Objective　To explore the clinical characteristics and drug resistance of Elizabethkingia meningoseptica (EM) nosocomial infection, so as to provide evidence for prevention of EM nosocomial infection and guiding the rational use of antibiotics. Methods　A retrospective study was conducted of 67 patients with EM infection in a tertiary hospital from January 2021 to December 2022. The infective characteristics and drug resistance were analyzed. Results　The cohort of 67 EM-infected patients was predominantly males aged ≥60 years, with the most frequent source being the first district of the intensive care unit (ICU), followed by the respiratory medicine and emergency department (19.40%, 13/67). The specimens were mainly isolated from respiratory tract (86.57%, 58/67), of which sputum accounted for 49.25% (33/67), and alveolar lavage fluid accounted for 37.31% (25/67). The majority of EM infections occurred in patients with pre-existing respiratory conditions (49.25%, 33/67), who generally experienced prolonged hospital stays and underwent invasive procedures, such as mechanical ventilation 94.03% (63/67), urinary catheterization (95.52%, 64/67), and central venous catheterization (97.01%, 65/67). Post-treatment, the improved rate of the 67 patients was 40.30% (27/67). Susceptibility testing demonstrated a high resistance rate of EM to cefoperazone-sulbactam, 98.39% (61/62), contrasted by significant susceptibility to compound trimethoprim-sulfamethoxazole (TMP-SMX)/cotrimoxazole, doxycycline, minocycline, and piperacillin-tazobactam, with susceptibility rates exceeding 90%. Conclusions　The patients infected with EM were almost elderly men with certain underlying diseases, experienced prolonged hospital stays, and had a history of invasive operations. The specimens of EM were mainly from Intensive Care Unit and isolated from respiratory tract. The strain showed high resistance to cefoperazone-sulbactam, whereas it remained highly susceptible to cotrimoxazole, doxycycline, minocycline and piperacillin-tazobactam, which may be considered as first-line treatment options.

Objectives:To investigate the effect of polyester filament fiber surgical drape in neurosurgery.Methods:A total of 181 neurosurgical surgeries were selected from April to July 2019 in a first-class general hospital. They were randomly divided into 2 groups, cotton group (92 cases) were covered with cotton drape, polyester filament fiber group (89 cases) were covered with polyester filament fiber. The anti-permeation performance, incidence of intraoperative hypothermia, and incidence of postoperative surgical site infection (SSI) between the two groups were compared.Results:At the end of the operation, the wetting rate of the cotton draped was 58.7% (54/92) and that in polyester filament fiber was 15.7% (14/89), with statistically significant differences ( χ2 value was 35.605, P<0.05);The incidence of intraoperative hypothermia was 22.8% (21/92) in the cotton group and 11.2% (10/89) in the polyester filament fiber group, with statistically significant differences ( χ2 value was 4.281, P<0.05). The incidence of SSI in the cotton group was 16.3% (15/92) , while that in the polyester filament fiber group was 6.7% (6/89) , with statistically significant differences ( χ2 value was 4.034, P<0.05). Conclusions:In neurosurgical operations with a long operation time and a large amount of irrigation fluid during the operation, using the polyester filament fiber drape can prevent the irrigation fluid from wetting the surgical drape, protect the surgical incision better, reduce the incidence of SSI and intraoperative hypothermia to some extent.

Objective:To explore the clinical effect and safety of interventional treatment of autogenous arteriovenous fistula(AVF) stenosis.Methods:From July 2017 to September 2018, 96 patients with arteriovenous fistula stenosis and occlusion admitted to Handan First Hospital, Hebei Province were retrospectively analyzed.All of them were dialysis patients with chronic renal failure.All patients underwent percutaneous balloon angioplasty via the cephalic vein.The success rate of technique, clinical success rate, perioperative complications and follow-up were observed.Results:(1) Technical success rate and clinical success rate: 90 patients were treated with percutaneous transluminal angioplasty (PTA) via the cephalic vein, the other 3 patients were treated with interventional therapy via the brachial artery, and 3 patients underwent reconstruction of internal fistula.The technical success rate was 93.8% (90/96), and the clinical success rate was 89.6% (86/96). (2) Perioperative complications: thrombosis in 4 cases, vasospasm in 3 cases.There were no serious complications such as vascular rupture, aneurysm, vascular dissection, and no perioperative death.(3) The first stage patency rate was 100% (90/90), 74.4% (67/90), 62.2% (56/90) and 46.7% (42/90) in 3, 6, 12 and 18 months after operation.Conclusion:Venipuncture can be used as the first choice for AVF stenosis interventional therapy because of its advantages of small trauma, no serious complications, no need of long-term compression at the puncture point, immediate dialysis, and avoidance of local hematoma and other complications caused by artery puncture.

