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Objective:To investigate the relationship between the changes of immune indexes and prognosis in patients with sepsis.Methods:Based on the hospitalization information from 2008 to 2019 in the American Medical Information Mart for Intensive Care-Ⅳ v2.0 (MIMIC-Ⅳ v2.0), the hospitalized data including CD3 count, CD4 count, CD8 count, CD4/CD8 ratio, immunoglobulins (IgA, IgG, IgM) levels and lymphocyte counts, gender, age, body mass index (BMI), sequential organ failure assessment (SOFA), and prognosis of patients with coronary heart disease, hypertension, diabetes mellitus, underlying diseases, and 28-day prognosis were collected. The immunological indexes affecting the prognosis of patients with sepsis were compared and analyzed. The receiver operator characteristic curve (ROC curve) was drawn to analyze the value of immunological indexes in predicting the 28-day prognosis of patients with sepsis.Results:A total of 33 745 patients were enrolled in the study, including 1 509 cases of sepsis and 32 236 cases without sepsis. Among the patients with sepsis, there were 1 084 cases alive and 425 cases died within 28 days. BMI (kg/m 2: 33.25±28.71 vs. 28.90±15.28) and IgA levels within 3 days and 7 days after admission in sepsis group were significantly higher than those in the non-sepsis group [within 3 days after admission: (275.01±216.96) mg/L vs. (85.99±75.76) mg/L; within 7 days after admission: (275.01±216.96) mg/L vs. (85.99±75.76) mg/L, all P < 0.05]. CD3 count, CD8 count within 3 days and 7 days after admission in sepsis group were significantly lower than that in the non-sepsis group [within 3 days after admission: CD3 counts were (1 080.74±849.23)/μL vs. (1 242.91±889.24)/μL, CD8 counts were (558.07±368.77)/μL vs. (625.07±529.66)/μL; within 7 days after admission: CD3 counts were (1 079.69±850.61)/μL vs. (1 242.48±889.23)/μL, CD8 counts were (556.70±467.23)/μL vs. (624.93±429.78)/μL, all P < 0.05]. The proportion of patients with hypertension, diabetes and coronary heart disease were significantly higher than those in the non-sepsis group [hypertension: 10.07% (152/1 509) vs. 2.47% (796/32 236), diabetes: 50.10% (756/1 509) vs.15.18% (4 895/32 236), coronary heart disease: 31.21% (471/1 509) vs. 19.19% (6 186/32 236), all P < 0.05]. In the sepsis group, the CD3 count, CD4 count and CD4/CD8 ratio in the survival group were significantly higher than those in the death group within 3 days and 7 days after admission [within 3 days after admission: CD3 counts were (1 127.20±857.14)/μL vs. (938.26±810.50)/μL, CD4 counts were (559.76±507.18)/μL vs. (338.75±267.11)/μL, CD4/CD8 ratios were 1.87±0.80 vs. 1.02±0.12; within 7 days after admission: CD3 count were (1 124.01±810.53)/μL vs. (943.78±808.21)/μL, CD4 count were (559.56±507.36)/μL vs. (341.95±266.56)/μL, CD4/CD8 ratios were 1.88±0.79 vs. 1.03±0.13, all P < 0.05]. The area under the ROC curve (AUC) of CD4/CD8 ratio within 3 days after admission in predicting the prognosis of septic patients at 28 days was 0.615 [95% confidence interval (95% CI) was 0.555-0.671], the sensitivity was 70.83%, and the specificity was 52.49%. Conclusions:Hypertension, coronary heart disease and diabetes are more likely to induce sepsis. The changes of immune indexes in patients with sepsis will occur in the early stage. Early CD4/CD8 index can predict the prognosis of patients with sepsis to a certain extent.
