OBJECTIVE:To evaluate the rational use of antimicrobials in 160 cases undergoing orthopaedic operations.MET_HODS:To analyse and evaluate the use of antimicrobials in 160 cases undergoing orthopaedic operations in 1999 in respect to the cost of antimicrobials related cost ratio,usage,clinical efficacy,and adverse drug reactions.RESULTS:The cost of antimicrobials per person()was 1 676.55 yuans and average day of treatment()was (7.3?3.4)d.151 patients healed by first intension.9 patients recovered in delayed healing.The ratio of the total cost,cost of drugs and cost of antimicrobials was 1∶0.38∶0.14.CONCLUSION:The use of the antimicrobials in 160 cases undergoing orthopaedic operations was reasonable.

Objective To detect fibrillin-1 gene (FBN1) mutations in patients with Marfan syndrome (MFS) by denaturing high-pedormance liquid chromatography (DHPLC) and DNA sequencing. Methods Genomic DNA was extracted from whole blood sample of 22 MFS patients. All 65 exens of FBN1 were amplified by polymerase chain reaction(PCR) respectively. Mutations were screened by DHPLC followed by DNA sequencing of the PCR products which showed different DHPLC profiles from the normals. Results Ten mutations of the FBN1 were found in 9 MFS patients. The mutations comprised four missense[5015G > C(C1672S),5309G > A(C1770Y),7241G > A(A2414G) and 7769G > A(C2590Y)], four nonsense [3295G > T ( E1099X ), 430"/insTCGT (G1441X), 4621C > T ( R1541X ) and 8080C > T (A2694X)], and two splice site mutations (IVS29 + 4A > T and IVSSO + 1G > A). Conclusion It is suggested that DHPLC coupled with DNA sequencing is an efficient method for the detection of FBN1 gene mutations, and it may be useful in diagnosis of MFS.

Objective To summarize the key nursing points in patients with monochorionic twins undergoing selective feticide with bipolar electrocoagulation.Methods Selective feticide with bipolar electrocoagulation were performed in 68 monochorionic twins with one twin anomaly.And the perioperative care was performed on the patients.Results Operations were accomplished successfully in 68 cases.No complications,such as infections,premature rupture of membrane and so on,were found in all cases seven days after operation.Conclusions The nursing key points include preoperative psychological nursing by interpretation of the operations,monitoring fetal heart sounds during operations,and close observation of body temperature,uterine contractions and fetal heart rate in pregnant women after operations.Careful perioperative nursing is helpful for improvement of operative success and to ensure normal development of fetus.

Objective To evaluate the changes in the expression of small intestinal thioredoxin 2 (Trx2) during different periods after orthotopic liver autotransplantation (OLAT) in rats.Methods Forty Sprague-Dawley rats,aged 8-10 weeks,weighing 210-260 g,were randomly divided into 2 groups using a random number table:sham operation group (group S,n =8) and OLAT group (n =32).Intestinal tissues were removed at 4,8,16 and 24 h after OLAT for microscopic examination and for determination of the levels of superoxide anion (O2--),hydrogen peroxide (H2 O2),glutathione peroxidase (GSH-Px),reduced glutathione (GSH) and Trx2.Intestinal damage was assessed and scored according to Chiu.Results Compared with S group,the Chiu's score and O2--activity at 4,8 and 16 h after OLAT and H2O2 content at 4 and 8 h after OLAT were significantly increased,and the levels of GSH-Px and GSH and expression of Trx2 at 4 and 8 h after OLAT were decreased in OLAT group (P ＜ 0.05).Chiu' s score at 4,16 and 24 h after OLAT and H2O2 content at 16 and 24 h after OLAT were significantly lower than those at 8 h in OLAT group (P ＜ 0.05).Conclusion The rats undergo decreased antioxidant capacity in the early phase and recovery in the late phase mediated by small intestinal Trx2 after OLAT.

