Objective To evaluate the effect of clinical pharmacists on parenteral nutrition support in-terventions, and to provide reference for clinical pharmacists to participate in the ERAS Nutrition Support Group work model. Methods A total of 490 patients hospitalized in department of hepatobiliary and pancreatic surgery from November 2016 to January 2017 were selected as control group. 521 patients hospitalized in depart-ment of hepatobiliary and pancreatic surgery from November 2018 to January 2019 were selected as intervention group. Nutritional risk, parenteral nutrition support indications, parenteral nutrition prescription energy and amino acid supply, prescription incompatibility and rationality, prescription osmotic concentration and phlebitis, parenteral nutrition and drugs in Y-tube compatibility of the above patients were analyzed to evaluate the effect of interventions by clinical pharmacists after participating in the nutritional support team. Results Patients with benign pancreatic diseases in the two groups had higher incidence of nutritional risk ( 78. 2％, 75. 6％) , and patients with benign biliary diseases had lower incidence of nutritional risk ( 76. 4％, 69. 9％) . Incidence of patients having parenteral nutrition support indications, namely NRS 2002≥3 points was higher in intervention group ( 83. 6％) than in control group ( 56. 6％); parenteral nutrition prescription energy and amino acid supply were higher in intervention group than in control group, patients in the intervention group had lower blood albumin dosage and no over-indication medication than patients in the control group; patients in both groups had no parenteral nutrition prescription safety issues such as glycolipid ratio ( kJ : kJ) <1, hot ni-trogen ratio ( kJ : g) <418, vitamin excess, electrolyte excess. The time of insulin addition in the nutrient solu-tion was lower in the intervention group ( 13. 4％) than in the control group ( 33. 3％) , and the difference was statistically significant ( P<0. 05 ) . The incidence of phlebitis was lower in the intervention group ( 10. 3％) than in the control group ( 57. 5％) , but no statistically significant difference was observed ( P>0. 05 ) . The compatibility of parenteral nutrition solution and drug in Y-tube was lower in the intervention group than in the control group. Conclusion The participation of clinical pharmacist in the ERAS nutrition treatment team, who will assist the doctor in formulating the nutritional treatment plan, monitor the patient's nutritional support and conduct regular indoor training, can effectively improve the reasonable application of parenteral nutrition sup-port, standardize the use of therapeutic drugs, and guide patients and caregivers to use the preparations safely so that to ensure patients' safety in clinical interventions.

硫唑嘌呤（Azathioprine,AZA）是一种非特异的免疫抑制剂。用于治疗激素无效或依赖者以及不能使用水杨酸偶氮磺胺吡啶或不能行手术治疗的溃疡性结肠炎患者。约10-28%的患者经历与硫嘌呤治疗相关的不良药物反应,其中最严重的反应是骨髓抑制,通常表现为白细胞减少,其发生率大约为2-5% [1] 。本文临床药师就一例口服硫唑嘌呤治疗溃疡性结肠炎引起白细胞减少症的病例做一分析与监护,对替代药物治疗提出建议方案,体现临床药师在临床工作中发挥积极作用。1临床资料

Objective To study the changes of the proliferation and Cyclin protein after the managemeng of the gastric cancer cell BGC-823 treated by the Cisplatin combined with Ulinastatin. Methods The gastric cancer cell BGC-823 was cultured in vitro and divided into four groups: the control group, Cisplatin group, Ulinastatin group and Cisplatin+Ulinastatin group. The gastric cancer cell and the proliferation were detected by MTT; The cyclin protein of Cyclin G1 and MEDF2D was detected by Western Blot and the level of miRNA Cyclin G1 was detected by RT-PCT. Results MTT showed that compared with control group, the pro-liferation rate was obviously decreased in Cisplatin group, Ulinastatin group and Cisplatin+ Ulinastatin group. There was significant difference (P<0.01). Compared with Cisplatin group and Ulinastatin group, the proliferation rate was obviously decreased in Cispl-atin+ Ulinastatin group. There was statiscally difference (P<0.01). Western Blot showed that compared with the control group, the protein of Cyclin G1 and MEDF2D decreased in Cisplatin group and Ulinastatin group (P<0.05), and in Cisplatin+ Ulinastatin group the protein also obviously decreased (P<0.01). Compared with Cisplatin group and Ulinastatin group, the levels of Cyclin G1 and MEDF2D were significantly decreased (P<0.01). RT-PCR results showed that compared with the control group, the level of miRNA Cyclin G1 was decreased in Cisplatin group, Ulinastatin group and Cisplatin+ Ulinastatin group. Compared with Cisplatin group and Ulinastatin group, the level of miRNA Cyclin G1 was decreased in Cisplatin+ Ulinastatin group (P<0.05). Conclusion Ulinastatin can decrease the proliferation of gastric cancer cell BGC-823 and is relate to the decreasing the cyclin protein of Cyclin G1 and MEDF2D.

