OBJECTIVE To investigate the distribution and drug resistance of pathogenic bacteria in septicemia in order to provide the reference for clinical antimicrobial agents usage.METHODS The blood samples of inpatients were cultured with blood culture apparatus,VITEK-AMS was used to identify the bacteria and conduct drug resistance test and ESBLs produced by Escherichia coli,and Klebsiella were detected by disc diffusion confirmatory test.RESULTS The 221 strains of pathogens that caused septicemia were mainly distributed in ICU,blood department and infection department.The 61 strains of E.coli were isolated,among which ESBLs were detected and accounted for 39.3%(24),26 strains of Klebsiella were isolated,among which ESBLs were detected and accounted for 26.9%(7),ESBLs strains were more resistant than ESBLs negative strains.Thirty two strains of Staphylococcus were isolated,among which MRS were detected and accounted for 62.5%(20).The pathogens showed highly multiple drug-resistance.Vancomycin and imipenem were the highest susceptible for Gram-positive and Gram-negative bacteria,respectively.CONCLUSIONS The pathogens that caused septicemia are mainly distributed in ICU,blood department and infection department.The situation of antibiotic resistance of pathogens is very serious now.Therefore,it is important to prevent the septicemia and to detect enzyme producing strains regularly for reference of reasonable antibiotic use.

OBJECTIVE To study the change and significance of TNF-? and IL-18 in the Acinetobacter baumannii sepsis. METHODS Sixty male SD rats were divided into 6 groups. The first group was normal control group. The second to sixth groups were sepsis groups which were killed at 4h,16h,24h,48h,72h after injecting A. baumannii through intraperitoneal injection to make sepsis model. The level of TNF-? and IL-18 in the serum of rats was measured by enzyme linked immunosorbent assay (ELISA). RESULTS The level of TNF-? in the serum increased markedly in the sepsis groups (P

Objective To explore a medical insurance model for rare diseases and orphan drugs applicable in China.Methods Eleven rare diseases from six disease systems and thirty-five orphan drugs covered were pinpointed for comparative analysis of their present coverage in various medical insurance systems in China.Results The coverage of 35 orphan drugs in the national essential drug list(2009)and the national essential drug list(2012)is 0 and 37.1％ respectively; the coverage in the national essential insurance medicine list is 54.3％ (19 types),and the average coverage in the medicine list for the New Rural Cooperative Medical Insurance Scheme is 33.6％.The study found insufficient rare diseases included in the Basic Medical Insurance Schemes in general.Conclusion The coverage of basic medical insurance for rare disease patients is low in China.In this regard,such measures should be taken to mitigate the economic burden for these patients,namely expanding the coverage of reimbursement list of orphan drugs,building the special reimbursement system of rare diseases and orphan drugs and improving the medical rescue system for rare diseases in China and their medical care level.

Objective To investigate the current situation of disability acceptance and alexithymia among uremia patients,and to explore the effects of alexithymia on disability acceptance.Methods Totally 342 uremia patients were recruited by convenience sampling method.Patients were investigated with general information questionnaire,Acceptance of Disability Scale (ADS) and the Toronto Alexithymia Scale (TAS-20).Results The mean scores of disability acceptance and alexithymia were 180.45±26.93 and 52.35±8.24,respectively.The affective disorder of recognition,affective disorder of description and extroverted thinking were significantly negatively correlated with each dimension of disability acceptance(P＜0.05).Multiple linear regression analysis showed that alexithymia,gender and course of disease were influencing factors of disability acceptance for uremia patients(P＜0.05).Conclusion The level of disability acceptance was in the medium level among uremia patients,and alexithymia,gender and course of disease were its influencing factors.Nursing staff could take effective measures to ameliorate alexithymia and to improve the level of disability acceptance for uremia patients.

