OBJECTIVE To investigate the distribution and drug resistance of nosocomial infection pathogens. METHODS Statistical methods were used to analyz the data of pathogens origin and drug resistance from 2005 to 2007. RESULTS A total of 326 strains were isolated from 604 nosocomial infection cases (54.0%),from which the Gram-negative bacilli were predominate (44.1%). The isolation rate ot fungi and Gram-positie bacteria was 41.6% and 14.3%,respectiviely. The top three pathogens were the fungi (41.6%),Pseudomonas aeruginosa14.3%,and enterobacter (10.6%). The rate of ampicillin-resistant Escherichia coli was 100%.The isolation rate of MRSA and MRCNS was up to 100.0% and 80.0%. CONCLUSIONS Fungi is common high among pathogens.The emergence of drug-resistant pathogens will continue to be a serious problem,we must take it intimately.

ced glutathione in MHD patients appears to be associated with an improvement of oxidative stress.

Objective To investigate the prevalence status of overweight and obesity among the middle‐aged and elderly pop‐ulations in southwest area and their influence factors .Methods By adopting the stratified cluster sampling method ,the mode of the questionnaire investigation combined with the physical examination was adopted to collect the effective data in 7 205 permanent resi‐dents aged 40-79 years old in cities and countries of Chongqing and Chengdu ,including the contents of age ,waistline ,hipline ,dias‐tolic blood pressure ,heart rate ,postprandial blood sugar ,triglyceride ,exercise frequency ,uric acid ,etc .The prevalence rates of over‐weight and obesity among the middle‐aged and elderly populations in southwest area and their distribution characteristics in cities and countries ,and in male and female populations were described .The related influence factors of overweight and obesity were in‐vestigatedResults The prevalence rate of overweight was 35 .91% among the middle‐aged and elderly populations in southwest area (37 .02% for cities ,32 .92% for countries ,33 .84% for males and 37 .41% for females);the prevalence rate of obesity was 11 .40%(11 .13% for cities ,11 .40% for countries ,8 .94% for males and 12 .84% for females);among them ,the overweight rate in cities was higher than that in countries ,the overweight rate in females was higher than that in males .The obesity rate in females was higher than that in males(P<0 .01) ,the obesity rate had no difference between cities and countries(P>0 .05) .The multivariate re‐gression analysis showed that lack of exercise ,overweight or obesity family history were the risk factors of male overweight and o‐besity ,while the difference between cities and countries ,lack of exercise were the risk factors of female overweight and obesity .Con‐clusion The overweight and obesity rates among the middle‐aged and elderly populations in southwest area are high ,the body mass in nearly half of people exceeds the normal standard .Strengthening the overweight and obesity related health education in communi‐ties and restraining the serious trend of overweight in the population of this area have an important significance for the prevention and treatment of cardiovascular diseases .

Objective To report three cases of fulminant ulcerative colitis (FUC) treated with infliximab (IFX) and the positive result for clinical purpose. Methods Three patients with FUC were infused with IFX (5 mg/kg) at interval of 0, 2, 6 wk. Sulfasalazine or probiotics was used for the maintanance of remission. The mucosal healing was evaluated by endoscopy and patholoic examination. ResultsComplete remission was found in 3 patients with FUC. Eight weeks after IFX withdraw, complete remission was found in two of three cases demonstrated by endoscopy, except for one case died from refractory ventricular tachycardia. The remaing 2 cases showed no active manifestation during 8 months' follow-up. Conclusion IFX therapy results in complete remission in 3 cases with FUC. However, further randomized control study is warranted for concrete evaluation on salty and application clinically.

Objective To report the nursing care for a patient with resistant hypertension underwent bilateral renal denervation therapy by cryofocus cryoablation system.Methods We summarized the nursing care work, which included the operation preparation, observation points, service during the operation, and the essential instruction for inpatient care and future follow-up, for one case of patient with resistant hypertension underwent bilateral renal denervation through the femoral pathway in February 2016. Results The whole operation spent 60 minutes, and after operation, the patient′s blood pressure decreased from 200/110 mmHg to (152.38±24.53)/ (83.65±12.71) mmHg. The operation was successful and the patient was discharged 3 days after operation. In the 3-month follow-up, the 24-hour mean blood pressure was 128/70 mmHg, without the presence of operation-related or nursing-related complications. Conclusions The perioperative nursing care includes the good preoperative preparation, precise nursing during the operation, and further intensive observation, which would facilitate the operation process, avoid the risk, and guarantee the operation quality.

