OBJECTIVE:To explore the risk factors for nosocomial infection of multidrug-resistant organism (MDRO) in ICU,and to provide reference for preventing and controlling MDRO in ICU. METHODS:In retrospective study,246 patients with nosocomial infection from ICU of Xi'an Aerospace General Hospital (hereinafter referred to asour hospital) during Jan. 2011-Dec. 2015 were selected and divided into non-MDRO infection group (140 cases) and MDRO infection group (106 cases). The detection and drug resistance of MDRO were analyzed in MDRO group. Univariate analysis and binary Logistic regression anal-ysis were used to explore risk factors for nosocomial infection of MDRO. RESULTS:During 2011-2015,435 strains of MDRO were isolated from 106 MDRO infection patients,in which Gram-negative bacteria accounted for 89.43%,showing severe drug re-sistance. Univariate analysis showed that the following 13 factors were related to nosocomial infection of MDRO,such as ICU ad-mission time,hypoproteinemia,acute cerebrovascular diseases,renal abnormalities,mechanical ventilation time,arterivenous cath-eterization time,urethral catheterization time,indwelling gastric tube time,type and time of using antibiotics,combined use of an-tibiotics,application of carbapenems and the third generation caphalosporins(P<0.05). Binary Logistic regression analysis showed that acute cerebrovascular diseases,type and time of using antibiotics were the independent risk factors for nosocomial infection of MDRO in ICU [odds ratios were 2.816,1.582,1.265,95%CI were (1.540,5.151),(1.085,2.306),(1.131,1.415)]. CONCLU-SIONS:Some prevention and control measures should be taken actively for high-risk MDRO infection patients in ICU to reduce the incidence of nosocomial infection of MDRO and improve the quality of health care.

Gastrointestinal bleeding in children is a potentially life threatening medical emergency requiring an appropriate diagnostic and therapeutic approach.The causes of hemorrhage are numerous and varies with age.The clinical presentation of gastrointestinal bleeding in children ranges from asymptomatic microcytic anemia to hypovolemic shock.Therefore,the primary focus in a child with gastrointestinal bleeding is rapid assessment,stabilization,and resuscitation followed by a diagnostic modalities.

Objective:To compare the social adaptability of Chinese and Japanese children Method:306 preschool children in Xi'an and 215 Japanese children were sampled The research instrument was the Infant-Junior Middle School Social Adaptive Capacity Scale Result:In the six fields of social adaptability, Chinese children had lower scores than Japanese children, except for that of sports Conclusion:Chinese preschool children have lower social adaptive capacity, which may be due to the overprotective attitude of Chinese parents or grandparents

Objective To investigate the clinical significance of plasma prothrombin activity (PTA) and serum alpha fetoprotein (AFP), prealbumin (PALB) in severe hepatitis patients treated with artificial liver plasma exchange. Methods The clinical data of 31 patients with severe hepatitis were retrospectively analyzed. The patients were treated with artificial liver plasma exchange based on the comprehensive treatment. The patients were divided into survival group (17 cases) and death group (14 cases) according to the clinical outcome. The plasma prothrombin time (PT) and serum AFP, PALB levels were detected before treatment, 3rd, 9th and 18th day after treatment and at the last time (prior to discharge/ in extrimis), and the PTA was counted. Results There was no statistical difference in PTA before treatment and 3rd day after treatment between 2 groups (P>0.05). The PTA levels 9th and 18th day after treatment and at the last time in death group were significantly lower than those in survival group:(30.17 ± 4.79)％vs. (39.74 ± 4.77)％, (25.47 ± 6.46)％vs. (42.79 ± 6.88)％and (21.40 ± 9.17)％vs. (47.17 ± 5.46)％,and there were statistical differences (P<0.05). There was no statistical difference in AFP before treatment between 2 groups (P>0.05);the AFP levels 3rd, 9th and 18th day after treatment and at the last time in death group were significantly lower than those in survival group:(121.9 ± 31.7)μg/L vs. (134.6 ± 31.8)μg/L, (88.7 ± 40.8)μg/L vs. (169.9 ± 41.7)μg/L, (56.9 ± 29.7)μg/L vs. (176.8 ± 48.1)μg/L and (29.8 ± 15.7) μg/L vs. (204.3 ± 41.2) μg/L, and there were statistical differences (P<0.05). There was no statistical difference in PALB before treatment between 2 groups (P>0.05); the PALB levels 3rd, 9th and 18th day after treatment and at the last time in death group were significantly lower than those in survival group: (107.2 ± 17.4) mg/L vs. (126.3 ± 33.2) mg/L, (91.2 ± 11.9) mg/L vs. (137.9 ± 35.7) mg/L, (54.7 ± 14.8) mg/L vs. (151.9 ± 27.9) mg/L and (43.3 ± 19.7) mg/L vs. (159.3 ± 41.2) mg/L, and there were statistical differences (P<0.05). Conclusions The plasma PTA and serum AFP, PALB levels are closely related with curative effect of artificial liver plasma exchange in severe hepatitis patients, and dynamic observation of its changes can help to determine the condition.

