This article summarizes our experience in nursing 40 gastric carcinoma patients receiving fast track(rapid recovery) surgery,proposing that the emphasis of nursing should be placed on psychological care and health education before the operation,warm-keeping during the operation,pain control,early food intake,early movement and management of complications after the operation,and necessary follow-up after discharge.

Objective To investigate the protective effect of resveratrol on ultraviolet A (UVA)-irradiated human fibroblasts and its mechanism.Methods Fibroblasts were isolated from normal human foreskin and subjected to primary culture and four passages of subculture.Then,some fibroblasts were incubated with various concentrations (0.01,0.1,0.5 and 1.0 mmol/L) of resveratrol for 6,24,48 and 72 hours separately,followed by methyl thiazolyl tetrazolium (MTT) assay for the evaluation of cell proliferation.Some fibroblasts were classified into four groups:blank control group remaining untreated,UVA group irradiated with UVA only,0.01 and 0.1 mmol/L resveratrol groups receiving UVA irradiation immediately followed by treatment with resveratrol of 0.01 and 0.1 mmol/L respectively.The dose of UVA irradiation was consistently 10 J/cm2 in these groups.After additional culture for 6,24,48 and 72 hours,MTT assay was conducted to evaluate cell proliferation,enzyme-linked immunosorbent assay (ELISA) to measure the levels of interleukin (IL)-1α,IL-1β,and IL-6 in the culture supernatant.Results Resveratrol at 0.5 and 1.0 mmol/L significantly inhibited the proliferation of fibroblasts,with the strongest inhibitory effect observed at 72 hours when the cell survival rate was 31.99％ ± 8.29％ and 21.15％ ± 5.76％,respectively.After irradiation with UVA of 10 J/cm2,the survival rate of fibroblasts was 78.01％ ± 12.74％ at 6 hours and 80.64％ ± 36.12％ at 72 hours,compared to 100.04％ ± 10.78％ and 99.95％ ± 12.23％ in the blank control group respectively (both P ＜ 0.05); the supernatant levels of IL-1α,IL-1β and IL-6 were significantly increased compared with the blank control group at 6 hours ((58.39 ± 0.67) vs.(48.51 ± 6.20) ng/L,(1294.37 ± 92.51) vs.(1023.25 ± 86.40) pg/L,(197.81 ± 6.37) vs.(160.45 ± 7.19) ng/L,all P ＜ 0.05),and the increase still existed at 72 hours for IL-1β ((1236.76 ± 56.49) vs.(1045.55 ± 48.14) pg/L,P＜ 0.05) and IL-6 ((215.65 ± 3.78) vs.(195.09 ± 1.78) ng/L,P ＜ 0.05).Compared with the UVA group,the 0.01 mmol/L resveratrol group showed significantly higher survival rates at all the four time points (all P ＜ 0.05),but lower supernatant levels of IL-1α at 6,24 and 48 ((43.89 ± 3.60) vs.(51.77 ± 1.77) ng/L,P＜ 0.05) hours as well as IL-lβ and IL-6 at all the four time points (all P ＜ 0.05),while the 0.1 mmol/L resveratrol group experienced no significant changes in cell survival rate at any of the time points,with a significant decrease only in the supernatant level of IL-6 at 6 and 24 ((182.90 ± 6.67) vs.(240.62 ± 1.42) ng/L,P ＜ 0.05) hours.In detail,the survival rate of fibroblasts was 91.93％ ± 12.90％,with the supernatant level being (1110.12 ± 51.91) pg/L for IL-1β and (201.94 ± 4.71) ng/L for IL-6 at 72 hours in the 0.01 mmol/L resveratrol group,compared to 80.64％ ± 36.12％,(1236.76 ± 56.49) pg/L and (215.65 ± 3.78) ng/L respectively in the UVA group (all P＜ 0.05).Conclusion Resveratrol at 0.01 mmol/L has a protective effect on UVA-irradiated fibroblasts,likely by inhibiting the secretion of IL-1α,IL-1β and IL-6.

Aim To purify Phospholipid-binding anticoagulation protein(PBAP) from Agkistrodon halys Brevicaudus Venom and study the biochemical characterization.Methods The Phospholipid-binding anticoagulation protein was purified from Agkistrodon halys Brevicaudus Venom by Cation ion exchange chromatography on CM Sephadex C-25 and negative ion exchange chromatography on DEAE Sepharose CL-6B,gel filtration on Sephacryl S-200 and Sephadex G-75 chromatography.Its anticoagulant activities in vitro were assayed by activated partial thromboplastin time(APTT);its molecular weight was calculated by SDS-polyacrylamide gel electrophoresis(SDS-PAGE) and its isoelectric point was estimated by the isoelectric focusing electrophoresis.Binding experiments of anticoagulation protein to phospholipids vesicles were performed with thinlayer chromatography.Results A kind of protein was purified from Agkistrodon halys Brevicaudus Venom which was able to prolong APTT.The SDSPAGE showed that it was dimer and its molecular weight was 24.0?10~3 under non-reducing condition and 14.6?10~3 under reducing condition.The isoelectric point was pH 5.2 by the isoelectric focusing electrophoresis.Having arginine ester-hydrolyzing enzyme and binding Phospholipid activify,its effect on APTT was activity stronger with concentration increasing.Conclusion It is a successful method of the purification of Phospholipid-binding anticoagulation protein from the Agkistrodon halys Brevicaudus Venom.

