Application and evaluation of management mode for the use of antimicrobial drugs in county-level medical communities led by anti-infective clinical pharmacists / 中国药房

OBJECTIVE To provide reference for improving the rational use of antimicrobial drugs in primary township medical institutions. METHODS Based on the county prescription pre-review center， a team led by anti-infective clinical pharmacists constructed the management mode for the use of antimicrobial drugs in county-level medical communities with clinical pharmacists as the main team by finding out the main problems in the use of antimicrobial drugs in primary township medical institutions， providing feedback on the problems， organizing relevant training for the problems， improving the customization rules of the prescription pre-review software， implementing the automatic interception and pharmacist online prescription review and other measures. Data on the use of antimicrobial drugs were collected and compared in the 15 primary township medical institutions between January-June in 2022 （before the implementation of the mode） and January-June in 2023 （after the implementation of the mode）. RESULTS Compared with before the implementation of the mode， the utilization rate of antimicrobial drugs in outpatients of primary township medical institutions decreased from 24.97% before the implementation of the mode to 19.39% after the implementation of the mode； the utilization rate of antimicrobial injection in outpatients decreased from 66.10% to 46.80%； the utilization rate of intravenous drip of antimicrobial drugs in outpatients decreased from 52.33% to 40.35%； the rates of combined use of antimicrobial drugs in outpatients decreased from 12.70% to 8.19%； the reasonable rate of antimicrobial prescribing in outpatients increased from 55.28% to 73.93%. After the implementation of the mode， the proportion of antimicrobial prescriptions for each diagnosis was basically the same as before； the defined daily dose system （DDDs） and proportion of a few antimicrobial drugs changed compared with before according to the anatomical therapeutic chemical classification of drugs， among which DDDs of lincomycin， gentamicin and other drugs declined significantly； DDDs of antimicrobial drugs for each classification was basically the same as before according to AWaRe classification. CONCLUSIONS The management mode of the use of antimicrobial drugs led by anti-infective clinical pharmacists is constructed in the prescription pre-reviewing center of county-level medical communities， which can effectively improve the rational use of antimicrobial drugs in the primary township medical institutions.

Effect of intervention on high caries risk children in some kindergartens in Zhangjiagang / 中国学校卫生

Objective@#To explore the prevention and control effects of different management modes on children with high risk of dental caries from some kindergartens in Zhangjiagang, and to provide a basis for relevant departments to formulate oral health management strategy.@*Methods@#In September 2020, 1 600 children aged 3 years old from 9 towns in Zhangjiagang were sampled by cluster sampling method for baseline survey, including oral examination, questionnaire survey and caries susceptibility test. According to the risk assessment criteria, high risk children were screened out and divided into two groups. In the experimental group, the frequency of fluoride application was once every 3 months, combined with behavioral management and oral health guidance. In the control group, fluoride application was conducted once every 6 months, combined with behavioral management and oral health guidance. The effect of caries prevention was evaluated one year later.@*Results@#The prevalence of caries in three year old children was 50.9% at baseline, and the prevalence of caries in boys and girls was 47.5% and 54.5%, respectively, with statistical significance ( χ 2=9.64, P <0.05). A total of 1 090 high risk children were screened out, including 475 in experimental group and 615 in control group. The prevalence of caries in the two groups at baseline was 74.1% and 75.1%, respectively, and dmft were (2.98±3.33) and (3.04±3.16), respectively, with no significant difference ( χ 2/t =0.15, 0.28, P >0.05). One year after intervention, the prevalence of caries in the two groups was 78.5% and 83.0%, respectively and dmft were (4.22±3.97) and (4.51±4.08), respectively, with no statistical significance ( χ 2/t=3.17, 0.05, P >0.05). The incidence of new caries in the experimental group was 3.7%, and the incidence of new caries was (1.26±1.69), lower than 7.6% and (1.45±2.04) in the control group, with statistical significance ( χ 2/t=6.89, 5.05, P <0.05).@*Conclusion@#The frequency of fluorination intervention once every 3 months combined with behavior management mode was more effective in controlling new caries in children with high risk of caries.

