Objective To evaluate the effect of antimicrobial management guideline on the daily antimicrobial use rate in a general hospital.Methods An one-day point-prevalence survey on antimicrobial use in hospitalized patients was conducted in 2010,2011,and 2012 by means of cross-sectional investigation method.Results The daily utiliza-tion rate of antimicrobial agents in 2010,2011,and 2012 was 65.40% ,42.09% and 26.74% respectively,the rate of the submission of specimens for bacterial culture was 22.53% ,35.74% and 41.74% respectively(χ2 trend= 266.42, 29.02,respectively,bothP<0.01). The utilization rate of single drug was 83.72% ,80.27% and 93.41% respec-tively. the utilization rate of both two-drug and more than three-drug combination kept a downward tendency. The utilization rate of antimicrobial agents in several departments(digestive internal medicine,cardiovascular,hematolog-ical tumor,neurology,general surgery,orthopedics,obstetrics,pediatrics,and ophthalmology)showed a decreasing tendency(all P<0 .0 1 ).Conclusion The implementation of antimicrobial management guideline has remarkably re-duced the daily antimicrobial use rate,and increased etiological detection rate for therapeutic antimicrobial use.

Objective To investigate the relationships between parameters of serum iron metabolism and liver in-flammatory activity grades, and to find out the difference in parameters of serum iron metabolism between patients with hepa-titis B and patients with hepatitis C. Methods A total of 166 patients with viral hepatitis were enrolled in this study, in-cluding 135 case of hepatitis B and 31 cases of hepatitis C. The serum iron metabolism indexes including serum iron (SI), se-rum ferritin (SF), transferring (TRF), total iron binding capacity (TIBC) were collected, and the transferring saturation (TS), al-anine aminotransferase (ALT), aspartate aminotransferase (AST), total bilirubin (TBIL) and albumin (ALB) were calculated. Thirty-nine patients were selected from 135 hepatitis B patients by corresponding gender, age and liver function with 31 hep-atitis C patients. The indicators of iron metabolism were compared between two groups. Results There was a positive corre-lation between age , TRF and TIBC. There were positive correlations between SI, SF, TS and ALT, AST, TBIL respectively, and negative correlations between SF, TS and ALB. TRF and TIBC were negatively correlated with ALT, AST and TBIL, but positively correlated with ALB (rs=0.551,P<0.001). The value of SF was significantly higher in patients with hepatitis C than that of patients with hepatitis B. The levels of TRF and TIBC were significantly lower in patients with hepatitis C than those of patients with hepatitis B (P<0.05). There were no significant differences in SI and TS between two groups. Conclu-sion There was a significant correlation between parameters of serum iron metabolism and live inflammatory activity grades. The iron overload phenomenon is much common in patients with chronic hepatitis C than that of patients with chronic hepatitis B.

Objective:To explore the correlation of nurses ’ organizational commitment and their professional identity status.Methods:Using Chinese employee organizational commitment scale and nurses professional identity evaluation scale questionnaire survey was conducted in 400 cases of clinical nurses , nurse compare different characteristics of organi-zational commitment and professional identity level , and USES the Pearson correlation analysis to investigate the correla-tion of both.ResultsNurses organizational commitment and professional identity total score , respectively (2.16-0.45) and (3.49 +0.84);Different cultural degree , job title, working years and the way of hiring nurses ’ professional identi-ty score comparison, the difference was statistically significant (P <0.05);Different ways of title, working years, and hire nurses’ organizational commitment score comparison , the difference was statistically significant (P <0.05);Pear-son correlation analysis showed that organizational commitment and the scores of each dimension career cognitive apprais -al, professional social skills , professional setback coping , social support and total scores of professional identity were sig -nificantly positive correlation (P <0.05).Conclusions:The nurse was significantly positively related to organizational commitment and their professional identity , and both have big room to improve .

