OBJECTIVE:To explore clinical pharmacists participating in anti-infection therapy in intensive care unit(ICU).METHODS:The typical cases of clinical pharmacists participating in anti-infection treatment in ICU were analyzed.RESULTS&CONCLUSION:Clinical pharmacists developed pharmaceutical care for anti-infection treatment in ICU and helped physicians to design individualized dosage regimen.It can improve the safety and effectiveness of antimcrobials in ICU patients and reflect the role of clinical pharmacists in rational use of drug.

Objective To compare in vitro fertilization and embryo transfer( IVF-ET ) outcome of gonadotropin-releasing hormone( GnRH ) antagonist protocol and GnRH agonist long protocol in patients with polycystic ovary syndrome ( PCOS)and to provide reference for rational selection of ovulation stimulation protocol for PCOS patients. Methods One hundred and four patients with PCOS who underwent IVF-ET were randomly divided into two groups. In the study group,41 patients were subjected to the GnRH antagonist protocol;In the control group,63 patients were subjected to a long protocol of GnRH agonist. Doses and duration of gonadotropin therapy,the thickness of endometrium and the profile of hormone level on the day of HCG administration,the number of retrieved oocytes,the ratio of fertilization,the ratio of cleavage,the ratio of the good quantity embryos,implantation rate of embryo,pregnancy rate,the cycle cancellation rate and the incidence rate of ovarian hyperstimulation syndrome( OHSS)were recorded. Results The IVF-ET outcome of the two groups was similar with respects to the number of oocytes,the ratio of fertilization,the ratio of cleavage,implantation rate of embryo and the pregnancy rate( P﹥0. 05). Significant differences were found(P﹤0. 05)between the two groups regarding to the doses and duration of gonadotropin therapy,the levels of serum E2 and LH on the day of HCG administration,and the cycle cancellation rate. The incidence rate of OHSS was not significantly different ( 2. 44% vs. 12. 70%) between the two groups. Conclusion The duration of gonadotropins administration,the cycle cancellation rate,incidence of OHSS and the financial burdern are reduced in patients treated with GnRH antagonist. The growth of follicle,the ratio of fertilization,the ratio of cleavage,implantation rate of embryo and the pregnancy rate are not different between the two methods. The GnRH antagonist protocol is optimal for patients with PCOS.

Objective To investigate the diagnosis value of soluble B7-H4(sB7-H4) in rheumatoid arthritis (RA) .Methods By using the ELISA sandwich method ,the serum levels of soluble B7-H4 ,anti-cyclic citrullinated peptide(anti-CCP) antibody and glu-cose 6-phosphate isomerase(GPI) were detected in 67 cases of RA ,72 cases of osteoarthritis(OA) and 75 cases of healthy people . The immunoturbidimetric method was adopted to determine the serum rheumatoid factor (RF) .Then the diagnostic value of sB7-H4 in RA was compared and analyzed .Results The serum level of soluble B7-H4 in the RA group was significantly higher than that in the control group and the OA group with statistically significant difference between them (P<0 .01) .The sensitivity of sB7-H4 in diagnosing RA was higher than that of RF ,anti-CCP antibody and GPI ,but the specificity was lower than that of anti-CCP antibody and GPI .There was better correlation between sB7-H4 with RF and anti-CCP antibody .The combination detecting of sB7-H4 ,RF , anti-CCP antibody and GPI could increase the diagnostic rate of RA .Conclusion B7-H4 has better clinical application prospects in diagnosing RA .

OBJECTIVE To study the drug-resistance of commonly encountered pathogens and the manifestations of irrational use of antibiotics,in order to provide the gist for clinical therapy.METHODS The retrospective analysis on the drug-resistance of commonly encountered pathogens that isolated from clinical samples and records of(irrational) use of antibiotics from Jan 2004 to Jon 2005 were carried out.RESULTS Among 870 isolates,the first five kinds of pathogens were Pseudomonas aeruginosa(17.47%),Klebsiella pneumoniae(9.66%),Acinetobacter baumannii(8.85%),Escherichia coli(7.36%)and Candida albicans(11.95%).They had resistance to the commonly used(antibiotics) in various degrees.In 4 462 records,there were 659 records of irrational use of (antibiotics),occupied 14.77%.CONCLUSIONS It is important that to strengthen the management of antibiotics(usage) and institutions in hospitals,to inform doctor the drug-resistance trend,based on the result of drug(sensitivity) test,in order to use antibiotics more rationally and reduce the appearance of drug-resistant bacteria.

