Architecture ; Humans ; Occupational Diseases ; prevention & control ; Occupational Health

Objective To investigate the clinical value of serum endocan and procalcitonin (PCT) in early diagnosis and prognosis evaluation of sepsis.Methods The patients with systemic inflammatory response syndrome (SIRS,n = 26) and sepsis (n = 78) admitted to intensive care unit (ICU) of the Third Hospital of Hebei Medical University from December 2014 to December 2016 were enrolled. According to the severity of disease, the sepsis patients were divided into general sepsis group (n = 20), severe sepsis group (n = 24), and septic shock group (n = 34). The cases were divided into survival group (n = 55) and non-survival group (n = 23) according to 28-day mortality. The serum endocan, PCT, acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ) score, and sequential organ failure assessment (SOFA) score were recorded when the patients were admitted into ICU. The differences in endocan, PCT, APACHE Ⅱ, SOFA score between SIRS and sepsis groups and within sepsis subgroups were compared. Spearman correlation analysis was used to analyze the correlation between the indexes of sepsis patients. Receiver operation characteristic curve (ROC) was used to evaluate the value of endocan and PCT for the diagnosis and prognosis of sepsis.Results ① Serum endocan, PCT, APACHE Ⅱ, SOFA score and 28-day mortality in the sepsis group were significantly higher than those in the SIRS group [endocan (μg/L): 4.28 (10.64) vs. 1.03 (0.69), PCT (μg/L): 3.94 (10.75) vs. 0.43 (0.39), APACHE Ⅱ:18.81±9.17 vs. 9.35±3.78, SOFA: 9.00 (7.20) vs. 4.50 (1.50), 28-day mortality: 29.49% vs. 11.54%, allP < 0.01]. The area under the ROC curve (AUC) of endocan, PCT, APACHE Ⅱ, SOFA score for sepsis diagnosis were 0.887, 0.842, 0.822, 0.835, respectively. When the cut-off value of endocan was 1.26μg/L, the sepsis diagnostic sensitivity was 87.2% and specificity was 81.8%. When the cut-off value of PCT was 0.75μg/L, the sepsis diagnostic sensitivity was 85.9% and specificity was 81.8%. ② With the severity of the disease increased, the index showed an increasing trend in patients with sepsis. Serum endocan, PCT, APACHE Ⅱ, SOFA score and 28-day mortality in septic shock group were significantly higher than those in severe sepsis group or general sepsis group [endocan (μg/L): 13.02 (6.70) vs. 3.33 (3.05), 1.60 (0.98); PCT (μg/L): 8.10 (17.68) vs. 5.47 (8.92), 1.57 (2.78); APACHE Ⅱ: 25.00 (9.50) vs. 18.00 (9.00), 9.50 (5.75); SOFA: 13.00 (4.50) vs. 8.00 (3.00), 5.00 (3.50); 28-day mortality: 52.94% vs. 20.83%, 0%; allP < 0.01]. There was a significantly positive correlation between endocan, PCT, APACHE Ⅱ, SOFA, indicating that the endocan and PCT can be used to assess the severity of sepsis. ③ Serum endocan, PCT, APACHE Ⅱ and SOFA score in non-survival group were significantly higher than those in the survival group [endocan (μg/L): 15.05 (9.23) vs. 2.32 (4.81), PCT (μg/L):18.40 (16.99) vs. 3.10 (6.67), APACHE Ⅱ: 28.13±7.56 vs. 14.91±6.64, SOFA: 14.70±3.65 vs. 7.38±3.26, allP < 0.01]. The AUC of endocan, PCT, APACHE Ⅱ, SOFA score for the prediction of non-survival sepsis were 0.915, 0.763, 0.899, 0.930. When the cut-off value of endocan was 4.37μg/L, the septic death prediction sensitivity was 95.7% and specificity was 70.9%. When the cut-off value of PCT was 7.68μg/L, the septic death prediction sensitivity was 65.2% and specificity was 78.2%.Conclusions Serum endocan is more clinically valuable than PCT in early diagnosis and prognosis assessment of sepsis.

OBJECTIVE: To upgrade the rational use of drug in China.METHOD: The importance of Chinese essential medicine policy in upgrading rational use of drug was analyzed by establishing the legal status of the current essential medicine policy.RESULTS&CONCLUSIONS: The undesirable practice of the essential medicine policy was one of the key reasons for unsatisfactory situation of rational drug use in China.Only by legislating, law enforcing and publicizing can we upgrade the rational use of drugs

Objective:To explore clinical characteristics and diagnosis in aged patients with pulmonary embolism. Methods:The data of electrocardiogram (ECG),clinical characteristics and diagnosis were summarized and ana-lyzed in 56 aged patients with pulmonary embolism.Results:The most frequent symptom was exertional dyspnea (69.6%).ECG had characteristic changes in 12 patients (21.4%).All 56 patients received multi-slice spiral CT pulmonary arteriography,and thrombus within pulmonary artery was found in all patients (100%);38 cases re-ceived nuclide lung ventilation perfusion scanning,the results were 32 cases (84.2%)with mismatching pulmonary perfusion and ventilation imaging;Ultrasound examine found there were phlebothrombosis in deep vein of lower limb of 26 cases (46.4%).Misdiagnosis:The 26 cases (46.4%)were misdiagnosed.A total of 14 cases (53.8%) were misdiagnosed as respiratory system diseases,including eight cases of infectious shock and six cases with pulmo-nary infection;12 cases (46.2%)were misdiagnosed as circulatory system diseases,including five cases of acute cor-onary syndrome,four cases of heart failure and three cases of cardiogenic shock.Conclusion:The most frequent symptom is exertional dyspnea in aged patients with pulmonary embolism;ECG has characteristic changes only in few patients;the pulmonary arteriography is major diagnosis method.

