Successful treatment of acute leukemia by secondary transplantation after the first haploidentical hematopoietic stem cell transplantation failure / 器官移植

Objective To evaluate the feasibility of secondary transplantation for patients with acute leukemia after failure of the first haploidentical hematopoietic stem cell transplantation. Methods Two acute leukemia patients underwent the first haploidentical hematopoietic stem cell transplantation from two donors with thalassemia, and the number of collected CD34+ cells was 2.57×106/kg and 1.99×106/kg per donor, respectively. The first haploidentical hematopoietic stem cell transplantation failed. Secondary transplantation was performed from two non-thalassemia donors, and the number of collected CD34+ cells was 4.28×106/kg and 5.75×106/kg per donor, respectively. A reduced-intensity conditioning regimen consisting of fludarabine (Flu), busulfan (Bu) and antithymocyte globulin (ATG) was adopted for the secondary transplantation. Results For two recipients, the time of secondary transplantation of neutrophil and platelet was +12 d and +10 d, +10 d and +10 d, respectively. Up to the final follow-up (+1 062 d and +265 d after secondary transplantation), the primary diseases of both two recipients have been completely relieved without evident post-transplantation complications. Conclusions Secondary transplantation with reduced-intensity conditioning regimen may successfully treat acute leukemia after failure of the first haploidentical hematopoietic stem cell transplantation.

Drug monitoring of omalizumab in treatment of 2 children with high level IgE allergic asthma / 药学实践杂志

Objective To explore the clinical efficacy and safety of the omalizumab treatment in children with high level IgE allergic asthma. Methods The clinical data of 2 children with allergic asthma treated with omalizumab in the Departemnt of Respiratory Medicine of Shanghai Children’s Hospital from August 2020 to May 2021 were retrospectively analyzed, and they had regular follow-up after end of treatment. The dosage and course of treatment, therapeutic effect and adverse drug reactions of omalizumab were analyzed. Results After receiving omalizumab treatment, asthma symptoms were well controlled, the dosage of inhaled corticosteroids during asthma treatment were reduced and nasal symptoms were relieved. 20 subcutaneous injections were received by 2 children, and no adverse reactions were found. After the treatment, regular pharmaceutical follow-up showed that the children were in good health. Conclusion Omalizumab is suitable for high level IgE allergic asthma and can improve asthma control symptoms with good long-term safety. However, the appropriate dosage and course of treatment still need further experience accumulation.

Effect and safety of Guanxinning tablets combined with antiplatelet therapy on acute coronary syndrome / 中国基层医药

Objective:To investigate the effect and safety of Guanxinning tablets combined with antiplatelet therapy on acute coronary syndrome. Methods:A total of 120 patients with acute coronary syndrome who received treatment in Shulan (Hangzhou) Hospital from January 2021 to December 2021 were included in this study. They were randomly divided into a control group and a study group ( n = 60/group). The control group was treated with antiplatelet drugs clopidogrel and aspirin. The study group was treated with clopidogrel, aspirin and Guanxinning tablets in combination. All patients were treated for 3 months. The levels of blood lipids (high-density lipoprotein cholesterol, total cholesterol, triglyceride, low-density lipoprotein cholesterol), C-reactive protein, tumor necrosis factor-α, endothelin-1, and vascular endothelial growth factor measured before and after treatment as well as the incidence of adverse reactions were compared between the two groups. Results:After treatment, serum levels of low-density lipoprotein cholesterol, total cholesterol, and triglyceride in each group were significantly decreased compared with those measured before treatment (all P < 0.05). After treatment, serum level of high-density lipoprotein cholesterol in each group was significantly increased compared with that measured before treatment ( P < 0.05). After treatment, serum levels of total cholesterol, low-density lipoprotein cholesterol, and triglyceride in the control group were (4.36 ± 1.01) mmol/L, (3.02 ± 0.28) mmol/L, and (1.98 ± 0.12) mmol/L respectively which were significantly higher than (3.98 ± 1.05) mmol/L, (2.52 ± 0.42) mmol/L, (1.58 ± 0.23) mmol/L in the study group ( t = -2.02, -7.67, -11.94, all P <0.05). Serum level of high-density lipoprotein cholesterol in the control group was significantly lower than that in the study group [(1.26 ± 0.08) mmol/L vs. (2.36 ± 0.16) mmol/L, t = 47.63, P < 0.001). After treatment, serum levels of C-reactive protein and endothelin-1 in the control group were (5.62 ± 0.56) mg/L and (86.24 ± 12.68) pg/L, respectively, which were significantly higher than (4.32 ± 0.82) mg/L and (75.26 ± 12.46) pg/L in the study group, ( t = -10.14, -4.78, both P < 0.001). After treatment, serum levels of tumor necrosis factor-α and vascular endothelial growth factor in the control group were (5.62 ± 0.56) mg/L and (76.28 ± 13.52) pg/L, which were significantly lower than (8.76 ± 1.06) mg/L and (86.32 ± 13.46) pg/L in the study group ( t = 20.23, 4.08, both P < 0.05). The incidence of adverse reactions in the study group was significantly lower than that in the control group [5.00% (3/60) vs. 8.33% (5/60), χ2 = -0.54, P > 0.05). Conclusion:Guanxinning tablets combined with antiplatelet has a remarkable therapeutic effect on acute coronary syndrome. It is highly safe and has a clinical application value.

