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1.
Int J Biol Macromol ; 261(Pt 2): 129821, 2024 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-38286371

RESUMEN

Chitosan (CT) is extensively applied in developing food packaging films due to its non-toxic, biodegradable, and good film-forming properties. But CT-based single polymer film has issues with poor physico-mechanical, thermal, and light barrier properties. Therefore, this study aimed to incorporate natural berry wax (BYW) at various concentrations (5 %, 10 %, 15 %, 20 %, and 25 %, wt%) into CT to improve the quality characteristics of CT film. The microstructure of the film matrix was effectively proven to be compatible with BYW through the utilization of SEM, XRD, and FTIR spectroscopy. The results demonstrated that the quality parameters of CT/BYW composite film were significantly affected by the increasing concentration of BYW. The integration of BYW with a concentration of 5 % to 20 % to CT substantially improved the film characteristics by reducing moisture content, swelling power, solubility, and water vapor permeability, increasing the film's opacity, thermal stability, and tensile strength as well as enhancing the biodegradable potential. Furthermore, CT/BYW films showed higher thermal stability and UV and visible light resistance compared to pure CT film. Taken together, the CT film with 20 % berry wax showed the best film characteristics and biodegradable potential, which could be promising for enhancing the shelf-life of various food products.


Asunto(s)
Quitosano , Quitosano/química , Frutas , Embalaje de Alimentos/métodos , Resistencia a la Tracción , Solubilidad , Permeabilidad
2.
Artículo en Chino | WPRIM (Pacífico Occidental) | ID: wpr-1023845

RESUMEN

AIM:This study aim to investigate the effects of lipopolysaccharide(LPS)-induced inflammation on the aging phenotype of hematopoietic stem/progenitor cells(HSPCs)in the bone marrow(BM)and spleen of mice.METHODS:(1)Young(2-month old)wild-type(WT)mice were treated with LPS to establish an actue inflammation model.The percentage of HSPCs in the BM and spleen of mice after LPS stimulation,as well as the ratio of mature cells in peripheral blood(PB)and spleen,were analyzed using flow cytometry.The proliferation of HSPCs in the BM and spleen was evaluated by examining the expression of the proliferation marker Ki67.In addition,changes in CD45 expression on HSPCs in the spleen of mice following LPS exposure were investigated by flow cytometry.(2)The percentage of HSPCs in BM and mature cells in PB and spleen of both young(2-month old)and old(24-month old)WT mice were analyzed by flow cytometry.(3)The transcriptome changes of hematopoietic stem cells(HSCs)after LPS stimulation was performed by an in silico analysis.RESULTS:(1)Mice exposed to LPS exhibited a significant increase in the percentage of HSPCs in BM and a marked elevation in the percentages of myeloid cells in PB and spleen compared to the mice in control group(P<0.05).(2)LPS exposure resulted in increased spleen weight and cell counts(P<0.05),along with a higher per-centage of HSPCs in the spleen compared to controls(P<0.05).(3)LPS stimulation promoted the proliferation of HSPCs in the BM and spleen(P<0.05).(4)The expression of CD45 was reduced on HSPCs from spleen of mice after LPS stimu-lation(P<0.01).(5)In comparison to young mice,aged mice showed an increase in spleen weight and a higher percent-age of HSPCs in the spleen(P<0.05).(6)Aged mice,in comparison to young mice,demonstrated a significantly higher percentage of HSPCs in the BM and myeloid skewing in the PB and spleen(P<0.01).(7)The silico analysis revealed up-regualtion of reactive oxygen species(ROS)and apoptosis signaling in HSPCs following LPS stimulation.CONCLU-SION:Young HSPCs stimulated by LPS exhibited an increase in cell number,a bias towards myeloid differentiation,en-hanced extramedullary hematopoiesis,and elevated levels of ROS and apoptosis,all of which collectively manifested the aging phenotype of HSPCs.

3.
Artículo en Chino | WPRIM (Pacífico Occidental) | ID: wpr-871943

RESUMEN

Apolipoprotein M (apoM), a member of apolipoprotein family, is primarily combined to high density lipoprotein (HDL) in plasma. The study of apoM developed into a new period since it was discovered as the major carrier of Sphingosine-1-phosphate (S1P) in circulation. apoM-S1P regulates diverse downstream signaling pathways mainly by binding to and activating specific cell-surface receptors. Being aware of the functions of apoM-S1P in different diseases helps us to explore the pathogenesis of diseases and casts new lights on its precaution and treatment. The relationship between apoM-S1P axis and diseases is reviewed below.

