OBJECTIVE To investigate the distribution and resistance of non-fermenting bacteria isolated from(patients) in 2005 and offer a basis for the treatment of bacterial infection.METHODS The isolated bacteria were(identified) with API identified test(API Inc,France) and Kirby-Bauer(K-B) test used for the antibiotics(susceptivity) test.The data were analyzed by using WHONET-5 software.RESULTS Totally 604 strains of non-fermenting bacteria were isolated from the 2908 pathogenic strains.The most common bacteria were Pseudomonas aeruginosa(52.32%),followed by Stenotrophomonas maltophilia(14.07%) and Acinetobacter baumannii((13.74%)).76.32% of non-fermenting bacteria were isolated from the sputum.These bacteria had various(resistances) to all detected antibiotics.CONCLUSIONS Non-fermenting bacteria have high isolation rate and(multi-drug) resistance,so antibiotics should be used correctly under the guidance of antibiotic susceptibility testing.

Objective To investigate the effects of Sangju Qingjie Decoction on the ventilator-induced lung injury in rats.Methods Thirty-six healthy male SD rats of both sexes,weighing 300-350 g,were randomly divided into 3 groups(n =12 each):control group(group C); mechanical ventilation group(group V)and Sangju Qingjie Decoction group(group SJ).The animals were anesthetized with intraperitoneal 3％ urethane 1.4 g/kg and tracheostomized.The femoral artery and vein were cannulated for blood sampling and drug administration.The animals were mechanically ventilated for 2.5 h(VT =40 ml/kg,RR 40 bpm,I:E =1:1,FiO2 21％).Ingroup SJ,Sangju Qingjie Decoction 300 g was injected into the stomach through a gastric tube once a day for 10 consecutive days,and mechanical ventilation was performed 2 h after the last injection.While in groups V and C,the equal volume of normal saline was given instead of Sangju Qingjie Decoction.Arterial blood samples were collected before ventilation,at the end of ventilation,and at 30 min after ventilation(T0-2)for blood gas analysis.Respiratory index(RI)and oxygenation index(OI)were calculated.The animals were then sacrificed and the lungs were removed for microscopic examination and determination of the content of TNF-α,IL-6 and IL-10 and W/D lung weight ratio.Results Compared with group C,RI at T1,2,the content of TNF-o,IL-6 and IL-10 and W/D ratio were significantly increased,and OI was significantly decreased at T1.2 in groups V and SJ(P ＜ 0.05).Compared with group V,RI at T1,2,the content of TNF-α and IL-6 and W/D ratio were significantly decreased,and OI at T1,2 and the content of IL-10 were significantly increased in group SJ(P ＜ 0.05).The pathological damage was attenuated in group SJ compared with group V.Conclusion Sangju Qingjie Decoction can attenuate the ventilator-induced lung injury through inhibition of inflammatory response in rats.

BACKGROUND: Clinical researches found that portal vein occlusion was beneficial to inhibit growth of hepatocarcinoma, promote compensatory hyperplasia of un-blocking hepatic tissue and decrease metastasis of portal vein occlusion; however, it should be fu~her proved by animal experiments.OBJECTIVE: To investigate models of portal vein occlusion of hepatic VX2 tumor in rabbits and evaluate value of multi-slice CT.DESIGN: Randomized grouping design and animal study.SETTING: Department of Radiology, Xinqiao Hospital of the Third Military Medical University of Chinese PLA.MATERIALS: The experiment was carried out in the Imaging Department of Xinqiao Hospital of the Third Military Medical University of Chinese PLA from July 2002 to January 2005. Forty New Zealand rabbits were divided according to digital table into 4 groups: immediate group (transplantation of tumor after immediate portal vein occlusion), 3-week group (transplantation of tumor at 3 weeks after portal vein occlusion), negative control group and positive control group, 10 in each group.METHODS: Hepatic VX2 tumor was transplanted with abdominal-embedding innoculation at immediate portal vein occlusion and 3 weeks after portal vein occlusion. Meanwhile, they were divided into negative control group (Left external branch of portal vein was done sham-operative block,and left exite was embedded and inoculated pseudoly) and positive control group (Transplanted tumor did not suffer from portal vein occlusion). All rabbits were scanned with multi-slice CT.MAIN OUTCOME MEASURES: General changes of liver, changes of tumor, metastasis of tumor, vascular-imaging displaying rate of multi-slice CT of hepatic artery and portal vein, blood flow of liver, blood volume,mean transit time, permeability of vascular surface and fraction of hepatic arterial infusion (HAI).RESULTS: All 40 animals were involved in the final analysis. ① Tumor did not grow in both immediate group and 3-week group. In 3-week group,left endite was atrophied and growth of tumor was inhibited. The maximal diameter of tumor was smaller than that in positive control group [(2.55 ±0.46), (3.59±0.37) cm, t=5.57, P ＜ 0.001]. Incidences of metastasis in liver and lung were lower in 3-week group than those in positive control group (10%, 40%; 100%, 90%); however, there was no significant difference. ② Scanning with multi-slice CT, displaying rate of branches hepatic artery was lower in grade Ⅲ than that in grade Ⅰ and Ⅱ (40%, 70%,100%, P ＜ 0.05); but there was no significant difference of displaying rate of portal vein at various grades (P ＞ 0.05). ③ Values of blood flow of liver,blood volume, mean transit time and permeability of vascular surface were lower in immediate group and 3-week group than those in control groups,but values of HAI were increased.CONCLUSION: Ligating left external branch of portal vein is an ideal way to establish models of portal vein occlusion of hepatic VX2 tumor in rabbits; furthermore, multi-slice CT plays a key role in evaluating effect of portal vein occlusion.

