Objective To investigate the clinical distribution of Acinetobacter Baumann in our hospital and its drug resistance,provide a reference for clinical medical thereby.Methods A retrospectively analysis for 406 Acinetobacter baumannii detected in our hospital from January 2010 to January 2012 was made,the clinical distribution was observed,and the resistance rates of several commonly used antimicrobial agents was calculated.Results Acinetobacter baumannii infections was mainly detected in respiratory medicine and intensive care unit,the detection rate were 27.3％ and 19.0％,the primarily infection site was the respiratory system,Acinetobacter baumannii was detected mainly from sputum specimens and the detection rate was 56.2％,the resistance rate of imipenem,meropenem and cefoperazone sulbactam was relatively low,which were 8.6％,10.6％ and 17.0％.Conclusion Acinetobacter baumannii is an important cause of nosocomial infections and prone to multidrug-resistant pathogens,it is a serious threat to patients,we must make a strict selection of appropriate antibiotic therapy based on susceptibility to reduce nosocomial transmission of Acinetobacter baumannii.

Objective To investigate the value of fluid resuscitation strategy in septic shock patients by pulse indicator continuous cardiac out ( PiCCO ) .Methods 42 septic shock patients were divided into the PiCCO group(n=26) and the control group(n=16).All patients measured heart rate(HR),mean artery pressure(MAP), central venous pressure(CVP);CI,GEDVI,SVRI,EVLWI,CVP as indicator of fluid resuscitation after 0h,6h,24h of the diagnosis were measured respectively in PiCCO group;CVP as guiding volume resuscitation was measured in the control group .The effect of fluid resuscitation was compared between two groups .To analyse the relationship between CVP,GEDVI and CI in PiCCO group .according to CVP increase 2mmHg ,GEDVI whether elevated 10%.Results After 6h EGDT treatment bundle HR ,MAP,APACHEII score and clearance rate of lactic in PiCCO group improved more than those in control group [(101.3 ±7.8) and (119.4 ±7.2),t=-7.520,P<0.05;(71.8 ±7.6) and (51.5 ±8.9),t=7.873,P<0.05;(17.0 ±3.4) and (22.7 ±4.1),t=-4.978,P>0.05;(53.6 ±11.5) and (-16.5 ±5.2),t =9.283,P <0.05].There were no differences in 28-Day mortality between two groups (t =-2.162,P>0.05),but ICU hospitalization time decreased in PiCCO group [(13.8 ±2.6) and (23.3 ±2.2),t=-5.075,P<0.05].Changes in GEDVI was positively correlated with Changes in CI (r=0.799,P<0.05),while changes in CVP was poorly correlated with CI (r=-0.446,P>0.05).Conclusion Hemodynamic monitoring by PiCCO directed fluid resuscitation strategy can elevate reversal rate .Compared with pressure index CVP ,GEDVI is a sensitive indicator of cardiac preload .Correlation between CVP and GEDVI can reflect cardiac function ,Especially for septic shock patients with cardiac depression .

Objective To investigate the anesthetic management of perventricular closure of ventricular septal defects (VSD) under transesophageal echocardiography. Methods A retrospective review of the clinical data of 52 children who underwent perventricular closure of VSD under transesophageal echocardiography were analyzed. All the children were performed tracheal intubation under general anesthesia, and the electrocardiogram, pulse blood oxygen saturation, invasive arterial pressure, central venous pressure, end tidal carbon dioxide partial pressure, temperature and urine output were continuously monitored throughout the procedure. The transesophageal echocardiography was necessary for guiding transcatheter or per-ventricular device placement. Results Perventricular closure of VSD was successfully completed in 51 children under transesophageal echocardiography, the operation time was (76.7 ± 36.4) min, the anesthesia time was (89.5 ± 27.1) min; 1 child was converted to open surgical repair. Conclusions The intraoperative transesophageal echocardiography technology is the key to the success of the surgery. At the same time of analgesia and sedation, the anesthesia doctor needs to pay attention to the changes of hemodynamics in children.

