Objective To analyze the age difference of gram negative isolates(GNB)from blood culture and antibiotic resistance profile between children and adults. Methods Age difference of pathogen distribution of GNB isolated from blood culture during 2015-2017 were retrospectively analyzed. WHONET 5.6 and Graphpad Prism 6 were used to perform Chi-square test on the pathogen proportion and antibiotic resistance rate. Results A total of 20 145 bacterial strains were isolated in Chongqing from 2015 to 2017. The top three strains of GNB were E. coli(56.7％, 6 688/11 799), K. pneumoniae(19.6％, 2 308/11 799), and P. aeruginosa(4.4％, 522/11 799). The resistant rate of E. coli to carbapenems was less than 1％. The resistant rate of K. pneumoniae to carbapenems was about 5％, while the resistant rate of S. marcescens was approximately 9％, similar to E. cloacae. The overall resistance rates of E. coli from adult patients to most antiobiotic agents were significantly higher than those of children, but the overall resistance rate of K. pneumoniae from children was higher than those of adults. The drug resistance rate of A. baumannii was higher than P. aeruginosa. A. baumannii isolates from adult patients were highly resistant to all drugs tested and more resistant than those from pediatric patients. Conclusions Majority of GNB strains isolated from blood culture were E. coli and K. pneumoniae, for which carbapenems are still active. More attention should be paid to carbapenem-resistant K. pneumoniae from children and A. baumannii from adults. National surveillance of nosocomial bloodstream infection should be highly evaluated.

Objective To investigate the clinical efficacy and side effects of nalbuphine for treatment of post combined spinal epidural anesthesia shivering undergoing cesarean section.Methods Ninety puerpera underwent elective caesarean section under combined spinal-epidural anesthesia,who developed shivering Wrench grade 3 or 4,aged 20-35 years,ASA physical status Ⅰ or Ⅱ,were randomly and double-blindly divided into three groups with 30 puerpera each to receive either saline (group C) or nalbuphine (group N,0.07 mg/kg) or tramadol (group T,1 mg/kg) as a slow intravenous bolus for treatment of shivering.Onset of shivering,time interval from treatment to cessation of shivering,success rate,recurrence rate after successon treatment outcome of shivering,OAA/S sedation scores,nausea and vomiting,bradycardia and hypotension were recorded.Results There was no significant difference of the time interval from treatment to cessation of shivering between the three groups.Compared with group C,there was statistically significant shorter time interval from treatment to cessation of shiveringin group N [(3.6±1.3) min vs (14.3±7.3) min] and group T [(4.2± 2.2) min vs (14.3±7.3) min],higher success ratein group N (93.3％ vs 16.7％) and group T (90％ vs 16.7％) and lower recurrance ratein group N (7.1％ vs 80.0％) and group T (11.1％ vs 80.0％)(P＜ 0.05).Higher sedation scores in group N were observed (P＜0.05).The incidence of nausea and vomiting was 60.0％ in group T,which was significantly higher than those in group C (20.0％) and group N (13.3％) (P＜0.05).There was no significant difference in the incidence of bradycardia and hypotension in three groups.Conclusion Nalbuphine can control the shivering of post combined spinal epidural anesthesia undergoing cesarean section safely and effectively,which seems suitable for parturients cesarean delivery due to the lower incidence of nause and vomiting and a certain sedation effect.

Objective To explore the effect of betulinic acid on NAFLD and its mechanism. Methods We used the high-fat diet animal models, with or without feeding the standard chow diet containing betulinic acid for 2 months. During this period, the body weight was monitored regularly and metabolism cage was used to monitor the energy metabolism of the animals. After killing the mice, molecular biological analysis was performed on serum and tissue related to liver. Results In diet induced obese mice animal experiments, the mice body weight had been reduced and NAFLD had been improved significantly by betulinic acid. The various indexs of serum and liver tissue had also been significantly improved. The metabolic rate increased significantly. Fatty acid synthase gene and protein levels were significantly lower. Furthermore, FAS activity was significantly lower than the control mice. Liver FAS activity of the high fat mice and the high fat mice treated with betulinic acid were (1873.6 ± 85.7) and (1181.6 ± 85.7) pmol NADPH/ min/ mg protein, respectively. Conclusion Betulinic acid inhibited FAS at expression and activity level, and improved lipid deposition in liver.

