A 75-year-old female patient underwent total thyroidectomy and neck lymph node dissection for thyroid malignant tumor. In order to supplement thyroid hormone after operation, the patient was given levothyroxine sodium tablets 100 μg by nasal feeding once daily. On the 5th day of treatment, the patient developed fever, with highest body temperature 39.0 ℃. The levothyroxine sodium were stopped, then her body temperature decreased to 36.2 ℃ the following day. After giving nasal feeding of levothyroxine sodium tablets again or oral levothyroxine sodium tablets produced by other manufacturers, fever recurred in the patient and the body temperature returned to normal after drug withdrawal. It was considered that the patient′s fever was drug fever caused by levothyroxine sodium tablets.

目的 为基因突变伴肾功能不全患者安全、有效应用他克莫司提供参考.方法 临床药师参与1例肾病综合征患者的临床治疗,提出他克莫司基因检测,根据检测结果CYP3A5*3突变建议他克莫司剂量减半,并进行药学监护.结果 医师采纳临床药师的建议,患者他克莫司血药浓度持续达标,临床症状有效改善,无明显药品不良反应发生.结论 临床药师通过对肾病综合征患者进行药学监护,能提高其用药有效性,减少药品不良反应发生.

目的 观察地佐辛的使用对大面积烧伤患者的镇痛效果,并于临床常用药曲马多进行比较,分析地佐辛镇痛的有效性和安全性.方法 将我院2018年8月～2019年4月收治的63例大面积烧伤患者随机分为三组,A组给予地佐辛镇痛,B组给予曲马多镇痛,C组给予安慰剂镇痛,比较三组患者治疗过程中的生命体征和疼痛情况,对地佐辛的镇痛效果进行评价.结果 地佐辛注射可以使换药后患者的心率、血压、呼吸频率和数字疼痛评分均较曲马多组和安慰剂组低,说明地佐辛的使用可以有效减轻烧伤患者换药中的疼痛,并且减轻效果比曲马多的好.结论 在大面积烧伤患者的换药中,地佐辛可以有效减轻疼痛,并改善患者的生命体征,对烧伤换药的镇痛使用提供了临床数据支撑.

哌拉西林钠他唑巴坦钠为青霉素类抗菌药物,抗菌谱广,对革兰阳性菌、革兰阴性菌及厌氧菌均有抗菌活性,临床应用广泛[1].其常见不良反应为过敏、皮疹、恶心、呕吐等[2],部分患者出现意识丧失等休克症状,甚至导致死亡[3].本研究中报道了1例哌拉西林钠他唑巴坦钠致产妇过敏性休克病例,以优化临床治疗过程.

目的:本文通过对儿童用药所致不良反应进行分析,探讨儿童用药导致不良反应的特点,促进儿科药物的合理使用.方法:采用回顾性调查方法进行研究,统计分析不良反应报告中涉及的年龄、药品种类、给药途径、临床表现及累及器官或系统的情况,分析儿科用药及药物不良反应发生情况.结果:1～7岁的患儿发生不良反应例数较多.抗菌药物引发的不良反应最多见,且大多通过静脉给药引起.药物不良反应涉及的器官以皮肤及其附件最多见.结论:加强儿童不良反应的监测,避免和减少儿科用药不良反应的发生,用药过程中要进行疗效的监测,必要时还应做血药浓度监测和重要组织器官功能的监测.

目的 探究地佐辛与曲马多对大面积烧伤患者换药中的应用价值.方法 选择2018年1—12月本院收治的78例大面积烧伤患者作为研究对象,随机分为A、B、C三组,每组各26例.换药前分别予地佐辛镇痛(A组)、曲马多镇痛(B组)和安慰剂镇痛(C组),比较三组给药前、给药后5 min及换药后20 min的心率、血压、数字疼痛评分(NRS疼痛评分)、汉化版烧伤专用疼痛-焦虑量表(C-BSPAS)进行镇静评分及不良反应发生情况.结果 给药后5 min及换药后20 min,A组及B组NRS疼痛评分、心率及平均动脉压均显著低于C组(P<0.05);NRS疼痛评分(A组

