Objective:To analyze and evaluate the usage and tendency of quinolones before and after the special rectification of antibacterial in one grade III level A hospital in üanjing to provide evidence for the special rectification of antibacterial and manage-ment. Methods:The usage records of quinolones in 2010( before the special rectification)and in 2011-2013( after the special rectifi-cation)were collected,and the sales revenue,DDDs,defined daily cost( DDC),drug resistance and adverse drug reactions( ADR) were analyzed retrospectively. Results:Both the amount and ratio of the sales revenue of quinolones were declined dramatically after the rectification(2011-2013). Among all kinds of quinolones,the sales revenue and DDDs of lomefloxacin aspartate injections was the highest before the rectification while moxifloxacin injections and levofloxacine hydrochloride injections ranked the first and the second respectively in sales revenue after the rectification(2012-2013). As for the DDDs,levofloxacin hydrochloride tablets and levofloxacine hydrochloride injections were the highest after the rectification. Besides,moxifloxacin injections had the highest DDC after the rectifica-tion. Moreover,the drug resistance of the main drug-resistant bacteria( namely staphylococcus,enterobacteriaceae and non fermenta-tion bacteria)to levofloxacin,norfloxacin and ciprofloxacin was declined after the rectification. The adverse drug reactions of levofloxa-cin,lomefloxacin,enoxacin and moxifloxacin were declined year by year after the rectification,and the ADR ratio of quinolones in all anti-bacterial agents was also declined. Conclusion:After the special rectification of antibacterials,the hospital exhibits obvious im-provement in all the application indices of antibacterials,reflecting a good result of the special rectification. However,the hospital still needs to strengthen the inspection over the clinical application of the fourth generation of quinolones.

It is important and difficult to establish the market competition mechanism in the health care re-form. Medical voucher system in Hong Kong and Macao can provide policy guidelines for Mainland China to promote institutional innovation, force public hospital reform and the rational allocation of medical and health resources. This paper introduced the origin and development of medical voucher system. Based on the description of the implementa-tion background, similarities and differences and effects of medical voucher system in Hong Kong and Macao, the pa-per found that medical voucher system could help encourage the demander to make more frequent use of medical serv-ices, improve their consciousness of prevention and health care and promote family doctor system. Through analyzing the applicability of medical voucher system in mainland China, the paper pointed out it was consistent with the reform orientation and could be served as a useful supplement to the health care system to improve medical insurance, medi-cal assisstance system as well as an effective measure to develop private medical institutions.

Objective To analyze the clinical efficacy and toxic reaction of Tegafur,Gimeraciland Oteracil Potassium Capsule combined with Gemcitabine chemotherapy for patients with radical resection for advanced gallbladder carcinoma.Methods The clinical dataof 135 patients with advanced gallbladder cancer who were admitted to the 1 st Affiliated Hospital of Zhengzhou University and supported after the gastrectomy by the pathology from June 2007 to June 2012 were retrospectively analyzed.All patients were divided into three groups by different therapeutic regimens,operation groups (Radical resection or Extended radical resection of gallbladder carcinoma) with 47 cases,chemotherapy A group (Tegafur,Gimeracil and Oteracil Potassium Capsule combined with Gemcitabine chemotherapy after Radical resection or Extended radical resection of gallbladder carcinoma) with 52 cases,and chemotherapy B group (5-Fluorouracil combined with Oxaliplatin chemotherapy after Radical resection or Extended radical resection of gallbladder carcinoma) with 36 cases.We collected the dates of all patients with the median survival time and the 1,3 and 5-year survival rate after operation,and counted the rate of major toxic reaction after chemotherapy.Results There were no significant differences in the general date of three groups (sex,age,tumor size,CA19-9,CA125,TNM stages,with or without cholecystolithiasis,operation methods,operation complication),The chemotherapy A group and chemotherapy B group had no differenceswiththe median survival time and 1,3 and 5-year survival rate after operation.There were significant differences in the median survival time and 3,5-year survival rate after operation between the operation group and chemotherapy A group (or between the operation group and chemotherapy B group).There were significant differences in the rate of whole toxic reaction and the rate of toxic reaction beyond Ⅲ degree between chemotherapy A group and chemotherapy B group.Conclusions The treatment of Tegafur,Gimeracil and Oteracil Potassium Capsule combined with Gemcitabine chemotherapy for patients with radical resection of advanced gallbladder carcinoma has a lower rate of whole toxic reaction and rate of toxic reaction beyond Ⅲ degree than 5-Fluorouracil combined with Oxaliplatin chemotherapy,and for patients with advanced gallbladder carcinoma,the frontal treatment can obviously prolong the median survival time and effectively improve the 3 and 5-year survival rate after operation.

