OBJECTIVE: To promote rational use of drugs in clinic. METHODS: The difference of chronopharmacodynamics, chronopharmacokinetics and chronotoxicity of drugs were introduced, referring to the relevant literatures, journals and practices. RESULTS: The same drug represented different efficacy and toxicity for one day due to delivery at different time. CONCLUSION: According to chronopharmacology, administration at optimal time contributes to efficacy and reduces adverse reaction.

Objective:To investigate the current situation of junior medical students'cognition on the relationship between doctors and patients,and to provide reference for medical students'medical education and medical education reform,Methods:Self-made questionnaire was adopted to investigate the cognitive status of doctor-patient relationship among junior medical students from three medical universities in Guangzhou.Results:Totally 41.04％ of junior medical students had a basic understanding of doctor-patient relationship,and the degree of understanding of doctor-patient relationship is not different between junior and senior medical students (P ＞ 0.05);76.62％ of medical students got acquainted with the status of doctor-patient relationship mainly through the media;86.57％ of junior medical students thought that the doctor-patient relationship was tense.The cognition of doctor-patient relationship between male and female students was similar (P ＞ 0.05),and so wasit between freshmen and sophomores (P ＞ 0.05).Male and female students had the same opinion on the future trend of doctor-patient relationship (P ＞ 0.05).Many junior medical students were optimistic about the future doctor-patient relationship.Compared with freshmen,sophomore medical students were less optimistic about the future doctor-patient relationship (P ＜ 0.05).Medical students mostly agreed on the causes of medical disputes (P ＞ 0.05),believing that the main reason was the medical system.Conclusions:The cognition of the doctor-patient relationship profoundly affects the junior medical students as well as their choices of future employment and communication styles between patients and them,which may have important significance for avoiding medical disputes.Society,schools and the media should actively create a good atmosphere for the doctor-patient relationship.

AIM: To confirm the optimum extraction of the total-saponins from Patrinia Villosa Juss. METHODS: Optimum conditions(ethanol concentration,extraction hours,ethanol solution quantity) were determined by the uniform design test,the extract was refined with macropore resin AB-8,and samples were measured colorimetrically at ?=560 nm compared with oleanolic acid as reference substance. RESULTS: The result was 95% ethanol as solvent, extraction time for 1 h adding 8 times amount of ethanol solution at 100 ℃ water bath for two times.under this condition,the total-saponins content was 0.668%,in accordance with the design forecast. CONCLUSION: The optimum extraction technique and purified methods could extract the total-saponins efficiently from Patrinia Villosa Juss.The technique is simple and adapts for production.

OBJECTIVE:To analyze intervention effect of Drug Rational Usage Guidelines System(DRUGS)on antibacterial agents use in department of obstetrics and gynecology in our hospital. METHODS:The application of antibacterial agents in depart-ment of obstetrics and gynecology in our hospital during Jan.-May(before intervention)and Jun.-Nov. 2012(after intervention)were extracted in respects of drug name,preoperative medication duration,perioperative additional condition,postoperative drug with-drawal time,drug combination,usage and dosage,average hospitalization stay,hospitalization cost. The intervention effects were analyzed. RESULTS:After intervention,the type of antibacterial agents were more in line with national regulations;the proportion of type Ⅰ incision surgery without antibacterial agents increased from 57.8% to 75.2%;the prophylactic application of antibacteri-al agents in type Ⅱ incision surgery within 0.5-2 h increased from 80.2% to 97.0%. The rate of reasonable antibacterial selection, drug combination,usage and dosage increased from 76.9%,64.9%,71.3% to 89.3%,84.6%,90.2%,respectively. The average hospitalization stay and antibacterial cost per capita decreased significantly. There was statistical significance among above indica-tors before and after intervention(P<0.05 or P<0.01). CONCLUSIONS:DRUGS effectively change irrational use of antibacterial agents in department of obstetrics and gynecology,which provide a new method for the management of antibacterial agents.

