Combined Modality Therapy ; Critical Care ; methods ; Humans ; Sepsis ; therapy ; Shock, Septic ; therapy

Critical Care ; trends ; Humans

Critical Care ; General Surgery ; Humans ; Rescue Work

Gastrointestinal Diseases ; Humans ; Infection ; Multiple Organ Failure ; Shock

China ; Critical Care ; history ; methods ; trends ; History, 20th Century ; History, 21st Century ; Humans

Objective To analyze the clinical features of pandrug-resistant Acinetobacter baumannii (PDR-Ab) in a hospital and compare the efficacy of different antibiotic treatments on patients with pneumonia caused by PDR-Ab.Methods Data were ret- rospectively collected from all isolated PDR-Ab strains in our hospital from February 2004 to March 2005.The clinical features and outcomes were reviewed.Results A total of 77 strains of PDR-Ab were collected, 45 of which were pathogens causing clini- cal infections (35 strains from lower respiratory tract, 6 from bloodstream, 3 from drainage fluid, and 1 from wounds).Lower respiratory tract was the most common source of PDR-Ab.More than 90% of the isolated PDR-Ab strains produced OXA-23 type?-lactamase.Cefoperazone-sulbactam plus minocyeline showed good efficacy for patients with PDR-Ab pneumonia.The total clinical cure rate was 68.4%.Bacterial eradication rate was 42.1%.The factors influencing bacterial clearance were pro- longed mechanical ventilation prior to positive culture (17.5 d vs 5.5 d).mixed infection (100% vs 12.5%) and lower GCS score (9.1?0.7 vs 13.2?2.1).Concomitant septic shock (OR=13.8) and APACHEⅡscore (OR=2.1) were independent factors of clinical outcome.Conclusions Nosocomial infections caused by PDR-Ab are not untreatable.Our analysis suggests that cefoperazone-sulbactam plus minocycline may be an effective treatment for lower respiratory tract infections caused by PDR-Ab in our hospital.

AlM:To investigate biological measurement parameters of anterior segment in acute angle- closure glaucoma ( AACG) .METHODS:Forty-six eyes of 46 patients with AACG and 52 eyes of 52 patients with shallow anterior chamber and 50 eyes of 50 normal individuals were examined. The parameters of anterior segment including chamber crowd rate (CCR), lens thickness (LT), lens position (LP) and anterior chamber depth ( ACD ) were measured by A-ultrasound according to different ages in each group. The data were performed statistical analysis in three groups.RESULTS: ln each age range group (≥50 ~ 59 years old, ≥60 ~ 69 years old, ≥70 years old ) , statistically significant differences in three groups ( AACG, shallow anterior chamber group and the controls ) were found in CCR, LT, LP, ACD (P<0. 01). There were statistically significant differences only in CCR (P<0. 01) but not in LT, LP and ACD ( P > 0. 05 ) between AACG and shallow anterior chamber group in each age range group.CONCLUSlON: CCR can be used as the index of evaluating crowding state of anterior segment in AACG patients and the sensitivity is better than LT and LP.

AlM: To discuss the application effect of surgical simulator to improve the microsurgical skills in junior ophthalmologist. METHODS: Lecture teaching, training in surgical simulator and operation in animal eyes were received in all these ophthalmologists. Results of the ability of operation in cataract surgery after this training were analyzed. RESULTS: After taught theory, students completed cataract surgical procedures on simulator and the mean test score was 75. 91 ± 6. 53 points. After trained on simulator repeatedly, the mean test score was 85. 57±4. 64 points. There was statistically significant difference ( P<0. 01) . During the third stage of practicing on animal eyes, the score was 89. 77 ± 7. 61 points, there was statistically significant difference compared with former two stages (P<0. 05).CONCLUSlON: Comprehensive training can improve microsurgical skills of junior ophthalmologist, but the long effect need to be observed.

