Objective To investigate the drug-resistance and distribution of 142 strains acinetobacter baumannii.Methods Drug-resistance test of acinetobacter baumannii strains was observed in 13 kinds of antibiotics.The drug sensitivity tests was performed by the method of Kirby-Bauer paper-diffusion with the standard of NCCLS.AmpC enzyme was examined by cefoxitin three dimension test and PCR amplification of ampC structure gene were studied.Results The main sources of specimen were sputum,wound secretion,urine and blood.The respiratory tract was a major site to the development of acinetobacter baumannii.Acinetobacter baumannii strain emerged mostly in the intensive care unites.The drug resistance to cefotaxime,ceftriaxome and aztreonam were high.PCR amplification showed that of 142 acinetobacter baumannii strains,23 strains had ampC structure gene which accounted for 16 2% total strains.The drug resistance of acinetobacter baumannii producing AmpC enzyme were significantly higher than those of non-producing AmpC.The best choice of treatment was imipenem.Conclusions Acinetobacter baumannii have higher multiple-antibiotic resistance,the finding prompting us to project prospective control strategies.

Objective To analysis effect of breviscapine on serum and copeptin, NT-proBNP, HIF-1αand IMA in patients with acute ischemic brain vascular disease.Methods 42 patients who were diagnosed with acute ischemic brain vascular disease were collected and randomly divided into experimental group and control group, each group had 21 cases.All patients were given conventional treatment of Western medicine, on this basis, control group was given vinpocetine injection 20 mg, once daily intravenous drip;experimental group given Dengzhan flower Suting injection 20 mg, once daily intravenous drip; continuous treatment for 2 weeks.Before and after the treatment, the serum levels of copeptin, HIF-1α, NT-proBNP and IMA were detected in two groups.ResuIts Compared with control group, patients in experimental group treatment effect was better, as follows: serum copeptin content decreased significantly ( P<0.05 ) .Serum NT-proBNP levels decreased significantly ( P<0.05 ) .Serum levels of HIF-1αcontent decreased significantly (P<0.05).Serum ACB value increased significantly (P<0.05).ConcIusion Breviscapine can reduce the acute ischemic brain vascular disease patients serum copeptin, NT-proBNP, HIF-1αand IMA content, and has good therapeutic effect in patients with acute ischemic cerebral vascular disease.

Objective To compare the effects of ephedrine and phenylephrine on hemodynamics in the patients undergoing surgery in prone position under general anesthesia.Methods Sixty American Society of Anesthesiologists physical status Ⅰ or Ⅱ patients, aged 20-60 yr, with body mass index of 18.5-2:5.0 kg/m2, scheduled for elective posterior lumbar interbody fusion under general anesthesia, were randomized to ephedrine group (group E, n =30) or phenylephrine group (group P, n =30).When hypotension [decrease in systolic blood pressure (SBP) ＞20％ of the baseline value, T0] occurred in supine position, SBP, diastolic blood pressure (DBP), mean arterial pressure (MAP), heart rate (HR), cardiac output (CO), cardiac index (CI) and central venous pressure (CVP) were recorded, and ephedrine 0.1 mg/kg (group E) or phenylephrine 1 μg/kg (group P) was injected via the central veins.The parameters mentioned above were recorded within 10 min after administration (T1-T10).Results Both ephedrine and phenylephrine could maintain the parameters of hemodynamics at the normal level.Compared with the baseline values at T0 , SBP, DBP, MAP and HR at T1-T10 and CO and CI at T2-T10 were significantly increased, and no significant change was found in CVP at each time point after administration in group E, and SBP and MAP at T1-T6, DBP at T1-T5, CVP at T2 and T3, and CO and CI at T1-T3 were significantly increased, and HR was decreased at T2 and T3 in group P.Compared with group P, SBP was significantly decreased at T1, and increased at T2-T10, DBP and MAP were decreased at T1, and increased at T3-T10, HR was increased at T1-T10, CO and CI were increased at T2-T10, and CVP was decreased at T1-T3 in group E.Conclusion Compared with phenylephrine, although ephedrine provides no significant effect on hemodynamics clinically, it can increase cardiac output to some extent in the patients undergoing surgery in prone position under general anesthesia.

