Objective To investigate the changes of drug resistance and class Ⅰ integron in clinically isolated Pseudomonas aeruginosa(PA) in our hospital form January 2013 to December 2015.Methods Clinically isolated PA strains were divided into the 3 time periods of 2013,2014 and 2015.Their resistance to 22 commonly used antibacterial drugs was investigated by adopting the VITEK-2;200 strains were randomly selected from the isolated strains during these 3 time periods.Class Ⅰ integron was detect by PCR.Results The detected PA in these 3 time periods had 366,437 and 520 strains respectively.The drug resistance of Pseudomonas aeruginosa to 22 commonly used antibacterial drugs was remarkably increased(P<0.05),especially in ICU.The detection rate of class Ⅰ integron positive bacteria was gradually increased year by year,moreover the drug resistance rate of class Ⅰ integron positive bacteria was significantly higher than that of class Ⅰ integron negative bacteria (P<0.01).Conclusion The drug resistance rate of PA in this hospital is higher.The proportions of multi-drug resistance and classⅠ integron are significantly increased.The hospital infection detection and drug-resistant bacterial monitoring should be strengthened to further standardize the use of antibacterial drugs.

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.

Objective:To evaluate the identification rate of separating gel or HB&L pretreatment methods of MALDI-TOF-MS, thereby to provide a new idea for the rapid and accurate identification of pathogens of bloodstream infections in daily clinic practice.Methods:A total of 149 alarmed positive blood culture samples of single bacterial infection by routine laboratory methods were collected between January to December 2020 from the Sixth Medical Center, Chinese PLA General Hospital. Samples were pretreated with the separation gel accelerating tube method or the HB&L microbial culture system, followed by direct MALDI-TOF MS bacterial identification, the identification rates of the two pretreatment methods were compared and results from the traditional method were used as the standard control.Results:Among the 149 positive blood culture samples, 47.0% (70/149) were gram-negative (G -) bacteria and 53.0% (79/149) were gram-positive (G +) bacteria. Identification rate of G -strain level was 78.6% (55/70) by serum separation gel coagulation tube method and 91.4% (64/70) by HB&L microbial culture system, the difference was statistically significant ( P=0.033). Identification rate of G +strain levels was 73.4% (58/79) by serum separation gel coagulation tube method and 87.3% (69/79) by HB&L microbial culture system, the difference was statistically significant ( P=0.028). For G -bacteria in the range of 3.000-2.300, the identification rate was 22.9% (16/70) by serum separation gel accelerating tube method and 38.6% (27/70) by the HB&L microbial culture system, the difference was statistically significant ( P=0.044). For G +bacteria in the range of 3.000-2.300, the identification rate was 19.0% (15/79) by serum separation gel accelerating tube method and 34.2% (27/79) by the HB&L microbial culture system, the difference was statistically significant ( P=0.031). Conclusion:The identification rate of HB&L microbial culture system is higher than that of serum separation gel coagulation tube method. Direct MALDI-TOF MS identification of pathogenic bacteria in positive blood culture samples after pretreatment is feasible in daily clinical practice.

Objective To explore the relationships among post traumatic stress disorder(PTSD),gratitude and posttraumatic growth (PTG) for terminal cancer patients.Methods Totally 119 advanced cancer patients were investigated with the self-demographic questionnaire,posttraumatic growth inventory (PTGI),the PTSD cheeklist-civilian version (PCL-C) and the Gratitude Questionnaire-6 (GQ-6).Results For terminal cancer patients,the total score of PCL-C was 34.02±12.49.The scores on re-experience,avoidance/numbness,hypervigilance were 9.79±3.78,13.85±5.68,10.36±3.80.The total score of gratitude was 29.37±7.48.The total score of PTG was 51.34± 13.57.The scores of life appreciation,personal relationship and self-strength were 8.00± 2.99,21.18± 5.84,22.16± 6.10.The total scores of PTG were significantly statistical significance among different PTSD groups(F=16.267,P＜0.01)and gratitude groups(F=43.674,P＜0.0 1).The total scores of PCL-C (r=-0.694,P＜0.01),re-experience (r=-0.664,P＜0.01),avoidance/numbness (r=-0.671,P＜0.01),hypervigilance (r=0.753,P＜0.01) and gratitude(r=-0.611,P＜0.01) were all correlated with PTG.The total score of PCL-C and gratitude could explain 66.6％ variation of PTG.For the relationship between PTSD and PTG,the moderation effect of gratitude was not significant (P ＞0.05).Conclusion The gratitude and PTSD were important influence factors for terminal cancer patients' PTG,while the moderation effect of gratitude was not significant,so in clinical intervention we should pay more attentions to the actual effects of gratitude,and we should not pursuit gratitude education blindly.

