Objective To investigate the situation of drug resistance and nosocomial infection of multi-drug resistant bacteria (MDR),guidance for clinical rational use of antibiotics.Methods A total of 1521 strains of MDR was isolated from January 2015 to December in Beijing Tongren Hospital,using matrixassisted laser desorption/ionization time-of-flight mass spectrometry (MALDI-TOF MS) identification of bacteria,VITEK-2 Compact and Kirby Bauer (KB) method for drug sensitivity test.Results In 1 521 strains of MDR,Acinetobacter Baumanii were 589 strains (38.7％),nosocomial infection rate were 16.6％;350 strains of Escherichia coli (23.0％),nosocomial infection rate were 9.0％;249 strains of Staphylococcus aureus (16.4％),nosocomial infection rate were 2.7％;171 strains of Klebsiella pneumoniae (11.2％),nosocomial infection rate were 14.3％;150 strains of pseudomonas aeruginosa (9.9％),nosocomial infection rate were 64.7％;12 strains of Enterococcus faecium (0.8％),nosocomial infection rate were 16.7％.MDR Acinetobacter Baumanii,MDR Pseudomonas aeruginosa,extended-spectrumβ-lactamase (ESBL) + Escherichia coli and ESBL + Klebsiella pneumoniae resistance rate to Imipenem were 100％,91.5％,0.6％ and 55.6％.Conclusions MDR pseudomonas aeruginosa (MDR-PAE),MDR acinetobacter baumanii (MDR-AB) and ESBL + Klebsiella pneumoniae were highly resistant,and the nosocomial infection rate were higher.

OBJECTIVE To investigate the different methods to calculate the rate of missing report on nosocomial infections.METHODS We had two methods to define the case of nosocomial infections,one was that the cases(infected) during the month we investigated,the other was that patients infected during the in hospital time.Then we got two different rates and "actually" nosocomial infection cases and compare the difference of the two results.(RESULTS) It was significant difference between these two results(P

Objective To explore a method for earlier evaluating death toll based on a function relationship ( an increasing hour-increasing death index ( K value) followed with time (T) changing after catastrophic earthquake. Methods Information data of 10 typical occurrences of catastrophic earthquake obtained from China International Search and Rescue Team (CISAR) were analyzed. Total deaths were estimated according to the simulation function made by hour-increasing death index (K value) followed with time (T) changing. Expected value of the simulation function was assessed by statistical software SPSS version 17.0 to establish the model of simulation function.Results The length of time (T) to reach K maximum (Kmmax) was ( 12.94 ± 8.18) h and then the K value was gradually decreased. Kmax was symmetrically scattered within 2 T time.Estimated death toll (W) within 2 T was obtained from calculating the integration summation of the function to get a formula as W =∫∞ kf(t) dt.This Estimated death toll(W) numbers was correlated approximately with the death toll (M) from authoritative report (P ＜ 0.01 ).According to the regression analysis of model simulation curve,the predictive function of death toll within 2 T was M =W1.23 ×0.194.A determinant coefficient of this power function R2 was 0.88. Conclusions Earlier estimating death toll within about 12 h should be carried out by using the data of real-time information report system.

Objective To analyze the associations between long-term outcomes of fresh femoral neck fractures treated with cannulated screws and the classification based on vertical neck (VN) angle.Methods A retrospective study was conducted of the 162 fresh femoral neck fractures treated with 3 cannulated screws at Department of Orthopaedics,The Sixth People's Hospital of Shanghai from January 2012 to December 2014.The relationships were analyzed using Logistic Regression between long-term complications and VN classification,including fixation failure,fracture nonunion and osteonecrosis of femoral head (ONFH).Results All the patients were followed up for an average of 25.7 months (from 6 to 36 months).Of them,151 obtained fracture union after an average of 4.5 months (from 3 to 9 months).Internal fixation failure occurred in 23 cases,nonunion of femoral neck in 11,ONFH in 21 and femoral neck collapse in 13.Logistic Regression analysis showed no significant associations between internal fixation failure,nonunion or ONFH and gender,age or reduction method (P ＞ 0.05) but significant associations of VN classification with fixation failure (P ＜ 0.001) and nonunion (P =0.001) and insignificant association of VN classification with ONFH (P =0.109).Conclusion VN classification,a new classification method for femoral neck fractures,may be closely related with incidences of fixation failure and nonunion.

