Objective To determine the distribution and drug resistance of pathogens isolated from wounds in orthopedic patients.Methods Wound samples were collected from 999 orthopedic patients in the Third Hospital of Hebei Medical University during July 2010 and June 2012.Pathogens were isolated and identified.The antimicrobial susceptibility test was performed by Kirby-Bauer method.Extended spectrum β-1actamases (ESBLs) were detected by double-disk diffusion test,and methicillin-resistant Staphylococcus aureus (MRSA) was detected by cefoxitin disk diffusion test.WHONET 5.4 was used for drug resistance analysis.Results A total of 1056 strains of pathogens were isolated,of which gram-positive cocci,gramnegative organisms and fungi accounted for 69.98％ (739/1056),28.79％ (304/1056),and 1.23％(13/1056),respectively.The top 5 pathogens were Staphylococcus aureus (265.25.09％).Pseudomonas aeruginosa (245,23.20％),Acinetobacter baumannii (199,18.84％) and Escherichia coli (86,8.14％).The resistant rates of Pseudomonas aeruginosa to cefoperazone/sulbactam,ciprofloxacin,levofloxacin and piperacillin/tazobactam were 13.58％,21.25％,21.67％ and 22.45％,while the highest resistance rate was to compound sulfamethoxazole (98.04％).Acinetobacter baumannii was highly resistant to most antibacterial agents except cefoperazone/sulbactam (14.29％),and 11 out of 199 strains were pandrug resistant.Enterobacteriaceae were completely susceptible to imipenem and meropenem,and their resistance rates to cefoperazone/sulbactam,piperacillin/tazobactam and amikacin were 1.16％-28.12％.ESBLs positive rates of Escherichia coli and Klebsiella pneumoniae were 48.84％ (42/86) and 34.38％(11/32),respectively.Staphylococcus aureus were susceptible to vancomycin,teicoplanin and linezolid,but were highly resistant to ampicillin (100.00％),penicillin G (99.25％) and erythromycin (80.06％).The rate of MRSA was 41.51％ (110/265).Enterococcus were highly resistant to erythromycin,rifampin,levofloxacin,high-concentration gentamicin,minocycline and nitrofurantoin,but were susceptible to teicoplanin and linezolid,and the rate of vancomycin intermediate strain was 4.55％ (1/22).Conclusions The pathogens of wound infections in orthopedic patients were of wide variety.Staphylococcus aureus,Pseudomonas aeruginosa,Acinetobacter baumannii,Escherichia coli and Enterobacter cloacae were the most prevalent pathogens,and most strains were multi-drug resistant.

