0.05). CONCLUSIONS The pathogenic bacteria from VAP subglottic secretion are mostly Gram-negative rods, in which the dominant bacteria are A. baumannii, P. aeruginosa, S. maltophilia, K. pneumoniae and Escherichia coli. Most of them are multi-drug resistant. The kinds of pathogenic bacterial strains in subglottic secretion and lower respiratory tract secretion are not only consistent but also similar to each other in terms of composition and drug resistance.

Objective:To estimate the safety and feasibility of flexible laryngeal mask airway (FLMA) for lumbar vertebral surgery in prone position.Methods: In the study,120 adult patients scheduled for lumbar vertebral surgery under intravenous general anesthesia were divided into group FLMA and reinforced tracheal tube (RTT) group at random.Heart rate (HR),systolic blood pressure (SBP) and diastolic blood pressure (DBP) were recorded at the beginning of anesthesia induction (T0) and on the time of artificial airway intubation (T1),1 min after intubation (T2),extubation (T3),1 min after extubation (T4) as well.The number and time required for intubation were recorded.Peak airway pressure (PPEAK),airway sealing pressure (PAS) in group FLMA and fiberoptic bronchoscopy scale (FBS) were recorded after artificial airway intubation,turned over into prone position and after the operation started,as well as on the time of 1 hour after the operation started,2 hours after operation started and when the operation stopped.Finally,respiratory complications after extubation,including hypoxemia,laryngospasm,coughing,vomiting,hoarseness,and pharyngalgia,were observed and whether there was blood or sewage inside and outside the artificial airway was recorded.Results: There was no difference in the number and time required for intubation between the two groups (P>0.05).There was no difference in PPEAK and FBS between the two groups,and also the same at the different time points in each group (P>0.05).PAS in group FLMA was the same at the diverse time points during anesthesia (P>0.05) and always higher than PPEAK in the perioperative period.In group FLMA,there was no difference in HR,SBP and DBP between the time points of T2 and T1,also of T4 and T3 (P>0.05).In group RTT,HR,SBP and DBP were significantly higher between the time points of T2 and T1 (P<0.01);SBP was significantly higher between the time points of T4 and T3 (P<0.01),DBP and HR were higher between the time points of T4 and T3 (P<0.05).SBP in group FLMA was significantly lower than in group RTT at T2 (P<0.01),HR and DBP were lower than those in group RTT simultaneously (P<0.05).On the time point of T4,SBP,DBP and HR in group FLMA were lower than those in group RTT (P<0.05).The incidence of coughing and pharyngalgia after extubation was significantly lower in group FLMA than in group RTT (P<0.01),with the incidence of hoarseness was lower in group FLMA than in group RTT (P<0.05).There was no difference in the incidence of hypoxemia,vomiting and blood seen outside the cuff between the two groups (P>0.05) while no laryngospasm and sewage seen outside the artificial airway in each group.Conclusion: For suitable patients,FLMA can be used in mechanical ventilation forlumbar vertebral surgery in prone position with more stable circulation and less respiratory complications than RTT.Further clinical validation is needed for the safety of FLMA.

Objective To explore the value of electronic colonoscope,MSCT and MRI in the etiological diagnosis of intestinal obstruction.Methods The clinical data of 140 ileus patients were retrospectively studied.Results 140 cases of ileus included 60 cases of colon ileus,70 cases of small intestines ileus and 7 indefinite cases.67 cases were checked with colonoscopy,among them,41 cases with colon tumors,6 cases with colon polypi,6 cases with colon set folds,2 cases with sigmoid colon turned round,2 cases with ileum tumor and 10 cases with unknown reason.80 cases were checked by MSCT checks,among them,26 cases with small intestines tumor 24 cases with small intestines muck piece,23 cases with unknown reasons,2 cases with muck stone 2,4 cases with bowel chamber outside lymphoid lump,1 case with bowel fastens film blood to bolt.30 cases were kept to cure.2 cases were turn round to reset under the eolonoscopy,3 cases were set folds air to infuse bowel to reset,6 cases with inside the mirror descend colon polyp were resected with hish frequency electricity resection.99 cases were cured by surgical operation.5 cases were dead and 135 cases were recovered from illness.Conclusion Electronic colonoscopy,MSCT and MRI checking are accurate methods to diagnose why and where of ileus,and which establish importance basts for clinical treatment.

