Objective:To explore the microbiological and disease distribution characteristics of multidrug-resistant bacteria in patients hospitalized in a critical care rehabilitation ward, and to analyze the risk factors leading to multidrug-resistant bacterial infections.Methods:Microbiology screening data describing 679 patients admitted to a critical care rehabilitation ward were retrospectively analyzed to divide the subjects into a multidrug-resistant group (positive for multidrug-resistant bacterial infections, n=166) and a non-multidrug-resistant group (negative for multidrug-resistant bacterial infections, n=513). The risk factors were then analyzed using logistic regression. Results:Among 369 strains of multidrug-resistant bacteria observed, 329 were gram-negative bacteria (89.2%), mainly Pseudomonas aeruginosa, Klebsiella pneumoniae and Escherichia coli. They were distributed in sputum (56.9%) and mid-epidemic urine (28.2%) specimens. Patients whose primary disease was hemorrhagic or ischemic cerebrovascular disease accounted for 40.96% and 23.49% of the multidrug-resistant bacterial infections, respectively. Logistic regression analysis showed that albumin level, dependence on mechanical ventilation, central venous cannulation, or an indwelling urinary catheter or cystostomy tube were significant independent predictors of such infections.Conclusion:The multidrug-resistant bacterial infections of patients admitted to the critically ill rehabilitation unit are mainly caused by gram-negative bacteria. Their occurrence is closely related to low albumin levels and mechanical ventilation, as well as to bearing an indwelling central venous catheter, a urinary catheter or a cystostomy catheter.

Objective:To explore the effect of tibial nerve vibration on triceps surae spasticity in stroke survivors and its electrophysiological mechanism.Methods:Thirty stroke survivors with upper limb spasticity were randomly divided into a treatment group and a control group, each of 30. Both groups were given routine rehabilitation training while the treatment group was additionally provided with local vibration of the tibial nerve with an amplitude of 0.3mm at 60Hz. Before and after the treatment, the modified Ashworth scale (MAS) and Clonus grading were used to assess muscle tone and spasticity. Electrophysiological functions were evaluated using the tibial nerve motor and sensory conduction test and F wave and H reflex sensing.Results:Before the treatment there were no significant differences between the two groups in their average MAS scores, Clonus grading, maximum H amplitude (Hmax), the ratio of maximum H to maximum M amplitude (H/M) or the intensity of stimulus required to elicit Hmax. After the treatment, however, all of those measurements had improved significantly in both groups with the average improvements in the treatment group significantly greater than those in the control group.Conclusions:Local vibration of the tibial nerve combined with traditional rehabilitation is more effective than traditional rehabilitation alone in relieving triceps surae spasticity and reducing muscle tone after a stroke. The vibration seems to inhibit excitation of the reflex pathway.

Objective:To determine the value of lung function, cannula diameter and swallowing function in predicting the success of tube blocking in patients with severe neurological diseases so as to standardize the tracheal decannulation procedure.Methods:The tracheotomy tube blocking of 28 neurological disease patients was studied retrospectively. Before their tracheotomy tubes were blocked the patients′ lung function and swallowing function had been evaluated, and sputum volume and endotracheal tube diameter had been recorded.Results:The five most useful predictors of success in tracheotomy tube blocking were FVC, FVC%, FEV1 (L), FEV1 (L), FEV1 (L) and PEF(L/S). Their OR values were all greater than 1, indicating good predictive power. FEV1 and PEF showed the best predictive power, with OR values of 81.70 and 27.77, respectively. There was no significant difference between the two groups in terms of the other indicators. FEV1 predicted that the best truncation value for tracheotomy tube blocking success is 0.42L, achieving a sensitivity was 100% a specificity of 63.64%, and a correction index of 0.636.Conclusion:FEV1 values can be a useful predictor of successful tracheotomy tube blocking. Using it should improve the success rate of tube decannulation.

