OBJECTIVE To find the distribution of pathogens and their antibiotics sensitivity in patients with bile duct diseases in order to guide clinical uses of antibiotics. METHODS Totally 128 bile samples were collected for bacterial cultures and sensitivity tests. RESULTS Pathogens were found in 68 samples(53.0%).The common pathogens were Escherichia coli(22.9%),Klebsiella pneumoniae(15.7%),Pseudomonas aeruginosa(11.4%) and Enterococcus faecalis(10.0%).Most bacteria were sensitive to imipenem,vancomycin,imipenem/cilastatin(Tienam),third and fourth generation cephalosporins;but resistant to penicillins,second-generation cephalosporins,macrolides and quinolones. CONCLUSIONS The most pathogenic bacteria in biles are E.coli,K.pneumoniae and Ent.faecalis and the antibiotic sensitivity tests can help clinical application of antibiotics.

Objective To observe and analyze the change situation of trace elements and cytokines in the patients with leukoderma.Methods Sixty-two patients with leukoderma in our hospital from June 2013 to January 2016 were selected as the observation group and contemporaneous 62 individuals undergoing physical examination were selected as the control group.Then the serum trace elements and cytokines levels were compared between the two groups and the detection results of above serum indexes in the observation group were compared among different grades and stages too.Results The serum trace elements levels of the observation group were all lower than those of the control group,the serum interleukin 10(IL-10)level was lower than that of the control group,while other serum cytokines levels were all higher than those of the control group,moreover the detecfion results of above serum indexes in the observation group had statistical differences among different grades and stages(P＜0.05).Conclusion Leukoderma has obvious effect on trace elements and cytokines and the influence of differente grades and stages of leukoderma on their expressions is inconsistent.

There is endothelial hyperpermeability in sepsis,trauma,ischaemia-reperfusion injury,acute respiratory distress syndrome and thrombosis,while an important mechanism underlying this process is increased paracellular leakage of plasma fluid and protein because of cytoskeleton contration under the role of histamine, thrombin,vascular endothelial growth factor and activated neutrophil. Structural changes initiate with agonist-re-ceptor binding,followed by activation of intracellular signalling molecules,then phosphorylate alter the hyperme-ability of cell-cell adhesion. Targeting key signalling molecules that mediate endothelial-junction-cytoskeleton dissociation demonstrates a therapeutic potential to improve vascular barrier function during inflammatory injury.

Objective To study the histocompatibility of domestic new type nitinol alloy ventricular septal defect(VSD) occluder in order to test the feasibility for clinical application.Methods The domestic new type nitinol alloy VSD occluder was inserted into 20 healthy dogs with intravenous balanced anesthesia and tracheal intubation,assisted by animal breathing machine respiration.The dogs were given oral antibiotic and would be killed in several months after operation.According to different slaughter time(1,2,3,6 months),they were divided into 4 sections and including 5 dogs in each section.The occluder sites,the intimal coverage and the change of inflammatory cells were observed through gross anatomy,with the help of the light microscope and electron microscope.SPSS 11.0 software was used to analyze the data.Results The thickness of the endocardial enhanced with the time(P

Objective To discuss and evaluate the value of insertion of inferior vena cava filter in treating lower extremity deep venous thrombosis(DVT).Methods Inferior vena cava filters were placed in 46 patients with lower extremity DVT prior treatment,20 in which were treated by therapy with anticoagulation and thrombolysis,and therapy with pressure gradient,and the other 26 patients by operation and thrombolysis therapy,and therapy with pressure gradient.Whether patients occurred pulmonary embolism was observed and the form and site of filters were monitored by periodic fluoroscopy.Results Inferior vena cava filters were placed successfully in all patients,38 cases were implanted permanence inferior vena cava filter,8 cases were implanted temporary inferior vena cava filter.Symptoms and signs of DVT disappeared or remitted in 44/46 patients after treatment.None of pulmonary embolism was occurred.Follow up 2-24 months(average 13 months) for 36 cases with permanence inferior vena cava filter,there was no complication of the filter and pulmonary embolism occurred.Conclusions The method of inserting inferior vena cava filter is simple and safe,which can prevent pulmonary embolism effectually to offer sufficient safeguard for the treatment of DVT.