目的:探讨急性腔隙性脑梗死(LI)患者出现早期神经功能恶化(END)与脑血管储备(CVR)改变的联系.方法:连续纳入发病24h内收治于吉林省人民医院神经内科的LI患者,根据发病72h内是否出现神经功能恶化,分为END组及非END组.采用经颅多普勒(TCD)结合CO2试验评价CVR功能,比较各组基线资料和CVR功能,筛选早期预测END的独立危险因素.结果:102例患者中有23例(22.5％)发生END,和非END患者比较,各项CVR参数及基线NIHSS评分的差异有统计学意义(P＜0.01).Logistic回归分析显示,屏气指数(OR=0.258,95％ CI 0.045 ～1.482,P=0.002)、过度换气指数(OR=0.000,95％ CI 0.000 ～0.001,P=0.000)和基线NIHSS评分(OR=1.182,95％ CI 1.065～1.311,P=0.001)是END的独立危险因素.结论:CVR受损可能与LI早期病情不稳定有关,早期进行CVR检测有助于预测LI病情恶化.

An HPLC method was used to determine the mass ratioes of songoramine and songorine in the fibrous roots of Aconitum carmichaeli Debx.A Zorbax Extend-C18 (4.6 mm × 250 mm ODS, 5 μm)column was used.The mobile phase consisted of V (acetonitrile)∶V (w (triethylamine)=0.1%)=6∶4 was used for isocratic elution.Flow rate was set at 1.0 mL/min,the wavelength of VWD detector was set at 220 nm and the column temperature was maintained at 25.0 ℃.The linear range of two alkaloids was the same as 0.1—10.0 μg (r 2 =0.999 8),the mean recoveries were 99.8%(RSD=1.49%,n=6)and 99.3% (RSD = 1.46%,n = 6 ) respectively. The mass ratioes of songoramine and songorine in the fibrous roots of Aconitum carmichaeli Debx were 57.0,1 10.0 μg/g respectively.

目的：研究中国男性各年龄组的腰椎松质骨微结构、生物力学特征。方法取捐献的新鲜男性L3椎体32个，年龄20～59岁，分成四个年龄组，每组8个椎体。常规操作去除L3周围软组织及附属结构，只保留椎体部分。沿椎体正中矢状面将椎体切成左右两半。将每半制成规则试件，将试件平均分成两部分，行生物力学实验。对切下的试件周围松质骨喷金后，行扫描电镜观测，用 eflim 软件对骨小梁进行形态学分析、测量。结果20～29年龄组到30～39岁年龄组，横向、纵向骨小梁均明显减小（P＜0.01）。横向、纵向骨髓腔高均明显增大（P＜0.01）。40～49岁年龄组到50～59岁年龄组横向、纵向骨小梁均减小（ P＞0.05）。横向、纵向骨髓腔高均增大（ P＞0.05）。20～29年龄组到30～39岁年龄组，板状骨小梁厚明显减小（ P＜0.01），弹性模量和极限应力均减小（ P＜0.01）。40～49岁年龄组到50～60岁年龄组，板状骨小梁厚略减小（ P＞0.05）。极限应力显著减小（ P＜0.05），弹性模量减小（ P＞0.05）。结论中国男性20～59岁椎体横向、纵向骨小梁宽和板状骨小梁厚度均逐渐减小，横向和纵向骨髓腔的高逐渐增大，松质骨极限载荷和弹性模量随着年龄的增长均减小。随着年龄的变化，骨微结构、密度和生物力学的改变是引起骨质疏松和骨折危险性增加的根本原因。

