Survey on the rationality and standardization of clinical oxygen therapy in a general hospital in Shanghai / 中华全科医师杂志

Objective@#To survey the current status of oxygen therapy in a comprehensive hospital in Shanghai and to assess its rationality and standardization.@*Methods@#Cluster sampling method was adopted in selecting in-patients who received oxygen therapy from various departments in Changhai Hospital from March 2018 to June 2018. General information such as gender, age, and department were recorded. The self-developed Oxygen Therapy Form for Inpatients was used to collect clinical data such as admission diagnosis, oxygen therapy indications, oxygen therapy orders, and related parameters. BTS guideline for Oxygen use in adults in Health care and Emergency Settings was used to assess the rationality and standardization of oxygen therapy.@*Results@#In this survey, 464 patients were assessed for their oxygen treatment orders. According to the guidelines, the overall reasonable rate of oxygen therapy was 92.2% (428/464); the standardization rate of oxygen therapy was 22.4% (104/464). Among them, the reasonable rate of oxygen therapy in internal medicine ward (64.7%, 46/71) was lower than that in surgery ward (98.3%, 304/309) and in wards of other specialties (92.8%, 78/84) (χ2=91.09, P<0.01); while the reasonable rate of general ward (90.9%, 362/398) was lower than that of ICU (100.0%, 66/66) (χ2=6.47, P<0.05). In the standardization assessment, the wards of other specialties (54.8%, 46/84) were better than the internal medicine ward (26.8%, 19/71) and the surgery ward (12.6%, 39/309) (χ2=68.35, P<0.01); while the ICU (65.2%, 43/66) was superior to the general ward (15.3%, 61/398) (χ2=80.81, P<0.01).@*Conclusions@#The rationality of oxygen therapy in the general hospital is acceptable, but the standardization needs to be improved. There are some differences in the rationality and standardization of oxygen therapy orders among different departments and different levels of wards.

Survey on the rationality and standardization of clinical oxygen therapy in a general hospital in Shanghai / 中华全科医师杂志

Objective:To survey the current status of oxygen therapy in a comprehensive hospital in Shanghai and to assess its rationality and standardization.Methods:Cluster sampling method was adopted in selecting in-patients who received oxygen therapy from various departments in Changhai Hospital from March 2018 to June 2018. General information such as gender, age, and department were recorded. The self-developed Oxygen Therapy Form for Inpatients was used to collect clinical data such as admission diagnosis, oxygen therapy indications, oxygen therapy orders, and related parameters. BTS guideline for Oxygen use in adults in Health care and Emergency Settings was used to assess the rationality and standardization of oxygen therapy. Results:In this survey, 464 patients were assessed for their oxygen treatment orders. According to the guidelines, the overall reasonable rate of oxygen therapy was 92.2% (428/464); the standardization rate of oxygen therapy was 22.4% (104/464). Among them, the reasonable rate of oxygen therapy in internal medicine ward (64.7%, 46/71) was lower than that in surgery ward (98.3%, 304/309) and in wards of other specialties (92.8%, 78/84) (χ 2=91.09, P<0.01); while the reasonable rate of general ward (90.9%, 362/398) was lower than that of ICU (100.0%, 66/66) (χ 2=6.47, P<0.05). In the standardization assessment, the wards of other specialties (54.8%, 46/84) were better than the internal medicine ward (26.8%, 19/71) and the surgery ward (12.6%, 39/309) (χ 2=68.35, P<0.01); while the ICU (65.2%, 43/66) was superior to the general ward (15.3%, 61/398) (χ 2=80.81, P<0.01). Conclusions:The rationality of oxygen therapy in the general hospital is acceptable, but the standardization needs to be improved. There are some differences in the rationality and standardization of oxygen therapy orders among different departments and different levels of wards.

