ObjectiveTo investigate the extracorporeal clearance rate of imipenem in severe infection patients in the mode of continuous vena-venous hemofiltration (CVVH) during continuous renal replacement therapy (CRRT), in order to approach if the concentration of imipenem in plasma could achieve effective levels of anti-infection, and to explore the effect of time and anticoagulation measure on imipenem clearance during CRRT treatment.Methods A prospective observational study was conducted. All adult severe infection patients complicating acute kidney injury (AKI) in the Department of Critical Care Medicine of the Fourth Hospital of Hebei Medical University from March 2013 to September 2014, who were prescribed imipenem as part of their required medical care, and CRRT for treatment of AKI were enrolled. 0.5 g doses of imipenem was administered intravenously every 6 hours or 8 hours according to random number table, and infused over 0.5 hour. The unfractionated heparin was used for anticoagulation in the patients without contraindications, and no anticoagulation strategy was used in the patients with high risk of bleeding. At 24 hours after first time of administration, postfilter venous blood and ultrafiltrate samples were collected at 0, 0.25, 0.5, 0.75, 1, 2, 5, 6, and 8 hours after imipenem administration. The concentration of imipenem in above samples was determined with liquid chromatography-mass spectrometer/mass spectrometer (LC-MS/MS).Results A total of 25 patients were enrolled. Thirteen patients received imipenem intravenously every 6 hours, and 12 patients, every 8 hours. The anticoagulation was conducted with heparin in 13 cases, and 12 cases without anticoagulation. The intra-day precision, inter-day precision, matrix effect, and recovery rate in low, medium, and high concentration of plasma and ultrafiltrate, and the stability of samples under different conditions showed a good result, the error of accuracy was controlled in the range of±15%. With the application of Prismaflex blood filtration system and AN69-M100 filter, under the mode with CVVH, the total clearance rate of imipenem was (8.874±2.828) L/h when the actual dose of replacement fluid was (31.63±1.48) mL·kg-1·h-1, the total CRRT clearance rate of imipenem in vitro was (2.211±0.539) L/h, which accounting for (30.1±15.7)% of the total drug clearance. In 6 hours interval dosage regimen, the percentages of the time> 4×minimum inhibitory concentration (MIC) at specific 4×MIC of 2, 4, 6, and 8μg/mL of imipenem were more than 40% of the dosing interval. But in the 8 hours interval dosage regimen, when the level was above the 4×MIC of 4μg/mL, maintaining time would drop below 40% of the dosing interval, with significant differences compared with that in 6 hours interval dosage regimen [4×MIC = 2μg/mL: (60.84±20.25)%vs. (94.01±12.46)%,t = 4.977,P = 0.001; 4×MIC = 4μg/mL: (39.85±15.88)% vs. (68.74±9.57)%,t = 5.562, P = 0.000; 4×MIC = 6μg/mL: (27.58±13.70)% vs. (53.97±8.36)%,t = 5.867,P = 0.000; 4×MIC = 8μg/mL:(18.87±12.43)% vs. (43.48±7.83)%,t = 5.976,P = 0.000]. No significant change in sieving coefficient of imipenem was found within a short time (6 hours), which indicated that there was no effect of anticoagulation on clearance of imipenem by AN69-M100 filter, and no statistical significance was found with repeated measure analysis (F = 0.186, P> 0.05).ConclusionsThe clearance rate of imipenem is increased significantly in vitro under the mode of CVVH with the actual dose of replacement fluid was (31.63±1.48) mL·kg-1·h-1 in severe infective patients with severe sepsis complicating AKI, affecting the level of plasma drug concentration, need to adjust the dosage regimen. When the time of the dosing interval was shortened, the concentration of imipenem in patients' plasma could be increased significantly. In a short period of time, the sieving coefficient of imipenem through AN69 filter is not affected by anticoagulation measures and time cleaning efficiency will not decline.

Objective To regulate nutrition support nursing, facilitate the development of nursing specialty, cultivate nutrition support nurse. Methods Establish nursing specialist team on nutrition support. 30 nurses received theory training, skill training, clinical practice, and completion reporting. Conduct nutrition knowledge management survey. Establish standardized wards of nutrition support nursing and conduct special inspection. Results Nursing specialist team on nutrition support was established, and 29 nutrition support nurses were cultivated. Before training, nurses' knowledge of nutrition and nutrition nursing management score were (3.46 ± 0.47), (0.70 ± 0.24) points, and the score were (4.63±0.14), (0.90±0.27) points after training, results was statistically significant (t=12.848, 2.981, P<0.01). Before and after special inspection of enteral nutrition, enteral nutrition pump and special infusion tube cases were 106,60 and 106, 60, results were statistically significant (χ2=4.747, 4.471, P<0.05). Before and after special inspection of parenteral nutrition, correct infusion and speed cases were 90, 92 and 61, 54, results were statistically significant (χ2=4.642, 7.644, P<0.05 or 0.01). Conclusions The development of nursing specialty of nutrition support was promoted, nurses′ comprehensive ability and self-identity was improved, management quality of nutrition support was.

