Clinical relationship between carbapenem-resistant Klebsiella pneumoniae infection and the severity of acute pancreatitis / 中华消化外科杂志

Objective:To investigate the clinical relationship between carbapenem-resis-tant Klebsiella pneumoniae (CRKP) infection and the severity of acute pancreatitis. Methods:The retrospective and descriptive study was conducted. The clinicopathological data of 109 patients with acute pancreatitis who were admitted to Sir Run Run Shaw Hospital affiliated to Zhejiang University School of Medicine from January 2017 to January 2018 were collected. There were 66 males and 43 females, aged (48±17)years. Blood, body fluid or anal swab samples of patients were collected aseptically. Patients were treated with gallbladder puncture and drainage, nasobiliary drainage, surgical debridement, computed tomography (CT) guided interventional drainage or conservative treatment, respectively, after being comprehensively diagnosed. Observation indicators: (1) severity of acute pancreatitis and results of CRKP infection test; (2) diagnostic value of CRKP infection for severity of acute pancreatitis; (3) treatment of acute pancreatitis; (4) prognosis of patients. Measurement data with normal distribution were represented as Mean± SD, and comparison between groups was conducted using the t test. Measurement data with skewed distribution were represented as M(range). Count data were described as absolute numbers, and comparison between groups was conducted using the chi-square test. Spearman correlation analysis were performed for correlation analyses. The receiver operating characteristic (ROC) curve was conducted to evaluate the diagnostic value. Results:(1) Severity of acute pancreatitis and results of CRKP infection test: of 109 patients, there were 37 cases with mild acute pancreatitis, 8 cases with moderate-severe acute pancreatitis, 64 cases with severe acute pancreatitis. There were 45 cases with mild disease and 64 cases with severe disease, 48 cases with CRKP infection and 61 cases without CRKP infection. There were 3 cases and 45 cases with CRKP infection in the 45 mild disease cases and 64 severe disease cases, respectively, showing a significant difference ( χ2=43.430, P<0.05). Result of Pearson correlation analysis showed that CRKP infection was positively correlated with the severity of acute pancreatitis ( r=0.631, P<0.05). The duration of hospital stay were (66±6)days and (24±3)days for the cases with CRKP infection and cases without CRKP infection, respectively, showing a significant difference ( t=47.661, P<0.05). (2) Diagnostic value of CRKP infection for severity of acute pancrea-titis: the area under the ROC curve, sensitivity, and specificity of CRKP infection for the diagnosis of SAP were 0.799 (95% confidence interval as 0.714?0.885, P<0.05), 0.688, and 0.911, respectively. (3) Treatment of acute pancreatitis: of 109 patients, 17 cases underwent nasobiliary drainage, 19 cases underwent gallbladder puncture and drainage, 42 cases underwent surgical debridement, 48 cases underwent CT guided interventional drainage and 43 cases underwent conservative treatment. One patient may undergo multiple treatments. Of 109 patients, 66 patients underwent one and more invasive treatments with 47 cases undergoing CRKP infection and 43 patients did not undergo invasive treatment with 1 case undergoing CRKP infection, respectively, showing a significant difference ( χ2=50.134, P<0.05). (4) Prognosis of patients: all 109 patients were followed up for 3?9 months, with a median follow-up time of 6 months. During the follow-up, there were 15 cases and 6 cases dead in the 48 cases with CRKP infection and the 61 cases without CRKP infection, respec-tively, showing a significant difference ( χ2=7.919, P<0.05). Conclusion:CRKP infec-tion is positively correlated with the severity of acute pancreatitis, and CRKP infection is associated with the duration of hospital stay and types of invasive treatments.