Objective To compare and analyze the kinetics changes of lower esophageal sphincter (LES) and esophageal body of achalasia after treated by simple dilation, dilation with botulinum toxin injection and stenting under endoscope. Methods The 99 clinical diagnosed achalasia cases were divide into simple dilation group, dilation with botulinum toxin injection group and stenting group, which were treated with simple dilation, dilation with botulinum toxin injection and stenting respectively. The resting pressure of LES, relaxing ratio, the percentage of concordant and discordant contraction of esophageal body and the contraction range at 10 cm above LES were tested. The variation of each indicator was compared and analyzed before and after the operation. Results Before treatment, the value of the resting pressure of LES, the percentage of discordant contraction,contracting amplitude of esophageal body was higher than normal, while the relaxing ratio of LES and percentage of concordant contraction of esophageal body was lower. There was no significant difference between 3 groups. One week after the treatment, there was no statistic difference in the variation of each indicator compared with pre-operation in 3 groutps. Six months after the treatment, theimprovement of LES resting pressure, relaxing rate and contracting amplitude of esophageal body in dilation with injection group and stenting group were better than those of dilation group (P was 0.041,0.006,0.037and 0. 029,0.004,0.033 respectively). However there was no statistic difference between dilation with injection group and stenting group. Twelve months after treatment, the improvement of LES resting pressure, relaxing ratio, the percentage of concordant contraction and contracting amplitude of esophageal body in stenting group were better than those of dilation group (P was 0.035,0.028, 0. 008, and 0. 007 respectively). However there was no statistic difference between dilation with injection group and simple dilation group. Conclusion Simple dilation, dilation with botulinum toxin injection and stenting are effective methods of achalasia treatment. The effect in near future is significant, while the long-term recurrence is in rising trend as time extension. The effect of stenting is better than the other two methods in the long-term.

Objective To study the effects of propofol used alone and in combined with opioids in gastroscopy,in order to select the more suitable anesthesia protocol.Methods A total of 285 pa-tients undergoing gastroscopy were selected in April ,201 5 in our hospital,including 105 males,180 females,ranging from 18 to 65 years old,weighing 40-90 kg,falling the category of ASA Ⅰ or Ⅱ. According to random number table,subjects were divided into four groups:dezocine group(group D, n =76),fentanyl group (group F,n =87),oxycodone group (group O,n = 71 )and control group (group C,n =5 1).Each group was implemented the corresponding anesthesia.SBP,DBP,HR,SpO 2 in baseline(T0 ),1(T1 ),3(T2 ),5(T3 )min after entering gastroscope were recorded.Choking cough, body movement,extra propofol,awakening time and inspecting time were observed.Results Among four groups,there was no statistical significance in age,gender,weight,blood pressure,heart rate and oxygen saturation and other general information.There were more cases given extra propofol in group C than in the other three groups (P <0.01 ).While for the experimental groups,there were more cases needing extra propofol in group O than in group D and group F (P < 0.01 ).The incidences of body movement and choking cough in group C were higher than those in the other three groups (P <0.01 ).Compared with the group C,dosage of propofol ,awakening time in the three groups,especially in group D,were much lower (P < 0.01 ).Conclusion Propofol in combination with opioids for sedation during painless gastroscopy can alleviate adverse reaction caused by propofol used alone.The more suitable anesthesia protocol is propofol with dezocine.

