Objective: To analyze the distribution and drug resistance characteristics of clinical separation germ in a hospital from 2013 to 2015 to provide reference and basis for the prevention and control of nosocomial infection and rational use of antibiotics.Methods: The microbial susceptibility of isolated strains was detected using the conventional methods, and the drug sensitivity was analyzed by BioMerieux ATB 1.22.The drug sensitivity was determined according to CLSI 2014 criteria.Results: A total of 18 421 specimens were isolated during 2013 and 2015, and a total of 3 744 strains were isolated with the total positive rate of 20.32%.The separation and identification of pathogenic bacteria at the top 5 were Escherichia coli (967 strains, 44.34%), Bauman Acinetobacter (323 strains, 14.81%), Klebsiella pneumoniae (312 strains, 14.31%), Staphylococcus aureus (297 strains 13.62%) and Pseudomonas aeruginosa (282 strains, 12.92%).Besides the natural resistance of Klebsiella pneumoniae to amoxicillin, the resistance rate of Escherichia coli to piperacillin was over 75%, while the sensitivity rate of Klebsiella pneumoniae to piperacillin and tazobactam was more than 90%.The sensitivity of Acinetobacter baumannii and Pseudomonas aeruginosa to clinical antibiotics was basically below 40%, and the overall resistance level was higher than that of Bauman.MRSA was sensitive to nitrofurantoin, minocycline, quinupristin-Dafoe and leptin glycopeptide antibiotics (such as teicoplanin and vancomycin).Conclusion: The hospital should strengthen the monitoring of bacterial resistance and track the results in a timely manner so as to provide reference for the rational drug use in clinical practice.

Objective To investigate the predictive value of plasma cystatin C (CysC) in patients with acute coronary syndrome (ACS) after pereutaneous coronary intervention (PCI).Methods A total of 660 patients with ACS admitted to cardiovascular department were enrolled in this study from January 2009 to June 2010.The enrollment criteria were:(1) the stenosis degree was above 75％ in at least one coronary artery checked by coronary angiography and successful PCI; (2) normal renal function or mild dysfunction with glomerular filtration rate (GFR) ＞ 60 ml/ ( min · 1.73 m2 ).Exclusion criteria were severe liver and renal insufficiency,malignancies and valvular heart diseases.The plasma CysC levels were examined by the latex enhanced immune turbidity method within 24 hours after admission.The relevant clinical data were recorded.The patients were followed up by out-patient interview or telephone from March to June 2011 and adverse cardiovascular events were recorded.The patients were divided into four groups according to CysC level:Q1 (CysC＜1.02 mg/L),Q2 (1.02 mg/L≤＜CysC ＜1.17 mg/ L),Q3 (1.17 mg/L ≤ CysC ＜1.35 mg/L) and Q4 (CysC ≥ 1.35 mg/L).Univariate and multivariate Cox hazards regressions were established to analyze the factors related to prognosis.The proportion differences between four groups were tested by x2.The survival ratio was estimated using the Kaplan-Meier method.Statistical significance was established at a P value of less than 0.05.Results ① A total of 606 ( 91.7％ ) patients successfully accepted follow-up.Mean follow-up time was ( 14.3 + 1.7 ) months.Of them,95 patients were subjected to adverse cardiovascular events ( 15.7％ ).②The incidences of adverse cardiovascular events in Q2,Q3,Q4 were significantly higher than those in Q1 ( P ＜ 0.001 ).The rates of mortality,nonfatal myocardial infarction and target lesion revascularization in Q4 were higher than those in Q1 ( P ＜ 0.05 ).The incidences of heart failure in Q3 and Q4 were higher than that in Q1 ( P ＜ 0.05 ).③Univariate analysis demonstrated that CysC,creatinine,LVEF,age,history of PCI and NYHA grade ≥3 were the risk factors of poor prognosis (P ＜ 0.05 ).④ Multivarite cox hazards regression revealed that the elevation of CysC level remained an independent predictor of adverse cardiovascular events.The relative risk of Q3 and Q4 were 3.930 (95％ CI 1.306-11.829,P =0.015 ) and 6.380 (95％ CI 2.171-18.751,P =0.001 ) compared with Q1.⑤　The cumulative rates of survival without adverse cardiovascular events in Q2,Q3 and Q4 decreased compared with Q1 (P ＜ 0.001 ).Conclusions High plasma CysC concentration is an independent predictor of adverse cardiovascular events in patients with ACS after PCI.