4.
Medicine (Baltimore) ; 98(34): e16747, 2019 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-31441847

RESUMEN

RATIONALE: Neurologic deficits are rare in patients with extranodal natural killer/T-cell lymphoma (NKTL), nasal type. We present a case that was initially suspected as tuberculous meningitis, but later diagnosed as central nervous system metastasis of NKTL, nasal type, which has never been published previously. PATIENT CONCERNS: A 55-year-old Chinese man presented with persistent headache and fever. The initial head computed tomography and magnetic resonance imaging (MRI) scan was normal. Low glucose, elevated protein, and pleocytosis of cerebral spinal fluid led to a diagnosis of tuberculous meningitis. The patient did not respond to anti-tuberculosis treatment, and his symptoms aggravated. MRI showed abnormal lesions in the right hemisphere and a lesion in the maxillary sinus region. DIAGNOSIS: Endoscopic biopsy of the maxillary lesion showed features consistent with NKTL. Positron emission tomography revealed a hypermetabolic mass involving the right maxillary sinus and brain. INTERVENTIONS: The patient received chemotherapy. OUTCOMES: The patient died 30 days after chemotherapy. LESSONS: Lymphoma of the nasal cavity and paranasal sinuses is extremely rare and may be easily misdiagnosed. Nasal NKTL metastasis should be considered when a patient presents with symptoms of leptomeningeal involvement.


Asunto(s)
Linfoma Extranodal de Células NK-T/diagnóstico , Antineoplásicos/uso terapéutico , Antituberculosos/uso terapéutico , Diagnóstico Diferencial , Humanos , Linfoma Extranodal de Células NK-T/tratamiento farmacológico , Masculino , Persona de Mediana Edad , Cavidad Nasal/patología , Tuberculosis Meníngea/diagnóstico , Tuberculosis Meníngea/tratamiento farmacológico
5.
Artículo en Chino | WPRIM (Pacífico Occidental) | ID: wpr-804825

RESUMEN

Objective@#To understand the etiology, genotype and molecular characteristics of acute viral gastroenteritis in Quanzhou from 2014 to 2017.@*Methods@#Specimens from 15 outbreaks of acute viral gastroenteritis in Quanzhou area from 2014 to 2017 were collected and real-time fluorescence quantitative PCR was used to detect norovirus GI and GII, sapovirus, astrovirus and rotavirus, and the result were statistically analyzed. Furthermore, specimens positive for norovirus was further subjected to the amplification and sequencing of polymerase and VP1 genes of norovirus, and sequences were analyzed using DNAstar and MEGA7.0 software.@*Results@#In this study, 96 specimens from 15 outbreaks of acute viral gastroenteritis were collected, and norovirus was detected in 30 specimens with a positive rate of 31.25%, among which 23 specimens were genotype GII and 7 specimens genotype GI. Meanwhile, 10 specimens were randomly selected for nucleic acid sequence analysis. The result showed that 9 of them were GII.P16/GII.2 and 1 was GI.6. The phylogenetic analysis showed that the new recombinant norovirus subtype GII.P16/GII.2 was highly homologous to the same subtype detected in outbreaks home and abroad recently.@*Conclusions@#The main pathogens caused the outbreak of acute viral gastroenteritis in Quanzhou from 2014 to 2017 were norovirus belonging to subtype GII.P16/GII.2 and subtype GI.6, and subtype GII.P16/GII.2 was the predominant strain which was found for the first time in Quanzhou.

