Hospital acquired pneumonia (HAP) and ventilatorassociated pneumonia (VAP) are common hospital-acquired infections with higher mortality, longer hospital stay and more hospitalization expenses. With the latest research results and evidence-based guideline methodology, Infectious Diseases Society of America (IDSA) and American Thoracic Society (ATS) have collaborated to create updated guidelines for the diagnosis and treatment of HAP and VAP in 2016. It is worth critically reading and thinking that most recommendations are supported by low-quality or very-low quality evidence and some strong recommendations is different from the actual clinical work in China. We will focus on these topics that are associated closely with clinical practice and inconsistent with the current implementation in China to provide better understanding of the guideline.

A total of 115 patients with Hoshimoto thyroiditis were classified under 2 groups: one group being treated with selenium and L-throxine (L-T4) and other group with L-T4 alone.All patients were followed up for 3 months.In the selenium treated group thyroid peroxidase antibody level was decreased in 33 patients (56%) and thyroglobulin antibody level was decreased in cases.

OBJECTIVE To perform a retrospective analysis to determine the prevalence of hospital infection and associated risk factors and offer strategies in our neonatal intensive care unit(NICU).METHODS The study enrolled 1082 neonatal patients hospitalized between Jan 1,2006 to Dec 31,2007.RESULTS There were 58 nosocomial infections(NI) in 1082 neonatal patients,and the infection rate was 5.36%.The most common infection was superficial(62.07%).The mortality of NI was 6.90%.The lower gestational age and birth weight,were risk factors of NI.Logistic regression analysis indicated that mechanical ventilation and birth weight ≤1500g were independent risk ractors for NI(P

Objective To set up a method for identification of Lonicerae japonicae flos volatile oils using Fourier-transform infrared spectroscopy. Methods The volatile oils of Lonicerae japonicae flos and Lonicerae flos was extracted by steam distillation combined with continuous liquid-liquid extraction with hexane. An oil film was prepared for Fourier-transform infrared spectroscopy scanning by dropping the volatile oils solution on the KBr disc and evaporating the solvent. The obtained infrared spectrum was treated by baseline removing and median filter smoothing. The spectral data within 1800-850 cm-1 was selected as the characteristic spectrum for hierarchical cluster analysis. And the volatile oils of Lonicerae japonicae flos and Lonicerae flos were discriminated by the result of hierarchical cluster analysis. Results Enough volatile oils were extracted for obtaining Fourier-transform infrared spectrum from small amount of Lonicerae japonicae flos. The method developed in the study was able to discriminate Lonicerae japonicae flos volatile oils from Lonicerae flos volatile oils. Conclusion The method can be used for identification of Lonicerae japonicae flos volatile oils.

Objective To observe the bone density, serum osteoprotegerin (OPG) level,relevant parameters of bone metabolism and sex hormones in elderly men with osteoporosis before and after treatment with oral Fosamax for 3 years. Methods The serum OPG level was compared between 72 randomly selected elderly male patients with osteoporosis and age-matched healthy controls. The bone density, serum OPG level, sex hormones, serum calcium and phosphorus,parathyroid hormone (PTH), osteoealein and urine type Ⅰ collegen crosslinked N-telopeptides (NTX),urine calcium and cretinine were tested in all elderly male patients with osteoporosis before and after 3 years of oral Fosamax treatment. The role of OPG in anti-osteoporotic therapy was studied by comparison of the parameters tested during the course of treatment. Results The serum levels of OPG osteoealcin, PTH and urine NTX were obviously higher in elderly men with osteoporosis than in healthy controls [(10.56±2.56) pmol/L vs. (8.91±2.20) pmol/L, (9.544±4.40) g/L vs. (6.774±2.87)rig/L, (70.39±35.58) ng/L vs. (47.11±21.80) ng/L, (72.06±9.78) nmol/L vs. (63.36±14.61)nmol/L, all P<0.05]. After treatment with oral Fosamax , the bone density was significantly increased. However, serum levels of OPG[(8.23±2.96)pmol/L], osteocalcinE(6.18±2.27)μg/L],PTH[(40.46±14.43) ng/L] and urine NTX[(64.83±11.40) nmol/L] were significantly decreased after treatment (all P<0.05). Spearman analysis showed that the improvement of bone density after treatment was closely associated with serum OPG level. Conclusions Serum OPG level in elderly patients with osteoporosis is much higher than that in control group. The improvement in bone density after treatment is associated with the decrease in OPG level. Bone density and relevant parameters of bone metabolism can be improved in elderly male patients with osteoporosis by using oral Fosamax.

OBJECTIVE:To compare the performance of several pattern recognition methods in the identification of volatile oils of traditional Chinese medicine(TCM)by infrared spectroscopy. METHODS:The volatile oils of several Lonicera and Citrus TCM were determined by infrared spectroscopy. All samples of infrared spectrum were classified by hierarchical clustering,K-mean clustering,artificial neural networks,and support vector machine. RESULTS:The results of hierarchical clustering and K-mean clus-tering were ineffective. Methods of artificial neural networks and support vector machine achieved correct classification rate of 100%. CONCLUSIONS:Artificial neural networks and support vector machine can be combined with infrared spectroscopy to cre-ate chemometric fingerprinting for the identification of volatile oils of TCM.

