One patient with advanced lung adenocarcinoma developed refractory hypertension after 19 months of treatment with bevacizumab and afatinib,the clinical pharmacist analyzed the patient's medication,and consulted the relevant literature,considering that the patient's refractory hypertension was related to bevacizumab and sleep difficulties.Because of the patient's proteinuria and the fact that the patient's blood pressure was not controlled below 130/80 mmHg,it was recommended that bevacizumab should be suspended,and the doctor accepted the recommendation.Through multiple adjustments to the antihypertensive regimen(nifedipine controlled-release,sacubitril/valsartan,metoprolol,indapamide)and sleep improvement(mirtazapine,lorazepam).The patient's sleep duration was extended to 4-5 hours,blood pressure was controlled below 130/80 mmHg,and bevacizumab treatment was resumed.In this case,the clinical pharmacist participated in the patient's drug treatment process,assisted the doctor in the adjustment of the individualized treatment plan for special populations,and promoted the patient's rational drug use.

One patient with advanced lung adenocarcinoma developed refractory hypertension after 19 months of treatment with bevacizumab and afatinib,the clinical pharmacist analyzed the patient's medication,and consulted the relevant literature,considering that the patient's refractory hypertension was related to bevacizumab and sleep difficulties.Because of the patient's proteinuria and the fact that the patient's blood pressure was not controlled below 130/80 mmHg,it was recommended that bevacizumab should be suspended,and the doctor accepted the recommendation.Through multiple adjustments to the antihypertensive regimen(nifedipine controlled-release,sacubitril/valsartan,metoprolol,indapamide)and sleep improvement(mirtazapine,lorazepam).The patient's sleep duration was extended to 4-5 hours,blood pressure was controlled below 130/80 mmHg,and bevacizumab treatment was resumed.In this case,the clinical pharmacist participated in the patient's drug treatment process,assisted the doctor in the adjustment of the individualized treatment plan for special populations,and promoted the patient's rational drug use.

Objective:To evaluate the safety and clinical efficacy of transplanting a muscle flap to treat the postoperative refractory empyema with a bronchopleural fistula.Methods:From July 2015 to December 2019, the clinical data of 15 patients who suffered from postoperative refractory empyema with bronchopleural fistula was retrospectively summarized. There were 13 males and two females with a mean age of 61.7 years. Ten cases had previous posterolateral thoracotomy and four cases underwent minimally invasive surgery. After conservative and endoscopic therapy, a pedicled latissimus dorsi muscle flap, a pectoralis major muscle flap, or a free vastus lateralis myocutaneous flap was harvested from the ipsilateral local thorax or thigh and was transferred to cover the intrathoracic cavity.Results:There was no perioperative death. During a mean follow-up of 14.8 months, one patient was dead, one suffered from a recurrence of refractory empyema, and l3 patients had an uneventful course with no recurrence of refractory empyema and bronchopleural fistula. Postoperative chest computed tomography or magnetic resonance imaging showed the empyema cavity was satisfactorily covered with a pedicle or free muscle flap.Conclusions:Muscle flap transplantation is an effective alternative for treating the postoperative refractory empyema with bronchopleural fistula, which can achieve promising short-medium-term results.

Objective:To evaluate the safety and clinical efficacy of transplanting a muscle flap to treat the postoperative refractory empyema with a bronchopleural fistula.Methods:From July 2015 to December 2019, the clinical data of 15 patients who suffered from postoperative refractory empyema with bronchopleural fistula was retrospectively summarized. There were 13 males and two females with a mean age of 61.7 years. Ten cases had previous posterolateral thoracotomy and four cases underwent minimally invasive surgery. After conservative and endoscopic therapy, a pedicled latissimus dorsi muscle flap, a pectoralis major muscle flap, or a free vastus lateralis myocutaneous flap was harvested from the ipsilateral local thorax or thigh and was transferred to cover the intrathoracic cavity.Results:There was no perioperative death. During a mean follow-up of 14.8 months, one patient was dead, one suffered from a recurrence of refractory empyema, and l3 patients had an uneventful course with no recurrence of refractory empyema and bronchopleural fistula. Postoperative chest computed tomography or magnetic resonance imaging showed the empyema cavity was satisfactorily covered with a pedicle or free muscle flap.Conclusions:Muscle flap transplantation is an effective alternative for treating the postoperative refractory empyema with bronchopleural fistula, which can achieve promising short-medium-term results.

