OBJECTIVE:To explore the method of pharmaceutical care for antifungal drug treatment of new type crypto-coccal meningitis by clinical pharmacist. METHODS:Clinical pharmacist participated in the drug treatment process for a pa-tient with new type cryptococcal meningitis. Clinical pharmacist provided pharmaceutical care in following aspects:assisting doctor to optimize antifungal drugs treatment plan,providing patients pharmaceutical monitoring and medication education, etc. During amphotericin B treatment,the patient developed refractory hypokalemia. Clinical pharmacists suggested doctors to reduce the dose of amphotericin B and additionally use voriconazole for antifungal treatment. RESULTS:The patient devel-oped refractory hypokalemia no more after the plan was adjusted. After 11 weeks of systematic antifungal treatment,the pa-tient was on the mend. CONCLUSIONS:The participation of clinical pharmacist in antifungal treatment of new type cryptococ-cal meningitis indicates that following the instructions,but not lost flexible disposal;providing service actively,and details is guarantee of safety.

Objective To investigate the surgical approaches indication, technique and efficacy for treatment of intracranial arachnoid cysts (IAC). Methods The clinical data of 56 patients with IAC who were diagnosed with MRI and/or CT techniques were retrospectively analyzed. According to the surgical approaches adopted, these cases were classified into 4 groups, group A with expectant treatment (12 cases), group B with endoscopic cystocisternal fenestration (15 cases), group C with cystoperitoneal shunting (21 cases), and group D with surgical cyst removal (8 cases). The outcomes of the patients were compared. Results The patients were followed up for 3 months to 46 months (mean 15 months). The rate of symptomatic improvement in group B was 14/15, in group C was 95.24%(20/21) and in group D was 5/8, and there was significant difference ( χ2=8.335, P<0.05). The rate of radiographic improvement in group B was 14/15, in group C was 90.48%(19/21) and in group D was 5/8, and there was significant difference (χ2=8.235, P<0.05). The rate of complication in group B was 1/15, in group C was 14.29%(3/21), and in group D was 5/8, and there was significant difference ( χ2=8.256, P<0.05) Conclusions In terms of therapeutic effect, surgical safety and minimal invasiveness, cystoperitoneal shunting and endoscopic cystocisternal fenestration should be the primary choice .

Objective To study the related factors of hemorrhage of uterine scar again after cesarean section,available for peer exchange.Methods A retrospective analysis of clinical data of 650 patients with scar uterus again cesarean section patients,analysis of postoperative hemorrhage patients,the causes of bleeding.They were divided into placental group (n =6),incision dehiscence group (n =7),uterine atony group (n =17)according to the causes of hemorrhage,and related factors of postoperative bleeding were analyzed.Results The bleeding volume of the placental group in operation[(2 500 ±500)mL]was higher than the uterine atony group[(1 300 ±400)mL] and the incision dehiscence group[(700 ±200)mL].The bleeding volume of the uterine atony group was higher than the incision dehiscence group (t =10.29,5.56,4.33,all P <0.05).The bleeding volume of the uterine atony group after operation[(100.09 ±36.45)mL]was higher than the placental group[(90.71 ±20.31)mL]and the uterine atony group[(81.23 ±30.34)mL].The bleeding volume of the placental group after operation were higher than the uterine atony group (t =3.94,3.02,2.78,all P <0.05).4 cases of hysterectomy,3 cases of conservative surgery in placental group.1 case of hysterectomy,16 cases of conservative surgery in uterine atony group.7 cases conservative surgery in incision dehiscence group.Conclusion placental factors,uterine atony,incision dehiscence all can lead to scar uterus again cesarean section hemorrhage.We should also strengthen the clinical prevention work,and actively take relevant measures,reduce postoperative bleeding risk,to ensure the safety of the mother and infant.

Objective To study the leaf morphology and structure of Cyclocarya paliurus.Methods Foliar maceration,preparation of venation order,sectioning paraffin blocks,and scanning electron microscope were used to study the leaf morphology and structure.Results Cuticular papillates,glandular hairs,peltate scales,and non-glandular hairs presented on the leaf epidermis of C.paliurus.Anomocytic stomata were confined to the lower epidermis.Large cluster crystals existed in the uppermost layer of palisade cells.Midrib included one closed vascular system and one additional vascular strand.Secondary veins are semicraspedodromous and form marginal loops,tertiary veins are percurrent,quaternary veins form orthogonal or polygonal areoles filled up by branched and freely ended veinlets.Conclusion These structure characteristics are first reported and are useful for leaf identification of C.paliurus from other Juglandaceae plants.

Objective To investigate the risk factors of vagus nerve invasion of advanced adenocarcinoma of esophagogastric junction (AEG).Methods The specimens from 98 patients with advanced AEG who underwent radical total gastrectomy and esophagogastric Roux-en-Y anastomosis from January 2011 to August 2012 at the First Affiliated Hospital of Anhui Medical University were collected.Serial section cutting was done and the upper and bottom incisional edges of every section were marked.The specimens were stained by hematoxylin-eosin solution,S-100 and CK immunohistochemistry.Vagus nerve invasion could be affirmed if cancer cells were observed in the peripheral space of vagus nerve and vagus nerve parenchyma or cancer cells infiltrated along the peripheral space of vagus nerve.Relationship between nerve invasion and clinicopathological factors was analyzed using chi-square test or Fisher exact probability.Factors related to vagus nerve invasion were analyzed using one-way analysis of variance and multi-factor logistic regression analysis.Results The incidence of vagus nerve invasion was 28.6％ (28/98),and the tumor only invaded the vagus nerve which had the same altitude as the upper incisional edge.The results of one-way analysis of variance showed that Siewert classification,intravascular cancer emboli,lymph node metastasis,the degree of lymph node metastasis,clinical staging,the degree of tumor differentiation were correlated with the vagus nerve invasion (x2 =14.156,14.552,5.454,10.706,6.919,14.767,P ＜ 0.05).The results of multi-factor logistic regression analysis showed that Siewert classification,intravascular cancer emboli and degree of tumor differentiation were the independent influencing factors of vague nerve invasion (OR =3.667,10.368,0.249,P ＜ 0.05).Conclusion Vagus nerve invasion is correlated with Siewert classification,intravascular cancer emboli and degree of tumor differentiation.The range of vagus nerve invasion is restricted under the upper incisional edge of tumor section.

