Gram-negative bacteria are the common pathogens causing nosocomial infections.The drug resistance of gram-negative bacteria has become increasingly serious in last two decades.Carbapenems were once considered as the last line of defense against serious infections of gram-negative pathogens.As carbapenemase-producing strains are spreading, the incidence of infections caused by carbapenem-resistant isolates is increasing worldwide.The pathogens are usually multiple drug resistant strains or extensively drug resistant strains, and effective treatment options are limited, even there are no more drugs in certain conditions.This article focuses on appropriate antibiotics and therapeutic strategies for effective control of infections with carbapenem-resistant gram-negative pathogens.

Objective We discussed the nursing of patients with superior mesenteric artery syndrome (SMAS) through duodenal circular drainage operation. Methods We carried out a retrospective analysis for 42 SMAS patients undergoing duodenal circular drainage operation from. 1959 to 2007. They were given preoperative psychological nursing, correct lying style, postoperative nutritional support and health education instruction. The treatment effect was observed. Results All patients cured and left hospital. The treatment effect was good after one to fifteen years of follow-up visit. Five patients who changed to adopt duodenal circular drainage operation also got good result after nine to ten years of follow-up visit. The incidence of anastomotic ulcer and anastomotic stenosis as well as reflux gastritis was not seen. Conclusion SMAS could be cured earlier through duodenal circular drainage operation and effective nursing.

Objective To analyze the clinical characteristics of patients with L isteria septicemia for better clinical diagnosis and management of the disease .Methods A retrospective study was carried out in 13 patients with confirmed diagnosis of Listeria septicemia from July 2009 to November 2013 in West China Hospital of Sichuan University .The clinical features ,laboratory tests ,treatments and clinical outcomes were reviewed and analyzed . Results The vast majority of the 13 patients were immunocompromised or with critical organ dysfunction . The in vitro antimicrobial susceptibility testing indicated that penicillin ,ampicillin and levofloxacin were the most active agents against Listeria ,followed by imipenem ,erythromycin , ciprofloxacin and tetracycline .Only 33 .3% of the 13 Listeria isolates were sensitive to oxacillin .Eight patients were cured ,2 improved ,2 died after therapy .The remaining one patient gave up therapy .Conclusions The incidence of Listeria septicemia was associated with advanced age and presence of underlying diseases .Early etiology diagnosis and appropriate antibacterial therapy can improve the outcome of such patients .Actively treating underlying diseases helps reduce the mortality rate .

Objective: We observed the influence of recombinant human growth hormone(rhGH) on protein metabolism in hepatocirrhotic rats and investigated mechanisms. Methods: Ninety rats were randomized into three groups(n=30 for each group): group A(normal rats), B(cirrhotic rats) and C(cirrhotic rats receiving rhGH). Rats in group C were subcutaneously given rhGH with a dosage of 1 U/(kg?d) for up to 1 week. The plasma concentrations of albumin(ALB), prealbumin(PA), transferrin(TF) and insulin-like growth factor-1(IGF-1) were detected on experimental day 14. And liver biopsy was taken to examine the expression level of albumin mRNA with TR-PCR. Results: The albumin, prealbumin, transferrin and IGF-1 levels in groups A and C were significantly higher than those in group B. The expression level of albumin mRNA in grup C was significantly higher than that in group B. Conclusions: The rhGH can improve the level of IGF-1 in plasma and improve the expression of albumin mRNA. Moreover, it may significantly improve the synthesis of protein and attenuate hypoproteinemia in cirrhotic rats.

