OBJECTIVE:To provide reference for rational application of Levofloxacin hydrochloride injection in the clinic. METHODS:With reference to the package insert of Levofloxacin hydrochloride injection,the guiding principles of clinical use of antibiotics,by reviewing related literatures,based on the weighted TOPSIS methods,detailed rules for drug utilization review (DUR) of Levofloxacin hydrochloride injection were made. And then 100 archived medical records of Levofloxacin hydrochloride injection in the first half of 2014 were evaluated in respect of medication rationality based on these rules. RESULTS:Among 100 cases,relative proximity of 51 cases was more than 70%(51.0%);that of 37 was between 50%-70%(37.0%);that of 12 cases was between 30%-50%(12.0%). CONCLUSIONS:Established DUR method of Levofloxacin hydrochloride injection on the basis of weighted TOPSIS methods can be used to evaluate the rationality of drug use and promote more rational evaluation behavior. And the results indicate that unreasonable use of Levofloxacin hydrochloride injection is still common in the hospital.

OBJECTIVETo evaluate the sensitivity and usefulness of 99mTc-sestamibi scintigraphy (SS) and neck ultrasonography (US) as preoperative localization procedures in patients with primary hyperparathyroidism (pHPT).

METHODS160 patients with proved pHPT in Peking Union Medical College Hospital from June 1983 to June 2002 were studied. There were 107 women(66.9%) and 53 men (33.1%), with a mean age of 38.9 years (10-73 years). 100 patients were underwent SS and 148 patients were underwent US prior to surgery, and the results were compared with operative and histological findings.

RESULTSThe sensitivity of SS and US in localization of the enlarged parathyroid glands was 94.0% and 85.1% respectively, and the positive predictive value of SS and US was 100% and 89.1% respectively, the overall sensitivity was 98.9% by combination of SS and US. In solitary parathyroid adenomas group (n = 145), the sensitivity of SS and US was 93.3% and 84.7% respectively; There was no significant difference (P = 0.428) in sensitivity of SS between the parathyroid glands correctly identified and undetected in classical neck location as compared with ectopic parathyroid glands, whereas significantly (P = 0.026) influenced by the US sensitivity.

CONCLUSIONSDifferent sensitivity exit between SS and VS in preoperative localization in patients with pHPT undergoing parathyroidectomy. The combined use of SS and US could increase the sensitivity of localization technique. Ectopic parathyroid had no influence on the sensitivity of 99mTc-MIBI scanning, but decreased the sensitivity of ultrasonography. The size of parathyroid tumors had effects on the sensitivity of ultrasonography. Otherwise, various conditions causing SS false negative were observed. Some interfere factors should be excluded when SS negative results were encountered in clinical practice.

Adolescent ; Adult ; Aged ; Child ; Female ; Humans ; Hyperparathyroidism ; diagnostic imaging ; pathology ; Male ; Middle Aged ; Neck ; diagnostic imaging ; Parathyroid Glands ; diagnostic imaging ; pathology ; Preoperative Care ; Radionuclide Imaging ; Sensitivity and Specificity ; Technetium Tc 99m Sestamibi ; therapeutic use ; Ultrasonography

BACKGROUNDEndovascular stent-grafting is widely used to treat thoracic aortic dissection. However, little information is available regarding outcome following simultaneous exclusion of multiple tears. This report details eight years of experience using simultaneous multi-tear exclusion for treatment of Stanford type B thoracic aortic dissection resulting in successful aortic remodeling without adverse events.

METHODSFrom September 1998 to January 2006, 29 type B thoracic aortic dissection patients (24 men, 5 women; 27 chronic, 2 acute; mean age 58 years, range 45 - 77 years) were treated by simultaneous multi-tear exclusion in our center. Magnetic resonance angiography was used as the preoperative evaluation method. Different kinds of stent-grafts were used. The patients were followed up with contrast-enhanced spiral computed tomography at 6 months postoperatively and yearly thereafter.

RESULTSTwenty-nine surgeries were completed successfully using at least 2 stent-grafts per patient (range: 2 - 6, mean: 2.7). No major procedure-related complications, such as rupture, paraplegia, aortic branch ischemia or cerebral infarction, were observed. During follow-up, favorable remodeling of the aorta was observed.

CONCLUSIONSThe mid-term result of thoracic aortic dissection with simultaneous multi-tear exclusion was satisfactory. With the improvement of stent-grafts, simultaneous multi-tear exclusion should find wider application and become an optimal strategy for thoracic aortic dissection.