Objective:This study aimed to investigate the correlation between the levels of serum amyloid A protein (SAA) and apolipoprotein A-Ⅰ (ApoA-Ⅰ) with the severity and prognosis of septic patients, in order to find new clinical prognostic markers for sepsis patients.Methods:This study prospectively included patients admitted to the intensive care unit of Northern Jiangsu People's Hospital from September 2021 to February 2022. Patients were diagnosed with sepsis according to the Sepsis-3 criteria and aged between 18 and 80 years old. Peripheral venous blood samples were collected at 0 h, 24 h, and 72 h after inclusion in the study, measured the levels of ApoA-Ⅰ and SAA, and the 72 h ΔSAA and 72 h ΔApoA-Ⅰwere calculated.. Patient demographics, laboratory parameters, acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ) scores, sequential organ failure assessment scores, etc., were recorded. Patients were divided into survival and death groups based on outcomes, and were divided into shock and non-shock groups based on the presence of shock. Logistic regression was used to combine ApoA-I and SAA to establish a new combined index. Receiver Operating Characteristic curve analysis was performed to evaluate the predictive value of SAA, ApoA-Ⅰ, 72 h ΔApoA-Ⅰ, 72 h ΔSAA and the combined SAA and ApoA-Ⅰ for the prognosis of sepsis patients.Results:A total of 108 patients were included in the analysis, with 48 cases in the non-septic shock group and 60 cases in the septic shock group; 77 cases in the survival group and 31 cases in the death group. There were statistically significant differences in SAA and ApoA-Ⅰ levels at each time point between the shock and non-shock groups (all P<0.05), as well as between the death and survival groups (all P<0.05). SAA levels at each time point were positively correlated with APACHEⅡ scores (all P<0.001), while ApoA-Ⅰ levels at each time point were negatively correlated with APACHEⅡ scores (all P<0.01). SAA levels could predict the risk of death in sepsis patients, with the highest area under curve (AUC) value at 24 h SAA (AUC=0.713, P=0.001), sensitivity was 65.3%, and specificity was 72.7% for predicting 28-day mortality in sepsis. ApoA-Ⅰ levels at each time point could also predict the risk of death in sepsis patients, with the highest AUC value at 72 h ApoA-Ⅰ (AUC=0.743, P<0.001), sensitivity was 69.4%, and specificity was 77.1% for predicting 28-day survival in sepsis. The combined detection of 24 h SAA and 72 h ApoA-Ⅰ increased the AUC value (AUC=0.758, P<0.05), but the Z test showed that the prediction of death risk in patients with sepsis was not significantly higher than that of a single index ( P>0.05). Conclusions:Serum levels of SAA and ApoA-Ⅰ could reflect the severity of sepsis in patients and serve as independent indicators for predicting the prognosis of sepsis patients. The overall diagnostic efficacy of the combined SAA and ApoA-Ⅰ was not significantly different from that of a single index.

Objective:To compare and analyze the clinical curative effect and safety of chemoembolization with drug-loaded microspheres of different particle sizes (D-TACE) for the treatment of hepatocellular carcinoma.Methods:Clinical data of 281 cases with hepatocellular carcinoma treated with drug-loaded microspheres-transarterial chemoembolization (TACE) were retrospectively analyzed. According to the different particle sizes of drug-loaded microspheres, they were divided into 100~300 μm (small particle size) and 300~500 μm (large particle size) group. Tumor response rate and complication conditions at 1, 3, and 6 months after chemoembolization were compared. The overall survival time of the two groups were analyzed. Quantitative data conformed to normal distribution and homogeneity of variance were compared using t-test, while other with Wilcoxon signed rank-sum test. Qualitative data were compared using χ2 test. Kaplan-Meier method was used for survival analysis, and the differences in survival were analyzed using Log-rank test. P＜0.05 was considered as statistically significant. Survival curves and histograms were drawn using GraphPad Prism9.1 software. Results:The complete remission rates at 1, 3 and 6 months after surgery in the small and large particle size groups were 31.25%, 30.15%, and 42.45% and 18.25%, 15.79% and 24.74%, respectively, and the differences were statistically significant between groups (P 1 month=0.012, P 3 month=0.009, P 6 month=0.008, P＜0.05). The objective remission rates at 1, 3 and 6 months after surgery in the small and large particle size groups were 88.19%, 76.99%, and 70.75% and 81.02%, 72.81% and 53.60%, respectively. Six months after surgery, the small particle size group (objective response rate = 70.75%) was significantly higher than the large particle size group (objective response rate=53.6%, P=0.012). The disease control rates of the small particle size group were 95.14%, 83.33%, and 74.53%, while large particle size group were 91.24%, 81.58%, and 64.95%, respectively, with no statistically significant difference between the two groups. However, the incidence of postoperative biliary tumors (6.20%) was significantly higher in the small-size than large-size group (0.70%), and the difference was statistically significant ( P＜0.05, P=0.03). There were no statistically significant differences between other adverse events such as post-embolization syndrome, liver abscess, and myelosuppression. The median survival time of the small and large particle size groups was 31.8 months and 20.5 months, respectively, but the difference was not statistically significant ( P=0.182). Conclusions:In the treatment of hepatocellular carcinoma with D-TACE, the short-term curative effect of the small particle size group was better than large particle size group, but the incidence of biliary tumors was high, and D-TACE of different particle sizes had no significant effect on long-term survival.

