Objective To investigate the distribution and drug resistance of pathogens of ventilator-associated pneumonia(VAP) in general intensive care unit(ICU).Methods Statistical methods were used to analyze retrospectively the data of pathogens and drug resistance of VAP in general ICU from 2004 to 2006.Results Totally 347 pathogens were isolated from deep-part secretion of lower respiratory tracts of 302 VAP in general ICU.The main pathogens included Pseudomonas aeruginosa(32.3%),Acinetobacter baumanii(31.1%),Staphylococcus aurous(16.7%),Klebsiella(7.5%) and Coagulase-negative Staphylococci(6.1%).Gram-negative bacillus showed a high resistance to piperacillin and Cefotaxime but high susceptibility to carbapenems and the enzyme inhibitor antibiotics.Gram-positive coccobacteria showed a high resistance to Penicillin,Clindamycin and Erythromycin but high susceptibility to Vancomycin and Quinolone.Conclusion Gram-negative bacillus was the main pathogen of VAP in general ICU,multidrug resistance was serious.The rate of methicillin-resistant staphylococcus aurous(MRSA) and methicillin-resistant coagulase-negative staphylococci(MRCNS) was high,with serious drug resistance.According to the data of the bacteria pathogen and antibiotics susceptibity,we can select antibiotics reasonably to control the infection and delay the emergency of new drug-resistant bacteria.

Objective To investigate and discuss the limb salvage strategies of malignant bone tumors in region S2 of shoulder girdle.Methods The data of 17 patients(13 males and 4 females)were retrospectivelv analyzed.All of them had malignant scapular tumor at least in region S2,and underwent limb salvage between January 2005 and January 2009.They aged from 14 to 55 years old(mean,32.6 years).The histologic types of them were chondrosarcoma in 6 patients,osteosarcoma in 4,fibrosareoma in 1,myeloma in 1,Ewing's sarcoma in 1,rhabdomyosarcoma in 1,non-Hodgkin lymphoma in 1,malignant giant cell tumor of bone in 1 and recurrent chondrosarcoma in 1.The tumors were staged according to Enneking surgical staging system:IB in 4 and IIB in 13.According to the MSTS classification system,the region S2 and lateral 1/3 of region S1 were effected in 11 cases,the region S2 and large part of region S1 were effected in 6 cases.The rotator cuff was involved to some extent in all patients,and the articular capsule were involved in 8 cases.Neo-adjuvant chemotherapy was given to 14 patients.The surgical strategies were depended on the range of tumor and preservation of articular capsule.The scapular prosthetic replacement was done in 8 cases with a relatively large range of tumor or resection of articular capsule,otherwise the scapular allograft replacement was done.Among the 11 cases with region S2 and lateral 1/3 of region S1 effected,the scapular allograft replacement was done in 9 cases with articular capsule preserved and the prosthetic replacement was done in 2 cases with articular capsule resected.And the prosthetic replacement was done in the other 6 cases.The articular capsule and partial rotator cuff were preserved and reconstructed preferentially.Results All patients were followed up 16-62 months (mean,35.1 months).Postoperative complications were noted in 9 patients, including mild allograft rejection and mild allograft resorption in 1 patient,allograft rejection in 1,prosthetic acromion exposure in 3,allograft resorption in 4.Local recurrence were noted in 1 patients.Three patients were dead because of extensive metastasis.The average function scores were 74.1%(range,53.3%-93.3%).Conclusion During the limb salvage surgery.it's very important to guarantee the en bloc resection of the tumor.In the meanwhile,the en bloc resection and functional reconstruction should be well balanced.

Objective To explore the predictive value of combined ABCD2 scores and tracheal constriction resulted from internal carotid atherosclerosis (ICAS) in cerebral infarction within 7 d of onset of a transient ischemic attack (TIA). Methods The clinical data of 171 patients with TIA,admitted to our hospital from September 2008 to March 2011, were retrospectively analyzed. All patients were evaluated with ABCD2 scale and degrees of tracheal constriction resulted from ICAS were examined by Color Doppler ultrasound.And 7-d follow-up of patients was performed to select those patients appearing cerebral infarction; and then, the relationships between risk of post-TIA cerebral infarction and both ABCD2 scores and degrees of tracheal constriction were analyzed using chi-square test. Results Among 171 TIA patients,39 (22.8％) suffered cerebral infarction within 7 d of onset of TIA.Significant difference of risk of post-TIA cerebral infarction was noted in patients with different ABCD2 scores and degree of tracheal constriction (P＜0.05): the higher the ABCD2 scores/ the degrees of tracheal constriction, the higher incidence of cerebral infarction in TIA patients. Conclusion A rather high accuracy may be achieved with ABCD2 scale in the prediction of short-term risk of cerebral infarction after onset of TIA,and a higher accuracy may be expected by combination of ABCD2 scale with carotid atherosclerosis findings.

