Objective: To retrospectively analyze the clinical efficacy and safety of rivaroxaban in the prevention of deep vein thrombosis ( DVT) after bones of lower extremity surgery. Methods:Totally 94 patients with bones of lower extremity surgery were col-lected in our hospital during June 2010 to June 2013. According to the taken medicine, the patients were divided into groupⅠ(rivarox-aban 10 mg,po,qd) and groupⅡ( low molecular weight heparin injection 4 000 IU, ih,qd) . The bleeding after the surgery, the data of blood routine and coagulation, the occurrence of DVT and the adverse reactions in the two groups were compared. Results:After the medicine treatment, the number of hemoglobin and platelet in the two groups was declined significantly (P<0. 05), while reached the normal value after the medicine withdrawal. No significant difference was found in the blood routine and coagulation routine in the two groups. One case of hemorrhea showed in group I, while three cases showed in groupⅡ. GroupⅠhad no DVT, while groupⅡ had 3 cases of DVT, and the difference was significant (P<0. 05). No severe adverse reactions appeared in the two groups. Conclusion:Rivaroxaban has good effect in the prevention of DVT with better efficacy and safety when compared with low molecular weight heparin.

Objective To explore specimen sampling for microbial culture in ICU patients with documented infections in order to offer clinical evidence for improving the rational use of antibiotics.Methods Patients with documented infection on the first day after admission into ICU and discharged from ICU from July to December 2012 and from July to December 2013 were enrolled in the study.Clinical data including presence or absence of infection,initial antimicrobial therapy,microorganism specimen sampling and culture were retrospectively analyzed.Results Of 841 patients discharged from ICU,443 had evidence of infections and received antimicrobial therapy on the admission day,and only 30 (6.8％) of them had microbiological detection results prior to treatment.There were microbial specimens available at infection sites on the admission day in 369 cases,and 360 cases (97.6％) of them were sampled in the first three days after ICU admission,while only 119 cases (33.1％) were sampled before the first dose of antimicrobial therapy.Specimens sampled were sputum (56.4％) in the majority,followed by the blood (17.4％).Further analysis of 269 infected patients receiving initial broad-spectrum antimicrobial therapy also showed that only 33.5％ cases were sampled before the first dose of broad-spectrum antimicrobial administration.The positive isolation rate of multi-drug resistant isolates including A.baumannii,S.maltophilia and B.cepacia from specimens sampled after first dose of initial broad-spectrum antimicrobial therapy were significantly higher than those sampled before antimicrobial therapy,P ＜ 0.05.There was no significant difference in isolation rate of Staph.aureus and Enterobacteriaceae between samples obtained before and after first dose of initial broad-spectrum antimicrobial therapy.Conclusions Few evidence of pathogenic microorganisms was available before initial antimicrobial therapy in ICU patients.Although sampling rate of microbial specimens is high,the most of them are sampled after the first dose of antimicrobial administration,and the patentially contaminated specimens such as sputum in predominance,obviously decrease the reliability of authentic results obtained from microorganism culture.

In this study, the rapid resolution liquid chromatography-quadrupole time-of-flight mass spectrometry (RRLC-QTOF/MS) was used to profile the metabolites of urine samples from chronic heart failure (CHF) patients and healthy controls to find the differential metabolites which could provide the scientific evidence to explain the pathogenesis of the disease and supply a better therapy plan.Urine samples from 15 CHF patients (age (62.27±3.14) years) and 15 healthy controls (age (65.41±4.63) years) were analyzed by RRLC-QTOF/MS.After processing the data, the multivariate statistical analysis (principal component analysis, PCA) was performed to find the potential biomarkers.Result showed that urine samples of CHF patients were successfully distinguished from those of healthy controls.Two significantly differentially expressed metabolites, uridine and alanyltryptophan, were found and identified as potential biomarkers.The result showed that the LC-MS based metabolomics approach had good performance to identify potential biomarkers, and the disorder of uracil metabolism and Tryptophan metabolism may play an important role in the mechanism of CHF.

