Objective:To explore the relationship between ventilator-associated pneumonia (VAP) and neutrophil/lymphocyte ratio (NLR) before mechanical ventilation in patients with malignant tumors.Methods:A retrospective nested case-control study was conducted. Patients with malignant tumor treated by mechanical ventilation admitted to the Third Affiliated Hospital of Guizhou Medical University from February 2015 to February 2020 were enrolled. The patients with VAP were selected as the case group, and the matched non-VAP cases were selected according to 1∶2 as the control group. The clinical data were collected, and the differences of each index between the two groups were compared. The influencing factors of VAP in patients with malignant tumor were analyzed by multivariate Logistic regression.Results:During the study period, 1 271 patients with malignant tumors were treated with mechanical ventilation, of which 241 cases had VAP, and the incidence of VAP was 18.96%. There were 232 VAP patients in the case group matched 464 non-VAP patients in the control group. The clinical data of age, gender, hospitalization diagnosis, primary tumor, regional lymph node and distant metastasis (TNM) stage, acute physiology and chronic health evaluation Ⅱ (APACHEⅡ), complications, duration of mechanical ventilation, hemoglobin (Hb) and serum albumin (Alb) levels were balanced and comparable between the two groups, and the cluster nursing measures were consistent. Compared with the control group, although there was no significant difference in neutrophil count (NEU) and lymphocyte count (LYM) in the case group [NEU (×10 9/L): 3.81±1.07 vs. 3.64±1.05, LYM (×10 9/L): 2.06±0.59 vs. 2.15±0.62, both P > 0.05], NLR was significantly increased (2.07±1.05 vs. 1.89±0.96, P < 0.05), and the hospital stay was significantly longer (days: 24.84±3.81 vs. 13.19±3.98, P < 0.01). NLR, gender, age, APACHEⅡ score, TNM stage, Hb, serum Alb and duration of mechanical ventilation were included in multivariate Logistic regression analysis. The results showed that patients with elevated NLR had higher risk of VAP [odds ratio ( OR) = 1.187, 95% confidence interval (95% CI) was 1.015-1.387, P = 0.032]. In patients with VAP, NLR was negatively correlated with the time of mechanical ventilation before VAP (r = -0.327, P = 0.000), and positively correlated with the time of treatment with antibiotics after VAP (r = 0.559, P = 0.000). Conclusion:Elevated NLR in patients with malignant tumors who were on mechanical ventilation can significantly increase the risk of VAP and increase the difficulty of treatment.

0.05).Conclusion In-vitro-cultured CB has good effects in the treatment of apoplexy.Neither in-vitro-cultrued CB nor natural CB for apoplexy has obvious adverse reaction.

OBJECTIVE:To study the rational use of antibacterials in inpatients.METHODS:A discussion was made on the use of antibacterials for 4 948 inpatients in 2004 and 5 476 inpatients in 2005 in our hospital,managed in accordance with the requirements for hospital management by level and the Guidelines for Clinical Use of Antibacterials.RESULTS & CONCL- USIONS:The inpatient use of antibacterials in our hospital has been made basically rational through implementation of systematic management,enactment of antibacterials management by level,monitoring on usage of antibacterials and enforcement of warning system for overusing.

