Objective To understand the current situation of multidrug-resistant organism (MDRO)infection in hospitalized patients in a tertiary first-class hospital,as well as efficacy of bundle intervention measures on preven-tion and control of infection. Methods Hospitalized patients who were infected with MDROs in this hospital during 2012-2014 were monitored and conducted bundle intervention. Results In 2012-2014,a total of 1909 MDRO strains were isolated. The isolation rates of MDROs in 2012-2014 were 30.69% ,31 .04% ,and 29.40% respec-tively,bedside intervention rates were 81 .02% ,92.05% ,and 94.23% respectively,implementation rates of clinical isolation were 69.97% ,82.98% ,and 93.04% respectively;MDRO isolation rates during 2012-2014 were not sig-nificantly different(P>0.05);bedside intervention rates and implementation rates of clinical isolation were both sig-nificantly different(both P<0.05). The top 3 isolated MDROs in 2012-2014 were extended-spectrumβ-lactamases (ESBLs)-producing Escherichia coli,multidrug-resistant Acinetobacter baumannii,and ESBLs-producing Klebsiel-lapneumoniae. Conclusion Bundle intervention measures,such as multi-department collaboration and strengthened on-site supervision,can promote more standardized management of healthcare-associated infection,enhance the im-plementation rate of clinical isolation,and effectively prevent and control the spread of MDRO in hospital.

Sentinel lymph node (SLN) is the first group of lymph nodes to receive breast lymph nodes and the first group of lymph node metastasis. It can accurately predict the metastatic status of axillary lymph nodes, which is an important reference factor in the diagnosis and treatment of breast cancer. It has become the first choice for early breast cancer staging. The rapid and accurate intraoperative localization and diagnosis of SLN is of great significance for the choice of operation mode and the improvement of therapeutic effect. SLN location and diagnostic methods are still needed to be investigated. This article reviews various methods in clinic recently.

Objective To determine the expression of two neuron developmental associated genes induced by hyperphenylalanine.Methods Primary embryonal rat cerebral cortical neurons were cultured for three day and cells induced by hyperphenylalanine for 12 hours.Real time quantitative RT-PCR was used to determine the influence of hyperphenylalanine on the expression of GAP-43 and Go?1 genes.Results GAP-43 mRNA was upregulated to 2.25 times and Go?1 was downregulated to 3.31 times by hyperphenylalanine.Conlusion Hyperphenylalanine may interfere the normal development of cerebral cortical neurons through influencing the expression of GAP-43 and Go?1 genes.

Objective To understand the occurrence of surgical site infection (SSI)following class I incision operation in a tumor hospital,explore the continuous surveillance and improve effectiveness,so as to provide reference for further inter-vention.Methods Targeted surveillance on thyroid surgery patients undergoing classⅠincision operations in a hospital in January-June 2013 were performed by medical record review,bedside observation,dressing change observation and patient follow-up,the surveillance result was compared with that of the same period of 2010.Results There was one case of SSI in January-June 2013 and January-June 2010 respectively,SSI rate was 0.20% and 0.18% respectively,there was no significant difference(P =1.000).In January-June 2013,prophylactic perioperative antimicrobial usage rate was 0.20%,which was lower than 27.21% of 2010;the coincident rate of indication for antimicrobial use was 100%, which was higher than 6.67% of 2010,the difference was statistically different(all P <0.001).Conclusion Targe-ted surveillance on SSI is helpful for the rational perioperative use of antimicrobial agents,the reducing of antimicro-bial prophylactic use doesn’t lead to the increase of class Ⅰ incision SSI.

Based on the principle of training students for rural areas and serving for grass roots,Mudanjiang medical college cultivates talents mainly from countryside and rural areas,thus it is of great importance to build up decent and accurate values for those will-be doctors who heal the wounded and prevent and cure diseases.As well as enhancing their professional qualifications,medical college teachers should also cultivate students' world view,philosophy,values,responsibility,occupational ethics,and a scientific development outlook.

