The writing of pharmacist-managed clinics documents （hereinafter referred to as “outpatient medication record”） is a necessary part of pharmacist-managed clinics service. Outpatient medication record is an important carrier to reflect the quality of pharmacist-managed clinics service. The Chinese Hospital Association Pharmaceutical Specialized Committee was entrusted by the Pharmaceutical Administration Department of the National Health Commission to lead the formulation of the Guidelines for the Pharmacist-managed Clinics Service and Document Writing and Usage （Reference） （hereinafter referred to as Guidelines） according to the compilation method of group standards and the technical route of “documentation combing→framework establishment→draft writing→opinion collection→Guidelines formation”. The Guidelines standardizes the basic requirements of pharmacist-managed clinics record management and the basic content of record， and provides a general template and two specialized templates including pregnant and lactating pharmacist-managed clinics record template and cough and asthma pharmacist-managed clinics record template， which provides a reference for medical institutions to write pharmacist-managed clinics record. This paper introduces the formulation process of Guidelines and analyzes the key contents of Guidelines， which is helpful for the application practice of Guidelines and further improves the quality of pharmacist-managed clinics work.

This paper reports a case of peritonitis caused by Campylobacter fetus in a continuous ambulatory peritoneal dialysis (CAPD) patient. The patient was a middle-aged man, with chronic kidney disease stage 5 secondary to chronic glomerulonephritis, and had been on CAPD for 6 years. He was admitted to our department with a 7 day history of abdominal pain and cloudy effluent. Peritoneal effluent culture was negative and metagenomic next-generation sequencing suggested Campylobacter fetus. Intraperitoneal treatment with amikacin was failed. Peritoneal dialysis catheter was removed and hemodialysis treatment was performed. After treatment of erythromycin oral for 4 weeks, the patient's symptoms was improved and discharged.

During the epidemic of COVID-19, The Fifth Hospital of Harbin Medical University organized and operated online blended teaching based on BOPPPS teaching mode. Before the opening of the school, the college concentrated on theoretical learning and online practice in BOPPPS teaching mode to ensure that teachers mastered online teaching methods before teaching. In the course of teaching, various means were used to strengthen the application of six modules in BOPPPS teaching mode. A multilevel online teaching supervision and feedback mechanism for colleges, teaching and research sections, teachers and students, and continuously improve the quality of teaching. The teaching practice of the first four weeks have shown that through the unified organization and implementation of the college, online teaching based on BOPPPS teaching mode can be realized efficiently, student-centered and participatory learning can be realized, and the online teaching ability of teachers can also be improved with satisfactory results.

