OBJECTIVE:To provide reference for clinical rational use of antibiotics. METHODS:The use of antibiotics in our hospital from Jan. 2012 to Dec. 2015 was analyzed,the DDDs was calculated,bacterial resistance rates over the same period was analyzed,and the relationship between them were analyzed with Pearson method. RESULTS:During 2012-2015,the top 3 antibiot-ic DDDs in our hospital were cephalosporins,macrolides and quinolones;bacterial with the top 5 detection rate was Escherichia co-li,Pseudomonas aeruginosa,Klebsiella pneumoniae,Acinetobacter Bauman and Staphylococcus aureus;the DDDs of imipenem cilastatin sodium showed a positive correlation with the resistance rate of P. aeruginosa(r=0.95,P<0.05)and the total resistance rate of Gram-negative bacteria (r=0.98,P<0.05),meropenem showed a positive correlation with the resistance rate of K. pneu-moniae(r=0.97,P<0.05),piperacillin sulbactam sodium showed a negative correlation with the resistance of P. aeruginosa(r=-0.98,P<0.05). CONCLUSIONS:DDDs is correlated with the antibiotic drug resistance rate of bacteria,which should be planned and scientific used to reduce the bacterial resistance.

OBJECTIVE:To investigate the effects of clinical pharmacists participating in the implementation of clinical path-way under the condition of disease diagnosis related groups-prospective payment system(DRGs-PPS),and to provide reference for promoting rational drug use in the clinic. METHODS:Patients with femoral neck fracture in the clinical pathway were collected from our hospital as research objects. The patient collected during Jan.-Dec. 2015 were included in control group(52 patients includ-ed,41 patients completed)and those collected during Jan.-Dec. 2016 were included in observation group(58 patients included,46 patients completed). Clinical pharmacists participated in the implementation of clinical pathway in observation group,and provided technological intervention and administrative intervention. No intervention was performed in control group. Hospitalization time, hospitalization cost,drug cost and ADR were observed in 2 groups. The rationality of antibiotics for prophylactic use,analgesic drugs,adjuvant drugs,anti-osteoporosis drugs and anticoagulant were compared between 2 groups. RESULTS:After clinical pharma-cists participating in the implementation of clinical pathway in observation group,there was no statistical significance in hospitalization time or the incidence of ADR between 2 groups(P>0.05); hospitalization cost and drug cost of observation group were significantly lower than those of control group,with statistical significance(P<0.05). Medication time and cost of antibiotics for prophylactic use,cost of analgesic drugs,medication time of adjuvant drugs in observation group were significantly shorter/lower than control group;type of anti-osteoporosis drugs was significantly more than control group,with statistical significance(P<0.05). CONCLUSIONS:Under DRGs-PPS,the participation of linical pharmacists participating in the implementation of femoral neck fracture clinical pathway can play an important role in regulating the clinical rational use of 5 kinds of drugs and ensuring the safety,effectiveness and econom-ics of drug use.

Objective To discuss the significance of near infrared spectroscopy (NIRS) in evaluation of intrapartum hypoxic-ischemic cerebral injury, and to provide a method to evaluate neonatal brain damage objectively and quantitatively. Methods A total of 63 neonates with fetal distress were divided into hypoxic-ischemic encephalopathy(HIE) group and non-HIE group. Thirtyfive newborns with no fetal distress were chosen as controls. Using NIRS, the brain regional oxygen saturation(rSO2) in these neonates were measured. Evaluation of brain rSO2 in the diagnosis of HIE was analyzed with receiver operating characteristic (ROC) curve. Results At the time of fetal head visible on vulval gapping and 5 min after birth, the HIE group showed decreased brain rSO2[(36. 6±5.0)% and (52. 0±4. 2)%], comparing with control group[(45. 9±4. 6)% and (59. 6±4. 4)%]and non-HIE group[(44.1±3.1) % and (57. 6±3. 5) %](P<0. 01) . The brain rSO2 was positively correlated with the pH and oxygen saturation of umbilical artery blood in all groups (P<0. 01). When the cut-off value of brain rSO2 was <39. 5% at fetal head visible on vulval gapping, the sensitivity and specificity of assessing HIE were 67% and 93%, respectively, while 70% and 86% when the cut-off value was <53. 5% at 5 min after birth. Conclusions The brain rSO2 obtained by NIRS could be used to evaluate brain oxygenation, and may be useful in predicting HIE in neonates with fetal distress.

