In order to identify problems in the use of antibiotics and propose corresponding countermeasures, a statistical analysis was made into 6 000 prescriptions and medical records detailing the use of antibiotics by outpatients and inpatients randomly selected from the years 2002～2003. It was found that the irrational use of antibiotics was prevalent. It is pointed out that high attention ought to be paid to the issue and countermeasures be adopted, including strengthening physician training in the "three basics", implementing various rules and regulations, adhering to the standards and guides for the use of antibiotics, dynamically tracing the use of antibiotics by means of the computer, and providing timely analysis and feedback of information on the use of antibiotics.

Objective To summarize the effect of bronchoscopy for sputum suction on aspiration pneumonia in elderly patients. Methods 45 elderly patients with aspiration pneumonia treated with bronchoscopy for early sputum suction on the basis of comprehensive treatment were assigned into group A ,and another 44 elderly patients with the same disease receiving the only comprehensive treatment as the control group (group B). After treatment,the two groups were compared in terms of temperature,WBC,arterial blood partial pressure of oxygen and lung shadow resolution. The key links in the operative manipulation were summarized. Results In group A, the temperature and WBC both resumed to the normal level, the time for increased arterial partial pressure of oxygen (PaO2) in group A was significantly shorter than in group B and lung shadow resolution significantly more evident than in group B (P < 0.01). In group A, the sputum suction was completed and there were no cases of death and serious complications. Conclusions Early bronchoscopy for sputum suction in the treatment of aspiration pneumonia in elderly people is effective. Skilled operation and accurate grasping of the key points of the suction process make sure that this technology can be more applicable in clinical practice.

Objective To investigate and analyze the cause of the illness, types and conditions combined with dysfunction of important organs and death of severe heatstroke patients in military hospitals in southern China. Methods 117 cases of heatstroke patients from Jan 1988 to Mar 2005 admitted to 8 military hospitals were retrospectively analyzed. Results 94.02% of the cases occurred during military drill; 10% of patients complained of slight discomfort before or during the drill; the incidence of thermoplegia, heat cramp and heat exhaustion were 43.26%, 42.55% and 13.86%, respectively, in severe heatstroke, and the respective death rate was 9.76%, 5% and 23%. The incidence of severe heatstroke combined with liver dysfunction was 31.9%, with central nervous impairment was 14.9%, and with MOF was 21.3%. All patients survived when no organ dysfunction occurred; the death rate in those with single organ dysfunction was 3.6%, while it was 35% in MOF patients. Conclusion An attempt to set up a predicting index of heatstroke might be beneficial for scientifically supervising the military drill for the servicemen. Reduction of the core temperature is the“the first critical point”in the treatment. Other “critical point” in the treatment may also be emphasized for those with MOF. The present therapeutic system for heat stroke as executed in the military needs to be perfected.

BACKGROUND:Bone marrow mesenchymal stem cells (BMSCs) can differentiate into renal paranchymal cells including renal intercapillary cells.BMSCs can repair kidney structure and function after damage.OBJECTIVE:To investigate renal histology and function changes following BMSC transplantation in a rat model of radiation-inducad damage.DESIGN,TIME AND SETTING:The cytological in vitro study was performed at the Laboratory of the Department of Hematology,Zhujiang Hospital from January to October 2009.MATERIALS:A total of 35 clean male Sprague Dawley rats were selected.Of them,20 were used to prepare BMSCs.The remaining was randomly assigned to a normal control,model and cell transplantation groups,with 5 in each group.METHODS:Rat BMSCs were incubated by the whole bone marrow method.When 90% cells were confluent,BMSCs were digested in trypsin for subculture.In the model and cell transplantation groups,rats were used to establish radiation-induced models,and then underwent X-ray general irradiation,at a dose of 500 cGy/min,100 cm from the target,6 Gy each,once per week,for consecutively 3 weeks.24 hours following irradiation,BMSCs of 3 passage were collected at logarithmic phase.In the cell transplantation group,1 mL cell suspension was infused into the rat caudal vein,containing 3×10~6 cells,totally three times.In the normal control and model groups,rat caudal vein received an equal volume of saline.MAIN OUTCOME MEASURES:The following parameters were measured:results of hematoxylin-eosin staining;serum and kidney malondialdehyde (MDA) content and superoxide dismutase (SOD) activity;serum creatinine and urea nitrogen levels.RESULTS:Kidney histopathology demonstrated thin renal cortex,increased number of mesenchyme,uneven renal corpuscle,and disordered structure of renal glomerulus,narrow renal glomerular vessel,partial disappeared capsular space,and degeneration and sclerosis of some glomerulus in the model group.In the cell transplantation group,renal cortex became thick,with clear structure;interstitial hyperemia and edema was significantly relieved;many complete renal corpuscles were observed;partial renal glomerulus presented degeneration and sclerosis;significant capsular space could be seen.Oxygen free radical examination results showed that compared with the model group,SOD activity was significantly higher (P ＜ 0.05),MDA levels were significantly lower (P ＜0.05) in the cell transplantation group.Renal function examination results demonstrated that compared with the model group,serum creatinine and urea nitrogen levels were significantly reduced in the cell transplantation group (P ＜ 0.05).CONCLUSION:BMSC transplantation can effectively treat renal radiation injury and improve renal function.