Surgical management of amputated finger replantation in close contact with a suspected COVID-19 patient / 中华显微外科杂志

Since December, 2019, the epidemic of COVID-19 occurred in Wuhan, Hubei Province. In the late of January, 2020, a patient, who had exposed to a COVID-19 suspect, had a severed finger and underwent finger re- transplantation surgery in our hospital.

New Thinking on Medical Ethics / 中国医学伦理学

The ultimate goal of ethics and medical ethics is to promote the harmonious coexistence of human beings, to help health and to enhance the happiness index of human beings. With the development of society, the progress of medical science and technology, the complication of the relationship among people, the diversification of factors that influence health, the change of health reform and policy and the advance of globalization, the ethical is-sues involved in medical practice are increasingly intricate. The contradiction between doctor and patient in medical ethics is the focus point of moral rule and also the focus of medical ethics research. At present, medical ethics need to face the contradiction between the growing human health needs and all kinds of factors that threaten human sur-vival. At the same time, it still deals with various ethical problems caused by the development and evolution of hu-man health and ecology. In reality, many ethical problems in medical practice and the scope of medical ethics re-search have been beyond the field of medical research. The evaluation and research of ethical issues in medicine are not just the tasks of medical workers and medical ethics scholars, and it should adopt the way of collaboration of multidisciplinary scholars and arouse the common concern of the whole society.

A Risk Prediction Model for In-hospital Mortality in Patients with Suspected Myocarditis / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Myocarditis is an inflammatory disease of the myocardium that may lead to cardiac death in some patients. However, little is known about the predictors of in-hospital mortality in patients with suspected myocarditis. Thus, the aim of this study was to identify the independent risk factors for in-hospital mortality in patients with suspected myocarditis by establishing a risk prediction model.</p><p><b>METHODS</b>A retrospective study was performed to analyze the clinical medical records of 403 consecutive patients with suspected myocarditis who were admitted to Ningbo First Hospital between January 2003 and December 2013. A total of 238 males (59%) and 165 females (41%) were enrolled in this study. We divided the above patients into two subgroups (survival and nonsurvival), according to their clinical in-hospital outcomes. To maximize the effectiveness of the prediction model, we first identified the potential risk factors for in-hospital mortality among patients with suspected myocarditis, based on data pertaining to previously established risk factors and basic patient characteristics. We subsequently established a regression model for predicting in-hospital mortality using univariate and multivariate logistic regression analyses. Finally, we identified the independent risk factors for in-hospital mortality using our risk prediction model.</p><p><b>RESULTS</b>The following prediction model for in-hospital mortality in patients with suspected myocarditis, including creatinine clearance rate (Ccr), age, ventricular tachycardia (VT), New York Heart Association (NYHA) classification, gender and cardiac troponin T (cTnT), was established in the study: P = ea/(1 + ea) (where e is the exponential function, P is the probability of in-hospital death, and a = -7.34 + 2.99 × [Ccr <60 ml/min = 1, Ccr ≥60 ml/min = 0] + 2.01 × [age ≥50 years = 1, age <50 years = 0] + 1.93 × [VT = 1, no VT = 0] + 1.39 × [NYHA ≥3 = 1, NYHA <3 = 0] + 1.25 × [male = 1, female = 0] + 1.13 × [cTnT ≥50 μg/L = 1, cTnT <50 μg/L = 0]). The area under the receiver operating characteristic curve was 0.96 (standard error = 0.015, 95% confidence interval [CI]: 0.93-0.99). The model demonstrated that a Ccr <60 ml/min (odds ratio [OR] = 19.94, 95% CI: 5.66-70.26), an age ≥50 years (OR = 7.43, 95% CI: 2.18-25.34), VT (OR = 6.89, 95% CI: 1.86-25.44), a NYHA classification ≥3 (OR = 4.03, 95% CI: 1.13-14.32), male gender (OR = 3.48, 95% CI: 0.99-12.20), and a cTnT level ≥50 μg/L (OR = 3.10, 95% CI: 0.91-10.62) were the independent risk factors for in-hospital mortality.</p><p><b>CONCLUSIONS</b>A Ccr <60 ml/min, an age ≥50 years, VT, an NYHA classification ≥3, male gender, and a cTnT level ≥50 μg/L were the independent risk factors resulting from the prediction model for in-hospital mortality in patients with suspected myocarditis. In addition, sufficient life support during the early stage of the disease might improve the prognoses of patients with suspected myocarditis with multiple risk factors for in-hospital mortality.</p>