Objective To study the factors which affect the functional restoration of the elbow for adults with supracondylar or intercondylar fractures of the humerus treated with open reduction and internal fixation. Methods 22 patients with supracondylar or intercondylar fractures of the humerus were treated with open reduction and internal fixation from January, 1999 to December, 2004. They were followed up for an average of 30 months and complete clinical data were kept. The function of the elbow was evaluated with the Mayo elbow performance index. The relationship between the results and the factors —initial time of postoperative rehabilitation, fracture classification, operative approach and interval from injury to operation —were analyzed with cumulative logistic regression model of SAS software V8.2 (SAS institute, Cary, North Carolina). Results Of the 22 cases, 7 were excellent, 9 good, 5 fair and 1 poor. The excellent and good rates were 72.7%. And the odds ratio estimates of the 4 factors were 0.786, 0.299(B/A)0.221(C/A), 1.038, 0.197 respectively. Conclusions The initial time of postoperative rehabilitation, the fracture classification and the interval from injury to operation affect the functional restoration whereas the operative approach does not. Early operation, anatomical reduction, stable fixation and early rehabilitation will help improve the functional restoration.

OBJECTIVE To explore the risk factors and countermeasures of burn wound infection.METHODS The data of burn patients in hospital from 2005 to 2007 were retrospectively analyzed.RESULTS From 341 burn patients 257 got infected and total infection rate was 75.4%.Investigation shows that the probability e of infection in 3 days was 12.9%,but the rate became 72.7% after 4 to 10 days.The bigger the wound area,the higher the possibility to got infected.The infection rate was 43.8% when BSA was smaller than 20.0%.When BSA was bigger than 41.0%,the rate was up to 88.0%.When BSA was bigger than 61.0%,the rate was 100.0%.Except that,antibiotics and standard medical performance were the important factors related to burn infection.CONCLUSIONS To strengthen the aseptic concept among medical staff,pay attention to the environment of hospital,and the sterilization of the materials,debridement and drainage in time,and rational usage of antibacterial drugs,are the effective countermeasures to reduce burn wound infection.

The brain edema is a secondary cerebral injury in intracerebral hemorrhage(ICH) and one of the main causes of deterioration and death.The toxic effect of blood clots is involved in the formation of brain edema.The article reviews the commonly used antiedema drugs including mannitol,glycerol,hypertonic saline,furosemide,albumin,glucocorticoids,sodium aescinate and aprotinin,and introduces such hopeful drugs as edaravone,deferoxamine,argatroban and celecoxib in the treatment of ICH.

Objective Our aim is to compare the safety and benefits of laparoscopic versus open incision hernia repair.Methods Forty-seven patients in our hospital were analyzed with prospective randomized double-blind study following either laparoscopic or open hernia repair.And others prospective randomized studies(PRS)were analyzed.Results Overall complication rate was similar in both groups(8.5% versus 9.2% in the laparoscopic and open groups respectively),but some early complications in the laparoscopic group maybe require a reoperation.Operating time was similar in the laparoscopic group.There was shorter length of stay and higher expense in the laparoscopic group and there was significant difference in the pain scores and medications,resumption of diet,or activity scores.At 2 weeks,there was no difference in the activity or pain scores,but physical function and physical health scores on the short-form 36(SF36)quality of life assessment forms were little in the laparoscopic group.Regardless of the technique(P=0.158).The result of PRS meta-analyses is that operating time was simila in the laparoscopic group.There was longer length of stay in the Laparoscopic group.And the rate of wound infection is significantly higher in the open groups.Conclusion Unlike other minimally invasive procedures,Laparoscopic hernia repair did not offer an advantage over open hernia repair in all studied parameters except pain,activities and quality of life scores at 2 weeks.It also took similar to perform.The choice of the procedure should be based on surgeon or patient preference.

The interaction between immune response and metabolic regulation can be viewed as a central homeostatic mechanism,dysfunction of which will lead to many diseases.This nonlinear interaction,which has the characteristic of super-complexity,can’t be controlled unless it is studied as a holism and the change of condition is researched.To study this homeostasis,bottom-up method used in system biology is limited.Ying-wei theory of TCM uses another method to describe di erent states of metabolic and immune systems e ectively.The unique approaches and rich experiences applied in TCM are of great value.

Objective To analyze and classify the characteristic of plain X-ray, CT scan, MRI and pathologic findings in ossification of the ligamentum flavum of the thoracic spine. Providing the clinic criterion to verify the extent and progression of ossification of ligaments based on medical imaging findings. Methods Twenty-four patients with thoracic myelopathy due to ossification of the ligamentum flavum underwent surgical decompression posteriorly. There were 18 males and 6 females with age ranging from 42-76 years (mean, 57.9 years). The morphology of ossification on the CT scan was divided into isotype and non-isotype. The signal intensity of ossification was compared with that of spinal cord on T2 stage in MRI, whose results were divided into four types, such as no signal, low signal, iso signal and high signal. There were two types of ossification in pathologic findings, the mature and immature ossification. 73 segments of ossified ligaments removed from surgery were evaluated and classified individually on the base of their X-ray, CT scan, MRI and pathologic findings. 27 segments of ossified ligaments were examined immunohistochemically by use of TGF-?1 antibody. The relationship between classification of X-ray, CT scan, MRI and pathology of the ossified ligaments were compared on the basis of individual segment, to determine whether there was correlation between these findings. Results The relationship between the pathologic findings of the 73 ossified fragments and the manifestation for the CT classification and MRI signal showed: 18 isotype ossification on CT scan turn out to be mature; and among the 55 non-isotype ossification, 51 were immature and 4 were mature. 22 no signal ossifications on MRI were confirmed as mature type; all the 50 low signal ossifications were immature type; and 1 iso signal ossification was immature type. 100% were matched between MRI and pathological findings, 94.5% matched between CT and pathological findings. Conclusion The extent and progression of ossification of ligaments may be verified and predicted clinically on the base of CT scan and MRI findings, which provide the clinic criterion to guide the extent and timing of decompression.