Objective:To analyze the epidemiological features of respiratory syncytial virus (RSV) infection in Beijing, and monitor the sequence variations in RSV glycoprotein (G) gene and clinical features of infected children.Methods:Respiratory tract specimens were collected from children with acute respiratory infection in the Children′s Hospital Affiliated to Capital Institute of Pediatrics from January 1, 2023 to December 31, 2023. RSV-positive specimens screened by multiple nucleic acid testing were subjected to PCR to amplify the full-length RSV G gene. A phylogenetic tree was constructed after gene sequencing to analyze RSV subtypes and trace G gene variants. Clinical data were retrieved from the medical record system to analyze the clinical features of children with RSV infection in Beijing.Results:A total of 5 489 respiratory specimens were collected from 3 046 male patients and 2 443 female patients. The average age of the patients was 4.36 years. A total of 589 RSV-positive specimens (10.7%, 589/5 489) were detected with 349 from male patients and 240 from female patients. The average age of children with RSV infection was (2.51±2.78) years and the median age was 0.48 years. RSV had been circulating among children in Beijing since March 2023 with two epidemic peaks in May (24.6%, 122/496) and December (18.2%, 126/693). The predominant subtype of RSV in the first half of 2023 was subtype A, but it was replaced by subtype B from November 2023. Phylogenetic analysis revealed a novel G gene of RSV subtype B (RSV-B-BA9-954bp) with a length of 954 bp, which belonged to a new cluster in the phylogenetic tree. The percentage of patients admitted to the Intensive Care Unit (ICU) was higher in children with new variant of RSV subtype B infection than in those with common RSV subtype B infection [44.1% (15/34) vs 25.2% (31/123), χ 2=4.600, P=0.032], while the counts of white blood cells and the levels of C-reactive protein were lower in the children with new variant infection ( P<0.05). Conclusions:RSV has been prevalent among children in Beijing since March 2023 with two epidemic peaks. The predominant A subtype is gradually replaced by to B subtype. A new variant of RSV B G gene (RSV-B-BA9-954bp) is detected among the children.

Objective:To study the genomic sequence of Coxsackievirus A8 (CV-A8) associated with hand, foot and mouth disease (HFMD) from 2013 to 2018 in China and to analyze the genetic evolution of each coding region of the full-length genome.Methods:The genome sequences of 11 CV-A8 strains isolated from patients with HFMD in different regions of China from 2013 to 2018 were determined. Sequence alignment and genetic evolution analysis were performed by Sequencher 5.0 and MEGA 7.0 software, etc.Results:Sequence alignment showed that the genome length of 11 CV-A8 strains ranged from 7 393 bp to 7 400 bp. There was no base insertion or deletion in the coding region compared with the prototype strain, but there were individual base insertion or deletion in the non-coding region. The nucleotide and amino acid similarities in the VP1 region of 11 CV-A8 strains were 78.3%-98.6% and 92.6%-99.7%, respectively, and the nucleotide and amino acid sequences identities with the CV-A8 prototype strain were 78.3%-98.2% and 92.6%-99.7%, respectively. Based on the phylogenetic analysis of VP1 region sequences, the CV-A8 can be divided into five genotypes: A, B, C, D and E. The 11 CV-A8 strains in this study belonged to genotypes C (1 strain), D (2 strains) and E (8 strains). The nucleotide and amino acid similarities of 11 CV-A8 full-length genomes were 81.3%-98.8% and 95.9%-99.5%, respectively. The phylogenetic tree of the P2 region showed that the eight E genotypes CV-A8 had the closest evolutionary distance with CV-A4, CV-A14, and CV-A16. The phylogenetic tree of the P3 region showed that the eight E genotypes CV-A8 had a close evolutionary distance with CV-A5, CV-A16, CV-A14 and CV-A4.Conclusions:The 11 CV-A8 stains in this study showed significant intra-genotype diversity in capsid region and recombinant diversity in non-capsid region which indicated that CV-A8 quasispecies were still undergoing dynamics variation. CV-A8 may become an important pathogen of HFMD and the monitoring of CV-A8 needs to be further strengthened.