OBJECTIVE To investigate the risk factors for nosocomial pneumonia(NP) caused by imipenem-resistant Acinetobacter baumannii(IRAB) and its antimicrobial susceptibility in vitro. METHODS The data of 34 cases of IRAB-NP were analyzed and 68 cases of NP caused by imipenem-susceptible A.baumannii(ISAB) were randomized as control.Antimicrobial susceptibility(MIC) was determined with the method of agar dilution. RESULTS The two independent factors associated with the development of IRAB-NP: previous fluoroquinolone(OR=5.738) and imipenem/meropenem(OR=7.129) use.The drug sensitivity test in vitro showed that these strains were multiresistant to commonly used antibiotics,and only ampicillin/sulbactam and cefoperazone/sulbactam whose resistance rate was less than 30%. CONCLUSIONS Previous imipenem/meropenem and fluoroquinolone use is independent risk factors for IRAB-NP.These strains are high drug resistant.

Objective To explore the relativity between clinical learning organization culture and core competency among registered nurses,to offer theoretic basis and practical advices for improving core competency among registered nurses.Methods 680 registered nurses in three tertiary hospitals in Ji'nan city were investigated with the general information questionnaire,Competency Inventory for Registered Nurses and the Dimensions of The Learning Organization Questionnaire.Results The total score and all the four subscales of learning organization were positively correlated with the core competency among registered nurses(P＜0.01),the dimension of overall situation senses and strategic leadership were the main influencing factors.Conclusions The cultivation of nurses' overall situation senses should be strengthened,providing strategic leadership for learning,strengthening cooperation and innovation,and promoting inquiry and communication.These will help increase core competency among registered nurses and improve their general competence.

Aim To investigate the effect of hypercholesterolemia on L-type Ca2+(ICa-L) current and intracellular calcium concentration ([Ca2+]i) in single ventricular myocytes of hypercholesterolemic rats.Methods 12 male wistar rats were randomly divided into two dietary groups:a group fed a normal diet(n=6)and a group fed high-cholesterol diet(n=6) for 4 weeks,respectively. The level of serum lipid was examined.Zymolytic method was used to isolate single ventricular myocytes from hypercholesterolemic and normal rats,which were loaded with Ca2+-sensitive fluorescent indicator Fluo-3/AM.[Ca2+]i represented by fluorescent intensity(FI)was measured by laser scanning confocal microscope.Whole cell patch clamp technique was used to record ICa-L.Results There was no significant influence exhibited on TG level.However, the serum total cholesterol(TC)level of hypercholesterolemic rats was much higher than that of model control group; at the test potential of 0 mV, ICa-L decreased from(-8.56?1.29)pA/pF(Control)to(-5.24?0.90) pA/pF(HC)(n=6 in each group,P

Objective To evaluate the protective effect and mechanism of luomaishutong(LMST)on acute myocardial ischemia-reperfusion injury in rabbits.Method Twenty-four New Zealand white rabbits were randomly divided into 3 groups:the LMST group,the control group and the sham-operated group.The AMI reperfusion model was established by removing the blockade after the occlusion of coronary artery for 2 hours.The changes of hemodynamics,oxygen free radical and clearance system were measured in all rabbits.Results (1)Compared with the control group,left ventricular systolic pressure(LVSP)and maximal changing rate of left ventricular innner pressure(?dp/dt_(max))increased remarkably in the LMST group after reperfusion,meanwhile, LVEDP decreased significantly.(2)In the control group,MDA level of cardiocyte was noticeably higher,while SOD and NOS levels were lower than in the sham-operated group.Compared with the control group,MDA level in the LMST group was significantly lower.Furthermore,SOD and NOS levels were higher in LMST group,and the infarcted area was smaller in the LMST group as well.Conclusions LMSF can protect myocardium after ischemia-repcrfusioninjury and improve cardiac function through inhibiting induced by oxygen free radicals.

