Objective:To analyze the drug resistance of Pseudomonas aeruginosa( PA) isolated from clinical specimen to provide the guidance for the clinical treatment. Methods:The infection status of PA from January 2012 to December 2012 was reviewed retro-spectively, and the results of susceptibility test for 448 PA strains were analyzed. Results:The antibiotic susceptibility of the PA strains to cefoperazone sodium and sulbac, ampicillin aodium and aulbacta,aiprofloxacin,cefepime,piperacillin/ sulbactam,amikacin, ceftazi-dime,meropenem, imipenem, minocycline, selectrin and aefuroxime was 100%, 76%, 72. 8%, 69. 4%, 66. 3%, 65. 6%, 64. 8%, 59. 9%,28. 9%,2. 4% and 0%,respectively. Conclusion:PA is one of the main pathogenic bacteria for nosocomial infection. It is necessary to strengthen the drug resistance test and standardize the application of antibiotics in order to provide the reference for clinical rational use of antibacterial drugs.

Background Retinal ichemic-reperfusion injury (RIRI) affects vision and life quality and has no ideal treatment outcome up to now.The mechanism of RIRI is associated with apoptosis.Researches showed that subretinal transplantation of bone mesenchymal stem cells (BMSCs) can relieve RIRI,but its mechanism is unclear.Objective This study was to observe the influence of BMSCs subretinal transplantation on the expressions of apoptosis protein Fas/FasL,caspases-3 after RIRI,and to explore the neuroprotecitve mechanism of BMSCs transplantation to treat RIRI.Methods Bone marrow was isolated and extract form femur and tibia of SD rat by the density gradient centrifugation method and then the BMSCs were collected.BMSCs suspension was prepared using DMEM containing low-glucose with the cell density 1 x 106-2× 106/ml.RIRI models were established by ligation of optical nerve (Daniel M method).Sixty-four SD rats were randomly divided into the normal control group,model control group,BMSCs transplantation group and PBS control group.Twenty-four hours after RIRI,BMSCs suspension with the cells density 5× 104 cells was subretinally injected in the rats of the BMSCs transplantation group,and equal volume of PBS was injected in the same way in the rats of the PBS control group.The expressions of Fas/FasL and caspase-3 were dynamically detected using immunohistochemistry at 6,24,48 and 72 hours after BMSCs transplantation.Results The positive response cells for Hoechst33324 were seen in subretina 72 hours after BMSCs transplantation.A few of positive cells for Fas,FasL,caspase-3 proteins were expressed in the rats of the normal control group at 6,24,48 and 72 hours after BMSCs transplantation.However,the positive cells for Fas,FasL,caspase-3 protein were significantly increased in the model control group and the BMSCs transplantation group compared with the normal control group at various time points after injection (all at P＜0.01),and the number of positive cells was significantly less in the BMSCs group than those of the RIRI group and the BMSCs transplantation group (P＜0.05,P＜0.01).No significant differences were found in the numbers of positive cells of Fas,FasL and caspase-3 proteins at various time points between the model control group and the PBS control group (all at P＞0.05).Conclusions The subretinal transplantation of BMSCs down-regulate the expression of Fas/FasL and caspases-3 proteins in RIR1 rats,and thus alleviate the apoptosis of retinal neural cells.

