OBJECTIVE To evaluate the application of antibiotics and its trend for reference to clinical utilization.METHODS The data about antibiotics used from 2005 to 2007 were collected and analyzed.RESULTS The consumption of antibiotics was fallen year by year.The rate of utilization was 67%.The rate of drug combination was 45% and the rate of antibiotic resistance test was 20%.CONCLUSIONS There are still a lot of problems in antibiotics usage of our hospital.It is necessary to strengthen the guidance and supervision.

Objective To assess the effects of dynamic monitoring of plasma Pro-B-type Natriuretic Peptide(Pro-BNP) in the evaluation of prognostic value and myocardial dysfunction in patients with septic shock.Methods The levels of plasma Pro-BNP were tested in 102 patients with septic shock on the 1,3,and 5 days.Data on ICU mortality and 28-day mortality were collected.The patients were divided into non-dysfunction group (CI＜3.0) and cardiac dysfunction group (CI≥3.0) according to levels of hemodynamic variables ( CI level).The prognostic value of plasma Pro-BNP was analyzed.Results Plasma Pro-BNP levels on the 1,3 and 5 days in 28-day survivors have a significant declining trend [( 1649.0 ± 257.5 ) ng/L,( 1867.6 ± 291.7 ) ng/L vs.(1229.9 ± 194.5) ng/L),while plasma Pro-BNP levels in non-survivors have an increasing trend [(4128.8 ± 1051.1),( 5315.9 ± 925.4 ) vs.( 6899.9 ± 1327.9 ) ng/L].There is statistical significance of plasma Pro-BNP levels at day 1,3 and 5 for the two groups ( t=3.057,5.083,and 6.290 respectively,P＜0.01 ).The 28-day mortality and Plasma Pro-BNP levels in cardiac dysfunction group were higher than of non-dysfunction group ( 28-day mortality:62.1％ vs.20.0％;Pro-BNP1:( 1592.8 ± 362.2 )ng/L vs.( 4556.6 ±732.7 ) ng/L;Pro-BNP3:( 2933.6 ± 421.7 ) vs.( 5768.5 ± 793.7 ) ng/L,Pro-BNP5:( 3014.5 ± 587.5 ) ng/L vs.(8873.9 ± 1670.1) ng/L ( x2=20.635,P=0.000,t=3.626,3.154,3.310,P＜0.01].Pro-BNP level greater than 3053 ng/L on the 5-day was an independent prognostic indicator of 28-day mortality ( sensitivity:88.4％;specificity:91.5 ％ ).Pro-BNP level greater than 2378 ng/L on the 5-day was an independent prognostic indicator of hospital mortality ( sensitivity:84.9％;specificity:91.8％ ).In multivariate logistic regression analyses,Pro-BNP level and APACHE score were independent predictors of 28-day mortality and hospital mortality.Conclusion Plasma Pro-BNP level shows obvious significance in evaluation of sepsis-induced myocardial depression severity in patients with septic shock.Pro-BNP level in ICU at day 5 after inclusion is an independent prognostic marker of mortality in septic shock.

Objective To examine cognitive function of the HIV/AIDS patients in the hospitals measured by the neuropsychological tests battery,make an evaluation of cognitive function of the HIV/AIDS patients,and diagnose the patients with HIV-associated neurocognitive disorders(HAND).Methods Ninety-nine normal individuals and two hundred and thirty HIV/AIDS inpatients,who were sampled by multi-stage random stratified in Guangxi,were tested by the 12 items of the neuropsychological tests.Results HIV / AIDS patients with abnormal neuropsychological test entries proportion ranges located between 21.3％-58.7 ％.The results of 12 items of the neuropsychological tests were associated with the results of clinical diagnosis.Among them,the results of SC time,SCW time,color attachment,and numbers of the contiguous error in WSCT tests were positively associated with the results of clinical diagnosis,and the correlation coefficient were 0.384,0.335,0.237 and 0.129,respectively.There was a negative correlation between the results of the rest assessment and the results of clinical diagnosis ; vocabulary fluency was the highest correlation coefficient,while numbers of the contiguous error in WSCT tests was the lowest.Conclusion A higher proportion of abnormal occurrence of Guangxi HIV / AIDS patients in the 12 neuropsychological test entry,and affect the subjects with or without HIV-related neurological assessment of cognitive impairment.The data suggest that a full neuropsychological tests can be better used for the preliminary study of the HIV ±/AIDS patients neurocognitive function.