Objective To study the level of serum lipids and body-fat content of high-fat diet induced pbesity rats(DIO).explore the relationship between intracellular caleium and ventrieufar arrhythmia.Methods Sixty male Sprague-Dawley(SD)rats were divided into control group(15)and experiment group(45),high-fat diet was administrated for 12 weeks to established obesity model,15 rats were selected into obesity group according to their body weight gain.The standard 2-lead electrocardiograph was used to detect the incidence and scores of arrhythmia induced by barium chloride(BaCl2,0.1 mg/kg)for 1 hour on every 8 rats from different groups respectively.Body-fat content.the level of serum total cholesterol(TC),triglyceride(TG),low density lipopmtein cholesterol (LDL-C) and high density lipopmtein cholesterol (HDL-C)were measured.The epididymal(EP),retroperitoneal (RE) and mesenteric(ME)white adipose pads was measured to obtain the body fat content.Single ventricular myrocytes of rats were isolated by enzymatic dissociation.The confocal laser scanning microscope was used to record basic intraceUular calcium level([Ca2+]i).Results The body-fat content in obesity group[(7.71±0.74)%] was significantly higher than control group[(4.69±0.37)%](t＝3.650,P＜0.05).The level of serum TC,TGand LDL-C were significantly higher(t＝3.801,2.778,3.536.P＜0.05) in obesity group[(1.26±0.04),(0.58±0.10),(0.51±0.04)mmol/L]than those in control group[(0.92±0.08),(0.29+0.03),(0.31±0.04) mmol/L].The level of serum HDL-C wa8 decreased gradually from control group[(0.53±0.05)mmol/L] toobesity group[(0.52±0.02)mmol/L],but there waft no significant difference between them(t＝0.186,P＞0.05).The incidence of arrhythmia induced by BaCl2(0.1 mg/kg)in obesity group was significantly higher than controlgroup(X2＝5.333,P＜0.05),and the scores of arrhythmla was increased in obesity group(2.5±0.6)too.The fluorescence intensity standing for[Ca2+]i was increased significantly(t＝2.409,P＜0.05)from obesity group(247.96±20.03)to control group (174.25±23.13).Conclusion As the free cytosolic calcium begin to accumulate,the arrhythmia morbidity is increased in obesity rats.

Objective To explore the clinical meaning of early systematic nursing intervention on the prevention of low limbs venous thrombus in ICU patients.Methods Totals of 120 patients in ICU were randomly divided into two groups by entering order number,odd numbers were experimental group(60 cases)and double numbers were control group(60 cases).Experimental group received early systematic nursing intervention while control group received ICU conventional nursing.All patients were measured the lower limb diameter per day,and were received colour Doppler examination to tested their femoral venous blood velocity in first,seventh and fourteen day of ICU,and their femoral venous blood velocity and incidence of low limbs venous thrombus were compared.Results No difference of femoral venous blood velocity in two groups was founded before intervention (P ＞0.05).After intervention,femoral venous blood peak velocity and average velocity of seventh and fourteen day in experimental group was(52.8 ± 9.6),(52.6 ± 8.8)and(34.2 ± 6.9),(35.3 ± 7.2),respectively,and higher than(41.3 ±7.8),(42.5 ±7.6)and(22.5 ±7.1),(23.7±6.6)in control group,differences between two groups were statistically significant(t =2.724,3.125,2.722,3.114 ;P ＜ 0.05); the incidence of low limbs venous thrombus in experimental group was lower than that of control group,and the difference was statistically significant(x2 =4.904,P ＜ 0.05).Conclusions Adopting early systematic nursing intervention can improve the femoral venous blood velocity,and effectively prevent and reduce the incidence of low limbs venous thrombus of ICU patients.

Objective To explore the nursing process of robot-assisted radical cystectomy and ileum neobladder so as to improve the quality of nursing matching.Methods Preoperative preparation,intra-operative positioning and cooperation,and peri-operative management of devices were managed by cooperating with six cases of robot-assisted radical cystectomy and ileum neobladder.Results All six operative procedures were successfully performed with no conversion to open surgery and high satisfaction of cooperation.Conclusions Preoperative preparation,reasonable layouts in the operation room,practiced operative procedures and close cooperation are the keys of the success of robot-assisted operations.

Objective To evaluate the in vitro activity of cefazolin penta-hydrate and other common used antimicrobial agents against clinical pathogens isolated within last 3 years. Method MIC values were deter-mined by standard twofold agar dilution method. Time kill curves were il-lustrated by colony form unit (cfu) count method. Totally , MICs of 604 isolates within last 3 years from 19 hospitals were tested. Result The results indicated that for Gram - positive aerobic pathogens, cafazolin pentahydrate showed satisfied in vitro activity against methicillin suscepti-ble Staphylococcus aureus ( MSSA), methicillin susceptibel Staphylococcus epidemidis (MSSE), penicillin susceptible Streptococcus pneumonies (PSSP) and Streptococcus spp. β-hemolytic group. MIC90 was ≤ 4 mg · L-1 For Gram- negative bacilli, cefazolin pentahydrate also showed antibacterial activity. MIC values was ≤ 8 mg · L-1 for non- ESBLs Enterobacteriaceae bacteria. Time- kill curves test results indicated that cefazolin pentahydrate typically is of time dependent profile against staph-ylococci, but for E. coli, the bactericidal activity slight increased with drug concentration increased. Conclution Compared with contrast drugs, the activities of cefazolin pentahydrate against G+ bacteria were better than cephalexin, clindamycin, clarithromycin, and silght better than cefotiam, and similar with amoxicillin/clavulanic acid, cefuroxime and levofloxacin. For non - ESBLs Enterobacteriaceae, the activies of cefazolin pentahydrate were better than cephalexin, and similar with amoxicillin/clavulanic acid and cefuroxime.

