Objective:To explore the role of clinical pharmacists participating in the management of prophylactic antibiotics during the perioperative period of thoracic surgery, and to evaluate the effects after participating in the practice.Methods:The use of antimicrobials during the perioperative period of thoracic surgery in Wenjiang Hospital of Sichuan Provincial People's Hospital in August 2019 (pre-practice) was retrospectively analyzed. The existing problems were summarized, and the possible causes of the existing problems were analyzed. The improvement measures were jointly developed by clinical pharmacists and physicians. Clinical pharmacists continued to manage the use of antimicrobials by means of medication order reviews, ward rounds for pharmacy service, and medication training. The use of prophylactic antibiotics during the perioperative period of thoracic surgery was compared between August 2019 (pre-practice group) and December 2019 (post-practice group) and the practical effect was evaluated.Results:Clinical pharmacists reviewed perioperative patients' medication orders once a day, ward rounds for pharmacy service twice a week, and medication training once a month. Twenty-two patients were enrolled before practice, and 26 patients were enrolled after practice. There were no significant differences in age, sex, body weight, operative time, type of surgical incision, and preventive use of antibiotics between the two groups (all P > 0.05). In the post-practice group, the appropriate time for preoperative administration was 100.0%, which was significantly higher than 88.2% in the pre-practice group. The reasonable rate of preoperative preventive drug selection was 100.0%, which was significantly higher than 44.4% in the pre-practice group ( χ2 = 17.50, P < 0.001). In the post-practice group, the duration of preventive medication was (1.82 ± 0.59) days, which was significantly shorter than (7.54 ± 3.25) days in the pre-practice group ( t = 11.97, P < 0.001). In the post-practice group, the cost of antibacterial drugs was 316.00(237.00,454.25) yuan, which was significantly lower than 1 136.00(391.81 , 2 184.65) yuan in the pre-practice group ( Z = -2.78, P < 0.05). The defined daily dose of antibiotics among inpatients was 2.67(2.00,3.42), which was significantly lower than 8.88(3.92 , 19.18) in the pre-practice group ( Z = -3.26, P < 0.05). There were no significant differences in the incidence of postoperative pulmonary infection and total length of hospital stay between the two groups (both P > 0.05). Conclusion:Clinical pharmacists participating in the management practice of perioperative prophylactic antibiotics in thoracic surgery can effectively promote the rational application of perioperative antibiotics, markedly improve the reasonable rate of prophylactic drug delivery, shorten the course of prophylactic drugs, reduce the cost of antibiotics, decrease the defined daily dose of antibiotics, without increasing the risk of postoperative pulmonary infection and the total length of hospital stay.

Objective: This study aimed to evaluate the role of preoperative two-dimensional (2D) shear wave elastography (SWE) in assessing the stages of liver fibrosis in patients with suspected biliary atresia (BA) and compared its diagnostic performance with those of serum fibrosis biomarkers. Materials and Methods: This study was approved by the ethical committee, and written informed parental consent was obtained. Two hundred and sixteen patients were prospectively enrolled between January 2012 and October 2018. The 2D SWE measurements of 69 patients have been previously reported. 2D SWE measurements, serum fibrosis biomarkers, including fibrotic markers and biochemical test results, and liver histology parameters were obtained. 2D SWE values, serum biomarkers including, aspartate aminotransferase to platelet ratio index (APRi), and other serum fibrotic markers were correlated with the stages of liver fibrosis by METAVIR. Receiver operating characteristic (ROC) curves and area under the ROC (AUROC) curve analyses were used. Results: The correlation coefficient of 2D SWE value in correlation with the stages of liver fibrosis was 0.789 (p < 0.001). The cut-off values of 2D SWE were calculated as 9.1 kPa for F1, 11.6 kPa for F2, 13.0 kPa for F3, and 15.7 kPa for F4. The AUROCs of 2D SWE in the determination of the stages of liver fibrosis ranged from 0.869 to 0.941. The sensitivity and negative predictive value of 2D SWE in the diagnosis of ≥ F3 was 93.4% and 96.0%, respectively. The diagnostic performance of 2D SWE was superior to that of APRi and other serum fibrotic markers in predicting severe fibrosis and cirrhosis (all p < 0.005) and other serum biomarkers. Multivariate analysis showed that the 2D SWE value was the only statistically significant parameter for predicting liver fibrosis. Conclusion 2D SWE is a more effective non-invasive tool for predicting the stage of liver fibrosis in patients with suspected BA, compared with serum fibrosis biomarkers.