Background: Early diagnosis and staging of liver fibrosis are important for the prognosis and evaluating the survival of patients.Aims: To systematically assess the diagnostic value of transient elastography (TE) for staging of liver fibrosis in patients with chronic liver disease.Methods: PubMed,Embase,Cochrane Library,CNKI,Wanfang and VIP from Jan.2001 to Dec.2015 were retrieved to collect the articles with staging of liver fibrosis in patients with chronic liver disease by TE.Data extraction was conducted.Article quality was evaluated by quality assessment of diagnostic accuracy studies 2 (QUADAS2).Meta-analysis was conducted by Stata 12.0 software.Results: Twenty articles involving 5 748 patients were included.Meta-analysis showed that the combined sensitivity,specificity and AUC of TE for diagnosing significant fibrosis (≥F2) were 0.78 (95％ CI: 0.73-0.82),0.85 (95％ CI: 0.80-0.88) and 0.88 (95％ CI: 0.85-0.91),respectively.The combined sensitivity,specificity and AUC for advanced fibrosis (≥F3) were 0.89 (95％ CI: 0.86-0.91),0.88 (95％ CI: 0.85-0.91) and 0.94 (95％ CI: 0.92-0.96),respectively.The combined sensitivity,specificity and AUC for cirrhosis (F4) were 0.91 (95％ CI: 0.86-0.95),0.89 (95％ CI: 0.87-0.92) and 0.95 (95％ CI: 0.93-0.97),respectively.Conclusions: TE technique has a good diagnostic value in assessing significant fibrosis,advanced fibrosis and cirrhosis in patients with chronic liver disease,especially for advanced fibrosis and cirrhosis.

Objective To investigate certain risk factors for and their impact on abnormal liver function in middle-aged and elderly adults.Methods A case-control study was constructed based on the SAGE cohort of 8642 registered residents aged 50 years or over in Shanghai.Of them,137 individuals with abnormal liver function,defined as aspartate transaminase (AST)＞ 40 U/L or alanine aminotransferase (ALT)＞ 40 U/L,were randomly selected as the observation group,while 411 healthy controls were 3 ∶ 1 matched with the cases in the observation group by gender and age (1 year).Face-to-face administered questionnaires and physical examinations were conducted and serum samples were tested for ALT,AST,glucose (GLU),total cholesterol (TC),triglycreide (TG),hepatitis B surface antigen (HbsAg) and anti-hepatitis C virus antibody (anti-HCV Ab).Chi square test and rank sum test were used for single factor analysis,and logistic regression analysis was used for multiple factors.Results The prevalence of HBsAg positive patients was 12.4 ％ (68/548) Univariate analysis showed that hepatitis virus infection and body mass index (BMI) were associated with abnormal liver function (both P＜0.000).Multivariate logistic regression analysis showed that hepatitis virus infection (OR=1.85,95％ CI:1.04 3.29,P-0.036) and obesity (OR=3.60,95％CI:1.92-6.73,P＜0.001) increased the risk of abnormal liver function,whereas chronic medication (OR=0.51,95％ CI:0.32-0.80,P =0.004) decreased the risk of abnormal liver function.Conclusions Among the study population,hepatitis virus infection and obesity are risk factors for abnormal liver function in middle-aged and elderly people.After adjustment for potential confounders,chronic medication is negatively correlated with abnormal liver function and may be a protective factor for liver function.

Objective To evaluate the effects of fluid restriction in combination with small dose of norepinephrine on cerebral oxygen metabolism in elderly patients undergoing gastrointestinal surgery.Methods Forty elderly patients of both sexes,aged 65-80 yr,with body mass index of 18-24 kg/m2,of ASA physical status Ⅰ or Ⅱ (NYHA Ⅰ or Ⅱ),with left ventricular ejection fraction≥50％,undergoing elective gastrointestinal surgery,were randomly divided into 2 groups (n =20 each) using a random number table:routine fluid administration group (group S) and restricted fluid administration + small dose of norepinephrine group (group RN).In group S,lactated Ringer's solution was given routinely,ephedrine 5 mg (per time) was injected intravenously,and MAP was maintained ≥ 65 mmHg during operation.In group RN,lactated Ringer's solution was infused intravenously at 5 ml · kg-1 · h-1 starting from 30 min before anesthesia,norepinephrine was infused intravenously at 0.01-0.03 μg · kg-1 · min-1 after induction of anesthesia,and MAP was maintained ≥ 65 mmHg.Intraoperative blood loss was replaced with the equal volume of 6％ hydroxyethyl starch 130/0.4 sodium chloride injection in both groups.At 5 min before skin incision,1 and 2 h after skin incision and postanesthesia care unit discharge time,arterial and jugular bulb venous blood samples were obtained for blood gas analysis,and arterial oxygen content,jugular bulb venous oxygen content,arteriovenous oxygen content difference,cerebral oxygen extraction rate,and the ratio of cerebral blood flow to cerebral oxygen metabolic rate were calculated.Results There were no significant differences between the two groups in arterial oxygen content,jugular bulb venous oxygen content,arteriovenous oxygen content difference,cerebral oxygen extraction rate,and the ratio of cerebral blood flow to cerebral oxygen metabolic rate.Conclusion Fluid restriction combined with small dose of norepinephrine produces no effects on cerebral oxygen metabolism in elderly patients undergoing gastrointestinal surgery.

