Objective To investigate the resistance of imipenem resistant Pseudomonas aeruginosa (IRPA),metallo-β-lactamase (MBLs) producing and prevalences of the coding genes of IRPA in ICU.Methods Eighty-six clinical strains of Pseudomonas aeruginosa in ICU continuously collected were analyzed retrospectively.Pseudomonas aeruginosa and its drug susceptibility was identified by BioMerieux VITEK-32 system,and double disk synergy test was used to screen the MBLs producing IRPA.Then,the MBLs phenotype positive IRPA were confirmed by PCR to explore the genotype of them.Results Except polymyxin B with 100.0％ sensitivity and amikacin with higher sensitivity,the percentage of drug resistance for other antibiotics was more than 46％.MBLs phenotype positive IRPA accounted for 48.8％ (42/86) by double disk synergy test and genotype positive accounted for 47.7％(41/86) by PCR in MBLs phenotype positive IRPA.Among these,the most common was IMP-1 which constituted for 26.7％ (23/86).What's more,there were 15.1％(13/86) strains IRPA which carried multidrug resistant genes.Conclusions The main mechanism of drug resistance of IRPA in ICU is MBLs producing and IMP-1 is the most prevalent genotype,and IRPA with multidrug resistant genes is serious.Thus,monitoring of MBLs should be strengthened to help to use antibiotics rationally and prevent transmission of these genes.

Objective To evaluate the clinical application value of computer graphics imaging technology in combination with CT urography in the diagnosis of postoperative complications of kidney stone.Methods 1 7 patients with postoperative complications of kidney stones underwent 64-detector CT urography examination.The images were transferred by network to a separate workstation to perform volume rendering (VR),maximum intensity projection (MIP),multiplanar reconstruction (MPR)and curved planar re-construction (CPR).All the postprocessing images were retrospectively analyzed.Results Postoperative complications were found in 1 7 patients including 13 with urinary residual stones,1 with severe hydronephrosis and twisted ureter,1 with residual stone in du-plex kidneys,1 with renal parenchyma rupture,1 with ureter rupture,1 with urine leakage of postcaval ureter,1 with renal hemor-rhage,1 with pleural effusion,and 1 with residual stone of multiple renal cysts.Conclusion Postoperative complications of kidney stones can be clearly demonstrated by computer graphics imaging technology in combination with CT urography,which may provide more information for treatment.

Diabetes Mellitus, Type 2 ; complications ; Humans ; Non-alcoholic Fatty Liver Disease ; complications

Objective To explore the change of 8-iso-prostaglandin F2α(8-iso-PGF2α),serum ferritin (SF) and superoxide dismutase(SOD) in serum from children with mycoplasma pneumoniae pneumonia(MPP) and severe mycoplasma pneumoniae pneumonia(SMPP),and investigate the correlation between the severity of lung injury induced by oxidative stress(OS) and the severity in children with SMPP.Methods Sixty cases with MPP,30 cases with SMPP and 20 health children were selected in our study.The level of 8-iso-PGF2α,SOD and SF in serum were detected.Results (1) There were no significant difference regarding of 8-iso-PGF2α levels between the MPP group and the healthy control group ((6.01 (13.14)) ng/L vs.4.33 (2.42)) ng/L,P ＞ 0.05).The 8-iso-PGF2α level in patient of the SMPP group was 24.20 (24.05)) ng/L,significantly higher than that in the healthy control group (P ＜ 0.01) and MPP group (P ＜ 0.01).(2) There were no significant difference between the MPP group μg/L] and the healthy control group in terms of SF level((80.91 (54.57) μg/L vs.(82.48 (70.60)) μg/L,P ＞ 0.05).The SF level in the SMPP group was 139.69 (120.98)) μg/L,significantly higher than that in the healthy control group(P ＜ 0.01) and MPP group(P ＜ 0.O1).(3) The level of SOD in the MPP group was 138.60(25.20)) kU/L,significantly higher than that in the healthy control group ((123.10(11.28)) kU/L; P ＜ 0.01).The level of SOD in the SMPP group was 94.43 (63.58)) kU/L,significantly lower than that in the healthy control group (P ＜ 0.05).And level of SOD in the MPP group was significantly higher than that in the SMPP group(P ＜ 0.01).Conclusion The severity of lung injury induce by OS was related with the severity of the children with SMPP.OS may be a important factor in patients with SMPP exacerbation of lung injury.

Objective Through observing the effect of low-dose T-2 toxin on chondrocyte,to study the molecular mechanism of cartilage damage.Methods The primary chondrocytes were isolated from articular cartilage of d 1-2 Wistar neonate rats through enzymatic digestion.Different doses (0.005,0.010,0.100 μg/L) of T-2 toxin were added after 24 h in vitro culture.The survival rate of chondrocytes was detected with Trypan blue staining.Echylosis (matrix metalloproteinase,MMP1) was analyzed by immunohistochemistry.The damage of articular chondrocyte was observed by transmission electron microscope.Results ①Cell morphology of in vitro cultured chondrocyte:the newly isolated chondrocytes were spherical.After 24 hours,the adherent cells gradually began to stretch the triangle or polygon;the nucleus was large and round;the cell was clear and transparent,containing secretory granules.②Cell proliferation:T-2 toxin had a significant inhibitory effect on chondrocyte proliferation,the higher the concentration of T-2 toxin,the significant the inhibitory effects [0.000 μg/L (control) group:3.45 × 108/L,0.005 μg/L T-2 toxin group:3.45 × 108/L,0.010 μg/L T-2 toxin group:2.06 × 108/L,x2 =9.554,P ＜ 0.05].③Immunohistochemical observation:dysplasia,nucleus condensation and membrane rupture were observed in T-2 toxin treated group,brown staining was observed in all groups at varying degrees.The deepest staining was in 0.005 μg/L T-2 toxin group,with the strongest secretion of MMP1;with increasing doses of the toxin,the damage to cartilage cells was severe,MMP1 secretion was less,staining was weak,and the weakest staining was in the 0.100 μg/L T-toxin group.④Under transmission electron microscopy:in control group,cytoplasm was rich in rough endoplasmic reticulum,nuclear membrane and cell membrane were clear;in 0.005 μg/L T-2 toxin group,the cell nucleus showed pyknosis,organelles were decreased in cytoplasm;in 0.100 μg/L T-2 toxin group,the microvilli was dropped out of cartilage surface,nuclear changes were obvious,and mitochondria was myeloid degeneration;rough endoplasmic reticulum was degranulation and expansion into cystiform,chondrocytes were apoptosis occasionally,the cell nucleus showed pyknosis,and the formation of high-density plaque.Conclusion Low dose of T-2 toxin could damage the primary cultured articular chondrocyte in vitro.The results have showed that there are damaged cytostasis,chondrocyte degeneration,necrosis and apoptosis.

