OBJECTIVE:To probe into the utilization of sedative hypnotics in outpatient prescriptions of our hospital. METHODS: In Mar. 2008, 1 317 prescriptions of sedative-hypnotics randomly selected from total 49 791 outpatient prescriptions were analyzed regarding the rationality of the utilization of top 5 drugs on the list of DDDs. RESULTS: The top 5 sedative hypnotics on the DDDs list were Alprazolam tablets, Estazolam tablets, Lorazepam, Zolpidem tablets (Stilnox) and Clonazepam tablets, and their DUIs were 0.54, 0.73, 0.19, 0.81 and 0.53, respectively. CONCLUSION: The dosages of sedative hypnotics in our hospital were basically reasonable and in conformity with the indications listed in package inserts.

Objective To explore the modified mesh in female pelvic floor reconstruction for pelvic organ prolapse and clinical effects of the application.Methods 78 patients with pelvic organ prolapse,line modified mesh pelvic floor reconstruction surgery(study group)and vaginal hysterectomy and vaginal repair of anterior and posterior wall(control group)treatment,clinical efficacy was compared.Results The mean operating time,blood loss,average body temperature,catheter indwelling time,residual urine volume,and postoperative hospital stay showed no significant difference(P＞0.05).No postoperative infection,vaginal hematoma,mesh erosion occurred.Two groups of patients before discharge degree of POP-Q points are 0°or Ⅰ degree,to cure the standard.Vaginal length of the control group was significantly shorter than after treatment(P＜0.05),while no significant change in the observation group(P＞ 0.05).Control group,the recurrence rate was significantly higher than the observation group(P＜0.05),while the observation group of sexual satisfaction was better than the control group(P＜0.05).Conclusion The modified mesh treatment of female pelvic floor reconstruction is an effective method of pelvic organ prolapse,the surgical curative effect is better,the recurrence rate is lower,worthy of clinical application.

Objective To investigate the application value of recombinant human growth hormone ( rhGH) in the treatment of severe burns .Methods 36 patients with severe burns were selected and randomly divided into the observation group and control group ,18 cases in each group .Both two groups used the same anti-infection therapy , nutritional support and surgical methods .The observation group received rhGH subcutaneous injection therapy , the control group used the same amount of daily injections of 0.9%sodium chloride.The levels of tumor necrosis factor-α( TNF-α) and interleukin 6 ( IL-6 ) , wound healing time , hospitalization time and other indicators were compared between the two groups.Results 7d,14d after treatment,the TNF-αand IL-6 levels of the two groups were (18.4 ± 3.3)ng/L vs (24.9 ±7.3)ng/L,(133.2 ±66.9)ng/L vs (271.4 ±88.9)ng/L,(15.4 ±3.2)ng/L vs (25.4 ± 4.9)ng/L,(90.9 ±20.8) ng/L vs (200.7 ±62.2) ng/L,the differences were significant between the two groups (t=3.74,4.75,4.02,4.69,all P<0.05).The healing time and hospital stay in the observation group were signifi-cantly shorter than those of the control group (t=3.75,3.86,4.75,4.64,all P<0.05).Conclusion rhGH therapy can significantly improve the wound healing of severe burn patients ,reduce hospitalization time,it has good clinical results.

Objective To investigate the antibiotic resistance of extended-spectrum-β-1actamases (ESBLs)-producing Escherichia coli (E.coli) and Klebsiella pneumoniae (K.pneumoniae) isolates and the risk factors of bloodstream infections caused by these strains.Methods Clinical data of 131 patients with E.coli or K.pneumoniae-induced bloodstream infections admitted in the Second Affiliated Hospital of Zhejiang Chinese Medical University during September 2009 and June 2014 were retrospectively analyzed.Species identification and antimicrobial susceptibility test were performed by Vitek 2 system,and ESBLs production was tested by standard disk diffusion method.Logistic regression analysis was performed to identify the risk factors of bloodstream infections induced by ESBLs-producing strains.Results Among 131 patients,65 were infected with ESBLs-producing strains,and 66 were infected with non-ESBLs-producing strains.The resistance rates of ESBLs-producing strains were above 50％ for penicillin,aztreonam and third/fourth generation cephalosporins,which were significantly higher than those of non-ESBLs producing strains.The resistance rates of ESBLs-producing E.coli and K.pneumoniae to carbapenems and piperacillin/tazobactam were 0-2.0％,2.3％ and 0-14.3％,26.7％,respectively.The univariate analysis revealed that patients with exposure to cephalosporins in recent 3 months (x2 =18.322,P ＜ 0.01),prior infection with ESBLs-producing strains (x2=14.610,P＜0.01),indwelling catheter in recent 3 months (x2 =13.016,P ＜ 0.01),history of hospitalization in recent 3 months (x2 =11.269,P ＜ 0.01),exposure to quinolones in recent 3 months (x2 =10.638,P ＜ 0.01),nosocomial infection (x2 =8.205,P ＜ 0.01),history of indwelling deep venous catheter or percutaneous central catheter in recent 3 months (x2 =4.817,P ＜ 0.05) and exposure to glucocorticoid hormone in recent 3 months (x2 =4.265,P ＜ 0.05) were associated with infection of ESBLs-producing strains.Multivariate Logistic regression analysis revealed that exposure to quinolones in recent 3 months (OR =6.851,P ＜ 0.01),prior infection with ESBLs-producing strains (OR =6.344,P ＜ 0.01),exposure to cephalosporins in recent 3 months (OR =3.719,P ＜ 0.01),and indwelling catheter in recent 3 months (OR =3.180,P ＜ 0.05) were independent risk factors for ESBLs-producing E.coli or K.pneumoniae infection.Conclusions ESBLs-producing E.coli or K.pneumoniae isolates are highly resistant to most antibiotics,and multidrug-resistance is common.Carbapenems were still the most effective antibiotics against ESBLs-producing E.coli or K.pneumoniae infection.Rational use of cephalosporins and quinolones,strictly following aseptic technique in operation,strict use of indications for indwelling catheterization,and completely eradicating ESBLs-producing strains in previous infections may be helpful in reducing bloodstream infections by ESBLs-producing E.coli or K.pneumoniae.