ObjectiveTo investigate the popularity of the sedated gastrointestinal endoscopy in mainland China.MethodsThe survey on the popularity of the sedated gastrointestinal endoscopy was conducted with questionnaires sent by e-mails or telephones to the GI endoscopy units of three levels of hospitals.ResultsFrom May,2010 to November,2010,169 units from 28 provinces (90.3％ ) were enrolled,including 46 hospitals of grade Ⅲ,91 of grade Ⅱ and 32 of grade Ⅰ.Sedated gastrointestinal endoscopy were performed in 110 (65.1％,110/169) hospitals,i.e.93.5％ (43/46) grade Ⅲ hospitals,68.1％(62/91) grade Ⅱ hospitals and 15.6％ (5/32) grade Ⅰ hospitals.Significant difference was observed between the grade Ⅲ and the grade Ⅱ hospitals (P ＜ 0.05 ),so was between the grade Ⅱ and the grade Ⅰ hospitals ( P ＜ 0.05 ).Propofol was frequently used in sedation in 98 hospitals ( 89.1％ ).The only 9.1％( 10/110)hospitals,which had full-time anesthetists or anesthetic nurses,were all grade Ⅲ hospitals.ConclusionThere has been great progress in the popularity of sedated gastrointestinal endoscopy in mainland China during the past decade.However,it is less frequently pefformed in grade Ⅰ and Ⅱ hospitals.Shortage of full-time anesthetists is still a problem.

The microbial transformation of buflomedil by Cunninghamella blakesleana AS 3.153 was studied, as well as a microbial model which can be used to mimic metabolism of buflomedil in mammal was established. Experiments were conducted to screen the capabilities of four strains of Cunninghamella species to transform buflomedil, in which C. blakesleana AS 3.153 was selected for a preparative biotransformation. Furthermore, the microbial model was established based on the transformation condition optimization. The parent drug and its metabolites produced by C. blakesleana AS 3.153 were detected by liquid chromatography-mass spectrometry method and three metabolites were identified while two of them were new found metabolites. Two major metabolites, para-O-desmethyl buflomedil and 12-C-oxidated buflomedil, were isolated by semi-preparative HPLC. Based on the comparison between different species, the microbial transformation of buflomedil by C. blakesleana AS 3.153 is more similar to the metabolism of buflomedil in human and Beagle dog than that in rat.

Objective To observe the relationship between early lactate clearance and APACHEⅡ in critically ill patients. Methods In 121 critically ill patients,APACHE Ⅱ and lactate clearance rate were recorded. According to APACHE Ⅱ score,all patients were divided into≤10 score group, (11 ～20) score group,(21 ～30) score group and ＞ 30 score group, then compared the level of the early lactate clearance rate. The early lactate clearance rate were also compared between survival group and death group. Then the relationship between early lactate clearance and APACHE Ⅱ were analyzed. Results In( 11 ～20) score group,the early lactate clearance rate was lower than those in ≤ 10 score group, but the difference was not significant ( P ＞ 0. 05 ). The early lactate clearance rate in (21 ～ 30) score group ( 18. 35 ± 10. 01 ) % was lower than those in ( 11 ～ 20) score group (27.35 ± 10. 22) % ( t = 3.481, P ＜ 0. 01 ),in ＞ 30 score group( 11.98 ± 9. 93 )% those was lower compared with (21 ～30) score group( t = 2. 968, P ＜ 0. 01 ). In death group, APACHE Ⅱ score(28. 1 ± 6. 7 ) was higher than that in survival group ( 18. 8 ± 8. 4) ( t = 3. 030, P ＜0. 01 ), the early lactate clearance rate was lower ( t = 3. 619, P ＜ 0. 01 ). APACHE Ⅱ score correlated well with the mean level of the early lactate clearance rate ( r = - 0. 641, P ＜ 0. 01 ). Conclusion The lactate clearance rate was the good fator on evaluation of condition and prognosis in the critically ill patients.