Objective:To compare the clinical effect and perioperative complications of the treatment of autogenous arteriovenous fistula stenosis by arterial and venous approach.Methods:The clinical data of 120 patients with AVF stenosis and occlusion who were treated with interventional therapy and met the inclusion criteria were collected and analyzed by retrospective case-control study.from September 2017 to August 2018, 60 patients with internal fistula stenosis were treated by transarterial approach (arterial approach group), and from September 2018 to may 2019, 60 patients were treated with a new surgical scheme(venous approach group). The operation success rate, perioperative complications and patency rate of 3, 6, 12 months after operation were compared between the two groups.Results:(1) The technical success rate was 96.7% (58/60) and the clinical success rate was 91.7% (55/60) in the arterial approach group, and 95.0%(57/60) and 93.3%(56/60) in the venous approach group.There was no significant difference in the technical success rate and clinical success rate between the two groups ( P=0.718 and 1.000, respectively) (2) Perioperative complications: in the arterial approach group, 3 patients had hematoma at the puncture point, 2 pseudoaneurysms and 5 thrombosis.There were 3 patients with thrombosis in the venous access group, and the difference in the incidence of complications between the two groups was statistically significant (χ 2=4.227, P=0.036). (3)The primary patency rates at 3, 6 and 12 months after operation were 95.0%(57/60), 75.0%(45/60) and 60.0%(36/60) in the arterial approach group, and 96.7%(58/60), 71.7%(43/60) and 61.7%(37/60) in the venous access group, respectively.There was no statistically significant difference between the two groups ( P=0.718, 0.749, 0.885). Conclusion:The interventional treatment for autogenous arteriovenous fistula stenosis through artery and vein approach can achieve good effect.There were many complications during the perioperative period, It is suggested that venous approach is preferred.

Objective:To investigate the pathological characteristics and the clinical significance of novel coronavirus (2019-nCoV)-infected pneumonia (termed by WHO as coronavirus disease 2019, COVID-19).Methods:Minimally invasive autopsies from lung, heart, kidney, spleen, bone marrow, liver, pancreas, stomach, intestine, thyroid and skin were performed on three patients died of novel coronavirus pneumonia in Chongqing, China. Hematoxylin and eosin staining (HE), transmission electron microcopy, and histochemical staining were performed to investigate the pathological changes of indicated organs or tissues. Immunohistochemical staining was conducted to evaluate the infiltration of immune cells as well as the expression of 2019-nCoV proteins. Real time PCR was carried out to detect the RNA of 2019-nCoV.Results:Various damages were observed in the alveolar structure, with minor serous exudation and fibrin exudation. Hyaline membrane formation was observed in some alveoli. The infiltrated immune cells in alveoli were majorly macrophages and monocytes. Moderate multinucleated giant cells, minimal lymphocytes, eosinophils and neutrophils were also observed. Most of infiltrated lymphocytes were CD4-positive T cells. Significant proliferation of type Ⅱ alveolar epithelia and focal desquamation of alveolar epithelia were also indicated. The blood vessels of alveolar septum were congested, edematous and widened, with modest infiltration of monocytes and lymphocytes. Hyaline thrombi were found in a minority of microvessels. Focal hemorrhage in lung tissue, organization of exudates in some alveolar cavities, and pulmonary interstitial fibrosis were observed. Part of the bronchial epithelia were exfoliated. Coronavirus particles in bronchial mucosal epithelia and type Ⅱ alveolar epithelia were observed under electron microscope. Immunohistochemical staining showed that part of the alveolar epithelia and macrophages were positive for 2019-nCoV antigen. Real time PCR analyses identified positive signals for 2019-nCoV nucleic acid. Decreased numbers of lymphocyte, cell degeneration and necrosis were observed in spleen. Furthermore, degeneration and necrosis of parenchymal cells, formation of hyaline thrombus in small vessels, and pathological changes of chronic diseases were observed in other organs and tissues, while no evidence of coronavirus infection was observed in these organs.Conclusions:The lungs from novel coronavirus pneumonia patients manifest significant pathological lesions, including the alveolar exudative inflammation and interstitial inflammation, alveolar epithelium proliferation and hyaline membrane formation. While the 2019-nCoV is mainly distributed in lung, the infection also involves in the damages of heart, vessels, liver, kidney and other organs. Further studies are warranted to investigate the mechanism underlying pathological changes of this disease.