A rapid, sensitive and simple liquid chromatography-tandem mass spectrometry (LC-MS/MS) method was developed and validated for the simultaneous determination of clevidipine butyrate and its primary metabolite clevidipine acid in dog blood. After one-step protein precipitation with methanol, the chromatographic separation was carried out on an Ecosil C18 column (150 mm x 4.6 mm, 5 µm) with a gradient mobile phase consisting of methanol and 5 mmol · L(-1) ammonium formate. A chromatographic total run time of 13.0 min was achieved. The quantitation analysis was performed using multiple reaction monitoring (MRM) at the specific ion transitions of m/z 454.1 [M-H]- --> m/z 234.1 for clevidipine butyrate, m/z 354.0 [M-H]- --> m/z 208.0 for clevidipine acid and m/z 256.1 [M-H]- --> m/z 227.1 for elofesalamide (internal standard, IS) in the negative ion mode with electrospray ionization (ESI) source. The linear calibration curves for clevidipine butyrate and clevidipine acid were obtained in the concentration ranges of 0.5-100 ng · mL and 1-200 ng · mL(-1), separately. The lower limit of quantification of clevidipine butyrate and clevidipine acid were 0.5 ng · mL(-1) and 1 ng · mL(-1). The intra and inter-assay precisions were all below 12.9%, the accuracies were all in standard ranges. Stability testing indicated that clevidipine butyrate and clevidipine acid in dog blood with the addition of denaturant methanol was stable under various processing and/or handling conditions. The validated method has been successfully applied to a pharmacokinetic study of clevidipine butyrate injection to 8 healthy Beagle dogs following intravenous infusion at a flow rate of 5 mg · h(-1) for 0.5 h.
Animals ; Butyrates ; blood ; pharmacokinetics ; Calibration ; Chromatography, Liquid ; Dogs ; Infusions, Intravenous ; Pyridines ; blood ; pharmacokinetics ; Tandem Mass Spectrometry

The study was aimed to investigate the clinical significance of serum lactate dehydrogenase (LDH), β2-microglobulin (β2-MG) and vascular endothelial growth factor (VEGF) detection in non-Hodgkin's lymphoma (NHL) patients. 58 newly diagnosed NHL patients from January 2010 to December 2011 in our hospital were selected as the study group (NHL group) and 58 healthy individuals were selected at the same time as a control group. Serum LDH level was determined by a biochemical method, while β2-MG and VEGF levels were determined by enzyme-linked immunosorbent assay. The results showed that as compared with control group, the LDH, β2-MG and VEGF levels in NHL group were significantly higher (P < 0.05). In NHL group, the LDH and VEGF levels at different pathological types and clinical stages changed remarkably. Compared with low grade patients, the LDH and VEGF levels of intermediate grade and high grade patients were significantly higher (P < 0.05). As compared with patients at stage I, the LDH and VEGF levels of patients at stage II, III and IV increased significantly (P < 0.05). Out from 58 cases in NHL group, 30 cases (51.72%) showed LDH-positive, 39 cases (67.24%) showed β2-MG positive and 29 cases (50.00%) showed VEGF-positive. It is concluded that some significant changes of serum LDH, β2-MG and VEGF appears in NHL patients, detection of these 3 tumor marker levels may be help to clinically grading patients with NHL.
Adult ; Aged ; Case-Control Studies ; Female ; Humans ; L-Lactate Dehydrogenase ; blood ; Lymphoma, Non-Hodgkin ; blood ; Male ; Middle Aged ; Neoplasm Grading ; Vascular Endothelial Growth Factor A ; blood ; Young Adult ; beta 2-Microglobulin ; blood

Aged ; Female ; Humans ; Male ; Middle Aged ; Multiple Myeloma ; diagnosis ; immunology ; Prognosis ; T-Lymphocyte Subsets ; immunology

OBJECTIVETo evaluate the efficacy and safety of high-dose dexamethasone-based regiments in newly diagnosed multiple myeloma patients with renal impairment.

METHODSThe clinical data of 22 patients with newly diagnosed multiple myeloma patients with renal impairment who received high-dose dexamethasone-based regiments from August 2006 to August 2008 in Peking Union Medical College Hospital were retrospectively reviewed.

RESULTSAfter receiving a median 4 cycles of high-dose dexamethasone-based regiments, renal impairment was reversed in 7 patients (31.8%) with a median time to reversal of 31 days. Sixteen patients (72.7%) achieved overall response, including 7 patients (31.8%) had complete remission / near complete remission. The grade 3 or 4 adverse events included neutropenia (13.6%), infections (22.7%), peripheral neuropathy (9.1%), and ileus (4.5%).

CONCLUSIONThe high-dose dexamethasone-based regiments are safe and effective for newly diagnosed multiple myeloma patients with renal impairment.

Aged ; Antineoplastic Combined Chemotherapy Protocols ; adverse effects ; therapeutic use ; Dexamethasone ; administration & dosage ; Female ; Humans ; Male ; Middle Aged ; Multiple Myeloma ; complications ; drug therapy ; Prognosis ; Renal Insufficiency ; complications ; Retrospective Studies ; Treatment Outcome

Because of different display parameters and other factors, digital medical images present different display states in different section offices of a hospital. Based on CPI integration profile of IHE, this paper implements the consistent presentation of medical images, and it is helpful for doctors to carry out medical treatments of teamwork.
Computer Simulation ; Diagnostic Imaging ; Integrated Advanced Information Management Systems ; Medical Informatics Computing ; standards

Autism spectrum disorder (ASD) is a complex neurodevelopmental disorder, with multiple genetic and environmental risk factors. The interplay between genetic and environmental factors has become the subject of intensified research in the last several years. Vitamin D deficiency has recently been proposed as a possible environmental risk factor for ASD. Vitamin D has a unique role in brain homeostasis, embryogenesis and neurodevelopment, immunological modulation (including the brain's immune system), antioxidation, antiapoptosis, neural differentiation and gene regulation. Children with ASD had significantly lower serum levels of 25-hydroxy vitamin D than healthy children.Therefore vitamin D deficiency during pregnancy and early childhood may be an environmental trigger for ASD.
Child Development Disorders, Pervasive ; etiology ; genetics ; Embryonic Development ; Homeostasis ; Humans ; Vitamin D ; physiology ; Vitamin D Deficiency ; complications