Objective To investigate the predictive value of gadolinium-ethoxybenzyl-diethylenetriamine pentaacetic acid (Gd-EOB-DTPA) enhanced MRI for microvascular invision (MVI) in hepatocellular carcinoma (HCC). Methods Retrospective analysis of 70 patients confirmed by pathology as HCC who underwent Gd-EOB-DTPA-enhanced MRI within 2 weeks prior to liver partial resection or liver transplantation surgery from January 2015 to May 2018 in Nantong Third People's Hospital. According to the pathological results of the postoperative pathology, MVI was divided into MVI positive group and MVI negative group, and alpha fetoprotein (AFP) was recorded. In Gd-EOB-DTPA-enhanced MRI, qualitative indicators including whether the tumor signal was uniform, peritumoral enhancement, tumor capsule, tumor margin, peritumor hypointensity and presence of fat in the tumor were assessed. Quantitative indicators including tumor diameter and the increase rate of liver-to-muscle ratio(ΔLMR) of post-enhancement arterial phase, portal vein phase, transitional phase and hepatobiliary phase were assessed and recorded. Theχ2 test was used to compare the qualitative parameters of the MVI-negative group and the MVI-positive group, and the Mann-Whitney U test was used to compare the non-normal quantitative parameters. In both inclusion and non-inclusion of peritumor hypointensity cases in the hepatobiliary phase. The multivariate logistic regression analysis was performed to indicate independent variables after univariate analysis. The prediction probability 1 (pre-1) and the prediction probability 2 (pre-2) were obtained, and the two as independent variables. with MVI as the gold standard, using ROC to analyze the diagnostic efficacy of both for HCC MVI, and using Z test to compare the area under the ROC of pre-1 and pre-2. Results There were 27 lesions in 26 cases of MVI-positive group and 50 lesions in 44 cases of MVI-negative group. There was a statistically significant difference between the MVI-negative group and the MVI-positive group in peritumoral enhancement, tumor capsule, tumor margin and peritumor hypointensity in the hepatobiliary phase (P<0.05), and there was no statistically significant difference in gender distribution, tumor signal uniformity and intratumoral fat (P>0.05). There was significant difference in lesion diameter between MVI-negative group and MVI-positive group (P<0.05) while no significant difference in age, AFP value andΔLMR between the two groups (P>0.05). Multivariate logistic regression analysis showed that tumor diameter, non-smooth tumor margin and peritumor hypointensity were independent risks of MVI when peritumor hypointensity was included, the sensitivity and specificity of the combined diagnosis of MVI were 77.8％ and 94.0％;Multivariate logistic regression analysis showed that tumor diameter and non-smooth tumor margin were independent risks of MVI when peritumor hypointensity was not included, the sensitivity and specificity of the combined diagnosis of MVI were 59.3％and 92.0％. The the area under the ROC of pre-1 and pre-2 were 0.900 and 0.816, their difference was statistically significant (P<0.05). Conclusion Gd-EOB-DTPA enhanced MRI can be used to predict HCC MVI preoperatively, especially peritumor hypointensity in hepatobiliary phase is important for the prediction of MVI.

Objective To explore the effect of quality control circle (QCC) on reducing the incidence of complications in the patients with peritoneal dialysis (PD). Methods Eighty-nine patients who underwent peritoneal dialysis after discharge were divided into QCC group (45 cases) and control group (44 cases) according to random sampling method. Both groups were followed up regularly, QCC activity was applied in patients of the QCC group on the basis of the QCC activity procedure. The intervention time was 1 year. The blood pressure, standard rate of urea clearance index, peritonitis incidence, catheter drift rate, infection incidences of external orifice of catheter, admission rate of complications and peritoneal dialysis withdrawal incidence between 2 groups were compared. Results After interference, the systolic and diastolic blood pressure in QCC group were significantly lower than those in control group:(124.11 ± 13.07) mmHg (1 mmHg=0.133 kPa) vs. (132.68 ± 12.09) mmHg and (72.13 ± 10.51) mmHg vs. (78.91 ± 11.79) mmHg, and there were statistical differences (P<0.05). The standard rate of urea clearance index in QCC group was significantly higher than that in control group:95.56%(43/45) vs. 81.82%(36/44), and there was statistical difference (P<0.05). After interference, the peritonitis incidence and admission rate of complications in QCC group was significantly lower than those in control group: 2.22% (1/45) vs. 13.64% (6/44) and 0 vs. 9.09% (4/44), and there were statistical differences (P<0.05). There were no statistical differences in catheter drift rate, infection incidences of external orifice of catheter and peritoneal dialysis withdrawal incidence between 2 group (P>0.05). The Spearman correlation analysis result showed that peritonitis was negatively correlated with education level (r = -0.28, P < 0.05), and standard rate of urea clearance index was positively correlated with education level (r = 0.21, P < 0.05). Conclusions The QCC management model can reduce the incidence of complications in patients with peritoneal dialysis.

