Objective To understand the current situation of multidrug-resistant organism (MDRO)infection in hospitalized patients in a tertiary first-class hospital,as well as efficacy of bundle intervention measures on preven-tion and control of infection. Methods Hospitalized patients who were infected with MDROs in this hospital during 2012-2014 were monitored and conducted bundle intervention. Results In 2012-2014,a total of 1909 MDRO strains were isolated. The isolation rates of MDROs in 2012-2014 were 30.69% ,31 .04% ,and 29.40% respec-tively,bedside intervention rates were 81 .02% ,92.05% ,and 94.23% respectively,implementation rates of clinical isolation were 69.97% ,82.98% ,and 93.04% respectively;MDRO isolation rates during 2012-2014 were not sig-nificantly different(P>0.05);bedside intervention rates and implementation rates of clinical isolation were both sig-nificantly different(both P<0.05). The top 3 isolated MDROs in 2012-2014 were extended-spectrumβ-lactamases (ESBLs)-producing Escherichia coli,multidrug-resistant Acinetobacter baumannii,and ESBLs-producing Klebsiel-lapneumoniae. Conclusion Bundle intervention measures,such as multi-department collaboration and strengthened on-site supervision,can promote more standardized management of healthcare-associated infection,enhance the im-plementation rate of clinical isolation,and effectively prevent and control the spread of MDRO in hospital.

Sentinel lymph node (SLN) is the first group of lymph nodes to receive breast lymph nodes and the first group of lymph node metastasis. It can accurately predict the metastatic status of axillary lymph nodes, which is an important reference factor in the diagnosis and treatment of breast cancer. It has become the first choice for early breast cancer staging. The rapid and accurate intraoperative localization and diagnosis of SLN is of great significance for the choice of operation mode and the improvement of therapeutic effect. SLN location and diagnostic methods are still needed to be investigated. This article reviews various methods in clinic recently.

Objective To determine the expression of two neuron developmental associated genes induced by hyperphenylalanine.Methods Primary embryonal rat cerebral cortical neurons were cultured for three day and cells induced by hyperphenylalanine for 12 hours.Real time quantitative RT-PCR was used to determine the influence of hyperphenylalanine on the expression of GAP-43 and Go?1 genes.Results GAP-43 mRNA was upregulated to 2.25 times and Go?1 was downregulated to 3.31 times by hyperphenylalanine.Conlusion Hyperphenylalanine may interfere the normal development of cerebral cortical neurons through influencing the expression of GAP-43 and Go?1 genes.

Objective To understand the occurrence of surgical site infection (SSI)following class I incision operation in a tumor hospital,explore the continuous surveillance and improve effectiveness,so as to provide reference for further inter-vention.Methods Targeted surveillance on thyroid surgery patients undergoing classⅠincision operations in a hospital in January-June 2013 were performed by medical record review,bedside observation,dressing change observation and patient follow-up,the surveillance result was compared with that of the same period of 2010.Results There was one case of SSI in January-June 2013 and January-June 2010 respectively,SSI rate was 0.20% and 0.18% respectively,there was no significant difference(P =1.000).In January-June 2013,prophylactic perioperative antimicrobial usage rate was 0.20%,which was lower than 27.21% of 2010;the coincident rate of indication for antimicrobial use was 100%, which was higher than 6.67% of 2010,the difference was statistically different(all P <0.001).Conclusion Targe-ted surveillance on SSI is helpful for the rational perioperative use of antimicrobial agents,the reducing of antimicro-bial prophylactic use doesn’t lead to the increase of class Ⅰ incision SSI.

Based on the principle of training students for rural areas and serving for grass roots,Mudanjiang medical college cultivates talents mainly from countryside and rural areas,thus it is of great importance to build up decent and accurate values for those will-be doctors who heal the wounded and prevent and cure diseases.As well as enhancing their professional qualifications,medical college teachers should also cultivate students' world view,philosophy,values,responsibility,occupational ethics,and a scientific development outlook.