Aged ; Aneurysm, Dissecting ; pathology ; surgery ; Aortic Aneurysm, Thoracic ; pathology ; surgery ; Blood Vessel Prosthesis Implantation ; methods ; Female ; Humans ; Male ; Middle Aged ; Stents ; Treatment Outcome

OBJECTIVETo investigate the difference in the efficacy between clonidine transdermal patch and haloperidol tablets in the treatment of moderate to severe tic disorders in children.

METHODSA total of 134 children with moderate to severe tic disorders were randomly divided into clonidine group (n=70) and haloperidol group (n=64). The clonidine and haloperidol groups were treated with clonidine transdermal patch and haloperidol tablets respectively, and the treatment lasted for 8 weeks in both groups. The Yale Global Tic Severity Scale (YGTSS) was used to evaluate the conditions of the children before and after treatment, and the adverse events during the treatment were recorded.

RESULTSThe haloperidol group had a significantly better treatment outcome than the clonidine group after one week of treatment (P<0.05); the treatment outcome showed no significant difference between the two groups after 3, 5, and 8 weeks of treatment (P>0.05). The clonidine group had significantly less reductions in the motor tics, vocal tics, and function impairment scores and total score of YGTSS than the haloperidol group after one week of treatment (P<0.05); there were no significant differences in YGTSS score reductions between the two groups after 3, 5, and 8 weeks of treatment (P>0.05). The clonidine group had a significantly lower overall incidence of adverse events than the haloperidol group (8% vs 37%; P<0.01).

CONCLUSIONSClonidine transdermal patch and haloperidol are both effective in the treatment of moderate to severe tic disorders in children. The clonidine transdermal patch, despite slow action, has comparable efficacy and fewer adverse effects compared with haloperidol.

Child ; Child, Preschool ; Clonidine ; administration & dosage ; Female ; Haloperidol ; therapeutic use ; Humans ; Male ; Severity of Illness Index ; Tic Disorders ; drug therapy ; Transdermal Patch

OBJECTIVETo investigate the significance of CD11b expression in neutrophils and lymphocytes in children with systemic inflammatory response syndrome (SIRS).

METHODSCD11b expression in neutrophils and lymphocytes was measured using flow cytometry in 36 children with SIRS (SIRS group) and 28 children with infectious disease but without SIRS (control group). The sensitivity and specificity of neutrophil CD11b for diagnosis of SIRS were evaluated.

RESULTSDuring the acute phase, an increased CD11b expression in neutrophils (96.7+/-8.1%) was observed in the SIRS group compared with the control group (85.1+/-5.1%) (p<0.05). Using neutrophil CD11b expression >92.2% as a cut-off value for diagnosis of SIRS, the sensitivity and the specificity were 97.2 % and 92.9% respectively. Lymphocytic CD11b expression in the SIRS group (13.4+/-8.6%) was lower than that in the control group (19.2+/-6.4%) in the acute phase (p<0.05). In the SIRS group, lymphocytic CD11b expression was remarkably suppressed in the severe sepsis subgroup (7.27+/-3.04%), showing significantly decreased expression compared with the non-infectious subgroup (19.3+/-2.9%) and the sepsis subgroup (15.9+/-12.5%) (p<0.01). In the convalescence stage lymphocytic CD11b expression in the SIRS group was similar to that in the control group.

CONCLUSIONSCD11b expression in neutrophils may serve as a reliable indicator for diagnosis of SIRS. The down-regulation of lymphocytic CD11b expression might be a signal of the condition aggravation in children with SIRS.

C-Reactive Protein ; analysis ; CD11b Antigen ; blood ; Child ; Child, Preschool ; Female ; Flow Cytometry ; Humans ; Infant ; Lymphocytes ; chemistry ; Male ; Neutrophils ; chemistry ; Sensitivity and Specificity ; Systemic Inflammatory Response Syndrome ; diagnosis ; immunology