ObjectiveTo investigate the status of job burnout of clinical nurses,and to analyze its relationship with self-efficacy and the environmental factors.MethodsMaslach Burnout Inventory,General Self-Efficacy Scale,Nursing Work Index-Revised and Nurses'Job Stressor Scale were used to investigate 239 clinical nurses from 2 tertiary first-class hospitals of Lianyungang City.Correlation and regression analysis were used to analyze the relationship between all the dimensions of nurse burnout,self-efficacy,professional nursing practice environment and job stressor.ResultsThe scores of emotional exhaustion and depersonalization were ( 23.95 ± 11.11 ) and (7.90 ± 6.58 ) respectively,indicating medium level of burnout.The score of decreased personal accomplishment was reverse coded,and the score was ( 27.51 ± 10.96),indicating a high level of burnout.Both work environment and self-efficacy were related to job burnout (P ＜ 0.05 or P ＜ 0.01 ).Environment played bigger roles in influencing emotional exhaustion and depersonalization,and self-efficacy influenced personal accomplishment more significantly.ConclusionMore attention should be paid to the improvement of nurses' self-efficacy and work environment in order ot reduce nurses'job burnout.

10.3969/j.issn.1007-3969.2013.04.012

Objective To evaluate the efficacy and safety of single forcep endoscopic purse-string suture closing the wound of cardia and gastric fundus after endoscopic full-thickness resection (EFTR) for patients with submucosal tumor (SMT).Methods The clinical data of 32 patients with wound in the cardia and gastric fundus after EFTR for SMT undergoing single forcep endoscopic purse-string suture in Endoscopy Center of Renmin Hospital of Wuhan University from January 2015 to January 2016 were collected.Completion of operation, postoperative complication and follow-up results of these patients were retrospectively analyzed.Results All of the patients successfully received EFTR and purse-string suture.The maximal diameter of tumors was 1-4 cm.The suture time was 10-15 min, and postoperative hospital stay was 5-10 d.Low fever and upper abdominal pain were found in 13 and 20 cases respectively, and all cases were alleviated or restored after conservative treatment.All patients underwent gastroscopy during follow-up of 1 month, and titanium clip and nylon rope were found on the wound surface in 29 cases (90.6%).Three months after operation, 28 patients underwent gastroscopy, and titanium clip but no nylon rope was detected in 15 cases (46.9%).Conclusion Single forcep endoscopic purse-string suture can effectively treat the postoperative wound in the cardia and gastric fundus of patients with submucosal tumors after EFTR.

Objective:To explore the safety profile of telmisartan based on the data from the literatures on its adverse drug reactions(ADRs).Methods:The literatures about clinical data of ADRs of telmisartan from 2004 to 2008 in China, collected by the databases of China Hospital Knowledge Database,Wanfang Data and VIP Information,were reviewed. Results:Of 1197 patients receiving telmisartan,95(7.94%) had ADRs involving six systems such as nervous system, cardiovascular system,gastrointestinal system,musculoskeletal system,and so on.The ADR incidences of oral 40 mg?d~(-1) administration and 80 mg?d~(-1) administration were respectively 5.29%(31/586) and 8.96%(42/469) and only 1 case (0.08%) was forced to stop his or her medication due to serious ADRs.Conclusion:Telmisartan was generally safe,and was generally well tolerated for its low incidence of adverse reactions,and therefore,there was no need to interrupt the treatment.The recommendation dose was locked in 40 mg?d~(-1).In clinical application of telmisartan,special attention should be paid to the ADRs of the nervous system and cardiovascular system.It is necessary to closely observe the serumal potassium level and orthostatic hypotension.

OBJECTIVE To study the relationship between how long to use peripheral vein catheter and bacterium colonization,then to make an approach to the optimal time duration of using peripheral vein catheter in summer season from infection prevention viewpoint.METHODS To divide the patients into four groups according to the different time duration of using peripheral vein catheter,and select 20 samples at random in every group.Make bacterial culture from skin(before sterilization,after sterilization and withdrawal of needles) and the catheter,and compare the colony number and strain distribution.RESULTS There was bacterium colonization on punctured skin after using peripheral vein catheter for a long time.The longer it was,the higher the positive rate was.After 96 hours there was bacterium colonization in vein catheter(10%) and after 120 hours positive rate was obviously higher(40%).CONCLUSIONS After using peripheral vein catheter for 96 hours in summer season,there is bacterium colonization in catheter,increasing the risk for infection,so the optimal time duration of using peripheral vein catheter in summer is 72-96 hours.