[Objective] To summarize the perioperative nursing points during the amnioreduction by fast and negative pressure drainage.[Methods] Amniodrainage and associated nursing care were performed in 93 hydramnios cases of pregnant women from January 2006 to December 2010,and the nursing key points were summarized.[Results] Operations were performed successfully in 93 hydramnios cases of pregnant women.No complications occurred in 92 eases 3 d after operation.Bellyache and uterine contraction occurred in one case 2h after operation,which indicated placental abruption,two dead fetuses were got out by cesarean section.[Conclusions] The nursing key points included preoperative psychological nursing by interpretation of the operation,monitoring fetal heart sounds and close observation of contrac-tions in pregnant women.Careful perioperative nursing for patients with hydramnios is important to improve the success rate and reduce postoperative complications.

Objective To evaluate the effect of deferoxamine on ventilator-associated lung injury in rats.Methods Twenty-four healthy male Sprague-Dawley rats,aged 6-8 weeks,weighing 250-300 g,were divided into 3 groups (n =8 each) using a random number table method:control group (group C),ventilator-associated lung injury group (group VALI),and ventilator-associated lung injury plus deferoxamine group (VALI+DFO group).Normal saline 2 ml was intraperitoneally injected in C and VALI groups,and deferoxamine 200 mg/kg (dissolved in 2 ml normal saline) was intraperitoneally injected in group VALI+DFO.The animals were connected to a small animal ventilator 15 min later and mechanically ventilated in volume-controlled mode,with tidal volume 40 ml/kg,respiratory rate 40-60 breaths/min,inspiratory/expiratory ratio 1 ∶ 1,and inspired oxygen fraction ratio 1.0.The rats were sacrificed after the end of mechanical ventilation,and the left lung tissues were removed for examination of the pathological changes (with a light microscope) which were scored and for determination of wet/dry weight ratio (W/D ratio).The right lung was lavaged,and lavage fluid was collected to prepare macrophage suspension,and the alveolar macrophage and mitochondrial reactive oxygen species (ROS) levels were determined using flow cytometry.Results Compared with group C,the pathological score,W/D ratio of lung tissues,and alveolar macrophage and mitochondrial ROS levels were significantly increased in group VALI,and the pathological score was significantly increased in group VALI (P＜0.05).Compared with group VALI,the pathological score,W/D ratio of lung tissues,and alveolar macrophage and mitochondrial ROS levels were significantly decreased in group VALI and DFO (P＜0.05).Conclusion Deferoxamine can reduce ventilator-associated lung injury,and the mechanism may be related to inhibiting oxidative stress in rats.

To search for nasopharyngeal carcinoma (NPC) biomarkers,laser capture microdissection (LCM) was used to purify the target cells from NPC and normal nasopharyngeal epithelial tissues (NNET). Two-dimensional gel electrophoresis (2-DE) was performed to separate the total proteins of microdissected NPC and NNEC,PDQuest software was applied to analyze 2-DE images,and the differential protein spots between the two types of tissues were identified by both MALDI-TOF-MS and ESI-Q-TOF-MS. The expression of cytokeratin 8(CK8),one of the differential proteins,in the microdissected NPC and NNEC as well as 4 NPC cell lines with different differentiated degrees and/or metastatic potentials was detected by Western blot. Immunohistochemistry was also used to detect the expression of CK8 in paraffin-embedded tissues including 63 cases of primary NPC,28 cases of NNET and 20 cases of cervical lymphonode metastasis. In the present study,2-DE patterns of microdissected NPC and NNEC were established,and 29 differential proteins in the above two tissues were identified,of which 15 only expressed or up-regulated in NPC and 14 only expressed or up-regulated in NNET. The expression level of differential protein CK8 between the NPC and NNET was selectively confirmed,and was found to be related to the differentiation and/or metastasis of NPC cell lines. Significant down-regulation of CK8 was observed in NPC compared with NNET,and significant up-regulation of CK8 was also observed in lymphonode metastasis compared with primary NPC. The data suggest that CK8 may be related to the differentiation and lymphonode metastasis of NPC,and may serve as molecular biomarkers for metastasis and differentiation of NPC.