Objective To investigate the effect of comfort nursing on dysphoria patients in neurosurgical department.Methods Thirty-six patients with dysphoria in the neurosurgical department were treated with comfort nursing. The degree of dysphoria after implementation of comfort nursing and the incidence of nursing-related adverse events were investigated.Results The degree of dysphoria in the patients after implementation of comfort nursing was lower than that after the implementation(P<0.05).There were 3 cases(8.33%)of nasogastric tube slippage and skin injury,2 cases(5.56%)of urinary catheter slippage and no case of falling out of bed.Conclusions The implementation of comfort nursing can stabilize the mood of patients and comfort the patients. It is helpful for abating the degree of dysphoria of patients,reducing the adverse effects of nursing work and ultimately improving the quality of nursing.

BackgroundFew studies have compared change in the health-related quality of life (HRQL) following treatment of non-ST-elevation acute coronary syndrome (NSTE-ACS) with either percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG). This study is tocompare changes in HRQL six months after hospital discharge between NSTE-ACS pa-tients who underwent either PCI or CABG.Methods HRQL was assessed using the Seattle angina questionnaire at admission and six months after discharge in 1012 consecutive patients with NSTE-ACS. To assess associations of PCI and CABG with HRQL changes, logistic regression models were constructed treating changes in the score of each dimension of the Seattle angina question-naire as dependent variables.Results Although both the PCI and CABG groups experienced angina relief and other improvements at 6-month follow-up (P<0.001), the CABG relative to PCI group showed more significant improvements in angina frequency (P= 0.044) and quality of life (P= 0.028). In multivariable logistic analysis, CABG also was an independent predictor for both im-provement of angina frequency (OR: 1.62, 95%CI: 1.09-4.63,P= 0.042) and quality of life (OR: 2.04, 95%CI: 1.26-6.92,P= 0.038) relative to PCI.Conclusions In patients with NSTE-ACS, both PCI and CABG provide great improvement in disease-specific health status at six months, with that of CABG being more prominent in terms of angina frequency and quality of life.

Objective To detect specific IgM of Lyme disease indirect ELISA using recombinant outer surface protein C(OpsC)of Borrelia burgdorferi in vitro was established. Methods Coated concentration of recombinant OspC and dilution multiple of serum anol concentration of enzyme secondary antibody were determined by block,and degree of percision.specificity interference and interruption test were performed. Results Best concentration of OspC was 150 μg/L.within-run CV was 6.3% between-run CV was 11.8%.Confimred 33 Lyme patients in clinic and 57 controls were examined meanwhile by this method and import ELISA kit,coincidena rate was 97.8%.Conclusion This ELISA using recombinant OspC was a good method for early diagnostic of Lyme disease.

Objective To explore the inhibitor of growth family member 4 (ING4) and hypoxia inducible factor-1α(HIF-1α)expression in colorectal cancer and the prognostic significance. Methods Immunohistochemistry was used to detect the ING4 and HIF-1α expression in 133 cases of colorectal cancer tissues and 76 cases of normal rectal tissues. Survival analysis was performed on the following data. Results ING4 in colorectal cancer tissues with positive rate (53.4%) was significantly lower than normal rectal tissue (85.5%) and the difference was statistically significant (P < 0.01); HIF-1α in colorectal cancer tissues with positive rate (69.9%) is higher than normal rectal tissue (42.1%), and the difference was statistically significant (P < 0.01); ING4 and HIF-1αexpression was related with tumor differentiation, Dukes stage and lymph node metastasis (P < 0.05); colorectal cancer tissues ING4 and HIF-1α expression was negatively correlated (r = -0.317, P < 0.001); By multivariate analysis, tumor differentiation, Dukes stage, lymph node metastasis, ING4 expression of HIF-1α expression has independent prognostic significance. Conclusion ING4 and HIF-1α may be involved in the occurrence and development of colorectal cancer , and combined detection could help determine the prognosis of colorectal cancer.

