Objective To study the impact of therapy strategy on outcomes of patients suffering from severe sepsis and/or septic shock. Method A total of 195 patients diagnosed as severe sepsis or septic shock were enrolled for prospective study from June 2008 to December 2009. Patient's clinical manifestation,treatments and outcomes were studied by using SSC database. Patients were divided into control group and treatment group. In control group, patients enrolled from June 2008 to December 2008, were treated with conventional medical care In treatment group, patients enrolled from January 2009 to December 2009 were treated with a novel algorithm of mandatory treatment for sepsis In-hospital mortality of two groups was compared. SPSS15.0 software was used for analysis of data. Chi-square test and unpaired t-test were used for comparisons between groups. Results Compared to the control group The need for blood lactate test was significantly grown in treatment group [98.2% (115/117) versus 2.56% (2/78), P ＜ 0.001]. Antibiotics was administered to 69.2% (81/117) patients of treatment group within 3 hours after their arrival at the emergency department compared to 35.8% (28/78) in the control group (P ＜ 0. 001). Blood cultures made before antibiotics given were 47.9% (56/117) in the treatment group compared to the control group 25.6%(20/78), P = 0. 003. The rate of fluid resuscitation was 80.3% (53/66) in the treatment group and 27%(10/37) in the control group, P ＜0.001. The rate of CVP (8 mmHg was 27.3% (18/66) in the treatment group and 8.1% (3/37) in the control group, P = 0. 023. In-hospital mortality was 29.1% (34/117) in the treatment group and 44.8% (35/78) in the control group, P =0. 032. Conclusions The algorithm of mandatory treatment for sepsis improved the therapeutic efficacy of the treatment for severe sepsis and septic shock, decreasing in-hospital mortality.

Chitosan and it's derivatives have good biologic and particular physical and chemical properties. They have a wide applied foreground on drug preparations. This study introduced the recent advances of them based on widely researching the information and the actual works, and provided reference for the study of oral drug preparations.

Objective To find out the relativity of diseases and emotional factors,provide foundation for the clinical epidemiologic survey,and to know about the doctors understanding of emotional etiology.Method Consulting to the diagnostic criterion of emotional diseases,whole-team-delamination method was adopted to research 54 703 registered case history of retrospective etiology in hospitals(Established Hospital of Shandong Province,Jinan City Central Hospital,TCM Hospital of Shandong Province) within 3 years.Result The cases that was related to emotions were totally 506,0.92% of all the cases.Of all the positive cases,62.5% of them were cardicvascular diseases,12.06% were digestive diseases,3.56% were gynecologic diseases.Of all the emotional etiology,agitation was 43.87%,anger was 25.69%.Female patients took up 56.72% of all the positive cases.Conclusion Cardiovascular diseases are more related to negative emotions,the basic emotion"anger"is more related to diseases,female is prior to male patients,age is of positive correlation of the occurrence of emotional diseases.

Objective To introduce and translate the Coping-adaptation Processing Scale:Short Form-15 items (CAPS:SF) and evaluate the reliability and validity among people after losing the only-child. Methods CAPS:SF was translated into Chinese (CV-CAPS:SF) according to Brislin. A sample of 77 people after losing the only-child were recruited to complete the scale to evaluate the reliability and validity of scale. Results The scale-content validity index of the CV-CAPS:SF was 0.94;the Cronbachαwas 0.85 and split-half coefficient was 0.84. The score of coping was (38.60 ± 5.30) points. The take strength from spirituality or the successes of courageous people was the highest (3.44±0.50) points;the use humor in handling the situation was the lowest (2.05±0.58) points. Different age, education degree, marital status, occupation, average monthly income of latest year, the length after losing the only-child in the face of the difference was statistically significant (t/F=7.636-85.130, all P<0.05). Conclusions The CV-CAPS:SF is reliable and valid. It could be used to help the nursing staff understand coping among people after losing the only-child .

