The traditional treatment for small-cell lung cancer (SCLC) has been traditional systemic platinum-containing chemotherapy because the response rate is 50-90%. Durvalumab is an immune checkpoint inhibitor that blocks the binding of programmed cell death protein 1 and programmed cell death 1 ligand 1. Durvalumab combined with traditional chemotherapy agents has been recommended as the first-line treatment for extensive-stage SCLC, but its use may cause immune-related adverse events. Autoimmune encephalitis is a rare and potentially fatal neurological adverse event. This current case report describes a male patient in his late 50s with ES-SCLC who developed autoimmune encephalitis associated with durvalumab treatment after three cycles of combination chemotherapy. This current case furthers the understanding of autoimmune encephalitis caused by durvalumab treatment.

Nirmatrelvir/ritonavir is a novel drug combination that is authorized by the Food and Drug Administration for the treatment of coronavirus disease 2019 (COVID-19). Ritonavir is a cytochrome P450 3A inhibitor and a P-glycoprotein inhibitor that increases the plasma concentration of tacrolimus and other medications. We describe the cases of two patients treated with nirmatrelvir/ritonavir: a patient who had undergone kidney transplantation and another with a history of hematopoietic stem cell transplantation. Toxic concentrations of tacrolimus were induced in both. This case series highlights the risk associated with the concomitant administration of tacrolimus and nirmatrelvir/ritonavir.

目的 建立Zeta电位法研究血小板因子4/依诺肝素钠(PF4/Eno)复合物表面电荷的方法,以比较和评价肝素类样品潜在的免疫原性.方法 考察不同孵育时间、不同PF4/Eno摩尔比例对PF4/Eno复合物表面电荷的影响,并对方法的精密度和专属性进行分析验证.结果 孵育时间在10～30 min时PF4/Eno复合物较为稳定;PF4/Eno复合物的PHRζ=0值约为12,PF4/Hp复合物的PHRζ=0值约为48,差异有统计学意义(P＜0.001),表明方法具有较好的专属性;日内精密度RSD＜8.0％,日间精密度RSD为8.2％,表明方法精密度良好.结论 建立的方法可以用于比较和评价肝素类样品潜在的免疫原性,并为依诺肝素钠仿制药的免疫原性一致性评价提供理论和方法上的 参考.

国际糖尿病联盟(International Diabetes Federa-tion,IDF)最新报告显示,2019年全球约4.63亿20～79岁成人患糖尿病,其年龄标化患病率高达8.3％,预计2030年和2045年上升为9.2％和9.6％[1].最新全国流行病学调查结果显示,我国大陆地区糖尿病总体患病率为12.8％,糖尿病前期患病率为35.2％.胰岛素是治疗糖尿病的重要药物,在我国的使用非常广泛[2].

目的 评价我院临床药师为慢性肾脏病患者提供药物重整服务的效果.方法 对2017年12月～2018年3月入住肾内科的符合纳入标准的慢性肾脏病(CKD)患者进行药物重整(MR),并采用欧洲药学监护网络基金会(PCNE)对药物相关问题(DRP)最新分类版本(V8.02)进行分析总结.结果 60例患者中共有48例(占80.00％)患者出现了59个DRP,其中50个是治疗效果方面(占84.75％);71个原因中医嘱方面的原因最多,有54个(占76.06％);造成的临床1级危害较多,有50个(占84.75％);临床药师共进行了145条干预,其中102条(占70.34％)干预被完全接受并执行.结论 CKD患者中DRP很常见,临床药师应对慢性肾脏病患者开展药物重整服务,并作为常规工作开展.