Objective:To analyze the drug resistance of Pseudomonas aeruginosa( PA) isolated from clinical specimen to provide the guidance for the clinical treatment. Methods:The infection status of PA from January 2012 to December 2012 was reviewed retro-spectively, and the results of susceptibility test for 448 PA strains were analyzed. Results:The antibiotic susceptibility of the PA strains to cefoperazone sodium and sulbac, ampicillin aodium and aulbacta,aiprofloxacin,cefepime,piperacillin/ sulbactam,amikacin, ceftazi-dime,meropenem, imipenem, minocycline, selectrin and aefuroxime was 100%, 76%, 72. 8%, 69. 4%, 66. 3%, 65. 6%, 64. 8%, 59. 9%,28. 9%,2. 4% and 0%,respectively. Conclusion:PA is one of the main pathogenic bacteria for nosocomial infection. It is necessary to strengthen the drug resistance test and standardize the application of antibiotics in order to provide the reference for clinical rational use of antibacterial drugs.

Objective:To investigate the clinical features and treatment outcome of Kallmann syndrome(KS) caused by fibroblast growth factor receptor-1(FGFR1) gene mutation in 4 patients.Methods:Targeted next-generation sequencing(NGS) was performed on thirty KS and normosmic idiopathic hypogonadotropic hypogonadism(nIHH) patients. FGFR1 mutation was identified in four KS patients. The clinical data, laboratory and imaging examinations, and treatment outcome were retrospectively analyzed.Results:Four male patients, aging from 11 to 22 years old, presented as micropenis, and with olfactory dysfunction. Among them, two had history of cryptorchidism, three had history of cleft lip and palate repair surgery. The most severe patient presented with short stature, left microtia and dental agenesis. FGFR1 heterozygous mutation was identified in all four patients, two were point mutation(p.Y374X; p. E670K), and the other was frameshift mutation(p.S346Yfs*61; p.S723*fs*1). One patient, who started treatment of the pulsatile GnRH pump during his youth, succeeded in having two babies.Conclusion:Patients with Kallmann syndrome caused by FGFR1 mutation presents complex clinical manifestations. Besides dysosmia, micropenis, microrchidia, and delayed pubertal development are the main clinical manifestations in male patients. Symptoms such as cleft lip and palate are helpful for early recognition. Genotyping analysis is crucial to confirm the diagnosis. The pulsatile GnRH pump can produce satisfactory therapeutic effect, but the age of initiating therapy should be carefully considered.

Objective To explore the correlation of pretreatment EBV DNA load, EBV EA-IgA and VCA-IgA antibodies levels with the clinical characteristics, curative effect and prognosis of the patients with early-stage extranodal nasal-type NK/T-cell lymphoma (ENKTCL). Methods We analyzed the clinical features and prognostic factors of 78 ENKTCL patients. Results Positive rates of pretreatment EBV DNA, VCA-IgA and EA-IgA were 43.6%, 20.5% and 14.1%, respectively. EBV DNA was significantly associated with Ann Arbor stage, primary site, PTI and non-CR (all P < 0.05). VCA-IgA and EA-IgA were related to positive EBV DNA and non-CR (all P < 0.05). Multivariate analysis showed that age, EBV DNA and non-CR were independent prognostic factors for OS (all P < 0.05); age, EBV DNA, primary site and non-CR were independent prognostic factors for PFS (all P < 0.05). Conclusion The pretreatment positive EBV DNA is related to advanced Ann Arbor stage, PTI, primary extra-nasal subtypes of upper aerodigestive tract and poor response to treatment. The elevated levels of EA-IgA and VCA-IgA are related to positive EBV DNA and poor response to treatment. Pretreatment EBV DNA could be used for risk stratification and prognosis prediction of ENKTCL, while EA-IgA and VCA-IgA play limited role in guiding the prognosis of ENKTCL.

