Objective To investigate the drug resistance situation and clinical distribution of multi‐drug resistance Acinetobacter baumannii(MDRAB) ,in order to provide references for clinical treatment and prevention of MDRAB infection .Methods The de‐partments ,types of specimens ,time of infection ,gender and age of patients with Acinetobacter baumannii(AB)infection from Janu‐ary to December 2014 were retrospectively analysed ,and drug resistance rates of MDRAB were analysed as well .Results A total of 123 strains of MDRAB were isolated ,which accounted for 44 .73% of all strains of AB .The antibacterial resistance rates were over 90% for MDRAB against 12 out of 15 common antibacterial agents ,while the antibacterial resistance rate for MDRAB against mi‐nocycline was relatively low(19 .23% ) .Distribution of AB and MDRAB infection concentrated to certain departments ,which shown that intensive care unit(ICU) ,departments of respiratory medicine and neurosurgery were the major departments of infection .The strains of AB and MDRAB isolated from sputum specimens accounted for 84 .00% and 93 .50% respectively .There was no signifi‐cant differences of MDRAB infection among 12 Months in 2014 .There was no statistically significant differences in constituent ratio of MDRAB infection and non‐MDRAB infection between patients in different gender and between patients in different age groups . Conclusion MDRAB strains are seriously resistant to commonly used antibacterial agents ,while minocycline could still be a signifi‐cant antibacterial agent for clinical treatment of MDRAB infection .Strengthening infection management in ICU and departments of respiratory medicine and neurosurgery ,and infection management of respiratory tract and wound could have significance for reduc‐ing the risk of MDRAB infection .

Objective To evaluate risk factors for multidrug-resistant Acinetobacter baumannii (MDRAB)infec-tion,so as to provide reference for making preventive and control measures of MDRAB infection.Methods Clinical data of patients with Acinetobacter baumannii (A.baumannii )infection in a hospital between April 2011 and Sep-tember 2012 were surveyed,distribution and specimen sources of A.baumannii and MDRAB were analyzed,and risk factors of MDRAB were assessed.Results Of 236 isolates of A.baumannii,74 (31.36%)were MDRAB .The isolation rate of MDRAB in intensive care unit and neurosurgery department was up to 60.00%(27/45)and 58.06%(18/31)respectively;MDRAB were mainly isolated from wound (45.45%),respiratory tract (34.27%),and urinary tract (17.65%).Univariate analysis revealed that difference in length of hospital stay,use of serum albumin,fiberbronchoscopy, coma days,tracheotomy,use of ventilator,incisional drainage,urinary catheterization,use of carbapenems,and antimicro-bial days in different groups were statistically different (P <0.05).Multivariate logistic regression analysis revealed that tracheotomy(OR95%CI :1.152-7.187),use of ventilator(OR95%CI :1.263 -7.664)were independent risk factors for MDRAB infection.Conclusion Tracheotomy and use of ventilator play an important role in the producing and sprea-ding of MDRAB ,management on drug-resistant bacteria is important in reducing MDRAB infection.

The correlation between the anatomic site of spinal cord injury and real-time conditions of bladder and urethral function was assessed in order to provide a reasonable basis for the clinical treatment of neurogenic bladder. A total of 134 patients with spinal cord injuries (105 males, 29 females; averaged 34.1 years old) were involved in this retrospective analysis, including urodynamic evaluation, clinical examination and imaging for anatomical position, and Bors-Comarr classification. The associations between the levels of injury and urodynamic findings were analyzed. The results showed that mean follow-up duration was 16.7 months (range 8-27 months). Complete spinal cord injuries occurred in 21 cases, and incomplete spinal cord injuries in 113 cases. Of the 43 patients with upper motor neuron (UMN) injuries, hyperreflexia and (or) detrusor sphincter dyssynergia were demonstrated in 30 (69.8%), 31 (72.1%) suffered low bladder compliance (less than 12.5 mL/cmH(2)O), 28 (65.1%) had high detrusor leak point pressures (greater than 40 cmH(2)O), and 34 (79.1%) had residual urine. Of the 91 patients with lower motor neuron (LMN) injuries, areflexia occurred in 78 (85.7%), high compliance in 75 (82.4%), low leak point pressures in 80 (87.9%), and residual urine in 87 (95.6%), respectively. The associations between the anatomical site of spinal cord injury and urodynamic findings were ill defined. In patients with spinal cord injury, this study revealed a significant association between the level of injury and the type of voiding dysfunction. The anatomical site of spinal cord injury can not be predicted in real-time condition of bladder and urethral function. Management of neurogenic bladder in patients with spinal cord injury must be based on urodynamic findings rather than inferences from the neurologic evaluation.

