Objective To evaluate the safety and efficacy of Voriconazole on invasive fungal infections in very elderly patients.Methods Clinical data of 24 very elderly patients with invasive fungal infections who had sought treatment at the Department of Geriatrics of our hospital from April 2013 to April 2014 were retrospectively investigated.The classifications and quantities of fungi,accompanying symptoms,adverse reactions,blood tests,and liver and kidney function indicators were recorded and analyzed before and after treatment.Results Each of the 24 cases was found to have been infected with one or more of 17 fungal strains belonging to the genus of Candida.The rate of complete fungal elimination after treatment was 70％ (12/17).Of the 24 cases,5 achieved a full recovery(20.8 ％),10 (41.7 ％) had significant improvement,5 (20.8 ％) had some improvement,and 4 cases(16.7％)showed no therapeutic benefits,with a total effectiveness rate of 62.5 ％.There was no significant difference in liver and kidney function before and after treatment(P＞0.05).A transient increase in serum creatinine occurred in 1 case and defective vision in another patient during Voriconazole treatment.Conclusions The incidence of invasive fungal infections is high in very elderly patients,with Candida as the main pathogen.Voriconazole is effective in treating invasive fungal infections in very elderly patients,and close monitoring of liver and kidney function is required during voriconazole treatment.

The problems in resources support in Library of Chinese Academy of Medical Sciences were analyzed according to the investigation on the utilization of and demand for information resources in 23 scientific researchers and 37 students in Institute of Basic Medical Sciences, Chinese Academy of Medical Sciences.Certain suggestions were put forward for the solution of these problems in terms of adjustment and optimization of subject resources, in-formation organization and revealing, exchange and communication between users, recommendation and training of subject resources .

OBJECTIVE:To provide reference for standardizing off-label drug use and guaranteeing clinical rational use of drugs. METHODS:2400 prescriptions were collected from outpatient department of our hospital during Jan.-Mar. 2016 at regular interval, and then divided into super-indication drug use, out-of-dose drug use, out-of-administration route drug use and out-of-group drug use. The out-of-label drug use were analyzed by reseaching package inserts,domestic and foreign guideline,do-mestic and foreign literature,MICROMEDEX Health Care Series database. RESULTS:There were 219 (9.1%) prescriptions of off-label drug use,involving 12 drug types and 38 items of off-label drug use. In mainly manifested as out-of-indication drug use (219 prescriptions,100%),out-of-group drug use (4 prescriptions,1.8%). All off-label drug use were supported by evidence, among which 9 items(23.7%)of off-label drug use were included in MICROMEDEX. Of all the related off-label drugs,Estradiol valerate tabletes(22.8%),Metformin hydrochloride tablets(17.4%)and Ethinylestradiol and cyproterone acetate tablets(12.3%) were the most common. CONCLUSIONS:All off-label drug use are supported by evidences in outpatient department of our hospi-tal. There are difference in the quality of those evidence. If off-label drug use is necessary in the clinic,it is suggested to fully weigh the advantages and disadvantages and establish related clinical management system and procedure to avoid medical risks and guarantee the safety of drug use.

Objective To evaluate the rationale of lowering the cutoff value of impaired fasting glucose(IFG)by studying the extent and severity of angiographic coronary artery disease(CAD)and the cardiovascular risk factors in subjects with different fasting plasma glucose(FPG)levels. Methods A total of 911 consecutive patients who had undergone coronary angiography were selected according to inclusion criteria. The subjects were studied in view of the extent and severity of angiographic CAD and the cardiovascular risk factors with different FPG levels. Results (1) Compared with the group of FPG<5.6mmol/L, the numbers of diseased vessels in the group with FPG 5.6-6.0mmol/L were significantly increased(P<0.05)after adjustment of age, sex and other influencing factors; the group with FPG 6.1-6.9mmol/L had both raised number of diseased vessels and the CAD Gensini cumulative index(P<0.01). (2) The prevalences of overweight, hypertension, hypertriglyceridemia, metabolic syndrome were progressively increasing with graded FPG levels. The prevalence of hypertriglyceridemia was significantly increased with FPG level at 5.0-5.6mmol/L(P<0.05),and the prevalences of metabolic syndrome and other components were significantly elevated with FPG level at 5.6-6.0mmol/L(P<0.05). Conclusion (1) The extent and severity of angiographic CAD were increased with increased FPG even in prediabetic period. The risk of angiographic CAD became increased significantly with FPG at 5.6-6.0mmol/L level. (2) The cardiovascular disease(CVD)risk was also increased with increasing FPG even in prediabetic period. The phenomenon of clustering of CVD risk factors was found at FPG 5.6mmol/L.

Objective To compare the clinical efficacy of intralesional betamethasone versus triamcinolone acetonide acetate in the treatment of active alopecia areata. Methods A total of 160 patients with active alopecia areata were divided into two groups, test group (n = 100) treated with intralesional betamethasone, and control group (n = 60) treated with intralesional triamcinolone acetonide. Both injections were given once every 3 weeks for 12 consecutive weeks. Results After 12-week treatment, the cure rate, response rate, and total response rate were 60.0%, 32.0% and 92.0% in the test group, respectively, compared to 41.7%, 31.67% and 73.3% in the control group, respectively. A significant increase was observed in the cure rate and response rate in the test group compared with the control group (χ2 = 10.25, 5.06, P < 0.01 and 0.05). During the treatment course, 8 (8%) patients in the test group and 9 (15%) patients in the control group developed localized atrophy of the scalp; 8 (8%) patients in the test group and 3 (5%) patients in the control group developed localized folliculitis; no significant difference was observed between the two groups in the occurrence of adverse reactions (P> 0.05). Conclusion Intralesional use of compound betamethasone injection has a notable therapeutic effect on alopecia areata.

