Radiation therapy (RT) plays an important role in the multimodality management of patients with breast cancer. Traditional RT techniques increase risk of death from cardiovascular diseases. With the development of new techniques, cardiac injury after RT has already been reduced. This article summarizes the studies on reducing cardiac injury by the development of RT techniques, as well as analyzes of risk factors for cardiac injury.Possible causes will also be discussed.

OBJECTIVE To determine risk factors of crossing infection of Pseudomonas aeruginosa in ICU and to evaluate efficiency of related control measures.METHODS Clinical data of all patients hospitalized in ICU during Feb to Nov 2005 were retrospectively analyzed.These clinical data included medical records,course of diseases,types of antibiotics used and their duration,invasive medical procedures,bacteria culture results and so on.Spot circumstance of ward,measures of isolation and sterilization,asepsis conception of staffs,fulfillment of laws to prevent intra-hospital infection were examined.RESULTS Forty six patients were hospitalized in ICU during 10 months.Bacterial culture was performed in all of them.Totally 108 strains of P.aeruginosa were cultured in specimens of 24 patients,among which 83 strains(76.9%) were cultured during May to Aug 2005(21 strains cultured monthly in average).As source of specimens,52 strains were from phlegm,26 strains from suction in trachea,17 strains from wound discharge, and 13 strains from other sources.Medicine sensitivity analysis revealed that most of the P.aeruginosa cultured strains were resistant to common antibiotics,including imipenem-cilastatin and meropenem.Major causes of this epidemic might include invasive medical procedure,abuse of antibiotics,deficiency of ward circumstance,imperfect in fulfillment of measures for infection prevention.CONCLUSIONS Control measures including improving clinical circumstance,insisting asepsis conception of staffs,appropriate use of antibiotics,and stressing microbiological inspection are vital in preventing and controlling epidemic of P.aeruginosa in ICU.

OBJECTIVE To investigate the infection and drug-resistance of Escherichia coli.METHODS Double disk diffusion test and improved three-dimensional test were adopted to test ESBLs and AmpC of 135 E.coli strains obtained from bile cultivation from operations of biliary inpatients in our hospital from 2003 to 2005,and King-Bauer′s was used to test the sensitivity of 14 kinds of common antibiotics.RESULTS The detection rate of ESBLs producing bacteria was 30.4%(41 strains),and that of AmpC producing bacteria was 5.2%(7 strains);drug-sensitivity test indicated,that E.coli was sensitive to meropenem,imipenem,cefoperazone / subactam,ciprofloxacin and amikacin.CONCLUSIONS E.coli is a main bacterium in biliary infection,and the strains producing ESBLs and /or AmpC are resistant to the cephalosporins of third and fourth generation;prematurely and excessively using broad-spectrum antibiotics before operation is the primary cause to increase in enzyme-producing strains.

OBJECTIVE To review the environment disinfection situation of our hospital operating room in the past three years and to discuss regulatory measurement.METHODS We carried out bacteriological monitoring of air,object surface and hands of medical personnel in operating room and made the advanced bacterial identification to distinct pathogenic bacteria and conditional ones.RESULTS A total of 478 number of times of air,652 number of times of object surface and 284 number of times of hands of medical personnel in the operating room,were detected during the past three years.Total qualification rate was 98.1%,90.2% and 96.5%,respectively,and it reflected an upward trend year by year.Staphylococcus,Escherichia coli,fungi,Acinetobacter baumannii and Pseudomonas aeruginosa were detected from the air and object surface.CONCLUSIONS Strengthening quality management of environmental disinfection,developing and implementing the various management systems,improving the precaution awareness of the operating room staff and strictly managing the people flow and object should become effective measures which guarantee the environment disinfection quality of the operating room and reduce hospital infection during surgery.

OBJECTIVE To investigate the genes associated ?-lactamases in Acinetobacter baumannii(ABA)isolated and preliminary discovery of Acinetobacter-derived cephalosporinases(ADC)-subtype in Shaoxing,Zhejiang.METHODS Eighteen ?-lactamases genes were detected by PCR,and a new ADC ?-lactamases gene fragments produced by PCR were sequenced and analyzed.RESULTS The positive rates of ADC-gene,TEM-gene and OXA-23 group-gene were 85.9%,27.1% and 58.8%,respectively.The other genes were not found in all 85 isolates tested.CONCLUSIONS There are very high positive percentages of ADC,TEM and OXA-23 group genes in A.baumannii isolated clinically and that is the important mechanism of multi-resistance.The ADC gene may be a novel subtype in lactamases(GenBank accession number:EF569590).

