Objective To observe the clinical effect of percutaneous transluminal angioplasty (PTA)combined with autologous peripheral blood stem cells(PBSC)transplantation in the treatment of lower extremity ischemic disorders.Methods Fourty-two cases of lower extremity ischemic disorders in the treatment group were treated with PTA and autologous peripheral blood stem cells injection and 40 cases in control group were treated with PTA exclusively.Results All the procedures were successful.In treatment group,ABI improved from 0.32 ±0.11 to(at the 3rd month)and 0.49 ±0.13(at the 6th month)(t=-6.765,-6.040,P＜0.05)while TcPO_2 improved from(26.1 ± 2.3)mm Hg to(32.7 ±4.2)mm Hg(at the 3rd month)and(34.5 ±2.7)mm Hg(at the 6th month)(t=-8.901,-14.250,P＜0.05).In control group,ABI improved from 0.30 ±0.12 to 0.47 ±0.15 and 0.47 ±0.130=-5.631,-5.873,P＜0.05)while TcPO_2 increased from(25.9 ±2.4)mm Hg to(28.9 ±2.9)mm Hg(at the 3rd month)and(28.9 ± 2.1)mm Hg(at the 6th month)(t=-5.090,-5.389,P＜0.05).There was significant difference in TcPO_2 on follow-up between the two groups after the treatment(P＜0.05).Conclusion Autologous PBSC transplantation in combination of PTA was effective for the treatment of lower extremity ischemic disorders.PBSC injection helps to increase TcPO_2.

OBJECTIVE:To discuss ward drug control to ensure safe.METHODS:We analyzed retrospectively the application of 5S theory in ward drug control.RESULTS & CONCLUSION:By this drug control mode,drugs were classified according to varieties,usage,frequency of use etc,drug control quality and work efficiency were enhanced,patients' needs could be satisfies and staff' s professional quality was enhanced.

Objective To investigate antimicrobial resistance of Escherichia coli (E.coli )isolated from patients with bloodstream infection,and provide evidence for rational use of antimicrobial agents in clinical practice.Methods BacT/A-lert automated blood culture system and VITEK 2 automated identification system were used for bacterial culture and identi-fication.Antimicrobial susceptibility testing and detection of extended-spectrum β-lactamases (ESBLs)-producing strains were performed by Kirby-Bauer method.Results From 2009 to 2011 ,a total of 235 strains of E.coli were isolated from patients with bloodstream infection,90 (38.30%)of which were ESBLs positive strains.The resistant rates of ESBLs-producing strains to ampicillin,cefotaxime and ceftriaxone were all 100%,but susceptibility rate to imi-penem/cilastatin and meropenem were all 100%,to cefmetazole and amikacin were >90%.The resistant rate of non-ESBLs-producing strains to ampicillin was the highest (70.63%),susceptibility rate to imipenem/cilastatin and meropenem were both 100%,to amikacin,cefotaxime,and cefmetazole were all >95%.The resistant rate of ES-BLs-producing strains was significantly higher than that of the non-ESBLs-producing strains.Ofβ-lactamase inhibi-tor,only susceptibility rate of ESBLs-producing E.coli to cefoperazone/sulbactam was>90%,susceptibility rates to piperacillin/tazobactam and ticarcillin/clavulanate were both<80%.Conclusion Antimicrobial resistant rate of ESBLs-producing strains causing bloodstream infection is high,individualized treatment strategies should be made according to antimicrobial resistance of bacteria causing infection in patients.

