OBJECTIVE To explore the clinical distribution characteristics and the drug-resistance of AmpC-producing Enterobacter cloacae in ICU. METHODS Seventy-eight strains of E. cloacae were isolated in ICU from Jan 2005 to Jan 2006 and antimicrocal sensitivities were determined by K-B method. RESULTS Among 78 E. cloacal strains derived from the lower respiratory tract and wound secretion,32 (41.0%) were AmpC producing and were sensitive to imipenem (96.9%) and merapenem (93.8%). CONCLUSIONS AmpC-producing E. cloacae is one of the main pathgens of nosocomial infection in ICU,imipenem and merapenem are the first choice to treat the infection.

Objective To investigate the diagnostic values of human epididymis (HE4)in lung cancer.Methods 80 patients with lung cancer were the experimental group,30 patients with benign pulmonary disease were the benign control group,and 30 healthy people were healthy control group.The levels of carcinoma embryonic antigen (CEA),cytokeratin protein fragment 21-1 (CYFRA21-1),neuron specific enolase (NSE) and HE4 in serum were detected.Results The levels of CEA,NSE,CYFRA21-1 and HE4 in lung cancer patients were higher than those in both the benign control group and the healthy control group (P＜0.05).The areas (AUC) under the receiver operating characteristic (ROC curve) were 0.870,0.818,0.746 and 0.897 for serum CEA,NSE,CYFRA21-1 and HE4 levels in diagnosis of lung cancer.The levels of CEA and HE4 were higher in patients with adenocarcinoma,the level of CYFRA21-1 was higher in patients with squamous cell carcinoma,the level of NSE was higher in patients with small cell lung cancer (SCLC) (P＜0.05).The detections of CYFRA21-1 (AUC=1.000),CEA (AUC=0.727) and HE4 (AUC=0.622) in serum are favorable for the diagnosis of squamous cell carcinoma,The detections of serum CEA (AUC=0.954) and HE4 (AUC=0.944) levels are favorable for the diagnosis of adenocarcinoma,and the detections of NSE (AUC=0.876) was favorable for the diagnosis of SCLC (P＜0.05).Conclusion The levels of CEA,NSE,CYFRA21-1 and HE4 in serum were abnormal in patients with lung cancer.The HE4 level in the patients was correlated with the pathological types and the metastasis of lung cancer.The detection of serum HE4 could be used in the diagnosis and evaluation of lung cancer.

Objective:To evaluate a Meta-analysis of randomized controlled trials ( RCTs) in multiple sclerosis ( MS) patients to evaluate the efficacy of vitamin D as add-on therapy. Methods: Searched Pubmed,EMbase,the Cochrane Library,CNKI,Wanfang Data base and so on up to february 2016 using the keywords:multiple sclerosis or MS and the drug names:vitamin D orCholecalciferol. Two authors independently selected the articles and extracted the data. We performed meta-analysis using Review Manager ( RevMan) version 5. 3 software. Results:Four RCTs with a total of 247 patients were selected.①Compared to the placebo, the EDSS score[MD=-0. 33,95% Confidence interval (CI)= (0. 68,0. 01),P=0. 05],the annual relapse rate[MD=-0. 08, 95%CI=(-0.37,0.21),P=0.60]and the number of gadolinium-enhancing lesions[MD=-0.16,95%CI=(-0.57,0.25),P=0. 45] showed no significant difference at 12 months,meanwhile the EDSS score[MD=-0. 48,95%CI=(0. 87,-0. 09),P=0. 02] and the annual relapse rate[MD=-0. 27,95%CI=(-0. 52,-0. 02),P=0. 03] were significantly less in the vitamin D group at 24 months.②Safety evaluation:There was no hypercalcaemia in vitamin D treated patients in each studies,main adverse events reported were diarrhoea, fever, constipation, dyspepsia, headache and so on. These symptoms were mild, after stopping drug can relieve the general. Conclusion: Vitamin D as an added in the treatment of MS showed as same as the placebo in some clinical indicators. However,after a longer treatment, the clinical indicators were significantly lower in the vitamin D group. Due to limited quantity and quality of the included studies,further larger and more prolonged studies are merited to verify the above conclusion.

