Objective To review the prevalence of nosocomial infection and the change of drug resistance in a comprehensive intensive care unit (ICU) and to provide theoretical basis for clinical prevention and treatment.Methods The strains of bacteria and fungi were isolated from ICU and their drug resistance was retrospectively analyzed from Jan.1st,2010 to Dec.31th,2011.Results The main pathogen of nosocomial infection were Gram-negative bacteria ( 73.3％ ),Gram-positive bacteria ( 17.9％ ) and fungi ( 8.7％ ).In bacterial infection,Gram-negative and G-positive bacteria accounted for 80.3％ and 19.7％ respectively.In Gram-negative bacteria,pseudomonas aeruginosa was the major type (21.7％).In Gram-positive bacteria,staphylococcus aureus (31.4％) was most prominent.Drug resistance of bacteria was severe,while that of fungi was mild.Conclusion Bacteria has severe drug resistance and exhibits multi-drug resistance for commonly used antibiotics.The principle of antibiotics application should be mastered and antibiotics should be chosen according to drug-sensitivity tests.

OBJECTIVE To investigate the distribution and drug resistance of pathogenic bacteria in blood culture,and provide a basis for clinical treatment.METHODS The blood samples were poured into the blood culture bottles of Beijing Botai Technique Development Center,and cultured with BacT/Alert 3D automated blood culture system.Isolated bacteria were identified by the VITEK system.Drug sensitivity was tested by the BIOMIC.RESULTS From Jan 2003 to Dec 2007,607 strains of pathogenic bacteria were isolated from 4116 clinic blood specimens,the positive rate was 14.8%,Gram-negative bacteria were the most common pathogens then Gram-positive bacteria and fungi.The sensitivity of Gram-negative bacteria to imipenem/cilastatin(TPM) was the best,the next was FEP;the sensitivity of Gram-positive bacteria to teicoplanin(TCN) was the best,Second was VAN.CONCLUSIONS Drug resistance of isolated pathogenic bacteria in blood cultures is very serious.Monitoring the change of pathogens and trends of drug resistance is very important in guiding the clinical use of drug.

Aim To investigate the effect of total flavonoids of Epimedium sagittatum(TFE)and its metabolites on the proliferation and function expression of newborn rats calvarial osteoblasts(ROB).Methods TFE was supplemented into the culture medium of ROB at 0.2,2,20,100 and 200 mg?L-1 respectively.The serum of rats administered TFES(SRAT) was also added into the medium in a parallel treatment at 2%,4%,8% and 16% respectively.Their effects on cell proliferation and function expression were studied by MTT and the analysis of osteogenic differentiation marks.Results TFE had no effect on cell proliferation and function expression at any concentration.However,2% and 4% SRAT stimulated cell proliferation and,4% SRAT promoted the maturation and function of osteoblast by improving the alkaline phosphatase(ALP) activity,bone gla protein(BGP) secretion,calcium deposition and the number of mineralized nodular structures.Conclusions The effective substance of herba epimedii treating on osteoporosis is not TFE itself but certain of metabolites derived from TFE and the products induced by these metabolites in serum.The metabolites in serum of TFE may enhance the cell function expression and proliferation.

Objective To discusses the feasibility of selective mini-cholecystolithotomy in treatment of gallstones .Methods To retrospectively analyzes the clinical data of the function good gallstones patients who treatmented by mini-cholecystolithotomy .Re-sults 4 cases treatmented by Laparoscopic cholecystectomy because of the severe cholecystitis ,1 case treatmented by laparoscopic cholecystectomy because of the severe adhesion around the gallbladder .51 cases treatmented by mini-cholecystolithotomy .In the fol-low-up of 1-3 years ,1 case of recurrence ,and the recurrence rate was 1 .96% .Conclusion The mini-cholecystolithotomy is a safe , effective ,feasible ,minimally invasive treatment method in treatmented gallstones ,but should be strictly grasp the surgical indica-tions .

