Objective To investigate the healthcare-associated infection(HAI) status, common infection sites, and antimicrobial use in a county hospital in 2011-2015.Methods With combination of bedside survey and case history reviewing, HAI among all hospitalized patients at 0:00-24:00 on April 26, 2011, April 25, 2012, May 14, 2013, September 9, 2014, and August 12, 2015 were surveyed, survey data were analyzed by software SPSS17.0.Results A total of 5 165 patients participated in 5 surveys of HAI prevalence rate, 132 patients had 138 cases of HAI, prevalence rate and case prevalence rate were 2.56％ and 2.67％ respectively.Intensive care unit had the highest average HAI prevalence rate(22.58％).Lower respiratory tract was the main HAI site (58.70％), followed by urinary tract (12.32％), upper respiratory tract (10.14％), and skin soft tissue(5.07％).A total of 45 strains of pathogens were isolated, mainly gram-negative bacteria (n=30, 66.67％).The total usage rate of antimicrobial agents was 45.27％, in 5 prevalence surveys were 61.48％, 43.89％, 37.81％, 39.43％, and 44.79％ respectively.The main purpose of antimicrobial use was therapy (including therapy + prevention), accounting for 78.27％;monotherapy accounted for 81.27％.Conclusion Through prevalence rate survey for 5 consecutive years, HAI management departments can be more comprehensively understand HAI in key departments, key patients, key sites of HAI, and antimicrobial use in this hospital, and provide basis for the formulation and implementation of HAI prevention and control measures according to the actual situation of the hospital.

Objective: To evaluate the influence of recombinant human brain natriuretic peptide(rhBNP)on ventricular remodeling and ventricular systolic synchrony in patients with acute myocardial infarction (AMI) after percutaneous coronary intervention (PCI).Methods: A total of 48 patients with AMI after PCI were randomized into two groups: rhBNP Group (n=25) and Routine treatment Group (n=23).Two dimension echocardiography was used to measure the index of left ventricular end-diastolic volume (LVEDVI), the index of left ventricular end-systolic volume (LVESVI), left ventricular ejection fraction (LVEF), the index of left ventricular mass (LVMI), the movement index of infarcted regional wall (RWMI) at 1 week, 4 weeks and 24 weeks after the treatment procedure.And at 1 week and 24 weeks period, equilibrium radionuclide angiography was performed respectively to evaluate the ventricular systolic synchrony.Results: ①1 week after PCI, LVESVI in rhBNP group was decreased and LVEF was increased than that in Routine treatment group (P<0.05, respectively).4 and 24 weeks after PCI, LVEDVI, LVESVI, LVEF were significantly different in rhBNP group than those in Routine treatment group (P<0.05,respectively).24 weeks after PCI, RWMI and LVMI were significantly decreased in rhBNP group than those in Routine treatment group(P<0.05,respectively).②24 weeks after PCI, phase shift, full width at half maximum and peak phase standard deviation were significantly improved in rhBNP group than those in Routine treatment group (P<0.05, respectively).Conclusion: Intravenous injection of rhBNP could inhibit left ventricular remodeling and improve left ventricular function.

Objective To evaluate the effect on the reversal of left ventricular aneurysm (LVA) and on heart function of percutaneous coronary intervention (PCI) therapy at different time of acute myocardial infarction (AMI). Methods A total of 326 patients with primary anterior AMI-accompanied LVA diagnosed by left ventriculography (LVG) from January 2001 to July 2004 were enrolled in this study. They were randomized into 4 groups according to the time of accepting PCI:≤3 h group, 4-6 h group, 7-12 h group and one week group. At the baseline and 6 months after AMI, the parameters of left ventricular diastolic volume index (LVEDVI), left ventricular systolic volume index (LVESVI), left ventricular ejection fraction (LVEF), left ventricular wall motion score (LVWMS) and left ventricular end diastolic pressure (LVEDP) were measured by LVG. The paradox volume index (PVI) was measured by equilibrium radionuclide at one week and 6 months after AMI.At 3 year following up to, the major adverse cardiac events (MACE) were recorded. Results At 6 months after PCI, the LVESVI, LVEDVI, WMS and LVEDP were all decreased while LVEF was increased in the four groups as compared with pre-PCl (P<0.05, respectively). Those parameters changed most obviously in ≤3 h group. At the 6th month after PCI, the PVI was lower in ≤3 h group (12.1±2.1)% than in 4-6 h, 7-12 h and one week group [(15.4±2.4)%, (16.5±2.5)% and (20.4±3.7)%, all P<0.05]. Within the 3 years follow-up, the MACE was significantly lower in 3 h, 4-6 h and 7-12 h groups than in one week group, and the mortality was lower too [(2.8%, 3.0% and 3.1% vs. 17.9%, all P<0.05]. Conclusions The early, fully and permanent open of the infraction-related artery can effectively inhibit the left ventricular remodeling process, prevent LVA formation, improve LV function and prognosis.

