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Pharmaceutical care of patient with cryptococcal meningitis:A case report

Chunxiao LI ; Fang LIU ; Xinyu ZHANG ; Suodi ZHAI

Journal of Peking University(Health Sciences).2003;0(05):-.

We provided pharmaceutical care for a cryptococcal meningitis case to study the role that clinical pharmacists played in clinical pharmacotherapy.In this case,clinical pharmacists gave advice on drug therapy strategy which was mostly accepted by physicians.During the whole course of drug treatment,focused on monitoring,prevention,and treatment of adverse reactions,clinical pharmacists carried out pharmaceutical care on efficacy,safety,economics and compliance of drug therapy.After 73 days' treatment,with CSF cryptococcal count negative twice and physical condition improved,the patient was discharged.No serious adverse reaction was observed in the period of treatment.The total pharmaceutical care was completed as planned.Through participating in the formulation of treatment strategy and carrying out pharmaceutical care,clinical pharmacists can play a role in improving the efficacy and safety of drug therapy in cryptococcal meningitis.Abstract:SUMM ARY W e provided pharmaceutical care for a cryptococcal meningitis case to study the role that clinical pharmacists played in clinical pharmacotherapy.In this case,clinical pharmacists gave advice on drug therapy strategy which was mostly accepted by physicians.During the whole course of drug treat-ment,focused on monitoring,prevention,and treatment of adverse reactions,clinical pharmacists carried out pharmaceutical care on efficacy,safety,econom ics and compliance of drug therapy.After 73 days’ treatment,with CSF cryptococcal count negative twice and physical cond ition improved,the patientwas d ischarged.No serious adverse reaction was observed in the period of treatment.The total pharmaceutical care was completed as planned.Through participating in the formulation of treatment strategy and carrying out pharmaceutical care,clinical pharmacists can play a role in improving the efficacy and safety of drug therapy in cryptococcalmeningitis.

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Bacterial biofilm on the apical external root surfaces of human teeth associated with chronic periradicular lesions

Huijie GUO ; Jiade WANG

Journal of Peking University(Health Sciences).2003;0(05):-.

Objective:To investigate the patterns of microbial infection on the apical external root surfaces of treated and untreated teeth associated with chronic apical periodontitis and to study bacteria in the biofilm in order to find out the species,constitution and origination of bacteria in periapical biofilm.Methods: Ten teeth with chronic apical periodontitis from patients of the Department of Stomatology of People's Hospital,Peking University: 5 untreated teeth with a radiographically visible chronic periradi-cular lesions and 5 teeth with extensive carious lesions,radiolucent lesions of varying sizes and attached periradicular tissues were selected for study.Using aseptic techniques and sterile instruments,bacterial samples of the root canals were taken,inoculated and separated according to usual practice.After extraction,ten teeth were fixed and the apical 5 mm portion of one root was sectioned.Root tips were dehydrated,sputter coated with gold,and then examined for the occurrence of bacteria on the apical root surfaces using scanning electron microscope.Five healthy teeth with vital pulp were used as controls.Results: Microbial study showed that ten specimens yielded bacterial growth.The most prevalent bacteria were P.micros and F.nueleatum.In the 5 untreated teeth,bacterial cells were usually observed close to the apical foramen in only 1 specimen.Morphologically,these bacteria consisted of cocci.In the 5 treated teeth,a dense bacterial aggregation composed mainly of cocci and rods was observed surrounding the apical foramen of all specimens.Besides rods,other bacterial morphological types were recognized,including coaggregations of cocci and filaments,characterizing a fully developed "corn-cob".No microorga-nisms were found in the healthy controls.Conclusion:Bacterial biofilm was always present in teeth with post-treatment endodontic disease.The presence of apical bacterial biofilm is clinically important,and it may cause failure of endodontic treatment as a consequence of persistent infection.

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Preliminary study of vulvar and vaginal intraepithelial neoplasias

Yanli GUO ; Li GENG ; Ke YOU ; Jie QIAO ; Congrong LIU

Journal of Peking University(Health Sciences).2003;0(05):-.

