Objective To learn drug resistance of bacteria isolated from a hospital of Chengdu from 2012 to 2013 .Methods From 2012 to 2013 ,39 732 clinical specimens were collected ,ATB Express half‐automatic bacteria identification system were used to identify the bacteria ,and paper diffusion(K‐B) method was used to do drug sensitive test ,results were judged according to Clini‐cal and Laboratory Standards Institute 2012 standard interpretation ,Whonet5 .6 was used to do statistical analysis .Results In the bacteria isolated from this hospital in 2012 and 2013 ,gram‐positive bacteria accounted for 27 .7% and 37 .4% respectively ,gram negative bacteria accounted for 72 .3% and 62 .6% .The top five pathogenic bacteria were E .coli(16 .3% ,20 .3% ) ,Pseudomonas aeruginosa(11 .5% ,11 .7% ) ,Staphylococcus aureus (11 .3% ,11 .4% ) ,Acinetobacter baumannii(10 .6% ,9 .3% ) ,Klebsiella pneu‐moniae(14 .7% ,12 .0% ) .The detection rates of Methicillin‐Resistant Staphylococcus(MRSA) were 56 .2% ,47 .7% .The positive rates of producing extended spectrum βlactamases(ESBLs) of E .coli and Klebsiella pneumonia accounted for 41 .0% ,32 .2% and 21 .0% ,10 .8% ,which were high sensitive to carbon penicillium alkene antibiotics and amikacin .Susceptibility monitoring results showed that the drug resistance of Acinetobacter baumannii was rising ,and the drug resistant of Pseudomonas aeruginosa to most antibiotic were decline .Conclusion The top five bacteria isolated from this hospital in 2012 and 2013 are given priority to gram‐negative bacteria ,in addition to the drug resistant trend of Acinetobacter baumannii increased slightly ,the drug resistant of other four common bacteria were decline .Clinical attention should focus on positive ESBLs ,E .coli ,Klebsiella pneumoniae ,MRSA and M ulti‐resistant bacteria .

Objective To investigate the therapeutic effect and safety of the clip with the flossmethod during endoscopic submucosal dissection for early gastric angle cancer. Methods A total of 27 gastric angle lesions diagnosed as early gastric cancer were treated by ESD. They were randomized to two groups, routine ESD group and clip with the flossgroup. The procedure time, complication events, en-block resection rate and complete resection rate were compared between the two groups. Also,the learning time was divided to two stages and the learning curve was studied according to the resected specimen areas per minute. Results The en block rate was 85. 7%(12/14) in the routine ESD group and 100. 0%(13/13) in the clip with the floss group. The procedure time in the clip with the flossgroup was significantly less than that in the routine ESD group (the median time 30 min VS 40 min, P =0. 011) . Perforation and the post operative bleeding did not occur in either group. The ESD learning curving during the first learning period and the mean resected specimen (area/min) in theclip with the floss group were larger than routine ESD group(30±6 mm2/min VS 20±5 mm2/min,P=0. 01). However, no difference presented during the second learning period between the two groups. Conclusion Clip with the flossmethod during endoscopic submucosal dissection for early gastric angle cancer as a novel procedure is safe, efficacious and worthy to recommend to beginning learners.