Objective To observe the curative effect and adverse reactions of intercostals nerve block combined with fentanyl transdermal system in treatment of post-thoracotomy pain syndrome (PTPS). Methods Intercostals nerve block combined with fentanyl transdermal system was used for treatment of 141 patients with PIPS. The degree of pain relief was evaluated by numerical rating scale (NRS),the quality of life of patients was evaluated by the quality of life score standard,and the adverse reactions were also observed. Results The overall remission rate was 97.85%,there were 51 cases (36.43%)with complete remission, 80 cases (57.14%)with significant remission,and 6 cases (42.85%) with moderate remission. The adverse reactions included nausea,vomiting, constipation,dizziness,skin pruritus and dysuria,no serious liver and kidney function damage and respiratory inhibition. The quality of life of all patients was improved. Conclusion Multimodal analgesia has better curative effect and less adverse reactions in treatment of PTPS,so it deserves clinical promotion.

Objective To investigate the correlativity between secretin-stimulated magnetic resonance cholangiopancreatography (sMRCP) findings and pathological severity in a swine chronic
pancreatitis (CP) model. Methods Thirty-nine swine were divided randomly into control group (n=12) and experimental group (n= 27). In experimental group, the main pancreatic duct (MPD) was incompletely ligated to establish the model of obstructive CP. In control group, laparotomy was performed but without ligating the MPD. At the 4th, 8th and 12th week after modeling, one third swine of each group were undergone a series of dynamic sMRCP scans before (0 min) and at 1, 3, 5, 7, 9, 11 min after administration of secretin (0.6 μg/kg). And the MPD diameter and duodenum filling (DF) degree were measured. All survivals were sacrificed to pathological examination including HE and Van Gieson staining for histopathological grading. According to pathological severity, swine were divided into normal group, mild CP group and moderate to severe CP group. MRI features and indexes, including baselined diameter (BD), end diameter (ED), maximum diameter (MD), the largest expansion rate (LER), time to peak (Tpeak) and end change rate of pancreatic duct and duodenal filling (DF) scores were measured. The relationships between pathological grading and sMPCP indexes were analysed. The comparison of sMRCP data among the 3 groups were used ariance analysis, χ2 test and U test. Correlations between sMPCP indexes and pathological severity were tested using Spearman rank correlation coefficients. The diagnostic efficiency of sMRCP indexes were evaluated by ROC method. Results (1) In experimental group, 22 CP models were established and 19 CP swine (mild CP, n= 8; moderate and severe CP, n=11) were performed sMRCP successfully. Eleven swine in normal group were obtained satisfactory MRCP images. (2) sMRCP results:BD of 3 groups were (1.56 ± 0.46),(2.95 ± 1.17),(7.41 ± 1.91) mm, respectively. ED were (1.49 ± 0.31),(2.96 ± 1.17) and (7.37±1.90) mm, respectively. MD were (2.39±0.43),(3.91±1.27) and (7.86±1.87)mm, respectively. The median of LER were 42.10%, 34.85% and 6.58%, respectively. The median of DF scores were 3, 3, 2, respectively. The differences of above indexes have statistically significance (P values were all<0.01). There were correlation between sMRCP indexes (BD, ED, MD, LER and DFscores) and pathological severity (r values were 0.89, 0.92, 0.90,-0.85,-0.66, respectively and P values were all<0.01). Tpeak and end change rate of pancreatic duct had no significant differences (P values were>0.05),and no correlation with pathological severity(P values were all>0.05).For differential diagnosis between normal and mild CP, the area under ROC of BD, ED, MD, LER and DFscores were 0.915, 0.977, 0.926, 0.778 and 0.472, respectively and differential diagnosis between mild CP and moderate to severe CP group, the area under ROC were 0.966,0.966,0.960,1.000 and 0.915, respectively. Conclusions sMRCP findings of CP have characteristics and could be used for in vivo evaluation on the CP pathologic grades.

