OBJECTIVE To analyze the pathogenic bacteria distribution and drug resistance in inpatients of burn department,and instruct clinical application of antibiotics reasonably.METHODS Pathogenic bacteria were isolated from inpatients of burn department from 2003 to 2006.K-B slip diffusion method was taken to carry out the sensitive test.Rate of drug resistance of the pathogenic bacteria was analyzed.RESULTS Totally 1325 strains were isolated,among them 846 strains were Gram-negative bacteria,464 strains were Gram-positive ones,and 15 strains were fungi.The percentage of these three groups was 63.85%,35.02% and 1.13%,respectively.The main strains of the Gram-negative bacteria were Pseudomonas aeruginosa,Escherichia coli,Acinetobacter baumannii,Enterobacter cloacae and Klebsiella pneumoniae,and that of the Gram-positive bacteria were Staphylococcus aureus,Enterococcus and Staphylococcus epidermidis.The major strain of fungi was Candida albicans.The pathogenic bacteria tested showed high drug resistance.The detection rate of the meticillin-resistanct S.aureus(MRSA) was 82.12%.The detection rate of the ESBLs from the K.pneumoniae and the E.coli was 60.17% and 41.89%.CONCLUSIONS It was showed that the major pathogenic bacteria infected of the inpatients of burn department are Gram-negative bacteria.The pathogenic bacteria are the multidrug-resistant ones.Enhanced monitoring on pathogenic bacteria distribution and drug resistance analyses among inpatients of burn department could benefit for the guide of clinical rational administration and depression of multidrug-resistant bacteria.

Objective:To explore the effect of "Internet+ nursing" based on browser and server (B/S) intelligent voice follow-up mode management platform in the postoperative follow-up of patients with hand and foot traumas.Methods:From November 2020 to April 2021, 200 patients with hand and foot traumas in Yiwu Central Hospital were selected by simple random sampling. The patients were divided into control group and observation group by random number table method, with 100 patients in each group. The control group was given routine follow-up, and the observation group received "Internet+ nursing" based on B/S intelligent voice follow-up mode management platform. The scores of self-care ability and compliance behavior of patients in the two groups before and after the intervention were compared, and the follow-up rate and satisfaction of patients in the two groups after 9 months after discharge were recorded and compared.Results:After intervention, the scores of self-concept, self-care responsibility, self-care knowledge and self-care skills in the observation group were higher than those in the control group with statistical differences ( P<0.05) . The scores of compliance behaviors such as medication, bad behavior control, rehabilitation exercise and daily life in the observation group were higher than those in the control group, and the differences were statistically significant ( P<0.05) . Nine months after discharge, the follow-up rate in the observation group was higher than that in the control group, with a statistically significant difference ( P<0.05) . The satisfaction scores of patients in the observation group on treatment effect, timeliness of drug adjustment, follow-up method, doctor-patient communication, health information were higher than those in the control group, and the differences were statistically significant ( P<0.05) . Conclusions:The "Internet+ nursing" based on the B/S intelligent voice follow-up mode management platform can improve the postoperative follow-up tracking efficiency and satisfaction of patients with hand and foot traumas, and increase the self-care ability and compliance behavior of patients.

Objective To compare the therapeutic effect of inhaled aerosolized and intravenous milrinone (a phosphodiesteraee-3 inhibitor) on postoperative pulmonary artery hypertension (PAH) in children with congenital heart disease (CHD).Methods Forty CHD complicated with PAH children aged 5-14 yr weighing 15-38 kg with pulmonary artery pressure (PAP) 30-90 mm Hg were randomly divided into 2 groups (n = 20 each): Ⅰ milrinone inhalation group and Ⅱ intravenous milrinone group. At the end of CPB, aerosolized milrinone 1 ml/kg was inhaled for 12 h at 30 min intervals, and each time milrinone was inhaled for 10 min in group Ⅰ . In group Ⅱ , a bolus of 10 g/kg milrinone was given iv followed by 12 h milrinone infusion at 0.5 μg·kg-1 ·min-1 . Blood samples were taken from aorta and pulmonary artery for blood gas analysis at the end of administration and venous oxygen saturation (S(-v)O2) was recorded. MAP, PAP, pulmonary vascular resistance index (PVRI) and systemic vascular resistance index (SVRI) were recorded every 2 h during milrinone administration. The duration of endotracheal tube, PAH, lung infection and postoperative hyoxemia were recorded during milrinone administration. Results PAP, PVRI and the incidence of lung infection and PAH were significantly lower, while MAP, SVRI and S(-v)O2higher in group Ⅰ than in group Ⅱ (P ＜ 0.05), but there was no significant difference in the duration of endotracheal tube and incidence of hyoxemia between the two groups(P ＞ 0.05). Conclusion Inhaled aerosolized milrinone has better therapeutic effect than intravenous milrinone on PAH in children with CHD.

