Objective To analyze the distribution and drug resistance of the isolated strains of K lebsiella pneumonia .Methods The strains of K lebsiella pneumonia were isolated from specimens from clinical departments ,and the drug resistance was tested . The results were analyzed .Results There were 415 strains of K lebsiella pneumonia were isolated .The isolated strains distributed mainly in Department of Neurosurgery (36 .1% ) ,Department of Respiratory Medicine (27 .7% ) ,and ICU (16 .9% ) .74 .7% of the strains were isolated from sputum specimens .30 .0% of the isolated strains were ESBLs positive .The drug resistance rates of K leb‐siella pneumonia to meropenem and imipenem were both low to 0 .5% .Conclusion Monitoring the drug resistance of K lebsiella pneumonia is very important to guide the treatment .

Objective: To study the clinical effect of nursing after laparoscopic myomectomy after nursing intervention. Methods: Retrospective analysis of our hospital from 2009 May to 2012 October in our department, laparoscopic myomectomy in the treatment of 148 cases of uterine fibroids patients clinical data, were randomly divided into 2 groups, 74 cases in each group, the control group routine nursing care to patients, nursing intervention on the patients with study group, The quality of life of patients with depression and anxiety scores were compared between the two groups before and after the rate and nursing of exhaust and ambulation time, hospitalization time, complications. Results: Research group of exhaust, ambulation, time of hospitalization, the incidence of complications compared with the control group, showed significant difference; the study group before operation and nursing of patients with anxiety and depression and quality of life scores compared with the control group, there was no significant difference, nursing intervention, there were significant differences. Conclusion: Laparoscopic myomectomy nursing intervention, can promote the rehabilitation, and improve the living condition, patients with significant effect, should be popularized.

Objective:To investigate the expression of multidrug resistance (MDR1) gene and multidrug resistance-associated pro-tein (MRP) gene in patients with non-small-cell lung cancer (NSCLC) and its relation to histopathological type. Methods:The MDRi and MRP genes were determined by reverse transcription-polymerase chain reaction (RT-PCR) in 48 NSCLCspecimens. Results:The positive rates of the MDR1 and MRP gene expression were 62.5％ and 66.7％ respectively in the48 patients. Twenty-one of the 48 NSCLCs (43.8％) expressed both MDR1 and MRP genes. The positive rates of the MRPgene expression in squamous cell carcinoma was significantly higher than those in adenocarcinoma (P＜0.01), and therewas no significant difference in MDR1 gene expression between the two groups (P＞0.05). Conclusion: The MDR1 andMRP gene expressions were both or respectively in the NSCLCs. The incidence of the MRP gene expression in squamous cellcarcinoma was higher than that in adenocarcinoma.

Objective To establish a new method to identify and analyze Qingdai Powder and its composition.Methods X-ray Diffraction with Fourier pattern was used.Results The standard X-ray diffraction with Fourier pattern and characteristic diffraction peaks of Qingdai Powder and its composition drugs were obtained.Conclusion The powder X-ray diffraction method can be used as a simple and convenient method for the identification of Qingdai Powder and its composition drugs.

Objective To observe the clinical effect and safety of subanesthetic doses of ketamine and fentanyl assisted regional anesthesia.Methods 90 children received abdominal operation or limbs operation were selected in our hospital.They were randomly divided into A,B and C group with 30 children in each group.The children in group A received sub-anesthetic doses of ketamine and fentanyl in nerve block anesthesia; the children in group B received sub-anesthetic doses of ketamine and fentanyl anesthesia aided;while the children in group C accepted traditional ketamine anesthesia.The indexes of respiratory frequency,mean arterial pressure,heart rate and oxygen saturation and other basic vital signs as well as anesthesia adverse events of situation were compared.Results The respiratory frequency,mean arterial pressure and heart rate in group A and B were lower than those in group C,the difference was statistically significant(all P ＜0.05),whereas no difference was observed on the oxygen saturation between two groups(P ＞0.05).The respiratory rate,mean arterial pressure and heart rate in group A and B showed no significant difference (all P ＞ 0.05).In adverse reactions,the muscle relaxants was in good condition in group A and B,no obvious body movement and gastrointestinal adverse events observed either.Group C with muscle relaxants in good condition,but body movement and some gastrointestinal adverse reaction can be observed occasionally.Conclusion Subanesthetic doses of ketamine and fentanyl has good anesthetic effect on regional anesthesia,and can effectively reduce the occurrence of adverse reactions,which is worthy of clinical application.

