Objective To investigate the distribution and antimicrobial resistance of pathogens from lower respira-tory tract in patients in intensive care unit (ICU),so as to provide reference for clinical treatment.Methods Distri-bution and antimicrobial susceptibility of pathogens isolated from ICU patients’sputum obtained through fiberbron-choscope between 2011 and 2014 were analyzed retrospectively.Results A total of 3 454 pathogenic strains were isolated between January 1 ,2011 and December 31 ,2014,the percentage of gram-negative bacteria,gram-positive bacteria,and fungi were 84.11 %,14.50%,and 1 .39% respectively.The detection rates of extended-spectrum β-lactamase-producing Escherichia coli and Klebsiella spp .in 2011 -2014 were 38.46% -73.33% and 26.95% -37.06% respectively. Enterobacteriaceae strains had low resistance rates to imipenem and meropenem (<20.00%);resistance of Acinetobacter baumannii was higher than Pseudomonas aeruginosa ,both had low resistance rates to amikacin(3.32%-37.16%);vancomycin-and linezolid-resistant strains were not found among Staphylo-coccus .In 2011 - 2014,detection rates of methicillin-resistant Staphylococcus aureus (MRSA)were 42.86% -61 .22%,methicillin-resistant coagulase-negative staphylococcus (MRCNS)were 86.96% - 91 .67%;resistance rates of Enterococcus faecium was higher than Enterococcus faecalis ,vancomycin-resistant strains were not found among Enterococcus faecalis and Enterococcus faecium ;the major fungus was Candida albicans .Conclusion Anti-microbial resistance of pathogens isolated from lower respiratory tract is getting more serious,clinicians should pay attention to non-antimicrobial infection control strategies in addition to rational use of antimicrobial agents.

Objective: To explore the predictive value of high-sensitivity C-reactive protein (hs-CRP) levels in patients with persistent atrial fibrillation (AF) recurrence after radiofrequency catheter ablation (RFCA). Methods: A total of 77 patients of persistent AF as the first diagnosis with initial RFCA in our hospital were studied. The patients were divided into 2 groups: Recurrent group, n=27 and Non recurrent group, n=50. Basic clinical conditions were studied by Cox model analysis to screen the risk factors for AF recurrence, receiver operating characteristic (ROC) curve was conducted to assess the predictive value of hs-CRP level on AF recurrence. Results: AF recurrence was related tothe age (HR=1.126, 95% CI 1.044-1.215, P=0.002), body mass index (HR=1.297, 95% CI 1.077-1.563, P=0.006), hypertension at stage II (HR=4.142, 95% CI 1.047-16.390, P=0.043), hypertension at stage III (HR=8.595, 95%CI 1.913-38.610, P=0.005), left atrial size (HR=1.438, 95% CI 1.212-1.707, P=0.000) and hs-CRP (HR=2.026, 95% CI 1.010-4.061,P=0.047). The area under ROC curve of hs-CRP level was 0.693,P=0.005 with the cut-off point at 0.355 mg/dl. Conclusion: Persistent AF recurrence after RFCA was related to pre-operative inflammatory status; actively control pre-operative condition may reduceAF recurrence, improve prognosis and decrease adverse cardiovascular event in relevant patients.

OBJECTIVE: To study the development strategy of clinical pharmacy under the condition of New Medical Reform in China. METHODS: The status quo and obstacle factors of clinical pharmacy were analyzed to probe into the chance for clinical pharmacy in China brought out by New Medical Reform. RESULTS: The reimbursement mechanism reform of state hospitals, National Essential Drug System, medical insurance system, charge for pharmaceutical care system and the construction of primary hospitals and public health service provide development opportunities of clinical pharmacy. CONCLUSION: The development strategy of clinical pharmacy should be associated with New Medical Reform and relevant policy, laws and regulations of clinical pharmacy should be improved. Great importance should be attached to exploring the training system of clinical pharmacists and approaches of clinical pharmacy.

