Objective To evaluate the relationship between ceftazidime-avibactam(CAZ-AVI)blood concentrations and efficacy in critically ill patients and to investigate the factors influencing blood levels.Methods The CAZ-AVI trough concentrations(Cmin)were detected in 29 patients who received CAZ-AVI treatment for at least 48 hours.The clinical materials of the patients were collected together for retrospective analysis.Results The Cmin of ceftazidime(CAZ)and avibactam(AVI)were(50.95±5.17)and(7.52±0.96)mg·L-1 in the effective group and(31.16±7.03)and(5.37±1.32)mg·L-1 in the ineffective group,respectively.The Cmin of CAZ in the effective group was significantly higher than in the ineffective group(P<0.05),and there was no significant difference in AVI Cmin between the two groups(P>0.05).Spearman's correlation analysis showed that CAZ Cmin was positively correlated with clinical efficacy(P<0.05),and no correlation between AVI Cmin and clinical efficacy(P>0.05).The optimal CAZ Cmin threshold was 24.59 mg·L-1.Multiple linear regression analysis showed that age and creatinine clearance was significantly correlated with the Cmin of CAZ,and creatinine clearance was significantly correlated with AVI Cmin(P<0.05).Conclusions The Cmin of CAZ correlates with efficacy,and it may be more beneficial for clinical treatment to keep the concentration of CAZ-AVI always greater than the minimum inhibitory concentration during the dosing interval.The creatinine clearance should be fully considered when optimizing CAZ-AVI dosage in critically ill patients.

Polymyxins are the first-line drugs used in multidrug resistance(MDR)Gram-negative infections.Polymyxin-induced nephrotoxicity is the major dose-limiting factor hindering its clinical use.It has been suggested that the mechanism of polymyxin-associated nephrotoxicity is related to its accumulation in the kidney upon extensive reabsorption from renal proximal tubular cells,and one or more renal transporters may mediate the process that polymyxins enter the renal tubular cells across cytomembrane.This review aimed to describe the roles of renal transporters in polymyxins reabsorption into the renal tubular cells and provide reference for reducing the nephrotoxicity of polymyxin.

Objective:To study the inhibitory effect of CPT combined with 5-Fluorouracil (5-Fu), Oxaliplatin(L-OHP) on gastric carcinoma cells in vitro. Methods:MGC823 and SGC7901 gastric carcinoma cell lines were selected for culture and passage. The two cell lines were distributed into blank control group, CPT group, 5-Fu group, L-OHP group, 5-Fu+ CPT group and L-OHP+ CPT group. The blank control group was not given any drugs, CPT group was given CPT 1 000 μg/ml 2-fold dilution until 0.004 μg/ml; 5-Fu group was given 5-Fu 2.5×10 6 ng/ml 10-fold dilution until 2.5×10 -4 ng/ml; L-OHP group was given L-OHP 1 000 μg/ml 2-fold dilution up to 0.002 μg/ml; 5-Fu+ CPT group was given 5-Fu step concentration 2.5×10 6 ng/ml 10-fold dilution up to 2.5×10 -8 ng/ml, and combined with CPT 300 ng/ml; L-OHP+ CPT group was given a 2-fold dilution of L-OHP step concentration 1 000 μg/ml up to 0.24 μg/ml and combined with CPT 300 ng/ml. The inhibition effect of cells after drug action was detected. The 50% inhibitive concentration (IC 50) of medicines and the synergistic effect of the combined drugs were analyzed. The measurement data were expressed as Mean ± standard deviation ( Mean± SD), and the t-test was used for comparison between groups. Results:The inhibition rate of 5-Fu+ CPT group was significantly higher than that of 5-Fu group, the differences in MGC823 and SGC7901 cell lines were statistically significant ( P=0.002, 0.009). The inhibition rate of L-OHP+ CPT group was also significantly higher than that of L-OHP group, the differences in MGC823 and SGC7901 cell lines were statistically significant ( P=0.037, 0.040). Compared with 5-Fu+ L-OHP group, IC 50 value of 5-Fu+ CPT group and L-OHP+ CPT group decreased significantly, the differences in MGC823 and SGC7901 cell lines were statistically significant (all P<0.001). The survival fraction of 5-Fu and L-OHP combined with CPT on the two cell lines was lower than 70%, which was estimated by Weeb coefficient. Conclusions:The combination of 5-Fu, L-OHP and CPT can significantly improved the inhibitory effect on MGC823 and SGC7901 cell lines. 5-Fu, L-OHP and CPT had good synergistic effect.

