Objective To analyze the changes of bacteria stains in acute obstructive cholangitis with suppuration (AOSC) and sensitivity of different bactera strains to antibiotics in recent decade.Methods The data of bacterial susceptibility of AOSC patients and sensitivity of different bacteria strains to antibiotics in our hospital collected from 1999 to 2001 (group A,n =54) and from 2009 to 2011 (group B,n =62) were analyzed.Resules In group A,there were 29 male and 24 female with age range of 35 ～ 82 and mean age of 57.5 years,and in group B,there were 23 male and 39 female with age range of 39 ～ 87 and mean age of 68.2 years.There were no differences in bacteria strains infected between two groups.However,there was a trend of increase in the proportion of the Pseudomonas aeruginosa and Staphylococcus aureus infection,and a trend of decrease in the proportion of Escherichia coli infection.The degrees of sensitivity of Escherichia coli to ciprofloxacin,ceftazidime,cefaclor and ceftriaxone were statistically different from those observed ten years ago ; and the degrees of sensitivity of Pseudomonas aeruginosa to ceftazidime and cefaclor were statistically different from those detected ten years ago as well.In recent years,the sensitivity of bacteria to antibiotics was on a downwards trend.Conclusions The pathogens of acute obstructive and suppurative cholangitis did not obviously change in recernt decade,but the sensitivity of bacteria to antibiotics was lowered.

ObjectiveTo observe the changes in plasma interleukin-33 (IL-33) in patients with sepsis and its regularity, the association between IL-33 and the infection, and the significance of IL-33 in predicting the prognosis of sepsis.Methods A prospective single-center single-blind clinical study was conducted. Forty patients with sepsis in intensive care unit (ICU) of Shengjing Hospital of China Medical University from May 2012 to January 2013 were enrolled. The patients were divided into general sepsis, severe sepsis and septic shock groups according to the severity of systemic infection and presence of organ dysfunction. The sepsis patients were again divided into 28-day death group and survival group. Ten healthy volunteers and 11 patients with systemic inflammatory response syndrome (SIRS) were enrolled as healthy control and SIRS groups. The levels of procalcitonin (PCT), IL-33, IL-6, IL-1β, tumor necrosis factor-α (TNF-α), and IL-33 receptor sST2 were determined with enzyme linked immunosorbent assay (ELISA) within 3 hours, and 24 hours and 5 days after enrollment to ICU. The acute physiology and chronic health evaluationⅡ (APACHEⅡ) score was calculated. The clinical outcome, length of stay in ICU, and duration of mechanical ventilation were recorded. The relationship between IL-33 and each parameter was analyzed by Spearman analysis. Receiver operating characteristic (ROC) curve was drawn to evaluate IL-33 in predicting the outcome of sepsis.Results Plasma IL-33 in sepsis patients within 3 hours after admission was significantly increased compared with that of the healthy controls and SIRS group (ng/L: 15.43±7.22 vs. 0.67±0.24, 1.25±1.09, bothP< 0.01). Compared with SIRS group, PCT in sepsis group was significantly increased [μg/L: 52.23 (19.69, 73.37) vs. 1.22 (0.69, 3.73),Z = -2.447,P< 0.001]. With exacerbation of illness, APACHEⅡ score, the values of PCT and IL-33 were gradually increased in general sepsis, severe sepsis and septic shock groups, while the length of stay in ICU and the duration of mechanical ventilation were gradually prolonged (P< 0.05 orP< 0.01). The concentration of IL-33 (ng/L) of sepsis patients admitted to ICU within 3 hours, and 24 hours and 5 days of the illness was 15.43±7.22, 11.82±6.16, 5.55±2.25, respectively (F = 4.823,P = 0.004). There was a positive correction between IL-33 within 3 hours after ICU admission and APACHEⅡ score (r = 0.351,P = 0.031), PCT (r = 0.412,P = 0.005), IL-6 (r = 0.535,P = 0.030), IL-1β (r = 0.674,P = 0.030), TNF-α (r = 0.250,P= 0.030), sST2 (r = 0.620,P< 0.001), and length of stay in ICU (r = 0.296,P = 0.013), duration of mechanical ventilation (r = 0.385,P = 0.011). Decreased plasma IL-33 level could be found in the survivors (n = 37,F = 7.798,P< 0.01), and its level in non-survivors (n = 3) was increased (F = 37.283,P> 0.05). The area under the ROC curve (AUC) of IL-33 and PCT in ROC curve were 0.821, 0.829. When the cut-off value of IL-33 was 13.79 ng/L, the sensitivity was 74.2%, the specificity was 79.6%; when the cut-off value of PCT was 4.70μg/L, the sensitivity was 87.5%, and the specificity was 81.4%.Conclusions The concentration of IL-33 3 hours after ICU admission was obviously increased in sepsis patients, and it was positively correlated with PCT, therefore it is valuable in the diagnosis of the infection. In addition plasma IL-33 is related to the severity of sepsis. Its trend of change is valuable in predicting the outcome and in distinguishing sepsis from SIRS.