6.
Artículo en Chino | WPRIM (Pacífico Occidental) | ID: wpr-806645

RESUMEN

Objective@#To analyze the distribution and the molecular biological characteristics of variant subtypes (H5, H7 and H9) of avian influenza virus (AIV) in the live poultry related external environment of Quanzhou form 2014 to 2017, and provide regional references for the prevention, control and early-warning of human infections.@*Methods@#Samples from monitoring sites of live poultry were collected in Quanzhou from 2014 to 2017. Influenza A and variant subtypes of AIV (H5, H7 and H9) were detected by real time RT-PCR, and the detection results were further analyzed statistically. Furthermore, the HA and NA genes of four representative H7N9 strains were sequenced, and the results were further analyzed with DNAstar and MEGA7.0.@*Results@#Among the samples from external environment, the positive rate of nucleic acid of influenza A was 29.04% (377/1 289), of which the positive rates of H5, H7 and H9 subtypes were 3.80%, 13.34% and 12.02%, respectively. The positive rate of H7N9 was higher than those of the other subtypes in all monitored years, of which the highest rate was found in 2017 (21.88%). As to the different types of samples, chopping board possessed the highest positive rate of influenza A (65.4%), followed by waste water (59.3%) and drinking water for the poultry (29.6%). Among the different monitoring sites, the positive rate of poultry farm is 6.94%, far lower than that in the open air (61.7%) and the live poultry trading market (52.8%). Sequencing of the HA and NA genes of four strains of H7N9 showed that the strains from external environment and the strains from H7N9 patients belonged to Pearl River Delta and Yangtze River Delta lineage, respectively. The cleavage sites of HA proteins of these four strains were all PKGR/G without highly pathogenic mutation. Meanwhile, they were low pathogenic H7N9 without oseltamivir resistant mutation (R292 K in NA), while they all possessed the E627 K mutation in the PB2 genes associated with virulence.@*Conclusions@#H7N9 AIV existed in the live poultry related external environment of Quanzhou, especially the farmers’ and the live poultry trading market, so that more persistent surveillance could be needed in the future.

7.
Artículo en Chino | WPRIM (Pacífico Occidental) | ID: wpr-507647

RESUMEN

Objective To investigate the effects of growth-discordant twin pregnancies on neonatal thyroid stimulating hormone (TSH) level and congenital hypothyroidism (CH).Methods A total of 3 444 live-birth twin neonates born between January 1,2012 and December 30,2014 in Ningbo City were enrolled.Blood samples via heel puncture were collected and tested.Incidence of CH in singleton and twin neonates was compared.Deviation of birth weight larger than 25% in twin neonates was set as the criteria for discordant growth.TSH and 17 α-hydroxylase levels in CH twins and normal twins,with or without discordant growth,were compared.Chi-square and non-parametric statistics were performed for data analysis.Results The incidence of CH in twin neonates was 0.56% (19/3 444),higher than that in singleton neonates [0.09% (203/225 712),x2=76.225,P<0.01].Among nineteen CH twins,CH occurred in both twins in eight cases (four twins) and in one of the twins in eleven cases.The gestational age at birth in the eight CH twins were less than 37 weeks,with four males and four females;five were low birth weight infants;one twin were dichorionic,and three twins were monochorionic.In the eleven cases of CH occurring in one of the twins,the gestational age was less than 37 weeks in nine cases,eight were low birth weight infants,six were male and five female;seven were monochorionic and four were dichoronic twins.Five cases of temporary hypothyroidism were all low birth weight infants among the growth-discordant twins.CH cases in growth-discordant group had lower birth weight than their normal twins [M(P25-P75),2 100 (1 800-2 600) vs 2 770 (2 530-2 960) g,Z=4.369],and a higher TSH level [15.4 (11.8-18.5) vs 6.4 (4.8-7.9) mU/L,Z=6.339] (both P<0.05).In normal twins with or without discordant growth,the neonates with a lower birth weight had a higher TSH level [3.6(2.5-4.7) vs 2.4(1.8-2.9) mU/L,Z=0.962] in weight consistent group,compared with 6.0(4.4-7.8) vs 3.4(1.9-4.1) mU/L in weight inconsistent group (Z=4.369),both P<0.05.Conclusions In the growth-discordant twins,neonates with a lower birth weight have a higher TSH level and a higher risk of temporary hypothyroidism.

