OBJECTIVE:To investigate the role of clinical pharmacists in the identification and treatment of serious drug erup-tion due to allopurinol. METHODS:Clinical pharmacists participated in the drug treatment for a patient with hyperuricemia. Through scanning the drugs used before and after hospitalization,suggesting to detect human leukocyte antigen(HLA)-B*5801 re-lated genes,and ultimately the cause of severe drug eruption was determined according to the detection result,i.e. allopurinol. At the same time,according to clinical symptom,genotype,lab detection indexes and results of drug sensitivity test,etc.,clinical pharmacists suggested to additionally use Ebastine tablets,Compound indometacin tincture,Triamcinolone acetonide and econazole nitrate cream and other symptomatic treatment;hormone+immunoglobulin shock therapy(Methylprednisolone sodium succinate for injection 80 mg,ivgtt,qd+Human immunoglobulin for intravenous injection 20 g,ivgtt,qd)replaced Allopurinol tablets to control allergic symptom;Bailing capsules and Compound α-ketoacid tablets were additionally used to improve renal function;Meropenem for injection and Voriconazole tablets were used to controll infection. Clinical pharmacists also provided pharmaceutical monitoring as therapeutic efficacy evaluation,electrolyte level monitoring,medication education and transferred-out follow-up,etc. RE-SULTS:Physicians adopted the suggestions of clinical pharmacists. The drug eruption of the patient gradually reduced,and pulmo-nary infection was improved. CONCLUSIONS:Severe drug eruption due to allopurinol has serious symptoms and long course of disease,and even endangers the lives of patients. It is suggested to screen HLA-B*5801 related genes before the use of allopurinol, and strengthen medical education to ensure the safety and effectiveness of drug use.

Objective To analyze the clinical efficacy of physical vibration lithecbole in treatment of urinary calculi. Methods Ana-lysed the efficacy of 80 patients who underwent physical vibration lithecbole only or combination therapy with surgery in urinary calculi in our hospital from February 2014 to July 2014. Result There were 1 to 4 times calculi discharge among the 80 patients. One month after the sur-gery, the calculi discharge rate was 33. 3% and the calculi clean rate was 22. 2% in the upper ureteral; the calculi discharge rate was 16. 7%and the calculi clean rate was 50. 0% in the distal ureteral; the calculi discharge rate was 40. 0% and the calculi clean rate was 23. 3% in the upper renal calyx;the calculi discharge rate was 27. 7% and the calculi clean rate was 38. 8% in the middle renal calyx;the calculi discharge rate was 60. 0% and the calculi clean rate was 20. 0% in the lower renal calyx. One month after the surgery of physical vi-bration lithecbole combined with Holium laser lithotripsy, the calculi discharge rate was 52. 1% and the calculi clean rate was 39. 1%. Con-clusion Physical vibration lithecbole is a noninvasive treatment for urinary calculi. It has good efficacy in calculi discharge and it can relieve the pain caused by calculi.

We reviewed and developed an indicator system framework for assessing teaching effect of laparoscopic simulation training through literature research, expert consultation, analytic hierarchy process and factor analysis. We also made an empirical study on the constructed index system. The system included 3 domains (A1: evaluation of laparoscopic simulator; A2: operation evaluation of experimental animals; A3: evaluation of clinical practice), 10 second-level indicators and 23 third-level indicators for assessing teaching effect of laparoscopic simulation training. The indicator system framework has good internal consistency (Cronbach α= 0.968) and external consistency (>0.72). The empirical study found that: in the results of A1-A3 in the first level indicator, the score of the experienced group was significantly higher than that of the inexperienced group ( P<0.05). In the evaluation results of the 10 secondary indicators in the secondary indicators B1-B10, the score of the experienced group was significantly higher than that of the inexperienced group ( P<0.01). For the first time, we have established and evaluated a comprehensive evaluation indicator system which is reliable and effective and can be used for further evaluation of teaching effect of laparoscopic simulation training. The following empirical studies have verified the effectiveness and practicability of the evaluation system.

OBJECTIVE To investigate the eff ects of hypoalbuminemia and human albumin supplementation on patients with acute kidney injury （AKI）after off-pump coronary artery bypass grafting （OPCABG）. METHODS From December 2018 to January 2020，clinical information of 484 patients with coronary atherosclerotic heart disease who underwent selective OPCABG in Tianjin Chest Hospital were analyzed retrospectively. The basic data ，American Society of Anesthesiologists （ASA）grading，the number of coronary artery bypass grafting ，amount of intraoperative bleeding ，use of artificial colloid ，minimum value of hemoglobin within 7 days after operation ，hypoalbuminemia occurred after operation ，monitoring time in postoperative intensive care unit ，drainage volume of thoracic catheterization ，perioperative blood transfusion ，amount of human albumin after operation were summarized. All patients were divided into non-AKI group （414 cases）and AKI group （70 cases）according to the occurrence of AKI. The differences of the above indexes between the two groups were compared. Multiple Logistic regression analysis was performed to analyze the risk factor of AKI when selecting the indexes with P＜0.1. According to whether hypoalbuminemia occurred after operation ，all patients were divided into normal protein group （347 cases）and hypoalbuminemia group （137 cases）. Hierarchical analysis was carried out to explore the correlation between human albumin supplementation and AKI. RESULTS The results of multiple Logistic regression analysis showed that there was no significant effect on AKI in postoperative hypoalbuminemia （P＞0.05），but there were significant effect in body mass index and the dosage of postoperative human serum albumin （P＜0.05）. The risk of AKI would increase by 12.7％ every time the body mass index increases by 1 unit；the risk of AKI increased by 17.3％ for every 10 g increase in the dosage of human albumin. Stratified analysis showed that the risk of AKI would increased by 26.9％ for every 10 g increase in postoperative human albumin supplementation in normal protein group and 14.0％ for every 10 g increase in postoperative human albumin supplementation in hypoalbuminemia group. CONCLUSIONS Hypoalbuminemia is not a risk factor fo r the development of AKI after OPCABG ，but human albumin supplementation is a risk factor for AKI after OPCABG.