The HACEK group microorganisms(Haemophilus parainfluenzae,Aggregatibacter actinomycetem-comitans,Cardiobacterium spp.,Eikenella corrodens,Kingella kingae)belong to Gram-negative bacilli and are members of the normal oropharyngeal microbiota,which can cause invasive opportunistic infection when the host immune barrier is damaged,with infective endocarditis being one of the most serious diseases.HACEK endocarditis is characterized by an insidious course,prolonged delay of diagnosis,and dependence on third-generation cephalo-sporins for treatment.In recent years,with the emergence and development of 16S ribosomal RNA gene sequencing technique,the rapid diagnosis of this disease is expected to be achieved.This paper summarizes the main clinical characteristics and research progress of infective endocarditis caused by HACEK group bacteria,aiming to provide reference for clinical diagnosis and treatment.

The HACEK group microorganisms(Haemophilus parainfluenzae,Aggregatibacter actinomycetem-comitans,Cardiobacterium spp.,Eikenella corrodens,Kingella kingae)belong to Gram-negative bacilli and are members of the normal oropharyngeal microbiota,which can cause invasive opportunistic infection when the host immune barrier is damaged,with infective endocarditis being one of the most serious diseases.HACEK endocarditis is characterized by an insidious course,prolonged delay of diagnosis,and dependence on third-generation cephalo-sporins for treatment.In recent years,with the emergence and development of 16S ribosomal RNA gene sequencing technique,the rapid diagnosis of this disease is expected to be achieved.This paper summarizes the main clinical characteristics and research progress of infective endocarditis caused by HACEK group bacteria,aiming to provide reference for clinical diagnosis and treatment.

Objective Combined with domestic and foreign guidelines,to explore the individualized treatment strategy of urosepsis,and to provide reference for standardized diagnosis and treatment of urosepsis patient.Methods To analyze the diagnosis and treatment process of a patient with urogenic sepsis who was admitted to the department of critical care medicine of the First Affiliated Hospital of Xi'an Jiaotong University in April 15,2021.During the diagnosis and treatment process,we performed puncture drainage fluid and urine culture as soon as possible to confirm the diagnosis from the perspective of etiology.Considering the possible pathogenic bacteria at the infection site,the drug resistance of pathogenic bacteria in medical units,and drug safety,imipenem and cilastatin was chosen for anti-infective therapy.A two-step approach was used for drug administration based on drug pharmacokinetics/pharmacodynamic(PK/PD)characteristics,and drug concentration monitoring.The patients were followed up after discharge.Results The patient was critically ill on admission and was diagnosed with urosepsis.We optimize the empirical use of antimicrobials based on their PK/PD characteristics.Ultrasound-guided percutaneous nephrostomy of the left renal pelvis was performed to adequately drain the infection.Urine culture returned as extended-spectrum β-lactamase(ESBL)-producing Escherichia coli,confirming the etiological diagnosis.After 7 days of treatment,the patient's condition improved,the antibacterial drugs were downgraded to piperacillin-tazobactam,and the total course of anti-infection was 14 days.The patient was in good condition 2 months after discharge,and underwent left ureteral calculus and lithotripsy in the local hospital,and the left nephrostomy tube was removed.After discharge,the patient's condition was stable,no recurrence was found after 7 months of follow-up,and daily life was not affected.Conclusions Management of infection foci in urosepsis patient is critical.Diagnosis and treatment should refer to domestic and foreign guidelines,and formulate treatment strategies based on the distribution of local pathogens,drug resistance,and the actual clinical conditions of patients.Optimize the use of antibiotics based on drug PK/PD characteristics,monitor the concentration of therapeutic drugs,and realize individualized treatment.

