Objective To understand the distribution and drug resistance dynamic status of common pathogens isolated from neurocranial surgical inpatients to provide a basis for clinically rational use of antimicrobial drugs .Methods A total of 413 strains of pathogenic bacteria isolated from neurocranial surgical inpatients from January 2013 to June 2016 were performed the identifica-tion and drug susceptibility test by using the Compact Vitek-2 automatic bacterial identificantion analyzer and the drug susceptibility test results were analyzed by using the WHONET5 .6 software .Results The commonest pathogenic bacteria were 90 strains of Pseudomonas aeruginosa ,69 strains of Klebsiella pneumonia ,52 strains of Escherichia coli ,50 strains of Acinetobacter baumannii and 37 strains of Staphylococcus Aureus .The common bacteria were resistant to many antibiotic drugs .The detection rate of me-thicillin-resistant Staphylococcus Aureus(MRSA) was 54 .1% ,no vancomycin-resistant Staphylococcus Aureus was found .Conclu-sion Clinicians should concern about the common pathogens and their drug resistance in their department ,rationally select antibac-terial drugs ,increase the curative effect and reduce the occurrence of bacterial drug resistance .

Objective To evaluate the effect of mechanical stretch preconditioning on pathological stretch-induced activation of γ-aminobutyric acid (GABA) signaling pathway in human type Ⅱ alveolar epithelial cells (AEC Ⅱ).Methods AEC Ⅱ cell line (A549 cells) culturedin vitro were divided into control group (group C), pathological stretch group (group P1) and mechanical stretch preconditioning group (group P2). In group C, A549 cells were cultured routinely. In group P1, A549 cells were exposed to 20% cyclic stretch for 6 hours. In group P2, A549 cells were exposed to 5% cyclic stretch for 60 minutes, and then exposed to 20% cyclic stretch for 6 hours. The cells were harvested for determination of the cell viability by methyl thiazolyl tetrazolium assay, lactate dehydrogeuase (LDH) release was determined by colorimetric method, the levels of interleukin (IL-1β and IL-6) and tumor necrosis factor-α (TNF-α) were determined by enzyme linked immunosorbent assay (ELISA), the mRNA expressions of IL-1β, IL-6 and TNF-α were determined by reverse transcription-polymerase chain reaction (RT-PCR), and the protein expressions of glutamic acid decarboxylase (GAD) and γ-aminobutyric acid A receptor (GABAAR) were determined by Western Blot.Results Compared with group C, the cell viability of group P1 was significantlydecreased (A value: 0.196± 0.071 vs. 0.886±0.107), the release rate of LDH was significantly increased [(12.3±2.4)% vs. (1.9±0.5)%]; the contents and mRNA expressions of IL-1β, IL-6 and TNF-α in cell culture medium were significantly increased [IL-1β (ng/L): 138.6±19.7 vs. 32.7±7.4, IL-6 (ng/L): 196.5±31.7 vs. 55.4±13.8, TNF-α (ng/L): 111.3±21.8 vs. 20.8±7.6; IL-1β mRNA (2-ΔΔCT): 2.79±0.44 vs. 0.83±0.12, IL-6 mRNA (2-ΔΔCT): 1.99±0.25 vs. 0.56±0.11, TNF-α mRNA (2-ΔΔCT): 2.54±0.37 vs. 0.72±0.09]; the protein expressions of GAD and GABAAR were significantly decreased [GAD (gray value): 0.38±0.12 vs. 1.75±0.45, GABAAR (gray value): 0.29±0.09 vs. 1.68±0.39; allP < 0.05]. Compared with group P1, the cell viability of group P2 was significantly increased (A value: 0.523±0.132 vs. 0.196±0.071),the release rate of LDH was significantly decreased [(6.9±1.7)% vs. (12.3±2.4)%]; the contents and mRNA expressions of IL-1β, IL-6 and TNF-α in cell culture medium were significantly decreased [IL-1β (ng/L): 79.2±11.6 vs. 138.6±19.7, IL-6 (ng/L): 89.6±15.6 vs. 196.5±31.7, TNF-α (ng/L): 55.9±11.4 vs. 111.3±21.8; IL-1β mRNA (2-ΔΔCT): 1.92±0.36 vs. 2.79±0.44, IL-6 mRNA (2-ΔΔCT): 1.09±0.18 vs. 1.99±0.25, TNF-α mRNA (2-ΔΔCT): 1.77±0.25 vs. 2.54±0.37]; the protein expressions of GAD and GABAAR were significantly increased [GAD (gray value): 1.26±0.33 vs. 0.38±0.12, GABAAR (gray value): 1.04±0.15 vs. 0.29±0.09; allP < 0.05]. Conclusion The mechanism by which mechanical stretch preconditioning attenuates pathological stretch-induced injury in human AECⅡ is related to the activation of GABA signaling pathway.

