Objective To investigate the pathogen distribution and drug resistance of gram-negative bacteria causing lower respiratory tract infections in patients with acute exacerbation of chronic obstructive pulmonary disease ( AECOPD) .Methods A total of 742 sputum samples were collected from AECOPD patients with lower respiratory tract infections in Taizhou Hospital of Zhejiang Province during January 2013 and December 2014.Vitek 2 Compact system combined with disk diffusion was used for strains identification and drug susceptibility test.Modified Hodge test and ethylenediamine tetraacetic acid (EDTA) synergic test were used to screen carbapenem-resistant strains.Statistical analysis was performed using WHONET 5.6 and SPSS 20.0 software.Results A total of 593 strains of gram-negative bacteria were isolated , in which 367 strains were nonfermentative bacteria (61.89%), 220 strains were enterobacteriaceae (37.10%), and the rest 6 strains ( 1.01%) were other gram-negative bacteria.Acinetobacter baumannii ( 186 strains ), Pseudomonas aeruginosa (99 strains), Stenotrophomonas maltophilia (33 strains) and Burkholderia cepacia (22 strains ) were top 4 nonfermentative bacteria , and they all showed high resistance to ampicillin , ampicillin/sulbactam, cefazolin, ceftriaxone, cefotetan and nitrofurantoin with resistant rates of 67.20%-100.00%. Drug resistance rates to other β-lactams, fluoroquinolones, aminoglycoside, compound sulfamethoxazole and minocycline were significantly higher in carbapenem-resistant Acinetobacter baumannii and Pseudomonas aeruginosa strains than those in non-carbapenem-resistant strains , and the differences were statistically significant (P <0.05 or <0.01).Stenotrophomonas maltophilia and Burkholderia cepacia strains were only sensitive to levofloxacin , compound sulfamethoxazole and minocycline . Klebsiella pneumonia (89 strains), Escherichia coli (80 strains) and Enterobacter cloacae (25 strains) were top 3 enterobacteriaceae , which were almost completely resistant to ampicillin , but were sensitive to piperacillin/tazobactam , cefoperazone/sulbactam , amikacin and carbapenems ( with resistant rates <15%) .More than 50%strains of extended spectrum β-lactamases ( ESBLs )-producing Klebsiella pneumonia and Escherichia coli were moderately or highly resistant to ampicillin/sulbactam , most cephalosporins ( except cefotetan and cefoperazone/sulbactam ), gentamycin, tobramycin, fluoroquinolones, aztreonam, compound sulfamethoxazole and minocycline , and the resistant rates were higher than those in non-ESBLs-producing strains (P <0.05 or <0.01).Conclusions Nonfermentative bacteria and enterobacteriaceae are the most prevalent gram-negative bacterial pathogens in lower respiratory tract infections in patients with AECOPD . Carbapenem-resistant Acinetobacter baumannii and Pseudomonas aeruginosa strains, as well as ESBLs-producing Klebsiella pneumonia and Escherichia coli strains are highly resistant to most antibacterial agents .

Objective To investigate the clinical diagnosis value of endoscopic ultrasonography (EUS) in upper gas-trointestinal tract bulgy lesion with smooth surface. Methods All 98 cases of patients with upper gastrointestinal tract bulgy lesion with smooth surface found by routine gastroscopy examination. They were examined by EUS and compared with pathologic examination. Results 65 cases were polypuse,10 cases were stromal tumor,5 cases were leiomyoma,7 cases were lipoma,4 cases were heterotopic pancrease,2 cases were cyst, 3 cases were venous aneurysm,2 cases were external pressure change. The diagnostic accordance rate of EUS and pathology examination were 93.68%. Con-clusion EUS can accurately determine the origin of upper gastrointestinal tract bulgy lesion with smooth surface. It is very important for treatment and evaluating prognosis.

Objective:To evaluate a novel distraction reductor in the surgical treatment of unstable distal radius fractures with metaphyseal volar comminution.Methods:From January 2019 to December 2020, 27 patients with unstable distal radius fracture complicated with metaphyseal volar comminution were treated at Department of Orthopaedics, Zhoupu Hospital Affiliated to Shanghai University of Medicine & Health Sciences. They were 6 males and 21 females, with an age of (69.4±9.4) years. All fractures were unilateral and closed, involving the right side in 17 cases and the left side in 10 cases. All patients were treated by internal fixation with an anatomical locking plate through the volar approach and the novel distraction reductor was used to reduce the fracture ends. Regular imaging examinations were performed to evaluate the reduction, maintenance and union of fractures after surgery. One year after operation, the curative efficacy was assessed by evaluation of the range of wrist motion, Disabilities of the Arm, Shoulder and Hand (DASH) score, Gartland-Werley score and Bartra radiology score.Results:All the operations went on successfully with a duration of (92.3±8.9) min. All the incisions healed primarily. The follow-up time was (15.9±2.9) months. The radial height, palmar tilt, ulnar inclination and articular surface step-off immediately after operation [(11.23±1.51) mm, 12.10°±3.44°, 20.54°±3.44°, and (0.95±0.42) mm] were not significantly lost compared with those one year after operation [(11.22±1.55) mm, 12.07°±3.44°, 20.51°±3.33°, and (0.93±0.40) mm] (all P>0.05). One year after operation, the range of wrist motion was good with dorsiflexion of 59.7°±5.5°, palm flexion of 63.0°±9.1°, pronation of 66.5°±5.5°, supination of 61.2°±5.6°, radial deviation of 22.7°±4.8°, and ulnar deviation of 30.3°±6.1°; DASH score was 13.5±5.5; Bartra radiology score was 88.6±6.5, giving an excellent and good rate of 88.9% (24/27);Gartland-Werley score was 2.7±2.1, giving an excellent and good rate of 92.6% (25/27). Follow-ups observed no poor fracture healing, internal fixation failure, tendon or nerve injury or traumatic arthritis. Conclusion:In the surgical treatment of unstable distal radius fractures with metaphyseal volar comminution, the novel distraction reductor can lead to ideal reduction of displaced fractures and effectively correct the shortening caused by volar cortex comminution to achieve satisfactory functional effects in clinic.