Objective • To investigate the role of group I metabotropic glutamate receptor (mGluR) in the regulation of N-methyl-D-aspartic acid receptor (NMDAR)-mediated synaptic plasticity in low dose ketamine protecting learning and memory function after modified electroconvulsive shock (MECS). Methods • The 2-3-month-old Sprague Dawley (SD) rats were used to establish depression models with chronic unpredictable mild stress. Ten healthy rats were used as the control group (group C), and another 30 depressed rats were randomly divided into group D, group M, and group KM. Group C was not treated, group D was treated with pseudo-MECS after intraperitoneal injection of normal saline, group M was given intraperitoneal injection of propofol, and group KM was given intraperitoneal injection of propofol combined with low-dose ketamine (10 mg/kg). Both group M and group KM underwent MECS. The sucrose preference test was used to evaluate the depression status. The Morris water maze was used to detect the spatial learning and memory function. The expression of NMDAR1, mGluR1 and mGluR5 proteins in the hippocampus was detected by Western blotting. Another 36 depressed rats were randomly divided into 6 groups: group DE, group m1E, group m5E, group DE', group m1E', and group m5E'. Group DE and group DE' were perfused with artificial cerebrospinal fluid alone. Group m1E and group m1E' were perfused with artificial cerebrospinal fluid containing mGluR1 blocker. Group m5E and group m5E' were perfused with artificial cerebrospinal fluid containing mGluR5 blocker. Long-term potentiations (LTP) were detected in group DE, group m1E, and group m5E. NMDAR-mediated field potentials (fEPSPNMDAR) were detected in group DE', group m1E', and group m5E'. Results • After treatment, the sucrose preference percentages of group M and group KM increased compared with group D (P<0.05), the escape latencies (EL) of group M and group KM were prolonged (P<0.05), and the space exploration times (SET) were shortened (P<0.05). Compared with group M, the EL of group KM was shortened (P<0.05), and the SET was prolonged (P<0.05). Compared with group D, the expression levels of NMDAR1, mGluR1 and mGluR5 in group M and group KM decreased (P<0.05). Compared with group M, the expression levels of NMDAR1, mGluR1 and mGluR5 in group KM increased (P<0.05). Compared with group DE, the LTP decreased in group m1E and group m5E (P<0.05). Compared with group DE', the fEPSPNMDAR of group m1E' and group m5E' decreased (P<0.05). Conclusion • Ketamine up-regulates NMDAR1 and group mGluR expression to enhance the activation of NMDAR in the hippocampus which may be responsible for the protective effects on spatial learning and memory function in depression rats undergoing MECS.

OBJECTIVETo investigate the clinical value of intraoperative ultrasonography in cervical laminoplasty.

METHODSThirty patients underwent cervical laminoplasty for cervical compressive myelopathy in our hospital from April 2010 to April 2012. Spinal cord compression ratio was calculated in preoperative MRI axial images for every patient. The spinal cord decompression status was evaluated by intraoperative ultrasonography during cervical laminoplasty. The pre- and post-operative Japanese Orthopaedic Association Scoring System (JOA) score was recorded, and the recovery ratios of surgery were graded using the Hirabayashi equation. The relationship between the parameters and neural recovery was explored.

RESULTSThe intraoperative ultrasonography was used to evaluate the ventral compression of the spinal cord. The ultrasonographic dynamic viewings were classified into three types based on the spinal cord contact with ventral structures after decompression: Type 1, non-contact (n=2); Type 2, contact and apart (n=16); and Type 3, contact (n=12). The patients were divided into two groups: group A, showing Type 1 or 2 findings, representing satisfied decompression; and group B, showing Type 3 findings with insufficient decompression. The recovery ratio was (73.3±21.0)%(31.3%-100.0%) in group A, but decreased to (43.2±33.1)%(0-83.3%) in group B(t=3.05,p=0.005). Pearson analysis showed that the patient age(r=-0.294,p=0.122), preoperative JOA score(r=0.059,p=0.759), and spinal compression ratio(r=0.269,p=0.151) was not correlated with Hirabayashi recovery ratio.

CONCLUSIONIntraoperative ultrasonography during laminoplasty is a feasible and promising method for evaluating spinal cord decompression status and predicting the prognosis following surgery.

Adult ; Aged ; Aged, 80 and over ; Decompression, Surgical ; Female ; Humans ; Laminectomy ; methods ; Male ; Middle Aged ; Monitoring, Intraoperative ; methods ; Spinal Cord Compression ; diagnostic imaging ; surgery ; Ultrasonography