Objective To analyze the relationship between serum leptin level and RAAS,insulin sensitivity.Methods We collected 38 patients with obesity-related hypertension,32 patients with hypertension,33 patients with obesity and 33 normal controls.Their serum levels of Leptin,FINS,PRA,AngⅡ,ALD and FPG were measured,and then the insulin sensitivity index(ISI) was calculated.Their body height and weight were measured,and body mass index(BMI) was calculated.Results ISI levels in patients with obesity-related hypertension,with hypertension or with obesity were significantly lower than that in the control(P

BACKGROUND:The purpose of lumbar disc protrusion and spondylolysis operation is not only to anterior decompression and fusion,but also to maintain the mechanical stability of vertebrae by holding the normal stress spot range of instantaneous center of rotation (ICR).OBJECTIVE:Using mechanical tenet to explain the pathological relationship between lumbar disc protrusion and spondylolysis,and to summarize the treatments for 68 cases with lumbar disc herniation and spondylolisthesis.METHODS:Totally 68 cases of lumbar disc protrusion and spondylolisthesis suffered lumbago or sciatica simultaneously.All patients were treated by the surgical method containing posterior whole or half laminectomy exploration decompression,discectomy,intervertebral fusion and the short segment posterior pedicle screw reduction and internal fixation.RESULTS AND CONCLUSION:All patients received 1.5 years follow-up.According to Stamffer criterion of therapeutic effectiveness,63 patients were good,and 5 patients were average,with 92.6% good rate.Due to abnormal ICR,the pathological disc and spondylolysis were reciprocal causation.Following implantation,the stress of ICR was kept in a normal range,and the anterior sliding power of vertebrae was reduced,which can maintain the mechanical stability of vertebrae.

Objective To investigate the effect of cholecystokinin (CCK) on rat intestinal interstitial cells of Cajal (ICC) and the small intestinal motor function during experimentally induced acute pancreatitis (AP).Methods 20 male SD rats were divided with a random number table into model group (n =15) and control group (n =5):the 15 rats in the model group were further divided into 3 subgroups,i.e.0,20,40 μg/kg CCK sub-groups.L-omithine was intraperitoneally injected to induce pancreatitis,while normal saline was injected in the control group.24 hours after establishing AP model,CCK was administered intraperitoneally every day for 5 consecutive days.The rats were sacrificed by cervical dislocation 30 minutes after gavage with 2 ml ink.Length of the small intestine which have become black and that of the whole small intestine were measured.Intestinal sections were studied by confocal microscopy after immunofluorescence with specific antibodies.The number of positive cells was compared among the groups.Results In the control group,the number of ICC in the myenteric plexus and deep muscular plexus was (21.16 ± 3.19) /field and (17.20 ± 1.75) /field,respectively;in the AP group was (5.00 ± 1.05) /field and (4.52 ± 1.05) /field,respectively;in the AP + CCK20 group was (10.76 ± 2.09) /field and (9.84 ± 1.68) /field,respectively;in the AP + CCK40 group was (13.72 ±2.97) /field and (12.40 ± 1.81) /field,respectively;the number of ICC in the AP group were significantly lower than those in the control group (P =0.001).The ratio of transmission distance in small intestine in the control,AP,AP + CCK20,and AP + CCK40 groups was 0.71 ± 0.05,0.54 ± 0.07,0.68 ± 0.10,and 0.74 ± 0.07,respectively.The intestinal motor function was reduced in the AP group,demonstrated by shortened transmission distance,which was improved after the administration of CCK (P =0.003).Conclusions Pancreatitis can cause ICC damage,reduce ICC number,destroy ICC network and the small intestinal motor function.CCK can mitigate the damage to ICC and protect the integrity of ICC network,thereby improving intestinal motor function.

