Urinary tract infections (UTIs) are common, recurrent infections that can range from mild to life-threatening. High recurrence rates of UTIs and increasing antimicrobial resistance may place a greater financial burden on the patients with UTIs. Thus, UTIs is becoming an increasingly serious public health problem. This review summarized how pathogens adhered to and colonized host cells, the important role of bacterial pili in the development of UTIs and the pathogenic mechanisms of different pathogens in UTIs and catheter associated urinary tract infections (CAUTIs). Elucidating the molecular mechanisms of host-pathogen interactions and the pathophysiological consequences of these interactions in UTIs is conducive to further understand the pathogenesis of UTIs.

Objective The purpose of this study was to assess the incidence,treatment and prognosis of silent pulmonary embolism (PE) after off-pump coronary artery bypass graft (CABG).Methods From December 2009 to September 2012,582 consecutive patients underwent off-pump CABG by a same surgeon.Their age ranged from 16 to 86 years with a mean age of (61.4 ± 9.3) years.Left internal mammary artery and saphenous vein were harvested routinely.A dose of 20 mg unfractionated heparin was given intravenously every 6 hours on the operative day after postoperative pleural fluid less than 50 ml per hour.All patients received aspirin 100 mg daily starting on postoperative day 1.The 64-slice coronary MDCT was performed to assess the graft patency on postoperative day 5 ～ 7.Results There were no in-hospital death.PE,which involved the lobar or more proximal arteries,was detected on the CT images of 10 patients (1.7％).In these 10 patients,there were no significant dyspnea or hypoxemia postoperatively ; echocardiography and ECG showed no specific signs of PE ; all bypass grafts were patent in CT images except a LIMA to LAD graft with LAD endarterectomy.PE involved both lungs in 6 patients,and only the right lung in 4 patients.All patients received anticoagulation with warfarin for 3 to 6 months except one.All patients were with good quality of life during 6 to 18 months of follow-up.Three to six months after discharge,8 patients received repeated MDCT,which showed diminish of PE.Conclusion Acute PE after off-pump CABG was an uncommon complication and was difficult to diagnose.MDCT played an important role in examining the patency of graft vessels and helped detect silent PE in CABG patients.The prognosis of acute PE after off-pump CABG was acceptable.PE diminished after 3 months of anticoagulation with warfarin.

Objective To learn the present hospital medical quality management,to explore and improve the quality of care management system.Methods Literature review analysis theory of medical quality management system,questionnaires analysis the present medical quality management,case and influencing factors.Results The literature review showed that the trend of quality management study increased year by year in recent 20 years,and is gradually becoming a hot topic in China.The management practices survey found the quality of care management systems mostly established,yet with rooms of improvement for the management content and details.Thanks to the three-stage introduction,operation and indepth study of international standards,hospitals have effectively promoted their quality management.Conclusions Key influencing factors for hospital quality management are the design of such quality management system itself,and lack of quality tools and resources.To build a better quality of care management system,efforts should be paid from both internal and external aspects,thus elevating such quality to a new level.

Objective To evaluate laparoscopic resection of gastric stromal tumors. Methods Clinical data of 20 patients undergoing laparoscopic resection of gastric stromal tumors from June 2003 to October 2007 were retrospectively analyzed. Result Laparoscopic wedge resection was completed successfully in all 20 patients with a mean operating time of(60±34) min, and without major complications. The mean hospital stay was (6.0±2.6) days. During a follow-up period from 10 to 22 months there was no recurrence. Conclusions Laparoscopic wedge resection is safe, effective, and minimally invasive for treating gastric stromal tumors.

