OBJECTIVE: To review the development of clinical pharmacy in Europe, analyze the quality assessment system and provide a reference for China. METHODS: By reviewing the literature of European hospital pharmacy or clinical pharmacy services from 1960 to 2013, sum up the development process of clinical pharmacy in Europe and analysis existing quality assessment system. RESULTS: European clinical pharmacy development can be divided into four parts; initial stage ("clinical pharmacy" introduced to hospital), exploring stage ("ward pharmacy service" mode), developing stage ("patient-centered" work system) and mature stage (improving "clinical pharmacists" evaluation system) ; It has formed quality assessment system of pharmacy service structure, process and outcome, but has not yet established a comprehensive system of evaluation criteria. CONCLUSION: Through analyzing and comparing the development progress and quality assessment system of European clinical pharmacy, it is useful to determine a clear direction of Chinese hospital pharmacy and to promote the establishment and improvement of Chinese quality evaluation system.

Objective:To produce rhBMP-4 with bioactivity in E.coli. Methods: The full-length human BMP-4 gene was mutated by PCR without changes in amino acid sequence, then the synthesized gene was cloned into plasmid pET-3c, transducted into BL21(DE)plysS, and induced by adding IPTG to a final concentration of 1.0 mmol/L. The protein product was purified using ion-exchange chromatography method and then renaturated, bioactivity was checked by C2C12 differentiation in vitro and mouse ectopic bone formation in vivo. Results: A 438 bp gene fragment encoding mature peptide of hBMP-4 was cloned , the protein product was mostly in the form of inclusion body, after renaturation, the engineering protein shows better bioactivity. Conclusion:The mutant strategy can enhance the expression of bioactive rhBMP-4 in E.coli expression system.

OBJECTIVE The purpose of the present study was to investigate the impact of fluvas-tatin formulation on the pharmacokinetics-genetic polymorphis relationship. METHODS We compared the difference between the pharmacokinetics of fluvastatin as an extended-release (ER) 80 mg tablet and an immediate-release(IR)40 mg capsule in terms of drug metabolism enzyme and transporter ge-netic polymorphisms. In this open-label, randomized, two-period, two-treatment, crossover study, ef-fects of BCRP, SLCO1B1, MDR1, CYP2C9, and CYP3A5 polymorphisms on the pharmacokinetics of fluvastatin were analyzed in 24 healthy individuals.Each treatment duration was 7 days with a washout period of 7 days between the crossover.Serum concentration of fluvastatin was evaluated using high-performance liquid chromatography-tandem mass spectrometry. RESULTS The SLCO1B1 T521C genotype had no statistically significant effect on IR 40 mg capsule of fluvastatinafter single or repeated doses.However,for the ER 80 mg tablet,the SLCO1B1 T521C genotype correlated with the AUC0-24of repeat doses (P=0.01). The CYP2C9*3 genotype correlated with the AUC0- 24after the first dose IR 40 mg capsule (P<0.05); however, the difference between CYP2C9*1/*1 and CYP2C9*1/*3 was not statistically significant after repeated doses. CONCLUSION The effect of SLCO1B1 T521C on fluvas-tatin exposure was observed and was more profound in ER and repeated dose administration than in IR and single dose administration.We recommend that formulation should be incorporated into future pharmacogenomics studies and clinical implication guidelines.

Objective To provide patients with reasonable individua-lized warfarin anticoagulation therapies according to the genotype testing.Methods Through clinical pharmacists′participation in anticoagulant therapy of an elderly female , who was admitted into hospital for aggrava-tion of heart failure due to atrial fibrillation and pulmonary infection , the reason for the elevated international normalized ratio ( INR ) was ana-lyzed , and the dose of warfarin was adjusted according to genotype results ( CYP2 C9*1/*1 and VKORC1 -1639 GA ).Before discharging her , pharmacist educated the patient so as to enhance self -anticoagulant therapy management.Results and Conclusion The patient's condition was improved.Her INR was 1.46 and in an upward trend before the day of her discharge.Guidance of genotypic testing combined with patients′concomitant diseases , medications, diet et al, could reduce time of INR to reach the target range and also improve the effectiveness and safety of anticoagulant therapy.

Objective To provide a reasonable anticoagulant treatment plan for an artrial fibrillation patient.Methods Clinical pharmacists participated in one case of senior patient who under warfarin treatment with digestive tract hemorrhage,and provided personal anticoagulant treatment plan by analyzing the reasons of labile international normalized ratio (INR) and bleeding and using anticoagulant gene test result.Result and conclusion The patient was discharged from hospital.By combination of disease,drug combination,genotype factors,the effectiveness and safety of treatment were improved.

Objective To explore the method of pharmaceutical care for patients with non-ST segment elevation acute myocardial infarction and pulmonary tuberculosis by clinical pharmacist.Methods Clinical pharmacist participated in an acute non-ST segment elevation myocardial infarction patients with pulmonary tuberculosis,analyzing the treatment options for patients,assessing the efficacy of anti-platelet drugs,discussing gene polymorphisms and the interactions efficacy between anti-TB drugs and anti-platelet drugs.Results and conclusion Analyzing the function and characteristics of each drug,managing of drug interactions,providing individual treatment strategies for patientssare the key points for clinical pharmacists participating in clinical work.

