Objective:To share the experience of clinical cooperation of physicians and clinical pharmacists in the treatment of one case of rodenticide poisoning. Methods: One case of rodenticide poisoning was early diagnosed by physicians according to the con-sciousness disorder and coagulation dysfunction. Clinical pharmacists participated in the drug treatment actively through providing vita-min K1 at the dose of 30 mg·d-1 as the treatment dose and monitoring the effectiveness. Toxicology analysis was recommended, and 718 ng·ml-1 bromadiolone was found out in the blood samples. According to the long half-life of bromadiolone, the initial duration of treatment was set at 2-3 months, while follow-up plan and final duration of treatment were defined based on coagulation parameters and poison concentration monitoring results. Results:The patient recovered rapidly after hospitalization due to the cooperation of physicians and clinical pharmacists through quickly correcting diagnosis of physicians and actively participating in medication of clinical pharma-cists. After the 3-month treatment, the coagulation parameters of the patient were normal and the patient was discharged with follow-up. Conclusion:The collaboration of physicians and clinical pharmacists leads to the optimal regimen with early, full dose and long course of vitamin K1 therapy.

Objetive To elucidate the mechanism of antibiotic resistance of Pseudomonas aeruginosa(P.a.) in an effort to provide a basis in clinical combined use of antibiotics against P.a.infection in clinical settings.Methods All P.a.strains were isolated by routine procedures and identified with VITEK-2 automatic bacterial identification console.The minimum inhibitory concentration(MIC) was detected using dilution method on agar plate following the instruction of CLSI.Results Ninety-two strains of P.a.were isolated from clinical infection specimens,most of them were obtained from respiratory tract(88.04%).Of the 92 strains,45(48.91%) were metallo-?-lactmases positive,and 25(27.17%) were AmpC positive.When treated with a combination of meropenem and imipenem,MIC≥1 was found in 17 strains(18.48%).The bacteriostatic rate of polymixin B and meropenem was 95.65% and 80.43%,respectively,that of amikaein,piperacillin/tazohaetam(PIT) and imipenem was 48.91%-71.74%,and that of cefoperazone/sulbactam(SUP) was 36.96%.The synergistic action of PIT,and SUP with amikacin was 60.87% and 58.70%,respectively,and that of PIT,SUP with minocycline were 44.57% and 43.48%,and of PIT,SUP with PLB were 28.26% and 7.61%,respectively.Conclusions P.a.strains in this study are mainly isolated from respiratory tract infection specimens.Multiple drug-resistant mechanisms are involved in the drug resistance of P.a.Enzyme inhibitors,such as PIT or SUP,with amikacin or polymixin B should be first selected for clinical treatment of P.a.caused infection.Meanwhile,antibiotics should be rationally administered in accordance with the seriousness of disease,and with the drug-resistant phenotype of the isolated strains.

The methods of diagnostic imaging for pulmonary embolism is diversified. However, the different characteristic features of diagnostic imaging and diagnostic accuracy impressive influenced the choice of selection by clinicians. Furthermore, the principle and indication of interventional therapy would have great impending force on the outcomings. This article presents a comprehension of diagnostic imagings and interventional therapy for pulmonary embolization.

Objective To investigate the imaging features of splenic littoral cell angioma (LCA)and correlate with pathological findings.Methods Ten patients of LCA with pathologically confirmed diagnosis were included in this study.A retrospective review of clinical data and imaging findings on CT and MRI was performed,along with review of the literature.Results Splenic littory cell angiomas presented with multiple nodules of varying sizes with a predoninance of small ones.Nine of 10 patients had clinical symptoms of splenomegalia and hypersplenia.MR T2WI and DWI showed masses with high-signalintensity.The CT and MRI enhancing pattern of LCA was similar to splenic hemangioma.There were many mammiliform structures pointing inside in the wall of the vascular channels,a hallmark feature allowing its differentiation from splenic hemangioma pathologically.Conclusion The CT and MRI findings of LCA can show some of its characteristic signs,especially on DWI,which can assist to identify LCA in clinical practice.

