OBJECTIVE To study the lower respiratory tract Acinetobacter baumannii infection in cardiac ICU and its risk factors,in order to take effective control measures. METHODS The risk factors of 5 cases respiratory A. baumannii infection in cardiac ICU of our hospital were investigated. RESULTS Patients with A. baumannii infections were concentrated,accounting for 21.7% at the same period in external cardiac ICU. According to the exposure time among children,the regional distribution and the same kinds of pathogens,the nospital acquired infection was determined as a local outbreak epidemia. The pathogenic microorganism monitoring carried out on ventilator-pipes,hands of health care workers and cardiopulmonary bypass machines etc. A. baumannii was found in tube of warming devices. CONCLUSIONS The in-door distribution and pracedures in cardiac ICU do not meet hygiene requirements,the poor sterile concept among medical staff and bad compliance of hand-washing,and the longterm use of mechanical ventilation,broad-spectrum antibiotics and immunosuppressive agents. All these factors contribute the outbreak of hospital acquired infection.

ion:Objective To study the effect of enteral nutrition on cardio-pulmonary function in elderly patients with chronic obstructive pulmonary disease (COPD) .Methods Fifty-eight elderly COPD patients were randomly divided into treatment group (enteral nutrition group ,n=29) and control group (free diet group ,n=29) .Their nutrition parameters (BMI ,serum total protein ,al-bumin and prealbumin) ,LVEF and pulmonary function (FEV1 ,FVC ,FEV1/FVC) were assayed before and after treatment .Results The BMI ,serum levels of total protein ,albumin and prealbu-min were significantly higher in treatment group after treatment than before treatment ( P<0.05) .However ,no significant difference was observed in these parameters in control group after treatment .The LVEF ,FVC ,FEV1 and FEV1/FVC were significantly higher in treatment group than in control group after treatment (P< 0 .05) .Conclusion Enteral nutrition in combination with conventional treatment can improve the nutrition and cardio-pulmonary function in elderly COPD patients ,thus shortening their hospital stay time .

Clinical practice is a special learning phase. Interns, as both students and doctors are confronted with multiple pressures from studies, employment and examination. Their ideology tends to fluctuate due to the influence of the society. Therefore, it's very important to strengthen the ideo-logical and political education. It is relatively difficult in managing interns due to their dispersed loca-tion and unfixed daily schedule. Internet not only expands the space and time of the ideological edu-cation, but also it has the features of vivid, interesting, timely, open and resource conservation. On the basis of analyzing the characteristics and difficulties of the clinical ideological education and the pros and cons of the network, we proposed the methods to utilize the advantages of network informa-tion technology to enhance the ideological and political education of clinical interns.

Objective To set up a method to detect the mutation of CYP2C9 1075A ＞ C and VKORC1-1639 G ＞ A in clinical practice,investigate the distribution of CYP2C9 1075A ＞ C and VKORC1-1639 G ＞ A in Beijing Han native,and evaluate the correlations between CYP2C9 1075A ＞ C,VKORC1-1639 G ＞ A and Warfarin maintenance dose,so that the results will contribute to Warfarin therapy.Methods A total of 145 Han Beijing patients received long-term Warfarin anticoagulant therapy orally in the people's hospital between May to September in 2011 were enrolled in this study.The patients suffer from atrial fibrilation,thromboembolism and heart operation respectively.The ARMS-TaqMan real time PCR technique was used to detect the mutation of CYP2C9 1075A ＞ C and VKORC1-1639 G ＞ A.The data were collected on gender,age and BSA.The correlations between stable warfarin dosage and each factor were analysised.Results The detection limit of ARMS-TaqMan real time PCR technique was 105 copies/ml in this assay.The intra-and inter-coefficients of variations (CV) were less than 5.5％ and less than 9.0％ respectively.The coincidence rate of ARMS-TaqMan real time PCR and direct sequencing was 100％ for testing 50 paralled samples.Among the 145 patients,the frequencies of CYP2C9 1075 AA,AC and CC was 93.8％ (136/145),6.2％ (9/145),0(0/145) respectively.The frequencies of VKORC1-1639 GG,GA and AA was 0.7 ％ (1/145),21.4％ (31/145),77.9％ (113/145) respectively.Allele frequencies of genotypes were in Hardy-Weinberg equilibrium.Every patients' INR was within range 2.0-3.0.Among the 145 patients,dosage requirements were higher in CYP2C9 1075 AA phenotype than that in AC type (F =0.199,P ＜0.05) and were higher in VKORC1-1639 GA phenotype than that in AA type (F=1.745,P ＜0.001).Irrespective of other factors,age,BSA,CYP2C9 1075 and VKORC1-1639 was accounted for 11.9％,12.9％,4.4％ and 16.7％ of interindividual variation of Warfarin dosage respectively.Linear stepwise regression analysis was used to identify factors contributing to Warfarin stable does.The final equation accounted for 40.4％ of interindividual variation of Warfarin dose.Conclusions The ARMS-TaqMan real time PCR technique was established to analyse CYP2C9 1075 and VKORCl-1639 genotype.The technique can achieve the needs of clinical practice.Warfarin dosing by multivariable regression equation in patients could increase efficiency for Warfarin dose adjustment,and could give suggestion for the individualization and rationalization for Warfarin dose.

