Non-responding pneumonia describes the situation, in which an inadequate clinical response is present de-spite antibiotic treatment. The incidence of treatment failure in community acquired pneumonia (CAP) can range up to 31%. At present, the diagnosis and treatment of this kind of disease remain a great challenge to CAP. For this reason, several stud-ies have attempted to establish risk factors and new strategies for the treatment of non-responding pneumonia. This article re-views the progress of the pathogeny and treatment of non-responding CAP.

Objective To evaluate the effect of comprehensive intervention measures on reducing the bacterial colonization of the intensive care unit (ICU)bedside notebook computer keyboards and mice.Methods According to bacterial contamination of ICU bedside notebook computer keyboards and mice,comprehensive intervention meas-ures were taken (including wiping computer keyboards and mice with alcohol twice a day,intensifying hand hy-giene,and monitoring hand-washing compliance),specimens of keyboards and mice were taken,bacterial detection results were analyzed.Results Before intervention,bacterial counts of keyboards and mice of 8 specimens were all>5 CFU/cm2 ,detection rate of Bacillus subtilis was 64.71 %,Micrococcus ,coagulase negative staphylococcus, Acinetobacter baumannii ,and Klebsiella pneumoniae were 17.65%-58.82%,Escherichia coli and Acinetobacter calcoaceticus were both 5.88%.After comprehensive intervention measures were taken,bacterial counts of only two specimens of keyboards and mice were >5 CFU/cm2 ,the qualified rate of monitoring result after intervention was significantly higher than before intervention (88.24% vs 52.94%;χ2 =5.10,P <0.05).Conclusion Compre-hensive intervention measures can significantly reduce bacterial count on ICU bedside notebook computer keyboards and mice,and decrease the occurrence of healthcare-associated infection.

Objective To classify the nursing faculty in a certain third-class and first-grade hospi-tal.Methods We carried out 2 times of expert consultations about the classification of 14 nursing man-agement faculty in a certain third-class and first-grade hospital by Delphi method.Besides we had further interviews with 5 nursing experts and 12 nurses by means of qualitative interview.Results We got weight of rationality and harmony degree of expert attitude with a authoritative coefficient of 0.7867.The results of qualitative interview included 4 thematic concep4 understanding degree,meaning,basis of classification system.Conclusion Scientific and operational classification system for clinical nurses could set basis for reasonable settlement of nurses resource and design of nurses'career.

OBJECTIVE:To establish the evaluation index system that is suitable for biological pharmaceutical industry cluster competitiveness,and provide reference for the evaluation of biological pharmaceutical industry cluster competitiveness in Jiangsu province. METHODS:Biological pharmaceutical industry cluster enterprises in Jiangsu province were selected as research samples. Through the questionnaires,the grey multi-index evaluation method was used to determine weight set,establish evaluation sample matrix,and evaluate and analyze 3 first-level indexes(8 second-level indexes,and 23 tertiary-level indexes),such as the innova-tion knowledge spillover,innovation network and social capital,etc. RESULTS & CONCLUSIONS:The financial indicators such as investment intensity of biological pharmaceutical industry cluster in Jiangsu province were low,and there was a shortage of funds problem;new drug patents of independent intellectual property rights were insufficient,and lacked of protection of intellectu-al property rights,there was an independent innovation motivation problem;profitability indexes such as the rate of product sales were low,there was a problem of low industrialization of scientific research;social culture score in social capital level was not high,there was a problem of strengthening soft environment such as the binding biological innovation public service platform. It is suggested to strengthen the cooperation among cluster enterprises and scientific research institutions,and improve enterprise innova-tion power;improve the mechanism of biological innovation and the level of industrialization of scientific research achievements;and actively guide the various types of biological innovation public service platform to participate in the construction of the soft en-vironment of the cluster.

Objective To comparatively complete clinical effectiveness of laparoscopic and open-bifemoral bypass in the treatment of advanced atherosclerosis.Methods During January 2008 to January 2013,according to the treatment method,a total of 60 patients with advanced atherosclerosis patients were divided into group A and group B,and there were 30 cases in each group,and group A was treated with open master bifemoral bypass surgery,and group B was treated with laparoscopic totally master bifemoral bypass surgery,to compare the general information of the two groups,surgery related indicators,clinical efficacy and survival rate,and to analyze the effect of surgical treatment on the prognosis of patients by COX model.Results The operation time of patients in group B (365.3 ±41.3) min and aortic clamping time (59.5 ± 18.3) min were significantly higher than that of group A,(294.3 ±35.5) min and(26.5 ± 19.3) min (P ＜0.05),bleeding amount (400.0 ± 145.3) ml and length of hospital stay (10.5 ± 2.1) d of group B patients was significantly lower than that of group A (1 002.3 ± 324.3) ml and (16.4 ± 4.3) d (P ＜ 0.05);postoperative mortality,thrombosis rate and the incidence of serious complications of patients in group B were significantly lower than group A (P ＜ 0.05);survival rate at different time of group B was significantly higher than that of group A (P ＜ 0.05);COX model analysis show that the surgical methods affect the postoperative mortality,thrombosis and the occurrence of severe complications.Conclusions Completely laparoscopic master bifemoral bypass can significantly decreased advanced main iliac artery occlusion disease mortality,and has small surgical trauma,less postoperative complications,rapid recovery and other advantages,especially for elderly critically ill patients,and it was worthy of clinical application.