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Objective:To investigate the correlation between heart rate variability (HRV) and early neurological deterioration (END) and poor outcomes in patients with branch atheromatous disease (BAD).Methods:Patients with BAD admitted to the Department of Neurology, Weihai Municipal Hospital from September 2020 to September 2022 were enrolled prospectively. END was defined as an increase of ≥2 points in the total score of the National Institutes of Health Stroke scale (NIHSS) or an increase of ≥1 in motor item score within 72 h of admission compared with the baseline. Poor outcome was defined as the score of the modified Rankin Scale >2 at 6 months after the onset. Multivariate logistic regression analysis was used to determine whether HRV parameters were the independent influencing factors of END and poor outcomes in patients with BAD. Results:A total of 117 patients with BAD were enrolled, including 76 males (65.0%), aged 64.27±6.95 years. Thirty-eight patients (32.4%) had END, and 21 (17.9%) had poor outcomes. Percentage of the number of pairs of adjacent R-R intervals differentiating by more than 50 ms (pNN50), number of adjacent R-R intervals differentiating by more than 50 ms (NN50), power in low frequency range (LF) and power in high frequency range (HF) in the END group were significantly lower than those in the non-END group, and the LF/HF ratio was significantly higher than the non-END group (all P<0.05). The standard deviation of the R-R interval (SDNN), standard deviation of the average of R-R intervals in all 5-min segments (SDANN), and HF in the poor outcome group were significantly lower than those in the good outcome group. Multivariate logistic regression analysis showed that HF (odds ratio [ OR] 0.994, 95% confidence interval [ CI] 0.991-0.998; P<0.001) was an independent protective factor of END in patients with BAD, and LF/HF ratio ( OR 1.455, 95% CI 1.056-2.005; P=0.022) was an independent risk factor for END in patients with BAD; SDANN ( OR 0.997, 95% CI 0.993-0.999; P=0.023) was an independent protective factor of good outcomes in patients with BAD. Conclusion:HF and LF/HF ratios are the independent influencing factors of END in patients with BAD, and SDANN is an independent influencing factor of the poor outcomes in patients with BAD, suggesting that autonomic dysfunction is involved in the pathophysiological mechanism of END and poor outcomes in patients with BAD.
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Thrombotic thrombocytopenic purpura (TTP) is a rare hematological disease with typical clinical manifestations of thrombocytopenic purpura, microangiopathic hemolytic anemia, neurological symptoms, fever and kidney damage. Two patients with TTP-associated cerebral infarction complicated with microhemorrhage and their shared specific imaging findings manifestations were reported. The magnetic resonance imaging of the 2 patients showed multiple cerebral infarctions at different stages. Susceptibility-weighted imaging showed cerebral microbleeds in the infarcted area. This special imaging feature can provide important clues for early identification and diagnosis of TTP nervous system injury.
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Objective To explore the main characteristics and influencing factors of military pharmacy postgraduates' creative ability,providing the basis for the creative ability training and education management of military pharmacy postgraduate students.Methods Full-time graduate students of three military medical colleges and universities were participated in this study,and questionnaire survey was carried out on 428 military pharmacy postgraduates by cluster random sampling.SPSS 16.0 was used to process descriptive analysis,t-test,F-test,correlation analysis and multiple regression analysis for data analysis.Results The creative ability of military pharmacy postgraduates is better than average (the median is 3),and the ability to construct knowledge was significantly higher than that of finding problems,solving problems and the ability of improvement and transformation (F=39.024,P＜0.001).The creative ability of doctoral students in grade three was higher than that of the master students in all grades (F=2.602,P＜0.05).The extrinsic motivation was significantly higher than intrinsic motivation (t=4.327,P＜0.001),and the interaction between teachers and students was significantly higher than that among students them-selves (t=6.755,P＜0.001).On the institutional category,it showed statistically significant in the training concept,the training subject,the training condition,the intrinsic motivation,the interaction between teachers and students,and the interaction among students themselves (t=-1.962,P＜0.05;t=2.697,P＜0.01;t=-2.593,P＜0.01;t=2.938,P＜0.01;t=4.595,P＜0.001;t=2.984,P＜0.01).The significant predictive effects on improving the creative ability of military pharmacy postgraduates were shown by training concept,training methods,academic atmosphere,intrinsic motivation,interaction between teachers and students,and the interaction among students themselves (F=48.711,P＜0.001).Conclusion The creative ability of military pharmacy postgraduates is in the middle level,and the important influencing factors lie in themselves and schools.The education departments should construct the innovation ability training model from the concept of innovation training,teaching methods,scientific research team,atmosphere of innovation,incentive mechanism and other aspects.