Dried Blood Spot Testing ; Gaucher Disease ; diagnosis ; Humans

Objective To investigate the clinical characteristics,peripheral insulin sensitivity,and β-cell function in patients with ketosis-prone diabetes(KPD).Methods Thirty-one patients with newly diagnosed ketosisprone diabetes were admitted to West China Hospital from January 2004 to December 2009.They were divided into 2 groups according to their body mass index (BMI):OB-KPD (BMI ≥ 25 kg/m2,n =22) and Lean-KPD (BMI ＜ 23 kg/m2,n =9).10 patients with newly-onset type 2 diabetes free from ketosis (OB-DM:BMI ≥ 25 kg/m2,n =10) were enlisted as control.Detailed assessments of medical history and symptoms of hyperglycemia were performed.The islet cell antibody (ICA),insulin autoantibody (IAA),anti-glutamic acid decarboxylase antibody (GAD-Ab),fasting plasma glucose,serum insulin,C-peptide and free fat acids concentrations were measured.All of the subjects underwent oral and intravenous glucose tolerance tests,euglycemic-hyperinsulinemia and hyperglycemia clamp test,to evaluate the insulin secretion and insulin sensitivity respectively.Insulin sensitivity was determined by glucose disposal rate (GDR) of steady state during euglycemic clamp and acute insulin secretion was calculated by insulin area under curve(AUCins 0-10 min) during IVGTT.Maximal insulin secretion was determined by glucose infusion rate (GIR) and serum insulin concentration of steady state during hyperglycemic clamp test.Results Age,sex,duration of diabetes were matched among groups.A family history of diabetes was strongly associated with those patients with obesity,compared with lean ketosis prone diabetes(16/22 vs 1/9).GDR was (4.91 ± 1.82) mg · kg 1 · min-1 in subjects with OB-KPD,being lower than that in Lean-KPD patients[(6.26 ± 1.89) mg · kg 1 · min-1] and OB-DM group[(6.78-± 1.69) mg · kg 1 · min-1,P＜0.01].Serum insulin and C-peptide in OB-KPD patients were higher than Lean-KPD patients.Area under the insulin curve [AUCins0-10min (183.86 ± 31.1) mIU/L] and GIR[(2.65 ±1.53) mg · kg-1 · min-1] in OB-KPD patients were lower than those in OB-DM group[(697.06-± 231.9) mIU/L,(6.53 ± 2.21)mg · kg 1 · min-1,P＜0.0 1],but slightly higher than the Lean-KPD group [AUCins0 10min (92.1 ±29.8) mUU/L,GIR (2.55 ± 1.49) mg · kg 1 · min-1,P＜0.05].Glucose disposal rate (GDR) was strongly associated with casual plasma glucose (r =-0.502,P＜0.01),HbA1C(r =-0.553,P＜0.0 1) and FFA eoneentrations (r=-0.504,P＜0.01) on admission.Conclusions Insulin resistance and β-cell dysfunction coexist in all KPD patients.OB-KPD patients exhibit more severe insulin resistance,while Lean-KPD patients have lower insulin secretion.KPD patients had severe hyperglycemia,hypertriglyceridemia,and high plasma FFA levels on admission,suggesting that hyperglycemia and elevated FFA levels could result in serious insulin resistance,β-cell dysfunction,and diabetic ketosis in patients with KPD.

ObjectiveTo compare the preventive effects oftramadol and ketamine on the patients with postoperative hyperalgesia after remifentanil-induced neurosurgical anesthesia.MethodsOne hundred and fifty patients undergoing craniotomy were assigned to tramadol group,ketamine group and normal saline group with 50 cases each by random digits table.Anesthesia was maintained with infusion of remifentanil [0.1-0.2μ g/( kg· min ) ],propofol and sevoflurane.Tramadol ( 1.5 mg/kg),ketamine (0.5 mg/kg) or normal saline was given before skin closing.The emergence time,trachea extubation time,patients required analgesia and tramadol consumption,reverse effect were recorded.The visual analog scale (VAS),Ramsay scores at 15,30,60,120 minutes after emergence were performed.ResultsPatients required analgesia and tramadol consumption in tramadol group and ketamine group were significantly lower than those in normal saline group (P ＜0.01 or ＜0.05 ).The occurrence of shiver in tramadol group was lower than that in normal saline group (P ＜0.05).VAS scores in tramadol group at 15,30 minutes and in ketamine group at 30 minutes after emergence were significantly lower than those in normal saline group (P＜ 0.05).Ramsay score in ketamine group at 15 minutes after emergence was higher than that in tramadol group and normal saline group [ (2.9 ±0.6) scores vs.(2.3 ±0.7) scores and (2.3 ±0.9) scores](P＜0.01).ConclusionTramadol has a goodpreventive effect for postoperative hyperalgesia induced by remifentanil in neurosurgery compared with ketamine.

ObjectiveTo investigate the incidence of postoperative residual paralysis and respiratory function of patients undergoing neurosurgical anesthesia.Methods Three hundred andtwenty-eight patients undergoing neurosurgical anesthesia (ASA Ⅰ - Ⅱ ) were divided into vecuronium group (135 cases) and rocuronium group (193 cases) by random digits table.Anesthesia was maintained with propofol in combination with sevoflurane and intermittented intravenous infusion boluses of muscle relaxatant.Extubation of the intratracheal tube in operation room was performed under clinical criteria.The neuromuscular function were detected by acceleromyography with supramaximal train-of- four(TOF) stimulation of the ulnar nerve,and pulmonary function were measured in postanesthesia care unit(PACU).The TOF ratio and pulmonary function were compared between two groups.ResultsThe incidence of postoperative residual paralysis was 31.9％(43/135) in vecuronium group,and 14.5％(28/193) in rocuronium group.Hypoxemia and hypercapnia occurred in vecuronium group with TOF ＜ 0.9 were higher than in those with TOF ≥0.9[7.0％(3/43) vs.4.3％(4/92) and 44.2％(19/43) vs.18.5％(17/92),P ＜ 0.01 ],while in rocuronium group with TOF ＜ 0.9 were higher than in those with TOF ≥ 0.9 [ 3.6％( 1/28 ) vs.1.2％ (2/165) and 39.3％( 11/28 )vs.17.0％ (28/165),P ＜ 0.01 ].ConclusionsThere is a high incidence of postoperative residual paralysis according to the clinical criteria of recovery of neuromuscular function of patients undergoing neurosurgical anesthesia,which would impair respiratory function.

The effects of elevated levels of glucose and (or) free fatty acids on insulin secretion were studied in obese rats by intravenous glucose tolerance test and isolated pancreas perfusinn. The results showed that both glucose- and arginine-stimulated insulin secretions were severely impaired by glucolipotoxicity and the production of ketone was increased dramatically.