AIM: To study the effects of As_2O_3 on the growth of human cervical carcinoma cell line, HeLa cells, human pancreatic carcinoma cell line, AsPC-1 cells, and the generation of reactive oxygen species (ROS) in the cells. METHODS: HeLa cells and AsPC-1 cells were treated with various concentrations of As_2O_3. The effects of As_2O_3 on HeLa cells and AsPC-1 cells survival and apoptosis were determined by MTT assay and light microscope, and cellular ROS was also measured by fluorometer. RESULTS: After being treated with 2 ?mol/L As_2O_3 for 48 h, the survival of HeLa cells was decreased, a marked apoptosis characteristic was observed in time- and dose-dependent manner. However, the survival of AsPC-1 cells markedly decreased after being treated with even 1?mol/L As_2O_3 for 24 h. When we measured the cellular hydrogen peroxide (H_2O_2) level, we found that the H_2O_2 level in HeLa cells started to rise after being incubated with As_2O_3 for 2 h, and sustained increased, reached the peak of H_2O_2 level at 8 h, then it began to decrease. While the H_2O_2 level in AsPC-1 cells started to rise at 2 h, reached the highest point at 5 h, after which it began to descend. At 12 h, the H_2O_2 level in HeLa cells and AsPC-1 cells were similar to that of the control group. CONCLUSION: The molecular mechanisms underlying As_2O_3 -induced apoptosis in cells derived from the solid tumors may be related to the cellular ROS level.

Objective To investigate the clinical effectiveness of pelvic floor reconstruction surgery with Prolift system and rou‐tine transvaginal surgery in treating pelvic organ prolapse (POP) .Methods We analyzed an retrospective study of 64 patients with POP patients from June 2009 to March 2011 .All patients were divided into two groups ,32 cases of the reconstruction group were treated with pelvic floor reconstruction surgery with Prolift system ,as reconstruction group ,the other 32 cases in routine treatment group with routine transvaginal surgery ,which inclouded transvaginal hysterectomy ,repair of anterior and posterior vaginal wall ,as routine treatment group ,the pre operative ,peri operative data and follow up results were compared between the two groups and to evaluate the outcomes of the two groups after surgery .Results The age ,body mass index ,menopause age ,pregnant times and the degree of uterus prolapse were no significant difference between the two groups (P>0 .05) .The operation of all the patients were successful .No patient were infected after surgery ,no vascular injury ,or urinary system injury ,or rectal injury occurred .Reconstruc‐tion group showed more significant in the amounts of blood loss ,average operation time ,anal exsufflation time ,mean of highest postoperative body temperature ,the urinary canal indwelling time and the postoperative hospitalization time compared with routine treatment group(P<0 .05) .The follow up rate was 93 .8% (30/32)in reconstruction group ,1 patient (3 .1% )experienced recur‐rence ,1 patient(3 .1% )experienced mesh erosion ,1 patient(3 .1% ) experienced new urinary tract symptoms ,of 19 patients who were sexually active ,1 patient suffered from algopareunia and 2 from sexual intercourse discomfort respectively .The follow up rate was 90 .6% (29/32)in routine treatment group ,4 patients(12 .5% )experienced new urinary tract symptoms ,8 patients(25% )expe‐rienced recurrence ,of 16 patients who were sexually active ,3 patients suffered from algopareunia and 5 from sexual intercourse dis‐comfort .The objective cure rates at 3 and 6 months after operation was no significant difference between the two groups (P>0 .05) ,but the objective cure rate at 12 months after operation was significantly different between the two groups (P<0 .05) .The objective curative rate in reconstruction group was significantly higher than that in routine treatment group .Conclusion Pelvic floor reconstruction surgery with Prolift system is a safe and effective methods of minimally invasive surgery ,patients had better regain integrity of anatomical structure and functions of pelvic floor in short term for POP when compared with routine transvaginal sur‐gery ,but its long term study is still needed .

Electrocardiography ; Female ; Fetal Hypoxia ; complications ; Humans ; Infant, Newborn ; Myocardial Infarction ; etiology ; therapy ; Myocardium ; metabolism ; pathology ; Treatment Outcome

Trypsin was purified from crude material of pig pancreas by AOT/isooctane reversed micellar system.The influence of the main operating parameters such as ethanol concentration in forward and backward extraction,pH,KCl and AOT concentration,temperature were investigated.Forward and backward extraction recovery of trypsin reached almost 90% and neared 100%,respectively.Finally,about 88% of total yield was obtained,and the specific activity of trypsin was increased to over 1800U/mg with purification factor of 5 folds more.In AOT-isooctane reverse micellar extraction system,denaturation or precipitation of proteins always occured due to strong electrostatic interaction between AOT-proteins molecules.It had been resolved by adding ethanol into reverse micellar system,and no denaturation was observed.Otherwise,the phase separation time was shortened significantly because of ethanol added.It was only 10 minutes or less to reach phases separation after forward and backward extraction.If this method can be applied in industry,efficiency will be greatly improved.

Neuroblastoma (NB) is a common malignant solid tumor that occurs during childhood;it has a significant heterogene-ity in clinical symptoms and outcome. NB diagnosis is complicated, and various clinical techniques are often involved in examining im-agery, cellular morphology, immunohistochemical staining, gene and molecule biology, and operation excision scope. Diagnoses are graded based on danger extent, which is indicated by clinical stages and unfavorable prognosis factors. These characteristics are the ba-sis for formulating the corresponding synthetic treatment plan. Limited studies are available on treatment norms for adult cases of NB;such cases are currently diagnosed and treated in accordance with child NB diagnosis and treatment norms. An adult patient diagnosed with NB stage 4 is presented. This patient experienced obvious relief from the symptoms after whole body chemotherapy, with further surgery operation indications. This successful case of multi-disciplinary joint diagnosis and cooperative treatment may provide potential treatment techniques for similar patients.