Objective To investigate the distribution of pathogens detected in blood cultures and the value of double blood cul‐ture .Methods There were 2 033 cases of blood cultures including 1 425 cases of single blood culture and 608 cases of doube blood cultures were in the study .Blood cultures were performed by using Bact/Alert3D automated detection system ,and the positive blood culture results were statistically analyzed .Results There were 251 blood culture positive samples ,the detection rate was 12 .3% (251/2 033) .Among them ,the positive rate of single blood culture was 11 .9% (169/1 425);positive rate of double blood culture was 13 .5% (82/608) .There were 216 strains of pathogenic bacteria(repeatedly culture of the same pathogen from the same patient only accounted for 1 strain) .The isolates of gram positive(G+ ) cocci accounted for 65 .7% (142/216) and the major bacteria were coagulase negative Staphy lococci .Escherichia coli and Acinetobacter baumannii were the dominant isolates among Enterobac‐teriaceae[accounted for 20 .8% (45/216)] and Non‐fermenting gram‐negative(G-) rods[accounted for 8 .8% (19/216)] ,respective‐ly .The isolating rate of doube blood cultures was significantly higher than the single one(P<0 .05) .Coagulase‐negative staphylo‐coccus were isolated primarily in single blood culture and double blood culture with only one test postive .Non‐fermenting gram‐neg‐ative rods and fungi were the most common strains isolated from double blood culture with two tests both postive .Conclusion The distributions of pathogens isolated from single blood culture ,double blood culture with only one test positive and two tests positive are different .Because collecting double sets of blood cultures can significantly increase the isolating rates and distinguish contamina‐tion from real bloodstream infection ,collecting double sets of blood cultures should be recommended .Double blood culture is helpful to improve the detection rate of pathogenic bacteria and bacteria identification .

Objective To investigate the aim antigen coursing the hyperacute rejection of xenotransplantation. Methods Documents about hyperacute rejection in xenotransplantation were reviewed and summarized in detail. Results Pig is thought to be one of the ideal donors of xenotransplantation, but the major obstacle is hyperacute rejection mediated by complement that is activated though human serum. ?-Gal is recognized as the major antigen and its expression is controlled by ?-1,3 galactosyltransferase. Immunoabsorption of pre-exsisted antibody, enzymatic digestion of ?-Gal, knockout ?-GT gene and transgenic technology have been used to solve this problem. Even so, there remain other antigens which can combine with natural antibodies in human serum, such as, 40?10 3 molecule in erythrocyte, 210?10 3, 10 5?10 3 and 50?10 3 antigen in pig embryo brain cell, etc. Conclusion ?-Gal is the major antigen which course the hyperacute rejection. Besides ?-Gal, many nonalpha-gal need further investigation.

Unclear clinical orientation in practice has become one of the common problems with the effective application of famous and excellent Chinese herbal drugs, consequently restricting their development. The authors suggest that there are three aspects to be considered in dealing with this problem. Clinical evaluation and orientation of the famous and excellent Chinese herbal drugs is an important task, and it is also a requirement for the internationalization of traditional Chinese medicine. Literature evaluation-pharmacology research-clinical expertise analysis method will establish a theoretical basis and method for post-marketing development of famous and excellent Chinese patent drugs.

OBJECTIVE:To study the action mechanism of the self-made Wuhuang tang(Chinese medicine)in the treatment of type Ⅲ prostatitis(chronic nonbacterial prostatitis,CNBP)so as to promote the action mechanism of traditional Chinese medicine to the molecular level.METHODS:90 patients with CNBP were divided into two groups(n=45 each):one group received western medicine alone,another group received integrated Chinese and western medicine(ICWM)(Wuhuangtang plus western medicine).The indicators such as the expressed prostatic secretions(EPS)routine,IL-1?,and TNF-? before and after the treatment were analyzed statistically.RESULTS:The levels of IL-1? and TNF-? in ICWM-treated group decreased significantly and the clinical symptoms of these patients improved significantly as compared with those treated with western medicine alone.CONCLUSION:The self-made Wuhuang tang can markedly alleviate the symptoms of CNBP patients and decrease levels of IL-1? and TNF-? in patients' EPS,thus it is an effective clinical empirical prescription for CNBP.

Objective To investigate the application and nursing care of bronchoalveolar lavage (BAL)by fiberoptic bronchoscopy in patients with mechanical ventilation. Methods 64 patients with mechanical ventilation in RICU were randomly divided into the control group and the observation group with 32 patients in each group. The patients in both groups were accepted anti-infection, atomization inhalation and other supportive treatments. The patients in the observation group were treated with BAL, and the patients in the control group accepted routine treatment. The therapeutic effects in the two groups were evaluated and compared. Results There was significant difference in the recovery rate and effective rate, the blood gas analysis compared with the control group was significantly improved, the time of pulmonary infection control window, mechanical ventilation, length of stay were shorter than the control group. The case number to remove ventilator successfully, organs failure and hospital mortality were less than the control group. Conclusions Fiberoptic bronchoscopy with BAL treatment could be safety and efficacy for patients with mechanical ventilation. Nursing intervention plays an important role and a good therapeutic effect for improving achievement ratio of BAL.

