OBJECTIVE：To eval uate the effect of pharmacists intervention on opioid treatment and management in outpatients with cancer pain under multidisciplinary team （MDT）mode. METHODS ：Totally 120 outpatients with cancer pain were selected from outpatient department of our hospital from Jan. 2016 to Dec. 2018，and divided into observation group and control group according to random number table method ，with 60 cases in each group. After 1 month follow-up ，patients in the control group were given opioid analgesics and routine intervention according to pain degree ，while patients in the observation group were given same treatment as control group and pharmacist intervention based on MDT. The pain condition ，medication compliance condition ， quality of life （QOL）score，the incidence of ADR and satisfaction degree were observed in 2 groups before and after intervention . RESULTS：Follow-up were completed in 2 groups. After intervention ，NRS scores of 2 groups were significantly lower than before intervention；the observation group was significantly lower than the control group ；medication compliance scores and QOL scores of 2 groups were significantly higher than before intervention ，the observation group was significantly higher than the control group at the same time . With the prolongation of treatment time ，the number of patients with mild pain and general medication compliance in 2 groups increased gradually ，and the observation group were significantly higher than the control group at the same time；the number of patients with moderate , severe pain and low medication compliance were significantly decreased gradually ， and the observation group was significantly lower than the control group at the same time. The number of patients with good medication compliance in the observation group was significantly higher than that in the same group before intervention and the control group at the same time （P＜0.05 or P＜0.01）. There was no significant difference in the incidence of ADR between 2 groups（P＞0.05）. The satisfaction of pain control results ，doctors’treatment and pharmacists follow-up in the observation group were significantly higher than control group （P＜0.05 or P＜0.01）. CONCLUSIONS ：Under MDT mode ，pharmacists participating in the management of opioid treatment for cancer pain outpatients can effectively relieve the pain ，and improve the medication compliance and quality of life .

Objective To study the association, clinical presentation, and diagnosis and treatment of bile duct cancer as a late complication of biliary-enteric anastomoses for benign diseases. Methods A retrospective study was carried out on 5 patients and the medical literature was reviewed. Results They were 3 males and 2 females. The average age was ( 66. 0 ± 0. 7 ) years. The average time period was ( 14. 0 ± 6. 1 ) years after biliary-enteric anastomosis. The clinical presentations included right upper quadrant pain, fever, chills and jaundice. CA19-9, CT and MRI were valuable in diagnosis. There were two patients with distal and three patients with perihilar cholangiocarcinomas (type IIIa, n=2, and type IV, n=1). Local resection with lymphadenectomy was carried out in one patient. Another patient underwent pancreaticoduodenectomy. The remaining three patients only underwent percutaneous transhepatic cholangial drainage ( PTCD). The 2 patients who underwent surgery died of progressive tumor disease at 8 and 13 months postoperatively. The other three patients who underwent palliative biliary drainage died within 6 months of PTCD. There was no significant difference between the two types of treatment ( P ＞0. 05). Conclusions Chronic cholangitis caused by reflux and bacterial infection was properly a predisposing factor leading to late development of bile duct cancer after biliary-enteric anastomosis for benign diseases. Patients treated with biliary-enteric anastomosis should be closely monitored for late development of cholangiocarcinoma. Some procedures such as choledochoduodenostomy and jejunum interposition choledochoduodenostomy should be abandoned because of their poor outcomes and severe complications. Proper indications of biliary-enteric anastomosis should strictly be followed and the Oddi's sphincter should be protected if possible to prevent late development of bile duct cancer.

Objective: To investigate the role of p38 MAPK pathway in IL-1β induced inflammatory secretory properties mesenchymal stem cells(SFMSCs) from human synovial fluid of temporomandibular joint. Methods: In vitro cultured hSFMSCs were divided into control group and IL-1β treated group(10 ng/ml IL-1β for 2 h), the activation of p38 MAPK was examined with western blot. Then, the gene expression and the secretion of IL-6 and IL-8 in control group, IL-1β treated group and p38 MAPK inhibitor pre-treated group(pretreatment with SB-203580 10 μmol/L prior to the addition of 10 ng/ml IL-1β) were examined by RT-PCR and cytometric bead array(CBA). Results: It was observed that the protein level of p-p38 MAPK, the secretion of IL-8 and IL-6 were increased in IL-1β treated group, and suppressed in p38 MAPK inhibitor pre-treated group. Conclusion: p38 MAPK pathway of SFMSCs might play a role in IL-6 and IL-8 secretion by SFMSCs in inflammatory environment.

