1例52岁的女性患者,因脓毒症,多部位耐甲氧西林金黄色葡萄球菌感染,药敏结果提示对替加环素敏感,使用替加环素100 mg静脉滴注.给药后第4天,患者出现进行性的凝血功能异常,表现为纤维蛋白原FIB下降,APTT、PT延长,INR升高.停药后,患者纤维蛋白原恢复正常,凝血功能逐渐恢复正常.

目的 研究超声触发载多西紫杉醇纳泡(LDLN)对兔VX2乳腺癌肿瘤模型的靶向抗肿瘤作用及监控.方法采用瘤块包埋法建立兔VX2肿瘤模型,将60只荷瘤兔随机平均分为6组:对照组(C组)、LNLD组、单纯药物组(Doc组)、药物联合超声组(Doc+US组)、单纯纳泡联合超声组(PLM+US组)、LDLN联合超声组(LNLD+US组),给予各组不同的药物注射及处理方法.各组治疗前后均行超声检查观察肿瘤的生长变化情况,计算并比较各组的肿瘤体积及体积抑瘤率(T IR).光镜下观察各处理组对兔VX2乳腺瘤组织细胞形态学的影响.结果在一定强度的超声作用下,LNLD+US组的TIR高于其他组,差异均有统计学意义(P<0.05);各给药组瘤组织内出现不同程度坏死区.结论超声触发LDLN对兔VX2乳腺癌肿瘤模型具有靶向抗肿瘤及监控的双重作用.

目的 探讨临床药师在感染性心内膜炎患者合理用药中的作用.方法 临床药师参与1例感染性心内膜炎患者个体化使用万古霉素的治疗过程,建议医师选择合适的抗感染药物,并根据治疗药物浓度监测、临床疗效和病情变化及时调整用药方案,提供个体化的药学服务.结果 与结论 临床药师为患者提供药学服务,提高了治疗依从性和临床疗效,减少了药品不良反应,能在合理用药中发挥重要作用.

AIM To evaluate the association between SLC47A 1 rs2289669 G ＞ A polymorphism and metformin therapeutic efficacy in type 2 diabetes patients.METHODS Databases including PubMed,Web of Science,Cochrane Library,Embase,Medline,CNKI,Wanfang,VIP,SinoMed were searched to obtain the relevant references about the association between SLC4741 rs2289669 G ＞ A polymorphism and metformin therapeutic efficacy in type 2 diabetes patients from the start to August 11,2017.For each study included,a quality assessment was performed using the methodological index for non-randomized studies (MINORS)criteria.Meta-analysis,sensitivity analysis were all done through RevMan 5.3.The pooled mean differences (MDs) were assessed for the dominant genetic model (GA + AA vs.GG),recessive genetic model (GA + GG vs.AA),additive genetic model (GG vs.AA),co-dominant genetic model (GG vs.GA) and co-dominant genetic model (GA vs.AA).RESULTS A total of 6 studies were included for final meta-analysis,involving 880 participants.After metformin treatment,SLC47A1 rs2289669 GA and AA genotypes patients showed an obviously higher reduction in glycated hemoglobin (HbA1c) than GG genotypes patients (MD =-0.49,95％CI (-0.81,-0.17),P =0.003).AA genotypes patients showed a slightly higher reduction in HbA1c than GA and GG genotypes patients,but the difference was not statistically significant (MD =0.31,95％ CI (0.00,0.62),P =0.05).AA genotype patients showed an obviously higher reduction in HbA1c than GG genotype patients (MD =0.51,95％ CI (0.29,0.73),P ＜ 0.000 01).In the Caucasus subgroup,no significant difference was found between GA and GG genotypes patients in HbA1c reduction (MD =0.55,95％ CI (-0.23,1.33),P =0.17).However,in the Chinese subgroup,GA genotype patients showed higher reduction in HbA1c than GG genotype patients (MD =0.45,95％ CI (0.15,0.76),P =0.004).No significant difference was found between GA and AA genotypes patients in HbA1c reduction (MD =0.17,95％ CI (-0.25,0.58),P =0.43).CONCLUSION The impact of SLC47A 1 rs2289669 G ＞ A polymorphism on metformin therapeutic efficacy in type 2 diabetes patients was evident according to the results of the present study.And the identification of SLC47A 1 rs2289669 G ＞ A genotypes may be developed as an indicator for metformin therapeutic efficacy in type 2 diabetes patients.