Objective To investigate the relationship of cellular immunity of the hand-foot-mouth disease (HFMD) children and the disease severity and the variation following the recovery of disease.Methods A total of 560 HFMD cases was collected,and divided into severe and common groups.Another 120 cases were collected for comparison.T cell subsets (CD3 +,CD4 +,and CD8 +) rates were tested.The difference in cell immunity in each group were compared,and the comparison of cell immunity improv-ment during acute and recovery periods was conducted at the same time.Results In the 560 cases of children with HFMD,CoxA16-positive rate in common group was higher than that in severe group (x2 =280.72,P ＜0.01,severe cases); EV71 and other virus positive rates in severe group were higher than that in common group (x2 =127.75,P ＜ 0.01,x2 =5.43,P ＜ 0.05).Cell immunity was compared among3 groups (t =9.82,4.98,3.06); CD3+,CD4+,CD8+ results,tested within 2h after admission and after 1 week,were compared between severe and common groups (common group t =7.73,3.86,4.71; severe group t =6.13,2.60,3.36).Compared to severe group,cell immunity improvement was more obvious between before and after 1-week treatment in common group (t =2.57,2.51,2.95).The difference was statistically significant (P ＜ 0.05).Conclusions According to the etiology test of children with HFMD,CoxA16-positive rate was higher in common group; EV71 and other virus positive rates were higher in severe group.Cell immunity function decreased in severe and common group at the beginning of the disease; it was,however,significantly restored after 1-week treatment; and it was related to the severity of clinical symptoms.

Objective To investigate the electrocardiographic characteristics and assess the efficiency of ra-diofrequency catheter ablation(RFCA) in ventricular arrhythmia arising from the aortic sinus of Valsalva. Methods Eighteen patients(6 males and 12 females)were selected to undergo RFCA for ventficular arrhythmia originating from the left aortic sinus of Valsava. All of them were symptomatic,but without evidence of structural heart disease. Activation mapping was performed in the endocardium of the aortic sinus of Valsalva,then ablation was performed at the site with the earliest ventricular wave in endocardium electrograms. At the same time, coronary and aortic angiog-raphy were performed to assess the anatomic relationship between the ventricular tachycardia (VT)/ventricular pre-mature contraction (VPC) origin and coronary arteries and aortic valve before the RF energy delivery. Results Eighteen patients were successfully managed, with no major complications related to the procedure. VT eliminated and VPC counts on 24-hour ECG monitoring decreased significantly after the ablation[18 474(12 399,26 812)/24h vs 4 (1,7)/24 h, Wilcoxon signed-rank test, P<0.05]. During a follow-up period of 6 monthes, there was no recur-rence. Conclusions Ventricular arrhythmia arising from the aortic sinus of Valsalva has specific electrocardiograph-ic characteristics, and it can be successfully and safely treated under the guidance of activation mapping.

Objective To evaluate the effects of pacing in right ventricular septum (RVS) on hemodynamics among atrioventricular sequential dual chamber pacing Methods Twenty patients with high grade or complete atrioventricular block received permanent dual chamber pacemaker ( DDD ),were randomized into right ventricular septum pacing group (RVS)and right ventricular apex pacing group (RVA)according to the ventricular leads position.The QRS duration of the ECG,the left ventricular ejection (LVEF),the interventricular mechanical delay( IVMD )and the plasma levels of brain natriuretic peptide (BNP)were compared before and after operations.Results Compared with the preoperation,the mean QRS duration ( ( 187.00 ± 15.67 ) ms and (94.00 ±9.17 ) ms),the IV MD ( (43.20 ± 6.79 ) ms and ( 15.00 ± 4.08 ) ms ),the level of BNP ( ( 89.70 ± 8.30) ng/L and (40.00 ± 4.73 ) ng/L) increased( P ＜ 0.05 ) and LVEF decreased significantly ( (53.70 ± 1.34) % and (58.60 ±1.65 )% ,P ＜ 0.05 ) in RVA group,but didn't change in RVS group (P ＞ 0.05 ).After three months following up,the mean QRS duration and the IVMD in RVS group( (119.00 ±7.38 )ms,(19.00 ±4.59)ms) were shorter than that of RVA group( ( 187.00 ± 15.67) ms,(43.20 ± 6.79) ms) ( P ＜ 0.05 ),the LVEF was higher and the plasma level of BNP was lower than that of RVA group ( (57.00 ± 2.00) % and ( 53.70 ± 1.34) %,(44.20 ± 9.18 ) ng/Land ( 89.70 ±8.30) ng/L,P ＜0.05).Conclusions The RVS pacing could keep the normal ventricular activation sequence and biventricular contraction synchrony farthest without side effects on hemodynamics in comparison with the RVA pacing.The RVS pacing is more approaching physiological rhythm than the RVA pacing.