脑梗死具有较高的致死率及致残率，超早期治疗关键是抢救缺血半暗带，采取脑保护措施减轻再灌注损伤。尤瑞克林即人尿激肽酶原，是从人尿中提取的蛋白水解酶，是近年研制的治疗脑梗死的新药，通过激活体内激肽原-激肽系统（ KKS系统），产生一系列的生物学效应治疗急性脑梗死。

The chemical constituents in the seeds of Oroxylum indicum(L.)Vent.was studied in this paper.The compounds were separated and purified by column chromatography and recrystallization,whose structures were established by spectroscopic methods.Ten compounds were isolated from Oroxylum indicum(L.)Vent.at last,and their structures were identified as Oroxin B(1),Oroxin A(2),Chrysin(3),Chrysin-7-O-β-diglucoside(4),Chrysin-7-O-galactopyranuronoside(5),Apigenin(6),Lupeol(7),2α,3β-dihydroxyllupeol(8),Stigmasterol(9),Oleic acid(10).Among them,compounds 6,7,8 and 9 were isolated from the plants in this genus for the first time.

心房颤动(房颤)是临床上最常见的心律失常之一,随着年龄的增长,房颤的发生率明显增加.我国心房颤动现状的流行病学研究显示,中国人群房颤患病率为0.77%,60～69岁人群房颤患病率为1.3%,而≥80岁为7.5%[1].血栓栓塞是房颤最常见的并发症,具有很高的致残率和致死率,而合理的抗凝治疗是降低血栓栓塞的有效方法.本文分析老年非瓣膜房颤患者华法林抗凝治疗的临床疗效,并评价其安全性.

氟桂利嗪作为钙离子通道拮抗剂,在治疗眩晕、缺血性脑血管病、偏头痛、耳鸣及抗癫痫辅助治疗方面有一定效果,并且价格廉价,目前已广泛应用于临床.然而,20多年的临床应用中发现其有比较多且较严重的锥体外系副作用--药源性帕金森综合征(DIP),但国内相关报道较少.现将近1年来诊断为氟桂利嗪所致DIP 24例分析如下.

目的 探讨白介素18(IL-18)和腺苷脱氢酶(ADA)联合检测鉴别结核性和恶性胸腔积液的价值.方法采用ELISA法、酶速率法检测19例结核性和25例恶性胸腔积液患者胸水中IL-18及ADA水平,并利用SPSS11.0软件进行ROC曲线分析得出它们在鉴别结核性和恶性胸腔积液中的最适临界值,并计算出相应的敏感度、特异度、准确度.结果结核性胸腔积液患者IL-18及ADA水平明显高于恶性胸腔积液(P＜0.01),以358 pg/ml、33 U/L为IL-18、ADA为鉴别诊断结核性和恶性胸腔积液的最适临界值,其敏感度、特异度及准确度均＞80%.结论 IL-18和ADA可作为诊断结核性和恶性胸腔积液的有效参考指标.

支气管舒张剂是慢性阻塞性肺疾病(COPD)治疗的主要手段.近年来长效支气管舒张剂的开发、应用及不同作用机制的支气管舒张剂联合应用是其治疗COPD的主要进展.本院呼吸内科对2007年9月至2008年3月门诊登记治疗的COPD.稳定期15例患者予以噻托溴铵和福莫特罗联合吸入治疗,对照组15例予以茶碱缓释片口服,观察联合应用长效p：受体激动剂(1,ABA)和抗胆碱药的协同效应.