Objective To explore the clinical value of 3.0T nuclear magnetic resonance susceptibility weighted imaging in diagnosis of neonatal hypoxic ischemic encephalopathy,thus to provide guidance for the clinical.Methods From December 10,2015 to December 10,2017,100 cases of neonatal hypoxic ischemic encephalopathy (observation group) and 100 cases of normal newborns in Lishui People's Hospital during the same period accepted health examination (control group) were selected in the research.All the cases received 3.0T magnetic resonance susceptibility weighted imaging,the diagnostic value of 3.0T MR susceptibility weighted imaging was observed.Results The ADC value of the observation group[(0.00 1 13 ± 0.000 01)mm2/s] was significantly lower than that in the control group[(0.001 98 ±0.000 02)mm2/s] (P ＜0.05).The neonatal ADC value of the mild group[(0.001 21 ± 0.000 01)mm2/s] was significantly higher than that in the moderate group[(0.001 12 ± 0.000 02)mm2/s] and the severe group[(0.001 02 ± 0.000 03)mm2/s] (P ＜ 0.05).ADC value was positively correlated with neonatal hypoxic ischemic encephalopathy,namely,the lower the ADC value,the more serious the neonatal hypoxic ischemic encephalopathy.The fractional anisotropy value and relative anisotropy value of newborn babies in the observation group were significantly higher than those in the control group (all P ＜ 0.05).Conclusion For neonatal hypoxic ischemic encephalopathy patients,3.0T nuclear magnetic resonance susceptibility weighted imaging in the diagnosis is feasible,it can help the clinician to analyze the disease,and has positive significance to carry out the treatment.

Objective To observe the clinical effect of Xiaoke-Yuzu decoction on diabetic peripheral neuropathy (DPN). Methods A total of 100 DPN inpatients were recruited and randomly divided into the treatment and control groups. The two groups were both received basic therapy, while the treatment group additionally received Xiaoke-Yuzu decoction. Toronto clinical scores and Chinese medicine symptom scores of both groups were collected to evaluate the clinical effect before and after the therapy. Results The Toronto scores of treatment group were significantly lower than control group after treatment (symptoms score 1.50 ± 0.94 vs. 2.23 ± 1.01, reflection score 3.60 ± 1.77 vs. 4.27 ± 1.72, feeling test score 1.53 ± 0.63 vs. 2.10 ± 0.84,all P<0.05). Meanwhile, the Chinese medicine symptom scores of treatment group were also significantly lower than the control group (main symptom score 1.77 ± 1.17 vs. 3.17 ± 1.82, posterior symptom score 2.23 ± 1.59 vs. 4.27 ± 1.57, the tongue and pulse score 1.83 ± 0.65 vs. 2.47 ± 0.51, all P<0.05). Conclusion Xiaoke-Yuzu decoction plus basic therpy could improve the clinical symptoms of DPN patients.

