OBJECTIVE To investigate the distribation of the AmpC enzyme in Acinetobacter baumannii isolated from burned patients. METHODS Susceptibility tests were used to detect antibiotic resistance to 20 kinds of antimicrobial drugs in 20 strains of A. baumannii isolated from burned patients, AmpC enzyme genes were detected by PCR and partial positive products were chosen to sequence. RESULTS Drug resistances to ?-lactam antibiotics in 20 strains of A. baumannii isolated from burned patients had exceeded 85% except levofloxacin or cefoperazone/sulbactam. Of ADC genes 95% were positive, but all DHA genes were negative. Through sequence and Blast analysis, partial ADC positive products were identical with that of EF546445. CONCLUSIONS The multidrug resistance of A. baumannii isolated from burned patients to ?-lactam antibiotics is serious. AmpC enzyme mediated by chromosome, ADC, prevails in A. baumannii isolated from burned patients.

OBJECTIVE To investigate the disseminateion of the carbapenemase in Acinetobacter baumannii isolated from burned patients.METHODS Susceptibility tests of 20 strains of A.baumannii isolated from burned patients to 20 kinds of antimicrobial drugs were detected.Subsequently,seven genes encoding carbapenemase,including OXA-23,OXA-24,OXA-51,OXA-58,IMP,VIM and SIM,were detected by PCR and genes of partial positive products were sequenced.RESULTS Drug resistances to ?-lactam antibiotics of 20 strains of A.baumannii isolated from burned patients all exceeded 85% except to levofloxacin or cefoperazone/sulbactam.Nineteen strains(95%) were OXA-23 genes positive and all other genes were negative.Through sequence and Blast analysis,OXA-23 gene products were identical with that of CAB69042.1.CONCLUSIONS The multidrug resistance of A.baumannii isolated from burned patients to ?-lactam antibiotics is critical.Carbapenemase of OXA-23 prevails in A.baumannii isolated from burned patients.

Objective To study the effects of Zhishang Sanfang (ZS) in promoting the union of radius fracture. Methods Twenty-eight rabbit models with fr acture were randomly allocated to ZS group (Group A) and control group (Group B).His tological, histochemical and histomorphological quantitative detection was used to observe the morphological features of the frature end in the 14th and 28th da y after operation. Results The formation of blood capillaries and bone trab eculae in Group A was superior to those in Group B. The scores of the four callu s and th e depth of the lateral callus in Group A were higher than those in Group B. Con clusion ZS has obvious effect in promoting the union of fracture.

OBJECTIVETo dicuss the application and therapeutic effect of middle-forearm flap based on perforator of ulnar artery for electrical burn wound on the wrist.

METHODSFrom Oct. 2009 to Oct. 2012, 10 cases of electrical burn wounds on the wrist were treated. A line from radialis medial epicondyle of humerus to the interior radialis pisiform bone was connected as flap axis. At the midpoint of the line, Doppler flow imaging meter was used to detect the emerging point of perforator vessel. The flap was designed and harvested. The flap was transferred reversely, with superficial vein retaining which was anastomosed with vein at recipient sites in 3 cases. The wounds in the donor sites were closed directly in 2 cases, and with skin graft in 8 cases.

RESULTSAll the 10 flaps survived completely. 7 cases without vein anastomosis underwent obvious flap edema during 2-4 days postoperatively, which resovled 1 week later. Sub-flap tissue necrosis and infection happened in 2 cases, which healed after dressing and drainage. Patients were followed up for 3-36 months with satisfactory results.

CONCLUSIONSThe middle-forearm flap based on perforator of ulnar artery has a stable and reliable blood supply. It offers a new choice for the electric burn wound on the wrist, especially at the ulnar side.

Burns, Electric ; surgery ; Forearm ; Humans ; Reconstructive Surgical Procedures ; Skin Transplantation ; Surgical Flaps ; blood supply ; transplantation ; Ulnar Artery ; Wrist Injuries ; surgery

The gut microbiota of intensive care unit (ICU) patients displays extreme dysbiosis asso-ciated with increased susceptibility to organ failure, sepsis, and septic shock. However, such dysbio-sis is difficult to characterize owing to the high dimensional complexity of the gut microbiota. We tested whether the concept of enterotype can be applied to the gut microbiota of ICU patients to describe the dysbiosis. We collected 131 fecal samples from 64 ICU patients diagnosed with sepsis or septic shock and performed 16S rRNA gene sequencing to dissect their gut microbiota compo-sitions. During the development of sepsis or septic shock and during various medical treatments, the ICU patients always exhibited two dysbiotic microbiota patterns, or ICU-enterotypes, which could not be explained by host properties such as age, sex, and body mass index, or external stressors such as infection site and antibiotic use. ICU-enterotype I (ICU E1) comprised predominantly Bac-teroides and an unclassified genus of Enterobacteriaceae, while ICU-enterotype Ⅱ(ICU E2) com-prised predominantly Enterococcus. Among more critically ill patients with Acute Physiology and Chronic Health Evaluation Ⅱ(APACHE Ⅱ) scores > 18, septic shock was more likely to occur with ICU E1 (P = 0.041). Additionally, ICU E1 was correlated with high serum lactate levels (P = 0.007). Therefore, different patterns of dysbiosis were correlated with different clinicaloutcomes, suggesting that ICU-enterotypes should be diagnosed as independent clinical indices. Thus, the microbial-based human index classifier we propose is precise and effective for timely mon-itoring of ICU-enterotypes of individual patients. This work is a first step toward precision medicine for septic patients based on their gut microbiota profiles.