Objective To probe into the present family bed workloads at community health centers in Shanghai,for bettering the service mode.Methods 41 community health centers in 17 districts or counties in Shanghai were randomly sampled with questionnaires,to learn the profile of the family beds and analyze the workloads provided by the institutions from 2010 to 2012.Results For the 41 institutions surveyed,patients aged 60 or above accounted for 95.07％ of the total patients,of whom the seniors over age 80 accounted for 51.00％; 3-year family bed setup rate is 4.45‰,5.09‰ and 5.51‰ respectively;the family bed checkup interval is 6.26 days,6.08 days and 5.84 days respectively.The average monthly payment from medical insurance per person is 441.86 yuan in 2010,433.41 in 2011,and 401.26 in 2012.Diseases makeup:Cardiovascular diseases accounting for 51.16 ％of the total,stroke patients for 31.02 ％,chronic bronchitis for 4.81％,and cancer patients for 1.10％.Among those patients withdrawn from family beds,86.54％ were cured,steady plus improvements.Conclusion Further improvement of the family bed service for better elderly chronic care management; preferential policies to further enhance the family bed service capabilities; emphasis of internal management to continuously improve the social benefits.

Objective: To investigate the principles of rational drug use for the patients suffering from heart failure complicated with diuretic-induced gouty arthritis.Methods: The clinical pharmacist participated in the diagnosis, treatment and drug adjustment of one patient suffering from heart failure complicated with furosemide-induced gouty arthritis.Taking the disease symptoms and potential gouty-inducing drugs into full consideration, clinical pharmacist suggested the withdrawal of related-drugs and the adjustment of treatment plan.Results: Considering the characteristics of the patient, clinical pharmacist adjusted the rational drug treatment.After the adoption of the suggestions, the gouty symptoms were relieved, heart failure was controlled and the condition was improved.Conclusion: Loop diuretics can easily trigger an acute attack of gout, especially for the patients with heart failure and gout history.Clinical pharmacist can make full use of professional advantages to optimize the treatment plan in order to reduce adverse reactions and promote the rational drug use by participating in clinical practice.

[Objective]To explore the short-term outcome and surgical technique of minimally invasive unicondylar knee arthroplasty(MIS-UKA) for medial compartmental osteoarthritis of the knee. [Methods]Forty-five patients(48 knees) with medial compartmental osteoarthritis of knee treated by MIS-UKA from May 2005 to December 2008 were reviewed and analyzed.The pain and range of motion(ROM) of the knees were evaluated by HSS score system before and after MIS-UKA.Pre-and postoperative alignment of the lower limbs was measured and compared.Surgery indications and surgical technique of MIS-UKA were also summarized.[Results]Forty-three knees in 40 patients were followed up for a mean time of 24 months(12-40 months).The pain over medial compartment of the knees was subsided or relieved in all cases.The post-operative ROM of the knees was 0?~135?(mean 120?),and alignment was 2? varus on the average(0?~6? varus).HSS score increased from 70(60~82) to 90(75~95).The good-to-excellent rate was 92%.[Conclusion]MIS-UKA is an effective method for medial compartmental osteoarthritis of the knee.Surgery indications and surgical technique are the key factors for the final results.

Objective To observe the variation of helper T cell (Th)9/regular T cell (Treg cell) balance in the inflammatory process of hepatitis B virus (HBV) infection.Methods Two hundred patients with chronic HBV infection in Zhejiang Hospital of Integrated Traditional and Western Medicine during August 2011 to June 2012 were divided into four groups according to alanine aminotransferase (ALT) levels.:chronic HBV carriers,chronic hepatitis B (CHB) with mildly [upper limit of normal (ULN)＜ALT＜3 × ULN],moderately (3 × ULN＜ALT＜5 × ULN),or significantly (ALT＞5 × ULN) elevated ALT,with 50 subjects in each group.In addition,30 healthy volunteers were enrolled as healthy controls (HC).ALT levels,HBV DNA,and Th9/Treg levels were measured by automatic biochemical analyzing equipment,real-time fluorescent quantitative polymerase chain reaction and flow cytometry,respectively.Th9/Treg levels of each group were observed.Means between groups were compared by t test,means of multiple groups were compared by one-way analysis of variance.Spearman rank correlation was used for correlation analysis.Results Age,sex distribution and HBV DNA levels of the four groups were comparable (P＞0.05).ALT levels of HC were significantly different from those of mildly,moderately,or significantly elevated ALT (t=8.48,18.41,28.93; all P＜0.05).Th9 cell levels,Treg cell levels and Th9/Treg ratio of HBV infected individuals were significantly different from those of HC (P＜0.05).With the increasing degree of inflammation,proportion of Th9 cells increased and Treg cells decreased gradually.The differences among the four groups were of statistical significance (P＜ 0.05).Th9 cell level was positively correlated with ALT (r=0.804,P=0.01),while Treg cell level was negatively correlated with ALT (r=-0.828,P=0.01).Conclusions Th9/Treg is imbalanced in patients with HBV infection,and closely correlated with ALT levels.