OBJECTIVE:To provide reference for the rational utilization of narcotic drugs in cancer pain patients. METH-ODS:In retrospective survey,2275 prescriptions of narcotic drugs for cancer pain patients in outpatient and emergency depart-ment of our hospital during 2014-2016 were analyzed statistically in respects of general information,drug amount,consumption sum and DDDs,etc. RESULTS:The proportion of male patients and female patients with cancer pain in our hospital were 65.63%and 34.37% within 3 years,mainly aged 21-90. The consumption amount and sum of narcotic drugs in our hospital increased year by year. Dosage forms were mainly tablet. The consumption amount,sum and DDDs of Morphine hydrochloride sustained-release tablets took up the first places among narcotic drugs. And those of Pethidine hydrochloride injection were the lowest. CONCLU-SIONS:The utilization of narcotic drugs is rational in outpatient and emergency department of our hospital on the whole. Morphine preparations are the predominant analgesic drugs for patients with cancer pain.

Objective To evaluate the effect of conversion from mycophenolic acid (MPA) to mizoribine (MZR) in renal transplant recipients with gastrointestinal tract (GI) symptoms.Methods A total of 355 renal transplant recipients with GI symptoms caused by MPA administration were enrolled from April 2015 to March 2017 in 25 different renal transplant centers in China.The symptomatic improvement of GI before (baseline) and after conversion to MZR (1,2,4 weeks) was assessed by each item of GI symptoms indication.In addition,the efficacy and safety of the conversion therapy during 12 months were determined.Results Patients showed improvement in GI symptoms including diarrhea,abdominal pain,abdominal distention and stomachache after conversion to MZR 1,2,4 weeks (P＜0.05).In patients with different severity of diarrhea,conversion to MZR therapy significantly improved diarrhea (P＜0.05).During 12 months,no patient experienced clinical immune rejection.We did not observe any infections,leucopenia and other serious side effects.Conclusion MZR could markedly improve GI symptoms caused by MPA administration in renal transplant recipients.

Objective: To analyze related factors on the number of mesenchymal stem cells in the synovial fluid of the temporomandibular joint (TMJ) and provide an research basis for understanding of the source and biological role of mesenchymal stem cells derived from synovial fluid in TMJ. Methods: One hundred and twenty-two synovial fluid samples from 91 temporomandibular disorders (TMD) patients who visited in Department of TMJ Center, Guanghua School of Stomatology, Hospital of Stomatology, Sun Yat-sen University from March 2013 to December 2013 were collected in this study, and 6 TMJ synovial fluid samples from 6 normal volunteers who were studying in the North Campus of Sun Yat-sen University were also collected, so did their clinical information. Then the relation between the number of mesenchymal stem cells derived from synovial fluid and the health status of the joints, age of donor, disc perforation, condylar bony destruction, blood containing and visual analogue scale score of pain were investigated using Mann-Whitney U test and Spearman rank correlation test. Results: The number of mesenchymal stem cells derived from synovial fluid had no significant relation with visual analogue scale score of pain (r=0.041, P=0.672), blood containing (P=0.063), condylar bony destruction (P= 0.371). Linear correlation between the number of mesenchymal stem cells derived from synovial fluid and age of donor was very week (r=0.186, P=0.043). The number of mesenchymal stem cells up-regulated when the joint was in a disease state (P=0.001). The disc perforation group had more mesenchymal stem cells in synovial fluid than without disc perforation group (P=0.042). Conclusions The number of mesenchymal stem cells derived from synovial fluid in TMJ has no correlation with peripheral blood circulation and condylar bony destruction, while has close relation with soft tissue structure damage of the joint.