Objective:To investigate the clinical features and treatment outcome of Kallmann syndrome(KS) caused by fibroblast growth factor receptor-1(FGFR1) gene mutation in 4 patients.Methods:Targeted next-generation sequencing(NGS) was performed on thirty KS and normosmic idiopathic hypogonadotropic hypogonadism(nIHH) patients. FGFR1 mutation was identified in four KS patients. The clinical data, laboratory and imaging examinations, and treatment outcome were retrospectively analyzed.Results:Four male patients, aging from 11 to 22 years old, presented as micropenis, and with olfactory dysfunction. Among them, two had history of cryptorchidism, three had history of cleft lip and palate repair surgery. The most severe patient presented with short stature, left microtia and dental agenesis. FGFR1 heterozygous mutation was identified in all four patients, two were point mutation(p.Y374X; p. E670K), and the other was frameshift mutation(p.S346Yfs*61; p.S723*fs*1). One patient, who started treatment of the pulsatile GnRH pump during his youth, succeeded in having two babies.Conclusion:Patients with Kallmann syndrome caused by FGFR1 mutation presents complex clinical manifestations. Besides dysosmia, micropenis, microrchidia, and delayed pubertal development are the main clinical manifestations in male patients. Symptoms such as cleft lip and palate are helpful for early recognition. Genotyping analysis is crucial to confirm the diagnosis. The pulsatile GnRH pump can produce satisfactory therapeutic effect, but the age of initiating therapy should be carefully considered.

Objective To evaluate the effects of psychological nursing in patients with endotracheal intubation. Methods The data were literatures and references of randomized controlled trials ( RCTs) about the effects of psychological nursing on patients with endotracheal intubation, which published from January 1998 to January 2014. The data were collected from the databases of PubMed,MEDLINE,Cochrane Central Register of Controlled Trials, CNKI and Wanfang Database. The qualified data were extracted from valid RCT and Meta analyzed using RevMan 5. 1 software. Results There were eight RCTs involved in the research and Meta-analysis showed that there were no statistical difference between psychological nursing group and control group in dependence rate (OR=0. 65, 95%CI:0. 23-1. 87, P=0. 43), weaning ventilator rate (OR=1. 99, 95%CI:0. 87-4. 52, P=0. 10), and reintubation rate (OR=0. 44, 95%CI:0. 14-1. 41, P=0. 17). However, the statistical significances shown in anxiety degree (WMD= -8. 68, 95%CI: -13. 57- -3. 79,P=0. 0005),anxiety (OR=0. 05, 95%CI:0. 01-0. 38, P=0. 003), depression (OR=0. 18, 95%CI:0. 07~0. 42, P<0. 001), fear (OR=0. 17, 95%CI:0. 06-0. 49, P=0. 001), hallucination (OR=0. 34, 95%CI:0. 15-0. 77, P=0. 010), desperation (OR=0. 09, 95%CI:0. 03 -0. 25, P<0. 001) and unplanned extubation (OR=0. 15, 95%CI:0. 05-0. 42, P=0. 0003). Conclusions Based on the routine nursing, psychological nursing can significantly decrease the ICU syndromes in patients with endotracheal intubation, such as anxiety degree and incidence rate, depression, fear, hallucination, desperation, and unplanned extubation.

Objective To investigate the effect of promoting natural delivery by implementing the systemic exercise and diet intervention for obstetric VIP primiparas during the middle and late pregnancy period . Methods From January 2011 to March 2012 , 97 primiparas were chosen as the intervention group in obstetric VIP clinic;at the same time, 274 cases of pregnant women were chosen as the control group from the general antenatal clinic of the hospital .Neither of the two groups of pregnant women had movement contraindication , and they all voluntarily made the decision for vaginal delivery .Pregnant women in the control group only accepted the general out-patient routine prenatal check-up and health guidance;while the pregnant women in the intervention group received the VIP systemic exercise and diet guidance in addition to the outpatient routine prenatal check-up and health guidance .The fetal presentation height before delivery , the degree of cervical dilation, the time of birth process, the amount of postpartum bleeding and the mode of delivery were compared within the two groups.Results The natural birth rate in the intervention group was 70.1%significantly higher than that of 35.8%in control group (χ2 =32.788, P<0.01).The descending level of fetal presentation in the intervention group was ( -0.65 ±1.15) cm, which was significantly lower than ( -1.12 ±1.10) cm in the control group (t=2.65, P<0.01).The total labor time and the first stage of labor time were (369.10 ± 166.82)min and (334.72 ±165.69) min, respectively, which were significantly shorter than (439.48 ± 177.93)min and (403.06 ±174.67)min in the control group (t=-2.57, -2.53;P<0.05).The weight of pregnant women before delivery and that of the neonates were (74.70 ±4.80) kg and (3 489.00 ±66.89) g, respectively, in the intervention group, and were (77.80 ±4.70)kg and (3 680.00 ±54.62)g, respectively, in the control group.The differences were significant (t=1.83, 1.12; P<0.05).Conclusions The VIP clinic provides the pregnant women with systemic exercise intervention and nutritional diet guidance , which result in decreasing the cesarean section rate , increasing the natural delivery rate , effectively shortening the time of labor process and reducing the amount of intrapartum bleeding .