Analysis of Drug Use of Anti-infective Treatment for a 400 g Super-premature Infant by Clinical Pharmacists / 中国药房

OBJECTIVE：To optimize the ant i-infective treatment plan for the super-premature infants and provide reference for the clinical treatment of the super-premature infants and the whole pharmaceutical care. METHODS ：A super-premature infant with gestational age of 25+5 weeks and weight of 400 g was delivered in the second department of neonatology in Hunan Maternal and Child Health Hospital. This child suffered from complex complications. Clinical pharmacists ，relevant medical staff and hospital infection department personnel formed a multidisciplinary treatment team. According to Neonatal Sepsis Treatment Scheme ， Antimicrobial Treatment Guide ，Premature Medicine ，combining with the analysis of infection indicators ，biochemical indicators ， vital signs and other indicators ，a individualized anti-infective diagnosis and treatment plan was developed for the child. After entering the NICU ，this child was given Piperacillin sodium and sulbactam sodium for injection （100 mg/kg，ivgtt，q12 h）for anti-infective treatment ；considering the possibility of sepsis ，clinical pharmacists suggested that Piperacillin sodium and sulbactam sodium for injection should be stopped and Meropenem for injection （40 mg/kg，ivgtt，q12 h）should be used instead. After 7 day of meropenem treatment ，clinical pharmacists suggested adding antifungal Fluconazole injection （5.0 mg/kg，ivgtt，qod）. After 11 days of meropenem treatment ，in order to avoid the aggravation of infection ，according to the drug sensitivity results （sensitive to Ticarcillin sodium and clavulanate potassium for injection ），clinical pharmacists suggested adding Ticarcillin sodium and clavulanate potassium for injection （75 mg/kg，ivgtt，q8 h）for combined anti-infective treatment ，and hospital infection treatment was carried out at the same time. After the infection index was stable ，all antibiotics were stopped. When E. coli infection occurred later，clinical pharmacists suggested that Piperacillin tazobactam sodium for injection （75 mg/kg，ivgtt，q8 h）should be used. After the infection aggravated ，Piperacillin tazobactam sodium for injection was stopped and Imipenem cilastatin sodium forinjection（20 mg/kg，ivgtt，q8 h）was used instead. The child received ladder treatment after the decline of infection index ，and Ceftazidime for injection （50 mg/kg，ivgtt，q12 h）was used. RESULTS ：The doctors adopted the above suggestions. After treatment ，the prognosis of the child was good ，the vital signs were stable ，and the body weight reached 3 000 g at discharge. CONCLUSIONS ：For preterm infants as special group ，before using antibiotics ，clinical pharmacists should focus on the vital signs ，infection indicators and laboratory test results of the child ，so as to help doctors improve the treatment plan and ensure the effectiveness and safety of their medication.

Factors associated with malnutrition among infants and young children aged 6-23 months in poor rural areas in Hunan Province, China / 中华预防医学杂志

Objective@#To describe the situation and identify factors associated with malnutrition among infants and young children aged 6-23 months in poor rural areas in Hunan Province in 2015.@*Methods@#8 735 rural infants and young children aged 6-23 months in 30 poor counties of Wuling Mountains and Luoxiao Mountains in Hu'nan province were selected by township-level probability proportional to size sampling (PPS) in August 2015, infants' body length and weight were measured, and questionnaires were used to collect infants' information on personal and family, and feeding status in the past 24 h. The prevalence of stunting, underweight and wasting were calculated according to the Growth Standards of Child Aged Under 7 in China which was established in 2009 by Community Health Department of National Health and Family Planning Commission, China (formerly Chinese MOH), and the prevalence of malnutrition was calculated according to the classification of children with anthropometric failure. Multi non-conditional logistic regression model were used to analyze factors associated with malnutrition among infants and young children aged 6-23 months.@*Results@#The prevalence of malnutrition among infants and young children aged 6-23 months was 13.7% (1 198/8 735), the prevalence of stunting, underweight and wasting among infants and young children aged 6-23 months were 4.8% (419/8 735), 9.7% (849/8 735) and 6.1% (531/8 735) respectively. Compared with male group, the OR value of malnutrition for the female group was 1.16; Compared with Han ethnic group, the OR value of malnutrition for the Miao and Tujia ethnic group were 0.83 and 0.66, respectively; Compared with mother with an education level of primary school or below, the OR value of malnutrition for the mother with junior high school, senior high school and university or above education were 0.65, 0.61 and 0.56, respectively; Compared with father with an education level of primary school or below, the OR value of malnutrition for the father with senior high school and university or above education were 0.71 and 0.61 respectively; Compared with normal birth weight group, the OR value of malnutrition for the low birth weight group and high birth weight group were 2.85 and 0.27 respectively; Compared with normal delivery group, the OR value of malnutrition for the premature delivery group was 1.37; all P values<0.05.@*Conclusion@#The prevalence of malnutrition among infants and young children aged 6-23 months in poor rural areas in Hunan province in 2015 was high; Infants and young children who were female, Han ethnic, parents with low education, low birth weight and premature delivery had higher risk of malnutrition.

