Objective　To study the antimicrobial resistance of isolated pathogens from surgical infections in Hubei area.Methods　The diameters of the inhibition zones of surgical isolates around antibiotic susceptibility test discs in 15 hospitals were computerfiled and analysed by the software of “WHONET-4” according to NCCLS published in 1999.Results　A total of 1314 surgical isolates were collected between October 1998 and September 1999.S.aureus,P.aeruginosa,E.coli,Enterobacter sp.and CNS were the main microorganisms.44.6% of staphylococcus was resistant to oxacillin.Imipenem,amikacin,ceftazidime and ciprofloxacin were most active against Gram-negative bacilli with the sensitities (in descending order) of 84.4% to 57.2%.Conclusion　Antimicrobial resistance should be seriously considered during surgical therapy and prohylaxis with antimicrobial agents.The tendency to antimicrobial resistance of clinical isolates should be followed up continuously.

Objective To study the antimicrobial resistance of isolated pathogens from surgical infections in Hubei area.Methods The diameters of the inhibition zones of surgical isolates around antibiotic susceptibility test discs in 15 hospitals were computerfiled and analysed by the software of “WHONET 4” according to NCCLS published in 1999.Results] A total of 1314 surgical isolates were collected between October 1998 and September 1999. S.aureus, P.aeruginosa, E.coli, Enterobacter sp. and CNS were the main microorganisms. 44 6% of staphylococcus was resistant to oxacillin. Imipenem, amikacin, ceftazidime and ciprofloxacin were most active against Gram negative bacilli with the sensitities (in descending order) of 84 4% to 57 2%.[WT5”HZ] Conclusion Antimicrobial resistance should be seriously considered during surgical therapy and prohylaxis with antimicrobial agents . The tendency to antimicrobial resistance of clinical isolates should be followed up continuously.

Object To emphasize the necessity and significance of informed consent in the plastic surgery.Further investigating the ethical implication involved in informed consent principles.To standardize the medical treatment action according to the informed consent principles.Methods Through the literature search method,counseling for experts,sampling surveys and other approaches to elucidate the importancy of informed consent in plastic surgery,to survey and analyze the difficulties and ethical dilemma encountered in the process of standardization.Results Plastic surgeons firmly are aware of the principles of informed consent,as a routine preoperative procedure,however there are still some difficulties in practice.Conclusions To respect the patient's right to know,plastic surgery doctors should be standardized to perform the principle of informed consent; meanwhile hospital should develop a series of systems to regulate the principle of informed consent.

Objective To investigate the association of serum C peptide concentration with the severity and the outcome of diabetic foot ulcer (DFU). Methods The clinical data of 257 inpatients with DFU were collected, including fasting and postprandial 2h C peptide levels and C peptide area under curve (AUCCP ). The patients were followed up on the outcomes of ulcers and death. The associations of serum C peptide concentration with the Wagner degree, infection severity, and healing rate were analyzed. Results The medians of fasting and 2h postprandial serum C peptide as well as AUCCP were 1. 37(0. 02 ~ 9. 00) nmol/ L, 3. 22(0. 02 ~ 29. 61) nmol/ L, and 511. 65 (3. 60 ~ 2 691. 30)nmol·min-1 ·L-1 respectively, which were lower than general levels. The time of follow-up in our study was 2. 8 (1. 0 ~ 5. 1) years. By the end of study, the wound of 75. 88% patients was healed, 3. 5%undergone major amputation, and 23. 74% died. After adjusting for relative factors, there were no significant associations of serum fasting and postprandial C peptide levels and AUCCP with Wagner degree and infection severity (P>0. 05). Cox regression analysis showed that the fasting plasma C peptide and hemoglobin were the independent protective factors for the healing of ulcers; old age, male, higher infection degree, and diabetes family history were their independent risk factors ( all P < 0. 05). Conclusions The lower plasma fasting C peptide concentration in patients with DFU is not correlated with Wagner degree and infection severity, but closely related with healing rate.

The distinction of antimicrobial resistance of clinical bacteria isolated from county hospitals and a teaching hospital was investigated. Disc diffusion test was used to study the antimicrobial resistance of isolates collected from county hospitals and a teaching hospital. The data was analyzed by WHONET5 and SPSS statistic software. A total of 655 strains and 1682 strains were collected from county hospitals and a teaching hospital, respectively, in the year of 2003. The top ten pathogens were Coagulase negative staphylococci (CNS), E. coli, Klebsiella spp., S. areus, P. aeruginosa, Enterococcus spp., Enterobacter spp., otherwise Salmonella spp., Proteus spp., Shigella spp. in county hospitals and Streptococcus spp., Acinetobacter spp., X. maltophilia in the teaching hospital. The prevalence of multi-drug resistant bacteria was 5% (4/86) of methicillin-resistant S. areus (MRSA), 12% (16/133) and 15.8% (9/57) of extended-spectrum beta-lactamases producing strains of E. coli and Klebsiella spp., respectively, in county hospitals. All of the three rates were lower than that in the teaching hospital and the difference was statistically significant (P < 0. 01). However, the incidence of methicillin-resistant CNS (MRCNS) reached to 70% (109/156) in the two classes of hospitals. Generally, the antimicrobial resistant rates in the county hospitals were lower than those in the teaching hospital, except the resistant rates of ciprofloxacin, erythromycin, clindamycin, SMZco which were similar in the two classes of hospitals. There were differences between county hospitals and the teaching hospital in the distribution of clinical isolates and prevalence of antimicrobial resistance. It was the basis of rational use of antimicrobial agents to monitor antimicrobial resistance by each hospital.

