Objective To explore the change trend and antimicrobial resistance of pathogens causing infection in extensive burn patients,and provide reference for clinical prevention and treatment.Methods Specimens from 9 extensive burn patients who were admitted to a hospital at the same time were performed pathogenic culture and an-timicrobial susceptibility testing, change trend and antimicrobial susceptibility of pathogens were observed. Results The main specimen was wound secretion,accounting for 93.81 %.The major pathogens causing infection were Acinetobacter baumannii (44.85%),Staphylococcus aureus (32.47%),Pseudomonas aeruginosa (12.37%), and Klebsiella pneumoniae (5.15%).With the prolongation of hospital stay,pathogens changed from one kind to multiple strains, and from susceptibility to resistance,multidrug resistance,and extensive drug resistance. Conclusion Itis difficult to avoid infection in burn patients,timely realizing the changes of pathogens causing infec-tion and antimicrobial resistance play an important role in the control of infection.

Objective To investigate the occurrence of central venous catheter-related bloodstream infection(CRB-SI)in mass severe burn patients,evaluate related risk factors for infection,and effectiveness of prevention and con-trol measures.Methods In August 2014,9 cases of severe burn patients were rescued in a hospital,all patients re-ceived CVC,infection prevention and control intervention measures were performed during the whole process of catheterization.Results All patients received 30 episodes of CVC,total CVC-days were 227 days,bacterial culture for three-cavity catheters of femoral veins in 2 patients were positive,incidence of CRBSI was 8.81 ‰;1 patient was isolated Enterococcus faecium ,1 isolated both Acinetobacter baumannii and Stenotrophomonas maltophilia .2 CRB-SI patients received femoral vein catheterization,catheterization site was trauma surface,duration of catheterization were both ≥7 days,both used three-cavity catheters,and third degree burns were ≥60%,both patients were cured after timely removal of catheters and receiving of antimicrobial agents.Conclusion CVC is helpful for long term, safe and effective fluid infusion,but it can cause CRBSI;infection prevention and control intervention for patients receiving CVC during the whole process of catheterization can reduce the occurrence of CRBSI.

Through combing and analysing the relevant records of Chongmai in The Inner Canon of the Yellow Emperor （《黄帝内经》）， the basis for the formation of the concept of Chongmai， its development， and the connotation of its name and reality are examined. It is believed that the concept of Chongmai is based on the observation of arterial pulsation by ancient people， and the practice of pulse diagnosis and blood letting by healing stone， to reflect the importance placed on the entity of the blood vessels， the concept of qi and blood in clinical practice. The name， route and function of Chongmai all reflect the above characteristics. With the development of medical theory and the standardization of the distribution and route of meridians by the three-Yin and three-Yang model thinking， the theory of the twelve meridians has taken a dominant position， and the arterial sites belonging to Chongmai are divided by the twelve meridians， resulting in the intersection and confusion between the positioning of the Chongmai and the twelve meridians in later generations. The independent function and disease characteristics of the Chongmai are becoming increasingly blurred， ultimately leading to a disconnection between the clinical application and theoretical positioning of Chongmai. Based on the high degree of belonging of the human arterial system to Chongmai， and based on the exuberance-decline and excess-deficiency， free and stasis of qi and blood， this article concluded that the connotation of Chongmai as the sea of blood， governs reproduction and menstruation， dominates disease of gynaecology， cold pathogen intruding the body， and mental disease， and formulates corresponding treatment methods， which has a unique value and significance in clinic.

Objective To establish the diagnostic model based on detection of serum biomarkers in pancreatic cancer (PC) associated diabetes.Methods From June 2013 to July 2014, at Ruijin Hospital, School of Medicine , Shanghai Jiao Tong University , 30 patients diagnosed with PC companied with new onset diabetic mellitus and 30 patients with new onset type 2 diabetic mellitus , were enrolled .Serum samples were examined by liquid chromatography-mass spectrometry ( LC-MS) for metabolomics analysis .Orthogonal partial least square ( OPLS ) was performed for raw data analysis to obtain the differentially expressed metabolites between two groups .The first 15 cases of each group were taken as training samples and the left as validation samples.The model was established using logistic regression via stepwise differentially expressed metabolites and clinical data input in training samples .The diagnostic efficiency of the model was verified in validating samples . Results Ten differentially expressed metabolites were identified in PC companied with new onset diabetic mellitus group and new onset type 2 diabetic mellitus group .The differentially expressed metabolites identified in positive ion mode were 3-ketosphingosine , arachidonoyl dopamine , phosphatidylethanolamine ( 18 :2 ) , ubiquinone-1 and valine .The differentially expressed metabolites identified in negative ion mode were C 16 sphingosine-1-phosphate, keto palmitic acid, isoleucine, N-succinyl-L-diaminopimelic acid and uridine.The diagnostic model was established in training samples:p=e(Xβ)/(1+e(Xβ)), ( Xβ) =-158.975-1.891 (age) +0.309 ( phosphatidylethanolamine 18:2 ) +1.035 ( C16 sphingosine-1-phosphate ) +0.084 (isoleucine) +1.1145 ( N-succinyl-L-diaminopimelic acid ).The area under curve ( AUC) of receiver operating characteristic (ROC) of this model was 0.982 in validation samples, the sensitivity and specificity were both 93.3％.Conclusion Serum metabolomics-based diagnostic approach is a promising method for screening PC from new onset diabetic mellitus .