Objective To understand the results and characteristics of targeted monitoring of healthcare-associated infection (HAI)in an intensive care unit (ICU)of a tumor hospital,so as to provide scientific basis for formulating measures of prevention and control of HAI.Methods Patients who admitted to an ICU from January to December 2013 were performed targeted monitoring,incidence of HAI was adjusted with an average severity of illness score (ASIS),three types of invasive procedure-related infection,distribution of pathogens,and multidrug-resistant or-ganisms were monitored.Results A total of 455 patients were monitored,the total patient-days were 2 483 days, 52 cases of HAI occurred,incidence of HAI was 11 .43%,incidence of HAI per 1 000 patient-days was 20.94‰,af-ter the adjustment with ASIS,incidence of HAI per 1 000 patient-days was 6.29‰.The main infection site was re-spiratory system(63.46%),followed by urinary system(19.23%);Incidence of ventilator-associated pneumonia per 1 000 ventilation-days,catheter-related bloodstream infection per 1 000 catheter-days,and catheter-associated urinary tract infection per 1 000 urinary catheter days were 12.08‰,0.95‰,and 4.07‰ respectively.A total of 181 path-ogenic isolates were detected,74.59% (n=135)of which were gram-negative bacteria,18.23%(n=33)were gram-positive bacteria,and 7.18%(n=13)were fungi;18.23%(n=33)were multidrug-resistant strains.Conclusion ICU is the high risk department of the occurrence of HAI,the main infection is respiratory tract infection,the major pathogen is gram-negative bacteria.Targeted monitoring can timely reflect the deficiency in infection control practice,is helpful for formula-ting effective prevention and intervention measures,and reducing the occurrence of HAI.

Objective To conduct a scoping review to systematically review the literature reporting enteral feeding protocol in critical ill children. And extract elements of enteral feeding protocol. Methods The database of BIOSIS Previews, PubMed, MEDLINE, EMbase, China Biology Medicine Disc, China National Knowledge Infrastructure and Wan Fang data were searched. Data were extracted on the information of article, elements of enteral feeding, evaluation of feeding etc. Results Three historical controlled studies, three case-control studies, two cohort studies, one narrative review and one qualitative study were included. Totally 16 elements were got, such as nutrition evaluation, estimated energy requirement, contraindication, feeding intolerance etc. And all protocols defined advancement and feeding intolerance. Conclusions Enteral feeding protocol has been used in most PICUs to optimize nutrition. But we observed variability in the composition of protocols and lack of evidence-based recommendations in few elements.

ObjectiveTo compare the preventive effects oftramadol and ketamine on the patients with postoperative hyperalgesia after remifentanil-induced neurosurgical anesthesia.MethodsOne hundred and fifty patients undergoing craniotomy were assigned to tramadol group,ketamine group and normal saline group with 50 cases each by random digits table.Anesthesia was maintained with infusion of remifentanil [0.1-0.2μ g/( kg· min ) ],propofol and sevoflurane.Tramadol ( 1.5 mg/kg),ketamine (0.5 mg/kg) or normal saline was given before skin closing.The emergence time,trachea extubation time,patients required analgesia and tramadol consumption,reverse effect were recorded.The visual analog scale (VAS),Ramsay scores at 15,30,60,120 minutes after emergence were performed.ResultsPatients required analgesia and tramadol consumption in tramadol group and ketamine group were significantly lower than those in normal saline group (P ＜0.01 or ＜0.05 ).The occurrence of shiver in tramadol group was lower than that in normal saline group (P ＜0.05).VAS scores in tramadol group at 15,30 minutes and in ketamine group at 30 minutes after emergence were significantly lower than those in normal saline group (P＜ 0.05).Ramsay score in ketamine group at 15 minutes after emergence was higher than that in tramadol group and normal saline group [ (2.9 ±0.6) scores vs.(2.3 ±0.7) scores and (2.3 ±0.9) scores](P＜0.01).ConclusionTramadol has a goodpreventive effect for postoperative hyperalgesia induced by remifentanil in neurosurgery compared with ketamine.