Objective To report the clinical effect of repair of significant tongue defect after tongue cancer radical resection using anterolateral thigh perforator free flap with CTA three-dimensional reconstruction technique assistance.Methods From January,2012 to November,2015,13 cases were performed using anterolateral thigh perforator free flap in the repair of significant tongue defect after tongue cancer radical resection.Preoperation CT scan of the free flap donor site was done to obtain the three-dimensional images of arterial blood area by Digital Three-dimensional Reconstruction CT Technique to determine the origin of the anterolateral thigh flaps,direction,classification,length,diameter and the position of pedicle perforator.According to the condition of the defect of the tongue,flap of area from10 cm×9 cm to 8 cm×6 cm was design,the flap arteries and veins were anastomosed with the external maxillary artery or the superior thyroid artery,anterior vein,internal jugular vein or external jugular vein respectively.The shape and recovery of function of the reconstructed tongue were observed regularly after operation.Results All the flaps in the 13 cases survived,in the postoperative 4 to 18 months followed up,the appearance of the reconstructed tongue was close to the normal one,the patients were satisfied with the mastication and feeding function.Conclusion CTA three-dimensional reconstruction technique assisted anterolateral thigh perforator free flap technique is useful in obtaining good clinical effect,and it is one of the most best methods for repairing significant tongue defect after tongue cancer radical resection.

Objective:To investigate the clinical value of the free fibula flap transplantation in repair of the defect of tibia and soft tissue with the help of augmented reality (AR) technology.Methods:From May, 2017 to May, 2019, 9 patients with tibial and soft tissue defects were treated. Before operation, CTA scan was performed on both shanks to obtain DICOM data of tibial bone defect. Images of the designed fibular flap and its blood supply model were imported into Sina software through computer virtual surgery assistant technology. With the AR technology, information of virtual fibula flap were projected onto the body surface at the donor site, and the operation was carried out under the precise positioning. In this group, the free fibular flap was harvested with an area of 6.0 cm×4.0 cm-12.0 cm×6.0 cm and the length of fibula was 6.0-13.5 cm. The free fibula flap were used to repair the tibial defect with 5.0-12.0 cm in length and soft tissue defect area at 5.0 cm×3.0 cm-10.0 cm×4.5 cm. Patients were followed-up to observe the survival of fibular flap and the functional recovery of the repaired lower limb, and evaluate the clinical effect.Results:All the fibular flaps survived without vascular crisis and without serious complications occurred at both of donor and recipient sites. After 8-12 months of follow-up, the flap was soft in texture and good in blood supply. The appearance of the repair site was not bloated. Callus began to form at the junction of fibula and tibia at 3-5 months and healed well in 8-12 months. No bone resorption, nonunion, loosening or falling off of screws were found. There was no pain in the shank of the recipient area. Patients could stand and walk freely, and the weight-bearing function was close to normal. According to Enneking system, the average score was 27 points; 7 cases were excellent and 2 cases were good.Conclusion:Application of AR technology in the repair of tibial bone defect with fibular flap transplantation has good clinical effect and has certain practical value.

Objective:To investigate the efficacy and toxicity of oxaliplatin reintroduction combined with raltitrexed as second-line che-motherapy after the first-line oxaliplatin-based chemotherapy in advanced colorectal cancer patients. Methods:The 48 evaluable pa-tients with advanced colorectal cancer following disease progression prior to the first-line chemotherapy were treated with oxaliplatin and raltitrexed (raltitrexed 3 mg/m2 ivgtt d1, oxaliplatin 100-130 mg/m2 ivgtt d1, q21d). All 48 patients were divided into two groups:Group A, non-oxaliplatin-based regimens as the first-line chemotherapy, 20 cases;Group B, oxaliplatin-based regimens as the first-line chemotherapy, 28 cases. Each group was evaluated every two cycles. Results:The response rates (RR) of Groups A and B were 30.0%(6/20) and 32.1%(9/28), the disease control rates (DCR) were 80.0%(16/20) and 75.0%(21/28), the median progression free survival time (mPFS) was 6.5 and 7.0 months, and the median overall survival time (mOS) was 10 and 13 months, respectively. No statistical sig-nificance was observed between the two groups in their RR, CR, mPFS, and mOS (P=0.264, 0.514, 0.713, 0.788), respectively. The most common adverse effects observed wereⅠ-Ⅱgrades of bone marrow suppression, aminotransferase abnormality, and digestive toxici-ties. The incidence of neurotoxicity (Ⅰ-Ⅱgrades) between the two groups was similar. Conclusion:Instead of irinotecan combined with raltitrexed, oxaliplatin reintroduction combined with raltitrexed for second-line chemotherapy after the first-line oxaliplatin-based chemotherapy in advanced colorectal cancer patients is feasible.