This study established a population pharmacokinetics-pharmacodynamics model of clopidogrel in patients with acute coronary syndrome. Fifty-nine patients were enrolled. The plasma concentration of clopidogrel active metabolite and vasodilator stimulated phosphoprotein platelet reactivity index (VASP-PRI) were selected as the pharmacokinetics index and the pharmacodynamics index, respectively. The covariates including demographic characteristics, laboratory indexes, combined medication, complications and genetic polymorphisms of related enzymes were screened for their influence on the pharmacokinetic and pharmacodynamics parameters. Population pharmacokinetic and pharmacodynamics data analysis was performed using NONMEM software. The general linear model and the indirectly effect model-turnover model for pharmacokinetic and pharmacodynamic analysis were selected as the basic model, respectively. The population typical values of K12, CL/F, V/F, EC50, K(in), and E(max) were 0.259 h(-1), 179 L x h(-1), 632 L, 1.57 ng x mL(-1), 4.29 and 0.664, respectively. CYP2C19 was the covariate in the final pharmacokinetic model, and the model was to design a prior dosage regimen.

BACKGROUNDThe surgical outcomes of decompression for thoracic spinal stenosis (TSS) are unfavorable. The purpose of this study was to determine the efficacy of intraoperative ultrasonography during "cave-in" 360° circumferential decompression surgery in patients with TSS.

METHODSThirteen patients with TSS underwent "cave-in" 360° circumferential decompression surgery between May 2010 and November 2010. Intraoperative ultrasonography was used after removal of the posterior wall of thoracic spinal canal to assess the morphologic restoration of the spinal cord and the anterior surface of the spinal canal. In seven patients, ultrasonography was used again after circumferential decompression to compare the cross-sectional area of the spinal cord before and after circumferential decompression.

RESULTSThe average period of follow-up was (12 ± 2) months (range 9 - 15 months). The Japanese Orthopedic Association score was significantly higher at the final follow-up (8.5 ± 2.1, range 3 - 10) than preoperatively (5.2 ± 1.1, range 3 - 7; P < 0.01). The cross-sectional area of the spinal cord was (30.8 ± 6.6) mm2 before and (53.6 ± 19.1) mm2 after circumferential decompression (P < 0.01). For five patients with TSS caused by thoracic disc herniation, the levels of circumferential decompression performed corresponded to those expected preoperatively. In contrast, for eight patients with TSS caused by ossification of the posterior longitudinal ligament, on average 1.6 ± 0.9 fewer levels of circumferential decompression were performed than expected preoperatively.

CONCLUSIONS"Cave-in" 360° circumferential decompression is an effective therapeutic option for TSS. Intraoperative ultrasonographic evaluation may reduce the levels of circumferential decompression and ensure sufficient decompression, and increase the efficacy of this surgical technique.

Adult ; Decompression, Surgical ; methods ; Female ; Humans ; Male ; Middle Aged ; Spinal Stenosis ; diagnostic imaging ; surgery ; Thoracic Vertebrae ; diagnostic imaging ; surgery ; Ultrasonography ; Young Adult

This study established a population pharmacokinetics-pharmacodynamics model of clopidogrel in patients with acute coronary syndrome. Fifty-nine patients were enrolled. The plasma concentration of clopidogrel active metabolite and vasodilator stimulated phosphoprotein platelet reactivity index (VASP-PRI) were selected as the pharmacokinetics index and the pharmacodynamics index, respectively. The covariates including demographic characteristics, laboratory indexes, combined medication, complications and genetic polymorphisms of related enzymes were screened for their influence on the pharmacokinetic and pharmacodynamics parameters. Population pharmacokinetic and pharmacodynamics data analysis was performed using NONMEM software. The general linear model and the indirectly effect model-turnover model for pharmacokinetic and pharmacodynamic analysis were selected as the basic model, respectively. The population typical values of K12, CL/F, V/F, EC50, K(in), and E(max) were 0.259 h(-1), 179 L x h(-1), 632 L, 1.57 ng x mL(-1), 4.29 and 0.664, respectively. CYP2C19 was the covariate in the final pharmacokinetic model, and the model was to design a prior dosage regimen.
Acute Coronary Syndrome ; metabolism ; Humans ; Polymorphism, Genetic ; Ticlopidine ; analogs & derivatives ; pharmacokinetics

BACKGROUNDDifficult airway remains not only a challenge to the anesthesiologists, but also a life-threatening event to the patients. Awake intubation is the principal choice to deal with difficult airway, and a key point for awake intubation is airway topical anesthesia. Yet, so far there is no ideal topical anesthesia approach for awake intubation. This study aimed at evaluating the effect of pressure-driven (by 10 L/min oxygen flow) lidocaine spray on airway topical anesthesia in order to find a powerful and convenient method for airway topical anesthesia for conscious sedation intubation.

