Objective To statistically analyze the bacterial flora change and drug resistance situation in the patients with bacteri‐al infection to provide reference for clinical rational drug use and the management of nosocomial infection .Methods The clinical samples were conventionally isolated and cultured .The bacteria identification and drug sensitivity test were performed by using the bioMerieux company VITEK2 automatic microorganism analyzer .The confirmation test of drug susceptibility adopted the disk dif‐fusion method recommended by the American Clinical and Laboratory Standardization Committee (CLSI) .Results The sample sources in the hospital infection during 2011-2013 were main sputum ,secretions and midstream urine ;the main infectious bacteria showed the increasing trend ,the top 5 of bacteria were :Escherichia coli (ECO) ,Klebsiella pneumoniae (KPN) ,Acinetobacter bau‐manii (ABA) ,Pseudomonas aeruginosa (PAE) ,Staphylococcus aureus (SAU);the top three of common multi‐drug resistant bacte‐ria were ABA ,PAE and ECO ,their constituent ratio during these three years had a small amplitude increase ;the antibiotics for Gram negative bacilli (G -) resistance rate of more than 70% during these 3 years were :ampicillin ,cefuroxime sodium and cefu‐roxime axetil;the antibiotics for Gram positive cocci (G+ ) resistance rate of more than 70% during these 3 years were penicillin and erythromycin ..Except for 4 cases of Enterococcus faecalis ,no other vancomycin‐resistant strains were found .Conclusion The sam‐ple source of bacterial infection is dominated by sputum ,the gram negative bacteria are the main force of hospital infection ,showing a increasing trend every year ,multi- drug resistant strains are also continuously rising ,penicillin is unsuitable to the clinical treat‐ment of bacterial infection ;imipenem has very high sensitivity to ECO and KPN .The hospital should attach great importance to the infection management ,strengthen the application and management of antibiotics ,decrease the outbreak and prevalence of bacterial infection and reduce the increase of drug resistant strains .

Objective To evaluate the effect of low dose fentanyl on target plasma concentration (CP) of propofol (P) given by target controlled infusion (TCI) required to prevent response to proseal laryngeal mask insertion in 50% of patients (EC50). Methods Forty-six ASA Ⅰor Ⅱ patients aged 20-50 yr with body mass index ≤ 30 kg/m2 undergoing elective gynecological laparoscopy were randomly divided into 2 groups (n=23each):propofol group (P) and propofol-fentanyl group (PF). Anesthesia was induced with TCI of propofol. The initial Cp of propofol TCI was set at 2.5 μg/ml in group PF and 4 μg/ml in group P. Following equilibration between plasma and effect site concentration of propofol, fentanyl 1 μg/kg (in group PF) or normal saline (in group P) was injected iv. Laryngeal mask airway (LMA) was inserted at 3.5 min after fentanyl administration. EC50 was determined by up-and-down sequential trial. The ratio of Cp between the two consecutive patients was 1.2 in group P and 1.1 in group PF. LMA insertion response was defined as nausea, bucking and/or body movement during insertion. "Probit method was used to calculate the Echo and 95 % confidence interval required to prevent LMA insertion response. Results The EC50 and 95 % confidence interval of propofol given by TCI required to prevent LMA insertion response was 4.68 (4.20-5.21)μg/ml in group P and 2.63 (2.45-2.83) μg/ml in group PF. There was significant difference between the 2 groups. Conclusion Fentanyl 1 μg/kg iv can significantly reduce the Cp of propofol TCI required to prevent LMA insertion response.