Objective:To review the application of pediatric magnetic resonance enterography (MRE) at Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology from 2012 to 2023, and to provide referenceable data for MRE use in complex pediatric clinical scenarios.Methods:This study was a cross-sectional study. The clinical and imaging data from children aged≤18 years who underwent MRE at Tongji Hospital between December 2012 and December 2023 were retrospectively analyzed. Out of 186 children who intended to receive the MRE examination, 12 failed, remainder 174 participants (mean age 14±4 years, range 1 month to 18 years) were included. Participants were categorized into an inflammatory bowel disease (IBD) group (118 cases) and a non-IBD group (56 cases), and further divided by age into infants (0-6 years, 8 cases), children (7-12 years, 37 cases), and adolescents (13-18 years, 129 cases). The overall image quality and the intestinal filling quality were scored using a 5-point scale. Statistical analyses included χ2 tests for age distribution, history of intestinal reconstruction surgery, and MRE success rates between IBD and non-IBD groups. Mann-Whitney U test was employed to compare subjective image quality scores between the abovementioned two groups. The Kruskal-Wallis test was used to detect the differences among the three age groups. Results:The success rate of MRE significantly increased with age: 66.7% (8/12) in infants, 88.1% (37/42) in children, and 97.7% (129/132) in adolescents ( χ2=15.39, P<0.001). A statistically significant difference in age distribution was observed between the IBD and non-IBD groups ( χ2=17.94, P<0.001). The proportion of infants in the non-IBD group was 14.3% (8/56), which was higher than that of the IBD group. The majority of the IBD group were adolescents, accounting for 78.8% (93/118). There was a statistically significant difference in the intestinal reconstruction surgery history ( χ2=2.83, P=0.005). The non-IBD group had a higher incidence of intestinal reconstructive surgery (21.4%, 12/56), compared to the IBD group (6.8%, 8/118). MRE intestinal filling quality or overall image quality scores between the IBD and non-IBD groups or among different age sub-groups were not statistically significant ( P>0.05). Conclusion:Juvenilization of non-IBD children and intestinal reconstructive surgery history could make the inspection more complex. High-quality imaging can still be achieved by adhering to technical specifications.

