Objective To explore the gram-negative bacteria distribution and drug resistance in severe infections patients in ICU in our hospital.Methods Gram-negative bacteria in 260 cases of the clinical specimens from ICU department in our hospital from Mar 2012 to Mar 2013 were isolated and cultured,and the distribution and drug resistance in main gram-negative bacteria were analyzed.Results 300 cases of gram-negative bacteria were isolated from the 260 cases of specimens,and 203 cases were isolated from sputum,accounting for 67.7％.The mainly gram-negative bacteria in 300 cases were as follows:Pseudomonas aeruginosa (53 cases),Acinetobacter baumannii (45 cases),Klebsiella pneumonia (39 cases),Escherichia coli (33 cases) and Enterobacter cloacae (29 cases).The resistance rates of Pseudomonas aeruginosa to ampicillin/sulbactam and ceftriaxone were 73.6 ％ and 66.0％,Acinetobacter baumannii to ampicillin/sulbactam and piperacillin/tazobactam were 80％ and 68.9％,Klebsiella pneumoniae to ampicillin/sulbactam and ciprofloxacin were 53.8％ and 48.7％,Escherichia coli to levofloxacin and ampicillin/sulbactam were 78.8％ and 75.8％,Enterobacter cloacae to ampicillin/sulbactam and ceftriaxone were 82.8％ and 65.5 ％,respectively.Conclusions Drug resistance in gram-negative bacteria in ICU infection is more severe,and more attention should be paid to sterilization in ICU ward and rational use of antibiotics in order to minimize the risk of infection.

The development process of science and technical in the industry of assistive devices in China went with every stages of the standardization. The authors looked back the standardization history of the industry of assistive devices in China, emphatically introduced the recent development status and proposed the suggestion how to carry out the standardization in the near future.

Lung cancer is the leading cause of cancer death worldwide. Significant advancements have been observed in the thera-py for non-small celllung cancer (NSCLC). With constant extension of new awareness regarding the histopathology of lung cancer, ho-mologous chemotherapeutic regimens have been developed on the basis of histopathological sub-typing methods. With developments in molecular biology, driving gene mutations during tumorigenesis and progression have been discovered. A series of targeted drugs for various molecular subtypes has also been investigated and developed on the basis of these mutations. This review summarizes recently published clinical outcomes on the management of advanced NSCLC and strategies to apply drugs in clinical treatments.

ObjectiveToinvestigatethecorrelationsofmethylenetetrahydrofolatereductase(MTHFR) gene C677T polymorphism w ith ischemic stroke and hyperuricemia in Chinese Han population in Shandong, China.Methods The patients w ith acute ischemic stroke and age-and sex-matched controls in Chinese Han population in Shandong, China w ere enrol ed. Polymerase chain reaction amplification and microarray hybridization w ere used to detect the MTHFR gene C677T polymorphism, and the serum uric acid concentration w as measured. Results A total of 145 patients w ith acute ischemic stroke and 145 age-and sex-matched controls in Chinese Han population in Shandong, China were enroled. The proportion of diabetes ( 26.90%vs. 6.89%; χ2 = 20.653, P< 0.001 ) and fasting blood glucose ( 5.56 ± 1.57 mmol/L vs.5.01 ±1.11 mmol/L;t= -3.390, P=0.001), homocysteine (median, interquartile range:18.2[16.30-22.55 μmol/L] vs.15.20[12.10-17.85 μmol/L]; Z= -6.323, P<0.001), and uric acid (43.0[361.60-490.45 μmol/L] vs.285.9[267.00-346.25 μmol/L]; Z= -10.360, P<0.001) levels in the ischemia stroke group w ere significantly higher than those in the control group. The distribution frequencies of TT genotype (42.07%vs.15.17%; χ2 =25.673, P<0.001) and T alele (58.28%vs. 34.48%; χ2 =33.008, P<0.001) in the ischemia stroke group w ere significantly higher than those in the control group. Multivariate logistic regression analysis showed that the uric acid (odds ratio [OR] 1.018, 95%confidence interval [ CI] 1.013-1.024; P<0.001), TT genotype ( vs.CT genotype OR 6.774, 95%CI 1.779-25.507; P=0.005), hypertension ( OR 1.919, 95%CI 1.013-3.636; P=0.045), and homocysteine (OR 1.153, 95%CI 1.059-1.258;P=0.001) w ere the independent risk factors for ischemic stroke. The ischemic stroke group w as combined w ith the control group, a total of 101 patients had hyperuricemia, and 189 had normal uric acid. The proportion in patients w ith diabetes ( 32.67%vs. 11.64%; χ2 = 23.749, P< 0.001), as wel as total cholesterol ( 5.67 ±1.56 mmol/L vs.5.10 ± 1.33 mmol/L; t= -3.255, P< 0.001 ) and homocysteine ( 19.50[17.10-24.70 μmol/L] vs. 15.40[12.60-18.05 μmol/L ]; Z= -7.236, P< 0.001 ) levels in the hyperuricemia group w ere significantly higher than those in the normal uric acid group. The distribution frequencies of the TT genotype (55.45%vs.13.76%;χ2 =56.409, P<0.001) and T alele (71.9%vs.32.54%;χ2 =79.561, P<0.001) w ere significantly higher than those in the normal uric acid group. Multivariate logistic regression analysis show ed that the TT genotype ( vs.CC genotype, OR 6.434, 95%CI 2.334-17.736; P<0.001 ), CT genotype ( vs.CC genotype, OR 2.234, 95%CI 1.019-4.898; P= 0.045 ), homocysteine ( OR1.081, 95%CI 1.010-1.157;P=0.024), and total cholesterin ( OR 1.363, 95%CI 1.123-1.653;P=0.002) w ere the independent risk factors for high hyperuricemia. Conclusions MTHFR gene C677T TT genotype and serum uric acid level are the independent risk factors for ischemic stroke in Chinese Han population in Shandong, China. MTHFR gene C677T TT genotype is also an independent risk factor for hyperuricemia in this population. Adjusting dietary habit may have a positive significance for the prevention of ischemic stroke in Chinese Han population in Shandong, China.

