Objective To compare the difference in pharmacokinetics characteristics of vancomycin in cerebrospinal fluid between administration by continuous infusion and interim infusion.Methods Twenty postoperative patients in the Department of Neurosurgery of Beijing Tiantan Hospital, Capital Medical University admitted into intensive care unit (ICU) to receive vancomycin for prophylaxis of intracranial infection were enrolled, and they were randomly distributed to a continuous intravenous infusion group and a interim intravenous infusion group, each group 10 cases. In continuous intravenous infusion group, the patients received a loading dose of vancomycin (15 mg/kg) by continuous intravenous pump infusion for 1 - 2 hours followed by 30 mg/kg vancomycin in a constant pump infusion rate for 24 hours; while in interim intravenous infusion group, the patients received 15 mg/kg vancomycin administered by intravenous pump infusion for 1 - 2 hours, once every 12 hours. The concentration of vancomycin in the cerebrospinal fluid at different time points was measured by two-dimensional liquid chromatography (2D-LC) method, the parameters of pharmacokinetics were calculated in the two groups, and the adverse reaction was observed.Results The comparison between the ratio of areas under the concentration-time curves (AUC) and minimum inhibitory concentration (MIC) of the continuous and interim groups showed no significant difference (19.7±14.0 vs. 16.1±6.4,P > 0.05). However, in the continuous intravenous infusion group, the drug concentration reached the peak value (0.96± 0.77)μg/mL at 12 hours, and later revealed a plateau concentration 0.91-0.93μg/mL for 12 hours; while in the intravenous infusion interim group, the drug concentration reached the peak value (0.92±0.47)μg/mL at 16 hours, in the later 2 hours declined to (0.84±0.45)μg/mL, and afterwards still had a tendency of persistent declination. In all the patients, no any adverse reaction related to the drug occurred.Conclusion Continuous intravenous infusion and interim intravenous infusion of vancomycin for the postoperative neurosurgical patients without intracranial infection have the similar efficacy of medication, but the former can achieve the peak concentration faster and later the fluctuation of drug concentration in cerebrospinal fluid is smaller than those in the latter.

Three hundred and nine community health service (CHS) practitioners were selected with randomized cluster sampling for survey with the job satisfaction questionnaire-occupational stress indicator (OSI).Degree of the job satisfaction was (68 ± 12)%.Position, work experience, income,feeling of recognition, degree of motivation, the scope for career development, the space for personal ambition and the relationship between salary and work load were potential influencing factors of job satisfaction to CHS practitioners.The authors suggest to establish the dynamic mechanisms of satisfaction study and to formulate comprehensive and effective incentive measures for CHS practitioners.

A clinical emergency skill contest using emergency care simulator (ECS) was carried out　on May 2011.Total 30 family physicians in 10 teams from Shenzhen community health centers participated in　the contest.The performance and the scores of each item were analyzed.The overall score was 61.3 ± 11.9.The average score for general treatment was 33.0 ± 6.9 with a score rate of 66％ (33/50) ; the average　score for cardiopulmonary resuscitation was 23.2 ± 7.2 with a score rate of 57.5％ (23/40) ; the average　team score was lowest (5.0 ± 1.1 ) with a score rate of 50.0％ (5/10).The results indicate that family　physicians should strengthen clinical skill training of emergency care,particularly in on-site response and　teamwork.

Objective To investigate the relationships between the parameters of intravoxel incoherent motion (IVIM)DWI at 3.0 Tesla and T staging of moderately differentiated adenocarcinoma of rectum.Methods Clinical data and MRI findings including con-ventional imaging and IVIM-DWI were collected in a total of 37 patients with moderately differentiated adenocarcinoma of rectum proven by pathology.The patients were divided into two groups without (staging T1 and T2)or with myometrial invasion (T3 and T4).The D,D? ,f and ADC values of rectal cancer and normal rectal wall were measured and were compared between the lesion and normal rectal wall,between both groups and among different T stages.The relationships of the parameters of IVIM-DWI and ADC values with the T staging of moderately differentiated adenocarcinoma of rectum were analyzed.Results The D,D? ,f and ADC val-ues of rectal cancer were lower than those of normal rectal wall with statistical differences in D,f and ADC values (P <0.05).The differences in D and D? values among different T stages were statistically significant,and LSD Duncan test showed that the differ-ence in D? value between T1 and T4 (P =0.01 7)and between T3 and T4 (P =0.003)and in D value between T2 and T3 (P =0.005) were statistically significant.The D,f,D? and ADC values of noninvasion group and invasion one were (0.93±0.1 6)×10 -3 mm2/s versus (0.77±0.1 9)×10 -3 mm2/s,(27.1±2.94)% versus (24.6 ±4.13)%,(12.6±2.44)×10 -3 mm2/s versus (12.3±3.49)× 10 -3 mm2/s,and (0.95±0.09)×10 -3 mm2/s versus (0.87 ±0.12)×10 -3 mm2/s respectively,and the difference in D value was statistically significant (t=2.5 12,P =0.01 7).Conclusion The parameters of IVIM-DWI and the ADC values are different in rectal cancer and normal rectal wall,and the D value may help to identify the tumor invasion into the muscularis propria.

