Objective To analyze the distribution of multidrug resistance bacteria infections in clinical departments and put for‐ward the corresponding countermeasures of prevention and control ,for providing basis for clinical diagnosis and treatment .Methods By carrying out the monitor of the drug resistance of bacteria ,the infection site and drug resistance strain and pathogenic bacteria distribution ,with 156 cases of multiple drug‐resistant bacteria infection ,were analyzed .Results The multidrug resistance bacteria of our hospital was distributed in the ICU unit ,accounted for 34% .Nosocomial infection of multidrug resistance bacteria was mainly the gram‐negative bacillus ,followed by the gram‐positive cocci ,and the majority of multidrug‐resistant bacteria were Escherichia co‐li(46 .2% ) ,Acinetobacter Baumannii(19 .9% ) ,Pseudomonas Aeruginosa(17 .9% ) ,Klebsiella Pneumoniae(17 .9% ) ,Staphylococcus Aureus(4 .5% ) .The priority was given to respiratory system infection ,accounted for 48 .1% ,followed by urinary system infection , accounted for 39 .0% .Conclusion The increase of multidrug resistance bacteria was very important problem that the hospital faced .It can effectively prevent and control multiple drug‐resistant bacteria infection by strengthening the monitoring of multi‐re‐sistant bacteria ,strictly executing disinfection and isolation measures ,the implementation of hand hygiene and reasonable application of antibiotics .

Objective To study the quality control of urinary arsenic detection .Methods Quality control before ,during and after analysis were performed to avoid the random error and control the system errors .Results The low detection value of self-made quality control material of urinary arsenic and coefficient of variation (CV) were (0 .644 ± 0 .024) mg/L and 3 .72% ,respectively , while the high detection value and CV were (1 .353 ± 0 .042) mg/L and 3 .14% ,respectively .Conclusion Quality control before , during and after analysis may effectively reduce the incidence of random error and control the system error of urinary arsenic detec-tion and ensure the accuracy of test results .

In order to promote our country's research on transitional care for patients with chronic kidney disease (CKD),the article summarized research progress on transitional care for patients with CKD,analysed the problems existed including lack of evidence-based basis,insugiciency of Intervention staff,one-sided intervention content and effect evaluation,etc,and put forward the corresponding countermeasures.

Objective To study the curative effect of transcatheter arterial chemoembolization( TACE) combined with conventional percutaneous ethanol injection therapy ( PEIT) in the treatment for primary liver cancer?Methods Forty cases patients with primary liver cancer(the diameter was equal or more than 8 cm) who were treat in the Third Hospital of Qinhuangdao from January 2007 to May 2013 were selected,and randomly divided into treatment group(20 cases) and control group(20 cases)?The control group underwent TACE,the treatment group were given TACE combined with PEIT, the clinical effect of the two groups were observed?Results The effective rate of the treatment group was 80%,significantly higher than that of the control group( 50%) ,the difference was statistically significant( P=0?04)?During the follow?up of 3 years,there were 3 cases of portal vein tumor thrombus,5 cases of hepatic metastasis,1 case of upper gastrointestinal bleeding and 2 cases of liver failure in the control group;there were 1 case of liver metastasis,1 case of liver failure and death in the treatment group?Conclusion The test of the curative effect of patients with huge hepatocellular carcinoma after combination therapy with TACE and PEIT proved combination therapy can increase the curative effect, decrease impairment of liver funvtion?It was a palliation road to treat huge hepatocellular carcinoma.

Objective To investigate the effect of external fixator on repairing the vascular injuries in the knee and calf.Methods From May 2004 to October 2010,208 patients (234 sides) with vascular injuries in knee and calf,treated with external fixation,were retrospectively analyzed,including 192 males (217 sides) and 16 females (17 sides) with an average age of 39.6 years (range,14-67).Blood vessel damage:the popliteal artery injury in 84 patients (86 sides),the anterior tibial artery injury in 36 (46),the posterior tibial artery injury in 41(49),the anterior tibial artery and the posterior tibial artery injury in 47 (53).Complete ischemic of the injured distal limb existed in 129 patients(141 sides),incomplete ischemia in 79 patiets (93 sides).All patients underwent emergency surgery.The AO external fixators were used in 164 patients,the chuangsheng inlaid external fixators in 37,and the hybrid external fixators in 7.The injured vessels were anastomosed directly,or indirectly with great saphenous vein.The wounds were treated with phase Ⅰ bandage,skin grafts,flap transplantation or VSD suction.Results One hundred and ninty four patients obtained successful limb salvage; but 14 patients underwent amputation owing to serious damage of limb and poor general condition.One hundred and twenty seven patients underwent the second stage debridement combined with skin graft or flap transplantation; 24 patients underwent the first stage free skin graft or flap transplantation;wound cicatrized by oneself in 43 patients.One hundred and forty eight patients were followed up for 8 months to 3 years.External fixators were removed after an average of 7.2 months (range,1-18).The average healing time of fracture in 102 patients was 5.6 months (range,3-13).Forty patients suffered bone nonunion or bone defect; after treated by fracture fixation,bone graft or bone transport,all of them got bone union.Conclusion The external fixation can shorten operation time as well as the time of limb ischemia,which is an effective option on repairing vascular injuries in knee and calf.

