Objective To explore and analyze the optimal timing of surgery and clinical efficacy of minimally invasive drilling drainage in the treatment of hypertensive cerebral hemorrhage .Methods 150 patients with hyperten-sive cerebral hemorrhage ,according to a random number table method ,were randomly divided into the three groups , 50 patients in each group.Patients in group A received minimally invasive drainage drilling within 6h after the onset of disease,patients in group B received minimally invasive surgery 6-24h after the onset,patients in group C were given elective minimally invasive surgery 24-72h after the onset.Another 50 patients with hypertensive cerebral hemorrhage who received craniotomy surgery over the same period ,were selected as the control group .The clinical effects were observed and compared in four groups .Results The total effective rate of group B was 88%,which was significantly higher than the other three groups (χ2 =4.00,6.38,12.70,all P<0.05).The early cure rate of the observation group was 40%,which was significantly higher than the control group (χ2 =8.57,P<0.05).After treatment,the number of cases whose activities of daily living degree recovered to grade I in the observation group was significantly higher than the other three groups (χ2 =4.11,5.00,8.32,all P<0.05).The excellent rate of group B was 88%(44/50),which was significantly higher than the other three groups (χ2 =6.83,5.83,15.43,all P<0.05).After treatment,the incidence rate of complications in group B was significantly lower than the other three groups ,the inci-dence rate of complications in the control group was the highest (χ2 =5.32,8.58,32.97,all P<0.05).Conclusion Minimally invasive drilling drainage in the treatment of hypertension cerebral hemorrhage can obtain significant effect , the optimal timing of surgery is 6-24h,minimally invasive treatment has advantages of less invasive ,faster recovery,fe-wer complications ,and less costs ,which is worthy of widely used in clinical practice .

ObjectiveTo evaluate the late-phase enhancement of carotid artery in patients with cerebral infarction by contrast-enhanced ultrasonography.MethodsSixty-eight patients whose bilateral carotid artery plaques were both wider than 1.5 mm with treatment in Zhejiang Provincial People?s Hospital from April to July in 2013 were enrolled in this study. Among the enrolled patients, there are 50 patients with cerebral infarction including 30 patients with unilateral cerebral infarction and 20 patients with bilateral cerebral infarction, and 18 patients without cerebral infarction. The enrolled patients underwent conventional and contrast-enhanced ultrasonography. The time-intension curve was obtained till 6 minutes after the injection of contrast agent. The late-phase enhancement intensity and relative intensity of maximal carotid plaque was measured and calculated. The differences of late-phase enhancement intensity and relative intensity between patients with cerebral infarction and patients without cerebral infarction, and between ipsilateral and contralateral side of cerebral infarction in patients with cerebral infarction were compared using two samplet test.ResultsThe late-phase enhancement intensity of carotid plaque in patients with cerebral infarction and in patients without cerebral infarction was (6.0±1.5) and (4.9±1.2) dB, respectively, and the relative late-phase enhancement intensity of carotid plaque was 0.9±0.2 and 0.8±0.2, respectively. The late-phase enhancement intensity and the relative intensity of carotid plaque was higher in patients with cerebral infarction compared with patients without cerebral infarction, and the differences had statistical significance (value oft was 2.132 and 2.258 respectively, value ofP were both less than 0.05). The late-phase enhancement intensity of carotid plaque in ipsilateral and contralateral side of cerebral infarction was (7.1±1.8) and (4.9±1.2) dB, respectively, and the relative late-phase enhancement intensity of carotid plaque was 1.2±0.3 and 0.8±0.2, respectively. The late-phase enhancement intensity and the relative intensity of carotid plaque was higher in ipsilateral side of cerebral infarction compared with contralateral side of cerebral infarction in patients with cerebral infarction, and the differences had statistical signiifcance (value oft was 3.132 and 2.953 respectively, value ofP were both less than 0.01).ConclusionThe late-phase enhancement of carotid plaque in patients with cerebral infarction is significantly different from that in patients without cerebral infarction.

