OBJECTIVE:To investigate the characteristics and regulation of antibiotics-induced ADR in our hospital and ex-plore effective prevention measures,in order to provide reference for safe and rational use of antibiotics in the clinic. METHODS:111 antiobiotics-induced ADR reports were collected from our hospital during 2012-2014,and analyzed in terms of patient’s gender and age,route of administration,drug category,organs/systems involved in ADR,etc. RESULTS:The patients aged <10 years old and >60 years old took up the highest proportion,accounting for 27.93% and 25.23%,espectively. ADR induced by intrave-nous route of administration had the highest incidence,accounting for 84.68%;cephalosporins-induced ADR was the most,account-ing for 26.13%;lesion of skin and its appendents was main antibiotics-induced ADR,accounting for 44.92%. CONCLUSIONS:Clinical pharmacists should provide technical support to doctors and nurses to aviod the occurrence of ADR.

OBJECTIVE:To provide reference for the development of pharmaceutical care for periconceptional women. METH-ODS:Probability proportionate to size sampling(PPS)method was adopted to select participants from periconceptional women in Yongchuan District. The participants were investigated by questionnaires about drug use safety knowledge,attitude and behavior. Ep-idata 3.0 software was used to establish database. The data were analyzed with SPSS 15.0 software. RESULTS:Totally 800 ques-tionnaires were distributed and then 779 valid questionnaires were collected with effective rate of 97.38%. The total awareness rate of knowledge about drug use safety was 57.69%. The awareness rate rise with the increase of educational level (P<0.01). The awareness rate was higher in pregnant women than in prepregnant ones,with statistical significance in most of the questions(P<0.05 or P<0.01). For questions about attitude for drug use safety,the positive answer rate was higher in pregnant women than in prepregnant ones,with statistical significance in most of the questions (P<0.01). Among 385 pregnant women,only 56.88% re-ceived folic acid following the WHO recommendation. Of 181 pregnant women who had taken medicine,8.29% indicated that the physicians or pharmacists did not inform that whether the medicine affected pregnancy. CONCLUSIONS:Among periconceptional women,awareness rate of drug use safety is in low level and varied by their educational levels. There are difference in awareness rate of drug use safety and attitude between prepregnant women and pregnant woman. Drug use behavior of pregnant woman is to be modified.

Hypoxia inducible factor-1αis a kind of hypoxia response factor. Acute cerebral ischemia and anoxia can induce up-regula-tion of hypoxia inducible factor-1α, and the downstream genes, which plays a role in both the energy metabolism and collateral circulation after cerebral ischemia. Neural stem and progenitor cells regeneration also benefit the functional outcome after ischemic stroke. Hypoxia in-ducible factor-1αmay induce proliferation and differentiation of neural stem and progenitor cells through Notch, Wnt/β-catenin pathways, etc., in the ischemic stroke model.

Objective To investigate whether apathy during the acute stage of stroke was related to glycated hemoglobin and homocysteine(Hcy) and functional disability,and to elucidate possible factors that are related to poststroke apathy (PSA).Methods Totally 298 patients with acute cerebral infarction who met the inclusion and exclusion criteria were recruited from the Fourth Affiliated Hospital of China Medical University.The control group of 298 volunteers was recruited from medical center in our hospital during the same period.The apathy scale (AS) was used to assess PSA within 2 weeks after stroke.Patients with an AS score≥ 14 points were defined as PSA,and the patients were divided into apathy group (A group) and non-apathy group (NA group) according to AS score.Modified Rankin Scale (mRS) was used to assess functional disability.Functional disability in daily living activities was assessed with the Barthel Index(BI).Serum levels of Hcy,glycated hemoglobin A1C (HbA1 c),lipid series and fibrinogen of patients were determined.Results The prevalence of PSA in patients was significantly higher than the control group (P ＜ 0.01).In the case group,A group had an older age,higher mRS score,higher Hcy level,lower educational level,lower BI score,and lower HbA1C level than the NA group(P ＜0.05).In the A group,the mRS score was positively correlated with the AS score(B =1.508,P =0.003),serum Hcy level was positively correlated with the AS score(B =0.170,P =0.013),the HbA1C level was negatively correlated with the AS score(B =-0.872,P =0.031).Conclusions The serum Hcy level,HbA1C level and functional disability are closely related to apathy during the acute stage of ischemic stroke.

