OBJECTIVE To investigate the evolution of drug-resistance of Staphylococcus aureus in children in Hubei tertiary level hospitals during four years and provide the evidence for clinically reasonable use of antibiotics.METHODS The summary data of drug sensitivity in clinical isolates of meticillin-resistant S.aureus(MRSA) and meticillin-sensitive S.aureus(MSSA) in children in Hubei tertiary level hospitals from 2004 to 2007 were investigated retrospectively and the results were analyzed statistically.RESULTS The tendency of infections with MRSA upgraded yearly during four years(5.7%→10.7%→40.8%→46.9%);the resistance rates of MRSA to various antibiotics were all higher than that of MSSA.The vancomycin-resistant S.aureus had not been detected.CONCLUSIONS The drug-resistance status of SA in Hubei is still very serious.We should adopt effective measurement to control the occurring and epidemic outbreak in combination with children physiological characteristic.

Objective To observe the morphology of thoracolumbar spinal nerve roots and their surrounding structures, in order to find out their anatomical relationship and to improve surgical procedures as well as to reduce the operative injury and complications. Methods 16 adult cadavers were studied anatomically. The diameters of spinal nerve roots from T10 to L3 at the outlet of intervertebral foramen, the percentages of the distance from spinal nerve roots to the upper border of corresponding vertebral bodies in vertebral height, the angles between spinal nerve roots with lateral border of vertebrae were measured and analyzed. The surgical incision and procedure for the treatment of thoracolumbar fracture were designed and applied in 58 patients of thoracolumbar injury. Results The diameters of spinal nerve roots increased gradually from T10 to L3 in the intervertebral foramen. The percentages of the distance from spinal nerve roots to the upper border of vertebrae in vertebral height gradually became larger too. The angles between spinal nerve roots with vertebral bodies diminished gradually. Around intervertebral foramen, the pattern of spinal nerves and blood vessels was arranged in order as vein, nerve and artery from above down below. The nerves and vessels extended out of the intervertebral foramen together. In clinical practice, 58 cases of thoracolumbar injury were surgically treated with traditional anterior approach and "renal" incision in 35 cases, and with modified anterior approach in "┑" shape in 23 cases. Prior to the modification of surgical techniques, the mean amount of blood loss was 670 ml, the mean operation time was 199 min; however, by the modification of surgical procedures, the mean amount of blood loss decreased to 435 ml, and the mean operation time reduced to 137 min. In an average follow-up of 9 months, the spine recovered to normal curvature and alignment in all cases; the fusion rate was 100%; no failure of implant occurred; neurological function was improved at least one grade in 94.5%. Conclusion Modified anterior approach is helpful to reduce operative injuries and complications. It makes surgical manipulation feasible comparing to the traditional approach.

Objective To assess the value of intra-aortic balloon pump (IABP) support in patients with acute myocardial infarction (AMI) complicated by cardiogenic shock (CS) undergoing percutaneous coronary intervention (PCI). Methods The clinical data of 41 patients with AMI complicated by CS receiving emergency PCI with IABP support were retrospectively reviewed, and 47 patients receiving emergency PCI without IABP support at the same time were included as the control group. Left ventricular function was evaluated in the 2 groups at 2 weeks and at 3 months after the operation respectively. The incidence of MACE was compared between the 2 groups at 30 days and also at 3 months after the operation. Results Patients receiving IABP support had greater improvement in left ventricular function at 2-week and 3-month after operation (43.8?8.2% vs 39.4?5.9%, 45.5?6.6 vs 40.6?4.6%, both P

Objective Clinical investigation of treatment of osteoporotic vertebral compression fractures by unilateral kyphoplasty.Methods After Surgical intervention of sixteen vertebral compression fractures by unilateral kyphoplasty,then investigate the changes of height and Cobb angle of vertebral bodies.Results All surgical procedures were finished safely.The mean height of the anterior and media vertebral bodies was 1.8?0.3cm,1.4?0.4cm preoperatively and 2.2?0.4cm、2.3?0.3cm postoperatively;the Cobb angle was decreased from 28.4??10.2? preoperatively to 19.2??4.5? postoperatively.The mean absolute value of the difference in height between right and left side of the vertebral bodies was 0.1cm in this group.Conclusions The kyphosis is improved and the operative time is reduced by unilateral kyphoplasty.Though this result is satisfied,more clinical studies are needed to be done for authenticating the effect of unilateral kyphoplasty on the treatment of vertebral compression fractures in the future.

