[Summary] The paper reported perioperative respiratory nursing experience of 31 patients with emphysema complicating pneumothorax treated with lung volume reduction surgery under video-assisted thoracoscopy .The thoracoscopic surgery was completed in 27 patients and conventional thoracotomy were required in 4 patients because of severe pleural cavity adhesions .No severe respiratory complications occurred in all the patients .We deemed that positive preoperative mental nursing , respiratory preparation and exercises, proper physical training , intraoperative prevention of hazardous inhalation , postoperative effective analgesia , and careful management of closed thoracic drainage are key points of perioperative nursing .

Objective To investigate the treatment method of osteoporotic refracture after vertebroplasty.Methods One hundred and twenty patients (140 vertebraes) with osteoporotic fractures from January 2010 to January 2011 were selected,12 months after operation,15 cases of refracture (20vertebraes) patients as the research object,11 cases were given bone cement to strengthen treatment,postoperative anti-infection,recovery given a positive rehabilitation exercise instruction ;4 cases were given anti-osteoporosis treatment.Follow-up of 10 months,whether leakage of bone cement and the recovery of anti-osteoporosis treatment were observed.Results Eleven patients with refracture in the process of bone cement injection had no prevertebral venous leakage and disc leakage,none of the patients had bone cement leakage after operation;including 3 cases occurred back pain after injection,the main consideration was surgery influenced the local nerve functions and given analgesic treatment,then pain significantly reduced; 4cases with anti-osteoporosis therapy and recoverd better,no pain and other unsuitable symptom occurred.Postoperative 3 d all of the patients could get out of bed,were discharged on 1 week after operation.All patients were not appear the adverse host reaction of fillers,with no occurrence of refracture.Through visual analog pain scale(VAS) score,VAS score in the 3 d after treatment and end-stage follow-up were significantly lower than before treatment [(3.05 ± 0.55),(0.05 ± 0.15) scores vs.(6.95 ± 0.65) scores],and VAS score at the time of end-stage follow-up was lower than 3 d after treatment,there was significant difference (P ＜0.05).Conclusion Bone cement to strengthen with anti-infection and rehabilitation exercise instruction and anti-osteoporosis in the treatment of osteoporotic refracture after vertebroplasty curative effect,safe and reliable effect,worthy of clinical popularization and application.

Objective:To study the expression of TCRV? subfamily which specially recognize the hepatoma cell antigen and the apoptosis of hepatoma cell induced by McAb costimulated PBLs.Methods:The change of the phenotype of PBLs was studied by flow cell cytometry and the level of the expression of TCRV? was studied by RT-PCR and Southern blot,the PTK by western blot.The hypermicroscopic ultrastructure was observed through transmission electron microscope.Results:The level of CD3 and CD8 of PBLs was significantly increased after acted with hepatoma cells,while there was no change in CD4.The expression of TCRV?7 of PBLs was dramaticly increased and peaked at 4 days.PTK increased correspondently,to 58% compared with 11% in control.Besides anti-CD3 McAb induced lymphocyte apoptosis,the mediated apoptosis of hepatoma cells was found in the other three groups.Conclusion:TCRV?7 was the tumor antigen specific T cell receptor,and it activate the PTK signal pathway.The McAb activated lymphocytes initiated apoptosis in hepatoma cells.

Objective To investigate the mecbanism of safflor injection treating myocardial contusion following thoracic impact.Methods Thirty healthy Japan big-ear rabbits were randomly assigned to the myocardial contusion control group (control group,n =15) and safflor injection group (safflor group,n =15).The rabbits with severe myocardial contusion were induced by BIM-Ⅱ Horizontal Bioimpact Machine.Blood samples were taken from common carotid artery of both groups to measure the levels of plasma thromboxance A2 (TXA2) and prostaglandin I2 ( PGI2 ) at 10 minutes before impact and at t0 minutes,30 minutes,1,3,6,12 and 24 hours after impact.Rabbits were dissected to observe the gross and micropathological changes of the hern at 24 hours after impact.Results The control group showed a distinct falling of plasma PGI2 concentration and a significant increase of plasma TXA2 concentration in the early period after severe myocardial contusion.The morphological observation revealed severe myocardial tissue injury as well.However,the safflor group showed insignificant variation pertaining to the reduction of plasma PGI2 concentration and increase of plasma TXA2 concentration,but obvious alleviation of myocardial tissue injury,as compared with the control group.Meanwhile,the ratio of TXB2 to 6- Ketoprostaglandin Fla (6-Keto-PGFla) in the safflor group was lower than that of the control group (P ＜0.05).Conclusion Safflor injection has therapeutic effect on myocardial contusion by elevating the concentration of plasma PGI2 and decreasing the concentration of plasma TXA2 in the early period after severe myocardial contusion.