Objective To explore the most suitable equation in accessing renal function for the elderly type 2 diabetic patients, and its clinical utility in combination with hypersensitive C-reactive protein (hsCRP). Methods The new Cystatin C-based equations for estimated glomerular filtration rate (Cys-eGFR) and conventional predictive equations were compared with isotopic GFR (iGFR) by linear regression analysis, paired t-test, Bland and Altman procedures and non-parametric receiver operating characteristic (ROC) curves. The new Cys-eGFR equation and hsCRP were also incorporated for detecting renal disease in this population. Results The new Cys-eGFR equation had a better relativity with iGFR (r= 0.767, P＜0.001), a less bias (bias: 0.0007, P＞0.05), a higher conformance (2SD: 21.56), higher sensitivity (90.7%) and specificity (88.6%) for diagnosing moderate decrease in renal function. There was a negative relationship between the new Cys-eGFR and hsCRP (r=-0.655, P＜0.01). When the new Cys-eGFR was 67.06 ml· min-1 ·1.73 m-2 and hsCRP was 5.65 mg/L, the combination of Cys-eGFR and hsCRP was better than the combination of serum creatinine and urine albumin/creatinine ratio in screening stage 3 chronic kidney disease (95%vs.46%). Conclusions The combination of new Cys-eGFR equation and hsCRP may screen an early decrease of moderate GFR.

Objective To observe the effect of raloxifene, a selective estrogen receptor modulator, on osteoporosis in the osteoprotegerin (OPG) gene knock-out female and male mice. Methods Two groups of OPG gene deficient (OPG-/-) female and male mice, 20 mice in each group, were assigned to raloxifene-treated (3 mg The effect of raloxifene was evaluated by comparing the values of bone mineral density (BMD) , bone strength,histomorphometric measurement and osteoclast number between the raloxifene treated group and placebo group.Results As compared with placebo group osteoporotic manifestations were improved in OPG-/- female mice treated with raloxifene orally. BMD was increased both in lumbar vertebrae (P<0.05) and femurs (P<0.01).Bone strength was measured in femurs by three-point bending test and vertebrae by stress test. Results showed that ultimate load, ultimate stress and Young's modulus were increased both at lumbar and femur bone, suggesting decreased risk of fracture. Tartrate-resistant acid phosphatase, a marker enzyme of osteoclasts, was detected, and the number of osteoclasts declined significantly after the treatment of raloxifene. At the same time, results of histomorphometric measurements indicated that bone trabecular volume was increased and bone formation rate decreased from(8.05±4.02)mm3·mm-2·year-1 to (5.48±1.89)mm3·mm-2· year-1(P＜0.05).These findings were found in the group of OPG-/- female mice treated with reloxifene but not in male mice. Conclusions Raloxifene is effective in treating osteoporosis in female OPG-/- mice, indicating that its action is at least in part independent of OPG gene. But it is ineffective in male OPG-/- mice.

Objective:To investigate the efficacy of clinical pathway teaching method in standardized training of general practitioners in gastroenterology.Methods:From 2018 to 2019, 40 residents who participated in the standardized training of general practitioners in the Department of Gastroenterology, Zhongshan Hospital Qingpu Branch, Fudan University Medical College were randomized into the experimental group and the control group. The residents of the experimental group were trained by clinical pathway teaching method, while the control group were trained by traditional methods. After 6 weeks' teaching, theoretical examination, operation skills and case analysis test were assessed and satisfaction surveys were conducted.Results:The operation skills and case analysis scores of the experimental group were significantly better than those of the control group [operation test (91.50±2.77) vs. (89.80±3.74), P<0.01; case analysis (92.10±1.98) vs. (86.40±2.87), P<0.01]. The teaching satisfaction of the experimental group was significantly higher than that of the control group, and the difference was statistically significant ( P<0.01). Conclusion:The teaching model of clinical pathway can improve the teaching quality of the residents in the department of gastroenterology, improve the satisfaction of the doctors in the training, and broaden clinical thinking, which is worthy of promotion in clinical teaching.

Objective To construct an evaluation index system of"Internet+Traditional Chinese Medicine nursing"service capability,in order to provide references for the standardized and effective evaluation of"Internet+Traditional Chinese Medicine nursing"service capability.Methods Literature analysis and semi-structured interview method were adopted,and three-dimensional quality structure model was used as the theoretical framework to initially construct the"Internet+Traditional Chinese Medicine nursing"service capability evaluation index item pool.From July to 0ctober 2022,the Delphi method was used to conduct 2 rounds of consultation with 16 experts from Guangdong Province,to evaluate the enthusiasm,authority,degree of opinion concentration and degree of opinion coordination of the experts in the correspondence consultation,and the weight of the index system was determined with the combination of chromatography analysis.Results 2 rounds of expert letter consultation were conducted.The questionnaire recovery rates were 100％,and the authority coefficients were 0.844 and 0.834,respectively.Kendall coordination coefficients were 0.161 and 0.110,respectively(P＜0.001).The first level indexes of the index system are structure evaluation,process evaluation and outcome evaluation.There were 3 first-level evaluation indicators,14 second-level evaluation indicators and 57 third-level evaluation indicators.Conclusion The evaluation index is scientific and practical,and it is carried out around the Internet+Traditional Chinese Medicine nursing capability,which provides a certain reference for the effective evaluation of the service capability of"Internet+Traditional Chinese Medicine nursing".