Objective To investigate the different operation methods for kyphosis deformity of ankylosing spondylitis(AS)complicated with cervical vertebral fracture and their effects.Methods A retrospective case series study was conducted to analyze the clinical data of 19 patients with AS kyphosis complicated with cervical vertebral fracture admitted to Henan People's Hospital from April 2007 lo October 2017.There were 18 males and one female,aged 28-73 years,with an average age of 38.6 years.Among the patients,17 were complicated with spinal cord dysfunction.According to the American spinal injury association(ASIA)classification,there were four patients with grade A,five with grade B,five with grade C and three with grade D.According to the degree of nerve injury and the displacement of fracture,reduction and fixation or orthopedic fixation were selected;14 patients with severe nerve injury(ASIA grades A-C)were treated with reduction and fixation,of which six were treated by simple anterior approach,two by simple posterior approach,five by combined anterior-posterior approach,and one by combined anterior-posterior approach 2 months after Halo fixation.Five patients with ASIA grade D or E were treated with orthopedic fixation.Firstly,kyphosis was corrected with manual technique and the Halo external fixator was installed,and then surgical fixation fusion was performed via simple posterior approach(one patient)or combined anterior-posterior approach(four patients).Visual analogue scale(VAS)was used to evaluate the relief of neck pain.The improvement of nerve function,the effect of orthopedic fixation,the fracture healing time and the postoperative complications were recorded.Results One patient died 11 days after operation due to pulmonary infection and respiratory failure.The remaining patients were followed up for 1-10 years,with an average of 27.3 months.The neck pain in all patients was relieved significantly,and the VAS score[(2.9±0.9)points]decreased significantly 3 days after operation compared with that before operation[(8.2±1.0)points](P＜ 0.05).The nerve function of 12 patients improved significantly(P＜ 0.05).The chin-brow vertical angle of the patients after orthopedic fixation was 60-180(mean,11.8°),suggesting that the level vision function was restored.Fracture healing time ranged from 3 to 8 months,with an average of 3.9 months.There were 4 patients with cerebrospinal fluid leakage and three patients with pulmonary infection.No complications such as wound infection and aggravation of nerve injury occurred.Conclusions For AS kyphosis combined with cervical spine fracture,if without severe nerve injury,manual correction of kyphosis and installation of Halo frame followed by fixation and fusion can effectively correct spinal deformity and improve the quality of life.Patients with severe spinal cord injury should avoid stage I correction and receive reduction of fracture and long segment fusion fixation as far as possible to facilitate the recovery of nerve function.

Objective:To observe the clinical efficacy of customized titanium mesh combined with concentrated growth factors(CGF)for restoration of anterior alveolar ridge defects.Methods:105 patients with anterior alveolar ridge defects were included and underwent implant restoration.The patients were classified into 2 groups by random number table method,those in control group(n=53)received customized titanium mesh,in study group(n=52)received customized titanium mesh combined with CGF.After 1 year follow-up,the success rate of implantation,alveolar ridge height,alveolar ridge bone augmentation,alveolar bone mineral density,bone thickness,aesthetic results and complications were compared between the 2 groups.Results:In 1-year follow-up,no implant loosening and shed-ding occurred in the 2 groups,and the success rate of implantation was 100％.The height of the alveolar ridge,the horizontal bone aug-mentation,the alveolar bone mineral density and bone thickness of study group were greater than those of the control group(P＜0.05).Study group scored higher on pink aesthetic/white aesthetic score(PES/WES)than control group(P＜0.05).In study group,there were 2 cases of postoperative swelling and pain,2 cases of periodontal infection,1 case of gingival bleeding and 1 of allergy.In control group,there was 1 case of postoperative swelling,1 of pain,1 of gingival bleeding,1 of allergy and 2 of periodontal infection(P＞0.05).Conclusion:Application of customized titanium mesh combined with CGF for restoration of anterior alveolar ridge defects can improve the height of the alveolar ridge and bone metabolism,ensure the aesthetic results.

