Objective:To understand the vancomycin dose, therapeutic drug monitoring(TDM) situation and therapeutic effect of children after liver transplantation.Methods:A retrospective analysis of the data of 98 children who received intravenous vancomycin treatment after liver transplantation were conducted in the Department of Critical Care Medicine of Beijing Friendship Hospital from January 2017 to June 2019, including demographic data, vancomycin dose, serum trough concentration, drug-related adverse reactions and clinical outcome data.Results:A total of 98 children received intravenous vancomycin treatment and at least one steady-state TDM blood sample was collected.Among them, 53 cases (54.1%) were male, and the median age was 9 months(5 months to 14 years old). The median first daily dose of vancomycin treatment was 50(30-60)mg/(kg·d), and the median duration of treatment was 14(3-54)days.Only 27.5%(27/98)of the children′s initial trough concentration reached the target concentration (10-20 mg/L), while 26 cases(26.5%) did not reach the target after adjusting the treatment.Six children(6.1%)had renal toxicity caused by vancomycin, and two children had skin rash.The effective treatment rate accounted for 51.7%(15/29). The initial trough concentrations of vancomycin in the effective and ineffective groups were(5.92±3.82)mg/L and(10.43±5.37)mg/L, respectively.The difference was statistically significant ( P=0.041). Conclusion:The rate of intravenous vancomycin in children after liver transplantation is low, and the dose needs to be adjusted individually.

Objective? To investigate the feasibility and safety of vacuum modelling pad for patients with lateral position in thoracic surgery to improve the convenience and comfortable experience for medical staff and patients. Methods? From May 2017 to March 2018, 100 patients who underwent thoracic surgery under general anesthesia with lateral position in the operating room of Sun Yat-sen University Cancer Center were randomly selected and divided into observation group(n=50) and control group (n=50) according to random number table. The polyurethane vacuum modelling pad was used for to secure the patients' position in the observation group, while the sand bag baffle was used to secure the patient's position in the control group. Position placement time and skin pressure blisters were recorded in both groups. Questionnaires were sent out after operation to collect the satisfaction of medical staff with this position. The patients' comfort was followed up within 24 hours after operation. Results? The position placement time in the observation group was (183.56±10.36) s, shorter than the control group with (290.80±14.71)s and the difference was statistically significant(P＜ 0.01); there were 11 cases of skin reddening under pressure and 2 cases of blister in the observation group, which is statistically different from the control group with 24 cases of skin reddening under pressure and 9 cases of blister(P＜ 0.05). Patients' comfort score was(6.72±0.39) in the observation group, higher than the control group with (6.02±0.44) and the difference was statistically significant(P＜ 0.01). In terms of the 4 items of "the convenient operation", "comfortable standing position", "patient safety" and"overall evaluation", the observation group scored higher than the control group with statistical differences (P＜0.01); in terms of the "surgical field exposure" and "fasten effects", there was no statistical difference (P＞0.05). Conclusions? The use of modelling pad for patient lateral position in thoracic surgery can not only prevent organ and skin damage and ensure patient safety, but also simplify the operation procedure, improve the comfort of standing position and the working efficiency and satisfaction of the medical staff.

Objective To investigate the effect of radial artery hemostat (TR Band) continuous compression time on bleeding of puncture point, thumb perception, palm swelling and subjective comfort in patients undergoing transradial percutaneous coronary intervention. Methods One hundred and fifty-five patients who underwent transradial percutaneous coronary intervention were randomly divided into two observation groups and a control group. All patients in the three groups were treated by TR Band patent hemostasis. All three groups received the consistent deflation schedule, except the TR Band was removed at the 12th hour post operation in the control group, and at the 6th hour in the 1st observation group and at the 4th hour in the 2nd observation group. Postoperative bleeding of puncture point, thumb perception, palm swelling and subjective comfort were observed in the three groups. Results The differences of postoperative bleeding of puncture point, thumb perception, palm swelling and subjective comfort among the three groups were statistically significant (χ2=6.31, P<0.05; F=5.26, 4.00, 14.69, P<0.01). In the 2nd observation group, palm swelling was the lowest, but perception, and comfort and bleeding rate is the highest among the three groups. In the 1st observation group, the overall indexes were medium among the three groups. Conclusions The optimal compression duration of TR Band post transradial percutaneous coronary intervention is 6 h, which does not increase the risk of bleeding, but also significantly improve local swelling and perceptual experience, and increase patient comfort.

