Objective To analyze the distribution of pathogens and its characteristics of drug susceptibility originating from nosocomial infections in the intensive care units(ICU) ,and to provide evidence for clinical anti-infection treatments. Methods The data of the pathogens and their chug susceptibility characteristics were retrospectively analyzed. Many kinds of samples were collected in ICU from May 2008 to October 2009. Results There were 605 postive strains and the highest postive rate in sputum. The Gram-postive bacteria strains were 122 ,including 98 strains of staphylococcus where postive β-lactamases were 93. The drug susceptibility rate of linezolid, vancomycin and rifampin was 100% ,98. 2% and 86. 7% ,respectively. However,the drug resistant rate of oxacillin was 98.9%. Totallly 393 strains of the Gram-negative bacteria have been found, where pseudomonas aeruginosa, acinetobactor baumannii,enterobacter cloacae, stenotrophomonas maltophilia and klebsiella spp were 133,106,24,20 and 19 strains, respectively. The drug susceptibility rate of imipenem, aztreonam, levofloxacin and amikacin was 61. 6%, 42.0%, 38.8 % and 36. 1%, respectively. But the drug resistant rate of the third and fourth generation cephalosporin was over 70%. 90 strains of fungi were also found. The most common fungi infection was candida. Conclusion The nosocomial infections in ICU occurs mainly in respiratory tract,most infections are caused by gram negative bacilli. Imipenem and aztreonam have greater susceptibility to treat them. Gram positive coccus still plays an important role in nosocomial infections in the ICU and they high level of resist beta-lactamase-producing drugs. But they are susceptive to linezolid,vancomycin and rifampin.

[Objective] To evalvate the influence of total knee replacement(TKR)on the lipid peroxdation in erythrocytes,and the prophylactic treatment of Vitamin E and fructose 1,6-diphosphate(FDP)on it.[Method]Totally 60 patients of knee osteoarthritis were divided into control group,Vitamin E group,Fructose 1,6-diphosphate(FDP)group and Vitamin E added FDP group.Blood samples were taken for biochemical determination of MDA and Cu-Zn-SOD before and after the operation at 1,3,5 and 7 days.[Result]MDA level in erythrocytes increased singnificantly after TKR compared with that before operation(P

BACKGROUND: Jaw defects are common clinically. It is desirable to find ideal seed cells combined with scaffolds to construct tissue engineered jaws for curing these diseases. OBJECTIVE: To investigate the growth characteristics of bone marrow mesenchymal stem cells (BMSCs) transfected with basic fibroblast growth factor (bFGF) gene after seeded on coral scaffold in vitro. DESIGN, TIME AND SETTING: An experimental study of bone tissue engineering was performed in the Research Institute of Stomatology, Sun Yat-sen University between March 2006 and June 2008. MATERIALS: Natural coral from China Hainan bench was made into pieces of 8 mm×8 mm×2 mm. METHODS: BMSCs were isolated from New England rabbits by density gradient centrifugation and then purified by adherent separation. bFGF-pcDNA3 gene was transfected into BMSCs using Lipofectamine TM 2000. bFGF gene-transfected (transfected group) or untransfected (untransfected group)BMSCs were seeded on different coral scaffolds. In addition, bFGF gene-transfected BMSCs were simply cultured but not on the coral scaffold for control (simple culture group). MAIN OUTCOME MEASURES: BMSC proliferation was detected by methyl thiazolyl tetrazolium (MTT) assay and BMSC growth on coral scaffold was observed under the scanning electron microscope. RESULTS: MTT assay showed that the BMSC proliferation rate was significantly higher in the transfected group than in the untransfected group (P < 0.05) and that there was no significant difference in BMSC proliferation between the transfected and simple culture groups (P > 0.05). Scanning electron microscope results displayed that BMSCs adhered to and spread over the coral scaffold, exhibiting various appearances, with some cells had grown into scaffold micropores or spanned micropore surface, and some extracellular matrix secreted by BMSCs were found. CONCLUSION: The transfected group exhibited better growth of BMSCs transfected by bFGF gene than the untransfected group. These findings indicate that coral skeleton does not influence BMSC proliferation and can be used as a scaffold of BMSCs to construct tissue-engineered bone.

Objective To contrast the efficacy of mechanical stapler and hand suture for cervical esophagogastrostomy in the treatment of esophayeal cancer.Methods From January 2001 to August 2007,217 cases of cervical esophagogastrostomy were done in esophageal carcinoma.Among them.136 cases were treated by mechanical stapler and 81 cases by hand.Results The incidence of anastomotic fistula was 2.2%(3/136)in mechanical stapler group and 11.1%(9/81)in the group by hand.There was significant difference between the two groups(P＜0.95).The incidence of cervical incision infection was 2.9%(4/136)in mechanical stapler group and 14.8%(12/81)in the group by hand.There was significant difference between these two groups(P＜0.05).There was no significant difference between these two groups about pulmonary infection,arrhythmia,chylothorax and laryngeal nerve injury.Conclusion The incidence of anastomotic fistula and cervical incision infection was reduced by mechanical stapler which was displayed to advantage in esophagogastrostomy.