Melatonin inhibits UVB-induced melanin synthesis by regulating p53-mediated premature senescence in HaCaT cells / 中华放射医学与防护杂志

Objective:To explore the mechanism and regulatory effects of melatonin on UVB-induced melanin synthesis in human immortalized keratinocytes (HaCaT), so as to provide a theoretical basis for the skin protection of melatonin.Methods:HaCaT cells were pretreated with 10 -5 mol/L melatonin and then irradiated with 80 mJ/cm 2UVB. The melanin content was detected by NaOH assay, the proportion of premature senescence cells was detected by β-galactosidase staining kit, and the protein expression levels of both p53 and tyrosinase (TYR) were detected by Western blot at 72 h after UVB exposure. After 12 h pretreatment of ATM/ATR inhibitor, p53 inhibitor and melatonin, the proportion of premature senescence and the change of melanin content in HaCaT cells were detected at 72 h after 80 mJ/cm 2 UVB irradiation. Results:Melatonin inhibited UVB-induced increases of melanin content ( t=56.65, 13.39, P<0.05) and TYR expression ( t=16.46, P<0.05) in HaCaT cells. Melatonin alleviated UVB-induced premature senescence ( t=7.139, P<0.05) and inhibited UVB-induced increase of p53 expression ( t=19.08, P<0.05) in HaCaT cells. In addition, ATM/ATR inhibitor, p53 inhibitor and melatonin all inhibited UVB-induced increase of melanin content in HaCaT cells. Conclusions:Melatonin inhibits TYR-mediated melanin synthesis by regulating p53-related premature senescence in HaCaT cells after UVB irradiation.

Microorganisms in the typical anaerobic digestion system of organic solid wastes: a review / 生物工程学报

The facultative anaerobic and strict anaerobic microorganisms enriched and acclimated during the anaerobic digestion process are crucial for the efficiency of the anaerobic digestion system. Most of the problems encountered during running anaerobic digestion processes could be effectively improved via stimulation of microbial metabolic activity. Benefited from the rapid development of microbiome techniques, deeper insights into the microbial diversity in anaerobic digestion systems, e.g. the microbe-microbe interactions and microbe-environment interactions, have been gained. A complex and intricate metabolic network exists in the anaerobic digestion system of solid organic wastes. However, little is known about these interactions and the underlying mechanisms. This review briefly summarized the representative interactions between microbial communities during anaerobic digestion process discovered to date. In addition, typical issues encountered during the anaerobic digestion of solid organic wastes and how microbes can tackle and alleviate these issues were discussed. Finally, future priorities on microbiome research were proposed based on present contribution of microbiome analysis in anaerobic digestion system.

