OBJECTIVE： To introduce the pharmaceutical care for refractory mycoplasma pneumoniae （MP） pneumonia combined with cerebral infarction in child by clinical pharmacist， and to improve further understanding of MP-induced cerebral infarction and the management level of the clinical pharmacist. METHODS： Clinical pharmacist provided whole course pharmaceutical care for a child case of refractory PM pneumonia complicated with cerebral infarction admitted to the Children’s Hospital of Fudan University in Oct. 2018. The drug use in anti-infection， anti-inflammatory， treatment of cerebral infarction， possible drug interactions and suspected ADR were analyzed during treatment. RESULTS： The child admitted to the hospital for treatment due to MP pneumonia. During the treatment， the child suffered from cerebral infarction symptoms. The child was given a series of treatment programs， such as Azithromycin for injection for anti-infection， Methylprednisolone sodium succinate for injection for anti-inflammation， Nadroparin calcium injection for anticoagulation， Mannitol injection for reducing intracranial pressure， Dextran 40 glucose injection anti-thrombosis， Compound glycyrrhizin injection for protecting liver function， Hydrotalcite tablets for protecting gastric mucosa， intravenous immunoglobulin symptomatic supportive treatment. During the treatment， due to the poor therapeutic effect of Azithromycin for injection， it was considered that the patient may have cerebral infarction caused by refractory MP infection， so the patient’s prognosis was good when Azithromycin injection was replaced with Levofloxacin hydrochloride injection for anti-infection. For the increase of liver enzyme during the treatment， clinical pharmacist suggested that anti-infection combined with liver protection was provided   for the child and then the liver enzyme returned to normal. During the treatment， clinical pharmacist mainly monitored the interaction and possible adverse reactions among anticoagulants， glucocorticoids， liver protecting drugs， drugs for reducing cranial pressure， antipyretic and analgesic drugs， and at the same time， made medication publicity and education for the family members of the child， and inform them of the adverse reactions of drugs to be paid attention to and the precautions for taking stomach protecting drugs， glucocorticoids and other drugs. CONCLUSIONS： Cerebral infarction caused by refractory MP pneumonia in children is because of excessive immune response directly or indirectly mediated by MP. The principle of treatment is to inhibit the inflammatory response， to solve the primary disease， and symptomatic supportive treatment. Multi-drug combination is needed in the course of treatment， so it is more necessary for the clinical pharmacist to participate in the whole process and to manage the drug refinement and ensure the safety of drug use.

OBJECTIVE:To establish the quality standard for Mongolian medicine Yishen powder. METHODS:TLC was used for the qualitative identification of Rheum palmatum and Terminalia chebula in the preparation;HPLC was used for the contents de-termination of aloe emodin,rhein,emodin,chrysophanol and physcion:the column was Inertsil C18 with mobile phase of metha-nol-0.1% phosphoric acid(gradient elution)at a flow rate of 1.0 mL/min,detection wavelength was 254 nm,column temperature was 35 ℃ and the injection volume was 10 μL. RESULTS:The TLC pots of R. palmatum and T. chebula were clear and well-sepa-rated,negative control without interference. The linear range was 23.55-117.75 ng for aloe emodin(r=0.9999),44.72-223.62 ng for rhein(r=0.9998),43.18-215.90 ng for emodin(r=0.9997),77.41-387.12 ng for chrysophanol(r=0.9999)and 46.02-230.10 ng for physcion (r=0.9997);RSDs of precision,stability and reproducibility tests were lower than 2.0%;recoveries were 95.80%-99.66%(RSD=1.21%,n=6),95.01%-98.07%(RSD=0.92%,n=6),95.06%-97.84%(RSD=0.5%,n=6),95.19%-97.66%(RSD=1.07%,n=6)and 95.07%-98.20%(RSD=0.95%,n=6). CONCLUSIONS:The established standard can be used for the quality control of Mongolian medicine Yishen powder.

Objective To study the clinical effect of BanxiaXiexinDecoction on gastric symdrome. Methods 82 patients withgastric syndrome hospitalized in our hospital from April 2012 to April 2014 were randomized evenly into the control group and the observation group In the control group , the patients were treated with thebasic treatment using Western medicine while the observation group was treated with BanxiaXiexin decoction based on the basic treatment. Then , the two group were compared in terms curative effects. Results The total effective rate in the observation group was significantly higher than that of the control group (92.68%vs. 70.73%, P < 0.05), while the rate of complications in the treatment group was significantly lower than that in the control group (12.20 vs. 29.27%, P < 0.05). Conclusion Western medicine plus BanxiaXiexin Decoctionis effective in the treatment of gastric syndrome. It may be fast at improving the symptoms and good at preventing the relapse of disease.

Aim To investigate the roles of chloride channels in the apoptosis and apoptotic volume de-crease (AVD)induced by adriamycin in nasopharyn-geal carcinoma CNE-2Z cells.Methods Apoptotic rates were detected by flow cytometry,and the volume changes were measured by the time-lapse live cell ima-ging technique.The patch clamp technique was used to record whole-cell chloride currents.Results Adria-mycin induced apoptosis of CNE-2Z cells.An early ap-optotic volume decrease was observed in the cell trea-ted with adriamycin.The cell volume was decreased by about 10% in 2 h.Adriamycin activated a chloride current which showed outward rectification.The chlo-ride channel blocker 5-nitro-2-(3-phenylpropylamino)-benzoate (NPPB ) could inhibit the adriamycin-in-duced chloride currents,apoptosis and prevent cell shrinkage.Conclusions Our findings suggest that ad-riamycin causes cell apoptosis by activation of chloride channels.Chloride channels may be involved in the apoptosis and apoptotic volume decrease induced by adriamycin in CNE-2Z cells.

