OBJECTIVE To investigate a management strategy for optimizing antimicrobial usage.METHODS We applied the PDCA(Plan,Do,Check,and Action) model to establish a management strategy for the appropriateness of antimicrobial usage.The components of the management model included providing educational program for medical staff,monitoring pathogens,analyzing the epidemic tendency of antimicrobial-resistant microorganisms,guiding physicians to proper use of antimicorbial treatment,and strengthening the surveillance,feedback and the(discipline).RESULTS These efforts resulted in a universal improvement in the awareness of appropriate(antimicrobial) therapy by medical staff,a significant decrease in the rate of antimicrobial use,and an increase in the numbers of specimens submitted for pathogen identification.Furthermore,the surgical prophylaxis was gradually standardized.CONCLUSIONS Our management strategy based on PDCA model is effective.

OBJECTIVE To evaluate the risk factors for nosocomial infection(NI) in patients with acute myocardial infarction.METHODS A retrospective study was carried out to investigate the clinical data of patients with acute myocardial infarction during the period from Jan 1,2004 to Dec 31,2006.RESULTS The incidence and case incidence of NI were 27.27% and 33.73%,respectively.Lower respiratory tract infection(69.50%) was the commonest,followed by urinary tract infection(12.06%) and gastrointestinal tract infection(10.64%).NI was closely related with patient′s age,duration of hospitalization,heart failure,urinary tract catheterization,longer stay in cardiac ICU and application of antimicrobial agents.CONCLUSIONS NI is high in patients with acute myocardial infarction,which should be paid attention on during the course of clinical treatment.

BACKGROUND: Hematopoietic stem cells have an ability of multi-directional differentiation and can be differentiated into megakayocytes in the presence of suitable hematopoietic growth factors and lineage special growth factors.Inducing of CD34+ stem cells to megakaryocytes in vitro involves many changes in gene expression, especially the signal transduction genes.OBJECTIVE: To study the expression of signal transduction genes after differentiation from stem cells into megakaryocytes.DESIGN: Open experiment.SETTING: Department of Tumor Immunology, Fujian Provincial Tumor Hospital.MATERIALS: 60-145 mL of cord blood was collected from normal labor fetuses under sterile conditions by using the blood-bag collective method. Patients and their relatives provided the confirmed consent. Reagents and equipments were detailed as follows: VarioMACS segregation apparatus, CD34+ Isolation Kit, SCGM serum-free medium, CD monoclonal antibodies, cytokines, human genome Oligo Set Version 2.1 from the CapitalBio Corporation, and LuxScan 10K/A bi-passage laser scanning apparatus. The researchers obtained consent from the local ethic committee.METHODS: This experiment was carried out in the Department of Tumor Immuonlogy, Fujian Provincial Tumor Hospital and the CaptialBio Corporation. from July 2005 to June 2006. RNA was extracted separately from CD34+ cells purified from cord blood and CD41+ cells induced from the same cord blood. The cDNA probes were synthesized by reverse transcription and purified. CD34+ cells before culturing and CD41+ cells after culturing were labeled with Cy3-dCTP and Cy5-dCTP respectively. Labeled DNA was dissolved in 30 μL hybridization fluid and hybridized at 42 ℃ over night MAIN OUTCOME MEASURES: The differential gene expression between haematopoietic stem cells and megakaryocytes involving cell signal transduction were detected by using DNA microarray analysis. According to the gene chip results,17 differentially expressed genes were selected for further analysis by RT-PCR.RESULTS: In this experiment, 3 522 differentially expressed genes were screened, including 1705 up-regulated genes and 1 817 down-regulated genes. In the 3 522 differentially expressed genes, there were 343 genes involved in cell signaling, 150 genes involved in transcription regulation, 21 genes involved in cell differentiation. The expression of the CD61 gene increased 369.83 fold, the expression of the CD41 gene increased 27.38 fold, and the expression of PF4 gene increased 24.06 folds; The expression of mitogen-activated protein kinases (MAPKs), G protein-coupled receptors (GPCRs) and members of RAS oncogene family increased mostly. The expression of the genes involved in STAT pathways, both SOCS1 and JAK2 were up-regulated, but STAT5A was down-regulated. As determined by the gene chip results, 17 differentially expressed genes were selected for further analysis by RT-PCR. GAPDH was used as the internal control, and RT-PCR results were in agreement and confirmed the finding from the gene chip expression results.CONCLUSION: Thrombopoeitin (TPO) and other hematopoietic growth factors may enhance the proliferation and differentiation of megakaryocytes derived from cord blood stem cells by GPCRs-Ras-MAPK pathway.