Objective: To evalute the clinical outcomes of intracytoplasmic sperm injection(ICSI) for infertility male with severe asthenospermia induced by multiple morphological anomalies of the flagella (MMAF). Methods: The clinical data of 15 patient with MMAF were retrospectively analyzed, who underwent ICSI treatment using hyponotic swelling test the "live" sperm in the Department of Reproductive Medicine of Yantai Yuhuangding Hospital from January 2011 to December 2016. Another 30 obstructive azoospermia (OA)patients are matched strictly who also accepted ICSI in the same treatment time. The two groups were compared in the couples'age, the body mass index(BMI), the duration of infertility, the retrieved oocytes, the number of ICSI oocytes, and the rates of fertilization, cleavage, transferrable embryos, good embryos, embryos implanted, clinical pregncncy, early abortion, singleton and twins. Results: After 27 cycles of ICSI, all of the MMAF patients achieved clinical pregnancy, including 11 cases of live birth, 2 cases of spontaneous abortion, and 2 cases of pregnancy maintenance. There were no significant difference between MMAF and OA groups in the couples'age and BMI, or the numbers of retrieved oocytes and ICSI oocytes(P>0.05), but the differences in the infertility duration had statistical meaning(P<0.001). No statistical differences were observed among groups in ICSI fertility rate(92.0% vs 91.6%), clesvage rate(95.4% vs 96.5%), high-quality embryonic rate(56.5% vs 57.5%), good blastocyst rate(23/61 vs 35/94), embryo implantation rate(20/48 vs 35/75), early abortion rate(4/19 vs 8/36), clinical pregncncy rate(15/27 vs 28/50), singleton rate (10/13 vs 20/25)and twinning rate(3/13 vs 5/25)(P>0.05). Conclusions: MMAF may not affect ICSI treatment outcomes, but genetic defects can be transmitted through ICSI. The affected couples should be informed of the necessity of prenatal genetic diagnosis before embryo implantation and the inevitable vertical transmission of genetic problems to the offspring.

Objective This study investigated the effects of self-efficacy intervention on the psychological state of orthodontic patients and established a reasonable intervention model to enhance clinical effects.Methods One hundred and thirty-six patients were numbered according to the order of treatment:odd numbers were assigned to the intervention group(self-efficacy intervention group),and even numbers to the control group.General knowledge of orthodontics was explained to the control group.Beside the general knowledge of orthodontics,the intervention group was given selfefficacy intervention.The two groups were assessed using the self-rating anxiety scale(SAS),self-rating depression scale(SDS),general self-efficacy scale(GSES),and Wong-Baker faces pain scale throughout treatment.Results The scores of Wong-Baker faces pain scale in intervention group were lower in the control compared with the intervention group;and the difference was statistically significant after 2 months of intervention(P＜0.05).A month after intervention,SAS,SDS,and GSES scores of the intervention and control groups were significantly different(P＜0.05).A year after intervention,SAS,SDS,and GSES scores of the intervention and the control groups were significantly different(P＜0.05).The satisfaction score in the intervention group is statistically higher than that in the control group(P＜0.05).Conclusion Self-efficacy intervention can significantly reduce the morbidity of the mental health problem,improve the curative effect of orthodontics,enhance the patient compliance,and relieve pain in orthodontic patients.

哌拉西林钠他唑巴坦钠为广谱青霉素类抗菌药物,常见不良反应有过敏、皮疹、恶心、呕吐等,亦可引起粒细胞减少,但导致血小板下降病例较为少见,本文报道一例哌拉西林钠他唑巴坦钠致重度血小板减少病例,以期能够引起大家的关注.