OBJECTIVE:To investigate the basic situation of pharmaceutical staffs and the development of pharmaceutical care in Chongqing primary health care institutions,and to provide references for promoting the development of pharmaceutical work in primary health care institutions. METHODS:A questionnaire survey was conducted to investigate the basic situation of pharmaceutical staffs and the development of pharmaceutical care in primary health care institutions from 38 districts and counties of Chongqing,and the data was analyzed statistically to put forward suggestion. RESULTS:A total of 1147 questionnaires about the general situation of primary health care institutions were sent out,and 813 valid questionnaires were collected,with effective recovery rate of 70.88％. A total of 1972 questionnaires about the general situation of pharmaceutical staffs and the development of pharmaceutical care were sent out,and 1904 valid questionnaires were collected,with effective recovery rate of 96.55％. The average number of pharmaceutical staffs in the community health service center was 4.5(2-14 persons),that of pharmaceutical staffs in township hospitals was 2.5(0-12 persons),accounting for 8.69％ and 8.17％ of professional medical staffs,respectively. Some of respondents were part-time nonprofessionals. The highest educational level of surveyed pharmaceutical staffs was college degree (51.79％),followed by high school degree and secondary school degree (21.64％). The professional titles were mostly assistant pharmacists (34.35％),followed by pharmacists (30.04％). Only 2.73％ of the licensed pharmacist certificates were obtained,and no one obtained the clinical pharmacist training certificate of National Health and Family Planning Commission. In community health service center and township hospital,the higher proportion of the job positions of the pharmacists were in outpatient pharmacy(79.67％ and 81.44％),inpatient pharmacy (32.94％ and 56.57％),TCM pharmacy(27.54％ and 40.85％) and warehouse (22.20％ and 24.05％);the lower proportion of the job positions of the pharmacists were in clinicalpharmacy room(1.40％ and 0),laboratory(0.23％ and 0)and PIVAS(0.23％ and 0). Top 6 pharmaceutical care projects carried out by the community health service center included drug dispensing(100％),out-patient prescription comment(70.00％),ADR monitoring(62.67％),medication consultation(60.67％),antibiotics prescription comment(58.00％),medication education and medication guidance(50.00％);pharmaceutical outpatient service,therapy drug monitoring and pharmacogenomics detection were not developed. The pharmaceutical care projects carried out by township hospital included drug dispensing (100％),ADR monitoring (62.29％),medication consultation (59.73％),medication education and medication guidance (53.85％),outpatient prescription comment (51.58％),and antibiotics prescription comment (45.40％);centralized intravenous pharmacy admixture and administration, pharmaceutical outpatient service, therapy drug monitoring and pharmacogenomics detection were not developed. CONCLUSIONS:The pharmaceutical talents are short in Chongqing primary health care institutions and part-time staffs also have a certain proportion. The overall quality of pharmaceutical staffs is not high,and their professional skills and capabilities are limited. The institutions do not pay enough attention to pharmaceutical care, and the development of pharmaceutical care is not ideal. To promote the development of pharmaceutical care,primary health care institutions should pay more attention to pharmaceutical care,increase the investment of funds in combination with the actual situation,optimize post setting,perfect the construction of institutions,and strengthen the introduction and training of pharmaceutical staffs so as to constantly improve their professional level and pharmaceutical care capabilities,and provide high-quality,safe,humanized and professional pharmaceutical care.

