Alveolar macrophages (AM) were studied by means of phase contrast microscope, differential interference contrast microscope, SEM and TEM. The content of AcP, LDH, SDH of the AM was measured by MPV3-TSA microspectrophotometerimage analytical instrument. Under phase contrast microscope, two different types of AM can be distinguished, i. e, the light cells and the dark cells. The two types of cells are spherical and flat in shape under differential interference contrast microscope. The observation with SEM and TEM showed that the spherical cells possess more filopodia and more lysosomes in cytoplasm, but the flat cells possess more lamellar podia. Quantitative cytochemistry demonstrated that the content of AcP, LDH, SDH in spherical cells are much more than that of flat cells. The results suggest that there are two types of alveolar macrophages exist in normal rat lung.

Abstract: Objective　To analyze the genotype of carbapenemase resistance genes and their genetic homology in multidrug-resistant Acinetobacter baumannii, and to provide a theoretical basis for guiding the rational use of antibiotics and controlling the prevalence of nosocomial infections. Methods A total of 83 multidrug-resistant Acinetobacter baumannii isolated from patients in the intensive care unit (ICU) and environmental specimens in the Sixth People's Hospital of Nantong from July 2020 to December 2021 were collected. The bacteria were identified and subjected to drug sensitivity tests using the BioMérieux DL96-Ⅱ automatic bacterial identification susceptibility system. The carbapenemase-related drug resistance gene types were detected using the polymerase chain reaction (PCR) method, and clones were analyzed by pulsed field gel electrophoresis (PFGE). Results The types of 83 ICU Acinetobacter baumannii specimens include sputum (43 strains), broncholavage fluid (20 strains), and surfaces of objects such as ventilators (20 strains). The resistance rates of all strains to imipenem, tetracycline, gentamicin, amikacin and ciprofloxacin were 100%, 32.5%, 38.6%, 41.0% and 77.1% respecitively, while the resistance rates to others such as ticarcillin and clavulanate were greater than 95%. All strains carried were detected to carry OXA-23 and OXA-51 genes, while OXA-24, OXA-58, IMP-1, VIM, IMP-4, SIM and NDM-1 resistance genes were all negative. PFGE homology analysis confirmed that 83 strains of Acinetobacter baumannii, with counts of 12, 18, 12, 13, 10, 6, 7, 5 respectively, mainly A, B, C, D, E clones, the rest were sporadic clones. Conclusions The carbapenem resistant Acinetobacter baumannii isolated from our ICU are widely drug-resistant to commonly used antimicrobial drugs, with B clone strain being the major prevalent strain. Carrying OXA-23 and OXA-51 genes may be an important reason for the resistance of Acinetobacter baumannii to carbapenem antibiotics in our ICU. Rational use of antimicrobial drugs, enhanced monitoring of bacterial resistance, and effective control of the generation and further spread of drug-resistant strains should be emphasized.

Objective: To observe the clinical therapeutic effects of supplementing Qi and activating blood circulation method(益气活血法) for critically ill patients.Methods: Ninety critically ill patients with(Qi-deficiency)(气虚) and blood stasis(血瘀) syndromes who diagnosed according to standard in a book named clinical diagnosis and treatment nomenclature of traditional Chinese medicine were randomly divided into the the treatment group(n=60) and the control group(n=30).The general therapy of the two groups was the same.Additionlly,the treatment group was administered Shenmai injection(丹参注射液) and Danshen power(丹参粉针剂),15 days were as one therapeutic course.Results: In the treatment group,the total effective rate of clinical therapeutic effects was 85.00 %;before and after treatment,traditional Chinese medical scores was 38.63?9.08 vs.24.27?7.43,acute physiology and chronic health evaluationⅡ(APACHEⅡ) 18.11?4.54 vs.12.47?1.64,platelet(PLT) count(198.00?54.16)?10~9/L vs.(174.00?40.82)?10~9/L,(haematocrit)(HCT) 0.340?0.049 vs.0.440?0.057,mean cell hemoglobin(MCH)(34.00?3.10)pg(vs.(31.00?1.83) pg).The differences of above parameters were significant between the two groups,and they were superior in the treatment group to those in the control group(all P