BACKGROUND: Bone marrow mesenchymal stem cells (BMSCs) can grow in host myocardium, differentiate under myocardial condition, improve cardiac function. However, biological characteristics of BMSC differentiation are still unclear presently.OBJECTIVE: To study the expression and electrophysiological characteristics of BMSC/n vitro connexin-43 following 5-azacitidine (5-aza) treatment.DESIGN, TIME AND SETTING: The cytological in vitro controlled study was perormed at the Heart Center, Hebei Provincial People's Hospital from July 2007 to February 2009.MATERIALS: A total of 24 male pigs aged 2 months were purchased from Exparimental Animal Center, Hebei Medical University.METHODS: Bilateral femoral bone marrow was obtained from pigs under sterile condition. BMSCs were harvested by Percoll density gradient in vitro. At passage 2, BMSCs were treated with 10 μmol/L 5-aza, and incubated in DMeM without inductor 24 hours later. Indices were measured I, 2, 3 weeks following induction. A control group was set up, which was not treated with 5-azacitidine. Following bone marrow extraction, experimental pigs were anesthetized to obtain ventricular muscle. Normal ventricular muscle cells were isolated and cultured by tissue block enzyme digestion method.MAIN OUTCOME MEASURES: Expression of connexin-43 was measured by immunohistochemical staining (ABC method). Ito current density and action potential were determined by patch clamp technique.RESULTS: At 1 and 2 weeks following 5-aza induction, some BMSCs were positive for connexin-43, with the presence of brown particles surrounding nuclei. At 3 weeks, positive rate of connexin-43 was 95%. The area with large cell density was presented with similar structure to normal myocardium. At +80 mV, compared with normal myocardial cells, Ito current density was significantly reduced in BMSCs following 1 and 2 weeks and in the control group (P < 0.05). Ito current density was significantly increased to a normal levels in BMSCs 3 weeks following induction (P > 0.05). No action potential was detected in BMSCs following 1 and 2 weeks of 5-aza, and action potential could be determined 3 weeks following induction, which was identical to normal myocardial cells.CONCLUSION: Through induced by 5-aza for three weeks, BMSCs have the similar expression of connexin-43 and electrophysiological characteristics as normal myocardium.

Objective　To find out the appropriate bedbound period after Coronary Arteriography (CAG) in order to reduce the complications and uncomfort caused by prolonged Bedbound period and affected limb immobilization.Methods　121 cases of CAG patients were randomly divided into the reduced period group (experiment group) and the conventional group (the control group),two ways of nursing and observation respectively.Result　the rate of complication occurred in the experiment group much less than that of in the control group and the bedbound period were different as well.The above items showed statistics significance (P<0.005～0.05).Conclusion　The reduced bedbound period decreases the suffering of CAG patients and provides the reliable clinical evidence for proper nursing approach in this field.

Ancient traditional Chinese medical ethics thought is a value system with Pre-Qin Confucian benevolence thought as the core. Under the cultivation and regulations of Pre-Qin Confucian benevolence, such as "benevolent love", "taking life as morality" and "self-denial and ritual", ancient Chinese medicine gradually formed the medical ethics ideal of "helping the world and saving people", the medical ethics goal of "life is the most important" and emotion towards patient of "considering others in one’s own place". Learn from the past, cultivate the professional emotion of "saving people and helping the world" of medical staff through example education; using recessive education to guide both doctors and patients to respect their lives, thus creating a social atmosphere of mutual respect between doctors and patients, and advocating doctor-patient communication that apply oneself to others with the help of carrier education; the essence of ancient traditional Chinese medical ethics thought is integrated into the construction of contemporary medical ethics, so as to overcome the problem of medical ethics anomie that life is technicalized and medical services are materialized in today’s medical development, make contemporary medical ethics thought meet the needs of today’s medical development, make medical development return to benevolence and promote the healthy development of medicine.