Objective To investigate the distribution and drug resistance of bacterial pathogens isolated from orthopedic wounds.Methods Data of bacterial strains isolated trom orthopedic wounds in the Third Hospital of Hebei Medical University from January 2008 to December 2012 were retrospectively analyzed.Strains were identified by using French bioMérieux Vitek32 identification system,and the drug susceptibility was tested by Kirby-Bauer method.Chi-square test for linear trend was performed to reveal the changes of distribution and drug resistance of the strains.Results A total of 2 456 bacterial strains were isolated,vith 1 652 (67.26％) gram-negative bacilli,777 (31.64％) gram-positive cocci,26 (1.06％) fungi,and 1 (0.04％) gram-positive bacillus.The top five pathogens were Staphylococcus aureus (666 strains,27.12％),Pseudomonas aeruginosa (606 strains,24.67％),Acinetobacter baumannii (355 strains,14.45％),Escherichia coli(188 strains,7.65％) and Enterobacter cloacae (187 strains,7.61％).The positive rate of Acinetobacter baumannii was on the rise during 2008 and 2012 (x2 =35.266,P ＜ 0.0l).The rates of pan-drug resistant strains in Acinetobacter baumannii and Pseudomonas aeruginosa were 6.20％ (22/355) and 0.17％ (1/606),respectively.The rates of extended-spectrum β-lactamases positive strains in Escherichia coli and Klebsiella pneumoniae were 39.89％ (75/188) and 29.23％ (19/65),respectively.The rates of methicillin-resistant strains in Staphylococcus aureus and coagulasenegative Staphylococcus were 40.69％ (271/666) and 52.38％ (22/42),respectively.The rate of vancomycin-intermediate strains in Enterococci was 3.70％ (2/54).The positive rate of methicillin-resistant &aphylococcus aureus was on the rise during 2008 and 2012 (x2 =18.317,P ＜ 0.01).Staphylococcus aureus were sensitive to teicoplanin,vancomycin and linezolid; Resistance rates to rifampicin and amikacin were 11.29％-33.33％; Resistance rates to penicillins and erythromycin were 76.80％-100.00％; Resistance rates to cefazolin,cefuroxime,cefoxitin,amikacin and levofloxacin were on the rise (P ＜ 0.05) ; And resistance rates to sulfamethoxazole (28.11％-48.35％) were on the decline in the same period (P ＜ 0.01).Resistance rates of Pseudomonas aeruginosa to imipenem,meropenem and sulfamethoxazole were on the rise (P ＜ 0.05) ; Resistance rates to ciprofloxacin,levofloxacin,amikacin,gentamicin and piperacillin/ tazobactam were on the decline (P ＜ 0.05) ; Resistance rates to cefoperazone/sulbactam were the lowest (9.15％-20.51％).Resistance rates of Acinetobacter baumannii to imipenem,meropenem,levofloxacin,piperacillin/tazobactam,sulfamethoxazole were on the rise (P ＜ 0.01); Resistance rates to cefoperazone/ sulbactam were the lowest (11.86％-19.70％).Escherichia coli and Enterobacter cloacae were sensitive to imipenem and meropenem,and the resistance rates to cefoperazone/sulbactam and piperacillin/tazobactam were low (0-14.29％); Resistance rates of Escherichia coli to piperacillin,cefepime,amikacin,levofloxacin,cefoperazone/sulbactam were on the decline (P ＜ 0.05) ; Resistance rates of Enterobacter cloacae to cefoxitin were on the rise (P ＜ 0.01),while the resistance rates to piperacillin,ceftazidime,cefoperazone,ceftriaxone,levofloxacin were on the decline (P ＜ 0.05).Conclusion During 2008 and 2012,the predominant bacterial pathogens of orthopedic wound in patients of the Third Hospital of Hebei Medical University are Staphylococcus aureus,Pseudomonas aeruginosa,Acinetobacter baumannii,Escherichia coli and Enterobacter cloacae,and most strains are multiple drug resistant.

Objective To investigate the effect of Astragalus Polysaccharide on peripheral circulation myeloid derived suppressor cells (MDSC) in lung cancer and its clinical effect. Methods 100 patients with advanced non small cell lung cancer were selected and divided into 2 groups, 50 cases in the control group treated with chemotherapy aalone, 50 cases in the experiment group received injection of Astragalus Polysaccharide on the basis of the control group, peripheral blood MDSC levels, peripheral blood T lymphocyte subsets levels, serum ARG I activity, TNF-α, IL-6 levels, the clinical effect and incidence of adverse reactions were compared after the treatment. Results Compared with the control group, peripheral blood levels of MDSC (Lin-HLA DR-\CD33+\CD11b+) was lower after treatment in the experiment group , peripheral blood levels of CD3+, CD4+T lymphocytes and CD4+/CD8+ were higher, and CD8+T lymphocytes level was lower after treatment, serum levels of ARG I activity, TNF-α, IL-6 levels were lower after treatment, (P<0.05) , the total effective rate in the control group(42.0%)was lower than the experiment group(64.0%), (P<0.05), the incidence of gastrointestinal reaction(40/24), 3 ~ 4 degree of leukocyte reduction(26/12), liver function damage(19/9), renal damage(17/7) in the control group were higher than the experiment group (P<0.05). Conclusion Astragalus Polysaccharide can significantly reduce the peripheral circulation MDSC (Lin-HLA DR-\CD33+\CD11b+) level in patients with lung cancer, improve T lymphocyte immune function, inhibit the activity of serum ARG I, reduce the level of TNF-αand IL-6, effectively improve the clinical efficacy, and reduce the toxic and side effects of chemotherapy.

