OBJECTIVE:To investigate the status of hospital infection and the antibiotic resistance of pathogenic microorganisms so as to provide references for empirical treatment of hospital infection and rational clinical administration of antibiotics.METHODS:The pathogenic microorganism infection of different specimen and the results of drug susceptibility test on the pathogenic microorganisms in hospital infection from 2005 to 2008 were analyzed.RESULTS:The ratio of gram-positive coccus to gram-negative bacillus in hospital infection was 2∶1,and the susceptibility test showed that pathogenic microorganisms in hospital infection had different degree of antibiotic resistance.CONCLUSION:Monitor on the antibiotic resistance of pathogenic microorganism is of utmost importance for the rational use of antibiotics in the treatment of hospital infection.

Objective To understand the current status and influencing factors of nursing safety management of geriatric care institutions in Shanghai. Methods Adopted questionnaire and experts spot-supervision to survey 25 geriatric nursing hospitals and 12 community health care centers which had more than 200 beds. The questionnaire had four parts including nature of institutions, general information of the managers, nursing risk management status and nursing safety quality status. Results The average score of nursing safety quality was (14.12 ± 2.03) points, there was no statistical significance in nature of institution, size of the institutions, age, education background, professional title, managerial experience, effect of nursing risk report and assessment and contingency plan (P> 0.05), but there was statistical significance in nurse managers′ knowledge about nursing risks, nursing risk management maturity and nurses training(F=2.818, 7.768, 3.555, P<0.05 or 0.01). Multiple linear regression showed that nurse managers′ knowledge about nursing risks, nursing risk management maturity and nurses training were the influence factors of nursing safety quality, and they account for 82.1%, and the regression equation was Y=7.988+0.365X1-0.380X2+0.350X3. Conclusions Strength the construction of nursing management team, perfect nursing management system, regular training could improve nursing safety quality of geriatric institutions in Shanghai.

Objective To study the prevalence of thrombocytosis in patients with non-small-cell lung cancer (NSCLC) and its correlation with clinicopathological features.Methods 156 patients with advanced NSCLC were retrospectively analyzed.The platelets degree between the groups with different sex,age,smoking,histological type of advanced NSCLC was compared and analyzed statistically.The relationship between the platelet count and chemotherapy effects was analyzed.Single analysis and Cox regression analysis were used for TTP and OS.Results Compared with the healthy persons,Plt significantly elevated in group with advanced NSCLC (36.5 ％,57/156 vs 5.0 ％,5/100) (P ＜ 0.01),and thrombocytosis group responded poorly to chemotherapy (22.8 ％,13/57 vs 39.4 ％,39/99) (P ＜ 0.05).The TTP (3.0 months vs 5.2 months) and OS (11.2 months vs 14.2 months) of Plt elevated group were significantly shorter than those of normal group.Conclusion Thrombocytosis is closely related to progress and metastasis of advanced NSCLC.Platelet count can be used as an assistant index in the prognosis judgment of patients with advanced NSCLC.

OBJECTIVE:To evaluate the effects of quality control circle(QCC)in improving the compliance of asthma/COPD outpatients handling inhaler devices. METHODS:By simple random sampling method,90 asthma/COPD outpatients receiving Tiotropium bromide powder for inhalantion,Salmeterol xinafoate and fluticasone propionate powder for inhalantion and Budesonide and formoterol fumarate powder for inhalantion were selected from our hospital during Apr. to Nov. 2015. The reasons for poor com-pliance of handling inhaler devices were analyzed by QCC. The countermeasures were formulated to improve the compliance,in-cluding clinical pharmacist education,follow-up,issuing education manuals,developing WeChat consulting. Operation step score of inhaler devices,compliance score and activity ability score of QCC members were analyzed statistically before and after QCC. RESULTS:After the development of QCC,operation step score of inhaler devices and compliance score in 90 asthma/COPD outpa-tients increased from 7.7 and 7.7 before activity to 8.8 and 9.3 after activity,the achievable rate of compliance was 114.3%,and the improvement rate was 20.8%. The sense of honor,responsibility,self-confidence,QCC techniques,communication and coordi-nation,team cohesion of all members were all improved obviously. CONCLUSIONS:QCC activity improves the compliance of asthma/COPD outpatients handling inhaler devices and shows the professional service level of clinical pharmacists,which is of sig-nificance to the improvement of pharmaceutical care.