Objective To investigate the temperament of children with epilepsy and the effects of various epilepsy-related variables on it. Methods The temperament of 60 pairs of epilepsy and normal children were assessed by temperament scale. The results of the two groups were compared. Epilepsy-related variables were analyzed. Result The scores of all dimensional variables in the epilepsy group were higher than that in normal group. The differences in adaptability and intensity of response between the two groups was statistically significant ( P <0. 05), and the differences in rhythmicity, approach-withdrawal toward new situations, emotional nature and persistence were more notable ( P <0.01). The temperament of epilepsy children was incline to difficult temperament( X2 = 10. 91, P <0.01). Age at onset of epilepsy, main caregiver and maternal education level had impaction on the temperament of epilepsy children..Conclusions The temperaments of epilepsy children tend to be negative. Children's temperaments are inclined to easy when their mothers are well educated and their main caregivers are parents, while they tend to be difficult temperament when the age of onset is early.

[Summary] Epigenetics defines heritable changes in gene expression that are not coded in the DNA sequence itself.Three systems,including DNA methylation,RNA-associated silencing and histone modification,are used to initiate and sustain epigenetic silencing.Type 2 diabetes mellitus(T2DM) is a polygenic disorder,which is caused by both genetic and environmental factors.However,pathogenesis of T2DM has not been elucidated.Recent studies have indicated that epigenetics may play an important role in the pathogenesis of T2DM,which is involved in the development and differentiation of β cell,secretion of β cell,insulin sensitivity and so on.Researches related to epigenetics may provide a new measure and target to clarify the pathogenesis of T2DM as well as prevent and treat the disease.

Proinsulin is the precursor of mature insulin.Proinsulin to insulin ratio reflects the degree of pancreatic β-cell dysfunction and the progression of type 2 diabetes, and may predict the risk of diabetes development.Some variants in susceptibility genes of diabetes are associated with the elevation of proinsulin to insulin ratio.Moreover, several antidiabetic drugs are able to decrease the proinsulin to insulin ratio in patients with type 2 diabetes.Therefore, the proinsulin to insulin ratio may act as a simple and useful indicator in the etiological study, risk prediction, disease progression and therapeutical evaluation in type 2 diabetes.

Objective To assess the influence of cumulative energy balance on outcome in septic patients requiring mechanical ventilation. Methods The indirect calorimetry (IC) was used to obtain target energy in 60 septic patients. The cumulative energy balance between survivors and non-survivors were compared. Logistic regressions was used to analyze the risk factors of death. Results Non-survivors had higher negative energy balance than survivors (P<0.05). The logistic regression analysis demonstrated that the start time of feeding and cumulative caloric balance were risk factors of mortality. Conclusions Effective nutrition support might be a good strategy to improve outcomes.