Objective:To explore the environmental risk factors of different categories of congenital heart defects ( CHD) and provide evidence for further risk factors and prevention research of CHD pheno-types. Methods:Data of Guangdong CHD Register Study from 2004 to 2012 were used. In the study, 3 038 CHD cases and 3 038 paired controls from 34 hospitals distributed in 17 cities were registered and related information were collected using uniform, and structured questionnaires. All the CHD phenotypes were coded according to the International Classification of Diseases 10th Revision (ICD-10) and classified into 6 categories according to their pathological features. Univariate analyses were adopted to filter poten-tial risk factors for each category of CHD. Then multivariate conditional Logistic regression was used to calculate the odds ratios of the risk factors for each category of CHD. Results:The risk factors for left-to-right shunt CHD included low ( OR=2 . 63 , 95%CI:2 . 04 -3 . 39 ) or over birth weight ( OR =2 . 21 , 95%CI:1 . 47-3 . 32 ) , premature delivery ( OR=1 . 95 , 95%CI:1 . 53-2 . 49 ) , polyembryony ( OR=1. 99, 95%CI: 1. 22 -3. 26), maternal low education, mother as factory worker (OR =1. 62, 95%CI:1 . 32-1 . 98 ) , parity≥2 ( OR =1 . 38 , 95%CI: 1 . 13 -1 . 69 ) , maternal abnormal reproduction history ( OR=2 . 29 , 95%CI:1 . 75-3 . 01 ) , fever ( OR=2 . 38 , 95%CI:1 . 26-4 . 48 ) , virus infection ( OR=1 . 80 , 95%CI:1 . 29 -2 . 51 ) , medicine usage ( OR=1 . 73 , 95%CI:1 . 11 -2 . 69 ) , passive smoking ( OR=1 . 69 , 95%CI:1 . 26-2 . 29 ) , chemical agent contact ( OR=8 . 71 , 95%CI:2 . 33 -32 . 58 ) , living in newly decorated houses ( OR=2 . 56 , 95%CI:1 . 60-4 . 09 ) or room close to the main road ( OR=1 . 40 , 95%CI:1 . 14-1 . 72 ) in the first 3 months of pregnancy and father as factory worker ( OR=1 . 46 , 95%CI:1 . 23-1 . 73 ) . The risk factors for pulmonary outflow tract obstruction CHD in-cluded low ( OR =5 . 98 , 95% CI: 2 . 88 -12 . 44 ) or over birth weight ( OR = 6 . 56 , 95% CI:1. 19-36. 26), maternal low education, parity≥2 (OR=2. 08, 95%CI:1. 03-4. 22), virus infection in the first 3 months of pregnancy ( OR =4 . 30 , 95%CI: 1 . 27 -13 . 45 ) . The risk factors for left ventricular outflow tract obstruction CHD included father as factory worker ( OR=6 . 01 , 95%CI:1 . 05-34. 59). The risk factors for transposition of the great arteries included low birth weight (OR=12. 93, 95%CI:1. 14-146. 26), maternal low education, mother as factory worker (OR=3. 69, 95%CI:1. 53-8. 91). The risk factors for conditions with intra cardiac mixing of oxygenated and deoxygenated blood in-cluded parity=2 ( OR=3 . 45 , 95%CI:1 . 42-8 . 38 ) . The risk factors for other CHD included over birth weight (OR=4. 87, 95%CI:1. 19-19. 94), maternal abnormal reproduction history (OR=2. 96, 95%CI:1. 14 - 7. 68 ), virus infection ( OR = 4. 92, 95% CI: 1. 56 - 15. 47 ), medicine usage (OR=4. 90, 95%CI:1. 22-19. 77) or passive smoking (OR=10. 31, 95%CI:1. 25-85. 05) in the first 3 months of pregnancy. Conclusion:The environmental risk factors were discrepant among different categories of CHD. Further risk factors study of CHD phenotypes should be performed specially. To prevent CHD, attention should be paid to the risk factors which are related to multi or complex categories of CHD.

[Objective]To evaluate the effects of sutureless technique in comparison to conventional techniques for repair of total anomalous pulmonary venous connection(TAPVC)with the method of propensity score analysis.[Methods]From October 2007 to December 2013,179 consecutive patients were enrolled in this study. Patients were operated with sutureless technique(n = 81)or Conventional technique(n=98),and followed up at an interval of 1 month,3 months,6 months and then once a year post-operation. During analysis,three type of propensity-score matching methods,including nearest neighbor caliper matching,Mahalanobis metric matching with propensity score ,optimal full matching were used to create balanced groups of patients receiving each treatment. Surgeons’performance difference was assessed with random frailty proportional hazards models with gamma. Composite endpoints was defined by postoperative death or late death or postoperative pulmonary venous obstruction(PVO),which was evaluated with Kaplan-Meier curve and multivariable Cox proportional hazard model,adjusted by Preoperative-PVO,age,gender,weight and TAPVC type.[Results]Nearest neighbor caliper matching method was the best choice during propensity score analysis. After matching ,sutureless group included 73 patients and Conventional group73 patients. In sutureless group,cardiopulmonary bypass(CPB)time(Z=2.18, P=0.030),cross-clamp time(Z=3.63,P<0.001),rate of composite endpoints(HR 95%CI=0.20(0.06~0.61),P=0.005),late death(HR 95%CI=0.03(0.01~0.55),P=0.017)were significantly better than that in Conventional group. In subgroup analysis ,for patients with pre-PVO,decreased composite endpoints was seen in sutureless group.[Conclusion]Comparison using thepropensity score analysis demonstrated that sutureless strategy for primary repair of TAPVC may associate with decreased mortality rate of post-PVO and CPB time and cross-clamp time.