Objective To construct a new recombinant immunotoxin expression vector fused with a murine interleukin18(IL18) gene and a truncated pseudomonas exotoxin (PE38) gene, and examine the expression of IL-18-PE38 fusion protein in Escherichia coli (E. coli). Method Murine IL-18 (mIL-18) cDNA was cloned from murine liver tissue through reverse transcription-polymerase chain reaction (RT-PCR). The mIL-18 cDNA was ligased with a PE38 gene carried by PRKL expression vector through T4 DNA ligase and constructed into fusion protein expression plasmid PRKL-IL18-PE38. The recombinant vector was identified by restriction endonucleases digestion, PCR and DNA sequencing. After transformed into E.coli BL21 and induced by IPTG, the expressed product was obtained and the molecular weight and specificity were determined by SDS-PAGE and Western-blotting. Result The new recombinant immunotoxin expression vector was constructed successfully. DNA sequencing revealed that the mIL-18 and PE38 gene were consistent with NCBI Gene Bank. The IL-18-PE38 fusion protein was expressed in E.coli BL21, and Western-blotting analysis indicated that the molecular weight of the expression product is about 56 kDa, and could react with the specific antibody against mIL-18. Conclusion IL-18-PE38 recombinant immunotoxin expression vector will provide the basis for study on the targeted cytotoxic activity to Th1 cells and may have some potential value in the treatment of Th1 cell-mediated autoimmune diseases.

Objective To investigate the fall efficacy of elderly people in nursing homes and its influencing factors. Methods A total of 174 elderly people in 8 nursing homes in Fujian province were recruited by convenience sampling method. They were investigated with a self-designed questionnaire about the demographic data, the Modified Falls Efficacy Scale (MFES) and the Kessler Psychological Distress Scale (K10). Results The mean score of fall efficacy was 7.81±1.15, which revealed a middle level. The score of get dressed and undressed scored 9.04 ±1.42, which was the highest, while the score of using public transport scored 5.80 ±3.21, which was the lowest. Multiple regression analysis showed that the mental health status, degree of self care, age were influencing factors of fall efficacy of elderly people. Conclusions The fall efficacy level of 174 elderly people is at medium level, which is different among fall efficacy with mental health status, degree of self care, age. Individualized interventions should be designed and provided for them.

Objective To investigate the perinatal outcome of fetus with increased nuchal translucency (NT) at first trimester.Methods The thickness of NT above 95th percentile of the fetuses with same crown-rump length (CRL) was set as the criteria of increased NT.The outcomes of fetuses with increased NT during early pregnancy from Jan.2008 to Dec.2009 in Guangzhou Women and Children's Medical Center were followed up.The information of ultrasound at second trimester,pregnant complications and delivery outcome were collected.All infants were followed up for 3 months after birth and were divided into four groups according to their different thickness of NT.The relationship between NT thickness and perinatal outcome were analyzed with single factor analysis of variance and multiple comparison method.Results Among the 178 cases we followed up,there were 2 spontaneous fetal losses and 19 terminations whose reasons were Down syndrome (n=6),severe a thalassemia (n =5),fetal malformations (n =7) and social factor (n =1).Among the 157newborns delivered,one was found with congenital heart disease.The rate of abnormal infants was 11.8％ (21/178) and the detection rate of abnormal infants was 9 5.2％ (20/21).Healthy living rate of fetus with NT thickness between 95th percentile and 2.9 mm was 96.1％ (122/127); 82.4％ (28/34) for those with NT thickness between 3.0 mm and 3.9 mm; and 35.3％ (6/17) when NT≥ 4.0 mm.Conclusions Increased NT might have close relationship with poor pregnant outcome.The thicker the NT,the lower the healthy living rate of the fetus.The pregnant outcome is very poor if NT≤4.0 mm.

Objective To investigate the effect of construction-process-result three-dimensional quality assessment mode in continuing nursing to patients with liver cirrhosis after endoscopic variceal ligation (EVL). Methods Toally 100 patients with liver cirrhosis after EVL hospitalized in the hospital between January 2014 to December 2015, 50 patients among them during January to December 2014 were set as the control group, the other 50 ones during January to December 2015 as the experiment group. The control group only received routine instruction at discharge and those in the experiment group were treated with continuing nursing based on construction-process-result three-dimensional quality assessment mode. Both groups were followed up for six months after discharge and then compared in terms of medication and diet compliance and re-bleeding rate. Result The patients in the experiment group were significantly better than those in the control group (P<0.05) in the medication and diet compliance. Conclusions The construction-process-result three-dimensional quality assessment mode can improve the quality of continuing nursing for the patients with liver cirrhosis after EVL. It can enhance the medication.