Objective:To explore the impact of empathy training programs on operating room nurses.Methods:A total of 100 internship nurses from the first phase and the second phase of clinical practice in the operation room of Liaocheng People′s Hospital from December 2016 to December 2018 were randomly selected. They were divided into the control group and the experimental group by randomized picking method. The experimental group was given empathy training intervention, and the control group students did not have the above training. The demographics of each intern student were recorded. The control group did not have the above training; the experimental group did three epistemological questionnaires immediately before the training, three weeks after the training and one month after the training, and the control group did not know the experimental group empathy training, at the same time as the experimental group, did three empathy questionnaire scores. Comparing the experimental group and the control group, the scores of the questionnaires in each stage of the experimental group were statistically different.Results:There were 48 nursing students in the control group and 45 nursing students in the experimental group. Before the training and immediately after the training, the median score of the empathy questionnaire was 107 points and 120 points. There was statistical difference ( U value was 6.53, P < 0.05). The median score of the empathy questionnaire for the 1 month after the training in the experimental group was 122 points, which was statistically different from that before the training ( U value was 7.53, P <0.05). There were statistically significant differences in the scores of the questionnaires in the immediately after the training and 1 month after the training between the control group and the experimental group ( U values were 6.34, 6.67, P<0.05). Conclusions:Through the empathy training program, the scores of empathy nurses in the operating room can be effectively improved.

OBJECTIVE: To compare the efficacy and safety of postoperative analgesia with low-dose sufentanil combined with transversus abdominis plane (TAP) block and with sufentanil alone in promoting patients'recovery following laparoscopic hysterectomy. METHODS: Sixty patients undergoing laparoscopic hysterectomy in our hospital between September, 2016 and August, 2017 were randomly allocated into two equal groups. In group A, the patients were given postoperative analgesia with 1 μg/kg sufentanil, 9.96 mg tropisetronmesylate, and 200 mg flurbiprofen axetil (diluted with 0.9% NaCl solution to 100 mL, pumped at the rate of 2 mL/h) combined with TAP block; in group B, the patients received similar postoperative analgesia but at a higher dose of sufentanil (2 μg/kg) without TAP block. Visual analogue scale (VAS) was used to evaluate pain at 15 min and at 4, 8, 12, 24 and 48 h postoperatively, and the first off-bed time, the length of postoperative hospital stay and the incidence of postoperative nausea and vomiting (PONV) were recorded in all the patients. RESULTS: Compared with those in group B, the patients in group A had significantly lower VAS scores at 15 min, 4 h, 8 h, and 12 h postoperatively ( < 0.01) with also statistically shorter first off-bed time and postoperative hospital stay ( < 0.01). Two (6.7%) patients in group A had mild PONV, and 6 (20.0%) in group B had PONV (including 4 with mild and 2 with moderate PONV). CONCLUSIONS Lowdose sufentanil combined with TAP block is effective for postoperative analgesia after laparoscopic hysterectomy and helps to reduce the incidence of PONV and shorten the first off-bed time and postoperative hospital stay to promote the recovery of the patients.
Abdominal Muscles ; Analgesics, Opioid ; Female ; Humans ; Hysterectomy ; Laparoscopy ; Pain Measurement ; Pain, Postoperative ; Sufentanil

Objective To investigate the effect of Dexmedetomidine hydrochloride combined with Butorphanol tartrate on stress state in elderly patients with severe illness.Methods A total of 120 elderly patients with severe illness admitted into our hospital from March 2016 to March 2018 were randomized into group A,B and C(n=40,each).Group A was given intravenous Midazolam for analgesia,group B was treated with intravenous Medetomidine for analgesia,and group C received Dexmedetomidine combined with Butorphanol tartrate for analgesia.The differences in mean artery pressure(MAP),heart rate(HR),C-reaction protein(CRP),interleukin-6 (IL-6),visual analogue scale (VAS)score and Ramsay score were compared among the three groups.Results The levels of MAP,HR,CRP,IL-6 and VAS score after 24,48 and 72 hours of combined treatment of dexmedetomidine and butorphanol tartrate were lower in group C than in group B(P ＜0.05).There was no significant difference in the levels of MAP,HR,CRP,IL-6 and VAS score between group A and B after 24,48 and 72 hours of administration(P＞0.05).Ramsay score was higher in group C (intravenous both Dexmedetomidine and Butorphanol tartrate) than in group B (intravenous Dexmedetomidine alone)at 24,48 and 72 hours after administration (P ＜ 0.05).There was no significant difference in Ramsay score after 24,48 and 72 hours of administration between group A and B(P＞0.05).The incidence of adverse reactions was lower in group C than in group A and B(10.0％ vs.35.0％ and 32.5％,x2 =7.168 and 6.050,P =0.007 and 0.014).There was no significant difference in the incidence of adverse reactions between group A and BCx2=0.056,P =0.813).Conclusions Dexmedetomidine hydrochloride combined with Butorphanol tartrate can effectively improve hemodynamics,and alleviate inflammatory reaction and pain in elderly patients with severe illness,with a good security.And it is worthy of clinical generalization.

