OBJECTIVE: To probe into the application of antimicrobials in our hospital and to provide reference for clinical rational use of drugs. METHODS: Retrospective analysis was applied to analyze consumption sum, DDDs and DDC of antimicrobials in our hospital from 2006 to 2009 statistically. RESULTS: The consumption sum and DDDs of antimicrobials in our hospital from 2006 to 2009 increased year by year. Majority of antimicrobials taking up the top place were injection in the list of consumption sum and were cephalosporins, macrolides and fluoroquinolones in the list of DDDs. The DDC of antimicrobials decreased year by year. CONCLUSION: The application of antimicrobials in our hospital is reasonable basically, but the application of a few categories of antimicrobials is not reasonable. The study of Guiding Principles for Clinical Use of Antibiotics should be strengthened to implement the application of antimicrobials classification system.

AIM:To investigate the correlation between matrix metalloproteinase-9(MMP-9),tissue metalloproteinase inhibitor-1(TIMP-1),MMP-9/TIMP-1 and carotid atheromatous plaque stability in cerebral infarction patients.METHODS:80 patients with cerebral infarction were categorized as microemboli-negative group(n=70)and microemboli-positive group(n=10),20 normal human were served as control group.The MMP-9 and TIMP-1 levels in plasma were determined by mean of ELISA in 3 groups.RESULTS:The levels of MMP-9 and TIMP-1 in plasma were significantly higher in cerebral infarction patients than those in control group(P

Objective To explore the relationship between insluin resistance(IR)and plasma fibrinogen, blood lipids levels in patients with gestational diabetes mellitus (GMD).Methods Totally 127cases pregnant women in their 24 -28 gestational weeks were divided into GDM group(n =37),gestational impaired glucose tolerance test (GIGT)group(n =30)and normal glucose tolerance(NGT)group(n =60)based on the American Diabetes Associ-ation(ADA)2009 GDMdiagnostic standards.All selected cases's height,weight,fasting blood glucose (FBG),fasting insulin (FIN),blood lipids and fibrinogen(FIB)level were tested,and their body mass index(BMI)and IR index (HOMA -IR)were calculated.Results During the mid -trimester,the levels of BMI,FIB,HOMA -IR,FBG,FIN, triglyceride (TG),cholesterol(TC),low density lipoprotein -cholesterol (LDL -C)in the GDM group were signifi-cantly higher than the GIGT and NGT groups.However,high density lipoprotein -cholesterol (HDL -C)was signifi-cantly lower (F =69.29,98.15,70.32、141.43、61.92,106.06,157.06,90.59,25.25,all P <0.01).FIB was sig-nificantly positively correlated with BMI,FBG,FIN,HOMA -IR,TC,TG,LDL - C (r =0.441,0.682,0.506, 0.599,0.493,0.591,0.633,all P <0.01 ),and negatively correlated with HDL -C(r =-0.419,P <0.01 ).Multiple stepwise regression analysis indicated that BMI,LDL -C,FBG and TG were independent risk factors affect-ing FIB(t =7.683,2.678,3.184,3.844,all P <0.01);FIB,BMI,FBG,FIN and TC were independent risk factors influencing HOMA -IR(t =68.784,3.201,29.702,58.100,2.904,all P <0.01).Conclusion Pregnant women have IR and blood lipid disorders during the mid -trimester,the overexpression of FIB is closely related to it.

Objective Alprostadil can improve the clinical efficacy of the treatment of hepatitis B cirrhosis, but little literature is available about its effect on serum inflammatory factors in patients with hepatitis B cirrhosis.This study aimed to investigate the effect of alprostadil on serum inflammatory factors and liver function of the patients with hepatitis B cirrhosis and its possible action mechanisms.Methods We equally randomized 162 cases of hepatitis B cirrhosis admitted to our hospital from August 2014 to July 2015 into a control and an observation group, the former treated by conventional antiviral, liver-protecting and supportive therapies, and the latter with alprostadil in addition, both for 4 weeks.Then, we obtained the serum inflammatory factors, the contents of serum interleukin-6 (IL-6), high sensitive C reactive protein (hs-CRP) and tumor necrosis factor alpha (TNF-α) as well as such liver function indexes as glutamic-pyruvic transaminase (ALT), total bilirubin (TBil) and prothrombin activity (PTA), and compared them between the two groups before and after treatment.Results After 4 weeks of treatment, the effectiveness rate was significantly higher in the observation than in the control group (82.72% vs 62.96%, P<0.05).Compared with the baseline, the patients in the observation group showed significant improvement after treatment in serum IL-6 ([275.62±43.39] vs [97.15±19.73] pg/mL, P<0.05), hs-CRP ([425.54±55.58] vs [50.23±6.69] ng/L, P<0.05), TNF-α ([321.74±80.73] vs [85.45±13.61] pg/mL, P<0.05), ALT ([139.54±37.36] vs [96.13±23.62] μmol/L, P<0.05), TBil ([395.39±41.13] vs [271.55±25.12] μmol/L, P<0.05), and PTA ([38.50±4.19] vs [68.36±8.11]%), and the improvement was significantly better than in the control group (P<0.05).Conclusion Alprostadil helps alleviate the inflammatory condition, improve the liver function, and promote clinical efficacy in patients with hepatitis B cirrhosis.