Objective: This study aimed to evaluate the role of preoperative two-dimensional (2D) shear wave elastography (SWE) in assessing the stages of liver fibrosis in patients with suspected biliary atresia (BA) and compared its diagnostic performance with those of serum fibrosis biomarkers. Materials and Methods: This study was approved by the ethical committee, and written informed parental consent was obtained. Two hundred and sixteen patients were prospectively enrolled between January 2012 and October 2018. The 2D SWE measurements of 69 patients have been previously reported. 2D SWE measurements, serum fibrosis biomarkers, including fibrotic markers and biochemical test results, and liver histology parameters were obtained. 2D SWE values, serum biomarkers including, aspartate aminotransferase to platelet ratio index (APRi), and other serum fibrotic markers were correlated with the stages of liver fibrosis by METAVIR. Receiver operating characteristic (ROC) curves and area under the ROC (AUROC) curve analyses were used. Results: The correlation coefficient of 2D SWE value in correlation with the stages of liver fibrosis was 0.789 (p < 0.001). The cut-off values of 2D SWE were calculated as 9.1 kPa for F1, 11.6 kPa for F2, 13.0 kPa for F3, and 15.7 kPa for F4. The AUROCs of 2D SWE in the determination of the stages of liver fibrosis ranged from 0.869 to 0.941. The sensitivity and negative predictive value of 2D SWE in the diagnosis of ≥ F3 was 93.4% and 96.0%, respectively. The diagnostic performance of 2D SWE was superior to that of APRi and other serum fibrotic markers in predicting severe fibrosis and cirrhosis (all p < 0.005) and other serum biomarkers. Multivariate analysis showed that the 2D SWE value was the only statistically significant parameter for predicting liver fibrosis. Conclusion 2D SWE is a more effective non-invasive tool for predicting the stage of liver fibrosis in patients with suspected BA, compared with serum fibrosis biomarkers.

Objective:Explore the main measures and operation mechanism to improve the scientific and technological innovation capacity of district and county hospitals by taking advantage of medical consortium, to achieve the goal of targeted poverty alleviation.Methods:Combine the practical exploration and empirical study on the main measures and operating mechanism to improve the scientific and technological innovation capacity of district and county hospitals, pre-and post comparison were conducted to analyze the effectiveness.Results:During the construction of medical consortium, a district-level general hospital has seen obvious increase in the comparison of many achievement indicators of scientific and technological innovation, with the growth rate ranging from 66.67% to 700%.Conclusions:Based on medical consortium, the operation mechanism that takes discipline construction as the starting point and key discipline establishment as the target, Scientific and technological innovation incubation platform, incentive mechanism and regular summary and evaluation can encourage district and county hospitals to improve scientific and technological innovation ability.

Objective:To investigate the effect of cluster protection measures on postoperative infection in elderly lumbar disc herniation patients undergoing minimally invasive surgery by using intervertebral foramen mirror surgery.Methods:A total of 98 elderly lumbar disc herniation patients treated with the surgery in our hospital were enrolled from January 2018 to December 2019.They were randomized into the intervention group(n=49)receiving cluster protection measures and the routine group(n=49)receiving conventional protection measures.The incidences of infection and related indexes after surgery were compared between the two groups.Results:A total infection rate was higher in the routine group [16.33%(8/49)]than in the intervention group [4.08%(2/49)]( χ2=4.009, P=0.045). The operation time, out-of-bed activity time, hospitalization days and surgical blood loss were less in the intervention group than in the routine group[(30.4±1.1) min vs.(101.9±51.1) min, (1.6±0.7) d vs.(3.7±1.2) d, (4.3±0.6) d vs.(13.2±3.8) d, (54.8±7.3) ml vs.(142.7±69.6) ml, t=9.759, 10.193, 15.789 and 8.780, all P=0.000]. Conclusions:Compared with the routine prevention measures, the cluster prevention measures can ensure the perioperative safety, shorten the operation time and reduce surgical blood loss, out-of-bed activity time and hospitalization days.Therefore, after careful perioperative treatment and protection, the cluster prevention measures can relieve pain, restore function, reduce the incidences of postoperative infection and complications, and achieve satisfactory nursing results.