Objective To analyze the correlation between fluid equilibrium and oxygen index in patients at early stage (within 2 weeks) of severe acutepancreatitis (SAP),and to discuss the effects of fluid equilibrium after resuscitation on the prognosis.Methods A clinical study was conducted.Ninety-seven patients with SAP admitted into Shengjing Hospital of China Medical University directly or transferred into intensive care unit (ICU) in 24 hours after admission between March 201 1 to October 2013 were studied.Finally,65 patients were enrolled in statistical analysis,and those with termination of treatment prematurely were excluded.The patients received treatment protocol formulated by the same physician in ICU.Patients were divided into improved group and death group according to the outcome.The differences in fluid equilibrium on 1,2,3,7,14 days after admission of ICU between the two groups were compared.The correlation between fluid equilibrium and oxygen index was analyzed with curve fitting.Results Among 65 patients enrolled,53 of them were improved after intensive care and were transferred into ordinary wards.However,12 patients died in ICU.Patients in the improved group showed delayed positive fluid equilibrium,and some patients even showed negative fluid equilibrium.Patients in death group needed more fluid to achieve fluid equilibrium.There was a significant difference in the need of fluid to reach an equilibrium between improved group and death group [1 day:1 814.5 (905.2,2 152.8) vs.3 891.0 (2 524.2,5 714.5),Z=-3.303,P=0.001; 2 days:2 469.0 (1 456.0,3 696.0) vs.6 498.0(4 617.8,8 763.5),Z=-4.431,P＜0.001 ; 3 days:3 234.0 (1 098.0,4 295.5) vs.9 533.5 (6 748.8,10 689.0),Z=-4.684,P＜0.001 ; 7 days:3 234.0 (1 033.0,5 162.0) vs.13 986.5 (8 045.8,14 518.0),Z=-4.718,P＜0.001 ; 14 days:3 234.0 (978.5,4 924.0) vs.13 436.5 (8 045.8,14 518.0),Z=-4.769,P＜0.001].There was no correlation between fluid equilibrium and oxygen index in improved patients within 3 days of ICU admission (R 2=0.000,P=0.827),and it fit the logistic curve in a relatively low level after 3 days of ICU admission (R 2=0.036,P＜0.001).Conclusions Early fluid resuscitation could help maintain hemodynamics stability in SAP patients.Those SAP patients who showed a negative equilibrium in early stage showed a better prognosis,and the fluid equilibrium and oxygen index in improved patients fit the logistic curve after 3 days of ICU admission.

Objective To analyze pathogen spectrum of intra-abdominal infection in patients in an intensive care unit (ICU).Methods Intra-abdominal infections and pathogens of 1 330 patients who admitted to ICU from January 2012 to March 2013 were analyzed retrospectively.Results 283 patients developed intra-abdominal infection,incidence of infection was 21.28%;133 (47.00%)patients were detected 186 isolates of pathogens,the proportion of gram-negative bacilli, gram-positive cocci,and fungi were 68.82%(n=128),28.49%(n= 53),and 2.69%(n=5)respectively.The major gram-negative bacilli were Escherichia coli ,Acinetobacter baumannii ,and Klebsiella pneumoniae ,the major gram-positive cocci were Enterococcus faecium,Staphylococcus aureus ,and Enterococcus faecalis .The detection rates of pathogens after patients stayed in ICU for ≤2,3-7,8-14,and>14 days were 70.43%(n=131),12.90%(n=24),10.22%(n=19), and 6.45%(n =12)respectively;Escherichia coli (n =51 )and Enterococcus faecium (n =21 )were the main pathogens when patients stayed in ICU for ≤48 hours,Acinetobacter baumannii was the main pathogen when patients stayed in ICU for >48 hours.Most intra-abdominal infection occurred after intestinal tract(53.23%)and hepatobiliary system operation (24.19%).39 (29.32%)patients isolated at least two kinds of pathogens,29 of whom isolated 2 kinds of pathogens. Conclusion Most pathogens of intra-abdominal infection in ICU patients are detected following intestinal tract and hepato-biliary operation,and mixed pathogens are common,predominantly gram-negative bacilli.Escherichia coli and Enterococcus faecium are the main pathogens when patients stayed in ICU for ≤48 hours,opportunistic pathogens are the main patho-gens when patients stay in ICU for >48 hours.