Objective To stage orthotopicilealneobladder function and construct the corresponding training mode according to the results of urodynamic examination.Methods 38 patients with bladder cancer underwent radical resection+orthotopicilealneobladder surgery between August 2013 and August 2017,and the urodynamic examination results of 3 months,6 months,1 year,2 years,3 years of were retrospectively analyzed.The bladder function of the patients with orthotopicilealneobladder was staged according to urodynamic examination,and the bladder function training mode was formed.Results As the follow-up time increased after surgery,day/night urine control increased,the maximum urine flow rate,the average urine flow rate increased,urination time shortening,bladder capacity increased,bladder basic pressure decreased,bladder filling state pressure,bladder compliance increased,micturition maximal bladder pressure,maximum abdominal pressure and maximum detrusor pressure increased,and all the indexes tended to be stable after 1 year.Bladder function training orthotopicilealneobladder is divided into four periods,respectively are Hospitalization period,recovery period(3 months after surgery),rehabilitation period(3 months to 1 year after surgery),stable period(1 year after surgery),and formed different stages of orthotopicilealneobladder bladder function training content.The focus nursing of each stage is that early period-drainage tube care,recovery period-incontinence care,rehabilitation period-urinary training,stable period-complications handling.Conclusions According to the results of urodynamic examination,it is possible to propose a targeted,scientific and practical bladder function training model for the orthotopicilealneobladder.

OBJECTIVE:To investigate the clinical efficacy of alprostadil combined with edaravone in the treatment of unsta-ble angina pectoris(UAP),and their effects on serum oxidative stress indexes,the levels of MMP-2 and MMP-9. METHODS:Be-sides conventional treatment,control group was treated with Alprostadil injection 2 ml added into 0.9% Sodium chloride injection (NS)100 ml,ivgtt,qd;while observation group was additionally treated with Edaravone injection 15 ml added into NS 100 ml, ivgtt,qd. Treatment courses of 2 groups lasted for 2 weeks. The frequency and duration of UAP attack,serum levels of MDA, SOD,TAC,MMP-2 and MMP-9 levels were observed 2 groups;the occurrence of ADR was also observed. RESULTS:There was no statistical significance in frequency of angina pectoris attack,duration,MDA,SOD,TAC,MMP-2 and MMP-9 between 2 groups before treatment (P>0.05). After treatment,the total effective rate of observation group (94.3%) was significantly higher than that of control group(81.4%). The frequency of angina pectoris attack and the level of MDA,were significantly reduced,and the duration of angina pectoris was significantly shortened SOD and TAC increased significantly;the change of observation group was more significant than that of control group with statistical significance(P<0.05). ADR was mild in 2 groups;there was no statisti-cal significance in the incidence of ADR(P>0.05). CONCLUSIONS:Alprostadil combined with edaravone is significantly effec-tive for UAP,reduces the frequency of angina,shortens the duration of angina pectoris,alleviates oxidative stress and reduces se-rum levels of MMP-2 and MMP-9 with good safety.

Rhizobium leguminosarum biov.trifolii H954 has been fermented for eight days on the GMS medium.Culture supernatant is extracted by ethanol precipitation,sample is purified by Sephadex G\|50,Sephadex G\|10 and DEAE\|Cellulose chromatoraphy.Gas chromatography(GC), 13 C nuclear magnetic resonance spectroscopy(NMR)and mass spectrometry(MS) analysis indicated that the sample is cyclic,neutral glucan,and composes of glucose linked solely by 1→2 glucosidic bonds.Cyclic glucan has degrees of polymerization ranging form 17 to 22,with a degree of ploymerization of 19 as the major glucan cycles.