Objective To assess the relationship between gastric carcinoma perfusion imaging parameters with the multislice spi-ral CT (MSCT)and the tumor angiogenesis(MVD,VEGF).Methods (1)33 patients with gastric cancer were carried on perfusion CT scanning in the suspected lesions,and compared with operation and histological result.MSCT perfusion parameters tumor,such as local blood flow (BF),blood volume (BV),mean transit time of contrast agent (MTT),permeability surface (PS),were recor-ded,and compared with clinical pathological data.(2)27 patients of 33 cases which CT perfusion plane matching with operation pa-thology specimens performed with tumor microvessel density (MVD),vascular endothelial growth factor (VEGF)monoclonal anti-body immunohistochemical examination of MVD,the most intensive areas of high power (×200 HP)field counted,and VEGF stai-ning positive judged.Results Achievement ratio of gastric carcinoma MSCT perfusion imaging was 84.85% (28/33).The average value of BF,BV,MTT and PS were 63.658 ± 18.305,7.5 1 1 ± 2.427,1 1.952 ± 4.325 and 31.81 7 ± 13.533,respectively,and MVD was 37.7 ± 11.1/200 HP (range:13-60).VEGF was positive in 16 cases,negative in 11 cases.Gastric carcinoma undifferentiated group perfusion parameter PS value (35.1 5 ± 12.74 )and MVD (40.53 ± 10.66 )were higher than the differentiation group (23.90 ± 12.71 and 31.13 ± 9.82 )(P < 0.05 ),but BF,BV,MTT not statistically significant;Differences of CT perfusion parameters and MVD were not significant statistically between invasive serosa and noninvasive ;PS value (36.65± 12.80)of lymph node metastasis was greater than without metastasis(22.70 ± 1 1.1 5 )(P <0.01 ),the other was no significant difference;TNM staging Ⅲ,Ⅳ phase group of BF value (69.56 ± 1 6.49),PS value (34.90 ± 12.80)and MVD value (40.74 ± 10.53)were higher than Ⅰ,Ⅱ Group (49.63 ± 1 5.04),(24.50 ± 13.13)and (30.63 ± 9.61)(P <0.01).Spearman correla-tion analysis in confidence (two tails)of 0.01 was statistically significant between MVD in tumor tissues and gastric cancer MSCT perfusion parameters of BF (r=0.404)and MTT (r=0.371),whereas BV and PS were no significance.The regression equation of MVD with BF and MTT:MVD =1 6.602+0.1 50XBF +0.967XMTT,model checking of F values was 6.62,P =0.003.Conclusion The gastric carcinoma multi-slice CT perfusion imaging parameters BF,MTT and MVD,VEGF(+)was positive correlation, MSCT perfusion imaging parameters reflects tumor VEGF positive expression of gastric carcinoma.

ObjectiveTo assess revascularization and vessel anastomosis in digital replantations with DSA.MethodsTwelve cases of digital replantations underwent digital subtract angiography during 2 to 4 days after fingers reattachment. The vessel anastomosis,hemodynamics,stenosis and discontinuation were investigated.The unobstructed and smooth anastomosis was suggested as early stage survival of the reattached fingers,the spasm and stenosis of the reattached vessels were considered as mild vascular crisis,and the discontinuation of hemodynamics were indicated as severe vascular crisis.ResultsThe total 27 vessels were clearly displayed on DSA.Of these vessels,23 vessels were unobstructed and smooth,all digits were survived.Diagnosis coincidence of early stage survival was 100%(23/23). Two vessels were obstructed,which were testified having thrombus by operation research.The other 2 vessels were spasm,the digits were also survived ultimately by expectant treatment.All 4 abnormal vessel anatomosis were found by DSA.Conclusion DSA is important modality in assessing revascularization and blood circulation for digital replantations,guiding in dealing with the vascular crisis,and in predicting early stage survival of the reattached digits.

Objective To investigate the serum levels change of vascular endothelial growth factor (VEGF) during operation of non-small-cell lung cancer (NSCLC). Methods 120 cases of NSCLC patient diagnosed by pathology as well as with operation indication were selected as the experimental group. The patients selected were required without any chemotherapy or radiotherapy before operation, besides that, they should have good compliance and free will to be examined. During the process of experiment, 60 cases concluded as healthy in the physical examination were chosen as control group. The correlative information of the experimental group were collected including periphery blood specimen collected in 3 days before the operation, and of the 1st day, 7th day and 30th day after the operation while the periphery blood specimen of control group were collected. The serum levels of VEGF were detected by adopting enzyme linked immunosorbent assay (ELISA) method. Results The serum levels of VEGF in NSCLC patients before operation, of the first postoperative day, of the seventh postoperative day and of the thirtieth postoperative day were significantly higher than that in healthy people (P＜0.01), respectively (279.14±44.89)μg/L, (282.70±42.74) μg/L, (353.79±44.55) μg/L, (178.40±43.43) μg/L and (91.40±16.55) μg/L. The serum levels of VEGF in NSCLC patients showed positive correlation with the stages (P＜0.01). Conclusion The serum levels of VEGF in NSCLC patients scale up. At the same time it shows positive correlation with the stages of the primary tumor. The serum levels of VEGF in NSCLC patients scales up by degrees in one week after the operation, and drop one month later.