Objective To discusses the clinical application value and safety of endoscopic minimally invasive cholecystolithotomy in gallstones treatment .Methods To retrospectively analyzes the clinical data of 94 patients with gallbladder stone from Feb .2010 to Feb .2013 ,and divided into endoscopic minimally invasive cholecystolithotomy (EMIC) group (46 cases) and laparoscopic chole-cystectomy (LC) group (48 cases) .Observed two groups of operation time ,intraoperative blood loss ,intraoperative bile duct inju-ry ,anal exhaust time ,postoperative hospitalization time ,bile reflux gastritis ,abdominal distention ,diarrhea ,common bile duct calculi and hospitalization expenses ,etc .Results Two groups of operation time ,hospitalization expenses ,length of hospital stay ,and intra-operative blood loss have no obvious difference(P>0 .05) ,in EMIC set ,the exhaust time ,postoperative bile duct calculi incidence , intraoperative bile duct injury ,bile reflux gastritis incidence and the incidence of abdominal distension ,diarrhea are significantly less than LC group (P<0 .05) .Conclusion The endoscopic minimally invasive cholecystolithotomy compared with laparoscopic chole-cystectomy had high security ,light pain ,quicker recovery ,less complications advantages .It has already achieved the purpose of min-imally invasive treatment ,while maintaining the integrity of bile duct and gallbladder function ,thus it is worthy of promoting .

Objective To investigate the clinical value of intraoperative cholangiography( IOC) by cystic duct during laparoscopic chol-ecystectomy( LC) . Methods The clinical data of 58 patients with LC received intraoperative cholangiography by cystic duct were analyzed retrospectively. Results In this group,Successful treatment of 55 cases(94. 83%),failed in 3 cases(5. 17%),no common bile duct calculi in 50 cases(90. 91%),small common bile duct calculi(0. 4 cm) in 5 cases(9. 09%). Among them 4 cases were received common bile duct exploration via laparotomy,1 case treated by laparoscopic transcystic biliary calculus extraction with Dormia basket. The cystic duct drained into the right hepatic duct in 1 patient. In all the cases,no bile duct injury,residual choledocholith,bile leakage,intra-abdominal infection and IOC related complications. Conclusion IOC during LC is simple and easy,with high success rate and good development effect,which can promptly discover the anatomical variations of biliary tract. It has important clinical application value to reduce biliary negative exploration,in-traoperative injury of biliary tract and postoperative common bile duct residual stone in basic hospital.

ObjectiveTo estimate the applications of ADC value and rADC value in the diagnosis of nodular lesions of breasts.Methods Fifty-two cases with 66 nodular lesions of breasts confirmed by histopathology underwent diffusion-weighted magnetic resonance imaging.Three b values (0,800 and 1000 s/mm2) were applied.The mean ADC values of the breast nodules,the ADC values of ipsilateral breast( rADC1 )and ADC values of contralateral breast (rADC2 )were respectively measured.The independent-samples t-test and chi-square test were used for statistical analyses.ResultsOf the 52 patients,there were 18 patients with infiltrating ductal carcinoma and 34 patients with fibroadenoma.50 patients with 64 lesions were examined by DWI.( 1 ) at b = 800 s/mm2,the mean ADC values of malignant nodules [ ( 1.01 ±0.09) × 10-3 mm2/s],rADC800-1 (0.52 ±0.07)and rADC800-2 (0.51 ±0.06) were lower than that of the benign nodules [ ADC value = ( 1.54 ± 0.28 ) × 10 -3 mm2/s,t = 8.217,P ＜ 0.01 ; rADC800-1 =0.77 ±0.15,t =9.339,P＜0.01 ; rADC800-2 =0.76 ±0.14,t = 10.394,P ＜0.01 ].The one-side upper limits of 95％ medical reference value of mean values of infiltrating ductal carcinoma were adopted as the threshold point to distinguish the malignant from the benign.The threshold value of breast malignant nodule ADC,the rADC800-1 and rADC800-2 were respectively 1.05 × 10-3 mm2/s,0.55 and 0.53.The sensitivities of the three methods were 75.0％,65.0％ and 60.0％ ; the specificities were 100.0％,95.7％ and 97.8％ ;the positive predictive values were respectively 100.0％,86.7％ and 92.3％ ; the negative predictive values were 90.2％,86.3％ and 84.9％; the diagnosis accordance rates were respectively 92.4％,86.4％ and 86.4％.( 2 ) at b = 1000 s/mm2,the mean ADC values of malignant nodules [ ( 0.93 ± 0.08 ) ×10-3 mm2/s],rADC1000-1 (0.53 ±0.09) and rADC1000-2 (0.52 ±0.07) were also lower than that of the benign nodules[ ADC value= (1.45 ±0.28) ×10-3 mm2/s,t=11.844,P＜0.01; rADC1000-1 =0.75 ±0.16,t=5.820,P ＜ 0.01 ; rADC1000-2 = 0.74 ± 0.15,t = 8.082,P ＜ 0.01 ].The threshold value points breast malignant nodule ADC,the rADC1000-1 and rADC1000-2 were respectively 0.97 × 10-3 mm2/s,0.58,0.55.The sensitivities were all 70.0％ ; the specificities were respectively 100.0％,95.7％ and 93.5％ ;the positive predictive values were 100.0％,87.5％ and 82.4％ ; the negative predictive values were 88.5％,88.0％ and 87.8％ ; the diagnosis accordance rates were 90.9％,87.9％ and 86.5％ respectively.There were no significant differences in specificities and the diagnosis accordance rates ( x2 = 1.232,2.263 ; P =0.942,0.812 ).Conclusions ADC value and rADC value are both important parameters of MRI in differentiating benign and malignant breast diseases.The study indicated that ADC value ( at b =800 s/mm2) was the most valuable parameter.

