OBJECTIVE To explore the systemic prevention messures of ventilator-associated pneumonia(VAP).METHODS Mesures were taken to 54 patients to prevent infection in 54 from 2006 to 2008 and 52 patients with similar symptoms at the same interval time were chosed as control.RESULTS In the test group VAP occurred in 14.81%,with(11.11%) of mortality.In control group VAP accounted for 42.31%,with(26.92%) of mortality.CONCLUSIONS Systemic prevention messures can decrease VAP occurrance.

Objective To present the clinical effect of dorsal carpometacarpal island flap with fascia, vessel and nerve to repair soft tissue defected. Methods The island flap was designed with root of fascia, dorsal metalcarpals artery and nerve.The flap to soft tissue defected in the nearby area was applied, including 30 cases in the last segment of thumb, 4 cases in the first segment of thumb, 1 case in the IP articulation of thumb, 1 case in the first segment of middle finger, 1 case in the carpometacarpal dorsal area and 1 case in the back of index finger. Results Thirty-eight cases were survived. All cases obtained good appearance and sensory recovery approach normally with little affection in supply area. Conclusions This method has advantage of simple, practical, high survive rate, low impairment, sensible and good appearance.

Abatract:Objective To observe the structure of human skin equivalent (HSE)model in vitro,and to preliminarily assess the barrier function of HSE.Methods The HSE model was established by two steps:preparation of dermal layer and preparation of full-thickness skin.Keratinocytes were inoculated on the surface of dermal layer prepared by type 1 collagen coating fibroblasts.After submerged cultured for one week,air-liquid interface cultured for three weeks to enhance the proliferation of keratinocytes,the HSE model was obtained.Then the macroscopical structure and electon microscopical structure of HSE were studied.To investigate the barrier function of HSE model,indometacin was selected as the model drug for the penetration testing in vitro.Results The structures similar to dermal layer and epidermal layer of human skin were developed in HSE model,furthermore,complete straum corneum with similar ultrastructure of human skin was developed on the surface of epidermal layer.The penetration testing showed that the barrier function of HSE was slightly lower than that of rat abdominal skin within 24 h,but the cumulative content (Q24 )of indometacin of HSE was far slower (only 28%)than rat abdominal skin from 22 to 24 h.However,the steady state flux of indometacin showed no significant difference in HSE model and rat abdominal skin(P >0.05).Conclusion The morphology and structure of HSE model were close to human skin;and in HSE model,the barrier function against indometacin was almost as the same as the rat abdominal skin.It is expected that HSE model be an alternative option of animal skin to evaluate the effect of transdermal drug delivery system.

Objective:To investigate the clinical effect of Flow-through perforator flap of posterior interosseous artery in repair of dorsal digital soft tissue defect with disorder of blood supply in digital tip.Methods:From January 2018 to June 2020, 12 patients who had digital dorsum soft tissue defect with digital tip blood supply disorder were treated with Flow-through perforator flap of posterior interosseous artery. The size of flaps was 2.0 cm× 2.0 cm-5.5 cm×3.0 cm. The posterior interosseous artery in the flap was bridged with the proper palmar artery of digit, 1 subcutaneous vein in the flap was anastomosed with the dorsal subcutaneous vein, and 1 subcutaneous vein in the posterior interosseous artery with the palmar subcutaneous vein. The donor sites were sutured directly. The wound healing, blood supply of digit and flap survival were observed after operation. The quality of flap survival and digital joint function were observed in the follow-up reviews at outpatient clinic.Results:All the 12 Flow-through perforator flaps of posterior interosseous artery survived, the blood supply of digit was good, and the wounds healed in the first stage. The follow-up period was 6-24 months. The appearance and texture of the flaps were good without obvious bloating. Only linear scar was left in the forearm donor site. According to the Trial Standard of Upper Limb Function Evaluation of Chinese Society of Hand Surgery, the results were excellent in 11 cases and good in 1 case.Conclusion:The perforator flap of posterior interosseous artery has constant anatomy, and the diameter of blood vessel matches the blood vessels of digits. It is suitable for Flow-through technique. It has less subcutaneous tissue, no secondary thinning, and the donor site can be closed directly. It is a good method to repair the dorsal soft tissue defect with disorder of digital end blood circulation.

OBJECTIVE To construct physiologically based pharmacokinetic model(PBPK) model of rosuvastatin in fasting state to predict its absorption in postprandial state and explore its possible food effect mechanism. At the same time, reasonable dietary suggestions were put forward for hyperlipidemia patients taking statins to improve the absorption of BCS Ⅲ statins. METHODS According to the literature and existing research, the physicochemical parameters, biopharmaceutical parameters and pharmacokinetic parameters of rosuvastatin modeling were obtained. The PBPK prediction model of rosuvastatin postprandial administration was established by GastroPlusTM software, and the model was verified by the measured blood concentration data to determine whether the drug absorption results of rosuvastatin postprandial can be accurately predicted, and the parameter sensitivity analysis was carried out. RESULTS The PBPK model of rosuvastatin was constructed to predict its postprandial absorption. The average folding error and absolute average folding error of the model prediction data and the measured data were calculated to be less than 2, and the fitting correlation coefficient combined with model verification showed that the fitting was good. At the same time, parameter sensitivity analysis showed that high-calorie diet, drug LogD and permeability had a greater impact on the absorption of rosuvastatin. CONCLUSION The established model can better predict the absorption of rosuvastatin after meals. Based on the results of parameter sensitivity analysis, reasonable dietary recommendations are proposed for hyperlipidemia patients taking BCSⅢ statins, including appropriately increasing the proportion of protein in the diet, reducing the proportion of fat and water-soluble dietary fiber, etc., to improve the intestinal absorption of BCSⅢ statins.