Objective:To investigate the efficacy of intramedullary plus extramedullary fixation in the treatment of fractures of distal radial diametaphyseal transition zone in children.Methods:The data were retrospectively analyzed of the 49 children who had been admitted to Pediatric Orthopedic Hospital, Honghui Hospital Affiliated to Xi'an Jiaotong University from July 2018 to April 2020 for fractures of distal radial diametaphyseal transition zone. There were 30 males and 19 females; 21 left sides, 27 right sides, and one case of bilateral sides. In the operation, an elastic intramedullary nail or Kirschner wire was used for intramedullary fixation while another Kirschner wire was used to fix the cortex at the distal and proximal ends of the fracture. The ranges of wrist motion and Disabilities of the Arm, Shoulder and Hand (DASH) scores at 1 and 9 months after operation were recorded and compared; the incidence of postoperative complications was also recorded.Results:The operation time for the 49 children averaged 45.0 min (from 39 to 51 min). The patients were followed up for 6 to 36 months (mean, 18.6 months). The fracture union time averaged 8.6 weeks (from 6.8 to 10.4 weeks). Needle tract infection developed in one case but the wound was healed after removal of the K-wire after callus formation and oral use of antibiotics for 3 days. Another case reported skin irritation the symptoms of which disappeared after the child reduced activities. The ranges of pronation, supination, flexion and extension of the wrist and DASH score were 47.9°±2.5°, 45.5°±3.0°, 51.2°±1.6°, 53.4°±1.7° and (36.7±4.5) points at one month after operation while they were 85.6°±3.1°, 87.6°±2.1°, 88.8°±2.0°, 88.0°±1.2° and (23.2±8.6) points at 9 months after operation. There were statistically significant differences in the above indexes between one and 9 months after operation ( P<0.05). Conclusion:In the treatment of fractures of distal radial diametaphyseal transition zone in children, intramedullary plus extramedullary fixation is simple in surgical techniques, easily repeatable, slightly invasive, and reliable in fixation.

Objective To evaluate the clinical efficacy of arthrography in the treatment of lateral condylar fracture of humerus with displacement of ≤ 2 mm in children.Methods A retrospective study was performed in the 21 children with lateral condylar fracture of humerus who had received arthrography in their surgery at Department of Pediatric Orthopedics,Honghui Hospital,Xi'an Jiaotong University College of Medicine from April 2015 to December 2016.They were 14 boys and 7 girls,aged from 5 to 12 years (average,8.6 years).Their primary diagnosis was made within one week from injury and they all had a displacement of ≤ 2 mm.Of them,2 were treated by plaster fixation because intraoperative arthrography found no fracture of articular cartilage (group A),11 by simple closed pining because intraoperative arthrography found fracture of articular cartilage involving the joint space (group B),and 8 by open reduction and fixation with kirschner wire because intraoperative arthrography found displacement of the involved articular surface (group C).The therapeutic efficacy was evaluated at final follow-ups by the Dhillon scoring system.Results All the 21 children were followed up from 9 to 23 months (average,16 months).The fracture union time ranged from 8 to 10 weeks (average,9 weeks) for groups A and B and from 11 to 13 weeks (average,12 weeks) for group C.By the Dhillon scores at final follow-ups,the therapeutic efficacy was evaluated as excellent in one and as good in one in group A,as excellent in 8 cases,as good in 2 cases and as fair in one in group B,and as excellent in 6 cases,as good in one and as fair in one in group C.No early closure of epiphysis,osteonecrosis or fishtail deformity was found in either group A or group B;one case of partial limitation of elbow flexion or extension,one case of fishtail deformity and one case of femoral head necrosis were observed in group C.No infection or skin necrosis was found in any of the 3 groups.Conclusions Because intraoperative arthrography can definitely judge whether the articular surface is intact or unstable,it can make up for the insufficiency of X-rays in judging integrity of the articular surface.In combination with closed reduction,percutaneous puncture or open reduction and internal fixation,intraoperative arthrography can contribute to an increased rate of successful surgery,and reduced complications due to redisplacement.

