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OBJECTIVE To explore and establish a long-term mechanism for rational control of intravenous fluids in hospitals. METHODS On the basis of the establishment of rules and regulations， through the exploration and implementation of the core technical strategy of “six-step method”， a new mode of intravenous infusion control was established. The contents of the “six-step method” were as follows： the first step was to sort out the diseases that did not require intravenous infusion； the second step was to sort out the alternative drugs/dosage forms； the third step was to sort out the alternative routes of infusion； the fourth step was to develop drug specifications； the fifth step was to explore the personalized medication needs of clinical departments； the sixth step was to develop a department-specific integrated infusion regimen. The utilization rate of intravenous fluids in inpatients and the average daily amount of intravenous fluids per bed in inpatients were used as the main indicators to evaluate the control effect. RESULTS The comparison of the average values of three months before and after the implementation of the “six-step” management mode in the department of thoracic surgery of our hospital showed that after management and control， the average utilization rate of intravenous fluids in inpatients decreased by 1.74%， the average daily use of intravenous fluids in inpatients per bed decreased by 0.30 bags/bottle， and the per capita use of infusion drugs under key control gradually decreased. CONCLUSIONS The “six-step” management mode can reduce the utilization rate of intravenous fluids in inpatients， and this management mode is practical and feasible.
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OBJECTIVE:To provide reference for rational selection of antibiotics against non-fermentative Gram-negative bacilli in clinic. METHODS:Etiological data of clinical isolated Pseudomonas aeruginosa(PA),Acinetobacter baumanii(AB) and Stenotrophomonas maltophilia(SM)were collected from the Affiliated Hospital of Qingdao University(called"our hospital"for short)during Jan. 2004-Dec. 2016. Drug resistance of them to commonly used antibiotics was analyzed retrospectively. RESULTS:Totally 15 587 strains of PA,7 446 strains of AB and 2 950 strains of SM were detected. Resistance rates of PA to commonly used antibiotics fluctuated but were in a decreasing tendency. Except for imipenem,resistance rates of PA to commonly used antibiotics decreased significantly,and resistance rates of PA to amikacin and gentamicin decreased to 4.60% and 7.48%, respectively. Resistance rates of AB to most commonly used antibiotics were more than 40%,but it was sensitive to tigecycline (drug resistance of 0-4.03%). Resistance rates of SM to cefoperazone sodium and sulbactam sodium increased from 3.03% in 2004 to 39.01% in 2016,but it was sensitive to sulfamethoxazole,minocycline and levofloxacin. CONCLUSIONS:Non-fermentative Gram- negative bacilli detected in our hospital are mainly PA. Resistance rate of PA to most of the antibiotics is declining;drug resistance of AB is severe;resistance rates of SM to cefoperazone sodium and sulbactam sodium show increasing tendency.Above 3 non-fermentative Gram-negative bacilli are sensitive to amikacin,tegocycline and minocycline. Clinical selection should be based on the results of drug sensitivity test.
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Objective To explore the effect of family doctor contracting service combined with drug therapy on the quality of life of patients with hypertension. Methods Selected in May 2016 to May 2017 in a city in a district of three community health service center clinics diagnosed with hypertension in patients with 840 cases, were given amlodipine besylate tablets treatment, and the implementation of conventional health management And community intervention. According to whether or not to accept the family doctor contract service is divided into observation group (a total of 435 cases) and the control group (a total of 405 cases). Health status questionnaire (SF-36) was used to assess the quality of life before and after the intervention, and the blood pressure control and quality of life improvement were compared between the two groups before and after treatment.Results There was no significant difference in the blood pressure level between the two groups before treatment. The systolic and diastolic blood pressure in the observation group were better than those in the control group (P<0.05). There were no significant differences in physiological function, physiological function, physical pain, general health, mental health, energy, social function, affective function and total score of SF-36 before treatment. The scores of the observation group were significantly higher than those of the control group before and after treatment. The difference was statistically significant (P<0.05). Conclusion Family doctor contract service combined with drug therapy can effectively control the patient's blood pressure levels, improve the quality of life.