Objective To investigate the clinical value of serum lipoprotein associated phospholipase A 2 (Lp-PLA2)as a biomarker for benign prostatic hyperplasia(BPH).Methods A total of 65 serum samples of BPH patients were selected as BPH group,64 serum samples of healthy male as control group.The serum lev-el of Lp-PLA2,total prostate specific antigen(tPSA)and free prostate specific antigen(fPSA)in both groups were detected,and the specificity and sensitivity of Lp-PLA2,F/T ratio and combine both were analyzed by ROC curve.Results The serum level of Lp-PLA2,tPSA and fPSA in BPH group were significantly higher than those in control group,the different were significant(P<0.05).ROC curve analyze shown that the area under the curve(AUC)of Lp-PLA2 was 0.763,95% confidence interval(CI)was 0.680-0.833;AUC of F/T ratio was 0.715,95% CI 0.633 -0.795;AUC of Lp-PLA2 combined with F/T ratio was 0.832,95% CI 0.756-0.892.Conclusion The serum level of Lp-PLA2 could be used as a potential diagnostic marker for BPH,and the diagnostic value of Lp-PLA2 combined with F/T ratio was better than ther single indicator. Key words:benign prostatic hyperplasia; lipoprotein associated phospholipase A 2; total prostate spe-cific antigen; free prostate specific antigen; F/T ratio

AIM:To explore the effects of different intensity of warfarin on patients with coronary atherosclerotic heart disease complicated with atrial fibrillation.METHODS:One hundred and seven cases of coronary heart disease complicated with atrial fibrillation patients in our hospital were selected and were randomly divided into experimental group (n =54) and control group (n =53) by random number table.The experimental group (low intensity) received initial amount of warfarin for 1.25 mg/d,and NR monitoring 24 h after treatment,if INR＜ 1.4,3-5 mg/d increased by 0.5-1.0 mg/d,monitoring one time per week,INR maintained within 1.4-2.0.INR of the control group (medium intensity) maintained within 2.0-2.6.One month monitoring after INR stabilized.All patients were treated for about 4 weeks,and warfarin was maintained at a dose of 1.25-7.5 mg/d.The primary and secondary end points and bleeding events were observed and compared after 2 years of treatment.RESULTS:The INR of the experimental group and the control group were 1.71 ± 0.38,2.36 ± 0.35,respectively.The ratio of total bleeding event of the experimental group and the control group was 22.2％ and 41.5％,respectively.Those of the experimental group were lower than those of the control group,and the difference was all statistically significant (P＜ 0.05).CONCLUSION:The efficacy of low-intensity warfarin in the treatment of coronary atherosclerotic heart disease complicated with atrial fibrillation is comparable to that of moderate-intensity warfarin therapy,but low-intensity warfarin shows better saftey.

