Objective To evaluate the effect of antimicrobial management guideline on the daily antimicrobial use rate in a general hospital.Methods An one-day point-prevalence survey on antimicrobial use in hospitalized patients was conducted in 2010,2011,and 2012 by means of cross-sectional investigation method.Results The daily utiliza-tion rate of antimicrobial agents in 2010,2011,and 2012 was 65.40% ,42.09% and 26.74% respectively,the rate of the submission of specimens for bacterial culture was 22.53% ,35.74% and 41.74% respectively(χ2 trend= 266.42, 29.02,respectively,bothP<0.01). The utilization rate of single drug was 83.72% ,80.27% and 93.41% respec-tively. the utilization rate of both two-drug and more than three-drug combination kept a downward tendency. The utilization rate of antimicrobial agents in several departments(digestive internal medicine,cardiovascular,hematolog-ical tumor,neurology,general surgery,orthopedics,obstetrics,pediatrics,and ophthalmology)showed a decreasing tendency(all P<0 .0 1 ).Conclusion The implementation of antimicrobial management guideline has remarkably re-duced the daily antimicrobial use rate,and increased etiological detection rate for therapeutic antimicrobial use.

Through analyzing the academic ideas in Shanghan Zhinan written by Wei-Ju ZHU, a modern famous physician, it is pointed out that ZHU's achievement on integrative medicine has been overlooked. Taking the theory of syndrome differentiation of six channels from Shanghan Lun as an example, ZHU presumed that the essence of therapeutic theory of traditional Chinese medicine was to conform to or strengthen human body's self-healing and self-regulating abilities. Since Yangqi is the major force in the body to help heal disease when it occurred, ZHU often took measures to strengthen Yang first in treating disease and also was good at using hot-natured herbs, such as Radix aconiti lateralis preparata. ZHU's thoughts on integrative medicine were concerned with etiology, pathology and therapeutics. In addition, ZHU generalized the syndrome differentiation into the theory of five phases and eight principles, and made important contributions to the history of integrative medicine. His thinking will provide valuable revelation for clinical practice and modern research on traditional Chinese medicine.

Phytoestrogens (PEs) and estrogen receptorβ(ERβ) have close relationship with breast cancer. PEs preferentially binds to ERβ rather than ERa. Although there are still some arguments, it provides a new though for researching the mechanism of Phytoestrogen-containing herbs on breast cancer and exploring the essence of TCM theory.

The spleen whose size reaches or exceeds third degree should be regarded as massive splenomegaly.Splenectomy for massive splenomegaly demands precise procedures.First,median incision on upper abdomen(or vertical rectus muscle splitting incision)and incision under left costal arch are preferred.Second,the spleen was freed and then 0.33 mg of epinephrine was injected via the splenic artery before splenic artery ligation.During the process,a cell saver helps to minimize blood loss and makes autoinfusion possible for patients with benign lesions.Third,preoperative administration of fibrinogen,platelet and essential styptieum combined with the cooperation between surgeons and anesthesi010gists are the key points of bloodless surgery which is important for the recovery of patients.Four common problems of splenectomy for massive splenomegaly should also be addressed,including operation discontinuance,perioperative hemorrhage,accessory injury and postoperative intractable fever.

To guarantee the basic quality of nursing service, many countries have carried out the licensure examinations for registered nurses, which are used not only to evaluate the quality of nursing education but also to guide the development of education. This paper reviewed the process of the establishment of the systems, and outlined the features of the examinations in content design, organization and implementation, improvement and development trends in both China and America in order to improve ours.