Objective:To detect the clinical features of vulvar and vaginal intraepithelial neoplasias(VIN and VAIN,respectively).Methods:Total 148 women were performed vulvar or vaginal coloposcopy-directed biopsy pathology tests,from Sep.2004 to Dec.2007.Results:Among 148 women,vulvar or vaginal histologic results were vulvar cancer for 1,VIN or VAIN 2,3 for 23,VIN or VAIN for 16,condyloma for 61,vulvitis and vaginitis for 47.Eighty-five percent(33/39) women with VIN or VAIN 2,3 were more than 30 years old.Compared to women with cervical intraepithelial neoplasia(CIN),women with VIN or VAIN were older.The rate of high-risk HPV DNA in women with vulvar or vaginal lesions was 84%(84/100).VAIN occurred mainly in the upper vagina(90%,69/75).VIN or VAIN often accompanied or followed CIN or cervical cancer(79%,31/39),and VIN or VAIN 2,3 often accompanied or followed CIN 2,3 or cervical cancer(70%,16/23).Conclusion:Our data suggest that women with high-risk HPV infection are at risk of developing VIN or VAIN 2,3.The vulva and vagina should be carefully inspected by colposcopic examination at the time of colposcopy for any abnormal findings.

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Lethal effects of nanoliposome encapsulated cisplatin on Saos-2 cells and its distribution in nude mice bearing human osteosarcoma xenografts

Guowen WANG ; Wei GUO ; Xiaodong TANG ; Changliang PENG ; Hui ZHAO

Journal of Peking University(Health Sciences).2003;0(05):-.

Objective:To investigate the killing effect of nanoliposome encapsulated cisplatin(NLE-CDDP) on human osteosarcoma cell line Saos-2 and explore the distribution of platinum(Pt) in tumor-bearing mice.Methods: Saos-2 cells were cultured at different concentrations of NLE-CDDP.MTT assay,inverted microscopic observation and flow cytometry assay(FCM)were used to observe the antiproli-ferative effect of NLE-CDDP on the human osteosarcoma cells.Antitumor effect of NLE-CDDP was determined using the xenografts models of human osteosarcoma cell Saos-2 in nude mice.The Pt concentration in the tissues of tumor-transplanted mice was determined by atomic spectrophotometer.Results: When treated at different concentrations of NLE-CDDP for 24-96 hours,the survival rate of Saos-2 cells decreased significantly(P

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Tumor-like inflammatory demyelinating diseases of the central nervous system with relapse onset:A case report and review

Xueliang QI ; Jing CHEN ; Riliang ZHENG ; Ying LI ; Yining HUANG ; Yun YUAN

Journal of Peking University(Health Sciences).2003;0(05):-.

Here we report the clinical,radiological and neuropathological findings of a patient with tumor-like inflammatory demyelinating diseases of the central nervous system.The patient was a 51-year-old man with a four-month history of inflammatory pseudotumor and no other significant medical history,who presented to our hospital recurrent relapse numbness and weakness of his right extremities,dysarthria and memory deterioration.Brain magnetic resonance imaging(MRI) showed mass focal lesion in white matter of left parietal lobes.The biopsy showed numerous infiltrating macrophages and lymphocytes within the perivascular.The patient responded clinically to corticosteroid and intravenous immunoglobulin(IVIG) therapy.According to the results of the biopsy and the MRI,a diagnosis of inflammatory pseu-dotumor of the central nervous system was made.The vascular dysfunction may act in the pathogenesis of inflammatory pseudotumor of the central nervous system.

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Eukaryotic translation initiation factor 2B and leukoencephalopathy with vanishing white matter

Yanxia PAN ; Ye WU ; Zhengping NIU ; Yuwu JIANG

Journal of Peking University(Health Sciences).2003;0(05):-.

