Objective:To evaluate the effects of different rates of compliance with the enhanced recovery after surgery (ERAS) protocol on postoperative recovery in patients undergoing hysterectomy.Methods:A total of 312 patients, aged 18-60 yr, with body mass index of 18-30 kg/m 2, of American Society of Anesthesiologists physical status Ⅰ-Ⅲ, scheduled for hysterectomy, were enrolled in the study.ERAS protocol was implemented.The patients were divided into 3 groups based on compliance rates: compliance rate<70% group (group A), 70%≤compliance rate<85% group (group B) and compliance rate≥85% group (group C). The development of postoperative complications, hospitalization time, patients′ satisfaction score and hospitalization cost were recorded. Results:Compared with group A ( n=88) and group B ( n=118), the total incidence of complications was significantly decreased in group C ( n=96) ( P<0.05). The patients′ satisfaction scores were gradually increased in A, B, and C groups on the day of discharge and at 30 days after discharge ( P<0.05). Conclusions:Higher compliance with the ERAS protocol is helpful for postoperative recovery in patients undergoing hysterectomy.

Objective: To investigate anemia rate and to analyze related factors in maternal women in Taicang of Jiangsu province. Methods: There were 13 278 pregnant women who had prenatal care and gave birth in 25 hospitals during 2014-2016 in Taicang of Jiangsu Province. We excluded 1 179 women who registered after 12 weeks of gestation, 144 women who did not test hemoglobin during gestation, and 25 women whose gestational weeks were incorrect. Finally, data from 11 930 pregnant women were analyzed. From the electronical medical record system of maternal and child health care, we obtained basic information of these pregnant women, their hemoglobin levels and related data during gestation and postpartum. Anemia rate was descripted, and factors associated with anemia were identified using multiple unconditional logistic regression. Results: Age of the 11 930 pregnant women was (27.0±4.5) years old, and the P₅₀ (P₂₅-P₇₅) of BMI at the first trimester was 21.4 (19.6-23.7) kg/m². The anemia rate during gestation was 37.2% (4 434/11 930). The anemia rate was 5.5% (276/5 035), 24.4% (1 802/7 377), and 47.8% (3 328/6 966) at the first, second and third trimesters, respectively. Anemia rate at 42 days postpartum was 19.9% (680/3 418). Multiple unconditional logistic regression indicated that anemia during gestation was related with maternal age <21 years old at prenatal registration (OR (95%CI): 1.28 (1.07-1.53)), body mass index(BMI) <18.5 kg/m² at the first trimester (OR (95%CI): 1.14 (1.00-1.29)), non-local residence (OR (95%CI): 1.35 (1.20-1.52)), education of middle school and lower (OR (95%CI): middle school: 1.24 (1.05-1.47), primary school: 1.36 (1.01-1.82)), occupation of housewife or farmer (OR (95%CI): housewife: 1.21 (1.06-1.38), farmer: 1.21 (1.03-1.44)). Anemia at 42 days postpartum was associated with multipara (OR(95%CI): 1.59 (1.12-2.27)), anemia at the first trimester (OR(95%CI): 3.26 (1.92-5.55)), no folic acid supplementation at the first trimester (OR(95%CI): 1.34 (1.00-1.80)), and hemorrhage≥500 ml during 24 h postpartum (OR(95%CI): 2.26 (1.02-4.97)). Conclusion Anemia rate was low for maternal women in Taicang of Jiangsu Province. The factors associated with gestational anemia included pregnant women's age, BMI, local or non-local residence, occupation, and education. The factors associated with postpartum anemia included multipara, anemia at the first trimester, no folic acid supplementation at the first trimester, and hemorrhage 24 h postpartum.