Objective: To investigate the mode of cell death caused by NDV strain Changchun and NDV strain Siping. Methods: Plaque formation, cell suppression test, gel electrophoresis, and TUNEL assay were used after the cells were infected by NDV. Results: The apparently pathological changes were observed in chicken embryo fibroblasts, BHK, Hela, Hep 2, HCT and OS 732 tumor cells, but not in Wish cells. The higher suppressed effect on tumor cells was found in the NDV strain Changchun than that in the NDV strain Siping. There was no dose effect relationship between NDV and tumor cell suppression, only optimum dose NDV could cause maximal tumor cells inhibitory effect. Conclusion: The mode of cell death might be different after infection of NDV. The NDV strain Changchun killed tumor cells mainly through apoptosis, while the NDV strain Siping killed tumor cells mainly through necrosis. \[

Objective To discuss on nursing of patients multiple- patient burn- blast combined injury, the cooperation of processes and quality control. Methods For 35 cases of burn- blast combined injury, emergency plan was initiated immediately, including staffing allocation, supplies allocation, nursing quality control and monitoring the inpatient areas, etc. Results 35 cases of burn- blast combined injury acquired immediate treatment of burn shock and nursing. Rescue rate of multiple- patient burn blast arrived 77.14%(27/35), with no case of nursing complication. Conclusions Timely allocation of nursing staff, rational quantity and structure, forceful organization and coordination, complete and timely supplies, correct quality control of emergence nursing and beneficial solutions are keys to ensure successive nursing of intensive patients of burn-blast combined injury, and also reflection of nursing quality guarantee.

Background and objective Non-small cell lung cancer (NSCLC) presents the highest morbidity and mortality among malignant tumors worldwide. hTe overall effective rate of epidermal growth factor receptor-tyrosine kinase inhibitor (EGFR-TKI) is 30% to 40%, and PFS (progression-free sruvival) is 12 months. However, EGFR-TKI resistance is typical in clinical observations, and this phenomenon signiifcantly affects tumor suppression. To overcome this resistance, a new prognostic factor associated with lung cancer drug resistance should be discovered. This study investigated the rela-tionship between the inhibitor of differentiation 1 (ID1) and non-small cell lung cancer EGFR-TKI resistancein vivo andin vitro to determine any statistical signiifcance and discuss the underlying mechanism.Methods Western blot and qRT-PCR were used to quantify the expression of ID1 in lung cancer. IHC was used to detect the expression of ID1 in pathological tissues (lung cancer tissues and adjacent tissues). MTT was used to detect cell proliferation, in which the cells were treated with geiftinib atfer being transfected by ID1 slow virus vector. Lung cancer cells were inoculated in nude mice until the tu-mor diameter grew to certain measurement. Geiftinib treatment was started, and the tumor volume was estimated.Results ID1 was highly expressed in NSCLC (P<0.05). Both ID1 expression and drug resistance of EGFR-TKI in NSCLC were positively correlated (P<0.05). hTe treatment group with geiftinib showed obviously less expression than the control group. Conclusion ID1 is highly expressed in NSCLC. ID1 expression was positively related to drug resistance of EGFR-TKI in NSCLC. Geiftinib can be used to effectively treat NSCLC, and the mechanism may be associated with an increased level of STAT3 phosphorylation.