Objective To observe the changes of serum levels of inflammatory cytokines in the elder patients with clopidogrel resistance (CLR) after coronary stenting. Methods A total of 93 patients with unstable angina pectoris received coronary stenting were enrolled, and peripheral blood samples were taken before and 24 hours, 1 week and 1 month after surgery. The platelet aggregation (PAG) induced by adenosine diphosphate (ADP) were detected, and all patients were divided into CLR group (n=33) and normal response group (n=60) according to PAG response. At the same time, the levels of C-reactive protein (CRP), soluble fragment of CD40 ligand (sCD40L) and P-selectin were detected by enzyme-linked immunosorbent assay. Results The incidences of CLR were 35. 5% (33/93), 26. 9%(25/93) and 20. 4%(19/93) respectively 24 hours, 1 week and 1 month after surgery. The levels of CRP C(8. 8 ± 2. 5) mg/L at 24 hours, (5. 3 ± 2. 5) mg/L at 1 week], P-selectin [(73. 8±34)×10~(-3) ng/L at 24 hours, (70. 5±31. 6)×10~(-3) ng/L at 1 week, (66. 4±22. 3) ×10~(-3) ng/L at 1 month] and sCD40L C(7. 7 ±2. 3)×10~(-3) ng/L at 24 hours] after surgery in CLR group showed significant differences comparing with pre-surgery and normal response group (all P< 0.05). The CLR at 30 days after coronary stenting was significantly correlated with the level of P-selectin (r=1.334) and smoking (r= 1.053). Conclusions The levels of CRP, P-selectin and sCD40L in some elder patients after coronary stenting are increased and may be correlated with CLR. The levels of P-selectin and smoking are the predictors for CLR.

Objective To investigate the pathogen distribution and drug resistance of gram-negative bacteria causing lower respiratory tract infections in patients with acute exacerbation of chronic obstructive pulmonary disease ( AECOPD) .Methods A total of 742 sputum samples were collected from AECOPD patients with lower respiratory tract infections in Taizhou Hospital of Zhejiang Province during January 2013 and December 2014.Vitek 2 Compact system combined with disk diffusion was used for strains identification and drug susceptibility test.Modified Hodge test and ethylenediamine tetraacetic acid (EDTA) synergic test were used to screen carbapenem-resistant strains.Statistical analysis was performed using WHONET 5.6 and SPSS 20.0 software.Results A total of 593 strains of gram-negative bacteria were isolated , in which 367 strains were nonfermentative bacteria (61.89%), 220 strains were enterobacteriaceae (37.10%), and the rest 6 strains ( 1.01%) were other gram-negative bacteria.Acinetobacter baumannii ( 186 strains ), Pseudomonas aeruginosa (99 strains), Stenotrophomonas maltophilia (33 strains) and Burkholderia cepacia (22 strains ) were top 4 nonfermentative bacteria , and they all showed high resistance to ampicillin , ampicillin/sulbactam, cefazolin, ceftriaxone, cefotetan and nitrofurantoin with resistant rates of 67.20%-100.00%. Drug resistance rates to other β-lactams, fluoroquinolones, aminoglycoside, compound sulfamethoxazole and minocycline were significantly higher in carbapenem-resistant Acinetobacter baumannii and Pseudomonas aeruginosa strains than those in non-carbapenem-resistant strains , and the differences were statistically significant (P <0.05 or <0.01).Stenotrophomonas maltophilia and Burkholderia cepacia strains were only sensitive to levofloxacin , compound sulfamethoxazole and minocycline . Klebsiella pneumonia (89 strains), Escherichia coli (80 strains) and Enterobacter cloacae (25 strains) were top 3 enterobacteriaceae , which were almost completely resistant to ampicillin , but were sensitive to piperacillin/tazobactam , cefoperazone/sulbactam , amikacin and carbapenems ( with resistant rates <15%) .More than 50%strains of extended spectrum β-lactamases ( ESBLs )-producing Klebsiella pneumonia and Escherichia coli were moderately or highly resistant to ampicillin/sulbactam , most cephalosporins ( except cefotetan and cefoperazone/sulbactam ), gentamycin, tobramycin, fluoroquinolones, aztreonam, compound sulfamethoxazole and minocycline , and the resistant rates were higher than those in non-ESBLs-producing strains (P <0.05 or <0.01).Conclusions Nonfermentative bacteria and enterobacteriaceae are the most prevalent gram-negative bacterial pathogens in lower respiratory tract infections in patients with AECOPD . Carbapenem-resistant Acinetobacter baumannii and Pseudomonas aeruginosa strains, as well as ESBLs-producing Klebsiella pneumonia and Escherichia coli strains are highly resistant to most antibacterial agents .