Objective To investigate the effect of traditional Chinese medicine on the renal function and quality of life in patients with early diabetic nephropathy (DN).Methods 78 diagnosed as DN and TCM syndrome type belonged to cases of yin deficiency of liver and kidney were included in the study,they were randomly divided into the control group(40 cases)and observation group (38 cases).The two groups underwent conventional treatment of western medicine,the observation group received traditional Chinese medicine.The 24h urine protein counts,blood glucose (FBG,2hPG),lipid column (TC,TG,LDL -C,HDL -C),UAER,ACR,SCR,bun and quality of life of SF-36,adverse reaction were observed.Results The blood glucose,blood pressure,UAER,ACR,SCR,BUN,SF -36 score,urinary protein count of the two groups were improved than before treatment.6 months after treatment,the 24h urine protein of observation group was (1.02 ±0.42)g,which was significantly lower than the control group,the difference was statistically significant (t =2.702,P <0.05).After treatment,UAER,ACR,SCr,BUN of the observation group were (82.09 ±10.74)mg/24h,(84.92 ±9.33)mg/g,(108.43 ±38.35)mmol/L,(6.17 ±2.65)mmol/L, which were better than the control group,the differences were statistically significant (t =8.960,P <0.01;t =15.528,P <0.01;t =11.987,P <0.01;t =10.566,P <0.01).No adverse reaction was observed.Conclusion The combination of Chinese and western medicine in the treatment of early DN has good efficacy and better than the use of western medicine alone,it can improve renal function and is safe and reliable.

Compound traditional Chinese medicine database was established by collecting 176 compound formulas for dysmenorrhea in the last twenty years. The proportion and frequency of herbal medicine were analyzed and the main herbs with mono-target or multi-target in the compound formulas were selected with simple and multiple linear regression. The linear regression equations were listed and the clinical effects of the compound formulas were evaluated. Of 173 herbs used in the compound formulas, the proportion and frequency of the herbs for activating blood and transforming stasis and regulating qi flow were high in the application. The dosage interval for 20 herbs in common use was estimated. Main herbs with mono-target or multi-target used in the compound formulas were selected with simple and multiple linear regression. The total effectiveness rate of the 176 compound formulas was tested with simple linear regression, and 167 compound formulas (94.84 % of the total) had the absolute error less than 4%. Herbs for activating blood and transforming stasis and regulating qi flow are most commonly used in treatment of dysmenorrhea. Clinical effects of the compound formulas could be forecast with stepwise regression equation.

Objective: To evaluate the relationship between the change of left ventricular mass and arterial stiffness in the aged patients with diabetes mellitus. Methods: The pulse wave velocity (PWV) and left ventricular mass index(LVMI)were used to estimate the left ventricular mass and arterial stiffness. The relationship between LVMI and PWV and other influencing factors were evaluated with univariate analysis and stepwise regressive analysis in 105 patients with diabetes mellitus. The value of PWV was compared in the subjects of the left ventricular hypertrophy and the non- left ventricular hypertrophy groups. Results: LVMI was positively correlated with PWV, systolic blood pressure, pulse pressure,medical history and body mass index (the values of r were 0.821, 0.792, 0.799, 0.664 and 0.241 respectively,P ＜ 0.01 or P ＜ 0.05). A stepwise regression analysis was used to assess the combined influence of variables on left ventricular hypertrophy. The model included the following variables: PWV, systolic blood pressure and diabetes mellitus medical history. PWV value was significantly higher in patients with left ventricular hypertrophy than that of the patients without left ventricular hypertrophy(t = 9.109,P < 0.01). Conclusion: The increased arterial stiffness is one of the important factors which lead to the increased left ventricular mass index in aged patients with diabetes mellitus.