Objective To evaluate the effect of domestic wire-reinforced epidural catheter on the occurrence of adverse events during epidural block.Methods Three hundred ASA Ⅰ or Ⅱ patients of both sexes,aged 18-64 yr,weighing 41-78 kg,scheduled for elective operations under combined spinal-epidural anesthesia,were randomly divided into 3 groups (n =100 each):polyvinyl chloride epidural catheter group (group A),imported wire-reinforced epidural catheter group (group B) and domestic wire-reinforced epidural catheter group (group C).Combined spinal-epidural anesthesia was performed routinely.The corresponding epidural catheter was inserted in each group.The catheterization without difficulty,paresthesia during catheterization,the number of patients in whom blood or cerebrospinal fluid was withdrawn from the epidural catheter,intravascular catheter insertion,injection obstruction,easiness during removal of the catheter,bleeding after removal,postoperative paresthesia and epidural hematoma within 1 week after operation were recorded.Results Compared with A group,the incidences of paresthesia during catheterization,the number of patients in whom blood or cerebrospinal fluid was withdrawn from the epidural catheter,injection obstruction and postoperative paresthesia were significantly decreased (P ＜ 0.05),and no significant change was found in the other parameters in B and C groups (P ＞ 0.05).There was no significant difference in all the parameters between B group and C group (P ＞ 0.05).Conclusion Domestic wire-reinforced epidural catheter can decrease the occurrence of catheterization-induced damage to the nerve and blood vessels and the efficacy is comparable with that of imported wire-reinforced epidural catheter.

Objective To monitor and compare the breathing mechanics on PC,VC and PRVC during pneumoperitoneum,and to discuss the significance of the clinic use of PRVC.Method Ninety laparoscopic cholecystectomy patients were equally divided into 3 groups (PC,VC,PRVC).Levels of PES,PAWM,PAP,PaCO2,ETCO2,TV MAP and HR were detected before pneumoperitoneum,and at 5,10,15 and 20 minutes postpneumoperitoneum.Results Pneumoperitoneum made three respiratory patterns with different levels of PAWM,PAP,and PES.PES post-pneumoperitoneum in the VC model was obviously higher than that in the PC and PRVC group.At 10 min post-pneumoperitoneum,levels of PaCO2 and ETCO2 increased obviously in the PC and VC group(P ＜ 0.05).Levels of PaCO2 and ETCO2 were increased in the PC group,but TV level post-pneumoperitoneum was significantly lower than that in the other two groups (P ＜ 0.05).Level of PaCO2 and ETCO2 were increased in the PC and VC group post-pneumoperitoneum,along with increases of MAP and HR (P ＜ 0.05).Levels of MAP and HR in the PRVC group post-pneumoperitoneum were significantly lower than those in the PC and VC group (P ＜ 0.05).Conclusion PRVC mode can effectively reduce the increases of pneumoperitoneum-induced PAWM,PAP,PES,without the unusual increase of PaCO2 and ETCO2 during surgeries,contributing to the stability of vital signs of perioperative patients.