Objective:To find the epidemiological characteristics of nosocomial infection in burn patients, to establish a risk prediction model for nosocomial infection in burn patients based on the screened independent risk factors of the infection, and to analyze its predictive value.Methods:A retrospective case series study was conducted. From May 2016 to December 2019, 3 475 burn patients who were admitted to the Department of Burns of Affiliated Hospital of Jiangnan University met the inclusion criteria, including 2 290 males and 1 185 females, aged from 1 to 94 years. The incidence of nosocomial infection, the detection site and specific composition of pathogenic bacteria were counted. The patients were randomly divided into training group (2 434 cases) and verification group (1 041 cases) in R 4.1.3 statistic software with a ratio of about 7∶3. Factors including gender, age, total burn area, combination of full-thickness burn/inhalation injury/shock/diabetes on admission, admission to intensive care unit (ICU), status of central venous catheterization/endotracheal intubation/urethral catheter indwelling/surgery, nosocomial infection status, days of antibiotic use, and days of hospital stay of patients were compared between the two groups. According to the occurrence of nosocomial infection, the patients were divided into nosocomial infection group (102 cases) and non-nosocomial infection group (3 373 cases), and in addition to the aforementioned data, non-nosocomial infection related data, the season of admission and types of antibiotics used were compared between the two groups. The above-mentioned data were statistically analyzed with one-way analysis of independent sample t test, chi-square test, and Mann-Whitney U test, and the indicators with statistically significant differences between nosocomial infection group and non-nosocomial infection group were included as variables in multivariate logistic regression analysis to screen independent risk factors for the development of nosocomial infection in 3 475 burn patients. On the basis of independent risk factors and important clinical characteristics, a nomogram prediction model was constructed for the risk of developing nosocomial infection of burn patients in training group. In both training group and verification group, receiver operating characteristic (ROC) curves for prediction of nosocomial infection by the prediction model were plotted, and the area under the ROC curve was calculated; calibration curves were plotted to evaluate the conformity between the predicted results of the prediction model and the actual situation; clinical decision curves were plotted to evaluate the clinical utility of the prediction model. Results:The incidence of nosocomial infection of patients included in this study was 2.94% (102/3 475); pathogens were detected from 212 specimens, mainly wound (78 cases, accounting for 36.79%) and blood (64 cases, accounting for 30.19%) specimens; 250 strains of pathogenic bacteria were detected, mainly gram-negative bacteria (153 strains, accounting for 61.20%). All clinical characteristics of patients between training group and verification group were similar ( P>0.05). There were statistically significant differences between patients in nosocomial infection group and non-nosocomial infection group in the aspects of age, total burn area, days of antibiotic use, antibiotic use type, days of hospital stay, combination of full-thickness burn, combination of inhalation injury, combination of shock, ICU admission status, central venous catheterization status, endotracheal intubation status, urethral catheter indwelling status, surgery status (with Z values of 4.41, 14.95, 15.70, 650.32, and 13.73, χ2 values of 151.09, 508.30, 771.20, 955.79, 522.67, 967.40, 732.11, and 225.35, respectively, P<0.01). ICU admission, endotracheal intubation, urethral catheter indwelling, and days of hospital stay were independent risk factors for developing nosocomial infection by 3 475 burn patients (with odds ratios of 5.99, 3.39, 9.32, and 6.21, 95% confidence intervals of 2.25-15.99, 1.56-7.39, 2.77-31.31, and 2.48-15.92, respectively, P<0.01). In training group and verification group, the area under ROC curves of the nosocomial infection prediction model based on independent risk factors, total burn area, and central vein catheterization were both 0.97 (with both 95% confidence intervals being 0.95-0.99); the calibration curve analysis showed that the prediction results of the prediction model were in good agreement with the actual situation; the clinical decision curve analysis showed that the prediction model had good clinical utility. Conclusions:The nosocomial infection in burn patients is mainly caused by gram-negative bacteria, with wound as the main infection site, and the independent risk factors including ICU admission, endotracheal intubation, urethral catheter indwelling, and days of hospital stay. Based on independent risk factors and important clinical features, the risk prediction model for nosocomial infection has a good ability to predict nosocomial infection in burn patients.