Incidence of acute kidney injury following cardiac surgery and related risk factors in 4 878 patients / 中华肾脏病杂志

Objective:To investigate the incidence of acute kidney injury (AKI) following cardiac surgery and related risk factors in 4 878 patients.Methods:The information from patients who underwent cardiac surgery through March 2015 to October 2015 was collected retrospectively from the electronic database of Beijing Anzhen Hospital. A total of 4 878 patients were divided into AKI group and non-AKI group according to whether AKI occurred within 7 days after cardiac surgery. The incidence of AKI was calculated, and the AKI incidence in different types of cardiac surgeries were compared. Clinical data such as baseline clinical information, operation information, comorbidity, hospital stay time, life ability score in discharge from the hospital, and so on, were compared between AKI group and the non-AKI group using univariate analysis. Risk factors for AKI following cardiac surgery were analyzed using the binary multivariate logistic regression.Results:A total of 933 patients suffered from AKI (19.1%) following cardiac surgery. The time of stay in the hospital was longer in AKI group than that in the non-AKI group [(14.4±8.9) vs (13.7±7.7) d, P<0.05)]. The incidence of AKI in different types of cardiac surgeries varied significantly ( P<0.001). The logistic regression analysis showed that male, diabetes, hypertension, the elevated basic serum creatinine, cardiac dysfunction (NYHA grade≥Ⅲ), cardiopulmonary bypass, a combination of operations≥3, the rethoracotomy exploration and hemostasia, and using an invasive ventilator for over 96 hours were the independent risk factors for the AKI following cardiac surgery (all P<0.05), and the odds ratio (95% confidence interval) were 1.81(1.46-2.24), 1.29(1.03-1.62), 5.85(4.73-7.22), 1.81(1.36-2.40), 4.49(3.60-5.60), 1.84(1.49-2.27), 23.24(18.25-29.59), 2.34(1.45-3.77) and 1.94(1.09-3.43) respectively. Conclusions:The incidence of AKI after cardiac surgery in Beijing Anzhen Hospital is 19.1%. AKI following cardiac surgery prolongs the time of stay in the hospital. Independent risk factors for AKI following cardiac surgery are multiple, and one of the most critical factors is a combination of operations≥3.

Application of the selective bcl-2 inhibitor venetoclax in hematologic malignancies / 白血病·淋巴瘤

Resistance to apoptosis is a key carcinogenic mechanism in hematologic malignancies. bcl-2 is considered to be an important anti-apoptotic protein of endogenous apoptosis pathway and bcl-2 targeting inhibition has become one of research hotspots of anti-hematologic malignancies. Venetoclax, a selective bcl-2 inhibitor, has been used in the treatment of chronic lymphocytic leukemia (CLL), acute myeloid leukemia (AML) and mantle cell lymphoma (MCL). This paper reviews the role of bcl-2 family in the regulation of apoptosis and advances of venetoclax in hematologic malignancies.

Clinical risk stratification ofde novo DSA after kidney transplantation based upon eplet mismatch / 中华器官移植杂志

Objective To compare HLA loci versus eplet match in predicting de novo DSA after renal transplantation and establish a risk stratification scheme based upon eplet mismatch for predicting the risk of de novo DSA .Methods A retrospective analysis of HLA serological versus and eplet mismatch was performed for 141 pairs of donors and recipients .And the predictive power of de novo DSA was evaluated by the follow-up results .Based upon eplet mismatch ,a preliminary scheme of risk stratification was established and experimentally verified .Results No significant difference existed in HLA serological mismatch between de novo DSA and DSA negative groups (10 .40 vs 8 .94 ,P=0 .1224) while there was a significant difference in eplet mismatch (100 .60 vs 70 .37 , P< 0 .0001 ) . The risk stratification scheme based upon HLA serological mismatch could not differentiate de novo DSA-free rates between low/medium/high-risk groups (100％ vs 94 .74％ vs 90 .41％ , P=0 .4485 , P=0 .4506 , P=0 .2060 ) .Instead the novel scheme based upon eplet mismatch revealed significant difference in the prevalence of de novo DSA between low /medium/high-risk groups (100％ vs 91 .04％ vs 66 .67％ ,P=0 .0001 ,P=0 .0001 ,P<0 .0001) .Conclusions As a better tool of predicting de novo DSA ,Eplet match is vital for the risk stratification scheme of de novo DSA .

