Adult ; Benzene ; Biomarkers, Tumor ; blood ; Female ; Humans ; Male ; Middle Aged ; Occupational Exposure ; Serum ; chemistry

ObjectiveTo study tear film functions of diabetes mellitus with pterygium before and after surgery.MethodsNinety patients with single side pterygium were divided into 3 groups with 30 cases each:simple pterygium (treatment group A ),pterygium combination with type 1 diabetes mellitus (treatment group B) and pterygium combination with type 2 diabetes mellitus(treatment group C).Ninety patients without pterygium were divided into 3 groups with 30 cases each:normal (control group A),type 1 diabetes mellitus (control group B) and type 2 diabetes mellitus (control group C ).Tear film functions were compared in each group before surgery,while tear film functions in treatment group B and C were compared between before and after surgery.ResultsBefore surgery,there was no significant difference among each group in lacrimal secretion test.Every group's tear film break-up time(BUT) was abnormal except control group A.Cornea fluorescein staining (CFS) score in treatment group B compared with control group B,and treatment group C compared with control group C were significant differences [ (9.08 ± 0.48 ) scores vs.(3.43 ± 0.51 )scores and (10.31 ±0.94) scores vs. (7.91 ±0.51 ) scores,P＜0.05].There was significant difference in mucus fern test(MFT) between treatment group B and control group B (P＜0.05).Tear clearance rate (TCR) were all abnormal except control group A.Before surgery compared with after surgery between treatment group B and treatment group C,there was no significant difference in lacrimal secretion test (P＞0.05 ),but there were significant differences in BUT,CFS score and MFT,the TCR were normal.Conclusion Diabetes mellitus with pterygium will aggravate damage in tear film functions,and these damaged functions could be recovered through pterygium surgery with conjunctival limbal autograft.

Objective To investigate the influence of Zhuanggu granule on the concentration of IL-1β and TN-F-α in knee cavity of patients with knee degenerated osteoarthritis. Methods A total of eighty patients with knee degenerated osteoarthritis were recruited into a Zhuanggu granule group (30 cases), a Sulphuric acid Glucosamine group (15 cases) and a Sodium Hyaluronate group (15 cases) according to Doll grouping method. After all groups were treated for 4 weeks, the changes of concentration of IL-1β and TNF-α was detected before and after the therapy Results After the treatment, the concentration of IL-1β and TNF-α in Zhuangu granule group was significantly lower than the other two groups (Sodium Hyaluronate and sulphuric Glucosamine group). Conclusion Zhuangu Granule could influence the concentration of IL-1β and TNF-α in patients of knee degenerated osteoarthritis.