Objective: To observe the effect of low-dose aspirin on allogeneic chronic allograft nephropathy in renal recipient rats and the possible mechanisms. Methods: Chronic allograft nephropathy model of rats were established and the recipient rats were randomly divided into 2 groups with 10 in each group. Cyclosporine A (5 mg/kg) was administered as a basic treatment one day before surgery to prevent and treat acute rejection. Aspirin therapy group was given oral aspirin (5 mg/kg) daily, and control group were given oral saline 2 ml/d. Animals were sacrificed 8 weeks after operation and the serum creatinine, urea nitrogen levels were determined. Renal histomorphology and immunohistochemistry approaches were used to examine TGF-β1 expression. Results: The severity of pathological lesion, increase of serum creatinine and blood urea nitrogen levels, and expression of fibrosis associated factor TGF-β1 in aspirin therapy group were significantly slighter than those of the saline control group (P<0.05). Conclusion: Low-dose aspirin in addition to routine anti-rejection treatment can be used for treatment of chronic allograft nephropathy in rats, which might be associated with the decreased expression of anticoagulation factor TGF-β1.

Mesenchymal chondrosarcoma originated in the primitive mesenchymal tissue .It usually devel-ops in the short bones such as hand ,foot and body bone ,while extremeIy rare in the orbit .We report a case of mesenchymal chondrosarcoma of the orbit which is confirmed by pathology .

Objective To evaluate the efficacy and safety of intermittent use of low-dose urokinase in the treatment of pulmonary embolism. Methods Forty-two patients with acute pulmonary embolism were divided into UK group with UK 10 000 U/(kg·d),7 days and rt-PA group with rt-PA 50 mg/2 h randomly. The efficacy was determined by the improvement of right heart dysfunction and perfusion defect 8 d and 14 d after the treatment. The bleeding incidence, death rate and PE recurrence were also evaluated. Results Differences of right heart dysfunction and perfusion defect between UK group and rt-PA group indicated no statistical significance (P >0.05).The rate of bleeding in UK group was lower than that of rt-PA group. Conclution The intermittent use of low-dose urokinase in the treatment of pulmonary embolism exhibits similar efficacy as rt-PA.

Objective To investigate the effect of penehyclidine hydrochloride (PHC) on iNOS expression in lung in septic mice.Methods Female KM mice were subjected to cecal ligation and puncture (CLP,a model of polymicrobial sepsis) or shame operation.Thirty-six KM mice weighing 20～25 g were randomly assigned into three groups:shame CLP group,CLP group and PHC group.Mice in PHC group were given PHC 0.45 mg/kg intraperitoneally at 1 h before CLP. Six hours after CLP,the lungs of each group were sampled for light and electronic microscopy.The expression of iNOS mRNA in lung tissue were detected by in situ hybridization.The survival rates were observed at 24 h after the operation. Results The CLP group was observed thickened alveolar septa,as well as mitochondrial cristae swelling and mitochondrial vacuolation under electronic microscope.Emptied lamellar bodies could be also found.Histology of lung in PHC group had little changed.Expression of iNOS in lung in PHC group was significantly lower than that of the CLP group.At 24 h after CLP challenge,70.0% of the PHC mice lived,remarkably increased compared with that of the CLP group (26.7%),P＜0.05.Conclusion PHC had effective effect for increasing the survival rates of septic mice,inhibiting the expression of iNOS and reducing the severity of lung injury.

Acupressure ; Acupuncture Points ; Adolescent ; Adult ; Child ; Female ; Humans ; Male ; Middle Aged ; Motion Sickness ; therapy ; Young Adult

Objective To investigate the feasibility of transplantation of human fetal liver-delivered mesenchymal stem cells(HFMSCs) and porous microcarries into normal heart tissue and whether it can improve heart function and regeneration of heart tissue.Methods SD rats were divided into HFMSCs injection group(n=9),microcarrier injection group(n=9) and control group(n=4),in which 80-100 ?l Perfadex with HFMSCs or gelatin porous microcarriers or pure Perfadex was injected into the wall of left ventricle.Heart function was evaluated by UCG before and 7 d after transplantation.On day 7,14,the survival of HFMSCs was tested by fluorescent in situ hybridization(FISH),regeneration or cardiac differentiation by immunohistological staining against desmin,tropomyosin and lectin,cellular immune response by the infiltration of macrophages,and lymphocyte reaction to HFMSCs by mixed lymphocyte culture(MLC) in vitro.Results Seven days after injection,the HFMSCs survived and improved the heart function,though no sign of differentiation into cardiomyocytes was seen.On day 14,a large amount of macrophages infiltrated into injection sites,and MLC showed prominent enhancement of proliferation of lymphocytes,when no transplanted cells were detected in the myocardium.On day 7,14,the microcarriers retained their round shape at the injection sites and were attatched by a large quantity of cells which were proven not cardiomyocytes or capilaries by immunohistological staining.Conclusion Transplantation of HFMSCs into normal heart improves heart function by short-period survival without differentiation,but the transplanted cells disappeared because of immune reaction.Transplantation of porous microcarriers into normal heart could not improve heart function either by regeneration of heart tissue or capilaries.