Objective To investigate the distribution and drug resistance state of Pseudomonas aeruginosa, so as to offer reasonable experimental data for clinical therapy. Methods A statistic analy- sis for the specimen souree, distribution of infected departments and drug resistance state to 441 iso- lates was conducted in a retrospective way. Results Among 441 strains, 357 (80. 95%) were isolated from sputum species. The department with the highest isolating rate was ICU (26.5%), followed by department of respiratory disease (20. 63 %), department of neurosurgery (19.05 %) and department of geriatrics (17. 01%). The most sensitive antibiotic was Meropenem, which total drug resistance rate was 13. 61%; the most insensitive antibiotic was ampicillin-sulbactam, which total drug resistance rate was 91.38%. The drug resistance rate of P. Aeruginosa was increasing year by year. Conclusion Clinical isolates of P. Aeruginosa mostly come from sputum samples and ICU, and they are highly and multidrug resistant to various antibiotics.

Objective To investigate the method and clinical effect of interventional treatment on placenta increta.Methods Fifteen patients with placenta increta were treated interventionally through uterine artery.and Methotrexate 50-100 mg were superselectively infused.Then gel foam particulate or stripes were used for embolization of uterine artery.The therapeutic effect,prognosis and side effects were observed and analyzed.Results All patients underwent uterine artery embolization (UAE) .One week after UAE,curettage was successfully performed.No heavily hemorrhage nor hysterectomy occurred.Conclusion Transcatheter uterine artery intervention is simple,safe and effective with highly successful rate and has little side effects for the treatment of placenta increta.

Objective To investigate the impact of PET-CT on the target volume delineation and precise radiothera?py planning for patients with advanced non-small cell lung cancer (NSCLC). Methods PET-CT scanning was performed in 30 histologically proved NSCLC patients. The gross tumor volume (GTV) was delineated, and radiotherapy planning was es?tablished with identical parameters based on the CT image and PET-CT fused image, respectively. The differences of doses between GTV, planning target volume (PTV) and organsat rise (OAR) were compared. Results PET-CT image results changed the target volume delineation in 30 patients with 8 increased and 22 decreased. There were no differences in GTV and PTV between the VGTV and VPTV statistically, although PET-CT image changed conventional CT image size sketch of GTV and PTV. The V20 of total lung decreased in the PlanPET-CT compared with that of PlanCT (P<0.05), but no differences were found in the V30 of total lung, mean lung dose (MLD), the data of spinal cord, esophagus and heart. Conclusion PET-CT may reduce the radiation injuries in the lung and improve the target dose.

Objective:To inspect the relationship between the therapeutic effect of DHA on lupus nephritis and the negative immune regulation of TLR4/NF-κB signal pathway which was induced by SIGIRR;in vitro,to observe the effect of DHA on damaged HK-2 cell.Methods: In vivo,MRL/lpr mice were divided in model group,DHA groups(25,50,100 mg/kg),positive group (prednisone,5 mg/kg),and C57BL/6 mice were taken as control group.Administrate drugs daily for 12 weeks.Examine the changes in renal pathology;the expression of SIGIRR,IRAK1,TRAF6 in kidneys were determined by Western blot.In vitro,treat human renal tubular epithelial cell HK-2 cells with LPS ,and co-culture cells with DHA at the concentration of 0.67 μg/ml to 6.00 μg/ml for 6 h, 12 h and 24 h.Detect SIGIRR expression by Western blot and the level of IL-6 and CCL2 of HK-2 cells by ELISA.Results:In vivo, renal pathology revealed that kidneys of model group were damaged , while treatment with 100 mg/kg DHA alleviated renal injury.Compared to model group ,SIGIRR expression of DHA 100 mg/kg group increased a little ,and the expression of this protein had a tendency to increase with the augment of DHA dose .In vitro,DHA treatment reduced secretion of CCL 2 in HK-2 cells,and treatment of 0.67 μg/ml DHA for 24 h increased SIGIRR expression significantly , which also showed a growing expression with time.Conclusion:DHA could inhibit development of mouse lupus nephritis through increasing SIGIRR expression which inhibited TLR4/NF-κB signal pathway;DHA inhibited CCL2 secretion of HK-2 cells which were irritated by LPS ,and it may be associated with increased expression of SIGIRR .

