Objective:To evaluate the anti-infective therapy in a patient with multi-site infections after brain surgery and explore the role of clinical pharmacist in the treatment. Methods:With the applications of PK/PD characteristics of drugs and the coping strategies of resistant , vancomycin combined with fosfomycin were used to treat the intracranial infection caused by methicillin-resistant Staphylococcus epidermidis with vancomycin MIC of 2 mg·L-1 , and the dynamic adjustment of antibiotics was applied to treat the pulmonary infection caused by two kinds of pathogens including MDR bacteria. Results:The intracranial infection was successfully controlled, the pulmonary infection was also under control, and the overall condition of the patient was significantly improved. Conclusion: In the medical team, clinical pharmacists should make full use of their advantages in drug characteristics to carry out clinical pharmaceutical care.

Objective To review and discuss the changes of diagnostic techniques and therapeutic modalities of pheochromocytoma during the past fifty years. Methods The clinical data of 362 patients (196 men and 166 women; age range,7-75 years;mean age,38 years) with pheochromocytoma from January 1955 to July 2004 were retrospectively analyzed.The disease course ranged from 20 d to 20 years with a mean of 3.9 years.According to the premedication,the past 50-year period was divided into 3 stages;and the diagnostic techniques,premedication, anesthetic skills,surgical procedures and perioperative death rate were compared among the 3 stages. Results There were 60 patients in the first stage (1955-1975) and their diagnoses were made on urine VMA and retroperitoneal air-contrast imaging.They had no premedication except for tranquilizers.The therapeutic modality was open surgery of resecting tumors under peridural anesthesia.The perioperative mortality was 8.3% (5/60).The second stage (1976-1994) included 105 patients and they were diagnosed mainly by 24-h urine catecholamine, ultrasonography and CT.Phenoxybenzamine was taken as the regular premedication and open surgery general anesthesia was used; the mortality decreased significantly to 1.0% (1/105).The third stage (1995-2004) consisted of 197 cases.In addition to 24-h urine catecholamine,ultrasonography and CT, 131I-MIBG scan was used as the specific diagnostic technique for pheochromocytoma widely.The premedication was phenoxybenzamine and urapidil.The microcirculation imaging analysis was used to judge the volume expansion preparation. Laparoscopic resection of the tumor under general anesthesia was adopted as the regular means.The perioperative mortality was 0.5% (1/197). Conclusions The diagnostic techniques for pheochromocytoma have become enriched and mature.The premedication has been standardized and included more medicines.The microinvasive surgery has become the current method for resecting tumors,and the perioperative mortality has become significantly decreased.

Objective To investigate the effects of antisense oligodeoxynucleotide c-myc (c-myc ASODN) on the growth of rabbit lens epithelial cells (LECs) induced by galactose. Methods Based on the translation initiation region of the second extron of c-myc gene, oligonucleotides were synthesized and modified with phosphorothioate. Lens epithelial cells were treated with galactose and c-myc ASODN. The effects of c-myc ASODN on the growth of LECs, cultured in high concentration of galactose, were observed by cytometry and MTT. Results The results demonstrated that c-myc ASODN at the doses of 2.5-10.0 ?mol/L inhibited the growth of LECs induced by galactose in a dose-dependent manner. Conclusion These results indicate that c-myc ASODN can inhibit the growth of LEC induced by galactose.

Objective: To investigate the outcome and inlfuencing factors of graft vessels including saphenous vein graft (SVG) and left internal mammary artery graft (LIMAG) in patients after coronary artery bypass grafting (CABG). Methods: A total of 92 patients with post-CABG symptom recurrence from 2010 to 2015 were analyzed by angiography and clinical features for their native coronary vessel and graft vessel. There were 83 male and 9 female patients with the mean age of (62.6±10.8) years. The outcomes of graft vessel were assessed; correlation study was conducted between SVG, LIMAG lesions and traditional atherosclerosis risk factors like age, gender, hypertension, hyperlipidemia, diabetic mellitus, smoking, family history of coronary artery disease (CAD) with other clinical factors such as the time of angina recurrence, thetime from coronary angiography (CAG) to CABG, type of SVG (sequential graft or individual graft), the features of native target vessel lesions prior grafting. Results: The average time from CABG to symptom recurrence was (35.10±24.7) months. There were 146 grafts including 52 LIMAG and 94 SVG (60 individual and 34 sequential grafts), the patency rate of LIMAG was higher than SVG (63.5% vs 44.7%),P=0.030. SVG lesion was positively related to symptom recurrence (OR=1.119, 95% CI 1.002-1.249,P=0.046) and trended to female gender (P=0.065), while not related to other clinical factors; LIMGA lesion was not related to any clinical factors. The patency rate of sequential SVG was higher than individual SVG (58.9% vs. 36.7%,P=0.038). The native target vessel lesion (deifned by pre-operative occlusion/stenosis) was similar between individual SVG group (24/14) and no-lesion SVG group (17/5),P=0.388; while the native target vessel lesion in LIMAG group (7/12) was lower than no-lesion LIMAG group (23/10),P=0.04. Conclusion: Post-CABG lesion was not obviously related to traditional risk factors of CAD, post-SVG lesion was positively related to the time of post-CABG angina recurrence. SVG mid-and long-term patency in sequential graft vessel was higher than that in individual graft vessel. Pre-CABG native coronary blood lfow would affect the outcome of individual LIMAG but not SVG.