Objective The goal of this report was to evaluate the applicability of the da Vinci S surgical system in thoracic surgery.Methods The da Vinci S surgical system consists of a console, a patient cart, and a vision system.The patient cart loading with 3 robot arms and 1 central endoscope arm connects the console which commands the movements of the arm tips.The robot arm tips are introduced via small chest wall ports and attached to the arms of the robot.The surgeon, sitting at the console, manipulates highly sensitive sensors that transfer the surgeon's movements to the arm tips.The so called EndoWrist'technology offers up , down, left, right, and twist, seven degrees of movements, thus exceeding the capacity of a surgeon's hand in open surgery.17 intrathoracic lesion cases, including 12 Myasthenia Gravis, 1 diaphragm hernia, 2 esophageal cancer, 1 pulmonary cancer , 1 pneumothorax, were evaluated for clinical application of the da Vinci S surgical system.Results Out of 17 surgical procedures, 14 procedures were done using the robot from beginning to the end, including 12 thymectomies, 1 diaphragm hernia repair, 1 pulmonary bleb dissection.Only gastric mobilizations, the abdominal part procedures were done using the da Vinci S system, and the thoracic part procedures were done through small incision thoracotomy in 2 cases with esophageal cancer.One resection of left upper lobectomy had to be converted due to surgical problem.The postoperative courses were uneventful.Conclusion The da Vinci operating robot can do nearly all kinds of thoracic operations.Advanced general thoracic procedures can be performed safely and effectively with the da Vinci S robot allowing precise dissection.This benefit becomes evident most elegantly in thymectomies.The robot operation procedures can be done by the doctors with open and assisted thoracopic surgery experiences and other personnels getting trained in a short period of time, but case selection and preparing emergency thoracotomy at any time is needed to ensure the patient safety.

Objective To investigate the correlativity between elasticity modulus and pathological severity in chronic pancreatitis (CP).Methods Twenty-one pigs were divided randomly into experimental group (n=18) and control group (n=3) using random number method.The main pancreatic duct (MPD) was incompletely ligated to establish the CP model.In control group, MPD was not ligated.The animals were killed in batches at 4th, 8th and 12th week after surgery.The pancreatic tissue was taken for elasticity modulus test and pathological examination, and the pigs were classified into control, mild, moderate and severe groups based on the severity of fibrosis.Cell density, fat infiltration and extracellular edema were observed and classified into mild and severe.The difference of elasticity modulus among different groups were compared by Variance analysis, the correlation between pancreatic fibrosis and elastic modulus was analyzed with Spearman correlation analysis, and ROC curve was used to evaluate its efficacy of diagnosing CP.Results Sixteen CP models were established successfully expected for 2 deaths (mild, n=7;moderate, n=2 and severe, n=7).All of the control group (n=3) showed normal pancreas.The elasticity modulus of control, mild and moderate to severe group were 0.4268±0.0566, 0.3203±0.0518 and 0.2235±0.0685, respectively.The difference between the groups was statistically significant (F=13.658,P<0.01), and the elastic modulus and pathological grade had a negative correlation (r=0.969, P<0.01).AUC of elasticity modulus for differentiating normal and mild CP was 1.000, the best critical value was 0.3807, and both the sensitivity and specificity of the diagnosis were 100%.AUC for differentiating mild and moderate to severe CP was 0.8730, the best critical value was 0.2646, and the sensitivity and specificity of the diagnosis were 85.7% and 77.8%, respectively.The pancreatic elasticity modulus of low parenchymal cell density group and high parenchymal cell density group were 0.1931±0.0373 and 0.3485±0.0655, respectively, which in the high cell density group was significantly higher than that in the low cell density group (t=-5.719, P<0.01).The elasticity modulus of negative infiltration or slight fatty infiltration group and severe fatty infiltration group were 0.3401±0.0697 and 0.1855±0.0344, respectively, which in the negative infiltration or slight infiltration group was significantly higher than that in severe infiltration group (t=5.102, P<0.01).The elasticity modulus of negative or mild cell edema group and moderate to severe cell edema group were 0.2760±0.0825 and 0.3024±0.1056, respectively;there was no statistically significant(t=-0.586, P >0.05).Conclusions The elasticity modulus can be used to detect the pathological changes of CP, and evaluate the CP pathologic grades.