Objective To summarise the clinical experience on the treatment of aortic dissection with stent-graft. Methods From June 2005 to November 2008, 117 patients with aortic dissection underwent surgery with stented elephant trunk (CRONUS stent-graft)which was implanted through the aortic arch under deep hypothermic circulatory arrest, including Stanford A in 50 patients who underwent Bentall operation and total arch grafting with stented elephant trunk operation in 28, Wheat operation and total arch grafting with stented elephant trunk operation in 8, ascending aorta and total arch replacement with stented elephant trunk operation in 14 and Stanford B in 67 patients who all underwent stented elephant trunk operation. Results The location of the entry was in the ascending aorta in 35 patients, the aortic arch in 4, the proximal descending aorta in 78. Cardiopulmonary bypass time was ( 159 ±31 ) min, average cross clamp time was (95 ±23) min, and average selected cerebral perfusion and lowerbody arrest time was (27 ±8) min. The in-hospital mortality was 2.6% (3/117). One patient died of the hemorrhage shock, one died of multi-organ failure postoperatively and the third died of infective endocarditis. The complications included transient neurologic deficit in 11(9.4%), cerebrovascular accident in 6 (5. 1%, cerebral embolism in 2 and cerebral hemorrhage in 4, of which 5 cases were discharged from hospital. One case died of multiorgan failure 18 days after discharge owing to his family' s giving up treatment), hemorrhage of anastomose which was treated by reoperation in 5,hoarseness in 2, renal failure in 1. One case died of the cerebral hemorrhage after 4 months due to inappropriate anticoagulation during following up. Conclusion The treatment of the aortic dissection with stent-graft which was implanted into the descending aorta through aorta arch is safe, effective and feasible, which will be helpful to vascular reconstruction by accurately close subintimal rip and can streamline surgery with minimally invasive and less complications.

Objective It is controversial to the surgical treatment of the DeBakey I aortic dissection.The purpose of the study was to summarize the clinical experience on total arch replacement combined with implantation of stented elephant trunk into the descending aorta for DeBakey I aortic dissection.Methods From June 2005 to March 2008,41 consecutive patients with acute(in 31)or chronic(in 10)DeBakey I aortic dissection underwent total arch replacement combined with implantation of stented elephant trunk into the descending aorta.The mean age was 57(27～76)years.Thirty-two patients were male.The procedure was performed under deep hypothermic circulatory arrest and selected cerebral perfusion.The stented elephant trunk was implanted through the aortic arch under deep hypothermic circulatory arrest.The stented elephant trunk was an 8～10 cm long self-expandable graft.Concomitant procedures included Bentall operation and total arch replacement in 24,Wheat operation and total arch replacement in 6,ascending aorta and total arch replacement in 11.Computed tomography was performed in every patient before discharge to evaluate the postoperative outcomes of the procedure.Results Cardiopulmonary bypass time was(168±32)min.The cross clamp time was(109±24)min and selective cerebral perfusion and the lowerbody circulatory arrest time wsa(31±11)min.The in-hospital mortality was 4.9%(2/41).One patient died of hemorrhagic shock and another died of multi-organ failure postoperatively.Fourteen cases suffered complications and 12 cases were cured.One case died of the cerebral hemorrhage after 4 months due to inappropriate anticoagulation during follow up.Conclusion Ascending aorta and total aortic arch replacement combined with implantation of stented trunk into descending aorta is a safe,effective and feasible way in closing the residual false lumen of the descending aorta with a low morbidity and mortality.This procedure might contribute to a better long-term outcomes of DeBakey I aortic dissection.

OBJECTIVE Investigating the distribution and drug-resistance of pathogenic bacteria in urinary tract infecion for children in Wuhan region to provide the evidence of diagnoses and treatment for clinician.METHODS The positive results of urine culture of 405 children with urinary tract infections from Jul 2002 to Dec 2005 were analyzed.All of the isolates were tested by Kirby-Bauer susceptibility method.RESULTS Among 405 pathogens,the majority was Escherichia coli which occupied 36.7%;then Enterococcus accounted for 29.4%.Totally 405 pathogens all showed the higher drug resistance,while antibacterial antivities of imipenem,amikacin and furantoin to E.coli and Klebsiella pneumoniae and of glycopeptides,high concentration of streptomycin and furantoin to Enterococcus were preserved well.CONCLUSIONS The effective measurements and reasonable use of antibiotics should be taken to hold back the occurrence and prevalence of urinary tract infecion for children.

