Objective To evaluate the risk factors for healthcare-associated infection (HAI)in patients in depart-ment of cardiology.Methods Clinical data of inpatients were performed retrospective case-control analysis,patients with HAI were as case group,while without HAI were as control group,factors for HAI between two groups were compared.Results 117 cases of HAI occurred among 2 308 patients,infection rate was 5.07%.The main infection site was respiratory tract (n=71 ,60.68%);a total of 90 pathogenic isolates were isolated,gram-negative bacteria, gram-positive bacteria,and fungi accounted for 72.22%(n=65),22.22%(n=20),and 5.56%(n=5)respective-ly.Univariate analysis revealed that 7 variables were risk factors for HAI,multivariate non-conditional logistic re-gression analysis revealed that independent risk factors for HAI were age,cardiac function classification,serum al-bumin level,and invasive operation.Conclusion HAI rate is higher among cardiology inpatients,which is related to many factors.Attention should be paid to the elderly,long term hospitalization,heart failure correcting,treatment for complications,reducing of invasive procedure,and strict sterile manipulation.

Recent studies have found that inflammatory response is positively associated with the progression of liver cirrhosis,acute-on-chronic liver failure,and primary liver cancer and can affect their prognosis,and as a marker for inflammatory response,neutrophil/lymphocyte ratio (NLR) is easy to calculate,has good repeatability,and holds promise for prognostic evaluation.This article introduces the research advances in the association of NLR with the prognosis of liver cirrhosis,acute-on-chronic liver failure,and primary liver cancer and points out that NLR plays an important role in evaluating the prognosis of liver cirrhosis,acute-on-chronic liver failure,and primary liver cancer.However,there are still controversies over the selection of optimal cut-off values for different diseases,and further studies are needed.

This paper introduces orthopedic resident training system of America including its devel-opment, certification system, selection system, clinical training mode and investigate system. And we hope to improve orthopedic resident training of China by analyzing the new rule of Chinese standardized resident training and the training experience of Peking Union Medical College Hospital.

Objective To discussing the methods used in creating non linear developable biomechanical models of skeletal muscle.Methods One of the basic tools of the analytical approach in analytical mechanics, the principle of virtual work for deformable systems, was used to create the model. By means of method of Lagrange multipliers, the problems of constraints, such as the incompressibility of skeletal muscle, were effectively tackled. Results and Conclusion The biomechanical models of skeletal muscle has been developed. The program of this model can be used to obtain nodal displacement coordinates of given nodal coordinates and parameters.

Objective To report immune-reconstruction in two patients with acute radiation sickness due to 60Co radiation accident after stem cell transplantation.Methods Patient “A” and “B” were diagnosed as intestinal form of acute radiation sickness(ARS)and extremely severe degree bone marrow form of ARS,respectively.Peripheral blood stem cell transplantation was successfully performed in these two patients.During their whole disease course,absolute lymphcyte count,neutrophil leukocyte count,T-lymphocyte subsets,natural killer(NK),and immunoglobulin were sequentially determined.Results Immunoglobulin was decreased after irradiation without any recovery tendency after the transplantation.After irradiation,absolute lymphcyte count decreased rapidly,but recovered partially after the transplantation(maintained at 0.5?109/L).Neutrophilic leukocyte count rose rapidly to normal after the transplantation.NK was lowered obviously after irradiation,and it rapidly recovered to normal level after the transplantation,and maintained at a level higher than normal.After irradiation,the proportion of CD4/CD8 showed a transient rise,followed by an abrupt lowering.After the transplantation,it showed a tendency of elevation,but it did not recover to normal.Conclusions The tendency of lowering of immunoglobulin,lymphocyte count,NK cell count,and CD4/CD8 ratio indicate that there is a rapid deterioration of both cellular and humoral immunity after irradiation.Following the homogeneic peripheral blood transplantation,neutrophil count and NK cell count showed a rapid recovery,lymphocyte count and CD4/CD8 ratio also showed a tendency of slow elevation,but there is no sign of recovery of immunoglobulin.The results indicate that there is a faster recovery of cellular immunity.

Objective To investigate the significance of HLA haploidentical peripheral blood stem cell transplantation for the treatment of intestinal form of acute radiation sickness. Methods Patient “A” from Shandong province suffered from a 60 Co radiation accident with a dose of 20-25Gy, and was diagnosed as intestinal form of acute radiation sickness. On the 3rd day after irradiation, total environmental protection (TEP), antibiotics treatment and emergency HLA zygosity with his elder sister were done, and HLA haploidentical peripheral blood stem cell transplantation was performed with a preconditioning regimen of “CTX+ATG+Flu”. The regimen for protecting from GVHD was “CsA/FK506+MMF+CD25+MSC”. Results WBC began to increase on the 17th day after treatment, and WBC recovered to 5.1?109/L on the 19th day, platelet to over 30?109/L, and RCT to normal. Bone marrow image showed hematopoietic recovery of the three cell lineages. Continuously detection of the implantation ratio of donor's cells by STR-PCR, sexual chromosome analysis and HLA zygosity showed stable complete donor-derived chimera. No GVHD was observed. On the 19th days after treatment, chest X-ray films and CT suggested that a mixed bacterial and fungous infection existed in the patient's lungs. The severest skin damage occurred on the 25th day which occupied 14% of whole body surface. The functions of lung, kidney and heart were damaged sequentially. The patient died of multiple organ failure (MOF) 33 days after admission. Conclusion It is the first time to report a successful HLA haploidentical peripheral blood stem cell transplantation for the treatment of intestinal form of acute radiation sickness in China. A successful transplantation might be a key for prolonging the survival period of such a patient.