8.
Artículo en Chino | WPRIM (Pacífico Occidental) | ID: wpr-481640

RESUMEN

Objective To study whether there was significant difference between pregnant women , data and the results of prenatal screening of single intrauterine fetal death ( sIUFD) when twin pregnancy and singleton pregnancy for guiding the clinical prenatal screening and risk consulting .Methods By comparative study, 56 cases of sIUFD when twin pregnancy were recorded from 2011 to 2014 in Ningbo Prenatal Diagnosis Center , all were natural pregnancy , the sistens gestational weeks were less than 14 weeks , and 4 993 natural singleton pregnancy .The pregnant women , data and the results of serological prenatal screening between sIUFD and singleton pregnancy were analyzed by t-test and rank sum test .Separately , the 56 cases of prenatal screening , risk value was calculated according to the twins and singleton , then the difference were analyzed combined with the results of follow-up.Results Pregnant women , data of two groups were analyzed, there were no statistically significant difference between sIUFD and singleton pregnancy .The age of sIUFD and singleton was (27 ±3)year-old and (27 ±3)year-old respectively, t=2.56, P>0.05; the weight of sIUFD and singleton was (55.2 ±10.23 ) kg and (56 ±10.34) kg, t=4.268, P>0.05.The gestational weeks of sIUFD and singleton were (39.21 ±0.78)weeks and (39.1 ±0.91) weeks, t=1.3, P>0.05;the weight of newborn was (3.38 ±0.41) kg and (3.31 ±0.43) kg, t=1.9, P>0.05.The AFP multiple of median (AFPMOM) of sIUFD and singleton was 1.41(0.99,1.83) and 1.02(0.84,1.24), Z=5.337, P0.05;unconjugated estriol multiple of median of sIUFD and singleton was 1(0.79,1.16) and 1.01(0.85,1.21), Z=1.334, P>0.05.Trisomy 21 risk of sIUFD and singleton was 7 750(2 200,28 000) and 5 300(2 000,12 000), Z=2.093, P<0.05, that had significant difference.The 56 cases of prenatal screening risk value was calculated according to the twins and singleton , among whom 42 cases had the same conclusion , 14 cases had the different conclusion .Among them, according to singleton calculation , 3 cases for high risk, according to the twin calculation of high risk for 17 cases,χ2 =12.1, P <0.05.According to follow-up, all newborns were normal.Conclusions For the natural pregnancy , sIUFD when twin pregnancy , if the sistens gestational weeks less than 14 weeks, the risk of prenatal screening results calculated according to singleton will be more reasonable , as for the prenatal screening for twin pregnancy , the method needs further exploration .

9.
Journal of China Medical University ; (12): 1066-1069,1074, 2015.
Artículo en Chino | WPRIM (Pacífico Occidental) | ID: wpr-603103

RESUMEN

Objective to evaluate the impacts of 6 standard comparible tables of biparietal diameter(BPD)-gestational age to the second trimester Down syndrome screening and the individual risk rate for pregnant woman. Methods A total of 25 346 pregnant woman with gestational age be-tween 12 to 20 weeks were recruited and analyzed in the study,including 32 Down syndrome. For each pregnant woman,we calculated the gestation-al age by six different BPD-gestational age tables,and the prenatal screening risk value of gestational age. then ROC curve,detection rate and posi-tive rate were used to evaluate the effect of different control tables on the screening results. In addition,individual risk rate was used to determine the influence of gestational age deviation on pregnant woman. Results According to the ROC,we found that our self-designed BPD table had the best AUC(0.972),while the table designed by a hospital in Shanghai had the least AUC(0.923). the difference was significant by statistic test(P =0.045). With the same detection rate of 75%,we found our self-designed table had the least positive rate with only 2.3%,and the cutoff was 1∶280, while the table of Chinese Obstetrics and Gynecology had the highest ratio(4.8%),and the cutoff was 1∶345. Our results suggest that once gesta-tional age is estimated to be higher than actual age,the risk will be higher and the positive rate will increase. However,if gestational age is estimated to be smaller,the risk will be smaller and the negative rate will increase. Conclusion the impacts of different tables on Down syndrome screening are different. Our self-designed BPD table is the most effective to estimate gestational age,and the control table of Hongkong is ranked No.2. the wrong estimation of gestational age will largely affect the individual risk of pregnant woman.