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Objective To observe the incidence of acute gastrointestinal injury (AGI) in intensive care unit (ICU) patients, and to approach the value of serum citrulline and intestinal fatty acid binding protein (IFABP) on diagnosis of AGI in critical patients. Methods A prospective study was conducted. 576 critical patients admitted to ICU of Yantai Yuhuangding Hospital from February 2016 to February 2017 were enrolled. According to the AGI classification proposed by European Society of Intensive Care Medicine (ESICM) in 2012, the AGI and severity of the patients were observed. The general data, severity and prognosis of patients with different AGI grades were recorded. According to the random number table, 20 patients with normal kidney function from AGI Ⅰ to Ⅳ were selected. The femoral artery blood was collected within 12 hours of ICU admission, and serum citrulline level was detected by high performance liquid chromatography (HPLC). Serum IFABP level was determined by enzyme-linked immunosorbent assay (ELISA). Twenty healthy subjects were selected as controls. The receiver operating characteristic curve (ROC) was drawn, and the predictive values of citrulline and IFABP for AGI diagnosis were evaluated. Results ① 576 patients were enrolled in the analysis. Of which 530 patients (92.0%) had AGI, and 289 patients with gradeⅠ (54.5%), 154 with grade Ⅱ (29.1%),64 with grade Ⅲ (12.1%), and 23 with grade Ⅳ (4.3%). With the increase in AGI classification, acute physiology and chronic health evaluation system Ⅱ (APACHE Ⅱ) score, sequential organ failure score (SOFA), the length of ICU stay and 28-day mortality were gradually increased. ② Compared with health control group, the levels of serum citrulline in patients with different AGI grades were significantly decreased, and IFABP was significantly increased. With the increase in AGI classification, the citrulline level was gradually decreased, and IFABP level was gradually increased [citrulline levels (μmol/L) in AGIⅠ,Ⅱ,Ⅲ,Ⅳ groups were 14.1±3.6, 12.7±3.1, 8.3±2.7, and 5.6±3.4, F = 3.287, P = 0.027, and IFABP levels (ng/L) were 526.7±204.9, 698.4±273.8, 894.7±455.9, and 1 062.8±532.2, F = 2.903, P = 0.043]. ROC curve analysis showed that citrulline had a higher predictive value for AGI diagnosis. The area under the ROC curve (AUC) was 0.927. When the cut-off value of citrulline was 9.7 μmol/L, the sensitivity and specificity were 87.5% and 87.5%, respectively. The AUC of IFABP was 0.043, which has no predictive value for the diagnosis of AGI. Conclusions The AGI is extremely common in ICU. The higher the AGI grade is, the worse the prognosis is. Citrulline has high diagnostic value for AGI in critical patients, but IFABP has no predictive value on the diagnosis of AGI.
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OBJECTIVE:To study the preventive effect of Qingnao tablet on cerebral ischemia-reperfusion injury in rats. METHODS:Rats were randomly divided into sham operation group,model group,Naoluotong capsule group (positive control, 0.05 g/kg),Qingnao tablet high-dose,medium-dose,low-dose groups(1.52,0.76,0.38 g/kg),10 in each group. Rats in all ad-ministration groups were intragastrically given relevant medicines,rats in sham operation group and model group were intragastrical-ly given equal volume of sodium carboxymethylcellulose solution,once a day,for 5 d. After 1 h of last administration,all rats were induced for cerebral ischemia-reperfusion injury model by suture-occluded method except for sham operation group. After 22 h of ischemia-reperfusion,neurological function deficit scoring was conducted;the pathological changes of the hippocampus were ob-served;superoxide dismutase (SOD),adenosine triphosphate (ATP),lactate dehydrogenase (LDH),tumor necrosis factor α(TNF-α)levels in brain tissue were measured. RESULTS:Compared with sham operation group,rats in model group appeared dif-ferent degrees of neurological deficits(score declined),sparse neurons,irregularly arranged in hippocampus as well as other patho-logical changes;ATP,SOD levels in brain tissue were decreased(P<0.01),LDH,TNF-α levels were increased(P<0.01). Com-pared with model group,neurological function deficit scores in Qingnao tablet doses groups were increased(P<0.05),neurologi-cal deficits were improved. Except for sham operation group,brain tissue indexes in other administration groups were significantly improved(P<0.05 or P<0.01). CONCLUSIONS:Qingnao tablet can increase ATP and SOD levels in brain tissue homogenate of model rats with cerebral ischemia-reperfusion,decrease LDH and TNF-α levels,and obviously improve rats'cerebral ischemia-re-perfusion injury.