Pharmacoeconomic Analysis of Penehyclidine Hydrochloride and Atropine in the Treatment of Acute Organophosphorus Poisoning / 中国药房

OBJECTIVE:To evaluate the economics of penehyclidine hydrochloride and atropine in the treatment of acute organophosphorus poisoning (AOPP).METHODS:The information of 118 AOPP patients were collected and divided into group A (59 cases) and B (59 cases) according to therapy plan.There were 22 cases of mild poisoning,20 cases of moderate poisoning and 17 cases of severe poisoning in group A.There were 21 mild cases,21 moderate cases and 17 severe cases in group B.Based on routine treatment,group A was given Penehyclidine hydrochloride injection intramuscularly with initial dose of 1 mg (mild),2 mg (moderate) and 4 mg (severe).Group B was given Atropine sulfate injection intravenously,with initial dose of 2 mg (mild),5 mg (moderate) and 10 mg (severe).Both received maintenance treatment according to patients condition and stopped taking medicine after symptoms disappeared.Clinical efficacies,the time of acetylcholinesterase recovery and ADR were observed in 2 groups.The economics of therapy plans for mild,moderate and severe poisoning were evaluated in 2 groups by cost-effectiveness analysis.RESULTS:There was no statistical significance in total response rate of mild poisoning or the time of acetylcholinesterase recovery between 2 groups (P＞0.05).Total effective rates of moderate and severe poisoning in group A were significantly higher than group B,and the time of acetylcholinesterase recovery was significantly shorter than group B,with statistical significance (P＜0.05).There was no statistical significance in the incidence of ADR in mild,moderate and severe poisoning patients (P＞0.05).Cost-effectiveness ratio of penehyclidine hydrochloride was similar to that of atropine in mild poisoning patients;that of penehyclidine hydrochloride were significantly lower than that of atropine in moderate and severe patients.It was inline with the results of sensitivity analysis.CONCLUSIONS:Based on routine treatment,penehyclidine hydrochloride is similar to atropine in therapeutic efficacy of AOPP and the time of acetylcholinesterase recovery.For moderate and severe AOPP patients,penehyclidine hydrochloride is significantly better than atropine in improving therapeutic efficacy and the time of acetylcholinesterase recovery.The safety of 2 drugs are satisfactory;penehyclidine hydrochloride possesses cost-effectiveness advantage.

lntervention of losartan on lung oxidative injury induced by paraquat in rats / 中国药理学与毒理学杂志