METHODSThirty adult patients referred for elective surgery under general anesthesia, aged 18 - C60 years and Mallampati class I or II, were recruited for the study. Before topical anesthesia, the observer's assessment of alert and sedation (OAA/S) scale was controlled between 3 and 4 by intravenous midazolam (0.03 mg/kg), propofol (2 mg×kg(-1)×h(-1)) and remifentanil (0.05 µg×kg(-1)×min(-1)). Ten minutes after sedation, topical anesthesia was performed with the pressure-driven lidocaine spray; the driving pressure was achieved by an oxygen flow of 10 L/min. After topical anesthesia, tracheal intubation was performed and the intubation condition was assessed with modified the Erhan's intubation condition score by an experienced anesthesiologist, and a score of less than 10 was considered to be satisfactory. Attempts to intubate the patient were recorded, and the complications such as local anesthetic toxicity, mucosa injury, and respiration depression were also recorded. The mean arterial blood pressure (MAP), heart rate (HR) and pulse oxygen saturation (SpO2) were recorded at different time points before and after intubation. Patients were asked 24 hours after the operation whether they could recall the events during intubation.

RESULTSAll patients were intubated at the first attempt, the average intubation condition score was 7.0 ± 1.1, from 6 to 10, satisfied intubation condition. MAP and HR increased significantly but mildly immediately after the tracheal intubation (P < 0.05), and decreased to the pre-intubation level soon after intubation. There were no related complications and patients had no recall of the intubation procedures.

CONCLUSIONSTopical anesthesia with pressure driven 2% lidocaine spray, where pressure is achieved by 10 L/min oxygen flow, can offer satisfactory intubation conditions for conscious sedation intubation.

Adolescent ; Adult ; Anesthesia, Local ; methods ; Conscious Sedation ; methods ; Female ; Humans ; Intubation, Intratracheal ; methods ; Lidocaine ; administration & dosage ; therapeutic use ; Male ; Middle Aged ; Young Adult

Adult ; Apoptosis ; drug effects ; Benzene ; poisoning ; Biomarkers ; analysis ; Bone Marrow Cells ; drug effects ; Female ; Flow Cytometry ; Humans ; Leukocytes, Mononuclear ; drug effects ; Lymphocytes ; drug effects ; metabolism ; Male ; Micronuclei, Chromosome-Defective ; drug effects ; metabolism ; Occupational Exposure ; analysis

OBJECTIVETo establish a convenient and effective method for the identification of Gynostemma and Cayratia japonica.

METHODEight species, including Gynostemm pentaphyllum, G. pentagynum, G. cardiospermum, G. longipe, G. yixingense, G. laxiflorum, G. guangxiense and C. japonica were investigated through PCR - RFLP of six chloroplast DNA fragments. The six gene fragments were digested by six restriction endonuclease respectively, including Taq I, Hpa II, EcoR I, Rsa I, Hha I, Hind III.

RESULTSeven species of Gynostemma and their adulterant could be identified by trnK1f-trnK2r and Rsa.

CONCLUSIONPCR - RFLP provides a quick, reliable molecular marker technique for identification of Cynostemma and their adulterant Cayratia japonica.

DNA, Chloroplast ; genetics ; DNA, Plant ; genetics ; Gynostemma ; classification ; genetics ; Polymerase Chain Reaction ; methods ; Polymorphism, Restriction Fragment Length ; genetics ; Vitaceae ; classification ; genetics

OBJECTIVE: To investigate the expressions and time-dependent changes of phosphatidylinositol-3-kinase (PI3K), phospho-PI3K (p-PI3K), protein kinase B (PKB/Akt) and phospho-Akt (p-Akt) during wound healing process of mice skin. METHODS: The changes of PI3K, p-PI3K, Akt and p-Akt expression in skin wound were detected by immunohistochemistry, Western blotting and real-time PCR. RESULTS: Immunohistochemistry showed the expression of PI3K and p-Akt were observed in mononuclear and fibroblast after skin wound, and reached peak in reconstruction. The positive bands of PI3K, p-PI3K, Akt and p-Akt were observed in all time points of the wound healing process by Western blotting. The expression peak of p-PI3K and p-Akt showed in inflammation and proliferation; the expression peak of PI3K and Akt in reconstruction. Real-time PCR showed the expression peak of PI3K mRNA in inflammation and reconstruction and the peak of Akt mRNA in reconstruction. CONCLUSION During the wound healing process, the expressions of PI3K, Akt, p-PI3K and p-Akt show different changes with significant correlation to wound time. The expression of PI3K/Akt may be a valuable marker for wound time estimation.
Animals ; Blotting, Western ; Class I Phosphatidylinositol 3-Kinases ; Fibroblasts/metabolism* ; Mice ; Phosphatidylinositol 3-Kinase ; Phosphatidylinositol 3-Kinases/metabolism* ; Phosphorylation ; Proto-Oncogene Proteins c-akt/metabolism* ; Real-Time Polymerase Chain Reaction ; Signal Transduction ; Skin/injuries* ; Wound Healing