Objective To evaluate the antibiotic resistance profile of the Aeromonas strains isolated from extra-intestinal specimens during 7-year period in a tertiary hospital in Chongqing for appropriate antibiotic treatment.Methods WHONET 5.6 software was used to analyze the clinical data and results of antimicrobial susceptibility testing of Aeromonas strains to 14 antibiotics according to CLSI breakpoints (CLSI-M45-A3).Results A total of 230 non-duplicate Aeromonas strains were collected from January 2010 to December 2016.The most common species were Aeromonas hydrophila (83.0％) and Aeromonas sobria (14.8％).Majority of the strains were isolated from wound secretion,bile and urine.Overall,46.8％ of the Aeromonas isolates were resistant to trimethoprim-sulfamethoxazole,followed by ceftriaxone (37.0％) and cefuroxime (28.8％).More than 10％ of the strains were resistant to aztreonam,cefepime and ciprofloxacin.More than 90％ of the strains were susceptible to piperacillin-tazobactam,cefoxitin,levofloxacin,gentamicin,amikacin,imipenem and meropenem.Only 4.0％ and 1.7％ of the strains were resistant to imipenem and meropenem,respectively.Aeromonas hydrophila showed higher antibiotic resistance than Aeromonas sobria to all the antibiotics tested except piperacillin-tazobactam,imipenem,and amikacin.None of the Aeromonas sobria isolates was found resistant to meropenem.Conclusions The Aeromonas hydrophila and Aeromonas sobria isolates are the dominant Aeromonas species in Chongqing.The antibiotic resistant profiles vary with Aeromonas species and site of infection.The use of third generation cephalosporins and trimethoprim-sulfamethoxazole should be cautious in Aeromonas infection due to the high resistance level.

BACKGROUND: Carbapenem-resistant Klebsiella pneumoniae (CRKP) is considered a serious global threat. However, little is known regarding the multidrug resistance (MDR) mechanisms of CRKP. This study investigated the phenotypes and MDR mechanisms of CRKP and identified their clonal characteristics. METHODS: PCR and sequencing were utilized to identify antibiotic resistance determinants. Integron gene cassette arrays were determined by restriction fragment length polymorphism (RFLP) analysis. Multi-locus sequence typing (MLST) and pulsed-field gel electrophoresis (PFGE) were used for epidemiological analysis. Plasmids were typed by using a PCR-based replicon typing and analyzed by conjugation and transformation assays. RESULTS: Seventy-eight strains were identified as resistant to at least one carbapenem; these CRKP strains had a high prevalence rate (38.5%, 30/78) of carbapenemase producers. Additionally, most isolates harbored MDR genes, including Extended spectrum β-lactamases (ESBLs), AmpC, and quinolone and aminoglycoside resistance genes. Loss of porin genes was observed, and Class 1 integron was detected in 66.7% of the investigated isolates. PFGE and MLST results excluded the occurrence of clonal dissemination among these isolates. CONCLUSIONS: A high prevalence of NDM-1 genes encoding carbapenem resistance determinants was demonstrated among the K. pneumoniae isolates. Importantly, this is the first report of bla(NDM-1) carriage in a K. pneumoniae ST1383 clone in China and of a MDR CRKP isolate co-harboring bla(NDM-1), bla(KPC-2), bla(CTX-M), bla(SHV), acc(6′)-Ib, rmtB, qnrB, and acc(6′)-Ib-cr.
China* ; Clone Cells ; Drug Resistance, Bacterial ; Drug Resistance, Microbial ; Drug Resistance, Multiple* ; Electrophoresis, Gel, Pulsed-Field ; Genes, MDR ; Integrons ; Klebsiella pneumoniae* ; Klebsiella* ; Molecular Epidemiology ; Phenotype ; Plasmids ; Pneumonia ; Polymerase Chain Reaction ; Polymorphism, Restriction Fragment Length ; Prevalence ; Replicon