OBJECTIVETo explore the correlation between serum hepatitis B surface antigen (HBsAg) level and hepatic tissue pathological staging in patients with chronic hepatitis B (CHB).

METHODSClinical data was collected from our hospital's records for 302 CHB patients with HBsAg-positive status for more than 6 months and who had undergone hepatic biopsy. The HBsAg level,HBV DNA level and other clinical data were measured using commercial diagnostic assays. Liver histology was scored using the GS staging system. Correlation between serum HBsAg quantity, HBV DNA quantity, stage of inflammation and degree of fibrosis was assessed statistically.

RESULTSThe correlation of serum HBsAg level and HBV DNA level was notable. The serum HBsAg level was a variable affecting hepatic tissue pathological stage significantly. Serum HBsAg level appeared to be a highly specific and sensitive diagnostic marker of hepatic fibrosis. As the severity of liver fibrosis increased, the quantitative levels of platelet (PLT), HBsAg and HBV DNA gradually decreased, and the APRI index gradually increased; there were significant differences between the groups (all P<0.001). Serum HBsAg and HBV DNA levels in patients with hepatitis B e antigen-positive (HBeAg(+)) status showed strong correlation (r=0.721, P<0.0001) by Spearman analysis. HBeAg(+) patients with moderate to severe fibrosis (S2-4) exhibited significantly lower serum HBsAg and HBV DNA levels compared with patients with no or mild fibrosis (S0-1; t=5.475 and 4.826, P<0.001). ROC analysis suggested that a serum HBsAg cutoff of 4.46 log 10 IU/mL (28 800 IU/mL) would provide a theoretical sensitivity of 76.3%, with theoretical specificity of 70.5% in HBeAg(+) CHB patients. A serum HBV DNA cutoff of 7.13 log 10 IU/mL (1.35*10(7) copies/mL) would provide a theoretical sensitivity of 71.1%, with theoretical specificity of 73.4% in HBeAg(+) CHB patients. Logistic regression analysis showed that the level of HBsAg was an independent prognostic factor of moderate to severe liver fibrosis, with alanine aminotransferase, aspartate aminotransferase, HBsAg, HBV DNA and PLT (P<0.001).

CONCLUSIONHBsAg and HBV DNA levels decrease gradually along with aggravation of liver fibrosis. The cutoff values of 28800 IU/mL for HBsAg and 1.35*10(7) copies/mL ofHBV DNA provide higher specificity and sensitivity for predicting the degree of liver fibrosis in HBeAg-positive CHB patients, and the former is an independent predictor of severe liver fibrosis.

Alanine Transaminase ; Aspartate Aminotransferases ; Biopsy ; Blood Platelets ; DNA, Viral ; Hepatitis B Surface Antigens ; Hepatitis B virus ; Hepatitis B, Chronic ; Humans ; Inflammation ; Liver Cirrhosis ; ROC Curve

OBJECTIVETo investigate the methods for assessing angiogenesis in experimental liver fibrosis.

METHODSMale C57BL/6 mice were randomly divided into a normal (unmodeled) group and a liver fibrosis model group.The model was established by a 4-week course of 10% CCl4 solution (in olive oil) intraperitoneal injection. Liver vasculature was observed by magnetic resonance (MR),computed tomography (CT),synchrotron radiation X-ray,and von Willibrand factor(vWF) immunofluorescence staining. Liver inflammation and fibrosis were observed by staining with hematoxylin-eosin and Sirius red.The t-test and Pearson's correlation analysis were used for statistical analyses.