Objective To evaluate the effect of ulinastatin on γ-aminobutyric acid (GABA) signal pathway in mice with ventilator-induced lung injury (VILI).Methods Thirty-six male Wister mice were randomly divided into 3 groups using a random number table:control group (group C), ventilator-induced lung injury group (group VILI),and ventilator-induced lung injury+ ulinastatin group (group UTI),n =12 in each group.VILI was induced by 4 h mechanical ventilation with tidal volume 40 ml/kg in groups VILI and UTI.Ulinastatin 1×10 5 U/kg was injected intraperitoneally 1 h before ventilation in group UTI,while the equal volume of normal saline was given in groups C and VILI.The mice were then sacrificed,the left lung was lavaged,and broncho-alveolar lavage fluid (BALF)was collected for determination of concentrations of protein,tumor necrosis factor-α(TNF-α),interleukin-1β(IL-1β)and intercellular adhesion molecule-1 (ICAM-1).The lung tissues were re-moved for determination of the wet to dry lung weight (W/D)ratio,the mRNA expression level of IL-1β,TNF-αand ICAM-1.The pathological changes of the lungs were determined under light micro-scope and the lung injury scores were also determined.Immunohistochemistry and Western blot were used to detected the protein expression level of GAD and GABAA R.Results The W/D ratio (6.7 ± 2.4 vs.8.5±2.3)and lung scores [(6.9±2.3)scores vs.(1 1.8±2.7)scores]were significantly de-creased in group UTI than those in group VILI.The concentrations of IL-1β[(56±1 1)ng/L vs.(77 ±1 5)ng/L],TNF-α[(105±29)ng/L vs.(1 58±37)ng/L]and ICAM-1 [(205±46)ng/L vs.(293 ±61)ng/L]in BALF in group UTI were significantly decreased than those in group VILI.The mRNA ex-pression levels of IL-1β(1.81±0.26 vs.2.58±0.34),TNF-α(1.61±0.15 vs.2.94±0.27)and ICAM-1 (1.74±0.27 vs.2.79±0.31)were significantly decreased in group UTI than those in group VILI.The protein expression levels of GAD (0.44±0.08 vs.0.18 ±0.04)and GABAA R (0.30 ±0.09 vs.0.15 ± 0.04)were significantly increased in group UTI than those in group VILI.Conclusion Ulinastatin can at-tenuate VILI probably through activating GABA signaling pathway.

ObjectiveTo study the effects of placental transfusion of umbilical cord milking on very low birth weight (VLBW) infants. Methods Fifty-seven VLBW infants born from September 2011 to May 2014 who had umbilical cord milking at birth were selected as experimental group. Sixty-one VLBW infants born from January 2008 to August 2011 who had normal cord clamping at birth were selected as control group. The complications of VLBW infants, blood transfusion, frequency of using pulmonary surfactant (PS), the duration of mechanical ventilation, the duration of oxygen and mortality were compared between two groups.Results The incidence of severe asphyxia, IVH and anemia was signiifcantly lower in experimental group than in control group (P< 0.05). The blood transfusion and transfusion volume, duration of mechanical ventilation, and duration of oxy-gen were signiifcantly lower in experimental group than in control group (P< 0.05).Conclusions Umbilical cord milking can reduce the incidence of severe asphyxia, IVH and anemia. It also can reduce the blood transfusion, the duration of mechanical ventilation, and the duration of oxygen in VLBW infants.