Data analysis of non-invasive prenatal testing based on special loci in cell-free fetal DNA / 中华医学遗传学杂志

OBJECTIVE To analyze the data of non-invasive prenatal testing based on specific loci of circulating cell-free fetal DNA (cffDNA). METHODS Selected loci of target chromosomes were analyzed by sequence capture and sequencing. Meanwhile, 600 loci were selected from other chromosomes for determining the concentration of cffDNA. RESULTS A total of 768 specific loci were captured on chromosomes 21 and 18, and used to determine whether the two were abnormal. When the minimum concentration of detected cffDNA was set at 3% and the threshold of Z score was set to [-6,6], the specificity of the analysis was 99.37% and the sensitivity was 100%. CONCLUSION A reliable, convenient and low-cost analytical method has been developed. The method requires less sequencing data for non-invasive prenatal testing, and can accurately detect abnormalities of fetal chromosomes 21 and 18, and simultaneously determine the concentration of cffDNA.

The application of chromosome specific site selection method in noninvasive prenatal testing / 临床检验杂志

Objective To establish a noninvasive prenatal testing(NIPT) method based on the chromosome specific site sequencing instead of the conventional whole genome sequencing.Methods Blood plasma samples from 200 pregnant women with known fetus karyotypes were collected.First,the specific loci on chromosome 13,18 and 21 were selected by the database filter.Then,these specific loci were captured by probes,and were performed sequencing.Finally,chromosome aneuploidy was identified by the Z-score.ResultsSeven fetuses with 21-trisomy syndrome,3 with 18-trisomy syndrome and 1 with 13-trisomy syndrome were detected by the chromosome specific site sequencing,and the results were accordant with those of the whole genome sequencing method.Conclusion The NIPT method based on the chromosome specific site sequencing has the advantages of low cost and high throughput,which may replace the NIPT method based on the whole genome sequencing.

Nutritional support for human immunodeficiency virus-infected patients during perioperative period / 中华消化外科杂志

Objective To investigate the efficacy of nutritional support for human immunodeficiency virus (HIV)-infected and malnutritional patients during perioperative period.Methods The clinical data of 283 HIV-infected patients who were admitted to the Shanghai Public Health Clinical Center from October 2008 to February 2012 were retrospectively analyzed.All patients were divided into malnutritional group and non-malnutritional group according to nutritional condition before operation.Twenty-eight patients with malnutrition (7 patients did not receive perioperative nutritional support due to emergency operation,and they were excluded from the study) and 248 patients in normal nutritional status were enrolled in the study.Nutritional support was given for 5-7 days before operation for patients with malnutrition,and all patients received nutritional support after operation.Differences in the immune function,nutrional status,the incidences of surgical incisional infection and sepsis,and perioperative mortality between the 2 groups were compared.Measurement data were analyzed using the paired t test,and the enumeration data were analyzed using the chi-square test.Results The levels of CD4,CD8 and hemoglobin in patients with malnutrition were (205 ± 24)× 106/L,(559 ± 55)× 106/L and (103 ± 24)g/L after perioperative nutritional support,which were significantly higher than (150 ± 33) × 106/L,(491 ± 45) × 106/L and (97 ± 19)g/L before nutritional support (t =-2.561,-1.302,-1.349,P ＜ 0.05).The levels of CD4,CD8 and hemoglobin were (197 ± 43) × 106/L,(547 ± 52) × 106/L and (103 ± 22) g/L at postoperative day 14,which were decreased compared with those after nutritional support,while no significant difference was detected (t =-1.108,0.600,-0.148,P ＞ 0.05).The incidence of incisional infection in patients with malnutrition was 42.9％ (12/28),which was lower than 45.2％ (112/248) of patients in normal nutritional status,with no significant difference (P ＞0.05).The incidence of postoperative sepsis and perioperative mortality were 75.0％ (21/28)and 3.6％ (1/28) in patients with malnutrition after operation,which were significantly higher than 32.7％ (81/248)and 0.8％ (2/248) in patients in normal nutritional status (P ＜ 0.05).Conclusion The mobidity of HIV-infected patients is high,and nutritional support for HIV-infected patients during perioperative period can improve their immunity.