Objective:To survey the influencing factors for depression based on path model analysis in late pregnant women, and to explore the interrelationships for depression.Methods:This cross-sectional study was conducted from January 2018 to March 2019.Antenatal women who came for a routine check-up at the antenatal clinic were invited to participate in the study.Collecting general information of pregnant women(including biological, psychological, social and other factors). The Hospital Anxiety and Depression Scale (HADS) was used to evaluate the incidence of depression during pregnancy.The differences between depression group and non-depression group were compared by SPSS 24.0, and the path analysis model was conducted by AMOS 21.0 to explore the influencing factors and interrelations of depression during pregnancy.Results:A total of 1 059 pregnant women completed questionnaire.The incidence of depression depression in third trimester women was 11.1%(118/1 059). The path model fitting well with the sample data(GFI=0.912, AGFI=0.901, RFI=0.920, CFI=0.931, RMSEA=0.033). Anxiety, psychological preparation for the current pregnancy, and level of education had both direct and indirect effects on depression in third trimester women(the total effects of the three factors were 0.381, -0.140 and -0.156, respectively). Sleep quality and family member with whom the pregnant women living during pregnancy had only direct effects (the effects were 0.136 and 0.107, respectively). Residence, monthly income of family and social support had only an indirect influence on depression(the effects were 0.175, 0.103, and 0.102, respectively).Conclusion:Path model analysis suggests that the residence, monthly income of family, family member with whom the pregnant women living during pregnancy and educational level are not easy to change. It is suggested the incidence of depression is reduced by intervening the pregnancy anxiety, social support, sleep quality and the psychological preparation for pregnancy.

Objective To analyze and compare the classification of left atrial size by different echocardiographic measurements based on the latest large sample of normal Chinese adults'echocardiographic data . Methods The echocardiography data of 1067 unselected adult outpatients were retrospectively analyzed . The outpatients were divided into normal or enlarged groups according to the left atrialantero-posteriordiameter(LAD)andleftatrialvolume(LAV),respectively.Results ①LADand LAV enlargement were found in 299 (28 .0％ ) patients and 449 (42 .1％ ) patients of the total population , respectively . ②There was a good positive linear correlation between LAD and LAV ( r = 0 .642 , P =0 .000) ,but the agreement for the classification of left atrial size by LAD and LAV was not ideal ( Kappa =0 .392 , P = 0 .000) . The majority of the patients ( 74 .6％ ) with abnormal LAD had abnormal LAV . Conversely ,among the patients with abnormal LAV ( 50 .3％ ) had normal LAD . ③ The sensitivity and specificity of judging left atrial enlargement were 76 .8％ and 66 .8％ for LAD>3 .7 cm in male ,and 74 .9％and 70 .6％ for LAD>3 .4 cm in female ,respectively . The sensitivity and specificity of judging severely left atrial enlargement were 75 .5％ and 78 .7％ for LAD>4 .0 cm in male ,and 84 .2％ and 75 .8％ for LAD>3 .7 cm in female ,respectively . Conclusions The agreement of the classification of left atrial size by LAD and LAV is limited . LAD-based assessment may result in an underestimation of left atrial size . When LAD is larger than 4 .0 cm for male or 3 .7 cm for female ,the accuracy of LAD in the diagnosis of left atrial enlargement is better .