Objective To investigate the distribution and the antibiotic resistance profile of clinical isolates in the First Affiliate Hospital of Anhui Medical University during 2015.Methods Antimicrobial susceptibility testing was carried out according to a unified protocol using Kirby-Bauer method and automated systems.Results A total of 5 524 nonduplicate clinical isolates were collected during 2015,including gram-negative bacteria (3 882,70.3 ％),gram-positive bacteria (1 642,29.7 ％).The prevalence of methicillin-resistant isolates in Staphylococcus aureus (MRSA) and coagulase-negative Staphylococcus (MRCNS) was 57.6％ and 83.0 ％,respectively.All staphylococcal isolates were susceptible to vancomycin and linezolid.E.faecalis and E.faecium accounted for 46.1％ and 46.8 ％ of enterococcal isolates.Some E.faecalis and E.faecium strains were nonsusceptible to vancomycin or linezolid.The prevalence of extended-spectrum lactamases (ESBLs) positive strains was 62.0 ％ in E.coli,32.2 ％ in Klebsiella and 18.8 ％ in Proteus mirabilis.Enterobacteriaceae strains were still highly susceptible to carbapenem antibiotics,evidenced by lower resistance rate of Enterobacteriaceae strains to ertapenem,imipenetn and meropenem (a11＜22 ％).Conclusions It seems that antibiotic resistance still poses a serious threat to clinical antimicrobial therapy.More attention should be paid to resistance surveillance and rational use of antibiotics.

OBJECTIVE To investigate and analyze the antibiotic usage in infectious disease hospital,and offer(scientific) rule for antibiotic usage.METHODS The retrospective investigation of antibiotics usage in 1991 in-(patients) from Sep 2004 to Mar 2005 was carried out.RESULTS From 1991 patients,909 patients used antibiotics,percentage of antibiotic usage was 45.7%;66.7% patients used one antibiotic,28.6% patients used twice,(4.73%) used triple.From them 29.3% were used for prevention,and 70.85% for treatment;of all the unsuitable use,widen range of the indication,longer(usage),changing frequently,etc were the main causes.CONCLUSIONS Unsuitable usage of antibiotics could be found in our hospital.It is necessary for hospital to strengthen the (management) of antibiotic usage in inpatients.

Objective To evaluate the impact of three to four cycles of neoadjuvant chemotherapy (NACT) on the survival of patients with N2-N3 nasopharyngeal carcinoma (NPC).Methods The clinical data of 915 patients with T1-4N2-3M0 NPC from 2007 to 2010 were retrospectively analyzed.A total of 179 patients treated with 3-4 cycles of NACT (NACT≥3 group) were matched with 358 patients treated with 2 cycles of NACT (NACT=2 group) and 179 patients treated without NACT (NACT =0 group,concurrent chemoradiotherapy group) for age,N stage,pathological subtype,and NACT regimen.The Kaplan-Meier method was used to calculate overall survival (OS),disease-free survival (DFS),recurrence-free survival (RFS),and distant metastasis-free survival (DMFS) rates,the log-rank test was used for survival difference analysis and univariate prognostic analysis,and the Cox proportional hazards model was used for multivariate prognostic analysis.Results For the NACT≥ 3,NACT =2,and NACT =0 groups,the 5-year OS rates were 89.4％,81.6％,and 73.7％,respectively (P=O.000),the 5-year DFS rates were 83.2％,69.8％,and 64.2％,respectively (P=O.000),the 5-year RFS rates were 86.0％,76.0％,and 69.3％,respectively (P=0.001),and the 5-year DMFS rates were 86.6％,76.0％,and 68.3％,respectively (P=0.000).Three to four cycles of NACT was an independent protective factor for OS,DFS,RFS,and DMFS in patients with N2-N3 NPC.Conclusion Three to four cycles of NACT can significantly improve the survival of patients with N2-N3 NPC.