Effects of sufentanil, remifentanil or fentanyl on cardiac output of elder patients during induction of general anesthesia / 中国基层医药

Objective To compare the effects of equivalent dose sufentanil,remifentanil or fentanyl on hemodynamic and cardiac output in the elderly patients during induction of general anesthesia.Methods Ninety elderly patients(ASA Ⅰ ～ Ⅱ) undergoing elective abdominal surgery under general anesthesia were randomly divided into sufentanil group(group S),remifentanil group(group R) and fentanyl group(group F),30 patients in each group.Patients in group S,group R and group F received sufentanil 0.2μg/kg,remifentanil 2μg/kg and fentanyl 2μg/kg Ⅳ,respectively,using an blind method before intubation.SBP,DBP,MAP,HR,CO,CI and SVR were recorded before of anesthesia (T0),immediately after induction (T1),1,3 minutes after tracheal intubation (T2,T3).Changes of SBP and HR during observation were also recorded.Results The MAP and HR in three groups at T1 were significantly lower than those at T0 and decreased significantly in group R than those in group F and S(P ＜0.05).The MAP and HR in group F significantly increased at T1 than T0.The MAP and HR in group R were significantly decreased after tracheal intubation.Compared with the baseline,the MAP and HR in group S at T1,T2,remained unchanged.In group R,there were two patients whose HR were under 50 bpm.In group F,the MAP at T1,T2 were significantly higher than those at T.In group S,there were no significant changes in CO,CI,SVR which were all within normal range (P ＞ 0.05).Conclusion Both sufentanil and remifentanil effectively inhibit the stress response during induction of general anesthesia.At the same time,sufentanil has better hemodynamic stability.

Combined detection of serum galactomannan and 1,3-β-D glucan in diagnosis of invasive pulmonary aspergillosis / 中华临床感染病杂志

Objective To evaluate the combined detection of serum galactomannan (GM test) and 1,3-β-D-glucan (G test) in diagnosis of invasive pulmonary aspergillosis (IPA).Methods A total of 136 patients suspected for IPA were enrolled in the study from Jinhua Central Hospital in Zhejiang Province from January 2007 to December 2011.GM and G tests were performed.x2 test was used to conpare the sensitivity,specificity,positive predictive value and negative predictive value of individual test and combined test,and the area under the ROC curve (AUC) was used to determine the effectiveness of the tests.Results The sensitivity and specificity of G test were 84.0％ and 80.9％,and those for GM test were 78.0％ and 88.2％,respectively.The combination of two tests (parallel) increased sensitivity to 92.0％ and the serial test increased the specificity to 92.6％.The AUC of the combined test was 0.923(95％ CI:0.867-0.980).Conclusion The combination of GM test and G test can improve the diagnostic effectiveness for IPA.

Flow cytometry method for antifungal susceptibility test and its clinical application / 中华临床感染病杂志

Objective To develop a rapid detection method of flow cytometry for antifungal susceptibility testing.Methods The experiment conditions of flow cytometry were optimized and the minimum inhibitory concentrations (M1Cs) of 230 strains of Candida spp to flucytosin,fluconazol,itraconazole,amphotericin B were detected.The MIC results obtained by flow cytometry were compared with M27-A2 reference assay.Results The agreement of MIC results between flow cytometry and M27-A2method was 85.0％ - 100％.Conclusion Flow cytometry can be used as a rapid and reliable method for antifungal susceptibility testing.

Appropriate dose of remifentanil combined with propofol for painless artificial abortion / 中国综合临床

Objective To compare different dose of remifentanil combined with propofol for painless abortion and approach to an appropriate dose of remifentanil.Methods Ninety pregnant women with ASA 1 were randomly divided into three groups(n=30)before administrating remifetanil,a bolus midazolam 1 mg was injected inminutes later.These two drugs did not stop administration until three minutes before the end of negative suction.MAP,HR,SpO2,BIS,RR,VT,PET CO2 were monitored.The onset,operation and recovery time,sedation score and adverse reaction were recorded.Results Sedation scores were significantly different between group A and C [(3.90±0.97)and(4.90±0.85),t=4.24,P＜0.01].Three cases in group A were found moving.MAP,HR,BIS decreased as compared witll baseline.HR reduced significantly in group C(P＜0.05,P＜0.01).Respiratory movement was lower and shallower.RR,VT decreased compared to preoperative one.PET C02 increased gradually (P＜0.05,P＜0.01).There were two cases of respiratory depressing in group A,four cases in group B and ten cases in group C(five cases apnea more than three minutes).All patients used oxygen mask to maintain SpO2＞95%.Incidence of adverse reactions such as chest titanic,nausea and vomiting,itching were of no difference among three groups(P＞0.05).All patients were satisfied with anesthesia.Conclusion The appropriate infusing dose of remifetory devices such as oxygen mask and monitoring life signs are very important to prevent respiratory depress and bradycardia during operation.