目的 分析该院骨科骨关节置换术患者围手术期抗菌药物使用情况.方法 收集2016年1月至2017年12月于该院行骨关节置换术的347例患者病历资料,分析围手术期抗菌药物使用情况.结果 骨关节置换术患者围手术期抗菌药物应用率为100.00%,术前0.5~1.0 h预防用药率为100.00%,单一药物应用率为100.00%.应用第一代头孢菌素类(头孢唑林)305例,占比最高,为87.90%;其次为林可酰胺类(克林霉素)26例,占7.49%;第三代头孢菌素类(头孢唑肟)4例,占1.15%;青霉素类10例,占2.89%;酶抑制剂类1例,占0.29%.抗菌药物平均使用时间(4.50±0.34)d.结论 该院骨关节置换术患者围手术期抗菌药物使用基本合理,但仍存在药物遴选不适宜、预防用药时间过长等问题.

Objective To comprehensively evaluate the clinical efficacy,safety and economic benefits of atorvastatin and fluvastatin in regulating dyslipidemia.Methods The clinical randomized controlled trials (RCTs) for comparing clinical efficacy of atorvastatin and fluvastatin on regulating dyslipidemia were retrieved from databases,including Cochrane Library,PubMed,Medline,Embase,Wiley,Springer,CNKI,Wanfang and VIP,till June 2016.Data were evaluated by two reviewers independently according to the Jadad standard.The changes of low density lipoprotein cholesterol (LDL-C),high density lipoprotein cholesterol (HDL-C),total cholesterol (TC) and triglyceride (TG) before and after treatment were extracted to perform Meta-analysis by using RevMan5.0 software.The economic evaluation was carried out,as well.Results A total of 7 RCTs were included,including 684 cases of patients treated with fluvastatin and 2 208 cases of patients treated with atorvastatin.The patients were spitted into two subgroups according to the same or different maximum dose of atorvastatin and fluvastatin.The results indicated that the effects of atorvastatin on down-regulating LDL-C,TC and TG levels were significantly better than those of fluvastatin,the differences were statistically significant (Z=23.63、23.32、5.50,P＜0.000 01).No significant difference was found in regulating HDL-C level between atorvastatin and fluvastatin.Conclusion Compared with fluvastatin,atorvastatin is more effective to regulate levels of LDL-C,TC and TG,but there is no significant difference in up-regulating HDL-C level.Additionally,application of atorvastatin is more economicallv effective.

Objective To investigate the protective effect and mechanism of quercetin on liver injury induced by isoniazid(INH)combined with rifampicin (RFP) in rats. Methods Totally 50 male Wistar mice were fed with feed and water,and 1 week after adaptive feeding,the mice were randomly divided into blank control group,liver injury model group and quercetin low,middle and high dose groups,10 mice in each group. In addition to the blank control group,the mice in the other groups were given INH and RFP(each 75 mg/kg) per day for 4 weeks to prepare the animal models of liver injury in mice,and the blank control group was given equal volume of normal saline,2 h after giving INH and RFP,the low,middle and high dose groups were given low dosage,middle dosage and high dosage of quercetin(50,100,200 mg/kg),the blank control group and the liver injury model group were filled with equal volume of distilled water. The serum levels of AST,ALT and TBIL,liver index,contents of MDA,GSH,and SOD in liver were measured after 4 weeks of giving quercetin,and the hepatic pathological changes were also observed. Results Quercetin could reduce the liver index, the serum level of AST,ALT,TBIL and the content of MDA,raise the liver GSH content,promote the the activities of SOD in liver in mice. The degeneration and necrosis of liver tissue were relieved,and the pathological changes of liver tissue injury were alleviated. Conclusion Quercetin has the protective effect on the hepatotoxicity induced by INH combined with RFP in mice,and the mechanism may be related to the inhibition of lipid peroxidation of quercetin.