Exploration of PBL and mini-CEX in the clinical probation teaching for medical students of eight-year program in hematology department / 中华医学教育探索杂志

Objective The study explored the feasibility of PBL teaching approach and mini-CEX scores evaluation method in hematology probation teaching practice. Methods 54 medical students of eight-year program were selected in the study and they were in hematology department of Sun Yat-sen Memorial Hospital for clinical probation. The study compared PBL teaching approach with traditional training method, and used mini-CEX to evaluate the students' clinical competence. Results The performance of PBL teaching group is better than traditional teaching group in the aspect of inquiry skill, clinical diagnosis, therapy plan and humanistic care (P<0.05). There is no significant difference of basic knowledge, physical examination skill and clinical operational skills between these two groups. More than 85％of the students in PBL group are satisfied with the teacher in the aspect of participation, feedback, guidance, correction and assistance. Conclusion Through this teaching practice, the study provides new methods for improving the teaching of pre-internal clinical practice in hematology department.

Practice of PDCA Method in the New Specialties Accreditation of Drug Clinical Trial Institution / 中国药房

OBJECTIVE:To explore the effects of PDCA method in the new specialties accreditation of drug clinical trial institution. METHODS:PDCA method was used for drug clinical trial institution office and 9 newly applied majors in our hospital. Total score of each major were compared before and after intervention,in order to make the newly applied major meet the standard of specialties accreditation of drug clinical trial. RESULTS:After conducting PDCA related training,establishing new specialties accreditation work group,formulating work goals and plans,9 new majors of our hospital were all approved by CFDA for new specialties accreditation;after intervention total score of each accreditation item for newly applied major were all higher than before intervention,with statistical significance(P<0.05),improved by more than 45.57%. CONCLUSIONS:It is feasible to adopt PDCA method in the preparation of new specialty accreditation of drug clinical trials. It is of significance to guarantee scientific and reliable drug clinical trial results and protect the rights and interests of the subjects.

Earlier renal fibrosis aggravates acute kidney injury induced by ischemia reperfusion in mice / 中华肾脏病杂志

Objective To investigate the influence of earlier renal fibrosis on ischemia and reperfusion induced acute kidney injury. Methods Male C57BL/6 mice at eight to twelve weeks old age were divided into 4 groups randomly: (1)Sham (n=3); (2)Unilateral ureter obstruction (UUO, n=6):UUO for 3 days (UUO3d, n=3) and UUO for 5 days (UUO5d, n=3);(3)Ischemia and reperfusion (IR, n=7): bilateral kidney ischemia for 40 minutes followed by 24 hours of reperfusion; (4)UUO for 3 days plus IR (UUO3d+IR, n=6): bilateral kidney ischemia after UUO 2 days for 40 minutes followed by 24 hours of reperfusion, and the real time for UUO was 3 days. Pathologic analysis for acute or chronic injury was performed on paraffin embedded kidney sections with hematoxylin and eosin (HE) or Masson staining. Apoptosis was detected by immunohistochemistry(IHC) and Western blotting with anti-caspase-3 antibody, and proliferation was observed by IHC with anti-ki67 antibody. Results On kidney sections with HE or Masson staining, it showed that the chronic kidney lesions and fibrosis got more severe as time of UUO prolonged from 3 days to 5 days; the area of matrix deposition increased in UUO5d and UUO3d mice significantly compared to Sham mice (P<0.05) and was smaller in UUO3d mice compared with UUO5d mice obviously (P<0.05). Acute kidney injury could be observed in UUO3d+IR mice, such as massive inflammatory cells infiltration, tubules dilation, brush border disappearance, tubular epithelial cells vacuolar degeneration, necrosis, casting formation, coexisting with chronic lesions: thinner cortex, broadened interstitial space, and increased blue stained matrix. Acute kidney injury score in UUO3d+IR mice was higher than that in IR mice significantly (P<0.05), and serum creatinine level increased significantly in UUO3d+IR mice compared to Sham mice (P<0.05). Caspase-3 expression increased and ki67 positive tubular cells decreased in UUO3d+IR mice than those in IR mice obviously (P<0.05). Conclusion Earlier renal fibrosis aggravates acute kidney injury induced by ischemia reperfusion in mice through increasing apoptosis and decreasing proliferation of tubular epithelial cells.