Objective To explore clinical results of posterior debridement combined with atlantoaxial fusion for upper cervical Tuberculosis.Methods From March 2007 to April 2012,8 patients with upper cervical Tuberculosis underwent posterior debridement combined with atlantoaxial fusion in our hospital were selected for retrospective analysis.3 cases were males and 5 females,aged 29-65 (43.5 ±13.2) years.According to the pedicle destruction,using different screws (pedicle screw or laminar screw)fixation.In the preoperative and final follow-up,Japanese Orthopaedic Association score (JOA) and neck disability index (NDI) were used to evaluate neurological function and calculate improvement rate JOA score.At final follow-up,clinical efficacy was evaluated by Odom's grade.situation of internal fixation,fusion of upper cervical were assessed by imaging examination.During follow-up,complications were documented and analyzed.Results Postoperatively 12 months,all bony fusion were achieved.Tuberculosis were reached clinical cure in 12-18 months.The JOA score increased from 10.5 ± 2.0 preoperatively to 15.6 ± 1.1 in final follow-up(P ＜0.05),and the NDI decreased from 29.9 ± 6.2 preoperatively to 8.6 ±1.6 (P ＜ 0.05).At last follow-up,according to Odom's standard,excellent were obtained in 6 cases(75.0％),good 1 cases (12.5％) and ordinary 1 case (12.5％).No severe complications was documented during follow-up.Conclusions The treatment of posterior debridement combine with atlantoaxial fusion,and structure grafting and local anti-Tuberculosis drug using intraoperative,not only could obtain reliable clinical efficacy,completely removal of lesions,but also obtain strong stability,which plays an important role in the treatment of cervical tuberculosis.

Objective To explore clinical results of posterior debridement combined with atlantoaxial fusion for upper cervical Tuberculosis.Methods From March 2007 to April 2012,8 patients with upper cervical Tuberculosis underwent posterior debridement combined with atlantoaxial fusion in our hospital were selected for retrospective analysis.3 cases were males and 5 females,aged 29-65 (43.5 ±13.2) years.According to the pedicle destruction,using different screws (pedicle screw or laminar screw)fixation.In the preoperative and final follow-up,Japanese Orthopaedic Association score (JOA) and neck disability index (NDI) were used to evaluate neurological function and calculate improvement rate JOA score.At final follow-up,clinical efficacy was evaluated by Odom's grade.situation of internal fixation,fusion of upper cervical were assessed by imaging examination.During follow-up,complications were documented and analyzed.Results Postoperatively 12 months,all bony fusion were achieved.Tuberculosis were reached clinical cure in 12-18 months.The JOA score increased from 10.5 ± 2.0 preoperatively to 15.6 ± 1.1 in final follow-up(P ＜0.05),and the NDI decreased from 29.9 ± 6.2 preoperatively to 8.6 ±1.6 (P ＜ 0.05).At last follow-up,according to Odom's standard,excellent were obtained in 6 cases(75.0％),good 1 cases (12.5％) and ordinary 1 case (12.5％).No severe complications was documented during follow-up.Conclusions The treatment of posterior debridement combine with atlantoaxial fusion,and structure grafting and local anti-Tuberculosis drug using intraoperative,not only could obtain reliable clinical efficacy,completely removal of lesions,but also obtain strong stability,which plays an important role in the treatment of cervical tuberculosis.

To explore the protective effect of sodium tanshinone IIA sulfonate (STS) on microcirculatory disturbance of small intestine in rats with sepsis, and the possible mechanism, a rat model of sepsis was induced by cecal ligation and puncture (CLP). Rats were randomly divided into 3 groups: sham operated group (S), sepsis group (CLP) and STS treatment group (STS). STS (1 mg/kg) was slowly injected through the right external jugular vein after CLP. The histopathologic changes in the intestinal tissue and changes of mesenteric microcirculation were observed. The levels of tumor necrosis factor-α (TNF-α) in the intestinal tissue were determined by using enzyme-linked immunoabsorbent assay (ELISA). The expression of intercellular adhesion molecule-1 (ICAM-1) in the intestinal tissue was detected by using immunohistochemisty and Western blot, that of nuclear factor κB (NF-κB) and tissue factor (TF) by using Western blot, and the levels of NF-κB mRNA expression by using RT-PCR respectively. The microcirculatory disturbance of the intestine was aggravated after CLP. The injury of the intestinal tissues was obviously aggravated in CLP group as compared with S group. The expression levels of NF-κB p65, ICAM-1, TF and TNF-α were upregulaed after CLP (P<0.01). STS post-treatment could ameliorate the microcirculatory disturbance, attenuate the injury of the intestinal tissues induced by CLP, and decrease the levels of NF-κB, ICAM-1, TF and TNF-α (P<0.01). It is suggested that STS can ameliorate the microcirculatory disturbance of the small intestine in rats with sepsis, and the mechanism may be associated with the inhibition of inflammatory responses and amelioration of coagulation abnormality.