Status of, and factors associated with, complementary feeding among infants and young children aged 6- 23 months in poor rural areas of Hunan Province, China / 中华预防医学杂志

Objective@#To describe the status of, and to identify the factors associated with, complementary feeding among infants and young children aged 6- 23 months in poor rural areas of Hunan Province, China.@*Methods@#A total of 8 735 infants and young children aged 6- 23 months from 30 poor rural counties in the Wuling and Luoxiao Mountains in Hunan Province were selected by township-level probability-proportional-to-size sampling in August 2015. Questionnaires were used to collect information on the feeding status of the infants in the previous 24 hours, along with personal/family information. The qualified rate of minimum dietary diversity (MDD), the minimum meal frequency (MMF) and the minimum acceptable diet (MAD) were calculated according to the WHO indicators for assessing infant and young child feeding practices. Multi non-conditional logistic regression models were used to analyze factors associated with complementary feeding among infants and young children aged 6- 23 months.@*Results@#The findings indicated that 73.9% (6 452/8 735) of infants and young children aged 6-23 months received the minimum dietary diversity, 81.6% (7 124/8 735) of infants and young children aged 6- 23 months received the minimum meal frequency and 49.0% (4 276/8 735) of infants and young children aged 6- 23 months received an acceptable diet. Compared with the boys, the OR for the MMF and MAD for the girls were 1.15 and 1.11, respectively. Compared with the 6-11 month group, the OR for the MDD for the 12-17 month and 18-23 month groups were 0.41 and 0.38, respectively; the OR for the MMF for the 12-17 month and 18-23 month groups were 1.53 and 2.46, respectively; and the OR for the MAD for the 12-17 month and 18-23 month groups were 0.60 and 0.60, respectively. Compared with the Han ethnic group, the OR for the MDD, MMF and MAD for the Miao ethnic group were 1.43, 1.72 and 1.56, respectively; for the Tujia ethnic group were 2.21, 2.02 and 2.11, respectively; and for the Dong ethnic group were 0.62, 0.61 and 0.64, respectively. When analyzing data related to the children's mothers, compared with women who gestated at the age of 25- 29, the OR for the MMF for women who gestated at less than 20 years of age was 1.59 and at greater than or equal to 35 years of age was 1.33. Compared with women with primary school education or below, the OR for the MDD, MMF and MAD for women with junior high school education were 0.77, 0.74 and 0.80, respectively; for women with senior high school education were 0.67, 0.65 and 0.68, respectively; and for women educated to university level or above were 0.66, 0.47 and 0.60, respectively. Compared with the normal birth weight group, the OR for the MMF for the low birth weight group was 0.71, and for the high birth weight group was 1.30. Compared with the caregivers who provided qualified feeding knowledge, the OR for the MDD, MMF and MAD for the caregivers who provided unqualified feeding knowledge were 1.45, 1.30 and 1.40, respectively. Compared with the breastfed group, the OR for the MDD and the MMF for the non-breastfed group were 0.53 and 0.36, respectively. All P values were <0.05.@*Conclusion@#Most infants and young children aged 6-23 months in poor rural areas of China met the MDD and MMF requirements, but fewer met the MAD requirements. The risk factors in infants and young children for complementary feeding included being of female gender, lower in age (months), of Miao or Tujia ethnicity, being born to a mother who gestated at less than 20 or ≥35 years of age, being born to a mother of low education, having a high birth weight, having a caregiver who provided unqualified feeding knowledge and being breastfed.