Objective To evaluate the value of perioperative multimodal stratified analgesia guided by PPRS-CYMZ 2.0. Methods One hundred and sixteen patients of both sexes, aged 16-85 yr, of A-merican Society of Anesthesiologists physical statusⅠ-Ⅲ, scheduled for elective surgery in our hospital in August 2016, were included in this study and assigned into empirical analgesia group(group E, n=79) and stratified analgesia group(group S, n=73). The risk of postoperative pain was estimated by an expe-rienced associate chief anesthesiologist based on his clinical experience, and the perioperative analgesic protocol was determined in group E. The risk of postoperative pain was assessed using the perioperative pain risk scale PPRS-CYMZ 2.0 by another experienced associate chief anesthesiologist, the risk was stratified according to the scores, and the corresponding stratified analgesic protocol was determined in group S. Vis-ual analog scale scores and parents′satisfaction with analgesia were recorded on postoperative day 30. The requirement for preventive analgesia, total pressing times of patient-controlled analgesia(PCA)pump in 0-6 h, 6-24 h and 24-72 h periods, PCA background infusion dose and consumption of rescue analgesics were recorded. The development of adverse events during postoperative hospital stay and postoperative re-covery were also recorded. Analgesia-related parameters of medical economics were calculated. Results There was no significant difference in postoperative pain risk stratification between group E and group S(P>0.05), and the majority of patients were at moderate risk. Compared with group E, no significant change was found in visual analog scale scores on postoperative day 30, PCA background infusion dose or incidence of postoperative adverse effects(P>0.05), the requirement for preventive analgesia and satisfaction scores were significantly increased in high risk patients, the consumption of rescue analgesics was decreased in moderate risk patients(P<0.05), no significant change was found in the total pressing times of PCA pump in each time period in low risk patients(P>0.05), the total pressing times of PCA pump was significantly decreased, and the direct analgesic cost per patient and total analgesic cost were decreased in moderate and high risk patients, and the first ambulation time and length of postoperative hospital stay were shortened in high risk patients in group S(P<0.05). Conclusion PPRS-CYMZ 2.0 can achieve perioperative multi-modal stratified analgesia and individualized treatment.

Objective This work was to study the distribution of Acinetobacter baumannii and analyze the change in the trend of its resistance,so as to provide experimental basis for clinical rational drug usage.Methods The identification of isolates were car-ried out by using VITEK-2 compact automatic identification system,and drug susceptibility testing was performed by disc diffusion method,the results were carried out according to the Standard of CLSI 2014 version for interpretation,and data analysis was per-formed with WHONET5.6.Results A total of 981 strains of Acinetobacter baumannii had been isolated from the samples in 2013 to 2015,most of them were isolated from respiratory samples accounted for 80.4%,followed by the urines and other body secre-tion.The distribution of this kind of bacteria mostly was 30.1% in ICU,departments of Emergency observation(16.0%),respirato-ry diseases(15.7%)and senior cadres(10.8%).The drug resistance of this kind of bacteria to polymyxin B and cefoperazone/sul-bactam was to a minimum of lower than 5.0%,and has relatively high sensitivity to amikacin and minocycline(<30.0%).And the resistance to other antimicrobials were higher than 30.0%,and the resistance to Nitrofurantoin and cefotaxime were higher than 94.0%.The most drug resistance of Acinetobacter baumannii in 2014 were lower than those in 2013,but the most drug resistance of Acinetobacter baumannii in 2015 were increased significantly as well as strains had been isolated from the samples.Conclusion The main source for isolation of Acinetobacter baumannii in this hospital mainly comes from sputum specimens of patients in ICU, departments of emergency observation,respiratory diseases and senior cadres.The high prevalence of antimicrobial resistance of this kind of bacteria should be prevented and controlled in nosocomial infection,and rational application of antimicrobial agents in order to reduce the spread of drug-resistant strains.

Objective To investigate the clinical application significance of flow cytofluroometric(FCM ) antibiotic susceptibility test for A .baumannii in vitro .Methods The sensitivity to Ampicillin/Sulbactam ,Levofloxacin ,Meropenem ,Cefotaxime of an Esch‐erichia coli standard strain and 66 isolates of A .baumannii were tested with FCM by using propidium iodide as a fluorescent probe . The survival rates of the bacteria in the culture after treatment with different dosages of the antibiotics were determined according to the fluorescence strength .The MIC value of the antibiotics against the 66 strains were judged with FCM ,compared with microdi‐lution and VITEK methods .Results The antibiotic resistant strains number of sultamicillin ,levofloxacin ,meropenem and cefo‐taxime sodium were 35 ,30 ,13 and 38 respectively in flow cytofluorometric antibiotic sensitivity test(FCST) of 66 strains of A .bau‐mannii .There was no significant difference(P>0 .05) compared with the antibiotic susceptibility results by the methods of VITEK instrument and microdilution by measuring with χ2 test respectively .Conclusion The established method of FCST for A .baumannii is suitable for dectecting bacterial drug‐sensitivity ,which is more rapid ,accurate and objective .