Objective To summarize the perioperative clinical effect of extracorporeal membrane oxygenation (ECMO) technique in bilateral lung transplantation of patients with idiopathic pulmonary arterial hypertension.Methods Of 18 recipients with idiopathic pulmonary arterial hypertension receiving double lung transplantation,there were 11 cases of 11 grade Ⅲ (WHO cardiac function ratings) and 7 cases of grade Ⅳ.All patients were given ECMO technique after anesthetic induction,and the speed and volume of ECMO were adjusted according to oxygenation and cardiac function.At the end of the operation,the ECMO flow rate was decreased to 1 L·min-1 ·m-2.If the hemodynamics was stable and the oxygenation index was above 300,the ECMO could be removed.All data were Collected at 7 time points (preoperation,30 min after two lung ventilation,15 min after ECMO,the establishment of one lung ventilation,30 min after pulmonary artery occlusion,30 min after pulmonary artery open and at the end of the operation).The prognosis of the recipients was observed postoperatively.Results All patients successfully completed operation under the support of ECMO technique.As compared with preoperation,PaO2 and PaCO2 were significantly increased at 30 min after two lung ventilation (P＜0.05).As compared with 30 min after two lung ventilation,PaO2 was significantly elevated (P＜0.05),PaCO2 and PAP were reduced at 15 min after ECMO (P＜0.05).As compared with 15 min after ECMO,PAP was significantly increased at 30 min after pulmonary artery occlusion (P＜0.05).As compared with 30 min after pulmonary artery occlusion,PAP was significantly reduced at 30 min after pulmonary artery open (P ＜ 0.05).ECMO of 3 patients was removed after operation at once and of 15 patients were not removed until 3.3 ± 2.5 days in ICU.Tencases suffered from left cardiac insufficiency to varying degrees after removing ECMO (including 3cases whose ECMO was removed at once after operation),3 of them received ECMO bypass again and 7 of them were relieved after administration of cardiotonic,diuretics and vasodilators.Two cases sufferred from wound fat liquefaction and infection and 2 cases had moderate femoral artery thrombosis after postoperative ECMO.One case had renal failure 5 days after operation and thereafter died of multiple organ failure 2 weeks later after treatment with the continuous ECMO pipelines of hemofiltration,then 17 cases were cured.The pulmonary arterial pressure of all recipients was (30.79 ± 6.18) mmHg 2 months after operation and the cardiac function rating was significantly increased (P ＜0.01).Conclusion The application of ECMO technique in the lung transplantation patients with idiopathic pulmonary hypertension can reduce the pulmonary arterial pressure,improve the safety of operation and has obvious auxiliary effect on the perioperative cardiac function.

Objective To explore the key points of anaesthetic management of bilateral lung transplantation treating severe idiopathic pulmonary arterial hypertension.Methods Clinical data of 20 cases with severe IPAH treated by bilateral lung transplantation were analyzed retrospectively, 2 males and 18 females, ASA physical status Ⅲ or Ⅳ.The hemodynamic changes were observed at various points (30 min after double lung ventilation, 15 min after ECMO, during one-lung ventilation, 30 min after pulmonary artery block, at the opening of pulmonary artery and at the end of surgery) and pre-and post-operative changes of cardiovascular morphology were analyzed with heart ultrasound.Results Compared with 30 min after double lung ventilation, PaO2 and SVV were significantly increased and PAP, PAWP and PaCO2 were decreased 15 min after extracorporeal membrance oxygenation (ECMO) (P<0.05).PAP and PAWP were significant higher and SVV was lower 30 min after pulmonary artery block than 15 min after ECMO (P<0.05).Opening of pulmonary artery had significantly increased SVV and reduced PAP and PAWP compared with pulmonary artery block (P<0.05).ECMO was removed in 4 cases at end of the surgery.The remaining 16 cases assisted by ECMO were transferred to ICU, 3 cases underwent thoracotomy for exploration and hemostasis 1 day after the operation while 13 cases suffered from different degrees of left heart dysfunction postoperatively, 4 of which had acute heart failure.Of the 4 cases, 2 were treated by right femoral vein-right femoral artery bypass (V-A ECMO bypass) and 2 underwent right femoral vein-right internal jugular vein bypass (V-V ECMO bypass).Moreover, 3 cases performed tracheotomy 5 days, 6 days and 13 days day after the operation, respectively.All the patients were cured and discharged.Their cardiovascular morphology was improved.Conclusion The key successful factors of IPAH treated by bilateral lung transplantation are to improving perioperative heart function, keeping stable hemodynamics during induction of anesthesia and the operation and using ECMO properly and postoperative support.