Objective:To analyze the clinical characteristics, therapeutic options and risk factors of mortality in patients with carbapenem-resistant Acinetobacter baumannii (CRAB) bloodstream infection, and to provide evidence for clinical treatment option and prognosis evaluation of CRAB bloodstream infections. Methods:A retrospective study was carried out in 224 patients with confirmed diagnosis of CRAB bloodstream infection during the period from January 2012 to December 2017 in West China Hospital, Sichuan University. The patients were divided into the death group and the survival group according to the survival status 28 days after collecting blood samples. The clinical features and therapeutic options of antibacterial drugs were reviewed. Student′s t test was used for analyzing normally distributed data and Mann-Whitney U test for non-normal data.Chi-square test was used for categorical variables. Univariate and multivariate logistic analysis were used to analyze the risk factors of mortality associated with CRAB bloodstream infection. Results:Among 224 cases of CRAB bloodstream infection, 121 cases died (54.02%). These patients were mainly in intensive care unit (ICU) and hematology department. The common underlying diseases were severe acute pancreatitis and severe cardiovascular events. The interleukin (IL)-6 level (median (interquartile range)) in the death group (480.40 ng/L (1 432.95 ng/L)) was higher than that of the survival group (107.05 ng/L (263.08 ng/L)), the difference was statistically significant ( Z=4.526, P<0.01). The procalcitionin (PCT) levels in the death group and the survival group were 3.81 μg/L (17.26 μg/L) and 2.12 μg/L (12.74 μg/L), respectively, with no difference between the two groups ( P>0.05). The death rate of empirical treatment with a single or more non-active antimicrobial agents was 57.14% (64/112), that of monotherapy with active agent was 45.68% (37/81), and that of combination therapy with at least one active drug was 64.52% (20/31). The differences had no statistical significance ( P=0.130). The logistic regression analysis showed that the risk factors of mortality associated with CRAB bloodstream infection were renal dysfunction (odds ratio ( OR)=2.181, P=0.024) and multiple organ dysfunction syndrome (MODS; OR=20.376, P<0.01). Conclusions:The fatality rate of patients with CRAB bloodstream infection is high. These patients with renal dysfunction or MODS have poor prognosis. In addition to early effective antibacterial therapy, individual comprehensive treatment should be implemented in order to improve the curative effect.

Objective:To summarize and discuss the concept and clinical manifestations of complex fracture-dislocations of the elbow in children, and compare its injury characteristics, treatment and clinical effect with adults.Methods:From September 2015 to January 2020, 34 patients seen and treated at our institution for complex fracture-dislocations of the elbow were identified, and their medical records and radiographs were reviewed retrospectively. The inclusion criteria were elbow dislocation combined with one or more fractures at the proximal ulna and radius. There were 25 boys and 9 girls, with an average age of 8.3±3.2 years. The left arm was involved in 27 cases, and the right arm was involved in 7 cases. The causes of injury included falling from a scooter in 16 cases, falling from height in 10 cases, cycling in 5 cases and traffic accident in 3 cases. All patients were treated with closed reduction and the application of plaster under local anaesthesia in the emergency room. Then, X-ray, CT and MRI were performed to evaluate the fracture-dislocation and ligament injury. The following treatment plan was comprehensively evaluated according to the size and displacement of the combined fracture block and the stability of the elbow, for example, open reduction with K-wires and tension band or plate fixation for olecranon fracture, open reduction with loop plate fixation for coronal process fracture, closed reduction or open reduction with K-wires or elasticstable intramedullary nail for radial neck fracture.Results:Among the 34 patients, there were 16 cases of transolecranon fracture-dislocation, 1 case of varus posteromedial rotational instability, 4 cases of valgus posterolateral rotatory instability and 13 cases of divergent dislocation of elbow. All patients were followed up for 13(8, 15) months, and the average fracture healing time was 3.5±0.8 weeks, with no failure of internal fixation. In 2 cases of elbow dislocation combined radial neck fracture, one case had ischemic necrosis of the radial head and one case had early closure of epiphyseal plate of the proximal radius. At the last follow-up, all patients had no subluxation, dislocation or instability of the elbow. The therapeutic efficacy was evaluated at the final follow-up by the Mayo elbow performance score (MEPS) as excellent in 25 cases, good in 5 cases, fair in 3 cases, and poor in one case, with excellent and good rate 88%.Conclusion:The complex fracture-dislocations of the elbow is rare in children. We have the opinion that the clinical characteristics are dislocation combined with one or more fractures of the proximal ulna and radius. Compared with adults, its pathological characteristics and the scope of injury are similar, but most of the injuries are mild. The clinical manifestations are mainly transolecranon fracture-dislocation and divergent dislocation of elbow. Good results can be achieved in most cases through open reduction with internal fixation for fractures.