OBJECTIVE:To evaluate the effect of clinical antibiotics use special rectification in our hospital. METHODS:100 discharged medical records of typeⅠincision surgery were randomly sampled from our hospital during May in 2010 to Apr. in 2011,May in 2011 to Apr. in 2012,May in 2012 to Apr. in 2013,May in 2013 to Apr. in 2014,totaling 400 records. And then evaluation indicators were analyzed statistically,such as antibiotics use intensity,perioperative DDDs of antibiotics in typeⅠinci-sion surgery,DUI,types of antibiotics during perioperative period,medication time,etc. RESULTS:Since the implementation of clinical antibiotics use special rectification in May 2011,the utilization ratio of antibiotics in typeⅠincision surgery of our hospital decreased from 96% to 33%;DUI decreased from 1.44 to 0.79;while reasonable rate of drug selection increased from 19.8% to 100%,and that of medication time increased from 43.8% to 100%. CONCLUSIONS:Rational medication evaluation indicators in typeⅠincision surgery of our hospital have been improved after the implementation of clinical antibiotics use special rectification.

Objective:To investigate the features, diagnostic value and clinical significance of prenatal ultrasound for umbilical cord ulcer (UCU).Methods:Ultrasonographic characteristics of three fetuses with UCU diagnosed at Guangzhou Women and Children's Medical Center from January 2014 to June 2020 were reviewed. Relevant articles published from January 1, 1990, to June 1, 2020, were retrieved from Wanfang, CNKI and PubMed databases and analyzed. Likelihood ratio, adjusted Chi-square test and Fisher's exact test were used to analyze the association between the pathological results and fetal outcomes. Results:(1) Among the three fetuses with UCU, two were complicated by upper gastrointestinal obstruction and one by intrauterine infection. Two of them survived and one died after birth. Prenatal ultrasound examination of the umbilical cord and amniotic cavity showed one case was normal, while the other two showing features such as flocculent hypoechoic sign around the umbilical cord, cloudy hyperechoic sign ejecting from the umbilical cord lesion in dynamic observation, exposed umbilical vessels and ribbon-like echo around the umbilical cord. (2) No reported case of UCU had been found in any publications in China. A total of 39 reported cases of UCU complicated by duodenal or jejunal obstruction were retrieved from English literature, among which intrauterine fetal death, neonatal death and live births accounted for 30.8% (12/39), 28.2% (11/39) and 41.0% (16/39), respectively. Six cases with intrauterine abnormalities detected by prenatal ultrasound survived after emergent cesarean section, showing a positive detection rate of 15.4% (6/39), of which three obtained a snapshot of umbilical cord bleeding and three were characterized by lamellar and linear echoes around the amniotic cavity or umbilical cord. Hemorrhagic amniotic fluid was observed in 66.7% (26/39) of the fetuses and decreased heart rate occurred in 35.9%(14/39). The site, number and pathological grade of UCU were not related to the pregnancy outcomes (all P>0.05). Conclusions:Prenatal ultrasound for detecting abnormalities in umbilical cord and amniotic cavity is of a certain value in the diagnosis of UCU. Lamellar and linear echoes around the umbilical cord may be the ultrasonographic characteristics of UCU. The real-time detection of UCU bleeding by prenatal ultrasound can provide direct evidence for timely clinical treatment.