Objective To investigate the clinical characteristics, risk factors and prevention measures of carbapenem-resistant Klebsiella pneumoniae (CRKP) infection. Methods Thirty-nine cases whose CRKP isolation and culture were positive and who were confirmed with nosocomial infection in 2nd affiliated hospital medical school of Zhcjiang University between July 2006 and July 2008 were retrospectively investigated. Results There were 22 (56.4%) sputum specimens among CRKP samples. The average age of the patients was 64.0 years old and the average length of staying in hospital was 80.8 days. There wcre 36 patients who had been in intensive care unit (ICU) within 2 weeks and 26 were conscious disturbance,38 received urethral catheterization, 34 inserted with central venous catheter, 32 received tracheal intubation and 30 assisted with mechanical ventilation. There were 27 (69. 2 % ) patients who were co-infected with other bacteria and 8 were co-infccted with fungi. The mortality was 46. 2% in patients with CRKP infection. Before CRKP-positive culture, 27 (69.2%)experienced ＞4 kinds of antibiotics with the majority of β-lactams/β-lactamase inhibitors and carbapenems.Conclusions CRKP infection frequently occurrs in elder and patients who prolonged stay in hospital,especially patients in ICU. Invasive procedures could increase the infection opportunities.

Objective To explore the effect of nursing clinical pathway in percutaneous coronary intervention(PCI)for patients with acute myocardial infarction(AMI).Methods Sixty AMI patients were randomly divided into nursing clinical pathway(NCP) group and control group equally by their registration sequence.Patients in the control group received routine nursing care,while patients in NCP group received nursing according to the nursing clinical pathway.Results Compared with the conventional group, the time of preoperative preparation,bed rest and hospitalization was obviously shortened.The incidence of complications and hospital costs were both declined,and meanwhile the quality of care and patient satisfaction improved significantly(P<0.05). Conclusions The application of nursing clinical pathway in patients with AMI can be timely and effective in the treatment of PCI, lower the mortality and complications and moreover improve nurses' working enthusiasm.

Objective As a classical approach for hyperthermic ablation,microwave ablation (MWA) has been widely used in the treatment of tumors that cannot be removed by traditional surgery.MWA devitalizes the neighboring tissue and kills tumor cells by thermal diffusion.In the last two decades,this technique has been improved for treating malignant bone tumor in our institute.In situ ablation has already replaced en bloc resection and achieved satisfactory treatment outcomes.This study explores whether tumor cell death induced by MWA would cause the release of immunogenic tumor antigens and tumor-specific immune responses.Methods Three models of MWA were established using osteosarcoma cell lines from the mouse,rat,and human,respectively.The expression of immunogenic molecules was measured during in vitro and in situ ablation with different ablation time and group design.Results The injection of tumor vaccines made from tumor cells or supernatant treated with in vitro ablation resulted in substantial inhibition of tumor cell growth in tumor-bearing animal models.The CDs + T cells induced by vaccines played a key role in the process.The effector cells released cytokines,IFN-γand TNF-α,to inhibit tumor cell growth and also trigger Fas/FasL-mediated apoptosis.Conclusions MWA-treated osteosarcoma cells can be used to induce specific antitumor immunogenic effects.Therefore,in situ MWA combined with immunotherapy provides an alternative treatment method for patients who have trouble due to their insensitivity to chemotherapy.

Objective To understand the current distribution of infected snails in Anhui Province.Methods The data of snail survey were collected,the database was set up and the position of environments of infected snails were determined with GPS,the E-map was established with ArcGis 9.1 and the distribution of infected snail was analyzed.Results In 2007,331 environments with infected snails were found in Anhui Province,and 62.5% of them were found in the lake regions and 37.5% in the mountainous areas.The infected snail habitat areas were 682.6 hm2,85.5% of them were distributed in the lake regions and 14.5% in the mountainous areas.The river beach and the canal were the main environments with infected snails in the lake regions and mountainous areas,respectively;and 97.2% of the environments with infected snail were distributed in the infection-uncontrolled villages or villages which reached the criteria of infection control of schistosomiasis.Grassland was the main vegetation with infected snails,and the second was the reeds and trees.Conclusions The current endemic situation of the infection-uncontrolled villages or villages which reached the criteria of infection control of schistosomiasis is severe and should be emphasized for schistosomiasis prevention and control.The distribution of infected snail is connected with the river system.In the lake regions,the infected snails are distributed over the bottomlands of the Yangtze River and tributaries and islets and lakes;in the mountainous areas,the infected snails are distributed in the rivers banks and irrigated areas or special environments.