Influential factors associated with 2-week prevalence of fever and diarrhea among infants and young children at the age of 6-23 months in poor rural areas / 中南大学学报(医学版)

Objective:To investigate the status and influential factors associated with 2-week prevalence of fever and diarrhea among infants and young children at the age of 6-23 months in poor rural areas.Methods:A total of 8 735 rural infants and young children aged 6-23 months in 30 poor counties of Wuling Mountains and Luoxiao Mountains in Hunan Province were selected in August 2015,and the questionnaires were used to collect information on the prevalence of fever and diarrhea,person and families,and feeding status.The data for prevalence of fever and diarrhea in infants and young children were calculated,and multi-non-conditional logistic regression model were used to analyze the influential factors.Results:The 2-week prevalence of fever and diarrhea in infants and young children was 20.8％ and 12.2％ respectively.The ages (OR=0.66,95％CI 0.58 to 0.75),Dong ethnicity(OR=1.42,95％CI 1.17 to 1.74) and low body weight (OR=1.31,95％CI 1.11 to 1.54) were influential factors for fever among infants and young children in poor rural areas;female (OR=0.86,95％CI 0.76 to 0.98),12-17 months (OR=0.80,95％CI 0.69 to 0.93),18-23 months (OR=0.51,95％CI 0.43 to 0.60),other ethnic minorities (OR=1.70,95％CI 1.13 to 2.56),non-complementary feeding (OR=1.65,95％CI 1.05 to 2.59) and low body weight (OR=1.39,95％CI 1.14 to 1.70) were the influential factors of diarrhea among infants and young children.Conclusion:The 2-week prevalence of fever and diarrhea among infants and young children aged 6-23 months in poor rural areas were quite serious.Low age,Dong ethnicity,and low birth weight are high risk factors for fever.Male,no addition of complementary feeding,and low birth weight are high risk factors for diarrhea.

Optimization of Ultrasonic-Assisted Extraction of Epimedin C and Icariin from Epimedii Wushanensis Herba by Using Response Surface Methodology / 中国中医药信息杂志

Objective To optimize ultrasonic-assisted extraction Epimedin C and Icariin from Epimedii Wushanensis Herba by response surface methodology. Methods On the basis of single factor tests, Box-Behnken experimental design and response surface methodology were adopted to optimize extraction conditions with the concentration of ethanol, ultrasonic time and solid-liquid ratio as factors. HPLC was used to determine the content of Epimedin C and Icariin from Epimedii Wushanensis Herba. Results Optimal ultrasound-assisted extraction technology was as following: the concentration of ethanol was 73%; the ultrasonic time was 22 min; the ratio of liquid to material was 1:32. The contents of Epimedin C and Icariin from Epimedii Wushanensis Herba were 15.90% and 0.75%, respectively. Conclusion This extraction technology can improve the extraction efficiency of Epimedin C and Icariin from Epimedii Wushanensis Herba, which is in accordance with predicted value.

Effect of different compatibility of tetramethylpyrazine on its pharmacokinetics in vivo / 中国中药杂志

<p><b>OBJECTIVE</b>To study the pharmacokinetics of single administration and different compatibility of tetramethylpyrazine (TMP) in rats.</p><p><b>METHOD</b>Thirty two Sprague-Dawley rats were randomly divided into 4 groups: the TMP (30 mg x kg(-1)) group, the TMP+FA (30 mg x kg(-1) + 50 mg x kg(-1)) group, the TMP+TET (30 mg x kg(-1) mg x kg(-1)) group and the TMP+FA+TET (30 mg x kg(-1) + 50 mg x kg(-1) + 20 mg x kg(-1)) group. After the oral administration, their blood samples were collected to detect plasmas concentrations by HPLC method and to calculate pharmacokinetic parameters DAS 2.0 program.</p><p><b>RESULT</b>In compatibility with FA, AUC(0-t), Cmax and Tmax showed no significant difference with the single administration of TMP, but t(1/2) and MRT,, were obviously longer than the single administration. In compatibility with TET and FA + TET, AUC (0-t), Cmax and Tmax showed significant increase than the single administration of TMP, whereas t(1/2) and MRT0, did not notably vary from the single administration.</p><p><b>CONCLUSION</b>FA can prolong TMP's action time in rats, and TET can accelerate TMP's absorption in rats.</p>