OBJECTIVE To investigate the resistance and the genes of quaternary ammonium compounds-resistance(qacE△1) and classⅠintegrase genes(intⅠ1)in continuously isolated Acinetobacter baumannii(ABA).METHODS K-B tests were performed to detect the susceptibility of 85 strains of ABA to 13 kinds of antimicrobial agents.The qacE△1 and intⅠ1 genes were analyzed by PCR.RESULTS The resistant rates to antimicrobial agents were between 8.2% and 81.2%.qacE△1 And intⅠ1 genes were 77.6%.CONCLUSIONS The 85 ABA strains are multiple-drug-resistant.There are very high positive percentages of qacE△1 and intⅠ1 genes in ABA isolated from Shaoxing,Zhejiang Province.

OBJECTIVE To study the antimicrobial agents resistance of Staphylococcus aureus isolated from clinic.METHODS To test the sensitivity of 20 common antimicrobial agents by K-B.MRSA was detected by cefoxitin disk;and the inducible resistance of clindamycin was detected by D-test.RESULTS The drug resistance rate of this term of S.aureus was high.Except vancomycin,minocycline,teicoplanin,nitrofurantoin and rifampin,the drug resistance rate was higher than 42.6%.From 312 strains of S.aureus 209 strains of MRSA were detected,the rate was 67.0%.The structural antimicrobial resistance rate of clindamycin was 29.5%,the detection rate of inducible resistance was 51.4%.CONCLUSIONS The antimicrobial resistance of S.aureus is increasingly severe.The high positive results of MRSA and D-test make great trouble to therapy,and should have taken more attention of clinic.

OBJECTIVE To explore the risk factors and countermeasures of burn wound infection.METHODS The data of burn patients in hospital from 2005 to 2007 were retrospectively analyzed.RESULTS From 341 burn patients 257 got infected and total infection rate was 75.4%.Investigation shows that the probability e of infection in 3 days was 12.9%,but the rate became 72.7% after 4 to 10 days.The bigger the wound area,the higher the possibility to got infected.The infection rate was 43.8% when BSA was smaller than 20.0%.When BSA was bigger than 41.0%,the rate was up to 88.0%.When BSA was bigger than 61.0%,the rate was 100.0%.Except that,antibiotics and standard medical performance were the important factors related to burn infection.CONCLUSIONS To strengthen the aseptic concept among medical staff,pay attention to the environment of hospital,and the sterilization of the materials,debridement and drainage in time,and rational usage of antibacterial drugs,are the effective countermeasures to reduce burn wound infection.

OBJECTIVE To analyze the etiological characteristics and risk factors of burn wound infection to provide scientific basis for preventive measures. METHODS The pathogens and risk factors of wound infection of burn patients were investigated. RESULTS Among 341 burn patients form Jan 2005 to Dec 2007, 257 patients were cultured positively in their wound surface with the total infection rate 86.0%. In the early period of infection, Gram-positive cocci were the main pathogens in preinfection, then Gram-negtive bacilli and fungal infection increased. Most of pathogens were opportunistic. From d4 to d10 after burn was the dangerous period of infection. Infection rate was related to the sizes of burn area. CONCLUSIONS Visiting hospital, debridement and takeing specimens to culture in time, correct antibiotics treatment, sterile environment and aseptic operation are the effective measures to reduce the wound infection.

OBJECTIVE To evaluate the present condition of bacteriological infection caused by drainage tube after modified radical mastectomy(MRM) and the prevention measure.METHODS Atotal of152 patients with drainage tube after MRM during 2005-2007 were analyzed,bacteria culture of drainage fluid from breast wound or axillary wound were taken in 24 hours after operation.The bacteria or fungi were identified with ATB bacterial analysis apparatus.RESULTS Seventy specimens from 52 patients were positive(positive rate 34.2%).Of 70 strains,40 were Gram-positive cocci,24 were Gram-negative bacilli and the other 6 were fungi.The reasons of infection included subsided immunity defense system,drainage tube application,incorrect aseptic processing or disinfection procedure,and obstruction of drainage tube.CONCLUSIONS The important prevention measures of bacteria infection through drainage tube after MRM include maintenance of aseptic environment in operating room,strict aseptic processing,fluent drainage,and proper indwelling time of drainage tube.