Objective Ti explire the applicatiin if PDCA circled management in the nurs-ing if intrathecal drug infusiin.Methods The changes if pain alleviatiin,cimplicatiins and health educatiin befire and after PDCA circled management in 25 patients were ibserved in 25 patients. Results Intractable pain in terminal cancer patients was much mire relieved after PDCA nursing. Conclusion PDCA cycle management can significantly imprive the life quality if patients and re-duce the cimplicatiins.

Objective Ti explire the applicatiin if PDCA circled management in the nurs-ing if intrathecal drug infusiin.Methods The changes if pain alleviatiin,cimplicatiins and health educatiin befire and after PDCA circled management in 25 patients were ibserved in 25 patients. Results Intractable pain in terminal cancer patients was much mire relieved after PDCA nursing. Conclusion PDCA cycle management can significantly imprive the life quality if patients and re-duce the cimplicatiins.

Objective:To explore the treatment method and clinical effect of chronic diabetic wounds of lower limbs in elderly patients with comorbidities.Methods:The clinical data of elderly comorbid patients with chronic diabetic wounds of lower limbs admitted to Chongming Hospital Affiliated to Shanghai University of Medicine & Health Sciences from December 2019 to November 2022 were retrospectively analyzed. Multidisciplinary consultation and comprehensive evaluation were conducted for the patient before surgery and the indicators related to the underlying disease were also adjusted to the safe range for surgery. The wound secretions were taken in time for bacterial culture and drug sensitivity test, and the wound was treated with dressing change and other standardized treatments. According to the location, shape, size and depth of the lower limb wound defect, as well as the infection degree, duration of infection, and extent of surrounding skin damage, debridement, vacuum sealing drainage, tension-reduced suture, skin or flap transplantation, limb (toe) amputation and other method were selected for treatment. After surgery, the prevention and control of the comorbidities of the elderly and nursing management were continued, and the wound healing was observed. According to the evaluation criteria of flap swelling at grade 4 (increased from grade Ⅰ to grade Ⅳ), the swelling degree of the lower leg and dorsum of the foot was evaluated in the early stage (3 to 12 weeks) and the later stage (13 to 52 weeks). At the last follow-up, according to the evaluation criteria of the ankle joint wound repair, the curative effect was comprehensively evaluated (excellent, good, general, poor), and the satisfaction evaluation (satisfied, general, unsatisfied) was also conducted.Results:A total of 85 patients were included, of which 41 were males and 44 were females; the age ranged from 65 to 93 years, with a mean of 71.4 years. Comorbidities of the elderly include hypertension, coronary heart disease, cerebrovascular accident, renal insufficiency, diabetes, tumor, gout, senile dementia, senile neurasthenia, sleep disorders, malnutrition, epilepsy, urinary incontinence, delirium, depression, etc. The wound duration ranged from 6 months to 15 years. The depth of the wound reached muscle or bone, and the defect area ranged form 3.5 cm×2.5 cm to 22.0 cm×10.5 cm. All 85 patients had positive bacterial cultures of wound secretions. Drug sensitivity test results: 72 cases were sensitive, 10 cases were intermediate, and 3 cases were completely resistant. Clinical medication was based on the drug sensitivity test result and the principles of antibiotic use. For the 3 resistant cases, nutrition, support and other treatments to enhance immunity were given, and the local wound was dressed with 0.45%-0.55% iodophor. Among the 85 cases, 65 were treated with vacuum sealing drainage, 10 patients were treated with tension-reduced suture, 19 were treated with full-thickness skin graft, and 21 were treated with local flap transfer, 20 were repaired by perforator pedicle flap, and 15 underwent amputation (toe). The follow-up period was 6 to 36 months, with an average of 12.5 months. Wound healed by primary intention in 57 cases; delayed healing in 21 cases, wound healed after dressing change or surgical repair; wound not healed in 7 cases, wound completely healed after amputation (toe) or other surgical treatment. Evaluation of the degree of swelling in the lower leg and dorsum of the foot: 18 cases of grade Ⅰ, 47 cases of grade Ⅱ, 15 cases of grade Ⅲ, and 5 cases of grade Ⅳ in the early stage; 62 cases of grade Ⅰ, 18 cases of grade Ⅱ, and 5 cases of grade Ⅲ in the later stage. Comprehensive evaluation of the therapeutic effect: 23 cases were excellent, 45 cases were good, 16 cases were general, and 1 case was poor, with an excellent-good rate of 80%. Satisfaction evaluation: 78 cases were satisfied, 7 cases were general, and the satisfaction rate was 91.8%.Conclusion:Generalist clinical thinking and multidisciplinary collaborative model are important strategies for treating chronic diabetic wounds of lower limbs in elderly patients with comorbidities. By controlling infection with antibiotics and dressing changes, and using reconstructive surgery techniques to repair the wound, the wound healing rate can be improved and satisfactory treatment outcomes can be achieved.

