OBJECTIVE:To study the classification of deviation in drug production. METHODS:From the perspective of dom-inant and hidden deviation,combining with the theory of risk management,risk of deviation was evaluated with different risk man-agement tools to define the severity of the deviation,and it was handled by different methods. RESULTS & CONCLUSIONS:Ac-cording to the identifiability of deviation in actual management,the deviation was divided into dominance and hidden deviation. The dominant deviation can be divided into deep and shallow level. Whether the causes of deviation could be cleared and the conse-quences could be estimates were judged after the shallow level classification,and the deviation was further divided into simple and complex deviation. As for deviation complex,it could be evaluated with the tools of risk management to define the deviation severi-ty. As for hidden deviation,it needed beforehand preventing with the tools of risk management directly to define deviation levels and provide reference for preventive measures. In the process of deviation management,key point is to relay on the scientific meth-od to identify and classify deviation,and divide the influence levels. Combining the theory of risk management to select and use risk tools is the effective way to solve the problem.

Objective To investigate the status and influencing factors of cooperation of doctors and nurses in the nutritional support of critically ill patients, and provide the basis for future improve the physician-nurse collaboration in the nutritional support. Methods Doctors and nurses who from ICU in Soochow were investigated by the Nurse-Physician Collaboration Scale (NPCS). Results The doctors′score of physician-nurse collaboration in the nutritional support of critically ill patients was 87.42 ±15.73, which was significantly higher than 80.97 ± 13.80 the nurses′(t=3.279, P= 0.001).In addition, under the item 1, 3, 5 in the dimension one as well as the total items in the dimensions two and three, the doctors′score was similarly higher than the nurses, and the differences are also statistically significant (Z=-3.894--1.964, all P<0.01 or 0.05). Technical titles, educational level and age was significantly related to the cooperative level between doctors and nurses respectively (χ2=11.037, P=0.012;F=3.488, P=0.037; F=3.499, P=0.016). Conclusions Doctors have higher levels of perceived collaboration than nurses in the nutritional support of critically ill patients, while both require further improvement. We should highlight the physician-nurse collaboration in feeding critically ill patients, and should improve the nutrition quality through standardized process management and active team cooperation.

AIMTo investigate the effects of injectio Salvia Miltiorrhiza (SM) on gentamicin (GM)-induced free radical formation in guinea pig cochlea, and to explore possible mechanisms on GM-induced ototoxicity.

METHODSBiochemical assays of superoxide dismutase (SOD) activity and malondialdehyde (MDA) content in guinea pig cochlea, combined with auditory brainstem response (ABR) measurement and transmission electron microscopic observation were used in this investigation.

RESULTSSOD activity was significantly declined while MDA content was distinctly increased in cochlear tissues after GM injection (P < 0.01). Moreover, they were well correlated with auditory function damage (|r| > 0.7). Co-treatment with SM evidently enhanced SOD activity and decreased MDA content (P < 0.01, P < 0.05). Furthermore, auditory function was markedly ameliorated. Morphological changes of cochlea were consistent with those of hearing function.

CONCLUSIONLipid peroxidation elicited by free radical was involved in GM-induced cochleotoxicity. SM might enhance SOD activity and prevent lipid peroxidation. As the result it might alleviate GM ototoxicity, and improve auditory function.

Animals ; Cochlea ; drug effects ; metabolism ; Free Radicals ; metabolism ; Gentamicins ; toxicity ; Guinea Pigs ; Lipid Peroxidation ; Malondialdehyde ; analysis ; Salvia miltiorrhiza ; Superoxide Dismutase ; metabolism

Objective To investigatethe status of physician-nurse collaboration in nutritional support among neurosurgical patients in secondary and tertiary hospitals in Suzhou, and to analyze the influence factors and to provide the basis for promoting cooperation consciousnes and quality of work. Methods One hundred and seventy-seven physicians and 506 nurses were investigated by the Nurse-Physician Collaboration Scale(NPCS) in 15 secondary hospitals and 15 tertiary hospitals in Suzhou. Results The cooperative status of physicians in tertiary hospitals was better than that of nurses (t=2.597, P=0.010). The cooperative status of nurses in tertiary hospitals was better than that in secondary hospitals (t=2.080, P=0.009). There was no significant difference in the cooperation between physicians and nurses in secondary hospitals (t=1.845, P=0.066). Multiple regression analysis showed that sex, profession, professional title, age, education degree and work seniority were the influence factors of physician-nurse collaboration intertiary hospitals (t=2.771, 2.597,F=3.745-12.513,P<0.01 or 0.05). Conclusions The physician-nurse collaboration in nutritional support among neurosurgical patients in secondary and tertiary hospitals is in good shape.Administrators should pay attention to influence factors of physician-nurse collaboration, and take measures to promote quality of medical care and nursing care.