Objective To evaluate the role of heparanase in endotoxemia-induced destruction of vascular endothelial glycocalyx in rats.Methods Forty-eight pathogen-free male Sprague-Dawley rats, aged 8-10 weeks, weighing 200-250 g, were randomly divided into 3 groups (n=16 each) using a random number table: control group (group C), lipopolysaccharide (LPS) group (group L) and LPS+ heparin group (group LH).Endotoxemia was induced by intravenous LPS 15 mg/kg in L and LH groups, and heparin sodium 100 U · kg-1 · h-1 was infused simultaneously in group LH.At 3 and 6 h after LPS injection, blood samples were collected from the femoral vein for determination of the serum concentrations of serum heparin sulfate (HS), syndecan-1, E-selectin and intercellular adhesion molecule-1 (ICAM-1) concentrations.The rats were then sacrificed, and lungs were removed for microscopic examination and for determination of wet/dry lung weight ratio (W/D ratio).Results Compared with group C, the serum HS, syndecan-1, E-selectin and ICAM-1 concentrations and W/D ratio were significantly increased in group L, and the serum HS and ICAM-1 concentrations were increased in group LH (P＜0.05).Compared with group L, the serum HS, syndecan-1, E-selectin and ICAM-1 concentrations and W/D ratio were significantly decreased in group LH (P＜0.05).The pathological changes of lungs were obvious in group L, and were significantly mitigated in group LH.Conclusion Heparanase is involved in endotoxemiainduced destruction of vascular endothelial glycocalyx in rats.

Objective To investigate the effect of curcumin an extract of a Chinese medical herb on the sensitivity of CD133 + rectal cancer cells to radiotherapy.Methods In vitro experiments:CD133 +cells were purified with immunomagnetic beads from HRT-18 cell line and divided into curcumin group,radiotherapy group and curcumin plus radiotherapy group.MTT assay and Annexin V/PI staining were used to measure the proliferation and apoptosis of the cells.In vivo experiments:Transplanted rectal tumor was established in 46 nude mice and randomly divided into curcumin group,radiotherapy group and curcumin plus radiotherapy group.Tumor size and apoptosis were detected by daily observation and TUNEL staining respectively.Results Curcumin inhibited proliferation and apoptosis of CD133 + rectal cancer cells when combined with radiotherapy.It also significantly increased the growth inhibition of rectal tumor and promoted the apoptosis of rectal cancer in vivo.MTT assay showed that after 24 hours,compared with that of radiotherapy group(14.6％ ± 1.0％),curcumin plus radiotherapy group (18.7％ ± 1.7％) inhibited the growth of the tumor(P ＜ 0.01).Annexin V/PI showed that curcumin plus radiotherapy group (28.8％ ±3.7％) was significantly different from the radiotherapy group(13.1％ ± 1.4％) in cell apoptosis (P ＜0.01).In vivo,after 6 days,tumor volume (521 ± 79) mm3 in curcumin plus radiotherapy group was significantly lower than that of radiotherapy group(717 ± 134) mm3 (P ＜ 0.01) ; TUNEL staining results indicated that the RCST in curcumin plus radiotherapy group (26.1％ ± 3.3％) were higher than that in radiotherapy group (12.0％ ± 2.1％) (P ＜ 0.01).Conclusions Curcumin significantly enhances the radiosensitizing effect for CD133 + rectal cancer cells.