OBJECTIVE To investigate the pathogens distribution and their antibiotic resistance in critically ill patients with pulmonary infection.METHODS Totally 171 isolates from sputa were studied and the drug sensitive test was analyzed in 103 critically ill patients.RESULTS These results showed that 29 G+ bacteria strains occupied 17.0%,there were 15 Staphylococcus aureus strains,11 S.epidermidis strains and 3 Enterococcus strains,respectively.In 107 G-bacteria strains occupied 62.6% were composed Stenotrophomonas maltophilia,Acinetobacter baumannii,Burkholderia cepacia and Klebsiella pneumoniae,and 35 strains were fungi,accounted for 20.5%,the main fungi were Candida albicans and C.tropicalis.The result of drug sensitive test showed that there were high rates of multiple drug resistance in most bacteria strains,but there were different drug resistance rates to different antibiotics.CONCLUSIONS G-bacilli play an important role in the pulmonary infections of these critically ill patients,the opportunistic pathogens,such as S.maltophilia are the main G-pathogens,and there are high percentages of drug resistance.The other bacteria such as S.aureus,K.pneumoniae,etc,have a multidrug resistance.Inspecting pathogens and studying the trend of their drug resistance are very important in reducing drug abuse and decreasing the rate of infection in hospital.

OBJECTIVE To highlight the characteristics of diffuse panbronchiolitis(DPB) in community hospital.METHODS One patient with DPB confirmed by clinic was described and relevant literatures were reviewed.RESULTS DPB was a chronic lower respiratory tract disease common in Japanese,rare in China,characterized by infiltration of inflammatory cells around bronchioles.Symptoms included cough,expectoration,and dyspnea after exercises.Pseudomonas aeruginosa was isolated from sputum in some cases.Some patients had the history and X-ray manifestation of sinusitis.The reason for a high misdiagnosis rate was due to unknown to its clinical findings and its diagnosis standard among doctors in community hospital.Chest high resolution CT(HRCT) could be attributed to the diagnosis of diffuse panbronchiolitis.The early treatment with macrolides was satisfied.CONCLUSIONS The patients with the history of chronic cough,expectoration and sinusitis,should be diagnosed.Long term,low dose macrolide therapy may improve the prognosis through an anti-inflammatory effect.

0.05). CONCLUSIONS The pathogenic bacteria from VAP subglottic secretion are mostly Gram-negative rods, in which the dominant bacteria are A. baumannii, P. aeruginosa, S. maltophilia, K. pneumoniae and Escherichia coli. Most of them are multi-drug resistant. The kinds of pathogenic bacterial strains in subglottic secretion and lower respiratory tract secretion are not only consistent but also similar to each other in terms of composition and drug resistance.

Objective To observe the effect of Danhong Injection(DI)on the thyroid hormone level in patients with angina due to coronary heart disease(CHD).Methods Sixty CHD angina patients were equally randomized into the treatment group and the control group.The two groups received routine western medicine such as aspirin,angiotensin convert enzyme inhibitor(ACEI),statins,beta-blockers and nitrate esters,and the treatment group was additionally given intravenous drip transfusion of DI 20 mL,qd.Twenty days constituted one treatment course.After treatment,the therapeutic effect was evaluated and the changes of serum thyroid hormone level were observed.Results In the control group,13 patients were markedly effective,9 effective,8 ineffective,and the total effective rate was 73.3%;in the treatment group,19 patients were markedly effective,6 effective,5 ineffective,and the total effective rate was 83.3%;the difference between the two groups was significant(P