Objective To evaluate the therapeutic effcacy with CT-guided percutaneous radiofrequency ablation(RFA)for the liver tumor.Methods 60 cases of patients with a total of 73 lesions were treated with radio-frequency ablation.The diameter of the lesions was 1.4～7.0cm.with a mean diameter of 4.2cm.The therapeutic efficacy was evaluated with enhanced CT scanning and AFP.Results 45 patients of 60 cases with lesions were full damaged,no blood flow Was found on enhanced CT scans.39 patients with significantly increased blood-AFP before treatment were decreased significantly after treatment,Complications occured in 11 patients,including refractory hiccup (n=2),epidermal scald(n=3),intrahepatic hemorrhage(n=2)and hepatic abscess(n=1).Conclusion The radiofrequency ablation was simple and effective treatment of liver tumor.The effect could be similar to that of surgical resection.

Objective To summarize the therapeutic results and experience of the interventional managements for pseudoaneurysms occurred after surgery. Methods Five pseudoaneurysms with different location that occurred after surgery in five patients were treated with different interventional managements. One patient suffered from a ruptured pseudoaneurysm of left common iliac artery, which was treated by obstructing the diseased artery with balloon via the abdominal aorta followed by the replacement of vascular prostheses. One patient had a pseudoaneurysm of right subclavian artery and endovascular covered stent was employed to isolate it. The remaining three patients were affected by pseudoaneurysm of terminal arteries and intraarterial embolization with gelfoam and/or steel coils was camed out. Results Complete closing of the pseudoaneurysm was obtained in all five patients and no therapy-related complications occurred. Conclusion Pseudoaneurysms occurred after surgery can be effectively treated with different interventional managements, it is worth popularizing this technique in clinical practice.

Objective:To explore the early diagnostic value of serum procalcitonin(PCT),C-reactive protein (CRP) and endotoxin in patients with sepsis caused by bacterial bloodstream infection.Methods:Retrospectively analyzed 123 cases of patients diagnosed with sepsis induced by bacterial bloodstream infection in our hospital from May 2010 to May 2015,detected their serum PCT,CRP and endotoxin levels,and analyzed the evaluation value of these three indexes for sepsis induced by bacterial bloodstream infection by receiver-operating characteristic curve (ROC).Results:Blood sample culture results showed that 123 cases of bacterial bloodstream infections caused by sepsis patients in the presence of infection of G+bacteria were 35 cases,G-bacteria infection of 88 cases;The levels of three index in the G+bacteria group were significantly lower than that in the G-bacteria group (P＜0.05);The serum PCT,CRP and endotoxin levels was positive correlated with each other among G+bacteria group,G-bacteria group and all bacteria group;ROC curves showed that the cutoff value of serum PCT,CRP and endotoxin for diagnosis of patients with sepsis induced by G+bacteria bloodstream infection were 1.58 μg/L,95.25 mg/L and 16.71ng/L,and their sensitivity and specificity were (65.92％,88.37％),(67.39％,84.38％) and (56.34％,78.93％) respectively;and the cutoff value for diagnosis of patients with sepsis induced by G-bacteria bloodstream infection were 2.45 μg/L,79.45 mg/L and 15.54 ng/L,their sensitivity and specificity were (78.73％,97.13％),(68.89％,92.38％) and (65.39％,95.33％)respectively.Conclusion:Detecting the serum PCT,CRP and endotoxin levels is helpful to identify patients with sepsis induced by G+ or G-bacteria bloodstream infection,with high sensitivity and specificity,which can be used in the early diagnosis of sepsis induced by bacterial bloodstream infection.