Objective To investigate the effect of multidrug resistance protein 4 (MRP4) overexpression on lipopolysaccharide (LPS)-induced vascular endothelial hyperpermeability of rat pulmonary micro-vascular endothelial cells (PMVECs) and its molecule mechanism. Methods Three to six passages of PMVECs were cultured in vitro, and they were divided into three groups: the cells in LPS group were only challenged by LPS 10 μg/mL after being cultured in serum-free medium for 24 hours; the cells in Ad-shRNA and Ad-MRP4 groups were infected with the empty virus control or recombinant adenovirus expressing MRP4 for 2 hours, and then were cultured in serum-free medium for 24 hours followed by stimulation of LPS 10 μg/mL. Endothelial permeability was assayed by the Transwell chamber models at 2, 6, 12, and 24 hours after LPS stimulation. Intracellular cyclic adenosine monophosphate (cAMP) levels were detected by enzyme-linked immunosorbent assay (ELISA). The morphological characteristics and distribution of F-actin was determined by laser confocal fluorescence microscope. The protein expressions of MRP4,β-catenin, vascular endothelium-cadherin (VE-cad) and ZO-1 were measured by Western Blot. Results ① After LPS stimulation, endothelium permeability and intracellular cAMP levels in PMVECs were significantly increased, peaked at 12 hours, and then decreased after 24 hours. Compared with LPS group and Ad-shRNA group, PMVECs of Ad-MRP4 group were exhibited a significant increase in endothelial permeability [12-hour permeability (A value):1.88±0.06 vs. 1.12±0.17, 1.10±0.18] and a significant decrease in intracellular cAMP level [12-hour cAMP (μg/L):2.39±0.02 vs. 2.97±0.01, 3.00±0.02, all P < 0.05]. There was no significant difference in endothelium permeability and intracellular cAMP levels at all time points between the LPS group and the Ad-shRNA group (all P > 0.05).② Under laser confocal fluorescence microscope, after LPS stimulation, the stress fiber formation was induced in three groups. But there were pronounced irregular aggregation of fiber in PMVECs of Ad-MRP4 group. ③ Furthermore, compared with LPS group and Ad-shRNA group, protein expression of MRP4 in Ad-MRP4 group was dramatically increased (gray value: 0.76±0.03 vs. 0.44±0.02, 0.43±0.02, both P < 0.05), and the protein expressions of β-catenin, VE-cad, and ZO-1 were significantly decreased [β-catenin (gray value): 0.14±0.03 vs. 0.23±0.04, 0.23±0.03);VE-cad (gray value): 0.21±0.01 vs. 0.34±0.02, 0.35±0.04; ZO-1 (gray value): 0.14±0.02 vs. 0.37±0.06, 0.33±0.07, all P < 0.05]. There was no significant difference in all protein expressions between the LPS group and Ad-shRNA group (all P > 0.05). Conclusion MRP4 overexpression can decrease intracellular cAMP levels, reduce intercellular junction protein expression, and then exaggerate LPS-induced vascular endothelial hyperpermeability.

90%),but they had low susceptibility rate to itraconazole(70.62%-50.45%).CONCLUSIONS The main species of fungi isolated from clinic is Can albicans which is susceptible to antifungal agents.It is important to give active treatment and choose antifungal agents reasonably for improving the prognosis and reduce drug-resistant strains.