Objective To investigate the direct economic loss caused by oral infection in patients with acute leuke-mia.Methods Acute leukemia patients with oral infection in a tertiary first-class hospital in Shandong Province be-tween January 2011 and December 2013 were investigated,the 1 :1 matched case-control method was used for com-paring hospitalization expense and length of hospital stay between oral infected (case group)and uninfected patients (control group ).Results A total of 994 patients with acute leukemia were monitored,277 had healthcare-associated infection,17 (5.56%)of whom were with oral infection.The median hospitalization expense of patients in case group and control group was￥37 327 and￥13 176 respectively,the total hospitalization expense of patients in case group was 2.83 times more than control group,difference was statistically significant (Z = -3.621 ,P <0.001).Each hospitalization expense of case group was higher than control group,especially expense for medicine, blood transfusion,laboratory examination,and therapy.The median length of hospital stay in case group and con-trol group were 17 days and 11 days respectively,rank sum test showed that difference in median length of hospital stay between two groups was statistically significant (Z =-3.627,P < 0.001 ).Conclusion Acute leukemia pa-tients with oral infection have increased hospitalization expense,prolonged length of hospital stay,and increased the financial burden.

Objective To investigate the direct economic losses caused by healthcare-associated infection(HAI)in patients with acute lymphoblastic leukemia (ALL)and acute non-lymphoblastic leukemia (ANLL).Methods All acute leukemia (AL)adult patients who were admitted to a hematology ward in a hospital between January 201 1 and December 2013 were included in the study,HAI group(case group)and non-HAI group (control group),ALL group and ANLL group were matched respectively in a 1:1 ratio,hospitalization expenses and length of hospital stay were compared.Results A total of 994 patients were included,166 were with ALL,828 with ANLL,there were 181 pairs of case group and control group,and 15 pairs of ALL group and ANLL group. Direct economic los-ses in ALL group and ANLL group were 13 089.0 ￥ and 21 565.0 ￥ respectively ;extension of length of hospital stay due to HAI were 10.5 and 10.0 days respectively,differences were statistically significant between case group and control group (both P<0.05). The total hospitalization expense,as well as fees for bed,consultation,treat-ment,laboratory examination,nursing,medicine,traditional Chinese medicine,and blood transfusion in ANLL group were all higher than ALL group,but there were no significant difference.Conclusion HAI in patients with AL can increase hospitalization cost and prolong length of hospital stay.

Objective NAC therapy was used to observe the effect of TNF-?,hs-CRP,PaO2,PaCO2and lung function in patients with COPD,so as to evaluate the therapeutic effect. Methods 65 patients with COPD were recruited and the patients were randomly divided into 2 treatment groups:control group (n=31) and experimental group (n=34). Patients in the two groups received the conventional treatment of COPD in unchanged dosage for the duration of the study except stopping using antibotic drug after infection was resolved. NAC tablets were taken orally at a dose of 600mg once a day in experimental group. After 8 weeks treatment,we appraised lung function and the plasma level of TNF-?,hs-CRP,PaO2 and PaCO2. Results Compared with normal controls,the plasma levels of TNF-? and hs-CRP increased significantly. The higher level of those ,the higher lung function class was in 65 COPD patients,and there was significant effect(P

Objective To investigate the anti-fibrotic effect of Kudancao tablets on bleomycin-induced pulmonary fibrosis in rats . Methods Forty healthy adult SD rats(200±20g)were randomly divided into 4 groups: normal control group(without any treatment),normal saline group(intratracheal instillation of normal saline), model group(intratracheal instillation of 5mg/kg of Bleomycin)and kudancao tablets group(intragastric administration of kudancao tablets suspended in normal saline,0.705g/(100 g.d),2 times/day and for 5 times, then intratracheal instillation of 5 mg/kg of Bleomycin 1h later). Rats in all groups were scraficed 14d and 28d after intratracheal instillation. Alkali hydrolysis method was used to detect the HYP content in lung tissues. The pathological changes were observed with HE staining and silver staining. ResultsCompared with the normal control group and normal saline group,the HYP content in the lung tissues of rats in model group increased significantly (P<0.01). Compared with the model group,the HYP content in the lung tissues of rats in kudancao tablets group decreased significantly(P<0.01). Pathological examination showed that significant fibrotic changes were found in lungs of rats in model group,while the fibrotic changes were ameliorated in lungs of rats in kudancao tablets group. ConclusionKudancao tablets may decrease the hydroxyproline content in lung tissues,and ameliorate the fibrotic degree of lungs of rats with bleomycin-induced pulmonary fibrosis.