Objective:To analyze the relationship between the gastric diseases classification under endoscopy and infection and antibiotic resistance of Helicobacter pylori ( H. pylori) based on the data of gastric diseases classification under endoscopy, H. pylori isolation and antibiotic resistance. Methods:From January 1, 2015 to December 31, 2019, endoscopic diagnosis and the data of drug susceptibility of H. pylori of 5 441 patients with benign gastric diseases along with gastrointestinal symptoms who visited The First People′s Hospital of Putuo District of Zhoushan were retrospectively collected. The H. pylori infection in patients with different genders and different types of gastric diseases and the drug resistance rates of H. pylori among different antibiotic types were analyzed. Chi-square test was used for statistical analysis. Results:The positive rate of H. pylori in 5 441 patients with benign gastric diseases was 51.37% (2 795/5 441). The drug resistance rates of clarithromycin, levofloxacin, metronidazole, amoxicillin, tetracycline and furazolidone were 26.73% (747/2 795), 43.22% (1 208/2 795), 98.68% (2 758/2 795), 0.32% (9/2 795), 0 and 0, respectively. Among the 2 795 cases of H. pylori-positive patients, only 23 cases (0.82%) were sensitive to all six antibiotics; 1 263 cases (45.19%) were resistant to single antibiotic; 1 072 cases (38.35%) were resistant to combination of two antibiotics, and 433 cases (15.49%) were resistant to combination of three antibiotics. The drug resistance rate to three antibiotics, clarithromycin, levofloxacin and metronidazole simultaneously was the highest (15.31%, 428/2 795). And only four patients (0.14%) were simultaneously resistant to four antibiotics clarithromycin, levofloxacin, metronidazole and amoxicillin. H. pylori infection rate in men was higher than that in women (55.23%, 1 615/2 924 vs. 46.88%, 1 180/2 517), and the difference was statistically significant ( χ2=37.76, P<0.01). However there were no statistically significant differences in the drug resistance rates of six antibiotics between different gender among H. pylori-positive patients (all P>0.05). There was statistically significant difference in the positive rate of H. pylori among patients with different types of gastric diseases ( χ2=909.07, P<0.01). The positive rate of H. pylori was the highest in patients with duodenal ulcer (97.53%, 79/81), and the lowest in patients with bile reflux gastritis (19.79%, 37/187). There were statistically significant differences in the drug resistance rates of metronidazole, clarithromycin, levofloxacin and amoxicillin among 9 types of gastric diseases ( χ2=24.75, 38.62, 80.54 and 7.01, all P<0.01). Conclusions:The positive rate of H. pylori and antibiotic resistance rate are different in patients with different types of gastric diseases. It is necessary to pay attention to the selection of drugs for ulcerative diseases in the process of clinical treatment. Individualized treatment is recommended according to the results of antibiotic susceptibility test.

Objective To explore whether anoxia can induce expression changes in connective tissue growth factor(CTGF)in renal tubular epithelial cells(TECs)and epithelial-mesenchymal transition of TECs.Methods Rat renal TECs(NRK-52E)anoxia models were established.NRK-52E cells were exposed to anoxia for 4 h.The real-time RT-PCR,Western blotting,immunohistochemical staining were used to detect the expression of CTGF at 6,12,24,48,and 72 h in NRK-52E cells.Morphological changes and cytoskeleton remodeling in NRK-52E cells under anoxia were examined by a laser confocal microscope and BODIPYFL staining respectively.Results Under anoxia,NRK-52E cells became round,enlarged and cytoskeleton was remodeled.The expression levels of CTGF mRNA and protein were up-regulated at 6 h,reached their peak at 48 h:the expression of CTGF mRNA protein was 29.33±0.21 and 1.30±0.02 respectively.Under anoxia,NRK-52E cells underwent an epithelial-mesenchymal transition process,including cytoskeleton remodeling,and morphological changes.Conclusion Anoxia can change the expression of CTGF and other fibrosis-associated genes in NRK-52E cells,and CTGF played an important role in fibrosis process and epithelial-mesenchymal transition development in NRK-52E cells.

The authors briefly introduced the management of clinical test for new drug development, clinical trials for drugs prepared in hospital and post-market drugs, and other types of clinical trials. The mechanism of WHO International Clinical Trial Register Platform (WHO ICTRP), Chinese Clinical Trial Register (ChiCTR) and Chinese Clinical Trial Registration and Publishing Collaboration (ChiCTRPC) were also introduced. The authors suggested the trialists to practice the basic philosophy of evidence-based medicine as the rules of their thought and action, and considered that this is the inner guarantee system for the validity of clinical trials.