Leukoencephalopathy with vanishing white matter(VWM) is one of the most prevalent inherited white matter disorders in childhood,and it′s the only known hereditary human disease due to the direct defects in protein synthesis process,with the gene defects in EIF2B1-5,encoding the five subunits of eukaryotic translation initiation factor(eIF2B ?,?,?,? and ?) respectively.eIF2B is essential for the protein translation initiation process,and its action is realized via eukaryotic translation initiation factor2(eIF2).Phosphorylation of eIF2? and eIF2B? is an important way to regulate eIF2B function,and thus play a key role in control of the protein translation level under physiological condition.Mutant eIF2B results in functional defects and decrease of the overall protein translation in cells,but in increase the translation of proteins with multiple upstream open reading frames,such as activating transcription factor 4(AFT4),which leads to the susceptibility to un-folded protein response under stress,and the following apoptosis.The exact pathogenic mechanisms of VWM are far from well understood.It′s suggested that level of AFT4 in cells with eIF2B mutations is higher than in wild type cells under physiological condition,which makes the mutant cells more susceptible to endoplasmic reticulum(ER) stress and unfolded protein response(UPR).Under stress,the defect eIF2B leads to a vicious cycle of UPR activation,which may underlie the neurological aggravation in VWM patients after minor stress,a specific cli-nical feature of VWM.Elucidating the pathogenesis of VWM will be helpful to further understand the protein translation process in eukaryotic cells,and provide a clue for possible therapeutic targets and treatment strategies in the future.Abstract:SUMM ARY Leukoencephalopathy with vanishing white matter(VWM) is one of the most prevalent in-herited white matter d isorders in childhood,and i′ts the only known hered itary human d isease due to the d irect defects in protein synthesis process,with the gene defects inEIF2B1-5,encod ing the five sub-units of eukaryotic translation initiation factor(eIF2B?,?,?,?and?) respectively.eIF2B is essential for the protein translation initiation process,and its action is realized via eukaryotic translation initiation factor2(eIF2).Phosphorylation of eIF2?and eIF2B?is an important way to regulate eIF2B function,and thus play a key role in control of the protein translation level under physiological cond ition.Mutant eIF2B results in functional defects and decrease of the overall protein translation in cells,but in increase the translation of proteins with multiple upstream open read ing frames,such as activating transcription factor 4(AFT4),which leads to the susceptibility to un-folded protein response under stress,and the following apoptosis.The exact pathogenic mechanisms ofVWM are far from well understood.I′ts sugges-ted that level ofAFT4 in cells with eIF2B mutations is higher than in wild type cells under physiological cond ition,which makes the mutant cellsmore susceptible to endoplasm ic reticulum(ER) stress and un-folded protein response(UPR).Under stress,the defect eIF2B leads to a vicious cycle ofUPR activa-tion,which may underlie the neurological aggravation in VWM patients afterm inor stress,a specific cli-nical feature ofVWM.E lucidating the pathogenesis ofVWM will be helpful to further understand the pro-tein translation process in eukaryotic cells,and provide a clue for possible therapeutic targets and treat-ment strategies in the future.

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Blood purification therapy of gestational hyperlipidemic pancreatitis:A case report

Hongliang LI ; Weihong AN ; Yangyu ZHAO ; Xi ZHU

Journal of Peking University(Health Sciences).2003;0(05):-.

Gestational hyperlipidemic pancreatitis is an uncommon complication of pregnancy that incurs a high risk of morbidity and mortality of both maternal and fetal patients.We described the response of continous renal replacement therapy in a woman with extreme gestational hyperlipidemia and severe pancreatitis.Five consecutive plasma exchanges didn't lead to a remarkable reduction(10.4% and 4.8%,for the first and fourth times,respectively) at triglyceride levels as the literatures have reported,which reveals that plasma exchange and continous veno-venous heamofiltration may be importment,instead of crucial methods in dealing with gestational hyperlipidemic pancreatitis.Abstract:SUMM ARY Gestational hyperlipidem ic pancreatitis is an uncommon complication of pregnancy that in-curs a high risk ofmorbid ity and mortality of both maternal and fetal patients.W e described the response of continous renal replacement therapy in a woman with extreme gestational hyperlipidem ia and severe pancreatitis.Five consecutive plasma exchanges d idn’t lead to a remarkable reduction(10.4% and 4.8%,for the first and fourth times,respectively) at triglyceride levels as the literatures have reported,which reveals that plasma exchange and continous veno-venous heamofiltration may be importment,in-stead of crucialmethods in dealing with gestational hyperlipidem ic pancreatitis.

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Severe uremic lung:A case report and review

Yu YAN ; Huiping ZHAO ; Mei WANG

Journal of Peking University(Health Sciences).2003;0(05):-.

We investigated the clinical and photographic characteristics of uremic lung and review the associated literature,so as to improve the diagnostic and therapeutic abilities of uremic lung.The clinical symptoms and signs together with the photographic characteristics of the patient who was diagnosed as uremic lung complicated with pulmonary infection and congestive heart failure in our division were analysed and the associated literature was reviewed.The patient was admitted for the complaint of cough,expectoration and dyspnea.He was diagnosed as chronic renal failure with pulmonary infection and congestive heart failure.The symptoms alleviated after adequate hemodialysis and antibiotic therapy.However,mild dyspnea remained with photographic examination still showing consolidation in the lungs.The diagnosis of uremic lung was established after the exclusion of pulmonary infections of other pathogens and tumor.After 8-month maintenance hemodialysis,the pulmonary lesions were thoroughly absorbed.Uremic lung is a common complication of end-stage renal failure.The diagnosis is established after the exclusion of cardiac pulmonary edema,pulmonary infections and tumors.Sufficient hemodialysis is the most adequate treatment for uremic lung.Abstract:SUMM ARY W e investigated the clinical and photographic characteristics of urem ic lung and review the associated literature,so as to improve the d iagnostic and therapeutic abilities of urem ic lung.The clinical symptoms and signs togetherwith the photographic characteristics of the patientwho was d iagnosed as ure-m ic lung complicated with pulmonary infection and congestive heart failure in our d ivision were analysed and the associated literature was reviewed.The patientwas adm itted for the complaint of cough,expecto-ration and dyspnea.He was d iagnosed as chronic renal failure with pulmonary infection and congestive heart failure.The symptoms alleviated after adequate hemod ialysis and antibiotic therapy.However,m ild dyspnea remained with photographic exam ination still showing consolidation in the lungs.The d iagnosis of urem ic lung was established after the exclusion of pulmonary infections of other pathogens and tumor.Af-ter 8-month maintenance hemod ialysis,the pulmonary lesionswere thoroughly absorbed.Urem ic lung is a common complication of end-stage renal failure.The d iagnosis is established after the exclusion of card iac pulmonary edema,pulmonary infections and tumors.Sufficient hemod ialysis is the most adequate treat-ment for urem ic lung.