In recent years,the use of direct oral anticoagulants (DOACs) have been gradually accumulated in clinical practice.In specific cases,the DOACs blood concentration of patients are needed to be clearly defined in order to assist in further diagnosis and treatment.Therefore,through the study of literature retrieval of DOACs laboratory test at home and abroad,we intended to explore detection method of four kinds of DOACs (dabigatran,rivaroxaban,apixaban and edoxaban).Meanwhile we also discussed the use of DOACs detection and its effect on coagulation function detection in emergency or during the perioperative period.Finally,the results turned out that patients with dabigatran can detect the blood concentration by activated partial thromboplastin time,diluted thrombin time and ecarin clotting time.Factor Xa activity assay can be used for patients taking direct a factor Xa inhibitor,and high sensitivity of prothrombin time detection are especially suitable for rivaroxaban patients.

OBJECTIVETo detect rare types of thalassemia mutations among southern Chinese population.

METHODSPeripheral blood samples from 327 patients from various regions of southern China were collected. The patients were suspected as rare-type thalassemia for their inconsistency between hematological phenotypes and results of routine mutation screening. The samples were further analyzed with GAP-PCR and DNA sequencing.

RESULTSOne hundred and eight cases were diagnosed as rare types of thalassemia. Among whom 10 rare α-globin gene mutations including --THAI, HKα, αααanti3.7, αααanti4.2, -α2.8, -α27.6, CD74 GAC>CAC (Hb Q-Thailand), CD30 (-GAG), CD31 AGG>AAG and CD118 (+TCA), and 12 rare β-globin gene mutations including CD37 TGG>TAG, CD39 CAG>TAG/CD39 CAG>TAG, β II-2 (-T), -90(C>T), -31(A>C), -88(C>T), CD7(-A), CD138(+T), CD89-93 (--AGTGAGCTGCACTG), CD54-58 (-TATGGGCAACCCT), Chinese G γ +(A γδβ)0 and Vietnamese HPFH (HPFH-6) were identified. -88(C>T) (HBB: c.-138C>T) and CD39 CAG>TAG (HBB: c.118C>T) were discovered for the first time in Chinese population. CD7(-A) (HBB: c.23delA) and CD138(+T) (HBB: c.416_417insT) were new types of β-globin gene mutations.

CONCLUSIONThe present study have enriched the mutation spectrum of thalassemia in southern China, which has provided necessary information for its diagnosis.

Humans ; Mutation ; Thalassemia ; genetics ; alpha-Globins ; genetics ; beta-Globins ; genetics

OBJECTIVETo investigate the prevalence of chronic obstructive pulmonary disease (COPD) and its risk factors in population over 40 years old in northern part of Guangdong province.

METHODSUsing uniform scheme, procedures and questionnaire, a cluster-randomized-sampling survey for the population aged over 40 years in a rural area of Shaoguan in the northern part of Guangdong province was performed. Spirometry was performed for every participant, followed by a bronchodilatation test when bronchial obstruction was present.

RESULTSThere were 1468 cases with complete data from 1498 people aged >or= 40 years including 640 males, 828 females with an average age of 54.3 years old. The total prevalence of COPD was 12.0%. The prevalence of COPD in males was significantly higher than that in females (18.3% vs. 7.1%, P < 0.01). Only 80.7% of the patients with COPD presented one or more symptoms as cough, phlegm, or dyspnoea. Underdiagnosis of COPD would be quite serious. Only 26.1% of the cases was previously diagnosed to have chronic bronchitis, emphysema, or COPD. Smoking was an important risk factor to COPD and 78.4% of the patients with COPD were smokers. However, relation of biomass and COPD called for further investigation.

CONCLUSIONPrevalence of COPD was much higher than expected in the northern part of Guangdong while smoking was an most important risk factor of COPD. Lung function test seemed to be of great importance to COPD diagnosis, especially in the earlier period of COPD.

Adult ; China ; epidemiology ; Female ; Humans ; Male ; Mass Screening ; Middle Aged ; Prevalence ; Pulmonary Disease, Chronic Obstructive ; epidemiology ; Risk Factors ; Sex Factors ; Smoking ; adverse effects ; Surveys and Questionnaires

;Objective To investigate the influence of pharmacist inter-vention on patients′knowledge of anticoagulation therapy with warfarin . Methods Two hundred sixteen patients who were admitted to cardiovas-cular wards and were prescribed anticoagulation therapy with warfarin from October 2013 to August 2014 were included in the study .According to the ward they stayed , patients were divided into control group ( Cardiology ward No1.) and intervention group ( Cardiology ward No 2.) . In the control group , physicians and nurses introduced anticoagulation knowledge for the patients as usual , while intervention group received medication education and guidance on warfarin use by pharmacists .All patients of two groups filled out an assessment questionnaire about warfa-rin anticoagulation at discharge ( outpoint =13 ) .If any answer to the questions was wrong , pharmacists would educate them again .The score of the questionnaire were compared between the two groups . Results The intervention group enrolled 112 patients while the control group enrolled 104 patients. Scores of assessment questionnaire at discharge of the intervention group and the control group were (10.50 ±2.24) vs (8.08 ±2.61) respectively,with statistical difference ( P <0.05 ) .Conclusion Knowledge of warfarin therapy was much better in patients who received pharmacist intervention than patients who received usual care . Integrated management model with pharmacist interventions can improve patients′cognition in anticoagulation therapy with warfarin .