Objective To explore the effect of emergency nursing combined with predictive rehabilitation nursing on rehabilitation and prognosis of patients with acute stroke. Methods One hundred and thirty patients with acute stroke admitted to Zhejiang Hospital from June 2017 to December 2018 were enrolled, and they were divided into an emergency nursing group and a combined nursing group according to different nursing methods, 65 cases in each group. The emergency nursing group was given emergency nursing; and the combined nursing group was given emergency nursing combined with predictive rehabilitation nursing. After 2 weeks, the clinical efficacy was evaluated. The neurological function, motor ability, cognitive function, activities of daily living, clinical efficacy and the incidence of complications were observed in the two groups. Results After treatment, the scores of American National Institutes of Health Stroke Scale (NIHSS) in two groups was significantly lower than that before treatment, the scores of simple Fugl-Meyer motor function (FMA) and simple intelligent mental state examination scale (MMSE), Barthel index (BI) were obviously higher than those before treatment, and the changes of the above indexes in the combined nursing group were more significant than those in the emergency nursing group after treatment (NIHSS score: 13.68±4.01 vs. 19.47±3.82, FMA score: 31.65±4.11 vs. 26.47±4.53, MMSE: 25.34±3.71 vs. 20.07±3.08, BI: 54.68±7.01 vs. 47.37±6.51), the differences were statistically significant (all P < 0.05). The total effective rate of the combined nursing group was significantly higher than that of the emergency nursing group [90.77% (59/65) vs. 75.39% (49/65), P < 0.05], and the incidence of complications in the combined nursing group was obviously lower than that in the emergency nursing group [21.51% (14/65) vs. 40.00% (26/65), P < 0.05]. Conclusion The emergency nursing combined with predictive rehabilitation nursing has good clinical effect on patients with acute stroke, it can effectively elevate the neurological function, motor ability, cognitive function and daily living ability, improve blood lipid and coagulation function indicators, reduce the incidence of complications, facilitate rehabilitation and improve prognosis.

Objective To study the clinical manifestations and antibiotic sensitivity features of early-and late-onset invasive infections caused by group B Streptococcus (GBS). Methods A total of 96 infants with invasive GBS infections were enrolled prospectively from seven tertiary hospitals of GBS Infection Research Cooperative Group in southwest Fujian, such as Xiamen Maternal and Child Care Hospital, etc., from January 2016 to June 2018. According to the onset time of infection after birth, they were divided into early-onset GBS disease (GBS-EOD) group (<7 d, n=67) and the late-onset GBS disease (GBS-LOD) group (7-89 d, n=29). Clinical manifestations, disease spectrum, complications and outcomes of the two groups were compared. Drug sensitivity test was carried out using disk diffusion test. Chi-square or Fisher's exact test, two independent sample t-test or Mann-Whitney U tests were used for statistical analysis. Results (1) The average ages at onset in GBS-EOD and GBS-LOD groups were (15.8±6.7) h (0.5-142.0 h) and (25.0±8.1) d (9-89 d), respectively. The incidence of tachypnea, pallor, fever and convulsion were noted in 68.7% (46/67) vs 44.8% (13/29), 52.2% (35/67) vs 17.2% (5/29), 23.9% (16/67) vs 65.5% (19/29) and 7.5% (5/67) vs 48.3% (14/29) of GBS-EOD and GBS-LOD groups with χ2 values of 6.282, 10.199, 15.146 and 21.237 (all P<0.05). The main clinical manifestations of GBS-EOD were tachypnea and pallor, while most of the patients in the GBS-LOD group developed fever and convulsions. (2) The incidence of pneumonia, sepsis, meningitis, sepsis complicated by septic joints, pneumonia complicated by sepsis, sepsis complicated by meningitis and pneumonia complicated by sepsis and meningitis were noted in 43.3% (29/67) vs 20.7% (6/29), 9.0% (6/67) vs 17.2% (5/29), 0.0% (0/67) vs 3.4% (1/29), 0.0% (0/67) vs 6.9% (2/29), 31.3% (21/67) vs 13.8% (4/29), 6.0% (4/67) vs 31.0% (9/29) and 10.4% (7/67) vs 6.9% (2/29) of GBS-EOD and GBS-LOD groups. There was a statistically significant difference in the disease spectrum between the two groups (Fisher's exact test, all P<0.001). Compared with the GBS-LOD group, the GBS-EOD group had a higher incidence of pneumonia [85.1% (57/67) vs 41.4% (12/29), χ2=19.116, P<0.001] and a lower incidence of meningitis [16.4% (11/67) vs 41.4% (12/29), χ2=6.922, P=0.009]. Complications such as acute respiratory distress syndrome (ARDS), pulmonary hemorrhage, shock and persistent pulmonary hypertension of the newborn (PPHN) occurred much more in the GBS-EOD group than the GBS-LOD group [28.4% (19/67) vs 6.9% (2/29), 13.4% (9/67) vs 0.0% (0/29), 11.9% (8/67) vs 10.3% (3/29), 4.5% (3/67) vs 0.0% (0/29), χ2=13.683, P<0.001]. (3) Among the 96 patients, 23 (24.0%) had meningitis and 73 (76.0%) developed pneumonia and sepsis. Meningitis resulted in a higher fatality rate [17.4% (4/23) vs 4.1% (3/73), χ2=4.564, P=0.035] and longer average hospital stay [(37.2±12.6) vs (14.1±5.3) d, t=7.831, P<0.001] than pneumonia and sepsis. Seven out of the 19 meningitis survivors developed intracranial complications. (4) The overall fatality rate in this study was 7.3% (7/96) and no significant difference was found between GBS-EOD and GBS-LOD group [7.5% (5/67) vs 6.9% (2/29), χ2=0.010, P=0.982]. Among the 67 GBS-EOD infants, 58 (86.6%) occurred within 24 h and five of them died, but no death was reported in the other nine cases occurred after 24 h. (5) Totally 96 strains of GBS were isolated with 100% sensitivity to penicillin, ampicillin, cefazolin and meropenem, and 97% to vancomycin. Around 79.3%-91.0% of GBS isolates were resistant to clindamycin and erythromycin. Conclusions Clinial features vary greatly in GBS-LOD and GBS-EOD cases. Infants with meningitis have poor prognosis. The drug resistance rate of GBS to erythromycin and clindamycin are relatively high.