Aim To investigate the vasorelaxation effects of saponins from flower of Panax notoginsen on the isolated thoracica aorta ,and to explore its possible mechanism.Methods Total saponins were extracted and high phase liquid chromatography was utilized to describe saponins ingredients;SD rat thoracic aortas were isolated.In vitro vascular ring experiment was used to observe,basal state of saponins on vascular ring,and high concentrations of K+solution pre-con-traction and phenylephrine (PE ) pre-contraction caused by systolic and diastolic function of the re-sponse.And different inhibitors were combined to ex-amine the possible mechanism of notoginsenoside in vascular ring.Results Cumulative concentration of saponins had no significant effect on the basis of state vessels,but had significant effect on endothelium-in-tact aortic (MAX Relaxation 23.6%) rings pre-con-tracted by high concentrations of K+;endothelium and endothelial aortia had significant effect on PE pre-con-traction, and endothelium MAX relaxation was 55.5 1%.Calcium-free solution and saponin cultivated aortic rings significantly inhibited pre-contraction.Af-ter nitric oxide synthase inhibitor L-NAME and indom-ethacin incubating vascular ring ,it could significantly inhibited vasodilatory effect of saponin.Conclusion Saponins have concentration dependent diastolic func-tion on rat thoracic aorta,and its main ways cause vas-odilation.Endothelial dependent diastolic function is related to activation of nitric oxide synthase and cy-clooxygenase pathway.

Objective To investigate correlation between microRNA (miR-494) and TH 17 cell differentiation in murine cervical heterotopic cardiac transplant model.Method The heterotopic cardiac transplant models of Balb/c→C57BL/6 mice were established as experimental group,and those of C57BL/6→C57BL/6 mice as control group.Real time-polymerase chain reaction(PCR) was used to detect miR-494 and interleukin(IL)-17A mRNA expression in the grafts.CD4+ T cells,CD8+ T cells and CD45+ myeloid cells were isolated from the grafts,and miR-494 and IL-17 mRNA expression was detected.In vitro,lymphocytes in the spleen from C57BL/6 mice were harvested,and CD4+ T cells were isolated with MACS and then stimulated to TH 1,TH 2,TH 17,Treg subset cells.The expression of IL-17A mRNA and miR-494 in different T subsets was examined by Reverse transcription-polymerase chain reaction(RT-PCR).Result Two grafts from each study group were harvested on the 7th day post-transplantation.In experimental group,the IL-17A mRNA expression was increased,while the expression of miR-494 was decreased as compared with control group with the difference being significant between two groups.The expression of IL-17A rnRNA in CD4+ T cells of the grafts was significantly increased,while that expression of miR-494 was decreased.In vitro,the expression of miR-494 in TH 17 cells was significantly lower than that in TH 1,TH 2 and Treg cells.Conclusion miR-494 is related closely to TH 17 cells differentiation in the transplant rejection,which may play a role in transplant rejection through regulating TH 17 cells.

BACKGROUND:Fol ow-up researches have shown that there is no statistical y difference in safety between kidney donor and healthy person after kidney transplantation, even the donors wil have better life quality. OBJECTIVE:To evaluate the safety of living-related kidney transplantation in living kidney donors. METHODS:Ninety-four cases of kidney donors received 1-10 years fol ow-up through regular clinical fol ow-up, telephone fol ow-up and regular renal patients self-help groups to compare the changes of serum creatinine, hematuria, proteinuria and blood pressure and lipid level in the donors before and after kidney transplantation. RESULTS AND CONCLUSION:The serum creatinine was significantly increased after nephrectomy (P<0.01), but al the donors had normal serum creatinine levels and remained stable. There was no significant difference in serum creatinine level between the latest fol ow-up and discharge (P>0.05). After nephrectomy, three cases (3.2%) suffered from hematuria, two cases (2.1%) had proteinuria, and improved after rest;six cases (6.4%) were subject to hypertension and six cases (6.4%) to hyperlipidemia. Al of the donors were alive. The living donor nephrectomy is feasible and safe. Preoperative assessment and long-term postoperative fol ow-up can guarantee the safety of the donors.