OBJECTIVE To determine the distribution of pathogens of bacterial infection in respiratory intensive care unit (RICU) to provide reference for the prevention of hospital infection. METHODS To collect specimens of the patients received endotracheal intubation from Jan 2006 to Dec 2006 in our RICU,to identify pathogens and drug sensitivity test. RESULTS We isolated 105 pathogenic bacteria from 626 specimens of the 58 patients,the G-bacilli accounted for 64.76%,G+ cocci accounted for 20.95%,fungi accounted for 12.38%; Acinetobacter baumannii was one of the main G-bacilli accounted for 19.05%. Staphylococcus aureus of G+ cocci for 9.52%,and Candida albicans of fungi for 7.62%; from 105 pathogens,65 from the respiratory tract,15 from the for urinary tract,eight from a catheter tube,six from the digestive tract,five from the blood,four from the various drainage tubes and two from the incision secretions. CONCLUSIONS Hospital infection pathogens exist in the respiratory tract infection in hospitalized patients of respiratory ICU with risk factors of age,underlying diseases,time in the intensive care unit,ventilator time and the use of invasive procedures in a certain relationship.

Objective To observe the influence of psychological intervention on therapeutic effect of massage therapy for fibromyalgia syndrome(FMS).Methods Sixty-eight FMS patients were equally randomized into the treatment group and the control group.The two groups were given massage therapy and oral use of amitriptyline tablets,and the treatment group received psychological intervention additionally.The therapeutic effect was evaluated with Visual Analogic Scale(VAS) and Hamilton Depression Scale(HAMD).Results After treatment,9 were clinically cured,12 markedly effective,10 effective,2 ineffective and the total effective rate was 93.9% in the treatment group;in the control group,3 were clinically cured,8 markedly effective,13 effective,8 ineffective and the total effective rate was 75.0%;the difference between the two groups was significant(P

For the employment orientation of graduates in clinical medical major from three-year medical eduction,a curriculum system,which will be used to foster practical medical talented person for urban and rural communities,has been proposed in this paper.We will take measures,which not only further defines training target and requirement for the practical medical person from the short school system and guides students to alterate their ideological concept but also reconstructures new curriculum system and reforms teaching methods,to ensure the implementation of the training objectives

Objective To establish a simple , stableand effective method for the isolation and purification of ABL tyrosine kinase and its mutant ABLT315I.Methods pET-28a vector was inserted in abl gene or its site directed mutagenesis.Then Escherichia coli BL21 competent cells were co-transformed with pGEX6P-1-ptp-1b and pET28a-abl/pET28a-ablc944t .The transformed BL21 cells were incubated, and then were stimulated with Isopropyl-β-D-thiogala-ctopyranoside ( IPTG ) to express ABL tyrosine kinase and its mutant .The ABL tyrosine kinase and its mutant was purified by affinity chromatography and gel filtration chromatography .SDS-PAGE was used to detect the purity and relative molecular weight of ABL tyrosine kinase and its mutant.BCA method was used to determine the concentration of ABL tyrosine kinase and its mutant .Finally, kinase activity of target protein was examined by ATP /NADH coupling method .ResuIts SDS-PAGE showed the high purity of ABL tyrosine kinase and its mutant.The concentration of ABL and ABLT 315I protein was reached 28mg/L of LB and 20mg/L of LB, respectively.Both of the target protein was measured to have good tyrosine kinase activity in vitro .ConcIusion A simple, stable and effective method for the isolation and purification of ABL tyrosine kinase and its mutant was found successfully in the study , which laying good foundation for High Throughput Drug Screening and structure analysis of protein subsequently .

In coal mines, main occupational hazard is coal-mine dust, which can cause health problem including coal workers' pneumoconiosis and lung cancer. Some heat shock proteins (Hsps) have been reported as an acute response to a wide variety of stressful stimuli. Whether Hsps protect against chronic environmental coal-mine dust over years is unknown. It is also interesting to know that whether the expression of Hsp27 and Hsp70 proteins as a marker for exposure is associated risk of lung cancer among coal miners. We investigated the association between levels of Hsp27 and Hsp70 expression in lymphocytes and plasma and levels of coal-mine dust exposure in workplace or risk of lung cancer in 42 cancer-free non-coal miners, 99 cancer-free coal miners and 51 coal miners with lung cancer in Taiyuan city in China. The results showed that plasma Hsp27 levels were increased in coal miners compared to non-coal miners (P<0.01). Except high cumulative coal-mine dust exposure (OR=13.62, 95%CI=6.05-30.69) and amount of smoking higher than 24 pack-year (OR=2.72, 95% CI=1.37-5.42), the elevated levels of plasma Hsp70 (OR=13.00, 95% CI=5.14-32.91) and plasma Hsp27 (OR=2.97, 95% CI=1.40-6.32) and decreased expression of Hsp70 in lymphocytes (OR=2.36, 95% CI=1.05-5.31) were associated with increased risk of lung cancer. These findings suggest that plasma Hsp27 may be a potential marker for coal-mine dust exposure. And the expression of Hsp27 and Hsp70 levels in plasma and lymphocytes may be used as biomarkers for lung cancer induced by occupational coal-mine dust exposure.

