Based on the reality of Anhui Medical University,the paper analyzes the adverse factors of carrying out combination with teaching for the literature retrieval course from the perspectives of emphasis,professional knowledge structure and teachers of professional courses,and puts forward corresponding countermeasures from implementation of teaching and teaching effect,in order to provide reference for medical colleges to carry out literature retrieval course effectively.

Objective:To study how to guide the individual dose of clopidogrel in line with the genetic testing results. Methods:Clinical pharmacists decided how to optimize the prescription of clopidogrel according to the genotype combined with the drug metabolism and drug interactions for three patients respectively with slow clopidogrel metabolism,intermediary metabolism and super fast metabolism. Results:The slow clopidogrel metabolism patient with subacute stent thrombosis after half a month of coronary stenting was switched to orally administrate with ticagrelor. The super fast metabolism patient suffered from repeatedly subcutaneous hemorrhage with antiplatelet therapy was suggested to lower the dose of clopidogrel,temporarily withdraw Maixuekang capsules and conventionally administrate with vitamin C tablets orally. The intermediary metabolism patient with late stent thrombosis co-treated with lansoprazole was suggested to increase the dose of clopidogrel or use ticagrelor instead,and when it was necessary,panxitorazole,ray Bella or the other ranitidine acid suppression drugs such as ranitidine could be considered. Conclusion:Through genetic testing and drug interactions,clinical pharmacists guide the clinical use of clopidogrel and the optimization of antiplatelet therapy.

Over-expression of P-glycoprotein (Pgp) is associated with the development of multi-drug resistance ( MDR). Pgp has been focused on as the main target in designing chemotherapy strategy. In this article we review some of the latest advancement in designing and evaluation methods of P- glycoprotein inhibitors.

Auditory Cortex ; metabolism ; Humans ; Magnetic Resonance Spectroscopy

Objective:To evaluate the clinical efficacy between preparation porcelain veneer(PPV)and no-preparation porcelain veneer(NPPV).Methods:44 patients with 97 PPVs and 23 patients with 57 NPPVs were followed up for 3 years.Mental tension, postoperative dentin sensitivity and satisfaction of the patients,survival rate of the veneers,sulcus bleeding index(SBI)of preopera-tive and postoperative 3 years were evaluated.A comparative analysis was taken to examine the clinical indicators of 2 groups accord-ing to the modified CDA /Ryge criteria.Results:Survival rates of PPVs and NPPVs were 96.91 % and 96.49%(P >0.05),satisfac-tion rates of the 2 group patients were 95.45% and 95.65%(P >0.05),respectively.Mental tension and the postoperative dentin sensitivity of patients in PPV group was higher than those in NPPV group.Preoperative and postoperative SBI were not statistically dif-ferent between the 2 groups(P >0.05).Marginal adaptation in PPV group was better than that in NPPV group.Color matching, Porcelain surface and Marginal stain were not statistically different between 2 groups.Conclusion:Preparation porcelain veneers and no-preparation porcelain veneers both are effective in clinical application.

Objective To study the effect of total nutrient admixture (TNA) on lipid metabolism in rats with acute hepatic failure (AHF). Methods Fifty-six male Wistar rats were randomly divided into four groups: normal diet group, nitrogen-free diet group, fat-free nutrient admixture group, and TNA group. All rats were injected with D-galac- tosamine to induce AHF model Meanwhile, 6 healthy Wistar rats were used as control group. TNA provided energy 221.75 kJ (1 kcal=4.184 kJ), nitrogen 0.365 g, nitrogen to energy ratio 1:145, amino acids 2.28 g (including branched-chain amino acid 0.70 g), glucose 7.85 g, and fat 1.25 g on a daily basis. After 10 days of the operation of Jugular vein puncture tube, blood glucose, blood lipid, liver and renal function were determined. Results The blood glucose level was significantly higher in TNA group than that in fat-free nutrient admixture group (P < 0.05). The levels of serum triglyceride and cholesterol were highest in fat-free nutrition admixture group, and triglyceride level was signif- icantly higher than that in normal diet group and nitrogen-free diet group (P <0.05). The levels of serum triglyceride and cholesterol were significantly higher in TNA group than those in normal diet group (P <0.05). The levels of ala- nine aminotransferase, alkaline phosphatase, total bilirubin and blood urea nitrogen were lower in TNA group than those in fat-free nutrient admixture group (P < 0.05). Conclusion The nutritional proportion of TNA is suitable for the metabolism disorder of hepatic failure, and therefore TNA can reasonably promote the anabolism and reverse the deteri- oration of hepatic failure in rats.