10.3969/j.issn.1000-8179.2013.12.009

ObjectiveTo investigate the extracorporeal clearance rate of imipenem in severe infection patients in the mode of continuous vena-venous hemofiltration (CVVH) during continuous renal replacement therapy (CRRT), in order to approach if the concentration of imipenem in plasma could achieve effective levels of anti-infection, and to explore the effect of time and anticoagulation measure on imipenem clearance during CRRT treatment.Methods A prospective observational study was conducted. All adult severe infection patients complicating acute kidney injury (AKI) in the Department of Critical Care Medicine of the Fourth Hospital of Hebei Medical University from March 2013 to September 2014, who were prescribed imipenem as part of their required medical care, and CRRT for treatment of AKI were enrolled. 0.5 g doses of imipenem was administered intravenously every 6 hours or 8 hours according to random number table, and infused over 0.5 hour. The unfractionated heparin was used for anticoagulation in the patients without contraindications, and no anticoagulation strategy was used in the patients with high risk of bleeding. At 24 hours after first time of administration, postfilter venous blood and ultrafiltrate samples were collected at 0, 0.25, 0.5, 0.75, 1, 2, 5, 6, and 8 hours after imipenem administration. The concentration of imipenem in above samples was determined with liquid chromatography-mass spectrometer/mass spectrometer (LC-MS/MS).Results A total of 25 patients were enrolled. Thirteen patients received imipenem intravenously every 6 hours, and 12 patients, every 8 hours. The anticoagulation was conducted with heparin in 13 cases, and 12 cases without anticoagulation. The intra-day precision, inter-day precision, matrix effect, and recovery rate in low, medium, and high concentration of plasma and ultrafiltrate, and the stability of samples under different conditions showed a good result, the error of accuracy was controlled in the range of±15%. With the application of Prismaflex blood filtration system and AN69-M100 filter, under the mode with CVVH, the total clearance rate of imipenem was (8.874±2.828) L/h when the actual dose of replacement fluid was (31.63±1.48) mL·kg-1·h-1, the total CRRT clearance rate of imipenem in vitro was (2.211±0.539) L/h, which accounting for (30.1±15.7)% of the total drug clearance. In 6 hours interval dosage regimen, the percentages of the time> 4×minimum inhibitory concentration (MIC) at specific 4×MIC of 2, 4, 6, and 8μg/mL of imipenem were more than 40% of the dosing interval. But in the 8 hours interval dosage regimen, when the level was above the 4×MIC of 4μg/mL, maintaining time would drop below 40% of the dosing interval, with significant differences compared with that in 6 hours interval dosage regimen [4×MIC = 2μg/mL: (60.84±20.25)%vs. (94.01±12.46)%,t = 4.977,P = 0.001; 4×MIC = 4μg/mL: (39.85±15.88)% vs. (68.74±9.57)%,t = 5.562, P = 0.000; 4×MIC = 6μg/mL: (27.58±13.70)% vs. (53.97±8.36)%,t = 5.867,P = 0.000; 4×MIC = 8μg/mL:(18.87±12.43)% vs. (43.48±7.83)%,t = 5.976,P = 0.000]. No significant change in sieving coefficient of imipenem was found within a short time (6 hours), which indicated that there was no effect of anticoagulation on clearance of imipenem by AN69-M100 filter, and no statistical significance was found with repeated measure analysis (F = 0.186, P> 0.05).ConclusionsThe clearance rate of imipenem is increased significantly in vitro under the mode of CVVH with the actual dose of replacement fluid was (31.63±1.48) mL·kg-1·h-1 in severe infective patients with severe sepsis complicating AKI, affecting the level of plasma drug concentration, need to adjust the dosage regimen. When the time of the dosing interval was shortened, the concentration of imipenem in patients' plasma could be increased significantly. In a short period of time, the sieving coefficient of imipenem through AN69 filter is not affected by anticoagulation measures and time cleaning efficiency will not decline.

OBJECTIVE:To investigate the effect of clinical pharmacist intervention on prophylactic application of antibiotics in cardiothoracic surgery. METHODS:Medical records of patients underwent cardiothoracic surgery were collected from our hospi-tal during Mar. to Apr. in 2014 (before intervention) and during Jun. to Jul. in 2014 (after intervention). Those were divided into pre-intervention group(n=115)and post-intervention group(n=119). The prophylactic application effect of antibiotics was com-pared before and after intervention. RESULTS:After intervention,the rates of prophylactic application were decreased significantly from 96.5% to 72.3%;the rationality rate of antibiotics selection was improved significantly from 27.9% to 94.2%;The course of prophylactic medication decreased significantly from(5.4±2.8)days to(2.3±1.8)days;the difference had statistical significance before and after intervention(P<0.01). The postoperative infection rate was decreased from 13.0% to 5.9%,the difference had no statistical significance(P=0.074). The average hospitalization time,average drug costs,and average hospitalization expenses were decreased significantly,the difference had statistical significance(P<0.05 or P<0.01). CONCLUSIONS:Clinical pharmacist inter-vention to prophylactic application of antibiotics in cardiothoracic surgery can control the infection effective and guarantee reason-able and safe use of drugs during perioperative period.

Objective:To evaluate the effect of continuing intervention on prophylactic application of antibiotics in sterile operation in urology department by clinical pharmacist to provide reference for the clinical prophylactic application of antibiotics. Methods:All cases of discharged patients underwent sterile operation in urology department of our hospital from July 2010 to June 2014 were divided into three groups according to the intervention time and methods: non-intervention group(n=141), stage Ⅰ intervention group(n=139), stage Ⅱ intervention group (n=162) and stage Ⅲ intervention group (n=137). The prophylactic application of antibiotics was statistically analyzed. Results:After the continuing intervention, the prophylactic application rate of antibiotics in the three inter-vention groups was decreased significantly from 100% before the intervention respectively to 34. 5%,18. 5% and 14. 6% after the in-tervention (P<0. 01). The rationality rate of prophylactic application was improved significantly from 36. 9% before the intervention respectively to 58. 3%, 63. 3% and 85. 0% after the intervention (P<0. 01). The course of prophylactic application was decreased significantly from (138.2 ±31.6)h respectively to (89.9 ±48.0)h,(72.8 ±32.5)h and(45.1 ±29.5)h (P<0.01) and the post-operative infection rate was decreased from 2. 8% respectively to 2. 1%,1. 8% and 1. 4%. Conclusion:The pharmaceutical interven-tion is feasible and valid to improve the rational prophylactic use of antibiotics in urological surgery.