ObjectiveTo provide anatomical basis of neural transplantation to repair deep branch of ulnar nerve defect with the ring finger radial digital branch.MethodsThirty-two sides of 16 cases fresh forearms were dissected and observed.Microdissect and measure the deep branch of ulnar nerve,quadrate pronator of median nerve and it's ring finger radial digital branch under 10-times operating microscope. ResultsThe diameter of quadrate pronator of median nerve was (1.13 ± 0.02)mm,ring finger radial digital branch of median nerve was (1.17 ± 0.05)mm,mid-palmar section of deep branch of ulnar nerve was(1.75± 0.07)mm.Dissect ring finger radial digital branch of median nerve to muscular branch of quadrate pronator under operating microscope,retaining it's blood supply.The length between the deep branch of ulnar nerve and ring finger radial digital branch was( 104.59 ± 20.25)mm.Conclusion①Solving the problem of nervegrafting without blood supply before,benefit to the survival of the grafting segment and the regeneration of the neuro fiber,and function restoring.②This kind of grafting is the bridging of muscular branch to muscular branch,abide by the principle of neurophysiology.③Neural transplantation to repair deep branch of ulnar nerve defect with the ring finger radial digital branch is an effective method.

Objective Observe the efficacy and safety of glucocorticoid deescalation combined antiviral therapy on severe hepati‐tis B .Methods Forty‐nine patients with early severe hepatitis were selected and divided them into observation group(n=24) and control group (n=25) randomly .Control group were given the conventional synthetic therapy while observation group were given conventional synthetic therapy combined glucocorticoid deescalation therapy .Then compare the differences of TBIL ,ALT ,PTA be‐fore and after treatment ,and the improvement time of syndrome and death rate between two groups .Results The death rate in ob‐servation group and control group were 16 .7% and 32 .0% respectively(P<0 .05) ,the improvement time of syndrome in observa‐tion group were shorten than control group(P<0 .05) ,and there was no statistical difference in bleeding and infection rate between two groups(P>0 .05) .After the treatment ,the TBIL ,ALT ,PT were improved in both two groups(P<0 .05) .But the observation group had better improvement than control group ,the difference had statistical significance(P<0 .05) .After treatment ,the changes of HBV DNA between two groups showed no significant difference(P> 0 .05) .Conclusion Glucocorticoid deescalation therapy could decrease the death rate ,shorten the syndrome lasting time in treating severe hepatitis B .It was an effective and safety meth‐od .

Objective To evaluate the use of transfer statements in inhouse transport of critical patients.Methods By means of continuous enrollment,123 critical patients were enrolled as a control group for conventional transport,and 111 such patients were enrolled as an observation group for transport using the transfer statement.Then the incidence of adverse events,transport during and nurse-nurse collaboration level of the two groups were compared.Results In the control group,its incidence of adverse events was 13.8%,the mean transport during was(19.5 ± 8.4)minutes,and the mean score for nurse-nurse collaboration level was ( 101.87 ± 7.13 ).In the observation group,its incidence of adverse events was 5.4%,the mean transport during was(13.5 ± 5.4)minutes,and the mean score for nurse-nurse collaboration level was(106.15 ± 8.86).Implementing the transfer statement has cut back the incidence of adverse events (P<0.05)and the transport duration significantly(t=3.833,P<0.01),while improving the level of nurse-nurse cooperation significantly(t= -4.261,P<0.05).Conclusions The transfer statement can increase the safety of patient transport,promote organization and coordination of nurses,and improve the efficiency of transport.

Hierarchical diagnosis and treatment is an effective way to "optimize and reconstruct medical and health service system" and solve the problems of "difficulty and expensiveness of getting medical treatment". At present, the hierarchical diagnosis and treatment still exists many problems in the process of practice, and the solu-tion of these problems not only requires government departments to do the top-level supporting policies, but also needs the medical institutions at all levels to change their thinking mode and innovate the appropriate hierarchical diagnosis and treatment system. This paper analyzed the dilemma of hierarchical diagnosis and treatment in China from the aspects of medical alliance operation mechanism, medical insurance system, physician multi-point occu-pation, medical resource allocation and medical information sharing and so on, and put forward corresponding countermeasures.

Objective To investigate the use of smartphone applications in the adherence with inhaled glucocortiocoids (ICS) therapy in asthma children. Methods Sixty-six asthma children and their caregivers in Shanghai Childrren's Medical center from July 2016 to February 2017 were recruited in this study using convenience sampling . All participants were randomly allocated to intervention and control groups. All participants were given routine education and technical guidance on inhalation. In addition all participants had the same chips attached to their regular nebulizers. The APP was installed on each caregivers' smartphone in the intervention group. Key modules of mobile applications include real-time monitoring of medication and health education. The ICS adherence rates were recorded by the chips and were monitored monthly by researcher. The frequency of asthma exacerbations, emergency department visits and hospital admissions in intervention group was collected by smartphone APP every 3 months. the frequency of asthma exacerbations, emergency department visits and hospital admissions in control group was investigated by researcher every 3 month. Results After 6 months follow up, although ICS compliance decreased in both groups. The first month's adherence in the intervention group was 98(97.0, 100.0)％, in the sixth month's was 96(92.0, 100.0)％. The first month's adherence in the control group was 93(68.5,100.0)％, in the sixth month's was 28(0, 55.5)％. The difference in adherence between the two groups was significant (Z=2.664, 4.318, P<0.01). The decline trend of the control group was significantly greater than that of the intervention group (F=25.097, P<0.01). The compliance of the control group was less than 60％from the third month and below 30％by the sixth month, below the average ICS compliance of 30％ to 60％ in China. Though the ICS compliance of intervention group was declining, the ICS compliance was more than 90％ and higher than the mean compliance in our country. No significant differences were found in the frequency of asthma exacerbations, emergency department visits and hospital admissions between the intervention and control group (χ2=3.043, 1.065, 1.015, P>0.05). But the frequency of asthma exacerbations, emergency department visits and hospital admissions of two times or more intervention group was lower than that in the control group. Conclusions Smartphone APP significantly improved the compliance of children with asthma aged 0 month to 3years old.