Objective To investigate the therapeutic effects, duration of hematopeietic depression and side effects of FLAG regimen for refractory and relapsed acute myeloid leukemia(AML). Methods 13 cases for 5 days, and granulocyte colony stimulating factor G-CSF 300 μg/d from day 0 till neutruphil recovery (ANC≥1x109/L). 13 patients were 8 males and 5 females. The median age was 41.8 years(range 28-67). It includes 5 relapsed AML patients and 8 refractory AML patients. Results Of the 17 times, 11 showed response to therapy; the rate of complete remission was 35.3 %(6/17); the rate of partial remission was 29.4 % (5/17) and the overall response rate was 64.7 %. Main toxicities were gastrointestinal side effects, myelosupression and the function of liver was lightly damaged. Neutropenia at lowest number began at the time of 5-12 days after regimen initiating and last 7-34 days, thrombocytopenia began at the time of 5-13 days and last 8-30 days. Conclusion FLAG regimen showed obvious effects for refractory and relapsed AML Most patients gained chance for hematopoietic stem cell transplantation. Hemotological and nonhemotological toxicities are acceptable.

Objective The purpose of the study was to clarify the reasons that may explain the families' non-disclosure of the truthful information to cancer patients in our medical background.Methods The study included 82 family members of cancer patients who was not told truthful diagnosis by convenience sampling.Data were analyzed by Bernard Berelson's content analysis.Results 13 categories and 7 themes were formulated,including avoiding,concerns,judgment,buffer,cognition,impact and endurance.The agreement rates were 75.2％ and 78.7％.Conclusions The families' non-disclosure of truthful information to cancer patients was a kind of avoiding behavior,the judgment of families impacted their attitude towards telling or not.

The application management of surgical instrument is introduced from five aspects including risk control, operation rules, quality inspection and metering management, periodical maintenance and prompt service.

OBJECTIVE To investigate the correlative between anxiety and coping mode of parents of children with air way foreign bodies. METHODS Self-rating anxiety scale (SAS) and simplified coping style questionnaire (SCSQ) were used to investigate the anxiety level and coping mode among 212 parents of children with airway foreign bodies. RESULTS The SAS scores of parents of children with airway foreign bodies was considerably higher than China normal, there was significant difference between the two (P <0.01), the positive coping style score was higher (P<0.05), while the negative coping style score was lower than the normal (P <0.01). The SAS score was significantly and positively related to the negative coping style score (P<0.01), and not related to the positive coping style score (P>0.05). CONCLUSION The parents of children with airway foreign bodies have higher anxiety level than the norm, they often take an positive coping style.

Objective To investigate the relationship between plasma low-density lipoprotein (LDL) levels and hematoma enlargement of early intracerebral hemorrhage,outcome at 3 months and death.Methods A total of 316 patients with primary intracerebral hemorrhage were included in the study.Their general information was documented.The patients underwent CT scans at 6 and 24 hours after onset.The lipids,blood glucose,blood pressure,and the National Institutes of Health Stroke Scale (NIHSS) scores were detected at the same time.The patients were followed up for 3 months and their modified Rankin scale (mRS) scores and the number of death were recorded.Results The decreased plasma LDL level (odds ratio [OR] 0.323,95％ confidence interval [CI] 0.128 - 0.819; P =0.017) and the increased systolic pressure (OR 1.015,95％ CI 1.000 -1.029; P =0.043) were independently associated with the early hematoma enlargement.The decreased plasma LDL level (OR 0.253,95％ CI 0.102-0.629; P=0.003) and the increased blood glucose (OR 1.458,95％ CI 1.257 - 1.693; P ＜ 0.001 ) were the independent risk factors for poor outcome at 3 months after onset.The decreased plasma LDL level (OR 0.211,95％ CI 0.075 - 0.597; P =0.003),the increased bloot glucose level (OR 1.406,95％ CI 1.212 - 1.632; P =0.001) and the increased blood glucose level (OR 1.026,95％ CI 1.009 - 1.043; P =0.002) were the independent risk factors for death within 3 months.Receiver operating characteristic curves showed that the LDL level ＜ 2.58 mmol/L was an independent predictor for hematoma enlargement (sensitivity 71.79％,specificity 64.71％,positive predictive value 40.00％,and negative predictive value 87.50％ ).Conclusion The decreased plasma LDL level was the independent predictor for early hematoma enlargement,poor outcome and death at 3 months in patients with primary intracerebral hemorrhage.

Objective To develop an un_fluorescent staining method in Comet Assay. Methods Some special un_fluorescent DNA staining methods, Feulgen, Methyl Green, Stains_all and Silver_Stain were tested in Comet Assay and the comparison studies with EB stain were carried out. Results Among the stain methods tested, just the silver_stain could give a satisfactory effect: legible, ease to judge the stained area of the comets head and tail, permanent, sensitive, could make little segment of DNA be stained, which couldnt be stained by EB stain, the length of comets head and tail, were over 2 times of that of EB stain, safety and economical. Conclusion The silver_stain method discarded the defects of EB stain, so that it could replace EB stain and make comet assay possible to be extended.