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Objective:To evaluate the prognostic value of extravascular lung water index (EVLWI) , soluble intercellular adhesion molecule-1(sICAM-1) and Krebs yon den lungen-6 (KL-6) in severe pneumonia patients with Severe Acute Respiratory Syndrome (ARDS).Methods:A prospective study was conducted in Respiratory Intensive Care Unit of the Affiliated Zhengzhou Central Hospital of Zhengzhou University from October 2017 to February 2020. The study included 65 severe pneumonia patients with ARDS, who was performed by measurement of pulse index continuous cardiac output and survived more than 3days after admission. The Extravascular Lung Water Index (EVLWI) , sICAM-1, KL-6 and Oxygenation Index(OI) on 1st, 3rd and 5th day were detected. APACHEⅡ score, patient survival events (days) and survival outcome were recorded. Correlation analysis between EVLWI, sICAM-1, KL-6 and OI was performed on the 1st, 3rd and 5th day after admission. Independent risk factors of mortality in severe pneumonia patients with ARDS were analyzed by multiple logistic regression. Receiver operating characteristic curve was drawn, and the prognostic value of each parameter was assessed finally.Results:The PCT, EVLWI, sICAM-1, KL-6 and APACHEⅡ score in the death group were significantly higher than those in the survival group ( P<0.05) at RICU admission, and the length of RICU stay was significantly shorter than that in the survival group ( P<0.05), while differences in other clinical characteristics between two groups were not statistically significant ( P>0.05) . These parameters including levels of EVLWI, sICAM-1, KL-6, Procalcitonin and APACHE Ⅱscore in the death group were significantly higher than those in the survival group on the 1st, 3rd and 5th day ( P<0.05), whereas the OI was significantly lower than that of the survival group on the 3rd and 5th day ( P<0.05). Logistic regression analysis showed that EVLWI, sICAM-1, KL-6 level were significantly related with the mortality of these patients. The levels of sICAM-1, kl-6 and EVLWI on 1st, 3rd and 5th day after RICU admission showed a significant negative correlation with OI ( P<0.001). Whereas, The levels of sICAM-1, kL-6 on 1st, 3rd and 5th day showed a significant positive correlation with EVLWI ( P<0.001). The sensitivity and specificity of sICAM-1, KL-6 combined with EVLWI in prognosis evaluation on 1st, 3rd and 5th day were 75.0%, 84.4%, 85.0%, 66.7%, 80.0%, 86.7%, respectively. The AUC was 0.864, 0.881, 0.892 on 1st, 3rd and 5th day, respectively ( P<0.001), which had a better prognostic value than each of them. Conclusions:EVLWI, sICAM-1 and KL-6 were independent risk factors for the prognosis of severe pneumonia patients with ARDS. The combination of EVLWI, sICAM-1 and KL-6 might be important in early predicting the prognosis of the 28d mortality.
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Precision medicine can achieve precise prevention and treatment of diseases and improve medical standards. The precision medical service system is a carrier and medium for providing precision medical services, which can promote the implementation of precision medical plans and satisfactorily meet the medical service needs of patients. On the basis of literature research and practice, the authors studied the actual situation and development trend of precision medical development in China and built a general framework of precision medical service system. This framework is based on the precision medical service supply system and demand system, centering on the service product system. Ensured by the supporting system, they proposed the implementation path of precision medical service system construction.
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Precision medicine can achieve precise prevention and treatment of diseases and improve medical standards. The precision medical service system is a carrier and medium for providing precision medical services, which can promote the implementation of precision medical plans and satisfactorily meet the medical service needs of patients. On the basis of literature research and practice, the authors studied the actual situation and development trend of precision medical development in China and built a general framework of precision medical service system. This framework is based on the precision medical service supply system and demand system, centering on the service product system. Ensured by the supporting system, they proposed the implementation path of precision medical service system construction.
