Objective To determine epidemiology and risk factors for nosocomial infections in severe patients.Methods The study included 434 patients (7394 patient-days)during a 2-year period (2010-2011).The incidence rate of infection,pathogenic bacteria,correlation factor of infected were analyzed.Results A total of 225 infections were identified in 113 patients(26.0％).The incidence and infection rates were 56.8 in 1000-patient days and 51.8％,respectively.The infections were pneumonia (40.9％),bloodstream (30.2％),urinary tract (23.6％) and surgical site infections (5.3％).Pseudomonas aeruginosa (22.6％),methicillin-resistant Staphylococcus aureus (22.2％) and Acinetobacter spp.(11.9％) were frequently isolated micro-organisms.Median length of stay with nosocomial infection and without were 13 days (Interquartile range,IQR,20) and 2 days (IQR,2),respectively (P ＜ 0.01).In logistic regression analysis,mechanical ventilation[odds ratio(OR):16.35 ;95％ confidence interval(CI):8.26 ～32.34;P ＜0.01),coma(OR:15.04;95％ CI:3.41 ～66.33;P ＜0.01),trauma(OR:10.27 ;95％ CI:2.34～45.01 ;P ＜0.01),nasogastric tube(OR:2.94 ;95％ CI:1.47 ～ 5.90; P ＜ 0.01),tracheotomy (OR:5.77 ;95％ CI:1.10 ～30.20;P ＜0.05) and APACHE Ⅱ scores 10 ～ 19(OR:10.80;95％ CI:1.10 ～ 106.01 ;P ＜0.05) were found to be significant risk faetors for nosocomial infection.Rate of nosocomial infection increased with the number of risk factors(P ＜0.01).Mortality rates were higher in infected patients than in non-infected patients(60.9 vs 22.1％ ;P ＜0.01).Conclusion These data suggest that,in addition to underlying clinical conditions,some invasive procedures can be independent risk factors for nosocomial infection in ICU.

Objective To study the genotypes of ESBL-producing Enterobacteriaceae in Xi'an city.Methods Totally 125 ESBL-producing Enterobacteriaceae strains were randomly selected from five hospitals of Xi'an City,and TEM-type,SHV-type and CTX-M-type ESBL genes were amplified by PCR.Results Among the 125 ESBL-producing Enterobacteriaceae strains,TEM-type ESBL genes were amplified from 33 strains,SHV-type ESBL genes were amplified from 26 strains,CTX-M-type ESBL genes were amplified from 49 strains,and two or more type ESBL genes were amplified from 22 strains.Conclusion CTX-M-type ESBL are prevalent in ESBL-producing Enterbacteriaceae in Xi'an City.

Objective To investigate the influence of high-fat diet on blood pressure and metabolism in Sprague-Dawley(SD) rats and its mechanism.Methods Forty male SD rats were randomly divided into 4 groups which were fed with a diet containing 53% calorie as fat(HF) or a normal diet(ND) for 5 or 10 weeks.Systolic blood pressure(SBP),body weight,abdominal adipose tissue,blood lipids,fasting insulin(FINS),and fasting plasma glucose(FPG) were measured after 5 and 10 weeks respectively.Results SBP of HF groups were higher than that of ND groups [HF5 vs.ND5,(105.506?4.634)mmHg vs.(100.060?4.773)mmHg,P

The frequency of peripheral lymphocyte subsets using monoclonal was studied in patients with viral myocarditis (MC). The percentage of T_8 positive cells was significantly lower in patients with MC of heart failure(MCHF) than that in patients with MC of arrhythmias and that in normal controls, whereas the T_4/T_8 ratio was significantly inereased in MCHF patients. At the same time, suppressive T cells (Ts) function in patients with MC was evaluated by shortlived assay. The Ts function was significantly reduced in MCHF patients, close correlation was found between the Ts function and the hemodynamic function in MCHF patients. Abnormal immunoreguiation may be of the important pathogenic factor in MCHF patients.

