Objective To statistically analyze the bacterial flora change and drug resistance situation in the patients with bacteri‐al infection to provide reference for clinical rational drug use and the management of nosocomial infection .Methods The clinical samples were conventionally isolated and cultured .The bacteria identification and drug sensitivity test were performed by using the bioMerieux company VITEK2 automatic microorganism analyzer .The confirmation test of drug susceptibility adopted the disk dif‐fusion method recommended by the American Clinical and Laboratory Standardization Committee (CLSI) .Results The sample sources in the hospital infection during 2011-2013 were main sputum ,secretions and midstream urine ;the main infectious bacteria showed the increasing trend ,the top 5 of bacteria were :Escherichia coli (ECO) ,Klebsiella pneumoniae (KPN) ,Acinetobacter bau‐manii (ABA) ,Pseudomonas aeruginosa (PAE) ,Staphylococcus aureus (SAU);the top three of common multi‐drug resistant bacte‐ria were ABA ,PAE and ECO ,their constituent ratio during these three years had a small amplitude increase ;the antibiotics for Gram negative bacilli (G -) resistance rate of more than 70% during these 3 years were :ampicillin ,cefuroxime sodium and cefu‐roxime axetil;the antibiotics for Gram positive cocci (G+ ) resistance rate of more than 70% during these 3 years were penicillin and erythromycin ..Except for 4 cases of Enterococcus faecalis ,no other vancomycin‐resistant strains were found .Conclusion The sam‐ple source of bacterial infection is dominated by sputum ,the gram negative bacteria are the main force of hospital infection ,showing a increasing trend every year ,multi- drug resistant strains are also continuously rising ,penicillin is unsuitable to the clinical treat‐ment of bacterial infection ;imipenem has very high sensitivity to ECO and KPN .The hospital should attach great importance to the infection management ,strengthen the application and management of antibiotics ,decrease the outbreak and prevalence of bacterial infection and reduce the increase of drug resistant strains .

Objective To systematically evaluate the efficacy and safety of injected hemocoagulase Agkistrodon for intraoperative bleeding.Methods We electronically searched several Chinese database till May 2014 to identify randomized controlled trials (RCTs) about injected hemocoagulase Agkistrodon for operative hemorrhage.The methodological quality of included RCTs was assessed,and the data were extracted by two reviewers independently according to the Cochrane Handbook.The homogeneous RCTs were pooled using RevMan software (Version 5.1.0).Results 2 358 articles were searched initially,and 12 RCTs involving 1 031 patients met the inclusion criteria.The results of Meta-analyses showed that:in the study groups,the average haemostatic time of the wound is shorter [OR =-40.29,95％ CI(-71.13,-9.44),P =0.01],the hemorrhagic volume of the wound [OR =-1.38,95％ CI(-1.90,-0.87),P ＜ 0.000 01],hemorrhagic volume per unit area of the wound [OR =-0.05,95％ CI(-0.06,-0.03),P ＜ 0.00001],introperative hemorrhagic volume and drainage volume on POD1 [OR =-18.52,95％ CI (-25.50,-11.53),P ＜ 0.000 01] are lower than the placebo groups.In all studies,no difference was found in the variation of hemostatic function,liver and renal function and drug-induced adverse events.Conclusions The injection of hemocoagulase Agkistrodon can significantly reduce the average haemostatic time of the wound,the hemorrhagic volume of the wound,overall introperative hemorrhagic volume and drainage volume on POD1,and does not affect the hemostatic function,liver and renal function and not increase the incidence of adverse effects or postoperative complications.