Objective To explore the protective effects and the mechanisms of peritoneal dialysis (PD) on multiple organs induced by acute organophosphoms pesticide poisoning(AOPP)in order to get a scientific basis for the application of PD to treat AOPP patients. Method The model of AOPP rabbits was made by intragastric administration of 25 mg/kg(0.5LD50)40% omethoate, and the symptoms of poisoning such as myosis, salivating and muscular tremor were observed. Eighteen male Japanese rabbits were randomly divided into control group and peritoneal dialysis group (PD group). Pralidoxime chloride and atropine were given by intra-muscular injection to rabbits of control group (re = 9). Rabbits of PD group ( n = 9) had a tube inserted into peritoneal cavity and peritoneal dialysis was given for 10 times after administration of pralidoxim chloride and atropine. Serum TNF-α,CK-MB (M.B. isoerizyme of creatine kinase), ALT, creatinine, and amylase were observed dynamically. The dialysate of peritoneal dialysis was remained in the peritoneal cavity for testing the nature of intoxicant by using Varian 3900/ Saturn 2100T GC/MS device. All data were analyzed with SPSS version 12.0 software. Statistical comparison between two groups was carried out by using student t-test and analysis of variance(ANOVA) followed by Dunnett-ttests before and after intoxication. The pearson correlation analysis was used for determination of the relationship between TNF-α and other biomarkers. Results After intoxication, serum TNF-α, CK-MB, ALT and amylase increased except creatinine, but the serum levels of those biomarkers in PD group were significantly lower than those in control group.The level of TNF-a had positive correlations with CK-MB ( r = 0.470), ALT ( r = 0.649), and amylase ( r = 0.517). The omethoate was detected in the dialysate of peritoneal dialysis. Conclusions Organophosphorus pesticides can lead the cardiac muscle, liver, kidney and pancreas to the injury through several mechanisms,and the inflammatory mediators play important role in the development of MODS induced by AOPP. Peritoneal dialysis can clean up intoxicants slowly and continuously and in turn lower down the level of inflammatory mediators resulted in protecting multiple organs from AOPP.

Objective:To explore the significance of digital orthopedic technology in surgical plan for spinal tumor and the preliminary outcomes of 3D printed vertebral bodies in spinal tumor surgery.Methods:The clinical data of 2 patients were retrospectively analyzed who had had a 3D printed vertebral body implanted at Center of Orthopaedics, Shenzhen Hospital from June 2018 to December 2019. One was a 32-year-old male, diagnosed with cervical neurinoma; the other was a 27-year-old female, diagnosed with giant cell tumor of lumbar bone. 3D virtual reconstruction of tumor and surrounding structures was established via Mimics software for surgical plan. Virtual osteotomy was simulated, their disease models and guide templates were 3D printed, and their metal artificial vertebral bodies were 3D printed after personalized design of the vertebral body diameter, porosity and procedures of reconstruction and fixation. Lesion resection and prosthesis implantation were carried out in accordance with the preoperative plan. After operation, the motor function of cervical or lumbar vertebrae, tumor recurrence, and spinal stability reconstructed were regularly observed.Results:Resections and reconstructions went uneventfully in both cases. The 2 patients were followed up for 21 and 13 months respectively. Their postoperative images showed that their 3D printed vertebral bodies fitted the neighboring vertebral bodies well. The spinal stability was reconstructed without any loosening or periprosthetic osteolysis, and the tumors were removed completely with no recurrence in both cases. Their spinal motor function was satisfactory.Conclusions:Digital orthopedic technology can offer accurate guidance in the treatment of spinal tumors. It is necessary to consider local physiological anatomy in personalized design of a metal vertebral body 3D printed. Clinical application of 3D printed metal vertebral bodies is a new strategy for spinal reconstruction following spinal tumor resection.

"The Expert Group on Tumor Ablation Therapy of Chinese Medical Doctor Association, The Tumor Ablation Committee of Chinese College of Interventionalists, The Society of Tumor Ablation Therapy of Chinese Anti-Cancer Association and The Ablation Expert Committee of the Chinese Society of Clinical Oncology" have organized multidisciplinary experts to formulate the consensus for thermal ablation of pulmonary subsolid nodules or ground-glass nodule (GGN). The expert consensus reviews current literatures and provides clinical practices for thermal ablation of GGN. The main contents include: (1) clinical evaluation of GGN, (2) procedures, indications, contraindications, outcomes evaluation and related complications of thermal ablation for GGN and (3) future development directions.
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