ObjectiveTo investigate the risk factors for acute renal injury (AKI) in patients with ischemic stroke.MethodsPatients with ischemic stroke were enrolled retrospectively.The general clinical data, vascular risk factors, drug use, stroke etiological typing, stroke severity, and baseline biochemical indices were collected.They were divided into either an AKI group or a control group according to whether AKI occurred or not.Multivariable logistic regression analysis was used to analyze the independent risk factors for occurring AKI in patients with ischemic stroke.ResultsA total of 214 patients with ischemic stroke were enrolled, including 32 (14.95%) had AKI and 182 (85.05%) did not have AKI.The proportions of patients in heart failure (62.50% vs.41.21%;χ2=4.998, P=0.025), mannitol use (87.50% vs.43.96%;χ2=20.643, P<0.001), furosemide use (87.50% vs.43.96%;χ2=20.643, P<0.001), contrast agent use (37.50% vs.19.23%;χ2=5.300, P=0.021), and contrast dosage >200 ml (28.13% vs.9.89%;χ2=6.637, P=0.010), as well as NIHSS score (18.0±4.5)vs.8.0±3.2;t=15.249, P<0.001), diastolic blood pressure (89.98±9.1 mmHg vs.80.56±8.19 mmHg, 1 mmHg=0.133 kPa;t=5.898, P<0.001), fasting blood-glucose (10.54±4.31 mmol/L vs.6.32±1.32 mmol/L;t=5.898, P<0.001), blood urea nitrogen level (11.21±2.13 mmol/L vs.7.98±2.34 mmol/L;t=7.293, P<0.001), and arterial lactate concentration (3.98±0.12 mmol/L vs.0.91±0.25 mmol/L;t=68.003, P<0.001) in the AKI group were significantly higher than those in the non-AKI group.Multivariate logistic regression analysis showed that after adjusting various confounding factors, higher NIHSS score (odds ratio [OR] 1.910,95% confidence interval[CI] 1.517-6.012;P=0.024), higher diastolic pressure (OR 1.816, 95% CI 1.652-3.876;P=0.018), arterial lactate concentration (OR 1.553, 95% CI 1.256-1.763;P=0.019), mannitol use (OR 3.765, 95% CI 2.081-9.658;P=0.017), furosemide use (OR 5.329, 95% CI 3.085-8.763 P=0.010), contrast agent use (OR 2.097, 95% CI 1.364-2.456;P=0.031), and contrast dosage >200 ml (OR 3.294, 95% CI 1.464-2.786;P=0.021) were the independent risk factors for AKI in patients with acute ischemic stroke.ConclusionsThe NIHSS score, diastolic blood pressure, arterial lactate concentration,mannitol use, furosemide use, contrast agent use and contrast dosage >200 ml were associated with AKI in patients with ischemic stroke.

Objective To study the clinical significance of leukocyte parameters measured by using automatic blood cell analyzer SysmexXE‐2100inpatientsnewlydiagnosedwithhepatitisB.Methods 96patientsnewlydiagnosedwithhepatitisB(observation group) and 100 people who underwent healthy examination during the same period(control group) were recruited in the study .Rel‐ative indicators were measured for the people mentioned above ,such as the DNA of Hepatitis B virus(HBV‐DNA) ,Hepatitis B sur‐face antigen(HBsAg) ,aspartate aminotransferase(AST ) ,alanine aminotransferase(ALT ) ,lymphocytes parameters Lymph‐Y and Lymph‐X ,neutrophils parameters Neut‐X and Neut‐Y .The test results were recorded and statistically analyzed by using software SPSS19 .0 .Results The differences of Lymph‐X ,Neut‐Y and Neut‐X were not statistically significant compared between observa‐tion group and control group(P>0 .05) ,while the differences of HBV‐DNA ,HBsAg ,AST ,ALT and Lymph‐Y were statistically significant compared between the two groups(P<0 .05) .In addition to that ,the parameter Lymph‐Y was positirely correlated with HBV‐DNA(r=0 .160 ,P=0 .026) and HBsAg(r=0 .149 ,P=0 .037) .Conclusion The peripheral blood lymphocytes parameter Lymph‐Y of patients newly diagnosed with hepatitis B is higher than healthy people ,which makes it possible to become an indicator for differential diagnosis .