Objective To evaluate the clinical efficacy of single plate,double plates,and intramedullary nail in treating medial cortical comminuted fractures of the medial distal femur.Methods A retrospective case control study was conducted on 63 cases of medial cortical comminuted fractures of the medial distal femur treated from November 2011 through October 2016.According to the type of internal fixation,19 cases of middle and distal shaft fractures were divided into the single plate group (n =11) comprising four males and seven females,aged averagely 57.5 years,and intramedullary nail group (n =8) comprising five males and three females,aged averagely 56.4 years.Forty-four cases of distal femoral fractures were divided into the single plate group (n =14) comprising six males and eight females,aged averagely 57.6 years,intramedullary nail group (n =9) comprising five males and four females,aged averagely 56.6 years,and double plates group (n =21) comprising 14 males and seven females,aged averagely 55.1 years.The rate and period of racture healing,distal femoral valgus resection (DFVR),femoral angle,change of DFVR and femoral angle,and complications were compared within and between groups.Results All the cases were followed up for 6-37 months (mean,13.4 months).Of 19 cases of middle and distal shaft fractures,there were no statistically significant differences in fracture healing rate and period,DFVR after operation and at the last follow-up,and the amount of change of DFVR between the single plate and double plates group (P ＞ 0.05).With respect to postoperative complications of the two groups,no significant difference was found for the rate of nonunion,infection,internal fixation failure,and mal union (P ＞ 0.05).However,the incidence rate of adverse events in single plate group (46％) was significantly higher than that in intramedullary nail group (0) (P ＜0.05).Of the 44 cases of distal femoral fractures,the pairwise comparisons among three groups showed no statistically significant differences in fracture healing rate,healing period,and the post operative femoral angle (P ＞ 0.05).The femoral angle at the last follow-up in intramcdullary nail group was (80.80 ± 2.93) °,significantly lower than (85.28 ± 5.89) ° in single plate group and (83.55 ± 3.51) ° in double plates group (P ＜ 0.05).Within the intramedullary nail group,no significant difference was found between the femoral angle immediately after operation and at the last follow-up (P ＞ 0.05),but significant difference was detected in both single plate group and double plates group (P ＜ 0.05).The amount of change of the femoral angle in intramedullary nail group [(0.25 ± 1.95) °] was significantly lower than (4.03 ± 3.78) ° in single plate group and (2.60 ± 2.24) ° in double plates group (P ＜ 0.05).With respect to post operative complications in the three groups,no significant difference was found for the rate of nonunion,infection,internal fixation failure,and malunion (P ＞ 0.05).The malunion rate in single plate group (36％) was significantly higher than that in double plates group (14％).The incidence rate of adverse events in single plate group (50％) was significantly higher than that in double plates group (14％) (P ＜ 0.05).Conclusions Three internal fixations have similar clinical results in fracture healing rate and period.For medial cortical comminuted middle and distal shaft fractures,and distal femoral fractures without involving articular surface,intramedullary nail has better results than locking plate.For medial cortical comminuted distal femoral fractures involving articular surface,double plates fixation might be a better option.

Objective: To investigate the safety and efficacy of radiofrequency ablation (RFA) with percutaneous iohexol-ethanol injection (PIEI), compared with RFA plus transcatheter arterial chemoembolization (TACE) for patients with primary liver cancer(PLC)in high-risk locations. Methods: From January 2012 to December 2014, 54 patients with PLC in high-risk locations were enrolled. They were divided into Group A (RFA combined with PIEI) and Group B (RFA plus TACE). The efficacy and adverse events were assessed. Results: 54 patients had 74 lesions in high-risk locations. There were 26 cases with 40 lesions in Group A, and 28 cases with 34 lesions in Group B. The complete ablation rate of Group A was significantly higher than that of Group B (92.5% vs 70.6%, P=0.014). The two-year local tumor progressionrateand two-year overall survival rate were similar between these two groups (Group A 20.0% vs Group B 38.2%, P=0.083; 90.3% vs 84.3%, P=0.523). Furthermore, the surgery-related severe adverse events of Group A (7.1%, one case of liver abscess and one case ofhematobilia) were more common than that of Group B (0%, P=0.491). No significant differences were found in common adverse events including fever, pain, elevation of aminotransferase and bilirubin. Conclusions Compared with RFA plus TACE, RFA plus PIEI resulted inbetter complete ablation rate in patients with primary liver cancer in high risk locations. Prospective, randomized, controlled trials are warranted for further evaluation.