BACKGROUND:Recent studies have demonstrated that surgical trauma leads to lipid peroxidation in erythrocytes.However,injured erythrocytes play an important role in thrombosis following replacement.OBJECTIVE:To evaluate the influence of artificial total knee replacement on the lipid peroxdation in erythrocytes,and the prophylactic treatment of vitamin E and fructose 1,6 diphosphate(FDP)on it.DESIGN,TIME AND SETTING:Contrast clinical study,which was carried out in the Department of Otthopaedics,Affiliated Hospital of Nantong University from January 2003 to June 2006.PARTICIPANTS:Sixty patients with knee osteoarthritis who underwent artificial total knee replacement by anesthesia of epidural block were divided into four groups,including control group,vitamin E group,FDP group and vitamin E+FDP group,with 15 cases in each group.METHODS:Vitamin E was orally taken in the vitamin E group three days before replacement,three times a day,100 mg for each.The administration was performed until the surgical morning.Thirty minutes after the operation,FDP(10 g)was intravenously dripped in the FDP group.Additionally.vitamin E was also orally taken in the vitamin E+FDP group three days before replacement,three times a day,100 mg for each;on the surgical morning,FDP(10 g)was intravenously dripped on the first 30minutes.Blood samples were taken for biochemical determination before and after the operation at 1,3,5,and 7 days.MAIN OUTCOME M[EASURES:Corltents of malonaldehyde(MDA)and cuprum/zincum/superoxide dismutase (Cu-Zn-SOD)in the erythrocytes.RESULTS:MDA level in the vitamin E group and FDP group was significantly higher than that in the vitamin E+FDP group before and 5 and 7 days after replacement(P<0.05);while,Cu-Zn-SOD level was significantly lower(P<0.05).Otherwise,there were no significant differences in vitamin E+FDP group before and after replacement(P>0.05).CONCLUSION:The artificial total knee replacement can enhance lipid peroxidation and decrease antioxygen capability.However,the combination of vitamin E and FDP can prevent and relieve lipid peroxidation and antioxygen capability after replacement.

Objective To observe the clinical effects of early use of neuromuscular blocking agents (NMBA) in patients with severe sepsis and acute respiratory distress syndrome (ARDS).Methods A prospective study was conducted.96 patients with severe sepsis and ARDS admitted from July 2012 to September 2013 to intensive care unit (ICU) of Liuzhou People's Hospital in Guangxi Zhuang Autonomous Region were enrolled and divided into severe ARDS group (n=48) and moderate ARDS group (n=48) according to the Berlin definition of ARDS.Then patients in each group were randomly divided into treatment group (n =24) and control group (n=24).All patients with diagnosis in accordance with the 2008 international septic shock and severe sepsis treatment guidelines were provided with comprehensive treatment and mechanical ventilation on the basis of analgesia and sedation.The patients in treatment group were given a loading dose of vecuronium during mechanical ventilation,started with 0.l mg/kg up to 0.05 mg ·kg 1 ·h 1 for continuous intravenous infusion for 24-48 hours.The acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ) score,sequential organ failure assessment (SOFA),arterial oxygenation index (PaOfFiO2),central venous oxygen saturation (ScvO2),arterial blood lactate (Lac),C-reactive protein (CRP) levels of two groups were compared before treatment and 48 hours after treatment,and 21-day mortality rate was finally compared.Results In moderate or severe ARDS group,there were no statistically significant difference in APACHE Ⅱ score,SOFA score,PaO2/FiO2,ScvO2,Lac and CRP before treatment between two groups.APACHE Ⅱ score,SOFA score,PaO2/FiO2,ScvO2,and Lac 48 hours after treatment were significantly improved in severe ARDS group compared with control group [APACHE Ⅱ score:16.58 ± 2.41 vs.19.79 ± 3.52,t=3.679,P=0.010; SOFA score:12.04 ± 2.17 vs.14.75 ±3.26,t=3.385,P=0.010; PaO2/FiO2 (mmHg,1 mmHg=0.133 kPa):159.31 ±22.57 vs.131.81 ± 34.93,t=3.239,P=0.020; ScyO2:0.673 ± 0.068 vs.0.572 ± 0.142,t=3.137,P=0.030; Lac (mmol/L):3.10 ± 1.01 vs.4.39 ± 1.72,t=3.161,P=0.030],while the value of CRP (mg/L) showed no significant difference (180.91 ±37.14 vs.174.66 ± 38.46,t=0.572,P=0.570).21-day mortality in treatment group was significantly lower than that in control group [20.8％ (5/24) vs.50.0％ (12/24),x2=4.463,P=0.035].In moderate ARDS group,each of the above clinical parameters were improved in both groups expect for CRP at 48 hours after treatment,but the indexes showed no statistically significant difference between two groups (all P＞0.05).21-day mortality rate in the treatment group was slightly lower than that in the control group which showed no statistically significant difference [16.7％ (4/24) vs.25.0％(6/24),x2=0.505,P=0.477].Conclusion The early use of NMBA treatment of patients with severe sepsis and severe ARDS cannot only improve the severity but also reduce 21-day mortality.

