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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 explo re the potential molecular mechanism of ursolic acid in the treatment of osteoporosis （OP）. METHODS：TCMSP，PubMed database and UniProt database were used to screen potential targets of monomer compound ursolic acid. OP related target genes were searched with GeneCards database. The common target genes of component-disease were obtained by Venny 2.1 online mapping tool. The protein-protein interaction （PPI）network of component-disease common target genes was constructed by using STRING database ，and topological analysis was carried out ；the core target genes ，whose degree value was greater than the average degree value ，were screened. GO functional annotation and KEGG pathway enrichment analysis of component-disease common target genes were carried out by DAVID database. AutoDock Vina 1.1.2 software was used for molecular docking ，using protein encoded by the core target gene as receptor and ursolic acid as ligand. RESULTS ：A total of 55 ursolic acid related target genes and 4 273 OP related target genes were excavated ，with a total of 44 common target genes. PPI network with above common target genes included 44 nodes and 513 edges，with an average node degree of 23.3. There were 24 core target genes ，including VEGFA，TP53，IL6，CASP3. There were 340 GO functional items were enriched （corrected P＜ 0.05），including 263 biological processes （negative regulation of apoptosis ，etc.），25 molecular functions （protein binding ，etc.） and 52 cell components （cytosol，etc.）. There were 90 KEGG signaling pathways （corrected P＜0.05），such as tumor pathway ， hepatitis B pathway ，TNF signaling pathway ，viral carcinogenesis and phosphatidylinositol 3 kinase/protein kinase B （PI3K-Akt） signaling pathway. The binding energy between ursolic acid and 6 proteins encoded by core target genes such as TP53 was lower than －5 kcal/mol，which had strong binding activity. CONCLUSIONS ：The therapeutic effect of ursolic acid on OP may be achieved by regulating VEGFA，TP53，IL6，CASP3，JUN and other core target genes and acting on multiple key pathways such as cancer pathway ， hepatitis B and TNF signaling
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Objective:To discuss the onset and development pattern and characteristics of refeeding syndrome (RFS) induced by nutrition support and to provide reference for rational drug use in parenteral nutrition management.Methods:Case reports of RFS from CNKI, Wanfang, VIP database and Pubmed from 2000 to 2020 were retrieved. The clinical data were collected and statistically analyzed.Results:A total of 17 reports, including 17 cases, were included in the analysis. Patients were 6 males(35.29%) and 11 females (64.71%). The distribution of age was from 29 weeks in a premature neonate to 87 years old. 12 cases (70.59%) of RFS occurred within 3 days after starting the nutrition support. The most common clinical manifestation were cardiovascular system symptoms (88.23%), with dyspnea as the most reported symptom (41.17%). 15 patients (88.23%) recovered after appropriate intervention and 2 patients died(11.76%).Conclusions:Refeeding syndrome is a potentially fatal condition. The risk of RFS should be assessed before initiating nutrition support. Patients at risk of RFS must be monitored closely at the early stage of nutritional support.
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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 investigate the dosage and consumption sum of opioid analgesic drug in Qingdao district. METH-ODS:The consumption data of drugs in 29 public hospitals at secondary or above level in Qingdao district were analyzed statistical-ly by ABC analytic methods and defined daily dose methods. RESULTS:In ABC analysis,5 kinds of class A drugs accounted for 20% of the total number of species,and the percentage of consumption sum was 77.38%;4 kinds of class B drugs accounted for 16.00% of all species numbers,and the percentage of consumption sum was 11.98%;other 16 kinds of drugs accounted for 64.00% of the total number of species,and the percentage of consumption sum was 10.64%. Oxycodone sustained-release tablets and Morphine sustained-release tablets with the highest DDDs consumed more health care costs,serial number ratio was 1.00,syn-chronization was good and conform to the actual needs of clinical work. CONCLUSIONS:The composition ratio of opioid analge-sic drug costs is consistent with the theoretical value,significant discrepancy between cost and DDDs does not appear.