OBJECTIVE: To investigate the current status of job burnout and working capability in miners of a copper-nickel mine of Xinjiang Municipality and explore the relationship between miners′ job burnout and working capability.METHODS: A total of 1 254 miners in a copper-nickel mine were selected as study subjects by stratified cluster sampling method. The Chinese Maslach Burnout Inventory and the Work Ability Index Questionnaire were used to investigate their job burnout and working capability.RESULTS: The total score of male miners′ job burnout was higher than that of female miners(P<0.05). The total score of high school educated miners′ job burnout was higher than that of junior middle school and below, junior college, undergraduate and above education groups(P<0.05). The total score of smelting miners′ job burnout was higher than that of mining and ore dressing miners(P<0.05). College degree group, unmarried group, intermediate professional title or above group, monthly income of 4 000-yuan group and mineral processing unit group had higher working capability(P<0.05). Multiple linear regression analysis showed that education level, type of jobs and job burnout level independently affect the miners′ working capability(P<0.01). The miners′ working capability decreased with decreasing education level and the increasing job burnout level(P<0.01). The working capability of ore dressing miners was higher than that of mining and smelting miners(P<0.05). CONCLUSION: The working capability of copper-nickel miners is negatively correlated with their job burnout. Reducing job burnout can improve the working capability of miners.

Objective To evaluate whether individualized dosage regimen based on therapeutic drug monitoring (TDM) is beneficial for improving the rate of pharmacokinetics/pharmacodynamics (PK/PD) reaching the standard and anti-infection efficacy. Methods Totally, 36 cases in the intensive care unit ( ICU ) of Nanjing Drum Tower Hospital using meropenem during January 2015 to December 2015 were collected, and divided into intervention group and control group. Results On the fourth day of administration, meropenem concentration in intervention group was significantly higher than that of the control group (22.5 μgmL-1 and 17.5 μgmL-1, respectively, P=0.007).With minimal inhibitory concentration (Cmin)>8 μgmL-1 serving as target, the rate of reaching the standard was both 22. 2% on day 2, 100. 0% and 72. 2% on day 4 in intervention group and control group, respectively (P=0.015). With minimal inhibitory concentration (Cmin) >32 μgmL-1 serving as target, the rate of reaching the standard was both 0 on day 2, 38. 9% and 5. 5% on day 4 in intervention group and control group, respectively (P=0.015). The clinical curative rate of the intervention group and control group was 83.3% and 72.2%, respectively (P=0.437), and the failure rate was 16.7% and 27.8%, respectively.Bacteria clearance rate was 88.9%and 55.5% in the intervention group and control group, respectively(P<0.05). Conclusion Individualized dosage regimen based on TDM in ICU patients is beneficial to improving the rate of PK/PD reaching the standard and anti-infection efficacy.

Objective To explore the hospitalization costs of patients with diabetic foot ulcer and analyze key influencing factors.Methods A total of 570 diabetic foot inpatients were recruited from January 2008 to March 2012 for analysis of the relationship between their hospitalization costs and clinical symptoms.The multifactor regression analysis model was used to identify main influencing factors for their hospitalization costs.Results The medical costs of such inpatients amounted to 1 9 825.6 yuan (12 476.6~32 745.9)yuan,while average hospitalization costs of the 3 401 diabetic patients admitted over the same period were but 9 757.1 yuan (6 282.1 ~ 1 5 723.7 )yuan,a difference of statistic significance.The single-factor analysis found statistical differences from the differences of hospitalization among various age,occupation,dorsal artery of foot,B ultrasound of lower extremity arteries,wagner classification,amputation,transfer,leucocyte,hemoglobin,serum albumin,serum creatinine and high density lipoprotein.Multifactor analysis found that the significant factors influencing the medical costs of inpatients were days of stay,albumin,wagner classification,dorsal artery of foot,leucocyte and age. Conclusion Hypoalbuminemia,high stage of wagner classification,weak or absent pulsation of foot dorsal artery,severe infection and aging were significant factors contributing to higher medical costs of hospitalization for patients with diabetic foot ulcer.