Objective To develop the regimens of β lactam antibiotics against bloodstream infection caused by Pseudomonas aeruginosa (PA).Methods A total of 64 strains of PA cultured by blood from 2015 to 2016,the minimum inhibitory concentration (MIC) of piperacillin/tazobactam (TZP),ceftazidine (CAZ),cefepime (FEP),imipenem (IPM),meropenem (MEM) against PA were determined,probability of target attainment (PTA) and cumulative fraction of response (CFR) were calculated by monte carlo simulation.Results CFRs of TZP 4.5 g (q6 h),CAZ 2 g(q8 h),FEP2 g(q8 h),IPM 1 g(q6 h) and MEM 1 g (q8 h,q6 h) were ＞ 90％ at experiential therapy,when MIC ≥ 16 μg· mL-1 at target therapy,PTA of all regimens ＜90％.Conclusion when the patient was PA bloodstream infection,we suggest TZP 4.5 g (q6 h),CAZ2 g(q8 h),FEP2 g(q8 h),IPM 1 g(q6 h) and MEM 1 g (q8 h,q6 h) regimens at experiential therapy,and combined with other antibiotics at target therapy when MIC ≥ 16 μg · mL-1.

Objective:To investigate the occurrence and characteristics of adverse drug reactions(ADRs)induced by antiepileptic drugs(AEDs),so as to provide reference for rational use of drugs clinically.Methods:The ADRs induced by AEDs from May 2004 to December 2016 in the First Hospital Affiliated to Soochow University were enrolled for the study. Drug variety,clinical manifestations,severity and outcomes of the ADRs were analyzed respectively.Results:There were 84 cases(involved 89 AEDs and 91 systems-organs)of ADRs induced by AEDs,mainly involving carbamazepine 43/91(47.3%), oxcarbazepine 15/91(16.5%)and sodium valproate 9/91(9.9%).Main impairment was associated with skin and appendices 64/91(70.3%),of which the cases of drug-induced hypersensitivity syndrome(DIHS),Stevense-Johnson syndrome(SJS) and toxic epidermal necrosis(TEN)accounted for 12/91(13.2%),14/91(15.4%)and 6/91(6.6%),respectively.Of the 29 cases treated with carbamazepin or oxcarbazepine and seized with DIHS,SJS or TEN,6 cases received HLA-B * 1502 allelic genetic test,and detection results were all positive.Serum drug concentrations in the 2 cases of ADRs induced by phenytoin so-dium were 29.7μg/ml and 36.6μg/ml,respectively.Conclusion:In the course of treatment with AEDs,special attention should be paid to those with idiosyncratic reactions.At the same time,genetic test and therapeutic drug monitoring should be performed and medication education be implemented to ensure safe and effective application of AEDs.

Objective To explore the breakthrough points the diagnosis and treatment of rare drug-induced autoimmune syndrome by clinical pharmacists.Methods Clinical pharmacists provided regimen adjustment suggestions in the diagnosis and treatment of a patient with insulin aspart-induced autoimmune syndrome.Results Doctors adopted their advice and the patient was cured and discharged.Conclusion Clinical pharmacists assist physicians to prepare a safe and effective treatment,and provide pharmaceutical care for patients,trying to avoid misdiagnosis of rare diseases.

OBJECTIVE:To provide reference for rational use of antithyroid drugs (ATD) in the clinic. METHODS:Retro-spective analyzed 60 cases of adverse reaction caused by Methimazole and Propylthiouracil in terms of age,gender,incubation peri-od,organ or system involved and clinical manifestation,which were searched from 2004 May-2014 Dec. in First Affiliated Hospital of Soochow University. RESULTS:Among 60 ADR cases,male was more than female,and the ratio of male to female was 1∶2.75;average age was(39.7 ± 13.4)years old,and 83.3%ADR occurred between 20 and 59 years old;66.7%ADR occurred within 30 days. Most common clinical manifestations were drug-induced liver disease(66.7%,40/60)and neutropenia(25%,15/60). There was statistical significance in the proportion of drug-induced liver disease caused by methimazole and propylthiouracil in all ADR cases(P<0.05),there was no statistical significance in the proportion of agranulemia caused by these two drugs(P>0.05). CON-CLUSIONS:Before and after the treatment of antithyroid drugs,it’s necessary to check hepatic function and the number of neutro-phile granulocyte,and we should monitor and follow up it to ensure the safe use of drugs.