OBJECTIVE:To investigate the role of clinical pharmacists in the anti-infection treatment for gas gangrene chil-dren. METHODS:Clinical pharmacists participated in the anti-infection treatment of a child with gas gangrene;according to clini-cal symptoms and consultation opinions of different departments,it was suggested to use Piperacillin sodium and tazobactam sodi-um for injection for initial anti-infection treatment. After debridement and drainage of left lower limb,removal of necrotic tissue, clinical pharmacists suggested to stop giving Piperacillin sodium and tazobactam sodium for injection and use Benzylpenicillin sodi-um for injection combined with Imipenem and cilastatin sodium for injection instead for anti-infection treatment according to etiolog-ical characteristic of gas gangrene and related guidelines. According to the results of bacterial culture of wound secretion and drug sensitivity test,clinical pharmacists additionally suggested to use Clindamycin hydrochloride and sodium chloride injection 0.6 g, q8 h,ivgtt to inhibit the generation of Clostridium perfringens.According to the changes of patient's signs and etiological results, it was suggested to stop taking Clindamycin hydrochloride and sodium chloride injection,use Vancomycin hydrochloride for injec-tion successively. RESULTS:The physicians adopted the suggestions of clinical pharmacists.After surgical treatment and anti-infec-tion treatment,the patient's condition was improved,the vital signs were stable,and the patient was transferred to the general ward of orthopedics department for further treatment. CONCLUSIONS:Clinical pharmacists participate in the treatment of gas gan-grene child,and assist physicians to formulate and adjust anti-infection treatment plan according to related guidelines,clinical symp-toms,etiological examination results and consultation opinions,so as to guarantee safe and effective drug use.

OBJECTIVE To explore and analyze the adverse drug event （ADE） signals of cinacalcet and etelcalcetide， to provide a reference for safe drug use in the clinic. METHODS ADE reports related to cinacalcet and etelcalcetide were extracted from the FDA Adverse Event Reporting System from January 1st， 2004 to June 30th， 2023 using the OpenVigil online tool. The Bayesian confidence propagation neural network method was adopted to detect the signals of ADE from the key organ systems. The signals were encoded according to the preferred term in the ADE terminology set of the Medical Dictionary for Regulatory Activities （26.0 edition）. RESULTS A total 41 709 and 1 710 ADE reports were extracted， and 29 and 45 safety signals were detected in key systems for cinacalcet and etelcalcetide， respectively； 20 and 36 positive signals were not included in the drug instructions. Hypocalcemia/decreased serum calcium， abnormal blood parathyroid hormone （PTH）/increased or decreased serum PTH were common ADEs of the two drugs， which were detected in the study. Among the signals not included in the drug instructions， new moderate and strong signals were detected， such as cinacalcet-induced calcification defense （metabolic and nutritional diseases）， bone starvation syndrome and high conversion bone diseases （musculoskeletal and connective tissue diseases） as well as etelcalcetide-induced sudden death， necrosis and treatment of non-responders （general disorders， administration site）， unstable angina pectoris， myocardial ischemia （cardiac diseases）， intestinal perforation， gastric antrum vasodilation and gastric ulcer （gastrointestinal diseases）. CONCLUSIONS In the clinical application of the two drugs， apart from the common ADEs such as hypocalcemia and abnormal blood PTH， the surveillance of some new potential ADEs should also be carried out， such as bone starvation syndrome， calcification defense， ventricular disease and other cinacalcet-induced ADEs， sudden death， myocardial ischemia， unstable angina pectoris， intestinal perforation， gastric ulcer and other etecalcetide-induced ADEs. If new ADEs appear， clinic should promptly assess the benefits and risks， and update the treatment plan and pharmacological monitoring plan to ensure the safety of patient medication.

Objective To evaluate cerebral perfusion through brain computed tomography perfusion imaging (CTP) in order to investigate the relationship between cerebral perfusion and vascular cognitive impairment (VCI).Methods A total of 103 patients with ischemic stroke were recruited, who received thrombolytic therapy and CTP test in the Fourth Affiliated Hospital of China Medical University from December, 2016 to May, 2017. The patients were divided into normal cognitive function group (control group, n=43), vascular cognitive impairment-no dementia group (VCIND group, n=48), and vascular dementia group (VD group, n=12) according to the degree of impairment in cognitive function after the assessment of Mini-Mental State Examination (MMSE) and Clock Drawing Test (CDT). The characteristics of cerebral blood flow perfusion in region of interest of brain CTP were analyzed.Results There was difference in incidence of diabetes among three groups (χ2=7.556, P<0.05). The rate of diabetes was higher in VCIND group and VD group than in the control group. Age and diabetes were the independent risk factors for VCI (OR>1, P<0.05). There was difference in cerebral blood volume (CBV) in frontal lobe, temporal lobe, and parietal lobe among three groups (F>3.216, P<0.05). CBV in frontal lobe, temporal lobe, and parietal lobe reduced in VD group than in the control group (P<0.05), while CBV in frontal lobe and temporal lobe reduced in VD group than in VCIND group (P<0.05). There was difference in mean transit time (MTT) in left temporal lobe, left parietal lobe, and centrum semiovale among three groups, while there was difference in left occipital lobe in time to peak (TTP) among three groups (F>3.116, P<0.05). MTT and TTP were higher in VD group than in the control group and VCIND group (P<0.05). There was no difference in cerebral blood flow (CBF) in both left and right brain, and MTT and TTP in right brain among three groups (P>0.05). CBV in frontal lobe, parietal lobe and right temporal lobe demonstrated positive relationship with the scores of MMSE (r>0.203, P<0.05). CBV in parietal lobe and left frontal lobe also demonstrated positive relationship with the scores of CDT (r>0.214, P<0.05).Conclusion The cerebral blood flow perfusion reduced in different levels of VCI, especially in frontal lobe, temporal lobe and parietal lobe. Cerebral blood flow perfusion reduced with the progress of cognitive impairment, and the left hemisphere injured earlier than the right one. Brain CTP may be applied in the early recognition of VCI.

