OBJECTIVE To investigate pathogenic bacteria and prognosis of abdominal infection and take measures to prevent and control it.METHODS We analyzed the clinical material and prognosis of 31 patients with abdominal infection retrospectively according to the culture results of puncture and drain liquid from abdominal cavity from Nov 2007 to Nov 2008.RESULTS In 31 patients,5 were complicated with pulmonary infectionwhich the infection rate was 16.13%,and 7(22.58%) died.Totally 48 pathogenic strains were isolated from ascitic fluid culture,20 strains(41.67%) were Escherichia coli,11 strains(22.92%) were Enterococus.Some of coagulase-negative Staphylococcus,Streptococcus,Candida,Klebsiella pneumoniae,and Staphylococcus aureus were also isolated.The resistance rates of E.coli to cephalosporins were above 50.00%,to quinolones were above 65.00%.The susceptibility rates of E.coli to some ?-lactamases inhibitors and carbapenem were very high.The resistance rate of Enterococus to rifampicin was 63.64%,to piperacillin/tazobactam and piperacillin was 81.82%,to erythromycin was 100.00%.The susceptibility rates of Enterococus to teicoplanin,vancomycin,and linezolid were 100.00%.CONCLUSIONS The predominant pathogenic bacteria of abdominal infection are E.coli and Enterococcus.Abdominal infection tends to combine with pulmonary infection.The patients who got into multiple organ dysfunction syndrome have high mortality.

Objective To compare the treatment responses of the inhaled salmeterol and fluticasone (50/500 μg) for three months in the different clinical phenotypes of chronic obstructive pulmonary diseases (COPD) which were chronic bronchitis phenotype and emphysema phenotype and to explore the difference of the treatment responses.Methods To enroll and follow up the stable COPD patients from outpatient department who received the treatment of inhaled salmeterol and fluticasone (50/500 μg).Patients with low attenuation area (LAA,the density on CT scan ＜-950 HU) ≥15％ of the while lung area％ (LAA％) were defined as emphysema group,while patients with LAA％ ＜ 15％ were defined as chronic bronchitis group.All the subjects received lung function test before and after three-month treatment.Results Totally,84 patients (49 male and 35 female patients) with stable COPD were enrolled with an average age (61.04 ±9.23) years old,30 patients in emphysema group and 54 patients in chronic bronchitis group.Before treatment,forced expiratory volume in one second (FEV1) ％ predicted value and residual volume (RV) ％ predicted value in emphysema group were lower than those of chronic bronchitis group (P =0.04 and P =0.01),while inspiratory capacity (IC)％ predicted value was higher than that of chronic bronchitis group (P =0.02).After three-month salmeterol and fluticasone inhalation treatment,FEV1 and RV were improved in both groups,but FEV1 and RV in chronic bronchitis group were improved more significantly than those of emphysema group (P =0.02 and P =0.03).Conclusions The treatment responses of different clinical phenotypes of COPD to inhalation of combination of salmeterol and fluticasone were different,chronic bronchitis phenotype had better treatment response compared to emphysema phenotype.

Objective To analyse the research motives and its influencing factors of nursing staff.Methods 1000 authors who wrote for “Nursing Research” were chosen with a random code sampling method and were surveyed with a questionnaire,which inquired about their research motivation and self-rated research ability scale.Results Nursing research motives include to summarise clinical experience66.2％ (524/793),to get promotion 55.4％ (420/793),to contribute to nursing profession 37.2％ (295/793),to report research achievements 35.6％ (282/793),and to meet the requirements of the institution17.5％ (139/793).Research motives were statistically different in terms of age,work expirence,educational background,professional title,attitude,research training,research ability,and work institution (P =0.013,0.037,0.048,0.002,0.024,0.008,0.005,0.009,0.004,P＜0.05).Conclusions To stimulate the enthusiasm for research in nursing staff,administrators need to pay great attention to higher education for nurses,enhance their research training,provide research platform,and to improve the incentive system.

Objective To investigate the long-term efficacy of autologous stem cell transplantation for systemic lupus erythematosus (SLE). Methods Long-term follow up of 48 SLE patients with autologous stem cell transplantation were studied. All patients were followed up for 10 years. Among the patients, 24 cases were treated with purified CD34+ cells transplantation and 24 cases were treated with non-CD34+ cell transplantation. Comparison between groups was performed by x2 test. Results Among 5 dead patients, 4 died of transplantation related complications including 3 cases treated with CD34+ transplantion. The survival rate of those patients with more than 10 years duration of lupus was 90%(43/48). Among 43 patients, 7 had disease flare, 6 were treated with non-CD34+ cell transplantation. Eight patients went to college, 26 returned to normal life and 4 of them had children. Conclusion The long-term effect of SLE treated with autologous hematopoietic stem cell transplantation and anti-thymocyte globulin (ATG) is good. The recurrence of CD34+ transplant patients is lower than those treated with non-CD34+ transplantation. The quality of life in SLE patients treated with transplantation is better than those treated with conventional therapy.