Objective To review the experience of the surgical treatment of adult patients with anomalous left coronary artery from the pulmonary artery(ALCAPA).Methods A retrospective,single institution review was conducted on nineteen adult patients with ALCAPA surgical treatment from February 2006 to October 2012.Of these patients,five were males and fourteen were females.The age was(35.3 ± 11.7) years.The weight was (61.2 ± 9.4) kg.Most patients showed some evidence of myocardial infarction or ischemia with either abnormal Q waves (4) or ST-T abnormality (13).Twelve patients with coronary angiography and four patients with coronary CT scan showed good coronary collateralization.The preoperative UCG showed the mean left ventricular ejection fraction(LVEF) was 0.60 ± 0.07,and the mean left ventricular end-diastolic dimension(LVEDD) was(52.4 ± 4.4) mm.Severe mitral regurgitation(MR) was seen in two patients,moderate in three patients and mild in four patients.The operative procedures included Takeuchi operation in seven patients,ligation of left coronary artery concomitant with coronary artery bypass graft in two patients,coronary artery re-implantation in ten patients.Of the ten patients with coronary artery re-implantation,two patients underwent mitral valve repair.Results There was no operative mortality.The mean cardiopulmonary bypass time was (144.5 ± 66.9) min and cross-clamp time was (96.4 ± 38.8) min,respectively.The mean mechanical ventilation time was(12.9 ± 3.7) h and intensive care unit time was(39.2 ± 12.5) h,respectively.The mean postoperative LVEF was 0.62 ± 0.04.No significant reduction in LVEDD (45.8 ± 5.5) mm,P ＞ 0.05.Mild and trivial MR were observed in one and four patients,respectively.Sixteen patients(84.2％) completed the follow up with a mean time of 19.2 months.All the patients survived with New York Heart Association class Ⅰ or Ⅱ.During the follow up period,no patient required reoperation or readmission.At the latest echocardiography,the mean LVEF of 0.63 ± 0.05 and mean LVEDD of(49.2 ± 4.6) mm did not significantly improved compared with the data preoperatively or postoperatively.Mild MR was detected in six patients,trivial in three patients during the follow-up period.Conclusion The adult patients with ALCAPA have a dormant disease process.Surgical treatment has been recommended at the time of diagnosis and the coronary re-implantation could be the first choice.As for the concomitant MR,the guideline for the adult MR should be followed.

Objective: Based on nationwide cardiovascular surgery registry database, to analyze the current status and future development of minimally invasive cardiovascular surgery (MICS) in China.
Methods: There were 45 institutions from 19 provinces nationwide involved in Chinese cardiovascular surgery technique registry study. A total of 16480 adult patients with cardiovascular surgery from 2010-09 to 2012-03 were divided into 2 groups, Conventional surgery group, n=14503 and MICS group, n=1977. The basic clinical conditions were analyzed and compared between 2 groups in order to explore the current status and future development of MICS in China.
Results: Compared with Conventional surgery group, the patients in MICS group had the younger age, better and stable pre-operative condition. In MICS group, compared with 4 other common procedures, the patients who received hybrid procedure had obviously shorter cardiopulmonary bypass (CPB) time, aortic occlusion time, ventilator using time, ICU and in-hospital stay time, meanwhile decreased post-operative drainage volume;except for Robotic surgery, it required less red blood cells and plasma at during and post-operative time, all P<0.01. There were 12 (0.6%) in-hospital death in MICS group, the total complication rate was at 4%.
Conclusion: MICS are widely used in China, its short-term safety and efifcacy are conifrmed. Upon cardiovascular disease spectrum changing, the MICS procedures will be adjusted accordingly.

