[Objective] To investigate the result from continuous quality improvement of care management in the prevention of ventilator-associated pneu-monia(VAP).[Method] The ICU patients from June to December 2010 were selected in a control group before the continuous quality improvement ,and the ICU patients from January to June 2011 were selected in the observation group after the continuous quality improvement. Before and after the contin-uous quality improvement,to investigate and analyze their knowledge on VAP and their adherence of continuing implementation about the VAP bundle nursing strategy in 26 medical staff.[Results] After the continuous quality improvement ,there was more significantly difference in their knowledge on VAP and their adherence of continuing implementation about the VAP bundle nursing strategy than before. By the continuous quality improvement, the VAP infection rate decreased from 41.2%to 23.7%,and the difference was statistical y significant. [Conclusion] In the care management for preventing VAP ,the application of continuous quality improvement management can increase the awareness of VAP ,improve the implementation of VAP prevention and con-trol measures,and reduce the incidence of VAP.

A melanoma is a highly malignant tumor that originates from melanocytes in the skin, mucosa, or tunica pigmentosa. The incidence and mortality rate of cutaneous melanoma are increasing annually. However, the efficacy of traditional therapy is extremely limited because of its low sensitivity and high toxicity. The application of the anti-CTLA-4 antibody and the BRAF inhibitor dramatically improves the overall survival of patients with advanced melanoma. However, their limited benefit ratio and high drug resistance curtail the use of anti-CTLA-4. Since the US Food and Drug Administration approved the use of the anti-PD-1 and anti-PD-L1 antibodies for ad-vanced melanoma in 2014, a significant survival benefit has been observed in patients with advanced melanoma. This review aims to highlight the applications of the anti-PD-1 antibody (pembrolizumab, nivolumab, and pidilizumab) and the anti-PD-L1 antibody (MP-DL3280A, BMS-936559, and MEDI4736) in the clinical treatment of melanoma by succinctly summarizing the results of recent reports.

0 05).Among the 13 patients with liver damage,AKP and ? GT were raised in 6,and AKP,? GT,TBIL and DBIL all elevated in 4 In 8 patients anti SMA and AMA were detected,and 5 showed AMA positive.Liver biopsy in 6 patients showed 3 with chronic active hepatitis among which 2 were complicated with liver cirrhosis,1 chronic persistent hepatitis and 2 cholangitis.Of the 6 patients 5 showed different degrees of infiltration of mononuclear cells in the portal tracts.Conclusion The occurrence of liver damage in pSS is rather high.The liver damage may be related to primary biliary cirrhosis (PBC).Patients′ response to corticosteroid treatment is favourable and their prognosis appears good.

0 05).Conclusion The standards of Amor and ESSG have higher sensitivity and specificity to diagnose spondyloarthropathy in China.The two standards have no difference in statistics.

Objective: To investigate the characteristics of etiology and drug resistance of nosocomial infection in the neurosurgery intensive care unit(NICU),and provide useful information for clinical practice.Methods: We analyzed the clinical data of 179 cases of nosocomial infection among 1 163 patients admitted in the NICU from June 2005 to March 2007.Results: From the 179 patients,346 strains of bacteria were obtained,of which Gram's negative bacili accounted for 52.89%,Gram's positive cocci 38.15% and fungi 8.96%.Of the diagnosed nosocomial infections,83.80% involved the lower respiratory tract,10.61% the urinary tract,2.79% the blood vessels,1.68% the central nervous system and 1.12% the hematological system.Conclusion: To reduce nosocomial infections in the NICU,emphasis should be placed on the control of lower respiratory tract infection as well as on the prevention and treatment of Gram's positive coccus infection in the acute stage and Gram's negative bacillus infection in the later stage.Intensified prevention measures based on the standard ones could help to get the drug-resistant strains under control.

Objective To explore the ultrasonographic manifestations of the fetal with asplenia syndrome. Methods At 21751 cases of fetal systemic ultrasound examination during 20-40 weeks, 4 cases with asplenia syndrome were diagnosed. and the ultrasonographic manifestations of the 4 cases were analyzed retrospectively. Results The ultrasonographic features of fetal asplenia syndrome;①with complex and serious cardiovascular malformation; ②visceral transposition; ③ absence of spleen. Conclusions When the complex cardiovascular malformations were found by prenatal ultrasound,the position of fetal spleen and internal organs in order to early diagnosis of fetal asplenia syndrome.

Objective To examine the usefulness of shock index (Sl) and adjusted shock index (corrected to temperature) (ASI) in predicting prognosis of patients with return of spontaneous circulation after cardiac arrest.Methods A prospective study,which data such as vital signs of the cases were collected by the Utstein template,was conducted in 111 of cases with return of spontaneous circulation after cardiac arrest to assess the value of SI and ASI for predicting their prognoses.Results There was no evidence to show difference between the cases with survival to hospital discharge and the ones who died about systolic blood pressure and heart rate (P ＞0.05).SI and ASI [(1.109 ±0.428) and (1.082 ±0.410)] of the group of death were higher significantly than the ones [(0.899 ± 0.303) and (0.844 ± 0.265)] of the group with survival to hospital discharge,P ＜ 0.05.The risk of death was elevated in the group with ASI ＞ 1.1,which odds ratio (5.4) higher than the ones of systolic blood prcssure ＜90 mm Hg (1.6)and ventricular rat ＞ 100 beat/min (3.1) significantly.The odds ratio of death with AS ＞ 1 was 2.8.Conclusions Shock index and adjusted shock index are easy to derive and conducive to predict effectively diseases prognosis such as survival to hospital discharge or death of patients with ROSC.