Objective To explore the influence factors of health literacy in middle-aged and elderly people in Hunan province.Methods With multi-stage randomized cluster sampling, people aged 45 years and over were selected from both urban and rural areas of six geographical regions of Hunan province, using the China residents health literacy questionnaire developed by Chinese Health Education Center, by face to face survey to get data. The influence factors were analyzed retrospectively with univariate and ordinal regression analysis.Results The 1158 persons were investigated and the valid questionnaires were 1154, the effective recovery rate was 99.7%. Univariate analysis showed that there were significant differences in heath literacy among different degree of education, age, gender, marital status, income, region and occupation (all P＜0.05). The results of ordinal regression analysis Showed that the major influence factors were degree of education, income,age and occupation.Conclusions The people at low levels of education or income should be concerned about health education and health promotion strategies.

Objective To observe the clinical efficacy of long-time needle retaining at scalp acupoints plus body acupuncture in treating motor dysfunction in the sub-acute stage of cerebral stroke.Method A hundred patients in sub-acute stage of cerebral infarction or hemorrhage scored 4-24 by the National Institute of Health Stroke Scale (NIHSS) were randomized into a treatment group and a control group, 50 cases in each group. The control group was intervened by dry rehabilitation training, while the treatment group was additionally intervened by long-time needle retaining at scalp acupoints (6-8 h) plus body acupuncture. The neural functional deficit, motor function, and activities of daily life were estimated and compared respectively by using NIHSS, Fugl-Meyer Assessment Scale (FMA), and Barthel Index (BI).Result The NIHSS score was significantly changed in the treatment group after 1 treatment course (P<0.05). After 2 treatment courses, the NIHSS scores were significantly changed in both groups compared to that before treatment (P<0.05). The FMA and BI scores were remarkably changed in both groups respectively after 1 and 2 treatment courses compared to that before treatment (P<0.05). After 2 treatment courses, there were significant differences in comparing the NIHSS score and BI score between the two groups.Conclusion Long-time needle retaining at Scalp acupoints plus body acupuncture can improve the neural function deficit, motor function, and activities of daily life in sub-acute stage of cerebral stroke.

BACKGROUND:Under certain conditions, bone marrow mesenchymal stem cels can be differentiated into hepatocytes, which are an important source of liver cels. Moreover, multiple factors can be involved in this induced differentiation process. OBJECTIVE:To investigate the inducible effect of cholestatic serum on the differentiation of bone marrow mesenchymal stem cels into hepatocytes. METHODS:Cholestatic animal model was prepared in rats to extract cholestatic serum. Bone marrow mesenchymal stem cels isolated from rats were divided into three groups and cultured in serum-free hepatocyte medium, serum-free hepatocyte medium plus cholestatic serum, serum-free hepatocyte medium plus normal serum, respectively. RESULTS AND CONCLUSION:The positive expression of alpha fetoprotein and keratin 18 and mass concentration of albumin were significantly higher in the serum-free hepatocyte medium plus cholestatic serum group than the other two groups (P < 0.05). These findings indicate that cholestatic serum has a certain inducible role in the differentiation of bone marrow mesenchymal stem cels into hepatocytes.

Objective To prepare human annexin V dimmer and make chance for its pharmacological research.Methods Pichia pastoris transformed by human annexin V gene was used in this investigation.The engineered yeast was cultured in BMGY media and induced with methanol media BMMY for secreting expression of human annexin V.The final BMMY media supernatant was adopted for preparation of human annexin V dimmer by ammonium sulfate precipitation,molecular sieve separation and ultra-filtration concentration.The purification process was monitored by SDS-PAGE and coomassie brilliant blue staining.Results Human annexin V was obtained after two days induction of pichia pastoris in BMMY media.The human annexin V dimmer was successfully prepared from culture supernant by serial ammonium sulfate precipitation,molecular sieve separation and ultra-filtration concentration.Conclusion We prepare the human annexin V dimmer(diannexin V)successfully.

