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Objectives This meta-analysis was performed to compare polymyxin monotherapy and polymyxin-based combination therapy for carbapenem-resistant Klebsiella pneumoniae (CR-KP) infections. Methods We conducted searches on MEDLINE, Embase and Cochrane Collaborative database for both observational studies and randomised controlled trials (RCTs) comparing polymyxin monotherapy with polymyxin-based combination therapy in patients with CR-KP infection. The primary outcome was mortality. We divided all included studies into several groups according to different combination-combination and different infection types. The odds ratio (OR) and 95% confidence intervals (CI) were calculated for outcome analysis. Results Ten studies with 481 patients were included. Polymyxin monotherapy was associated with higher mortality than polymyxin-based combination therapy in treatment of CR-KP bloodstream infections (BSI) (OR 1.93, 95% CI 1.14–3.27, P = 0.01) and ventilator-associated pneumonia (VAP)/hospital-acquired pneumonia (HAP) (OR 3.82, 95% CI 1.15–12.71, P = 0.03). In subgroup analysis of different combinations, mortality was significantly higher with polymyxin monotherapy compared with combination therapy with tigecycline (OR 1.88, 95% CI 1.05–3.37, P = 0.03), or with cabapenem (OR 3.11, 95% CI 1.25–7.74, P = 0.01), but no differences were found in combinations with aminoglycosides (OR 1.29, 95% CI 0.72–2.29, P = 0.38). Three-drug combination therapy including polymyxin was also associated with significant survival benefit (OR 3.86, 95% CI 1.60–9.32, P = 0.003). Conclusions Polymyxin-based combination therapy provides significant survival benefit in treatment of CR-KP, which appears to be more pronounced when a carbapenem or tigecycline is included in the regimen.

The transmission corridors can be effectively saved using 750 kV four-circuit transmission line on the same tower. In order to reduce the corona level, structure optimisation of fittings plays an important role in the transmission line design. In this study, the electric field distribution of 750 kV transmission line on six cross-arms tower was calculated based on finite element method, and the influences of pipe diameter, ring diameter and installation position of the grading ring were analysed. The results show that the increase of pipe diameter can reduce the electric field strength of grading ring while the increase of installation position and decrease of ring diameter are important to protect the end fitting of composite insulator. When using grading ring with the pipe diameter of 100 mm, the ring diameter of 700–900 mm and the installation position of 150–250 mm, the electric field strength can be controlled in a reasonable range. These results can provide references for the grading ring design of 750 kV four-circuit transmission line on the same tower.

Composite cross-arm of ultra-high voltage (UHV) tower bears both electric and mechanical loads. Owing to its high operation voltage and very complex insulation structure, potential and electric field distributions of composite cross-arm are extremely uneven. It may affect long-term stable operation of transmission line. Using three dimension finite element method (FEM), this paper presented research on voltage equalizing characteristics of composite cross-arms in 1000 kV tower. Computation model was established. The potential and electric field distributions of middle phase and side phase under several design schemes were computed. The program for grading and shielding devices was designed and then optimized. The electric field computation results showed that the electric field strengths on key positions were within permitted range. Corona tests showed that no visible corona discharge was found from insulators or fittings when the applied voltage was 1.2 times of test voltage. The design of the grading and shielding devices can be applied in actual projects.

Objective To discuss the preservation solution (PS) contamination and initial experience of liver transplantation from organ donation by citizens after death and initial experience. Methods The 78 liver transplant recipients were divided into positive group and negative group based on the finding of the culture of PS. The positive group received the sequential therapy of antibiotics with ertapenem and imipenem for one week, and the negative group stopped using imipenem. The situation of PS contamination and infection after liver transplantation and prognosis during the follow-up 3 months of the recipients were analyzed. Results PS culture positive rate was 41.03%, and 33 strains of pathogens were isolated. The most common pathogenic bacteria were gram-negative bacilli (9 strains, 27.27%) and coagulase –negative staphylococci (9 strains, 27.27%). The infection rate after liver transplantation was 31.25% and 13.04%, respectively, in positive group and negative group (χ2=3.837, P=0.048). The most frequent infection sites were lower respiratory tract (5 cases, 31.25%), abdominal cavity (5 cases, 31.25%) and surgical incision (4 cases, 25.00%). There was no significant difference in postoperative infection rate among patients with different CTP, MELD and surgical methods (P>0.05). One case (1.28%) was infected with the same pathogenic bacteria as PS contamination 3 weeks after liver transplantation, and died of multiple organ failure. There was no significantly difference in the acute rejection rate (1,3.13% and 2, 4.35%) and mortality (2,6.25% and 5,10.87%) between the two groups (P>0.05). Conclusion Contamination of the PS is frequent in liver transplantation, and it is the risk factor for postoperative infection of recipients. Early targeted antimicrobial treatment against pathogens cultured from PS play a positive role in reducing the contamination-associated infection rate after liver transplantation.