【Objective】 To evaluate the safety and effectiveness of Perioperative Transfusion Trigger Score (POTTS) in guiding surgical patients blood transfusion intraoperatively and postoperatively. 【Methods】 A total of 900 patients(perioperative Hb 60~100 g/L) from December 2017 to March 2021 were collected, including 251 males and 649 females, with ASA grading Ⅰ~Ⅳ, and randomly divided into experimental group and controls. In the experimental group, the allogeneic RBC transfusion trigger(Hb threshold) and transfusion units in anemia patients was determined by POTTS. While those in the controls were decided by physicians according to current guidelines concerning transfusion. The proportion and units of allogeneic RBC transfusion, the incidence of postoperative complications, the mortality of hospitalization and discharge for 4 weeks, Hb value, healing of surgical incision, ICU admission rate and ICU length of stay, length of hospitalization, etc were recorded. 【Results】 The proportion of allogeneic RBC transfusion in the experimental group(35.3%)were less than the controls(42.2%)(P<0.05). The units of allogeneic RBC transfused, incidence of postoperative complications and mortality in hospital and 4 weeks after surgery, healing of surgical incision (grade A/ grade B/ grade C), the Hb level 24 h after surgery and at discharge, the ICU admission rate and ICU length of stay, length of hospitalization were not significantly different between the groups. 【Conclusion】 The peri-operative allogeneic red blood cells transfusion guided by POTTS can reduce the proportion of allogeneic RBC transfusion, and is safe and effective.

OBJECTIVETo understand the distribution of diarrheagenic Escherichia (E.) coli in population in Shanghai and discuss the practice model of cooperation in enteric infectious disease prevention and control between public health institution and hospital.

METHODSSentinel hospitals were assigned, standard detection and identification of diarrheagenic E. coli were conducted, incidence curve of diarrheagenic E. coli infection was drawn and epidemiologic survey and laboratory detection were conducted for suspect diarrheagenic E. coli infection outbreaks.

RESULTSA total of 7 204 stool specimens were collected from diarrhea patients in 4 hospitals during 2012-2013, in which 712 (9.9% ) were diarrheagenic E. coli positive, including 351 enteropathogenic E. coli (EPEC) strains, 292 enterotoxigenic E. coli (ETEC) strains, 32 enteroinvasive E. coli(EIEC) strains and 6 Shiga toxin-producing E. coli (STEC/EHEC) strains, as well as 31 mixed strains. EPEC infection mainly occurred in children aged 1-5 years; and all of these infections were caused by aEPEC. The incidence peak of ETEC infection was during August, the positive rate was >20%. The ETEC infection mainly occurred in infants aged 1-28 days in 2012 and in people aged 20-60 years in 2013 (P<0.05). ST was the major type (59.6%), followed by LT (27.8%) and ST/LT (12.6%). EIEC infection increased in children obviously in 2013 (P<0.01). No EHEC O157:H7 case was detected, but two EHEC O26:H11 (eae-hlyA-stx1a) cases in children were reported for the first time in Shanghai. The survey result indicated that the multidrug-resistant ETEC (STh-CS21-CFA/I-ClyA-EatA-ST2332-SHNL0005) strain causing outbreak in 15 newborns in Shanghai in 2012 was in the same clone as the strain detected in Zigong in Sichuan province.

CONCLUSIONSignificant change has occurred in diarrheagenic E. coli distribution in Shanghai in recent years, ETEC has potential risk to cause outbreak of hospital acquired infection in neonates and food borne infection. The active surveillance on ETEC and other enteric pathogens by both public health institutions and hospitals need to be improved.

Adult ; Child, Preschool ; China ; epidemiology ; Diarrhea ; microbiology ; Disease Outbreaks ; Enteropathogenic Escherichia coli ; isolation & purification ; Enterotoxigenic Escherichia coli ; isolation & purification ; Escherichia coli Infections ; epidemiology ; Humans ; Incidence ; Infant ; Infant, Newborn ; Middle Aged ; Sentinel Surveillance ; Young Adult