OBJECTIVE:To explore the use of antibiotics in the department of respiratory diseases and pediatric outpatient department after the introduction of initiative intervention stragety on the rational use.METHODS:A field investigation was carried out on the international RDU index of antibiotics in the department of respiratory diseases and pediatric outpatient department by self-control test.Initiative intervention on physicians' prescribing practices was carried out at four stages:befter intervention,following first intervention,second intervention,and third intervention,respectively.Data statistics was analyzed by SPSS11.0 software.RESULTS:The percentages of patients treated with antibiotics and injcetable antibiotics in the department of respiratory diseases dropped from 61.6% and 19.2% before intervention to 30.0% and 14.0% after third intervention(P

Objective To discuss nursing care of patients underwent corneal Descemet stripping endothelial keratoplasty to treat bullous keratopathy. Methods 22 patients who underwent corneal Descemet stripping endothelial keratoplasty to treat bullous keratopathy accepted strengthened psychological care, perfect preoperatively preparation, to sleep in face-up supine position, meanwhile complications were observed and treated carefully. Results 22 patients could persist in sleeping in face-up position for 4days postoperatively. Graft shift occurred in two cases. And after gas reinjection the grafts adhered very well. Intraocular pressure rose in 7 cases .After timely treated these 7 patients were cured and discharged. Conclusions Careful preoperative evaluation and preparation could reduce postoperative complication. Strict measures to keep patients sleeping in face-up supine position, timely observation and treatment of complications should be important to ensure the success of the operation.

Objective:To analyze the immunotherapy and clinical characteristics of coronavirus disease 2019 (COVID-19) patients, and focus on exploring the effects of immunotherapy and mesenchymal stem cells (MSC) transplantation in the critically ill patients' treatment.Methods:Fity-five COVID-19 patients were admitted to the Fifth People's Hospital of Wuxi from January 23rd to March 31st, 2020 as the research object. The demographic characteristics of the cases and the methods of immunotherapy were analyzed, focusing on the immunized indicators, positivity of pathogens and clinical indicators of critically ill COVID-19 patient, and the effects of immunotherapy and stem cell transplantation were evaluated.Results:Aged, male and people with comorbidities were the main risk factors in the development of severe and critical COVID-19. All of confirmed COVID-19 cases (n = 55) had been treated with interferon-α (IFN-α), of which 81.8% (n = 45, mild and ordinary) of the patients were recovered, 14.6% (n = 8) of the patients were converted to severe, 3.6% (n = 2) of the patients were converted to critical, and some severe patients were treated with gamma globulin and albumin as adjuvant treatment. Critically ill patients were not only treated with IFN-α, gamma globulin and albumin, but also treated with convalescent plasma and MSC transplantation. Due to pulmonary hemorrhage and persistently low blood oxygen saturation, terminal lung transplantation therapy was implemented. The total number of lymphocytes, CD4 +, CD8 + T lymphocytes, natural killer (NK) cells and B cells in peripheral blood of the two critical COVID-19 patients were significantly reduced, and the functions of lung, liver, and kidney were severely damaged on admission, manifested as significant increase of the levels of blood C-reactive protein (CRP), alanine aminotransferase (ALT), aspartate aminotransferase (AST), and blood urea nitrogen (BUN), etc. and decrease of blood oxygen saturation, and type Ⅰ respiratory failure, and the noninvasive assisted ventilation was needed to improve. After adjuvant immunotherapy such as gamma globulin, the nucleic acid of 2019 novel coronavirus (2019-nCoV) turned into negative. The CRP of one critically ill patient was significantly lower than the value at admission (minimum of 21 mg/L). But the lung inflammation progressed rapidly, and the pathological results of the lung tissue from the lung transplantation showed hemorrhage and irreversible fibrosis. The ability to secrete immunoglobulin A (IgA) was significantly reduced. Liver function had been significantly improved and stabilized after treatment with convalescent plasma during the recovery period. MSC transplantation treatment reduced the BUN level by > 50% compared with the previous period, and the total number of lymphocytes in the patient increased by more than 2 times (rose from 0.23×10 9/L to 0.57×10 9/L), but the total amount of lymphocytes was still lower than the normal reference value (< 1.1×10 9/L). The lung inflammation lesions were obviously absorbed, and the vital signs were stable. Conclusions:In addition to IFN, gamma globulin, antiserum and MSC transplantation therapy can help clear the virus and reduce inflammation. Although MSC transplantation fail to completely change the immunecompromised state of critically ill patients, it controlled the progression of inflammation in the liver and kidneys.

Objective To assess the clinical diagnostic value of CT guided transthoracic core needle biopsy (TNB) in patients with pulmonary peripheral lesions. Methods The pathological findings, follow up results, mass size, complications due to paracentesis, and other examination results in 223 patients with pulmonary peripheral lesions undergoing TNB were analyzed retrospectively. Results The positive predictive value of malignant lesions was 100%. False negative was found in 3 cases. There was no false positive of malignant lesions in all the cases. The sensitivity and specificity were 93.6% and 100%, respectively. The negative predictive value of benign lesions was 94.8%. There was no significant difference in the satisfaction rate of multiple biopsy between the large and small nodules. The satisfaction rate of a single biopsy of the large nodule was significantly better than that of the small nodule ( P