As the third generation platinum antitumor drug with independent intellectual property rights,a number of basic and clinical research shows lobaplatin can effectively inhibit the proliferation of human breast cancer cell lines including triple-negative breast cancer in vivo.Compared with the cisplatinbased regimens,lobaplatin-based regimens have similar efficacy,and better safety profile.It becomes the new treatment option of metastatic breast cancer,and remains to be further study to optimize clinical rational drug use.

The training mode of the medical doctoral students in Albert Einstein College of Medicine is relatively perfect. Its advances are mainly embodied in the following three aspects:detailed and comprehensive training in scientific research capabilities, great emphasis on the process control and the strict assurance system in quality control. The above training mode helps Albert Einstein Col-lege of medicine to set up the good medical doctoral cultivation characteristics with the tolerance, competition, flexibility and freedom. To learn from those good traits, great efforts should be made in our medical doctoral cultivation mode to strengthen the role of tutor team, ensure the students' inter-ests, deepen the academic exchanges and meet the various needs of society.

Objective To explore the application value of calcium hydroxide agent in root canal disinfection of patients with chronic periapical periodontitis in stomatology department.Methods 108 cases patients with chronic periapical periodontitis from June 2013 to June 2014 in Cixi Guanhaiwei Zhen Health Centers were randomly divided into study group (n =54) and control group (n=54).The control group received camphor phenol cotton for root canal disinfection, and study group received calcium hydroxide agent.The clinical curative effect between two groups was compared.Results After 7 days’ treatment, the total effective rate was 98.15%in study group, which was significantly higher than 79.63%in control group (χ2 =9.375,P<0.05).After follow up 6 months, the total effective rate was 94.44%in study group, which was significantly higher than 77.78%in control group (χ2 =6.271,P<0.05).The incidence of endodontic interappointment pain (EIP) in study group was 11.11%, which was significantly lower than 25.93%of control group (χ2 =3.93,P<0.05).Conclusion Calcium hydroxide agent has a significant efficacy on in root canal disinfection of patients with chronic periapical periodontitis in stomatology department, could reduce the incidence of EIP and promote healing of chronic periapical periodontitis, which is the first disinfectant in the stomatology department of primary hospital.

Objective To observe the effects of mirtazapine to improve the life quality of malignant tumor patients with moderate or severe depres-sion. Methods Patients with mood disorders screened by the physician were then graded by the Hamilton Depression Scale(HAMD)under the tu-telage of ward psychological consultant. Fifty patients with moderate or severe depression were selected by psychological doctors and recruited for the study. After obtaining consent,the patients received 15-60 mg/d mirtazapine every night for 9 weeks. According to the Quality of Life Rating Scale (QOL),the scores of these patients were evaluated at the pretreatment,the 3rd week and the 9th week of the post-treatment. Then,the life quality conditions before and after treatment were revaluated. Results The scores of HAMD were 33.16±7.25,28.74±6.24,and 22.58±6.71 at the pretreat-ment,the 3rd week and the 9th week of the post-treatment,respectively. There were significantly different among the HAMD scores at the pretreat-ment,the 3rd week and the 9th week of the post-treatment.(F=30.99,P<0.01). The scores of HAMD were improved significantly between the pre-treatment and the 3rd week of the post-treatment(P<0.05). The scores of HAMD were also improved significantly between the 3rd week and the 9th week of the post-treatment(P<0.05). After treatment by mirtazapine,the appetite,spirit,sleep,fatigue,pain,the reorganization of cancer,the attitude towards treatment,the side effect of treatment and the facial expression were significantly improved(P<0.01). Conclusion Mirtazapine could improve the life quality of malignant tumor patients with moderate or severe depression.

Objective:In the medical cooperation, in order to realize the homogeneity of the medical, teaching, research, management, avoid to the waste of resources and the low benefit of patients with traditional cooperative mode. So combining the Internet and cloud computing technology to realize the reconstruction of the traditional mode of cooperation.Methods: Because of the need for equivalent cooperation, Beijing Friendship Hospital set up The Tiered Medical Work Platform Based on Medical image and Cloud Computing which between Beijing Friendship Hospital and Beijing Pinggu Hospital. The Work Platform was able to provides applications such as remote reading, remote diagnosis, remote consultation, remote difficult case discussion, remote teaching, training and so on.Results: The Work Platform solved the problem of wasting of human resource cost in our hospital, and improved the allocation of medical resources, improved the level of medical service of Beijing Pinggu Hospital, made people get benefits.Conclusion: Telemedicine technology can realize the reconstruction of traditional medical cooperation mode, establish standardized information sharing platform, increase the efficiency of medical resources allocation, improve the ability of primary diagnosis and treatment services, provide assist in forming the pattern of Tiered Medical.