OBJECTIVE To eval uate the cost-util ity of regimen containing bortezomib in the treatment of newly diagnosed multiple myeloma in China. METHODS From the perspective of China ’s health system ，Markov model was constructed based on SWOG S 0777 clinical trial. The simulation time limit was 10 years，and the cycle was set with reference to the treatment cycle. Taking quality adjusted life years （QALYs）as the utility index ，the utility and cost were discounted at a discount rate of 5％；the willingness to pay （WTP）threshold was set to be 3 times of China ’s per capita gross domestic product （GDP）in 2021（242 928 yuan/QALY）. The incremental cost-utility ratio （ICER）of dexamethasone combined with bortezomib and lenalidomide （VRD） versus dexamethasone combined with lenalidomide （RD）were compared with cost-utility analysis. The sensitivity analysis was performed for the uncertainty of the model. RESULTS Results of baseline analysis showed that VRD regimen could obtain 0.65 more QALYs than RD scheme ，but its treatment cost was 135 782.77 yuan more than RD regimen ，ICER was 206 623.35 yuan/ QALY，which was lower than the WTP threshold set in this study ，VRD regimen was cost-effective. Single factor sensitivity analysis showed that the health utility value in progressive free survival had the greatest impact on the results ，the decrease of utility value would make the ICER higher than the WTP threshold ，and VRD regimen would no longer have advantages. Under the WTP threshold of 3 times of China ’s per capita GDP in 2021，the probability of VRD regimen being cost-effective was 86.5％； with the increase of WTP threshold ，the possibility of VRD regimen becoming more cost-effective than RD regimen would increase. CONCLUSIONS Under the WTP threshold of 3 times of China ’s per capita GDP in 2021，compared with RD regimen，VRD regimen is cost-effective in the treatment of newly diagnosed multiple myelo ma in China.

OBJECTIVE：To compare the protective effects model mice between the aboveground and underground parts of Astragalus membranaceus on immunosuppression ，and to provide reference for further utilization and development of A. membranaceus. METHODS ：A total of 240 ICR mice were divided into 4 batches，60 mice in each batch ，with half male and half female. Each batch of mice were randomly divided into blank group ，model group ，A. membranaceus aboveground part and undergroud part low-dose and high-dose groups （3，6 g/kg，by crude drug ）according to body weight and sex ，with 10 mice in each group. Blank group and model group were given normal saline intragastrically. A. Membranaceus groups were given corresponding concentration of drug intragastrically ，10 mL/kg，once a day ，for consecutive 30 days. Except for blank group ， other groups were intraperitoneally injected with cyclophosphamide 40 mg/（kg·d）for consecutive 3 days，since 24th day of treatment，to establish immunosuppression model. The levels of serum immunoglobulin （IgG，IgM，IgA），inflammation factors [nitric oxide ，interleukin-2（IL-2），IL-6，tumor necrosis factor-α] and half hemolysis value were detected in each group. Body weight ，thymus index ，spleen index ，phagocytic index ，activity of natural killer （NK）cell，splenic lymphocyte proliferation ability，dinitrofluorobenzene-induced delayed metamorphosis reaction in mice （by weight difference between left and right ears ） and the number of hemolytic plaque were determined. RESULTS ： Compared with blank group ， the serum levels of immunoglobulin，body weight ，thymus index ，spleen index ，phagocytic index ，NK cell activity ，the proliferation ability of splenic lymphocyte，the number of hemdytic plaque and half hemolysis value were decreased significantly in model group （P＜0.05）， while inflammation factor level as well as weight difference between left and right ears were increased significantly （P＜0.05）. Compared with model group ，above indexes of mice in A. membranaceus groups were improved significantly ，in dose-dependent manner（P＜0.05）. Compared with A. membranaceus undergroud part group ，above indexes of A. membranaceus aboveground part group were improved significantly （P＜0.05）. CONCLUSIONS ：Aboveground and underground part of A. membranaceus both have pretective effect on immunosuppression model mice ，and the effect of aboveground part of A. membranaceus is stronger than underground part of A. membranaceus .