Objective: To explore the application value of computed tomography angiography (CTA) and three-dimensional reconstruction in repairing high-voltage electrical burn wounds in necks, shoulders, axillas, and upper arms with tissue flaps. Methods: From December 2014 to December 2018, 12 patients with high-voltage electrical burns in necks, shoulders, axillas, and upper arms were hospitalized. The size of wounds ranged from 13 cm×10 cm to 32 cm×15 cm after complete debridement. Before tissue flap repair, the subclavian artery-axillary artery-brachial artery and their branches were examined by CTA. The main target vessels and their branches were conducted by three-dimensional reconstruction, and the development of the axis vessels for the tissue flaps planning to dissect and their branches were observed. For wounds in upper arms, amputation stump bone exposed wounds, and wounds in axillas and the anterior, the latissimus dorsi myocutaneous flap is the first choice for repair, if the thoracodorsal artery and internal and external branches are well developed according to CTA examination. Latissimus dorsi myocutaneous flaps were used in 6 patients with the area of myocutaneous flap ranging from 16 cm×12 cm to 32 cm×17 cm. All the donor sites were covered by split-thickness skin graft of thighs. For large wounds in occiputs, necks, and scapulas, the contralateral lower trapezius myocutaneous flap is the first choice for repair, if the superficial descending branch and deep branch of the contralateral transverse cervical artery are well developed according to CTA examination. For small wounds in necks and scapulas, the ipsilateral lower trapezius myocutaneous flap can be used for repair, if the superficial descending branch of the ipsilateral transverse cervical artery is well developed according to CTA examination. Lower trapezius myocutaneous flaps were used in 4 patients with the area of myocutaneous flap ranging from 18 cm×12 cm to 25 cm×17 cm. The donor site of one patient was sutured directly and the donor site of the other 3 patients was covered by split-thickness skin graft of thighs. For wounds in the posteromedial side of upper arms and the anterior side of axillas, the lateral thoracic skin flaps can be used for repair, if the latissimus dorsi myocutaneous flap can not be utilized for reasons of back burn or no muscle is needed for dead space, when the blood supply of side chest skin is reliable according to CTA examination. Lateral thoracic skin flaps were used in 2 patients with the area of skin flap ranging from 16 cm×12 cm to 17 cm×14 cm. The donor site of one patient was sutured directly and the donor site of the other one patient was covered by split-thickness skin graft of thigh. Results: During the operation of tissue flap repair in 12 patients, the orientation and starting position of the axis vessels were consistent with those observed by CTA examination before operation. All the tissue flaps survived after operation. During follow-up of 1 to 24 months, the patients were satisfied with no serious scar contracture affecting the function nor secondary infection or chronic ulcer. Conclusions CTA and its three-dimensional reconstruction technique can clearly reconstruct the subclavian artery-axillary artery-brachial artery and their branches before repair of high-voltage burn wounds in necks, shoulders, axillas, and upper arms. It can be used to observe whether the vessels are embolized or not and the starting position and orientation of blood vessels, which can provide an important reference for the selection of tissue flap transplantion.