Objective To evaluate the efficacy and safety of mesenchymal stem cells(MSCs)in preventing early acute rejection after renal transplantation.Methods Eighty-eight primary cadaveric renal allograft recipients in our department were randomized into two groups treated with bone marrow MSCs (BMSCs group,n =43) or not (control group,n =45).Main immunosuppressive therapy regimen consisted of steroids,tacrolimus or cyclosporine and mycophenolate mofetil in all recipients.Estimated glomerular filtration rate (eGFR) of transplant kidney,incidence of acute reaction (AR),graft survival and incidence of adverse events were recorded within 24 months.Results In BMSCs group,the incidence of AR was 4.7 ％ and 9.3 ％ at 3rd month and 6th month respectively,significantly lower than 20.0 ％ and 26.7 ％ (P＜0.05) in the control group.The eGFR at day 7,14and 30 post-transplantation was significantly higher in the BMSCs group than in the control group (P＜0.01,P＜0.01,P＜0.05 respectively).The incidence of adverse events in the BMSCs group and the control group was 44.2 ％ (19/43) and 66.7 ％ (30/45,P ＜ 0.05) respectively and the rate of infection was 37.2 ％ (16/43) and 33.3 ％ ( 15/46,P ＞ 0.05) respectively within 24 months.Conclusion Induction therapy with autogenous BMSCs appeared to be more effective in the prevention of AR following cadaveric kidney transplantation and was associated with better clinical outcomes as far as early renal graft function without compromising patient safety.

Objective To evaluate the effect of γ-aminobutyric acid (GABA) preconditioning on pathological stretch-induced damage to type Ⅱ alveolar epithelial cells by mechanical ventilation.Methods A549 cells cultured in vitro (0.2× 106/ml,2.5 ml/well) were randomly divided into 3 groups using a random number table:control group (group C),pathological stretch group (group P) and GABA preconditioning+pathological stretch group (group G).A549 cells were exposed to 20％ cyclic stretch at 0.3 Hz for 6 h in groups P and G;GABA 50 μmol/L was given 30 min before cyclic stretch in group G.After the end of pathological stretch,the cells were collected for determination of the cell viability by methyl thiazolyl tetrazolium assay and lactate dehydrogenase (LDH) release by colorimetricmethod;the expression of F-actin was observed with indirect immunofluorescence;the expression of Rho-associated kinase 1 (ROCK1) and GABAAR were determined by western blot.Results Compared with group C,the cell viability was significantly decreased,the amount of LDH released was increased,the expression of ROCK1 was significantly increased and the expression of GABAAR was significantly decreased in groups P and G (P＜0.05);Compared with group P,the cell viability was significantly increased,the amount of LDH released was decreased,F-actin was re constructed,the expression of ROCK1 was significantly decreased and the expression of GABAAR was significantly increased (P＜0.05) in group G.The reconstruction of F-actin in group P was better than that in group G and worse than that in group C.Conclusion GABA preconditioning can attenuate pathological stretch-induced damage to type Ⅱ alveolar epithelial cells probably through up regulating the expression of GABAA receptor.

Objective To evaluate the changes in activation of γ?aminobutyric acid(GABA)sig?naling pathway during ventilator?induced brain injury in rats. Methods Thirty?six pathogen?free adult male Sprague?Dawley rats, weighing 280-320 g, were divided into 3 groups(n=12 each)using a random number table: low tidal volume group(LV group), ventilation with high tidal volume for 2 h group(HV1 group)and ventilation with high tidal volume for 6 h group(HV2group). The rats were mechanically ven?tilated for 2 h with the tidal volume set at 10 ml∕kg and the respiratory rate 40 breaths∕min in group LV. The rats were mechanically ventilated for 2 h with the tidal volume set at 40 ml∕kg and the respiratory rate 40 breaths∕min in group HV1. The rats were mechanically ventilated for 6 h with the tidal volume set at 40 ml∕kg and the respiratory rate 40 breaths∕min in group HV2. Blood samples were collected at the end of ven?tilation for determination of serum neuron?specific enolase(NSE)and S100β protein concentrations by en?zyme?linked immunosorbent assay. Six rats were then sacrificed and their brains were removed for determi?nation of interleukin?1β(IL?1β)and tumor necrosis factor?α(TNF?α)contents(by enzyme?linked im?munosorbent assay)and expression of glutamic acid decarboxylase(GAD)and GABAAreceptors(by Western blot). Morris water maze test was performed on 2nd day after the end of ventilation. Results Compared with group LV, the serum concentrations of NSE and S100β protein and contents of IL?1β and TNF?α were significantly increased, the expression of GAD and GABAAreceptors was up?regulated, the es?cape latency was prolonged, and the percentage of swimming distance at the original platform was decreased in HV1and HV2groups(P<0.05). Compared with group HV1, the serum concentrations of NSE and S100β protein and contents of IL?1β and TNF?α were significantly increased, the expression of GAD and GABAAreceptors was up?regulated, the escape latency was prolonged, and the percentage of swimming distance at the original platform was decreased in group HV2(P<0.05). Conclusion Activation of GABA signaling pathway is enhanced during ventilator?induced brain injury, which may be involved in the patho?physiological mechanism of ventilator?induced brain injury in rats.