BACKGROUND: Permanent or transient implantation of biomaterials can result in biomaterials-centered infections (BCI) in lung cancer patients.OBJECTIVE: To investigate the relationship between BCI and peripheral blood transforming growth factor β1 (TGF-β1) in patients with lung cancer.METHODS: A total of 248 lung cancer patients undergoing in vivo intravascular catheter indwelling > 7 days were included.Quantitative method was used for intubation, bacteriological culture and paired blood culture, and API Staph strips were adopted for positive patients. While enzyme-linked immunosorbent assay was used to detect TGF-β1 levels in the peripheral blood of patients with lung cancer and 75 healthy volunteers as normal controls.RESULTS AND CONCLUSION: Among the 248 patients, there were 82 BCI-positive cases, and 166 BCI-negative cases.Thirteen patients were confirmed to have catheter-related bloodstream infection. There were 48 Gram-positive bacteria, 24Gram-negative bacilli, and 10 fungal. The levels of TGF-β1 were higher in BCI-positive patients than BCI-negative patients (P < 0.05); the levels of TGF-β1 in the BCI-negative group were higher than those in the normal control group (P < 0.05). For lung cancer patients with nosocomial infection induced BCI, there are various species of pathogenic bacteria, and Gram-positive bacteria are more common. To detect TGF-β1 levels in patients with lung cancer is of significance for early prevention of BCI.

Objective To study the effect of epinephrine on biofilm formation of the qseC-deleted mutant of Escherichia coli on biomaterial.Methods The strains used in this study are Escherichia coli MC1000 and MC1000AqseC.LB was used for all the experiments.To determine the effect of epinephrine on motility,halos were measured in LB medium at 37℃ in the presence of epinephrine(50 μmol/L).LB with epinephrine and without epinephrine were used,and then the experiment of bacterial biofilm formation on PVC material was taken.The relative amount of biofilm was estimated.The thickness of bacterial community and bacterial community quantity in the unit area on PVC materials were measured by confocal laser scanning microscope( CLSM),and the surface structure of biofilm formation was observed by scanning electron microscope(SEM).Results The mutant strain formed less biofilm than the wild-type strain in LB.The increment in motility of wild-type strain due to epinephrine addition was shown,but mutant strain is unaffected.Similarly,biofilm formation of the wild-type strain was increased by epinephrine,but epinephrine did not affect the biofilm formation of the qseC mutant.The CLSM and SEM showed that epinephrine stimulated biofilm formation of wild-type strain on PVC materials,but had no effect on qseC-deleted mutant strain.Conclusion Epinephrine increases Escherichia coli biofilms on biomaterials through qseC.

Objective To investigate the role of quorum sensing Escherichia coli regulator C (qseC) in intestinal bacterial translocation in rats subjected to hemorrhagic shock.Methods Thirty Sprague-Dawley rats,weighing 250-300 g,were randomly divided into 5 groups (n =6 each):control group (group C),MC1000-sham shock group (group M-SS),MC1000qseC-sham shock group (group △-SS),MC1000-hemorrhagic shock group (group M-HS),and MC1000△ qseC-hemorrhagic shock group (group △-HS).The rats drank 150 μg/ml of disinfect water containing streptomycin in 3 consecutive days to inhibit the autochthonous flora in the intestinal tract.From 4th day,the rats were fed with Escherichia Coli MC1000 or MC1000△ qseC 1 ml/100 g by gastric perfusion once a day for another 3 consecutive days in the other 4 groups,while the rats were fed with normal saline instead in group C.Hemorrhagic shock was induced by blood-letting.The mesenteric lymph node (MLN),spleen and liver specimens were obtained at 24 h after operation for bacterial culture and the bacteria were identified.Bacterial translocation from gut to MLN,spleen and liver was observed and the number of bacteria in MLN,spleen and liver tissues were counted.Results The rate of bacterial translocation was significantly higher,and the number of bacterial colonies in MLN,spleen and liver tissues and the total number of bacterial colonies were significantly larger in groups M-HS and △-HS than in group C,and in group M-HS than in groups M-SS and △-SS (P ＜ 0.05).The rate of bacterial translocation was significantly lower,and the number of bacterial colonies in MLN,spleen and liver tissues and the total number of bacterial colonies were significantly smaller in group △-HS than in group MHS.Conclusion QseC is involved in the intestinal bacterial translocation following hemorrhagic shock in rats.