Objective To study the role of early intravenous nutrition given aggressively combined with early minimal feeding on very low birth weight infants (VLBWI),and to evaluate the clinical value of intestinal barrier protein and MicroRNA.Methods All of 62 cases of VLBWI admitted in NICU,the Maternal and Child Health Hospital of Nantong Affiliated to Nantong University from January 2006 to June 2014 were recruited.Sixty-two VLBWI were randomly divided into group A and group B.Thirty infants in group A were exposed to conventional intravenous nutrition.Thirty-two infants in group B were treated with early intravenous nutrition aggressively combined with early minimal feeding.The time of birth weight recovery,days with intravenous nutrition,hospital stay and complications were recorded.The liver and kidney functions,electrolytes,blood gas analysis were monitored.Enzyme-linked immunosorbent method was used to detect intestinal fatty acid binding protein (Ⅰ-FABP),an intestinal barrier protein in plasma.Infection related MicroRNA155 was detected with fluorescent quantitative polymerase chain reaction (RT-PCR).Results Group B was superior to group A in weight loss after birth [(13.70 ± 3.10) ％ vs (5.46 ± 2.64) ％,P ＜ 0.05],shorter recovery time of body weight [(12.20 ± 3.38) d vs (6.82 ± 3.20) d,P ＜ 0.05],fewer days with intravenous nutrition [(29.62 ± 4.16) d vs (20.80 ± 3.20) d,P ＜ 0.05] and shorter hospital stays [(44.60 ± 6.32) d vs (28.91 ± 4.36) d,P ＜ 0.05].Compared with group A,the infants in group B had less complications,including hyperbilirubinemia (31.2％ vs 56.7％),extrauterine growth retardation (34.3％ vs 73.3％),cholestasis (6.2％ vs 23.3％),feeding intolerance (15.6％ vs 53.3％) and necrotizing enterocolitis (0 vs 16.7％) (all P ＜ 0.05).Although Ⅰ-FABP had a higher plasma concentration in group A than that of group B [(9.083 ± 1.059) μg/L vs (7.563 ± 0.739) μg/L],the difference was not significant (t =1.190,P =0.076 4).However,the plasma levels of Ⅰ-FABP in infants with necrotizing enterocolitis were significantly higher than those of group B [(19.500 ± 3.510) μg/L vs (7.563 ±0.739) μg/L,t =5.231,P =0.035 0].The expression of MicroRNA155 in group A was markedly higher than that of group B (2-△△ct were 0.81 ± 0.12 and 0.24 ± 0.08,respectively,P ＜ 0.05).Conclusions Giving aggressive intravenous nutrition early combined with early minimal feeding was safety and effective to VLBWI,which was of benefit to their growth and development,reducing complications and shorting hospital stays.The detection of intestinal barrier protein Ⅰ-FABP and MicroRNA155 is useful for monitoring feeding complications of VLBWI.

OBJECTIVE To study the distribution of drug-resistant gene of meticillin-resistant coagulase negative Staphylococcus(MRCNS) in children septicemia.METHODS The total MRCNS isolates were 40,and whether in there harbored genes mec,erm and qac was studied.RESULTS Among 40 CNS strains,in there harbored genes mec,erm,and qac were 38(95.0%),30(75.0%) and 18(45.0%),respectively.CONCLUSIONS MRCNS in children septicemia where harbor drug resistance genes is very serious,so we should pay great heed to its effective control.

OBJECTIVE To investigate the clinical application of antibiotic agents in a hospital.METHODS A cross section investigation method was used to survey the clinical application of antibiotic agents for emergency,out-patient clinic and hospitalization patients in a hospital within a day.RESULTS The usage rate of antibiotic agents for emergency patients was the maximum(54.67%) and the percentage of drug combination was multitude(23.42%).It was involved in 10 categories of antibiotic agents,cephalosporin was used at most(61.92%).The usage rate of antibiotic agents in Department of Gynecology and Obstetrics(OG) was the maximum(37.96%).Department with top defined DDD rate was Respiration Medical Department(RMD,39.90%).The average rate of etiological examination in the whole hospital was 6.67%.CONCLUSIONS It is higher in the usage rate of antibiotic agents for emergency patients.It is much more usage of antibiotic agents in OG and RMD,furthermore,the antibiotic agents are excessively used and the rate of etiological examination is low.Management should be further strengthened for rational use of antibiotic agents.