BACKGROUNDBreast cancer is one of the most common malignant female diseases worldwide. It is a significant threat to every woman's health. Vascular endothelial growth inhibitor (VEGI) is known to be abundant in endothelial cells. According to previous literature, overexpression of VEGI has been shown to inhibit tumor neovascularisation and progression in cellular and animal models, but there has been limited research on the significance of VEGI in the breast cancer.

METHODSIn our study, cell lines MDA-MB-231 were first constructed in which VEGI mediated by lentivirus over-expressed. The effects of VEGI over-expression on MDA-MB-231 cells were investigated both in vitro and in vivo. The expression of VEGI in the MDA-MB-231 cells after infection of lentivirus was analyzed using real-time PCR and Western blotting. The effect of the biological characteristics of MDA-MB-231 cells was assessed by growth, invasion, adhesion, and migration assay with subcutaneous tumor-bearing nude mice models. Then the growth curves of the subcutaneous tumors were studied. Expressions of VEGI, CD31 and CD34 in the tumors were analyzed by immunohistochemistry and apoptosis was detected by flow cytometry and immunohistochemistry.

RESULTSInfection of MDA-MB-231 cells within the lentivirus resulted in approximately a 1 000-fold increase in the expression of VEGI. As can be seen in the invasion, adhesion and migration assay, the over-expression of VEGI can inhibit the ability of MDA-MB-231 cells during migration, adhesion and invasion. The volume of the subcutaneous tumor in the over-expression group was distinctly and significantly less than that of the control groups. Immunohistochemistry analysis of the tumor biopsies clearly showed the expression of VEGI in the over-expression group increased while CD31 and CD34 decreased significantly. In vitro and in vivo, the early apoptosis rate and the apoptosis index were increased within the VEGI over-expression group as compared with the control group.

CONCLUSIONSTaken together, recombinant lentivirus that were successfully constructed, demonstrated up-regulated VEGI gene expression in breast cancer cells. Lentivirus-mediated over-expression of VEGI weakened the ability of the breast cancer cell migration, adhesion and invasion. Over-expression of VEGI diminished the tumorigenic capacity of breast cancer cells in vivo. Up-regulation of VEGI gene expression however inhibited breast cancer MDA-MB-231 cell in the early apoptosis.

Apoptosis ; genetics ; physiology ; Breast Neoplasms ; genetics ; metabolism ; pathology ; Cell Line, Tumor ; Cell Proliferation ; genetics ; physiology ; Female ; Gene Expression Regulation, Neoplastic ; genetics ; physiology ; Genetic Vectors ; genetics ; Humans ; Lentivirus ; genetics ; Vascular Endothelial Growth Factors ; genetics ; metabolism