PURPOSE:Subjects with normal occlusion, Angle Class Ⅲ malocclusion and Angle Class Ⅲ malocclusion with temporomandibular dysfunctions(TMD) were included, and their protraction and retraction, opening and closing mouth were recorded and compared to determine the condyle movement characteristics of Angle Class Ⅲ malocclusion patients with TMD.METHODS:Thirty cases of Angle Class Ⅲ malocclusion with TMD (experimental group), 30 cases of simple Angle Class Ⅲ malocclusion (control group 1) and 30 cases of normal occlusion (control group 2) were chosen, the condyle movement of mouth opening and closing, protraction and retraction were recorded and analyzed by computer aided axiography (CADIAX Ⅲ) , the measurements were compared and qualitative analysis was performed. SPSS 10.0 software package was used for statistical analysis.RESULTS:The indexes of opening and closing mouth, forward, backward and lateral movement were higher in experimental group and control group 1 than in the control group 2, especially in the vertical direction. The maximum variation was on the Y axis between the experimental group and the control group 2, the lateral movement of working side was significantly higher than that of the normal group, while the movement ranges at other directions were significantly smaller than that of control group 2, especially in opening and closing mouth horizontally upward and the maximum space displacement at right, upward direction (P<0.01).CONCLUSIONS:The tracking of condyle movements has its own characteristics in three dimensions in the experimental group ,compared with control group 1 and 2.

Objective: To investigate the pharmaceutical care of clinical pharmacists in drug treatment of patients with multiple drug resistant bacterial infections in ICU.Methods: By participating the whole process of the treatment of patients with multiple drug resistant bacterial infectionin ICU, pharmacistsassisted the clinician to develop treatment plans, and take care the whole process of monitoring and treatment.Results: Clinical pharmacists applied the professional knowledgeof pharmaceutical sciences to participate in the formulation of individual drug regimen, protect the safety of patients with medication.Conclusion: Clinical pharmacists participated in the drug treatment of patients, improved the clinical efficacy and safety of ICU multiple drug resistant bacteria infection in patients with clinical medication.

目的 建立青岛汉族18～25岁与26～40岁两个年龄段正常(牙合)成人口腔颌面部软组织侧貌的HOL-DAWAY分析法参考值,并探讨不同性别、不同年龄段间口腔颌面部软组织特点差异.方法 选取青岛汉族正常(牙合)且侧貌良好的样本91例,每个样本拍摄X线头颅定位侧位片.在计算机上用Winceph 8.0软件进行定点测量,所得数据使用SPSS 16.0软件进行统计学处理.结果 得出了青岛汉族人18～25岁与26～40岁两个年龄段的HOLDAWAY软组织分析法的各项参考值.18～25男女性之间Ss-Pn、上唇基部厚度、上唇紧张度、Si-H差异有显著性(t=2.52～5.50,P＜0.05).26～40岁男女性之间Ss-Ls、上唇紧张度、上唇基部厚度、Sn-H线距、H角以及Pg-Pg'差异有显著性(t =3.48～6.85,P＜0.05).18～25男性与26～40岁男性比较,Sn-H线距和H角差异有显著性(t =6.22、8.61,P＜0.05).18～25女性与26～40女性比较,Ss-Ls和上唇紧张度差异有显著性(t=2.83、5.12,P＜0.01).青岛汉族人大多数测量项目在HOLDAWAY标准值之内.青岛汉族人与广西壮族人比较差异有显著性.结论 青岛地区男性的整体侧貌立体感强于女性.软组织侧貌的增龄性变化具有性别差异.青岛汉族人侧貌突度介于白种人和广西壮族人之间.

The injection of the drug of the immune enhancement is mainly used in the treatment of malignant tumor, chemotherapy and improve the immune function. The common adverse reactions are chest tightness, shortness of breath, itching, rash, erythema, wheal, chills, fever, more severely can cause anaphylactic shock. In this paper, we report 1 cases of severe allergic shock caused by injection of mannose. In the application of Mannatide, patient should be asked in detail about the history of allergy, strictly do skin test, once allergic reaction, to respond quickly, so as not to delay treatment timing.

Objective To investigate the clinical application effects of Activator and MBT appliance in the two- stage treatment of skeletal Class II1 malocclusion. Methods 17 Class II division 1 patients with mandibular retrusion in mixed or early permanent dentition were chosen (Activator in the first phase,MBT appliance in the second phase.)Before and after the treatment all the patients were taken panoramic and cephalometric. Results The changes of cephalometric measurement of hard tissue:SNB increased 2.9o,ANB reduced 2.9o,L1- NB reduced 3.5 o,Go- Gn increased 3.0mm and N- Me went up 5.6mm;The changes of cephalometric measurement of soft tissue:Cm- Sn- UL increased 7.2o,LiB'Pg' increased 12.1 o,Ns- Sn- Pos had 2.0oreduction,Ls- E went down 1.6mm and Li- E had 2.1mm increasion.Class I molar and canine relationships were achieved after the treatment.The overjet was significantly decreased,and the profile was remarkably improved. Conclusion Two - stage treatment was effective on the improvement of facial profile in mixed or early permanent dentition in Class II division 1 patients.The skeletal jaw relationship can be distinctly improved. Activator can promote the mandible growth.