Objective? To explore the effects of autonomic skills intensive training in simulation teaching among nursing students. Methods? From September 2014 to May 2017, we selected 159 nursing undergraduates of school of nursing in Capital Medical University as subjects by purposive sampling. A total of 73 students from the class of 2010 and 2011 were selected in control group received problem-based learning (PBL) combined with simulation teaching;86 students from the class of 2012 and 2013 were set in experimental group attending autonomic skills intensive training in self-management simulation laboratory before simulation teaching. We compared the comprehensive theoretical knowledge achievements, objective structured clinical examination achievements and effects evaluation on simulation teaching central laboratory of nursing students between two groups. Results? At the end of the course of adult nursing, the physical examination, scenarios simulation, fundamental nursing skills and professional nursing operation of nursing students in experimental group were higher than those in control group with statistical differences (P＜0.05). Pearson correlation analysis showed the time of autonomic skills intensive training had positive correlations with the scores of comprehensive theoretical knowledge, physical examination, scenarios simulation, fundamental nursing skills and professional nursing operation (P＜0.01). There were 74 nursing students with the thought that opening simulation teaching central laboratory could improve their self-confidence. Conclusions? The comprehensive achievements and self-confidence of nursing students can be improved by autonomic skills training and actively participating in lab management. [Key words]? Students, nursing;? Teaching;? Autonomic learning;? Open laboratory;? Skill training;Simulation

Objective To investigate the effects of cardiopulmonary resuscitation ( CPR ) training for residents in suburb of Beijing , and analyze its influential factors .Methods A total of 116 Residents in suburban district of Beijing received CPR training course according to 2010 ACC/AHA CPR guidelines, and chest compression related skills were tested immediately after CPR training .Results A total of 116 residents compressed (44.39 ±10.21) mm and of which adequate compression rate was 30.2% (35/116).78.4%(91/116) participants performed which was ( 118.70 ±22.81 )/min adequate mean compression rate . Residents with different ages and level of education presented different compression depth ( t/F =2.960, 4.149, respectively;P<0.05) and rate (t/F=2.037,6.587, respectively;P<0.05).Conclusions The quality of CPR is impacted by ages , the level of education and other factors among Beijing suburban residents , and the depth of compression is the key and difficult point during training .

Objective:To explore the feasibility and safety of integrating the geriatric intensive care unit (GICU) into the friendly management model of the elderly critically ill patients.Methods:A prospective controlled study was conducted. Patients with elderly critically ill admitted to the GICU and the general intensive care unit (ICU) of Jintan First People's Hospital of Changzhou from December 2021 to May 2023 were enrolled. Patients in the ICU group received the traditional intensive care and nursing mode. In addition to the ICU group basic medical care measures, the patients in the GICU group were treated with friendly management models such as flexible visitation, diagnosis and treatment environment optimization, caring diagnosis and treatment, and family participation in hospice care according to their condition assessment. The gender, age, main diagnosis, and acute physiology and chronic health evaluation Ⅱ (APACHEⅡ) at admission were recorded and compared between the two groups. During the treatment period, the incidence of nosocomial infection, unplanned extubation, falling out of bed/fall, unexpected readmission to ICU/GICU, and ICU/GICU mortality, the incidence of post-intensive care syndrome (PICS), the satisfaction rate of patients/families with medical care, and the satisfaction rate of patients/families with diagnosis and treatment environment were recorded and compared between the two groups.Results:According to the admission criteria for ICU and GICU, as well as the willingness of the patients and/or their families, a total of 59 patients were finally included in the ICU group, and 48 patients were enrolled in the GICU group. There were no significantly differences in gender, age, main diagnosis and APACHEⅡ score between the two groups, and there were comparability. There were no significantly differences in the incidence of adverse events such as nosocomial infection [13.6% (8/59) vs. 12.5% (6/48)], unplanned extubation [5.1% (3/59) vs. 6.2% (3/48)], falling out of bed/fall [3.4% (2/59) vs. 0% (0/48)], unexpected readmission to ICU/GICU [8.5% (5/59) vs. 10.4% (5/48)], and ICU/GICU mortality [6.8% (4/59) vs. 6.2 (3/48)] between the ICU group and GICU group (all P > 0.05). Compared with the ICU group, the incidence of PICS in GICU group was significantly lower [8.3% (4/48) vs. 25.4% (15/59), P < 0.05], the satisfaction rate of patients/families with medical care [89.6% (43/48) vs. 74.6% (44/59)] and satisfaction rate of patients/families with diagnosis and treatment environment [87.5% (42/48) vs. 67.8% (40/59)] were significantly increased (both P < 0.05). Conclusion:The use GICU as a friendly management model for elderly critically ill patients is feasible and safe, and it is worthy of further exploration and research.