Objective To discuss the influence hand hygiene intervention on general ICU acquired methicillin-resistant staphylococcus aureus (MRSA) infection and its improvement. Methods Hand Hygiene Cognition Questionnaire that passed the reliability and validity test was used to compare the change of cognition on hand hygiene of medical staff. According to the results of the questionnaire, the intervention was carried out by continuous intensive training. The compliance with hand hygiene of medical staff was observed by monitoring equipment in the ward. Implementation status and effect of hand hygiene of medical staff on duty were examined randomly each month. At the same time MRSA infection rate of patients in comprehensive ICU was monitored in the same period. The relationship between hand hygiene compliance and MRSA infection rate was analyzed. Results The score of medical staff of cognition of hand hygiene was (41.70±3.67) points before the intervention, while the score was (44.10±3.55) points after the intervention. The difference had statistical significance (t=24.37, P<0.01). The correct rate of hand washing, positive rate of bacterial culture in hand, hand hygiene compliance and infection rate of MRSA of patients in comprehensive ICU were 68.75%, 14.58%, 66.90%, 12.90% respectively before the intervention. The correct rate of hand washing, positive rate of bacterial culture in hand, hand hygiene compliance and infection rate of MRSA of patients in comprehensive ICU were 88.54%, 3.12%, 74.14%, 3.10% respectively after the intervention. The difference had statistical significance (χ2=7.809-24.520, P<0.01). Conclusions Questionnaires with high credibility reviews could better identify issues in hand hygiene compliance, and sustained, reinforcing intervention measures could improve the compliance of hand hygiene; Good hand hygiene practice of medical and nursing staff contributes to controlling MRSA infection rates in general ICU.

ObjectiveTo observe the clinical efficacy of hair needle therapy in treating dry eye syndrome (DES).Method Eighty patients diagnosed with DES were randomized into a treatment group and a control group, 40 cases in each group. The treatment group was intervened by 0.1% Sodium Hyaluronate eye drops plus Hair needle therapy; the control group was by 0.1%Sodium Hyaluronate eye drops alone. The subjects were re-examined after 1-month treatment. The therapeutic efficacy was evaluated by observing the subjective symptoms, SchirmerⅠtest (SIT), tear break-up time (BUT), and fluorescein test (FL).Result The subjective symptoms, SIT, BUT, and FL scores were significantly improved after intervention in the treatment group (P<0.05);the control group only had the subjective symptoms improved after intervention (P<0.05), while other indexes didn’t show significant differences (P>0.05); after treatment, there were significant differences in comparing the subjective symptoms, SIT, BUT, and FL scores between the two groups (P<0.01).ConclusionHair needle therapy plus Sodium Hyaluronate eye drops can produce a more significant efficacy than Sodium Hyaluronate eye drops alone in treating DES.

OBJECTIVE:To compare and analyze the ADR in Chinese Pharmacopoeia(2010 edition)(ChPD)and non-phar-macopoeia quality standard drugs(NChPD)and its standard. METHODS:In respective study,ADR reports and drug utilization da-ta in our hospital from 2012 to 2014 were collected and divided into ChPD group and NChPD group,the index differences were an-alyzed. RESULTS:The percentages of reported ADR to product regulation [(0.27 ± 0.10)%] and to drug use frequency [(0.15 ± 0.06)%] in ChPD group were significantly lower than NChPD group [(0.62 ± 0.08)%、(0.32 ± 0.07)%],with statistical signifi-cance (P<0.05). Compared with the percentage of general reported ADR to drug use frequency in NChPD group [(0.44 ± 0.12)%],there was no significant difference in ChPD group [(0.23±0.09)%](P>0.05);the percentage of new severe reported ADR to drug use frequency in ChPD group [(0.04 ± 0.01)%] was significantly lower than NChPD group [(0.27 ± 0.05)%],with statistical significance (P<0.05). And there were no significant differences in indexes in different years (P>0.05). CONCLU-SIONS:Drug quality standards should be payed more attention,from the perspective of which to reduce the incidence of adverse drug reactions. While the drugs introduced to hospital should be strictly controlled and timely adjust the drug structure;the pharma-copoeia standard drugs should be generalized among doctors to reduce ChPD drug reactions and ensure the drug safety.