Meta-analysis for correlation of Chlamydia trachomatis infections with tubal pregnancy / 中华临床感染病杂志

Objective To investigate the correlation of Chlamydia trachomatis (Ct) infection with tubal pregnancy by Meta-analysis. Methods Eligible literatures were searched from Chinese websites cnki,wanfangdata and eqvip from 1998 to 2007. Meta-analysis was conducted for the correlation of Ct infection with tubal pregnancy by software RevMan 4.2, and the results were expressed as odds ratio (OR) and 95% confidence intervals (95% CI). Results Thirty-five articles were retrieved, of which 16 were included in the Meta-analysis. The combined ORs of Ct infections in cervix uteri and in uterine tube to tubal pregnancy were7.14 (95% CI: 5.20-9.80) and6.50 (95% CI: 4.52-9.34), respectively. Conclusions There are significant correlation between Chlamydia trachomatis infection and tubal pregnancy.

Application of emergency deep venous catheterization outside the operation room / 中国综合临床

Objective To evaluate the advantages and disadvantages of inserted internal jugular vein cathe-ters and femoral vein catheters in emergency patients outside the operation room.Methods 206 patients received right internal vein catheterization(group J,n=110)and right femoral vein catheterization(group F,n=96).Suc-cessful rates of puncture,operation time,incidence of complications were observed and compared between the two groups.SAS6.04 software was used to analyze the data of the two groups.Results Emergency deep venous catheter-ization was accomplished in all the patients.There were no severe complication in two groups,such as pneumothorax and cardiac arrest.The rate of successful puncture in group J was 88%(97/110),however,100%(96/96)in group F.There was statistical significant difference between two groups(P<0.05).Mean time needed in group J (21.5±8.4)m was more than that in group F(12.5±5.3)min(P<0.05).The cases of puncturing into artery or serious arrhythmia in group F(2 cases)were less than that in group J(7 cases including hematoma in 4 cases)(P<0.05).6 cases were found to have arrhythmia in group J but there was not arrhythmia in group F(P<0.05).Con-chsion Different ways of emergency deep venous catheterization should be selected according to different condi-tions of patients outside the operation room.For critically ill patients,femoral vein puncture is more safe,with high rate of Success and less complication.

Application of emergency deep venous catheterization outside the operation room / 中国综合临床

Objective To evaluate the advantages and disadvantages of inserted internal jugular vein cathe-ters and femoral vein catheters in emergency patients outside the operation room.Methods 206 patients received right internal vein catheterization(group J,n=110)and right femoral vein catheterization(group F,n=96).Suc-cessful rates of puncture,operation time,incidence of complications were observed and compared between the two groups.SAS6.04 software was used to analyze the data of the two groups.Results Emergency deep venous catheter-ization was accomplished in all the patients.There were no severe complication in two groups,such as pneumothorax and cardiac arrest.The rate of successful puncture in group J was 88%(97/110),however,100%(96/96)in group F.There was statistical significant difference between two groups(P<0.05).Mean time needed in group J (21.5±8.4)m was more than that in group F(12.5±5.3)min(P<0.05).The cases of puncturing into artery or serious arrhythmia in group F(2 cases)were less than that in group J(7 cases including hematoma in 4 cases)(P<0.05).6 cases were found to have arrhythmia in group J but there was not arrhythmia in group F(P<0.05).Con-chsion Different ways of emergency deep venous catheterization should be selected according to different condi-tions of patients outside the operation room.For critically ill patients,femoral vein puncture is more safe,with high rate of Success and less complication.

Detection of Meticillin-resistant Staphylococcus aureus by Real-time PCR / 中华医院感染学杂志

OBJECTIVE To establish a method of real-time PCR for detection of mecA gene in meticillin-resistant Staphylococcus aureus(MRSA).METHODS The experiment conditions including Mg2+ concentrations,primers concentrations and probe concentrations were optimized for real-time PCR in the light of factorial design principle.Totally 109 strains of S.aureus were collected and detected respectively in oxacillin disk diffusion method and real-time PCR and MRSA detection rate in the two methods were compared and analyzed.RESULTS Thirty seven MRSA isolates were detected by real-time PCR from the 109 S.aureus strains.The MRSA isolating rate by real-time PCR was conspicuously higher than oxacillin disk diffusion method,by which 27 MRSA isolates were detected.CONCLUSIONS The technology of real-time PCR to rapid identification of MRSA is superior to common PCR and it can make up the deficiency of detecting borderline-resistant strains in oxacillin disk diffusion method.