OBJECTIVE To investigate the bacterial resistance of clinical isolates from pediatric hospital for the guidance of rational use of antibiotics.METHODS Disc diffusion test(Kirby-Bauer method) was used to study the antimicrobial resistance(fastidious bacteria were detected by E test).WHONET5 was applied for analysis.(RESULTS) In the period of study from 2002 to 2003,2 303 strains which were the first isolated from each patient were collected.Of 2 303 clinical isolates,Gram positive organisms accounted for 29.7%,Gram negative ones for 70.3%.Escherichia coli,Klebsiella spp,Staphylococcus aureus,coagulase-negative staphylococci and Pseudomonas aeruginosa were the most common strains among the isolates.Meticillin-resistant S.aureus(MRSA) and meticillin-resistant coagulase(-negative) staphylococci(MRCNS) accounted for 9.7% and 67.6% of S.aureus and coagulase-negative(staphylococci),respectively.Resistant rates of MRSA and MRCNS were higher than that of meticillin-susceptible S.aureus(MSSA) and meticillin-susceptible coagulase-negative staphylococci(MSCNS) to antimicrobial agents commonly used in clinic.No vancomycin resistant strains of staphylococci were found. 4.1% of Enterococcus spp were vancomycin resistant strains.Resistant rate of Streptococcus pneumoniae was 11.9% to penicillin. Most of isolates of Enterobacteriaceae were susceptible to imipenem.The incidences of E.coli and Klebsiella spp producing extended spectrum beta-lactamases(ESBLs) isolates were 49.7% and 63.1%,respectively.The resistance rates of(ESBLs) producing strains to antimicrobial agents(except carbapenems) were higher than those of ESBLs nonproducing ones.CONCLUSIONS Bacterial resistance is still or even a more serious clinical problem than before.The(surveillance) of antimicrobial susceptibility in pediatric hospital is of great significance.It is also very important to promote the rational use of antimicrobial agents so that resistance is minimized and take effective strategy for the control of the problem.

Objective:To study the biological effects of TCR to hepatoma cell by transfection V?7 to lymphocytes. Methods:TCRV?7 gene was amplified by RT PCR and cloned to expression vector pLXSN. The recombinant was transferred into lymphocytes by Lipfectin Reagent transfection,then the lymphocytes were co cultured with hepatoma cells.The phenotype of lymphocytes was detected on the Flow Cytometry and the ultrastructure of the hepatoma cells was showed by electronic microscope.Results:The lymphocyte amount with TCRV?7 expressing in those being transfected was much more than those no transfection.Apoptosis appeared in the hepatoma cells.Conclusion:TCRV?7 subfamily can recognize hepatoma antigen and stimulate T cell.

Objective To study the characteristics of heterotopic heart transplantation by echocardiographyand evaluate the heart function and acute rejection.Methods Five male 49-61 years old patients with heterotopic heart transplantation were studied using echocardiography pre-,intra-,post～operation and at follow-up.The anastomoses of great vessels of recipient with donor heart,chamber size,left ventricular wall thickness with wallmotion.left ventricular ejection fraction(LVEF),valvular function,pulmonary artery pressure,pericardial and pleural effusion were observed.Results All patients were end-stage coronary artery disease with NYHA class of received heterotopic heart transplantation with coronary artery bypass grafting.Some patients received mitral valvuloplasty,ventricular aneurysmectomy and stem cell transplantation simultaneously.During the operation,intra-operation transesophageal echocardiography was used to monitor and evaluate the surgical procedure with chamber sizes,anastomoses,native with donor heart ventricular and valvular function,and air bubble in chambers.The cardiac functions of donor heart backed to normal post operation,while the functions of recipient heart were increased gradually.All patients survived in 6 months and one year follow-up,with significantly improved functions of heart in situ[LVEF(44.0±15.6)%].The main reject reaction was small pericardial perfusion and pleural effusion.Conclusions Heterotopic heart transplantation has distinctive characteristics with echocardiography study,which is also an important technique in evaluation at pre-,intra-,post-operation and also at follow-up.

Objective To explore the optimal storage standard of fresh human milk, and to observe the influence of different cold storage condition (time-temperature) on macronutrients (fat, protein, carbohydrates, TS and energy), immune sub-stances (sIgA, lactoferrin, IL-6, 8, 10 and TNF-α) and bacteria indicators of fresh human milk.Methods Fresh milk samples (n=30) were divided and stored at three temperature and nine time points, which are 4℃ (24 h, 48 h, 72 h), -18℃(72 h, 7 d, 14 d, 4 w, 8 w, 12 w), and -80℃ (12 w, 24 w). At each time point, the macronutrients , immune substance, and bacteria colony counts of each milk sample were measured and compared with fresh milk. Results Compared with fresh milk, all indicators with the exception of lactoferrin in stored human milk showed signiifcant difference (P<0.05). Under 4℃ refrigeration condition, fat, IL-6, and TNF-α decreased, bacteria colony counts and Gram-positive colony counts increased over 72 h storage (P<0.05). Under-18℃ freezing condition, fat, protein, TS, energy and IL-6 decreased from 72 h to 12 w storage (P<0.05); carbohydrates and sIgA also decreased from 4 w and 8 w storage, respectively (P<0.05). Under -80℃ freezing condition, fat, protein, TS, energy and IL-6 decreased over 24 W storage (P<0.05).Conclusions The macronutrients, immune substance, and bacteria indicators of human milk were affected obviously by cold storage. Refrigerated at 4℃ should not be longer than 72 h, -80℃ freezing condition should be chosen for more than two months storage.

