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Objective To explore the effect of failure mode and effect analysis (FMEA) on reducing the unplanned extubation rates for patients with severe craniocerebral injury. Methods FMEA model was used to analyze the main reasons of unplanned extubation patients with severe craniocerebral injury, 7 failure modes with higher RPN scores was selected. The nursing intervention for the fixation of the catheter were improved. The control group with 181 cases of patients without FMEA application were given routine care. FMEA group owning 196 cases were given the optimization process. The incidence rate of unplanned extubation of two groups was compared. Results After improvement of the nursing process of patients with severe craniocerebral injury for fixing the catheter, the RPN of 7 failure modes was lowered. Compared with the control group, the total rate of unplanned extubation in FMEA group decreased to 1.1% (9/832), less than 5.1% (40/779) of the control group. The statistical difference was significant (χ2=22.410, P 0.05). Conclusions The FMEA model can be effective in reducing the rate of unplanned extubation .
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Objective To detect the change of hemorrheology and prethromboticstate markers levels in patients with obstructive sleep apnea hypopnea syndrome (OSAHS) and to explore the pathogenic mechanisms of cardio-cerebrovascular thromboembolic diseases in OSAHS patients. Methods Polysomnography was performed in 86 patients with OSAHS and in 20 control subjects matched for age and body mass index. The patients with OSAHS were divided into mild group , moderate group , and severe group according to the apnea hypopnea index (AHI). Hemorrheology and prethromboticstate markers levels were measured in all the subjects for correlation analysis. Results The whole blood viscosity, erythrocyte aggregation index, and erythrocyte electrophoresis time in mild OSAHS group , moderate OSAHS group and severe OSAHS group were significantly higher than those in the control group. The whole blood viscosity, erythrocyte aggregation index, and erythrocyte electrophoresis time were also significantly different between the three OSAHS groups , increasing with the severity of OSAHS. Plasma viscosity was not significant difference between OSAHS groups and the control group. Plasma D-D , AT-Ⅲ and vWF levels were also not significant difference between OSAHS groups and the control group. Conclusions The change of hemorrheology in OSAHS patients may contribute to the vulnerability of patients to cardio-cerebrovascular thromboembolic diseases.
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Objective To analyze the genotype and plasmid transfer of Enterobacteriaceae carring blaNDM‐1 with blaIMP‐4 or blaKPC‐2 .Methods From April 2012 to October 2014 ,a total of 33 non‐repeatitive carbapenem‐resistant Enterobacteriaceae ( including Imipenem‐resistant , meropenem‐resistant or Ertapenem‐resistant) were isolated from 5 hospitals in Wenzhou and Hangzhou . Identification and antimicrobial susceptibility test were performed using Vitek 2 Compact automatic microbiology analyzer . Phenotypes of carbapenemase were screened using modified Hodge test and ethylenediamine tetraacetic acid‐disk synergy test .Extended spectrum βlactamase test was determined by the double disk combination test which was recommended by Clinical and Laboratory Standards Institute .AmpC activity was tested by a three‐dimensional Cefoxitin method .Drug resistant genes including blaNDM‐1 and linkage of ISAba125‐NDM were detected by polymerase chain reaction (PCR) .The purified PCR products were cloned and sequenced .Plasmid conjugation experiment and elimination method were carried out to test partial bacterial strain and K . pneumoniae carrying blaNDM‐1 with blaIMP‐4 or blaKPC‐2 .Results Of the 33 non‐repeatitive carbapenem‐resistant Enterobacteriaceae ,28 were strains of K .pneumoniae ,1 strain of K . oxytoca,2strainsof Escherichiacoli,1strainof K.planticolaand1strainof E.cloacae.Thirteenstrains were isolated from Hospital of Sir Run Run Shaw of Zhejiang University ,thirteen from Wenzhou Hospital of Traditional Chinese Medicine ,one from Wenzhou People′s Hospital ,three from the First Affiliated Hospital of Wenzhou Medical University and three from Wenzhou Hospital of Integrated Traditional Chinese and Western Medicine .Thirty‐one strains were confirmed as carbapenemase‐producing with 24 of blaKPC‐2 ,3 of blaNDM‐1 ,1 of blaNDM‐5 and 3 of blaIMP‐4 .Among them ,one strain carried blaNDM‐1 with blaIMP‐4 and one strain carried blaNDM‐1with blaKPC‐2 ,respectively .The plasmid transfer and conjugation experiment was performed between strains carrying blaNDM‐1 and Escherichia coli EC600 or K . pneumoniae ATCC13833 and genes of blaNDM‐1 and ISAba125‐NDM were obtained .Conclusions blaKPC‐2 gene is the popular carbapenemase genotype .blaNDM‐1 or blaNDM‐5 may be correlated with linkage gene of ISAba125‐N DM .Coexistence of blaNDM‐1 carrying blaIMP‐4 or blaKPC‐2 is detected in the same strain , respectively . Enough importance should be attached to the strains ,because most of them are multiple drug resistance with related genes located in the plasmid which is easily spread between strains .