Objective To investigate changes in serum levels of antinuclear antibody(ANA), anti?double?stranded DNA(dsDNA)antibody and anti?extractable nuclear antigen(ENA)antibody before and after anti?tumor necrosis factor?α(TNF?α)therapy in psoriatic patients. Methods Clinical data obtained from 32 patients with psoriasis were analyzed retrospectively. Of the 32 patients, 13 received intravenous injection of 5 mg/Kg infliximab at week 0, 2, 6 for 3 sessions, then once every 8 weeks(infliximab group), while other 19 received subcutaneous injection of 25 mg etanercept twice every week(etanercept group). The treatments in the 2 groups both lasted more than 3 months. Serum levels of ANA, anti?dsDNA antibody and anti?ENA antibody and changes of clinical symptoms were detected and observed respectively before each treatment in the infliximab group, as well as every 3- 6 months in the etanercept group. The 75%reduction in psoriasis area and severity index(PASI75)and disease activity score of 28 joints(DAS28) were used to evaluate clinical efficacy. Serum levels of ANA, anti?dsDNA antibody and anti?ENA antibody were measured by indirect immunofluorescence(IIF)assay, Western blot analysis combined with enzyme?linked immunosorbent assay(ELISA), and Western blot analysis, respectively. Results After 3?month treatment, the 32 patients achieved clinical remission to different extents. Of 32 patients receiving anti?TNF?αtherapy, 7(21.9%)developed new autoantibodies. Concretely speaking, 4 patients in the infliximab group developed autoantibodies in 8.3 ± 5.1 months, including 3 cases positive for ANA and 3 for anti?ENA antibody. Three patients in the etanercept group developed autoantibodies in 9.0 ± 3.0 months, including 3 cases positive for ANA and 1 for anti?ENA antibody. Conclusion Partial patients with psoriasis may develop autoantibodies after anti?TNF?αtherapy.

Background and purpose: The literature on dose-volume parameters and pneumonitis is extensive. The results are inconsistent, both for the best predictive metrics and significant comorbid factors. This study aimed to investigate a prospective functional equivalent uniform dose (fEUD) with perfusion single photon emission computed tomography (SPECT) images as predictors of radiation pneumonitis (RP) in patients undergoing curative radiotherapy (RT). Methods: Functional lung imaging was performed using SPECT for perfusion imaging. Perfusion factors were defined as the mean percentile perfusion levels of the 4 areas, top to 75%, 75% to 50%, 50% to 25%, 25% to 0%, re-spectively. fEUD was calculated from perfusion factors and standard dose-volume parameters extracted from treatment planning computed tomography (CT) scans. Total lung (TL), ipsilateral (IL) and contralateral lung (CL) volumes minus gross tumor volume (GTV), whole-lung V5, V20, whole lung fEUD, IL and CL fEUD, and general equivalent uniform dose (gEUD) were analyzed to evaluate correlations between RP using Common Terminology Criteria for Adverse Events (CTCAE) version 4.03. Statistical significance was defined as P<0.05. Results: A total of 15 patients treated with intensity modulated RT or 3D conformal RT were analyzed, grades≥3 RP were observed in 6 patients. There was only a trend toward significance for unilateral (UL) fEUD of higher dose side (P=0.007). Whole-lung V5, V20 were almost identical between patients who developed pneumonitis and patients who did not, as the values were below the recommended thresholds from published papers. Unilateral fEUDs were linear with unilateral gEUDs (t=0.815, P=0.000). Conclusion: SPECT-based equivalent uniform dose appears to be a better predictor of RP compared to stan-dard dose-volume parameters. Planning constraints should aim to keep unilateral fEUD below 21 Gy.

Background and purpose:The effective rate of ifrst-line chemotherapy for advanced lung cancer is 30%-40%. The purpose of this study was to evaluate the efifcacy and adverse effects of pemetrexed combined with carboplatin or cisplatin in the treatment of patients with advanced non-squamous non-small cell lung cancer (NSCLC). Methods:One hundrend and twenty-one patients with advanced non-squamous NSCLC were enrolled in this study and all of these patients had been conifrmed with pathology or cytology. Among the 121 cases, 60 cases were male and 61 were female, the median age was 59 years, adnenocarcinoma in 113 patients and large cell carcinoma in 8 patients. Combination regimen: patients received pemetrexed 500 mg/m2 on day 1 and carboplatin 300 mg/m2 or cisplatin 70 mg/m2 on day 1 by intravenous infusion, administrated every 3 weeks for 2 to 6 cycles. All patients who received 2 or more cycles could be evaluated. Disease control rate (DCR) was the primary end point; secondary end points included progression-free survival (PFS), 1-year survival rate and safety.Results:There was 1 case with complete response (CR), 44 cases achieved partial response (PR), 50 had stable disease (SD) and 26 cases had progressive disease (PD) in the overall cases. ORR and DCR were 37.2% (45/121) and 78.5% (95/121), respectively. The median PFS time was 5.2 months and 1-year survival rate was 59.0%. In pemetrexed combined with carboplatin group, the ORR and DCRwere 38.3% (23/60) and 78.3% (47/60), respectively; The median PFS was 5.1 months (95%CI: 3.8-6.4 month) and 1-year survival rate was 55.2%. The patients treated with pemetrexed plus cisplatin, the ORR and DCR were 36.1% (22/61) and 78.7% (48/61), respectively. Median PFS was 6.2 months (95%CI: 4.3-8.1 month) and 1-year survival rate was 62.5%. There were no statistical differences between carboplatin/pemetrexed and cisplatin/pemetrexed for both ORR, DCR, PFS and 1-year survival rate (P>0.05). The major adverse effects were leukopenia, neutropenia, fatigue and gastrointestinal reaction.Conclusion:Pemetrexed plus platinum chemotherapy could be considered as the ifrst-line treatment option for advanced non-squamous NSCLC patients. Pemetrexed combined with carboplatin/ cisplatin regimen has efifcacy with mild toxicity and better tolerability.