Objective To study the effect of dexmedetomidine hydrochloride injection ( Dex) on awakening quality in Pediatric Patients with congenital heart disease undergoing fast_track anesthesia and whole Video_assisted thoracoscoPic surgery. Methods One hundred and twenty Pediatric Patients ( ASA I orIIleVel) with congenital heart diseases were randomly chosen for this study. They receiVed femoral artery and Vein cannulation to establish cardioPulmonary byPass and three small holes were obtained in the right chest for the PurPose of undergoing the whole Video_assisted thoracoscoPic surgery on rePairmen of atrial sePtal defect or simPle Ventricular sePtal defect. They were randomly diVided into two grouPs: Dex_assisted fast_track anesthesia grouP (D grouP,n=60) and general fast_track anesthesia grouP (C grouP,n=60). Each one in grouP D was injected with loading dose of Dex (1 μg·kg-1),then was intraoPeratiVely infused with maintenance dose of 0. 5 μg·kg-1·h-1. Children in grouP C were giVen the same dose of saline in the same way. Hemodynamic changes in the two grouPs at each time Point:before anesthesia ( t0 ) ,at the time of extubation ( t1 ) ,5 min Post_extubation ( t2 ) ,10 min Post_extubation ( t3 ) ,15 min Post_extubation ( t4 ) , 30 min Post_extubation (t5) and at the time of transferring out of CICU (t6),resPectiVely,were obserVed. Restlessness extent, incidence,time of eye oPening after calling, fully awaking time, extubation time, the time of transferring out of CICU and VAS scores,were also recorded. Results From t0 to t2-t5 ,SBP in D grouP was decreased from (114. 2±10. 5) mmHg to (107. 2±10. 3) -(105. 3±11. 3) mmHg,DBP decreased from (61. 3±9. 2) mmHg to (58. 8±7. 8) -(57. 3±6. 3) mmHg,and HR gradually decreased from (95. 2±15. 7) time·min-1 to (85. 7±13. 7)-(83. 3±12. 6) time·min-1,with significant differences (P<0. 05). ComPared with C grouP,SBP and DBP at t2-t5 were decreased significantly (P<0. 01),and HR at t1-t5 decreased significantly (P<0. 01). OVerall incidence of agitation was significantly higher in grouP C than in grouP D (48. 3%vs. 16. 7%,P<0. 01). Incidence of moderate and seVere agitation were significantly higher in grouP C than in grouP D (18. 3%vs. 6. 7%,and 20%vs. 1. 7%,resPectiVely,P<0. 01). In grouP D,time of eye oPening after calling,fully awaking time,extubation time,and the time of transferring out of CICU were Prolonged,without significant difference as comPared with grouP C (P>0. 05). VAS at 30 min after extubation was significantly higher in grouP C than in grouP D(4. 7±0. 7 vs. 2. 4±0. 6,P<0. 05). Conclusion Injection of Dex with loading dose (1 μg·kg-1) and intraoPeratiVe infusion of maintenance dose of 0. 5 μg·kg-1·h-1 in children with congenital heart disease undergoing fast_track anesthesia and whole Video_assisted thoracoscoPic surgery could be conduciVe to maintain hemodynamic stability, reduce restlessness occurrence, enhance security during awakening Process, and alleViate Post_oPeratiVe Pain.

Objective To explore the effect of hepatitis B virus (HBV) X protein (HBx) on autotaxin (ATX) expression and its significance. Methods The recombinant eukaryotic expression vector of HBx ,pcD-NA3.1(+)-HBx,and the recombinant luciferase reporter gene vector of ATX promoter,pGL3-ATX,were con-structed and used to co-transfect HepG2 cells to examine the effect of HBx on the activity of ATX promoter. The sta-ble cell expressing HBx,HepG2.HBx,was constructed,and Western blot(WB)was used to detect the effect of HBx on ATX expression. Results The luciferase activity of pcDNA3.1(+)-HBx and pGL3-ATX group was 1.47 times as that of the empty vector cDNA3.1(+)and pGL3-ATX group(P<0.000). WB detection showed that the expression of ATX protein was increased in HepG2.HBx cells,and 1.75 times as that of HepG2 cells(P<0.05). Conclusion HBx can activate ATX promoter and up-regulate ATX expression ,thus suggests that HBV infection might enhance ATX/LPA signaling.

Objective To analyze the changes of lymphocyte subsets in peripheral blood of patients with drug eruption . Methods 18 newly diagnosed patients were served as the drug eruption group ,and were subdivided into cephalosporin group (n=9) ,penicillin group(n=5) and Chinese medicine group(n=4) according to different sensitizing drugs .20 healthy people were taken as the control group .Flow cytometry were utilized to detect the percentages and absolute counts of T lymphocytes (CD3+ ,CD3+CD4+ and CD3+CD8+ ) ,B lymphocytes ,natural killer cell(NK) and natural killer T lymphocytes(NKT) in their peripheral blood . Results Differences of percentages of T lymphocytes (CD3+ ,CD3+ CD4+ ) ,B lymphocytes ,NKT cells between the drug eruption group and the control group showed statistical significant (P<0 .05) .Difference of percentages of CD3+ CD8+ lymphocytes of pa-tients between the drug eruption group and the control group demonstrated no statistical significant (P>0 .05) ,while that of abso-lute counts of T and B lymphocytes of patients was statistical significant between the drug eruption group and the control group (P<0 .05) .Conclusion The percentages of CD3+ ,CD3+CD4+ lymphocytes of patients with drug eruption decrease ,while those of NKT cells increase ,which may be related to the patients′immune regulation .