Objective To analyze the distribution and antibiotic resistance of the microorganisms isolated from blood samples in the Cardiovascular Institute,Beijing Fuwai Hospital,for clinicians to improve antimicrobial therapy.Methods Blood samples were cultured and bacterial isolates were identified and tested for their susceptibility to antimicrobial agents.Results A total of 2 017 (8.3％) strains of microorganisms were isolated from 24 348 blood samples.Finally,1 009 nonduplicate strains were analyzed,including gram positive cocci (n=574,56.9％),gram negative bacilli (381,37.8％),and Candida species (54,5.4％).The top gram positive cocci were coagulase-negative Staphylococcus (31.8％),Streptococcus (11.0％),Staphylococcus aureus (5.5％),Enterococcus faecalis (4.0％),and Enterococcus faecium (1.5％).The top gram negative bacilli were Acinetobacter baumannii (6.7％),Pseudomonas aeruginosa (6.0％),Escherichia coli (5.7％),Klebsiella pneumoniae (4.3％),Stenotrophornonas maltophilia (3.5％),and Enterobacter cloacae (3.3％).Candida albicans was the most frequently isolated Candida species.Staphylococcus isolates were sensitive to linezolid,vancomycin,tigecycline,and quinupristin-dalfopristin.Enterococcusfaecalis were sensitive to linezolid,tigecycline,high level streptomycin,high level gentamicin,penicillin,ampicillin,and vancomycin.Enterococcus faecium were less sensitive than Enterococcus faecalis.All Enterococcus strains were sensitive to linezolid,tigecycline,high level streptomycin,high level gentamicin,and vancomycin.Gram negative bacilli were relatively sensitive to cefoperazone-sulbactam,piperacillin-tazobactam,cefepime,amikacin and carbapenems.A.baumannii and P.aeruginosa isolates showed lower susceptibility to carbapenems than E.coli,K.pneumoniae and E.cloacae.Conclusions The distribution of the pathogens isolated from blood samples was relatively stable in the past five years in our hospital.Gram positive cocci are more prevalent than gram negative bacilli in blood samples.Clinicians should select antimicrobial agents according to the distribution of pathogens and the antimicrobial resistance profile.

Objective To investigate and summarize the clinical characteristic of autoimmune pancreati-tis(AIP).Methods Clinical data of 13 patients with AIP, admitted to the West China Hospital from 2009 to 2013, were retrospectively analyzed .Results The median age of the 13 patients was 48 years old.The main clinical manifestations included epigastric pain or discomfort (8 cases), obstructive jaundice(7 cases)and weight loss(10 cases).Diffuse enlargement of pancreas and localized pancreatic enlargement were observed in 6 cases, pseudocyst and pancreatic stones were observed in 1 case.Dilation of pancreatic duct was found in 4 cases.Bili-ary stricture and thickened wall of bile duct were detected in 8 cases, dilated gallbladder with delayed enhance-ment of the thickened wall in 7 cases, retroperitoneal fibrosis surrounding the aorta in 1 case, abdominal lymph-adenopathy in 6 cases, stenosis of splenic vein in 4 cases, and Sjogren's disease and ulcerative colitis in 1 case. The positive rate of serum IgG, RF, ANA was 71.43%(5/7), 42.86%(3/7), and 42.86%(3/7), respec-tively.8 patients were misdiagnosed and underwent surgery .Steroid therapy was administered in all patients with satisfactory response.Conclusions AIP is a rare and autoimmune disease ,without speci? c symptoms,and often be misdiagnosed as pancreatic cancer or bile duct carcinoma .We must give more attention to AIP and keep pa-tients from undergoing unnecessary surgery .