Objective To evaluate the factors influencing prognosis and to explore the pathological mechanism in which herpes simplex virus encephalitis(HSE) was one of the severe types of acute viral encephalitis in children and had poor prognosis.Methods Twenty-one children with HSE were diagnosed by the clinical syndrome of focal encephalitis and HSV DNA-PCR positive in cerebrospinal fluid(CSF) from Jan.2012 to Oct.2013,among whom,19 patients were treated with intravenous Acyclovir,30 mg/(kg · d) 48 hours after onset and were followed up for 6 to 24 months.Clinical data were collected including Glasgow Coma Score,the brain magnetic resonance imaging(MRI),and electroencephalography(EEG).All MRI examinations including plain scan and contrast enhancement were carried out at the beginning of admission and 1 month after the onset of symptoms.The clinical outcomes were divided into two levels accoming to the severity of the neurological deficit,then the data were analyzed by using Logistic regression and Fisher's exact probability method.The OR value was calculated.Results Eighteen children survived,of whom 5 cases had no neurological deficit(27.8％),3 cases were left with mild impairment(16.7％),and the above 8 cases were thought to have better outcome.Six cases had moderate impairment (33.3％) and 4 cases had severe impairment(22.2％) and 1 child died,and these 11 cases were thought to have worse outcome.Patients aged between 1 month and 10 years,average (2.03 ± 2.23) years old.The mean GCS score was (9.68 ± 2.65) scores,the GCS of the patients were more than 7except for one death child with 3 scores.The multiple factor analysis showed that EEG,age,GCS and the range and character in MRI were significantly correlative to the prognosis(P ＜ 0.05).The single factor analysis illustrated that age 1-4 years old(OR =30,95％ CI 2.066-366.510,P =0.002),GCS ≤ 10 scores(OR =27.518,95％ C1 2.066-366.510,P =0.004)and the wide necrosis existence involving diffuse white matter or deep nuclei of MRI findings (OR =12,95 ％ CI 1.294-111.323,P =0.017) indicated the worse outcome.Conclusions Age,GCS score,nature and damage degree of MRI lesions are the main important factors affecting the prognosis of children's HSE.HSE in children is apt to involve the cortex such as frontal lobe,parietal lobe even diffuse white matter or deep nuclei,which indicates the poor prognosis.

Objective To explore the effects and mechanism of atrovastatin on the expression of the NF-κB in renal tissues of diabetic rats.Methods A total of 60 male SD rats was randomly taken out 40 rats to make diabetic model by injection of 65mg streptozotoein (STZ) into enterocoelia,the rest of 20 rats were normal control group.After the model made,atrovastatin (2 mg/kg/d) was given to the treated group,and the normal control group and diabetic rats without treatment group were given equivalent water.After 12 weeks,the rats were killed.Total RNA of the renal tissues was isolated from one kidney for each rat,and the renal tissues from the another kidney was prepared for immunohistochemistry (IHC) analysis.The NF-κB mRNA expressions among three groups were determined by RT-PCR.The distribution of NF-κB in the renal tissues was observed,and compared its difference among three groups.ResultsPCR showed that NF-κB mRNA was increased in the renal tissues of diabetic rats compared to control rats ( P ＜ 0.05 ).Drug-treated rats showed significantly decreased levels of NF-κB mRNA in the renal tissues compared to the untreated diabetic group( P ＜0.05).The results were also observed in protein lelel of NF-κB expression.IHC showed that there existed positive cells in the glomerular and renal tubulointerstitum.Conclusions Atrovastatin can down-regulate the expression of NF-κB and suppress the increased level of NF-κB protein in the renal tissue of diabetic rats,and slow the progress of retinopathy.

Objective In the treatment of tumor with high intensity focused ultrasound (HIFU),the acoustic pressure distribution determines the safety and reliability of HIFU.It is necessary to predict the acoustic field produced by HIFU transducer.Methods To analyze the acoustic pressure distribution of HIFU generated by different excitation frequency and variable incentive power,comparison was made between the acoustic pressure simulated by finite difference time domain (FDTD) method and the ones measured by experiments.ResultsThe resultsshowed that the pressureat focalpoint increasedwiththe increasing of excitation power,while the change in the focal length was negligible.The focal point moved towards the transducer with the frequency increasing until the maximum sound pressure was gained at the resonant frequency (RF).Conclusion The simulation results are consistent with the experiment results,indicating that the acoustic fields can be predicted by simulation.

