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Objective To evaluate the effect of multiple intervention measures on perioperative antimicrobial use in pa-tients undergoing typeⅠincision operation in a hospital,and provide basis for rational use of antimicrobial agents. Methods 9 823 patients with type I incision operation in April and October of 2005-2012 were surveyed retrospectively, data of 2005 was as baseline,from 2006 to 2012,multiple measures,including training,examination,supervision,feed-back,and cooperation of relevant departments were conducted,antimicrobial use before and after intervention was com-pared.Results The qualified rate of perioperative antimicrobial use in patients undergoing typeⅠ incision operation in-creased from 14.20% in 2006 to 92.30% in 2012;the rate of combined use of antimicrobial agents was relatively higher (7.00%-9.00%)in 2006-2009,had a downward trend in 2010- 2012,and decreased to 3.20% in 2012.Types of an-timicrobial agents for prophylactic use in typeⅠincision operation in 2006 and 2007 were similar to that of 2005,the main used antimicrobial agents were cephalosporins,penicillin and it’s compounds,and aminoglycosides;the major antimicrobial prophylaxis in 2008-2012 were the first and second generation cephalosporins,penicillin and it’s compounds.Multivariate non-conditional logistic regression analysis showed that age (40 - 59 years old),departments (orthopedics,general surgery,and ophthalmology),and years (2011 and 2012)were the main influencing factors for the qualified use of antimicrobial agents(all P<0.05).Conclusion Implementation of multiple intervention measures can improve the qualified rate of perioperative antimicrobial use in typeⅠ incision operation,reduce types of antimicrobial use and rate of combined antimicrobial use.
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Objective To explore the treatment of acquired benign tracheoesophageal fistula.Methods Clinical data of 13 cases of acquired benign tracheoesophageal fistula were retrospectively studied and the related literature was reviewed.The physical conditions,locations of fistula and risk factors of the patients were assessed before surgery.A specific surgical protocol was determined for each individual patient using either radical surgery or palliative surgery to repair the fistula.Ten patients underwent radical surgery,including suture closure of the esophageal or tracheal defects only in 7 patients and segmental tracheal reseetion in 3 patients.The remaining 3 patients underwent palliative operation.Results No major complication was observed except pulmonary infectin in 2 patients.No patient died during the perioperative period.All but one patient who treated with mediastinal and neck radiation therapy 4 years ago were able to resume oral food three months after operation.All patients were followed up for 8 months to 73 months[mean (39.6 ± 19.7) months]and no fistulas were occurred in the patients who received a radical surgery.The tracheoesophageal fistula orifices became smaller or closed fairly well in the patients who underwent a palliative surgery.Conclusion Surgery is the treatment of choice for acquired benign tracheoesophageal fistula.Airway and esophagal stent placement is not recommended.Adequate drainage of gastric juice is a crucial step in the management of the condition.
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BACKGROUND: Biological characteristics of porcine cardiovascular system are similar to that of human. The metabolism, immune system, mechanism of disease have 99% homology between pig and human. OBJECTIVE: To develop ventricular aneurysm animal models by plugging left anterior descending branch. DESIGN, TIME AND SETTING: The animal observational study was performed at the Laboratory of Functional Material and Animal Experimental Center, Tongji Hospital Affiliated to Tongji University from December 2005 to July 2007. MATERIALS: A total of 13 pigs, of both genders, weighing 30-40 kg, were used in this study. METHODS: After abdominal cavity and intravenous anesthesia, balloon with "WYW" stent was put into 13 pig left anterior descending coronary artery following No. 7 artery sheathing canal was implanted. The balloon was dilated and the stent was positioned into the distal point of the first diagonal branch to obstruct the artery under digital subtraction angiography. During and after the operation, electrocardiogram was monitored and recorded to maintain stable vital sign. MAIN OUTCOME MEASURES: Electrocardiogram, serum myocardial enzymes, myocardial radionuciide imaging, echocardiography and angiography and pathological changes were observed. RESULTS: One rat died of anesthetic accident before surgery. Six rats died from ventricular fibrillation during plugging, and the other 6 rats were survival. 