Objectives: To provide evidence of the clinical efficacy of Xuebijing (XBJ) on blood coagulation in patients with sepsis. Methods: We conducted this meta-analysis in The People’s Hospital of Liaoning Province, Shenyang, China between December 2013 and May 2014. We searched a number of databases for relevant randomized controlled trials (RCTs) published before December 2013 using the keywords ‘Xuebijing’, ‘coagulation’ and ‘sepsis’. Statistical analysis was performed with Review Manager 5.2 from the Cochrane Collaboration. Results: Fourteen RCTs involving 867 patients were included. Compared with placebo, XBJ injection significantly improved platelets (mean differences [MD] = 42.14, 95% confidence interval [CI]: 22.42 - 61.86, p

Tess of the D’Urbervilles is one of the most famous novels of Thomas Hardy. Tess—the heroine brings us deep inspiration and profound reflection. And the author Thomas Hardy describes the impacts of the industrial civilization on a village panoramically, then Tess as an individual miniature, further shows the people struggle in the plight of the struggle in the material. Tess is difficult to be recognized by the society, which makes her realize the hypocrisy of bourgeois society and the distortion of ethics. Briefly in this paper, the author tries to find out the causes of the tragedy of Tess by analyzing the characteristics of Tess and the male characters in Tess’ life and make people have a better understanding of the literary work.

Due to unbalanced energy resources and allocation of productive force in China, our country has to develop and build ultra-high voltage grid. As most of western regions in China are located in high attitude area, the construction of power transmission and transformation project would inevitably go though these different altitude regions with average elevation of over 1000 meters. The atmospheric condition in different altitude regions has distinctive impact on the discharge voltage of outdoor insulators. The experimental results from low altitude regions cannot be used for engineering design of high altitude applications. The characteristic of air gap discharge is the basis of UHV transmission line external insulation design. Studying the discharge characteristics of side-phase discharge and its altitude correction can not only provide reference for choosing air gap distance in power projects at high altitude, but also be used for correcting air gap discharge voltage at high altitude. For the purpose of obtaining air gap discharge voltage and its correction in different altitudes, typical phase-to-phase air gap was selected, and comparative experiments were conducted under the same configuration condition at the different altitude areas such as Wuhan (35m), Chengdu (500m), Guiyang (1000m), Kunming (2100m). The experiments were carried out under extreme weather conditions which considered air pressure, temperature and humidity, including direct alternating current (AC) voltage discharge tests with gap length of 1.3m, lightning impulse (LI) voltage discharge tests with gap length of m, and switching impulse (SI) voltage discharge tests with gap length of 3.3m and 4.2m. According to the test results, the influence of atmospheric conditions and altitude correction factors of AC, LI, and SI discharge voltage were calculated and analyzed systemically in this paper. Finally, altitude correction parameters of typical air gap discharge voltage at high altitude of 2100m in voltages of AC, LI and SI were proposed, and the impact of proposed changes in the voltage range under the influence of factors such as temperature, humidity, and barometric pressure, etc., obtained modified formula to meet the needs of practical engineering.

In this paper, experiments on artificial polluted insulator are conducted to study the 50% withstand voltage U50 of artificial polluted suspension insulators under different levels of contamination and asymmetric contamination on the top/bottom surface. The electrical fields along the insulator surfaces under different scenarios, such as asymmetric contamination on top/bottom surface, and uneven circumferential distribution of surface contamination, have been calculated by the use of finite element analysis for field simulation. The simulated result shows that asymmetric top/bottom surface contamination has a greater impact on the insulator electrical field distribution, which has practical meanings to the anti-fouling design of the transmission line under different pollution level across the country.

Objective The aim of this study is to investigate the use of multipolar radiofrequency (RF) ablation with internally cooled electrodes to control hemorrhage percutaneously from blunt liver trauma. Methods Blows were used to 10 heparinized and anesthetized domestic pigs, resulting in blunt liver trauma. Eight pigs were percutaneously treated by using multipolar RF ablation with internally cooled electrodes. Two pigs were not treated (control group). The treated pigs were killed humanely 2 hours after the treatment. Results Blunt liver trauma was successfully produced by the application of abdominal impact in all pigs. Hemostasis was achieved in all treated pigs with 8.5 ± 4.5 minutes of RF ablation treatment. No delayed hemorrhage, bile leakage, pus, or other fluid was found in the livers in all treated pigs when they were killed 2 hours after the treatment. Conclusions Multipolar RF ablation with internally cooled electrodes is effective in producing hemostasis percutaneously by direct treatment of injured parenchyma in blunt liver trauma.