Objective To observe the effect of aerobic exercise combined with impedance training on the blood pressure variability and other blood-related indexes of patients with hypertension. Methods Ninety patients with essential hypertension were randomly divided into group A, group B and group C, each of 30. All were treated with conventional anti-hypertensive drugs. Groups B and C additionally underwent 40 minutes of aerobic training and group C also received resistance training. There were 3 training sessions a week for 12 weeks. Each subject's 24 h systolic blood pressure (24hSBP), 24 h diastolic blood pressure (24hDBP) and their standard deviations were ob-served before and after the 12 weeks. Blood indexes were examined and a plasma arteriosclerosis index was calculated. Results Before the treatment, there were no significant differences in any of the average measurements among the three groups. After the treatment, the average 24hSBP and 24hDBP of all three groups had decreased significantly, but larger decreases were observed in groups B and C. Compared with group B, the average 24hSBP and 24hDBP of group C had decreased significantly more. The average levels of atherogenic index of plasma ( AIP) and lipoprotein phospholipase A2 of groups B and C were significantly lower than before the treatment and also significantly lower than group A's average. The decrease in group C was significantly greater than in group B. Conclusions Anti-hyperten-sive drugs can lower blood pressure, but cannot effectively control blood pressure variation, reduce blood lipids or im-prove the arteriosclerosis index. Long-term, regular aerobic exercise can decrease these indicators and reduce cardio-vascular disease risk in elderly patients with hypertension. Aerobic exercise combined with mild to moderate circulato-ry resistance exercise is more effective than aerobic exercise alone.

Objective To analyze and evaluate the current progress of blood transfusion department establishment and clinical blood transfusion management in Hangzhou,China.Methods Questionnaires were sent to 35 medical institutions to gather information regarding blood transfusion department establishment and clinical blood transfusion management in the provincial,municipal and county tier hospitals.The investigated criteria covered the establishment of the hospital blood transfusion management committee,the utilization of software and hardware of the transfusion department,the compatibility status of various software systems in use and performance evaluation of these systems in clinical applications,etc.In addition,tests were also conducted on members of the blood transfusion departments to confirm whether they are properly trained and present adequated knowledge of clinical blood applications Results were then collected for statistical and descriptive analyses.Results The results out of the 35 hospitals surveyed presented no obvious statistical significance.Nevertheless,the average score of these hospitals in different segments helped us to reach the following conclusions:1,Triple-A hospitals scored the highest average score for patient clinical status evaluation pre-transfusion;2.Double-B hospitals came first when it comes to patient clinical status evaluation post transfusion;3.Triple-B hospitals possessed the most thorough clinical records for transfusion treatment.A total of 350 papers were issued and 350 papers were collected,with 327 out of the 350 considered valid.As for the test results regarding the departments members,triple-A,triple-B and double-A hospitals scored significantly higher than double-B and unranked hospitals.(P＜0.05);.350 clinical transfusion records were also collected and 247 of which are considered valid.It appears there are numerous difference in Hb indexes among the tested hospitals and even the departments of internal medicine and surgical presented different takes on the subject as well.Conclusion The clinical blood transfusion management in Zhejiang province and the establishment of blood transfusion departments still need to be improved.A plan to manage clinical blood use need to be carried out ASAP,which would specify evaluation references,standardize personnel training and tech investments.Ultimately,we hope such actions would help to further regulate the clinical blood use in the region.

Objective To synthesize 2-(5-[18 F] fluoro-pentyl)-2-methyl-malonic acid (18 F-ML-10) and to investigate the biodistribution in mice and the primary clinical application.Methods 18F-ML-10 was synthesized by domestic synthesis module MF-2V-IT-1.Quality control of the probe was performed after automated synthesis.The biological characteristics of 18F-ML-10 were assessed by biodistribution assay on male Kunming mice and microPET imaging on a male SD rat.Six patients with brain metastasis (4males,2 females,and age 21-68 years) were enrolled in this study.18F-ML-10 PET images were acquired before and at 48 h after radiotherapy.SUVmean and SUVmax of ROI were calculated.GTV changes were measured by MRI before and 3 months after radiotherapy.Response of brain metastasis to radiotherapy was assessed by PET imaging with 18F-ML-10.Two-sample t test was used.Results The non-corrected radiochemical yield of 18F-ML-10 was (26.5±7.3)％ with acceptable quality.The radiochemical purity exceeded 99％.18F-ML-10 was excreted through the kidneys,and the radiouptake in the blood was declined rapidly.The radiotracer accumulation was low in most of other organs.The testis showed a significant uptake.The SUVmean and SUVmax after radiotherapy (5.54±2.72 and 7.29±3.09) were significantly higher than the baseline values(3.81±1.13 and 4.97±1.05;t=2.670,2.663,both P＜0.05).The GTV after radiotherapy was significantly lower than the baseline value:(13.14±9.39) cm3 vs (23.34± 18.13) cm3;t =3.002,P＜0.05.Conclusions 18F-ML-10 could be synthesized reliably and repeatedly by domestic synthesis module.It has satisfactory properties in vivo and is probably suitable for early assessment of the response to radiotherapy in patients with brain metastasis.