ObjectiveTo evaluate the consistency of HER2 gene status before and after neoadjuvant chemotherapy in breast cancer by FISH (fluorescence in situ hybridization) and IHC (immunohistochemistry) techniques,and analyze the factor of the difference in the result and the feasibility of HER2 gene tested by FISH in the neoadjuvant chemotherapy breast cancer patients.Methods FISH and IHC for HER2 gene expression status was performed on the archival paraffin-embedded sections of breast cancer tissues before and after neoadjuvant chemotherapy from 135 Chinese female patients,x2 test of paired comparison of enumeration data and Kappa analysis were used to compare the difference and consistency of this two techniques.ResultsThe detection rate of HER2 status in punctured cancer tissues before neoadjuvant chemotherapy by FISH and HER2 did not show statistical difference in our research while the opposite result were showed in cancer tissues after neoadjuvant chemotherapy.Moreover,the two techniques of HER2 test were less concordant in patients accepted taxanes neoadjuvant chemotherapy than CAF treatment.ConclusionsThe consistency of FISH and IHC techniques of cancer tissues before neoadjuvant chemotherapy gained advantage compared to the ones after neoadjuvant chemotherapy.Patients received neoadjuvant chemotherapy especially taxanes should take the test of HER2 gene status by FISH technique.

Objective　To study the clinica features, diagnosis and surgical treatment of simple and complex macromastia. Methods　The clinical and pathological data of 21 patients with macromastia in our hospital from 1990 to 2000 were analysed retrospectively. Simple macromastia in 16 patients with 29 breasts, complex macromastia in 5 patients with 8 breasts. Results　The average age of patients was 23 years old. All the 21 patients were treated surgically. Among the 5 patients with complex macromastia, subcutaneous mastectomy and reconstruction were performed on 2 patients with breast fibroadenomatosis; of the 2 patients with giant fibroadenoma, one underwent tumor excision, the others were subjected to tumor excision with reduction mammaplasty; the last one with breast fibrous disease, selective partial breast excision and reduction mammaplasty was performed. All the patients had satisfactory mammary appearance and hadn't recurrrence of the breast disease in follow up period. Conclusions　(1) Macromastia often happens in the adolescent and young women. (2) It is necessary to do biopsy during operation for distinguishing the simple from the complex macromastia. (3) The treatment for simple macromatia is reduction mammaplasty; for complex macromatia is dissection of the disease area completely and redution mammaplasty simultaneously. For macromastia with fibroadenomatosis, subcutaneous mastectomy with reconstruction can prevent tumor recurrence and get better mammary appearance.

EPA exists wildly in artery vascular endothelium and could be activated by endogenously activated substances and regulate the vascular tone. The endothelium-dependent vascular relaxation mediated by EPA has been used for almost 20 years as an indicator of endothelium dysfunction. In many cardio-vascular diseases, EPA function was down-regulated. The pharmacological profiles of EPA could be characterized by muscarinic properties, as well as non-muscarinic properties in selectivity for agonists and antagonists and in binding characteristics. The endogenous ligand, receptor type and molecular pharmacological characteristics of EPA are waiting to be investigated.

Objective To explore the contribution of ultrasonic examination and localization in early breast cancer screening of chinese women with dense breast.Methods From February,2002 to April,2006,the breasts of 5 000 women were examined using ultrasonic examination,and in about 4 000 women a mass was detected,which included 142 cases of breast cancer proved by pathology with diameter ≤2cm occurred in patients with dense breast.In these parients,ultrasonic visualization and molybdenum target mammographic were performed.Results In these with breast cancer and dense breast,there were 47 cases(33.10%) with microcalcification detected by ultrasonography,the sensitivity rate was 74.60% and the accuracy rate was 88.73%.Only 38(26.76%) cases were detected by mammography,the sensitivity rate was(60.32)% and the accuracy was 82.39%.About 44.37% breast cancer with dense brast display as the(microcalcification).There were 110 cases(77.46%) of the small breast cancer detected by ultrasonography,the sensitivity was 88.71% and the accuracy rate was 90.14%.There were 100 cases(70.42%)(detected) by mammography,the sensitivity rate was 80.65% and the accuracy rate was 83.10%.Also,in 12 patients an unpalpation breast lesion was correctly excised by the use of ultrasonic localization.(Conclusions)(1)For the small breast cancer in dense breast the sensitivity and the accuracy of ultrasonography(surpassed) those of mammography.(2)The ultrasonic examination is an effective way for early breast cancer screening in young women with dense breast and flat breast.Ultrasonography can improve the rate of dignosis in early breast cancer,and also improve the breast-conserving surgical rate.Ultrasonography is worth of widespread use spreading.

Objective:To study the tissue speciality of endothelium-dependent vascular relaxation mediated by endothelial protein activated by acetylcholine (EPA)and its relationship with atherosclerosis.Methods:The tension of the isolated artery preparations was recorded using isometric-tension method and the isolated endothelium-intact vessels derived from normal and hyperlipidemic animal artery.Results:The EPA-mediated endothelium-dependent vascular relaxation was exhibited in rabbit aorta, renal, femoral, carotid, pulmonary arteries and cat aorta, renal, femoral, mesentery, coronary arteries but with different EC50. The sensitivity of EPA to ACh in descending order: pulmonary>renal>aorta>femoral>carotid arteries in rabbits. In cats,coronary>aorta>femoral>mesentary>renal. The endothelium-dependent vascular relaxation mediated by EPA in aorta, carotid and pulmonary arteries decreased significantly in hyperlipidemia rabbits.Conclusions:EPA effect existed wildly in testing artery and was of different tissue sensitivity. The decrease in EPA potency was closely related to occurence of atheroclerosis.