Objective:To investigate the influences of age-adjusted Charlson comorbidity index (ACCI) on prognosis of patients undergoing laparoscopic radical gastrectomy.Methods:The retrospective cohort study was conducted. The clinicopathological data of 242 gastric cancer patients who underwent laparoscopic radical gastrectomy in 19 hospitals of the Chinese Laparoscopic Gastrointestinal Surgery Study Group-04 study, including 54 patients in Fujian Medical University Union Hospital, 32 patients in the First Hospital of Putian City, 32 patients in Renji Hospital Affiliated to Shanghai Jiaotong University School of Medicine, 31 patients in Zhangzhou Affiliated Hospital of Fujian Medical University, 17 patients in Nanfang Hospital of Southern Medical University, 11 patients in the First Affiliated Hospital with Nanjing Medical University, 8 patients in Qinghai University Affiliated Hospital, 8 patients in Meizhou People′s Hospital, 7 patients in Fujian Provincial Hospital, 6 patients in Zhongshan Hospital of Fudan University, 6 patients in Longyan First Hospital, 5 patients in the First Affiliated Hospital of Xinjiang Medical University, 5 patients in the First Hospital Affiliated to Army Medical University, 4 patients in the Second Affiliated Hospital of Guangzhou University of Traditional Chinese Medicine, 4 patients in West China Hospital of Sichuan University, 4 patients in Beijing University Cancer Hospital, 3 patients in the First Affiliated Hospital of Xiamen University, 3 patients in Guangdong Provincial People′s Hospital, 2 patients in the First Affiliated Hospital of Xi′an Jiaotong University, from September 2016 to October 2017 were collected. There were 193 males and 49 females, aged 62(range, 23?74)years. Observation indicators: (1) age distribution, comorbidities and ACCI status of patients; (2) the grouping of ACCI and comparison of clinicopathological characteristics of patients in each group; (3) incidence of postoperative early complications and analysis of factors affecting postoperative early complications; (4) follow-up; (5) analysis of factors affecting the 3-year recurrence-free survival rate of patients. Follow-up was conducted using outpatient examination or telephone interview to detect postoperative survival of patients up to December 2020. Measurement data with normal distribution were represented as Mean± SD, and comparison between groups was conducted using the t test. Measurement data with skewed distribution were represented as M( Q1, Q3) or M(range), and comparison between groups was conducted using the Mann-Whitney U test. Count data were described as absolute numbers or percentages, and comparison between groups was conducted using the chi-square test or Fisher exact probability. Comparison of ordinal data was conducted using the nonparametric rank sum test. The X-Tile software (version 3.6.1) was used to analyze the best ACCI grouping threshold. The Kaplan-Meier method was used to calculate survival rates and draw survival curves. The Log-Rank test was used for survival analysis. The Logistic regression model was used to analyze the factors affecting postoperative early complications. The COX proportional hazard model was used for univariate and multivariate analyses of factors affecting the 3-year recurrence-free survival rate of patients. Multivariate analysis used stepwise regression to include variables with P<0.05 in univariate analysis and variables clinically closely related to prognosis. Results:(1) Age distribution, comor-bidities and ACCI status of patients. Of the 242 patients, there were 28 cases with age <50 years, 68 cases with age of 50 to 59 years, 113 cases with age of 60 to 69 years, 33 cases with age of 70 to 79 years. There was 1 patient combined with mild liver disease, 1 patient combined with diabetes of end-organ damage, 2 patients combined with peripheral vascular diseases, 2 patients combined with peptic ulcer, 6 patients combined with congestive heart failure, 8 patients combined with chronic pulmonary diseases, 9 patients with diabetes without end-organ damage. The ACCI of 242 patients was 2 (range, 0-4). (2) The grouping of ACCI and comparison of clinicopathological characteristics of patients in each group. Results of X-Tile software analysis showed that ACCI=3 was the best grouping threshold. Of the 242 patients, 194 cases with ACCI <3 were set as the low ACCI group and 48 cases with ACCI ≥3 were set as the high ACCI group, respectively. Age, body mass index, cases with preoperative comorbidities, cases of American Society of Anesthesiologists classification as stage Ⅰ, stage Ⅱ, stage