Objective To investigate the clinical characteristics and prevalent features of an influenza erupting prevalence.Methods All of 653 patients with an erupting influenza were enrolled in the study from May 29,2003 to July 3,2003. The data included clinic manifestations and etiology. The retrospective study was used to evaluate the clinical and prevalent features. Results All patients consisted of 392 boys and 261 girls aged 5~17 years(mean 11.5 years),who were all students in middle school or primary school. Most of the patients had no typical symptoms including chill(2.45%),headache(30.00%),tiredness(10.87%)and the aching in whole body(4.44%),whereas fever,faucial inflammation and lymphatic follicular hyperplasia of the faucial posterior wall were the most common among these patients,accounting for 100%,60.03%,64.78% respectively. There were 98 patients whose peripheral leukocyte amounts were increased,most happening on the 6 ~7 th day from the onset(75.51%)following the fever on the 5~6 th day(80.6%). Detection of serum double virus-antigen indicated that influenza virus antibody increased more than 4-fold,as well as parainfluenza virus and adenovirus. Even in minority patients,there were several kinds of virus antibody raised 4-fold at the same time. We applied antivirus allopathy associated with the Chinese traditional medicine such as injection of shuanghuanglian or yuxingcao,plus the effectual antibiotics when necessary . All of the patients were cured and no sequelae. Conclusion Sometimes the influenza is prevalent only in some special crowds and has no typical symptoms such as chill,headache,tiredness and the aching in whole body.The antibiotics should be used in time after the synthetic treatment has no effect,when the patient has the onset for more than 5 days and has the fever for more than 4 days.

1 000 rnl were randomly divided into 2 groups : AHHD group ( n = 18) and control group ( n = 18). The patients were premedicated with intramuscular atropine 0.007-0.01 mg?kg-1 . Radial artery and right internal jugular vein were cannulated before induction of anesthesia for MAP and CVP monitoring, blood sampling and fluid administration. Anesthesia was induced with TCI of propofol. The target plasma propofol concentration was set at 3 ?g ? ml -1 . When the patients lost consciousness, fentanyl 2 ?g ? kg-1 was given intravenous and tracheal intubation was facilitated by vecuronium 0.1 mg? kg-1 , 10min after intubation additional fentanyl 2 ?g? kg-1 and vecuronium 0.08 mg? kg-1 were given. In AHHD group lactated Ringer's solution 10 ml ? kg-1 was infused over 30 min before TCI propofol was started. 10 min after start of TCI propofol 6% HES 20 ml? kg-1 was infused within 30 min. In control group the patients received only lactated Ringer's solution 10 ml?kg-1 . TCI of propofol was maintained for 1 h. Arterial blood samples were taken before and 2, 5, 10, 20, 30, 40, 50 and 60 min after TCI propofol was started, and at 2.5, 5, 10, 15, 20, 25, 30 min after termination of TCI propofol for determination of blood concentration of propofol by gas-chromatography - mass spectrometry (GC-MS) . The TCI system comprising Graseby 3 500 infusion pump controlled by Stelpump 1.07 software which included Tackley pharmacokinetic parameters. Results In AHHD group Hb was reduced from initial (130? 14)g?L-1 to (90? 15)g?L-1 and Hct from initial 38% ? 3% to 26% ? 4 % at the end of AHHD. The measured blood propofol concentrations were significantly lower in AHHD group than those in control group at the corresponding time points (P

Obuective To assess the population pharmacokinetic parameters and analyze thecharacteristics of pharmacokinetics of propofol given by target-controlled infusion (TCI) in Chinese using anoulinear mixed effect model (NONMEM) program. Methods Sixty-one ASA Ⅰ-Ⅱ patients (26 male, 35female) aged 18-64yr, weighing 41-83kg undergoing elective operation under general anesthesia were studied. TheTCI system consisted of (1 ) Stel pump Software 1 .07 designed by Coetzee, (2) cable R232 connector, (3)Graseby 3500 infusion pump, (4 ) pharmacokinetic parameters developed by Tackley. The patients werepremedicated with intramuscular phenobarbital sodium 1-2 mg?kg~(-1) and atropine 0. 5 mg. Anesthesia was inducedwith TCI of propofol. Target plasma concentration of propofol was set at 3?g?ml~(-1). Fentanyl 2?g?kg~(-1) andvecuronium 0. 1mg?kg~(-1) were given i. v. when the patients lost consciousness. TCI of propofol lasted 60 min. 976blood samples were obtained before induction of anesthesia and at 2, 5, 10, 20, 30, 40, 50, 60, 62. 5, 65, 70,75, 80, 85, 90 min ther TCI was started for determination of plasma propofol concentration by gas-chromatography-mass spectrometry (GC-MS). Population pharmacokinetic parameters were assessed and thecharacteristics of the pharmacokinetic profile was analyzed using NONMEM program. Results The pharmacokineticprofile of propofol given by TCI in Chinese was best described by an open two-compartment model. Thepharmacokinetic parameters for the final model: K_(10) was 0.111, K_(12) 0 .064 and K_(21) 0 .023 min~(-1); V_1 was 0 .205and V_2 0.404 L?kg~(-1); CL_1 was 22 .76 and CL_2 13 .24 ml?min~(-1). The estimated concentrations were well correlatedwith the measured concentrations in the final model. Weight was found to covariate significandy with V_1 and CL_1and age with K_(21). However gender had no significant effect on pharmacokinetic parameters.Conclusion Thepopulation pharmacokinetic profile of propofol administered by TCI in Chinese can be well described by an open two-compartment model. The volume of central compartment was smaller and the inter-compartmental transfer ratefrom central compartment to peripheral compartment was faster in Chinese.