Objective:To explore the correlation among cardiac troponin I (cTnI),cardiac troponin T (cTnT),crea-tine kinase isoenzyme (CK-MB)levels and range of myocardial infarction in aged patients with acute myocardial in-farction (AMI).Methods:Clinical data of 80 aged AMI patients hospitalized in our internal medicine department from Sep 2012 to Sep 2013 were retrospectively analyzed.Correlation among levels of cTnI,cTnT,CK-MB and range of myocardial infarction were analyzed before and one week after treatment.Results:Compared with before treatment,there were significant reductions in levels of cTnI [(4.63±0.21)μg/L vs.(0.15±0.03)μg/L],cTnT [(0.71±0.05)μg/L vs.(0.17±0.01)μg/L],CK-MB [(40.21±2.13)U/L vs.(23.32±2.11)U/L]and myo-cardial infarction area [(35.25±4.65)mm2 vs.(23.17±3.76)mm2 ]after treatment,P <0.01 all;Pearson cor-relation analysis indicated that cTnI,cTnT and CK-MB were all positively correlated with myocardial infarction area (r =0.99,0.98,0.95,P <0.01 all).Conclusion:Cardiac troponin I,T and creatine kinase isoenzyme are closely related to myocardial infarction range.Combination of these three indexes can be used as important basis for judging myocardial infarction range in patients with myocardial infarction.

AIM: In order to explore the role of activator protein-1 (AP-1) and cAMP response element binding protein (CREB) in acute lung injury and anti-inflammatory mechanism of glucocorticoid. METHODS: Using the acute lung injury (ALI) model of rats by intravenous lipopolysaccharide (LPS, 5 mg/kg), the activities of AP-1 and CREB by electrophoretic mobility shift assay (EMSA) in lung tissue and effects of dexamethasone on the activities were observed. RESULTS: After injection of LPS, the peak activity of AP-1 was observed at 2 hours and it returned to normal in 12 hours. CREB peak activity was at 1 hours but it did not return to normal in 12 hours. Dexamethasone significantly inhibited the activities of AP-1 and CREB. CONCLUSIONS: AP-1 and CREB may play important roles in ALI in rats. One of the important anti-inflammatory mechanisms of glucocorticoid is its transcription al modification. [

AIM: To observe the effects of dexamethasone and interleukin-10 (IL-10) on the release of proinflammatory cytokines, tumor necrosis factor-?(TNF-?), IL-6 and activation of transcriptional factors, nuclear factor-?B(NF-?B), activator protein-1 (AP-1) and cAMP response element binding protein (CREB) in cultrued human peripheral blood mononuclear cells (hPBMC). METHODS: The hPBMC were divided into control group, lipopolysaccharide (LPS) stimulated group, dexamethasone and IL-10 treated group. The contents of TNF-? and IL-6 in supernatant were mensured by ELISA. The activity of NF-?B, AP-1 and CREB of nuclear abstract were analyzed by electrophoretic morbility shift assay (EMSA). RESULTS: The content of TNF-? was significantly increased 1 hour after LPS stimulation, and it was significantly inhibition by dexamethasone and IL-10. The contents of IL-6 and IL-10 were significantly increased after LPS stimulation for 12 hours. The production of IL-6 was still inhibited by dexamethasone and IL-10, but the production of IL-10 was not affected by dexamethasone. The activities of NF-?B, AP-1 and CREB were significantly increased 1 hour after LPS stimulation. Dexamethasone and IL-10 significantly ihibited their activities, but the effects of dexamethasone was stronger than that of IL-10. CONCLUSIONS: LPS induces the release of several pro and anti- inflammatory cytokines and induces the activation of several transcriptional factors in hPBMC. Dexamethasone and IL-10 can inhibite the production of proinflammatory cytokines TNF-?, IL-6 and the activation of NF-?B, AP-1 and CREB. Dexamthasone has more significant inhibitory effect on AP-1 and CREB than IL-10.