OBJECTIVE:To explore the role of clinical pharmacists in the clinical nutrition therapy for patients with parenteral nutrition-associated liver dagame (PNALD),and to promote the rational use of nutrition drugs. METHODS:Clinical pharmacists participated in the treatment of a case of PNALD,and suggested adjusting 5% Glucose and sodium chloride injection 500 mL to 0.9% Sodium chloride injection 500 mL,30% Long-chain triglycerides 250 mL to 20% Medium/long chain fatty emulsion 250 mL,8.5% Compound amino acid injection(18 AA)1000 mL to 8% Compound amino acid injection(15 AA)750 mL;addition-ally using 20%Alanyl glutamine injection 100 mL and 10% ω-3 Fish oil fat emulsion injection 100 mL in"all in one"parenteral nutrition(PN)formula. The remaining recipes remain unchanged. Reduced glutathione and S-methionine were also adopted for pro-tecting liver and receding jaundice,and the amount of PN was decreased gradually and replaced by enteral nutrition (EN). RE-SULTS:Physicians adopted the suggestions of clinical pharmacists,and liver function of the patient recovered to normal. CON-CLUSIONS:Main factors of PNALD include medication time of PN,types and intake of lipid,over nutrition. Clinical pharmacists provide pharmaceutical care in nutritional treatment for patients,which can assure effective and safe use of nutritional drugs,and reduce the occurrence of complication and ADR.

Pharmacotherapeutics course plays an important role in cultivating pharmacy students' capabilities to use drugs rationally.The emerging issues in pharmacotherapeutics teaching were summarized including teaching team lacking of clinical pharmacists,teaching content being unable to present the characteristics of pharmacotherapeutics,and teaching method focusing more on knowledge than capability.The counter measures were introduced such as building up a teaching team of clinical pharmacists,optimizing and integrating the teaching contents,and applying the case-based teaching method.

Objective:To evaluate the clinical use of biapenem standardability and rationality with DUE mode and apply guide-lines for its rational clinical use. Methods:According to biapenem DUE standard,332 patients who received biapenem in one hospital were analyzed. Results:(1)Antibacterials management:Microbial inspection rate was 82. 2% (80%);the coincidence rate of consul-tation process 51. 3% (100%);the coincidence rate of course record 83. 4% (100%);the coincidence rate of prescription privileges was 97. 3% (100%);(2)The indications of drug use:suitable rate was 98. 2%(90%);(3)Medication process:the correct rate of the administration route,solvent selection and incompatibility were 100% (100%);and effect of monitoring compliance rate was 80. 4%(85%);(4)Medication effective rate was 78. 6% (80%). Conclusion:The clinical use of biapenem was quite well in one hospital, but there are some shortcomings. Hospital should do some intervention and rectification for existing problems to ensure the rational use of antimicrobial drugs. Biapenem DUE standard had certain effect on promoting the rational use of biapenem in clinical.

目的:分析某院住院患者注射用兰索拉唑临床应用的合理性.方法:制定质子泵抑制剂用药评价标准,抽取本院2014年7月1日至2014年7月31日注射用兰索拉唑(泽祥)用量排名前11位科室的住院患者中使用该药的病例118例,对病例中注射用兰索拉唑(泽祥)的适应症、用法用量等回顾性分析.结果:118份病例中存在不合理用药病例85例,合格率为27.97％.主要存在无适应证用药和用药疗程过长等问题.结论:某院住院患者注射用兰索拉唑在临床应用过程中存在一些不合理现象,医院应尽早制定注射用兰索拉唑的使用标准或规范,加强对医务人员合理用药知识的培训,以提高药物使用的合理性.