Objective To investigate the distribution of pathogens in intensive care units (ICU ) and their drug resistance . Methods 668 strains of pathogens isolated from specimens from ICU were collected .VITEK 2 Compact automated microbial iden-tification and susceptibility analyzer was utilized to conduct the antimicrobial susceptibility tests .Kirby-Bauer disk diffusion suscep-tibility test(K-B) was employed to conduct the antimicrobial susceptibility test for Gram-negative bacteria cefoperazone/sulbactam . Results 668 strains of pathogens were derived from sputum [434 (65 .0% )] ,blood[83(12 .0% )] ,urine[88(13 .0% )] ,drainage [14(2 .0% )] ,secretions[14(2 .0% )] and other[35(5 .2% )] .Acinetobacter baumannii was the major detected pathogen in Gram-negative bacteria and the resistance rates were over 50% toward other drug excepting levofloxacin ,sulfamethoxazole and amikacin . Staphylococcus Staphylococcus was the major detected pathogen in Gram-positive bacteria and it showed good sensitivity toward ni-trofurantoin ,quinupristin/dalfopristin ,tigecycline and vancomycin .Candida albicans demonstrated the highest detection rate in fun-gi .Conclusion ICU pathogens have drug resistance in serious condition ,and pathogens and drug resistance monitoring should be strengthened .

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 A retrospective analysis was conducted on standardized laparoscopic left lateral sectionectomy in liver resection (LLLR) using the "Two Step Two Endo-GIA" procedure.The aim of the study was to improve safety and efficacy of the operation.Methods All patients who underwent LLLR in Department of General Surgery,the First Affiliated Hospital of Soochow University from May 2014 to July 2018 were included in the study.All patients were divided into laparoscopic group (n=56) and open group (n=44).The operative plan followed the standardized procedure used in our department.Results Of 56 patients,there were 28 males and 28 females.No hepatic hilar occlusion was required and no case was converted to laparotomy.The average age was (55.7± 13.0),tumor diameter (6.3±3.7) cm,liver dissection time (30.0± 10.9) min,intraoperative blood loss (142.3±22.8) ml,and postoperative length of hospital stay (6.1±2.4) d.The average follow-up was (36.6± 10.1) months.One patient developed mild bile leakage and recovered after drainage.The other patients had no serious postoperative complications.The laparoscopic group was superior to the open group in operation time (90.0±17.0 vs.129.3±38.8) min,fasting time (1.5±1.0 vs.2.1±1.1) d,TBil (13.0±2.6 vs.19.0±3.1) μmol/L and ALT (80.0±19.3 vs.200.0±32.1) U/L.Conclusion A standardized LLLR has the advantages of short operation time,good reproducibility and short learning curve.It can be used as a standard procedure at all hospital levels.

Objective:To investigate the clinical characteristics and treatment of the abdominal cocoon.Mehods:The clinical data of 28 patients with abdominal cocoon from Jan 2004 to Dec 2018 were analyzed retrospectively.Results:Intestinal obstruction was the main clinical manifestations (25 cases), recurrent chronic ileus(17 cases) and abdominal mass (7 cases). Preoperative imaging examination showed varying degrees of intestinal obstruction. CT or MRI scan displayed that small intestinal loops were disorganized , clustered and encased in a thickened capsule. All the cases underwent operations, showing that small bowel were encapsulated in a dense gray-white fibrous membrane. Adhesiolysis and fibrous membrane excision were done with segmental enterectomy when it was necessary. Early postoperative intestinal obstruction occured in 6 cases, all were cured by conservative treatment.Conclusions:The combination of clinical symptoms and CT or MRI may facilitate in preoperative diagnosis. Abdominal cocoon is putative diagnosis when recurrent intestinal obstruction with abdominal mass. Surgery is the therapy of choice.