Objective To investigate the effect of acute hypervolemic hemodilution (AHHD) on pharmacokinetics of propofol given by target-controlled infusion (TCI). Methods Thirty-six ASA Ⅰ-Ⅱpatients (18 male, 18 female) undergoing elective surgery were randomized to one of two groups: control group (n = 18) and AHHD group ( n = 18). The patients were premedicated with atropine 0.007-0.01mg?kg-1 and phenobarbital 1-2mg?kg-1 i.m. . Radial artery and right internal jugular vein were cannulated before induction of anesthesia. Anesthesia was induced with TCI of propofol. The target plasma propofol concentration was set at 3 ?g?ml-1. When the patients lost consciousness, fentanyl 2?g? kg-1 was given i.v. and tracheal intubation was facilitated by vecuronium 0. 1 mg?kg-1 . Ten minutes after tracheal intubation an additional dose of fentanyl 2 ?g?kg-1 and vecuronium 0.08 mg?kg-1 was given i.v.. TCI of propofol continued for 1 hour. In AHHD group lactated Ringer's solution 10 ml?kg-1 was infused over 30 min before induction of anesthesia. 10 min after TCI propofol was started, 6 % HES 20 ml ?kg-1 was infused within 30 min. In control group the patients received only lactated Ringer's solution 10 ml? kg-1 . All fluid infused was prewarmed to 35℃ Arterial blood samples were taken before and 2,5, 10, 20, 30, 40, 50 and 60 min after TCI propofol was started and 2.5, 5, 10, 15, 20, 30 min after termination of TCI propofol for determination of blood concentration of propofol by gas-chromatography-mass spectrometry (GC-MS) . The TCI system consisted of Graseby 3500 infusion pump controlled by Stelpump 1.07 software, which included Tackley pharmacokinetic parameters. Results The demographic data including sex, age, body weight and amount of propofol consumed were comparable between the two groups. The pharmacokinetic profile of propofol given by TCI was best described by a two-compartment open model during AHHD. The pharmacokinetic parameters tor the final model; K10 was0.116, K12 0.0907 and K210.024mm-1 ; V, was 0.311 and V2 0.446L?kg-1 ; Cl1 was 33.31 and Cl2 16.65 ml?min-1?kg-1 respectively. V1 and V2 were significandy larger, and transfer and clearance rates were significantly higher in AHHD group than those in control group. At the end of AHHD, Hb decreased by 31.0% and Hct by 31.3%; total plasma protein decreased by 30.1% and plasma albumin by 25.7% as compared with the baseline values before AHHD. Conclusion AHHD has significant effect on pharmacokinetics of propofol. Less propofol is bound to plasma protein and duration of action is relatively shorter. During AHHD the target plasma propofol concentration should be increased to some extent to achieve the same depth of anesthesia.