Objective To investigate the correlation between hemorrhagic transformation (HT) and each parameter of blood pressure variability (BPV) in patients with massive cerebral infarction caused by cardioembolic middle cerebral artery occlusion. Methods The patients with massive cerebral infarction caused by unilateral cardioembolic middle cerebral artery occlusion admitted to hospital within 24 h after onset were selected. For patients without revealing HT with head MRI on admission were analyzed retrospectively. According to the results of MRI rescan within 7 days after onset, they were divided into either a HT group or a non-HT group. Al specific parameters of blood pressure were compared and analyzed between the 2 groups, specificaly including initial value (initial), mean value ( mean), maximum value (max), minimum value (min), maximum-minimum difference (max-min), standard deviation (sd), successive variation (sv), and maximum value of sv (svmax) of systolic blood pressure (SBP) and diastolic blood pressure (DBP). Results A total of 146 patients were enroled in the analysis, and 77 (52. 7% ) had HT within 7 d after onset. Al the blood pressure parameters were grouped by quartiles. Multivariate logistic regression analysis showed that after adjusting for age, admission time, baseline National Institutes of Health Stroke Scale score, congestive heart failure, antiplatelet therapy, initial blood glucose, prothrombin time, and international normalized ratio of the patients, SBPmin , SBPmax-min , SBPsv , SBPsvmax , DBPinitial, DBPsd , DBPmax , DBPmax-min , DBPsv , and DBPsvmax had significant independent association with and HT (likelihood ratio test of trend, al P < 0. 05). Conclusions Higher BP level and variability may increase the risk of HT in patients with massive cerebral infarction after cardioembolic middle cerebral artery occlusion. A smooth and slow antihypertensive treatment may need for these patients.

Objective To investigate the effect of via-anal ileus tube used as a drainage in left-sided acute malignant colonic obstruction.Methods Forty-seven cases of left-sided acute malignant colonic obstruction were divided into control group (25 cases) and tube group (22 cases).The patients in control group received intraoperative colonic lavage for one-stage surgery.The patients in tube group received via-anal ileus tube for decompression before the surgery.Compared the difference of bowel movement recovery time,exhaust time,fasting time,postoperative hospitalization time,hospitalization costs and complication rate between two groups.Results The technically successful rate in tube group was 90.9％ (20/22),and one-stage surgery were performed.No anastomotic leakage or postoperative stenosis occunred after operation.There were 23 cases in control group who performed coloclysis in operation and one-stage surgery.The bowel movement recovery time,exhaust time,fasting time,postoperative hospitalization time and hospitalization costs in tube group were significantly lower than those in control group [(12.78 ± 2.07) h vs.(18.01 ±3.42) h,(78.76 ± 11.43) h vs.(96.38 ±13.09) h,(3.18 ±1.76) d vs.(5.51 ±2.95) d,(10.23 ± 2.33) d vs.(15.86 ± 6.74) d,(25 437.43 ± 2 343.67) Yuan vs.(31 051.32 ± 2 542.73) Yuan](P ＜ 0.01 or ＜ 0.05).After operation,there were 2 cases of stomas fistula and 2 cases of peritoneal cavity infection in control group,and none of them in tube group,the complication rate in control group was significantly higher than that in tube group [17.4％ (4/23) vs.0,P ＜ 0.05].Conclusions The via-anal ileus tube used as a drainage in left-sided acute malignant colonic obstruction is effective and safe,and can improve the rate of one-stage anastomoses,decrease the complication rate,promote the promote.It has important clinical value.