Objective To understand the epidemiological characteristics and related risk factors on HIV,HBV infection of people from the southwest province of China and to provide basic data for the development of related strategies.Methods According to the information on current HIV epidemics,one township from the area was selected as the study field and all the adult population were surveyed using a questionnaire to collect social demographic data and information on infection-related factors.Results A total of 2 290 adults were investigated and data showed as follows:the average HIV infection rate as 7.9％,the average HBV infection rate as 3.1％,and the average HIV/HBV co-infection rate as 1.2％.As for HIV infection,people whose yearly family gross income between 1 000 and 3 000 Yuan (OR=0.28) or more than 5 000 Yuan (OR=0.14) were less likely to be infected with HIV than those people whose annual family gross income less than 1 000 Yuan.People with educational level of primary school and above were more likely to carry HIV than those who were illiterate (OR =3.28).People who had the history of migration were less likely to carry HIV than those who had not (OR=0.33).People who had the history of being drug abusers were more likely to infect HIV than those who had not (OR=46.32).People whose spouses had the history of using drugs were more likely to infect HIV than those who had not (OR=3.52).People whose spouses had been infected with HIV were more likely to infect HIV than those who had not (OR=9.56).As for HBV infection,people who had the history of migration were more likely to infect HBV (OR =2.48).As for HIV/HBV co-infection,people whose spouses had the history of HIV infection were more likely to infect HIV/HBV co-infection than others who did not have the history (OR=6.04).Conclusion There had been a serious HIV/AIDS epidemic in our study field.Other than taking measures as detection and vaccination on HBV,health education should be strengthened,together with measurements as needle exchange and methadone substitution therapy,to control the spread of AIDS.

Objectives:Fluid resuscitation is an important treatment for sepsis. However, the optimal choice of fluid is still controversial. This study aimed to investigate the effect of Sodium Bicarbonate Ringer’s Solution on the outcome of patients with sepsis.Methods:This was a single-center, prospective, randomized controlled clinical study, From July 2021 to June 2023, adult patients with Sepsis who met the diagnostic criteria of Sepsis 3.0 admitted to the Department of Critical Care Medicine of Jiangdu People's Hospital of Yangzhou were randomly assigned to the sodium bicarbonate ringer’s solution group or the normal saline group according to the random number table. Patients received either sodium bicarbonate ringer’s solution or normal saline as fluid for resuscitation and maintenance therapy. Clinicians determined the amount and rate of infusion based on volume assessment. The 30-day mortality, the degradation of endothelial glycocalyx degradation products at multiple time points, the mortality in intensive care unit (ICU), the incidence of major adverse renal events (MAKE30) within 30 days, and other clinical outcomes were compared between the two groups. Enzyme-Linked immunosorbent assay was used to determine the concentration of endothelial glycocalyx coating degradation products in peripheral blood. The count data were analyzed by χ 2 test, and the measurement data were analyzed by independent sample t test. Results:A total of 67 patients who met the inclusion criteria were enrolled during the study (32 patients in the sodium bicarbonate ringer’s solution group and 35 patients in the normal saline group). There were no significant differences in baseline data such as age, gender, underlying diseases, and SOFA score at enrollment between the two groups ( P>0.05).The 30-day mortality (28.1% vs. 40.0%), ICU mortality (15.6% vs. 20.0%) and MAKE30 (31.2% vs. 42.9%) in the sodium bicarbonate ringer’s solution group were lower than those in the normal saline group, but the differences were not statistically significant ( P>0.05). The levels of SCD-1(1317.3±206.9) pg/mL, HA (75.1±24.9) ng/mL and HS (75.6±13.8) ng/mL in the sodium bicarbonate ringer’s solution group were significantly lower than those in the normal saline group [(1514.6±264.9) pg/mL, (96.5±25.4) ng/mL, (85.8±15.8) ng/mL] on the third day (all P<0.05). Conclusion:Although the use of sodium bicarbonate ringer’s solution for resuscitation in sepsis patients cannot significantly reduce the 30-day mortality rate, but significantly reduce the degradation of polysaccharide coating, decrease the occurrence of hyperchloremia and acidosis.