Objective To report the diagnosis and treatment of an extremely severe bone marrow form of acute radiation sickness complicated with disseminated Trichosporon Asahii in Jining,Shandong province, China.Methods An extremely severe bone marrow form of acute radiation sickness was transfered to our hospital 3 days after the accident on October 24,2004.The patient was performed allogeneic stem cell transplantion from his brother and soon acquired hematogenesis recovery, however, refractory disseminated Trichosporonosis(mainly lung) then occured in the patient.after the hemato-reconstitusion,and gradually aggravate.Result Strong support treatment and high dosage combination of drug therapy were used to combat fungi ,the accumulative dose of Ampghotec (amphotericin B) was 2965mg, the accumulative dose of itraconazole was 4000mg, and the accumulative dose of Caspofungin(concidas) was 3020mg. The refractory disseminated Trichosporon Asahii was once partially controlled, but the radiation injury and infection were still becoming worse even after many kinds of antiinfection drugs, the patient then died of multiple organ failure on d75 after the accident. Conclution The combination of Ampghotec with Caspofungin and Itraconazole in the treatment of disseminated Trichosporon Asahii was effective, no related toxicity occured, which has not been reported before. However, with continuously injury of radiation, we couldn’t cure the Trichosporonosis thoroughly, and the patient finally died of multiple organs failure related with radiation and infection.According to the clinical treatment of the patient, we also acquired the experience that when we resolve the hematogenesis, to promote the immunologic reconstitution and the tissue damage repair, control the whole body radiation damage and infection will be the key point for this kind of patient to survive.

Objective To observe the changes of serum high-sensitivity C-reactive protein (hs-CRP) in 2 patients diagnosed as acute radiation sickness, and to evaluate its clinical significance. Methods Two victims from Shandong province, China were accidentally received a 60 Co irradiation from a dropped 60 Co source in 2004. They were exposed to more than 20Gy (patient A) and 9Gy (patient B) of X-ray irradiation respectively. The patient A was diagnosed as extremely severe bone marrow form of acute radiation sickness (ARS), and patient B was diagnosed as having developed intestinal form of ARS. The two patients successfully got HLA-haploidentical (patient A) and HLA-identical (patient B) peripheral blood stem cell transplantation, and their hematopoiesis recovered, but they cached serious bacterial infection in whole clinical course. Hs-CRP was quantitatively detected by automatically immunoturbidimetric assay. Result The serum level of hs-CRP in the two patients elevated quickly when they suffered from serious bacterial infection, and declined markedly when the infection was controlled effectively. The serum level of hs-CRP also increased slightly when the patients suffered from severe damage on organs or skin function. There existed 3 peak values of hs-CRP level in patient A when kept in the hospital, with a highest value of 188.8mg/L; there existed 4 peak values of hs-CRP level in patient B when kept in the hospital, with the highest value of 377.2mg/L. Conclusion The present results suggested that hs-CRP may be a good indicator to acute radiation sickness complicated with serious bacterial infection, for the hs-CRP levels may fluctuate following the bacterial infection and effectively controlling.

Objective To investigate the infectious complications after nonmyeloablative allogeneic peripheral blood stem cell transplantation (NASCT). Methods Ten patients with leukemia received NASCT from HLA-identical or 1-3 antigen mismatched sibling donors with conditioning regimens of Flu/Cy+BU+ALG. Five patients were acute leukemia (AL) and all of them is in complete remission (CR1). Cyclosporine in combination with methotrexate was administered for GVHD prophylaxis. Results WBC recovered to more than 0.5 ?10 9/L during postoperative 10 day to 38 day and platelet recovered to more than 20?10 9/L during postoperative 8 day to 16 day. Bacterial infections occurred in 3 patients (30 %) and cytomegalovirus (CMV) infections in 2 patients (20 %). Varicella zoster virus (VZV) infections occurred in one patient (10 %). No fungal infections were documented. No patients died as a result of infection . Conclusion NASCT is a safe and effective therapeutic method for leukemia. It reduces acute GVHD,regimen-related toxicity and early neutropenia associated with traditional allo-HSCT.

Objective To compare the results of mobilization of peripheral stem cells of two different G-CSF dosage schedules in 30 healthy donors. Methods In one group 15 healthy subjects received 5?g/kg filgrastim once daily subcutaneously (SC), while in the other group another 15 individuals received 2.5?g/kg of filgrastim twice daily SC. Peripheral blood stem cells were collected after five days of filgrastim administration, and flow cytometric immunophenotyping was performed for the first harvest. Results The MNC count was 2.93?10 8/kg donor body weight in the 5?g/kg Qd group compared with 4.42?10 8/kg in the 2.5?g/kg bid group (P0.05). Conclusion Administration of filgrastim twice a day at 2.5?g/kg instead of once a day at 5?g/kg is more efficient in mobilizing stem cells without obvious side effect.