Objective To investigate the changes of electrolyte metabolism in patients undergoing moderate elective abdominal operation,and explore its relationship with postoperative complications.Methods The clinical data of 1117 inpatients (age ≥ 18 years) who had undergone moderate elective abdominal operation in the Department of General Surgery of Beijing Hospital from January 1,2011 to December 31,2011 were retrospectively analyzed.They received postoperative fasting for ≥ 3 days,and the preoperative liver function and renal function were normal.The perioperative electrolyte changes and clinical outcomes were recorded.For patients with normal preoperative electrolytes but abnormal postoperative electrolytes,its potential correlations with the postoperative infections and total complications were analyzed.Results The rates of abnormal postoperative electrolytes were as follows:potassium,24.1％ ; sodium,6.4％ ; chloride,27.6％ ; calcium,61.7％ ; magnesium,16.3％ ; and phosphorus,71％.The vast majority of ion levels were below the normal levels.The total complication rate was 19.7％ and the postoperative infection rate was 17.19％.Univariate logistic regression analysis showed that the postoperative total and infective complications were significantly associated with the increased (P =0.007) or decreased (P =0.007) serum potassium,the decreased serum sodium (P =0.016),the decreased serum phosphorus (P =0.004),and the decreased magnesium (P =0.049).Conclusions Electrolyte decrease is common after moderate elective abdominal operations.There is a certain correlation between postoperative electrolyte decrease and postoperative complications.Therefore,attention should be paid to maintain electrolyte balance during the perioperative period.

Objective To determine the median effective target plasma concentration (Cp50) of remifentainil inhibiting body movement evoked by puncture during brachial plexus block in pediatric patients.Methods Pediatric patients of both sexes,aged 5-12 yr,who grown normally,scheduled for elective forearm or hand surgery,were enrolled in this study.Children were premedicated with oral midazolam 0.2 mg/kg at 30 min before anesthesia.The initial target Cp of remifentainil was 5.0 ng/ml.The target Cp was determined by up-and-down sequential method.Each time Cp increased/decreased by 20％ in the next patient depending on the response of the previous patient to puncture.The ratio between the two successive concentrations was 1.2.The puncture was performed after the target effect-site and plasma concentrations were balanced.Body movement was defined as puncture-induced movement of truncus,limbs and/or head and neck.The Cp50 and 95 ％ confidence interval of remifentainil were calculated by Dixon method.Results Cp50 of remifentainil inhibiting body movement evoked by puncture during brachial plexus block was 3.9 ng/ml,and 95 ％ confidence interval was 3.6-4.2 ng/ml.Conclusion Cp50 of remifentainil inhibiting body movement evoked by puncture during brachial plexus block is 3.9 ng/ml in pediatric patients.

Objective To evaluate the effects of hypocaloric parenteral nutrition on metabolism and prognosis of aged post-traumatic patients. Methods The prospective randomized controlled study was designed. Twenty-four aged post-operative patients were divided into 2 groups: hypocaloric parenteral nutrition group (Caloric 15 kcal?kg -1?d -1/Nitrogen 0.1 g?kg -1?d -1 ) and traditional parenteral nutrition (Caloric 28 kcal?kg -1?d -1/Nitrogen 0. 2 g?kg -1?d -1), respectively. Serum glucose, protein, and lipid levels, infection-related complications, nutrition therapy hospital expenses, hospitalization duration after operation were analysed. Results During nutritious fluid transfusion at 1-5 days after operation, nutrition therapies, serum glucose level of hypocaloric group was obviously lower than that of the traditional group 〔(6.8?0.3) mmol L -1 vs (8.3?0.4) mmol?L -1 , P

Objective To study the development of hereditary dystrophic retina of rd mice and photoreceptors apoptosis. Methods Retinal sections of rd mice and their controls at different ages ranging from postnatal days 5 to 40 were examined by morphological(light and electronic microscope), morphometric and TUNEL analysis. Results Compared with age-matched control mice, the retinal dystrophy of rd mice began at postnatal days 10, resulting in rapid loss of photoreceptors and reaching a peak at postnatal days 18. TUNEL postitive nucleus of photoreceptor cells emerged from postnatal days 10 and reached a peak at postnatal days 14 and 16. Ultrastructure of photoreceptor cell layer showed marked nuclear pyknotosis and chromatin margination. Apoptotic bodies of photoreceptor cells were observed.Conclusion Rd mice retina degenerated during the process of maturity. Photoreceptor cell death occurred through apoptosis.