OBJECTlVE To expIore the intervention effect of Iosartan on the Iung oxidative injury in-duced by paraquat(PQ). METHODS AduIt maIe SD rats were randomIy divided into 4 groups:normaI controI group,PQ intoxication group(rats were treated with singIe ig PQ 40 mg·kg-1 ),Iosartan inter-vention for 7 and 14 d groups(rats were ig given Iosartan 10 mg·kg-1 daiIy for 7 and 14 consecutive days after PQ was given). AII rats were sacrificed on the 16th day to obtain Iung tissues. HE staining was used to observe the Iung pathoIogicaI changes. The activities of superoxide dismutase(SOD),cataIase (CAT)and totaI antioxidant capacity(T-AOC)and content of Iipid peroxide(LPO)were detected by spectrophotometry. ReaI-time quantitative PCR was used to investigate the NF-κB mRNA expression in Iung tissue. RESULTS PathoIogicaI examination showed that acute Iung injury and significant Iung fibro-sis appeared in PQ intoxication group but were reversed by Iosartan. The IeveIs of SOD,CAT and T-AOC decreased whiIe the content of LPO in PQ intoxication group increased significantIy compared with controI group(P﹤0.05). Compared with PQ intoxication group,the IeveIs of SOD,CAT and T-AOC in-creased and the content of LPO decreased in Iosartan intervention for 7 and 14 d groups(P﹤0.05),and the IeveIs of T-AOC and LPO in Iosartan intervention for 7 and 14 d groups and the activities of SOD and CAT in Iosartan intervention for 14 d group nearIy returned to normaI. The mRNA expression of NF-κB was upreguIated after rats were exposed to PQ,downreguIated in Iosartan intervention for 7 and 14 d groups in rat Iung tissues( P﹤0.05),but nearIy returned to normaI. CONCLUSlON Oxidative stress may be invoIved in the acute PQ poisoning process and Iosartan might have intervention effect on acute PQ Iung damage by improving the antioxidant capacity and downreguIating the mRNA expression of NF-κB.

Clinical characteristics and treatment assessments of severe enterovirus 71 infected children / 中华儿科杂志

<p><b>OBJECTIVE</b>To facilitate early recognition of ominous clinical manifestations, to understand pathophysiology and assess treatment effects in patients with severe enterovirus 71 (EV71) associated hand, foot and mouth disease (HFMD).</p><p><b>METHOD</b>A retrospective analysis was performed based on the clinical records, laboratory data and treatment effects which were collected from twelve severe EV71 infected cases from nine hospitals in 2008, in Hubei province, China.</p><p><b>RESULT</b>Of the 12 severe cases, ten (83.3%) were male and two female. The median age was 1.96 yrs (8 m to 7 yrs). The mean hyperthermic duration was 6 days with the peak temperature over 38.5 degrees C, and mean rash duration was 7 days. Fever and rash emerged simultaneously in 4 of 5 cases with cardiopulmonary failure. The severe complications included encephalitis (10 cases), pulmonary edema or hemorrhage (5 cases). Eleven cases were checked with magnetic resonance imaging (MRI) and four cases showed characteristics of encephalitis or meningitis, two with images of naso sinusitis and ethmoid-mastoid inflammation. Chest X-ray examination showed with pulmonary edema on single or both sides (5 cases), bronchitis (4 cases), and normal image (3 cases). There was no specific finding in the cardiac ultrasound and electrocardiogram in any of the patients, as well as the white blood cell count, blood glucose, prothrombin time, partial thromboplastin time and D-dimer. Cerebrospinal fluid showed aseptic meningitis with the increase of cell count in 7 cases. All patients were treated with antibiotics and/or antivirals, such as cephalosporins, ribavirin etc. Eleven patients were treated with intravenous immunoglobulin (total dose 2 - 4.5 g/kg) for 2 - 5 days, and the highest blood concentration of immunoglobulin was detected increasing at 7 g/L. Seven cases were also treated with methylprednisolone 10 - 30 mg/(kg x d), four with dopamine, dobutamine, or digitalis. In addition, by using continuous positive airway pressure by nasal catheter and maintenance of circulation in the cases with cardiopulmonary failure could not relieve the symptoms of dyspnoea, and mechanical ventilation was required to maintain for a mean of 72 hrs (24 - 96 hrs). Except one case died of pulmonary edema in the early stage, others were cured without sequelae.</p><p><b>CONCLUSION</b>Severe EV71 infection is more common in children younger than 3 years old, in which the profound complications include encephalitis and pulmonary edema. The mechanical ventilation should be critically urged for child with complicating cardiopulmonary failure as soon.</p>