Objective To investigate the factors related to death of thoracic trauma emergency in children.Methods Total 528 children and infants aged 0-14 years with thoracic injuries , including 317 boys and 211 girls, admitted in emergency department from January 2010 to January 2014 were included in the study.The factors related to emergency death were investigated by using conditional logistic analysis.Results Among 528 cases, emergency death occurred in 34 cases with an emergency mortality rate of 6.44%.Single-factor analysis showed that emergency death was correlated with complication with other organ trauma, the time of first medical intervention , the time of arriving at first contact hospital , the rank of first contact hospital , hypoxemia and causes of injuries ( all P<0.05 ); however , not correlated with the gender, age, of patients, areas of residence, family economic status and seasons of injury occurring (all P>0.05).Logistic analysis showed that the time of first medical interventio n>30 min ( B=1.467,95%CI:0.412-0.975), complication with other organ trauma (B=2.342,95%CI:0.415-0.943), hypoxemia (B=2.915,95%CI:0.749-0.819), and first visiting to tertiary hospital (B=-1.861,95%CI:1.023-1.742) were influencing factors of emergency death.Conclusion The results indicate that to improve the success rate of emergency treatment of thoracic trauma in children , it is necessary to reduce the time of first medical intervention and to correct the hypoxemia promptly.

Objective To study the effects of chronic exposure to inorganic arsenic (iAs) in drinking water on bone mineral density (BMD) in mice and its underlying mechanisms.Methods Five-month-old female C57BL/6 mice were randomly divided into sham groups and ovarectomy (OVX) groups (n =19 mice each group),which were further randomly assigned into control group (distilled water) and iAs exposure groups [5 mg/L and 20 mg/L,inorganic arsenite (iAsⅢ):inorganic arsenate (iAsv) =1 ∶ 1].Following 3 months of exposure to iAs,BMD of the mice were determined by the dual energy X-ray detector.RAW 264.7 cell line and bone marrow hematopoietic stem cells (BMHSC) primarily isolated from C57BL/6 mice were used to study the in vitro effects of iAs on osteoclast differentiation and underlying mechanisms.During differentiation induced by receptor activator of nuclear factor-κ B ligand (RANKL,50 μg/L) and macrophage colony-stimulating factor (M-CSF,30 μg/L),RAW 264.7 cell line were treated with 0.00,0.25,0.50,0.75,1.00,1.50 μmol/L iAsⅢ,while BMHSC with 0.0,0.2,0.4,0.6,0.8,1.0 μmol/L iAsⅢ for 6 days.Based on the effect of iAsⅢ on the differentiation of RAW cells,RAW 264.7 cell line were treated by 0.6 μmol/L iAsⅢ combined with 0,5,10 mmol/L of N-acetyl-cysteine (NAC).Tartrate resistant acid phosphatase (TRAP)-positive red-colored cells with 3 or more nuclei were considered mature osteoclast.Results The femoral BMD of the mice [(80.04 ± 4.06) mg/cm2] that had been exposed to 20 mg/L of iAs for 3 months was substantially decreased compared to that of sham control mice [(84.44 ± 4.40) mg/cm2].As expected,the BMD of the OVX group [(76.36 ± 3.36) mg/cm2] was significant decreased compared to that of the sham control group (P ＜ 0.05).However,the BMD among the OVX groups showed no significant difference [5 mg/L:(77.74 ± 4.91) mg/cm2;20 mg/L:(75.56 ± 3.71) mg/cm2,P ＞ 0.05].In vitro studies,the iAsⅢ evidently affected the osteoclast differentiation in a concentration-dependent fashion.Low concentrations of iAs Ⅲ exposure significantly augmented osteoclast differentiation in the two cell models while high concentrations showed inhibitory effect.In RAW 264.7 cells,the number of osteoclasts in different groups was significantly different (F =1 522,P ＜ 0.05),in the 0.50 μmol/L iAs Ⅲ group the number of osteoclasts reached the peak.In the BMHSC,the nmnber of osteoclasts in different groups was also significantly different (F =1 781,P ＜ 0.05),in the 0.6 μmol/L iAsⅢ group the number of osteoclasts reached the peak.NAC pretreatment significantly abolished low-level iAsⅢ(0.6 μmol/L)-induced augmentation of osteoclast differentiation in a concentration-dependent fashion (0 mmol/L:109.33 ± 3.06;5 mmol/L:56.00 ± 2.65;10 mmol/L:22.67 ± 0.58,F =1 940,P ＜ 0.05).Conclusions The inhibitory effect of iAs on bone metabolism is dependent on the availability of ovary function,suggesting that iAs may interfere with estrogen metabolism and/or function to disturb bone metabolism.Oxidative stress induced by iAs exposure stimulates osteoclast differentiation,and the increased osteoclast differentiation may be involved in the reduction of BMD caused by chronic iAs exposure.These preliminary findings suggest that antioxidant intervention may be an effective approach to prevent osteoporosis induced by chronic iAs exposure.