Objective To assess the efficacy and tolerability of lercanidipine versus amlodipine in the treatment of mild to moderate hypertension .Methods A systematic literature search (since build the library to June 2013) of Medline ,PubMed ,Em‐base ,Cochrane library ,Springer ,Wiley ,CNKI ,VIP and Wanfang was conducted for randomized controlled trials (RCT ) that com‐pared the efficacy and tolerability of lercanidipine versus amlodipine for mild to moderate hypertension .RevMan 5 .0 software was used for meta‐analysis .Results A total of 8 RCT was included ,involving 1 537 patients .The efficacy meta‐analysis results showed that there were no statistical significance in the differences(P>0 .05) between lercanidipine group and amlodipine group in total re‐sponse rate ,the normalized rate ,SBP and DBP decreased effect .Also compared with amlodipine ,the tolerability Meta‐analysis re‐sults showed that lercanidipine had the similar incidence of total adverse events ,headache and flushing ,but lercanidipine was associ‐ated with a more reduced risk of peripheral edema [OR=0 .38 ,95% CI(0 .25 -0 .58) ,P=0 .000] ,a more significant reduction in risk of participants withdrawing for adverse reactions [OR=0 .57 ,95% CI(0 .37-0 .86) ,P=0 .008] and peripheral edema [OR=0 .24 ,95% CI(0 .12 -0 .47) ,P=0 .000] .Conclusion Based on the current evidence ,the safety and compliance of lercanidipine is better than amlodipine in the treatment of mild to moderate hypertension .

目的：探讨人脐静脉内皮细胞（HUVECs）原代培养的方法，为体外研究血管内皮细胞功能提供实验基础。方法取健康剖宫产新生儿脐带15-20c m，2h内用0.1%I I型胶原酶37℃孵育12m i n得细胞，用改良M199培养液于37℃，5%C O2培养箱中培养，倒置显微镜下观察细胞形态特点，免疫组织化学染色进行细胞鉴定，管腔形成实验观察细胞传代后小管形成能力变化。结果采用0.1%I 型胶原酶灌注法及改良培养基可相当数量、细胞形态良好的HUVECs，利用Ⅷ因子相关抗原进行鉴定得到纯度大于99%，且传代后管腔形成能力与原代细胞无差别（P<0.05）。结论用0.1%I 型胶原酶分离方法和改良的M199培养基可得到数量多、形态好、功能稳定的人脐静脉内皮细胞，可成功构建体外研究血管内皮细胞的模型。

目的 观察神经节苷脂GM1联合纳美芬治疗重型颅脑损伤的临床疗效.方法 将115例重型颅脑损伤患者随机分为神经节苷脂GM1联合纳美芬治疗组(A组)和常规治疗组(B组),观察两组患者的意识恢复情况、并发症及近期疗效.结果 A组在苏醒时间、总有效率均优于B组,且明显降低了呼吸道感染、酸碱平衡障碍等并发症.结论 神经节苷脂GM1联合纳美芬治疗重型颅脑损伤疗效确切.

目的:系统性评价不同维持剂量氯吡格雷对经皮冠脉介入(percutaneous coronary intervention,PCI)术后患者的疗效和安全性,为临床决策提供依据.方法:采用循证医学的文献分析评价方案,全面收集不同维持剂量氯吡格雷应用于PCI术后患者的随机对照试验(randomized controlled trials,RCTs).提取有效数据,评价纳入研究的方法学质量,采用Rev Man 5.0软件对数据进行Meta分析.结果:共纳入13项RCTs,共2 883例患者.Meta分析结果显示:与75 mg常规维持剂量氯吡格雷相比,150 mg的高维持剂量明显降低患者血小板聚集率(MD=-12.20,95％CI=-13.77～-10.63,P=0.000),同时明显降低主要不良心脏事件(major adverse cardiac events,MACE)发生率(RR=0.41,95％CI=0.27～0.63,P=0.000).而且,高维持剂量组不增加患者主要出血风险(RR=1.61,95％CI=0.90～2.87,P=0.110)和次要出血风险(RR=1.19,95％CI=0.87～1.62,P=0.270).结论:与75 mg常规维持剂量氯吡格雷相比,PCI术后患者应用150 mg氯吡格雷具有更好疗效且不增加出血风险.