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Objective To study the platelet inhibition rate of foreign clopidogrel,domestic clopidogrel,combined domestic clopidogrel and tongxinluo and their effct on major adverse cardiovacular events (MACE) after PCI.Methods Two hundred and twenty patients after PCI were divided into foreign clopidogrel treatment group (n=77),domestic clopidogrel treatment group (n=80),combined domesticclopidogrel and tongxinluo treatment group (n =63).The high platelet reactivity (HPR) in 3 groups was detected by thrombelastography after PCI.The incidence of MACE in 3 groups was compared.Results The incidence of left anterior descending branch lesion was lower,the number of sacculi was smaller,and the incidence of HPR was higher in foreign clopidogrel treatment group than in domestic clopidogrel treatment group and combined domestic clopidogrel and tongxinluo treatment group after PCI (63.6％ vs 87.5％ vs 77.8％,P=0.002;2.3±1.1 vs 2.8±1.4 vs 2.7±1.5,P=0.026;24.7％ vs 21.3％ vs 11.1％,P=0.030).The incidence of HPR was significantly higher in foreign clopidogrel treatment group than in combined domestic clopidogrel and tongxinluo treatment group (24.7 ％ vs 11.1％,P =0.040).No significant difference was found in the incidence of MACE in 3 groups (P ＞ 0.05).Conclusion The incidences of MACE of domestic clopidogrel and foreign clopidogrel are similar.Combined clopidogrel and tongxinluo can improve the platelet inhibition rate after PCI.
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Objective To evaluate the prognosis value of plasma soluble vascular endothelial growth factor receptor (sFlt-1) combined with extravascular lung water index (EVLWI) in acute respiratory distress syndrome (ARDS) complicated with septic shock caused by severe pneumonia. Methods A retrospective analysis was conducted in Respiratory Intensive Care Unit of the Affiliated Zhengzhou Central Hospital of Zhengzhou University from January 2015 to July 2017. The study included 52 severe pneumonia patients with ARDS complicated with septic shock, who was performed by measurement of pulse index continuous cardiac output (PICCO) and survived more than 3 days after admission. According to the 28-day mortality, these patients were divided into the survival group (31 cases) and the death group (21 cases). PICCO was used to record the EVLWI level. The plasma level of sFlt-1 was measured by enzyme-linked immunosorbent assay (ELISA). Acute physiology and chronic health evaluation II (APACHE II) score and sequential organ failure assessment (SOFA) score were calculated. Independent risk factors were analyzed by multiple logistic regression. Correlation analysis between plasma sFlt-1 and EVLWI and APACHE II values was performed on the 1st, 2nd and 3rd day after admission. Receiver operating characteristic curve (ROC) was calculated, and the prognostic value of each parameter was assessed. Results The blood lactate, APACHE II score and SOFA score in the death group were significantly higher than those in the survival group at RICU admission (P<0.05), and the length of RICU stay was significantly shorter than that in the survival group (P<0.05), while differences in other clinical characteristics between the two groups were not statistically significant. The levels of EVLWI, sFlt-1 and blood lactate, APACHE II score and SOFA score in the death group were significantly higher than those in the survival group on the 1st, 2nd and 3rd day (all P<0.05), whereas the PaO2/FiO2 was significantly lower than that of the survival group on the 2nd and 3rd day (all P<0.05). Logistic regression analysis showed that sflt-1 level and EVLWI were significantly related with the patient mortality. The levels of sFlt-1 on day 1, 2 and 3 after RICU admission were positively related to EVLWI and APACHE II score (all P<0.01). The sensitivity and specificity of sFlt-1 combined with EVLWI in prognosis evaluation were 89.7％, 78.2％ and 86.3％, 75.7％, respectively. The AUC of sFlt-1 combined with EVLWI was 0.875 and 0.856 on the 1st and 3rd day, respectively (all P<0.01), which had a better prognostic value than each of them. Conclusions SFlt-1 could be used as a biomarker of mortality for severe pneumonia patients with ARDS complicated with septic shock. The combination of sFlt-1 and EVLWI might be important in early prediction of the prognosis of the 28-day mortality in patients with ARDS complicated with septic shock caused by severe pneumonia.
