OBJECTIVE:To ensure clinical medication safety and avoid medication errors. METHODS: Various errors occurred during 2006～2007 in the pharmacy intravenous admixture service of our hospital were analyzed in accordance with drug package inserts, Chinese Pharmacopeia, and Clinical Medication Information, meanwhile the countermeasures were formulated. RESULTS: The ratio of errors in the pharmacy intravenous admixture service was 0.001%, and the internal ratio of errors was 0.04%. The errors occurred mainly in the following steps: medical orders (by doctors), input of medical orders (by nurses), arrangement of drugs (by pharmacists), allocation of nurses, as well as the check of finished products. CONCLUSIONS: By taking the following measures such as constructing consummate quality safety management system, enhancing pharmacists’ prescription-checking ability, strengthening management on personnel, intensifying checking system etc, the incidence of errors in pharmacy intravenous admixture service can be reduced and the rational clinical medication can be promoted.

ObjectiveTo analyze the characteristics of severe trauma patients with acute kidney injury (AKI) receiving renal replacement therapy (RRT), in order to look for the risk factors of AKI and the opportune time for the initiation of RRT on prognosis.Methods A retrospective cohort study involving consecutive patients with severe trauma in emergency intensive care unit (ICU) in the Second Affiliated Hospital of Zhejiang University School of Medicine, from August 2011 to December 2014, was conducted. Inclusion criteria included age≥18 years, injury severity score (ISS)> 16, AKI receiving RRT, and the duration of hospital stay> 24 hours. The general data, the risk factors of AKI, the prognostic indicators, and the information of RRT were recorded. All patients were divided into two groups according to the prognosis, the time of onset of AKI and the initiation time of RRT. The independent risk factors for prognosis were screened by binary logistic regression analysis.Results Seventy-three patients were eligible for enrollment, including 48 deaths (65.8%); 49 patients suffered from AKI≤48 hours after trauma (early stage group), and in 24 patients it was longer than 48 hours (late stage group). In 55 patients RRT was routinely started (routine RRT group), 18 patients underwent RRT ahead of routine criteria decided by the judgment of the attending doctor (earlier RRT group). The main risk factors of RRT in traumatic patients with AKI were shock and sepsis, each accounted for 90.4% and 53.4%. Compared with survival group, in death group, the proportion of male patients was lower (70.8% vs. 100.0%,χ2 = 7.238,P = 0.007), acute physiology and chronic health evaluationⅡ (APACHEⅡ) scores were higher (23.7±5.1 vs. 14.4±3.7,t = 8.031,P< 0.001), Glasgow coma score (GCS) was lower [5.0 (3.0, 15.0) vs. 15.0 (8.0, 15.0),U = 320.000,P = 0.001], incidence of shock and sepsis was higher (97.9% vs. 76.0%,χ2 =6.755,P = 0.009; 64.6% vs. 32.0%,χ2 = 7.014,P = 0.008), the rate of use of contrast medium was lower (27.1% vs. 56.0%,χ2 = 5.898,P = 0.015), the time for the diagnosis of AKI post trauma was delayed [days: 2 (1, 5) vs. 2 (1, 2), U = 762.000,P = 0.049], the time for the initiation of RRT post trauma was later [days: 6.0 (3.0, 12.0) vs. 3.0 (2.0, 4.5), U = 868.500,P = 0.002], the recovery rate of renal function at discharge was lower (10.4% vs. 100.0%,χ2 = 54.497, P< 0.001). Compared with late stage group, in early stage group, the mortality was lower (55.1% vs. 87.5%,χ2 =7.509,P = 0.006), and the incidence of sepsis before AKI was also lower (38.8% vs. 83.3%,χ2 = 12.854,P< 0.001). Compared with routine RRT group, the recovery of renal function at discharge was better with a lower mortality rate in the earlier RRT group, but the difference was considered to be insignificant (55.6% vs. 36.4%,χ2 = 2.064,P = 0.151;50.0% vs. 70.9%,χ2 = 2.633,P = 0.105). Logistic regression analysis showed GCS [odds ratio (OR) = 0.852, 95%confidence interval (95%CI) = 0.747-0.972,P = 0.017], shock before AKI (OR = 85.350, 95%CI = 5.682-1 282.073, P = 0.001), and sepsis before AKI (OR = 11.499, 95%CI = 2.127 - 62.161,P = 0.005) were independent risk factors for the judgment of prognosis.Conclusions Shock and sepsis are the major risk factors of RRT in trauma patients with AKI. Shock, sepsis and traumatic brain injury are the independent risk factors of death. Perhaps early initiation of routine RRT cannot improve the outcome of the patients with posttraumatic renal insuficiency.

The studies on pathophysiological mechanism and treatment method of spontaneous intracerebral hemorrhage mainly focus on animal experiment,which has been established various animal models in the laboratory.According to the different implanted tissues,there are four kinds of intracerebral hemorrhage,including ischemia,trauma,spontaneous or implanting intracal extraneous materials reduced intracerebral hemorrhage.Further more,the implanted extraneous materials contain inert substances-reduced intracerebral hemor-rhage,biological agent induced and autologous arterial blood simulated intracerebral hemorrhage.This paper summarizes the kinds,preparation methods and characteristics of each animal models of intracerebral hemorrhage.