Objective To analyze the potential factors facilitating post-pyloric placement of spiral naso-jejunum tube in critically ill patients.Methods A retrospective study was carried out in patients requiring enteral nutrition (EN) from Apr 2005 through Dec 2011 in Intensive Care Unit (ICU).Severity of illness was assessed with APACHE Ⅱ score (acute physiology and chronic health evaluation Ⅱ).A selfpropelled spiral naso-jejunum tube was placed and observed for 24 hours.The forward movement and place of the tube tip was checked by bedside X-ray.The APACHE Ⅱ score,therapeutic measures,agents administered within 24 hours after tube insertion were recorded.The patients were divided into the success group and the failure group identified by bedside X-ray whether the tube tip entered into jejunum or not.Univariate analysis and multivariate Logistic regression analysis were used to find out the potential factors impacting on the success or failure in post-pyloric placement of naso-jejunum tube.Results A total of 508 patients composed of 337 male and 171 female,and aged (62.0 ± 19.2) years with APACHE Ⅱ score of (21.9 ± 7.3) were enrolled for study.The placement was successful in 205 (40.4％) of 508 patients.Univariate analysis showed that APACHE Ⅱ score ≥ 20,sedatives and analgesics,catecholamines,prokinetics,artificial airway and mechanical ventilation were potential factors facilitating the post-pyloric placement of naso-jejunum tube.Multivariate logistic regression identified that APACHE Ⅱ score ≥ 20,sedatives and analgesics and prokinetics were independent factors facilitating the post-pyloric placement of naso-jejunum tube.Conclusions The success rate of self-propelled spiral nasojejunal tubes insertion was relatively low.The prokinetics contributed higher success rate of naso-jejunum tube placement than factors of APACHE Ⅱ score ≥ 20,sedative and analgesic,catecholamine drugs,artificial airway and mechanical ventilation.There were no effects of age and gender on the placement of naso-jejunum tube.

Objective: To investigate the relationship between exercise and serum lipid level in middle-aged population. Methods: Based on “multicenter collaborative study of cardiovascular epidemiology” research, a total of 3482 subjects at the age of (35-59) years from urban and rural areas of Beijing and Guangzhou were enrolled in this study. According to daily energy expenditure of exercise (EEexer), the participants were divided into 3 groups: No exercise group, (daily) EEexer below median group and (daily) EEexer above median group. The type and duration of exercise were collected by the questionnaire, daily EEexer was calculated and the relationship between exercise and serum lipid level was estimated by covariance analysis. Results: There were 47.1% (807/1712) male and 41.1% (727/1770) female participants having exercise. With controlled age, area, education level, smoking, drinking, BMI and energy expenditure of physical activity outside of exercise (EEPA), serum levels of TC, LDL-C, non-HDL-C and TG were decreased in women by elevated EEexer groups accordingly, and among them, there were significant differences in LDL-C and non-HDL-C levels between groups, P<0.05; compared with No exercise group, in female daily EEexer above median group, LDL-C and non-HDL-C levels decreased about 0.14 mmol/L,P=0.0063 and 0.14 mmol/L, P=0.0155 respectively; while in men, TC, LDL-C, non-HDL-C and TG levels showed a decreasing trends by elevated EEexer groups but with no statistical significance. No association was found for HDL-C in men and women. Conclusion: Serum levels of LDL-C and non-HDL-C were lower in female daily EEexer above median group than No excise group, the effects were independent from working and other physical activities.