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@#Objective To observe the change of coagulation function in chronic stress depression model rats and the effects of elec-troacupuncture (EA) on it. Methods A total of 32 Sprague-Dawley rats were randomly divided in control group (n=8), model group (n=8), EA group (n=8) and fluoxetine group (n=8) after a week of acclimation. The 21-day unpredictable mild stress combined with solitarily feed-ing was used to make the depression model in the latter three groups, meanwhile EA group and the fluoxetine group accepted EA and fluox-etine. They were measured the prothrombin time (PT), activated partial thromboplastin time (APTT), thrombin time (TT) and fibrinogen (FIB). Serum levels of 6-keto-prostaglandin F1α(6-keto-PGF1α), P-selectin, thromboxane B2 (TXB2) were determined with enzyme-linked im-munoabsorbent assay. Results The cross and rear scores were significantly lower in the model group than in the control group (P<0.01). The scores increased in EA group and the fluoxetine group (P<0.01) compared with the model group. Compared with the control group, PT, APTT and TT decreased (P<0.01), FIB increased (P<0.05), the level of 6-keto-PGF1αdecreased, the level of P-selectin and TXB2 increased (P<0.01) in the model group. Compared with the model group, PT, APTT and TT increased (P<0.05), the level of 6-keto-PGF1αincreased (P<0.01), and the level of P-selectin and TXB2 decreased (P<0.05) in EA group and the fluoxetine group, and FIB decreased in EA group (P<0.05). Conclusion The chronic stress depression rats are impaired in the coagulation function and platelet activation, and can be allayed with electroacupuncture and fluoxetine.
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Objective To observe the clinical efficacy and safety of olanzapine in the treatment of mental disorders caused by brain organic diseases.Methods Eighty-one patients with mental disorder caused by brain organic disease were enrolled in the study and randomly divided into the control group(39 cases)and the experimental group(42 cases).The control group was treated with risperidone tablets and the experimental group was treated with olanzapine tablets,the patients in the two groups were treated for 4 weeks.After 4 weeks, the clinical efficacy,the scores of BPRS and the adverse reactions in the treatment were observed.Results The total efficiency of the control group 66.7%(26/39),the total efficiency of experimental group was 92.8%(39/42),there was significant difference in total efficiency between the two groups(χ2=7.889,P<0.05).Before the treatment,BRPS scores in the two groups were(51.42±6.38)points and(50.32±7.15)points,respectively, After 4 weeks of treatment,BRPS scores were(39.21 ± 7.43)points and(30.10 ± 3.88)points in the two groups,the differences in BPRS score in the two groups before treatment and at 4 weeks after treatment were statistically significant(control group: t=7.845,P=0.003,experimental group: t=8.321,P=0.002),there was significant difference between the control group and the experimental group in BPRS score(t=6.773,P=0.003).The incidence rate of body mass increase in the experimental group was 40.5%(17/42),significantly higher than that of the control group(15.4%)(6/39),the difference was statistically significant(χ2=6.576,P<0.05),while the incidence rates of myotonia and tremor adverse reaction were 16.7%(7/42)and 19.0%(8/42),significantly lower than those in the control group 35.9%(14/39)and 38.5%(15/39),the differences were statistically significant(myotonia:χ2=5.187,P<0.05;tremor; χ2=4.433,P<0.05).Adverse drug reactions can be effectively alleviated after symptomatic treatment.Conclusion Olanzapine has good clinical efficacy and safety and low adverse reactions in the treatment of mental disorders caused by organic brain disease.
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Objective To improve the understanding of the epidemiology,clinical features,diagnosis and treatment of Tsutsugamushi disease,and reduce the misdiagnosis rate.Methods The clinical data of 56 cases of Tsutsugamushi disease misdiagnosed were analyzed retrospectively.Results 28 cases were misdiagnosed as acute upper respiratory tract infection(50.0%),3 cases were malaria(5.4%),1 case was cholecystitis(1.8%),24 cases were infectious fever(42.8%).The average misdiagnosed time:10.3days.55 patients were found Eschar or ulcer (98.2%),54 cases were found Eschar or ulcer on one part of body,1 case was found two eschars.54 cases had been effectively treated,50 cases were treated with chloramphenicol,4 cases with azithromycin.The average time of temper-ature that dropped to normal were respectively:1.3d,1d.Conclusion awareness of Tsutsugamushi disease should be raised,history seriously should be inquired and specific signs should be identified,which can degrade the misdiagnosis rate and reduce the mortality rate.