Objective To observe the impact of the diverse caloric energy intake on the outcomes and occurrence rate of complications in septic patients.Methods A prospective single-blind randomized controlled trial was conducted.158 cases of septic patients in intensive care unit (ICU) were enrolled and randomly assigned to three groups according to their different target value of nutrition:group A [measurements of resting energy expenditure (MREE)＜90％],B (MREE 90％-110％) and C (MREE ＞ 110％).The caloric intake,mechanical ventilation duration (MVD),nosocomial infection rate,28-day and 60-day mortality were analyzed.Results Daily energy intake in 7 days after ICU admission was as follows:the difference in target value of nutrition(kJ/d:7 075.0 ± 1 046.5,5 667.8 ± 1 908.8,4 428.8 ± 1 377.8),calory intake (kJ/d:4 671.6 ± 1 205.6,5 655.3 ± 1 373.0,6 053.0 ± 1 557.2),enteral nutrition value (kJ/d:2 051.1 ± 1 046.5,3 980.9 ± 1 586.5,5 337.1 ±2 921.8) and average intake rate [(66.0 ± 15.8)％,(100.0 ± 5.7)％,(134.0 ± 19.7)％],and they were statistically significant difference among A,B,C groups (all P＜0.05).The parenteral nutrition in group C were much higher than that in group A and group B (kJ/d:2 055.3 ± 273.4vs.427.0 ± 273.4,473.0 ± 332.0,both P＜0.05).The calories provided by glucose and diprivan were similar among three groups.The MVD and ICU stay were shorter in group B than that in groups A and C [MVD (days):8.4 ± 6.3 vs.11.0 ± 8.2,17.8 ± 13.0,P＞ 0.05 and P＜ 0.05 ; ICU stay (days):11.0 ± 6.4 vs.14.9 ± 9.6,17.8 ± 13.0,respectively,P＞0.05 and P＜0.05].The total hospital stay (days:32.0 ± 22.5,26.8 ± 7.0,30.4 ± 21.4) and nosocomial infection rate [91.1％ (51/56),84.0％ (42/50),90.4％ (47/52)] were similar among A,B,C groups (all P＞0.05).There was no difference in survival rate at 28 days among three groups as shown by the Kaplan-Meier survival curve (F=3.145,P=0.076).The survival rate at 60 days showed a tendency of lowering in groups A and C,especially in group C (F=9.284,P=0.010).Conclusion Both higher and lower caloric energy intake may be associated with an adverse impact,but appropriate caloric intake would improve the outcome and reduce the complication rate in septic patients.

Objective To ob serve the clinical effect of blood-activating and stasis-dissolving drugs combined with western medicine ( WM) for the treatment of recurrent spontaneous abortion ( RSA) induced by prethrombotic state ( PTS). Methods A total of 120 patients with RSA at PTS were randomly assigned to treatment group (68 cases) and control group (52 cases). Patients in both groups were treated with aspirin and low molecular weight heparin, while those in the treatment group additionally received Chinese medicine for activating blood and dissolving stasis. Before and after treatment, indexes of coagulation-fibrinolysis and the development of embryos were compared between the two groups. Results The therapeutic effective rate was 88.24% in the treatment group, higher than that of the control group ( 69.23%, P<0.05). The levels of plasma thrombin time ( TT) , D-dimer, fibrinogen and antithrombin Ⅲ ( AT-Ⅲ) were all improved ( P<0.05) in the two groups after treatment. Besides, the treatment group had better effect on improving levels of plasma D-dimer, fibrinogen and AT-Ⅲ ( P<0.05). During the treatment, no drug-induced adverse reaction was found. Neither neonatal deformity nor maldevelopment occurred. Ninety-seven cases achieved successful pregnancy, and 45 cases had given term girth ( 29 cases from the treatment group and 16 from the control group). Fifty-two cases were in stable middle- and late-stage of pregnancy. Conclusion Therapy of activating blood and dissolving stasis is an effective method for RSA at PTS. It has obvious effects on improving high coagulation state during pregnancy. Chinese medicine combined with WM shows better therapeutic efficacy than WM alone.