OBJECTIVE To systematically evaluate the efficacy and safety of selective COX -2 inhibitors for preemptive analgesia in patients undergoing total hip/knee arthroplasty （THA/TKA），and to provide evidence -based reference for clinical drug use. METHODS Retrieved from CNKI ，VIP，CBM，Wanfang database ，PubMed，Embase，Scopus，Web of Science and Cochrane library ，randomized controlled trials about selective COX -2 inhibitors for preemptive analgesia combined with post - operative analgesia of THA/TKA （trial group ）versus post -operative analgesia （control group ）were collected during the inception to February 15，2022. After screening the literature and extracting the data ，the RCT bias risk assessment tool recommended by the Cochrane System Evaluator ’s Manual 5.1.0 was used to evaluate the quality of the included literature . Meta-analysis was performed by using RevMan 5.3 software. RESULTS Six RCTs involving 916 patients were included . The visual analog （VAS）scale scores of pain at rest [MD＝－0.20，95%CI（－0.30，－0.10），P＜0.000 1]，VAS scores of pain at movement [MD＝－0.20，95%CI （－0.27，－0.13），P＜0.000 01]，total consumption of patient controlled analgesia （PCA） [MD＝－5.89，95%CI（－8.98， －2.80），P＝0.000 2]，and the incidence of postoperative nausea and vomiting [RR＝0.79，95%CI（0.65，0.95），P＝0.01] in trial group were significantly lower than control group . CONCLUSIONS Compared with postoperative administration alone ，preemptive plus postoperative analgesia with selective COX -2 inhibitor can significantly alleviate the early postoperative pain ，reduce the total consumption of PCA and the incidence of postoperative nausea and vomiting in THA/TKA patients .

OBJECTIVE： To investigate pharmaceutical care of cancer pain therapy in medical institutions from Beijing area， and to provide reference for improving the quality of pharmaceutical care for cancer pain in medical institutions and formulating cancer pain therapy decision by public health administration departments at different levels. METHODS： Inspection results of standardized diagnosis and treatment for cancer pain were analyzed retrospectively in Beijing Pain Therapy Quality Control and Improvement Center during Feb.-Mar. 2018. Scoring results of pharmaceutical care （20 points） and its 5 sub-items （personnel participation， drug supply， drug management， outpatient prescription comment and inpatient prescription comment， 4 points each item） were analyzed statistically and classified according to hospital level and pharmaceutical care inspection results. RESULTS： A total of 64 hospitals in Beijing participated in the inspection， including 27 tertiary A hospitals （42.19％）， 21 tertiary B hospitals （32.81％）， 16 secondary hospitals or first-level hospitals （25.00％）. Pharmaceutical care in all hospitals met the inspection requirements with qualified rate of 100％. 52 hospitals performed excellently （81.25％）， and 12 hospitals were qualified for pharmaceutical care （18.75％）. Among 5 sub-items of personnel participation， drug supply， drug management， outpatient prescription comment and inpatient prescription comment， the average score of drug supply item was the highest （3.83±0.05）； the lowest was the personnel participation item （2.93±0.13）. The results of pharmaceutical care inspection in tertiary A hospitals （17.80±0.28） and tertiary B hospitals （17.78±0.30） were significantly better than those in secondary hospitals or first-level hospitals（16.16±0.50）（P＜0.01 or P＜0.05）； there was statistical significance only in the score of outpatient prescription comment among 5 sub-items（P＝0.026）. Total scores of the hospitals with excellent pharmaceutical care were significantly higher than those of the hospitals with qualified pharmaceutical care in terms of personnel participation， outpatient prescription comment and inpatient prescription comment （P＜0.01 or P＜0.05）. There was significant difference in the inspection results of pharmaceutical care among the excellent group， the qualified group and the unqualified group classified by the results of personnel participation item （P＜0.01 or P＜0.05）. CONCLUSIONS： The quality of pharmaceutical care for cancer pain therapy in medical institutions from Beijing area has reached the qualified level， but the participation of clinical pharmacists in cancer pain therapy and outpatient prescription comment still need improvement in further. The training of clinical pharmacists and information construction of narcotic drug management should be strengthened so as to improve the overall quality of pharmaceutical care for cancer pain.