Objective To observe the TCM syndromes of acute exacerbation of chronic obstructive pulmonary disease (COPD) with malnutrition. Methods TCM Syndromes Questionnaire of Acute Exacerbation of COPD was formulated with TCM clinical epidemiology methods. Totally 220 cases of hospitalized patients met the inclusion criteria were divided into two groups, 120 cases of malnutrition and 100 cases of non-malnutrition. The clinical data were observed and syndrome elements of malnutrition group and non-malnutrition group were analyzed to discuss the rule of syndromes in acute exacerbation period. Results In addition to respiratory system, the frenquency of symptoms such as weight loss, shortness of breath, easy cold, aversion to wind and cold, poor appetite, abdominal distension, constipation, belching, dizziness and tinnitus, tooth loose and hair loss, soreness and weakness of waist and knees significantly increased in COPD with malnutrition, mainly involving in syndromes of spleen deficiency and incoordination between spleen and stomach. In patients with acute exacerbation of malnutrition COPD, the single syndromes were 36 cases (30%), the composite syndromes were 84 cases (70%). The simple excess syndromes were 38 cases (31.67%), the simple deficiency syndromes were 23 cases (19.17%), and the intermingled deficiency and excess syndromes were 59 cases (49.17%). Conclusion Patients with acute exacerbation of COPD with malnutrition are mainly composite syndromes and the intermingled deficiency and excess syndromes. Spleen deficiency and incoordination between spleen and stomach may be the important pathogenesis of COPD with malnutrition.

Objective To investigate the changes in prevalence of nutritional risk and undemutrition in patients with head and neck cancer during radiotherapy.Methods In this longitudinal observational study,a convenience sampling method was used to recruit patients with head and neck cancer who were receiving radiotherapy in Beijing Cancer Hospital.Nutritional Risk Screening 2002 (NRS 2002) was applied to assess the prevalence of nutritional risk in the patients,and Patient-Generated Subjective Global Assessment (PG-SGA) and body composition test to determine the prevalence of malnutrition (undernutrition) before,during and after radiotherapy.Results 56 patients finished the three follow-up exams.Along with the progress of radiotherapy,the scores of NRS 2002 increased gradually (1.64±1.09 vs.2.30 ±1.06 vs.3.14 ±1.07,x2 =46.639,P＜0.001),and the prevalence of nutritional risk also increased gradually (21.43％ vs.37.50％ vs.71.43％,x2 =29.700,P ＜0.001);the total scores of PG-SGA [1 (1-13) vs.6 (1-15) vs.12 (1-18),x2 =63.206,P＜0.001] and dimensions of weight [0 (0-4) vs.1 (0-4) vs.3 (0-6),x2 =40.798,P＜0.001],intake [0 (0-2) vs.1 (0-2) vs.2 (0-4),x2=64.707,P＜0.001] and symptoms [0 (0-7) vs.2 (0-10) vs.6 (0-11),x2 =61.562,P ＜ 0.001] all increased gradually with statistical significance.The prevalence of malnutrition in different stage of radiotherapy were significantly different (x2 =64.999,P ＜ 0.001).The body composition analysis in 40 patients showed that all the indicators of body composition decreased significantly along with the progress of radiotherapy.There was a great loss in patients' body weight during radiotherapy,especially the fat-free mass.Conclusions The prevalence of nutritional risk and undernutrition may increase in patients with head and neck cancer during radiotherapy.Lean body mass accounted for most of the weight loss.We should pay more attention to those patients' nutritional status during radiotherapy.