Objective ToexploretheclinicalefficacyandsafetyofEmbospheremicrospherescombinedwithcoilsinbronchialarteryembolization (BAE)forpatientswithmassivehemoptysis.Methods FromJanuarytoDecember2017,63patientswith massivehemoptysiswere enrolledinourhospital,ofwhich29patientsreceivedEmbospheremicrospherescombinedwithcoilembolizationwereincludedasobservation group,andother34patientsreceivedembolizationwithEmbospheremicrospheresweretreatedascontrolgroup.Allthepatientswere followed-upin72hours.Results Theincidenceofhemostasisinobservationgroupwas96.55% within72hours,whichwassignificanthigher thanthatincontrolgroup (79.41% )(P<0.05).Themainreasonsforfailureweretherecanalizationofembolizedtargetvessel,the leakageofresponsiblevesselandpulmonaryarterypseudoaneurysm.Therewasnosignificantdifferenceoftheincidenceofadversereactions (mainlyincludingchesttightness,fever,chestpain)betweenthetwogroups(P=0.966).Conclusion Embospheremicrospherescombinedwith coilscansignificantlyimprovethehemostaticeffectofBAE,anddidnotincreasetheincidenceofpostoperativeadversereactions.

Objective To examine the benefits of ECMO for potential organ donors with hemodynamic instability after brain death.Methods Three brain-dead potential donors who presented with hemodynamic instability despite maximal medical management,finished a declaration of brain death,that were supported by extracorporeal circulation membrane oxygenation (ECMO).Results Donor organs,including six kidneys,and two livers,were harvested from the three donors under ECMO support,leading to 8 successful transplantations.The organs functioned well and the recipients made full recoveries.Conclusion Our experience indicates that ECMO allows for the maintenance of abdominal organ tissue perfusion without warm ischemia before organ procurement,providing sufficient time for safe organ donation procedures and reducing the risk of unpredictable cardiac arrest that could result in the donor death and graft loss.

Objective To determine the water absorption coefficient of single-flavor root and rhizome Chinese herbal medicine pieces at room temperature, and guide the water addition in the decoction process of decocting machine of Chinese herbal.Methods The water absorption coefficient of 222-flavor root and rhizome Chinese herbal medicine pieces were studied, the simulated prescriptions were decocted according to the recommended formula of the decocting machine manufacturer and the water absorption coefficient, and the amount of liquid were obtained by the two methods which were compared with the amount of liquid required.Results The water absorption coefficients of roots and rhizomes with different textures were quite different.The amount of liquid obtained according to the manufacturer′s recommended formula was quite different from the amount of liquid required and there was no rule to follow.The error of the amount of liquid obtained according to the water absorption coefficient and the amount of liquid required was small and regular.Conclusion The experimental determination of the water absorption coefficient of traditional Chinese medicine decoction pieces could guide the amount of water added to the decoction machine.

Objective:To explore the application rules and effects of "Four Elements, One Peptide, and Two Transplantations" in the bundle treatment of the patients with coronavirus disease 2019 (COVID-19), so as to provide a scientific evidence for effective treatment and prevention of severe type.Methods:A retrospective comparative study method was used to analyze the clinical data of COVID-19 patients admitted to Wuxi Fifth People's Hospital from January 2020 to March 2022, including demographic information, underlying diseases, clinical classification, length of hospital stay, treatment cost, clinical symptoms, laboratory tests and other key indicators, and evaluate the application rules and effect of "Four Elements, One Peptide, and Two Transplantations" in the bundle treatment of the patients with COVID-19.Results:The L-type new coronavirus strain was predominant in 2020, the Delta variant in 2021, and the Omicron variant in 2022. The proportion of mild cases was highest in 2022, with the highest proportion of > 65 years old patients developing severe and critical. Among the 150 patients, the proportion of interferon use (100.0%) was the highest in the bundle treatment regimen of "Four Elements, One Peptide, and Two Transplantation". The combined use of vitamin C, interferon and thymopeptide was highest in 2022. More than 75.0% of the age > 65 years old group had underlying diseases, which was also the age group with the highest proportion of "Four Elements, One Peptide, and Two transplantations". Compared with mild cases, the age, length of hospital stay, and hospitalization cost of patients with COVID-19 increased significantly with severity. Mild, ordinary, severe, and critically ill patients all had low lymphocyte counts, with 40.0% of severe patients having the lowest lymphocyte counts within 3 days of admission. The lymphocyte count of critically ill patients was reduced or continuously reduced after admission, and the use of the "Four Elements, One Peptide, and Two transplantations" method to regulate immunity can effectively save the lives of critically ill patients. Of all cases of COVID-19 infection, 51.3% were asymptomatic, followed by respiratory symptoms (48.7%) and lung lesions (38.0%). Patients with renal dysfunction received this bundle therapy was highest, followed abnormal coagulation and abnormal liver function. This bundle therapy promoted a significant increase in CD4 + T lymphocytes and B lymphocytes in various cases. After treatment, as the virus turns negative, the proportion of M1 type macrophages increased, and the proportion of regulatory T cell (Treg cells) that suppress immunity and the infection related C-C chemokine receptor type (CCR10 +) Treg cells decreased. Mild adult cases showed a great change and declined rapidly. Conclusions:Advanced age with underlying diseases is a risk factor for severe disease of COVID-19, the "Four Elements, One Peptide, and Two transplantations" bundle fine treatment of COVID-19 can improve the proportion of lymphocyte composition and organ function, which can control the occurrence and development of severe diseases. In addition to the proportion of CD4 + T cells, the changes of the M1 macrophage, total Treg cell, and CCR10 + Treg cell proportions can be used to determine disease changes of adult patients.