Background Despite national and international guidelines and recommendations, inappropriate prophylactic antibiotic use for clean wound surgery remains a common phenomenon in many Chinese hospitals, causing higher medical costs and bacterial resistance. Objective To improve the prescribing behavior for antibiotic prophylaxis and decrease antibiotic abuse and/or misuse in clean wound surgery. Setting The teaching hospital of a medical university in Southwest China. Methods A collaborative multidisciplinary program involving educational, technical, and administrative strategies was undertaken. It was characterized by a monthly evaluation by clinical pharmacists for randomly selected cases of clean wound surgery, as well as a group discussion attended by correlative personnel, consisting of the administrative staff, experts from the Rational Drug Use Committee, clinical pharmacists and surgeons. Main outcome measure The overall incidence of antibiotic prophylaxis, appropriate antibiotics selection, appropriate initial dosage timing, proper drug combination and the duration of antibiotic prophylaxis were measured. Results from 2009 to 2014, the rate of antibiotic prophylaxis for clean wound surgery declined from nearly 100% to 20-30%. Improvements were also observed in drug selection, timing of the first dose, and dosage and duration for antibiotic prophylaxis. Broad-spectrum antibiotics and enzyme inhibitors have seldom been used after 2011. The medical cost for antibiotics also decreased. Conclusion A collaborative multidisciplinary program, together with a group discussion, is efficient for improving rational antibiotic prophylaxis for clean wound surgery. This study indicates that clinical pharmacists can play a pivotal role in providing the professional evaluation of medical cases, education, and intervention.
Near-infrared laser provides a novel nerve stimulation modality to regulate the cell functions. Understanding its physiological effect is a prerequisite for clinic laser therapy applications. Here, the whole-cell sodium (Na) channel kinetics of neuron cell was employed to determine the temporal roles of infrared laser. The Na currents were elicited by electrical pulses that were synchronized at the rising and falling edges of the 980 nm laser pulses, respectively, to investigate the different infrared effect on cell functions. The time constants of activation (τ(m)) and inactivation (τ(h)) kinetics were extracted from fitting of the Na current (m(3)h) according to the Hodgkin-Huxley (HH) model. By comparing the time constants without and with the laser irradiation, we obtained that laser pulses changed the Na current kinetics by accelerating τ(h)-phase and slowing down τ m-phase at the beginning of the laser pulse, whereas both phases were accelerated at the end of the pulse. After relating the ratios of the time constants to the temperature characteristics of Na channel by Q10, we found that the accelerating in Na current kinetics could be related to the average temperature of extracellular solution in the corresponding time span by choosing Q10 = 2.6. The results of this study demonstrated that there was a positive correlation between the acceleration of the Na current kinetics and increases in temperature of the extracellular solution.
This study aimed to compare the effects of moderate versus deep hypothermia anesthesia for Stanford A aortic dissection surgery on brain injury. A total of 82 patients who would undergo Stanford A aortic dissection surgery were randomized into two groups: moderate hypothermia group (MH, n = 40, nasopharyngeal temperature 25 °C, and rectal temperature 28 °C) and deep hypothermia group (DH, n = 42, nasopharyngeal temperature 20 °C, and rectal temperature 25 °C). Different vascular replacement techniques including aortic root replacement, Bentall, and Wheat were used. The intraoperative and postoperative indicators of these patients were recorded. There were no differences in intraoperative and postoperative measures between MH and DH groups. The concentrations of neuron-specific enolase and S-100β increased with operation time, and were significantly lower in MH group than those in the DH group (P < 0.05). The occurrence rates of complications including chenosis, postoperative agitation, and neurological complications in MH group were significantly lower than in DH group. The recovery time, postoperative tube, and ICU intubation stay were significantly shorter in MH group than those in DH group (P < 0.05). There were no significant differences revealed in hospital stay and death rate. MH exhibited better cerebral protective effects, less complications, and shorter tube time than DH in surgery for Stanford A aortic dissection.
Photothermal effect (PE) plays a major role in the near-infrared laser interaction with biological tissue. But, quite few interactions can be quantitatively depicted. Here, a two-step model is proposed to describe a 980-nm infrared laser interaction with neuron cell in vitro. First, the laser-induced temperature rises in the cell surrounding area were measured by using an open pipette method and also calculated by solving the heat conduction equation. Second, we recorded the modifications on sodium (Na) channel current in neuron cells directly by using a patch clamp to synchronize the 980-nm laser irradiation and obtained how the electrophysiological function of neuron cells respond to the temperature rise. Then, the activation time constants, τ(m), were extracted by fitting the sodium currents with the Hodgkin-Huxley model. The infrared laser modulation effect on sodium currents kinetics was examined by taking a ratio between the time constants with and without the laser irradiations. The analysis revealed that the averaged ratio at a specific laser exposure could be well related to the temperature properties of the Na channel protein. These results proved that the modulation of sodium current kinetics of a neuron cell in vitro by 980-nm laser with different-irradiation levels was linearly mediated corresponding to the laser-induced PE.
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