Objective To study the effect and mechanism of gastric bypass surgery on type 2 diabetic rats.Methods The models of type 2 diabetic rats were induced by stretozotocin and 20 diabetic rats were randomly divided into 2 groups:diabetes-operation group (DO group,n =10)and diabetes-control group(DC group,n =10).20 normal rats were randomly divided into 2 groups:normal-operation(NO group,n =10) and normalcontrol group(NC group,n =10).Rats in DO and NO group underwent GBP and rats in DC group and NC group underwent sham operation.Fasting blood glucose(FBG) levels of rats in each group were detected before operation and on 72 h,1th week,4th week,8th week after operation.On the 8th week after operation,pancreas tissues were harvested for HE staining and immunofluorescence,histological changes observed.Results The FBG levels of rats were not statistically significant different before operation between DO group and DC group or between NO group and NC group (P ＞ 0.05).After operation,the FBG levels of rats in DO group gradually declined (P ＜ 0.05).FBG levels of rats in DO group were lower after operation than before operation(P ＜0.05) ; After operation FBG levels of rats were higher in DO group than in NO group and NC group at the same time point (P ＜0.05).In DC group,the difference of FBG levels of rats at different time point was not statistically significant(P ＞ 0.05).The difference of FBG had no statistically significance between the different time points of the same group or between the same time point of different groups (P ＞ 0.05).HE staining showed that,in DO group,newborn small islets appeared in pancreas which increased the number of islet.The new islets were smaller,mostly around the pancreatic duct and the structure was similar to that of the normal islets.Immunofluorescence staining also showed that the number of islets increased.Insulin immunofluorescence found more isolated small islets composed of two or three insulin positive cells.Insulin and glucagon double immunofluorescence found insulin and glucagon double positive(INS +/GLU +)cells in some islets.Conclusions GBP has obvious hypoglycemic effects on FBG levels of type 2 diabetic rats,in which the regeneration of pancreas islets may play an important role,while on normal rats GBP has no hypoglycemic effects.

Objective To explore the treatment of the ICU ventilator associated pneumonia(VAP),and the prevention strategy.Methods Analyzed the clinical features and microbiological data of 80 ICU VAP patients. Results The main pathogenic bacterias of VAP were acinetobacter baumannii and pseudomonas aeruginosa,which were Gram negative bacteria.A total of 200 strains pathogenic bacteria were isolated,in which,Gram negative bacteria reached to 76.0%,which mainly including:acinetobacter baumannii strains,klebsiella pneumoniae,pseudomonas aeruginosa and so on.24.0% was Gram positive bacteria,including staphylococcus aureus accounted for 10.5%,and the epidermis staphylococcus,hemolysis staphylococcus and so on.Proportion of fungi was 11.0%.According to the results of microbiological data,the effective anti-microbial treatments were administered.After treatments for 10 days, the VAP infection parameters(including temperature,the white blood cell count and the number of strains)were grad-ually back to normal.Conclusion The main VAP pathogenic bacteria are Gram negative bacteria,patients commonly are infected by two or more bacterias,which lead to the multiple infection,the treatment should be fully based on mi-crobiology and clinical monitoring data,and the formulating personalization antibacterial treatment.

Objective: To compare two methods (microbial assay and radioimmunoassay) for measuring plasma folate concentrations, and to examine the relationship between plasma folate levels, and alcohol consumption, tobacco use and body mass index, and the risk of hyperhomocysteinemia in China. Methods: We used a microtiter plate microbial assay and a radioimmunoassay to measure the folate concentration in 88 plasma samples. After comparing the results of these two methods and fitting a regression line, we examined the geographical, seasonal, and gender differences in folate concentration of plasma collected from 2 422 adults in south and north areas in China, and evaluated the association of plasma folate concentration, with alcohol consumption, cigarette smoking, and body mass index, and with the risk of hyperhomocysteinemia, using the data from the two assays. Results: The data from the two assays had a linear relationship ( r =0.879, P =0.000); the regression was Y =0.683 X +0.308 (where X and Y were nature logarithmic transformations of plasma folate by microbial assay and radioimmunoassay, respectively); however, the mean plasma folate levels by microbial assay were much higher than those obtained by radioimmunoassay. Both data sets showed similar plasma folate distributions among Chinese adults, associations with other risk factors, and the risk of hyperhomocysteinemia. We estimated that 19.9% of the Southerners and 67.1% of the Northerners had plasma folate concentrations by radioimmunoassay lower than the 6.8 nmol/L used to define plasma folate deficiency. Conclusion: There is a linear relationship between plasma folate levels determined by microbial assay and radioimmunoassay, but because of the different levels obtained in the two assays, it is difficult to use the microbial assay results to evaluate folate status at this time. The use of 10.5 nmol/L as a cut off for plasma folate deficiency by microbial assay needs further study.