Objective To investigate the prevalence and drug resistance profile of the strains isolated from cerebrospinal fluid of neurosurgery patients so as to provide guidance for the prevention and treatment of intracranial infection.Methods The prevalence and drug resistance of strains isolated from cerebrospinal fluid of neurosurgery patients admitted from Jan 2011 through Dec 2015.Results A total of 1 060 strains were isolated from 23 259 CSF samples.The positive rate of culture was 4.56％.After 1 060 strains were categorized and some of the same species were eliminated,419 strains of different species were obtained,including 103 (24.6％) strains of gram-positive bacteria,293 (69.9％) strains of gram-negative bacteria and 23 (5.5％) strains of fungus.The three leading strains isolated were Acinetobacter spp.(165 strains,39.4％),Klebsiella pneumoniae (72 strains,17.2％),coagulase negative staphylococcus (54 strains,13.6％).The Acinetobacter baumannii isolates showed high resistance rate to meropenem (82.3％) and to cefoperazone sulbactam (76.4％),while the rates of drug resistance to colistin and amikacin were quite low found to be 3.1％ and 29.8％,respectively.The drug resistance of Klebsiella pneumonia was serious in which the rate of drug resistance to meropenem was 72.6％,and the rate of drug resistance to cefoperazone sulbactam was 79.0％,and rates of drug resistance to colistin and Amikacin were quite low found to be 0％ and 35.2％,respectively.The detection rates of MRSA,MRSE and MRSH were high found to be 76.5％,100％ and 100％ respectively.Non-susceptible to vancomycin and teicoplanin strains in staphylococci species were not found.Conclusions The majority of strains isolated from the cerebrospinal fluid were gram-negative bacteria,and the detection rates of Acinetobacter and Klebsiella pneumoniae were high,and the rates of drug resistance of Acinetobacter baumannii and Klebsiella pneumoniae were high.Doctor should pay more attention to the prevalence of pathogenic strains isolated from cerebrospinal fluid and drug resistance of those strains in order to rational use of antibiotic according to the drug resistance detection.

Objective: To elucidate clinical characteristics and build a prognostic nomogram for patients with vulvar cancer. Methods: The study population was drawn from the Surveillance, Epidemiology, and End Results (SEER) database. Patients were randomly assigned to training and validation sets. Cox proportional hazards model and competing risk model were used to identify the prognostic parameters of overall survival (OS) and cancer-specific survival (CSS) to construct a nomogram. The nomogram was assessed by concordance index (C-index), area under the curve (AUC), calibration plot, and decision curve analysis (DCA). Results: A total of 20,716 patients were included in epidemiological analysis, of whom 7,025 patients were selected in survival analysis, including 4,215 and 2,810 in training and validation sets, respectively. The multivariate Cox model showed that the predictors for OS were age, marital status, histopathology, differentiation and tumor node metastasis (TNM) stages, whether to undergo surgery and chemotherapy. However, the predictors for CSS were age, race, differentiation and TNM stages, whether to undergo surgery and radiation. The C-index for OS and CSS in the training set were 0.76 and 0.80. The AUC in the training set for 1-, 3- and 5-year OS and CSS were 0.84, 0.81, 0.80 and 0.88, 0.85, 0.83, respectively, which was similar in the validation set. The calibration curves showed good agreement between prediction and actual observations. DCA revealed that the nomogram had a better discrimination than TNM stages. Conclusions The nomogram showed accurate prognostic prediction in OS and CSS for vulvar cancer, which could provide guidance to clinical practice.

ObjectiveTo explore the application value of CT pulmonary angiography (CTPA) in assessing the severity of acute pulmonary embolism (APE) and right heart function in rehabilitation patients. MethodsFrom January, 2013 to January, 2020, 133 inpatients (94 positive and 39 negative) who underwent CTPA examination in Beijing Bo'ai Hospital were involved. Positive patients were further divided into mild, moderate and severe groups based on the pulmonary artery obstruction index (PAOI). The clinical parameters and right heart function indicators were compared. Spearman correlation analysis was used to analyze the correlation between PAOI, and clinical parameters and right heart function indicators, and Logistic regression analysis was used to predict the risk factors of APE. ResultsThere was significant difference in lower extremity venous thrombosis, D-dimer, oxygen partial pressure, PAOI and left process of interventricular septum among four groups (H ≥ 12.350, P < 0.01). PAOI was moderately positively correlated with D-dimer (r = 0.443, P < 0.001) and left process of interventricular septum (r = 0.520, P < 0.001), and was weakly positively correlated with lower extremity venous thrombosis (r = 0.399, P < 0.001), left pulmonary artery diameter (r = 0.213, P = 0.014) and inferior vena cava regurgitation (r = 0.229, P = 0.008). Lower extremity venous thrombosis (OR = 7.708, P < 0.001) and left process of interventricular septum (OR = 3.641, P = 0.008) were independent risk factors for the onset of APE. The combination of the two indicators was effective for diagnosis of APE, and AUC was 0.795 (95% CI 0.715 to 0.874). ConclusionCTPA may be applied to evaluate the severity of APE and right heart function in rehabilitation patients.