In order to investigate the relationship between apoptosis and the expression of API5 in the penis cavernosal tissues of diabetes mellitus(DM) rats,the streptozotocin(STZ) was used to induce the diabetic mellitus rat model.DMED rats were screened by APO erectile dysfunction experiment,and tested intracavernous pressure(ICP).The Apoptosis of penile cavernosal tissues in diabetes mellitus(DM) rats was tested by terminal deoxynucleotidyl transferase mediated dUTP-digoxigenin nick end labeling(TUNEL) assay,and the expression of API5 though immunohistochemical and Western blot after 10 weeks.The results showed that the glucose concentration was significantly higher in test group than control group(P<0.05);the body weight was significantly reduced in test group than control group(P<0.05);the ICP and ICP/MAP were much lower in test group than control group(P<0.05);the number of apoptotic cells in penile cavernosal tissues in DM rats was dramatically increased in test group than control group(P<0.05);the expression of API5 of penile cavernosal tissues in DM rats was significantly downregulated in test group than control group.Our results suggested that the increased apoptotic rate in the penile cavernosal tissues in DM rats could be one of the mechanisms contributing to diabetic erectile dysfunction.Additionally,API5 is involved in the regulation of apoptotic cell death in this process,while API5 may be involved in the regulation of the DM rat corpus cavernosum apoptosis gene.

Objective To explore the effects and possible mechanism of lycopene on nonalcoholic fatty liver disease(NAFLD) in rats.Methods Fatty liver model of rat was induced with high-fat chow.After the fatty liver model was established,the therapeutical experiment was executed by lycopene.The following parameters were detected in all groups:the activities of AST and ALT in serum;the activities of SOD;the contents of MDA;the levels of CHO,TG,FFA,LDL-C HDL-C and CHE in serum or liver tissue.The changes of histology were observed.Results Compared with the natural recovery group,the changes of low-dose or high-dose of lycopene-treated groups were as follows:the activities of AST and ALT in serum were decreased;the liver tissue activities of SOD were raised,however the contents of MDA were diminished;the serum levels of TG,CHO,LDL-C and FFA were decreased;but the levels of HDL-C were increased;the serum and liver tissue activities of CHE were diminished;the degree of fat deposition could be alleviated and histopathological changes were improved significantly.Conclusion The degeneration degree of NAFLD can be alleviated by lycopene.The mechanisms possibly contribute to its action of antioxidation and plasma lipoprotein modulation.

Objective To evaluate the bioequivalence of two kinds of benproperin e sustained release preparations in healthy volunteers.Methods 18 healthy male v olunteers were divided into two groups randomly and two kinds of benproperine su stained release preparations were given to each volunteers in cross way.HPLC was selected to determine the concentration of benproperine in serum.3P97 program s oftware was used to calculate the pharmacokinetic parameters and evaluate the bi oequivalence of two kinds of benproperine sustained release preparations in heal thy volunteers.Results The main pharmacokinetic parameters were as follows:Tmax were(4.28±0.96)h,(4.66±1.28)h,Cmas were(92.85±26.03)ng/mL,(96.93±28.43)ng/ mL,AUC0-48 were(2 403.06±690.47)ng/mL·h,(2 445.50±591.03)ng/mL·h,respectiv ely.Conclusion The two preparations are bioequivalent.

Objective To study the bioavailability in vivo of Cefalexin Capsule.Methods The randomized,crossed-over study was conducted in 18 healthy volunteers.After a single dose of cefalexin 500 mg,the plasma drug levels were determined by HPLC.Results The main pharmacokinetic parameters in the test and reference praperations of cefalexin were as follows:Tmax was (56.67±18.23)min and (61.67±24.62)min;Cmax was (31.08±6.41)μg/mL and (29.95±6.56) μg/mL;AUC0-300 was (3 074.56±516.01)μg/(mL·min) and (3 069.21±469.81)μg/(mL·min).Conclusion The test and reference preparations are bioequivalent.