Objective To evaluate the efficacy and safety of domestic cefepime ,ceftazidime and cefathiami-dine on bacterial infection in gynecology .Methods 460 patients were randomly divided into Group A (155 patients) for 2.0g.bid of cefepime,Group B (155 patients) for 2.0g.bid of ceftazidime and Group C (150 patient) for 2.0g. bid of cefathiamidine ( intramuscular injection:once every 12 hours ) , and the periods of treatment were all 7 to 10 days.Control observation and study was carried out following Guiding Principle of Clinical Application of Antibacterial Agents.Results The clinical efficacies in Groups A ,B and C were 94.84%,82.58% and 67.33%respectively(χ2 =11.63,37.96,all P<0.05);the bacterial clearance rates were 92.52%,81.38% and 64.71%respectively(χ2 =8.00,9.97,all P<0.05).The clinical efficacy of Group A >that of Group B>that of Group C;the adverse effectives were 9.68%,10.32% and 9.33% respectively (χ2 =0.09,P>0.05).Conclusion Cefepime may still be used as the first line drugs ,and drug resistance of various degrees has occurred to ceftazidime and cefathi -amidine,and especially cefathiamidine ,which should be used with caution .

Objective To evaluate the role of using non-invasive ventilation with bi-level positive airway pressure (BiPAP) in order to reduce the need of re-intubation in pediatric patients with respiratory failure after cardiac surgery. Method From January 2007 to December 2007, 25 patients aged from three months to 11 years with median 2.3 years operated on for cardiac surgery with respiratory insufficiency after extubation and re-intubation indicated were enrolled in this study. They were put on non-invasive nasal (mask) BiPAP ventilation before re-intubation. The arterial blood gas, A-aDO2 and PaO2/FiO2 were measured. In addition, clinical data including heart rate, respiratory rate, and the product of heart rate and systolic pressure were recorded before and after BiPAP. The software SPSSD 13.0 was used to process by ANOVA test for statistical analysis. Meanwhile, the outcome of these patients was analyzed. Results Twenty-five patients with 30 episodes of respiratory insufficiency were treated with BiPAP ventilation with median duration of 1.96 days ranged from 0.03 to 12 days. Of these respiratory failure episodes, 25 ones (83.3%) could be controlled by BiPAP and the needs of re-intubation were avoided. Five episodes of respiratory failure in 4 patients could not be quelled and the endo-tracheal tubes were inserted in these patients. All patients were saved with a median of mechanical ventilation duration of 3.4 days and ICU stay of 10.6 days. No major complications were observed. The heart rate, respiratory rate and the rate-pressure product were decreased significantly one hour after BiPAP (P < 0.05 all). Meanwhile, patients showed rapid improvement of oxygenation. The pH, SpO>2 and PaO2/FiO2 were increased significantly and A-aDO2 was decreased significantly (P < 0.05 all). The PaCO2, was decreased significantly four hours after BiPAP (P < 0.05). Conclusions Non-invasive nasal mask BiPAP can be used safely and effectively in children after cardiac surgery to improve oxygenation/ventilation, decreasing the work of breathing. It may be particularly useful in patients with high risk of re-intubation.

Objective To reduce infection risk in hemodialysis patients through analyzing the causes of over stand-ard colony forming unit(CFU)and conducting bacteriological detection of hemodialysis concentrated B solution. Methods According to microbial monitoring results of hemodialysis concentrate B solution in a hospital between November 2011 and May 2012,disinfection frequency of B solution was changed and dispensing container was covered during the process of using,four groups were divided according to different measures (group A disinfected twice a week,covered dur-ing the process of using;group B twice a week;group C once a week;group D once every two weeks),monthly bacte-riological detection of B solution was conducted,condition before and after disinfection of four groups were com-pared.Results Bacterial count in group A,B ,C and D was(25.41 ±15.08),(28.24±28.04),(68.58 ±22.58), and (75.25±26.63)CFU/mL,respectively (F =79.00,P <0.01 );bacterial count of group A,B,and C after in-tervention were all lower than group D before intervention (all P <0.01),bacterial count of group A and B was the lowest.The qualified rate of group A was 100.00%,the unqualified rate of group B,C,and D was 13.95%, 24.24%,and 35.94% respectively(χ2 =28.70,P <0.01 ),the unqualified rates of group A,B,and C after inter-vention were all lower than group D.Conclusion Hemodialysis concentrated B solution should be used within 24 hours after preparing,disinfected twice a week,and covered during the process of using ,so as to control B solution colony number within the standard level.