[ ABSTRACT] AIM:To observed the correlation between Th17 cell level and the symptom severity and prognostic factors of chronic obstructive pulmonary disease ( COPD) , and to explore the clinical application value of Th17 cell level in assessing the prognosis of patients with COPD.METHODS:The patients with diagnosed COPD ( n=110) in our hospital during May 2013 to December 2014, and 40 healthy subjects were enrolled in the study.According to the Global Initiative for Chronic Obstructive Lung Disease ( GOLD) , the COPD patients were divided into group A ( low risk, less symptoms) , group B (low risk, more symptoms), group C (high risk, less symptoms) and group D (high risk, more symptoms), which were given inhaled corticosteroid/long-acting β2 agonist or corticosteroid/long-acting β2 agonist +long-acting anti-muscarinic agent treatment for 3 months.The proportion of Th17 cells, cytokines (IL-17 and IL-6), the COPD assessment test ( CAT) score, age, body mass index, pulmonary function and the times of acute exacerbation of COPD in previous 1 year were observed before and after treatment.The correlation analysis between the level of Th17 cells and other clinical characteristics was performed.RESULTS:Th17 cell, IL-17 and IL-6 levels in COPD group were significantly higher than those in control group (P<0.05).With the increase in the severity of COPD symptoms, Th17 cells, cytokines (IL-17 and IL-6) and CAT score in groups B and D were significantly higher than those in groups A and C (P<0.05).The univariate analysis showed that the levels of Th17 cells in groups B and D before treatment were positively correlated with the CAT score (P<0.05), which were negatively correlated with FEV1, FEV1%Pred, FVC and FVC%Pred.The levels of Th17 cells were not correlated with the CAT score, FEV1 , FEV1%Pred, FVC and FVC%Pred in groups A and C.The levels of Th17 cells after treatment were positively correlated with the CAT score, which were negatively correlated with FEV1 , FEV1%Pred, FVC and FVC%Pred (P<0.05).CONCLUSION:The peripheral Th17 cell level has a good correlation with IL-17, IL-6, CAT score and pulmonary function in COPD patients, suggesting a potential value to predict the symptom severity and prognosis of COPD.

Objective To investigate effect of tiotropium bromide combined with formoterol on oxidative stress and lipid peroxidation in peripheral blood in elderly patients with chronic obstructive pulmonary disease.Methods 80 elderly patients with chronic obstructive pulmonary disease from our hospital were selected and divided into conventional group and experimental group, conventional group on the basis of conventional therapy was treated with salmeterol xinafoate and fluticasone propionate powder for inhalation with 2 suction per times, 2 -3 times per day for 14d.Experimental group was treated with tiotropium bromide spray combined with formoterol fumarate powder for inhalation with 2 suction per times, 2-3 times per day for 14 d.7 d for a period of treatment, after 2 courses of the treatment, changes of clinical signs, blood gas levels, peripheral blood oxidative stress products and lipid peroxidation and inflammatory factors were compared before and after treatment.Results Compared with conventional group,the recovery time were shorter(P<0.05) ,and blood gas levels, peripheral blood oxidative stress products and lipid peroxidation, inflammatory factors were lower(P<0.05). Conclusion Tiotropium bromide combined with formoterol can significantly reduce airway hyperresponsiveness, inhibit inflammation, relieve clinical symptoms.And the drug resistance is low, the side effect is small, the clinical curative effect is ideal, may be the clinical treatment effective plan, and has the vital significance.