Objective To investigate the protective effect of multidrug resistant associated protein 4 (MRP4) inhibitor on rats with sepsis-induced acute lung injury (ALI). Methods Sixty Sprague-Dawley (SD) rats were randomly divided into sham group, sepsis group and MRP4 inhibitor MK571 treatment group, with 20 rats in each group. Sepsis model was reproduced by cecal ligation and puncture operation (CLP), and the rats in sham group were only received celiotomy without ligation and puncture. Rats in MK571 treatment group were intraperitoneally injected with MRP4 inhibitor MK571 (20 mg/kg) 30 minutes before model reproduction, while rates in sham group and sepsis group were given the same amount of normal saline. Twenty-four hours later, the femoral artery blood of mice was collected, and arterial blood gas analysis was measured. Serum tumor necrosis-α (TNF-α) was determined by enzyme-linked immunosorbent assay (ELISA). The lung tissues were collected, and the wet/dry weight ratio (W/D) was calculated. The expression of MRP4 protein in lung tissue was determined by Western Blot. Results Compared with sham group, arterial blood pH value and arterial partial pressure of oxygen (PaO2) were significantly lowered [pH value: 7.18±0.03 vs. 7.40±0.03; PaO2 (mmHg, 1 mmHg = 0.133 kPa): 63.15±6.24 vs. 98.05±2.58], while arterial partial pressure of carbon dioxide (PaCO2) was dramatically higher in the sepsis group (mmHg: 56.60±8.30 vs. 37.85±3.18), serum TNF-α level in the sepsis group was significantly increased (ng/L: 146.24±19.99 vs. 25.77±9.83), the W/D ratio of lung tissue was significantly increased (7.75±0.47 vs. 4.09±0.58), and the expression of MRP4 protein was up-regulated in the sepsis group (gray value: 0.153±0.006 vs. 0.087±0.005, all P < 0.05). Compared with the sepsis group, arterial blood pH value (7.30±0.02 vs. 7.18±0.03) and PaO2 (mmHg: 80.30±5.34 vs. 63.15±6.24) were significantly elevated in the MK571 treatment group, while PaCO2 was dramatically decreased (mmHg: 29.25±3.24 vs. 56.60±8.30), the serum level of TNF-α was significantly decreased (ng/L: 97.96±16.72 vs. 146.24±19.99), the W/D ratio of lung tissue was significantly reduced (5.89±0.51 vs. 7.75±0.47), and MRP4 protein expression was significantly down-regulated (gray value: 0.124±0.006 vs. 0.153±0.006, all P < 0.05). Conclusion MRP4 inhibitor may improve lung function in rats with sepsis-induced ALI by down-regulating MRP4 protein expression and reducing levels of inflammatory cytokines, which exerts protective effect on ALI.

Objective The present study analyzed the performances of hearing impaired children and normal hearing children at age 3 on the open set monosyllables test to provide reference for rehabilitation .Methods 30 typi-cal children and hearing impaired children at age 3 were randomly selected and tested using the open -set monosylla-ble test in evaluation of auditory response to speech (EARS) .Results ① There were significantly differences be-tween different test items in both groups ,the decreasing order of the score was tone> vowel>consonant>word(P<0 .01) ,and the scores on vowels ,consonants and words of hearing -impaired children were respectively signifi-cantly lower than that in normal hearing children(P<0 .001) .②There were similarities and differences between the mistakes of typical children and hearing impaired children .Blade-palatals and laterals in both groups achieved the lowest accuracy .While the accuracies on bilabials ,labiodentals ,nasals and plosives were highest in typical children , the accuracy on velar was highest in hearing impaired children .And the accuracies of consonants and nasal vowels on each place and manner of articulation in hearing -impaired children were significantly lower .Conclusion The study showed that the performances on vowels ,consomants and words of hearing -impaired children aged 3 in the open set monosyllables test were poorer than that in normal hearing children .The main errors were between the same places or methods of articulation ,especially for Blade -palatals and laterals .It is possible related to the deficiency of lan-guage input with the hearing impairment and the age with HA/CI .