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OBJECTIVE:To explore the construction effect of rational drug use monitoring system on the improvement of clini-cal drug use in the hospital. METHODS:The data about the construction of rational drug use monitoring system were collected from our hospital,including pharmacist workstation prescription check(check before prescription/medical order charging to realize warning in advance),clinical pharmacy management system prescription comment(realize prescription/medical order comment after-wards)and adverse drug reaction/adverse drug event(ADR)reporting information platform(realize online ADR reporting)during 2014-2015. The data was analyzed to evaluate the effectiveness of system construction. RESULTS & CONCLUSIONS:There were a total of 3 417 329 prescriptions audited by the pharmacist workstation within 2 years through improving system functions,includ-ing 7 315 prescriptions were returned to doctors to be modified,the percentage of which declined from 0.39% to 0.08%. The pass rate of prescription comment pre-judgment increased from 81.2% to 90.4% in 2015 by clinical pharmacy management system. The valid case number of ADR monitoring and reporting increased from 186 cases to 267 cases,involving all department of our hospi-tal. The construction of rational drug use monitoring system in our hospital can improve the standardization of prescription/medical orders,the level of rational drug use and the case number of ADR,which has achieved the expected results.
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Objective To enhance the understanding of clinical characteristics and genetic testing of chromosome 4q21/q22 deletion syndrome. Methods Chromosomal microarray analysis was used to detect genetic change in a child with special facial appearance and development delay. Results A 15.26-Mb deletion containing 76 geinges in chromosome 4q21.21q22.2 was identiifed. Thus, this girl was diagnosed as chromosome 4q21/q22 deletion syndrome. Conclusions Chromosome 4q21/q22 deletion syndrome has varied clinical manifestations including typical characteristics (such as absolute or relative macrocephaly, megalencephaly with a characteristic head shape and facial appearance, profound hypotonia, small hands and feet, short limbs, feeding difficulties), mental retardation/severe developmental delay, and other system abnormalities ( such as congenital heart disease, seizure, kidney cysts, etc). The diagnosis of chromosome 4q21/q22 deletion syndrome relies on chromosomal microarray analysis.
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OBJECTIVE:To provide reference for the rational use of haemocoagulase hemostatic drugs in the clinic by under-standing the perioperative utilization. METHODS:In retrospective study,1 200 discharge records of perioperative prophylactic ap-plication of haemocoagulase hemostatic drugs were collected randomly during Jan.-Dec. 2014.,and then analyzed statistically in re-spects of consumption sum and amount,application,irrational drug use,etc. The cost of hemocoagulase accounted for 7.39% of total drug cost,among which Haemocoagulase agkistrodon for injection had the highest consumption amount and sum,with utiliza-tion ratio of 51.44%. Average medication time of hemocoagulase during perioperative period was 2.36d;maximal average cost of hemocoagulase was 684.52 yuan in ENT and head and neck surgery department/ stomatology department;ENT and head and neck surgery department/ stomatology department,urinary surgery department had long average medication time,being 3.85d and 3.50d. RESULTS:Only 39.42% haemocoagulase hemostatic drugs were reasonably used during perioperative period. The unreasonable manifestation included:improper medication time(52.15%), too long medication course after operation(35.75%),wrong usage (5.61%)and replacing various haemocoagulase hemostatic drugs without reason(5.06%). CONCLUSIONS:The striking phenome-non of irrational use of haemocoagulase hemostatic drugs during perioperative period is severely worrying,so we need to strength-en the standard management and pharmaceutical supervision and intervention by clinical pharmacists.
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OBJECTIVE:To analyze the problems about the prescription review by the monitoring system for rational drug use (PASS 1.6.1.7) and discuss the countermeasures. METHODS:A retrospective method was adopted. A total of 4 942 prescriptions of our hospital in the first quarter of 2015 were selected at random,and reviewed by PASS and the pharmacist respectively. The re-view results were analyzed,and then countermeasures were put forward for the problems found to exist in the software review. RE-SULTS & CONCLUSIONS:The conformity rates of prescriptions which had been determined as acceptable through PASS review and pharmacist review were 81.20% and 97.40% respectively. PASS misjudged 929 (18.80%) rational prescriptions as irrational ones,mainly concerning administration and dosage,simultaneous existence of Western medicine and Chinese patent medicine on one prescription,repeated drug use and use with caution,etc. PASS misjudged 122(2.47%)irrational prescriptions as rational pre-scriptions,mainly concerning administration and dosage,inconformity between diagnosis and drug use,etc. The above-said prob-lem was attributed to imperfect hospital management and insufficient software intelligence. It is suggested that the hospital should strengthen the data maintenance and management of information system and PASS developer should improve software rules to in-crease the accuracy rate of prescription review.