Objective To compare the efficacy and safety of the non-invasive high frequency ventilation (NHFV) and non-invasive intermittent positive pressure ventilation (NIPPV)in neonates with respiratory distress syndrome (RDS) after extubation.Method Neonates with RDS from January 2015 to January 2016,who required high frequency ventilation after birth and were extubated after treatment were retrospectively studied.The enrolled patients were divided into NHFV group and NIPPV group to compare the rate of successful extubation within 7 days,non-invasive respiratory ventilation support time and complication incidence.Result In total 42 neonates were included,NHFV group were 21 cases and NIPPV group were 21 cases.The rates of successful extubation were not statistically different (71.4％ vs.80.9％,P ＞ 0.05);Compared with NIPPV group,NHFV group had shorter ventilation time [3.5 (2.2,4.1) d vs.4.6 (2.8,5.3)];the incidence of bronchopulmonary dysplasia,pneumothorax,intraventricular hemorrhage,periventricular leukomalacia,retinopathy of premature and necrotizing enterocolitis between groups were not statistically different (P ＞ 0.05).Conclusion NHFV is a new safe and efficient ventilation support method for extubated neonates,and needs further research.

Objective To investigate the clinical features and prognostic factors of nosocomially acquired candidemia.Methods A retrospective analysis was conducted for hospitalized patients with nosocomial candidemia between January 2012 and December 2014 at the First Affiliated Hospital of Anhui Medical University.The univariate and multivariate Logistic regression analyses were used to determine the prognostic factors of candidemia.Results A total of 92 patients were diagnosed with nosocomially acquired candidemia.The most common pathogen was Candida glabrata (C.glabrata,39/92,42.4％),followed by Candida albicans (C.albicans,30/92,32.6％),then Candida krusei (C.krusei,7/92,7.6％),Candida tropicalis (C.tropicalis,5/92,5.4％),Candida parapsilosis (C.parapsilosis,4/92,4.4％) and other Candida spp.(7/92,7.6％).The sensitivity rates of Candida spp.strains against flucytosine,amphotericin B,voriconazole,fluconazole and itraconazol were 100.0％,98.9％,92.4％,82.6％oo and 77.2％,respectively.The 30-day attributable case fatality rate was 13.0％(12/92).Multivariate Logistic regression analyses indicated that presence of central venous catheter (OR=4.833,95％CI:1.010-23.125,P=0.049),invasive mechanical ventilation (OR=6.075,95％CI:1.144-32.257,P=0.034),and receiving hemodialysis (OR =8.367,95 ％ CI:1.390-50.364,P =0.020)were factors independently correlated with increased mortality.Conclusions The pathogens causing nosocomially acquired candidemia are mainly C.glabrata,C.albicans and C.krusei.The drug susceptibility of Candida spp.varies among fluconazole,itraconazol voriconazole.The resistant rates of Candida spp.against voriconazole,fluconazole and itraconazol are different.The presence of central venous catheter,invasive mechanical ventilation and receiving hemodialysis are factors independently correlated with increased mortality.

Objective Discuss medical health integration continuance management mode in the prevention of elderly patients after discharge in bed household application effect of pressure ulcers. Methods To 120 cases of elderly patients in bed in hospital time order is divided into control group and experimental group,by the medical health outreach group respectively in the hospital two days before the assessment of patients and family rehabilitation plan,the control group given conventional discharge and telephone follow-up after discharge,the experimental group according to the medical health integration management mode,made up of medical health outreach team to stay in bed for elderly patients after discharge pressure ulcer risk factors assessment,targeted prevention of pressure sores rehabilitation plan,group management,remote care joint family supervision,timely follow up the capa and the exami-nation of the effect,the pressure ulcer management and quality of life scale to compare two groups of patients at discharge,6 months after hospital discharge,the quality of life of 12 months after discharge and the incidence of pressure ulcers in a year. Results The experimental group was lower than those of control group,the incidence of pressure ulcers was statistically significant difference(P<0.05); 6 months and 12 months after discharge physiological field,psychological field in the quality of life score were higher than control group,the difference was statistically significant(P<0.05); Score compared two groups of environmental and social sciences has no statistical significance (P>0.05). Conclusion Medical health integration continuance management can effectively reduce the incidence of pressure ulcers that occupy the home stay in bed for elderly patients,improve their quality of life.

OBJECTIVE To investigate beta-lactamases production in multi-resistant Citrobacter strains isolated from the First Affiliated Hospital of Anhui Medical University.METHODS Standard agar dilution method was used to determine the minimal inhibitory concentration(MIC) of 52 clinically isolated Citrobacter strains,improved three-dimensional tests were performed to detect the ESBLs-producing,AmpC-producing and MBL-producing strains in 31 Citrobacter isolates,then beta-lactamases-encoding genes were amplified by polymerase chain reaction(PCR).RESULTS Thirty one Citrobacter strains were resistant to many beta-lactams antibiotics.Twenty four strains ESBLs-producing,3 AmpC-producing and 2 ESBLs-producing plus AmpC-producing strains have been detected by improved three-dimensional tests,and not found MBL-producing ones.Twenty strains had blaTEM gene and 1 strain had blaSHV gene,8 strains had blaCTX-M-1 gene,15 strains had blaCTX-M-13 gene and 5 strains had blaCIT gene by PCR.CONCLUSIONS Multi-resistant Citrobacter strains produce one or more types of ESBLs and AmpC beta-lactamase,it may be an important reason of resistance to beta-lactams antibiotics.