10.3969/j.issn.1007-3969.2013.05.002

Objective To quantitatively observe the value of relationship between nodule and corresponding capsular with ultrasonography in assessment of malignant and benign thyroid nodules.Methods A total of 79 cases with subcapsular tumors of thyroid gland confirmed pathologically were analyzed retrospectively,and the relationship between tumors and capsule was analyzed.Longitudinal diameter of nodules (from the junction of nodule and capsule to the deepest of nodule,V) and distance from nodule protruding thyroid capsule to the highest point of nodule (L) were measured,and L/V was evaluated.Diagnostic efficiency of L/V in diagnosis of malignant thyroid nodule was evaluated.Results The average L/V of benign and malignant nodules was 0.241± 0.041 and 0.162± 0.054,respectively (t=-7.367,P＜0.01).The area under ROC curve of L/V in diagnosis of benign and malignant thyroid nodules was 0.87 (P＜0.01).When L/V=0.225,the sensitivity was 82.17％,and the specificity was 87.53％;when L/V=0.245,the sensitivity was 67.10 ％,and the specificity was 95.12％.Conclusion Ultrasonography can clearly show the relationship between thyroid nodules and capsule,and L/V can be used for differential diagnosis of benign and malignant thyroid nodules.

Background and purpose: Abnormal expression of arginase 2 (ARG2) in a variety of human malignant tumors was detected. Previous studies found that ARG2 significantly increased in hepatocellular carcinoma (HCC) and was related to histological grading of HCC. This study aimed to analyze the association of ARG2 expression with cell proliferation, apoptosis and prognosis in HCC. Methods: The expression levels of ARG2 mRNA in 14 samples of HCC, paracancerous liver tissues and 14 samples of normal liver were detected by reverse transcriptionpolymerase chain reaction (RT-PCR). Tissue sections from 158 HCC patients were examined immunohistochemically for protein expression of ARG2, proliferation-related proteins (Ki-67 and cyclin D1) and apoptosis-related proteins (activated caspase-3, caspase-8 and caspase-9). Immunofluorescence double labeling method was used to detect the coexpression of ARG2 and activated caspase-3, and the colocalization between ARG2 and apoptotic cells. Patients were followed up by telephone. Results: TThe expression of ARG2 mRNA was significantly increased in HCC compared with the paracancerous liver tissues and normal liver tissues (F=27.10, P＜0.01). The expression of ARG2 was positively correlated with the expression of Ki-67 and cyclin D1, respectively (r=0.247 8, P＜0.01; r=0.372 7, P＜0.01). The expression of ARG2 was positively correlated with the expression of activated caspase-3 and caspase-8, respectively (r=0.191 0, P＜0.05; r=0.180 5, P＜0.05), but not with the caspase-9 (r=0.108 9, P＞0.05). Immunofluorescence double labeling showed that ARG2 was coexpressed with the activated caspase-3 and colocalized with apoptotic cells. Kaplan-Meier survival curves showed that the median survival time was 32 months in ARG2(-) group, 18 months in ARG2(+) group and 15 months in ARG2(++) group. The log-rank test results showed that there were significant differences in median survival time between the groups, and the median survival time in ARG2(-) group was longer than that in ARG2(+) and ARG2(++) groups (χ2=12.278, P＜0.01). Conclusion: ARG2 may be involved in regulating the proliferation and apoptosis of HCC cancer cells. Detecting the expression of ARG2 in HCC tissues may indicate prognosis.