Risk Factors for Mortality of Bloodstream Infections in Patients with Hematologic Diseases / 中山大学学报(医学科学版)

[Objective] To explore the risk factors for mortality of bloodstream infections in the patients with hematologic diseases,so as to provide evidence for reasonable and effective application of treatments.[Methods] The clinical data of 242 cases of bloodstream infections who were hospitalized from Jan 2012 to Jun 2016 were analyzed retrospectively,then the analysis was performed for risk factors.The statistical analysis was processed by SPSS 19.0.[Results] A total of 266 strains of pathogens were isolated,including 99 strains of gram-positive bacteria,accounting for 37.2％,and 164 strains of gram-negative bacteria,accounting for 61.7％.Multivariate analysis showed that the significant independent risk factors for mortality were active states of hematologic diseases (P =0.007,OR =5.622,95％ CI 1.586 ～ 19.924),presentation with septic shock(P =0.007,OR =4.978,95％ CI 1.560 ～15.884),cardiac insufficiency (P =0.001,OR =11.878,95％ CI 2.760 ～ 51.120),level of albumin less than 35 g/L (P =0.036,OR =3.468,95％ CI 1.087 ～ 11.066),polymicrobial infection (P =0.010,OR =6.024,95％ CI 1.540 ～ 23.563),and Staphylococcus haemolyticus (P =0.001,OR =19.308,95％ CI 3.392 ～ 109.888)/Enterococcus (P =0.002,OR =15.266,95％ CI 2.817 ～82.728) infection.The survival curves show that the inappropriate initial antimicrobial therapy group or presentation with any one of the independent risk factors had a lower probability of survival than the control group.[Conclusions] Bloodstream infections in patients may cause high mortality rate,so it is necessary that we use antibiotic reasonably and spare no effort to reduce the mortality rate by appropriate application of antimicrobial therapy and effective intervention of the risk factors.

Effect of vein pump injection of epinephrine on serum potassium during gastric cancer radical surgery / 实用医学杂志

Objective To investigate vein pump injection of epinephrine on the effect of serum potassium during gastric cancer radical surgery. Method Forty patients with ASA grade Ⅱ~Ⅲ underwent surgery within a time limit of gastrointestinal under general anesthesia. All patients were randomly divided into the experimental group and the control group.Patients in the experimental group received continuous intravenous injections of adren-aline[0.03 to 0.1 μg/(kg·min)].Patients in the control group received equal dose of saline.Potassium concentra-tions at different time points were determined and compared between patients in two groups. Results No signifi-cant differences were observed in gender and age distribution of patients in the experimental group and the control group. Compared with the control group,potassium concentration was significantly decreased in patients at T3mo-ment(30 min pump injection of norepinephrine)(P<0.05),but was lower than that of patients in the experimen-tal group at T1moment(before anesthesia)(P<0.05).Compared with the control group,potassium concentration was significantly increased in the experimental group at T4moment(pump adrenaline injection for 10 min)(P <0.05),which was also significantly higher than that in the experimental group at T1moment(P < 0.05). Mean-while,compared with the control group,potassium concentration was also significantly increased in the experimen-tal group at T5moment(stop the pump adrenaline injection for 30 min),which was also significantly higher than that in the experimental group at T1moment(P < 0.05). Conclusions Intravenous injection of adrenaline can reduce potassium concentration in patients received gastrointestinal surgery,and potassium concentration can be increased after adrenalin injection was stopped.

Effects of different group B streptococci strains on platelet activation / 中国病理生理杂志

AIM:To explore the ability of different group B streptococci ( GBS) strains on inducing platelet activation.METHODS:Six strains of GBS, separated from the septic patients with thrombocytopenia, were used as the inducers.Light transmission aggregometry was used to measure platelet aggregation.Scanning electron microscopy ( SEM) was performed to investigate the interaction of platelets with bacteria.The expression of platelet CD62P, Toll-like receptor 2 ( TLR2) and TLR4 was determined by flow cytometry and Western blotting.Furthermore, the activity of platelet TLR2 (or TLR4) was blocked by anti-TLR2 (or anti-TLR4) monoclonal antibody, and the platelet aggregation induced by GBS was detected.RESULTS:Only 3 of 6 GBS strains isolated from the septic patients induced platelet aggregation and up-regulated the expression of CD62P and TLR2 in the platelets (P<0.05), but not TLR4.Incubation with anti-TLR2 anti-body, but not anti-TLR4 antibody, significantly blocked platelet aggregation induced by GBS.CONCLUSION:Some GBS strains from the patients are able to trigger platelet activation in vitro, and platelet TLR2 may play an important role in the interaction between GBS and platelets.

