After summing up the experience of recent years' clinic teaching, ICU department in Fangcun Branch of Second Clinical Medical College of Guangzhou University of TCM comes to a conclusion that, the clinical teaching of ICU should pay attention to and ensure effective implementation of beginning educationg. And following the PDCA method (Plan, Do, Check & Act) will make the work orderly, normative and controllable and meanwhile raise the students' observing and analysis ability as well as their operation and doctor-patient communication ability. In this way we can mostly enhance the effect of teaching.

Objective To investigate the risk factor profile of pneumonia caused by pandrug-resistant Acinetobacter baumannii (PDRAB)in intensive care unit for better distinction between PDRAB infection and colonization.Methods The clinical data of 99 patients diagnosed as A.baumannii pneumonia between February 2009 and March 2012 in Fangcun Hospital,a branch of Guangdong Provincial Hospital of Traditional Chinese Medicine,were reviewed and analyzed retrospectively.The risk factors associated with pandrug-resistance in A.baumannii were examined with multivariate logistic regression analysis.Results ICU stay,duration of invasive ventilation,longer duration of treatment with carbapenems,beta-lactam/beta-lactamase inhibitor,or quinolone antibiotics,use of ≥3 classes of antimicrobial agents,≥3 invasive procedures (including indwelling gastric canal, catheterization,central venous catheter,arterial sheath),and fiberoptic bronchoscopic treatment were associated with PDRAB pneumonia (P <0.05).Multivariate logistic regression analysis showed that use of ≥3 classes of antibiotics,fiberoptic bron-choscopic treatment,and longer duration of treatment with beta-lactam/beta-lactamase inhibitor were independent risk factors predicting the emergence of PDRAB pneumonia.Conclusions We should pay more attention to these risk factors in clinical prac-tice for better differentiation between PDRAB infection and colonization so that appropriate control measures can be taken pro-actively.

Objective To investigate the safety and efficacy of long-term low doses of Azithromycin combined with Budesonide/Fomoterol in the treatment of stable Ⅲ to Ⅳ COPD patients. Methods Collect the confirmed COPD patients of our hospital, they were randomly divided into two groups: the control group (160μg/ 4.5 μg, Bid), the joint group (160 μg/ 4.5 μg/ Bid + azithromycin 250 mg qd). Then Observe the PEF, FEV1, FEV1/FVC, mMRC, 6 MWT, AECOPD of the two groups after treatment for 3 months and 6 months. Results the index of PEF, FEV1, FEV1/FVC of joint group improved more significantly (P < 0.05) than control group after 6 months; the mMRC, 6 MWT, AECOPD, of the two groups improve the similar degree in terms of 3 months (P > 0.05), joint group improved more significantly than control group after 6 months (P < 0.05). Conclusion the therapy of Long-term low doses of azithromycin combined with Budesonide/Fomoterol can more significantly improve lung function index , as the treatment time extended , it can significantly improve clinical symptoms ,reduce the number of exacerbations than single inhaled Budesonide/Fomoterol .

In the basic skill teaching of "Diagnostics Foundation"in Chinese medicine colleges and universities, the standardized patients are used to strengthen students’ clinical basic skill,let them consolidate their theoretical knowledge and change it into their skills,which is an effective way to guarantee the students to enhance their"double-base"ability,namely the elementary theory and clinical basic skill,and their self-confidence and shorten the time from the classroom to the clinical practice running-in period.

Adult ; Chemical and Drug Induced Liver Injury, Chronic ; Dimethylformamide ; poisoning ; Female ; Humans

Objective To study the effects of helicase-like transcription factor (HLTF)transfection on DNA repair protein level in radiation-induced apoptotic cells.Methods Human lung carcinoma A549 cells were cultured and transfected with FLAG-tagged wild type HLTF (wild type HLTF transfection group),RING structure domain (ubiquitin conjugating region) mutatation HLTF expressing plasmid (mutant transfection group),empty plasmid (congtrol group) respectively.And the other cells were used as mock transfection group.All cells were irradiated with 15 Gy of 60Co γ-rays to induce apoptosis.Western blotting was used to detect the protein levels of the DNA repair proteins HRAD17 and HRAD52 in the transfected cells.Results The levels of HRAD17 and HRAD52 in the wild type HLTF transfection group was significantly lower than that of the control group.There was no significant difference in HRAD17 and HRAD52 levels between the mock transfection group and ubiquity in conjugating region mutation group.complexes of HLTF and HRAD17 and HRAD52 could be found in the irradiation-induced cells.Conclusions HLTF mediates the degradation of HRAD17 and HRAD52 in the irradiation-induced apoptotic cells possibly by the interaction of the protein complex causing ubiquitination of the repair proteins.