Objective To systematically assess the efficacy of endoscopic operation and open operation for treating carpal tunnel syndrome .Methods The computer retrieval from MEDLINE ,EMBASE ,Cochrane August ,CNKI ,VIP ,Wanfang databases were conducted for collecting all related randomized controlled trials (RCT ) from February 1989 to February 2012 .The included litera-tures were performed the data extraction ,assessment of bias risk and the quality evaluation .Mata analysis was performed by the RevMan 5 .1 .6 software .Results 21 RCTs including 1 863 operations ,982 cases endoscopic carpal tunnel release (ECTR) and 881 cases of open carpal tunnel release(OCTR) ,met the inclusion criteria .Meta analysis showed that the differences in terms of postop-erative grip strength ,two points discrimination ,incidence of complications ,satisfaction rate ,postoperative symptom relief rate and operation time between the ECTR group and the OCTR group had no statistical significance .The ECTR group was better than the OCTR in the aspects of the time returnning to work ,pinch strength ,postoperative pain rate .Conclusion The ECTR group is supe-rior to the OCTR group in terms of the time returnning to work ,pinch strength ,postoperative pain rate .The other related indexes have no obvious differences between the two kinds of operation procedures .Due to the poor quality of some RCTs ,the above conclu-sion needs more high-quality ,large-sample clinical researches to confirm .

Objective To study the clinicopathologic features and differential diagnosis of deep angiomyxoma(DAM). Methods Seven cases of DAM were collected from 2000 to 2008. All the patients were examined by microscopy and immunohistochemistry. Results 6 patients with DAM were females and 1 was male, with median age of 48.5 years. Median maximum dimension was 5.9cm, with invasive growth pattern. The tumor cells of DAM were infantile, spindle or stellate,diffuse and nodular arrangement. A distinctive histologic feature of DAM was its vascularity. Non-arborizing, thin-wall, ectastic capillaries or more commonly, small thick-wall vessels were dispersed throughout the tumor. Mast cells and extravasated red blood cells were frequently found in the stroma, immunohistochemical study showed that 7 cases were positive for vimentin, desmin, ER and PR, 5 for CD34 and SMA, and negative for S-100 and CK. Conclusion DAM is a rare soft tumor that occurs principally in the vulval and vagina region of woman. Misdiagnosis has happened frequently. Immunohistochemical staining are helpful to diagnosis for DAM, but no significance to distinguish it.

Objective To survey membrane inhibitor of reactive lysis(MIRL) expression in non-small cell lung careinoma(NSCLC) and to analyze the relationship between MIRL expression and clinical staging, adjuvant chemotherapy and disease-free survial. Methods The expression of MIRL in 8 adjacent tissues and 36 NSCLC sam-pies were determined by immunohistochemistry. Furthermore, the relationship between MIRL expression and clinical stage ,adjuvant chemotherapy and disease-free survival was assayed by follow-up. Results Among 36 samples of non-small-cell lung cancer,there were 10(27.8%) samples expressing MIRE. Out of 18 samples of squamous carcinoma, 4(22.2%) expressed MIRL,while 6(37.5%) expressed it in 16 samples of adenocarcinoma,there was no statistical significance between them(P>0.05). There were no expression in 2 samples of large cell carcinoma. There was no correlation between MIRL expression and disease-free survival(P>0.05). MIRL positive expression rate in patients with preoperational adjuvant chemotherapy was significantly lower than that of those without preoperational adjuvant chemotherapy(P<0.05). Conclusions There is great percentage of MIRE expression in NSCLC. Our present study suggests that the immunological inhibition of MIRL should be blocked when monoclonal antibody is used in the treat-merit of NSCLC.

Bronchoplasty was extended to the segmental level and the effect of the multi-segmental surgery for the central non-small lung cancer was observed. The involved lobular bronchi and part of main bronchi were resected and single-layer continuous suture with 5-0 Prolene was used for suturing of the carina of the reconstructed segmental bronchi to form lobular bronchi. Then, single-layer continuous suture with 4-0 Prolene was employed to anastomose the "lobular bronchi" with main bronchi. Our results showed that the 15 bronchoplasties were successfully performed. The tumors were completely removed and postoperatively, the pulmonary functions of the patients were substantially improved. No broncho-pleural fistula and stomal stenosis took place in all the cases. The quality of life of the patients were obviously improved. It is concluded that multisegmental bronchoplasty can completely remove the tumor of central non-small-cell lung cancer and conserve more non-involved lung. The procedure is especially suitable for those patients with severely impaired lung functions and it expands the indications of surgical resection of lung cancer.
Anastomosis, Surgical ; Bronchi/*surgery ; Carcinoma, Non-Small-Cell Lung/*surgery ; Lung Neoplasms/*surgery ; Pneumonectomy/*methods ; Pulmonary Surgical Procedures/*methods ; Recovery of Function ; Treatment Outcome

Objective To summarize the treatment results,operative complications and experiences of laparoscopic modified pull-through(Soave)precedure.Methods Twenty children with Hirschsprung disease(HD),16 males and 4 females,with age from 3.5 months to 4 years old,underwent laparoscopic modified pull-through(Soave)precedure under whole anesthesia and tracheal intubation,and the pathological colon was freed by ultrasonic surgical knife.Results All cases were operated on successfully.The average operating time was 132 min.The average resection colon was 35 cm and the average volume of bleeding was about 14 mL without blood transfusion.Two patients had postoperative enterocolitis;3 patients were no complications postoperation,such as constipation,soiling,intestinal obstruction,preianal intestine prolapse or cuff narrowing,and all patients had 1-2 bowel movements per day during a period of 6 months to 3 years follow-up.Conclusion Laparoscopic modified pull-through(Soave)precedure has smaller incision,less bleeding,quick recovery and less complications.