Objective:To explore the effect of hanging electronic baking lamp on the quality and progress of flap recovery in patients with hand injury flap repair.Methods:A total of 180 patients undergoing hand injury flap repair in Yantaishan Hospital in Yantai City from January 2019 to May 2022 were selected as the research objects by the convenient sampling method. They were divided into the control group and the observation group, with 90 cases in each group. The control group was treated with routine nursing combined with ordinary baking lamp nursing, while the observation group was treated with routine nursing combined with hanging electronic baking lamp nursing. The postoperative flap recovery quality (survival rate, healing grade) and recovery process (exudation drying time, the regression time of swelling , the healing time of flap wound) were compared between the two groups.Results:In the control group, 85 flaps survived, with a survival rate of 94.44% (85/90) ; in the observation group, 87 flaps survived, with a survival rate of 96.67% (87/90) ; there was no statistically significant difference in the results between the two groups ( P>0.05) . In the control group, there were 43 cases of grade A skin flap healing, 26 cases of grade B skin flap healing and 21 cases of grade C skin flap healing; in the observation group, 63 cases had grade A healing, 16 cases had grade B healing and 11 cases had grade C healing; there was statistically significant difference in the level of skin flap healing between the two groups of patients ( P<0.05) . The exudation drying time were (3.79±1.22) d in the observation group and (3.21±1.38) d in the control group; the regression time of swelling were (5.23±1.06) d in the observation group and (3.89±1.19) d in the control group; the healing time of the flap wound in the observation group was (12.36±2.58) d, while in the control group it was (8.98±1.47) d; the differences were all statistically significant ( P<0.05) . Conclusions:The use of a hanging electronic baking lamp after surgery can improve the quality of skin flap recovery for patients undergoing hand injury flap repair and accelerate their recovery progress.

Objective To explore the clinical features and causes of misdiagnosis of the patients with acquired deficiency of vitamin K-dependent coagulation factors (ADVKDCF). Methods Retrospective analysis was performed with the data from 62 patients with ADVKDCF for etiological factors, clinical manifestations,laboratory examinations, diagnosis and treatments. Results Among the 62 patients, 51 patients were with unknown causes( subgroup A) and 11 were with clear histories of anticoagulant rodenticide poisoning( subgroup B). The presentations of hemorrhage of the patients varied with hematuria as the most common first symptom,followed by skin, mucosa, muscle, internal organs bleeding (28/62). The most common hemorrhage symptom is hematuria. 35 of the 62 patients had hemoglobin(Hb) levels less than 100 g/L due to blood loss( the lowest level was 32 g/L). Thirty-eight patients were misdiagnosed at the first visit and the median time from hemorrhage manifestation to definite diagnosis was 8 days (range,2 to 192 days). ADVKDCF was mostly misdiagnosed as the urinary system diseases (23/38), followed by hemophilia (8/38). Laboratory examinations showed normal platelet count , throm bin time (TT) and normal fibrinogen(Fg) concentration, but prolonged plasma prothrombin time (PT), activated partial prothrombin time (APTT) and international normalized ration (INR). All of patients received high dose vitamin K ( intravenous vitamin K1 with a initial dose of 20 to 240 mg/d and then oral vitamin K4 maintenance) . The bleeding symptoms disappeared 1 day after treatment and the Hb levels increased dramatically. There were significant differences in PT, APTT and INR of the patients before and after treatment( P ＜0. 01 ). Followed by a median follow - up of 8 months , no patient had severe adverse effects or recurrence. Conclusion The hemorrhage presentations of the patients with ADVKDCF are various. The most common hemorrhage symptom is hematuria. The misdiagnosis rate of ADVKDCF is high with urinary systems disorders as the most common misdiagnosis. Sequential treatment with vitamin K is an effective and safe method to prevent recurrence. Early detection of coagulation function is helpful to reduce misdiagnosis possibility.

Objective To explore the application of quality control circle ( QCC) on continuing nursing care among patients with high pressure sore risk. Methods A total of 218 patients, who discharged from hospital with high risk of getting pressure sore since July 2012 to December 2013 partly from the First People′s Hospital of Wujiang District and partly from community health center and nursing home, were equally divided into experimental group (110) and control group (108). The patients of experimental group treated with normal discharged education and traditional care while patients in the experimental group underwent the continuing nursing care. After 4 weeks discharged, it had been compared the knowledge and skill of pressure sore in caregivers, and the cure of pressure sore was observed at 8 weeks follow up after discharged. Results After 4 weeks QCC, the standard rate of knowledge and skill in caregivers was 90. 91% in the experimental group and 18. 52% in the control group (χ2 =115. 41,P<0. 01), while the occurrence rate of pressure sore was 6. 36%in the experimental group comparing with 29. 63% of the control group (χ2 =20. 08,P<0. 01). After 8 weeks QCC, the cured rate of pressure sore was 57. 14% of the experimental group compared with 12. 50% of the control group (χ2 =43. 111,P <0. 01). Conclusions Application of QCC on continuing nursing care can effectively reduce the incidence of pressure sore among patients at home and in community, as well as increase recovery rate. It is one of innovation for new medical arena.