The widespread use of antibiotics has been effectively controlled serious life-threatening infections.The trituration,exploitation and use of antibiotics has been rapidly developed and applied to many fields.Due to the extensive use of various antibiotics,the emergences of drug-resistant bacteria and the rates of bacterial resistance have increased unceasingly which has been a common focus in the world.Resistant pathogen can reduce the effectiveness of antibiotics,and which is a serious threat to human health.De-escalation therapy of antibiotics can quickly and effectively control serious infections,and avoid bacterial resistance,and induce fungal infections.The rational use of antibiotics in pediatrics is very imperative,which includes strengthening management of antibiotics,and improving awareness and vigilance of the adverse reactions of antibiotics,and consummating specification of medication.Then,realize the correct,safe,rational medication of antibiotics.

Bronchiolitis obliterans(BO) is chronic airflow obstruction syndrome characterized by small airway obstruction and airflow limitation.In children, BO is secondary to severe infection of respiratory tract, and its development is related with inflammation and immune response.At present, the diagnosis of BO mainly is depended on the clinical manifestation, lung function and examination results of high resolution computed tomography (HRCT) because of difficulty of lung biopsy.Pulmonary HRCT is a non-invasive examination, and worthy of generalization.Currently, BO has no accepted effective treatment,early diagnosis and treatment can block the progression of BO.Due to lack of realization of BO, doctors and parents fail to give enough attention, BO has a prolonged course and very poor prognosis.

Compared with"Global Minimum Essential Requirements in Medical Education",our standardized surgery resident educating training performance is basically identical at training requirements and even more advanced in some aspects according to the situation of our country.But many"no standard"things still exist in course of practing.We have analyzed the problems of educ-tion of operation sense of them and make suggestions in the article for eduction of operation sense.

Objective To explore the effect of psychological intervention combined with drug multimodal therapy on orthopedic analgesia and its effect on stress response, and to provide reference for clinical application.Methods 88 cases treated with open reduction and internal fixation for lower limb fracture as the object of study were collected from March 2015 to March 2017 in Baoji traditional Chinese medicine hospital, which were received multi-mode drug treatment.According to whether to receive psychological intervention, 88cases were divided into the intervention group(45 cases) and the control group(43 cases).Postoperative pain was assessed by visual analogue scale(VAS) and simplified McGill questionnaire(SF-MPQ), the changes of plasma CRP and IL-6 levels were compared before and after operation.Results There was no significant difference in VAS score, SF-MPQ score, preoperative plasma CRP and IL-6 levels between the two groups.One and 24 hour after operation, VAS score and SF-MPQ score were higher than those at admission(P<0.05).The VAS score and SF-MPQ score in the intervention group were lower than those in the control group at different time points(P<0.05).One and 24 hour after operation, plasma CRP and IL-6 levels in the two groups were significantly higher than those before operation(P<0.05), the levels of plasma CRP and IL-6 in the intervention group were significantly lower than those in the control group(P<0.05).Conclusion Psychological intervention combined with multimodal drug therapy can effectively reduce the degree of postoperative pain and stress reaction, and is conducive to postoperative rehabilitation.

Epilepsy was arousing the attention of medical circles because of the complexity of its mechanism and the difficulty of its control.The project which used the pioneering research as the basement and was directed by the chinese medicine used the modern multidisciplinary research technologies and explored the mechanism of the brain damage in epilesy.The project′s treatment idea is different from the others,which provided a new way for seeking new medicines for treating epilepsy.The research techniques took use of the application of the behavioral methods and the electrophysiological methods creatively and the subject firstly used this way to observe it dynamically,which greatly improved the accuracy of evaluating the models and pharmacodynamics studies of the epilepsy.The research method of the project firstly observed the changing mechanism of the brain damage and the regulation of the apoptosis related genes,and even the efficiency of tsaoko-anemarrhenae decoction,which enriched the scientific intension of the decoction.The conclusions palyed a very important role in exploiting the new medicine for treating epilepsy and enriching the knowledge of the five visceras in chinese medicine.