Objective:To investigate the effect and mechanism of transcription factor Foxp 3 on the proliferation and cell cycle of human lung adenocarcinoma cell line A 549.Methods:We knocked down the expression of Foxp 3 using siRNA.Foxp3 inhibition was detected by RT-PCR.Cell proliferation was detected by MTT.Cell cycle of A549 cells were detected by flow cytometry after the transfection of siRNA.Cell cycle-related checkpoint genes were filtered by RT-PCR.The regulation of Foxp3 on cell cycle-related checkpoint genes were detected by immunofluorescence and dual -luciferase reporter assay system.Results: The proliferation of A549 cells were inhibited after silencing Foxp3,and A549 cells were arrested in G0/G1 cycle.G1/S cycle checkpoint gene CCND1 was down regulated.Mechanism research show that Foxp 3 can regulate the expression of CCND 1 directly.Conclusion: Foxp3 can promote the proliferation of A549 cell line by up regulating G 1/S cycle checkpoint gene CCND 1.This provides a new target for the therapeutic targets of lung adenocarcinoma.

Objective To investigate the expression of procalcitonin (PCT) and C-reactive protein (CRP),and endotoxin in bloodstream infection with different microorganisms,so as to assess the value of these inflammatory cytokines in early diagnosis of sepsis in bloodstream infections patients.Methods Data of 152 septic bloodstream infected patients with 90 male and 62 female aged from 62 to 102 years and 79.2 ± 16.3 years in average admitted from January 2012 to December 2013 were analyzed retrospectively.According to the results of blood culture,the microorganisms could be categorized into gram-negative bacteria,gram-positive bacteria and fungus groups,and the levels of serum CRP,PCT,and endotoxin were compared among these groups of bloodstream infections patients within 24 hours after admission.Results (1) A total of 152 strains of microorganisms were surveyed including 92 gram-negative strains (61.18％),43 gram-positive strains (28.29％),and 16 fungal strains (10.53％).In the gram-negative strains,Klebsiella pneumoniae (n =29),Acinetobacter baumannii (n =24),Escherichia coli (n =23),Burkholderia cepacia (n =9) and Pseudomonas aeruginosa (n =4) were the most common isolates.In the Gram-positive strains,13 strains of Staphylococcus aureus were isolated.(2) In the gram-negative bacterial bloodstream infections group,there were 60 (64.52％) patients with endotoxin positive,and there were no endotoxin positive cases with detected gram-positive bacteria and fungal bloodstream infections.The median levels of PCT were significantly different among the three groups [gram-negative strains group:7.760 (3.365,28.585) ng/mL,gram-positive strains group:0.705 (0.265,3.225) ng/mL,fungal infection group:1.245 (0.543,1.998) ng/mL].In the fungal bloodstream infection group,the mean level of CRP was higher than that in other two groups [gram-negative strains group:(126.01 ± 66.53) mg/L,gram-positive strains group:(77.58 ±54.21) mg/L,fungal infection group:(140.14 ±71.21) mg/L].(3) The receiver operating characteristic (ROC) curve of inflammatory cytokines was made for the diagnostic value in bloodstream infections.ROC curve used to distinguish between gram-positive bacterial bloodstream infections group and fungal group showed that AUCPCT+CRP =0.791.When PCT cut-off value was 0.92 ng/mL,and CRP cut-off value was 68.00 mg/L,the sensitivity was 50％ and the specificity was 95.5％.ROC curve used to distinguish between the gram-negative bacterial bloodstream infections group and fungal group showed that AUCPCT+CRP+LPS =0.947.When PCT cut-off value was 2.16 ng/mL and CRP cutoff value was 94.10 mg/L,and endotoxin was positive,the sensitivity was 82.8％ and the specificity was 100％.ROC curve used to distinguish between gram-negative bacterial bloodstream infections group and gram-positive bacterial group showed that AUCPCT+CRP+LPS =0.947.When PCT cut-off value was 2.68 ng/ mL,CRP cut-off value was 106.5 mg/L,endotoxin was positive,the sensitivity was 74.2％ and the specificity was 97.7％.Conclusions Gram-negative bacteria were the most common microorganisms in bloodstream infections in ICU patients.Compared with single inflammatory cytokine,the serum concentrations of PCT,CRP and endotoxin used together could provide more sensitivity and specificity for the early diagnosis of bloodstream infection with different microorganisms.