Objective To explore the relationship of serum ferritin with insluin resistance(IR)and inci-dence of fatty liver in adults with simple obesity.Methods According to body mass index (BMI),78 adults with simple obesity were divided into three groups,including 34 cases in Ⅰ degree obesity group,30 cases in Ⅱ degree obesity group and 14 cases in Ⅲ degree obesity group,and 35 adults with simple overweight and 67 healthy adults were also enrolled as control group.The height,weight,waistline,hip circumference,incidence of fatty liver,fasting blood glucose (FBG),fasting insulin (FIN),blood lipids and ferritin(SF)level were tested,and the body mass index (BMI),WHR and IR index (HOMA -IR)were calculated.Results When BMI increased,levels of SF,HOMA -IR, FBG,FIN,triglyceride (TG),cholesterol (TC),low density lipoprotein -cholesterol (LDL -C)were gradually increased(F =378.92,12.01,55.50,123.96,90.09,127.65,23.81,all P <0.01).However,high density lipopro-tein -cholesterol (HDL -C)was gradually degraded(F =114.56,P <0.01).The incidence of fatty liver had signifi-cant differences in Ⅰ,Ⅱ,Ⅲ degree obesity groups((t =24.872,7.885,all P <0.01),and with the degree of obesity increased,the rate of fatty liver increased significantly.SF range interquartile and level in fatty liver group was signifi-cantly greater than the non fatty liver group,the difference was statistically significant (t =22.99,P <0.01).SF was positively correlated with BMI,WRH,FBG,FIN,HOMA -IR,TC,TG,LDL -C (r =0.863,0.719,0.789,0.703, 0.617,0.785,0.717,0.771,all P <0.01),and negatively correlated with HDL -C(r =-0.530,P <0.01).Multi-ple stepwise regression analysis indicated that BMI,FIN,LDL -C,HOMA -IR were independent risk factors affecting SF(t =4.646,2.595,-5.073,6.666,all P <0.01).SF,BMI,FBG,FIN,LDL -C were independent risk factors influencing HOMA -IR(t =6.535,3.254,18.827,61.227,2.154,all P <0.05).Conclusion Simple obesity adults had obvious blood lipid disorders and IR,easy to complicated with fatty liver,the incidence of fatty liver associ-ated with severity of obesity,the overexpression of SF is closely related to it.

Objective To studythe cephalocaudal relationship ofabdominal aortic bifurcation relative toumbilicus and iliac crest vertex and their correlations with abdominal adipose tissue thickness and age. Methods The vertical distances,cephalocaudal relationship and other related anatomic parameters of aortic bifurcation relative to umbilicus and iliac crest vertex in 108 patientswere measured by consecutive abdominal CT scanning. The correlations of the acquired data with abdominal adipose tissue thickness and age were analyzed using Pearson correlation coefficient. Results Umbilicus was located at cephalad to aortic bifurcation in 67 patients(62.0%), caudal in 34(31.4%)andthe same level in 7(6.5%),with the vertical distance of(4.53 ± 17.51)mm to the aortic bifurcation. No statistically significant relationship was found between abdominal adipose tissue thickness(P>0.05) or age(P>0.05). Iliac crest vertex relative to aortic bifurcationwas located at cephalad,caudal and the same level in 31,71 and 6 patients,taking up 28.7%,65.7%and 5.6%,respectively. Its vertical distance to the bifurcation was(-6.34 ± 14.49)mm,nonrelated with abdominal adipose tissue thickness(P>0.05),but positively correlated with age(P<0.01). The difference in the cephalocaudal relationship of aortic bifurcation relative to umbilicus and iliac crest vertex was statistically significant(P<0.01). Conclusion Compared with iliac crest vertex,umbilicus is an important landmark of locating abdominal aortic terminal occlusion position in vitro because it mostly lies cephalad to aortic bifurcation in the front of the body,not easy to vary with abdominal adipose tissue thickness and age.