Objective To investigated the inhibitory effect of an IgG-Fc region specific inhibitory peptide on the ANCA-accelerated apoptosis of neutrophils. Methods The peptide was prepared by solid-phase peptide synthesis and its biological activity was identified by rosette formation assay. ANCA was prepared from the sera of active Wegener's granulomatosis (WG) and microscopic polyangiitis (MPA) patients. Neutrophils isolated from the blood of healthy volunteers were primed with TNF-?(2 ng/ml) then incubated with ANCA. At different intervals(3, 6, 12, 18 hours) the neutrophils were harvested to assess the apoptosis by flow cytometric analysis of JC-1 staining, Sub-G1 population and fonnation TUNEL technique. Results Tg19320 bound tightly to human IgG dose-dependendy and inhibited statistically the rosette formation between SRBC-IgG and U937 cells(20.3% vs 53.2% ,P

ObjectiveTo survey the status of Helicobacter pylori (HP)infection in cholangiocarcinoma,and its relation to clinical and pathological parameters and prognosis. MethodsHP infection in 80 cholangiocarcinoma samples and 30 controls was detected by PCR,in those with positive results the expression of Cag A and its subtypes of Vac A sla,m1 and m2 was further tested by PCR.ResultsChi-square test showed that the detection rate of in HP ( + ) in cholangiocarcinoma group is 71％,higher than 20％ in control group.The positive cases of CagA and VacA sla,m1,m2 in cholangiocarcinoma group was respectively 30,40,5 and 43 cases.HP infection in cholangiocarcinoma was correlated with the location of the tumor(x2 =27.580,P ＜ 0.05 ). MultivariateLogisticanalysisshowedthat cholangiocarcinoma is over 10 times more likely in HP ( + ) patients than HP ( - ) ( OR =10.531 ).Cox regression analyses showed that the infection of HP(HR =8.105,P =0.032),the staging of TNM( Ⅱ/ⅢHR=9.141,P=0.040,Ⅳ HR =29.071,P=0.040) and surgery (HR=9.531,P =0.015) are all independent prognostic factors of cholangiocarcinoma. Life table analyses showed HP infection negatively affects the survival time of cholangiocarcinoma after a surgery ( u =10.074,P =0.002),and the median survival time is 7.25 months shorter than HP( - ) patients. ConclusionsIt is common that HP infection complicating cholangiocarcinoma,usually with the genotype of VacA sla/m2,HP infection is a risk factor for cholangiocarcinoma,and negatively affects oatients survival after surgery.

Objective To explore the relationship between cholelithiasis and the function of sphincter of Oddi (SO). Methods To identify the existence of calculi, choledochoscopy was performed in patients 6 weeks after exploration of the common bile duct (CBD) and T tube drainage, in which 71 were patients with stones in gall bladder, CBD or intra-hepatic bile duct, and 9 with trauma of pancreas or liver.Biliary manometry was performed after choledochoscopy, and an additional manometry was applied after calculus removal if calculi were detected. The indices measured included SO basal pressure ( SOBP), amplitude of SO contractions (SOCA), frequency of SO contractions (SOF) and CBD pressure (CBDP). The patients with cholelithiasis were classified into cholecystolithiasis group, choledocholithiasis group, and hepatolithiasis group according to the position of calculi. Patients with trauma were assigned as the control group.Results All variables in 50 patients with choledocholithiasis were similar before and after the procedure.The variables in patients with cholecystolithiasis and choledocholithiasis had no difference from those of the control (P ＞ 0. 05 ). The SOBP and SOCA of patients in hepatolithiasis group were lower than those of the control group ( P ＜ 0. 05 ), while no difference in SOF was detected (P ＞ 0. 05 ). Conclusion The function of SO in patients with hepatolithiasis is abnormal ( decrease in SOBP and SOCA). Biliary manometry cannot be the reliable evidence for the existence of calculi in bile duct.