ObjectiveTo investigate the individualized treatment for traumatic liver rupture. MethodsClinical data of 58 patients with traumatic liver rupture diagnosed and treated in the CAPF Sichuan Provincial Corps Hospital between April 2011 and December 2013 were retrospectively studied. The informed consents of all patients were obtained and the local ethical committee approval had been received. Among the 58 patients, 31 were males and 27 were females with the age ranging from 2 to 76 years old and the median of 44 years old. According to the American Association for the Surgery of Trauma (AAST) grading for liver injury, 33 patients were with GradeⅡ liver injury, 16 with GradeⅢ liver injury and 9 with GradeⅣ liver injury. After admission, all patients underwent routine abdominal examination and abdominocentesis for the closed liver rupture. In addition, blood routine, coagulation function, hepatic and renal function, abdominal ultrasound and computer tomography (CT) were also examined emergently to know about the location, size and depth of liver rupture, blood loss, underlying diseases and combined injuries. The individualized treatments, including non-surgical treatment and surgical treatment were performed according to the AAST grading criteria for liver injury and the comprehensive conditions of patients.ResultsNon-surgical treatment was given to 24 patients in which 9 cases were found having obviously increased ascites by ultrasound and CT examination 3-7 d after treatment. Laparoscopic exploration was then performed on the 9 patients. During the operation, 5 were found with mild bleeding and the bleeding was stopped successfully with electrotome, cavitron ultrasonic surgical aspirator or titanium clip. And the rupture bleeding of the other 4 cases were found stopped. Two patients received CT scan 2-3 weeks after treatment and were found with encapsulated effusion near the right liver lobe and 1 case with effusion in hepatic and renal recesses. All these 3 patients underwent CT-guided puncture drainage and were cured. A total of 34 patients underwent emergency exploratory laparotomy. Among these patients, 25 underwent debridement of devitalized liver tissues and wound suture, 6 underwent regular segmental hepatectomy or hepatic lobectomy, 2 underwent hepatic artery branch ligation and wound suture, and 1 underwent greater omentum iflling and suture. After the treatment, 1 patient developed perihepatic abscess and was cured after puncture drainage. All 58 patients recovered and were discharged. Forty-ifve patients were followed up for 1-6 months. No recurrence of bleeding, bile leakage, infection, hepatic insufifciency and other complications were observed.ConclusionsIndividualized treatment can be applied for traumatic liver rupture. Patients with small and shallow liver rupture may receive non-surgical treatment under a close observation and patient with unstable vital signs and progressive bleeding at the liver rupture may receive surgical treatment. Both treatments can achieve good curative effects.

Objective:To analyze the postoperative paravertebral muscle degeneration and its correlations with health related quality of life (HRQL) in patients undergoing minimally invasive surgery-transforaminal lumbar interbody fusion (MIS-TLIF).Methods:The clinical data of the 50 patients were retrospectively analyzed who had undergone single-segmental MIS-TLIF at Department of Spinal Cord Surgery, The People's Hospital of Henan Province from January 2019 to December 2021. The relative volumes of lumbar posterior muscle (LM), the relative volumes of the psoas major (PM), and the rates of fatty degeneration (FD) of the fused segment and its adjacent segments were compared respectively between preoperation, 6 and 12 months postoperation. The correlations were analyzed between the HRQL scores [visual analog scale (VAS) for pain and Oswestry disability index (ODI)] and the relative LM volumes, the relative PM volumes, and the FD rates of the fused segment and its adjacent segments at 12 months postoperation.Results:Compared with the preoperative values, the relative LM volumes and the relative PM volumes of the fused segment and its adjacent segments at 6 and 12 months postoperation were significantly reduced while the FD rates significantly increased. However, the FD rate of the fused segment at 12 months postoperation (20.6% ± 6.1%) was significantly lower than that at 6 months postoperation (29.7% ± 8.2%) ( P < 0.05). The VAS score was strongly negatively or positively correlated with the relative LM volume ( r = -0.819, P < 0.001) and the FD rate ( r = 0.86, P < 0.001) of the fused segment, and moderately negatively correlated with the relative PM volume ( r = -0.435, P = 0.016). The ODI index was moderately negatively correlated with the relative LM volume ( r = -0.512, P = 0.004) and the relative PM volume ( r = -0.402, P = 0.020) of the fused segment, but moderately positively correlated with the FD rate of the fused segment ( r = 0.565, P = 0.001). There was a moderate negative correlation between the ODI index and the relative LM volume of the adjacent segments ( r = -0.478, P = 0.012). Conclusions:After MIS-TLIF, the volume of the paravertebral muscles decreases and the dorsal muscles develop fatty degeneration. The improvement of LM fatty degeneration may be observed by 12-month follow-up in the fused segment, but not in the adjacent segments. The LM volume and the FD rate of the fused segment are the most closely related to the postoperative HRQL.