Objective: To establish the two-dimensional gel electrophoresis pH 4-7 maps of human gastric carcinoma and paired paracancerous mucosa,and to analyze differently expressed proteins of human gastric carcinoma and paired paracancerous mucosa.Methods: The total proteins of human gastric carcinoma and paired paracancerous mucosa were extracted,separated and analyzed by two-dimensional electrophoresis(2-DE).Results:By comparing and analyzing pH 4-7 protein expression maps of 5 cases of gastric carcinoma and paired paracancerous mucosa,128 differently expressed protein spots were detected,of which 56 expressed only in gastric carcinoma,27 in normal gastric mucosa tissues,32 more highly and 13 more lowly in gastric carcinoma than in paracancerous mucosa tissues. Conclusion: Proteins express differently in gastric carcinoma from paired paracancerous mucosa.Searching for differently expressed proteins between the two types of tissues may throw light on the molecular mechanism of gastric carcinoma.

Objective To observe the effect of Jiaweibugan decoction on c-jun mRNA expression of sciatic nerve in experimental di-abetic rat and explore the preventive and therapeutic effects of Jiaweibugan decoction on peripheral neuropathy in experimental diabetic rats. Methods The diabetic rat model, was established by streptozotocin (STZ). The rots were killed on the 4th or 8th week from the beginning of treatment, and c-jun mRNA of sciatic nerve was detected by reverse-transcriptase polymerase chain reaction (RT-PCR). Serum SOD was determined by xanthine oxidase method. Results The results of RT-PCR showed that c-jun mRNA expression of the model group on the 4th or 8th week was higher than that of the normal control group (P <0.05) , while those in model rats treated by Jiaweibugan decoction were markedly lower than those in non-treated model rats(P <0.05). The results showed that SOD of the model group on the 4th or 8th week was lower than that of the normal control group (P < 0.05) , while those in model rats treated by Jiaweibugan decoction were markedly higher than those in non-treated model rats(P < 0.05). Conclusion Jiaweibugan decoction has a preventive and therapeutic effect on peripheral neuropathy in experimental diabetic rats.

Objective To investigate ultrasound guidended nerve block of femoral nerve in emergency operation.Methods 40 patients who planned to accept surgery of feet,lower limb under knee.They were randomly devided into 2 groups:ultrasound guidended group and the control group.Femoral nerve and Sciatic nerve were blocked by ultrasound guidended technique or classic landmark technique.1.5% lidocaine was administered for nerve block.Sensory block was observed every 5 minutes in 30 minutes.Onset time,effect of anesthesia,algesia time and complications were recorded.T-test and varience difference were applied.Results The onset time of local anesthetics was faster in the ultrasound guided group than that of the control group.Effect of analgesia was better in in the ultrasound guided group than that of the control group. Conclusion Nerve block of femoral nerve and the sciatic nerve guided by ultrasound was better than the classic technique.

Objective To observe the expression of cytotoxicity and receptors on NK cells in breast cancer,and investigate the impact of soluble MICA(sohble MHC class Ⅰ-related molecules A,sMICA) on NK cells receptors expression and cytotoxicity.Methods ELISA was used to examine the sMICA in peripheral blood.The expressions of activated receptor(NKG2D),killer inhibitory receptor (KIR)(CD158b) and NK cells were identified by flow cytometry(FCM).Cytotoxicity of NK cells to breast cancer were tested by MTT.Results sMICA was (205.36±71.27)ng/L in breast cancer patients and 81.6 % samples were detected.There were positive correlations between sMICA levels with breast cancer stages.There were no difference of NK cells percentage between breast cancer and healthy person.The cytotoxicity of NK cells and expressions of NKG2D were obviously lower in breast cancer with sMICA(+) than in healthy person,but CD158b was higher in healthy person.After cultured with sMICA,NK cells cytotoxicity decreased from(76.2±6.7)% to(48.4±4.1)% and the expression of NKG2D reduced from(92.5±7.1)% to (62.5±6.4)%,but the the expression of CD158b increased from(10.6±3.2)% to (43.6±3.4)%.IL-15 up regulated the expression of NKG2D and NK cells cytotoxicity,but decreased the expression of CD158b by co-culturation with IL-15 and sMICA in sMICA+ patients with breast cancer.Conclusion sMICA reduced the expression of NKG2D and increased the expression of Kill,which lead to the down regulation of NK cells cytotoxicity.IL-15 can reverse this effect.