OBJECTIVE:To establish the quality standard for Mongolian medicine Yishen powder. METHODS:TLC was used for the qualitative identification of Rheum palmatum and Terminalia chebula in the preparation;HPLC was used for the contents de-termination of aloe emodin,rhein,emodin,chrysophanol and physcion:the column was Inertsil C18 with mobile phase of metha-nol-0.1% phosphoric acid(gradient elution)at a flow rate of 1.0 mL/min,detection wavelength was 254 nm,column temperature was 35 ℃ and the injection volume was 10 μL. RESULTS:The TLC pots of R. palmatum and T. chebula were clear and well-sepa-rated,negative control without interference. The linear range was 23.55-117.75 ng for aloe emodin(r=0.9999),44.72-223.62 ng for rhein(r=0.9998),43.18-215.90 ng for emodin(r=0.9997),77.41-387.12 ng for chrysophanol(r=0.9999)and 46.02-230.10 ng for physcion (r=0.9997);RSDs of precision,stability and reproducibility tests were lower than 2.0%;recoveries were 95.80%-99.66%(RSD=1.21%,n=6),95.01%-98.07%(RSD=0.92%,n=6),95.06%-97.84%(RSD=0.5%,n=6),95.19%-97.66%(RSD=1.07%,n=6)and 95.07%-98.20%(RSD=0.95%,n=6). CONCLUSIONS:The established standard can be used for the quality control of Mongolian medicine Yishen powder.

Objective:To analyze and investigate the clinical efficacy on repairing soft tissue defects of the thumb distal with dorsal neurocutaneous vascular flap.Methods:Select 100 cases of patients with soft tissue defects of the thumb distal from January 2014 to December 2016,who were randomly divided into two groups,the control group and observation group.Take the abdominal skin flap to repair soft tissue defects of the thumb distal in the control group,with the thumb distal with dorsal neurocutaneous vascular flap in the observation group.The survival condition,the indicators of feelings,the appearance of skin flap,as well as the DASH score of the hand fimction have been recorded and analyzed through follow-up patients,to observe the effects on repairing soft tissue defects in the two groups.Results:All transplanted tisssues were all survived in the observation group and control group.Compared with control group,the sense of touch,temperature sense,monofilament,two-point discrimination,scar contracture of the observation group were better(P＜0.05),the incidence of bloat was lower (P＜0.05).The DASH scores were 29.56± 2.14,38.13± 3.12 in the observation group and control group,which was significantly lower in the observation group than that of the control group(P＜0.05).Conclusion:The clinical efficacy of the dorsal neurocutaneous vascular flap is better than that of abdominal skin flap on repairing soft tissue defects of the thumb distal.For no injury for major vascular nerves,little influence on donor area,being simple to operate,being better feelings of the finger pulp,appearance,dorsal neurocutaneous vascular flap on repairing soft tissue defects of the thumb distal is an ideal choice.

Objective To investigate the clinical effect of the treatment for hand trauma with free flap of radial artery superficial palmar branch.Methods Selected 100 cases of patients with hand trauma who were treated in our hospital from January 2013 to December 2015.All the patients were treated with free flap of radial artery superficial palmar branch.The postoperative necrosis rate,survival rate,and infection rate of flap of all the patients were observed.All the patients were followed up for 6 months,and the healing of fracture were evaluated by X-ray examination so as to evaluate the hand function recovery.Results After the treatment,there were 9 cases of flap local necrosis and 10 cases of local infection,and the necrosis rate and infection rate were 9% and 10% respectively.The infection was controlled effectively after the symptomatic treatment and the flaps all survived.The swelling degree of skin flap was slight and the appearance was good.After 6 months of follow-up, the 100 cases all get epithelization completely.The X-ray examination showed that the fracture healing is good,with 7 cases of hook nail deformity and 5 cases of slow nail regeneration.The hand function recovery was excellent in 73 cases (73%),good in 16 cases (16%),and medium in 10 cases (10%).Conclusion It is an effective treatment for hand trauma with free flap of radial artery superficial palmar branch,as it can receive high flap survival rate and good recovery of hand function.

OBJECTIVE:To establish a method for simultaneous determination of luteolin and apigenin in Mongolian medicine Scabiosa atropurea. METHODS:HPLC was performed on the column of Diamond C18 with mobile phase of acetonitrile-0.4%phos-phoric acid(34∶66,V/V)at a flow rate of 1.0 ml/min,the detection wavelength was 350 nm,column temperature was 30 ℃,and the injection volume was 10 μl. RESULTS:The linear range was 66-396 ng for luteolin(r=0.999 8)and 93-558 ng for apigenin (r=0.999 6);RSDs of precision,stability and reproducibility tests were lower than 2%;recoveries were 98.15%-101.79%(RSD=1.42%,n=6) and 98.66%-104.05%(RSD=1.81%,n=6),respectively. CONCLUSIONS:The method is simple with good precise,stability and reproducibility,and can be used for the simultaneous determination of luteolin and apigenin in Mongo-lian medicine S. atropurea.