Objective To improve the quality of the management of the elderly patients with cancer in Sichuan province,and to understand the attitudes and perspectives of elderly surgeons and oncologists for the management and treatment of elderly patients with cancer.Methods A face-toface questionnaire interview was conducted with oncologists (n 64) and geriatricians (n =64).128 physicians were involved in this study.Results The cancer management and therapeutics were deemed appropriate at present by 9.38％ (6/64)of the geriatricians and 25.00％ (16/64)of the oncologists.The 39.06％ (25/64) of geriatricians used to notice geriatric syndromes,while 81.25％ (52/64)of oncologists never concerned about the geriatric syndrome(P=0.011).As for the causes of the therapy-associated toxicity,oncologist versus geriatrician payed an attention to malnutrition (100.00％ vs.100.00％ in both groups),to mobility disorders(65.63％ vs.65.63％,84/128 in both groups),to cognitive impairment/mood disorder (89.06％ in geriatrician group vs.75.00％ in oncologist group,P=0.038).For the factors affecting treatment decisions,a physical ability attention (oncologists vs geriatricians:70.31％ vs.92.19％;P =0.002),and comorbidity (oncologists vs geriatricians:62.50％ vs.79.69％,P =0.032) had statistically significant difference.In addition,lack of geriatrics knowledge was also reported by more oncologists.However,one hundred percent of participants wanted very much to cooperate with each other in their clinical work.When responding to the clinical scenario,the 10.94％ (7/64)of geriatricians and 32.81％ (21/64)of oncologists chose modified treatment for 65-74 years old patient with cancer(P =0.003).When the age of the patients was 75-84 years old,only 12.50 ％ (8/64) of geriatricians prefer end-of-life care,while 31.25 ％ (20/64) of oncologists chose it (P =0.010).Conclusions Selection of treatment decisions in the elderly patients with cancer affect by ageing.Both oncologists and geriatricians are concerned with the elderly patients with cancer,ageing syndrome,total sickness and functional status.And these doctors support an establishment of a multi disciplinary team cooperation for the elderly patients with cancer.Therefore,the establishment of mutual cooperation between the two professionals is necessary and feasible.

Objective Through the investigation of the status quo of the nursing staff in the general hospitals in Harbin, the present situation of the nursing managers in Harbin is evaluated, which provides the basis for the medical staff management, continuing education and training direction of Harbin medical institutions. Methods The social basic demographic situation, training, work content, work pressure and strength of 150 nursing managers in the Harbin general hospital were investigated by self-designed questionnaire. Survey data using EpiData3.1 and Excel 2010 software to establish a database, input, mapping, analysis. Results The nursing management personnel basic quality was good. Generally included department based on the actual work of the complete personnel division of labor and scheduling, responsible for items, equipment, drugs, ward management, responsible for other work assigned by department, hospital care tasks. 85％(127/150) of the staff undertook the nursing management of the department and undertook clinical nursing work;62％(93/150) of nursing managers believed that work was at full load. Most care managers thought the work pressure was higher. The stress source was mainly from the tension, responsibility and workload of the patient. The training of nursing managers focused on nursing skills and professional knowledge. The training form was mainly for expert lectures, intensive teaching and practical training. There was an urgent need to strengthen training on risk management, stress management, psychology, and management knowledge. Conclusions The basic quality of nursing management personnel in Harbin comprehensive hospital is good, but there is still a gap between the requirements of the international nurses' core competence, hospital managers should attach importance to constructing systematic training system for nursing management personnel, and strengthen the construction and cultivation of core competence of nursing management.