OBJECTIVETo assess the effect of Qingfei Quyu Decoction (QQD) in preventing radiation pneumonitis in esophageal carcinoma patients by concurrent using it with chemoradiotherapy.

METHODSA total of 120 patients with mid-late stage esophageal carcinoma were randomly assigned to the treatment group (60 cases) and the control group (60 cases). All patients received concurrent radiochemotherapy. Patients in the treatment group additionally took QQD, one dose per day for 8 successive weeks. The incidence of radiation pneunonitis was compared between the two groups. The improvement rates of short-term benefit rate, Karnofsky performance scale (KPS), and body weight (BW) improvement rate were calculated between the two groups. The 1-and 2-year overall survival rates were compared between the two groups.

RESULTSThe incidence of radiation pneunonitis was 8.93% (15/56) in the treatment group and 18.64% (11/59) in the control group (P < 0.05). The short-term benefit rate was 92.86% (52/56) in the treatment group and 69.49% (41/59) in the control group (P < 0.05). Besides, the KPS and BW improvement rate were higher in the treatment group [89.29% (50/56) and 83.05% (49/59) ] than in the control group [80.36% (45/56) and 66.10% (39/59)] (P < 0.05). The 1-and 2-year overall survival rate were 66.07% and 35.71% in the treatment group, higher than those of the control group (61.02% and 30.51%; P > 0.05).

CONCLUSIONConcurrent using QQD with chemoradiotherapy for treating esophageal carcinoma patients could lower the incidence of radiation pneumonitis, attenuate the degree of radiation induced lung injury, improve clinical benefit rate, and elevate their QOL.

Carcinoma, Squamous Cell ; Chemoradiotherapy ; adverse effects ; Drugs, Chinese Herbal ; therapeutic use ; Esophageal Neoplasms ; drug therapy ; radiotherapy ; Humans ; Radiation Pneumonitis ; prevention & control ; Survival Rate

Objective The Augmentation index(AI)is an indicator of pulse wave reflections.To under- stand the validity of AI in the elderly,we studied the determinants of AI in an elderly population.Methods All subjects older than 70 years living in Zhaoxiang Town,Qingpu District,Shanghai were recruited.Pulse wave a- nalysis at the left radial artery was performed by using Omron HEMg000AI device.The augmentation index (AI)adjusting for a heart rate of 75 beats/min was used for statistical analysis.Results One thousand two hun- dred eighty-six participants included 761(59 %)women,and 815(63 %)hypertensive patients with average age 76.3 years participate the study.Women had a significant higher AI than men(90.3% versus 85.8%,P

Objective To understand the related factors of rabies epidemic and provide the basic data for rabies control and prevention in China by statistic and retrospective analysis of rabies surveillance data in 2010.Methods We used descriptive epidemiology method and statistic analysis to analyze the epidemiological characteristics of rabies in 2010 of China.Results 2048 rabies cases were rabies cases were reported in 817 counties (districts) in 2010,which dropped 7.46％ compares to 2009.The incidences in children and elder people were high; farmers are main occupation of the cases,the male to female ratio of the cases was 2.44:1.Children and older people are higher acquired rabies than other age population.640 cases reported through national rabies sentinel surveillance system,87.50％ cases were caused by exposed to dogs,bite was the main exposure reason.The situation of deposing wounds was poor,and the use of vaccine was still low in individual cases,but in the rabies clinic cases under surveillance,the vaccine usage can reach 98％,the usage of immunoglobulin (RIG) or anti-serum for category Ⅲ exposure in either group cases was not high.Conclusion The epidemic of the rabies in 2010 was eased,Out-patient post-exposure prophylaxis was in good station,but there are still lots of problem existed: post-exposure prophylaxis of individual case was not desirable yet.