e thickness and axial MPR images with 7 mm reformatted slice thickness is the optimal protocal.

Objective To investigate the clinical distribution situation and drug resistance change of Klebsiella pneumoniae in the Navy General Hospital during 2011‐2015 in order to provide reference for rational use of antibacterial agents in clinic .Methods The clinically isolated Klebsiella pneumoniae in this hospital during 2011‐2015 were selected and performed the analysis on the de‐tection rate ,department distribution ,specimens source ,resistance of antibacterial drugs and change trend of resistance to carbapen‐em antibacterial drugs .Results The number the detected Klebsiella pneumoniae strains and isolation rate during 2011 -2015 showed an increasing trend year by year ,the specimens sources were mainly from 10 departments of intensive care units(ICU) ,hy‐perbaric oxygen department ,respiratory department ,radiation oncology department ,kidney disease department ,etc .;the submitted specimens were dominated by sputum and urine ,accounting for 59 .7% and 21 .4% of submitted specimens ;the drug resistance of Klebsiella pneumoniae during 2011‐2015 showed the increasing trend year by year .Klebsiella pneumoniae had higher resistance rates to piperacillin ,ampicillin ,ampicillin/sulbactam and cefuroxime and had lower resistance rate to amikacin ,imipenem ,meropen‐em and tobramycin ;the resistance rates to imipenem and meropenem were increased year by year ,and pan‐drug resistant Klebsiella pneumoniae showed a rapidly rising trend .Conclusion The drug resistance of Klebsiella pneumonia is serious ,especially carbapene‐ms‐resistant Klebsiella pneumoniae is significantly increased in the recent years ,therefore its drug resistance monitoring should be strengthened for guiding rational drug use in clinic .

Objective To classify the accessory fissures and assess the frequency of accessory fissures of the lung by 64-slice spiral CT (MSCT). Methods Of 2664 patients, 847 patients were included in this study excluding the patients with pulmonary parenchymal distortion, pleural disease or lobectomy. Allvolume raw data with a slice thickness of 0.6 mm were reformatted in sagittal and coronal orientations with 3 mm thickness and the accessory fissures were assessed. Results A total of 177 accessory fissures in 144 patients (17.0%) were detected. Most of the accessory fissures were incomplete except 10 fissures on the right lung (8.2%) and 2 fissures on the left lung (3.6%) were complete. The most common fissurewas the superior accessory fissure on the right low lobe (n = 112,13.2%) ,followed by the left minor fissure (n= 51,6.0%), the right inferior accessory fissure( n = 6,0. 7% ), the left superior accessory fissure ( n =4, 0.5%), the azygos fissure (n = 3,0.4%) and the accessory fissure on the right upper and middle lobe(n = 1,0.1%). Conclusion 64-slice CT is an efficient method to observe and classify the accessory fissures of the lung with MPR technique and can provide reliable and useful imaging information for the clinician.