Objective To analyze the characteristics of change in plasma cholesterol level in patients with sepsis, and to explore its relationship with prognosis and its clinical significance. Methods A retrospective analysis was conducted. 568 patients with sepsis admitted to Department of Critical Care Medicine of Beijing Friendship Hospital Affiliated to Capital Medical University from August 2013 to August 2015 were enrolled, and 475 patients without sepsis hospitalized in the same period served as the control. The basic clinical data of the two groups were collected, and the results of blood fat and biochemical parameters were compared. The patients with sepsis were divided into death group and survival group, and risk factors influencing the prognosis of patients with sepsis were analyzed with multivariate logistic model regression analysis. Results Compared with non-sepsis patients, the levels of plasma total cholesterol (TC) and high density lipoprotein cholesterol (HDL-C) in the patients with sepsis were significantly lower [TC (mmol/L): 2.5±1.2 vs. 3.4±1.4, t = 4.274, P = 0.021; HDL-C (mmol/L): 1.6±0.9 vs. 2.5±0.8, t = 3.413, P = 0.018], and that of low density lipoprotein cholesterol (LDL-C) showed no statistically significant difference (mmol/L: 1.9±0.9 vs. 2.1±0.9, t = 0.749, P = 0.614). In the patients with sepsis, the patients in death group (n = 227) were older than those of the survival group (n = 341, years: 74.3±15.5 vs. 65.5±17.5, t = 4.037, P = 0.012), serum creatinine (SCr) was higher than that of survival group (μmol/L: 251.0±115.6 vs. 167.4±108.7, t = 3.254, P = 0.023), the levels of plasma TC, HDL-C and LDL-C were significantly lower than those of survival group [TC (mmol/L): 2.2±1.6 vs. 2.9±1.1, t = 3.057, P = 0.023; HDL-C (mmol/L): 1.4±0.8 vs. 1.9±0.8, t = 4.692, P = 0.016; LDL-C (mmol/L): 1.7±0.7 vs. 2.0±0.8, t = 2.541, P = 0.038]; there was no significant difference in the proportion of male, body mass index (BMI), based disease, intensive care unit (ICU) hospitalization time, the severity of the disease and other biochemical indexes between two groups. With single factor analysis with indicators of statistical significance as a covariate into binary logistic regression equation, the results show that age was the risk factor of death in patients with sepsis [odds ratio (OR) = 1.024, 95% confidence interval (95%CI) = 1.010-1.048, P = 0.009], and TC was the protective factor on the prognosis of patients with sepsis (OR = 0.747, 95%CI = 0.682-0.811, P = 0.013). Conclusions Plasma cholesterol levels in patients with sepsis were significantly lowered, and the levels in death group was significantly lower than that in the survival group. TC may be used as a clinical indicator to assess the outcome of patients with sepsis.

Objective To study the application of oral motor intervention program in premature infants with oral feeding.Methods Totally 82 cases of premature infants from August 2014 to July 2015 were selected as the research object,and were assigned to the observation group and the control group according to lot method,with 41 cases in each group.Patients in the control group received regular feeding intervention,while patients in the observation group received oral motor intervention.The feeding process,hospitalization time,feeding performance,situation of body weight increasing and adverse reactions were compared between two groups.Results There was no significant difference in gestational age between two groups when infants began to correct the feeding method (P ＞ 0.05).The gestational age and the time of progress in infants with completely oral feeding of the observation group were significantly shorter than that in the control group (P＜ 0.05).The hospitalization time in the observation group was significantly shorter than that in the control group,while the feeding efficiency,feeding effect and the intake of milk were significantly higher than that in the control group (P＜0.05).The situation of body weight in the observation group before discharge was significantly better than that in the control group (P＜0.05).The feeding intolerance,apnea,the rate of blood oxygen saturation reducing adverse reaction were significantly lower than that in the control group (P＜0.05).Conclusions To a certain extent,oral exercise intervention program can improve the oral feeding process of premature infants and reduce the hospitalization time of premature infants.It is advantageous to the rapid growth of body weight in premature infants and the improvement of feed efficiency,and it also can reduce the rate of adverse reactions.

OBJECTIVE:To establish HPLC fingerprint sectrum of Rhaponticum uniflorum. METHODS:HPLC was performed on the column of Hypersil-ODS with mobile phase of 0.3% phosphoric acid-acetonitrile(gradient elution) at flow rate of 1.0 ml/min,detection wavelength was 220 nm,column temperature was 30 ℃ and volume injection was 10 μl. The luteolin was refer-ence,17 batches of R. uniflorum from different production places was analyzed and similarity evaluation system for chromatograph-ic fingerprint of TCM (2004 A edition)was adopted for the similarity analysis. RESULTS:There were totally 11 common peaks with similarity degree≥0.900 of 17 batches. According to the verification,the fingerprint spectrum and reference fingerprint spec-trum of R. uniflorum had good consistency. CONCLUSIONS:The established method is specific and stable,and can provide refer-ence for the identification and quality control of R. uniflorum.