Objective To compare postoperative pulmonary infection in patients undergoing surgical operation at different surgical opportunities.Methods Patients who underwent surgical operation in a hospital from January to December 2014 were surveyed retrospectively,patients' data were reviewed,patients with postoperative pulmonary infection were compared.Results A total of 20 343 surgical patients were investigated,227(1.12％) had postoperative pulmonary infection.Postoperative pulmonary infection rate in patients undergoing emergency operation was higher than that of selective operation (5.13 ％ vs 0.70 ％,x2 =307.49,P＜0.001).Postoperative pulmonary infection rates in patients undergoing emergency neurosurgical,general surgical,and cardiothoracic surgical operation were all higher than selective operation (all P ＜ 0.001).Among patients with pulmonary infection following emergency operation,the proportion of those who aged ＜60 years,with preoperative irrational antimicrobial use,cardiovascular disease,hypertension,and tracheotomy were all higher than those who received selective operation (all P＜0.05);the proportion of patients with cancer is lower than that of elective surgery patients(P＜0.05).Conclusion Postoperative pulmonary infection rate in patients undergoing emergency operation is higher than selective operation,postoperative pulmonary infection rates in patients undergoing emergency neurosurgical,general surgical,and cardiothoracic surgical operation are high.Patients with cardiovascular disease and hypertension are the focus of protection;for elective surgery,cancer patients are the focus of protection.

Objective To explore relationship between the plasma calcitonin-gene related peptide(CGRP) level and brain damage in neonatal asphyxia. Methods Dynamic variation of plasma CGRP level was monitored in 62 asphyxiated newborn infants and 21 normal infants by radioimmunoassay, and the relation between the brain damage and CGRP in neonatal asphyxia was analyzed. Results Plasma CGRP level markedly elevated at acute stage of neonatal asphyxia(P

Objective To investigate the expression pattern of Th1 and Th2 in patients with pulmonary tuberculosis including sputum positive pulmonary tuberculosis and coinfection with human immunodeficiency viruses(HIV), and its relation to disease severity.Methods The expression pattern of CD4+T lymphocytes, Th1 and Th2 cells in peripheral blood samples from sputum positive pulmonary tuberculosis patients, coinfection with HIV patients and healthy controls were studied by flow cytometry.Results The expression of CD4+ T lymphocytes and Th1 cells in sputum positive pulmonary tuberculosis patients were significantly lower than that in healthy group(31.22?9.80)%,(9.78?3.09)% vs (43.77?10.78)%,(25.26?4.73)%; The expression of Th2 cells in culture positive pulmonary tuberculosis patients was significantly higher than that in healthy group(18.65?3.49)% vs(10.15?2.60)%; The Th2 level in severe pulmonary tuberculosis patients was significantly higher than that in the medium and mild patients(21.70?2.67)% vs (14.87?1.66)% ,(17.48?2.06)%, while the CD4+T lymphocytes and Th1 levels were significantly lower; The CD4+ T lymphocytes and Th2 cells levels in pulmonary tuberculosis patients coinfection with HIV were lower than that in tuberculosis patients without HIV coinfection(21.88?3.71)%,(8.79?2.28)% vs (31.22?9.80)%,(18.65?3.49)%.Compared with the healthy group, Th1 cells level in pulmonary tuberculosis patients with or without coinfection of HIV were lower(25.21?4.73)% vs (9.39?2.65)%,(9.78?3.09)%.Conclusion Patients with sputum positive pulmonary tuberculosis showed lower expression of Th1 and higher expression of Th2,This profile was correlated with disease severity.Patients with pulmonary tuberculosis and HIV coinfection showed both of lower expression of Th1 without enhancement of the type 2 response.

The clinical internship is an important transitional period for humanistic spirit cultivation of the medical students.But in this period there are some problems exposed.For example,there is the lack of transitional link in management; the clinical instruction doctors lack educational consciousness or guidance ability,the medical students pay little attention to enhancing the individual humanistic spirit level and there is a gap between theory and practice of humanistic spirit for them.Strengthening training for students,attaching importance to training,selection and incentive of clinical instruction doctors and revising handbook of clinical internship will help to solve the problems.