Nosocomial Infection in Clinical Immunology Laboratory:Risk Factors and Control Strategies / 中华医院感染学杂志

OBJECTIVE To explore the risk factors and control strategies of nosocomial infection in clinical immunology laboratory.METHODS The positive detection rates of HBV marker and antibodies to HAV,HCV,HEV,HIV,TP,and TB in total of 91 877 samples in clinical immunology laboratory during Jul 2004 and Jul 2005 were retrospectively surveyed and statistically analyzed.RESULTS The number of positive specimens of HBV marker and antibodies to HAV,HCV,HEV,HIV,TP,and TB were respectively 8 376,7,26,24,107,3,522,and 52 and the positive detection rates of these items were respectively 16.68%,0.43%,0.20%,2.22%,6.49%,0.03%,4.75%,and 4.61%.CONCLUSIONS It is very important to understand the infection sources and risk factors in clinical immunology laboratory in order to strengthen management of hospital infection and protection of occupational exposure.

Distribution and Drug-resistant Analysis of Staphylococcus spp in Nosocomial Infections / 中华医院感染学杂志

OBJECTIVE To analyze infection state and drug resistance feature of Staphylococcus spp with a view of offering references for controlling and treating infection led by it.METHODS Totally 652 strains of Staphylococcus isolated from patients with infection were identified and their drug resistance was analyzed.RESULTS From them 204 strains were Staphylococcus aureus and 448 strains were coagulase negative Staphylococcus detected and the isolating rate of MRSA and MRCNS were respectively accounted for 55.4% and 84.6%.The most common coagulase negative Staphylococcus strains were S.haemolyticus and S.epidermidis.The drug-resistant rates of MRS were higher transparently than MSS.CONCLUSIONS Staphylococcus are one of the main pathogens leading to nosocomial infections.As a result, it is very important to use antibiotics properly for infection control and nosocomial infection management.

Sporadic Hepatitis E among Inpatients: An Epidemiological Analysis / 中华医院感染学杂志

OBJECTIVE To investigate the current situation of sporadic hepatitis E and analyze its epidemiologic feature among inpatients in our hospital from 2002 to 2004. METHODS The clinical records of inpatients with positive results of HEV-IgM and diagnosed for sporadic hepatitis E during the period of Jan 2002 to Dec 2004 were analyzed with epidemiological method. RESULTS Totally 329 inpatients′ HEV-IgM antibody was positive among(4 641) detected inpatients′ sera.There were 239 male inpatients who accounted for 72.64% and(90 female) inpatients who accounted for 27.36% of the total inpatients whose HEV-IgM antibody was positive.There were 272 inpatients,presenting rate of 82.67%,comed from rural areas and 57 inpatients,presenting rate of 17.33%,comed from urban areas.The case rate of sporadic hepatitis E was respectively 4.92%,6.93% and 9.17% from 2002 to 2004. CONCLUSIONS The incidence of hepatitis E is increasing in recent years,in which male inpatients are higher than females′ and rural inpatients are higher than urban ones.

Drug-resistance to Antibiotics of Gramnegative Bacteria in Jinhua Region / 中华医院感染学杂志

OBJECTIVE To study the change in drug-resistance to antibiotics in Gram-negative bacteria in Jinhua region in order to guide clinical application of antibiotics reasonably.METHODS The antibiotics resistance of Gram-negative bacteria from clinical samples in four general hospitals in Jinhua region during from Jan 2005 to Dec 2007 was studied retrospectively.RESULTS The detecting rates of extended-spectrum ?-lactamases in Escherichia coli and Klebsiella pneumoniae were rising from 41.0%and 25.3% in 2005 to 56.0%and 53.2% in 2007,respectively.Furthermore,0.8% isolates were resistant to carbapenemase from all E.coli and K.pneumoniae strains.The rate of antimicrobial resistance to carbapenemase was 20.0% in Pseudomonas aeruginosa and was increased from 27.0% in 2005 to 41.0% in 2007 in Acinetobacter baumannii.CONCLUSIONS The drug-resistance rate in Gram-negative bacteria hase increased obviously in past three years in Jinhua region.It suggests that there be an urgent need for surveillance of Gram-negative bacterial resistance in different hospitals and rational antibiotics usage be emphasized during clinical therapy.