Objective: To explore the significance of Th17 in hepatocellular carcinoma, expecially with HBV infection.Methods:Cytometric bead array(CBA) was employed to detect 5 cytokines(IL-2,IL-4,IL-6,IFN-γ,IL-17A)from 39 tumor and non-tumor tissues of HCC and combined clinical data for comparative statistic analysis.Results:The expression of IL-2,IL-4,IFN-γin liver cancer tissue[(4.61±0.28),(3.37±0.58),(3.08±1.08)pg/ml,respectively] was significant lower than non-cancer tissue [(5.57±0.59),(3.77±0.70),(3.69±1.20)pg/ml,respectively].Otherwise,the expression of IL-6,IL-17A in cancer tissue [(280.09±254.68), (2.66±1.66) pg/ml, respectively] was higher than non-cancer [(6.58 ±1.92), (1.49 ±0.98) pg/ml, respectively].And,whatever cancer or non-cancer tissue,the expression of IL-17A in tissue[(3.45±1.86)pg/ml] with high HBV load (>1 000 U/ml) was significant higher than tissue with low HBV load[(1.97±1.16)pg/ml].Conclusion: IL-17A was highly expressed in HCC,and IL-2,IL-4,IFN-γmay inhibit its expression,and IL-6 may promote it.Hepatitis B virus infection may promote Th17 expression,thereby reducing patient′s prognosis.

Objective To investigate the prevalence of vitamin D deficiency in medical intensive care unit (ICU) and its relationship with severity of disease and prognosis.Methods A prospective study was performed to evaluate vitamin D status in 216 patients admitted to the medical intensive care unit.The incidence of hypovitaminosis D was observed.Acute Physiology and Chronic Health Evaluation Ⅱ (APACHE Ⅱ) score,days kept in ICU and on ventilator,main laboratory findings,and mortality rate were compared among patients with different serum 25-hydroxyvitamin D [25 (OH) D] levels.Potential risk factors for mortality were analyzed by multivariate logistic regression analysis.Results One hundred and fifty-three patients (70.8％) developed hypovitaminosis D.25 (OH) D deficiency was identified in 95 (44.0％),25 (OH) D insufficiency in 58 (26.8％),and 25 (OH) D sufficiency in 63 (29.2％) patients.APACHE Ⅱ score,positive blood culture,the incidence of multiple organ dysfunction syndrome(MODS),and mortality rate were higher in deficiency group compared with the other two groups [APACHE Ⅱ score:deficiency group 25 (20,28) score,insufficiency group 22 (17,26) score,sufficiency group 19 (18,20) score,P＜0.01 ; positive blood culture:deficiency group 18.9％,insufficiency group 13.8％,sufficiency group 3.2％,P=0.015 ; MODS:deficiency group 48.4％,insufficiency group 43.1％,sufficiency group 25.4％,P=0.025; mortality rate:deficiency group 40％,insufficiency group 24.1％,sufficiency group 15.9％,P =0.003].25 (OH)D levels were negatively correlated with APACHE Ⅱ score and mortality rate (r =-0.325,P＜0.01 ; r=-0.276,P＜0.01,respectively).Analysis by multiple logistic regression demonstrated that 25 (OH) D deficiency (OR =3.005,95 ％ CI 1.321-5.875,P =0.008) was independent risk factor for mortality.Conclusions This study demonstrates that vitamin D deficiency is highly prevalent among patients admitted into ICU.Vitamin D deficiency is associated with disease severity,and seems to be an independent risk factor for mortality.

OBJECTIVE To analyze the epidemiological characteristics,the efficiency of the surveillance system for nosocomial infections in our hospital,the sensitivity,specificity and timeliness of case reporting and to evaluate the efficiencies of the monitoring and reporting system.METHODS We reviewed the nosocomial infection reporting data in the year of 2005 and identified all the reported cases,confirmed cases and under-reported cases.Sensitivity and specificity of the reporting system were calculated based on these data.RESULTS The incidence of nosocomial infection was 3.04% in 2005.A majority(72.07%) of the cases were reported within 7 days of occurrence.Respiratory tract infection accounted for 57.75% of all nosocomial infections and was by far the most common site of concern.The rates of false positive reporting ranged from 14-37% and were statistically significantly associated with the sites of the infection(P