OBJECTIVE:To explore the clinical utilization of carbapenems in a hospital,analyze and evaluate its medication rationality. METHODS:All the 508 medical records of inpatients treated with carbapenems from Jul. 2012 to Jun. 2015 were retro-spectively investigated,the utilization and pathogenic examination of carbapenems were evaluated;by setting the carbapenems eval-uating standard,the medication rationality of carbapenems was evaluated and inappropriate cases were classified and analyzed statis-tically. RESULTS:The drug utilization indexed (DUI) of Imipenem and cilastatin sodium for injection and Meropenem for injec-tion were 0.80 and 1.32,respectively;the total rate of microbial inspection was 95.9%;according to the drug sensitive test result, the rate of drug selection was 62.8%;there were 54 cases(10.6%)of irrational use records,in which,irrational dosage(42.6%) and improper drug selection (31.4%) were the major problems. CONCLUSIONS:There are some inappropriate medication prob-lems in carbapenems utilization in the hospital. Developing the carbapenems utilization evaluation is helpful to discover typical medi-cation problems,which can provide reference for intervention and continuous improvement of rational drug use.

Objective To analyze the behavior of patients with serious adverse drug reactions and look for risk factors leading to serious adverse drug reactions .Methods Patient medication behavior evaluation method was established,which was used in cases of serious adverse reaction caused by stains in recent three years in Beijing Chuiyangliu Hospital .Clinical pharmacists participated in field survey .Medication behavior of patients was analyzed from three aspects of knowledge ,attitude and ability .Results Three patients had serious adverse reactions occurred in recent 3 years,drugs were suspected of simvastatin and atorvastatin .The score of medication knowledge was lower than 20%.The score of health attitude was lower than 20%.The score of taking ability was lower than 20%. Conclusion In the investigation of serious adverse reaction ,pharmacists found the risk behavior of patients with daily medication is an important cause of patients with serious adverse reaction .Pharmacists should strengthen the drug education and publicity ,especially in patients with risk factors of medication behavior such as knowledge ,attitude and ability in their daily work .

This report presents the case of a 59-year-old man with severe COVID-19 that gradually progressed to cytokine release syndrome and then acute respiratory distress syndrome; he was successfully treated via integration of therapeutic plasma exchange and traditional Chinese medicine. The patient initially presented with a sore throat, severe muscle aches, productive cough and fever. On the worsening of symptoms, remdesivir was administered. However, as the symptoms continued to worsen and a cytokine release syndrome was suspected, oxygen was provided through a high-flow nasal cannula (50 L/min) and therapeutic plasma exchange was performed to prevent worsening of the acute respiratory distress syndrome. On the same day, a course of traditional Chinese medicine was introduced in consultation with the infectious house staff. The patient's symptoms gradually improved; the levels of C-reactive protein and D-dimers reduced, and the patient was weaned to a simple oxygen mask and eventually to room air. This is the first reported case of the integration of these treatments. Together, they prevented the patient from requiring intubation, played a role in cytokine management, and also improved the clinical symptoms, including productive purulent sputum, cough, frequent stool passage and intermittent fever, with no adverse effects. As a result, the patient was discharged within two weeks of the integration of these treatments. Therefore, the integration of therapeutic plasma exchange and traditional Chinese medicine is an effective therapy for patients with severe COVID-19.
Male ; Humans ; Middle Aged ; COVID-19/therapy* ; Cytokine Release Syndrome ; Plasma Exchange ; Medicine, Chinese Traditional ; Cough/drug therapy* ; Respiratory Distress Syndrome/therapy* ; Oxygen/therapeutic use*