Experimental autoimmune encephalomyelitis (EAE) is an autoimmune disease of the central nervous system (CNS); it serves as a model for the human multiple sclerosis (MS). In mice, EAE is mediated by T cells specific for various myelin basic proteins which migrate from the periphery to the CNS. In search of a way to prevent the induction and progression of EAE, we observed the effects of recombinant immunotoxin IP10-DT390 on blocking or eliminating the active T cells in the EAE model. In this paper is presented an experimental gene therapy-based model in which the mice were made resistant to EAE induction by plasmid DNA encoding recombinant immunotoxin that was injected into the leg muscles of mice. The new immuno-biological construct could selectively impair autoreactive T-cell homing while the duration of clinical signs is shorter, and the new construct would not affect other components of the immune response. These data demonstrated the effectiveness of the constructs in the treatment of EAE and suggested its usefulness in the treatment of other autoimmune diseases.
Animals ; Chemokine CXCL10 ; biosynthesis ; genetics ; therapeutic use ; Diphtheria Toxin ; biosynthesis ; genetics ; therapeutic use ; Encephalomyelitis, Autoimmune, Experimental ; immunology ; pathology ; therapy ; Female ; Genetic Therapy ; Immunoglobulin Fragments ; biosynthesis ; genetics ; therapeutic use ; Immunotoxins ; genetics ; metabolism ; therapeutic use ; Mice ; Mice, Inbred C57BL ; Receptors, CXCR3 ; metabolism ; Recombinant Fusion Proteins ; biosynthesis ; genetics ; therapeutic use ; Recombinant Proteins ; biosynthesis ; genetics ; therapeutic use ; T-Lymphocytes ; immunology ; Transfection

Objective:To evaluate the application value of SPECT lung perfusion imaging in guiding radiotherapy path, optimizing the radiotherapy plan for lung cancer and protecting lung function during radiotherapy for locally advanced non-small cell lung cancer.Methods:In this study, 84 patients with stage Ⅲ non-resectable non-small cell lung cancer were randomly divided into the control group ( n=44) and observation group ( n=40). In the control group, radiotherapy plan based on conventional CT images was delivered, and two plans based on the lung function information suggested by conventional CT and SPECT lung perfusion imaging: P1 and P2 were given in the observation group. All patients in the observation group were finally treated according to the P2 plan. The incidence of radiation pneumonitis, and changes in lung function before and after radiotherapy were statistically compared between two groups. The dose-volume parameters of P1 and P2 were statistically compared. Results:After the plan was optimized, the incidence of radiation pneumonitis in the observation group was significantly reduced and the decline of lung function was significantly improved (both P≤0.001). The functional dose parameters were significantly improved in the P2 plans (both P<0.05), whereas the irradiation dose of organs at risk did not significantly change ( P>0.05). Conclusion:SPECT lung perfusion imaging optimizes the intensity-modulated radiotherapy plan, which can reduce the functional lung dose and increase the tumor radiotherapy dose without increasing the irradiation dose of other organs at risk.

Objective:To explore the teaching effect of individualized teaching based on problem-based learning (PBL) that applied in gynecology practice teaching under the background of conflicts between postgraduate examination preparation and clinical internship for medical undergraduates.Methods:A total of 157 medical students of the five-year program who started gynecology internship and meanwhile prepared for the postgraduate entrance examination in 2018 were enrolled in the study and divided into two groups randomly. One group received traditional teaching (control group), and the other group received individualized teaching mode based on PBL (observation group). After the internship, the two groups of students were assessed for their theoretical and clinical skills, and the students' evaluation of the teaching effect was acquired through a questionnaire survey. SPSS 22.0 was used to perform chi-square test.Results:The students in observation group had statistically significant higher scores in theory and skill tests than those in the control group ( P<0.001). The evaluation of boosting their enthusiasm for internship, advancing self-learning ability, conducing to improving learning methods in the future, and enhancing clinical skills and thinking ability in the observation group was significantly better than that in the control group ( P<0.05). Conclusion:The individualized teaching model based on PBL could efficiently alleviate the conflicts between internship and postgraduate entrance examination preparation and improve the effect of gynecology practice teaching.