Objective:To evaluate the value of ultrasonography in evaluating the influential factors of early insufficient flow after central venous catheter placement in dialysis patients.Methods:Three hundred and twenty seven hemodialysis patients who underwent central venous catheterization at the Affiliated Hospital of Chengde Medical College from May 2016 to June 2019 were selected. According to the catheter flow, the patients were divided into the low catheter flow group(43 cases) and the normal catheter flow group(284 cases). The distribution variance of clinical features(age, gender, blood pressure) were compared and whether some ultrasonic parameters(position of catheter tip, left ventricular ejection fraction, left atrial end-systolic diameter, left ventricular end-diastolic diameter, distance from the catheter tip to superior vena cava beyond right atrial opening) had influence on the insufficient catheter flow in the early stage between the two groups were analyzed.Results:The differences of left ventricular ejection fraction, left atrial end-systolic diameter and position of catheter tip between the two groups were statistically different( P<0.05). However, univariate and multivariate analyses showed that there were significant differences in catheter tip approaches and touches the wall of right atrium( OR=5.393, 95% CI=2.039-14.263, P=0.001), increased left atrial end-systolic diameter( OR=0.321, 95% CI=0.124-0.827, P=0.019), left ventricular ejection fraction in critical range( OR=2.953, 95% CI=1.113-7.835, P=0.030) and decreased left ventricular ejection fraction( OR=5.828, 95% CI=1.869-18.174, P=0.002) were the independent risk factors of early insufficient catheter flow. Conclusions:Insufficient catheter flow after central venous catheterization is related to catheter position, left atrial end-systolic diameter and left ventricular ejection fraction. Ultrasonography evaluation is a primary method to observe the position of the catheter tip in dialysis patients and diagnose the early insufficient catheter flow after central venous catheterization.

Objective:To explore the safety and effectiveness of laparoscopic local pancreatectomy in the treatment of cystic neoplasms of pancreatic head.Methods:Retrospective analysis was conducted of data on patients with pancreatic head cystic neoplasms who received laparoscopic surgery at the Department of Hepatobiliary Surgery, the Second Hospital of Hebei Medical University from February 2017 to October 2022. A total of 83 patients were enrolled, including 30 males and 53 females, aged (43.7±16.7) years old. All patients were divided into an observation group ( n=55) and a control group ( n=28) based on different surgical procedures. The observation group underwent laparoscopic local pancreatectomy (laparoscopic duodenum-preserving pancreatic head resection or laparoscopic enucleation), while the control group underwent laparoscopic pancreaticoduodenectomy (LPD). The age, gender, body mass index, postoperative hospital stay, proportion of discharged patients with drainage tubes, surgical time, intraoperative blood loss, intraoperative blood transfusion rate, and fistula were compared between two groups. Results:All patients successfully completed the surgery, and there were no cases of conversion to laparotomy or perioperative deaths. There was no statistically significant difference in age, male proportion, body mass index, postoperative hospital stay, and discharge rate with drainage tube between the two groups of patients (all P>0.05). The observation group had a surgical time of (194.4±114.0) min, intraoperative bleeding of 50 (50, 200) ml, and intraoperative blood transfusion rate of 5.5%(3/55), all of which were better than that of the control group, (380.0±71.6) min, 200 (100, 400) ml, and 32.1%(9/28), with statistical significance (all P<0.05). Among them, the B/C fistula rates in the laparoscopic local pancreatectomy group and LPD group were 12.7%(7/55) and 10.7%(3/28) ( P=0.790), respectively. Conclusion:Compared with traditional LPD, laparoscopic local pancreatectomy can shorten surgical time, reduce intraoperative bleeding, and lower intraoperative blood transfusion rate. And there is no significant disadvantage in the B or C grade fistula.