4 weeks following surgery, coronary angiography showed blood flow at distal end was blocked 100%. Left ventricle angiography demonstrated that wall motion at apex of the heart and the left ventricle disappeared. Before embolism, electrocardio-monitoring displayed electrocardiogram was normal. After plugging, ST segment was raised continuously; amplitude of R wave was decreased; T wave was erected; ST-T fusion wave appeared; precordial leads were obvious. ST segment was reduced to basic level 2 week later, and pathological Q wave appeared 4 weeks later. Serum treponin was increased at 12 hears following surgery compared with before surgery (P < 0.01). Radioactive nuclide myocardial imaging revealed that cardiac apex and left ventdcle anterior wall showed radioactive nuclide perfusion filling defect, thin ventricular wall and ventricular aneurysm. Cardiac ultrasonic showed six pigs suffered from weaken segmentation contraction motor of local ventricular wall, especially at anterior wall of the left ventricle and cardiac apex. After hematoxylin-eesin staining, optical microscope exhibited that cardiac muscle fiber disappeared, which was replaced by collagen fiber, with the presence of some capillary at the infarct of cardiac apex. Pyknosis and lysis of residual cardiac muscle fiber were visible in infarct region of anterior wall of the right ventricle. Many inflammatory cells and capillary infiltration were detected besides collagen fiber filling. CONCLUSION: The new approach of "WYW" intervention embolization is able to develop the ventricular aneurysm animal model, which is similar to clinical pathophysiological variation. The outcome is precise and reliable.
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Objective To explore the clinical use of sieving detection about inhalant allergens and fx5E in the CAP anaphylactogen detection system among the pathogen diagnosis of childhood asthma. Methods Two hundred and fifty cases of childhood asthma all received the sieving detection about allergen inhalant allergens and fx5E in the CAP anaphylactogen detection system which was produced by Sweden Pharmacia Company. The test's results were compared between age, sex, season, hypersensitive history and family hypersensitive history. Results Total positive ratio of CAP allergen was 82.80%, positive ratio of inhalant allergens was 79.20%, positive ratio of fx5E was 32.40%. The positive rate of inhalant allergens increased with age, the positive rate of fx5E decreased with age. The test's results were no significant difference between sex and the family hypersensitive history. The test's results were significant difference between the patient's hypersensitive histories. Conclusions Inhalant allergens are the most important allergen among childhood asthma. Sieving detection about allergen in the CAP anaphylactogen detection system is an important vitro test among childhood asthma.
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Background and purpose:Resistance to anticarcinogen is one of the key factors that affect the treatment efficiency in lung cancer. The purpose of this study was to investigate the clinical significance of the multidurg resistance-related proteins P-gp, multidrug resistance-related proteins(MRP),lung resistance associated protien(LRP) and GST-?by detecting their expression in lung cancer and to investigate the mechanism of resistance to anticarcinogen. Methods:S-P immunohistochemistry was used to examine the expression level of proteins P-gp, MRP, LRP and GST- ?in 226 samples of lung cancer and 23 samples of normal lung tissues. Results:The positive rates of P-gp, MRP, LRP and GST-? in lung cancers were 46.0%, 42.0%, 54.4%, 62.4% respectively. Significant difference existed between tumorous tissue and normal lung tissue (17.4%, 13.0%, 17.4%, 21.7%). The positive rates of P-gp, MRP, LRP and GST-? in poorly differentiated-type of NSCLC were 33.3%, 22.8%, 33.3%, 47.4%, compared with differentiated-type of NSCLC (59.7%, 58.1%, 73.6%, 79.1%) (P
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Purpose:To study the effectiveness of surgical treatment of 15 tracheoesophageal fistulas secondary to carcinoma of esophagus a fter radiotherapy. Methods:clinical records of 15 tracheoesophageal fistulas secon dary to carcinoma of esophagus after radiotherapy were analysed.several surgical techniques were analyged for different cases. Results:In all 15 cases, only two of them died,the postoperativ e death rate is 15.38%, and the total complication rate is 30.76%.1-year survi val is 50%, and the median-life span is 12 months. Conclusions:Approriate surgical treatment together with active preoperative preparation, elaborative postoperative nursing care, can improve t he quality of life, reduce postoperative complication rate, and prolong survival .