Objective:To investigate clinical curative effect of multiple composite tissues replantation with microsurgical technique in single hand.Methods:From May 2008 to December 2021, the clinical data of patients who underwent multiple composite tissue replantation in single hand in Chongming Hospital Affiliated to Shanghai University of Medicine & Health Sciences and Taizhou Hospital of Zhejiang Province, Wenzhou Medical University, were retrospectively analyzed. According to the severed site, anatomical level, the injury cause, the severity of injury, the size of severed tissue, and replantation conditions (such as blood vessels for anastomosis), the severed tissue was evaluated and carried out modified classification (type Ⅰ-Ⅳ) before the operation, and the surgical plan was designed. The severed composite tissue was debrided in emergency, the severed bone and muscle tissue were fixed, and the arteries, veins and nerves were anastomosed by microsurgical technique under a high-power microscope. The ratio of arteries to veins was 1∶1-1∶2. If enough arteries and veins could not be found, arteriovenous shunt could be used to form arterial venous flap or venous arterialized flap, or form artery flap by just artery anastomosis, or form venous flap by just vein anastomosis. Then skin tissue was sutured after recanalization. After the operation, the patients received specialized treatment and guided rehabilitation exercise. The wound healing of hand, skin color, skin quality, swelling degree, sensation, pain degree of joint, and activity function were followed up after the operation. At the last follow-up, the patient’s self-evaluation of the treatment effect was divided into three levels: satisfactory, average, and unsatisfactory. One chief physician and one doctor-in-charge were responsible for the comprehensive evaluation of curative effect, according to the assessment standard for upper limb function issued by Chinese Medical Association of Hand Surgery. 80-100 points were excellent, 60-79 points were good, 40-59 points were fair, and <40 points were poor.Results:A total of 94 severed composite tissues in 35 patients, including of 20 male patients and 15 female patients were enrolled. The average age was 36.4 years (range, 16-65 years). Fifty severed tissues in 18 cases were classified into type Ⅰ, 40 severed tissues in 15 cases type Ⅱ, 4 severed tissues in 2 cases type Ⅲ. Among the 35 cases, 1 case of thumb pulp severed tissue was necrotic at the edge (0.3 cm×0.5 cm) due to local contusion, 1 case of index finger lateral severed tissue was necrotic at the edge (0.3 cm×0.8 cm) due to local avulsion injury, and healed after dressing change, and the other replanted composite tissue survived. The patients were followed up for 3 to 65 months (average, 18.5 months). The wounds were completely healed, and the color, elasticity, and quality of the replanted tissue was close to the surrounding normal skin. There was no obvious swelling or atrophy deformity of the hands. According to the patients’ self-assessment, 31 cases were satisfied and 4 cases were average. Comprehensive evaluation of hand function and appearance: excellent in 23 cases, good in 9 cases, fair in 3 cases, excellent and good rate was about 91.4% (32/35).Conclusion:Though multiple composite tissues replantation with microsurgical technique in single hand is difficult, and vascular anastomosis technical requirement is high, once surgery succeeds, the function and appearance can get good recovery, and patient satisfaction is also relatively high.