Objective The infection rate and the corresponding intervention measures of postoperative application of ampicillin sodium to reduce abdominal incision after operation. Methods The control group in the conventional antibiotic administration based on preoperative, postoperative combined with ampicillin sodium; research group in the control group based on the use of the corresponding operation room intervention measures. Results The incidence of incision infection in study group (18.18%) was significantly lower than the control group (4.55%)(P<0.05); the control group SDS, SAS scores did not change significantly than before , SDS of the study group, SAS scale score was significantly lower than before (P<0.05). Conclusion Application of ampicillin sodium combined with the corresponding intervention measures can significantly reduce abdominal incision surgery in two postoperative infection rate and is conducive to protect the quality of life of patients, life safety.

Objective To evaluate the performance of high-fluorescence body fluid cell (HF-BF)mode on the platform Sysmex XE-5000 automated blood analyzer,and analyse its clinical application value in diagnosis of meningeal carcinomatosis.Methods E-valuated the performance of HF-BF by using precision test and methodology comparison test.Retrospectively analyzed 295 test re-sults of cerebrospinal fluid in Zhongshan Hospital Affiliated to Xiamen University from June 2010 to September 2012.Results HF-BF on the platform Sysmex XE-5000 automated blood analyzer had high precision,and exhibited a good consistency with cytolgical examination.The percentage of high-fluorescence body fluid cell(HF-BF%)in the meningeal carcinomatosis group was higher than that in other cerebral diseases groups,had statistically significant differences (P < 0.05 ).The cut-off value for HF-BF% was 4.3%,while the area under a receiver operating characteristic (ROC)curve (AUC)was 0.933,the sensitivity was 95.2%,and the specificity was 92.7%.When HF-BF% was over 4.3%,it was more likely to detect tumor cell in cerebrospinal fluid cytology.Con-clusion HF-BF is an effective reference index for the early diagnosis of meningeal carcinomatosis and has significant clinical appli-cation value.

Objective To explore the alterations of ultrastructure of neuron and synapse in rat hippocampus induced by the expression changes of phospho cAMP response element-binding protein 1 (p-CREB1),and the effect of venlafaxine on the expression of p-CREB1 and relative neuronal and synaptic plasticity.Methods Fifty-four rats were randomly divided into 4 groups:normal group (n =12),depression model matched group (n =14),saline group (n =14),and venlafaxine medication group (n =14).Sucrose water consumption test and open field test were performed to observe the behavior of animals.To investigate the learning and memory ability,rats were tested by Morris water maze.The expression of p-CREB1 protein was detected by immunohistochemistry and the CREB1 mRNA was measured by RT-PCR.The ultrastructure of neuron and synapse were observed with electron microscope.Correlation analysis was used to measure the associations among the number of p-CREB1 positive cells,the parameters of Morris water maze and synaptic morphology.Results (1) The sucrose consumption in depression model matched group (7.4 ± 1.0) ml/100 g and saline group (7.5 ± 1.0) ml/100 g were significantly less than that in normal group (9.6 ± 0.3) ml/100 g and medication group (9.4 ± 0.8) ml/100 g,(F =17.851,P ＜ 0.01).Morris water maze showed that the escape latent period in depression model matched group (61.1 ± 10.5) s and saline group (59.0 ± 10.6) s were more than that in normal group (29.8 ± 10.1) s and medication group ((35.0 ± 8.5) s;F =30.559,P ＜ 0.01),which demonstrated the learning and memory ability of depression rats were decreased.(2) The positive cell number of p-CREB1 in the hippocampus of depression model matched group (21.07 ±5.99) and saline group (24.57 ±6.97) were lower than that in normal group (29.70 ± 6.21) and medication group (41.50 ± 11.95;F =16.497,P ＜ 0.01).(3) The CREB1 mRNA expression in the hippocampus of depression model matched group (0.58 ± 0.47) and saline group (0.45 ± 0.24) were less than that in normal group (1.03 ± 0.89) and medication group (1.10 ± 0.45;F =6.669,P ＜ 0.01).(4) There were pathologic alterations in the ultrastructure of neurons and synapses in the hippocampus of depression rats,which were improved by pharmacological intervention.(5) The number of p-CREB1 positive cells was related to the parameters of Morris water maze and synaptic morphology.Conclusion p-CREB1 expression is correlated with neuronal and synaptic plasticity,and venlafaxine may be effective through influencing the expression of p-CREB1 and neuronal and synaptic plasticity.