Objective To evaluate the capabilities of disc diffusion and Vitek2-compact GN13 methods for testing antimicrobial susceptibility of screening ESBLs ( extended-spectrumβ-lactamase) in En-terobacteriaceae clinical isolates.Methods A total of 93 Enterobacteriaceae strains were isolated from pa-tients with intra-abdominal infections in 21 hospitals during 2011 to 2012.The in vitro minimum inhibition concentration ( MIC ) values of ampicillin-sulbactam, piperacillin-tazobactam, ertapenem, ceftazidime, ceftriaxone, cefepime, imipenem, amikacin, ciprofloxacin and levofloxacin were determined by disc diffu-sion, Vitek2-compact GN13 and broth microdilution methods, respectively.Categorical agreement ( CA ) rates of disc diffusion and Vitek2-compact GN13 methods were determined by using broth microdilution meth-od as the reference method.The genes encoding ESBLs were screened in Escherichia coli (E.coli), Kleb-siella pneumoniae (K.pneumonia), Klebsiella oxytoca (K.oxytoca) and Proteus mirabilis (P.mirabilis) strains by using PCR analysis and gene sequencing.Disc diffusion and Vitek2-compact GN13 methods were used for the phenotypic confirmatory test of ESBLs and the sensitivity, specificity, positive predictive value and negative predictive value of the two tests were evaluated.Results The CA values of disc diffusion and Vitek2-compact GN13 methods for the 10 antibiotics were all >90% as compared with broth microdilution method.The major error (ME) rate for ertapenem was 3.2%and the very major error (VME) rates for am- picillin-sulbactam, ceftazidime and cefepime tests were all 2.2% by using Vitek2-compact GN13 method. The sensitivity, specificity, positive predictive value and negative predictive value of disc diffusion and Vitek2-compact GN13 methods in the phenotypic confirmatory test of ESBLs were 96.7%(29/30), 100%(20/20), 100%(30/30) and 95%(19/20), respectively.Conclusion Both disc diffusion and Vitek2-compact GN13 methods could be used for testing the antimicrobial susceptibility and the detection of ESBLs in Enterobacteriaceae clinical isolates with the advantage of accuarcy.Attention should be paid to the posibil-lity of oaurance of ME and VME when testing ertapenem, ampicillin-sulbactam, ceftazidime and cefepime by using Vitek2-compact GN13 method.

OBJECTIVE To study the characteristic of nosocomial pulmonary infection to find out the measures for prevention and control.METHODS The patients with radiation brain injuries(RIB) from Oct 2004 to Jun 2007 underwent retrospective investigation.The reasons and sites of pulmoary infection were analyzed.RESULTS The incidence of pulmonary infection of patients with RIB after radiotherapy was 68.5%.Major factors of infection were bulb palsy,invasive treatment and hormone usage.The Gram-negative bacteria were the predominant pathogens.CONCLUSIONS The nosocomial pulmonary infection is related to many factors.Antibiotic usage according to drug susceptibility results and controlling of the risk factors are important measures to reduce the rate of infection.

To observe the therapeutic effects of transcutaneous electric acupoint stimulation on early-stage adhesive shoulder periarthritis. Methods:by using the research approach of evidence-based medicine such as multi-center,large sample and randomization,the 163 cases of early-stage adhesive shoulder periarthritis were treated with transcutaneous electric point stimulation and electric acupuncture respectively to observe the therapeutic effect of transcutaneous electric acupoint stimulation and compare its effect with electric acupuncture.Results and Conclusion:The total effective rate of transcutaneous electric point stimulation on early-stage adhesive shoulder periarthritis reached 96.5%,showing no significant difference with the electric acupuncture group;the transcutaneous electric acupoint stimulation could not only relieve pain,but also improve the shoulder joint movement. As a result,the transcutaneous electric acupoint stimulation is an easy and more effective therapy for shoulder periarthritis.

Objective To explore the analgesic effect of ropivacaine combined with sufentanil in epidural anesthesia on walk on painless labor.Methods 134 cases of maternal pregnancy were selected and randomly divided into two groups.61 cases were treated with conventional delivery,73 cases in the experiment group were treated with walk on painless labor.The visual analogue scale and improved Bromage classification score were compared at the first stage of labor,the second stage of labor,the third stage of labor.Results Compared with the control group,the rate of cesarean section was higher(P<0.05),The visual analogue scale was higher at the first stage of labor,the second stage of labor,the third stage of labor,the duration of labor were lower at the first stage of labor,the second stage of labor,the third stage of labor(P<0.05),and there was no significant difference between the two groups in the motor nerve block.Conclusion Ambulatory labor analgesia on maternal effect significantly,can significantly reduce the pain degree of maternal birth process and deliverry time,postpartum less complications.