Although gene therapy was regarded as a promising approach for glioma treatment, its therapeutic efficacy was often disappointing because of the lack of efficient drug delivery systems. Mesenchymal stem cells(MSCs) have been reported to have a tropism for brain tumors and thus could be used as delivery vehicles for glioma therapy. Therefore, in this study, we attempted to treat glioma by using MSCs as a vehicle for delivering replication-competent adenovirus. We firstly compared the infectivity of type 3, type 5, and type 35 fiber-modified adenoviruses in MSCs. We also determined suitable adenovirus titer in vitro and then used this titer to analyze the ability of MSCs to deliver replication-competent adenovirus into glioma in vivo. Our results indicated that type 35 fiber-modified adenovirus showed higher infectivity than did naked type 3 or type 5 fiber-modified adenovirus. MSCs carrying replication-competent adenovirus significantly inhibited tumor growth in vivo compared with other control groups. In conclusion, MSCs are an effective vehicle that can successfully transport replication-competent adenovirus into glioma, making it a potential therapeutic strategy for treating malignant glioma.
Adenoviridae ; Animals ; Brain Neoplasms ; pathology ; therapy ; Cell Line, Tumor ; Genetic Vectors ; Glioma ; pathology ; therapy ; Humans ; Mesenchymal Stem Cell Transplantation ; Mesenchymal Stromal Cells ; Mice ; Mice, Inbred BALB C ; Mice, Nude ; Neoplasm Transplantation ; Oncolytic Virotherapy ; Random Allocation ; Virus Replication ; Xenograft Model Antitumor Assays

BACKGROUNDPopulation based epidemiologic study on the main diseases and birth status of liveborn neonates remains scarce in China, especially in rural areas where a large number of neonates are born. The aim of this study was to establish an epidemiological basis of live births in Julu County, a representative of the northern and mid-western parts of China in terms of demography, disease pattern and women and children's health care infrastructure.

METHODSThe perinatal data of all live births were prospectively collected in three participating county-level hospitals from September 1, 2007 to August 30, 2008.

RESULTSThere were 5822 live births in these hospitals. Among all live births, 53.7% were male and 4.5% were born prematurely. Mean (SD) birth weight (BW) was (3348 ± 503) g. The low (< 2500 g) and very low BW (< 1500 g) infants accounted for 3.8% and 0.5% of the total births, with 6.5% as small for gestational age and 2.8% as multi-births. Cesarean section rate was 30.2%, of which 68.6% were elective. There were 745 infants (12.8% of the live births) admitted to local neonatal wards within 7 days of postnatal life, in which 48.3% and 19.3% were due to perinatal asphyxia and prematurity, respectively. The incidences of perinatal aspiration syndrome, transient tachypnea and respiratory distress syndrome were 4.9%, 0.6% and 0.5%, respectively. Neonatal mortality was 7.6‰ (44/5822), with 16 in delivery room and 28 in neonatal ward before discharge.

CONCLUSIONSThis study provided a population-based perinatal data of live births and neonatal mortality in a northern China county with limited resources. Neonatal disorders related to perinatal asphyxia remain a serious clinical problem, which calls for sustained education of advanced neonatal resuscitation and improvement in the quality of perinatal-neonatal care.

Asphyxia Neonatorum ; epidemiology ; Birth Weight ; China ; epidemiology ; Female ; Humans ; Infant Mortality ; Infant, Newborn ; Infant, Newborn, Diseases ; epidemiology ; therapy ; Male ; Prospective Studies ; Respiratory Distress Syndrome, Newborn ; epidemiology ; therapy

OBJECTIVETo retrospectively analyze the experiences, indications, technique, and results of coronary artery bypass grafting (CABG) in patients over 70 years old.

METHODSNinety-one patients received coronary artery bypass grafting from March 2004 to March 2008. Ages ranged from 70 to 83 years old, 22 patients over 75 years old. Conventional CABG (CCABG) in 72 patients, off-pump CABG (OPCAB) in 19 patients. Clinical data has no significant differences in two groups. The rate of using left internal mammary artery was 96.7%. The number of grafts in CCABG and OPCAB group were 2 to 5 (3.5 +/- 0.8) and 1 to 4 (2.9 +/- 0.7) respectively.

RESULTSIn-hospital death in 2 cases, both were from chronic obstructive pulmonary disease and pulmonary infection. Cerebral infarction in 1 case and pulmonary infection in 2 cases in CCABG group, but no significant difference between two groups, and no difference in intubation, ICU stay, respiratory failure, renal function failure. But number of grafts in CCABG was significantly more than that in OPCAB (P < 0.01). Postoperative follow-up was 3 to 36 months, 1 case with recurrent angina in OPCAB.

CONCLUSIONSAccording to the characteristic of coronary artery disease in elderly, fully revascularization and improving myocardial blood supply, patients over 70 years old with CABG can obtain the same efficacy as younger patients. There were not significant difference between CCABG and OPCAB.

Aged ; Aged, 80 and over ; Coronary Artery Bypass ; methods ; Coronary Artery Bypass, Off-Pump ; Coronary Disease ; surgery ; Female ; Humans ; Male ; Retrospective Studies ; Treatment Outcome