Objective:To explore the treatment method and clinical effect of chronic diabetic wounds of lower limbs in elderly patients with comorbidities.Methods:The clinical data of elderly comorbid patients with chronic diabetic wounds of lower limbs admitted to Chongming Hospital Affiliated to Shanghai University of Medicine & Health Sciences from December 2019 to November 2022 were retrospectively analyzed. Multidisciplinary consultation and comprehensive evaluation were conducted for the patient before surgery and the indicators related to the underlying disease were also adjusted to the safe range for surgery. The wound secretions were taken in time for bacterial culture and drug sensitivity test, and the wound was treated with dressing change and other standardized treatments. According to the location, shape, size and depth of the lower limb wound defect, as well as the infection degree, duration of infection, and extent of surrounding skin damage, debridement, vacuum sealing drainage, tension-reduced suture, skin or flap transplantation, limb (toe) amputation and other method were selected for treatment. After surgery, the prevention and control of the comorbidities of the elderly and nursing management were continued, and the wound healing was observed. According to the evaluation criteria of flap swelling at grade 4 (increased from grade Ⅰ to grade Ⅳ), the swelling degree of the lower leg and dorsum of the foot was evaluated in the early stage (3 to 12 weeks) and the later stage (13 to 52 weeks). At the last follow-up, according to the evaluation criteria of the ankle joint wound repair, the curative effect was comprehensively evaluated (excellent, good, general, poor), and the satisfaction evaluation (satisfied, general, unsatisfied) was also conducted.Results:A total of 85 patients were included, of which 41 were males and 44 were females; the age ranged from 65 to 93 years, with a mean of 71.4 years. Comorbidities of the elderly include hypertension, coronary heart disease, cerebrovascular accident, renal insufficiency, diabetes, tumor, gout, senile dementia, senile neurasthenia, sleep disorders, malnutrition, epilepsy, urinary incontinence, delirium, depression, etc. The wound duration ranged from 6 months to 15 years. The depth of the wound reached muscle or bone, and the defect area ranged form 3.5 cm×2.5 cm to 22.0 cm×10.5 cm. All 85 patients had positive bacterial cultures of wound secretions. Drug sensitivity test results: 72 cases were sensitive, 10 cases were intermediate, and 3 cases were completely resistant. Clinical medication was based on the drug sensitivity test result and the principles of antibiotic use. For the 3 resistant cases, nutrition, support and other treatments to enhance immunity were given, and the local wound was dressed with 0.45%-0.55% iodophor. Among the 85 cases, 65 were treated with vacuum sealing drainage, 10 patients were treated with tension-reduced suture, 19 were treated with full-thickness skin graft, and 21 were treated with local flap transfer, 20 were repaired by perforator pedicle flap, and 15 underwent amputation (toe). The follow-up period was 6 to 36 months, with an average of 12.5 months. Wound healed by primary intention in 57 cases; delayed healing in 21 cases, wound healed after dressing change or surgical repair; wound not healed in 7 cases, wound completely healed after amputation (toe) or other surgical treatment. Evaluation of the degree of swelling in the lower leg and dorsum of the foot: 18 cases of grade Ⅰ, 47 cases of grade Ⅱ, 15 cases of grade Ⅲ, and 5 cases of grade Ⅳ in the early stage; 62 cases of grade Ⅰ, 18 cases of grade Ⅱ, and 5 cases of grade Ⅲ in the later stage. Comprehensive evaluation of the therapeutic effect: 23 cases were excellent, 45 cases were good, 16 cases were general, and 1 case was poor, with an excellent-good rate of 80%. Satisfaction evaluation: 78 cases were satisfied, 7 cases were general, and the satisfaction rate was 91.8%.Conclusion:Generalist clinical thinking and multidisciplinary collaborative model are important strategies for treating chronic diabetic wounds of lower limbs in elderly patients with comorbidities. By controlling infection with antibiotics and dressing changes, and using reconstructive surgery techniques to repair the wound, the wound healing rate can be improved and satisfactory treatment outcomes can be achieved.