Objective To investigate the genotype of carbapenem-resistant Acinetobacter baumannii(CRAB) acquired from intensive care units (ICUs) environment in Shanghai hospitals and to evaluate the gene homology of CRAB isolated from patients and environment in ICUs in Shanghai hospital.Methods Sixty-one CRAB isolated from ICUs environment in Shanghai hospitals and 14 strains isolated from ICUs patients in S hospital were typed by REP-PCR based DiversiLab system.Results There were 7 types of the CRAB isolated from ICUs environment in Shanghai hospitals.Type G1 was the dominant type,accounting for 75.4％ of all CRAB,mainly in 13 hospitals in Shanghai.The percentage of the 7 types CRAB strains were 75.4％,13.1％,3.3％,1.6％,1.6％,3.3％ and 1.6％,respectively.Except for 1 strain of type G6 isolated in D hospital,type G1 CRAB was identified in every hospital which was isolated CRAB.There were 25 strains isolated from patients and environment in S hospital ICUs,which were divided into 4 types.Type G1 was the dominant type mainly distributed in SICU and CICU,including 9 from patients and 8 from environment.The distribution diagram of environmental and patients' strains indicated that the patients in adjacent bed isolated G1 CRAB in SICU and a patient in CICU and its surrounding environment both isolated G1 CRAB.Conclusion Type G1 is the dominant type in ICUs environment in Shanghai hospitals.There are inter-hospital transmission of CRAB in ICUs environment and highly homology of CRAB isolated from patients and environment in ICUs in Shanghai hospitals.Active surveillance of infection and colonization by CRAB,together with implementation of enhanced control strategies should be taken to eradicate CRAB in ICU environment.

Objective To monitor the constituents and resistant tendency of bacterial pathogens isolated from diarrheal patients in our hospital form 1994 to 2005 to offer the basis for guiding epidemiologic study,vaccination research and clinical treatment. Methods Enteric pathogenic bacteria were cultured and identified to species,group and serotype with biochemical and serologic methods and the susceptibility of bacteria to antimicrobial agents were tested. Results Enteric pathogenic bacteria were isolated predominantly in male patients and mainly in children and youngsters. It reached a peak from July to September every year. Shigella spp.(75.11%) was the most frequendy isolated pathogens and followed by Vibrio spp.(12.7%),Salmonella spp.(6.28%),Aeromonas spp.(4.43%) and Escherichia coli(1.25%).During the period from 1994 to 2005,diarrheal pathogens had a trend of decrease especially Shigella spp.and Salmonella spp.. Of the 6329 isolates of Shigella spp., 75.62% was S. flexneri and S.soanei,S.dysenteriae and S. boydii constituted 23.98%,0.22% and 0.01% respectively.The sensitivity of different species,group or serotype to different antimicrobial agents was not the same.S.flexneri and Aeromonas spp. were highly resistant to most of antibiotics. However, S.sonnei and Vibrio spp.had good susceptibility to antibiotics tested except trimethoprim/sulfamethoxazole and ampicillin. Conclusion There are many species and serotypes of enteric pathogenic bacteria causing infective diarrhea and the distribution changes gradually in Beijing. The resistance rate of enteric pathogenic bacteria to antibiotics is not the same in different species and serotypes.so strict surveillance iS always needed.

Objective To analyze the outcome of patients receiving intrauterine insemination with husband sperm,in order to evaluate the effect of relative factors on pregnancy rate after intrauterine insemination. Methods Ninety-eight infertile couples who received intrauterine insemination in the Affiliated Hospital of Nantong University from March 2013 to May 2014 were selected as our subjects and 181 cycles were included. The information including clinical factors including maternal age,infertile time,infertile causes, ovulation induction protocol,time of insemination and postwash total motitle sperm(TMS)and pregnancy rate were recorded. Results (1)Totally 26 patients received clinical pregnancies,and clinical pregnancy rate(CPR) was 14. 36% per cycle. With age increase pregnancy rate decreased( χ2 = 1. 654 9,P = 0. 647).(2)The pregnancy rate of the patients was the same within the infertile time( χ2 = 1. 588 5,P = 0. 662).(3)The pregnancy rate of the patients with secondary infertility was lower than that of the patients with primary infertility,but there was no significant difference(χ2 = 0. 923 3,P = 0. 337).(4)The pregnancy rate of ovulation induction cycles was lower than that of nature cycles,but there was no significant difference(χ2 = 2. 222 0,P= 0. 136).(5)Postwash TMS was showed the same trend(χ2 = 0. 643 4,P = 0. 422). Conclusion In terms of intrauterine insemination with husband sperm,age,infertile time,infertile types,ovulation induction protocol and posrwash TMS can affect pregnancy rate,and the effects of various factors should be considered comprehensively in the process of therapy.