OBJECTIVETo investigate the rationality and feasibility of primary closure of the common bile duct after choledochotomy for common bile duct calculi.

METHODSFrom January 1990 to June 2001, 386 patients with the evidence of stones in the common bile duct underwent choledochotomy. Among them, 215 received primary closure of the common bile duct (group A) and 171 T-tube drainage (group B). The patients with emergency operations were excluded. Intraoperative choledochoscopy or cholangiography was routinely performed to rule out the possibility of retained stones. The duct was meticulously stitched using 0/3 to 0/5 absorbent sutures for primary closure. A T-tube was placed in the subhepatic space in the patients of both groups.

RESULTSPostoperative bile leakage was seen in 9 patients of group A and in 5 of group B, respectively (P > 0.05), and no reoperations were necessary. After surgery, the average time and volume of transfusion was 4.9 days and 9.1 liters in group A, versus 7.3 days and 12.8 liters in group B (P < 0.01). The patients in group B had a longer postoperative hospital stay than the those in group A (average 17.6:10.0 days, P < 0.01). T-tube removal resulted in bile peritonitis in 5 patients at day 16, 17, 19, 21 and 22 after surgery in group B, and 3 patients required repeated surgery.

CONCLUSIONSPrimary closure of the common bile duct after choledochotomy is safe, effective, and inexpensive in selected patients with common bile duct calculi, and should be regarded as an alternative procedure.

Adult ; Aged ; Biliary Tract Surgical Procedures ; methods ; Choledocholithiasis ; surgery ; Common Bile Duct ; surgery ; Female ; Humans ; Male ; Middle Aged ; Retrospective Studies ; Treatment Outcome

The correlation between the anatomic site of spinal cord injury and real-time conditions of bladder and urethral function was assessed in order to provide a reasonable basis for the clinical treat-ment of neurogenic bladder. A total of 134 patients with spinal cord injuries (105 males, 29 females;averaged 34.1 years old) were involved in this retrospective analysis, including urodynamic evaluation,clinical examination and imaging for anatomical position, and Bors-Comarr classification. The associa-tions between the levels of injury and urodynamic findings were analyzed. The results showed that mean follow-up duration was 16.7 months (range 8-27 months). Complete spinal cord injuries occurred in 21 cases, and incomplete spinal cord injuries in 113 cases. Of the 43 patients with upper motor neu-ron (UMN) injuries, hyperreflexia and (or) detmsor sphincter dyssynergia were demonstrated in 30 (69.8%), 31 (72.1%) suffered low bladder compliance (less than 12.5 mL/cmH2O), 28 (65.1%) had high detrusor leak point pressures (greater than 40 cmH2O), and 34 (79.1%) had residual urine. Of the 91 pa-tients with lower motor neuron (LMN) injuries, areflexia occurred in 78 (85.7%), high compliance in 75 (82.4%), low leak point pressures in 80 (87.9%), and residual urine in 87 (95.6%), respectively. The as-sociations between the anatomical site of spinal cord injury and urodynamic findings were ill defined. In patients with spinal cord injury, this study revealed a significant association between the level of injury and the type of voiding dysfunction. The anatomical site of spinal cord injury can not be predicted in real-time condition of bladder and urethral function. Management of neurogenic bladder in patients with spinal cord injury must be based on urodynamic findings rather than inferences from the neurologic evaluation.

Anterior Cruciate Ligament Reconstruction ; Femur/surgery*