Objective:To investigate the role of clinical pharmacist in the treatment of patients with severe infection. Methods:Clinical pharmacist participated in the consultations for a patient with severe intracranial infection after craniocerebral operation in neurosurgery. According to the conditions of the patient and the results of antibiotic susceptive test,clinical pharmacist made an individualized medication for the patient,and the regimen included cefoperazone/ sulbactam,meropenem, vancomycin and Angong Niuhuang Wan. Results:The intracranial infection in the patient was improved gradually and controlled finally. Conclusion:Based on self professional knowledge,clinical pharmacist can participate in the clinical treatment of patients with severe infection,and assist doctors to develop treatment regimen in order to improve treatment effects. It will help clinical pharmacist preferably blend in clinical treatment team.

Objective To explore the role of hypoxia inducible factor 1α(HIF-1α)-mediated signaling pathway in angiotensin Ⅱ(Ang Ⅱ)induced renal interstitial fibrosis. Methods Renal tubular epithelial cells were cultured and treated with different concentrations (10-9-10-6 mol/L)of Ang Ⅱ for 24 h and 48 h.Real-time quantitative PCR and Western blotting were preformed to detect the mRNA and protein expressions of HIF-1α,prolyl hydroxylase 2 (PHD2)and tissue inhibitor of metalloproteinase 1 (TIMP-1)in renal tubular epithelial cells. Results HIF-1αmRNA level was increased with Ang Ⅱ treatment in a concentration dependent manner.When cells were treated with Ang Ⅱ concentration at 10-7mol/L for 24 h,the mRNA level was markedly increased by 166%.Furthermore,by real-time quantitative PCR and Western blotting,compared with the control group,Ang Ⅱincreased the mRNA and protein levels of HIF-1α and TIMP-1 (P<0.05,respectively),while the mRNA and protein levels of PHD2 were decreased markedly (P<0.05,respectively)in renal tubular epithelial cells.Conclusion Ang Ⅱ reduces HIF-1αdegradation in renal tubular epithelial cells probably by reducing the expression of PHD2,which increases the expressions of HIF-1α and TIMP-1 involved in renal interstitial fibrosis.

Anti-glutamic acid decarboxylase antibody-associated encephalitis is a kind of autoimmune encephalitis mediated by anti-glutamic acid decarboxylase antibody, which belongs to anti-neuronal intracellular synaptic protein antibody-associated encephalitis. Clinical manifestations include stiff-person syndrome, cerebellar ataxia, limbic encephalitis, seizures, etc., often associated with a variety of autoimmune diseases, rarely associated with tumors. Detection of anti-glutamic acid decarboxylase antibody is crucial for clinical diagnosis. Immunotherapy helps to relieve symptoms and improve prognosis. The incidence of this disease is low, and there are few reports at home and abroad. This paper intends to review the research on this encephalitis, hoping to improve the clinicians′ understanding and the level of diagnosis and treatment of the disease.

Objective To investigate the dose-response relationship of the treatment temperatures and heating time on human cervical carcinoma hela cells,aiming at providing experimental evidences for clinical hy-perthermia. Methods Hela cells were heated at 37 ～ 70 ℃ in temperature-controlled water baths, the tempera-ture was divided into nine groups,each time was divided into eight subgroups (1 ～ 30 min). The morphology changes of cells after hyperthermia were detected by inverted microscope. Proliferation rates were measured by MTT colorimetric assay. The apoptesis rates were determined by flow eytometric analyse. The levels of prolifera-ring cell nuclear antigen (PCNA) were measured with immunohistochemistry. Results lnereaseing the heating time at the same temperature, or increaseing heating temperature at the same time, the cell proliferation, survival rates and PCNA expression decreased. There was no significant morphological change about cells ,but have small amount of apoptosis and a direct role of the suppression and destruction at 41 ℃ and 43 ℃ group. A large num-ber of cells shrinked to round and a major role for apoptosis at 46℃ group. Cell necrosis was major role at 50 ℃and 55 ℃ group. More than 55 ℃ for necrotic cells. Conclusion With the increase of heating temperature and heating time, its treatment of Hela cells gradually enhance. So combining dose-effect relationship of hyperthermia temperature and time can reach the best therapeutic effects.