Heart ; Heart Transplantation ; Humans ; Lung

Objective To explore and analyze the on-site investigation of hand,foot and mouth disease (HFMD) silent infection among medical staffs and children families,so as to provide evidence for the prevention of HFMD.Methods Totals of 42 medical staffs,who worked at HFMD ward,and 101 family members,who had children with HFMD,had been selected to take throat swab and stool samples during the period of HFMD outbreak from March to June 2013.According to the close degree of contact,the family members were divided into intimate contact group and non close contact group.All samples qualitatively classified through universal enterovirus type (UE),enterovirus 71 type (EV71),Coxsackie virus A group 16 type (CA16) to judge weather HFMD was silent infection or not.Results All 42 medical staffs presented negative for samples,but 25 cases of family members (24.75％) showed positive UE,22 cases positive EV71 (21.78％),3 cases other positive enterovirus type (2.97％),no positive CA16.The throat swap positive EV rate of HFMD children family members reached 3.45％,EV positive rate of stool samples 33.33％ (x2 =9.913,P ＜ 0.01);the positive EV71 rate for throat swap was 3.45％,stool samples 29.17％ (x2 =8.028,P ＜0.01).The EV and EV71 positive rate and for family members in the non close contact group were 23.40％ (11/47) and 23.40％ (11/47) compared 25.93％ (14/54) and 20.37％ (11/54) for family members in the close contact group.Conclusions When we understand the mechanism of transmission,we can improve the prevention of HFMD.It is worthy to popularize the measures such as the establishment of hospital infection prevention system,the increasing attention of disinfection and isolation,strengthening health education and awareness of medical staffs.

Objective To observe the effects of hyperbaric oxygen combined with rehabilitation training on the motor ability of ischemic stroke patients.Methods Eighty ischemic stroke patients were randomly divided into a treatment group and a control group,with 40 cases in each group.The control group was treated with Bobath' s approach,while the treatment group was treated with Bobath's methods supplemented by hyperbaric oxygen therapy.The United States National Institutes of Health Stroke Scale (NIHSS),the Fugl-Meyer motor assessment scale (FMA) (lower part) and each patient's maximum walking speed (MWS) were used to evaluate the patients before,and after 8 weeks of treatment.Results After treatment the average NIHSS score,FMA score and MWS were 4.17 ± 1.4％,31.2 ± 3.3 and 54,.3 ± 16.2 m/min,respectively,in the treatment group.The control group' s results were 6.81 ± 1.2％,26.2 ± 2.2 and 45.6 ± 18.3 m/min.The intra-group differences in evaluation results before and after treatment were statistically significant in both groups.An inter-group comparison showed that the treatment group performed significantly better after treatment than the control group in terms of FMA and MWS.After treatment,the treatment group showed significantly better walking performance in terms of cadence,stride length,step length on the affected side,gait cycle and double support duration.Conclusion Hyperbaric oxygen can make rehabilitation training more effective in improving the neurologic deficits,motor function and walking ability of hemiplegic stroke survivors.

Objective To observe efficacy of percutaneous laser disc decompression (PLDD) and its correlation with plasma levels of β-endorphine and substance P in patients suffering from protrusion of lumbar intervertebral disc (PLIVD). Methods Seventy-eight patients with PLIVD were randomly divided into two groups, one group (40 patients) treated with PLDD and the other (38 patients) treated with lumbar spine traction and physical therapy as control. Their peripheral plasma levels of β-endorphine and substance P were measured before the procedure and one day, one week and four weeks after it, respectively.Meanwhile, the visual analogue scale (VAS)was applied to assess their pain index. Results Plasma level of substance P was (186±66) ng/L and (419±82) ng/L, and (127 +83) ng/L and (322 +47) ng/L,in treatment and control groups, one day and one week after the procedure, respectively, and that of β-endorphine was (313 ±27) mg/L and (187 ±56) mg/L, and (364 + 18) mg/L and (211 +39) mg/L,one day and one week after it, respectively ( all P ＜ 0. 01 ), with its clinical efficacy of 90% (36/40)and 66% (25/38) one week after it, respectively ( P ＜ 0. 01 ) . Four weeks after it, plasma level of substance P was (64 ±50) ng/L in treatment group as compare to that in controls (93 ±75) ng/L, and that of β-endorphine was (410 ± 21 ) mg/L and (317 ± 42 ) mg/L, respectively, with efficacy of 95% (38/40) and 84% (32/38), respectively. Conclusions Plasma level of substance P can be reduced and that of β-endorphine can be increased by PLDD in patients with PLIVD, thus relieving their pain.Measurements of substance P and β-endorphine can be used as objective indicators to evaluate clinical efficacy of PLDD.