Objective To study the value of lung window and soft tissue window in measuring colon diseases with experimental CTVC examination.Methods Twenty-four artificial polypoid diseases were placed with glue in a thoroughly cleaned porcine colon(overall length,150 era)that was distented with air and submerged in a water phantom and scanned 10 times on a 64-MSCT(GE Light speed)with identical scanning parameters.The data were reconstructed every 0.625 mm and reviewed using 2D images, navigation,MPR and 3D volume-rendered images on a GE AW 4.2 workstation.The maximum diameters of the artificial polypoids were measured by two radiologists with more than 10 years working experience in lung window(W = 1000,L =-700)and soft tissue window(W =400,L =40),respectively.The average value of maximum diameters of the artificial polypoids were measured for 10 times and were compared with the actual diameter.Results Twenty-four artificial polypoid diseases and their shape,size,loeation and relation of diseases with bowel wall were all showed excellently.The maximum diameter measured was close to the actual diameter.The average value was mostly less than actual diameter and a few of them more than the actual diameter.The maximum diameter measured in lung window was close to the actual diameter,and there was no difference between the two data sets(t =0.431,P =0.669).There was difference between the maximum diameter measured in soft tissue window and the virtual diameter(t = 2.691,P = 0.010). Conclusion In screening the colon diseases,CTVC is a good method of choice with no insult or less insult, and higher repeatability.The lung window should be chosen in measuring colon diseases in CTVC examination.

Objective To explore the effect of lysophosphatidic acid(LPA)on blood-brain barrier(BBB) permeability and its possible mechanism.Methods LPA or LPA+suramin(L+S)were stereotaxically injected into the right eaudate nucleus in SD rats in vivo.Evans blue(EB)was used to quantitatively measure the permeability of BBB at different time points.The expression of matrix metalloproteinase-9 was detected by immunohistochemistry technique.The pathological ultrastruetural changes of BBB were assessed by transmission electron microscopy.Results The BBB permeability began to increase after LPA administered into ipsilateral eaudate nucleus,and reached the peak at 24h.Then the permeability of BBB gradually lowered after 48h.In comparison with the same time points of control group,there were quite significant differences(P＜0.01).After L+S was injected,the change of BBB permeability had differences in comparison with those of LPA group in the same time points,(P＜0.05).MMP-9 positive cells were mainly vascular endothelial cells.The numbers of MMP-9 positive blood vessels grew at 6h in LPA group,and the expression of it reached maximum at 24h,then the number of it decreased at 48h,showing significant statistical differences in comparison with the L+S group(P＜0.01),It was observed microscopically that ultrastrueture of BBB of the LPA group was changed sharply,such as basement membrane roughed and fragmented,astroeyte end-feet swolled markedly and perivaseular space enlarged obviously.But there were no remarkable changes in BBB in L+S group.Conclusion LPA can induce increase of BBB permeability and its possible mechanism is the strong expression of MMP-9 protein produeted by endothelial cells through the mediation of LPA receptor,leading to degradation of basement membrane.

MicroRNAs(miRNAs)are a class of small RNA molecules which play a pivotal role in the regulation of genes involved in diverse processes.Recently,many viral-encoded miRNAs have been discovered,which suggests that viruses also use this fundamental mode of gene regulation.Although the functions of most viral- encoded miRNAs are unknown,some of them are involved in evading CTL,mediating latent infection,apoptosis suppression,etc.Uncovering the role of viral miRNAs in the pathopoiesis offers an immense opportunity not only to develope effective antiviral therapies,but also to identifying novel molecular targets for developing antiviral reagents.Therefore,recent progress on vmiRNAs was reviewed.