Objective Based on Chinese guidelines for the management of ischemic stroke, a standardized stroke management program was performed to provide intensive education and training for medical physicians, aiming to enhance their knowledge and ability for ischemic stroke prevention and treatment, thereby reducing patients′ in-hospital cost and length of stay, and improving patients′ clinical prognosis. Methods This study was conducted in 20 general hospitals throughout Hainan province. A total of 163 physicians from 20 hospitals involved in the management of stroke patients were trained by highly experienced physicians based on the Chinese guidelines for diagnosis and treatment of acute ischemic stroke 2014 and the Chinese guidelines for secondary prevention of ischemic stroke and transient ischemic attack 2014. Prior to and post the standardized stroke management training, the data of 3218 and 3367 patients with ischemic stroke were respectively collected. Quality of life assessments including the Barthel index (BI) and the modified Rankin Scale (mRS) score of all patients were recorded at baseline and after discharge. The length of stay and in-hospital cost were directly collected from the hospital information system. Results Physicians′ knowledge and ability manifested as testing scores were significantly improved after training (78.2 ± 15.5 vs 55.6 ± 10.7, t=69.1, P<0.01). The average length of stay of post-training patients was significantly shorter than that of pre-training patients ((8.7 ± 0.9) vs (11.7 ± 1.5) days, t=97.9, P<0.01). The average in-hospital cost of post-training patients was significantly less than that of pre-training patients ((7681.7 ± 1397.7) vs (11846.2 ± 2514.6) Yuan, t=82.5, P<0.01). Both BI (68.2 ± 3.2 vs 43.5 ± 5.3, t=227.7, P<0.01) and mRS score (2.74±0.51 vs 3.65±0.71, t=59.5, P<0.01) were significantly improved for post-training patients. Multivariate linear regression analysis illustrated that standardized stroke management was negatively associated with in-hospital cost (r=-0.461, P<0.01), length of stay (r=-0.357, P<0.01) and mRS score (r=-0.298, P<0.01), and was positively associated with levels of BI (r=0.376, P<0.01). Conclusion Standardized stroke management program might be a cost-effective choice for the management of ischemic stroke as it reduces the in-hospital cost and improves patients′BI and mRS levels.

The incidence of each of the rare disease is very low. The complexity and diagnosis difficulty of the rare disease lead to the difficulties in the clinical research and development (R&D) of drugs for rare diseases. There is an urgent clinical need for the drug development of rare diseases in China. Encouraging R&D of new drugs, particularly the innovative drugs with China's own independent intellectural property is the basis for solving the predicament in drug shortage in China.. In order to further improve the efficiency of clinical R&D of drugs for rare diseases, the National Medical Products Administration (NMPA), Center for Drug Evaluation (CDE) issued Technical Guidance for Clinical Research and Development of Drugs for Rare Diseases. This is the first guidance for rare diseases in China that is drafted from the standpoint of the clinical technology research and development.The guidance is the scientifitc thinking and framework for the drug developing enterprises to research and develop drugs for rare disease efficiently and appropriately by following drug developing protocols and relating to the special features of rare disease.This paper presents the concepts and rationale in the guidance for the appraisal of rare disease drug research and development.

Agricultural activities, including stock-farming, planting industry, and fish aquaculture, can affect the physicochemical and biological characters of freshwater lakes. However, the effects of pollution producing by agricultural activities on microbial ecosystem of lakes remain unclear. Hence, in this work, we selected Honghu Lake as a typical lake that is influenced by agriculture activities. We collected water and sediment samples from 18 sites, which span a wide range of areas from impacted and less-impacted areas. We performed a geospatial analysis on the composition of microbial communities associated with physicochemical properties and antibiotic pollution of samples. The co-occurrence networks of water and sediment were also built and analyzed. Our results showed that the microbial communities of impacted and less-impacted samples of water were largely driven by the concentrations of TN, TP, NO-N, and NO-N, while those of sediment were affected by the concentrations of Sed-OM and Sed-TN. Antibiotics have also played important roles in shaping these microbial communities: the concentrations of oxytetracycline and tetracycline clearly reflected the variance in taxonomic diversity and predicted functional diversity between impacted and less-impacted sites in water and sediment samples, respectively. Furthermore, for samples from both water and sediment, large differences of network topology structures between impacted and less-impacted were also observed. Our results provide compelling evidence that the microbial community can be used as a sentinel of eutrophication and antibiotics pollution risk associated with agricultural activity; and that proper monitoring of this environment is vital to maintain a sustainable environment in Honghu Lake.
Agriculture ; Animals ; Anti-Bacterial Agents ; analysis ; China ; Eutrophication ; Geologic Sediments ; chemistry ; microbiology ; Lakes ; chemistry ; microbiology ; Microbiota ; Risk Factors ; Water Pollutants, Chemical ; analysis