Ancient traditional Chinese medical ethics thought is a value system with Pre-Qin Confucian benevolence thought as the core. Under the cultivation and regulations of Pre-Qin Confucian benevolence, such as "benevolent love", "taking life as morality" and "self-denial and ritual", ancient Chinese medicine gradually formed the medical ethics ideal of "helping the world and saving people", the medical ethics goal of "life is the most important" and emotion towards patient of "considering others in one’s own place". Learn from the past, cultivate the professional emotion of "saving people and helping the world" of medical staff through example education; using recessive education to guide both doctors and patients to respect their lives, thus creating a social atmosphere of mutual respect between doctors and patients, and advocating doctor-patient communication that apply oneself to others with the help of carrier education; the essence of ancient traditional Chinese medical ethics thought is integrated into the construction of contemporary medical ethics, so as to overcome the problem of medical ethics anomie that life is technicalized and medical services are materialized in today’s medical development, make contemporary medical ethics thought meet the needs of today’s medical development, make medical development return to benevolence and promote the healthy development of medicine.

The purpose of medical practice and attitude towards the remuneration of the ancient traditional Chinese medicine （TCM） practitioners have a high degree of commonality with Mozi’s concept of righteousness and benefit. Under the regulation of Mozi’s “ideology of valuing righteousness and advocating benefit”， ancient TCM practitioners formed the purpose of the medical practice of benefiting patients with skills and prioritizing righteousness， as well as the attitude towards the remuneration of balancing righteousness and benefit and gaining benefits from righteousness. Learning from the past to the present， the essence of TCM’s concept of righteousness and benefit was used to cultivate the pursuit of righteousness in medical practice among medical staff through infection education. Ideological and political education courses and media promotion were used to urge medical staff to keep the bottom line of medical practice of regulating benefit with righteousness. With the help of incentive mechanisms， various paths were constructed such as salary distribution that balanced righteousness and benefit incentive mechanisms， as well as organically integrated them into contemporary medical ethics education on the concept of righteousness and benefit， with a view to establishing a view of medical concept of righteousness and benefit that is in line with the current economic and social development， and to assist in building a harmonious doctor-patient relationship， promoting the medical health development， and building a human health community.

Objective To explore the correlation between serum cystatin C,lipoprotein associated phospho-lipase A2 (LP-PLA2) and lower limb vascular disease in patients with type 2 diabetes mellitus.Methods From August 2014 to December 2016,a total of 187 type 2 diabetic patients in Weihai Central Hospital were selected. According to the ankle brachial index (ABI),the patients were divided into without lower limb vascular disease group (SDM group,85 cases) and with lower limb vascular disease group (T2DM+LLVD group,102 cases).Meanwhile,82 healthy people were selected as control group.The cystatin C,LP-PLA2,hemoglobin (HbAlc),triglyceride,total cholesterol,high density lipoprotein cholesterol ( HDL-C) and low density lipoprotein cholesterol ( LDL-C) were calculated.Results Compared with the control group [(0.788 ±0.084)mg/L],the cystatin C was significantly high-er in the SDM group[(0.913 ±0.135)mg/L] and the T2DM +LLVD group[(1.114 ±0.225)mg/L],and the difference was statistically significant (t＝5.511,9.121,all P＜0.01).The cystatin C in T2DM+LLVD group was higher than that in the SDM group ( t ＝7.209,P ＜0.01 ).Compared with the control group [( 342.76 ± 33.49)ng/mL],LP-PLA2 was significantly higher in the T2DM+LLVD group[(513.54 ±94.26)ng/mL],and the difference was statistically significant ( t ＝11.428,P＜0.01 ).Compared with the SDM group [( 352.28 ± 67.82)ng/mL],the cystatin C and LP-PLA2 levels were significantly higher that in the T2DM+LLVD group,and the difference was statistically significant (t＝7.209,13.181,all P＜0.01).Conclusion Cystatin C and LP-PLA2 play important roles in type 2 diabetic patients with lower limb vascular disease.Cystatin C and LP -PLA2 may become the forecast indicators in type 2 diabetic patients with lower limb vascular disease.