Objectives: . Laryngeal ultrasonography (LUS) has been suggested as an alternative diagnostic tool for unilateral vocal fold paralysis (UVFP). The present study applied LUS and quantitative laryngeal electromyography (LEMG) in female UVFP patients to investigate the pathophysiologic mechanisms of UVFP. Methods: . In this cross-sectional study, vocal fold (VF) length parameters included resting and phonating VF length measured using B-mode LUS, and color Doppler vibrating length (CDVL) measured using the color Doppler mode. Results: . Forty female patients with UVFP were enrolled, among whom 11 and 29 were assigned to the thyroarytenoid (TA) muscle+cricothyroid (CT) muscle group (with CT involvement) and the TA (without CT involvement) group, respectively. In the TA group, the turn frequency in thyroarytenoid-lateral cricoarytenoid (TA-LCA) on the paralyzed side, as observed through LEMG, correlated with the VF length during the resting phase (R=0.368, P=0.050) and CDVL values (R=0.627, P=0.000) on the paralyzed side. In the TA+CT group, the turn ratio in the CT muscle correlated with the normalized phonatory vocal length change (nPLC; R=0.621, P=0.041) on the paralyzed side. Conclusion . CDVL and nPLC are two parameters that can be utilized to predict the turn frequencies of TA-LCA in UVFP cases without CT involvement, and the turn ratio of CT in cases of UVFP with CT involvement, respectively. The findings suggest that LUS, as a noninvasive tool, can serve as an alternative method for assessing the severity of laryngeal nerve injury and offer valuable insights into the pathophysiology of UVFP.

Objectives: . A novel J-shaped anterolateral thigh (ALT) flap reconstruction technique was developed to simultaneously restore swallowing and speech functions in patients following total laryngopharyngectomy. This study aimed to assess the outcomes and surgical complications in patients who underwent J-flap reconstruction over time. Methods: . Patients who underwent J-shaped ALT flap phonatory tube reconstruction were enrolled. Surgical morbidities and outcomes were evaluated every 3 months post-surgery for a period of 12 months or until death. Results: . Of the 36 patients, 13 underwent circumferential pharyngeal wall resection (circumferential defect [CD] group), and 23 underwent partial resection (partial defect [PD] group). After 12 months, 97% of the patients were able to resume oral intake without the need for a nasogastric tube, and 50% achieved fluent speech using the reconstructed phonatory tube. The CD group experienced a higher rate of delayed healing than the PD group (30.8% vs. 0%, p=0.012). Additionally, the PD group showed significantly higher percentages of individuals consuming solid food at both the 3- and 12-month intervals than the CD group (81.0% vs. 23.1% and 78.9% vs. 40%, respectively). Conclusions . This study investigated the progression of speech and swallowing functions over time after reconstruction of the voice tube with a J-flap. Using a J-shaped ALT flap phonatory tube effectively restored both speech and swallowing functions, providing long-term benefits, regardless of whether the defect was circumferential or partial.

Objectives: . A novel J-shaped anterolateral thigh (ALT) flap reconstruction technique was developed to simultaneously restore swallowing and speech functions in patients following total laryngopharyngectomy. This study aimed to assess the outcomes and surgical complications in patients who underwent J-flap reconstruction over time. Methods: . Patients who underwent J-shaped ALT flap phonatory tube reconstruction were enrolled. Surgical morbidities and outcomes were evaluated every 3 months post-surgery for a period of 12 months or until death. Results: . Of the 36 patients, 13 underwent circumferential pharyngeal wall resection (circumferential defect [CD] group), and 23 underwent partial resection (partial defect [PD] group). After 12 months, 97% of the patients were able to resume oral intake without the need for a nasogastric tube, and 50% achieved fluent speech using the reconstructed phonatory tube. The CD group experienced a higher rate of delayed healing than the PD group (30.8% vs. 0%, p=0.012). Additionally, the PD group showed significantly higher percentages of individuals consuming solid food at both the 3- and 12-month intervals than the CD group (81.0% vs. 23.1% and 78.9% vs. 40%, respectively). Conclusions . This study investigated the progression of speech and swallowing functions over time after reconstruction of the voice tube with a J-flap. Using a J-shaped ALT flap phonatory tube effectively restored both speech and swallowing functions, providing long-term benefits, regardless of whether the defect was circumferential or partial.