Objective To summarize the experiences of extracorporeal membrane oxygenation (ECMO) technique in human lung transplantation. MethodsECMO was used in 45 patients undergoing lung transplantation.There were 32 cases of dilated pulmonary fibrosis and pulmonary hypertension,4 cases of chronic obstructive pulmonary disease,2 cases of pneumosilicosis,2 cases of phthisis,one case of diffuse panbronchiolitis,2 cases of bronchiectasis and 2 cases of primary pulmonary hypertension. In 3 patients, ECMO conduit was used as a bridge to the lung transplantation for 13,19 and 6 days respectively before operation,and ECMO support was done after the operation.In 40 patients ECMO support was done during operation.In 2 patients without using cardiopulmonary bypass, ECMO support was done after operation because of primary graft dysfunction.Results In 40 patients undergoing ECMO support during operation,the ECMO conduit was removed in 37 patients immediately after the operation.ECMO mean blood flow was (2.8 ± 0.6)L/min,running time was (7.7 ± 0.9) h,and 31 patients survived. In 3 patients undergoing postoperative ECMO support,ECMO was removed in 2 cases at 36th h and 6th day after the operation respectively,and the remaining one died from acute renal failure 2 weeks after the operation though the continuing hemofiltration was applied through ECMO conduit. In 2 patients without using cardiopulmonary bypass and 3 patients using ECMO during operation,ECMO support was used initially or again after operation because of PGD or acute heart failure.Three patients were cured,and 2 patients were died from multiple system organ failure.Conclusion ECMO is an important auxiliary tool in lung transplantation for preoperative,intraoperative and postoperative supports. As the transition bridge to recipients,ECMO can be used for preoperative supports; during operation,it can stabilize the haemodynamics,and postoperation,it can improve severe pulmonary function dysfunction and PGD.

Type 2 diabetes mellitus (T2DM) is one of the most common chronic diseases and public health problems. Roux-en-Y gastric bypass (RYGB) can rapidly, effectively and sustainably improve glycemic control in morbidly obese patients with T2DM. However, the mechanisms of glycemic control after RYGB are still unclear now. Duodenal-jejunal bypass (DJB) is an improved RYGB sparing intact stomach, which is mainly used to investigate the mechanisms of RYGB to treat T2DM. DJB has also been used to treat non-obese T2DM patients. In the present article, we review the results and mechanisms of DJB to treat T2DM on the basis of the previous studies to further elucidate the mechanisms of RYGB in the management of T2DM.
Diabetes Mellitus, Type 2 ; surgery ; Duodenum ; surgery ; Gastric Bypass ; Humans ; Jejunum ; surgery

OBJECTIVETo investigate the changes in the expression of nuclear receptor subfamily1 (Nr1d1) in the lungs of rats with ventilation-induced lung injury and explore the molecular mechanism.

METHODSSeventy-two rats were randomly divided into 4 groups for observation at 4 time points (1:00 AM, 7:00 AM, 1:00 PM and 7:00 PM), and each group was further divided into 3 subgroups (Group FB, Group LV and Group HV). After ventilation for 3 h, the rats were sacrificed and lung tissue samples were obtained for testing the expression of Nr1d1 using gene chip technology and RT-PCR.

RESULTSNr1d1 gene expression was down-regulated in HV group as shown by gene chip RT-PCR data. Cosine analysis showed that Nr1d1 expression exhibited a rhythmicity in FB group (P<0.05).

CONCLUSIONThe rhythmicity of Nr1d1 expression disappears as the tidal volume the increase. Diminished Nr1d1 expression is closely correlated with ventilation-induced lung injury in rats.