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Liver transplantation for the patients with end stage liver disease and portal vein thrombosis

Pengji GAO ; Jiye ZHU ; Guangming LI ; Xisheng LENG

Journal of Peking University(Health Sciences).2003;0(05):-.

Objective:To investigate the outcome of liver transplantation(LT) for end stage liver disease with portal vein thrombosis(PVT) in different processes.Methods: Data from 308 patients who underwent LT from July 2004 to February 2008 were retrospectively assessed.The processes of varies grades of PVT during LT were analyzed and estimated for whether the outcome of LT was different between patients with or without PVT.Results: There were 46 patients with PVT,including 11 of grade 1,14 of grade 2,18 of grade 3 and 3 of grade 4.LT performed in grade 1 and 2 PVT patients without special intervention.LT was performed in 16 patients with grade 3 PVT after simple thrombectomy or thrombus-extraction.The other 2 patients with grade 3 PVT received the donor superior mesenteric vein to act as a bridge between the donor portal vein and host superior mesenteric vein.Two cases with grade 4 PVT received a cavo-portal hemitransposition,and the other one anastomosis between graft portal vein and varicose coronary vein.The postoperative 1-year survival rates of patients without PVT and patients with PVT were 91.6%(240/262),80.5%(211/262)vs 86.9%(40/46),76.1%(35/46),respectively.The patients with PVT had a recurrence rate of 4.3%(2/46).Conclusion: Most patients suffering from end stage liver disease with PVT can be successfully treated by LT.However,the result of the patients with diffused PVT undergoing LT is relatively poor.

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Aggrecanases and osteoarthritis

Chao LI ; Yongping CAO ; Zhenpeng GUAN ; Deyong HUANG ; Zigang GE

Journal of Peking University(Health Sciences).2003;0(05):-.

Osteoarthritis is mainly caused by the degenerative changes of cartilage and cartilage extracellular matrix,while Aggrecanases degradate Proteoglycans which are the major components of cartilage.This review includes three aspects:(1) We have concluded the major enzymes(ADAMTS-4 and ADAMTS-5) which regulate the metabolism of cartilage extracellular matrix.Meanwhile,we have summarized the structure of aggrecanases(ADAMTS-4 and ADAMTS-5) and introduced the function of each regional structure;(2) We have concluded the way cytokines and glycosaminoglycans regulate the metabolism of aggrecanases,and discussed the regulation and control principle of cytokines and glycosaminoglycan;(3) We have summarized the majority of inhibitors to the aggrecanases,introduced the endogenic inhibitors,and put our emphasis on the extrinsic inhibitors(chelating agents,polypeptides and so on).Through deeper research on the enzymes,it will help us further understand the pathogenesis of osteoarthritis,and open up new avenues to clinical treatment.Abstract:SUMM ARY Osteoarthritis is mainly caused by the degenerative changes of cartilage and cartilage extra-cellular matrix,while Aggrecanases degradate Proteoglycanswhich are the major components of cartilage.This review includes three aspects:(1) W e have concluded the major enzymes(ADAMTS-4 and ADAMTS-5) which regulate the metabolism of cartilage extracellular matrix.Meanwhile,we have sum-marized the structure of aggrecanases(ADAMTS-4 and ADAMTS-5) and introduced the function of each regional structure;(2) W e have concluded the way cytokines and glycosam inoglycans regulate the metab-olism of aggrecanases,and d iscussed the regulation and control principle of cytokines and glycosam inogly-can;(3) W e have summarized the majority of inhibitors to the aggrecanases,introduced the endogenic inhibitors,and put our emphasis on the extrinsic inhibitors(chelating agents,polypeptides and so on).Through deeper research on the enzymes,it will help us further understand the pathogenesis of osteoar-thritis,and open up new avenues to clinical treatment.

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