Objective To investigate the effects of long-term glucocorticoid administration on neuromuscular block of cisatracurium in elderly patients undergoing general anesthesia. Methods Forty ASA Ⅱ or Ⅲ patients,aged≥65 yr,with BMI of 18-24 kg/m2 ,scheduled for elec-tive operation were studied.According to the history of using or not long-term glucocorticoid,patients were assigned into two groups (n = 20 each):control group(group C),glucocorticoid group(group J).Midazolam 0.03 mg/kg was injected,mask inhalation of 8% sevoflurane and flow rate of oxygen 8L,every 30 s decline 2%,until the 4%.After the disappearance of eyelash reflex,cisatracurium 0.1 5 mg/kg was injected intravenously.After 1 min intravenous injection of remifentanil 2 g/kg and 30 s after stop of sevoflurane inhalation anesthesia, endotracheal intubation for mechanical ventilation,target controlled infusion of propofol and remifentanil anesthesia,using TOF-Watch SX acceleromyography monitoring of muscle relaxation,and onset time,clinical duration and recovery in-dex(for T1 to return from 25% to 75% of the control twitch)were recorded.Results Compared with group C,the onset time was significantly prolonged,clinical duration and recovery index were short-ened in group J (P <0.05 ).Conclusion Long-term glucocorticoid admininstration could reduce the neuromuscular blocking effect of cisatracurium in elderly patients.

Objective To evaluate the effects of long?term glucocorticoid administration on cisatra?curium?induced neuromuscular blockade in the patients undergoing laparoscopic operation. Methods Six?ty?four patients of both sexes, aged 40-64 yr, with body mass index of 18-22 kg∕m2 , of American Society of Anesthesiologists physical status Ⅱ or Ⅲ, scheduled for elective laparoscopic operation under general anesthesia, were assigned into 4 groups ( n=16 each) according to whether or not glucocorticoid was used for a long?term period: control ( non?hormone and non?laparoscopic operation ) group ( group C ) , hor?mone + laparoscopic operation group ( group HL ) , non?hormone + laparoscopic operation group ( group NHL) and hormone +non?laparoscopic operation group ( group HNL) . Midazolam 0.03 mg∕kg was injected intravenously, 8% sevoflurane was inhaled by mask, and the concentration of sevoflurane was decreased by 2% every 30 s until the concentration of 4% was reached. After loss of eyelash reflex, remifentanil 2μg∕kg was injected intravenously over 1 min, and 30 s later sevoflurane inhalation was stopped. The patients were tracheally intubated and mechanically ventilated. Anesthesia was maintained with propofol and remifentanil given by target?controlled infusion. Neuromuscular blockade was monitored with accelerograph TOF?watch
SX. At 20 min of pneumoperitoneum in NHL and HL groups or 20 min after intubation in C and HNL groups, cisatracurium 0. 15 mg∕kg was injected intravenously. The onset time, maximal degree of N?M block, clinical duration and recovery index of cisatracurium were recorded. Results Compared with group C, the onset time was significantly prolonged, the maximal degree of N?M block was decreased, the clini?cal duration was shortened, and the recovery index was decreased in HL and HNL groups ( P<0.05) , and the clinical duration was significantly prolonged, the recovery index was increased ( P<0.05) , and no sig?nificant change was found in the onset time in group NHL ( P>0.05) . Compared with group HNL, the clin?ical duration was significantly prolonged, the recovery index was increased (P<0.05), and no significant change was found in the onset time in group HL ( P>0.05) , and the onset time was significantly shortened, the clinical duration was prolonged, and the recovery index was increased in group NHL ( P<0.05) . Com?pared with group NHL, the onset time was significantly prolonged, the maximal degree of N?M block was decreased, the clinical duration was shortened, and the recovery index was decreased in group HL ( P<0.05) . Conclusion Long?term glucocorticoid administration can weaken cisatracurium?induced neuromus?cular blockade in the patients undergoing laparoscopic operation.

Objective To explore impacts of social support and coping styles on self-perceived burden of patients with spinal cord injury. Methods A total of 150 patients with spinal cord injury were investigated using Self-Perceived Burden Scale, Social Support Rating Scale, and Medical Coping Modes Questionnaire by cross-sectional survey method. Results The total score of self-perceived burden was at a moderate level and the average score was (33.98±10.76) points. Resignation of coping style had directly positive effect on self-perceived burden, path coefficient was 0.19, subjective support, support utilization had directly negative effect on SPB, path coefficient were-0.18,-0.21;objective support exerted directly negative influence on self-perceived burden through resignation of coping style. In other words, the resignation of coping style played a mediating role between social support and self-perceived burden, effect size was 0.034. Conclusions Most of patients with spinal cord injury suffer from moderate self-perceived burden. Objective support, subjective support, support utilization and the resignation of coping style are the important factors that affect self-perceived burden.