Analysis on Perioperative Use of Aztreonam in a Hospital / 中国药房

OBJECTIVE:To investigate the utilization of aztreonam in perioperative patients in order to promote rational use of antimicrobial agents. METHODS: 215 discharged surgery cases were collected in Mar. 2009 and analyzed retrospectively to evaluate the rationality of drug use. RESULTS: Of 215 cases, preventive use accounted for 122 cases, among which rational use 29 cases and irrational use 93 cases; treatment use accounted for 93 cases, among which reasonable use 54 cases and unreasonable use 39 cases. CONCLUSION: Perioperative use of aztreonam was not in line with Guiding Principles for Clinical Use of Antibacterial Drugs, Notice for Further Strengthen Management of Clinical Use of Antibacterial Drugs Issued by General Office of the Ministry of Health. Unreasonable utilization require to arouse attention of medical personnel and strengthen management.

The clinical study of obstructive sleep apnea syndrome with myocardial ischemia and cardiac arrhythmia / 中国基层医药

Objective To investigate the correlation between obstructive sleep apnea syndrome(OSAS)with myocardial ischemia and arrhythmia.Methods To observe the occuring rate of premature beats and change of ST- segment,90 eases of OSAS patients were detected by the polysomnogram(PSG)and dynamic electrocardiogram at the same time.Results Total morbidity of myocardial ischemia was 32.2 % in OSAS patients,and it was 59.4 %, 15.8 %,20 % in serious,moderate and mild groups respectively.There was a statistically significant difference be- tween the three groups and the control group(P0.05).Conclusion As one of the risky factors of cardiovascular diseases,OSAS can induce myocardial ischemia and arrhythmia.

Significance of Detection of Chemokines in Serum of Infants Respiratory Syncytial Virus Infection / 实用儿科临床杂志

Objective To explore the roles of macrophage inflammatory protein- 1?(MIP- 1?) and regulated upon activation normal I" cell expressed and secreted(RANTES)in pathogenesis of respiratory syncytiai virus(RSV) infection,and explore the roles of these chemokines asthma caused by RSV mfectron. Methods Serum samples were obtained from 45 infants with RSV infection, including 10 hroivhial asthma, 15 bronchitis or pneumonia ,20 upper respiratory tract infection ;20 healthy infants with non - RSV infection as the normal group. ELISA method was used to determine the concentrations of MIP- 1? and RANTES in serum. Results MIP - 1? and RANTES levels in infants with RSV infection were much higher than those of non - RSV infected healthy subjects (P

Human Genne Myo-Inositol Monophosphatase 2 Gene and Clinical Disease / 实用儿科临床杂志

Human genne myo-inositol monophosphatase 2(IMPA2) was recently a novel and promising gen that was associated with disease,especially in mental and neuro diseases.Its locus is in chromosome 18p11 2,about 15 kb.It encodes IMPA2 enzyme.IMPA2 enzyme as a mainly and catalytic inositol plays an important role in cell signaling system.The mechanism of action of IMPA2 gene is still unclear.But in basic research on genetic structure and IMPA2 product,the biochemical functions and crystal structure have gradually been recognized;In the clinical application,the association with disease has been detected in manic depression,schizophrenia and febrile seizuers.IMPA2 even has been a susceptible gene to certain diseases.IMPA2 has increasingly been the hotspot in gene research.

Determination of Tirofiban Hydrochloride/Sodium Chloride Injection by UV Spectrophotometry / 中国药房

OBJECTIVE:To develop a method for the determination of tirofiban in Tirofiban hydrochloride/sodium chloride injection.METHODS:Tirofiban was determined by UV spectrophotometry at a wavelength of 225 nm.RESULTS:The linear range of tirofiban was 30～70 ?g?mL-1(r=0.999 7) and its average recovery was 100.04% (RSD=0.23%).CONCLUSION:The method is simple,accurate and reliable for content determination of Tirofiban hydrochloride/sodium chloride injection.