Animals ; Circadian Rhythm ; Down-Regulation ; Female ; Lung ; metabolism ; Male ; Nuclear Receptor Subfamily 1, Group D, Member 1 ; metabolism ; Oligonucleotide Array Sequence Analysis ; Random Allocation ; Rats ; Rats, Sprague-Dawley ; Respiration, Artificial ; adverse effects ; methods ; Reverse Transcriptase Polymerase Chain Reaction ; Tidal Volume ; Ventilator-Induced Lung Injury ; metabolism

Objective To evaluate the intraoperative condition and prognosis of extracorporeal memberane oxygenation (ECMO) in patients with idiopathic pulmonary fibrosis (IPF) undergoing single lung transplantation.Methods Fifty-five patients (49 males and 6 females,aged 18-75 years,ASA physical status Ⅲ or Ⅳ) undergoing single lung transplantation were divided into ECMO group (E group,n =41) and control group (C group,n =15).Lung ischemia time,operative time,intraoperative crystal fluid volume,intraoperative colloids fluid volume,total fluid volume,albumin volume,bleeding volume,blood transfusion volume and urine volume were recorded.ECMO time,extubation time,the length of ICU stay and postoperative hospital stay were assessed.Results There was no significant difference in lung ischemia time,operative time,intraoperative crystal fluid volume,intraoperative colloids fluid volume,total fluid volume,albumin volume,bleeding volume,volume of blood transfusion,urine volume,ECMO time,extubation time,the length of ICU stay,postoperative hospital stay and mortality rate during hospitalization between the two groups.Blood plasma volume was significantly more in E group (9.3 ± 4.5 mL/kg) than that in C group (5.4 ± 4.2 mL/kg;P＜0.01).ECMO time was positively related to extubation time,the length of ICU stay and mortality rate during hospitalization (P＜0.01).Conclusion ECMO does not affect intraoperative condition and prognosis of patients.According to ECMO time we can judge the prognosis of patients.

Objective To evaluate the effect of donor age on short-term survival of patients with idiopathic pulmonary fibrosis (IPF) after lung transplantation. Methods Clinical data of 235 IPF donors and recipients of lung transplantation were retrospectively analyzed. Univariate and multivariate Cox proportional hazard regression models were employed to analyze the correlation between donor age and short-term mortality rate of IPF patients after lung transplantation. Kaplan-Meier was used to draw the survival curve. Results Univariate Cox regression analysis showed that donor age was correlated with the 1-year fatality of IPF patients after lung transplantation. The 1-year fatality of recipients after lung transplantation was increased by 0.020 times if donor age was increased by 1 year (P=0.009). Oxygenation index of the donors, preoperative oxygenation index, preoperative lung allocation score, preoperative N-terminal pro brain natriuretic peptide, pattern of transplantation, pattern of intraoperative extracorporeal membrane oxygenation and intraoperative blood transfusion volume of the recipients were correlated with 1-year fatality after lung transplantation (all P < 0.1). Multivariate Cox regression analysis demonstrated that there was no correlation between donor age and 30-, 90-, 180-d and 1-year fatality of IPF patients after lung transplantation (all P > 0.05). Sensitivity analysis showed that there was no significant difference in 30-, 90-, 180-d and 1-year fatality after lung transplantation among donors aged < 18, 18-33, 34-49 and ≥50 years (all P > 0.05). Conclusions Donor age exerts no effect upon short-term survival of IPF patients after lung transplantation. Considering the mechanical ventilation time, oxygenation index, infection and other factors of donors, the age range of lung transplant donors may be expanded.

Lung transplantation is the only effective approach to treat end-stage lung diseases. Nevertheless, early prognosis of lung transplant recipients is significantly worse than that of other solid organ transplant recipients. Primary graft dysfunction (PGD) is one of the main causes affecting clinical prognosis of the recipients. PGD is an early acute lung injury after lung transplantation, which is the main cause of early death of lung transplant recipients. Risk factors of PGD after lung transplantation consist of donor, recipient and operation, etc. In this article, the risk factors of PGD after lung transplantation were reviewed, aiming to provide reference for clinical practice.