Objective In order to improve the outcome of surgical treatment for atherosclerotic heart disease,we summarize our clinical experience of surgical treatment during the last four years and propose our therapeutic strategy.Methods A retrospective study was performed including consecutive 1052 patients receiving isolated or combined CABG surgery which was performed by a single surgical team from January 2006 through March 2010 at Fu Wai Hospital.Patients'characters were quantified by European score System for cardiac operative risk evaluation (EuroSCORE).Operative strategies were classified as candioplegic arrest,on-pump beating,isolated off-pump,and the hybrid procedures to treat the concomitnnt diseases,such as peripheral vascular disease,atrial fibrillation,congenital heart diseases,et al.Clinical data including the surgical indications,preoperative patient co-morbidity,postoperative clinical course,and perioperative outcomes were analyzed of.Results Patients showed a mean EuroSCORE of 3.4 ±2.6.There were 127 patients ( 12％ ) with a EuroSCORE ＞6.The mean age of the patients was(61.2 ± 9.5 ) years,ranging from 26 to 84 years.The overall in-hospital postoperative mortality rate was 0％,and all patients had an uneventful recovery course and discharged.The transfusion rate was 31.9％.950 patients (90.3％)were OPCAB and 102 (9.7％) were on-pump CABG.There were 87 patients underwent concomitant CABG and heart valvereplacement or repair.21 patients underwent hybrid procedure by simultaneous peripheral artery stenting and OPCAB,and 14patients underwent redo CABG.The Average number of distal anastomoses was 3.2 ±0.9,and the mean postoperative hospital stay was (7.7 ± 2.5 ) days.Fourteen patients had re-exploration for bleeding,8 with pneumonia,5 with acute renal insufficiency and 6 had intra-aortic balloon pump (IABP) for cardiac dysfunction.All these patients recovered after proper treatment.Conulusion Surgical treatment for the coronary heart disease could achieve satisfactory curative effects by the individualized treatment,technological innovation and strengthen perioperative management.Excellent results and low major complications in the perioperative coupe could be expected through this strategy.

Objective To report therapeutic effects of patients with bladder cancer treated by intra-operative radiation and to recommend an effective method for the treatment of bladder cancer.Methods During the operation,when the tumor of bladder had been removed,a boost dose of electric beam from a linear accelerator was irridiated to the tumor bed.28 cases were follawed-up in a long period.Results Lower local recurrence was observed in patients received intra-operative radiation therapy,only 2 cases had a small recurrent tumor in the bladder during the follow-up period.26 cases had bean followed up,no tumor recurred.Conclusion The intraoperative radiation therapy is a useful treatment for the bladder cancer.

Objective Summarizing single clinical experience with extracorpomreal membrane oxygenation(ECMO) as a supplement to extracorporeal cardiopulmonary resuscitation(ECPR) in adult patients with cardiac arrest to explore new ideas.Methods We retrospectively analyzed the characteristics of 17 patients who underwent ECMO as part of ECPR from July 2005 to September 2014 at Fuwai Hospital,and analyzed the differences between the survival group(n =6) and the in-hospital death group.Results The mean CPR time was(44.53 ± 21.39) min.The support duration of ECMO was(106.38-± 70.43) h.12 patients of all were successfully weaned from ECMO,and 6 patients survived to hospital discharge.There were significant differences between the two groups in terms of the last serum creatinine and blood lactate acid level before ECMO,and the time to lactate normalization.11 patients died,7 patients developed bleeding,and 8 cases developed infection.Conclusion Single-center data showed that applying ECMO as a means of ECPR improved the survival rate in cardiac arrest patients.Additionally,creatinine and lactic acid were good indicators for assessing prognosis.Refractory circulatory dysfunction and neurologic complications have an adverse impact on the survival of cardiac arrest patients.

Objective To analyze the relationship between polymorphisms of EDNRB gene and Hubei provincial patients of Han ethnicity with sporadic Hirschsprung disease(sHD). Methods Peripheral blood samples from 104 patients with sHD and 84 parents of 42 patients, and 120 normal children(as controls) were collected. PCR-SSCP and direct DNA sequencing were used to detect mutations and polymorphisms of exon-4 in EDNRB gene. The differences of allele frequencies and genotype distribution in polymorphic sites were further analyzed between the three groups. Allele frequencies of SNPs in forty-two sHD trios were analyzed by transmission disequilibrium test(TDT), and the association between phenotype of HD and SNPs was analyzed. Results No mutant site was detected and one polymorphic site of c831 G→A(L277L) was observed in Hubei provincial patients of Han ethnicity with sHD. The allele frequency of A(68% vs 53%) and genotype frequency of AA(49% vs 30%) were significantly higher in sHD group than that in control group(P