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Vam3 is a potential pharmacologically active ingredient isolated from Vitis amurensis Rupr. A rapid, simple and sensitive method to determine Vam3 levels in rat plasma and tissue was developed based on LC-MS/MS. Vam3 and an internal standard (IS) were chromatographed on a C18 short column with acetonitrile-0.1% formic acid in water by gradient elution. MS detection was performed by electrospray ionization in negative ion multiple reaction-monitoring modes. This method monitored the transitions m/z 451.0→345.0 and m/z 301.0→164.0 for Vam3 and IS, respectively. The calibration curve was linear over a concentration range of 1.64-1000 ng/mL. The inter-day and intra-day variabilities in precision was less than 12.8%, while the inter-day and intra-day accuracies ranged from -10.60% to 9.08% in plasma and tissue homogenates. This method was applied to investigate the pharmacokinetics and tissue distribution of Vam3 in rats. The results indicated that Vam3 had poor absorption into systemic circulation and extensive tissue distribution after oral administration, and the absolute bioavailability was low (0.79%). Vam3 had a relatively long terminal elimination half-life in lung, and the highest concentration was found in small intestinal tissue. The developed method and the pharmacokinetic data can provide a basis for further studies on the bioactivity of Vam3.
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Objective To investigate the relationship between body mass index (BMI) and long-term survival in patients with chronic obstructive pulmonary disease (COPD).Methods A retrospective cohort study was conducted in 1124 patients with completed data among 1528 hospitalized patients with COPD.Vital status was ascertained at death registry and civil affairs department.Clinical characteristics were acquired from medical record.Patients were divided into 4 groups according to the quartile of BMI:BMI＜18.9 kg/m2 (group A),BMI from 18.9 kg/m2to 22.7 kg/m2 (group B),BMI from 22.8 kg/m2 to 26.2 kg/m2 (group C),BMI＞26.2 kg/m2 (group D).The differences in survival curves were compared between groups by using log-rank test.The relationship between all-cause mortality and BMI was evaluated by Cox proportional hazards regression model.Results The median BMI of 1124 patients was 22.7 kg/m2 [(18.9-26.2) kg/m2].270 patients (24.0％) had BMI＜18.5 kg/m2.162 patients (14.4％) died during follow-up.There was significant difference in the survival curves in the four groups (x2 =7.97,P＜0.05).Survival rate was highest in group C and lowest in group A.After adjustment for other factors,BMI was an independent risk factor for predicting long-term survival.The survival rate was respectively decreased by 41 ％ and 35 ％ in group C and D as compared with group A.Conclusions Weight loss is comman in COPD patients.BMI is an independent risk factor for predicting long-term survival.BMI is easily acquired and stable,which is especially suitable to evaluate the prognosis of patients with acute exacerbation.
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Objective To establish a real-time fluorescence quantitative methylation assay to investigate the methylation status of GSH-sulphur-transferase P1(GSTP1) gene promoter region in hepatocellular carcinoma(HCC) and to investigate whether which can be used as the early diagnostic indicator of HCC .Methods Ninety-five serum samples were collected from 40 patients with HCC ,30 patients with liver cirrhosis and 25 individuals with healthy physical examination as controls .The methylation level of GSTP1 gene in these serum samples were quantitatively determined by using the real-time fluorescence quantitative methylated spe-cific PCR technique .The receiver-operation characteristic(ROC) curves were adopted to evaluate its diagnostic value for HCC .Re-sults The methylation quantitative level of GSTP1 gene in HCC serum was significantly higher than that in the healthy controls (P<0 .05) .The ROC curve analysis demonstrated that the methylation quantitative analysis of GSTP1 gene could efficiently distin-guish HCC and cirrhosis from healthy controls (AUC=0 .8641) .With the methylation rate of 2% as the critical value for diagno-sing HCC ,its diagnostic specificity was 87 .5% ,the sensitivity was 69 .6% ;the combination detection of serum GSTP1 gene methy-lation and serum AFP could increase the detection rate of HCC to 75% .Conclusion The real-time fluorescence quantitative methyl-ation assay can accurately quantify the methylation level of serum GSTP1 gene ,which has certain application value for the early di-agnosis of HCC .
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This article describes a phantom holder in CT couch which adjusted easily and accurately, installed easily. The holder mainly include removing and locking equipment between phantom holder and table top, move horizontally equipment between left and right, rotating equipment between left and right. After holder and table top fixed one part, holder with phantom can move horizontally, front and back, rotate between left and right in a small angle, in order to make operator test phantoms accurately and easily. At the same time, this phantom holder realized free adjustment after first adjustments, which shortened operator work time.