Aim To investigate Jianpi Qinghua Chinese herbal compound( JQCC) on the expressions of the rel-evant proteins of TLR4 and its downstream MyD88-de-pendent pathways, and on the inflammatory factor TNF-α in the animal model of chronic atrophic gastritis ( CAG) in rats, so as to discuss the molecular mecha-nism of JQCC in the treatment of CAG. Methods 53 Wistar rats were randomly divided into the blank con-trol group(n=8) and the CAG model group(n=45), and the animal model of CAG in rats was replicated by the “ammonia + sodium deoxycholic acid + ethanol”method. After the successful modeling was confirmed, the rest of the 40 CAG rats in the CAG model group were divided into the model group, the vitacoenzyme-tablet group, the low dose of JQCC group, the medium dose of JQCC group, the high dose of JQCC group ( each group n =8 ) . The experimental animals of all the groups were given intragastric administration of medication continuously for 30 days. Then the patho-logical histological changes were observed by HE stai-ning. The protein expressions of TLR4, MyD88, NF-КB and COX-2 were tested by Western-blot assay. And the serum TNF-α level was measured by ELISA. Results The protein expressions of TLR4 , MyD88 , NF-КB and COX-2 and the serum TNF-α level in the rats in the model group were increased evidently ( P<0. 01). Compared with the model group, the gastric mucosa lesions were improved in the low dose of JQCC group, the medium dose of JQCC group, the high dose of JQCC group, together with significant decreases of the protein expressions of TLR4 , MyD88 , NF-κB and COX-2 and the serum TNF-α level ( P <0. 05 or P <0. 01 ) . Conclusion JQCC could effectively improve the pathological and histological changes in the gastric mucosa in CAG rats, and the therapeutic mechanism might be related to the expressions of the relevant pro-teins of TLR4-MyD88-dependent pathways and the ex-pressions of anti-inflammatory cytokines.

Objective To discuss the clinical efficacy of compound gastritis mixture (CGM) in treating precancerous lesions of gastric carcinoma (PLGC).Methods Totally 85 PLGC patients were randomly divided into treatment group and control group. The treatment group took CGM and the control group took Vitacoenzyme tablets. One therapeutic course was three months, and the treatment lasted for two courses. The clinical symptoms, electronic gastroscopy presentation, and pathological tissues before and after treatment were observed, the clinical efficacy was evaluated.Results There was statistical significance in TCM syndrome between the two groups (P<0.05), and the effective rate in the treatment group was more obvious than that in the control group (P<0.01). The symptoms of the two groups were significantly improved (P<0.05,P<0.01), but the improvements of the main symptoms in the treatment group were superior to those in the control group (P<0.05,P<0.01). The total effective rate of electronic gastroscopy presentation was 80.0% (36/45) in the treatment group, which was better than that of the control group (P<0.05). Pathological curative effects of chronic atrophic gastritis, intestinal metaplasia, and dysplasia in the treatment group were also better than those in the control group (P<0.05).Conclusion CGM has definite clinical efficacy in treating PLGC.

Objective To explore the effect of Kruppel like factor 4 (KLF4) on epithelial-to-mesenchymal transition and invasion ability of pancreatic cancer.Methods The expression of KLF4 in 70 pancreatic cancer tissues and 10 normal pancreatic tissues was detected by immunohistochemistry,and the correlations between KLF4 expression and pathological characteristics were analyzed.Small hairpin RNA targeting KLF4 (sh-KLF4) and negative control shRNA were constructed.After the transfection of shRNA,qRT-PCR and western blot were used to detect the mRNA and protein expression of KLF4,E-cadherin and vimentin,and cell scratch-wound assay and transwell assay were utilized to determine the ability of invasion and metastasis.Results KLF4 expression (47.1％) was lower in pancreatic cancer tissues compared with normal pancreatic tissues (80.0％),and negatively correlated with cell differentiation,tumor stage and distant metastasis.Down-regulated KLF4 expression in PANC1 cell caused decreased mRNA and protein expression of E-cadherin (F =25.71,P =0.0011) and increased mRNA and protein expression of vimentin (F =24.95,P=0.0012).Knockdown of KLF4 in PANC1 cell promoted the transition from epithelial morphology to mesenchymal morphology,and enhanced the healing ability (F =47.82,P ＜ 0.001),migration (F =53.68,P=0.0001) and invasion (F=27.65,P=0.0009).Conclusions Knockdown of KLF4 can promote EMT and enhance the invasion ability of pancreatic cancer.

Objective To summarize the experience of perioperative management for repair of congenital diaphragmatic hernia (CDH) supported by extracorporeal membrane oxygenation (ECMO). Method Retrospective review was conducted for the clinical data of CDH patients who received surgical repair on ECMO from December 2016 to June 2018 in Guangzhou Women and Children's Medical Center. Result Four fetus with prenatal diagnosis of left-side CDH were transferred to our Center and received standardized perinatal management. Moderate-severe pulmonary hypoplasia was recognized after evaluation by fetal imaging. Four cases were initiated with veno-arterial ECMO at 3, 35, 41, 11 h of life, respectively. Repair of the diaphragmatic defect was performed within two weeks after cannulation of ECMO. Furthermore, activated clotting time goals were adjusted to 180～220 s, activated partial thromboplastin time were stabilized between 50～80 s, platelets count were maintained>100×109/L and hematocrit was kept>30％before the surgery. The surgeries of four patients were completed on the 0.9th, 0.5th, 3.6th, 5.1th day of life on ECMO, respectively. The defect was repaired by parachute patch. The operative time was 85～210 min. According to CDH Staging System defect size (A to D), there were two with defects at grade C and other two at grade D. Postoperative total volume of drainage was 215～1301 ml and ECMO duration was 3.0～39.3 d. Three of them survived during neonatal period, while one died. Conclusion Repair of CDH on ECMO is feasible and help to improve neonatal survival, especially for those with moderate-severe pulmonary hypoplasia.