目的 探讨倒置埋伏阻生上颌中切牙的矫治时机和矫治方法.方法 选择10例患者共10颗上颌单侧倒置埋伏阻生中切牙为研究对象.矫治前常规拍摄全口曲面断层片、CT片,确定倒置埋伏牙的冠根形态及其与邻牙的关系.根据埋伏牙的翻转角度选择面弓式前方牵引器或主弓丝牵引.牵引结束测试牙髓活力.结果 通过7～14个月牵引,倒置埋伏阻生的上颌中切牙基本达到牙列的正常位置;埋伏牙牙髓活力测试结果为25.9±2.8,对侧同名牙为25.0±3.3,差异无统计学意义(t=1.15,P=0.159).结论 倒置埋伏阻生的上颌中切牙并非一定需要拔除,选择恰当的时机对倒置埋伏阻生的上颌中切牙给予有效的外科-正畸联合治疗,效果较好.

目的:比较前方牵引器及下颌支抗颌间牵引两种正畸牵引方式矫治上中切牙埋伏倒置阻生的疗效.方法:选择10例患者10颗埋伏倒置阻生上颌中切牙,在三维CT片上的位置、三维方向和埋伏阻生的程度均相似,随机分为两组,分别行前方牵引器牵引和颌间牵引,对两组的牵引时间和成功率进行比较,分别采用t检验和x2检验进行统计学处理.结果:前方牵引组牵引时间长于颌间牵引组,有显著差异(P＜0.05),前方牵引组成功率为100％,颌间牵引组为60％,差异有显著性(P＜0.01).结论:埋伏倒置阻生的上中切牙外科开窗术后,通过前方牵引器牵引的时间显著长于下颌支抗颌间牵引,但成功率显著高于颌间牵引.

目的探讨青少年前牙开病人的髁突形态特点,为临床诊疗提供参考依据。方法选择2011—2013年到我科就诊的20例青少年前牙开病人作为试验组,以20例青少年正常者作为对照组。两组第二恒磨牙均萌出,均拍摄全颌曲面断层片,利用硫酸纸描记测量,比较髁突形态特点。结果两组髁突上部高度（UH）、升支高度（RH）比较差异有统计学意义（F=10.206、6.356,P＜0.05）,而髁突高度（H）、髁突颈部宽度（W）比较差异无统计学意义（P＞0.05）。两组UH/RH比较差异有统计学意义（F=16.967,P＜0.05）,而H/W比较差异无统计学意义（P＞0.05）。结论青少年前牙开病人与正常者UH与RH存在明显差异。

目的 探讨颏部软组织厚度和垂直骨面型的关系,以期为正畸、正颌病人的治疗提供依据.方法 选取120例青岛地区汉族成人骨型Ⅰ类错(牙合)病人作为研究对象,根据下颌平面角分为低角组、均低角组、均高角组和高角组,每组30例(男、女各15例).测量并比较各组颏前点(Pog)、颏顶点(Gn)、颏下点(Me)的软组织厚度.结果 成人骨型Ⅰ类错(牙合)不同垂直骨面型间Gn-Gn'、Me-Me'测量值比较差异均有显著性(F=8.647、4.044,P＜0.05),Pog-Pog'测量值差异无显著性(P＞0.05).除高角组外,其他组Gn-Gn'、Me-Me'、Pog-Pog'测量值男性均大于女性(t =2.133～3.727,P＜0.05).结论 成人骨型Ⅰ类错(牙合)病人的颏部软组织厚度与垂直骨面型存在相关关系,除高角组外,男性病人的颏部软组织厚度大于女性.

Drug induced fever is one of the most common clinical adverse reactions, and also a common cause of fever. This paper reported a suspected case of vancomycin or meropenem induced drug fever.