Comparative study on pharmacokinetics of tetramethylpyrazine, ferulic acid and their compatibility / 中国中药杂志

<p><b>OBJECTIVE</b>To study the pharmacokinetics of tetramethylpyrazine (TMP), ferulic acid and their compatibility.</p><p><b>METHOD</b>Twenty-four Sprague-Dawley rats were randomly divided into 3 groups: TMP 20 mg x kg(-1), ferulic acid 20 mg x kg(-1) and TMP 20 mg x kg(-1) + ferulic acid 20 mg x kg(-1). All the rats were given intragastric administration then blood samples were obtained from fossa orbitalis at several time points. All the plasmas concentrations were analyzed by HPLC method and the data were treated by DAS 2.0 program.</p><p><b>RESULT</b>The main pharmacokinetics parameters of TMP 20 mg x kg(-1) group, ferulic acid 20 mg x kg(-1) and TMP 20 mg x kg(-1) + ferulic acid 20 mg x kg(-1) were as follows: t(max) 0.5 h, t1/2 0.856 h,MRT 1.321 h, AUC 5.112 microg x h(-1) x L(-1), C(max) 2.834 microg x L(-1); t(max) 0.083 h, t1/2 1.024 h, MRT 1.324 h, AUC 1.581 microg x h(-1) x L(-1), C(max) 1.492 microg x L(-1); t(max) 0.583 h, t1/2 37.901 h, MRT 3.798 h, AUC 4.097 microg x h(-1) x L(-1), C(max)1.571 microg x L(-1); t(max) 0.6 h, t1/2 7.860 h, MRT 2.894 h, AUC 1.984 microg x h(-1) x L(-1), C(max) 1.03 microg x L(-1), respectively.</p><p><b>CONCLUSION</b>The experiments suggested that the compatibility of TMP and ferulic acid had interaction in pharmacokinetics; all the t1/2 and MRT were prolonged and had the effect of lente liberates.</p>

Relationship of tetramethylpyrazine on expression of vascular endothelial growth factor and development of adjuvant-induced arthritis in rats / 中国中药杂志

<p><b>OBJECTIVE</b>To explore the effect of tetramethylpyrazine (TMP) on the expression of vascular endothelial growth factor (VEGF) in the synovium of adjuvant-induced arthritis (AIA) in rats.</p><p><b>METHOD</b>AIA rats were treated with different doses of TMP. The effects of treatment were monitored by footpad thickness, contents of tumor necrosis factor-alpha (TNF-alpha) in serum, microvessel density (MVD) and the expression of VEGF protein in the synovium.</p><p><b>RESULT</b>Compared with arthritis model, 100 mg x kg(-1) TMP could remarkably reduce the footpad thickness, contents of TNF-alpha in serum and the expression of VEGF in the synovium.</p><p><b>CONCLUSION</b>TMP can attenuate the degree of chronic inflammation in AIA rats, and its mechanism might be associated with inhibiting the expression of VEGF.</p>

Quality Standard Study on Danqi Tablets / 浙江中医药大学学报

[Objective] To set up standard method of quality to Danqi Tablets.[Method] Take HPLC to make nature authentication,take reverse HPLC to test the content of salvianolc acid B in the preparation.[Result] The authentication is strong in attribute and has good repetition,the measurement has good linear relation,the recycle rate is 101.7%,RSD 1.77%.[Conclusion] The quality standard can effectively control the quality of Danqi Tablets.