Objective To investigate antimicrobial resistance among gram-negative bacilli in China in 2010.Methods A total of 1 259 consecutive and non-repetitive gram-negative bacilli were isolated from 13 teaching hospitals from September to December in 2010 in China.All of these isolates were sent to the central laboratory for re-identification and susceptibility testing.The MIC of meropenem and other antibacterial agents were determined by agar dilution method.Interpretive results was determined by CLSI M100-S21.Results The activity of 14 antibacterial agents against 845 Enterobacteriaceae isolates was as follows in order:meropenem ( 98.1％,829 ),amikacin ( 94.0％,794 ),imipeuem ( 90.0％,761 ),piperacillin/tazobactam ( 87.5％,739 ),cefepime ( 83.0％,701 ),ertapenem ( 82.4％,696 ),cefoperazone/sulbactam ( 80.3％,678 ),colistin (75.4％,637),ceftazidime (70.0％,591 ),ciprofloxacin (59.1％,499 ),cefoxitin ( 54.8％,463 ),ceftriaxone ( 53.5％,452 ),cefotaxime ( 52.3％,442 ) and minocycline(51.5％,435).The prevalence of ESBL was 61.3％ (106/173) in Escherichia coli,which was much higher than 41.2％ (70/170) in Klebsiella pneumoniae.The susceptibility rate of Klebsiella pneumoniae against meropenem,imipenem,amikacin and colistin were more than 90％,but were highly resistant to ceftriaxone and cefotaxime.Over 80％ of Enterobacter cloacae,Enterobacter aerogenes,Citrobacter freundii,were susceptible to meropenem,amikacin,cefepine,cefoperazone/sulbactam,imipenem,piperacillin/ tazobactam,and ertapenem.The most active antibiotics against Pseudomonas aeruginosa were Colistin (98.4％,182),Amikacin ( 85.9％,159 ),Piperacillin/Tazobactam ( 80％,148 ),Ceftazidime ( 79.5％,147),Meropenem (74.1％,137),Ciprofloxacin (74.1％,137),Cefepime (73.5％,136),Imipenem (71.9％,132) and Cefoperazone/Sulbactam (70.8％,131 ).Less than 37％ of Acinetobacter baumannii isolates were resistant to carbapenems.The susceptible rate to Minocycline was 47.8％.Colistin kept good activity against Acinetobacter baumannii (susceptible rate,97.8％,n =176),The prevalence of Pan-drug resistant P.aeruginosa and A.baumannii was 18.9％ (n =35),and 61.8％ (n =108),respectively.Conclusions Carbapenems remained very high activity against Enterobacteriaceae.Increasing resistance to the antimicrobials agents test among A.baumanni and P.aeruginosa,especially carbapenems among A.baumanni brought great concern.

Objective: To study the epidemiological characteristics of tsutsugamushi disease, and to confirm the existence of the disease's epidemic foci in Taizhou. Methods: From 2013 to 2014, Dongxing town hospital and Xingqiao town hospital were selected as specimen collection sites in Jingjiang city. Blood samples (5 ml) were collected from 40 patients with acute tsutsugamushi disease. A total of 59 rodents were captured with cage night method in the survey sites at 5, 7, 9, 10, and 11 months in 2013, from which, the spleen, liver, and kidney specimens were selected. Chigger mites were captured by small blackboard method and from the ears of the captured rodents. A total of 226 small blackboards were laid, 27 mites were captured, and the samples were grounded into suspension. Nested-polymerase chain reaction and cell and tissue culture techniques were used to test the specimen from the probable patients, host animals and chigger mites. Results: Among the 40 acute tsutsugamushi disease blood samples, 29 were found to meet the test requirements, 17 were positive for orientia tsutsugamushi nucleic acid with 59% of the positive rate, and 1 stran orientia tsutsugamushi was isolated. 59 rats were captured and the density of mice was 5.5%. Among them, there were 26 Mus musculus (2.4%), 18 Rattus flavipectus (1.7%) and 15 Smelly shrew (density 1.4%). 1 Smelly shrew was tested positive for orientia tsutsugamushi nucleic acid, and the negative results were found in the other rodent specimens. 27 Chigge mites were collected by small blackboard method and the density of mites was 0.12 for each blackboard, among which 3 larvae and 24 nymphs were found. 33 Chigger mites were collected from the ears of 3 Smelly shrew, and the density of the mite was 11 per mouse. All the captured Chigger mites were identified as Leptotrombidium scutellare and 1 group of specimens of Chigger mites from the external environment were positive for orientia tsutsugamushi nucleic acid. Conclusion There was a high density of mice in the epidemic area from May to November and the species of the chigger mites were Chigger mites in Taizhou. The nucleic acid of the oriental tsutsugamushi was detected in the patients with acute scrub typhus, rodents and vectors. According to the above-mentioned results, it was considered that the scrub typhus epidemic area of Taizhou city has the natural foci of scrub typhus.