Objective:To investigate the clinical efficacy and precautions of O-arm combined with navigation-assisted steotomy and hemivertebra resection for congenital cervicothoracic hemivertebra.Methods:From February 2016 to October 2020, the clinical data of 12 patients with cervicothoracic hemivertebra admitted in Henan Provincial People's Hospital were retrospectively analyzed, including 5 males and 7 females, aged 9.4±2.6 years (range, 4-15 years). Intraoperative neural monitoring system was used to ensure the safety of surgical correction process and O-arm navigation system assisted the implantation of pedicle screws,hemivertebra resection, and scoliosis deformity correction. Postoperative CT was used to evaluate the accuracy of screw placement, and routine preoperative and postoperative X-ray films of the full-length spine in standing position were taken to measure the coronal and sagittal Cobb angles. The correction rate of scoliosis and kyphosis, internal fixation, shoulder height difference and bone graft fusion were calculated at the final follow-up.Results:A total of 108 pedicle screws were inserted in 12 patients, and the screw placement accuracy rate was 96.3% (104/108). The follow-up time was 37.9±10.2 months (range, 24-61 months). The number of fused segments was 5.4±1.1 (range, 4-7). One week after surgery, the correction rate of Cobb angle was 78.5%±3.2% for scoliosis and 70.1%±5.4% for kyphosis. There were statistically significant differences in side and kyphosis Angle and Scoliosis Research Society (SRS)-22 score between preoperative and 1 week after surgery ( P<0.05). There was no significant difference between the operation and the last follow-up ( P>0.05). At the last follow-up, all the 12 patients achieved gradeⅠ fusion. SI was 2.4±0.8 cm before operation, 1.0±0.6 cm at 1 week after operation, and 0.7±0.5 cm at last follow-up, and the difference was statistically significant ( F=38.30, P<0.001). No pseudojoint formation, significant loss of correction Angle, or rupture of internal fixation relaxant occurred during the operation or during follow-up. Conclusion:O-arm combined with navigation-assisted steotomy and hemivertebra resection for the treatment of congenital cervicothoracic hemivertebra has the advantages of good orthopedic effect, reduced radiation exposure and fewer complications, and accurate pedicle screw implantation and hemivertebra resection.

Objective To understand the sense of gain of elderly chronic patients,explore their influencing factors,and provide a basis for the subsequent enhancement of the sense of gain of elderly chronic patients.Methods The data for this study were obtained from a survey of elderly chronic patients in the affiliated hospital of Guangdong Medical University.Convenience sampling was used to survey 380 elderly chronic patients with hypertension,coronary heart disease and benign prostatic hyperplasia treated in the hospital.The questionnaire included sense of gain,demographic factors,physical function,psychological function,and social function,etc.One-way multi-sample rank test,Spearman′s correlation analysis,multifactorial ordered logistic regression model and CHAID categorical decision tree analysis were performed using SPSS 26.0.Results Among the 380 older chronically ill people surveyed,2.9%had no sense of gain at all,40.5%had unclear or moderate sense of gain,and 66.6%had a very strong sense of gain.The results of multifactorial ordered logistic regression showed marital status,education level,social support and spiritual pillars are associated with sense of gain with all above variables being statistically significant(P＜0.05).The OR values for unmarried,below junior high school level,high school and specialist,able to interact with others as they did before they got sick,spiritual pillars to make them no/a little feel the meaning of life,and limited moderate activities are 0.318,0.172,0.307,0.500,0.145,0.407,0.545,respectively,indicating relatively low sense of gain.The elderly chronic patients who usually did not feel depressed or sad,and did not have financial difficulties in their families due to their illness and treatment had a higher sense of gain with OR values being 3.042 and 1.988,respectively.The results of categorical decision tree analysis showed that whether or not spiritual support can make feel the meaning of life or the value of life,whether or not interact with other people as did before the disease,whether or not the disease has caused family′s financial difficulties,and whether or not have limitations on moderate activities are the most important factors influencing the sense of gain of the elderly chronic patients.Conclusion It is necessary to pay attention to the mental aspects of the elderly chronic patients and maintain interpersonal communication,and take targeted measures to help them reduce the degree of activity limitation as much as possible,so as to enhance the sense of gain of the elderly chronic patients.

OBJECTIVE： To provide reference for strengthening clinical application of key monitoring drugs and promoting rational drug use in clinic. METHODS： Based on evidence-based medicine， taking key monitoring drugs Shuxuetong injection as example， clinical evidence of domestic and foreign clinical studies were collected. The included literatures were graded according to the quality of GRADE evidence and recommended strength system. Evidence-based medicine evidence for the indications of Shuxuetong injection were evaluated， and criterion for clinical use of Shuxuetong injection was formulated in Huaihua First People’s Hospital （our hospital）. RESULTS： The main content of criterion for clinical application of Shuxuetong injection formulated by our hospital was that there was A-level evidence support for acute ischemic cerebral infarction， but it was weakly recommended and only used for adjuvant therapy； there was B-level evidence support for anticoagulation （for preventing DVT）， diabetic peripheral nerve lesion， but it was weakly recommended； there was only C-level or D-level evidence support for other indications， it was strongly recommendation against use. CONCLUSIONS： Clinical pharmacists formulate the criterion for clinical application of Shuxuetong injection by evidence quality evaluation method， provide reference for clinical application management of key monitoring drug and play an important effect on rational drug use in clinic.