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Objective To compare the value of NBI with magnify endoscopy (NBI-ME) and Lugol chromoendoscopy (LCE) in preoperative assessment of early esophageal cancer, and assess whether the former can replace the latter. Methods 59 patients, sampled in the Second Hospital of Lanzhou University, the First Hospital of Lanzhou University and the Second Hospital of Lanzhou City from January 2014 to December 2015, were examined respectively by NBI-ME and Lugol chromoendoscopy not only to distinguish the lesion boundaries but also predict the pathological types as well for statistical analysis with the combination of the final postoperative pathological results. Results Only 64.4 % (38/59) of lesion boundaries can be well-distinguished by NBI-ME, which is significantly lower than that distinguished by Lugol chromoendoscopy (91.5 %, 54/59), with its kappa value 0.208 0.05 (0.369), Kappa > 0.4 (0.429), P 0.05 (0.475), Kappa <0.4 (0.286), P < 0.01 (0.001), showing the poor concordance instead. Conclusions To some extent, pathological type predicted by NBI-ME indeed had an concordance with postoperative pathology, which was also superior to the results examined by Lugol chromoendoscopy, while there was no denying that Lugol chromoendoscopy had an obvious advantage over NBI-ME in terms of distinguishing lesion boundaries, therefore, it can not be completely replaced with NBI-ME at present.
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OBJECTIVE:To observe the correlation of vitamin D with the incidence of cardiovascular disease and risk factors in elderly patients with type 2 diabetes mellitus. METHODS:94 patients,aged 60 years old above,with type 2 diabetes mellitus were collected retrospectively. Those patients were divided into diabetes group(41 cases)and diabetes complicated with cardiovas-cular disease group(53 cases)according to the condition of disease. 25(OH)D levels and lab indicators of 2 groups were detect-ed. The relationship of cardiovascular lesion with risk factor was analyzed by Multivariate Logistic regression;the correlation be-tween 25(OH)D and risk factors was analyzed by pearson analysis. RESULTS:There was statistical significance in the levels of 25 (OH)D,TC,TG,UA and Ca between diabetes group and diabetes complicated with cardiovascular disease group,with statistical significance(P<0.05). pearson analysis showed that the level of 25(OH)D was negatively related to age,FIB,TC and UA,and positively related to D-dimer and HDL-C,especially correlated with FIB and TC significantly,with statistical significance (P<0.01). Multivariate Logistic regression analysis showed that the deficiency of 25(OH)D was pathogenic factors of type 2 diabetes mellitus. CONCLUSIONS:There is a correlation between the level of 25(OH)D and cardiovascular risk factors as age,FIB,TC, UA,D-dimer,HDL-C. Vitamin D deficiency is the independent risk factors for cardiovascular disease in elderly patients with type 2 diabetes mellitus.
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Objective To observe the effects of blood nourishing and wind expel formulae on learning and memory capabilities of rats with tic disorders. Methods Intradialytic Parenteral Nutrition peritoneal injection was used to establish the rat model of tic disorders. The successful test subjects were categorized into 5 different groups, namely the model group, the Chinese medicine groups (low dosage, medium dosage and high dosage) and the western medicine group. The test groups were each given gastric perfusion of the related medicine, whereas the control and model groups were each given equal amounts of saline solution continuously for 8 weeks. Open field test and water maze test were carried out in the 1st, 4th and 8th weeks to evalute the learning and memory capabilities. Results In comparison with the control group, the model group showed obvious increase in movement across grid and decrease in vertical locomotion. Statistical significance was obtained showing an increase in vertical locomotion in the treatment groups compared with the model group. In the Chinese medicine groups, the medium and high dosage groups exhibited shorter escape latency and increased exploratory behavior (P<0.05) in the 4th and 8th weeks. Conclusion Among the blood nourishing and wind expel formula, the medium and high dosage showed ameliorating effects on the memory and learning capabilities of rats with tic disorders.