Objective To investigate the antibiotic resistance of clinical isolates from hospital for the guidance of rational use of antibiotics .Methods Automatic VITEK‐2 system was used to identify bacterial strains and analyze the antimicrobial resistance . WHONET 5 .6 was applied for data analysis according to the breakpoints of Clinical and Laboratory Standards Institute 2013 . Results A total of 3 880 nonduplicate strains were collected in 2013 ,35 .2% (1 366/3 880) of which were gram positive organisms ,64 .8% (2 514/3 880) were gram negative bacteria .The top 6 most frequently isolated microorganisms were E . coli (20 .2% ) , K . pneumoniae (12 .0% ) , P . aeruginosa (11 .1% ) , coagulase negative Staphylococcus (9 .8% ) , A . baumannii (9 .8% ) ,E .f aecalis (8 .1% ) .The bacteria were mainly isolated from respiratory tract (51 .0% ) ,urine (26 .2% ) , and blood (9 .4% ) .The prevalence of both meticillin‐resistant Staphylococcus was higher than 72 .0% .No staphylococcal strainwasfoundresistanttolinezolid,vancomycinortigecycline.Amongthe509Enterococcusisolates,E.faecalisandE. f aecium accounted for 61 .5% and 32 .8% ,respectively .No enterococcal strain was resistant to vancomycin or tigecycline . Enterococcal isolates also showed low resistance (<2 .0% ) to teicoplanin and linezolid .About 67 .4% of the E .coli strains and 32 .0% of the K lebsiella isolates produced extended spectrumbeta‐lactamases.Thestrainsof E.coli,Klebsiella spp.,Enterobacterspp.,and Proteusspp.wererelatively susceptible to beta‐lactam/beta‐lactamase inhibitor combinations such as cefoperazone‐sulbactam and piperacillin‐tazobactam , carbapenems such as meropenem ,imipenem and ertapenem ,and amikacin (< 15 .0% of the strains were resistant) . K . pneumoniae isolates were more resistant than other gram‐negative bacilli .P .aeruginosa was relatively susceptible to amikacin , tobramycin ,cefepime ,gentamicin ,piperacillin‐tazobactam ,but more than 20% of these strains were resistant to meropenem and imipenem .More than 35 .0% of the A . baumannii isolates were resistant to any of the antimicrobial agents tested . Conclusions Antimicrobial resistance is still a serious threat in clinical antimicrobial therapy .It is important to promote the rational use of antimicrobial agents so that resistance is minimized . It is necessary to conduct epidemiological survey and proactively implement effective interventions in the clinical setting with relatively heavy burden of antimicrobial resistance .

Objective:To observe the effect of tuina manipulations on blood pressure and its variability in hypertension patients. Methods:Forty hypertension patients were randomized into an observation group and a medication group, 20 cases in each group. The observation group was intervened by tuina manipulations of kidney-tonifying blood-circulating and collaterals- unblocking in addition to regular medication, while the medication group was by the same medication. The 24-hour blood pressure monitoring was performed before intervention and after 3-month intervention. The blood pressure and its variability were observed and compared. Results:There were no significant differences in comparing the blood pressure and blood pressure variability between the two groups before intervention (P>0.05); after 3-month intervention, the blood pressure and its variability were significantly improved in both groups (P<0.05); the improvements in the observation group were more significant than those in the control group (P<0.05). Conclusion:Tuina manipulations of kidney-tonifying blood-circulating and collaterals-unblocking plus medication can produce a better effect than regular medication in promoting blood pressure and its variability, and this method is worth applying in clinic as it’s easy-to-operate and has no adverse effect.