Objective To investigate bacterial spectrum characteristics and distribution of urinary tract infections with different time phase in intensive care unit(ICU).Methods From January 2012 to March 2013,the clinical data of 1330 cases in ICU,treated with urinary catheter indwelling,was retrospectively reviewed.Among them,705 cases were male and 625 cases were female.Their age ranged from 11 to 94 years old,mean (55.4 ± 19.2)years old.Acute physiology and chronic health scores (APACHE Ⅱ) were 1 to 69,mean 17.1 ±9.3.Duration of catheter indwelling ranged from 1 to 28 days,mean 23 days.The urine was collect through catheter via sterile syringe for bacterial culture.The incidence of urinary tract infection,bacterial infection spectrum,composition ratio and bacteria distribution in 1,2 and 4 weeks after admission were recorded.Results Total urinary tract infection cases were 36(2.7％).There were 15 urinary tract infection cases in 625 famale cases(2.4％),There were 21 cases in 705 male cases (3.0％).49 pathogens were obtained,including 32 gram-negative bacilli (65.3％),17 gram-positive cocci (32.7％) and 1 fungus 2.0％.Enterococcus faecium (30.6％),E.coli (22.4％),Acinetobacter baumannii(10.2％),and Klebsiella pneumoniae (10.2％) were the predominant species.According to hospitalized time,the bacteria spectrum distribution showed Gram negative bacilli were 50.0％ (8 pathogens),57.1％ (4 pathogens),76.9％ (20 pathogens) and Gram positive bacteria were 43.8％ (7 pathogens),42.9％ (3 pathogens),23.1％ (6 pathogens) in the differet observed time point,respectively.A fungus was only observed in the first week after admission 6.3％.Concluusions Gram-negative bacilli were predominant bacterial of urinary tract infections in ICU patients.The incidence of fungus infection was low.E.coli,Acinetobacter baumannii and Klebsiella pneumoniae were the predominant species in Gramnegative bacilli.And Enterococcus faecium was the predominant specie in gram-positive cocci.It was similar for gram-negative bacilli and gram-positive cocci in the first two weeks.After two weeks Gram-negative bacilli turned to the main species.

Objective To explore the neuroprotective role of propylene glycol alginate sodium sulfate(PSS) following cerebral ischemic reperfusion in rats.Methods Middle cerebral artery occlusion (MCAO) and reperfusion models were made using an intraluminal filament method.The rats in PSS treatment group were injected intraperitoneally with PSS(18.75 mg/kg) at 0,24 and 48 h after reperfusion,same quantity of normal saline was used in control group,sham-operation group and normal group.We studied neurological scores,infarct size,histological and ultrastructure changes of neurons and cell apoptosis.Results(1) The neurological score was(1.83?)0.75 in treatment group and(2.83?)0.75 in control group,the infarct size was((107.9?)12.1) mm~3 in treatment group and((150.3?)30.5)mm~3 in control group.The differences were significant between the two groups(all(P)0.05),and obviously decreased 6,12,24,48 and 72 h after reperfusion((P

Objective To compare and discuss the changes of cardiac structure and function between young and middle-aged obese and normal healthy subjects.Methods 67 obese objects were divided by the body mass index(BMI)into 3 groups and 23 normal objects were included.Echocardiography was performed using a HDI 3000 and a 2.0～3.0 MHZ transducer.The LV end-diastolic and end-systolic dimension were measured.LV diastolic function was determined by peak E wave velocity,A wave velocity and E/A ratio,IVRT.Results LVEDD,LVESD,IVS,LVMI of obese group were significantly greater,larger than those in control group (P0.05).BMI had significant positive correlation with the LVEDD(r=0.37,P