Objective To investigate the characteristic changes of the metabolism products in the auditory cortex (transverse temporal gyrus) in diabetes combined with nerve deafness using 1 H magnetic resonance spectros‐copy (1 H -MRS) ,and to discover the early warning indicator of nerve deafness in type 2 diabetes .Methods PTA was performed in 98 patients with type 2 diabetes (diagnosed by Endocrinology Department) ,and in 15 healthy sub‐jects in the control group .The patients were classified into four groups :the group of type 2 diabetes;type 2 diabe‐tes with unilateral and bilateral deafness ,and the normal control group .Cerebral metabolism was studied by assess‐ing the ratios of nitro -acetyl aspartate contrast to choline (NAA/Cho) as well as to creatine (NAA/Cr) ,myo-in‐ositol to creatine (mI/Cr) and choline to creatine (Cho/Cr) ratios in the auditory cortical separately in these groups . The Pearson correlation analysis was applied to determine blood glucose value with the nerve metabolites while the ROC curves were made for those metabolism markers to find the best diagnostic threshold .Results NAA/Cr and NAA/Cho were negatively correlated with AHI index and Cho/Cr ,mI/Cr was positively correlated with blood glu‐cose value .Significantly lower values of NAA/Cho ratio were found in patients'(diabetes without deafness) auditory cortex compared with 15 age-matched control subjects (P<0 .05) .NAA/Cr and NAA/Cho ratio in diabetes with deafness were significantly lower than those in control group (P< 0 .05) ,Cho/Cr higher than those of in other groups (P<0 .05) .NAA/Cr and NAA/Cho ratio in injured and uninjured auditory cortex of diabetes with unilateral deafness were significantly lower than those of in control group (P<0 .05) ,then we made a self -comparison be‐tween the injured and uninjured auditory cortex ,finding that NAA/Cho ratio had a significant difference .All of the metabolisms were tested by the curve of ROC .The area of NAA/Cho under the ROC curve was 81% ,which had a higher accuracy .NAA/Cho equal to 1 .65 can be used as boundary indicators between diabetes without deafness and diabetes with deafness groups ,the areas of the remaining indicators under the ROC curve was<50% .Conclusion NAA/Cho may be the early warning marker of nerve deafness in type 2 diabetes .

Objective To investigate the iodine nutritional status of the crowd that did not participate in the iodine deficiency disorders (IDD) survey in iodine deficiency areas in Jiangsu Province so as to provide a basis for prevention and control of IDD.Methods Eight to ten years old children were chosen from the counties(cities,districts) of Jiangsu Province that did not participate in the IDD survey and urine samples of students and salt samples of their families were researched.In each county (city,district) one township (street) was selected according to 5 directions of east,south,west,north,center; in each township one primary school was selected and in each primary school 20 children aged 8-10 were chosen half of the male and female,to collect their urine samples and salt samples at their families.Urinary iodine was measured using arsenic cerium catalytic spectrophotometric method (WS/T 107-2006),and salt iodine was measured using direct titration of universal test method in salt industry (GB/T 13025.7-1999).Iodine nutrition criterion of international health organization recommended staindard:children urinary iodine ＜ 100 μg/L as iodine deficiency,100-199 μg/L as iodine appropriate,200-299 μg/L as iodine more than appropriate,≥ 300 μg/L as iodine excess.Results A total of 7 523 urinary samples of 8-10 years old children were collected from 76 iodine deficiency counties (cities,districts),and the median of urinary iodine was 235.0 μg/L.In all investigated counties (cities,districts),the medians of urinary iodine of 22 counties(cities,districts) were 100-199 μg/L,42 counties(cities,districts) were 200-299 μg/L,and 12 counties (cities,districts) were ≥300 μg/L.A total of 7 523 salt samples were collected,and the median of salt iodine was 29.68 mg/kg; Taizhou City had the highest salt iodine median,which was 31.43 mg/kg; and Lianyungang City,the lowest,25.11 mg/kg.The coverage rate of iodized salt was 98.6％(7 417/7 523); iodized salt qualification rate was 98.6％ (7 312/7 417); and consuming rate of qualified iodized salt was 97.2％(7 312/7 523) in 76 iodine deficiency counties (cities,districts).Conclusions The progress in prevention and control of IDD in iodine-deficient areas that did not participate in IDD survey in the past is good in Jiangsu Province; the overall level of iodine nutrition of whole population is adequate.But the median of urinary iodine in some counties (cities,districts) is at a higher level.