Objective To investigate the clinical distribution and drug-susceptibility characteristics of yeast speeies in tumor patients with invasive yeast infections in order to provide the gist for clinical therapy.Methods The medical records of 70 tumor patients with invasive yeast infections from January 2006 to December 2008 were collected.retrospectively.The relationship between different tumor types and invasive yeast infections was analyzed.The clinical distribution and drug-susceptibility characteristics of 70 isolates of yeast were investigated.Results The sites of invasive yeast infections were abdominal(32 cases),blood(18 cases),biliary(9 cases),central nervous system(6 cases)and chest infection(5 cases).respectively.The most common species causing the above infections was Candida albicans(34 isolates,48.6%).The mortality of invasive yeast infection was 15.7%.The main types of tumor in 70 patients with invasive yeast infections were pancreatic carcinoma(12 cases),stomach carcinoma(11 cases)and hepatocellular carcinoma(7 cases).No relationship was found between tumor types and yeast infections with different species(P=0.804,P>0.05).There were 18 patients with tumor metastasis.Among them.9 patients had yeast bloodstream infections and 6 with yeast abdominal infections.Yeast bloodstream infections were more likely to be found in patients with tumor metastasis(χ~2=5.357,P<0.05).Seventy isolates of yeasts were all sensitive to triazoles.The MIC values of amphotericin B aginst 6 isolates of Candida and 2 Laurent cryptococcal were 2μg/ml.Conclusion Patients with tumor metastasis should be paid more attention for yeast invasive infections.and triazoles kept activity against yeasts tested.

Objective To investigate the differences of the correct memorization of a sentence with auditory between the hearing-impaired children after rehabilitation training and normal children.Methods Twenty-four hearing-impaired children and 14 normal hearing children at age 3~4 were selected.The hearing-impaired chil-dren were divided into two groups according to the length of the hearing device.The closed-set sentence test of e-valuation of auditory response to speech (EARS)was used.Results 1 .In the first test,the hearing-impaired chil-dren with hearing device 2 to 3 years whose correct rate was 57.14%were close to the normal children whose correct rate was 58.93%.The hearing-impaired children with hearing devices 1 to 2 years whose correct rate was 32.5%were worse than the children of other two groups 2 .In the second test,the hearing-impaired children with hearing devices 2 to 3 years whose correct rate was 44.64% were better than the hearing-impaired children with hearing devices 1 to 2 years whose the correct rate was 22.5%.The normal children whose the correct rate was 55.36%were better than the children of other two groups.3.There was no significant difference to correctly memorize a sen-tence between three groups in the first test,but there was significant difference to correctly memorize a sentence between the hearing-impaired with hearing device 1 to 2 years and the hearing-impaired children with hearing de-vice 2 to 3 years (P<0.05),and significant differences also existed between the hearing-impaired with hearing de-vice 1 to 2 years and normal children (P<0.05),but there was no significant difference between the hearing-im-paired children with hearing device 2 to 3 years and normal children (P>0.05).Conclusion The length with hear-ing device strengthens the ability of hearing-impaired children in correctly memorizing a sentence after rehabilitation training.And the content of test affects the result ,it provides reference to the hearing-impaired children's auditory training .

Objective To investigate the alteration of energy metabolism and oxidative injury in the myocardia suffering from lethal ventricular tachyarrhythmia (LVTA). Methods Two LVTA-SCD SD rat models, induced by aconitine injection or coronary artery ligation (CAL), respectively, were developed. Rats that died from over-anaesthesia or CAL-induced heart failure were served as their controls, respectively. Mitochondrial membrane potential (MMP), reactive oxygen species (ROS), malonaldehyde (MDA), phosphocreatine (PCr) in the ventricular myocardia, and serum troponin I (cTnI) were detected, and compared between LVTA rats and their controls. Results Fourteen ACO-LVTA and six CAL-LVTA rats were successfully developed. As compared to their controls, ACO-LVTA and CAL-LVTA rats had higher ROS and MDA content, and lower concentration of PCr in the ventricular myocardia. MDA content in ACO-LVTA group is signiifcantly higher than that of its control (P<0.05). MMP in myocardia of ACO-LVTA is lower than that of its control, but is higher than those of two CAL groups. Serum cTnI in rats of both LVTA models is higher than those of their controls and pre-treated control. Specially, serum cTnI in CAL-LVTA was signiifcantly higher than that of ACO-LVTA and its control (P<0.01). The myocardial ROS content is correlated with the duration of VT and VF (P<0.05), with correlation coefifcients being 0.44 and 0.46, respectively. Conclusions After LVTA, the ventricular myocardia had lower MMP and PCr content, higher concentration of ROS, MDA, as well as higher serum cTnI than their controls, indicative of oxidative injury and alteration of energy metabolism under LVTA-SCD.