Simvastatin,a 3-hydroxy-3-methylglutaryl coenzyme A reductase inhibitor,is widely prescribed to patients with hypercholesteremia and its muscular toxicity has been widely reported.The metabolism of simvastatin depends on the enzymic activity of cytochrome P450 3A4 (CYP3A4) and inhibitors of CYP3A4 can result in clinical events by interacting with simvastatin.Diltiazem is a moderate inhibitor of CYP3A4,which is known to increase the serum concentration of simvastatin.Here we report a patient with unrecognized hypothyroidism who had been stable for more than one year on low-dose simvastatin therapy of hypercholesteremia and rhabdomyolysis occurred with the addition of diltiazem.This is one of scanty reports of rhabdomyolysis induced by simvastatindiltiazem drug interaction,especially in hypothyroid patient.This case reminds the clinicians that although diltiazem as a moderate CYP3A4 inhibitor can be used cautiously with small doses of CYP3A4-dependent statius (eg,simvastatin),these two commonly used drugs should be avoided in hypothyroid patient.

Objective To analyze the causes of death and prognostic indicators of rheumatoid arthritis (RA).Methods A retrospective investigation was performed on 91 RA patients who were admitted into our hospital from 1990 to 2011.The clinical features and laboratory data were studied to assess the causes of death and the relationship between causes of death and disease activity and treatment.T test and x2 test were used for statistical analysis.Prognostic indicators of mortality were studied by Cox propor-tional hazards models.The prognostic indicators of RA were also analyzed.Results The three most common causes of death in patients with RA were infection (57％),cardiac-cerebral vascular diseases (13％) and cancer (12％).Severe disease activity and presence of extra-articular manifestations were more common among the patients who died.Seventy-five percent patients presented with systemic symptoms including fever,fatigue and weight loss,followed by pulmonary fibrosis (32％) and pleural effusion (27％).Cox regression analysis revealed that the presence of extra-articular features was independent risk determinant for mortality while DMARDs treatment was the independent protect determinant.Conclusion Infection,cardiac-cerebral vascular diseases and cancer are the main causes of death in RA.The presence of extra-articular features is the independent risk factor of RA.

Objective To compare the Health Related Quality of Life (HRQOL) of patients with sys temic lupus erythematosus (SLE) with other common chronic diseases (coronary heart disease,diabetes and hypertension).Methods Responses from Short Form-36 (SF-36) questionnaires from outpatients,inpatients with SLE,other common chronic diseases and healthy controls were analyzed in all domains.Results The mean age of patients with SLE was 39+13 years old,while those of patients with coronary heart disease,dia betes and hypertension were 65±16,60±13,59±14 years respectively.All SLE patients were significantly worse in all domains of SF-36 questionnaire,compared with the healthy controls.The responses of inactive patients with SLE,were not significantly worse than those with other chronic diseases in all domains (P＞0.05).On the contrary,the responses of patients with active SLE were significantly worse than those of patients with inactive SLE,as well as patients with other chronic diseases (P＜0.05).Conclusion HRQOL of patients with active SLE is significantly worse when compared to patients with other common chronic diseases.