酒精性心肌病(ACM)是一种特殊类型的继发性心肌病,其病因是由于长期过量饮酒造成心肌损伤,临床上以心脏扩大、心律失常、心功能不全为主要表现.近年来,随着酒精性饮料消耗明显增多,ACM的发病率呈上升趋势[1].心率变异性(HRV)检测是反映自主神经对心脏活动调节功能的无创性检测方法,它具有定量性、可重复性、非侵入性等特点,近年来广泛应用于临床,可对心血管系统疾病的诊治及预后评估提供帮助[2].本文观察38例酒精性心肌病的心率变异性变化,以评价ACM患者的自主神经的调节功能.

研究表明,高血糖可以刺激炎症细胞因子的释放,导致急性期反应物的分泌[1].很多报道显示血清C-反应蛋白(C-RP)在糖尿病大血管病变中明显增高,是糖尿病大血管并发症的预测因子,其与糖尿病微血管病变的关系亦有报道[2,3].糖尿病肾病是常见的糖尿病微血管并发症,本研究探讨血清C-RP与老年糖尿病肾病的关系及在发病中的意义.

目的研究秦皮提取物对实验性脂肪肝的治疗作用并对机制进行初步探讨。方法采用薄层层析硅胶法分离纯化秦皮,得到秦皮提取物,采用Wistar大鼠作为实验动物,设立脂肪肝模型组,正常饮食对照组和秦皮实验组,进行灌胃治疗。进而对肝细胞分泌型TG和ApoB以及肝细胞微粒体腔VLDL中TG和ApoB进行含量测定。结果秦皮提取物组大鼠肝分泌型TG和ApoB的含量较模型组明显降低(P<0.05),并呈剂量依赖关系,秦皮提取物组大鼠肝细胞微粒体腔VLDL中TG和ApoB的含量较模型组明显降低(P<0.05),并呈剂量依赖关系,与正常对照组相比没有显著差异。结论秦皮提取物对大鼠实验性脂肪肝具有一定的治疗作用,其机制可能与抑制TG、ApoB的生成及转运有关。

目的研究中药天南星提取物诱导人肝癌SMMC-7721细胞凋亡及其生化机制。方法用MTT法、DNA凝胶电泳及流式细胞术等对经天南星提取物作用后培养的人肝癌SMMC-7721细胞进行观察分析。并用Westernblot检测了细胞内Caspase-3的表达。结果从2mg/ml(P<0.05)到8mg/ml(P<0.01)三组不同浓度的天南星提取物溶液均有不同程度抑瘤作用,4、8mg/ml的浓度具有明显地诱导SMMC-7721细胞凋亡的作用,天南星提取物作用后,Westernblotting法和DNA梯状电泳法检测到SMMC-7721细胞内caspase-3不同程度的表达增高及发生的DNA片断化现象;流式细胞检测显示在4、8mg/ml浓度下出现了典型的二倍体峰。结论提示天南星提取物有诱导SMMC-7721细胞程序性死亡的作用,其生化机制可能是通过激活特定的传导通路caspase途径实现的。

阻止动脉粥样斑块的发生和发展,有助于降低冠心病和脑梗死的发生率及病死率[1,2].笔者采用疏血通注射液对经颈动脉彩色超声发现颈动脉粥样斑块形成患者进行治疗,取得了满意临床疗效.

目的探讨老年肺心病住院患者水溶性维生素B1、B2、C的营养情况及其与疾病的关系.方法对23名老年住院肺心病病人维生素B1、B2和维生素C的每日平均摄取量进行调查,同时检测4 h尿负荷试验.结果老年住院肺心病患者维生素B1与维生素B2存在摄入不足、维生素B1储备降低.结论对老年肺心病患者应注重补充相关维生素.

目的探讨丝裂霉素C(Mitomycin-C即MMC)用于老年人抗青光眼手术的最佳方法.方法195眼青光眼小梁切除术中巩膜瓣下放置丝裂霉素C棉片(0.4 mg/ml),时间合理.结果术后2个月随访达到Ⅰ型、Ⅰ型滤过泡,眼压控制正常者,成功率90.88%.结论根据老年人球结膜特点,小梁切除术中合理应用丝裂霉素C效果满意.