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ObjectiveTo observe the clinical effect of low molecular weight heparin calcium in the treatment of chronic obstructive pulmonary disease combined with pulmonary heart disease.MethodsA total of 64 patients with chronic obstructive pulmonary disease combined with pulmonary heart disease from December 2008 to December 2010 were enrolled in this study and divided into treatment group and control group by random digits table with 32 cases each.The control group was given routine treatment and the treatment group was given low molecular weight heparin calcium for 7 days at the basis of routine treatment.ResultsThe total effective rate in treatment group[ 90.6％ (29/32) ] was significantly higher than that in control group [ 68.8％ (22/32) ] (P ＜ 0.05 ).In treatment group,the levels of arterial carbon dioxide tension (PaCO2) and arterial oxygen tension (PaO2) after treatment [(54.64±9.63),(74.21 ± 11.76) mm Hg (1 mm Hg =0.133 kPa)] were significantly decreased compared with before treatment [(78.66 ± 11.22),(53.42 ± 8.84 ) mm Hg ] (P ＜ 0.01 ).In control group,the levels of PaCO2 and PaO2 after treatment [ (61.10 ±7.24),(65.07 ± 8.21 ) mm Hg] were significantly decreased compared with before treatment[ (79.52 ± 12.54),(51.35 ± 7.31 ) mm Hg ] (P ＜ 0.05 ).After treatment the levels of PaCO2 and PaO2 in treatment group were better than those in control group (P ＜ 0.05).ConclusionsThe low molecular weight heparin calcium in treatment of chronic obstructive pulmonary disease combined with pulmonary heart disease can effectively improve the clinical manifestation.It is worth the clinical promoted application.
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Objective To investigate the effect of chronic low-frequency electrical stimulation on the structural and metabolic changes of diaphragm of emphysema rabbits.Methods The rabbit model of emphysema was made by papain-inhaling of ultrasonic atomization once a week for 3 weeks in 30 adult Japanese rabbits,6 receiving 10 Hz chronic low frequency electrical stimulation,6 receiving 40 Hz,and 6 receiving(10+40)Hz.Other 6 emphysema rabbits and 6 normal rabbits served as control.An enzyme chemical method was used to observe the changes in the enzyme activities of sarcoplasmic reticulum Ca2+-ATPase,succinate dehydrogenase(SDH)and the lactate dehydrogenase(LDH)and changes in MHC in control group,emphysema group,and emphysema+chronic low frequency electrical stimulation group.Results Following chronic electrical stimulation using 40 Hz,10 Hz,and(10+40)Hz,the relative contents of MHC were increased in the diaphragmatic muscle of rabbits with emphysema.The percentage of MHC-Ⅰ was significantly increased in the 10 Hz group,while that of MHC-Ⅱa was significantly increased in the(10+40)Hz group.Following chronic electrical stimulation using 40 Hz and(10+40)Hz,diaphragmatic muscle SR Ca2+-ATPase activity was increased in rabbits with emphysema(P
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Objective To investigate the effect of chronic ultra-low frequency electrical stimulation on mechanical characteristic of diaphragmatic muscle of emphysema rabbit.Methods The rabbit model of emphysema was made by inhaling papain of ultrasonic atomization once a week for 3 weeks in 24 adult Japanese rabbits,6 receiving 10 Hz chronic ultra-low frequency electrical stimulation,6 receiving 40 Hz,6 receiving 2.5 Hz and 40 Hz.Another 6 rabbits served as control.The twitch tension (Pt),titanic tension(Po),time to peak tension(TPT),half-relaxation time(1/2RT),fatigue index(FI) and fatigue recovery index(FRI) were measured in control group,emphysema group,emphysema+chronic ultra-low frequency electrical stimulation groups.Results As compared with the control rabbits, Pt and Po decreased,TPT and 1/2RT prolonged,FI and FRI increased in the only emphysema rabbits.Pt and Po were higher,TPR and 1/2Rt was shorter in the only emphysema rabbits than the rabbits in 40 Hz and(2.5+40) Hz groups(P0.05),more increase in FR and FRI(P