This paper summarized the common medical ethical issues in clinical pharmacy service and analyzed them from the perspective of medical ethics.It put forward some countermeasures to solve these problems,such as helping clinical pharmacists to establish a patient-centered service mode,improving their occupation accomplish-ment,and avoiding moral issues and medical disputes caused by ethical issues under the premise of ensuring pa-tients' safety and rational use of drugs,and thus to comprehensively improve service level of clinical pharmacists.

Objective To observe the effects of epidural anesthesia and subarachnoid anesthesia on puerperants and fetus perioperatively undergoing cesarean delivery after epidural labor analgesia.Methods A retrospective cohort study was conducted to select and analyze the relevant clinical data of women who had epidural labor anal-gesia and were converted to cesarean delivery at Beijing Tiantan Hospital.According to the anesthesia method of cesarean section,the participants were divided into the epidural anesthesia(EA)group and the subarachnoid an-esthesia(SA)group.That were aimed to compare the effects of the two anesthesia methods on the mother and fe-tus perioperatively.Results Compared with women in the epidural anesthesia group,women in the subarachnoid anesthesia group had a better anesthesia outcome,visual analogue scale(VAS)scores,frequency(%)[VAS scores 0-3:5(25%)vs.14(70%);VAS scores 4-6:12(60%)vs.6(30%);and VAS scores 7-10:3(15%)vs.6(30%)],and higher perioperative complication rate.There was nonsignificance difference in perio-perative maternal bleeding,neonatal Apgar score,and neonatal umbilical artery blood gas analysis between the two groups.Conclusions In women with epidural analgesia undergoing cesarean section,the anesthesia effect of subarachnoid anesthesia is better than that of the epidural anesthesia.The anesthesiologist must pay attention to prevent complications in the perioperative period.

Objective To construct a prognostic model for uterine corpus endometrial carcinoma(UCEC)using the prognosis-associated ADME genes involved in controlling drug absorption,distribution,metabolism,and excretion(ADME),providing a reference for predicting the prognosis of UCEC and tumor treatment.Methods The gene expression and clinical information data of UCEC were obtained from the TCGA and ICGC databases.Prognosis-related ADME genes were screened using the univariate Cox regression analysis.Least absolute shrinkage and selection operator(LASSO)regression was used to identify optimal prognostic genes,and then a risk score model was constructed.Kaplan-Meier curve and receiver operating characteristic(ROC)curve were constructed to assess predictive capability.R software was used to perform differentially expressed genes anal-ysis,functional enrichment analysis.Results A nine-gene signature(DHRS7B,CYP46A1,SLCO4C1,NR1I2,SLC16A1,SLCO3A1,ARSA,ABCC5,MGST2)was used for constructing a risk score model.Survival analysis showed that the survival time in high-risk patients was significantly shorter than in low-risk patients(the train set:P＜0.001;the test set:P=0.032).The are-as under the ROC curve of the train set and the test set for ROC at 1,3,5 years were 0.792,0.724,0.712,and 0.651,0.620,0.677,respectively.Univariate and multivariate Cox regression analysis showed that the risk score was an independent risk factor for UCEC(HR=1.77,P=0.035).In addition,there was a significant difference in the miRNA-mediated silencing and regulation of sprouting angiogenesis pathways between the high-risk and low-risk score groups.Conclusion The prognosis model con-structed with nine key ADME genes may have the potential to be used for predicting the survival prognosis of patients with UCEC.

Objective:To study the impact of repeat hepatectomy for patients with post-hepatectomy recurrent hepatocellular carcinoma (HCC).Methods:The data of patients who developed post-hepatecotmy recurrent HCC and underwent repeat hepatectomy at the General Surgery Department of Beijing Tongren Hospital from May 2013 to May 2016 (the Recurrence Group), were retrospectively compared with the data from patients who underwent initial hepatectomy for HCC during the same study period (the Primary Group). The general data, perioperative data, postoperative complications and survival of the two groups were compared.Results:The primary group included 179 patients, consisting of 133 males and 46 females, aged (57.3±11.7) years, with a range from 14.0 to 84.0 years. The recurrence group included 36 patients, consisting of 30 males and 6 females, aged (55.9±11.4) years, with a range from 40.0 to 77.0 years. There were no statistically significant differences between the two groups in gender, age, hepatitis virus infection status, preoperative alpha fetoprotein, Child-Pugh score and indocyanine green retention rate at 15 min ( P>0.05). However, there were statistically significant differences ( P<0.05) between the two groups in operative time [(244.2±84.3)min vs. (283.4±66.8)min], intraoperative blood loss[(428.5±151.6)ml vs. (756.2±187.4)ml], anatomic or nonanatomic hepatectomy, single tumor or multiple tumors, and maximum tumor diameter[(5.81±2.24)cm vs. (3.69±1.55)cm]. There were no statistically significant differences between the two groups in incidences of tumor capsular invasion, tumor thrombus and degrees of tumor differentiation ( P>0.05). There were no statistically significant differences in surgical complication rates ( P>0.05), and in 1-year and 3-year overall and disease free survival rates between the two groups ( P>0.05). Conclusions:Repeat hepatectomy for recurrent HCC after hepatectomy was safe and effective. Its long-term survival outcomes were similar to first hepatectomy for HCC.

Objective To investigate the effects of fluid shear stress on rolling adhesion of neutrophils on immobilized platelets under flows. Methods Experiments were performed at the parallel plate flow chamber. Platelets were adhered to the functionalized flow chamber bottom which were coated with vWF-A1 first, and then washed with PBS under wall shear stress (WSS) of 1 Pa for different time (0 min, 2.5 min, 7.5 min). A high-speed camera was used to observe and record the rolling adhesion events of neutrophils on immobilized platelets under 50 mPa WSS, and the adhesion parameters such as the number of adhesion events, the tether lifetime of cells and rolling velocity. Results Neutrophils could specifically bind to the immobilized platelets on vWF-A1-coated bottom of the flow chamber. Mechanical stimulation on immobilized platelets had no effects on the tether lifetime of neutrophils on the platelets, but up-regulated the adhesive ratio of neutrophils on the platelets and slowed down the rolling of neutrophils on the platelets. Conclusions Mechanical stimulation on the immobilized platelets will significantly make the circulating neutrophils to be captured easily and promote the rolling adhesion of neutrophils on platelets.