Ⅲ, tumor diameter, cases with tumor histological type as signet ring cell or poorly differentiated adenocarcinoma and cases with tumor type as moderately or well differentiated adenocarcinoma, cases with tumor pathological T staging as stage T1, stage T2, stage T3, stage T4, chemotherapy cycles were (58±9)years, (22.6±2.9)kg/m 2, 31, 106, 85, 3, (4.0±1.9)cm, 104, 90, 16, 29, 72, 77, 6(4,6) in the low ACCI group, versus (70±4) years, (21.7±2.7)kg/m 2, 23, 14, 33, 1, (5.4±3.1)cm, 36, 12, 3, 4, 13, 28, 4(2,5) in the high ACCI group, showing significant differences in the above indicators between the two groups ( t=-14.37, 1.98, χ2=22.64, Z=-3.11, t=-2.91, χ2=7.22, Z=-2.21, -3.61, P<0.05). (3) Incidence of postoperative early complications and analysis of factors affecting postoperative early complications. Of the 242 patients, 33 cases had postoperative early complications, including 20 cases with local complications and 16 cases with systemic complica-tions. Some patients had multiple complications at the same time. Of the 20 patients with local complications, 12 cases had abdominal infection, 7 cases had anastomotic leakage, 2 cases had incision infection, 2 cases had abdominal hemorrhage, 2 cases had anastomotic hemorrhage and 1 case had lymphatic leakage. Of the 16 patients with systemic complications, 11 cases had pulmonary infection, 2 cases had arrhythmias, 2 cases had sepsis, 1 case had liver failure, 1 case had renal failure, 1 case had pulmonary embolism, 1 case had deep vein thrombosis, 1 case had urinary infection and 1 case had urine retention. Of the 33 cases with postoperative early complications, there were 3 cases with grade Ⅰ complications, 22 cases with grade Ⅱ complications, 5 cases with grade Ⅲa complications, 2 cases with grade Ⅲb complications and 1 case with grade Ⅳ complica-tions of Clavien-Dindo classification. Cases with postoperative early complications, cases with local complications, cases with systemic complications were 22, 13, 9 in the low ACCI group, versus 11, 7, 7 in the high ACCI group, respectively. There were significant differences in cases with postoperative early complications and cases with systemic complications between the two groups ( χ2=4.38, 4.66, P<0.05), and there was no significant difference in cases with local complications between the two groups ( χ2=2.20, P>0.05). Results of Logistic regression analysis showed that ACCI was a related factor for postoperative early complications of gastric cancer patients undergoing laparoscopic radical gastrectomy [ odds ratio=2.32, 95% confidence interval ( CI) as 1.04-5.21, P<0.05]. (4) Follow-up. All the 242 patients were followed up for 36(range,1?46)months. During the follow-up, 53 patients died and 13 patients survived with tumor. The 3-year recurrence-free survival rate of the 242 patients was 73.5%. The follow-up time, cases died and cases survived with tumor during follow-up, the 3-year recurrence-free survival rate were 36(range, 2-46)months, 29, 10, 80.0% for the low ACCI group, versus 35(range, 1-42)months, 24, 3, 47.4% for the high ACCI group. There was a significant difference in the 3-year recurrence-free survival rate between the two groups ( χ2=30.49, P<0.05). (5) Analysis of factors affecting the 3-year recurrence-free survival rate of patients. Results of univariate analysis showed that preoperative comorbidities, ACCI, tumor diameter, histological type, vascular invasion, lymphatic invasion, neural invasion, tumor pathological TNM staging, postoperative early complications were related factors for postoperative 3-year recurrence-free survival rate of gastric cancer patients undergoing laparoscopic radical gastrectomy [ hazard ratio ( HR)=2.52, 3.64, 2.62, 0.47, 2.87, 1.90, 1.86, 21.77, 1.97, 95% CI as 1.52-4.17, 2.22-5.95, 1.54-4.46, 0.27-0.80, 1.76-4.70, 1.15-3.12, 1.10-3.14, 3.01-157.52, 1.11-3.50, P<0.05]. Results of multivariate analysis showed that ACCI, tumor pathological TNM staging, adjuvant chemotherapy were indepen-dent influencing factors for postoperative 3-year recurrence-free survival rate of gastric cancer patients undergoing laparoscopic radical gastrectomy ( HR=3.65, 11.00, 40.66, 0.39, 95% CI as 2.21-6.02, 1.40-86.73, 5.41-305.69, 0.22-0.68, P<0.05). Conclusions:ACCI is a related factor for post-operative early complications of gastric cancer patients undergoing laparos-copic radical gastrectomy. ACCI, tumor pathological TNM staging, adjuvant chemotherapy are indepen-dent influencing factors for postoperative 3-year recurrence-free survival rate of gastric cancer patients undergoing laparoscopic radical gastrectomy.