Background The main cause of filtering surgery failure is over proliferation of fibroblasts in filtering channels,leading to excessive fibrosis and scar formation.Researches determined that p38 mitogen-activated protein kinase(MAPK) signaling pathway plays an important role in fibroblast phenotype transition. Objective The present study was to investigate the inhibitory effect of p38 MAPK inhibitor on myofibroblasts transdifferentiation and the extracellular matrix synthesis after filtration surgery in rabbit eyes. Methods Trabeculectomy was performed on 24 eyes of 12 clean New Zealand white rabbits to establish the filtering operative models.The models were randomized into model group,SB203580 group and mitomycin C ( MMC ) group.1 ml SB203580 ( 0.2 g/L) was conjunctively injected at the end of operation in the rabbits of the SB203580 group,and the cotton piece with 0.2 g/L MMC solution was placed on the operative area for 3 minutes intraoperatively in the rabbits of the MMC group.The bleb appearances were examined under the slit lamp microscope,and intraocular pressure(IOP) was measured with Icare tonometer I,3,7,10,14 days after operation.0.2 ml aqueous humor was extracted and the conjunctive tissue at the filtering area was obtained 14 days after operation for the detection of α-smooth muscle actin (α-SMA) and fibronectin protein by ELISA.Expression of ACTA2 mRNA,connective tissue growth factor(CTGF) mRNA and alpha2 chain of type Ⅰ collagen( COL1A2 )mRNA in conjunctive tissue was assayed with fluorescence real-time PCR. Results Vascularization of fibrosis of filtering bleb were obvious in the eyes of the model group,and the bleb was flat and diffuse in the eyes of the SB203580 group and MMC group on 14 days following operation.No significant difference was seen in IOP before trabeculectomy among these three groups( F=0.065,P=0.937 ).IOP was gradually elevated with the increase of time after operation ( F =32.873,P =0.030 ).ELISA assay showed that α-SMA level in conjunctiva was lower in the SB203580 group and MMC group compared with the model group,and that of MMC group was significant lower than the SB203580 group( P＜0.05 ).Fibronectin level in conjunctiva was lower in the SB203580 group and MMC group compared with the model group,and that of MMC group was significant lower than the SB203580 group (P＜0.05).Fluorescence real-time PCR showed that expressions of the ACTA2 mRNA,CTGF mRNA and COL1A2 mRNA were significantly different among the three groups( P＜0.01 ),with the highest expression in model group and the lowest expression in the MMC group ( P ＜ 0.05 ). Conclusions Fibrotic reaction after trabeculectomy can be suppressed by inhibiting p38 MAPK signal pathway.The mechanism of SB203580 is to reduce the synthesis of myofibroblasts transdiffercntiation and extracellular matrix.

BACKGROUND:Massive blood loss was caused by an over-reactive fibrinolytic system, as a sequence of tourniquet usage and surgery trauma in total knee arthroplasty. As an antifibrinolytic drug, tranexamic acid has been proven to decrease not only the obvious and total blood loss, but also the ratio of alograft blood transfusion in total knee arthroplasty. Nevertheless, the effect of tranexamic acid on hidden blood loss in total knee arthroplasty had not been clarified yet. OBJECTIVE: To observe the effect of intravenous infusion of tranexamic acid on hidden blood loss in primary total knee arthroplasty. METHODS:Clinical data of 54 patients who received primary unilateral total knee arthroplasty in the Third Hospital, Peking University from June to December 2013 were retrospectively analyzed. They were divided into two groups according to the use of tranexamic acid. 22 patients in the tranexamic acid group were given 2 g tranexamic acid by intravenous infusion during surgery. 32 patients in the control group were given an equal volume of physiological saline. Patients in both groups were oraly given anticoagulant rivaroxaban after replacement. Hemoglobin level and blood hematocrit were recorded before and after surgery for 5 consecutive days. The total amount of blood loss and hidden blood loss were calculated by using Cross equation. The difference in the amount of blood loss was compared between the two groups. Lower extremity venous ultrasound examination was conducted at 1 week after replacement to determine deep venous thrombosis in the lower limb. RESULTS AND CONCLUSION:No significant difference in general data and perioperative conditions was detected between the two groups (P > 0.05). Postoperative drainage, dominant blood loss, total blood volume, the amount of autologous blood transfusion and the amount of alogeneic blood transfusion were significantly less in the tranexamic acid group than in the control group (P < 0.05). According to Gross formula, the difference of hidden blood loss was statisticaly significant between the tranexamic acid group (302.9±189.9) mL and the control group (596.8±271.4) mL (P < 0.05). Deep vein thrombosis appeared in one case between the two groups after replacement. Results indicate that intravenous infusion of tranexamic acid dramaticaly decreased the hidden blood loss in unilateral total knee arthroplasty, reduced alogeneic blood transfusion, and simultaneously did not increase the incidence of deep vein thrombosis in the lower limb.