Objective To investigate the curative effect of neural stem cells (NSCs) transplantation on sequela after traumatic intracranial hematoma. Methods 20 patients with sequela after traumatic intracranial hematoma were treated with NSCs transplantation. Cells were engrafted into subarachnoid cavity via lumbar puncture. They were assessed with Functional Independence Measure (FIM) before and half a year after the transplantation. Results The FIM scores were significantly increased after the transplantation (P<0.01).Conclusion NSCs transplantation could promote functional recovery and improve the living quality of patients with sequela after traumatic intracranial hematoma in the aspects of self-care, sphincter control, mobility, locomotion, communication and social adjustment/cooperation.

Objective To analyze and compare the capacity and efficiency of county-level hospitals′medical service by using the diagnosis related groups ( DRGs ) method. Methods The homepage data of discharged inpatients from seven county-level hospitals in Wenzhou region in 2013 - 2015 period were analyzed, for measurement of the medical service capacity changes of such hospitals using the number of DRGs, total multiplicity of weight, and CMI value, and that of their medical service efficiency changes using expense consumption index and time consumption index. Results The study found in the seven hospitals 8. 49% increase of the total number of DRGs, 17. 34% increase of total multiplicity of weight, and 5. 06%increase of CMI value, with unchanged expense consumption index and 9. 82% decrease of the time consumption index. These facts evidenced enhancements of these hospitals in both service capacity and service efficiency in general. Conclusions DRGs as tools prove useful objectively and scientifically. Policies of Two emphases at primary ends and two enhancements have been implemented desirably.

Aim: To explore the in situ intestinal absorption in rats of ZLR-8, an insoluble NO-donor drug, and to compare the intestinal absorption enhancement by spray-dried emulsion. Methods: Intestine of rats was cannulat-ed for in situ perfusion. UV and HPLC methods were used to monitor phenolsulfonphthalein and ZLR-8, respec-tively. The effects on ZLR-8 absorption of the intestinal segments, the concentration of ZLR-8 and the pH of the circulating perfusate were studied. The absorption of ZLR-8 suspension was compared to that of the spray-dried emulsion. Results: 1-h in situ intestinal perfusion of the spray-dried emulsion allowed the estimation of the absor-tion percentage to be (23. 54 ± 1. 40) %, (15. 95 ± 0. 09) %, (12. 30 ± 0. 74) %, (3. 98 ± 0. 12) %, respec-tively; the absorption rate constants in duodenum, colon, jejunum and ileum to be (0.248 6 ±0.046 0) h~(-1), (0. 143 7 ±0. 036 0) h~(-1), (0. 069 2 ±0. 001 3) h~(-1), (0. 020 8 ±0. 000 4) h~(-1), respectively. Significant differ-ences in absorption characteristics were found among intestinal segments. In the range of 3. 4-9. 4, pH of the per-fuate had significant influence on the absorption of ZLR-8, and better absorption appeared at pH of 5. 4 to 7. 4. It was found that the absorption rate constant was unaffected by ZLR-8 concentration. However, the absorption amount was proportional to ZLR-8 concentration. Compared to the ZLR-8 suspension, the in situ intestinal absorption of ZLR-8 in rats given the spray-dried emulsion increased significantly. Conclusion: It was only found that ZLR-8 administered in suspension has minor absorption in rat duodenum while no apparent absorption occurred in other segemnts. ZLR-8 in spray-dried emulsion was fairly absorbed in the rat intestinal segments. Passive diffusion was invloved in the absorption of ZLR-8. Spray-dried emulsion significantly enhanced the intestinal absorption of ZLR-8 in rats.