Objective:To investigate the protective effect of intensity-modulated radiotherapy (IMRT) on salivary gland function in nasopharyngeal carcinoma (NPC) patients. Methods:In total, 101 NPC patients who were admitted from March 2010 to November 2012 were enrolled in this study. The parotid gland, the submandibular gland, and the oral cavity were sketched as the organs at risk (OARs). The patients were treated with IMRT and were evaluated through a face-to-face interview using a dry mouth assessment ques-tionnaire during the follow-up visits at 3, 6, 12, 18, and 24 months. The dose volume histogram of the salivary gland of the patients was also considered. Results:The mean doses (MDs) in the parotid gland were 37.4 and 33.8 Gy in the affected and uninjured sides, respec-tively. Meanwhile, the MDs in the submandibular glands were 51.6 and 45.7 Gy in the affected and uninjured sides, respectively. The MD of the oral cavity was 38.2 Gy. At 6 months after the treatment, the symptom of xerostomia was significantly improved in 77.2%of the patients (78/101). One year later, only less than 5%of the patients complained of having G3 or higher-grade xerostomia. Conclu-sion:With time, xerostomia significantly improved after the radiotherapy. At least one of the V30 to V35 of the parotid gland was≤50.0%, whereas at least one of the V40 to V45 of the submandibular glands was≤66.7%~50.0%. The MD for the oral cavity should be<40 Gy to effectively protect salivary gland function.

Objective To investigated the protective ways of intensity modulated radiotherapy (IMRT)for submandibular gland function in patients with nasopharyngeal carcinoma.Methods From March 2010 to November 2012,101 patients with nasopharyngeal carcinoma were enrolled into study.They were treated with IMRT and evaluated by face to face dry mouth questionnaire during the follow-up of 3,6,12,18,24 and more than 24 months,meanwhile,their dose volume histogram of submandibular gland were taken into consideration.Results The average contralateral median dose and that of ipsilateral submandibular gland were (45.69±7.22) Gy and (51.64±8.20) Gy,respectively,and the V35,V40,V45,V50 were 95.82 ％,69.99 ％,46.90 ％,25.50 ％,and 100 ％,96.50 ％,82.24 ％,60.98 ％,respectively.There were positive relationship between the xerostomia grading of 3,6,and 12 months after radiotherapy and the average dose of submandibular gland or the V35,V40,V45,V50.After 6 month,the xerostomia in 77.2 ％ (78/101) was significantly improved,and after 12 months,less than 5 ％ of patient complained about G3 or more grade of xerostomia.Conclusions When using IMRT in nasopharyngeal carcinoma,it' s necessary to reduce the irradiated volume and the dose of submandibular gland.It is confined that the median dose of contralateral submandibular gland should be less than 40-45 Gy,and V40 or V45 ≤66.7 ％ or ≤50 ％,which can effectively protect the function of salivary gland.

Objective:To preliminarily discuss the mechanism of Salvia miltiorrhiza and Rrhizoma alismatis in the prevention and treatment of lipid metabolism through regulating the imbalance of fibrinolytic system in rats with non-alcoholic fatty liver. Methods:The model of non-alcoholic fatty liver in rats was duplicated by high-fat diet feeding. Totally 60 adult Wistar rats were randomly divided into 6 groups (n=10 per group), namely the control group, the model group, Salvia miltiorrhiza group, Rrhizoma alismatis group, Salvia miltiorrhiza and Rrhizoma alismatis group,and Dongbaogantai group. The control group and the model group were given distilled water,and the other group was given Salvia miltiorrhiza,Rrhizoma alismatis,Salvia miltiorrhiza combined with Rrhizoma alismatis and Dongbaogantai,respectively. Rhizoma Alismatis decoction at high dose and low dose as well as Dongbaogantai was respectively adminis-trated in the designed groups,and the corresponding indices were detected 4 weeks later. Results:In the model control group,the con-tents of TC、TG、FFA in serum and the expression of PAI-1 were significantly elevated(P<0.05 or P<0.01),while the expression of t-PA was significantly reduced(P<0.01).After treatment,the contents of TC、TG、FFA in serum and the expression of PAI-1 in every treatment groups were reduced(P<0.01),while the expression of t-PA was elevated(P<0.01).Conclusion: Increasing the expres-sion of t-PA and reducing the expression of PAI-1 might be viewed as the mechanisms of Salvia miltiorrhiza and Rrhizoma alismatis in the prevention and treatment of non-alcoholic fatty liver disease.

Scientific and rigorous selection of theories,models or frameworks is the premise of high-quality nursing research.This work introduces the development process,basic information,application in nursing of T-CaST(Theory Comparison and Selection Tool,T-CaST),and shows the specific application process of this tool through examples,to provide evaluation methods for nursing scholars to choose appropriate guiding theories in the research process,and has guiding significance for developing high-quality nursing research under the guidance of theories,models or frameworks.