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Objective To investigate the correlations of Mycoplasma penetrans(MPe)infection with the differentiation.invasiveness and metastasis of stomach and colorectal calFcinomas.Methods Sixty five patients with stomach carcinoma,57 patients with colorectal carcinoma and 80 healthy individuals as controls were enrolled in this study.MPe was isolated and then confirmed by PCR.χ2 test was performed to analyze the correlations of MPe infection with the differentiation,invasiveness and metastasis of carcinoma.Results The rate of MPe isolated from stomach carcinoma group(41/65,63.1%)was significantly higher than that from stomach ulcer group(χ2=38.2,P＜0.01).The rate of MPe isolated from eolorectal carcinoma group (1/20,5%)was also significantly higher than that from colorectal polyps group(χ2=21.2,P＜0.01).The proportion of poor differentiation and the invasiveness in MPe positive stomach carcinoma group were significantly higher than those in MPe negative group(χ2:33.4 and 25.0.P＜0.01).The proportion of poorly differentiation and lymphatic metastasis(N3)in MPe positive colorectal carcinoma group were significantly higher than those in MPe negative group(χ2=34.4,P＜0.01).Conclusion Differentiation,invasiveness and metastasis are highly correlated with MPe infection in stomach and colorectal carcinomas.
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50%).The resistance of Enterococcus avium and E.faecalis to ciprofloxacin was over 30%.CONCLUSIONS To Gram-negaive bacteria may use ?-lactamase inhibitors with antimicrobials and amikacin.To nonfermenters may use ciprofloxacin.To Gram-positive bacteria may use teicoplanin,nitrofurantoin,ampicillin/sulbactam and others.
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AIM: To explore the pathological features of airway inflammation in patients with eosinophilic bronchitis(EB) and compared to those with cough variant asthma(CVA).METHODS: Flexible fibre optic bronchoscopy was performed in 11 patients with EB,10 with CVA,14 with bronchial asthma and 10 normal controls.The mean thickness of the basement membrane was measured by light microscopy.Using immunohistochemical and special staining,the localization and density of inflammatory cells(eosinophils,mast cells,T lymphocytes) were detected in bronchial submucosa in EB and CVA patients.RESULTS: The mean thickness of the basement membrane was significantly increased in the subjects with EB [2.92 ?m(2.10-6.50 ?m)],CVA [5.64 ?m(3.23-8.48 ?m)] and bronchial asthma [9.08 ?m(6.61-11.99 ?m)] rather than that in the normal controls [2.08 ?m(1.62-3.40 ?m)].There were also significant differences among the three groups.The number of mast cells and eosinophils in the bronchial submucosal from subjects with EB [75 cells/mm~2(35-112 cells/mm~2),7 cells/mm~2(0-31(cells/mm~2))] was substantially decreased than those in subjects with CVA [148 cells/mm~2(34-200 cells/mm~2),114 cells/mm~2((1-768 cells/mm~2));P