BRICS AIDS medicines and antiretroviral therapy protection strategy and implications for China / 中国卫生政策研究

BRICS has been dealing with the problem of increase in the number of the patients who require an-tiretroviral therapy and this therapy’s price-rise by promoting medicine to domestic production and reducing the impor-ted drug price. This paper reviewed the situation of BRICS HIV epidemic and prevention, anti-retroviral therapy drugs production and supply, drug security policy and strategy, and the following seven recommendations are straight forwarded to China based on the BRICS AIDS antiretroviral treatment coverage strategic comparison:(1) The estab-lishment of an ARV drugs co-ordination mechanism;(2) The reduction of the drug patent licenses while increasing the domestic generic drugs possibility;(3)Negotiations with the original research process of domestic pharmaceutical enterprises to obtain a voluntary license or speed up the technology transfer;(4) The use of antitrust laws to promote access to medicines for a voluntary license pharmacy localization; ( 5 ) If necessary, starting the compulsory medi-cines licensing to achieve localization;(6) Reducing the drug prices by bargain and negotiation;and (7) Strengthe-ning NGO built-in capacity.

Systematic Review of the Efficacy and Safety of Prostaglandin E1 Combined with Hydration for the Preven-tion of Contrast-induced Nephropathy / 中国药房

OBJECTIVE:To systematically evaluate the efficacy and safety of prostaglandin E1 combined with hydration for the prevention of contrast-induced nephropathy(CIN)and provide evidence-based reference for the clinical treatment. METHODS:The PubMed,Medline (Ovid),EMbase (Ovid),Cochrane Library,VIP,CJFD and WanFang database were retrieved to collect the randomized controlled trails(RCT)of prostaglandin E1 combined with hydration for the prevention of CIN. After information collec-tion and methodology quality evaluation,the Meta-analysis was performed using Rev Man 5.3 software. RESULTS:12 RCTs involv-ing 1 732 patients were included. The results of Meta-analysis showed that the incidence of CIN in test group was significantly low-er than control group[RR=0.40,95%CI(0.30,0.53),P<0.001],the incidence of phlebitis was higher than control group [RR=10.18,95%CI(1.37,75.67),P=0.02] and there was no significant difference in the need rate of renal replacement between test group and control group[RR=0.44,95%CI(0.12,1.61),P=0.21]. CONCLUSIONS:Intravenous prostaglandin E1 combined with hydration can effectively reduce the incidence of CIN. Occurance of phlebitis should be paid attention to. Due to the limited quality and sample of included studies,it remains to be further verified by high-quality and large-sample RCT.

Analysis of the Cause and Preventive Measures of 26 Cases of Medication Errors of High-alert Drugs in the Outpatient Prescriptions of Our Hospital / 中国药房

OBJECTIVE:To provide reference for reducing and avoiding medication errors of high-alert drugs in outpatient de-partment. METHODS:The medication errors of high-alert drugs in outpatient prescriptions were collected from our hospital during 2013-2014,and then analyzed retrospectively in terms of the type and degree of medication error,caused factors of medication er-rors,etc. RESULTS:670 997 prescriptions were checked in two years,and 501 medication errors were found,including 26 medi-cation errors of high-alert medication. There were 7 incorrect route of administration of insulin,1 repeated medication and 1 incor-rect dose of oral hypoglycemic agents,6 repeated administration of opioid drugs and non steroidal anti-inflammatory drugs,2 indi-cation error of paracetamol and codeine phosphate,1 specification and 1 indication error of glucose injection,2 route of administra-tion error of lidocaine,2 administration frequency errors of methotrexate,2 dose error of digoxin and 1 dose error of warfarin;18 doctors'prescribing errors were found by pharmacists'prescription audit,accounting for 69.2%;8 doctors'prescribing errors were not found by pharmacists'prescription audit,accounting for 30.8%. CONCLUSIONS:Medication errors of high-alert drugs occur mainly in the prescription segment,and the main reason is that the electronic prescription system lack of compulsory strategy and policy constraints. Improvement of safety administration of high-alert drugs need to find the error link and adopt targeted medi-cation safety practices.