Objective To evaluate the methods for the prevention of internal jugular vein malposition of peripherally inserted central catheter (PICC) in patient with limited neck motion.Methods 210 patients who underwent PICC placement using ultrasound-guided modified Seldinger technique were divided into observation group (n =106) and control group (n =104) with a random number table.Ultrasound probe compression on the internal jugular vein was used in the observation group,while finger compression was used in the control group.The 2 groups were compared in terms of incidence of internal jugular vein malposition,accuracy of PICC tip position in X-ray,and incidence of complications.Results Incidence of PICC malposition was significantly lower in the observation group than the control group [3 (2.8％) vs.36 (34.6％),P =0.000].The accuracy of PICC tip position in both groups was 100％.No complication was observed in the observation group,while the rate of complication in the control group was 4.8％,with a statistically significant difference (P =0.022).Conclusion The ultrasound probe compression method can significantly lower the incidence of internal jugular vein malposition of PICC and is safer than the finger compression method.

Over the last decade, chronic critically ill (CCI) has emerged as an epidemic in intensive care unit (ICU) survivors worldwide. Advances in ICU technology and implementation of care bundles has significantly decreased early deaths of critically ill patients, and have allowed them to survive previously lethal multiple organ failure (MOF). However, more and more survivors leave persistent low grade organ dysfunctions, depend on continues organ support, need to stay in ICU, and become CCI patients. These patients experience a persistent immune dysregulation with persistent inflammation, immunosuppression, and catabolic syndrome. Therefore, malnutrition is an important feature of patients with CCI, and nutritional support is a crucial part of their treatment. The main strategies of nutritional support are as follows: providing sufficient calories and proteins with appropriate anabolic agents to promote anabolic metabolism, using immunomodulators to improve immune suppression and inflammatory responses, and supplementing micronutrients to enhance metabolic support. In this review, the nutritional assessment, calorie assessment, protein assessment and other nutrient supplementation (such as β blocker, testosterone and oxandrolone, immunonutrition, vitamins) of CCI patients were reviewed, so as to provide reference for the treatment of CCI.

Objective: To explore the correlation among cardiac troponin I (cTnI), cardiac troponin T (cTnT), creatine kinase isoenzyme (CK-MB) levels and range of myocardial infarction in aged patients with acute myocardial infarction (AMI). Methods: Clinical data of 80 aged AMI patients hospitalized in our internal medicine department from Sep 2012 to Sep 2013 were retrospectively analyzed. Correlation among levels of cTnI, cTnT, CK-MB and range of myocardial infarction were analyzed before and one week after treatment. Results: Compared with before treatment, there were significant reductions in levels of cTnI [(4.63±0.21) μg/L vs. (0.15±0.03) μg/L], cTnT[(0.71±0.05) μg/L vs. (0.17±0.01) μg/L], CK-MB [(40.21±2.13) U/L vs. (23.32±2.11) U/L] and myocardial infarction area [(35.25±4.65) mm2 vs. (23.17±3.76)mm2] after treatment, P<0.01 all; Pearson correlation analysis indicated that cTnI, cTnT and CK-MB were all positively correlated with myocardial infarction area (r=0.99, 0.98, 0.95, P<0.01 all). Conclusions: Cardiac troponin I, T and creatine kinase isoenzyme are closely related to myocardial infarction range. Combination of these three indexes can be used as important basis for judging myocardial infarction range in patients with myocardial infarction.