Objective To investigate the effect of Shenfu injection preconditioning on ventilator-induced brain injury in rats.Methods Sixty healthy adult male Sprague-Dawley rats,weighing 300-320 g,were divided into 3 groups (n=20 each) using a random number table:control group (group C),ventilator-induced brain injury group (group VIBI) and Shenfu injection group (group SF).Rats were mechanically ventilated for 6 h with tidal volume of 40 ml/kg in VIBI and SF groups.Rats were mechanicaliy ventilated for 6 h with tidal volume of 10 ml/kg in group C.Shenfu injection 20 ml/kg was injected intraperitoneally at 30 min before ventilation in group SF.Blood samples were collected at 2 and 6 h of ventilation for measurement of the concentrations of serum S100β protein (by enzyme-linked immunosorbent assay).Then the rats were sacrificed at the end of ventilation,and brains were removed for determination of the contents of interleukin-1β (IL-1β) and tumor necrosis factor-α (TNF-o) (by enzyme-linked immunosorbent assay) and expression of glutamate decarboxylase (GAD) and γ-aminobutyric acid type A (GABAA) receptor in brain tissues (by Westem blot).Results Compared with group C,the serum concentrations of S100β protein at each time point of ventilation and contents of IL-1β and TNF-α in brain tissues were significantly increased,and the expression of GAD and GABAA receptor was down-regulated in VIBI and SF groups (P＜0.05).Compared with group VIBI,the serum concentrations of S100β protein at each time point of ventilation and contents of IL-1β and TNF-α in brain tissues were significantly decreased,and the expression of GAD and GABAA receptor was up-regulated in group SF (P＜0.05).Conclusion Shenfu injection preconditioning can relieve ventilator-induced brain injury in rats,and the mechanism may be related to inhibiting inflammatory responses and activating GABA signaling pathway.

Objective:To evaluate the fixation with a locking fibular intramedullary nail for treatment of extra-articular distal tibial fracture complicated with fibular fracture (AO/OTA 43A).Methods:A retrospective study was conducted to analyze the data of 31 patients who had been treated by fixation with a locking fibular intramedullary nail for extra-articular distal tibial fracture complicated with fibular fracture at Department of Orthopaedics, The 909th Hospital of Joint Logistics Support Force between January 2018 and December 2021. There were 20 males and 11 females; (41.5±15.7) years in age; AO classification of the distal tibial fractures: 10 cases of type 43A1, 10 cases of type 43A2, and 11 cases of type 43A3; 11 open fractures and 20 closed fractures. Fracture healing, fibular alignment, tibiotalar angle, and incidence of complications were regularly followed up and recorded after surgery. At the last follow-up, the ankle joint function was assessed using the Olerud Molander ankle score (OMAS) and the ankle-hindfoot score of American Orthopaedic Foot and Ankle Society (AOFAS).Results:All the 31 patients were followed up for (17.5±3.3) months after surgery. All of them achieved fine fracture union. The union time was (3.9±0.8) months for tibial fractures, and (3.6±0.9) months for fibular fractures. No internal fixation failure was observed. The last follow-up revealed the following: the fibular alignment was 1.8°±1.3° and the ankle tibiotalar angle 9.1°±2.3°; no fibular rotation, shortening, or separation displacement happened; the OMAS score was (88.3±6.2) points, and the AOFAS ankle-hindfoot score (87.4±6.0) points. Two patients required removal of the distal locking screw of the fibular intramedullary nail due to soreness around the lateral malleolus caused by screw loosening. There were no other related complications.Conclusion:Fixation with a locking fibular intramedullary nail is an effective treatment for extra-articular distal tibial fracture complicated with fibular fracture, demonstrating advantages of firm fixation, limited complications, minimal trauma and soft tissue irritation, and good clinical efficacy.