Objective To compare the laboratory and clinical results between unstimulated in vitro maturation (IVM) and IVM converted from in vitro fertilization (IVF) in polycystic ovarian syndrome (PCOS) and non-PCOS patients.Methods We divided 591 IVM cycles in the First Affiliated Hospital of Wenzhou Medical Univesity from Jan.2008 to Dec.2013 into 4 groups:group A1B1,PCOS patients underwent unstimulated IVM protocol,240 cycles; group A1B2,PCOS patients underwent IVM converted from conventional stimulated IVF protocol,153 cycles; group A2B1,non-PCOS patients underwent unstimutlated IVM protocol,103 cycles; group A2B2,non-PCOS patient underwent IVM converted from conventional stimulated IVF protocol,95 cycles.Multiple linear regression method and binary logistic regression method were used to assess the influence of PCOS and protocols for IVM on laboratory and clinical outcomes.Results The mean number of oocytes retrieved was positively related with PCOS [partial regression coefficient (B)=3.37,P＜0.01].The maturation rate of oocytes was positively related with hCG-prime prior to oocyte aspiration (B=0.05,P=0.010).High-quality embryo rate was positively related with PCOS and IVM converted from IVF (B=0.08,P=0.010; B=0.09,P=0.001),as well as implantation rate related with them (B=0.07,P=0.010; B=0.10,P＜0.01).PCOS and IVM converted from IVF improved hCG positive (hCG＞10 U/L) rate (OR=1.636,95％CI:1.113-2.204,P＜0.05; OR=1.861,95％CI:1.307-2.649,P＜0.05) and the clinical pregnancy rate (OR=1.507,95％CI:1.041-2.240,P＜0.05; OR=1.881,95％CI:1.312-2.696,P＜0.05).IVM converted from IVF protocol decreased the spontaneous abortion rate (OR=0.490,95％CI:0.245-0.978,P＜0.05).Multiple gestation rate and ectopic pregnancy rate were not affected by PCOS condition and protocol used (P＞0.05).Conclusions PCOS and IVM converted from IVF protocol improved the high-quality embryo rate,implantation rate,hCG positive rate and clinical pregnancy rate.IVM converted from IVF protocol reduced the spontaneous abortion rate.PCOS patients may be more suitable for the IVM treatment.No matter PCOS or non-PCOS patients,IVM converted from IVF protocol had better pregnancy outcome than that of unstimulated cycle.

Objective: To reduce the noise level of surgical intensive care unit through quality improvement program based on one-meter rule. Methods: Measure the status quo of noise level and find out the main noise resources. Implement one-meter rule for three weeks and retest the noise level for a period of seven days. Investigate the satisfaction of medical staff and patients. T-test was performed to compare the noise level and satisfaction. Results: The mean noise level were (58.58±0.95) dB before implementation of quality improvement program and was lowered to (55.89±0.92)dB. There was a significant difference(t=4.890, P=0.001). The five time points except eleven o′clock during which the noise levels were over 60 dB decreased significantly after implementation of one-meter rule (t=2.858-6.643, P<0.05). After intervention, satisfaction related to noise level of medical staff and patients scored 10.97±0.93 and 10.63±1.15 respectively, which were higher than before (8.68±1.49, 8.13±1.18) and there were significant differences (t=-11.231,-10.701,P<0.01). Conclusions One-meter rule intervention can decrease the noise level significantly, and increase medical staff′s and patients′ satisfaction, which is worthy of extensive promotion and application.

Objective To observe the clinical efficacy of acupuncture-moxibustion plus moving cupping on the back in treating sub-health in the undergraduates. Method According to the theory of preventive treatment in the Chinese medicine, 30 undergraduates with sub-health were treated by acupuncture at Baihui (GV20), Guanyuan (CV4), and bilateral Zusanli (ST36), plus moving cupping to the Governor Vessel, totally for 20 d. The Self-rating Sub-health Scale (SRSHS) was adopted for evaluation before and after intervention, for observing the clinical efficacy. Result Of the 30 subjects, 14 were recovered, 14 showed effective, 2 failed, and the total effective rate was 93.3%. The SRSHS score dropped significantly after intervention (P＜0.001). The psychological factor responded most significantly to the intervention, followed by the physical factor, while the social function factor didn’t show a significant change. Conclusion Acupuncture-moxibustion plus moving cupping is significantly effective in improving and treating the sub-health state in the undergraduates.

Objective To explorepredictive factors of psychological stress reaction of medical staff members with blood-occupational exposure and to provides scientific basis for the hospital administrators toprovide psychological support and interventionfor medical staff members with blood-occupational exposure. Methods Seventy-eight medical staff members with blood-occupational exposure were recruited as participants. The Socio-demographic Questionnaire, Posttraumatic Stress Disorder Checklist-5, the Perceived Stress Scale, the Hospital Anxiety and Depression Scale, the Ruminative Responses Scale and the Emotion Regulation Questionnaire were used to evaluate the participants' psychological stress reactionat different stages and the styles of their emotion regulation. Correlation analysis and Hierarchical Regression analysis were used to analyze the predictive factors of psychological stress reaction of medical staff members with blood-occupational exposure. Results Ruminative thinking and emotion regulation can predict the psychological stress reaction of medical staff members with blood-occupational exposure at different stages. Conclusions According to the psychological stress reaction and ruminative thinking of medical staff members with blood- occupational exposure, psychological intervention should be implemented within one month to decrease the psychological trauma of medical staff members with blood-occupational exposure.