Objective To explore the effect of sodium cantharidinate and vitamin B6 injection on plasma D-dimer level in patients of advanced esophageal cancer after chemotherapy and the relationship between plasma D-dimer level and clinical pathological parameters thereof. Methods Fifty-eight patients with advanced esophageal cancer confirmed by path-ological examination were randomly divided into two groups. Twenty-nine patients (experimental group) received chemother-apy (PF chemotherapy) combined with sodium cantharidinate and vitamin B6 (0.5 mg once daily). Twenty-nine patients (con-trol group) received same volume of saline. And there were 20 healthy volunteers as the normal control. The plasma D-dimer level was determined one day before the first cycle of chemotherapy and the third cycle of treatment. Results The plasma D-dimer level was significantly higher before chemotherapy in patients with advanced esophageal cancer than that in normal control group (P<0.05). There were no significant differences in plasma D-dimer level between patient gender, age, clinical stage and pathological levels. The D-dimer level was significantly down-regulated after chemotherapy. The D-dimer level was significantly lower in experimental group than that in control group (P<0.05). The incidences of digestive and hemato-logical adverse reactions were much lower in experimental group than those in control group. Conclusion The elevated plasma D-dimer level was found in patients with advanced esophageal cancer, and which was down-regulated by chemother-apy. The chemotherapy of sodium cantharidinate and vitamin B6 can further reduce the D-dimer level, and relieve the ad-verse reactions of chemotherapy.

Objective To investigate the change pattern of perioperative plasma D-dimer levels in patients with lung cancer, and the relationship between plasma D-dimer level and clinical pathological features thereof. Methods A to-tal of 64 patients with lung cancer were taken as cancer group, and 15 cases of benign lung disease were used as control group. The plasma levels of D-dimer were determined 2 days before operation, 1 day, 5 days and 9 days after operation in two groups. The clinical pathological parameters and type of surgery were evaluated at the same time. Results Plasma D-dimer levels were significantly higher in patients with lung cancer than those in control group (t=3.087, P<0.05). D-dimer levels were significantly lower in patients of TNM stageⅠthan those in patients of stageⅡorⅢ(P<0.05, respectively). Plas-ma D-dimer levels were significantly higher in patients with small cell cancer than those of patients with non-small cell can-cer (P<0.05). The perioperative plasma levels of D-dimer changed with time trends (P<0.001). In cancer group, D-dimer levels increased on the first day after operation, and then significantly decreased on the fifth and ninth day after operation (P<0.05). In control group, D-dimer levels increased on the first day after operation. The level of D-dimer was the same lev-el on the fifth day and the first day after operation (P=0.174). The level of 9 days after operation decreased to the level before operation (P=0.631). There was significant difference in overall data between cancer group and control group (P=0.005). D-dimer levels were significantly higher in cancer group than those of control group except for the fifth day after operation. Con-clusion Plasma D-dimer levels were much higher before operation in patients with lung cancer than those of controls. Plas-ma D-dimer levels were associated with TNM stage and cell type. D-dimer levels were significantly increased from the first day after operation, and then decreased significantly until the 9-day after operation, which were lower than that before opera-tionin lung cancer patients. But the level was still higher than that in patients with benign lung diseases.

Objective To summarize the experience in the treatment of Marfan syndrome of pregnancy complicated with acute type A aortic dissection.Methods Three women with Marfan syndrome of pregnancy complicated with acute type A aortic dissection were treated.The average age was 28.6 (25-31) years,and the average gestational age was 36.5 (32-38) weeks.At first caesarean operation were performed under general anesthesia.Bentall + Sun' s operation was performed under deep hypothermic circulatory.After operation,the mother and fetus were followed up.Results Three women and their fetus were safe.The average extracorporeal circulation time,aorta clamp time and circulatory arrest time were 265 (210-280) min,135 (120-160) min and 26.5 (20-29) min,respectively.After a mean follow-up of 2.0 (1.0-2.5) years,3 patients were living well.CT angiogram detected normal aortic,with no signs of distal dilation.Three fetus were normal in development and neurocognitive function.Conclusion Methods of surgical repair and fetal delivery should be chosen based on aortic pathological changes and gestational age to maximize the safety of the mother and fetus.