Objective To evaluate the feasibility and effectiveness of four closure techniques ,large incision with plastic distal at‐tachment and clip with suction ,1 .1 cm small incision with plastic distal attachment and clip with suction in natural orifice translu‐minal endoscopic surgery(NOTES) .Methods Forty‐one ex vivo porcine stomachs were involved in this research .According to the size of incision and different methods of incision closure ,all ex vivo porcine stomachs were divided into four groups .Group A in‐volved 8 ex vivo porcine stomachs ,their size of incision were 1 .2-2 .0 cm ,and their incisions were closured by a clip closure direct‐ly ;group B involved 10 ex vivo porcine stomachs ,their size of incision were 1 .2-2 .0 cm ,and their incisions were closed by plastic end attachment with suction and clip enclosure technique;group C involved 10 ex vivo porcine stomachs ,their size of incision were smaller than 1 .1 cm ,and their incisions were by a clip closure directly ;group D involved 13 ex vivo porcine stomachs ,their size of incision were smaller than 1 .1 cm ,and closured by plastic end attachment with suction and clip enclosure technique .Stomach leaks were evaluated by leaking studies after the procedure .Results In group A ,1 incision was closed successfully ,7 incisions were clo‐sured unsuccessfully ;in group B ,2 incisions were closed successfully ,8 incisions were closed unsuccessfully ;in group C ,2 incisions were closed successfully ,8 incisions were closured unsuccessfully ;in group D ,11 incisions were closed successfully ,2 incisions were Closured unsuccessfully .Fisher′s exact test showed that group D was significantly related to the success of incision closure .The were significant differences between group A and D ,group B and group D(P<0 .05) .Conclusion Small incision(smaller than 1 cm) and plastic end attachment with suction and clip enclosure technique are optimal in NOTES procedure in this ex vivo porcine stomachs study .

Objective The optimal access for natural orifice transluminal endoscopic surgery is still uncertain .This study was designed to compare the practicability and maneuverability of transgastric ,transunmbilical ,and transrectal approach in abdominal surgery in a canine model .Methods Three dogs were used in this research .Three approach :trangastric ,transunmbilical and tran-srectal approach were carried out for abdominal exploration ,liver biopsy ,bladder biopsy and an attempted cholecystectomy .The ma-neuverability ,endoscopic image ,performer′s perception ,and spatial orientation were evaluated .Results The maneuverability of trangastric ,and transrectal approach NOTES were better than transunmbilical NOTES .Abdominal exploration ,live biopsy ,and bladder biopsy were completed successfully .The cholecystectomy was failed because of poor exposure and difficulty of separating the around tissure .Conclusion The optimal approach for upper abdomen NOTES is transrectal route .For lower abdomen NOTES , the trangastric approach is superior to other accesses .Further study is needed to develop more flexible and precise equipment for NOTES and to evaluate more feasible access approach .

Objective:To study the relationship between cytotoxic T lymphocyte antigen 4 (CTLA-4) gene + 49A/G polymorphism and the risk of periodontitis.Methods:A comprehensive literature research was electronically performed to retrieve currently published studies regarding the association of CTLA-4 gene +49A/G polymorphism with periodontitis susceptibility.The individual OR with 95％ CI was pooled to calculate the strength of the association using RevMan 5.2 software.Results:4 out of 18 seached studies satisfied the standard for Meta-analysis.A total of 702 cases and 926 controls were finally included in the Meta-analysis.Overall,no significant association of CTLA-4 gene + 49A/G polymorphism with the risk of periodontitis was observed (P ＞ 0.05).In the subgroup analysis by ethnicity,the results showed a significant association of CTLA-4 gene + 49A/G polymorphism with increased risk of periodontitis in Asian population(P ＜ 0.05) but not in Caucasian population(all P ＞ 0.05).The stratification analysis by subtypes of periodontitis revealed no significant association of the polymorphism with chronic and aggressive periodontitis respectively (all P ＞ 0.05).Conclusion:The present studies suggest that CTLA-4 gene + 49A/G polymorphism may be not associated with the risk of periodontitis in the overall population,but correlated with an increased risk of periodontitis in Asian population.