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Equipment Design , Tomography, X-Ray ComputedABSTRACT
In the load capacity test of CT diagnosis table top, by analyzing the easy destroy area and related test data for the table top, using a simple mechanical auxiliary support structure in local area of the table top to solve the insufficient loading strength problem of table top and obtain significant results during the actual product usage.
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Tomography, X-Ray Computed , MethodsABSTRACT
BACKGROUND:Bone marrow stem cells are defined by their multi-potential ability, and can be differentiated into intrinsic cells in the kidney. OBJECTIVE:To study the effects of mobilizing autologous bone marrow stem cells by granulocyte colony-stimulating factor plus stem cellfactor on cellapoptosis and proliferation of rats with renal ischemia-reperfusion injury. METHODS:Total y 160 male Sprague-Dawley rats were randomly divided into four groups:control group, model group, cytokine treatment group, cytokine control group. Rat models of unilateral renal ischemia-reperfusion injury were established in the model and cytokine treatment groups. Rats in the cytokine treatment group and cytokine control group received subcutaneous injection of granulocyte colony-stimulating factor (50μg/kg) and stem cellfactor (200μg/kg), once a day, for 5 continuous days. Rats in the model and control groups had no treatment. Apoptotic cells were detected by terminal deoxynucleotidyl transferase-mediated dUTP-biotin nick end labeling method, and the expression of CD34-positive cells, Caspase-3, Bcl-2, proliferating cellnuclear antigen in the kidney were measured using immunohistochemistry staining. RESULTS AND CONCLUSION:The number of CD34-positive cells in renal tissue of the cytokine treatment group was significantly higher than that of the control group and model group (P<0.05). The apoptotic index and expression of Capase-3 in the model group and cytokine treatment group were higher than those in the control group and cytokine control group (P<0.05). The apoptotic index and expression of Capase-3 in the cytokine treatment group were lower than that in the model group (P<0.05). The expression of Bcl-2 in the model group and cytokine treatment group was higher than that in the control group and cytokine control group (P<0.05). The expression of Bcl-2 in the cytokine treatment group was higher than that in the model group (P<0.05);however, as time went on, Bcl-2 expression was obviously decreased. Proliferating cellnuclear antigen expressed both in the model group and in the cytokine treatment group. Additional y, the proliferative index reached peak at 24 days in the model group, and then decreased gradual y;while in the cytokine treatment group, it reached the peak at 10 days, maintained a high level until the 17th day, and then decreased gradual y. Mobilization of autologous bone marrow stem cells by combination of granulocyte colony-stimulating factor and stem cellfactor can increase proliferation and decrease apoptosis of renal tubular epithelial cells after renal ischemia-reperfusion injury, and thus, promote the recovery from renal tubular injury.
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Objective To explore the diagnostic value of bronchoscopy combined materials drawn in multiply methods in patients with bacteriological negative pulmonary tuberculosis.Methods The clinical data of 74 patients with pulmonary tuberculosis were retrospectively analyzed.All the patients had sputum acid-fast staining more than three times,25 patients were sputum bacteriological positive and 49 patients were bacteriological negative or had no sputum.Bronchoscopy was performd in 28 cases,including biopsy examining,brush examining,bronchoalveolar lavage fluid(BALF) smear and sputum spear acid-fast stain test.Results In 28 patients undergoing examination,microscopic abnormalities were found in 14 cases,taken 50.0％.15 cases performed lesion biopsy or transbronchiallung biopsy(TBLB) were diagnosed tuberculosis,taken 53.6％.Brush acid-fast staining was positive in 7 cases,taken 25.0％.BALF smear postive in 10 cases,taken 35.7％.And phlegm test after bronchoscope positive in 6 cases,taken 21.4％.Combined multiply index,23 cases finally diagnosed as pulmonary tuberculosis,taken 82.1％.Conclusion Bronchoscopy with materials drawn in multiply methods has a high value in diagnosing bacteriological negative pulmonary tuberculosis,we should take advantage of it as soon as possible.
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@#Objective To explore the effects of skill-training on social function in patients with schizophrenia recession. Methods 60 patientswith schizophrenia recession were divided into 2 equal groups (n=30) for 1-year treatment. The control group was treated only withdrugs, and the treatment group was treated with skill-training in addition. The patients were assessed with the Scale of Social Skill of ChronicSchizophrenic Inpatients (SSSI) and the Positive and Negative Symptom Scale (PANSS) before, 6 months and 12 months after treatment.Results The total scores of PANSS decreased significantly in the treatment group compared with the control group (P<0.01). The scores ofSSSI decreased significantly in the treatment group after treatment. However, there was no significant differences in the control group (P>0.05) 6 months after treatment, but was 12 months after treatment (P<0.05). Conclusion Based on the medicine treatment, skill-training mayimprove the flinched mental symptom to remain the social function.