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Objective To provide a valid tool for assessment of the interpersonal climate of research teams by develo -ping a team interpersonal climate questionnaire .Methods Based on literature research and panel study , a pilot question-naire was constructed and handed out to a sample of 378 research graduate students in research teams .The analysis of va-lidity and reliability was conducted by SPSS 16.0 and Amos 17.0 for the questionnaire.Results The interpersonal climate in research teams is a two-facet concept , including mentor-mentee dyadic interpersonal relationship .The peer interpersonal relationship.The mentor-mentee dyadic interpersonal relationship consists of five dimensions: identification, support, developmental direction, individualized care , effectiveness of relationship , with the alpha coefficient ranging fron 0.931 to 0.959, while peer interpersonal relationship has only one dimension .Conclusion ①The interpersonal climate is a two-facet, six-dimension concept .②The self-developed interpersonal climate questionnaire achieves satisfactory validity and reliability .
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Objective To investigate the intervention effect of motivational interviewing health education based on trans-theoretical model to hospitalized patients with cerebral infarction on their healthy diet cognition and behavior change.Methods 60 patients with cerebral infarction were selected with convenient sampling method,and in accordance with the incorporating order randomly divided them into the intervention group and the control group,each with 30 cases.The intervention group received the motivational interviewing health education based on the trans-theoretical model,which mainly focused on a healthy diet,while the control group received regular health diet education.The intervention effect was compared between two groups.Results The comparative difference of baseline data between the two groups before intervention had no statistical significance,while after intervention the change on knowledge and attitude of these two groups both had statistical significance,but the intervention group improved more obviously than the control group; In regards to behavior change phrase,comparing the healthy eating behavior phase of the intervention group patients before and after the intervention,it was found that before the intervention only 4 cases were on the stage of about-to-change,accounting for 13.3％,but after the intervention the proportion was up to 40.0％ with 12 cases.Using chi-square test to compare the behavior phrase difference of the patients before and after the intervention,the difference was statistically significant.Conclusions Motivational interviewing technique based on the trans-theoretical model is an effective method in terms of cognitive and behavioral change,and the health education will improve the cognition on healthy diet and the behavior of the hospitalized patients with cerebral infarction.
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The prevalence of diabetes mellitus and its relative risk factors in adolescents were investigated in Hanjiang district, Yangzhou. A total of 2 153 adolescents aged from 16 to 18 years old from 7 high schools were enrolled. The prevalence of diabetes mellitus and impaired fasting glucose was 6.13% and 16.12%, respectively. The independent risk factors are obesity or overweight.
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OBJECTIVE:To establish a method for the dissolution determination of Benidipine hydrochloride tablets.METHODS:According to Chinese Pharmacopeia(2005 edition),Benidipine hydrochloride tablets were added into hydrochloride acid 0.1 mo?lL-1 at rotation speed of 50 r?min-1,then samples were obtained after 30 min.The absorbance of samples was detected at detection wavelength of 359 nm and accumulative dissolution was calculated.RESULTS:The linear range of benidipine hydrochloride was 5～30?g?mL-1(r=0.999 9)with an average recovery of 99.76%(RSD=0.47%).The accumulative dissolutions of 3 batches of samples were all above 80%.CONCLUSIONS:Established method is simple and reliable for the dissolution determina-tion of Benidipine hydrochloride tablets.
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OBJECTIVE:To optimize the extraction technology for Huangshen electuary.METHODS:In this experiment the optimum extraction technology for Huangshen electuary was investigated by the L9(34) orthogonal test with the content of Astragaloside Ⅳ as technology index.The effects of three factors including the extraction times,time length of extraction and solvent ratio were investigated.RESULTS:The best extraction technology for Huangshen electuary was as follows:the solid-liquid ratio was 1∶10 and the decoction was carried out for 3 times(2 hours/time).CONCLUSION:The optimum extraction technology for Huangshen electuary is stable and feasible.
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OBJECTIVE:To evaluate the status quo of the use of antiallergic drugs.METHODS:The antiallergic drugs used during 2004～ 2006 in the inpatient pharmacy including the non-surgery department,surgery department and pediatric department of our hospital were analyzed statistically in respect of kinds,consumption sum and DDDs.RESULTS:The antiallergic drugs had a fluctuation in consumption sum and DDDs,showing a reduction in 2006.No significant change was noted in the structure of drug use.CONCLUSION:More and more new antiallergic drugs went on the market,but the application still gives priority to the cheaper kinds.
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Hamayou is the processed oviduct of Rana temporaria chensinensis David or R. amurensis. It is a well known traditional Chinese medicine for nourishing the "Yin" and invigorating the kidney. Products produced in Gansu Province was found to have a coefficient of expansion of 53. 5~66. 8. Its essential aminoacid content was found to be 4. 43% ~5. 22% higher than those produced in the North-eastern Provinces