Objective To study the clinical char acteristics and outcome of two lymphoma patients mimicking Beh?et's disease. Methods Lymphoma was diagnosed in two patients mimicking Beh?et's disease referred to our Department in 2015. A search on published similar cases in Chinese database and the Pubmed was also performed and then analyzed. Results Eight patients were indentified in this pooled analysis, six of which were non-Hodgkin lymphoma (NHL). All of the eight cases presented with cutaneous lesion, seven cases with fever, seven cases with oral ulceration and six cases with orogenital ulceration, respectively. Ocular involvement was present in four of the eight cases, two were with a positive pathergy test. Among feverish patients, six were moderate or high fever, four were high fever, one was low-grade fever. Neutropenia was found in four patients, and lymphocytoponia in four of five patients with detailed data. All patients fulfilled the 2014 International Criteria for Beh?et's Disease (ICBD) with an average score of (5.8 ±1.5), ranging from 4 to 8. Survival period ranged from one month to 36 months, with an average of 8 months. Conclusion For patients diagnosed as Beh?et's disease are finally diagnosed as lymphoma. For patients with Beh?et's disease present-ation but also present with mediate to high fever, atypical deepseated ulcer, neutropenia or lymphocytoponia, malignancy especially lymphoma should be investigated.

Objective To investigate the effect of hirudin on janus kinase 2 / signal transducer and activator of transcription 3 (JAK2 / STAT3)signaling pathway in rats with intracerebral hemorrhage. Methods A total of 216 healthy male Wistar rats were divided into sham operation group,model group, and hirudin group (n =72 in each group)using random digit table. The model of cerebral hemorrhage was induced by injecting autologous arterial blood into the caudate nucleus,and the equal volume isotonic saline was used instead of autologous arterial blood in the sham operation group. Hirudin were injected at 6,24, 72,and 120 h,respectively in the hirudin group,while the sham operation group and the model group were injected with isotonic saline during same period. Neurobehavioral scores,brain water content and brain coefficients of the 3 groups at the different time points were compared. The changes of brain cell apoptosis were detected with annexin V-fluorescein isothiocyanate/ propidium iodide double staining flow cytometry. The expression levels of phosphorylated JAK2 (p-JAK2)and phosphorylated STAT3 (p-STAT3)in brain tissue were detected with Western blot. Results (1)Compared with the sham operation group at same time period,neurobehavioral score,brain water content,brain coefficients,brain cell apoptosis rate,and the expression levels of p-JAK2 and p-STAT3 were increased significantly in the rats of the model group. The differences between the two groups were statistically significant (all P < 0. 05). Compared with the model group at same time period,neurobehavioral score,brain water content,brain coefficients,and brain cell apoptosis rate were decreased significantly in the rats of the hirudin group. The differences between the two groups were statistically significant (all P <0. 05). (2)At 6,24,72,and 120 h after modeling,the expression levels of p-JAK2 were 0. 632 ±0. 036,0. 783 ± 0. 045,1. 250 ± 0. 071,and 1. 006 ± 0. 052,respectively,and those of p-STAT3 were 0. 155 ±0. 005,0. 193 ±0. 006,0. 379 ±0. 012,and 0. 317 ± 0. 010,respectively in model group. The expression levels of p-JAK2 were 0. 267 ± 0. 014,0. 248 ± 0. 013,0. 329 ± 0. 018,and 0. 283 ±0. 016,respectively,and those of p-STAT3 were 0. 139 ± 0. 004,0. 081 ± 0. 001,0. 283 ± 0. 009, and 0. 174 ± 0. 005,respectively in the hirudin group. The expression levels of p-JAK2 and p-STAT3 in hirudin group were lower than those in the model group. There were significant differences between the two groups (all P < 0. 05). Conclusion Hirudin can reduce apoptosis of brain cells after intracerebral hemorrhage in rats,its protective mechanism may be associated with the inhibition of JAK2 / STAT3 signaling pathway.