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Objective To evaluate the significance of selective salpingography(SSG)and fallopian tube recanalization(FTR)in diagnosis and treatment for obstructive infertility.Methods Totally, 268women with infertility caused by obstruction of the fallopian tube were divided randomly into two groups, one (Group A)with a non-operative hysterosalpingeal system by insertion of co-axial cannula and guiding filament made by COOK Corporation in the US and another(Group B)with a self-prepared hysterosalpingeal system modified based on the apparatus of COOK Corporation, for SSG and FTR.Then, efficacy of SSG and FTR for the infertile women was evaluated by one-year cumulative pregnancy rate and reeanalization rate of the fallopian tube.Resnits One hundred and seventy of 198 fallopian tubes were recanalized in Group A, with a recanalization rate of 85.8%, and 290 of 320 tubes in Group B were recanalized.with a recanalization rate of 90.6%.reaching statistically significant difference.Furthermore, recanalization rate varied with different sites of occlusion of the fallopian tube.Pregnancy rate was 35.3%(36/102)in Group A, significantly higher than that in Group B(47.6%, 79/166).As the same, pregnancy rate varied with different sites of occlusion of the fallopian tube.Conclusion Selective salpingography and fallopian tube recanalization with self-prepared hysterosalpingeal system have dual effects on diagnosis and treatment for tubal infertility of women, which are simpler, safer and more reliable, worth to be clinically applied.
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With the increasing enrollment of high school and commonalty of higher education,it is very important to transform educational thought and concept,explore the approach and method for clinical teaching administration,improve teaching condition,enhance construction of teaching staff and emphasize the development for learning ability,practice ability and pioneering ability of clinical medical undergraduates.
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Objective To explore the diagnostic value and clinical significance of simultaneous detection of AFP,AFU and TSGF in patients with primary hepatic carcinoma(PHC).Methods Serum AFP,AFU and TSGF were detected simultaneously in 62 patients with PHC and 30 controls.Results The levels of AFU and TSGF in primary hepatic carcinoma were all significantly higher than that of controls(P
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OBJECTIVE To study commonly encountered pathogenic bacteria leading to lung infection and their drug sensitivity. METHODS In the period of Jan 2003 to Feb 2005,the pathogenic species and drug sensitivity of 233 positive samples isolated from 496 phlegm samples were analyzed.RESULTS Totally 234 strains of pathogenic bacteria were(isolated) from 233 phlegm samples.It had been found that 132 strains of Gram-negative bacilli,(accounted) for(56.4%);57 strains of Gram-positive cocci,accounted for 24.4 %;41 strains of fungi,accounted for 17.5%;and 4 strains of Gram-positive bacilli,accounted for 1.7%.The pathogens of the highest infective rate were:(Pseudomonas) aeruginosa(15.4%),Candida albicans(11.6 %),Enterobacter cloacae(6.0%),Klebsiella(pneumoniae)(5.6%),Escherichia coli(5.1%),Staphylococcus aureus(4.3 %),Streptococus pyogenes((4.3%)),Acinetobacter baumannii(3.6%),and C.tropicalis(3.6 %).Results of drug sensitivity indicated that drugs selected sensitive to Gram-negative bacilli were:imipenem(75.4%),piperacillin/tazobactam(38.9%),(ciprofloxacin)(37.3%),gentamicin(37.3%),and amikacin(36.5%).Drugs sensitive to Gram-positive cocci were:vancomycin(75%),rifampin(55%),and erythromycin(35%).CONCLUSIONS The commonly encountered pathogens of lung infection in our hospital are: P.aeruginosia,C.albicans,E.cloacae,K.pneumoniae,E.coli,S.aureus,and S.pyogenes.Infective rate of Candida is increasing evidently.Antibiotic resistance of bacteria(becomes) severe,drugs applied became less and less.Clinic should(actively) develop phlegm cultivation and drug sensitivity test,applying antibiotics reasonably,reducing production of bacteria resistant to drugs.