Objective To evaluate the effect of omega-3 polyunsaturaed fatty acid on liver function, donor's T lymphocytes and acute rejection following orthotopic liver transplantation in rats. Methods Orthotopie liver transplantation from BN (RT1 n) to Lewis was performed. Normal saline (NS, n = 6), parenteral nutrition (PN, n = 6) or parenteral nutrition and Omega-3 fatty acid (OM, n = 6) was given through internal jugular vein catheter respectively beginning the first day for consecutive 6 days. At 7thday, the liver function and pathological changes of the transplant liver were observed. The percentage of CD4+ , CD8+, CD4+ CD25+ and CD8+ CD28- T lymphocytes were analyzed by flow-cytometry. Results In OM group the CD4+, CD8+ , CD4+ CD25+ and CD8+ CD28- T lymphocytes significantly decreased, compared with NS (t = 4.28, P < 0.01 ; t = 2.63, P < 0.05 ; t = 2.59, P < 0.05 ; t = 8.86, P <0.01)or PN group(t =8.06, P<0.01; t =3.57, P<0.01; t =5.35, P<0.01; t =7.98, P<0.01). The ratio of CD4+ to CD8+ significantly decreased in OM group compared with NS group and PN group(t = 6.25, P<0.01; t=4.92, P<0.01). RAI (rejection activity index) in NS group, PN group and OM group was 7.17 +0.98, 6.17±0.75 and 4.33±0.52, respectively. The rejection grade in OM group was siguificanfly alleviated than that in NS group and PN group(t =6.25, P <0.01;t =4.92, P <0.01). Conclusion Omega-3 fatty acid inhibits T lymphocytes, especially help T lymphocytes, alleviates acute rejection. The suppressor T cell and the regulatory T cell were not responsible for the alleviation of the rejection.

Objective To summarize the clinical outcomes after the optimization of nutrition support in elderly patients after hepatic carcinoma surgery.Methods The clinical data of 52 elderly patients with hepatic carcinoma in Beijing Hospital were collected and analyzed from 2007 to 2009(research group).Nutritional Risk Screening(NRS)2002 was applied for the nutrition risk screening at admission.NRS 2002 score≥3 was regarded as at nutritional risk.Enteral nutrition(EN)or EN combined with parentoral nutrition(EN+PN)supports were provided during the peri-operative stage.The control group included 30 patients from 2005-2007 under the same conditions with rescareh group but only received PN supports pest-operatively.Nutritional parameters,complications,lengh of hospital stay,and healthcare expenditures were analyzed.Results Body weight and plasma albumin were no significantly different in two groups(P>0.05)by the 7th post-operative day.The incidence of infection-relatod complications and length of hospital stay were significantly lower in research group than in control group (P<0.05).Conclusions Nutrition risk screening should be performed for the elderly patients with hepatic carcinoma after admission.Optimization of peri-operative nutrition support can reduce complications and improve the clinical outcomes.

Liver cirrhosis in China can be caused by many causes of which the most important one is chronic viral hepatitis. Hemorrhage and ascites were the main manifestations of decompensated liver cirrhosis, and the main cause of hemorrhage is viral hepatitis. The pathological basis of hemorrhage is portal hypertension and its secondary pathophysiological changes. Additionally, the deficiency of coagulation factors and the imbalance of coagulation and fibrinolysis both of which caused by the hypofunction of liver are also important reasons. This article reviews the mechanism of hemorrhage in decompensated liver cirrhosis in order to provide help for further research.

The incidence of diffuse gastric cancer is increasing year by year, comprehensive therapy is the main treatment. The main reason of surgical treatment failure is local recurrence, and the long-term curative effect is generally poor. Radiotherapy is an important part of comprehensive treatment for diffuse gastric cancer, which can reduce tumor stage before surgery and prevent recurrence and metastasis after surgery. Effective neoadjuvant radiotherapy is one of the approaches to improve surgical resection rate in patients with diffuse gastric cancer. In this paper, the clinical application of radiotherapy for diffuse gastric cancer will be reviewed, including the selection of reasonable radiotherapy system, precise location, dose setting, application of sensitization technology and mechanism of sensitization, in addition, the prevention and treatment of neoadjuvant radiotherapy and radiotherapy complications will be introduced.