Objective To discuss the clinical effect of two-dimensional oral care for patients with mechanical ventilation by orotracheal intubation,and improve the quality of oral care.Methods Seventy inpatients with mechanical ventilation by orotracheal intubation from Feb 2011 to Jul 2012 in ICU were selected and randomly divided into experimental group (n ＝ 35) and control group (n ＝ 35).Experimental group was given two-dimensional oral care (oral swab just one time before intubation,and brush teeth and suction three times a day after intubation).Control group was given traditional oral care three times a day.Throat swab specimens were gathered for bacterial colony counts before intubation,and in 4 h,12 h,24 h,48 h after intubation,respectively.Bacteria quantitative culture was performed in sputum specimens and in throat swab specimens (one time per three days) after intubation.Oropharyngeal bacteria change and the incidence rate of ventilator associated pneumonia (VAP) were observed.Results Among all 70 patients,61 cases were valid,15 cases had VAP,and 8 cases died.In the experimental group,31 were valid,4 had VAP and 3 died,while in the control group,30 were valid,11 had VAP and 5 died.The difference of the incidence rate of VAP was statistically significant (x2 ＝ 4.643,P ＝ 0.040) and the difference of the incidence rate of death was not statistically significant (x2 ＝ 0.654,P ＝ 0.473).The difference of oropharyngeal bacterial colony counts had no statistical significance between two groups before intubation (t ＝-0.563,P ＝ 0.589),while the difference of oropharyngeal bacterial colony counts had statistical significance between groups in 4 h,12 h,24 h,48 h after intubation (t＝1.957,-2.520,-3.560,-2.165,respectively; P＜0.05).Conclusions Two-dimensional oral care can effectively reduce oropharyngeal bacterial colony,and decrease the incidence rate of VAP for patients with mechanical ventilation by orotracheal intubation.Thus it is a better nursing method to improve oral care quality.

OBJECTIVETo study the effect of oleic acid (OA) on expression of aquaglyceroporin genes, AQP3 and AQP9, in hepatocyte steatosis and to investigate the underlying molecular mechanisms using an in vitro system.

METHODSHepG2 cells were treated with OA at different concentration to establish in vitro models of nonalcoholic hepatocyte steatosis. The corresponding extents of hepatic steatosis modeling were assessed by oil red O staining and optical density (OD) measurements of the intracellular fat content. The model lines were then treated with inhibitors of the PI3K/Akt and p38 MAPK signaling pathway factors and effects on AQP3/9 expression was measured by real time RT-PCR and western blotting.

RESULTSThe fat concentration, indicative of hepatic steatosis, increased in conjunction with increased concentrations of OA (0 less than 250 less than 500 mumol/L). OA exposure also down-regulated AQP3 mRNA and up-regulated AQP9 mRNA levels in a concentration-dependent manner. The most robust changes in expression occurred in response to the 500 mumol/L concentration of OA for both AQP3 (0.47+/-0.18; t = 4.5450, P less than 0.05) and AQP9 (1.57+/-0.21; t = 3.0306, P less than 0.05). Treatment with OA + PI3K pathway inhibitor (LY294004) significantly decreased AQP9 mRNA expression (4.55+/-0.62) as compared to the control group (1.00+/-0.10; t = 9.7909, P less than 0.01), that 500 mumol/L OA group (2.43+/-0.53; t = 4.5018, P less than 0.05), and the LY294002 group (1.90+/-0.16; t = 7.1683, P less than 0.01). Treatment with p38 MAPK pathway inhibitor (SB230580) significantly increased the OA-suppressed level of AQP3 mRNA to the level detected in the control group (1.27+/-0.11; t = 5.7455, P less than 0.01) and decreased the OA-stimulated AQP9 mRNA (0.38+/-0.09; t = 6.5727, P less than 0.01). No significant changes in mRNA expression of AQP3/9 were observed with inhibition of the ERK1/2 and JNK signal transduction pathways. The OA-induced changes in protein expression levels of AQR3 and AQP9 followed a similar trend of the genes. Finally, OA suppressed the level of phosphorylated Akt (from 0.21+/-0.02 to 0.13+/-0.03; t = 3.8431, P less than 0.05) but elevated the level of phosphorylated p38 (from 0.58+/-0.06 to 1.02+/-0.10; t = 12.5289, P less than 0.01). Again, OA treatment produced no significant affect on ERK1/2 and JNK phosphorylation.

CONCLUSIONOA down-regulates AQP3 expression by stimulating the p38 MAPK signaling pathway, and up-regulates the AQP9 by blocking the PI3K/Akt pathway and activating the p38 MAPK signaling pathway.

Aquaporin 3 ; metabolism ; Aquaporins ; metabolism ; Fatty Liver ; metabolism ; pathology ; Gene Expression Regulation ; drug effects ; Hep G2 Cells ; Humans ; Oleic Acid ; pharmacology ; Phosphatidylinositol 3-Kinases ; metabolism ; Signal Transduction ; p38 Mitogen-Activated Protein Kinases ; metabolism