OBJECTIVE:To explore the clinical utilization of carbapenems in a hospital,analyze and evaluate its medication rationality. METHODS:All the 508 medical records of inpatients treated with carbapenems from Jul. 2012 to Jun. 2015 were retro-spectively investigated,the utilization and pathogenic examination of carbapenems were evaluated;by setting the carbapenems eval-uating standard,the medication rationality of carbapenems was evaluated and inappropriate cases were classified and analyzed statis-tically. RESULTS:The drug utilization indexed (DUI) of Imipenem and cilastatin sodium for injection and Meropenem for injec-tion were 0.80 and 1.32,respectively;the total rate of microbial inspection was 95.9%;according to the drug sensitive test result, the rate of drug selection was 62.8%;there were 54 cases(10.6%)of irrational use records,in which,irrational dosage(42.6%) and improper drug selection (31.4%) were the major problems. CONCLUSIONS:There are some inappropriate medication prob-lems in carbapenems utilization in the hospital. Developing the carbapenems utilization evaluation is helpful to discover typical medi-cation problems,which can provide reference for intervention and continuous improvement of rational drug use.

Objective To analyze the clinical and neuropathological characteristics of subacute combined degeneration (SCD) of the spinal cord. Methods The clinical data were collected in 38 cases of SCD. The serum levels of Vitamin B 12 and folic acid in 34 cases and the serum homocysteine levels in 15 cases were determined. The sural nerves in 4 patients were observed by light and electron microscopes. Results The levels of vitamin B 12 in 25 cases and levels of folic acid in 7 cases were lower than normal value, but the levels of homocysteine in 6 cases were higher than the normal value. Pathological examination showed that there were different degrees of segmental loss of myelin sheaths and axonal degeneration in the peripheral nerves in 4 cases. Conclusion The diagnosis of SCD depends on clinical and laboratory data. The biopsy of the sural nerve shows that the main lesion is the loss of myelin sheaths.

Objective To analyze the behavior of patients with serious adverse drug reactions and look for risk factors leading to serious adverse drug reactions .Methods Patient medication behavior evaluation method was established,which was used in cases of serious adverse reaction caused by stains in recent three years in Beijing Chuiyangliu Hospital .Clinical pharmacists participated in field survey .Medication behavior of patients was analyzed from three aspects of knowledge ,attitude and ability .Results Three patients had serious adverse reactions occurred in recent 3 years,drugs were suspected of simvastatin and atorvastatin .The score of medication knowledge was lower than 20%.The score of health attitude was lower than 20%.The score of taking ability was lower than 20%. Conclusion In the investigation of serious adverse reaction ,pharmacists found the risk behavior of patients with daily medication is an important cause of patients with serious adverse reaction .Pharmacists should strengthen the drug education and publicity ,especially in patients with risk factors of medication behavior such as knowledge ,attitude and ability in their daily work .

BACKGROUNDBronchioloalveolar carcinoma is a kind of special lung cancer. The aim of this study is to analyze its characteristics, surgical intervention and prognosis.

METHODSFifty-eight surgically treated patients with bronchioloalveolar carcinoma from 1993 to 2000 were followed up. The clinical characteristics, surgical mode, site of recurrent disease and survival were analyzed.

RESULTSOut of 58 patients, 15 were male (25.9%), and 43 were female (74.1%). Fifty-one patients performed lobectomy ( 87.9%). The 1-, 3- and 5-year survival rate was 91.4%, 75.9% and 60.3% respectively. There was no remarkable difference in survival between chemotherapy group and non-chemotherapy group after surgery (P= 0.22).

CONCLUSIONSLobectomy is performed commonly in patients with bronchioloalveolar carcinoma. No obvious correlation is found between postoperative chemotherapy and survival.

Objective To examine the expression of human ?-defensin 2 (hBD_ 2 ) recombinant adenovirus expression vector in rat dermal multipotent stem cells (dMSCs) and to observe the antiseptic activity of recombinant hBD_ 2 . Methods The expression of hBD_ 2 in dMSCs was examined by RT-PR, fluorescent immunochemistry and Western blotting, and the concentration of recombinant hBD_ 2 in supernate was measured by ELISA. The antiseptic activity of recombinant hBD_ 2 was assessed by K-B disc agar diffusion test. Results hBD_ 2 could be effectively expressed in dMSCs, and the concentration of recombinant hBD_ 2 in supernate was about 743.6 ng/ml . Recombinant hBD_ 2 in supernate showed antiseptic activity. Conclusion Recombinant adenovirus expression vector of hBD_ 2 could be effectively expressed in dMSCs, and the recombinant hBD_ 2 in supernate showed obvious antiseptic effects toward some standard bacteria lines.

Objective To observe the repair effect of human ?-defensin 2 (hBD 2)-modified rat dermal multipotent stem cells (dMSCs) transplantation on infected wound. Methods Thirty Wistar rats were excised a piece of whole-layer back skin, 3 mm in diameter, then infected the wound with 1?10 8/ml pseudomonas aeruginosa 1 ml, then the rats were injected on the wounded back respectively with dMSCs modified by hBD 2 (n=10), or pure dMSCs (n=10) or none as control (n=10). The repair effect was evaluated by observing the amount of bacteria under the scar, wound healing time and the percentage of remaining wound area. Results The amount of bacteria under the scar in rats that were transplanted with dMSCs modified by hBD 2 was less than that in rats transplanted with dMSCs or controls (P

BACKGROUNDNeoadjuvant chemotherapy is one of the hot points of lung cancer therapy,which has been proven to be able to improve resection rate and 5-year survival of patients.But its effect on operation safety is not clear yet.The aim of this study is to confirm the effect of neoadjuvant chemotherapy on pulmonary arterial wall so as to assess its safety for operation in patients with lung cancer.

