Although young anesthetists demonstrate the excellent characteristics of agile thought , strong manipulative ability and are ready to receive challenge, they are short of teamwork cooperation spir-it. Clinical anesthesia knowledge and skill can be improved and teamwork cooperation spirit can be culti-vated through correcting attitude , modest learning , implementing tutor system among young doctors , strengthening the understanding of team spirit , cultivating interpersonal communication ability and orga-nizing regular learning discussions.

Objective To explore the application of laparoscopy in non-traumatic acute abdominal emergency. Methods The authors retrospectively analyzed 201 cases of emergency laparoscopy between March 1999 and May 2002. Results All the 201 patients were unequivocally diagnosed during operation. Laparoscopic operations were successfully completed in 190 cases (139 cases of acute appendicitis, 21 cases of acute cholecystitis, 19 cases of upper gastrointestinal tract perforation, 10 cases of intestinal obstruction and 1 case of common bile duct stones accompanied with acute cholecystitis), with a success rate of 94.5% (190/201). The remaining 11 patients underwent a conversion to open surgery. Conclusions Emergency laparoscopic exploration can not only clarify a diagnosis for acute abdominal emergency with unknown causes but also simultaneously offer a therapeutic method in at least 90% of cases.

Objective To understand the clinical characteristics of staphylococcal bloodstream infection in patients with secondary immunodeficiency,as well as the distribution and drug resistance of Staphylococcus aureus (SAU)and coagulase negative Staphylococcus (CNS).Methods A total of 101 patients with Staphylococcus isolated from blood sample were retrospectively reviewed in our hospital.The patients were classified into a group with secondary immunodeficiency and another group with normal immune function as control group.SPSS 18.0 statistical software was used to analyze the data,and compare the two groups of patients in terms of clinical characteristics,pathogens,antibiotic resistance,etc.Results All the 70 patients with staphylococcal bloodstream infection and secondary immunodeficiency had various degrees of fever except 2 cases (temperature < 36 ℃).Chills and shiver were reported in 30.0% of the patients,and migratory lesions in 15.5% of the patients.Lungs were the most common site of infection.About 11.4% of the patients complicated with septic shock.The case strains of SAU,of which 18 (43.9%)strains were MRSA,CNS 29 (41.4%)strains,of which 24 (82.8%)strains were MRCNS.In the control group,26 (83.9%)strains of SAU were identified,of which 11 (42.3%)strains were MRSA,and all the 5 (16.1%)strains of CNS were identified as MRCNS.The incidence of CNS infection in the patients with secondary immunodeficiency was significantly different from that in the control group (P =0.013).All the MRS strains were multidrug-resistant organism (MDRO)except one strain of Staphylococcus intermedius .The staphylococcal strains isolated from the patients with secondary immunodeficiency showed high rate of resistance to penicillin (100%), clindamycin (73.0%), erythromycin (90.0%)and gentamycin (61.0%).No strain was found resistant to tigecycline,linezolid or vancomycin.The resistance rate did not show significant difference between the patients with or without secondary immunodeficiency. Conclusions The clinical characteristics of staphylococcal bloodstream infection in the patients with secondary immunodeficiency are similar to the patients without secondary immunodeficiency,except higher incidence of septic shock and death,but the incidence of CNS infection is relatively higher,MDRO is more prevalent.Antimicrobial agents should be prescribed in clinical practice according to disease conditions and the result of antimicrobial susceptibility testing.

OBJECTIVE To study the epidemiology and the sensitivity to antibiotics of bacteremia in intensive care unit,and provide the reference for the clinical antimicrobial agents usage. METHODS 465 cases of bacteremia from Jan 2005 to Dec 2007 in the First Affiliated Hospital,Medical College of Zhejiang University were retrospectively analyzed. RESULTS Totally 1465 strains of pathogens were isolated in three years,and the positive rates were 22.6%.From them 155 strains were fungi(10.6%),611 strains were Gram-positive bacteria(57.9%) and 392 strains were Gram-negative bacteria(37.1%).G + strains mainly included coagulase-negative Staphylococcus(CNS,43.0%) and Staphylococcus aureus(2.1%);the sensitive antibiotics were vancomycin and teicoplanin.G-strains mainly included Acinetobacter baumannii(8.6%);Stenotrophomonas maltophilia(6.6%);Pseudomonas(5.1%) and Klebsiella pneumoniae(5.3%),the sensitive antibiotics were cefoperazone/sulbactam. CONCLUSIONS The positive rates of blood culture are higher in intensive care unit than in others.We should pay more attention to CNS for its high infection rate.The sensitive antibiotics of G + are vancomycin and teicoplanin.The sensitive antibiotics of G-are cefoperazone/sulbactum.Antimicrobial therapy should be conducted according to susceptibility test.The candidemia caused by non-Candida albicans(NCA) is increaseing in recent 3 year.