ObjectiveTo investigate the significance of synchronic heart rate variation(HRV) and blood pressure variation(BPV) in the evaluation of coronary artery disease(CAD).MethodsOne hundred and three patients who received coronary artery angiography were divided by the lesion degree into occlusion group (28 cases with more than 1 complete-occlusion coronary artery),non-occlusion group (45 cases with more than 1 coronary artery stenosis ≥50％ but without complete-occlusion) and control group (30 cases without stenosis ≥50％).Occlusion group and non-occlusion group were divided by lesion location into left anterior descending (LAD) lesion (32 cases),left circumflex ( LCF ) lesion (23 cases ) and right coronary artery(RCA) lesion (18 cases).And these two groups were also divided by lesion branch number into 1 lesion branch (23 cases),2 lesion branches (19 cases) and 3 lesion branches(31 cases).The time domain indexes of HRV were detected and calculated by 24 h dynamic blood pressutre and ECG,including standard deviation of normal number of R-R intervals (SDNN),standard deviation of per 5 min average normal R-R intervals(SDANNind),24 h average of standard deviation of per 5 min normal R-R intervals(SDNNind),root mean square of standard deviation of adjacent normal R-R intervals (rMSSD),and percentage of the difference of adjacent normal R-R intervals ＞ 50 ms (PNN50).And indexes of BPV were detected,including daytime systolic pressure standard deviation (dSSD),daytime diastolic pressure standard deviation (dDSD) and nighttime systolic blood pressure standard deviation (nSSD).The correlations between synchronic HRV and BPV and different coronary artery lesions were analyzed.ResultsSDNN,SDANNind significantly decreased and dSSD obviously increased with the aggravation of coronary stenosis,and there was statistical significance[ ( 115 ± 35 ) ms vs.(98 ± 25 ) ms vs.( 78 ± 28 ) ms,( 100 ± 30) ms vs.( 86 ± 23 ) ms vs.( 70 ± 29 )ms,(14 ± 3) mm Hg (1 mm Hg=0.133 kPa) vs.(20±4) mm Hg vs.(28±2) mm Hg](P＜0.05).rMSSD and PNN50 decreased,dDSD and nSSD increased with the aggravation of coronary artery stenosis,but there was no statistical significance (P＞0.05).SDNN and SDANNind in patients with LAD lesion and LCX lesion were significantly lower than those in control group,and dSSD was obviously higher than that in control group (P ＜ 0.01 or ＜ 0.05 ).SDANNind,rMSSD,PNN50,dDSD and nSSD in patients with LAD lesion and LCX lesion had no significant difference compared with those in control group (P ＞ 0.05 ).SDNN,SDANNind,SDNNind,rMSSD,PNN50,dSSD,dDSD and nSSD in patients with RCA lesion had no statistical significance compared with those in control group ( P ＞ 0.05 ).All the indexes of HRV tended to descend and indexes of BPV trended to raise with the increasing number of coronary artery lesion branches.But only the changes of SDNN,SDANNind,SDNNind,rMSSD,PNN50 and dSSD had statistical significance (P ＜ 0.05).Conclusions The more significantly HRV decreases and dSSD increases in patients with coronary artery disease,the more serious the coronary artery stenosis is and the wider the lesions are.The lesions are commonly located in LAD.It has certain guiding value for the evaluation of coronary artery diseases.

The incidence of invasive fungal infection in critically ill patients is increasing year by year. Its clinical manifestation lacks specificity which is difficult for early diagnosis. It′s hard to identify inva-sive fungal infection with fungal colonization in clinical practice. We need to find out the way to distinguish them.

Objective:To determine the location of mycobacterium tuberculosis(MTB) and whether the cellular immunity is induced after intragastric administration of BCG in mice.Methods:Viable MTB were detected in mesenteric lymph nodes?spleen and lungs at day 15,30 and 60 after intragastric administration of BCG to mice.The proliferation of T-lymphocyte with the stimulus of the purified protein derivative(PPD) was measured at day 60 and 90 after intragastric administration of BCG to mice.The expression of interleukin-2(IL-2) of T-lymphocyte in spleen was detected at day 60 and 90 after intragastric administration of BCG.Results:Viable MTB were detected in the mesenteric lymph nodes and spleen at day 15,30 and 60 after intragastric administration.At day 60 and 90 after intragastric administration of BCG to mice,the ratio of T-lymphocyte proliferation was 31.32%,37.94% separately and the production of IL-2 was 37.47?5.60 U/ml,39.41?7.73 U/ml separately.There were no statistically significant differences in the cellular immunity between the mice of the intragastric administration of BCG significant differences in the cellular immunity between the mice of the intragastric administration and the mice of the subcutaneous vaccination of BCG( P 0.05).Conclusion:Intragastric administration of BCG can induce cellular immunity in mice.