OBJECTIVE: To investigate the correlation of hemoglobin (Hb) level with prognosis of elderly patients diagnosed as sepsis. METHODS: A retrospective cohort study was conducted. Information on the cases of elderly patients with sepsis in the Medical Information Mart for Intensive Care-IV (MIMIC-IV), including basic information, blood pressure, routine blood test results [the Hb level of a patient was defined as his/her maximum Hb level from 6 hours before admission to intensive care unit (ICU) and 24 hours after admission to ICU], blood biochemical indexes, coagulation function, vital signs, severity score and outcome indicators were extracted. The curves of Hb level vs. 28-day mortality risk were developed by using the restricted cubic spline model based on the Cox regression analysis. The patients were divided into four groups (Hb < 100 g/L, 100 g/L ≤ Hb < 130 g/L, 130 g/L ≤ Hb < 150 g/L, Hb ≥ 150 g/L groups) based on these curves. The outcome indicators of patients in each group were analyzed, and the 28-day Kaplan-Meier survival curve was drawn. Logistic regression model and Cox regression model were used to analyze the relationship between Hb level and 28-day mortality risk in different groups. RESULTS: A total of 7 473 elderly patients with sepsis were included. There was a "U" curve relationship between Hb levels within 24 hours after ICU admission and the risk of 28-day mortality in patients with sepsis. The patients with 100 g/L ≤ Hb < 130 g/L had a lower risk of 28-day mortality. When Hb level was less than 100 g/L, the risk of death decreased gradually with the increase of Hb level. When Hb level was ≥ 130 g/L, the risk of death gradually increased with the increase of Hb level. Multivariate Logistic regression analysis revealed that the mortality risks of patients with Hb < 100 g/L [odds ratio (OR) = 1.44, 95% confidence interval (95%CI) was 1.23-1.70, P < 0.001] and Hb ≥ 150 g/L (OR = 1.77, 95%CI was 1.26-2.49, P = 0.001) increased significantly in the model involving all confounding factors; the mortality risks of patients with 130 g/L ≤ Hb < 150 g/L increased, while the difference was not statistically significant (OR = 1.21, 95%CI was 0.99-1.48, P = 0.057). The multivariate Cox regression analysis suggested that the mortality risks of patients with Hb < 100 g/L [hazard ratio (HR) = 1.27, 95%CI was 1.12-1.44, P < 0.001] and Hb ≥ 150 g/L (HR = 1.49, 95%CI was 1.16-1.93, P = 0.002) increased significantly in the model involving all confounding factors; the mortality risks of patients with 130 g/L ≤ Hb < 150 g/L increased, while the difference was not statistically significant (HR = 1.17, 95%CI was 0.99-1.37, P = 0.053). Kaplan-Meier survival curve showed that the 28-day survival rate of elderly septic patients in 100 g/L ≤ Hb < 130 g/L group was significantly higher than that in Hb < 100 g/L, 130 g/L ≤ Hb < 150 g/L and Hb ≥ 150 g/L groups (85.26% vs. 77.33%, 79.81%, 74.33%; Log-Rank test: χ² = 71.850, P < 0.001). CONCLUSIONS Elderly patients with sepsis exhibited low mortality risk if their 100 g/L ≤ Hb < 130 g/L within 24 hours after admission to ICU, and both higher and lower Hb levels led to increased mortality risks.
Humans ; Male ; Female ; Aged ; Retrospective Studies ; Sepsis/diagnosis* ; Critical Care ; Intensive Care Units ; Prognosis ; Hemoglobins ; ROC Curve