Objective This retrospective cohort study aims to evaluate and compare the prognosis of surgical repair for total anomalous pulmonary venous connection(TAPVC) with different drainage type.Methods From January 2006 to Decem-ber 2013, 328 consecutive patients were enrolled in this study .The distribution of the defects was 109 cases with cardiac, 161 with supracardiac, 32 with infracardiac, and 26 with mixed type of the drainage into the systemic circulation .The clinical re-cords of all the patients were reviewed.Studied variables were extracted from the clinical records.Followed-up was conducted at an interval of 1 month, 3 months, 6 months and then once a year post-operation.Prevalence of peri-operative conditions were compared among four different types.Studied endpoints was defined by postoperative total death or pulmonary venous obstruc-tion(PVO), which was evaluated with Kaplan-Meier curve and multivariable Cox proportional hazard model, adjusted by differ-ent surgical strategy, emergency operation, preoperative-PVO, neonates, weight, combing with other complex cardiac defects,NYHA cardiac function, severe pulmonary hypertension and severe tricuspid regurgitation.Results There were significant discrepancyof preoperative conditions among four types of TAPVC.Patients with infracardiac TAPVC presented the most criticalsymptoms and clinical indexes, which included having largest proportion of neonates, preoperative PVO, severe NYHA grading,pulmonary hypertension and tricuspid regurgitation, having lowest body weight at operation and youngest age.The cardiopulmonarybypass time, aortic crossclamp time and mechanical ventilation time were significantly longer in infracadiac and mixedTAPVC comparing to the other two types.For early mortality(death in hospital), infracadiac(9.4%) and mixed(11.5%)TAPVC demonstrated higher rates of death than cardiac(4.6%) and supracardiac(7.5%)TAPVC, although had no statisticalsignificance.For intermediate-term results, mortality in infracadiac(21.9%) and mixed(30.8%) TAPVC were significantlyhigher than cardiac ( 8.3%) and supracardiac (11.8%) TAPVC.Reoperation was more frequently required in mixed(19.2%), then infracadiac(15.6%)TAPVC.Mixed and infracadiac types are independent risk factors for TAPVC prognosis,after adjusting by the confounding factors.Conclusion Mixed and infracadiac types are independent risk factors for postoperativedeath and PVO among TAPVC patients.This study provided evidence for clinical assessment and management strategy fordifferent types of TAPVC.

Acute suppurative cholecystitis is a complex acute abdomen in general surgery, which usually occurs in middle-aged and elderly people. With the improvement of living standards and the aging of the population, the incidence of the disease is increasing year by year. Elderly patients have certain clinical particularities, and they are often combined with other underlying diseases such as cardiovascular and cerebrovascular diseases. Therefore, specific programs should be implemented for different situations during patient treatment, and a more complete risk assessment should be carried out. The preferred treatment for acute suppurative cholecystitis is surgery, but for patients with poor general conditions or intolerable surgery, percutaneous transhepatic gallbladder drainage may be a good alternative. This article reviews the clinical characteristics, diagnosis and treatment of acute suppurative cholecystitis in the elderly.

OBJECTIVETo investigate the appropriate cut-off values of waist circumference(WC)for central obesity and severe central obesity in Chinese adults.

METHODSA total of 10 265 participants aged 35-69 years from the cross-sectional survey of the PRC-USA Collaborative Study of Cardiovascular and Cardiopulmonary Epidemiology between 1993 and 1994 with integral data were included. Each integer unit in centimeters of WC in a given range was used as the cut-off point to detect clustering of risk factors, which was defined as an individual with 2 or more risk factors including hypertension, diabetes, hypercholesterolemia, hypertriglyceridemia and low levels of high-density lipoprotein cholesterol. Sensitivity, specificity and distance from the receiver operating characteristic (ROC) curves to the upper left corner of the ROC graph were calculated. The WC value corresponding to the point on the ROC curve nearest to the upper left corner was considered as the optimal cut-off value for central obesity and the value corresponding to the point with specificity of 90% or more was considered as the optimal cut-off for severe central obesity.

RESULTSThe mean WC was (80.5 ± 9.9) cm in men and (77.8 ± 10.0) cm in women; 18.1% (890/4 921) of men and 14.5% (776/5 344) of women were identified with two or more major risk factors. Based on the ROC curve analysis, the optimal value of WC to detect clustering of risk factors was ≥ 84 cm for men and ≥ 80 cm for women, and the shortest distance to the upper left corner was 0.430 and 0.450, respectively. The cut-off values of WC to detect clustering of risk factors with specificity of 90% or more were ≥ 93 cm and ≥ 91 cm for men and women, respectively.

CONCLUSIONThe cut-off points of WC for central obesity and severe central obesity in Chinese adults obtained from this study are equal or similar to the WC cut-off values proposed by the Guidelines for Prevention and Control of Overweight and Obesity in Chinese Adults.

Adult ; Aged ; Asian Continental Ancestry Group ; Cholesterol, HDL ; Cross-Sectional Studies ; Diabetes Mellitus ; Female ; Humans ; Hypercholesterolemia ; Hypertension ; Hypertriglyceridemia ; Male ; Middle Aged ; Obesity, Abdominal ; ROC Curve ; Risk Factors ; Waist Circumference