Objective To investigate the impact of obstructive sleep apnea hypopnea syndrome (OSAHS) on development of nonalcoholic fatty liver disease (NAFLD) in the non-obese elderly.Methods A total of 91 non-obese elderly patients were divided into 3 groups,29 cases with mild to moderate SAHS (mild-to-moderate OSAHS group),31 cases with severe OSAHS (severe OSAHS group),30 cases without OSAHS and matched with age,sex and BMI (control group).The changes in NAFLD severity index including serum liver enzyme levels,Type Ⅲ procollagen peptide (PⅢ P)and liver/spleen CT ratio were observed,and the influence factors for the changes were analyzed.Results Serum alanine aminotransferase (ALT),aspartate aminotransferase (AST)ALT/AST ratio and serum PⅢ P levels were significantly higher in severe OSAHS group than in mild-to-moderate OSAHS and the control group(F=25.71,15.15,18.64,respectively,all P＜0.01).There was no significant differences in serum liver enzyme ALT,AST and P Ⅲ P levels between mild-to-moderate OSAHS and the control groups(all P＞0.05),and the ALT/AST ratio was significantly higher in mild-to-moderate OSAHS group than in the control group(P＜0.01).The Liver/spleen CT ratio was significantly lower in OSAHS groups than in control group,while the ratio was lower in severe OSAHS group than in mild-to-moderate OSAHS group(all P＜0.01 or 0.001).Serum PⅢ P level was significantly higher in OSAHS groups than in control group(F=31.46,P＜0.01),while PlⅢ P levels were not significantly different between the mild-to-moderate OSAHS group and the control group(P ＞ 0.05).The correlation analysis showed that the liver/spleen CT ratio in OSAHS group was negatively correlated with AHI(r=-0.785,P＜0.001),but was positively correlated with the lowest oxygen saturation(r=0.517,P=0.001).The ALT/AST ratio and serum P Ⅲ P level in OSAHS patients were positively correlated with AHI (r=0.463,0.770,both P＜0.001),but were negatively correlated with the lowest oxygen saturation (r=-0.395,-0.514,P＜0.01 or 0.001).The multiple regression analysis showed that AHI was the only variable that affected liver/spleen CT ratio and serum P Ⅲ P level in OSAHS patients.Conclusions OSAHS patients in the non-obese elderly are always complicated with NAFLD,characterized by abnormal liver enzymes,hepatic steatosis and fibrosis.The severity of lesion is increased with the deterioration of OSAHS.AHI may play an important role in the development of NAFLD in the non-obese elderly with OSAHS.

Objective To evaluate the effects of sevoflurane preconditioning on caveolin-3 expression during myocardial ischemia-reperfusion (I/R) in rats.Methods Healthy male Wistar rats,aged 6-8 weeks,weighing 250-300 g,were anesthetized with intraperitoneal pentobarbital 30 mg/kg and heparin 1 000 IU/kg.Their hearts were excised and perfused with K-H solution in a Langendorff apparatus.Thirty isolated rat hearts were randomly assigned into 3 groups (n =10 each) using a random number table:control group (group C),I/R group and sevoflurane preconditioning group (group SP).After 30 min of equilibration,group C was continuously perfused with K-H solution for 90 min,group I/R underwent 30 min of ischemia followed by 60 min of reperfusion,and group SP was perfused with K-H solution saturated with 2％ sevoflurane for 10 min followed by 5 min washout with K-H solution,then underwent 30 min of ischemia followed by 60 min of reperfusion.HR,left ventricular enddiastolic pressure (LVEDP),+ dp/dtmax and-dp/dtmax were recorded at the end of equilibration,immediately before ischemia and at 30 and 60 min of reperfusion.Myocardial specimens were obtained from the cardiac apex for microscopic examination.Myocardial specimens were obtained from the left ventricle for determination of caveolin3 expression.Results Compared with group C,+ dp/dtmax and-dp/dtmax were significantly decreased immediately before ischemia,and HR,LVDEP,+ dp/dtmax and-dp/dtmax were decreased at 30 and 60 min of reperfusion in groups I/R and SP,and caveolin-3 expression was down-regulated in group I/R and up-regulated in group SP (P ＜ 0.05).Compared with group I/R,HR,LVDEP,+ dp/dtmax and-dp/dtmax were significantly decreased immediately before ischemia and increased at 30 and 60 min of reperfusion,and caveolin-3 expression was up-regulated in group SP (P ＜ 0.05).The pathological changes were significantly attenuated in group SP as compared with group I/R.Conclusion The mechanism by which sevoflurane preconditioning attenuates myocardial I/R injury in rats may be related to up-regulation of myocardial caveolin-3 expression.