Objective To investigate the characteristics of co-infection in initial treatment acute leukemia induction chemotherapy.Methods The clinical features of 179 untreated acute leukemia patients with nosocomial infection were analyzed after combined chemotherapy.Results In the 179 patients,151cases achieved complete remission,the complete remission rate was 84.4 ％,82 cases suffered from nosocomial infections,the incidence of infection was 45.8 ％.The sites of infection were oral,anal,lung,as well as primary foci was not clear bacteremia.In 428 specimens,the isolated bacterial colony counted a total of 66,the number of fungal colonies was 9,the bacterial colony was G-bacteria-based.G-bacteria had different degrees of resistance to many antibiotics.Extended-spectrum β-lactamases strains had not been detected in these specimens.Conclusion Acute leukemia patients is easy to co-infection after chemotherapy.Control and prevention of nosocomial infections should run throughout the entire treatment process,application of laminar flow bed helps reduce the newly diagnosed acute leukemia patients with nosocomial infection incidence.

Pancreatic ductal adenocarcinoma (PDAC) is one of the most aggressive and lethal human cancers. Cur-rent studies on the relationship between complicated type 2 diabetes mellitus (T2DM) and PDAC prognosis have demonstrated inconsis-tent results. The present study aimed to determine the relationship between complicated T2DM and the clinicopathological characteris-tics of PDAC, and evaluate whether complicated T2DM is a significant predictor for overall survival in patients with resectable PDAC. Methods: In this study, clinicopathological characteristics were observed in 136 patients who underwent surgery for PDAC at the Shengjing Hospital of China Medical University between January 2009 and February 2011. The relationship between complicated T2DM and overall survival of PDAC patients was analyzed using univariate and multivariate analyses. Results:The median age of pa-tients was 60 years (range: 35-80 years). Among the 136 patients, 76(55.9%) were male. The prevalence of complicated T2DM was 27.9%in 136 PDAC cases. Preexisting T2DM was not associated with any of the clinicopathological characteristics (all P>0.05). Uni-variate analysis showed that complicated T2DM (P=0.045), maximum diameter (P=0.011), histological differentiation (P=0.013), pT stage (P=0.034), vessel invasion (P=0.032), and pTNM stage (P=0.030) were significantly associated with the overall survival of PDAC patients. The median overall survival time was 14.2 months for T2DM patients, and 18.8 months for non-T2DM patients. In mul-tivariate analysis, complicated T2DM [hazard ratio (HR), 1.873;95%confidence interval (CI), 1.187-2.954;P=0.007], poorly differenti-ated tumor (HR, 2.647;95%CI, 1.413-4.957;P=0.002), and maximum diameter≥4.0 cm (HR, 1.699;95%CI, 1.094-2.640;P=0.018) were the independent predictors associated with poor overall survival. Conclusion:Complicated T2DM was associated with poor prog-nosis. It could be used as a prognostic predictor in patients with resectable PDAC. If confirmed, these findings may provide a novel ap-proach for individualized adjuvant therapy.

OBJECTIVE To investigate the status of traumatic infection among earthquake in order to provide reasonable evidence for anti-infective therapy. METHODS Samples were collected from 14 patients with compound fracture or osteofascial compartment syndrome for bacterial,fungal and anaerobic culturing,then according to pathogens to choose antimicrobial susceptibility test (AST). RESULTS Among 14 victims,10 had germ growth in wound secretions,the infection rate was 71.43%. Among 17 samples the bacteria,fungi and anaerobic were isolated in 12,4 and (samples,respectively),the isolated rates were 70.59%,23.53% and 5.89%. The main pathogens for the first culture were Enterobacter cloacae,coagulase negative Staphylococcus (CNS) and Acinetobacter. The Clostridium tetani and C. perfringens were all negative. We also isolated 5 strains of fungi from them 1 strain of Candida. CONCLUSIONS Most of the victims from disaster area have got bacterial infection. Most of them are combined infection,some of the infections are nosocomial infections. The key points of the treatment are to find pathogens immediately and choose a reasonable antibacterial agents according to the AST.