10.
Artículo en Chino | WPRIM (Pacífico Occidental) | ID: wpr-475462

RESUMEN

Objective To analysis and summary the chromosome abnormal existing in old pregnant women from 2002 to 2013,and to provide basis for clinicians intervene the fetus with chromosome disorders.Methods The 4 539 pregnant women in Ningbo city from 2002 August to 2013 October accepted the fetal karyo type detection,were retrospective analyzed,the frequency of abnormal chromosomal karyotypes was calculated according to different age groups,and the pregnancy outcomes of the old pregnant women were followed up.Thechi-square testswere performed on the frequency dateof the abnormal chromosome karyotype,polymorphism,and serum screening of high risk for fetal chromosome detection of less than 35-years-old pregnant women.Results The total of advanced maternal age pregnancyduring the past 11 years in Ningbo City is 32 080,and the follow-up rate was 99.90%,there are 10 infants borned with chromosomal abnormalities,the 1 290 caseswere detected withadverse pregnancy.A total of 4 539 advanced maternal age pregnancyaccepted amniocentesis,in those we found 107 cases of chromosome abnormality fetus,116 cases of polymorphism.A total of 5 232 high-risk pregnant women accepted the serum screening in the same period (less than 35 years old),finding 135 cases of fetal chromosome abnormal and 69 cases of polymorphism.Conclusion To strengthen the prenatal diagnosis,especially for puerperae above the age of 39,will lower the birth rate of infants with chromosome disease and will be conducive to the high quality of population in Ningbo.

11.
Artículo en Chino | WPRIM (Pacífico Occidental) | ID: wpr-429076

RESUMEN

Objective To investigate rational management for pregnant women with intermediate risk of Down syndrome (DS) through a retrospective analysis of second trimester maternal screening results for DS.Methods Second-trimester triple maternal serum screening for DS was performed.High risk ( ≥ 1/270) pregnant women received prenatal diagnosis.Intermediate (1/1000 to 1/270) and low (<1/1000) risk pregnant women received routine obstetric examination.Data of ultrasound diagnosis,karyotype analysis of amniotic fluid and postpartum follow-up were collected.Outcomes of pregnant women were retrospectively analyzed.The incidences of DS among three groups were compared.Data of different groups were compared with Fisher exact or Chi-square test.Results Eighty-six thousand eight hundred and seventy-four pregnant women accepted maternal serum screening and outcomes of 86 126 cases were followed up,among which 4342 cases were DS high risk,8196 intermediate and 73 588 low risk.The incidence of DS was 6.22‰(27/4342) for high risk,0.73 ‰ (6/8196) for intermediate risk and 0.04 ‰ (3/73 588) for low risk group.The incidence of DS was higher in high risk group than in intermediate risk group (Fisher exact probability,P=0.000),and was higher in intermediate risk group than in low risk group (Fisher exact probability,P=0.000).Comparison among the three subgroups within intermediate risk group showed no significant differences (x2 =0.047,P =0.977).Conclusions Pregnant women with intermediate risk of DS should be paid more attention.Reasonable management such as ultrasound diagnosis and prenatal consultation should be provided.

12.
Artículo en Chino | WPRIM (Pacífico Occidental) | ID: wpr-408031

RESUMEN

Generic drug products (test products: drug A, B...) are bioequivalent to an innovator product (reference product) when their bioavailabilities in the same molar dose are similar. Bioavailability is usually expressed by following pharmacokinetic parameters: the area under plasma concentration-time curve (AUC), the maximum plasma concentration (Cmax) and the time of maximum plasma concentration (tmax). This paper used a two period crossover bioequivalence study to develop convenient, friendly user interface software, BA&BE Analysis to statistically process data in clinical pharmacology studies and other areas. The method involves user input of data for analysis into a grid format, setting variables and parameters, followed by one-way analysis of variance (ANOVA), bioavailability and bioequivalence analysis of the data. The software developed in the present study should help scientists to carry out data analysis of bioavailability and bioequivalence testing quickly and easily.

13.
Artículo en Chino | WPRIM (Pacífico Occidental) | ID: wpr-411002

RESUMEN

Purpose The aim is to prepare the extract of immunocompetent cell proliferation from human placenta and to try to find out a suitable method of preserving the extract.Methods The extract was mainly prepared by heat-treating placenta homogenated fluid. Then the activity to stimulate murine splenic lymphocyte proliferation in vitro was done with MTT , exposing the extract to radioisotope 60 Co.Results The content of protein was 2~3mg per gram placenta measured by Lowry′s Method.The rate to promote cell proliferation was more than 80 percent.The activity lasted a few months after being exposed to radioisotope.Conclusion The extract prepared by heat-treating not only had high activity, but also had the unique method and good repeatability.This prepared extract as a kind of stable,reliable and remarkably promoting lymphocyte proliferation reaction had the value of development production on broad scale as well as in clinical practice.