Objective To observe the therapeutic effect of titanium plate and Kirschner wire system for treatment of calcaneal fracture.Methods The data of 189 patients with calcaneal fracture treated with operation were retrospectively studied,of which 102 patients of calcaneal fracture were treated with titanium plate fixation (titanium plate group),87 patients were treated with Kirschner wire system (Kirschner wire group).The operative time,blood loss,postoperative complication,healing time,before and after treatment Bohler angle,Gissane angle and middle calcaneal width,and Maryland foot function score were observed.Results The patients of the 2 groups were observed with 12-36 (24.0 ± 9.5) months follow-up.The operative time and blood loss in Kirschner wire group were significantly lower than those in titanium plate group [(42.3 ± 12.5) min vs.(67.5 ± 23.1) min and (137.7 ± 42.8) ml vs.(245.0 ± 55.6) ml],there were statistical differences (P ＜ 0.05).The Bohler angle,Gissane angle and middle calcaneal width in the 2 groups after treatment were significantly better than those before treatment [titanium plate group:(32.80 ± 6.35)° vs.(7.81 ± 8.75)°,(130.42 ±6.93)° vs.(175.80 ± 6.05)°,(30.77 ± 3.56) mm vs.(42.60 ±5.24) mm; Kirschner wire group:(30.11 ±4.91)° vs.(9.54 ±8.90)°,(132.89 ±9.54)° vs.(173.11 ±9.05)°,(32.00 ± 4.18) mm vs.(42.78 ± 4.96) mm],there were statistical differences (P＜ 0.05).The excellent rate of Maryland foot function score after treatment in titanium plate group was significantly higher than that in Kirschner wire group [92.2％ (94/102) vs.81.6％ (71/87)],there was statistical difference (P ＜ 0.05).Therewere 6 cases appeared infection of incisional wound in titanium plate group,there was no complication in Kirschner wire group,there was statistical difference (P ＜ 0.05).Conclusions Titanium plate and Kirschner wire system are the commonly used methods in treatment of calcaneal fractures,each has its advantages and disadvantages,titanium plate has long time operation,much blood loss and prone to infection,but the excellent rate is higher.Also note that the incision location,restoration and reconstruction of calcaneal anatomy subtalar joint.

Objective To explore the effect of the island flap application on repairing large scale defects on the face.Methods Based on the defect size,shape and location,preauricula narrow stem side geny-neck flap,submental island flap,angular artery flap,eyelid musculus orbicularis flap and nasolabial groove island flap were used to repair the large scale defects of the face in a one-stage operation.Results All flaps survived well without any obvious complications.35 patients were followed up for 1 to 36 months.Repaired tissues were well matched with the surrounding tissue.Resulting facial contour and appearance were good,and cosmetic results overall were satisfactory.Conclusion The application of island flaps to repair the large scale defects on the face in a one-stage operation is a better method that can achieve good contour and satisfactory cosmetic results.

Objective To study the effect of the quality control circle in reducing not using needed security signs of emergency nursing. Methods A panel for quality control circle was set up to implement quality control circle activities in order to promote the use of drug signs, anti-accident signs, hospital infection signs and nursing security signs. The un-qualified rate of the sign uses were compared between pre-and post-implication of quality control circle. Result The un-qaulified rate of drug sign uses was significantly decreased after the implementation (P<0.01). Conclusion The quality control circle can be effective for improving the rate of using nursing signs and thus enhancing nursing quality.

To explore the roles of astrocytes in the epileptogenesis, astrocytes and neurons were isolated, purified and cultured in vitro from cerebral cortex of rats. The astrocytes were activated by ciliary neurotrophic factor (CNTF) and astrocytic conditioned medium (ACM) was collected to treat neurons for 4, 8 and 12 h. By using Western blot, the expression of calmodulin dependent protein kinase II (CaMK II), inducible nitric oxide synthase (iNOS) and adenylate cyclase (AC) was detected in neurons. The results showed that the expression of CaMK II, iNOS and AC was increased significantly in the neurons treated with ACM from 4 h to 12 h (P<0.05), and that of iNOS and AC peaked at 8 h and 12 h respectively. It was suggested that there might be some epileptogenic factors in the ACM and such signal pathways as NOS-NO-cGMP, Ca2+/CaM-CaMK II and AC-cAMP-PKA might take part in the signal transduction of epileptogenesis.