BACKGROUND: Nitric oxide (NO) can influence glucose transportation. Although its signal transmission pathway is not certain, it has been confirmed that the pathway is different from insulin. OBJECTIVE: To explore NO signal transmission pathway and the regulatory mechanism for the glucose uptake of skeletal muscle during exercise. RETRIEVAL STRATEGY: Using the keywords of "nitric oxide, signal, glucose", we searched the Pubmed database for the relevant articles about the transmission pathway and its regulation of glucose uptake in skeletal muscle published from January 1996 to November 2007. Meanwhile, the related foreign language books were retrieved manually from national library. Articles about the regulation of NO to muscular blood flow, signal transmission and glucose under exercise stress in human and gnawer were selected. Pathologically related basic studies were excluded. LITERATURE EVALUATION: Sixty related literatures (books) were collected, and 30 were accorded with the inclusive criteria, of which 5 were review articles, 23 were basic researches and 2 were related books. Meanwhile, 20 articles were related to the effects of NO on blood flow regulation and vasodilation, 4 articles and 2 books were related to signal transduction and 4 were about its signaling effect during exercise. DATA SYNTHESIS: NO is a signal molecule. It can mediate various biological phenomenon and displays strong vasodilation effect. The production of NO is increased in vivo during exercise, and NO can stimulate glucose uptake in skeletal muscle through its transduction. CONCLUSION: The generation of NO during exercise has positive effect on glucose uptake in skeletal muscle. The contraction and glucose uptake are closely correlated to the generation and transmission of NO, but the mechanism is still unclear.

Objective To investigate the similarities and differences in research hot pots between International Journal of Pediatrics and Pediatrics in the last five years.Methods The key words with high frequent occurrence were extracted from Wanfang database,and the Mesh with high frequent occurrence were enrolled in this study.Results The similarities of the hot pots between the two journals were asthma,neonatal diseases and neoplasm.The differences lied in that the hot pots of International Journal of Pediatrics included congenital heart diseases,allergic diseases and renal diseases,whereas the hot pots of Pediatrics were obesity,child health care and attention deficit disorder with hyperactivity.Conclusion By employing co-words cluster analysis,the research focuses of the two journals are found out,and its differences are compared.

Objective To evaluate laparoscopic hepatectomy for the treatment of primary liver cancer. Methods Nine patients with primary liver cancers at segment Ⅱ, Ⅲ, Ⅴ, Ⅵ and at the edge of the liver underwent laparoscopic partial hepatectomy with hand-assist devices, harmonic scalpel, and Endo-GIA. Results All operations were successful including resection of tumors involving both Ⅱ and Ⅲ segments, and irregular segmentectomy, and 2 cases with additional laparoscopic splenectomy. Surgery lasted for 80～145 min. Intraoperative bleeding was 150～700 ml, with no postoperative complications. Patients were followed-up for 5～25 months with intrahepatic tumor recurrence on 3rd, 4th and 13rd month in one each respectively. Conclusion Hand-assisted laparoscopic partial hepatectomy is a safe and feasible approach for primary liver cancer in clinically selected patients.

Objective To investigate the endocrine disrupting chemicals contamination in source water and tap water in a city and to provide the scientific data for the water quality inspection,management and water treatment.Methods Fifteen samples of source water and tap water were collected in April,2006 and February,2007.Extraction of potential EDCs from samples was performed in columns packed with XAD-4 resins by using solid-phase extraction(SPE).Each sample was dried under a gentle air stream for 1 h and eluted with a mixture of acetone(20 ml) and dichloromethane(40 ml) for 3 times.The extracts were collected into a glass flask,evaporated under a gentle air stream and suspended again in 0.5 ml dichloromethane.Gas chromatography-mass spectrometry(GC-MS) was used for quantitative or qualitative analysis of the organic pollutants and the optimum conditions were determined.Results Seventy-eight organic pollutants were identified from the water samples.Most of them were phthalates,hydrocarbon,phenol,and benzene.Phthalates were found in all samples.Among them,bis(2-ethylhexyl) phthalate(CAS# 117817),di-n-butyl phthalate(CAS# 84742),and pentachlorophenol(CAS# 87865) were regarded as suspected endocrine disrupting chemicals.The concentration of bis-(2-ethylhexyl) phthalate and di-n-butyl phthalate ranged 0.004 75-4.450 ?g/L and 0.002 25-2.39 ?g/L,respectively.The concentration of pentachlorophenol was 0.727 ?g/L.Conclusion The source water and tap water in this city has been seriously polluted by organic pollutants,the main endocrine disrupting chemicals detected in the present investigation are phthalates and pentachlorophenol and the related health effects remain to be studied.

3 cm ?3 cm) in 19 cases (0.8%). No nursing-related complications occurred in-hospital. Conclusion Standardized nursing management is related to the prognosis of aged ACS patients and is an important part of the perioperative preparation for primary PCI.