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Objective To investigate the expression pattern and significance of two importantoocyte-secreted factors:growth differentiation factor 9(GDF9)and bone morphogenetic protein 15(BMP15)during oocyte maturation in women with polycystic ovary syndrome(PCOS)and infertile women due to husband factors.Methods Total of 25 oocytes[9 at germinal vesicle GV stage,9 at M Ⅰ stage and 7 at M Ⅱ stage]were obtained from 12 patients with PCOS and 82 oocytes(29 at GV stage,26 at M Ⅰ stage and 27 at M Ⅱ stage)were from 56 controls.The nested quantitative real time(RT)PCR was uscd to detect the abundance of GDF9 and BMP15 mRNA in each oocyte.Results(1)The expression level of GDF9 mRNA at the GV stage,M Ⅰ stage and M Ⅱ stage in PCOS group were 44.8(4.2-529.0),27.6(9.8-172.7)and 49.0(0.2-65.9)respectively,the expression in were 149.9(55.4-387.9),29.9(2.5-205.8)and 657.8(149.4-1376.2)in control group,respectively.The expression of GDF9 mRNA at M Ⅱ stage was significantly lower in PCOS group than in controls(P ＜ 0.01),however,the differences didn't reach statistical significant at GV or M Ⅰ stage between the two groups(P ＞ 0.05).The expression of GDF9 mRNA displayed some changes at different maturation stage in controls(P ＜ 0.05,P ＜ 0.01),however,the expression didn't demonstrate any dynamic changes in PCOS group(P ＞ 0.05).(2)The expression level BMP15 mRNA at the GV stage,M Ⅰ stage and M Ⅱ stage in PCOS group were 0.1(0.1-22.0),3.2(0.6-55.0)and 6.4(3.2-8.5),respectively,the expression were 41.6(6.5-96.1),4.0(2.0-10.4)and 49.7(2.3-139.5)in control group,respectively.The expression of BMP15 mRNA at GV stage was significantly lower in PCOS group than in controls(P ＜ 0.01),however,the differences were not significant at M Ⅰ or M Ⅱ stage between the two groups(P ＞0.05).The expression of BMP15 mRNA also displayed some changes at different maturation stage in controls(P ＜ 0.05),however,the level didn't demonstrate any dynamic changes in PCOS group(P ＞ 0.05).Conclusion It was suggested that the low expression of oocyte secreted factors in mature oocytes from PCOS patients might be associated with impaired oocyte quality and developmental competence in PCOS.
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Objective To investigate characteristics of anti-Müllerian hormone (AMH) secretion and mechanism of aberrant folliculogenesis by the ratio of luteinizing hormone (LH)/follicle-stimulating hormone(FSH) in polycystic ovarian syndrome (PCOS) patients. Methods Base on the ratio of LH/FSH,total 95 patients with PCOS were divided into two groups,including 49 cases in higher ratio group (LH/FSH≥2) and 46 cases in normal ratio group (LH/FSH < 2) matched with 62 infertile cases with tubal factor and regular menstruation as control group. Body mass index (BMI) were calculated in all objectives. The serum AMH were detected by enzyme linked immunosorbent assay(ELISA). Ovarian sexual hormones,fasting blood glucose, insulin and lipid were measured by chemiluminescence method. The correlation between AMH and metabolic index was analyzed by multilinear regression. Results (1) AMH: the serum level of AMH were (7.2±4. 3) μg/L in higher LH/FSH group, (5. 2±3. 8) μg/L in normal LH/FSH group and (3.7 ±2. 2) μg/L in control group, which all reached significant difference among those 3 groups(P < 0. 01). (2) The correlation between AMH and biological metabolic index: estradiol (E2) was negatively correlated with serum level of AMH in higher LH/FSH ratio group (r = -0. 318). The serum level of AMH were positively correlated with BMI, fasting glucose, homeostasis model assessment insulin resistance index (HOMA-IR) in normal LH/FSH ratio group (r = 0. 493,0. 362,0.303). After controlling affect factors, serum levels of AMH were positively correlated with LH/FSH in higher LH/FSH ratio group (r = 0. 301), but negatively correlated with E2 (r = -0. 429). However, in normal LH/FSH group, serum level of AMH was only positively correlated with BMI (r = 0. 428). Conclusion The PCOS patients with higher LH/FSH ratio are primarily caused by hypothalamic-pituitary dysfunction, while the PCOS patients with normal LH/FSH ratio are mainly caused by metabolic disorders.