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.

A 57-year-old male patient with brain metastases after radical resection of adenocarcinoma of the lung and adjuvant chemotherapy received anlotinib 12 mg orally once daily (2 weeks on and 1 week off) combined with temozolomide 150 mg orally once daily (3 weeks on and 1 week off). After 5 months of treatments, the patient developed symptoms such as cough, chest tightness, and exertional dyspnea, which gradually worsened. No obvious abnormalities were found in laboratory tests, electrocar-diogram, or cardiac echocardiography. Chest CT examination showed interstitial pulmonary edema in bilateral lungs, which was considered to be related to anlotinib. Anlotinib and temozolomide treatments were stopped and glucocorticoid and symptomatic treatments were given. Five days later, the patient′s cough, chest tightness, and other symptoms were relieved. Anlotinib was replaced by bevacizumab, which was combined with temozolomide to continue the anti-tumor treatment, and the patient did not experience discomfort. One month later, chest CT showed that the interstitial edema in bilateral lungs was markedly absorbed.

A 57-year-old male patient with brain metastases after radical resection of adenocarcinoma of the lung and adjuvant chemotherapy received anlotinib 12 mg orally once daily (2 weeks on and 1 week off) combined with temozolomide 150 mg orally once daily (3 weeks on and 1 week off). After 5 months of treatments, the patient developed symptoms such as cough, chest tightness, and exertional dyspnea, which gradually worsened. No obvious abnormalities were found in laboratory tests, electrocar-diogram, or cardiac echocardiography. Chest CT examination showed interstitial pulmonary edema in bilateral lungs, which was considered to be related to anlotinib. Anlotinib and temozolomide treatments were stopped and glucocorticoid and symptomatic treatments were given. Five days later, the patient′s cough, chest tightness, and other symptoms were relieved. Anlotinib was replaced by bevacizumab, which was combined with temozolomide to continue the anti-tumor treatment, and the patient did not experience discomfort. One month later, chest CT showed that the interstitial edema in bilateral lungs was markedly absorbed.

Mushroom poisoning with amatoxins can cause liver dysfunction in patients, and death in severe cases. The amatoxins detection by enzyme-linked immunosorbent assay (ELISA) can help early clinical diagnosis. Three patients were identified as α-amatoxin containing mushroom poisoning by ELISA. The first symptoms of patients was gastrointestinal symptoms, and liver function damage occured later. One patient gave up treatment and died. After received supportive treatments such as adsorption of toxins, catharsis, fluid supplementation to promote toxin metabolism and liver protection, 2 patients were recovered and discharged.

Mushroom poisoning with amatoxins can cause liver dysfunction in patients, and death in severe cases. The amatoxins detection by enzyme-linked immunosorbent assay (ELISA) can help early clinical diagnosis. Three patients were identified as α-amatoxin containing mushroom poisoning by ELISA. The first symptoms of patients was gastrointestinal symptoms, and liver function damage occured later. One patient gave up treatment and died. After received supportive treatments such as adsorption of toxins, catharsis, fluid supplementation to promote toxin metabolism and liver protection, 2 patients were recovered and discharged.

The laparoscopic vision platform developed from the prototype of candlelight reflector device to HD, 3D and 4K ultra HD, which revolutionized surgery from open surgery to minimally invasive surgery. With the continuous application in gastric cancer surgery, the importance of laparoscopy in radical gastrectomy is gradually recognized. Radical gastrectomy mainly includes lymph node dissection and digestive tract reconstruction. The reconstruction of digestive tract after radical gastrectomy for distal gastric cancer has been a hot topic of discussion and research, which is directly related to the incidence of postoperative complications, nutritional status and quality of life. This paper mainly discusses the Roux-en-Y digestive tract reconstruction of radical gastrectomy for distal gastric cancer with 4K laparoscopic.

According to the current evidence-based medicine researches, the eastern and western countries have reached a consensus that D2 operation is a standardized procedure for advanced gastric cancer.However, the postoperative five-year survival rate is still not satisfactory. Professor Gong Jianping of Tongji Hospital, Tongji Medical Gollege of Huazhong University of Science and Technology proposed a theory of membrane anatomy (the third element of surgical anatomy) and the concept of cancer leakage—an epoch-making concept in surgical anatomy. The Department of Gastrointestinal Surgery, The Affiliated Hospital of Guizhou Medical University was honored to be selected as one of the first domestic replication units of 3D laparoscopic radical gastrectomy under membrane anatomy. Professor Gong Jianping has visited our hospital several times for surgical demonstration, explanation of membrane anatomy theory and replication training. Through the understanding of membrane anatomy theory, we found that 3D laparoscopic radical gastrectomy guided by membrane anatomy can achieve good results, e.g less bleeding, complete resection, complete lymph node dissection and avoidance of side damage, meanwhile the operation is simple and safe. At the same time, it can avoid the shedding of cancer cells, so as to reduce the iatrogenic leakage of cancer and improve the efficacy of radical gastrectomy. In addition, the standardized procedure of laparoscopic radical gastrectomy makes it scientific, reproducible and easy to be popularized.

According to the current evidence?based medicine researches, the eastern and western countries have reached a consensus that D2 operation is a standardized procedure for advanced gastric cancer. However, the postoperative five?year survival rate is still not satisfactory. Professor Gong Jianping of Tongji Hospital, Tongji Medical Gollege of Huazhong University of Science and Technology proposed a theory of membrane anatomy (the third element of surgical anatomy) and the concept of cancer leakage—an epoch?making concept in surgical anatomy. The Department of Gastrointestinal Surgery, The Affiliated Hospital of Guizhou Medical University was honored to be selected as one of the first domestic replication units of 3D laparoscopic radical gastrectomy under membrane anatomy. Professor Gong Jianping has visited our hospital several times for surgical demonstration, explanation of membrane anatomy theory and replication training. Through the understanding of membrane anatomy theory, we found that 3D laparoscopic radical gastrectomy guided by membrane anatomy can achieve good results, e.g less bleeding, complete resection, complete lymph node dissection and avoidance of side damage, meanwhile the operation is simple and safe. At the same time, it can avoid the shedding of cancer cells, so as to reduce the iatrogenic leakage of cancer and improve the efficacy of radical gastrectomy. In addition, the standardized procedure of laparoscopic radical gastrectomy makes it scientific, reproducible and easy to be popularized.

According to the current evidence?based medicine researches, the eastern and western countries have reached a consensus that D2 operation is a standardized procedure for advanced gastric cancer. However, the postoperative five?year survival rate is still not satisfactory. Professor Gong Jianping of Tongji Hospital, Tongji Medical Gollege of Huazhong University of Science and Technology proposed a theory of membrane anatomy (the third element of surgical anatomy) and the concept of cancer leakage—an epoch?making concept in surgical anatomy. The Department of Gastrointestinal Surgery, The Affiliated Hospital of Guizhou Medical University was honored to be selected as one of the first domestic replication units of 3D laparoscopic radical gastrectomy under membrane anatomy. Professor Gong Jianping has visited our hospital several times for surgical demonstration, explanation of membrane anatomy theory and replication training. Through the understanding of membrane anatomy theory, we found that 3D laparoscopic radical gastrectomy guided by membrane anatomy can achieve good results, e.g less bleeding, complete resection, complete lymph node dissection and avoidance of side damage, meanwhile the operation is simple and safe. At the same time, it can avoid the shedding of cancer cells, so as to reduce the iatrogenic leakage of cancer and improve the efficacy of radical gastrectomy. In addition, the standardized procedure of laparoscopic radical gastrectomy makes it scientific, reproducible and easy to be popularized.