Objective To explore the distribution of pathogenic micro-organisms in the diabetic patients with foot infection,and to investigate the characteristics of the pathogen distribution and its relationship with the severity of diabetic foot ulcer( DFU ).Methods Ninety diabetic foot patients with positive culture of micro-organisms were classified into Wagner 1-5 grades according to the severity of DFU,which was ranked as mild,moderate,and severe infection based on the gradient of infection.The family,genus,and strain of micro-organisms were analyzed,and associated factors were discussed in regard to the kinds and severity of DFU and infection.Results With rising Wagner's grades and aggravating infection,the bacterial floras were transformed from gram-positive cocci( 61.1％ in Wagner 1 ) to gram-negative rods( 80.0％ in Wagner 5),at the same time,composite( 10.0％ to 28.6％ ) and opportunist ( 83.3％ to 100％ ) infections were increased.Wagner's grade,severity of infection,previous treatment,patients' age,control of blood glucose,course of DFU,etc,were all related to types of infection and opportunist infection ( P＜0.05 ).Conclusions Proportion of gram-negative bacilli with opportunist composite infection seems to increase in patients with severe DFU and severe infection requiring appropriate application of antibiotics.

BACKGROUNDLung cancer is one of the most common malignant tumors in China. Surgical resection is still the first choice of treatment for most lung cancer patients. The prognosis of lung cancer after surgical treatment is correlated to many factors. One of them is nosocomial infection. This study is to investigate the distribution of the pathogens causing nosocomial infection and its correlative factors in patients with lung cancer.

METHODSOne hundred and thirteen cases that had hospital-acquired infection out of 1227 surgically treated patients with lung cancer were analyzed statistically.

RESULTSOf all the pathogenic species, the most prevalent species were Gram-negative bacteria with average positive detection of 64.03% (299/467). The second were Gram-positive bacteria (145/467, 31.05%) and the third were fungi (23/467, 4.92%). The results of drug sensitivity tests showed that all of strains had higher resistance rate. The rate of extended spectrum β-lactamases (ESBLs) and meticillin-resistant Staphylococcus (MRS) was very high. The incidence of nosocomial infection was seriously correlated with age, fatness, long smoking history, complicated diseases such as diabetes, damaged renal function and using time of mechanical ventilation over 24 hours.

CONCLUSIONSThe nosocomial infection of lung cancer patients after surgical treatment is seriously correlated with patient's age, fatness, long smoking history, complicated diseases such as diabetes, damaged renal function and using time of mechanical ventilation over 24 hours. More attentions should be paid to the pathogenic species and its correlative factors of nosocomial infection in lung cancer patients. The resistance of bacteria to the commonly used antibiotics is produced in various degrees. During clinical therapy with antibiotics, antibiotics should be selected according to the results of drug sensitivity tests. In order to reduce the production of drug-resistance, the appropriate use of antibiotics must be strengthened.