Objective The coronary slow flow phenomenon (CSFP) is a coronary artery disease with a benign course,but its pathological mechanisms are not yet fully understood.The purpose of this controlled study was to investigate the cellular content of blood in patients diagnosed with CSFP and the relationship of this with coronary flow rates.Methods Coronary angiographies of 3368 patients were selected to assess thrombolysis in myocardial infarction (TIMI) frame count (TFC) values.Seventy eight of them had CSFP,and their demographic and laboratory findings were compared with 61 patients with normal coronary flow.Results Patients'demographic characteristics were similar in both two groups.Mean corrected TFC (cTFC) values were significantly elevated in CSFP patients (P ＜ 0.001).Furthermore,hematocrit and hemoglobin values,and eosinophil and basophil counts of the CSFP patients were significantly elevated compared with the values obtained in the control group (P =0.005,P =0.047,P =0.001 and P =0.002).The increase observed in hematocrit and eosinophil levels showed significant correlations with increased TFC values (r =0.288 and r =0.217).Conclusion Significant changes have been observed in the cellular composition of blood in patients diagnosed with CSFP as compared to the patients with normal coronary blood flow.The increases inhematocrit levels and in the eosinophil and basophil counts may have direct or indirect effects on the rate of coronary blood flow.

Objective_ To investigate the effect of resting heart rate on the progression to diabetes in impaired glucose regulation patients. Methods A total of 638 patients with impaired glucose regulation, from January 2011 to December 2012 in our endocrinology clinic, were selected for the study. According to the resting heart rate, patients were divided into four groups:<66 beat/min group, 66 to 69 beat/min group, 70 to 75 beat/min group, and>75 beat/min groups. All patients'baseline data were collected. The incidences of diabetes in different resting heart rate groups were compared, and the relationship between resting heart rate and the progression to diabetes was estimated using multiple regression analysis. Results In 704 patients with impaired glucose regulation, 636 patients have been completed 2 years follow-up, or reached the end of follow-up ( diagnosed as diabetes ) , the follow-up rate was 90. 34%. During two years follow-up, the incidence of diabetes of<66 beat/min group, 66 to 69 beat/min group, 70 to 75 beat/min group, and>75 beat/min group were 16. 2%, 19. 4%, 25. 0%, and 33. 0%, respectivlely. And the Cochran Armitage trend test showed that χ2 =11. 109, P=0. 001, the difference was statistically significant ( P<0. 05). According to blood glucose monitoring, the 636 patients with impaired glucose regulation were divided into impaired fasting glucose group, impaired glucose tolerance group and impaired fasting glucose combined with impaired glucose tolerance group:the Cochran Armitage trend test showed that, with the resting heart rate accelerating, the incidence of diabetes increased. The incidence of diabetes in impaired fasting glucose combined with impaired glucose tolerance group was higher than that of impaired fasting glucose group and impaired glucose tolerance group ( P=0. 062, 0. 113). The average resting heart rate in 68 impaired glucose regulation patients progressed to diabetes was (79.8±8.3)beat/min,andin568non-diabetescases,itwas(74.5±7.2)beat/min(t=-5.043,P<0.01). With the use of patients progressing to diabetes as the dependent variable, different resting heart rate group as independent variables, and resting heart rate<66 beat/min group as a reference, the logistic regression analysis showed that the risk of the progression to diabetes increased with the resting heart rate levels. Conclusion Higher resting heart rate is linked to higher risk of diabetes in patients with impaired glucose regulation.

OBJECTIVE:To discuss the effect of trastuzumab combined with chemotherapy on efficacy and serum tumor mark-ers in patients with human epidermal growth factor receptor 2(HER2)positive advanced gastric cancer. METHODS:74 advanced gastric cancer patients in HER2 positive were randomly divided into observation group and control group,37 cases in each group. Control group received cisplatin + capecitabine chemotherapy;based on it,observation group additionally received trastuzumab by intravenous infusion in the first day,8 mg/kg. 21 d was a course,and it lasted for 6 months. The short-term efficacy,long-term effi-cacy,serum tumor marker contents and toxic and side effects were compared between 2 groups. RESULTS:The effective rate (56.76% vs. 32.44%)and control rate(89.19% vs. 65.86%)in observation group were significantly higher than control group,the differences were statistically significant(P<0.05);progression-free survival time and median survival time in observation group sig-nificantly longer than control group,the differences were statistically significant(P<0.05);contents of serum carcinoembryonic anti-gen,carbohydrate antigen (CA)199,CA724 in observation group significantly lower than control group,the differences were statis-tically significant(P<0.05). And there were no significant differences in the incidences of nausea and vomiting,liver damage,bone marrow suppression and hand-foot syndrome in 2 groups (P>0.05). CONCLUSIONS:Trastuzumab combined with chemotherapy helps to reduce serum tumor markers content,and improve short-term efficacy,long-term efficacy of advanced gastric cancer patients with positive HER2.