Objective:To study the clinical characteristics and management strategies of late bleeding after laparoscopic pancreaticoduodenectomy (LPD).Methods:The clinical data of 58 patients with post-pancreaticoduodenectomy hemorrhage (PPH) admitted to the Department of Hepatobiliary Surgery of the Second Hospital of Hebei Medical University from March 2018 to March 2022 were retrospectively analyzed, including 42 males and 16 females, aged (61.88±11.02) years old. According to the occurrence of intra-abdominal erosion factors (e.g., pancreatic fistula, biliary fistula, gastrointestinal anastomotic fistula, intra-abdominal abscess), patients were divided into the erosion group ( n=42) and non-erosion group ( n=16). All patients underwent standard lymphadenectomy. Clinical data including the PPH time-point, occurrence of rebleeding, and treatment outcomes were accessed. The management strategies of PPH in the two groups of patients were analyzed. Results:The PPH time-point in the erosion group and non-erosion patients was 8.00 (5.00, 19.25) d and 21.50 (12.75, 26.75) d, respectively ( P=0.001). PPH can occurred within one month after surgery in both erosion and non-erosion groups. In the erosion group, 31 cases (73.81%, 31/42) were treated by re-operation, two (4.76%, 2/42) by interventional radiology and nine (21.43%, 9/42) with conservative protocol, respectively. In the non-erosion group, five cases (31.25%, 5/16) were treated by re-operation, seven (43.75%, 7/16) by interventional radiology and four (25.00%, 4/16) with conservative protocol, respectively. The incidence of re-bleeding is higher in the erosion group [47.6% (20/42) vs 12.5% (2/16), P<0.05]. Clinical manifestations, sites and severity of bleeding, and treatment outcomes were also different in the erosion and non-erosion groups (all P<0.05). Conclusions:The occurrence of intra-abdominal erosion factors can affect the clinical characteristics and treatment strategy of late bleeding after laparoscopic pancreaticoduodenectomy. Surgery remains the treatment of choice for post-pancreaticoduodenectomy hemorrhage either as an urgent or last resort.

Objective:To evaluate the safety and effectiveness of clinical application of " variable diameter measurable pancreatic duct" in laparoscopic pancreaticoduodenectomy (LPD).Methods:A retrospective study was conducted at the Second Hospital, Hebei Medical University Liver Surgical Team from July 2019 to July 2020 using the " HongShi single stitch" method of pancreatic duct to jejunum anastomosis on 147 patients who underwent LPD. According to the type of pancreatic duct, the patients were divided into having normal pancreatic ducts (the normal group, n=61) and those having " variable diameter measuring pancreatic duct" (the variable diameter group, n=86). The perioperative data and postoperative complications were compared and analyzed. Results:There were 89 males and 58 females, aged (56.7±1.5) years. There were no significant differences in age, gender and body mass index between groups ( P>0.05). For the variable diameter group, the diameter of the divided pancreatic stump was (3.2±0.1) mm, and the depth of internal pancreatic duct stenting was (4.7±0.2) cm. However, it could not be measured accurately in the normal group. The incidence of postoperative pancreatic fistula rate was significantly lower in the variable diameter group than the normal group [2.32% (2/61) vs. 11.47% (7/86), P=0.023]. Conclusion:The variable diameter measurement of pancreatic duct was safe and effective in choosing patients to undergo LPD.

Objective:To study the retrocolonic approach for laparoscopic pancreaticoduodenec-tomy (LPD).Methods:The clinical data of 53 patients who underwent LPD using the retrocolonic approach at the Second Hospital of Hebei Medical University from January 2019 to December 2021 were analyzed retrospectively. There were 36 males and 17 females, aged (61.9±8.8) years old. The operation time, intraoperative bleeding and postoperative complications were analysed.Results:LPD was successfully performed in 53 patients via the retrocolonic approach. The operation time was (285.7±49.8) min, and the resection time for specimens was (120.0±10.5) min. The median intraoperative blood loss was 200 ml and blood loss ranged from 50 to 800 ml. Among the 53 patients, 3 patients underwent combined portal vein resection and reconstruction (end-to-end anastomosis). The operation time was 300, 325 and 385 min, respectively, and the intraoperative blood loss was 400-800 ml. During the operation, 5 patients (9.43%) had transection of the middle colonic artery and underwent resection of part of the transverse mesocolon due to invasion of the transverse mesocolon by tumours. Postoperative complications occurred in 5 patients (9.43%), including 4 patients with pancreatic fistula and 1 patient with hemorrhage and with delayed gastric emptying. The postoperative passage of first flatus was (5.40±1.14) days in 5 patients with transection and (2.92±1.03) days in 48 patients without transection of the middle colonic artery. All patients were discharged home successfully. The postoperative pathological results showed all patients to achieve R 0 resection. Conclusion:Laparoscopic pancreaticoduodenectomy via the retrocolonic approach was safe and feasible for patients with a large duodenal tumor, pancreatic head uncinate process tumor with or without invasion of the portal vein and mesenteric vessels.