OBJECTIVE To enhance the healing rate of the wounded victims in earthquake and to do a good job on the nosocomial infection prevention and control according to the feature of the victims. METHODS The advance medical team on the train evaluated thd traumatic condition of the victims and sorted them according to their condition,then the victims with raw surface infection and that with no wound were arranged to the different sections and wards.The cleaning and medical inspection procedure for the victims were formulated.The secretions of their open wound surface with bacterial,fungal and anaerobic culturing at the very beginning were taken when their traumatic condition were examined.The management of wards,attendants and visitors were strengthened,the hand hygiene compliance and the right way to disposal clinical waste the disinfection and sterilization were supervised and directed. RESULTS Most of the 76 victims were with limbs injury,of which 14 victims with open injury,10 got bacterial or fungal infection.The infection rate was 71.43%.Most of them had got combined infection.No Clostridium tetani and C.perfringens were isolated from the secretion of the raw surface.Three victims were complicated with urinary system infection,1 with pulmonary infection and 1 with bed-sore infection after wounded in earthquake.Basing on effective debridement and change dressings,the antibacterial agents were applied according to pathogenic bacteria and the antimicrobial susceptibility test,so the wound surface and general infection were controled effectivelly.Another 35 victims with closed fracture who were operated with internal fixation and reposition after discection in the limited time were not infected. CONCLUSIONS The infection rate of raw surface of victims with open injury is high.Most of the wound surface are infected with some multidrug resistant bacterial and fungi and combined with urinary system infection or pulmonary infection.The nosocomial infections precaution and control should be strengthened to prevent cross infection when treating the victims wounded in earthquake.

Objective This study seeks to use a meta-analytical approach to quantitatively assess the results of applying the problem-based learning(PBL) teaching model and the traditional lecture-based learning(LBL)teaching model to basic medical courses in undergraduate medical edu-cation. Methods The CNKI and VIP databases were electronically searched to retrieve randomised controlled trial studies that examined the use of PBL methods for basic medical courses in under-graduate medical education. In these studies PBL teaching model was used in experiment group and LBL teaching model was used in control group. Pass rate or test scores was used to evaluate the effect of learning. The retrieved documents ranged from the time that each database was first constructed to December 2012. After two researchers performed literature screening independently, data extraction, and quality assessment procedures in strict accordance with the inclusion and exclusion criteria of this study, the Stata 11.0 software package was utilized to conduct the meta-analysis. Results This meta-analysis examined 28 studies that included a total of 3703 subjects. The modified Jadad scores of 20 studies(71.4%) were less than 4, and those of 8 studies(28.6%) were more than or equal to 4. The meta-analysis revealed that compared with the traditional teaching model, the PBL teaching model did not produce improved examination passing rates for a course [relative risk(RR):1.05, 95%confidence interval(CI):(0.99, 1.10), P=0.098] but could improve examination scores for a course [standardized mean difference (SMD): 0.73, 95% CI: (0.51, 0.96), P<0.001]. Conclusion For basic medical courses in undergraduate medical education, compared to LBL teaching, PBL teaching can improve students' test scores but cannot improve students' pass rate. PBL used in basic medical courses has di-versified forms and lacks unified criterion, so there is still a long way to go for the appli-cation of PBL.

Objective To observe the effect of combination of dexmedetomidine and sufentanil on postoperative analgesia for the highly nicotine dependent patients undergoing esophagectomy. Methods Ninety highly nicotine dependent patients undergoing esophagectomy were randomly allocated into three groups (n = 30 each): low-dose sufentanil group (Group S1), high-dose sufentanil (Group S2), dexmedetomidine and sufentanil group (Group DS). All patients of three groups received postoperative PCIA with following setting: 2 mL/h;bolus: 2 mL; lock time: 5 min; 4 hours limited: 40 mL. The scores of VAS and Ramsay, effective presses/total presses of PCIA, the consumption of sufentanil during 72 h after operation, side effects and the satisfaction degree of patients were recorded. Results Compared with those of group S2, the scores of VAS (both at rest and movement) decreased significantly in group DS from 1 h to 8 h (P<0.05). Compared with those of group S1, the scores of VAS (both at rest and movement) decreased significantly in group S2 and DS from 1 h to 72 h (P<0.05). Compared with that in group S1 and S2, the consumption of sufentanil during 72 h after operation decreased significantly in group DS (P < 0.05). Compared with those in group DS, The numbers of nausea and vomiting were significant decreased in group S1 and S2(P < 0.05). Compared with those in group S1, the remedial cases were significantly decreased in group S2 and group DS (P < 0.05). Conclusion The effect of combination of dexmedetomidine and sufentanil is superior to that of sufentanil in terms of postoperative analgesia in highly nicotine dependent male patients undergoing esophagectomy.