OBJECTIVE:To investigate the effects of blood concentration monitoring of cylosporin A(CsA) in patients with nephrotic syndrome(NS)on efficacy and safety. METHODS:The medical records of 154 NS patients receiving CsA and blood concentration monitoring in nephrology department of China-Japan Friendship Hospital during Jan. 2014-Aug. 2017 were analyzed retrospectively. The results of blood concentration monitoring in 63 adult inpatients with refractory NS receiving CsA for the first time within 6 months of initial treatment were analyzed statistically. The relationship of blood concentration monitoring with efficacy and safety was analyzed. RESULTS:The blood concentration of CsA in 154 patients were monitored for 512 times with an average of 3.32 times/person,and average blood concentration was(125.98±105.13)ng/mL. The patients with blood concentration of CsA＜100 ng/mL accounted for 44.14%. There was no statistical significance in average monitoring times or average blood concentration between male and female,average blood concentration of CsA among different age groups (P＞0.05). The blood concentration was monitored for 237 times in 63 adult inpatients with refractory NS receiving CsA for the first time within 6 months of initial treatment(induction period). Average blood concentration of effective group were significantly higher than ineffective group;the proportion of effective group with blood concentration＜100 ng/mL was significantly lower than that of ineffective group,with statistical significance (P＜0.05). Among 63 patients,17 patients suffered from ADR (the incidence of ADR was 26.98%). The average blood concentrations of ADR patients were significantly higher than those without ADR;the monitoring times of ADR patients with blood concentration＞150 ng/mL was significantly higher than those without ADR,with statistical significance(P＜0.05). There was no statistical significance in the incidence of ADR between effective group and ineffective group (P＞0.05). Among effective group,there was no statistically significance in average blood concentration between ADR patients and patients without ADR(P＞0.05);the monitoring times of ADR patients with blood concentration＞150 ng/mL was significantly higher than patients without ADR,with statistical significance(P＜0.05). With the increase of monitoring times,the incidence of ADR decreased gradually. There was no statistical significance in the incidence of ADR among patients who were monitored for different times (P＞0.05). CONCLUSIONS:The pharmacokinetics of CsA varies in different patients and many factors affect its blood concentration. The changes of blood concentration affect the efficacy and safety of CsA. It is difficult to determine the dosage of CsA based on experience in the treatment of NS with CsA. Great importance should be attached to blood concentration monitoring of CsA and the implementation of individualized dosage regimen based monitoring results so as to improve therapeutic efficacy and reduce the occurrence of ADR.

An 81-year-old male patient received an IV infusion of zoledronic acid 4 mg once monthly for prostate cancer with bone metastasis in a local hospital. After 31 times of administration,the medication was given once every 3 months and after 3 times of treatment,the drug was stopped. The total accumulated dose of zoledronic acid was 136 mg. Two months after drug withdrawal,the patient developed pain in the left upper jaw when chewing food. He was diagnosed with endodontitis and 4 times of arrachement was performed in the local hospital. After the last operation,the wound did not heal with local pyorrhea and pain. The CT examination in China-Japan Friendship Hospital showed the osteonecrosis of left maxilla,which was considered to be related to zoledronic acid. Intravenous infusion of cefuroxime sodium 1. 5 g and metronidazole 0.5 g twice daily,and gargle with 0.02% chlorhexidine acetate solution 20 ml thrice daily were given. The patient underwent debridement of infection focus in left maxilla. The medications after the operation were as the same as before,except adding regional rinsing with 0.9% sodium chloride injection. On day 4 after operation,the local inflammation in left maxilla improved and 3 weeks later,the wound healed.

An 81-year-old male patient received an IV infusion of zoledronic acid 4 mg once monthly for prostate cancer with bone metastasis in a local hospital. After 31 times of administration,the medication was given once every 3 months and after 3 times of treatment,the drug was stopped. The total accumulated dose of zoledronic acid was 136 mg. Two months after drug withdrawal,the patient developed pain in the left upper jaw when chewing food. He was diagnosed with endodontitis and 4 times of arrachement was performed in the local hospital. After the last operation,the wound did not heal with local pyorrhea and pain. The CT examination in China-Japan Friendship Hospital showed the osteonecrosis of left maxilla,which was considered to be related to zoledronic acid. Intravenous infusion of cefuroxime sodium 1. 5 g and metronidazole 0.5 g twice daily,and gargle with 0.02% chlorhexidine acetate solution 20 ml thrice daily were given. The patient underwent debridement of infection focus in left maxilla. The medications after the operation were as the same as before,except adding regional rinsing with 0.9% sodium chloride injection. On day 4 after operation,the local inflammation in left maxilla improved and 3 weeks later,the wound healed.