Objective To investigate the advantage of the technique of static compression screws with medial support using one ordinary cannulated compression screw (OCCS) and 2 headless cannulated compression screws (HCCSs) in reducing complications in the treatment of vertical femoral neck fractures.Methods From December 2014 to July 2017,79 patients were treated at Department of Orthopaedics,The Sixth People's Hospital of Shanghai for vertical femoral neck fractures.They were 51 men and 28 women,aged from 20 to 65 years (average,49.1 years).Their injury involved 45 left sides and 34 right sides.Of them,37 were treated with one OCCS at the top and 2 HCCSs at the bottom of a triangle arrangement for fixation of the vertical femoral neck fracture (the experimental group);the other 42 were treated with 3OCCSs at a triangle arrangement for fixation of the vertical femoral neck fracture (the control group).Their fracture healing and complications were followed up at postoperative 6 weeks,3,6 12,18,24 months and any time of discomfort by anteroposterior and lateral X-ray films of the knee joint.Results The 2 groups were compatible due to insignificant differences between their preoperative general data (P ＞ 0.05).This cohort was followed up for 9 to 24 months (average,17.5 months).Of them,52 achieved fracture union.Of the 27 patients who failed,8 were in the experimental group (21.6％) and 19 in the control group (45.2％),showing a significant difference in the rate of failure between the 2 groups (P ＜ 0.05).In the experimental group,the rate of nonunion was 8.1％ (3/37),the rate of implant failure 18.9％ (7/37),and the rate of fermoral neck varus 8.1％ (3/37),all significantly lower than those in the control group [26.2％ (11/42),40.5％ (17/42) and 23.8％ (13/42),respectively] (P ＜0.05).Conclusion For treatment of vertical femoral neck fractures,the technique of static compression screws with medial support is not only easy but also leads to a lower rate of complications.

Objective:To investigate the application value of domestic robotic surgical system in radical resection of hilar cholangiocarcinoma (hCCA).Methods:The retrospective and descriptive study was constructed. The clinicopathological data of a 66-year-old male patient with hCCA who was admitted to the Second Hospital of Shandong University in November 2022 were collected. Radical resection of hCCA was performed using the Toumai? laparoscopic surgical robot system. Observation indicators: (1) intraoperative conditions; (2) postoperative conditions; (3) follow-up. Count data were represented as absolute numbers and (or) percentages.Results:(1) Intraoperative conditions. The patient underwent radical resection of hCCA successfully using robotic surgical system, including tumor resection, lymph node dissection, and gastrointestinal reconstruc-tion. The operation time and volume of intraoperative blood loss were 400 minutes and 100 mL, respectively, and no intraoperative blood transfusion was required. (2) Postoperative conditions. The patient began ambulation on postoperative day 1 and began taking liquid food on postoperative day 4. Liver function examination and abdominal computed tomograph (CT) on postoperative day 5 showed a decrease in serum bilirubin, no biliary or intestinal leakage, and no edema or necrosis at the anastomotic site. The abdominal pre-anastomotic and post-anastomotic drainage tubes were removed on the 7th and 9th day after the surgery respectively, and the patient was discharged on the 10th day after surgery. Results of postoperative pathological examination showed moderately to poorly differentiated adenocarcinoma of the bile duct. Immunostaining was positive for CK7 and CK19. The Ki-67 proliferation index was 35%. The proximal and distal resection margin of bile duct were negative. The tumor diameter was 30 mm. Perineural invasion was positive. The surgical specimen margin was negative. Two lymph nodes were identified containing tumor cells positive for malignancy. No tumor cell metastasis was detected in the No.8, No.12 or gastric lesser curvature lymph nodes submitted for pathological examination. (3) Follow-up. The patient was followed up at postoperative 1-, 3-, 5-month after discharge. During follow-up period, results of liver function examination and abdominal CT showed liver function restore to normal levels, no complication such as biliary fistula, intestinal fistula, gastroparesis or tumor metastasis.Conclusion:The Domestic Toumai ? laparoscopic surgical robot system can be applied to radical resection of hCCA.

In December 2019, a new outbreak of coronavirus pneumonia began to occur. Its pathogen is 2019-nCoV, which has the characteristics of strong infectivity and general susceptibility. The current situation of prevention and control of new coronavirus pneumonia is severe. In this context, as front-line medical workers bearing important responsibilities and pressure, while through strict management strategy, we can minimize the risk of infection exposure. By summarizing the research progress and guidelines in recent years in the fields of colorectal cancer disease screening, treatment strategies(including early colorectal cancer, locally advanced colorectal cancer, obstructive colorectal cancer, metastatic colorectal cancer and the treatment of patients after neoadjuvant therapy), the choice of medication and time limit for adjuvant therapy, the protective measures for patients undergoing emergency surgery, the re-examination of postoperative patients and the protection of medical staff, etc., authors improve treatment strategies in order to provide more choices for patients to obtain the best treatment under the severe epidemic situation of new coronavirus pneumonia. Meanwhile we hope that it can also provide more timely treatment modeling schemes for colleagues.

COVID-19, caused by SARS-COV-2, has the characteristics of world epidemic, highly infectious and large base of death. In China, transmission route of SARS-COV-2 has been contained so effectively that COVID-19 has been well controlled due to the proactive national prevention and control strategy. However, not only does it bring a huge impact on the existing medical structure model, but also an objective impact on the treatment of patients with chronic diseases such as malignant tumors. Based on the progress reported in the domestic and international literatures and the actual management experience of our team, this paper reflects on the treatment strategies for patients with gastrointestinal stromal tumor (GIST) during the epidemic period of COVID-19. We focus on risk stratification for primary GIST and forming treatment strategies accordingly. Major considerations include the impact of delayed operation, the burden of medical resources, the waiting time for elective operation, and the principle of emergency operation. In addition, we focus on the level of evidence for non-surgical approaches with a view to developing a holistic strategy of "priority management principles" to guide clinical treatment in the context of limited resources and different GIST priorities.
COVID-19 ; China ; Gastrointestinal Stromal Tumors ; Humans ; SARS-CoV-2