RESULTSCompared with the normal group,the model group had more robust inflammation and fibrosis in liver tissue.The liver tissue in the modeled mice showed significant deceases in MR signal intensity on T2WI before and after enhancement (386.67+/-69.04 vs.492.67+/-112.50,t =-2.456, P=0.026).The liver tissue in the modeled mice also showed significantly decreased enhancement CT values (P < 0.01).Synchrotron radiation X-ray imaging showed that the small vessels in the liver tissues of the modeled mice were significantly increased compared to that in the normal mice (P < 0.01).The MR T2W enhanced signal value (439.67+/-104.80, Pearson's r=0.714, P=0.009) and microvascular relative length (676.53+/-122.75, Pearson's r=0.791, P=0.002) were positive correlated with microvessel density (MVD) (14.50+/-5.95),as shown by detection of labeled vWF.The before and after CT enhancement difference (132.60+/-57.02, Pearson's r=-0.612, P=0.034) was negatively correlated with MVD.

CONCLUSIONs MR,CT and synchrotron radiation X-ray imaging can be used for assessing angiogenesis in liver fibrosis,and the findings from each are correlated with the traditional MVD detection method. The two-dimensional imaging of synchrotron radiation X-ray is more intuitive,and has been confirmed as an effective evaluation method for liver angiogenesis.

Animals ; Disease Models, Animal ; Inflammation ; pathology ; Liver Cirrhosis ; pathology ; Liver Function Tests ; Magnetic Resonance Spectroscopy ; Male ; Mice ; Mice, Inbred C57BL ; Neovascularization, Pathologic ; Synchrotrons ; Tomography, X-Ray Computed

Objective To investigate the inhibitory effect of 188 Re-labeled BaGdF5-poly ( ethylene glycol) ( PEG) nanoparticles ( NPs) on hepatoma cells, and explore the application of the radiolabeled NPs for SPECT imaging. Methods BaGdF5-PEG NPs were synthesized by hydrothermal method, and were fur-ther radiolabeled with 188Re using diethylene triamine pentaacetic acid (DTPA) as a coupling agent. The human hepatoma cells SMCC 7721 were treated with different concentrations of BaGdF5-PEG NPs, 188 ReO-4 or 188Re-DTPA-BaGdF5 NPs (14.8, 74.0, 370.0×104 Bq/ml) for 24 h, and then the cell proliferation rates were measured by 3-(4,5-dimethyl-2-thiazolyl)-2,5-diphenyl-2-H-tetrazolium bromide (MTT) assay. 188ReO-4 and 188 Re-DTPA-BaGdF5 NPs were administrated into normal rabbits via the ear vein, respectively. For the former, static SPECT/CT imaging were performed at 30, 60 min post-injection, and for the latter, dynamic SPECT images were captured within 10 min, and static SPECT/CT images at 30, 60, 120 min post-injec-tion. The rabbit VX2 tumor model was established, and a microcatheter was inserted into hepatic artery via the rabbit femoral artery, and then the mixture of 188 Re-DTPA-BaGdF5 NPs and lipiodol was injected into the tumor region. SPECT/CT imaging for VX2 tumor was performed at 30 min later. Data were analyzed by two-sample t test. Results The BaGdF5-PEG NPs were nearly square and the particle size was about 10 nm. The labeling yield of 188 Re-DTPA-BaGdF5 was 94.1％ at the optimum conditions. Moreover, it showed high stability in vitro and in vivo. In vitro, BaGdF5-PEG NPs did not exhibit obvious cytotoxicity even at a high concentration. Both 188 ReO-4 and 188 Re-DTPA-BaGdF5 could inhibit the proliferation of SMCC 7721 cells, but 188 Re-DTPA-BaGdF5 showed a significantly stronger inhibitory effect at the doses of 74.0 and 370.0×104 Bq/ml ( t values:4.21,4.09, both P<0.01) . In vivo, 188 ReO-4 was absorbed by maxillary glands and was quickly elimi-nated from blood via the kidneys. The 188 Re-DTPA-BaGdF5 NPs mainly accumulated in the liver and spleen. In addition, retention and accumulation of 188 Re-DTPA-BaGdF5 NPs in the liver tumor could be achieved by using transarterial intervention technique for drug delivery. Conclusion 188Re-DTPA-BaGdF5 NPs have cer-tain killing effects on hepatoma cells in vitro, and with the help of transarterial intervention technique, the NPs can be aggregated within liver tumor, where they not only can be used for SPECT imaging, but also have potential therapeutic effects.