Objective To develop a diabetes risk score (DRS)to predict the risk of development of incident diabetes in male senile people in Beijing. Methods DRS was developed basing on a test group including a cohort of 1 370 individuals aged 48-87 years without diabetes at baseline, followed for 10 years by Logistic regression and validated on a value group including a cohort of 340 individuals aged 43-88 years without diabetes at baseline. Results The model with the highest area under the ROC curve ( AUC ) included age, hypertension,history of hyperglycemia, body mass index, fasting plasma glucose, triglycerides, and high-density lipoproteincholesterol (HDL-C). DRS was developed basing on this model with a range from 0 to 12 and an optimal cut-off of 4. AUC were respectively 0. 726 ( 95% CI0. 692-0. 759 ) and 0. 765 ( 95% CI0. 691-0. 839 ) in test group and validation group. The sum score value ≥4 had sensitivity of 65.3% and 68. 1%, specificity of 70. 0% and 64.8%, positive predictive value of 37.0% and 23.2%, negative predictive value of 88.2% and 94. 1%.Conclusion The DRS, derived from clinical information combined with plasma glucose and lipids, is an effective tool to predict incident diabetes.

Objective To investigate the relations and evaluation value of serum thymidine kinase 1 (sTK1) in the treatment of patients withacute exacerbation of chronic obstructive pulmonarydisease (AECOPD). Methods The retrospective treating studies were performed on 104 patients with AECOPD , sTK1 level was de-tected by chemiluminescence dot-blot assay before and after treatment , and the correlation between the expression of sTK1 and CRP after treatment in the two groups was analyzed. Results The levels of sTK1 and CRP in the ef-fective group significantly lowered after treatment (P < 0.05). The expression of sTK1 in the effective group and in the ineffective group after treatment was significantlycorrelated with CRP (P < 0.05). Conclusion sTK1 can be used as a valuable indicator to evaluate the severity of AECOPD and to estimate the efficacy of AECOPD thera-py.

Objective To explore the expression plasma heat shock protein HSP90αand its clinical signifi-cance for lung cancer patients . Methods Plasma levels of HSP90α protein of 60 patients with lung cancer and 24 healthy individuals are detected by ELISA analysis . Results The average plasma levels of HSP90αprotein [(190.338 ± 105.861) ng/mL] in patients with lung cancer were significantly higher than in healthy con-trols [(41.020 ± 19.736) ng/mL, t = 10.480, P < 0.001]. The sensitivity of HSP90α is higher than CEA, NSE, CYFRA21-1. The sensitivity of HSP90α, CEA, NSE, CYFRA21-1 and STK1 is 100%. HSP90α is correlated with STK1 and metastasis (χ2 = 4.656, P = 0.031). Conclusions This study demonstrates that the plasma level of HSP90αprotein is a useful diagnostic biomarker in lung cancer. The sensitivity is much higher when HSP90αcom-bined with CEA, NSE, CYFRA21-1 and STK1.

OBJECTIVE:To investigate the application effect of PDCA circulation method in clinical pharmaceutical care. METHODS:According to the method of PDCA cycle,clinical pharmaceutical care quality and satisfaction degree of physicians, nurses and patients in 2013 were investigated to find out the problems;the reasons were analyzed and countermeasures were made out,checked and implemented. Finally,the quality of clinical pharmaceutical care,the medical staff and patient's satisfaction with clinical pharmaceutical care were compared before and after the implementation of PDCA circulation. RESULTS:Due to the poor quality of clinical pharmaceutical care and low satisfactory degree of our hospital,we formulated related countermeasures,such as enhancing the medication service skill of clinical pharmacists in obstetrics and gynecology department,extending the coverage of pharmaceutical ward round,developing the pharmaceutical care for patients with high risk pregnancy or underwent assisted repro-duction,strengthening communication and propaganda of medical staff and patients. After the implementation of countermeasures, the quality indicators of clinical pharmaceutical care were improved in 2014,compared to 2013,such as the number of patients in-cluded in pharmaceutical ward round increased from 445 to 1 780;total number of reasonable medication intervention suggestion in-creased from 14 to 29;that of pharmaceutical consultation increased from 8 to 23;the satisfaction degree of medical staff and pa-tients improved from 55.93% and 45.95% to 100% and 92.10%,respectively. CONCLUSIONS:PDCA circulation can significant-ly improve the quality of clinical pharmaceutical care and satisfactory degree of our hospital,and promote pharmaceutical care of our hospital.

Objective To investigate the dynamic change and its clinical significance of serum thymidine kinase 1 (STK1) in patients with non-small-cell lung cancer (NSCLC) when undergoing 4 cycles of chemotherapy. Methods We detected STK1 levels of 59 patients with NSCLC throughout 4 cycles of chemotherapy using Enhanced Chemiluminescence Western Blot and analyze its relationship with chemotherapy responses . Results STK1 levels with different chemotherapy regimens had no significant difference. STKK1 levels in patients with effective response were significantly lower after 4 cycles of chemotherapy. STK1 levels in patients with effective response were significantly lower than those in non-responders throughout 4 cycles of chemotherapy. The positive rates of STK1 in those with effective response were lower than those in non-responders after the last two cycles of chemotherapy. STK1 levels between lung squamous carcinoma and lung adenocarcinoma had no significant difference. Conclusion The detection of the changes of serum TK1 in patients with NSCLC undergoing chemotherapy is useful in evaluating the effect of chemotherapy and the later therapeutic schedule.