METHODSThirty-two patients underwent lobectomy or pneumonectomy with mediastinal lymphadenectomy after a neoadjuvant chemotherapy,compared with 36 patients surgically treated only.During the operation,the changes of thoracic structure were observed.After the operation,the pulmonary artery specimens were detected pathologically.

RESULTSThe incidence of pleural fibrosis and thickening of pulmonary arterial tunica adventitia in neoadjuvant chemotherapy group was significantly higher than those of control group(59.38% vs 22.22%,P < 0.01;68.75% vs 19.44%,P < 0.01).The incidence of tunica intima,internal elastic membrane and tunica media damage in neoadjuvant chemotherapy group was also markedly higher than those of control group(65.62% vs 33.33%,P < 0.01;59.38% vs 19.44%,P < 0.01;71.88% vs 22.22%,P < 0.01).

CONCLUSIONSNeoadjuvant chemotherapy may lead to pleural fibrosis and thickening of pulmonary arterial tunica adventitia and increase crispness of pulmonary arterial wall,which may increase difficulty and risk of operation.

BACKGROUND AND OBJECTIVES: The aim of this study was to identify clinical, lesional, and procedural predictors for adverse outcomes of coronary angioplasty and stenting in coronary bypass candidates. SUBJECTS AND METHODS: This cohort study included 107 consecutive candidates for coronary artery bypass surgery who underwent percutaneous coronary intervention with multiple coronary stents between Jan 2004 and Dec 2011. The study endpoint was major adverse cardiovascular events (MACEs) including all-cause mortality, nonfatal myocardial infarction, repeat revascularization, and stent thrombosis. Follow up was from the date of index percutaneous coronary intervention to the date of the first MACE, date of death, or December 31, 2015, whichever came first. RESULTS: In this study (age 62.3±11.2 years, 86% male), 38 patients (36%) had MACE. Among baseline, angiographic, and procedural parameters, there were significant differences in lower left ventricular ejection fraction (LVEF) and worse renal function. In a Cox regression model, LVEF and chronic kidney disease (CKD) were significant predictors for MACE. After a multivariate adjustment, CKD remained a significant predictor of MACEs (hazard ratio: 2.97, 95% confidence interval: 1.50-5.90). CONCLUSIONS: For coronary bypass candidates who were treated with coronary angioplasty and stenting, CKD seems to be the strongest predictor for adverse outcomes compared with other traditional factors.
Angioplasty ; Cohort Studies ; Coronary Artery Bypass ; Coronary Artery Disease ; Follow-Up Studies ; Humans ; Mortality ; Myocardial Infarction ; Percutaneous Coronary Intervention* ; Renal Insufficiency, Chronic* ; Stents ; Stroke Volume ; Thrombosis

PURPOSE: At present, there is still controversy between parents of children with muscular dystrophy (MD) and health-care professionals on care issues. Partnerships can connect the affected children and their families to appropriate health-care services, to jointly face the care environment together and thereby improve the quality of life of children with MD. Therefore, the objective of this study was to explore partnerships between families and health-care professionals from the perspectives of parents of children with MD. METHODS: Husserl's phenomenological research was applied to explore the basic structures of parents' descriptions of MD. Through purposive sampling, we conducted in-depth interviews with parents, and analyzed the data according to the theory of Giorgi. Nineteen parents (10 mothers, 9 fathers) participated in this study. The precision of the research results was tested by applying the four standards of Lincoln and Guba. RESULTS: This study identified five constituents: feasible resources and detailed care information; the provision of an integrated medical care across systems; family and home as key elements in critical care; respect and care for family care demands; and finally, feedback and support from families. CONCLUSION: This study demonstrated that partnerships were established by health-care professionals, enhancing the care capacity of the families, developing the preventive medicine of MD, and enhancing children's potential for self-care within the families. Hospital policies should include the promotion of family partnership care. The findings can help health-care professionals recognize the life experiences of children with MD when providing medical care.
Child* ; Critical Care ; Humans ; Life Change Events ; Mothers ; Muscular Dystrophies* ; Parents ; Partnership Practice ; Preventive Medicine ; Quality of Life ; Self Care

Purpose: We examined the self-care experiences of adolescents with spinal muscle atrophy (SMA) and their perceptions of the interactions between their body and the environment. Methods: We interviewed ten adolescents with SMA aged 13–18 years regarding personal care practices. Purposive sampling was conducted in two medical centers in northern Taiwan. Data were analyzed using the Giorgi analysis method. Results: Four constitutions were identified: (1) limited space for independent development, (2) multiple reconstructions of self-image to improve physical ability, (3) self-care of disease, and (4) developing activity styles to accommodate social culture. Conclusion The self-care lived experiences of patients reflect dynamic changes in the body and environment. Self-existence was exhibited by adjustment, practice, and creativity of physical activity to integrate into society. Nursing staff should understand the self-care experiences and needs of adolescents with SMA to develop a database of self-care skills. This study recommended that nursing staff improve their ability to guide patients in taking care of themselves by developing body awareness self-care courses and individual care plans in response to various stages of disability to help patients delay deterioration, realize their physical potential, and promote independence and social development.