Objective To discuss the role of p38MAPK signal pathway in the process of TWEAK inducing rheumatoid arthritis(RA) fibroblast-like synoviocyte(FLS) to synthesize MMP-9 and look for a new target for RA treatment. Methods RA FLS were primarily cultured and stimulated with TWEAK. Western blot was used to detect the expression of p-p38MAPK and p65 in RA FLS. FLS were pretreated by SB203580 or not. ELISA was used to detect the concentration of MMP-9 in cell-cultured fluid. The mRNA expression of MMP-9 was measured by RT-PCR. Results TWEAK( 100 ng/ml) can make p38MAPK phosphorylated and increased the expression of p65 protein in the cell nucleus. SB203580 can partially inhibit the expression of MMP-9 and MMP-9 mRNA produced by RA FLS which is induced by TWEAK. Conclusion TWEAK induced RA FLS to synthesize MMP-9, in that process, the p38MAPK signal trausduction pathway was in active state, and induced the expression of NF-κB.

Standardized training of resident doctors has become a necessary way to train qualified doctors. In order to unify the training standards, standardize management and improve the training effect, the relevant state departments have issued a series of documents, but there are still many regulations in the process of non-standard situation. Especially in surgical inpatients of standardized training of residents, we only pay attention to the training of students' operation skills but infusion of the operation consciousness such as whether the surgery should be done, when operation should be done, what kind of surgery should be implemented as well as operative effectis insufficient. Based on the problems existing in the clinical study and work of the surgical residents in the affiliated hospital of a university, we discuss the effective strategies for the standardized training of surgical residents.

Objective To apply failure mode and effect analysis (FMEA) to reduce nursing risk of peripherally inserted central catheter (PICC).Methods 100 patients with PICC in central hospital of Minxing District of Shanghai were named as the experimental group,failure mode and effect analysis were performed in this group to obtain the value of risk priority number (PRN) and array them according to the RPN value to work out improved plan systematically and put it into practice to guide the clinical operation and nursing care.98 PICC patients in Xinzhuang health service center and Tumor Hospital of Minhang district were set as the control group,which were subjected to traditional nursing.All statistical analysis were done by SPSS 11.0 software package,the differences of the incidence of PICC-related nursing risk between the two groups due to the implementation of FMEA was analyzed by X2 test.Results Application of FMEA could reduce the nursing risk of PICC,After the application of FMEA,the incidence of PICC-related complications such as focal or systemic infection,puncture site oozing and bleeding,skin allergies,mechanical phlebitis,too deeply placed catheter,catheterization into cervical veins and reflexed into axillary vein,catheter occlusion,catheter migration,difficult removal of catheter,puncture failure in the experimental group decreased obviously,the differences had statistical meaning.Conclusions The application of failure mode and effects analysis can reduce the nursing risk of PICC,decrease medical disputes,alleviate the suffering of patients,reduce medical costs caused by PICC-related complications,and improve the satisfaction degree of patients and the quality of nursing care.

Objective To provide the scientific foundation for the rational antibiotic therapy.Methods The wild type (10 strains)and hyper-inducible type(5 strains)of trial strains,which were chosen in the First Affiliated Hospital of China Medical University from June 2003 to June 2004,were screened by ceftazidime,and then AmpC ?-lactamase activity was detected.Three dimensional test was used to detect phenotype mutation ,and the mutation rate was calculated.Results None of AmpC ?-lactamase activity was detected in the wild type of Serratia marcescans、Cloaca Enterobacter and hyper-inducible type Serratia marcescans.For the hyper-inducible type Cloaca Enterobacter,there was marked difference compared with the AmpC ?-lactamase activity induced by the 2 MIC ceftazidime for that of MIC and 1/2 MIC(P

Objective To discuss the safety of endoscopic sphincterotomy (EST) in treatment of choledocholithiasis in patients over 80 years.Methods From 2005 to 2007,893 patients with choledocholithiasis were divided into group A (n= 148,aged over 80 years) and group B (n=745,aged below 60 years).The clinical data,complications and EST successful rate were retrospectively reviewed between two groups.Results ① The important chronic concomitant diseases were significantly higher in group A than those in group B ( 29.3 % vs 8.1 % ,P＜0.01).② The EST successful rate in group A and B was 95.6% and 96.5%,respectively ( P＞0.05).③ Sixteen patients in group A had complications including 13 caused by EST itself,3 related with EST and one died of aspiration pneumonia.While in group B,41 complications were caused by EST itself and no EST related complications.There was a statistically difference in EST related complications between two groups (P < 0.01 ).In complications caused by EST itself,there was no difference between two groups (P 0.05 ).④ The average hospital stay was ( 7.2 ± 2.2) days in group A and (5.1 ± 1.4) days in group B with no significant difference (P 0.05),Conclusion The EST is safe and effective in treatment of patients over 80 years.