Pharmaceutical Practice for a Patient with Hiatal Hernia Complicating with Venous Catheter-related Infection / 中国药房

OBJECTIVE:To provide reference for clinical desicion,drug use and ADR avoidance. METHODS:Clinical pharmacists participated in the consultations and therapy plan about a patient with hiatal hernia complicating with venous catheter- related infections. Clinical pharmacists suggested pulling out peripherally inserted central catheter(PICC)and placing a catheter again. Anti-infective therapy plan had been adjusted:vancomycin 0.5 g/time,ivgtt,q12 h;fluconazole 0.2 g,ivgtt,qd(0.4 g,ivgtt,qd on the first day),cefoperazone/sulbactam 2 g,ivgtt,q8h. Vancomycin and fluconazole were additionally used for anti- infective therapy. RESULTS:Doctors adopted the suggestions of clinical pharmacist,and pulled out PICC;and then the infection of the patient was controlled effectively. Finally,the infection had been cured. CONCLUSIONS:The participation of clinical pharmacists in the consultation contributes to rational drug use,and assists doctors to make the right clinical decisions and avoid adverse drug events.

Quality management at 2 0 hospitals in Shanghai and recommendations / 中华医院管理杂志

Objective To learn the present hospital management conditions in Shanghai for upgrading quality of care.Methods The stratified sampling method was used for a questionnaire survey of the quality of care at 20 hospitals in Shanghai (10 tertiary hospitals and 10 secondary hospitals).The survey covered such six dimensions as organizational framework,management functions,management tools,professional training,regulations and norms,and supervision over operations.Results Medical quality management system is established at such hospitals and all of them have established medical quality management committees.Rooms of improvement remain in such details as departmental quality management,regulations standardization,IT support,and management tools popularity.Conclusion Management regulations and standards of medical quality management should be improved and implemented from both external and internal aspects,to improve medical quality and patient safety.

Prevalence of informing of HIV infection status during medical care seeking and influential factors among people living with HIV/AIDS / 中华流行病学杂志

<p><b>OBJECTIVE</b>To understand the prevalence of informing doctors of the HIV infection status during medical care seeking and influential factors among people living with HIV/AIDS.</p><p><b>METHODS</b>The study was conducted among people living with HIV/AIDS in 7 provinces in China, including those receiving HIV test, HIV counsel and HIV infection treatment. The data were analyzed with software SAS 9.2. Chi-square test was used to compare the informing rates in patients with different characteristics. Univariate and multivariate logistic regression analyses were conducted to identify the influential factors.</p><p><b>RESULTS</b>Of the 2 432 HIV/AIDS patients, 49.7% (716/1 442) didn't inform the doctors of their HIV infection status actively. The non-active informing rate was 51.9% (559/1 077) in males, 62.9% (212/337) in age group 18-30 years old, 58.1% (555/955) in those with a educational level >primary school, 65.7% (241/367) in those working in private/joint companies or the self employed and 62.5% (197/315) in those living in small cities. The non active informing rate was highest in those infected through sexual contact (66.3%, 275/415). Multivariate logical regression analysis indicated that those infected through illegal blood donation would like to inform of the HIV infection status actively (OR=0.083, 95% CI: 0.049-0.141) , but those working in private/joint companies or the self employed would like not to inform of the HIV infection status actively (OR=1.531, 95% CI: 1.017-2.304).</p><p><b>CONCLUSION</b>The non active informing rate of HIV infection status was high in people living with HIV/AIDS. It is necessary to conduct the targeted health education to encourage people living with HIV/AIDS to inform of their HIV infection status actively.</p>