Objective:To investigate the association between glutathione S-transferase pi (GSTP1) gene polymorphism and toxici-ties related to high-dose methotrexate (HD-MTX) in children with acute lymphoblastic leukemia (ALL). Methods:GSTP1 genotypes and allelic frequencies in 51 children with ALL were determined by Nest PCR, denaturing gel gradient electrophoresis (DGGE), and DNA sequencing. HD-MTX adverse reactions were analyzed using the National Cancer Institute Common Toxicity Criteria (NCICTC). Results:We identified three SNPs of GSTP1, including rs1695 (A313G), rs1138272 (G439T), and rs4891 (T555C). The wild types, het-erozygous types, and homozygous types of GSTP1 rs1695/rs4891 polymorphisms were detected in 32 cases (62.7%), 16 cases (31.4%), and 3 cases (5.9%), respectively. GSTP1 rs1695/rs4891 polymorphisms included only one heterozygous type and one homozygous type. The allele frequencies of the three SNPs were 21.6%, 2.9%, and 21.6%. The AG+GG/TC+CC genotype of GSTP1 rs1695/rs4891 was associated with decrease in the odds of peripheral hemoglobin (OR=0.25, 95%CI=0.06-1.00, P=0.049). The AG+GG/TC+CC genotype of GSTP1 rs1695/rs4891 in standard and intermediate-risk ALL children was significantly correlated with higher odds of gastrointesti-nal toxicity (OR=0.125, 95%CI=0.02-0.78, P=0.026). Conclusion:GSTP1 rs1695 (A313G)/rs4891 (T555C) gene polymorphism is as-sociated with the reduction of peripheral hemoglobin in ALL children and with the odds of gastrointestinal toxicity in standard and inter-mediate-risk ALL children who receive high-dose methotrexate.

Objective To discuss the clinical significance of fluid management of severe patients according to arterial pressure-based cardiac output (APCO) monitoring volume responsiveness index.Methods A retrospective cohort study was conducted.The severe patients were selected from the intensive care unit (ICU) of the First Hospital of Jilin University from June 1st,2012 to December 31st,2013.The hemodynamic parameters were monitored by APCO,and the fluid resuscitation was managed by stroke volume variation (SVV) and passive leg-raising test (PLR) when the acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ) score ≥ 15,heart rate ＞ 100 bpm with the result that the preload and heart function could not be evaluated.The heart rate,SVV,lactic acid (Lac) and central venous pressure (CVP) and curative effect were recorded before and after carrying out fluid management strategy.The criteria of clinical effective was defined as heart rate decreased and (or) stroke volume (SV) increased ≥ 10％,accompanied by blood Lac and SVV decreased,other than,the cases did not meet above criteria were considered ineffective.Results Sixty-eight patients were enrolled in the study.① Before carrying out fluid management strategy:40 cases with CVP＞ 12 cmH2O (1 cmH2O=0.098 kPa),and 16 cases with 5-12 cmH2O,12 with ＜5 cmH2O.SVV＞13％ in 35 cases,SVV ＜ 13％ in 9 cases.PLR positive in 18 cases,and PLR negative in 6 cases.It was implicated that the patients with poor preload (SVV ＞ 13％ and PLR positive) accounted by 77.9％ (53/68).② There were 49 effective cases and 19 ineffective cases 4 hours after carrying out fluid management strategy,and the effective rate was 72.06％ (49/68).While there were 56 effective cases and 12 ineffective cases after 12 hours,and the total effective rate was 82.35％ (56/68).③ In effective group,heart rate,SVV,Lac after fluid management strategy were significantly lower than those before fluid management strategy [4 hours after fluid management strategy:heart rate (bpm) 112.45 ± 13.53 vs.129.55 ± 15.49,SVV (15.47 ± 6.32)％ vs.(21.20 ± 7.40)％,Lac (mmol/L) 4.16 ± 3.12 vs.6.21 ± 4.11 ; 12 hours after fluid management strategy:heart rate (bpm) 110.02 ± 13.92 vs.129.61 ± 14.93,SVV (14.61 ± 15.52)％ vs.(20.66 ± 7.40)％,Lac (mmol/L) 3.35 ± 2.26 vs.6.11 ± 4.02,P＜0.05 or P＜0.01],while there was no significant difference in those markers between before and after fluid management strategy in ineffective group [4 hours after fluid management strategy:heart rate (bpm) 119.53 ± 11.68 vs.125.79 ± 11.58,SVV (16.95 ±6.48)％ vs.(18.47 ±4.96)％,Lac (mmol/L) 5.55 ± 3.80 比 6.54 ± 3.72 ; 12 hours after fluid management strategy:heart rate (bpm) 115.92 ± 11.71 vs.123.40 ± 11.59,SVV (17.17 ± 6.09)％ vs.(19.42 ± 8.25)％,Lac (mmol/L) 6.33 ± 3.40 vs.7.21 ± 3.81,all P＞ 0.05].CVP only at 12 hours after fluid management strategy in effective group was significantly higher than that before fluid management strategy (cmH2O:12.88 ± 3.38 vs.11.27 ± 4.97,P＜0.05).Conclusion SVV monitored by APCO is a good indicator of volume responsiveness index,which can be used as an important reference combined with PLR for fluid management of severe patients.