Objectives: . A novel J-shaped anterolateral thigh (ALT) flap reconstruction technique was developed to simultaneously restore swallowing and speech functions in patients following total laryngopharyngectomy. This study aimed to assess the outcomes and surgical complications in patients who underwent J-flap reconstruction over time. Methods: . Patients who underwent J-shaped ALT flap phonatory tube reconstruction were enrolled. Surgical morbidities and outcomes were evaluated every 3 months post-surgery for a period of 12 months or until death. Results: . Of the 36 patients, 13 underwent circumferential pharyngeal wall resection (circumferential defect [CD] group), and 23 underwent partial resection (partial defect [PD] group). After 12 months, 97% of the patients were able to resume oral intake without the need for a nasogastric tube, and 50% achieved fluent speech using the reconstructed phonatory tube. The CD group experienced a higher rate of delayed healing than the PD group (30.8% vs. 0%, p=0.012). Additionally, the PD group showed significantly higher percentages of individuals consuming solid food at both the 3- and 12-month intervals than the CD group (81.0% vs. 23.1% and 78.9% vs. 40%, respectively). Conclusions . This study investigated the progression of speech and swallowing functions over time after reconstruction of the voice tube with a J-flap. Using a J-shaped ALT flap phonatory tube effectively restored both speech and swallowing functions, providing long-term benefits, regardless of whether the defect was circumferential or partial.

OBJECTIVE:To provide reference for pharmacists to participate in the management of chronic disease. METHODS:A total of 259 patients with chronic airway disease [included asthma and chronic obstructive pulmonary disease (COPD)] met the inclusion criteria were selected from our hospital and 5 community health care centers of medical consortium. These patients received medication safety assessment management,which was led by clinical pharmacists of our hospital with the participation of community pharmacists,including medication safety comprehensive evaluation and risk classification management, follow-up and medication guidance, integrated prescriptions checking, establishment of shared database. 1 years after the implementation,the effectiveness were evaluated by score the relatived indicators in related groups. RESULTS:After a year of the management mode practice,compared with before intervention,the patients'safety medication cognitive ability score in high-risk and low-risk group increased from(4.49±1.26)and(7.31±1.01)to(5.40±1.56)and(7.44±0.91);medication adherence score increased from(4.96±1.21)and(7.08±1.24)to(6.66±1.08)and(7.38±0.98);ACT score from asthma patients increased from (16.15±2.58)and(21.15±1.03)to(16.80±2.57)and(21.64±1.55);CAT score from COPD patients decreased from(25.51± 4.07) and (14.90 ± 3.95) to (24.20 ± 3.96) and (13.80 ± 4.08);the rate of irrational prescription effective identification and intervention by pharmacists increased from 3.6％ and 1.4％ to 9.4％ and 7.6％,respectively. All the differences above were statistically significant (P<0.05). CONCLUSIONS:The participation of pharmacists in long-term medication safety assessment management for chronic airway disease patients can improve patients'safety medication cognitive ability,medication adherence, disease control and the pharmacists'ability of irrational drug use identification and intervention.

Traditional Chinese Medicine (TCM) has been extensively used to ameliorate diseases in Asia for over thousands of years. However, owing to a lack of formal scientific validation, the absence of information regarding the mechanisms underlying TCMs restricts their application. After oral administration, TCM herbal ingredients frequently are not directly absorbed by the host, but rather enter the intestine to be transformed by gut microbiota. The gut microbiota is a microbial community living in animal intestines, and functions to maintain host homeostasis and health. Increasing evidences indicate that TCM herbs closely affect gut microbiota composition, which is associated with the conversion of herbal components into active metabolites. These may significantly affect the therapeutic activity of TCMs. Microbiota analyses, in conjunction with modern multiomics platforms, can together identify novel functional metabolites and form the basis of future TCM research.

A large number of non-specific immune cells, such as macrophages, neutrophils and natural killer cells, as well as specific immune cells, such as B cells and T cells, are presented in the atherosclerotic plaques and arterial blood. In addition, immune-related regulatory molecules such as interferon-γ, interleukin-17, and interleukin-1β highly express in atherosclerotic lesion tissues, which is similar to the tumor immune microenvironment and influence the atherosclerosis progression. In this paper, the research progress of immune cells and related factors involved in the immune microenvironment around cerebral atherosclerotic lesions is reviewed to provide idea and basis for its clinical diagnosis and treatment.