Objective: To observe the analgesic and sedative effect and safety of application of dexmedetomidine combined with remifentanil in dressing change of conscious patients with non-intubation in burn intensive care unit. Methods: Forty patients conforming to the study criteria hospitalized in our burn intensive care unit from April 2015 to April 2017 were selected. Prospective, randomized, and double-blind method was used for the design. Patients were divided into dexmedetomidine group and dexmedetomidine+ remifentanil group according to the random number table, with 20 cases in each group. Patients in the two groups were respectively given corresponding drugs during dressing change. The frequency and time of dressing change, Verbal Rating Scale (VRS) score of patients during dressing change (at drug administration for 25 minutes) and after dressing change (25 min after dressing change), Ramsay Sedation Score (RSS) during dressing change, satisfaction level for anesthesia of the patients and physicians after dressing change, dosage of remifentanil, and various adverse effects during and after dressing change were recorded. The heart rate, mean arterial blood pressure (MAP), respiratory rate, and pulse oxygen saturation (SpO₂) before drug administration and at 10, 15, and 25 minutes after drug administration were also recorded. Data were processed with analysis of variance for repeated measurement, t test, chi-square test, and Fisher′s exact probability test. Results: (1) Totally 38 patients completed the trial. There were no statistically significant differences between patients in two groups in gender, American Association of Anesthesiologist Grading, age, weight, and total burn area (χ²=0.230, 0.146, t=0.224, 0.351, 0.367, P>0.05). (2) The frequency of dressing change of patients in two groups were both 48 times. The time of dressing change and VRS scores during dressing change of patients in two groups were similar (t=0.821, 1.522, P>0.05). The VRS score of patients in dexmedetomidine+ remifentanil group after dressing change was (3.1±0.4) points, obviously lower than (3.8±0.8) points in remifentanil group (t=2.213, P<0.05). The RSS, satisfaction level scores for anesthesia of the patients and physicians after dressing change in dexmedetomidine+ remifentanil group were (3.13±0.32), (3.44±0.41), and (3.13±0.25) points, respectively, obviously better than (1.82±0.24), (2.71±0.23), (2.53±0.41) points in remifentanil group (t=2.226, 2.684, 7.702, P<0.01). The dosage of remifentanil of patients in dexmedetomidine+ remifentanil group was (282±19) μg, obviously less than (340±31) μg in remifentanil group (t=9.896, P<0.01). There were no statistically significant differences between patients in two groups in rates of respiratory inhibition and hypotension (χ²=0.211, 0.154, P>0.05). Compared with those in remifentanil group, the rates of nausea, vomiting, and other gastrointestinal symptoms of patients in dexmedetomidine+ remifentanil group were obviously reduced (P<0.05), but the rate of bradycardia was obviously increased (χ²=6.008, P<0.05). (3) There were no statistically significant differences between patients in two groups in heart rate, MAP, respiratory frequency, and SpO₂ before drug administration (t=0.444, 0.892, 1.059, 1.039, P>0.05). The heart rates of patients in dexmedetomidine+ remifentanil group at 10, 15, and 25 minutes after drug administration were (83±11), (78±10), and (82±14) times per minute, respectively, significantly lower than (95±10), (87±12), and (89±12) times per minute in remifentanil group (t=5.592, 3.992, 2.630, P<0.05 or P<0.01). The MAP of patients in dexmedetomidine+ remifentanil group at 15 and 25 minutes after drug administration were (69.4±3.1) and (73.8±2.2) mmHg (1 mmHg=0.133 kPa), respectively, significantly lower than (75.4±3.0) and (78.1±3.5) mmHg in remifentanil group (t=9.181, 7.206, P<0.01). There were no statistically significant differences between patients in two groups in respiratory frequency at each time point after drug administration (t=1.489, 1.862, 1.963, P>0.05). The SpO₂ of patients in dexmedetomidine+ remifentanil group at 15 minutes after drug administration was 0.972±0.018, obviously lower than 0.979±0.015 in remifentanil group (t=2.070, P<0.05). Conclusions Application of remifentanil with small dosage has effective analgesia for conscious burn patients with non-intubation during dressing changes, however, adverse effects such as nausea and vomiting are likely to occur. Remifentanil combined with dexmedetomidine not only guarantee the analgesic effect, but also reduce the dosage of analgesics, improve the sedative effect and satisfaction of the patients for anesthesia, and reduce various adverse effects. However, it will increase the incidence of bradycardia and has some inhibition effect on circulation at the same time.

The researching thinking approach of "descending the dimension with the lowering rank, ascending the rank with the raising of nsion of dimension", which could exclude the intervention of non-crucial fact ors and reveal the complexity of syndrome as well, provides a feasible approach for syndrome standardization. A study was conducted by analyzing some syndromes and their correlated factors selected from the "Ancient Good-sized Medical Records Database" through unconditional logistic multivariate stepwise regression by SAS 6.12 universal statistical software to sieve the variable, and the mathematical mode of regression equation was obtained eventually, expressed as logit (p) = alpha + beta1X1 + beta2X2 + ... + betamXm. With that, the research of syndrome standardization was proceeded on the syndromes with diagnostic significance to provide references for standardization of syndrome differentiation. I
Diagnosis, Differential ; Humans ; Logistic Models ; Medicine, Chinese Traditional ; methods ; standards ; Reference Standards ; Research Design