14.
Artículo en Chino | WPRIM (Pacífico Occidental) | ID: wpr-517238

RESUMEN

Objective To research the stress to experimental myocardial infarction under general anesthesia combined with thoracic epidural anesthesia(TEA) Methods Nine rabbits in experimental group were anesthetized with 1% sodium pentobarbitone with tracheal intubation after sectioned, and after the epidural catheters was put into to make sure that the epidural anesthesia was effective, the anterior descending branches of their left coronary artery were ligated All procedures in control group were similar to those of experimental group except for thoracic epidural anesthesia The blood samples from left common carotid artery before ligation were taken 15,30,60,120,180 and 240min after ligation, to measure the plasma levels of monoamine neurotransmitters with high performence liquid chromatography, the Ag Ⅱ and cortisol levels with radioimmunoassay TNFa content in non infarction myocardium was assessed with immunohistochemistry Results There were no differences in NE and 5 HT levels between both groups before ligation Thirty min after the ligation, NE level in experimental group remained unchanged, but in control group increased markedly(P

15.
Artículo en Chino | WPRIM (Pacífico Occidental) | ID: wpr-517165

RESUMEN

Objective To research the different protective effects of general anesthesia combined with thoracic epidural anesthesia on experimental myocardial infarctionMethods Rabbits of experimental group were anesthesitized with 1% sodium pentobarbitone (30 mg/kg, iv) Following tracheal intubation, epidural catheter was put into at T_ 6-7 with the anterior end of the catheter reaching at T_ 2-3 After the epidural anesthesia was made sure to be effective, the anterior descending branches of left coronary artery were ligated Blood samples were collected before ligation, 15, 30, 60, 120, 180 and 240 min after ligation All procedures of control group were similar to those of experimental group except for thoracic epidural anesthesia Nitric oxide (NO), creatine kinase(CK), lactate dehydrogenase (LDH), aspartate transaminase (AST), superoxide dismutase (SOD) were detected The changes of the activities of CK and LDH, and NO level during the research course in both groups were analyzed with liner regression Results The regression coefficients of CK, LDH and NO in the experimental group were significantly lower than those in control group In the experimental group the activities of CK and LDH decreased markedly, NO level increased significantly as compared with those in control groupConclusions General anesthesia combined with thoracic epidural anesthesia produces the protective effects on the myocardial infarction and the stress-induced injury

16.
Artículo en Chino | WPRIM (Pacífico Occidental) | ID: wpr-519076

RESUMEN

Objective To evaluate the effect of thoracic epidural block combined with general anesthesia on c-fos and heat shock protein(HEP) 70 gene expression of myocardium from non-infarct area in rabbits with acute myocardial infarction. Methods Twenty-eight New Zealand white rabbits of either sex (12 male, 16 female), weighing 2.5-3. 8kg were randomly divided into two groups with 14 animals in each group: general anesthesia group and combined general-epidural anesthesia group. The rabbits were anesthetized with 1 % pentobarbital and tracheotomized and intubated. Spontaneous breathing was maintained. Epidural catheter was placed with one of the tips reaching T2-3. 2% lidocaine was injected and the effectiveness of epidural block was confirmed by decrease in MAP. Left common carotid artery was cannulated for intra-arterial pressure monitoring. Chest was then opened, and anterior descending branch of left coronary artery was ligated. Myocardial infarction was confirmed by changes in ECG. 4 hours after ligation the animals were sacrificed and a piece of myocardium from non-infarct area was taken for measurement of the concentration, OD and ratio of total RNA in 100 mg of myocardium. 0.7 ?g of total RNA was used for determination of c-fos and HPS 70 expression relative to ?-actin gene(c-fos/ ?-actin, HSP70/ ?-actin) by using one-step RT-PCR. Results c-fos/ ?-actin and HSP70/ ?-actin were significantly lower in combined general-epidural anesthesia group than those in control group(P

17.
Artículo en Chino | WPRIM (Pacífico Occidental) | ID: wpr-575263

RESUMEN

0.05).Conclusion The results of pharmacokinetic study on salvianolate can guide the clinical trial design and reasonableuse of medicaments in clinic.

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