Objective:The goal of this study was to analyze the clinical significance of relationship between myocardial collateral and the levels of hypoxia‐inducible factor 1‐alpha (HIF‐1α) and vascular endothelial growth factor A (VEGF‐A) in patients with coronary chronic total occlusion lesion .Methods:89 patients with coronary chronic total occlusion lesion confirmed by clin‐ical data and coronary angiography were identified .The levels of HIF‐1αand VEGF‐A were measured by ELISA ,and the rela‐tive expression of VEGF‐A of peripheral blood mononuclear cell (PBMC) were measured by real‐time PCR .The results were statistically analyzed by the statistical programme for social sciences (SPSS version 18 .0) and software SAS JMP 9 .0 .Results:Compared to Rentrop 0‐1 grade group (18/38 ,47 .4% ) ,Rentrop 2 (11/31 ,35 .5% ) and Rentrop 3 (3/20 ,15 .0% ) grade group had fewer diabetes mellitus .Rentrop 2 [(6 .67 ± 1 .41) mmol/L] and Rentrop 3 [(5 .48 ± 1 .26) mmol/L] grade group had low‐er fasting blood glucose than Rentrop 0‐1 grade group [(7 .24 ± 1 .39) mmol/L] .Rentrop 2 (12/31 ,38 .7% ) and Rentrop 3 (3/20 ,15 .0% ) grade group had fewer clinical heart failure (NYHA Ⅱ ~ Ⅳ grade) than Rentrop 0‐1 grade group (20/38 , 52 .6% ) .Rentrop 2 [(85 .5 ± 27 .7) pg/mL ,(139 .5 ± 42 .1) pg/mL] and Rentrop 3 [(103 .3 ± 30 .2) pg/mL ,(162 .6 ± 43 .3) pg/mL] grade group had higher levels of HIF‐1αand VEGF‐A than Rentrop 0‐1 grade group [(42 .0 ± 16 .1) pg/mL ,(76 .5 ± 32 .2) pg/mL] .Rentrop 2 (1 .31 ± 0 .46) and Rentrop 3 (1 .38 ± 0 .44) grade group had higher level of relative expression of VEGF‐A in PBMC than Rentrop 0‐1 grade group (1 .00 ± 0 .28) .Conclusions:Chronic and consistent ischemia and hypoxia in‐duced the increase of expression of HIF‐1αand VEGF‐A is important for establishment of coronary collateral ,increasing blood supply and improving the heart function and prognosis .

Coronary Occlusion ; therapy ; Coronary Vessels ; Humans ; Percutaneous Coronary Intervention

BACKGROUNDClinical meaning of recovery phase limited ST segment depression of a treadmill exercise test is controversial. The aim of this study was to re-assess the diagnostic and prognostic value of ST segment depression during the recovery phase with the active phase of a treadmill exercise test in suspected coronary artery disease patients.

METHODSClinical, exercise and angiographic data were retrospectively collected from 602 patients in the study. Five hundred and seventy-six patients developed ST segment depression during the active phase of the treadmill exercise test (group 1) and 26 patients developed ST segment depression only during the recovery phase (group 2).

RESULTSWith similar major clinical features, the prevalence of significant coronary artery stenosis and average Gensini scores were lower in the recovery phase-limited depression patients (group 2 vs. group 1, 50.0% vs. 66.9%, P = 0.031 and group 2 vs. group 1, 1.5 vs. 8.5, P = 0.04). At a median follow up of 50.9 months for 22 group 2 and 34.8 months for 438 group 1 patients, the prevalence of total cardiac events was higher in group 1 than in group 2 patients (RR 1.60, 95% CI 1.00-2.54, P = 0.049).

CONCLUSIONThe present study provides preliminary evidence that the diagnostic and prognostic value of recovery phaselimited ST segment depression of treadmill exercise test is limited.

Coronary Angiography ; Coronary Artery Disease ; diagnosis ; Electrocardiography ; Exercise Test ; Female ; Humans ; Male ; Middle Aged ; Prognosis ; Retrospective Studies