Objective To explore the correlation between HLA-B* 5801 allele and allopurinolinduced severe cutaneous adverse reaction (SCAR) in Han ethnic group patients in Jiangsu province.Methods The patients who developed SCAR after receiving allopurinol were cnrolled in SCAR group (36 cases),the patients without any adverse reaction receiving allopurinol over 6 months were enrolled in allopurinol control group (50 cases) and 167 healthy volunteers were enrolled in healthy control group.The subjects'peripheral blood samples were taken to detect the HLA-B* 5801 allele by sequence-specific primer polymerase chain reaction and polymerase chain reaction-sequencing based typing,in order to analyze the correlation between HLA-B* 5801 allele and allopurinol-induced SCAR.Results There were 36 cases in SCAR group comprised 22 males and 14 females with median age of 61 years (21 to 87 years).There were 50 cases in allopurinol control group comprised 42 males and 8 females with median age of 74 years (49 to 93 years).The difference of sexual distribution between 2 groups was statistically significant (P =0.02).The dose of allopurinol in two groups was 0.1-0.3 g everyday and the median dose was 0.2 daily.The subjects in SCAR group developed SCAR 5 to 47 days after receiving allopurinol.The case number of cases with drug hypersensitivity syndrome,Stevens-Johnson syndrome(SJS),toxic epidermal necrolysis (TEN) and SJS/TEN were 20,10,3 and 3,respectively.The positive rate of HLA-B* 5801 allele was 97.2％ (35/36) in SCAR group,8.0％ (4/50) in allopurinol control group,and 12.0％ (20/167)in healthy control group.The risk of developing SCAR was significantly higher in subjects with positive HLA-B * 5801 allele than those with negative HLA-B* 5801 allele (OR =403,95％ CI:43-3761,P =0.000).The sensitivity and specificity of the HLA-B * 5801 allele for prediction of allopurinol-induced SCAR were 97.2％ and 92.0％,respectively.Conclusions The HLA-B* 5801 allele in Han ethnic group in Jiangsu province is highly correlated with allopurinol-induced SCAR.The patients should be received genetic screening before administration of allopurinol,which may decrease the incidence of SCAR induced by allopurinol.

OBJECTIVE:To discuss the significance of clinical pharmacists participating in pharmaceutical care for patients after heart mechanical valve replacement.METHODS:Clinical pharmacists assisted physicians to supply personalized medication monitoring for a patient with epilepsy after heart mechanical valve replacement,which was analyzed retrospectively in respects of genetic factors,combined diseases,drug interactions,and also supplied comprehensive pharmaceutical care.RESULTS:Through personalized medication monitoring of warfarin,the duration of INR turning to normal was significantly reduced and ensured the patient's safety during taking warfarin.CONCLUSION:Clinical pharmacists participate in personalized medication monitoring of warfarin for a patient underwent heart mechanical valve replacement,which could improve the safety and effectiveness of initial and long-term anticoagulant therapy.

<正>1病例患者,女,53岁,体质量65kg,2009年10月6日因"左上肢乏力2周"入我院介入科诊治。既往有糖尿病史3年,服用格列美脲、二甲双胍,血糖控制可;高血压病史2年,间断服用复方利血平,未监测血压;否认心脏病史及脑梗死病

By analysing and summarizing the pharmaceutical practice of clinical pharmacists in the respiratory medical ward in our hospital,we provide potent supports to rational drug use and ensure the security and efficiency of drug use.

Objective:To analyze the characteristics and objective law of adverse drug reaction by anti-infective agents and to promote rational drug use.Methods:A tatol of 310 ADR case reports collected in a triple-A hospital in Suzhou caused by anti-infection drugs in 2009 were analyzed statistically in respect of patients' age,sex,drug categories inducing ADR,route of administration,clinical manifestations etc..Results:Of the tatol 310 ADR cases induced by anti-infection,50.65%(157/310)were female,and 49.35%(153/310)were male.The age of patients over 60 accounted for 35.81%(111/310);the drugs involved totalled 59 kinds,among which ADR caused by cephalosporins were the highest 29.35%(91/310),next were quinolones 23.87%(74/310);82.58%(256/310)ADR induced by intravenous administration.The ADR manifested dominantly by skin rash and pruritus(38.84%).Conclusion:Anti-infective agents were used rationally and the monitoring of ADR caused by anti-infective agents should be strengthened to reduce the harm of ADR to the patients.