BACKGROUND:Central pancreatectomy is a surgical treatment for tumors at the neck or the middle part of the pancreas, which can reserve more normal pancreas, not cut adjacent organs, and reduce the incidence of postoperative internal and external pancreatic secretion deficiency with respect to the expanded proximal and distal pancreatectomy. OBJECTIVE: To systematicaly evaluate the clinical efficacy of the central pancreatectomy and distal pancreatectomy. METHODS: A computer-based search of Chinese and English databases was performed, and then 15 controled clinical trials were included and systematicaly evaluated using RevMa5.2 software. RESULTS AND CONCLUSION: Totaly 1 079 cases were included in this study, which consisted of 436 central pancreatectomy cases and 643 distal pancreatectomy cases. Meta-analysis showed that compared with the distal pancreatectomy group, the incidences of postoperative pancreatic fistula and complications were significantly higher, the risk of postoperative endocrine and exocrine insufficiency were significantly lower, while the surgical time (SMD: 59.23, 95%CI: 22.41-96.05, P < 0.01) and hospital stays (SMD: 7.01, 95%CI: 1.94-12.09,P< 0.01) were longer in the central pancreatectomy group. These findings indicate that although the central pancreatectomy has a high postoperative complication incidence, it can be accepted clinicaly, which may be a reasonable operation method to preserve pancreatic exocrine and endocrine function.

AIM: To observe the effects and location of autologous bone marrow stem cells(BMSCs) transplanted through renal artery into ischemic-reperfusion(I/R) injured kidney.METHODS: BMSCs were collected from rabbits after isolated and then labeled with 5-bromo-2-deoxyuridine(BrdU).Twenty-eight rabbits were subjected to clamping renal pedicles for 105 min and divided into the transplantation group and control group randomly.BrdU labeled BMSCs or saline were injected into the kidney by renal artery,respectively.Before and after I/R at the 1st,3rd, 5th,7th,14th,21th and 28th d,the venous blood was collected to measure serum Cr and BUN.In the same time,renal tissue was collected for pathological and immunohistochemical study.RESULTS: After I/R,serum Cr and BUN levels in the rabbits in two groups became higher,and on the 1st and 3rd d after I/R,reached the highest level.On the 7th d the serum Cr and BUN levels in transplantation group were lower than those in control group.On the 28th d the levels of serum Cr(90.1?11.1) ?mol/L and BUN(8.0?1.5) mmol/L in transplantation group were significantly lower than those in control group(135.6?32.5) ?mol/L and(10.9?2.5) mmol/L,respectively(P

Objective: To investigate a better method to correct the secondary nasal deformity of postoperative cleft lip, by using the expanded polytetrafluoroethylene (ePTFE) to reinforce the intensity of the nasal alar cartilage. Methods: ePTFE was used to reinforce the intensity of the cleft side of nasal alar cartilage and corrected 120 cases of the secondary nasal deformities of postoperative cleft lip. Results: All the 120 cases of patients with nasal alar tumbling showed significant improvements. In follow-up, 76 cases of patients' wound healed well. No rejection in all cases. Conclusion: The ePTFE is an ideal implant material to correct the secondary nasal deformities of postoperative cleft lip.

Objective To explore the application of CT value in calculating the proton incident energy in proton treatment planning system. Methods Bethe-Block formula and the formula for calculating the proton range were analyzed to study the correlation of the range of proton beam ( 70-250 MeV ) between a variety of radiation equivalent material and water. Procedure of Monte Carlo SRIM2008 was used to verify the possibility of a constant proportional coefficient of range ( Ci ). The proportional coefficient ( Ci ) of range in radiation-equivalent material and the CT value were fitted by using Origin 8.0 software to study the functional relation of CT value and Ci. The actual range of proton was equivalent to a range of water and incident proton energy could be calculated. Results There was a constant range of Ci of proton beam (70-250 MeV) between a variety of radiation equivalent material and water. There was a functional relation between CT value and Ci ( r = 0.999). The actual range of proton in radiation equivalent material can be equivalent to a range of the water. Conclusions CT values and a range of proportional coefficient ( Ci ),and the actual required range of the tumor could be used to accurately calculate the water equivalent range,and the incident proton energy to the position of Bragg peak. A new exploration for using CT technology in proton treatment planning system could be obtained.