Objective To observe the incidence of acute gastrointestinal injury (AGI) in intensive care unit (ICU) patients, and to approach the value of serum citrulline and intestinal fatty acid binding protein (IFABP) on diagnosis of AGI in critical patients. Methods A prospective study was conducted. 576 critical patients admitted to ICU of Yantai Yuhuangding Hospital from February 2016 to February 2017 were enrolled. According to the AGI classification proposed by European Society of Intensive Care Medicine (ESICM) in 2012, the AGI and severity of the patients were observed. The general data, severity and prognosis of patients with different AGI grades were recorded. According to the random number table, 20 patients with normal kidney function from AGI Ⅰ to Ⅳ were selected. The femoral artery blood was collected within 12 hours of ICU admission, and serum citrulline level was detected by high performance liquid chromatography (HPLC). Serum IFABP level was determined by enzyme-linked immunosorbent assay (ELISA). Twenty healthy subjects were selected as controls. The receiver operating characteristic curve (ROC) was drawn, and the predictive values of citrulline and IFABP for AGI diagnosis were evaluated. Results ① 576 patients were enrolled in the analysis. Of which 530 patients (92.0%) had AGI, and 289 patients with gradeⅠ (54.5%), 154 with grade Ⅱ (29.1%),64 with grade Ⅲ (12.1%), and 23 with grade Ⅳ (4.3%). With the increase in AGI classification, acute physiology and chronic health evaluation system Ⅱ (APACHE Ⅱ) score, sequential organ failure score (SOFA), the length of ICU stay and 28-day mortality were gradually increased. ② Compared with health control group, the levels of serum citrulline in patients with different AGI grades were significantly decreased, and IFABP was significantly increased. With the increase in AGI classification, the citrulline level was gradually decreased, and IFABP level was gradually increased [citrulline levels (μmol/L) in AGIⅠ,Ⅱ,Ⅲ,Ⅳ groups were 14.1±3.6, 12.7±3.1, 8.3±2.7, and 5.6±3.4, F = 3.287, P = 0.027, and IFABP levels (ng/L) were 526.7±204.9, 698.4±273.8, 894.7±455.9, and 1 062.8±532.2, F = 2.903, P = 0.043]. ROC curve analysis showed that citrulline had a higher predictive value for AGI diagnosis. The area under the ROC curve (AUC) was 0.927. When the cut-off value of citrulline was 9.7 μmol/L, the sensitivity and specificity were 87.5% and 87.5%, respectively. The AUC of IFABP was 0.043, which has no predictive value for the diagnosis of AGI. Conclusions The AGI is extremely common in ICU. The higher the AGI grade is, the worse the prognosis is. Citrulline has high diagnostic value for AGI in critical patients, but IFABP has no predictive value on the diagnosis of AGI.

Objective To explore the effect of family integrated care (FIC) model on the growth and development in preterm infants. Methods A total of 128 cases of hospitalized preterm infants from January 2016 to June 2016 were selected and divided into intervention group(64 cases)and control group (64 cases) by random number table. Intervention group was received FIC after the condition was stable, control group was adopted current traditional preterm infants care. The weight, body length and head circumference of both group were recorded at 3rd month,Neonatal Behavioral Neurological Assessment (NBNA)was assessed at correction gestational aged 40 weeks,hospital stays were counted while outpatient visits and readmission case were collected within 3 month after discharge. Results The study included 118 cases,56 cases in intervention group and 62 cases in control group.The weight,body length and head circumference in intervention group was (4 315.77 ± 856.48) g,(54.22 ± 2.74)cm, (36.23 ± 1.25) cm at 3rd month,while in control group was(3 886.52±812.94)g,(53.84±2.61)cm,(35.99± 1.58)cm.It showed that the weight,body length and head circumference in intervention group were significantly higher than those in control group(t =2.785, 2.512, 1.785, P<0.01 or 0.05). The score of NBNA was (36.85 ± 2.01) points and hospital stays was(16.96±8.01)d in intervention group,while (35.97±1.86)points and(20.41±7.26)d in control group,there were significant differences(t=2.692,-2.534,all P<0.05).Incidence of outpatient visits and readmission were 14.29%(8/56),3.57%(2/56)in intervention group and 32.26%(20/62),14.51% (9/62) in control group, incidence of outpatient visits and readmission were significantly lower in intervention group as compared with control group (χ2=5.251, 4.170, all P<0.05). Conclusions FIC model is implemented in neonatal progressive care unit for preterm infants, it could promote growth and development in preterm infants,shorten the length of hospital stays,while decrease incidence of outpatient visits and readmission.