Objective To observe the effects of Ganmai Yangxin Decoction on the expression glutamate system in hippocampus of rats with depression;To discuss its mechanism for the treatment of depression.Methods Totally 40 SPF grade SD rats were randomly divided into blank group and modeling group,chronic unpredictable mild stress method was used to establish a depression model.Successfully modeling rats were randomly divided into model group,fluoxetine group and Ganmai Yangxin Decoction group,with 8 rats in each group.The rats in Ganmai Yangxin Decoction group were gavaged with 7.67 g/kg decoction,the fluoxetine group was gavaged with 10 mg/kg fluoxetine,and the blank group and model group were gavaged with 10 mL/kg normal saline,for 4 weeks.and modeling continued while administering the medication.Sucrose preference experiments and forced swimming experiments were used to evaluate the depression status of rats,ELISA was used to detect glutamate content in hippocampal tissue,Nissl staining was used to observe the morphology of neurons in hippocampal CA3 region,immunohistochemical staining was used to detect the expression of GFAP protein in hippocampal CA3 region,Western blot was used to detect the expressions of EAAT1,EAAT2,EAAT3,VGLUT1 and VGLUT2 protein in hippocampal tissue,RT-PCR was used to detect the mRNA expressions of EAAT1,EAAT2 and EAAT3 in hippocampal tissue.Results Compared with the blank group,the body mass of the model group rats decreased(P<0.01),sucrose preference rate decreased,forced swimming immobility time increased(P<0.01),and glutamate content in hippocampal tissue increased(P<0.01),the number of neurons in hippocampal CA3 region decreased,with irregular arrangement and structure changed,the number of Nissl bodies decreased,and the positive expression of GFAP in hippocampal CA3 region decreased(P<0.01),the expressions of EAAT1,EAAT2,EAAT3 protein and mRNA,and VGLUT1 protein in hippocampal tissue decreased(P<0.01),while the expression of VGLUT2 protein increased(P<0.05).Compared with the model group,the Ganmai Yangxin Decoction group and the fluoxetine group showed an increase in body mass(P<0.05),an increase in sucrose preference rate,and a reduction in forced swimming immobility time(P<0.01),and the glutamate content in hippocampal tissue decreased(P<0.01),the number of neurons in the hippocampal CA3 region increased,the structure improved,and there were more Nissl bodies,the positive expression of GFAP in hippocampal CA3 region increased(P<0.01),the expressions of EAAT1,EAAT2,EAAT3 protein and mRNA,and VGLUT1 protein in hippocampal tissue increased(P<0.05,P<0.01).Conclusion Ganmai Yangxin Decoction can improve depression-like behavior in rats,and its mechanism of action is related to up-regulating the expression of glutamate transporters,increasing the number of astrocytes,and reducing glutamate content in hippocampus.

The distinction of antimicrobial resistance of clinical bacteria isolated from county hospitals and a teaching hospital was investigated. Disc diffusion test was used to study the antimicrobial resistance of isolates collected from county hospitals and a teaching hospital. The data was analyzed by WHONET5 and SPSS statistic software. A total of 655 strains and 1682 strains were collected from county hospitals and a teaching hospital, respectively, in the year of 2003. The top ten pathogens were Coagulase negative staphylococci (CNS), E. coli, Klebsiella spp. , S. areus, P. aeruginosa, Enterococcus spp. , Enterobacter spp. , otherwise Salmonella spp. , Proteus spp. , Shigella spp. in county hospitals and Streptococcus spp. , Acinetobacter spp. , X. maltophilia in the teaching hospital. The prevalence of multi-drug resistant bacteria was 5% (4/86) of methicillin-resistant S. areus (MRSA), 12% (16/133) and 15.8 % (9/57) of extended-spectrum β-lactamases producing strains of E. coli and Klebsiella spp. , respectively, in county hospitals. All of the three rates were lower than that in the teaching hospital and the difference was statistically significant (P＜0.01). However, the incidence of methicillin-resistant CNS (MRCNS) reached to 70 % (109/156) in the two classes of hospitals. Generally, the antimicrobial resistant rates in the county hospitals were lower than those in the teaching hospital, except the resistant rates of ciprofloxacin, erythromycin, clindamycin, SMZco which were similar in the two classes of hospitals. There were differences between county hospitals and the teaching hospital in the distribution of clinical isolates and prevalence of antimicrobial resistance. It was the basis of rational use of antimicrobial agents to monitor antimicrobial resistance by each hospital.

Objective Secondary infection with pseudomonas aeruginosa( PA) in diabetic foot ulcer( DFU) was analyzed to investigate the related risk factor, antibiotic resistance, and prognoses of the infection. Methods Pathogen cultures were carried out in 966 DFU patients with their clinical data collected. All of the patients were followed-up for two years to observe the outcomes, including ulcer healing, amputation, recurrence of ulcers, non-fatal cardiovascular events, and death. The antibiotic susceptibility, risk factors and associated outcome of secondary PA infection were analyzed. Results Total incidence of PA infection was 13. 0％ in DFU patients, of which 38. 1％was secondary. The susceptibility rates of secondary infected PA to tobramycin, meropenem, eftazidime, levofloxacin, cefepime, and cefepime were similar to those in primary infected PA. However, the susceptibility rates of secondary infected PA to piperacillin, piperacillin/tazobactam, ciprofloxacin, imipenen, gentamicin, aztreonam, and amikacin decreased by 12％ to 22％ as compared with primary infected PA. The healing rate was much lower in patients with secondary PA infection compared with those with primary PA infection, and the accumulated healing rates at2yearswere44.44％ and70.4％ (P=0.01) respectively. Theriskofulcerhealingfailurewithintwoyears increased by 3 folds in patients with secondary PA infection. After adjusting for age, sex, Wagner grade, infection grade, and duration of DFU, plasma albumin level was an independent risk factor for secondary PA infection in patients with DFU(P=0. 001). Conclusions The antibiotics susceptibility rates of secondary infected PA were lower than those of primary infected PA. Secondary PA infection in DFU was less likely to be healed. Plasma albumin level was a risk factor for secondary PA infection.