Objective To investigate the effect of spleen-supplementing and lung-strengthening therapy on patients with chronic obstructive pulmonary disease(COPD)treated by mechanical ventilation and enteral-parenteral nutritional support.Methods Acute exacerbation COPD patients complicated with respiratory failure treated by mechanical ventilation were randomized into group A(n=32)and group B(n=30).The two groups received invasive or non-invasive mechanical ventilation,routine western medicine and enteral-parenteral nutritional support.Group A received oral use of Jianpi Yifei Granules(mainly composed of Radix Ginseng Destillata,Rhizoma Atractylodis Macrocephalae,Poria,Radix Ophiopogonis,Cortex Mori,Radix Astragali)and electroacupuncture(EA)on bilateral acupoints of Zusanli additionally.The treatment lasted 2 weeks.The changes of leg circumference and arm circumference,and serum levels of total protein(TP),albumin(Alb),prealbumin(PAlb)and hemoglobin(Hb)were observed.The outcomes of mortality rate during hospitalization,success rate of removing respiratory machine,time for parenteral nutritional support,time for invasive or non-invasive mechanical ventilation,fee for nutritional support and hospitalization fee in intensive care unit(ICU)were compared in the two groups.The incidences of complications of pneumonia,fungal infection,and upper gastrointestinal hemorrhage were also observed during mechanical ventilation.Results After treatment,serum levels of TP and PAlb were higher in group A than those in group B(P0.05);leg circumference and arm circumference in the two groups increased(P0.05).Time for parenteral nutritional support,time for invasive or non-invasive mechanical ventilation,and fee for nutritional support and hospitalization fee in ICU were lower in group A than those in group B(P

Adolescent ; Adult ; Blood Donors ; Child ; Child, Preschool ; Female ; Gastrointestinal Diseases ; drug therapy ; etiology ; Graft vs Host Disease ; drug therapy ; etiology ; Hematopoietic Stem Cell Transplantation ; adverse effects ; Hormones ; administration & dosage ; therapeutic use ; Humans ; Male ; Middle Aged ; Transplantation, Homologous ; Young Adult

Objective To discuss the significance of the application of neutrophil to lymphocyte ratio (NLR)combined with prostate specific antigen (PSA)in early diagnosis of prostate carcinoma.Methods 120 cases with surgery treatment of prostate carcinoma were selected as study group,and 120 healthy people were selected as control groups.The NLR and PSA were tested to diagnose the prostate carcinoma.The critical value of NLR in diagnosing prostate carcinoma was evaluated by ROC curves,and the advantages of combination of NLR and PSA were judged. Results By using ROC curves to evaluate the NLR in diagnosis,the critical value was 2.75.The susceptibility, specificity,Youden index,correct index were 0.79,0.85,0.65,0.72.The susceptibility,specificity,positive predictive value,negative predictive value,correct index of NLR combined with PSA in diagnosing the prostate carcinoma were 0.85,0.83,5.00,0.18,0.68.Conclusion The application of NLR has higher susceptibility and specificity to diagnose prostate carcinoma.NLR combined with PSA can improve the susceptibility and specificity of early diagnosis of prostate carcinoma.

OBJECTIVETo compare clinical efficacy of anatomic locking plate and Gamma nail in treating unstable femoral intertrochanteric fractures with external wall fractures.

METHODSFrom June 2010 to June 2014,clinical data of 44 patients with intertroehanteric fractures associated with lateral wall fractures (type 31A2.2-3.3) followed more than 12 months,which treated with Gamma nail or anatomic locking plate,were retrospective analyzed. Sixteen patients were treated with anatomic locking plate, including 6 males and 10 females aged from 32 to 83 years old with an average of 56.5 years old. Twenty-eight patients were treated with Gamma nail including 17 males and 11 females aged from 26 to 87 years old with an average of 60.4 years old. Operative time, intraoperative fluoroscopy times, blood loss (intraoperative and hidden blood loss), hospital stays were observed and compared. PPMS and HHS scoring were used to evaluate postoperative clinical effect.

RESULTSAll patients were followed up from 12 to 24 months with an average of 16.2 months. Operative time in Gamma nail was shorter than anatomic locking plate; while blood loss( intraoperative and hidden blood loss) and intraoperative fluoroscopy times in anatomic locking plate were less than that of in Gamma nail. There was no significant meaning in hospital stays between two groups. Postoperative full weight-bearing time in anatomic locking plate was prolonged than Gamma nail. At the final following-up, PPMS in Gamma nail was 7.50 ± 1.78 and 6.82 ± 1.38 in anatomic locking plate, and there was no obvious meaning between two groups (t = 2.341, P = 0.132); there was no significant differences in HHS score between Gamma nail (83.25 ± 11.18) and anatomic locking plate (86.14 ± 12.36) (t = 1.923, P = 0.243). The incidence of complications in Gamma nail was less than anatomic lock-ing plate (P = 0.005).

CONCLUSIONAnatomic locking plate for intertrochanteric fractures with external wall fractures could avoid re-injury of external wall, especially for severe comminuted fractures, difficult for intramedullary nailing, and there was no significant meaning in hip joint function compared with Gamma nail, while postoperative incidence of complications was higher than Gamma nail, so early weight-bearing was not stress.

Adult ; Aged ; Bone Nails ; Bone Plates ; Female ; Fracture Fixation, Intramedullary ; instrumentation ; methods ; Hip Fractures ; surgery ; Hip Joint ; surgery ; Humans ; Male ; Middle Aged ; Retrospective Studies ; Young Adult