Objective To evaluate the colon cleaning efficacy and safety of prucalopride combined with polyethylene glycol electrollytes powder in bowel preparation for colonoscopy examination and treatment under colonoscopy in elderly patients.Methods Elderly patients who prepared for colonoscopy were enrolled from October 2014 to January 2015.They were divided into group A,B and C.Patients of group A only took polyethylene glycol electrolyte powder (137.12 g dissolved in 2 000 mL warm water,stired until completely dissolved),patients of group B took polyethylene glycol electrolyte powder (same usage as group A) combined with prucalopride 2 mg/d for one day,patients of group C took polyethylene glycol electrolyte powder (same usage as group A) combined with prucalopride 2 mg/d for three days.The bowel preparation effects,especially ascending colon and ileocecal junction and cardiovascular adverse effects in all the patients and constipation patients of three groups were compared.Student t test,chisquare test and analysis of variance were performed for statistical analysis.Results A total of 124 elderly patients were divided into group A (64 cases),group B (23 cases) and group C (37 cases).Bowel preparation scores of total colon and ascending colon-ileocecal junction of group A,B,C were 8.34±0.90 and 2.56±0.56,8.96±0.21 and 2.96±0.21,8.86±0.35 and 2.86±0.35,respectively.The cleaning effects in total colon and ascending colon-ileocecal junction of group B were better than those of group A (t=5.52 and 5.15,both P＜0.05).The cleaning effects in total colon and ascending colon-ileocecal junction of groupCwere better than those of group A (t=4.69,3.65,both P＜0.05).There was no statistically significant difference between group B and group C in cleaning effects in total colon and ascending colon-ileocecal junction (both P＞0.05).There were 33,11 and 29 constipation cases in group A,B and C,respectively.The bowel preparation scores for total colon and ascending colon and ileocecal junction of group A,B,C were 7.85±0.94 and 2.24±0.56,8.91±0.30 and 2.91±0.30,8.83±0.38 and 2.83 ± 0.38,respectively.The cleaning effects in total colon and ascending colon-ileocecal junction of group B were better than those of group A (t=6.72 and 5.49,both P＜0.05).The cleaning effects in total colon and ascending colon-ileocecal junction of group C were better than those of group A (t=104.04 and 59.65,both P＜0.05).There was no significant difference between group B and group C in cleaning effects in total colon and ascending colon ileocecal junction (both P＞ 0.05).No obvious cardiovascular adverse events were observed in the patients of three groups.Conclusions The cleaning effects of prucalopride combined with polyethylene glycol electrolytes powder are good for colonoscopy examination in elderly patients,including elderly patients with constipation,especially in ascending colon and ilecocecal junction.No obvious cardiovascular adverse events are observed.

Objective To understand the distribution and antimicrobial resistance of pathogens causing wound in-fection in army officers and soldiers following military training injury,and provide reference for antimicrobial use in clinical anti-infection treatment.Methods Wound secretion from injured army patients who were admitted to a mili-tary hospital between January 2014 and June 2015 was performed bacterial culture and antimicrobial susceptibility testing.Results 647 pathogenic bacteria strains were isolated from 1 029 wound secretion specimens ,isolation rate was 62.88%,the top 6 isolated bacteria were Staphylococcus aureus (S .aureus ,29.99%,n =194),Escherichia coli (E.coli,19.32%,n=125),Pseudomonas aeruginosa (19.17%,n=124),Enterococcus spp .(13.60%,n=88), Klebsiella pneumoniae (K .pneumoniae ,7.73%,n =50),and Acinetobacter baumannii (A.baumannii,5.87%, n=38).S .aureus and Enterococcus spp .had high susceptibility to vancomycin,linezolid ,and daptomycin (resist-ance rates ≤3.41 %),44.33% of S .aureus were methicillin-resistant,2.27% of Enterococcus spp .were vancomy-cin-resistant .E.coli and K .pneumoniae had high susceptibility rates to piperacillin/ tazobactam (resistance rates were 1 .60% and 0 respectively),except A.baumannii,resistance rates of gram-negative bacteria to carbapenems were all low (resistance rates ≤4.00%).Conclusion Military clinicians should select appropriate antimicrobial agents according to antimicrobial susceptibility testing results,reduce the disability rate due to infection in trauma patients,and provide clinical support for the treatment of the wounded.