Objective: To analyze and compare the changes of cardiac structure and function in patients with borderline pulmonary hypertension. Methods: Echocardiographic data of 617 outpatients from February to October 2018 in Peking University People′s Hospital were retrospectively analyzed. According to the estimated mean pulmonary artery pressure (mPAP), the patients were divided into normal group (mPAP<19 mmHg), borderline group (19 mmHg≤mPAP<25 mmHg) and elevated group (mPAP≥25 mmHg). Results: ①Compared with normal group，the patients were older in borderline group and elevated group[(39.2±10.1)years old vs (46.5±13.5)years old vs (51.8±14.2)years old，all P<0.001] and the proportions of male were relatively lower (69.9% vs 58.9% vs 54.4%，all P<0.01). The incidences of smoking，drinking and cardiovascular complications increased significantly. ②Compared with normal group，the left atrium[(30.2±8.2)ml/m² vs (34.5±9.7)ml/m²，P<0.001]，left ventricle[(57.4±11.6)ml/m² vs (60.6±12.5)ml/m²，P<0.01]and right atrium[(19.5±5.9)ml/m² vs (22.6±7.0)ml/m²，P<0.001] were enlarged in borderline group.Left ventricular global long-axis strain (GLS_LV) increased[(-20.1±2.5)% vs (-21.1±3.1)%，P<0.001]，but the long-axis strain in the middle segment of right ventricular free wall (GLS_RVFWmid) decreased[(-31.4±6.6)%对(-27.2±8.8)%，P<0.001] in borderline group.Meanwhile，left ventricular diastolic function was impaired. ③Age，sex，right atrial volume，right ventricular area，RV-S′，GLS_LV，GLS_RVFWmid and mitral valve E/e′ were independent risk factors for mPAP elevation. Conclusions Early changes of cardiac structure and function exist in the patients with borderline pulmonary hypertension. Echocardiography is critical for the early diagnosis and follow-up monitoring of pulmonary hypertension.