Objective To investigate the predictive value of metabolic syndrome in patients with acute coronary syndrome (ACS) after percutaneous coronary intervention (PCI).Methods A total of 660 patients with ACS admited to cardiovascular department,first affiliated hospital of zhengzhou university were enrolled in this study from January 2009 to June 2010.The enrollment criteria were:the stenosis degree were above 75％ in at least one coronary artery by coronary angiography and successful PCI procedure.Exculsion criteria were:liver and renal insufficiency,malignancies and valvular heart diseases.The relevant clinical data and labtory examination were recorded after admission. The patients were followed up by outpatients interview or telephone from March to June 2011 and adverse cardiovascular events were recorded.The patients were divided into MS and non-MS groups,and basic clinical data were compared between two groups.The proportion difference between two groups were tested by chi square. Multivariate logistic regression was established to analyze the factors related to progonosis.The survival ratio was estimated using the Kaplan-Meier method.Statistical significance was established at a P value of less than 0.05.Results ①A total of 606 (91.7％) patients successfully accepted follow-up.Mean follow-up time were ( 14.3 ±1.7 ) months.95 patients experienced adverse cardiovascular events ( 15.7％ ).②There were 393 patients (64.96％ ) satisfied the definition of metabolic syndrome.The patients in MS group were with higher BMI,SBP,DBP,blood glucose and disordered lipid (all P ＜ 0.05 ),with less fale patients (P =0.016),less current somking (P =0.008 ) and with higher platelet (P =0.037 ). The incidence of adverse cardiovascular events in two groups were 17.81％ and 11.79％ ( P ＞ 0.05 ). ③ Multivarite logistic regression revealed that the predictors of adverse cardiovascular events were age [ OR =2.628,95％ confidence interval (CI) 1.395 ～ 4.954,P =0.003 ],New York Heart Association (NYHA) ≥ 3 grade ( OR =2.310,95％ CI 1.095 ～4.870,P =0.028) and left ventricular ejection fraction (LVEF) ( OR =4.328,95％ CI 1.955 ～9.580,P ＜ 0.001 ).However,MS was not related with prognosis ( OR =1.170,95％ CI 0.583 ～ 2.345,P =0.659 ).④The cumulative survival rates of no adverse cardiovascular events in the two groups were no significant difference ( P ＞ 0.05 ).Conclusions MS is a risk factor with coronary heart disease.Howerer,it has no relationship with adverse cardiovascular events in patients with ACS after PCI.

Objective To analyze the influencing factors of disaster resilience in medical rescue workers,to construct a prediction model for the low-level risk of disaster resilience in medical rescue workers,and to verify the predictive effect of the model.Methods Using the convenience sampling method and the snowball method,1 037 medical rescue workers who participated in disaster rescue in 18 provinces(autonomous regions and municipalities)were selected as the participants from May to July 2022.Online questionnaire surveys were conducted using general information questionnaires,disaster resilience measuring tools for healthcare rescuers,the Mindful Attention Awareness Scale,the Simple Coping Style Questionnaire and the Depression-Anxiety-Stress Scale.Univariate and multivariate logistic regression analyses were used to determine the independent influencing factors for the low level of disaster resilience of medical rescue workers.A risk prediction model was constructed,and a nomogram chart was drawn.The model's effectiveness was evaluated using the receiver operating characteristic curve(ROC)and calibration curve.The Bootstrap method was applied for internal validation.Results The logistic regression analysis showed that per capita monthly income of households,whether to participate in on-site disaster rescue,positive coping,mindfulness level,and adequacy of rescue supplies were independent influencing factors for the disaster resilience of medical rescue workers(P＜0.05).The predictive formula for the low-level risk of disaster resilience in medical rescue workers was established as follows:Logit(P)=8.741-0.381 x per capita monthly income of households-0.891 x whether to participate in on-site disaster rescue-2.544 x positive coping-0.020 x mindfulness level-0.222 x adequacy of rescue supplies.The area under the ROC curve was 0.823,and the optimal critical value was 0.353.The sensitivity and specificity were 79.12％and 71.43％,respectively.The Hosmer-Lemeshow test showed that x2=12.250(P=0.140),and the predicted curve fitted well with the ideal curve.The external validation showed that the sensitivity and specificity of the model were 75.00％and 66.39％,respectively,and the overall accuracy was 69.95％.Conclusion The prediction model in this study has sound predictive effects and can provide references and guidance for managers to select,recruit,and train medical rescue workers.