Objective:To observe the safety and efficacy of 0.01% atropine eye drops in the prevention of myopia onset in schoolchildren.Methods:A randomized double-blind controlled study was conducted.Sixty Chinese Han children (60 eyes) with binocular spherical equivalent (SE) between + 0.50 D and -0.75 D (pre-myopia) by cycloplegic autorefraction treated in The First Affiliated Hospital of Zhengzhou University were enrolled from July to October 2020.Aged 6-12 years old, the children were divided into 0.01% atropine group and control group according to a random number table, with 30 cases (30 eyes) in each group.The children were given one drop of 0.01% atropine or placebo eye drops in both eyes once a night.The SE, axial length (AL), accommodative amplitude and pupil diameter were compared before and after 3-month, 6-month of treatment between the two groups.Discomforts were recorded.This study adhered to the Declaration of Helsinki.The study protocol was approved by an Ethics Committee of The First Affiliated Hospital of Zhengzhou University (No.2020-KY-286). Written informed consent was obtained from guardian of each subject.Results:After treatment, 26 and 25 subjects completed the 6-month follow-up in 0.01% atropine group and control group, respectively, among which 3 subjects in 0.01% atropine group accounting for 11.5% and 9 in control group accounting for 36.0% developed myopia, showing a statistically significant difference ( χ2=4.238, P=0.040). There were significant differences in the overall comparison of SE and AL at different time points between before and after treatment ( Ftime=10.981, 81.854; both at P<0.001). At 3 and 6 months after treatment, there were significant increases in the SE and AL of control group and AL of 0.01% atropine group compared with respective baseline values (all at P<0.05). There was no significant difference in SE at 3 and 6 months after treatment compared with baseline SE in 0.01% atropine group (both at P>0.05). At 6 months after treatment, the change in SE in 0.01% atropine group was (-0.15±0.26)D, which was significantly less than (-0.34±0.35)D in control group, and the change in AL in 0.01% atropine group was (0.17±0.11)mm, Which was significantly shorter than (0.28±0.14)mm in control group, with significant differences between them ( t=2.207, P=0.032; t=3.127, P=0.003). There were significant differences in pupil diameter at different time points between before and after treatment ( Ftime=2.263, P=0.032). At 3 and 6 months after treatment, the pupil diameter was increased in comparison with baseline in 0.01% atropine group (both at P<0.05). There were significant differences in accommodative amplitude at different time points between before and after treatment in the two groups ( Fgroup=0.882, P=0.042; Ftime=0.337, P=0.033). The accommodative amplitude at 3 and 6 months after treatment were decreased in comparison with baseline in 0.01% atropine group and control group at corresponding time points (all at P<0.05). Within a month after treatment, photophobia in bright sunlight occurred in 5 cases in 0.01% atropine group, accounting for 16.7%(5/30), and 2 cases in control group, accounting for 6.7%(2/30), showing no significant difference ( χ2=0.647, P=0.421). No near-vision blur and other uncomfortable symptoms was found in the two groups. Conclusions:After 6-month application of 0.01% atropine eye drops, the prevalence of myopia in pre-myopia schoolchildren decreases and the changing rate of SE and AL slows down.The accommodative amplitude is slightly reduced and pupil diameter is slightly increased, with no obvious effects on study and life.

Objective:To provide reference for future research based on bibliometric analysis on research status and developing trend of the application of ultrasonography for insertion of naso-intestinal tubes in China.Methods:All published literatures on the application of ultrasonography for insertion of naso-intestinal tubes were retrieved from CNKI, Wanfang Database, CBM and VIP before September 2019.Results:A total of 54 effective literatures were included and published in 40 Chinese journals and the number of literatures increased year by year. The core journals accounted for 57.41% and the fund literature accounted for 25.93% of the total literature. Experimental and quasi-experimental studies, accounted for 88.89% of the total literature. The main subjects were adult critically ill patients, accounting for 98.15%. The main research contents of the included studies were ultrasound-guided naso-intestinal tube placement and ultrasonic naso-intestinal tube localization.Conclusions:Studies on the ultrasonography for insertion of naso-intestinal tubes in China is still in its initial stage and are developing rapidly. While the distribution of the research area is unbalanced, the depth and scope of the studies are not enough, and the research types and contents are relatively limited. In the future, it is necessary to carry out multicenter and large sample research, combine quantitative research with qualitative research, pay more attention to the application of nasal-intestinal tube in critically ill children to broaden the breadth and scope of the research content.