Objective To compare the clinical outcomes of total laparoscopic pancreatoduodenectomy (TLPD) and open pancreaticoduodenectomy (OPD).Methods From August 2013 to December 2014,137 pancreaticoduodenectomies (PDs) were performed at the Department of General Surgery of our hospital,of which 19 TLPDs were performed at the Department of Minimally Invasive Surgery (the Experimental group).At the same time,another cohort of 19 OPDs were matched for age,gender,body mass index (BMI),ASA score and tumor site and they formed the control group.The clinical data in the perioperative period were evaluated,and the short-term clinical outcomes were compared.Results Operation time in the experimental group was significantly longer than the control group [(407.8 ± 146.5)min vs (263.3 ± 65.3) rmin,P ＜ 0.05].The mean intraoperative blood loss [(309.7 ± 151.2)ml vs (509.4 ± 309.9)ml],mean intensive care time after surgery [(47.5 ±16.8)h vs (68.1 ± 19.1)h],mean postoperative time to pass flatus [(3.5 ± 1.1) d vs (4.3 ± 1.1) d],mean postoperative hospitalization stay [(8.8 ± 2.1) d vs (10.8 ± 2.3)d] and mean incision length [(5.1 ± 0.9)cm vs (14.4 ± 1.3)cm] in the experimental group were significantly different from the control group (P ＜ 0.05).There were no significant differences on the intraoperative R0 resection rates,intraoperative pathology,tumor size [(20.6 ± 9.6) mm vs (25.9 ± 10.2)mm],number of lymph node dissected [(17.7 ± 6.5) vs (19.4 ± 5.6)],complication rates,recurrence rates and mortality between the two groups (P ＞ 0.05).Conclusions TLPD had comparable safety and therapeutic outcome when compared with OPD.Moreover,TLPD has the advantages of less bleeding,smaller wounds and faster postoperative recovery.TLPD requires specialized appliances and equipments,better surgeon experience and patient selection to achieve a high success rate.

OBJECTIVES: From the point of view of clinical data representation, this study attempted to identify obstacles in translating clinical narrative guidelines into computer interpretable format and integrating the guidelines with data in Electronic Health Records in China. METHODS: Based on SAGE and K4CARE formulism, a Chinese clinical practice guideline for hypertension was modeled in Protege by building an ontology that had three components: flowchart, node, and vMR. Meanwhile, data items imperative in Electronic Health Records for patients with hypertension were reviewed and compared with those from the ontology so as to identify conflicts and gaps between. RESULTS: A set of flowcharts was built. A flowchart comprises three kinds of node: State, Decision, and Act, each has a set of attributes, including data input/output that exports data items, which then were specified following ClinicalStatement of HL7 vMR. A total of 140 data items were extracted from the ontology. In modeling the guideline, some narratives were found too inexplicit to formulate, and encoding data was quite difficult. Additionally, it was found in the healthcare records that there were 8 data items left out, and 10 data items defined differently compared to the extracted data items. CONCLUSIONS: The obstacles in modeling a clinical guideline and integrating with data in Electronic Health Records include narrative ambiguity of the guideline, gaps and inconsistencies in representing some data items between the guideline and the patient' records, and unavailability of a unified medical coding system. Therefore, collaborations among various participants in developing guidelines and Electronic Health Record specifications is needed in China.
Asian Continental Ancestry Group ; China* ; Clinical Coding ; Cooperative Behavior ; Decision Support Systems, Clinical ; Delivery of Health Care ; Electronic Health Records ; Humans ; Hypertension ; Methods* ; Practice Guidelines as Topic ; Software Design ; Translating

Objective To investigate the relationship of the serum level of IL-23 and MMP-9 with the clinicopathologic features in patients with esophageal squamous cell carcinoma (ESCC). Methods 48 pathologically confirmed ESCC patients and 30 Endoscopic biopsy of benign were included in this study. The serum levels of IL-23 and MMP-9 were examined by enzyme-linked immunosorbent assay (ELISA). Results Serum IL-23 level in patients with ESCC was significantly higher than that in controls (t = 26.66, 16.89, P<0.05). Furthermore, Pearson′s correlation analysis revealed that serum IL-23 was positively correlated with the serum MMP-9 level in ESCC patients (r = 0.790, P < 0.05). Statistical analysis showed that enhanced serum IL-23 significantly correlated with the degree of differentiation and lymph node metastasis. Conclusion Overexpression of IL-23 may involve in the occurrence and development of ESCC. IL-23 may contribute to tumorinvasion and metastasis by stimulating the expression of MMP-9.

Objective To develop a conceptual framework for the synopsis of information of health examination reports (HERs) and its style sheet so as to provide a reference for information collection and management in health examination institutions.Methods A conceptual framework for the synopsis of information of HERs and its core data elements were developed based on HERs items from 11 health examination institutions,and a style sheet for the synopsis of information of HERs was then designed.Results The conceptual framework included 4 dimensions (e.g.identification information,health-related information,health exam summary,health evaluation and guidance),16 sub-dimensions,52 core data elements and 25 value domains.The structure and content of the designed sheet were consistent with the dimensions,subdimensions and core data elements of the conceptual framework.Conclusions The developed synopsis of information of HERs could be a feasible solution for structured and standardized representation of clients' health examination information.The selection and filling of some items should be validated and refined in the future.