disposal methods and the reasons of complications in operation of totally implantable central venous port (TICVP).

METHODSA total of 2 007 patients were enrolled in this observational, single-center study between December 2008 and March 2013. TICVP implantation was performed with one small skin incision and subcutaneous puncture of subclavian or jugular vein. Patient's profiles, indications of port system, early and delayed complications, and disposal methods were evaluated. There were 38 male and 1 969 female patients, aged from 21 to 85 years, with a mean of 47.6 years.

RESULTSThe mean duration of the TICVP system was (242 ± 12) days, ranging from 9 to 1 243 days. The achievement rate of puncture in the right jugular vein (99.76%) was the highest. Sonographic approach using the internal jugular vein were better than the external landmark-guided technique (99.80% vs. 96.34%, χ² = 29.905, P = 0.000). The rate of immediate complication was 0.80%, which included pneumothorax, hemothorax, lymphatic fistula and thrombosis. Early complications rate was 0.10%, which included pocket hematoma, catheter migration, venous thrombosis, port pocket infection, fibrin sheath formation. Late complications rate was 7.87%, which included catheter fracture, pinch-off syndrome, catheter-related bloodstream infection, fibrin sheath formation, catheter migration, extravasation, port inversion and port reveal. The rate of removal due to complications was 1.34% (27/2 007), and the early complication was higher (χ² = 8.053, P = 0.011).

CONCLUSIONSThe low incidence of complications suggests that TICVP is safe and reliable for long term intermittent venous access. The results support the use of TICVP in the oncology patients and patients requiring long-term intravenous therapy.

Adult ; Aged ; Aged, 80 and over ; Catheterization, Peripheral ; adverse effects ; methods ; Female ; Humans ; Male ; Middle Aged ; Postoperative Complications ; Prostheses and Implants ; Retrospective Studies ; Young Adult