Objective To study the status of prevalence of hyperlipidaemia among rural residents aged from 30 to 59 in Changzhou and provide evidence for taking prevention measures.Methods By the means of the cluster random sampling,a questionnaire survey and medical examination were conducted among 10 018 permanent residents in rural areas of Changzhou.The fasting plasma cholesterin(TC),triglycerides(TG),high density lipoprotein-C(HDL-C) were measured.Age-standardized prevalence rates were calculated by using the direct standardization method according to 2000 China population census.Results The prevalence of hyperlipidaemia of this population was 32.3%,the age-standardized prevalence was 31.3%,and the prevalence among men was significantly higher than women(P

Objective To analyze the drug resistance and homology of Acinetobacter baumannii (Ab) isolated from patients with explosive injury ,so as to explore the characteristics of drug resistance and prevalence of infection .Methods A total of 61 strains of AB isolated from clinical specimens of patients with explosive injury were collected .The antimicrobial susceptibility of these iso‐lates was detected by using K‐B test .All the strains were gene typed by using the pulsed field gel electrophoresis .Results The re‐sults of antimicrobial susceptibility test shown that the 61 isolates of Ab had high resistance rate ,and were multi‐drug resistant to common antibacterial agents ,except for tigecycline (the resistante rate was 11 .5% ) and minocycline (the resistante rate was 48 .0% ) .The 61 isolates of Ab were divided into 8 kinds of genotypes ,among which type A was the most prevalent one (25 strains) .Other genotypes were type B(10 strains) ,type C(6 strains) ,type D(4 strains) ,type E(8 strains) ,type F(3 strains) ,type G(4 strains) and type H(1 strain) .The isolates of Ab were with high homology .Conclusion Multi‐drug resistance is observed in strains of Ab isolates from patients with explosive injury .Clonal strains of AB may be disseminates among regions ,which indicates that high attention should be paid to these strains .

Objective To understand the occurrence of healthcare-associated infection(HAI) in intensive care units (ICUs) in secondary and above hospitals in a province, and provide basis for HAI management.Methods HAI management quality control center in a province performed targeted monitoring on HAI in ICUs in secondary and above hospitals in a province from July 1, 2010 to June 30, 2015.Results ICUs in 176 hospitals were monitored, the incidence of HAI in ICUs for 6 consecutive years was 7.23％, case incidence of HAI was 9.72％;incidence of HAI showed a decreased trend in 6 years(P<0.001).The adjusted rate of HAI per 1 000 patient days in the general hospital ICUs was higher than that of special hospital ICUs (4.30‰ vs 3.53‰).Incidence of HAI in surgical ICUs and general ICUs were both relatively higher, adjusted rates of HAI per 1 000 patient days were 4.79‰ and 4.21‰ respectively.Respiratory tract, urinary tract, and bloodstream infection were major HAI in ICUs, accounting for 68.64％, 14.45％, and 10.09％ respectively, the utilization rates of central venous catheter, ventilator, and urinary catheter were 49.86％, 39.16％, and 81.95％ respectively, incidence of three catheter-associated infection were 1.74‰, 13.77‰, and 2.08‰ respectively, incidence of three catheter-associated infection decreased year by year (P<0.001).The utilization rates of ventilator, central venous catheter, and urinary catheter in different ICUs were not correlated with the incidence of infection(all P>0.05).A total of 36 223 strains of pathogens were isolated, the top 6 isolated pathogens were Acinetobacter baumannii(22.77％), Klebsiella pneumoniae (11.96％), Pseudomonas aeruginosa(11.94％), Staphylococcus aureus (8.08％), Candida albicans (5.63％), and Escherichia coli(5.55％).The isolation rates of carbapenem-resistant Klebsiella pneumoniae showed a increased tendency for 6 years(P<0.05).Conclusion Continuous targeted monitoring on HAI in ICUs, regular analysis on risk factors for HAI, and timely implementation of intervention measures can effectively decrease the incidence of HAI.