Objective? To investigate the therapeutic hypothermia related knowledge and training demands of neurosurgery nurses at a hospital. Methods? From January to April 2018, we selected 139 neurosurgery nurses at a ClassⅢ Grade A hospital by cluster sampling. All of the nurses were investigated with the self-designed therapeutic hypothermia knowledge questionnaire and therapeutic hypothermia knowledge demands questionnaire of nurses. Results? A total of 59.7% of nurses mastered therapeutic hypothermia related knowledge and 11.5% of them mastered the knowledge well. Three terms of therapeutic hypothermia related knowledge were with the highest accuracy rate including the necessity of calm assessment, need of sedation and analgesia as well as mechanical ventilation support at low temperature. Three terms of them were with the lowest accuracy rate including the duration of the cooling, duration of holding phase and recommended temperature of therapeutic hypothermia monitoring. Neurosurgery nurses were willing to learn therapeutic hypothermia related knowledge by various ways. Conclusions? Neurosurgery nurses' mastery of therapeutic hypothermia knowledge needs to be improved. Mastery of knowledge and demands should be taken into account in contents and ways of inservice training.

Objective To study the superiority of severe multiple trauma treatment model based on damage control strategy. Methods In the intergrated injury first-aid mode, the intensive care unit-guided damage control strategy was used to treat severe multiple trauma. Results A total of 789 severe multiple damage patients were treated with damage control strategies in our hospital from December 2018 to December 2018. Sixty-nine patients died and the survival rate was 91.25％. Conclusions The intensive care unit-guided trauma control strategy has a satisfactory clinical effect in the treatment of patients with severe multiple trauma.

Objective:This study will analyze the clinical characteristics and risk factors that may be related to the 30-day mortality of patients infected with CRAB in intensive care unit (ICU), and explore the resistance of CRAB and its influence on mortality.Methods:From December 2012 to February 2021, 173 ICU patients with CRAB infection in the Fifth Medical Center of PLA General Hospital were selected as the research objects, and the relevant data were collected for retrospective analysis. There were 119 cases (68.8%) in survival group and 54 cases (31.2%) in the non-survival group. Patients with CRAB infection were (52.9±13.5) years old, including 140 males (80.9%) and 33 females (19.1%).The first detected CRAB was collected, and antibiotic sensitivity test was conducted after the strain was resuscitated to analyze the antibiotic resistance. Univariate and multivariate Cox models were used to analyze independent risk factors associated with 30-day mortality in patients with CRAB infection.Results:Univariate and multivariate Cox analysis showed that acute physiology and chronic health evaluation scoring system Ⅱ(APACHE Ⅱ)(HR=1.058, 95% CI:1.012-1.106, P=0.013) and septic shock (HR=6.240, 95% CI:2.227-17.483, P<0.001) were independent risk factors related to 30-day mortality in ICU patients with CRAB. Treatment with β-lactamase inhibitor (HR=0.496, 95% CI: 0.275-0.893, P<0.019) can reduce the 30-day mortality of patients with CRAB infection in ICU. The resistance rate of CRAB to cephalosporins, carbapenems, aminoglycosides and quinolones were more than 80%. The survival rate of patients infected by aminoglycoside resistant CRAB is low(χ2=4.012, P<0.05). Conclusion:The APACHE Ⅱ score, septic shock and use of β-lactamase inhibitors were independent factors associated with the 30-day mortality in ICU patients with CRAB infection.

Objective To investigate the standard rate and common types of mistakes in ventricular intracranial pressure monitoring in neurosurgery intensive care unit ( NICU ) . Methods A total of 45 nurses were enrolled by convenience sampling method and investigated with assessment criteria developed by Department of Neurosurgery. Results There were 75. 6% nurses conformed to the operation standard, while 24. 4% nurses didn′t. The common types of mistakes were ventricular drainage unclosed before measuring pressure (37. 5%), measuring pressure without zero correction (25. 0%), incorrect zero position (16. 7%), measuring pressure immediately after nursing operations (8. 3%), measuring pressure without patients′head at median position (8. 3%), and tubes obstruction (4. 2%), etc. The different ages, professional (technical) titles and working years of nurses in ICU were the influencing factors of standardized ventricular intracranial pressure monitoring. Conclusions Nurses have some non-standard operation and multiple practice during ventricular intracranial pressure monitoring. More attentions should be paid to provide standardized ventricular intracranial pressure monitoring training for nurses who are young, low occupational title and short of working experience in ICU.