To investigate the relationship between the plasma levels of chemokine CXCL9/Mig and acute graft-versus-host disease (aGVHD) after allogeneic hematopoietic stem cell transplantation (allo-HSCT). The plasma levels of CXCL9/Mig of 35 patients who received all-HSCT were detected by using ELISA assay, these patients included 13 patients with grade 0-I, 12 patients with grade II and 10 patients with grade III - IV aGVHD, respectively. The four different time points including prior to allo-HSCT, one week before aGVHD onset, the plateau of aGVHD and time after completely controlled, were studied. The results showed that the plasma levels of CXCL9/Mig in the patients with serious aGVHD (grade II - IV) were significantly increased during aGVHD than those in the patients without aGVHD or with slight aGVHD (P < 0.001). It was found that CXCL9/Mig levels were significantly correlated with the severity of grade aGVHD (P < 0.001). Another important finding was that CXCL9/Mig levels obviously increased at one week before aGVHD was diagnosed. CXCL9/Mig level was not obviously correlated with CMV infection or other infectious complication (P > 0.05). It is concluded that the plasma level of CXC19/Mig significantly correlated with the severity of aGVHD and plays a critical role in pathogenesis of aGVHD, the changes in plasma level of CXCL9/Mig after allo-HSCT may be used as a valuable indicator for early diagnosis of aGVHD, finally, provide a early therapeutic approach to reduce aGVHD severity and improve the outcome for patients after allo-HSCT.
Chemokine CXCL9 ; blood ; Graft vs Host Disease ; blood ; Hematopoietic Stem Cell Transplantation ; adverse effects ; Humans

OBJECTIVE: To observe the effects of immune complexes (IC) prepared from human oxidized density lipoprotein (oxLDL) antibodies and human oxLDL on the foam cell forming and the macrophage activation, and to further uncover the possible mechanisms of immune complexes contributing to the atherosclerosis occurrence. METHODS: The immune complexes of human oxLDL and purified human oxLDL antibodies were added to culture U937 cells by protocols: polyethylene glycol-precipitated insoluble IC (PEG-IC) and IC immobilized by absorption to red blood cells (RBC-IC). With oxLDL as controls and heat-aggregated gamma globulin as an inhibitor of Fc gamma receptor, we measured the cholesterol ester, total cholesterol of the cellular extracts, and quantified the secreted MMP-1 of supernatants from U937 cells. RESULTS: A significant increase of MMP-1 release [(0.769 +/- 0.030) ng/ml vs (0.513 +/- 0.034) ng/ml, P < 0.01] and a higher level of cholesterol ester accumulation [(20.271 +/- 1.668) microg/mg protein vs (17. 226 +/- 1.298 ) microg/mg protein, P < 0.05] in U937 cells incubated with RBC-IC were observed, compared with those incubated with RBC-oxLDL. However, the above quantative difference between the cholesterol ester accumulation induced by oxLDL and insoluble PEG-IC was even more striking, and cholesterol ester accumulation was dosage-dependent. Heat-aggregated gamma globulin (10 mg/ml) as an inhibitor of Fc gamma receptors competitively inhibited cholesterol ester accumulation and decreased PEG-IC stimulating MMP-1 secretion to 71%. CONCLUSION Immune complexe of ox-LDL can transform macrophages into foam cells and activted macrophages. The immunological function of oxLDL is involved in the process of atherosclerosis occurrence.
Antibodies ; pharmacology ; Atherosclerosis ; etiology ; metabolism ; Cholesterol Esters ; metabolism ; Foam Cells ; drug effects ; Humans ; Lipoproteins, LDL ; immunology ; pharmacology ; Macrophage Activation ; drug effects ; Matrix Metalloproteinase 1 ; biosynthesis ; U937 Cells

Objective:To investigate the effect of PhysioTouch on upper limb lymphedema after breast cancer surgery. Methods:From September, 2017 to August, 2018, 42 patients with upper limb lymphedema after breast cancer operation were randomly divided into control group (n = 21) and experimental group (n = 21). Both groups accepted complex decongestion therapy, while the experimental group accepted PhysioTouch in addition, for four weeks. They were assessed with difference of upper limb volume, Disabilities of the Arm, Shoulder and Hand (DASH), and European Organization for Research and Treatment of Cancer Quality of Life Questionnaire of Breast Cancer (EORTC QLQ‐BR23) before and after treatment. Results:All the indexes significantly improved in both groups after treatment (t > 17.925, P < 0.001), and improved more in the experimental group than in the control group (t > 2.407, P < 0.05). Conclusion:Combination of PhysioTouch can further relieve upper limb edema after breast cancer operation, and improve their shoulder-hand function and quality of life.