Objective To investigate outcomes of different surgical approaches for treating cases of fracture and dislocation of the lower cervical spine.Methods The study involved 26 cases of fracture and dislocation of the lower cervical spine treated surgically from December 2002 to January 2012,including 19 males and 7 females with age ranging from 27 to 62 years (average 39 years).According to the AO classification,there were 12 cases of type B3.1,three of type B3.2,two of type C2.1,three of type C3.1,and six of type C3.2.Preoperative spinal cord function graded by Frankel criteria was six cases of grade A,five of grade B,seven of grade C,six of grade D,and two of grade E.Conventional skull traction was done for all patients before operation.Vertebral cannal decompression and interbody fusion through anterior,posterior or anterior-posterior approaches were determined according to type of fracture dislocation and severity of spinal cord injury.Radiography was performed regularly after operation to review the correction of dislocation,restoration of vertebral height,and interbody fusion.Spinal cord function was also evaluated postoperatively.Results No large blood vessel injury or aggravation of spinal cord injury occurred intraoperatively.There were no complications of incision infection,leakage of cerebrospinal fluid,herniation of bone graft or implant breakage postoperatively.All cases obtained successful correction of fracture and dislocation of the lower cervical spine as well as the recovery of cervical sequence,physiological curvature,and vertebral height in the 12 to 24 months of follow-up (average 16 months).Bony fusion was obtained for all cases at postoperative 3-6 months (average 3.5 months).Spinal function evaluated by Frankel criteria at the latest follow-up showed was grade A in six cases,grade B in three,grade C in five,grade D in five and grade E in seven,with different degree of improvement for all cases.Conclusions Operative approaches should be selected according to the specific status of fracture and dislocation of the lower cervical spine.Anterior approach can be performed for vertebral or intervertebral disc injury straightly and the procedure handles cervical instability immediately.Posterior surgical approach can be used to settle dislocation and interlocking of the articular process directly,but the intervertebral disc injury should be ruled out simultaneously in order to avoid further injury of spinal cord during the reduction process.Combined anterior and posterior surgical approach can be applied to treat fracture and dislocation of lower cervical spine and intervertebral disc injury concurrently but has high risk and large operation wound.

Objective To investigate the efficacy and safety of fludarabine cytarabine and granulocyte colony stimulating factor (FLAG) chemotherapy on adult relapsed or refractory adult acute lymphoblastic leukemia (ALL) patients.Methods Twenty adult patients with relapsed or refractory ALL were treated with salvage therapy which was combined of fludarabine,cytarabine and granulocyte colony stimulating factor (FLAG).Another 20 cases in control group were treated with primal induction regimen and idamycin combined with etoposide and high-dose methylprednisolone.Sides effects of 2 groups were compared and FCM was used to investigate the cells with leukemia associated with immunophenotype,final comparing with bone marrow morphology.Results Hematologic toxicity was similar both in the treatment group and control group.Nonhematology complications consisted of heart and liver toxicity (1/20 and 9/20) were weaker than those in control group (4/20 and 1/20),which were mild to moderate and could be alleviated with supportive therapy.The median overall survival was no significant difference between both sides,eights patients (40.0 ％) who achieved complete remission received salvage therapy,the disease-free survival and the median overall survival were 6 months (range 4-30 months) and 11 months (range 9-30 months),respectively.Seven patients (35.0 ％) achieved complete remission in the treatment group,the disease-free survival and the median overall survival were 4 months (range 3-30 months) and 9 months (range 9-30 months) for 7 patients,respectively.In the treatment group early recurrence [5.0 ％ (1/20)] and outside marrow of recurrence rate (0)were lower than in control group [20.0 ％ (4/20) and 10.0 ％ (2/20)].Conclusion FLAG is a well-tolerated regimen for adult relapsed or refractory ALL patients which enables patients to receive allogeneic stem cell transplantation.

This paper proposes a media access control (MAC) layer design for wireless body area network (WBAN) systems. WBAN is a technology that targets for wireless networking of wearable and implantable body sensors which monitor vital body signs, such as heart-rate, body temperature, blood pressure, etc. It has been receiving attentions from international organizations, e. g. the Institute of Electrical and Electronics Engineers (IEEE), due to its capability of providing efficient healthcare services and clinical management. This paper reviews the standardization procedure of WBAN and summarizes the challenge of the MAC layer design. It also discusses the methods of improving power consumption performance, which is one of the major issues of WBAN systems.
Equipment Design ; Health Services Accessibility ; trends ; Healthcare Disparities ; Humans ; Monitoring, Physiologic ; instrumentation ; Telemedicine ; instrumentation ; Wireless Technology