Objective To investigate the effects of intrathecal different doses of dexmedetomidine hydrochloride in spinal block by ropivacaine hydrochloride . Methods Forty lower limb surgery scheduled for elective under spinal anesthesia, were randomly divided into 2 groups (n = 20 each): the control and the treatment groups.The control and the treatment group were intrathecally injected with 4,12 μg dexmedetomidine hydrochloride respectively.The 0.75% ropivacaine hydrochloride 1.5 mL was injected for spinal anesthesia.SBP,DBP,HR,SpO2 and Ramsay Sedation Score were recorded before the spinal anesthesia conduct and thereafter every five minutes. And the onset and duration of block were recorded,adverse reaction like nausea, vomiting and respiratory depression were also observed. Results Compared with the control group,the onset of sensory block was shorter [(6.9±2.6) min vs (8.7±2.9) min] (P<0.05),and the duration of sensory and motor block was longer in the treatment group[(130.8±30.1) min vs (115.9±23.9) min] (P<0.05) and [(145.9±29.0) min vs (130.0±30.1) min] (P<0.05). Conclusion Intrathecal dexmedetomidine hydrochloride at 12 μg improves anesthesia via shortening the sensory block onset and prolonging sensory and motor block,which maintains hemodynamically stable,and does not generate adverse reactions as nausea,vomiting,bradycardia and respiratory depression.

Objective　To evaluate the efficiency of low molecular weight heparin(LMWH, fraxiparine) given as a single predialysis bolus injection with reused dialyzers in comparison with standard heparin(SH) administered with a continuous infusion. Methods　30 hemodialysis patients were studied in a radomized crossover fashion. Dialyzers fibrer bundle volumes(FBV), predialysis hemocrit and 2 h clearance of urea, creatinine were observed in the first, the fourth dialysis. The plasma heparin activities(anti-Fxa levels) were measured by the chromogenic substrate assay in 0 h, 2 h, 4 h of dialysis. Results　Significant increase (P<0.05) was seen in the number of dialyzer reuse in LMWH group compared with SH group; there was not significant decrease in dialysis FBV as well as 2 h clearance of urea, creatinine (P>0.05); in addition, the plasma heparin activity(anti-Fxa levels) were comparable in both groups after 2 h of dialysis, however, they were significantly higher after 4 h in the LMWH than those in the SH group (P<0.05). Conclusion　LMWH as a single bolus dose can prevent decrease in dialyzer clearance. It is clinically worthy of further popularity.

ObjectiveTo study the main bacterial species,distribution and drug sensitivity of nosocomial bacterial infections after living donor liver transplantation (LDLT) in children.Methods The clinical data of the incidence,pathogen distribution and antibiotic-sensitivity of early postoperative bacterial infection occurring in 41 cases of LDLT were retrospectively analyzed.ResultsThe bacterial infections rate after LDLT was 80.5％,and 71.3％ of bacterial infections occurred in the first two weeks after LDLT. The most common sites of bacterial infection were lower respiratory tract,abdomen andbiliarytract, andPseudomonasAeruginosa, Staphylococcusepidermidis, and Escherichia coli were the most common bacterial pathogens. 101 microorganisms were found and gram-negative bacteria (73.3％) predominated over gram-positive bacteria (26.7％).The detectable rate of ESBLs in gram-negative bacteria was 81.1％.Moreover,the detectable rate of MRCNS in gram-positive bacteria was 59.3％,and 11.1％ of gram-positive bacteria were HLAR Enterococcus.Most gram-negative bacteria had high drug-resistance rate of β-lactam inhibitors and cephalosporins (more than 60％),but were sensitive to imipenem and meropenem (less than 10％). ESBLs and AmpC-lactam,mediated by Chromosomal and plasmid,could not damage the structure of imipenem and meropenem.Pseudomonas aeruginosa was highly resistant to imipenem,meropenem,and most antibiotics used for pediatrics. Coagulase-negative staphylococcus was sensitive to vancomycin,linezolid,quinupristin/dalfopristin.ConclusionThe bacterial infection rate was high after LDLT in children.Most of the pathogens were antibiotics multi-resistant.Effective prevention of infection,early diagnosis and appropriate use of antibiotics are the key to control the infection.

Polylactic acid (PLA) and its copolymer are biodegradable polymer materials which are widely used in the medical field because of their excellent mechanical properties, chemical stability, good biocompatibility, and biodegradability. In this paper, research advances in the study on polylactic acid and its application in vascular stent are discussed.

The rabbit enteropathogenic E. coli (rEPEC) strain RDEC-1 possesses a lifA homologue adjacent to the LEE pathogenicity island. To study the entire nucleotide sequence and biological function of lifA,the DNA sequence and biological function of RDEC-1 lifA were analysed with gene cloning,gene knock-out and in vivo virulence examination. The result showed that the entire coding sequence of the lifA of RDEC-1 shares nearly absolute homology with the lifA of human isolates. RDEC-1 lifA inhibited IL-2 expression in stimulated rabbit peripheral blood mononuclear cells. We further demonstrated significant reduction in fecal bacterial shedding by RDEC-1 derivative lifA mutant when compared with its parent strain. In a competitive study when rabbits were inoculated with a combination of the WT and the mutant, the WT was the predominant bacteria recovered from fecal samples, while fewer mutant bacteria were recovered. However,the lifA mutant is able to induce A/E type of lesions as efficient as the parent strain. The data provide direct evidence that lifA of rEPEC plays a role in immunomodulation and in in vivo colonization in the intestinal tract.

Adaptor Proteins, Signal Transducing ; Animals ; Carrier Proteins ; CpG Islands ; DNA Methylation ; Genes, Tumor Suppressor ; Genes, p16 ; Genes, p53 ; Humans ; MutL Protein Homolog 1 ; Mutation ; Neoplasm Proteins ; genetics ; Neoplasms ; genetics ; Nuclear Proteins