OBJECTIVE: To compare the efficacy on insomnia between Fang 's scalp acupuncture combined with conventional acupuncture and the simple conventional acupuncture. METHODS: A total of 66 patients with insomnia were randomly divided into an observation group (33 cases, 1 case dropped off) and a control group (33 cases, 2 cases dropped off). In the control group, the routine acupuncture therapy was applied to Shenmen (HT 7), Baihui (GV 20), Zhaohai (KI 6) and Sanyinjiao (SP 6), etc. Based on the treatment as the control group, Fang's scalp acupuncture therapy was supplemented at fuxiang tou, fuzang shangjiao, fuzang zhongjiao, siwei, etc. At these scalp points, the needles were inserted perpendicularly with flying needling technique and manipulated with trembling one. In either group, the treatment was given once daily, continuously for 2 weeks. Before and after treatment, separately, the score of Pittsburgh sleep quality index (PSQI) and the score of Chinese perceived stress scale (CPSS) were observed, as well as the parameters monitored by polysomnography, i.g. total sleep time (TST), sleep onset latency (SOL), wakefulness after the sleep onset (WASO), sleep efficiency (SE), the percentages of the time of rapid eye movement sleep phase (REM) and non-rapid eye movement sleep phase 1, 2, 3 and 4 in TST (REM%, N1%, N2%, N3%). The efficacy was compared between two groups. RESULTS: After treatment, the scores of each factor and the total scores of PSQI, as well as CPSS scores were all lower than those before treatment in the two groups (P<0.01, P<0.05); except the score for sleep quality, the score of each factor and the total score of PSQI, as well as CPSS score in the observation group were lower than those in the control group (P<0.01, P<0.05). After treatment, TST, SE%, REM% and N3% were increased and SOL, WASO, N1% were decreased as compared with before treatment in the two groups (P<0.01, P<0.05), and N2% in the observation group was decreased (P<0.01); SE%, REM% and N3% in the observation group were higher than the control group (P<0.05) and N1% and N2% were lower than the control group (P<0.05). The total effective rate was 93.8% (30/32) in the observation group, higher than 87.1% (27/31) in the control group (P<0.05). CONCLUSION Fang 's scalp acupuncture, on the base of routine acupuncture, obviously improves the sleep quality and perceived stress and adjusts the sleep structure in the patients with insomnia.
Acupuncture Points ; Acupuncture Therapy/methods* ; Humans ; Scalp ; Sleep ; Sleep Initiation and Maintenance Disorders/therapy* ; Stress, Psychological/therapy* ; Treatment Outcome

OBJECTIVETo investigate the correlation and consistency between thromboelastography(TEG) and routine coagulation tests, and to evaluate the value of the two methods in determining the blood coagulation of patients.

METHODSThe TEG, routine coagulation tests and platelet counts of 182 patients from the Intensive Care Unit(ICU) and Department of Gastroenterology in our hospital from January to September 2014 were performed and analyzed retrospectively for their correlation, Kappa identity test analysis and chi-square test, and the diagnostic sensitivity and specificity of both methods in the patients with bleeding were evaluated.

RESULTSThe TEG R time and PT, R time and APTT showed a linear dependence (P<0.01). The relationship between the TEG K value, α-Angle, MA and Fibrinogen showed a linear dependence (P<0.001). And the relationship between the TEG K value, α-Angle, MA and the platelet count were in a linear dependent way (P<0.001). The Kappa values of the TEG R time with PT and APTT were 0.038 (P>0.05) and 0.061 (P>0.05), respectively. The chi-square test values of the TEG R time with PT and APTT were 35.309 (P<0.001) and 15.848 (P<0.001), respectively. The Fibrinogen and the TEG K value, α-Angle, MA value had statistical significance (P<0.001), with a Kappa value of 0.323, 0.288 and 0.427, respectively. The chi-square test values between Fibrinogen and the TEG K value, α-Angle, MA value were not statistically significant, with X2=1.091 (P=0.296), X2=1.361 (P=0.243), X2=0.108 (P=0.742). The Kappa values of the platelet count and the TEG K value, α-Angle, MA value were 0.379, 0.208 and 0.352, respectively, which were also statistically significant difference (P<0.001). The chi-square test values between the platelet count and the TEG K value, α-Angle, MA value showed a statistically significant difference (P<0.001), with X2=37.5, X2=37.23, X2=26.630. The diagnostic sensitivity of the two methods for the patients with bleeding was less than 50%.

CONCLUSIONThere was a significant correlation between some TEG parameters and routine coagulation tests, but the consistency is weak. Moreover, the diagnostic sensitivity of two methods in the patients with bleeding is low. It was concluded that the TEG cannot replace the conventional coagulation tests, and the preferable method remains uncertain which could reflect the risk of bleeding.

Blood Coagulation ; Fibrinogen ; Hemorrhage ; Hemostatics ; Humans ; Platelet Count ; Retrospective Studies ; Thrombelastography