Objective To explore the clinical significance and gene mutation profiles of renal transplant patients with unconjugated hyperbilirubinemia (Gilbert's syndrome).Methods Genomic DNA was extracted from peripheral blood samples of 8 renal transplant patients with Gilbert'S syndrome.UGT1A1 * 6 and UGT1A1 * 28 genotypes were identified through digital fluorescence molecular hybridization and DNA sequencing.Results There are 2 cases of UGT1A1 * 28 heterozygous mutant,3 cases of UGT1A1 * 6 homozygous mutant,2 case of UGT1A1 * 6 heterozygous mutant,1 case of UGT1A1 * 28 heterozygous mutant combined with UGT1A1 * 6 heterozygous mutant.Conclusion There is a higher heterozygous or homozygous gene mutation rate of UGT1A1 * 6 and UGT1A1 * 28 in renal transplant patients with Gilbert's syndrome.Genetic mutation of UGT1A1 * 6 and UGT1A1 * 28 may be the reason of Gilbert's syndrome after renal transplant.

Objective To observe the effects of buccal acupuncture therapy and body acupuncture therapy on plasma metabolomites of rheumatoid arthritis rabbits model; To search for the metabolites related to the mechanism of buccal acupuncture and body acupuncture. Methods Sixteen rabbits were made into rheumatoid arthritis models by complete freund's adjuvant before the treatment. The buccal acupuncture group was treated by buccal acupuncture on the knee acupoint; 13 mm × 0.32 mm needle straight 0.2–0.5 mm, twist the main points of stimulation 15 s, once a day. The body acupuncture group was treated by body acupuncture on the Xiyan and Zusanli acupoints; with 13 mm × 0.32 mm needle straight 2–3 mm, every 5 min each time, twisting needle method, 100 times/min for 15 s, once a day. After the continuous treatment for 5 days, UPLC-QTOF/MS was applied to test metabolite from the plasma sample of all groups. Similarity analysis, hierarchical cluster analysis (HCA), principal component analysis (PCA), orthogonal partial least squares-discriminant analysis (OPLS-DA) were applied in this research; meanwhile load analysis method was used to identify the meaningful metabolites. Results The similarity analysis, HCA and PCA all showed the significant difference of endogenous metabolites in plasma samples among the buccal acupuncture group, the body acupuncture, the model group and the blank group. The 4 groups of different plasma sample metabolite were completely separated in three dimensions by OPLS-DA and all the samples were gathered respectively. The load analysis indicated that there were 19 kinds of endogenous metabolites which showed the significant differences between buccal acupuncture group and model group, and also happened between the body acupuncture group and the model group; N-cetyl-L-phenylalanine and 2-phenyl propionate in metabolism of phenylalanine and tyrosine decreased significantly in the buccal acupuncture group while significantly increased in the body acupuncture group. Conclusion There are relative similarity on the mechanism of treating rheumatoid arthritis between buccal acupuncture and body acupuncture. However, N-acetyl-L-phenylalanine and 2-phenyl propionate, as the main potential biomarkers of the difference, indicate that the dissimilarity can be significant.

A 79-year-old female patient with type 2 diabetes was ordered to receive subcutaneous injection of biosynthetic human insulin injection 8 U [ Novolin R 3 ml:300 U ( cartridge) ] before 3 meals. Because of no matching insulin pen, the nurse used normal insulin syringe ( 40 U/ml, 0. 2 ml contains common insulin injection 8 U) as a substitution of Novolin R insulin pen and gave the patient an injection of 0. 2 ml Novolin R liquid ( including Novolin R 20 U) according to her experience of using normal insulin syringe formerly. About 4 hours later, the patient developed sweating, coma, and no responses to call. Her fingertip blood glucose was 2. 8 mmol/L. She received an intravenous injection of 50% glucose 40 ml immediately. About 10 minutes later, her fingertip blood glucose increased to 4. 4 mmol/L. About 70 minutes later, her fingertip blood glucose increased to 6. 0 mmol/L and her consciousness recovered.

A 79-year-old female patient with type 2 diabetes was ordered to receive subcutaneous injection of biosynthetic human insulin injection 8 U [ Novolin R 3 ml:300 U ( cartridge) ] before 3 meals. Because of no matching insulin pen, the nurse used normal insulin syringe ( 40 U/ml, 0. 2 ml contains common insulin injection 8 U) as a substitution of Novolin R insulin pen and gave the patient an injection of 0. 2 ml Novolin R liquid ( including Novolin R 20 U) according to her experience of using normal insulin syringe formerly. About 4 hours later, the patient developed sweating, coma, and no responses to call. Her fingertip blood glucose was 2. 8 mmol/L. She received an intravenous injection of 50% glucose 40 ml immediately. About 10 minutes later, her fingertip blood glucose increased to 4. 4 mmol/L. About 70 minutes later, her fingertip blood glucose increased to 6. 0 mmol/L and her consciousness recovered.