BACKGROUND: Zein has excel ent solubility, heat resistance and biodegradability, but its biocompatibility and effect on periodontal defects repair are under discussion. OBJECTIVE: To analyze biocompatibility of zein and its effect on periodontal defect repair. METHODS: Zein scaffold was prepared by solvent casting/particulate leaching. In vitro test: Human periodontal ligament cel s were co-cultured with zein scaffold for 18 days, and cel growth was observed by scanning electron microscope. In vivo test: Eight Beagle dogs were enrol ed to establish periodontal defect models, which were randomly assigned to receive zein scaffold implantation as experimental group, or interrupted suture as control group. Afterwards, the defect region was observed by scanning electron microscope at 3 months. RESULTS AND CONCLUSION: In vitro results: Human periodontal ligament cel s adhered wel and tightly on the scaffold with a fusiform, and could grow around pores. In vivo results: In the experimental group the scaffold dissolved completely, bone trabecular arranged regularly, and mature tissues appeared, to be integrated with the surrounding tissues; in the control group, the defect region almost healed, but there were irregular fibers and obvious lacunae. Moreover, compared with the control group, the height of new alveolar bone and bone defect, as wel as the length of junctional epithelium were significantly decreased, and new cementum was significantly increased in the experimental group (P < 0.05). To conclude, zein scaffold has good biocompatibility and can promote periodontal defect repair.

BACKGROUND:In recent years, tissue engineering technology as a new model for tissue regeneration has provided new ideas and methods for the repair of periodontal tissue defects. OBJECTIVE:To investigate the effect of human periodontal ligament cels-polyglycolic acid scaffold complex for repair of periodontal tissue defects. METHODS:Passage 4 human periodontal ligament cels at a density of 1.5×109/L were seeded onto the polyglycolic acid scaffold to prepare cel-scaffold complex. Then mongrel dogs were selected to make animal models of periodontal tissue defects and then randomly assigned into experimental group subjected to cel-scaffold complex implantation or control group subjected to direct coronal reset and suture of the gingival flap. Colagen content, new blood capilaries, new cementum, new alveolar bone and new periodontal ligament were detected within 4 weeks after operation; hematoxylin-eosin staining of periodontal tissue defects was done at 8 weeks after operation. RESULTS AND CONCLUSION:In the experimental group, the colagen content, number of newborn capilaries, amount of new cementum, new alveolar bone and new periodontal ligament tissues were significantly higher than those in the control group at postoperative 1, 2, 3, 4 weeks (P< 0.05). At 8 weeks after operation, in the experimental group, there were more vessels arranging on the connective tissue surface of new alveolar bone, the alveolar bone showed a sawtooth-like interlinking with the periodontal tissues in the presence of a thin layer of cementum; in the control group, only new alveolar bone and cementum formed below the incisure. These findings indicate that human periodontal ligament cels-polyglycolic acid scaffold complex can promote periodontal tissue regeneration.

Objective:To investigate the effects of 125I radioactive particle implantation in the treatment of maxillofacial malignancy. Methods:43 patients with maxillofacial malignancy were treated with 125I radioactive particle implantation.The procedure was carried out according to the treatment planning system(TPS),with the particles spaced uniformly at 1 cm intervals and with the activity of 0.7 m Ciby 41 particles per case on a verage.All patients were followed up for 6-60 months.Results:The whole treatment procedurewas successful,and no particle displaced.The follow-up rate was 93.02% and treatment effective rate(CR+PR) was 90.70%.Norecur-rence was foundinall target areas.The mortality due to tumor was 9.30%and total survival rate was 74.43%.The cumulative survival rate of the patients in 0.5,1,2,3 and 5 years was 93.0%,85.7%,79.3,69.8% and 56.9% respectively.Survival periodon aver-age was 36.06-50.04 months,with the median of 43.05 months.The longest tumor-free survival period was 60 months.Radiation in-jury rate was 20.93% and only level 1 radiation injury was observedinall the cases.Facial nerve dys function was found in 2 cases and recovered after treatment.Conclusion:Treatment of maxillofacial malignancy by implantation of 125I particles is convenient and mini-mally invasive.The treatment canincrease survival rate of the patients and guaran tee the oropharynxes' function.