Evaluation of Bacterial Drug Resistance Detection in Lower Respiratory Tract Infection Therapy / 中华医院感染学杂志

OBJECTIVE To evaluate bacterial drug resistance detection value in lower respiratory tract infection treatment.METHODS The data of distribution and antimicrobial resistance of clinical strains in sputum samples in patients with lower respiratory tract infection within some periods were collected and analyzed by WHONET software.Meanwhile,the delivery rates and detection positive rates of clinical species and antibiotics application status in clinic were retrospectively analyzed.RESULTS The delivery rates and detection positive rates of clinical species in patients with lower respiratory tract infection within some periods were 67.8% and 55.9%,respectively.The proportion of Gram-negative bacilli and Gram-positive cocci was 82.39% and 14.18%,respectively.Different drug resistance was displayed in different pathogenic bacteria.Resistant rate of Enterobacteriaceae bacteria and non-ferment bacteria against ciprofloxacin and piperacillin/tazobactam was 47.8%,34.8%and 31.5%,44.7%,respectively and resistant rate of S.aureus against levofloxacin was 63.9%.CONCLUSIONS Although the pathogenic bacteria in patients with lower respiratory tract infection show higher drug resistance to general antibiotics,most of patients with lower respiratory tract infection are treated according to clinical experience of doctors,not based on the results of bacterial culture and antimicrobial susceptibility test.Therefore,the results of bacterial culture and antimicrobial susceptibility test do not play a proper role to direct anti-infective therapy in clinic.

Risk Factors and Infection Characteristics in Patients with Chronic Severe Hepatitis B / 中华医院感染学杂志

OBJECTIVE To analyze the characteristics of nosocomial infections,risk factors and prevention measures in patients with chronic severe hepatitis B.METHODS A retrospective review of the medical records of 354 patients with chronic severe hepatitis B admitted between Jan 2006 and Dec 2006 was performed.RESULTS The incidence of nosocomial infection in patients with chronic severe hepatitis B was 16.67% and mainly infection sites consisted of abdominal cavity(40.32%),and upper respiratory tract(22.58%).The most common infection(47.46%) was occurred during the period of hospitalization 15-30 days after and the most commonly pathogens were Gram-negative bacilli(68.75%).The infection risk factors were associated with invasive operation,hypoalbuminemia,endotoxemia,advanced age,antibiotics application and decrease in cell immune function.CONCLUSIONS It is important for the patients with chronic severe hepatitis B to strengthen management on related risk factors in order to prevent nosocomial infection effectively.

Detection of Meticillin-resistant Staphylococcus aureus by Fluorescence in situ Hybridization and Flow Cytometry / 中华医院感染学杂志

OBJECTIVE To establish and evaluate detection method of meticillin-resistant Staphylococcus aureus(MRSA) by fluorescence in situ hybridization(FISH) and flow cytometry.METHODS The experiment conditions including bacteria suspension concentrations,probe concentrations,and hybridization temperatures were optimized for FISH test in the light of orthogonal design principle.The fluorescence signals were detected by flow cytometer,and detection results by FISH and flow cytometry were compared with that of real-time PCR.RESULTS The optimal hybridization conditions of FISH detecting MRSA were 40?105 of bacteria suspension concentrations per microliter of hybridization buffer solution,and 4 ng of probe concentrations per microliter of hybridization buffer solution and 50 ℃ of hybridization temperatures.The sensitivity and specificity of detecting MRSA by FISH-FCM were 97.3% and 100.0%,respectively,and detection results between FISHFCM and real-time PCR had not significant deviation.CONCLUSIONS Fluorescence in situ hybridization and flow cytometry,which detect directly mecA gene in MRSA, are a fast and accurate methods for MRSA detection and can apply in clinical laboratory.