Aim To investigate the vasorelaxation effects of saponins from flower of Panax notoginsen on the isolated thoracica aorta ,and to explore its possible mechanism.Methods Total saponins were extracted and high phase liquid chromatography was utilized to describe saponins ingredients;SD rat thoracic aortas were isolated.In vitro vascular ring experiment was used to observe,basal state of saponins on vascular ring,and high concentrations of K+solution pre-con-traction and phenylephrine (PE ) pre-contraction caused by systolic and diastolic function of the re-sponse.And different inhibitors were combined to ex-amine the possible mechanism of notoginsenoside in vascular ring.Results Cumulative concentration of saponins had no significant effect on the basis of state vessels,but had significant effect on endothelium-in-tact aortic (MAX Relaxation 23.6%) rings pre-con-tracted by high concentrations of K+;endothelium and endothelial aortia had significant effect on PE pre-con-traction, and endothelium MAX relaxation was 55.5 1%.Calcium-free solution and saponin cultivated aortic rings significantly inhibited pre-contraction.Af-ter nitric oxide synthase inhibitor L-NAME and indom-ethacin incubating vascular ring ,it could significantly inhibited vasodilatory effect of saponin.Conclusion Saponins have concentration dependent diastolic func-tion on rat thoracic aorta,and its main ways cause vas-odilation.Endothelial dependent diastolic function is related to activation of nitric oxide synthase and cy-clooxygenase pathway.

Objective To evaluate the outcome of radiotherapy for recurrent esophageal cancer after surgery and to determine the prognostic factors. Methods From Jan 2004 to Dec 2009, 93 patients of esophageal carcinoma with loco-regional recurrence as the first site of failure after surgery were retrospectively reviewed. Kaplan-Meier method was used to analyze the survival. Logrank test was used to evaluate the difference between the groups. Multivariate survival analysis was conducted using a Cox proportional hazard regression model with a backward stepwise procedure. Results The overall survival rates at 1, 2 and 3 years were 40. 9% , 10. 1% and 6. 7% ,respectively,but with a median survival time of 11.0 months(95% CI 9. 4-12. 6) . In univariate analysis, age,PS, radiation dose and retreatment methods were independent prognostic factors. In multivariate analysis, only radiation dose and retreatment methods were independent prognostic factors for overall survival. Conclusions The prognosis of patients with postoperative loco-regional recurrence of esophageal cancer is poor. However, a long-term survival maybe expected by definitive chemoradiotherapy.

Objective To study the clinicopathological features in the diagnosis of serous microcystic adenoma of pancreas.Method A clinicopathological and immunohistochemical study was conducted on 7 patients with serous microcystic adenoma of pancreas.Results All the patients were female,with a mean age of 51 years.Clinical symptoms were present in 2(28.6％)patients.On microscopy,the tumor composed of variable-sized cysts.The cyst wall was covered by simple cuboidal epithelium.The cytoplasm was clear and glycogen-rich.The nucleus of the epithelial cells was small and round.In the center,there was no nucleolus and no nuclear division.There were bulky fibrous tissues between the cystic cavities.Immunohistochemical study showed AE1/AE3,CK7,CK8,CK19,CK/LMW,EMA were positive,and CEA,CD31,CD34,D2-40,Syn,CgA,Calretinin,Vim were negative.Conclusions Serous microcystic adenoma of pancreas is a rare tumor,which was common in old women.Serous microcystic adenoma of pancreas is a benign tumor with good prognosis.The diagnosis is made on histopathological and immunohistochemical study.

Objective To explore the outcomes and prognostic effects of Ivor Lewis esophagectomy and evalue the N staging.Methods Participants comprised 1145 patients with ESCC from Jan.2004 to Dec.2013,who under-went Ivor Lewis esophagectomy.The clinicopathologic data were analyzed.Kaplan -Meier and Cox regression methods were used for survival analysis.Results The morbidity of postoperative complication was 9.15% and with 1.83% of motality.The 1 -,3 - and 5 -year survival rates were 84.2%,58.4%,47.9% respectively.The median survival time was 55 months and average survival time was (70.16 ±2.086)months.Cox model multivariate analysis was used for those of P <0.05 in single variate analysis.Univariate analysis revealed that gender(P =0.003),smoking history (P =0.013),alcohol history(P =0.017),tumor location(P =0.001),body mass index(P =0.008),tumor length (P =0.000),differentiation degree(P =0.000),numbers of metastic zones(P =0.000)of lymph node metastasis (P =0.000),depth of invasion (P =0.000),pathological staging(P =0.000),vascular tumor thrombus (P =0.000),nerve involvement(P =0.000)and postoperative adjuvant therapy(P =0.000)were influencing prognosis factors.And multivariate analysis revealed that differentiation degree(P =0.000),depth of invasion(P =0.000), numbers of metastic zones (P =0.013 )of lymph node metastasis (P =0.000)were independent risk factors. Conclusion Ivor Lewis esophagectomy was a safe and effective treatment,and tumor differentiation degree,depth of invasion,numbers and zones of lymph node metastasis were important prognostic factors.