Objective To investigate the clinical characteristics,peripheral insulin sensitivity,and β-cell function in patients with ketosis-prone diabetes(KPD).Methods Thirty-one patients with newly diagnosed ketosisprone diabetes were admitted to West China Hospital from January 2004 to December 2009.They were divided into 2 groups according to their body mass index (BMI):OB-KPD (BMI ≥ 25 kg/m2,n =22) and Lean-KPD (BMI ＜ 23 kg/m2,n =9).10 patients with newly-onset type 2 diabetes free from ketosis (OB-DM:BMI ≥ 25 kg/m2,n =10) were enlisted as control.Detailed assessments of medical history and symptoms of hyperglycemia were performed.The islet cell antibody (ICA),insulin autoantibody (IAA),anti-glutamic acid decarboxylase antibody (GAD-Ab),fasting plasma glucose,serum insulin,C-peptide and free fat acids concentrations were measured.All of the subjects underwent oral and intravenous glucose tolerance tests,euglycemic-hyperinsulinemia and hyperglycemia clamp test,to evaluate the insulin secretion and insulin sensitivity respectively.Insulin sensitivity was determined by glucose disposal rate (GDR) of steady state during euglycemic clamp and acute insulin secretion was calculated by insulin area under curve(AUCins 0-10 min) during IVGTT.Maximal insulin secretion was determined by glucose infusion rate (GIR) and serum insulin concentration of steady state during hyperglycemic clamp test.Results Age,sex,duration of diabetes were matched among groups.A family history of diabetes was strongly associated with those patients with obesity,compared with lean ketosis prone diabetes(16/22 vs 1/9).GDR was (4.91 ± 1.82) mg · kg 1 · min-1 in subjects with OB-KPD,being lower than that in Lean-KPD patients[(6.26 ± 1.89) mg · kg 1 · min-1] and OB-DM group[(6.78-± 1.69) mg · kg 1 · min-1,P＜0.01].Serum insulin and C-peptide in OB-KPD patients were higher than Lean-KPD patients.Area under the insulin curve [AUCins0-10min (183.86 ± 31.1) mIU/L] and GIR[(2.65 ±1.53) mg · kg-1 · min-1] in OB-KPD patients were lower than those in OB-DM group[(697.06-± 231.9) mIU/L,(6.53 ± 2.21)mg · kg 1 · min-1,P＜0.0 1],but slightly higher than the Lean-KPD group [AUCins0 10min (92.1 ±29.8) mUU/L,GIR (2.55 ± 1.49) mg · kg 1 · min-1,P＜0.05].Glucose disposal rate (GDR) was strongly associated with casual plasma glucose (r =-0.502,P＜0.01),HbA1C(r =-0.553,P＜0.0 1) and FFA eoneentrations (r=-0.504,P＜0.01) on admission.Conclusions Insulin resistance and β-cell dysfunction coexist in all KPD patients.OB-KPD patients exhibit more severe insulin resistance,while Lean-KPD patients have lower insulin secretion.KPD patients had severe hyperglycemia,hypertriglyceridemia,and high plasma FFA levels on admission,suggesting that hyperglycemia and elevated FFA levels could result in serious insulin resistance,β-cell dysfunction,and diabetic ketosis in patients with KPD.

Objective To investigate the expression of PHF8(PHD-finger protein 8) in human hepatocellular carcinoma (HCC) and its clinicopathologic significance.Methods The expression of PHF8 in 60 hepatocellular carcinoma samples as well as their natched paraneoplastic tissues,and 15 normal liver tissues were evaluated by immunohistochemistry.Statistical methods were used to analyse the relationship between the expression of PHF8 and the clinicopathological features of these patients.Results The PHF8-positive expression rate in the HCC samples was 55.0％ and it was significantly higher than that in the paraneoplastic tissues and the normal liver tissucs (16.7％,6.7％,respectively,P＜0.05).The expression of PHF8 was closely related to tumor size,tumor nodular numbers,pathological differentiation and TNM-staging (P＜0.05 for all).The 5-year disease-free survival and overall survival in the PHF8-positive group was significantly lower than that in the negative group (P＜0.05).Conclusions PHF8 was overexpressed in HCC samples,and its expression was closely associated with HCC clinicopathological features and prognosis of the patients.