Objective To explore the alterations of ultrastructure of neuron and synapse in rat hippocampus induced by the expression changes of phospho cAMP response element-binding protein 1 (p-CREB1),and the effect of venlafaxine on the expression of p-CREB1 and relative neuronal and synaptic plasticity.Methods Fifty-four rats were randomly divided into 4 groups:normal group (n =12),depression model matched group (n =14),saline group (n =14),and venlafaxine medication group (n =14).Sucrose water consumption test and open field test were performed to observe the behavior of animals.To investigate the learning and memory ability,rats were tested by Morris water maze.The expression of p-CREB1 protein was detected by immunohistochemistry and the CREB1 mRNA was measured by RT-PCR.The ultrastructure of neuron and synapse were observed with electron microscope.Correlation analysis was used to measure the associations among the number of p-CREB1 positive cells,the parameters of Morris water maze and synaptic morphology.Results (1) The sucrose consumption in depression model matched group (7.4 ± 1.0) ml/100 g and saline group (7.5 ± 1.0) ml/100 g were significantly less than that in normal group (9.6 ± 0.3) ml/100 g and medication group (9.4 ± 0.8) ml/100 g,(F =17.851,P ＜ 0.01).Morris water maze showed that the escape latent period in depression model matched group (61.1 ± 10.5) s and saline group (59.0 ± 10.6) s were more than that in normal group (29.8 ± 10.1) s and medication group ((35.0 ± 8.5) s;F =30.559,P ＜ 0.01),which demonstrated the learning and memory ability of depression rats were decreased.(2) The positive cell number of p-CREB1 in the hippocampus of depression model matched group (21.07 ±5.99) and saline group (24.57 ±6.97) were lower than that in normal group (29.70 ± 6.21) and medication group (41.50 ± 11.95;F =16.497,P ＜ 0.01).(3) The CREB1 mRNA expression in the hippocampus of depression model matched group (0.58 ± 0.47) and saline group (0.45 ± 0.24) were less than that in normal group (1.03 ± 0.89) and medication group (1.10 ± 0.45;F =6.669,P ＜ 0.01).(4) There were pathologic alterations in the ultrastructure of neurons and synapses in the hippocampus of depression rats,which were improved by pharmacological intervention.(5) The number of p-CREB1 positive cells was related to the parameters of Morris water maze and synaptic morphology.Conclusion p-CREB1 expression is correlated with neuronal and synaptic plasticity,and venlafaxine may be effective through influencing the expression of p-CREB1 and neuronal and synaptic plasticity.

Purpose To investigate the significance of arterial phase display of right ovarian vein (ROV) for patients with pelvic congestion syndrome (PCS) through multi-slice CT angiography (MSCTA) Materials and Methods Forty-three patients with PCS confirmed clinically who underwent MSCTA were involved in the study. Revascularization was realized via add vessel volume rendering technique and maximum intensity projection (MIP) and the relationships among ROV early development, location of converging vascular, development of LOV and pelvic draining veins were analyzed. Results Out of 43 cases of ROV early development during arterial phase, 21 cases (48.8%) took ROV as draining vein of PCS, among which 17 cases (81.0%) converged into the inferior cava vena. In 19 cases (44.2%), ROV took part in the formation of PCS, all originating from the main right renal vein. Three cases (7.0%) were renal vein-derived PCS, among which two ROV originated from the main right renal vein and one from the branch of the right renal vein. Conclusion According to the imaging features of bilateral ovarian veins and pelvic veins, ROV, as draining veins, is associated with the formation of PCS.