Objective To investigate the molecular characteristic,the virulence factors and antimicrobial resistance of Methicillin-resistant Staphylococcus aureus (MRSA) isolated from pediatric patients.Methods Ninety-eight non-duplicate strains of and 49 non-duplicate strains of Methicillinsusceptible Staphylococcus aureus (MSSA) isolated from the three children's hospitals in Shanghai in 2008 were investigated.Panton-valentine leukocidin (PVL) gene was detected by polymerase chain reaction (PCR).The genotypes of staphylococcal cassette chromosome mec (SCCmec) of the MRSA isolates were confirmed by multiplex PCR.The sequence type (ST) of each strain was determined by multilocus sequence typing (MLST),and the algorithm eBURST was used to identify groups of clonal complex (CC).The minimal inhibitory concentrations (MIC) of fourteen antibiotics for all isolates were determined by agar dilution method.Results Among 98 isolates of MRSA,the positive rate of PVL genes was 6.1％ (6/98).In contrast,the positive rate of PVL genes was 4.1％ (2/48) of the MSSA strains.Among 98 isolates of MRSA,4.1％ (4/98),23.5％ (23/98),53.0％ (52/98) and 15.3％ (15/98) of the strains harboured SCCmec types Ⅱ,Ⅲ,Ⅳ and Ⅴ,respectively. The remaining four isolates (4.1 ％) presented a unique SCCmec pattern that could not be classified to any known types by the employed typing assays.Combining the ST and SCCmec type,the predominant clones were ST59-SCCmec Ⅳ (30 strains) and ST239-SCCmec Ⅲ (23 strains),followed by ST5-SCCmecⅣ and ST1-SCCmecⅣ (8 strains for each clone),ST239-SCCmec Ⅴ (6 strains),ST88-SCCmecⅤ (5 strains),ST5 SCCmecⅡ (4 strains),ST59-SCCmec Ⅴ (3 strains),ST8-SCCmecⅣ and ST88-SCCmecⅣ (2 strains for each clone),ST22-SCCmecⅣ,ST910-SCCmecⅣ and S45-SCCmec Ⅴ (1 strain for each clone),eBURST analysis distributed the MRSA isolates into several CC.ST8 and ST239 belonged to ST8 CC,ST1 belonged to ST15 CC,ST910 belonged to ST 30 CC,ST59,ST5,ST88,ST45,ST22,ST9 and ST7 were the origin of their own CC.The results of MIC showed that the 67 strains of MRSA harboring SCCmec type Ⅳ or SCCmec type Ⅴ were more susceptible to various non-β-lactam antibiotics than 27 strains of MRSA harboring SCCmec type Ⅱ or SCCmec type Ⅲ,and no vancomycin-resistant strain was found.Conclusions In three children's hospitals in Shanghai,the PVL gene-positive rate of MRSA isolates is relatively low,SCCmec type Ⅳ and SCCmec type Ⅴ could spread among hospitals to cause a small scale epidemic and have a variety of ST.

Objective:To investigate the distribution and drug resistance of pathogens in urinary tract infection in children.Methods:The clinical data of 108 cases of urinary tract infections with positive urinary culture from January 2018 to December 2018 in our hospital were analyzed retrospectively.The patients were divided into simple urinary tract infection group( n=29) and complex urinary tract infection group( n=79). Antibiotic resistance in each group was compared. Results:Gram-negative bacilli were found in 90 cases(77.59%, 90/116). Gram-positive cocci were found in 26 cases(22.41%, 26/116). Escherichia coli, Klebsiella pneumoniae and Enterococcus faecium were the main pathogens.Gram-negative bacilli had the lowest resistance rate to amikacin, imipenem and piperacillin/tazobactam(about 10%). The resistance rate of Gram-negative bacilli to furantoin and quinolones was about 20%, while 30% to 40% to the third and fourth generation cephalosporins and their enzymatic preparations.No Gram-positive cocci was found to be resistant to vancomycin and linezolid.The resistance rate of Gram-positive bacteria to streptomycin and furantoin was 0-20%.There was no significant difference in resistance rate of Gram-negative bacteria to common antibiotics between simple urinary tract infection group and complex urinary tract infection group( P>0.05). Conclusion:Gram-negative bacteria are the main pathogens of urinary tract infections.With the change of drug resistance of pathogens, it may be necessary to change the empirical treatment of urinary tract infection.Furantor can be used as a recommendation for the empirical treatment of mild infection.In the past, there may be underestimate of drug resistance of simple urinary tract infection, and further research is needed.