Objective To analyze the TCM syndrome and treatment rule for the treatment of chronic atrophic gastritis based on data mining;To provide reference for its clinical treatment.Methods With the help of the big data platform of evidence-based literature of TCM covering several dominant diseases in the field of digestion,literature on the experience of famous doctors,theoretical discussion and case reports in the treatment of chronic atrophic gastritis published from 1 January 2000 to 31 July 2022 was retrieved.Medical records were screened according to the inclusion and exclusion criteria.The data of TCM disease names,clinical symptoms,tongue manifestation,pulse manifestation,TCM syndrome,TCM treatment method and other terms in medical records were standardized and statistically analyzed.Results Totally 169 articles were included,including 228 medical cases,involving 228 patients,with a cumulative number of 361 visits,with an average age of(53.17±11.11)years old,with the largest number of 50-60 years old.Chronic atrophic gastritis mostly belonged to the categories of"stomach pain"and"epigastric puffiness"in TCM,and its main symptoms were stomach pain,epigastric puffiness and belching.The common tongue manifestation include dark red tongue,white moss,thin or greasy moss.The common pulse manifestation included wiry slippery pulse,wiry thready pulse and wiry pulse.The high-frequency syndromes included liver-stomach qi stagnation syndrome,spleen-stomach dampness-heat syndrome,liver-qi stagnation and spleen-qi deficiency syndrome.The disease locations were mainly in the stomach,spleen and liver,and the syndrome elements were mainly qi deficiency,qi stagnation,blood stasis,dampness and heat,etc.The complex syndrome elements were more than the single syndrome elements,and the two syndrome elements of qi deficiency + qi stagnation was the most common.The most commonly used treatment methods were supplementing,regulating qi and regulating blood.Conclusion The treatment of chronic atrophic gastritis with TCM mostly focuses on the stomach,spleen and liver.The core syndrome elements are qi deficiency,qi stagnation,and blood stasis.The methods of nourishing qi and strengthening the spleen,soothing the liver and stomach,regulating qi and blood are often used.

Objective To summarize and compare the clinical characteristics of anti N-methyl-D-aspartate (NMDA) receptor encephalitis with positive and negative anti-thyroid antibodies (ATAbs),and explore the clinical characteristics and possible mechanism of anti-NMDA receptor encephalitis with positive ATAbs.Methods The clinical data of 53 patients with definitely diagnosed anti-NMDA receptor encephalitis,admitted to our hospital from January 2016 to April 2019,were collected.The patients were divided into two groups according to positive and negative ATAbs,and the clinical characteristics,experimental results and prognoses of the two groups were compared.Results Among the 53 patients,16 were combined with positive ATAbs,of which 11 were female (68.8％);37 were combined with negative ATAbs,of which 11 were female (29.7％);number of female patients in the positive ATAbs group was significantly larger than that in the negative ATAbs group (P＜0.05).The incidences of decreased consciousness,abnormal mental behavior or cognitive impairment,and epilepsy in the positive ATAbs group were higher than those in the negative ATAbs group,but the differences were not statistically significant (P＞0.05).There were no significant differences in prodromal manifestations,first symptoms (abnormal mental behavior or cognitive impairment,and epilepsy),main clinical manifestations,and incidence of complications between the two groups (P＞0.05).As compared with the negative ATAbs group,positive ATAbs group had significantly higher maximum modified Rankin scale scores (4[4,5] vs.3 [2,5]),abnormal rate of rheumatic immunity antibodies (50.0％ vs.13.6％),and rate of adopting two or more immunotherapy measures (93.7％ vs.51.4％;P＜0.05).Conclusion The clinical manifestations of anti-NMDA receptor encephalitis in the positive ATAbs patients are similar to those in the negative ATAbs patients,but the illness is more serious;moreover,the positive ATAbs patients are mostly combined with multiple antibody abnormalities,which may require more active immunotherapy.

Alzheimer's disease (AD) is a neurodegenerative disease mainly manifested by progressive cognitive impairment, which is seriously harmful to human health and causes a heavy burden to society and family. Aquaporin 4 (AQP4) is an important type of aquaporins (AQPs) in mammalian brain, and more and more studies have found that it plays an important role in the occurrence and development of AD. In this paper, the structure, distribution and function of AQP4 are summarized, and various ways of its participation in the pathogenesis of AD are systematically described to provide reference for the treatment of AD.