Objective To evaluate the role of nuclear factor-E2 related factor 2 (Nrf2)-antioxidant response element (ARE) pathway in cardio-protection by ischemic or pinacidil postconditioning ( IP,PP) against ischemia-reperfusion (I/R) injury in isolated rat hearts.Methods Fifty-six male SD rats of both sexes weighing 200-250 g were anesthetized with intraperitoneal amobarbital sodium.The isolated rat hearts were perfused in a Langendorff apparatus with Krebs-Hensleit buffer (K-H).Fifty-six isolated rat hearts with I/R injury were randomly divided into 7 groups ( n =8 each):normal control group (group C) ; group I/R; group IP and group PP1-4 postconditioning with 4 different concentrations of pinacidil.After 20 min of equilibration,the perfusion was suspended for 40 min (global ischemia) followed by 60 min of reperfusion in group I/R.In group IP after 40 min of global ischemia,the isolated hearts underwent 6 cycles of 10 s reperfusion and 10 s ischemia followed by 58 min of reperfusion.In group PP1-4 at the end of 40 min of global ischemia,the isolated hearts were perfused with K-H containing pinacidil 5,10,30 and 50μmol/L for 5 min respectively followed by 55 min reperfusion with regular K-H.Left ventricular developed pressure (LVDP) and LVEDP were measured immediately before global ischemia and at the end of 60 min reperfusion.Myocardial specimens were obtained at the end of reperfusion for detection of Nrf2,quinopeoxidoreductase (NQO1),HO-1 and SOD1 mRNA (by RT-PCR) and protein (by Western blot) expression.Results I/R significantly up-regulated Nrf2,NQO1,HO-1 and SODI mRNA and protein expression,decreased LVDP and increased LVEDP in group I/R as compared with group C.IP and 30,50 μmol/L pinacidil postconditioning further significantly increased Nrf2,NQO1,HO-1 and SOD1 mRNA and protein expression and IP,5,10,30,50 μmol/L pinacidil postconditioning significantly increased LVDP and decreased LVEDP as compared with group I/R.Conclusion Ischemic or pinacidil postconditioning can attenuate I/R injury by activating Nrf2-ARE pathway in isolated rat hearts.

OBJECTIVE:To investigate the clinical characteristics and gene polymorphism of oxcarbazepine (OXC)- induced Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN). METHODS:Retrieved from CNKI,Wanfang,VIP, PubMed,EMBase,SpringerLink and other databases,case reports about OXC-induced severe ADR were summarized and ana-lyzed. RESULTS:Twelve literatures were collected,and 13 case reports about OXC-induced SJS/TEN were obtained. Male had more OXC-induced severe skin ADR than female. ADR mostly occurred during 1-14 d after medication. All patients were cured with treatment of glucocorticoid and antiallergy,without death case. Genotyping for 8 patients were performed and 6 of them showed the presence of HLA-B*1502 allele. While HLA-B alleles of 2 patients were HLA-B*1518/B*4001,which was the variation of HLA-B*1502. CONCLUSIONS:OXC-induced ADR should be monitored closely. Great importance should be attached to patient education and follow-up program. HLA-B*1502 gene detection should be performed to guide rational use of OXC and optimize clini-cal drug use plan.

Objective To explore the role of clinical pharmacist in individualized treatment of hypertension.Methods A patient withH hypertension receiving pharmaceutical care from clinical pharmacists was retrospectively analyzed.Results Patient's MTHFR (C677T) gene type was TT homozygous.Clinical pharmacist suggested doctor modify treatment,and then patient's plasma homocysteine dropped from 61.5 to 16.0 μmol·L-1,and blood pressure dropped from 173/ 111 mmHg(1 mmHg =0.133 kPa) to 130/80 mmHg.Conclusion Clinical pharmacist provides individualized treatment for patient with hypertension to ensure the safety and effectiveness of the drug by genotyping.

Objective To evaluate the effects of telmisartan by SOCS-3/SREBP-1c pathway and its efficacy of improving insulin resistance (IR) in rats with high-fat diet-induced nonalcoholic steatohepatitis (NASH).Methods A total of 70 SD male rats were assigned randomly into 3 groups: A (normal control,20 rats,basic diet),B (model control,30 rats,high-fat diet) and C (treatment with telmisartan,20 rats,high-fat diet).After the IR-NASH model was made successfully,proved by 10 rats randomly from the group B with euglycemic hyperinsulinemic clamp technique (EHCT) and liver histology,the rats in the group C were intragastrically administrated telmisartan (5 mg/kg/d) for 4 weeks,and then all rats were tested with EHCT and sacrificed to test the blood chemistry,interleukin-6,homeostasis model assessment of insulin resistance,hepatic pathological analysis,and semiquantitative RT-PCR for determining SOCS-3 and SREBP-1c mRNA.Results Rats with high-fat diet developed steatohepatitis and insulin resistance at the 12th week and had more weight gain and higher liver index at the 16th week.IL-6,SOCS-3 and SREBP-1c mRNA expressions in the group B were up-regulated obviously,and each was positively correlated with the velocities of glucose infusion rates at 60~120 min.Blood chemistry and pathological observation in the group C were all improved;both SOCS-3 and SREBP-1c mRNA were down-regulated,and each negatively correlated with VGIR60-120,while serum IL-6 stayed at a high level.Conclusions Telmisartan can remarkably improve hepatic function and insulin resistance in rats with IR-NASH,the mechanisms of which would not be by path of reducing the secretion of IL-6,but by down-regulating the expressions of SOCS-3 and SREBP-1c mRNA.