Objective To explore the clinical manifestations,antimicrobial therapy,and risk factors of mortality in patients with Acinetobacter baumannii bloodstream infection.Methods Clinical data of 153 patients with Acinetobacter baumannii bloodstream infection hospitalized in First Affiliated Hospital of Zhejiang University from January 2013 to September 2014 were analyzed retrospectively.According to the 28-day survival after diagnosis,the patients were divided into death group (n =76) and survival group (n =77).Data related to demographic and clinical characteristics,underlying diseases,treatment,invasive procedures,bacterial resistance to antibiotics,acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ)scores at onset,and antimicrobial therapy were collected.The index as an independent risk factor of mortality was demonstrated by multivariate logistic regression analysis.Results This study included 153 patients with Acinetobacter baumannii bloodstream infection.The 28-day mortality was 49.7％.The independent risk factors of mortality were APACHE Ⅱ score ≥22 at onset (OR =15.7,95％ CI 5.1-48.1,P ＜ 0.001),septic shock (OR =6.3,95 ％ CI 1.9-21.3,P =0.003),and administration of steroids (OR =3.6,95％ CI 1.0-12.3,P =0.043).Compared with subjects treated with non-cefoperazone-sulbactam-based regimen,those treated with cefoperazone-sulbactam for multidrug-resistant Acinetobacter baumannii (MDR-AB) had significantly lower mortality on day7,day14 and day28 (8.9％ vs 59.2％,31.1％ vs 65.8％,44.4％ vs 72.4％ respectively).Conclusions The patients with Acinetobacter baumannii bloodstream infection have high mortality within one month.Administration of steroids and septic shock are associated with poor prognosis.APACHE Ⅱ score ≥ 22 at onset predicts adverse outcome.Cefoperazone-sulbactam-based antimicrobial therapy improves patients' survival.

OBJECTIVE:To investigate the feasibility,safety and efficacy of domestic small waist big edge-type occluder for patients with multiple outlets sac-type membranous ventricular septal defection (VSD),and summarize its technical problems and the choice of treatment strategies.METHODS:A total of 20 patients with sac-type membranous VSD,underwent left ventricular angiography at left anterior oblique 45°-60° plus CAOD 20°-25°;the left ventricular entrance diameters were 7-21 (10.9±5.2) mm,more than 2 outlets in the right ventricular surfaces,and the largest outlet diameters were 3-10 (4.8±2.9) mm.According to the result from transthoracic echocardiography (TTE) and angiography,the sac-bag size,shape,location,extent of tissue adhesion,and stability were determined.Different types of small waist big edge-type occluder were implanted,and the occluder diameter was 5-14 (4.6±2.8) mm.Following 15 minutes of blocking,the immediate effects of occlusion were observed through repeating left ventricuiar angiography and TTE.All patients rechecked ultrasonic cardiography and electrocardiogram at 5-7 days of hospital stay,and 1,3,6 and 12 months following surgery.All patients took aspirin tablets for 6 months.RESULTS:Of 20 patients,17 cases underwent domestic small waist big edge occluder,blocked successfully through left ventricular entrance,2 cases were successful using symmetry block,and 1 case was failed.Intraoperative occlusion did not affect the aortic valve and tricuspid valve function.There were 1 case with left bundle branch block and 1 case with right bundle branch block during the operation,and all recovered within a week by using hormone therapy.After 6 months,the cardiac sizes were reduced to different degrees.CONCLUSION:It is safe and effective to treat multiple outlets sac-shaped membranous VSD with domestic small waist big edge-type occluder.The key technology,according to the sac size,shape,firmness,outlet orientation,import size,and the size of aortic stump,is to determine the block site and to select a suitable occluder.

Objective To retrospectively assess the clinical manifestations and treatment of secondary syphilis with ocular impairment as the initial symptom. Methods Clinical data were retrospectively analyzed on secondary syphilis with ocular impairment as the initial symptom collected from September 1998 to October 2008. Results There were 11 syphilitic patients presenting acute ocular impairment as their initial manifestation. Skin eruptions developed simultaneously with ocular impairment in 2 patients, following ocular impairment in 9 patients. All patients were positive for rapid plasma reagent test (RPR) and treponema pallidum haemagglutination assay (TPHA), but negative for HIV. Of these patients, 9 suffered from uveitis (iridocyclitis, choroiditis or panuveitis), 2 from optic neuritis; 3 had unilateral ocular involvement, 8 had bilateral ocular involvement. After treatment with injected penicillin or ceftriaxone sodium, 9 patients experienced complete visual recovery, 2 partial visual recovery. Conclusions Ocular impairment occurs in patients with secondary syphilis at a low incidence, with no characteristic clinical manifestations. For patients who have no response to conventional ocular therapy, ocular syphilis should be considered and serological examination for syphilis is recommended.