Objectives To analyze the incidence of cranial nerve injury in patients after receiving carotid endarterectomy ( CEA) in a single-center and to investigate its correlation with surgical experiences. Methods The clinical data of patients underwent CEA at Beijing Xuanwu Hospital, Capital Medical University from January. 2001 to December 2013 were analyzed retrospectively. Cranial nerve injury was assessed at day 7 after procedure according to the clinical symptoms,and they were followed up at 1,3,6, and 12 months. The incidence of permanent cranial nerve injury was evaluated. The incidences of permanent cranial nerve injury were further analyzed at two time periods ( from January 2001 to September 2011 and from October 2011 to December 2013 ) . Results ( 1 ) A total of 598 consecutive patients treated with CEA were enrolled,and 15 (2. 5%) of them had cranial nerve injury,including 2 (0. 3%) facial nerve injury,7 (1. 2%) hypoglossal nerve injury,and 6 (1. 0%) vagus nerve injury. Only 1 case (0. 2%) did not recover completely at 6 months after procedure. ( 2 ) The patients with cranial nerve injury were 10 (3. 2%,10/308) and 5 (1. 7%,5/290) respectively from January 2001 to September 2011 and from October 2011 to December 2013). There was no significant difference (P < 0. 05). Conclusion The incidence of cranial nerve injury was low after CEA,and most patients could recover completely. The increased surgical experiences did not show the reduction of cranial nerve injury rate evidently after CEA.

Objective To explore the semitivity of ovarian cancer cell line SKOV3 to paclitaxel,oroteasome inhibitors,bortezomib,and their combination.Methods The methyl thiazolyl tetrazolitim (MTT)assay was applied to examine the cell viability after treatment.The annexin V-propidium iodide apoptosis detection kit was used to determine the apoptosis rate of different groups.Western blot assay was used to evaluate the expression levels of phosphorylated protein kinase B(AKT)and glycogen synthase kinase-3 beta(GSK-3β).Results In MTT assay,the cell viability ratios of the combination group at serial time points from 12,24,36,48 and 72 hours Were(65.2±5.8)%,(58.3±14.4)%,(35.3±5.0)%,(19.2±1.5)%,and(11.4 ±2.5)%,which were significantly lower than those of the paclitaxel group (P<0.05).After arug treatments,apoptosis rates of paclitaxel group,bortezomib group and the combination group were (14.7±0.5)%,(15.1±0.8)%and(20.5±0.7)%respectively.The rate of the combination group was significantly higher than that of non-treated group and paclitaxel group(P<0.05).Western blot assay showed the changes in expression levels of phosphorylated AKT and GSK-3β,which were decreased significantly after paclitaxd and bortezomib combination treatment [(3.2±0.8)%,(19.3±0.4)%;P<0.05].Conclusions The lethal effect of paclitaxel on tumor cells could be increased significantly by its combination with proteasome inhibitors,bertezomib.The AKT/GSK-3β signaling pathway plays an important role in the molecular mechanism of the combination treatment.

Objective: To explore the effect of DMAIC(Define, Measure, Analyze, Improve, Control) in reducing catheter-related urinary tract infection. Methods: A retrospective case control method was used to select 578 patients admitted and treated in comprehensive ICU of Tianjin First Central Hospital from January to December 2018 with catheters as research objects.The 283 patients from January to June 2018 were the control group, and 295 patients from July to December 2018 were the observation group.Routine methods were used in the control group, and DMAIC method with 6 sigma management was used in the observation group. The correct rate of implementation of each measure, the utilization rate of urinary catheter and the infection rate between the two groups were compared. Results: Implementation rate of early extubation assessment, urine collection accuracy, urine tube fixed correctly, urine tube cleaning time, urine collection bags location accuracy were 60.42%(171/283), 69.61%(197/283), 79.86%(226/283), 89.40%(253/283), 92.58%(262/283)in the control group, 80.34%(237/295), 90.85%(268/295), 94.92%(280/295), 96.27%(284/295), 97.97%(289/295) in the observation group, the differences were statistically significant (χ²= 9.411-41.415, P < 0.01). The rate of urinary catheter usage was 75.31%(3 856/5 120) in the observation group and 82.60%(4 098/4 961) in the control group, the differences was statistically significant (χ²=80.475, P < 0.01). The rate of catheter associated urinary tract infection was 0.26‰ (1/3 856) in the observation group and 1.95 ‰ (8/4 098) in the control group, the differences was statistically significant (χ²=5.832, P< 0.05). Conclusions DMAIC can improve the accuracy of nursing measures, optimize the catheter care process, and reduce catheter-related urinary tract infections.