ObjectiveTo explore the application of enlargement of plastic surgery for dural closure with radial neuro-patch in standardize large decompressive craniectomy (SLDC).MethodsTwenty-one patients (observation group) who needed a SLDC for various reasons were treated with radial incision in dura to release the high intracranial pressure and enlargement of plastic surgery for dural closure with radial neuropatch from March 2009 to June 2010.The neuro-patch were used as the dural substitutes.Twenty-one patients were treated with SLDC only for the similar reasons (control group).General healing effects were compared betweentwo groups.ResultsIn 6 hours and 72 hours after surgery,the rate of obvious effectiveness in observation group was significantly higher than that in control group [33.33％(7/21 ) vs.14.29％(3/21 ),33.33％(7/21 ) vs.19.05％(4/21 ) 、61.90％( 13/21 ) vs.28.57％(6/21 ),61.90％( 13/21 ) vs.38.10％(8/21 )](P ＜ 0.05).The rate of intracranial infection,cerebrospinal leak and epilepsy in observation group [0,0,4.76％ ( 1/21 )]was significantly lower than that in control group [14.29％ (3/21),14.29％ (3/21),19.05％ (4/21)](P ＜0.05).The rate of subcutaneous or subdural cerebrospinal fluid accumulation,cenencephalocele,cerebral ventricular malformation,brain hernia through the skull window had no significant difference between two groups [19.05％(4/21 ),0,4.76％( 1/21 ),0 in observation group;23.81％(5/21 ),9.52％(2/21 ),9.52％(2/21 ),4.76％( 1/21 ) in control group) (P ＞ 0.05 ).After followed up of 6-12 months,the rate of the well general outcome in observation group was significantly better than that in control group [85.71％ ( 18/21 ) vs.71.43％ ( 15/21 )](P ＜ 0.05 ).The rate of moderate-critical function handicapped in control group was significantly higher than that in observation group [23.81％(5/21 ) vs.9.52％(2/21 )](P＜0.05 ).ConclusionsThe SLDC is effective for decreasing the intracranial pressure,and the enlargement of plastic surgery for dural closure with radial neuro-patch can improve the efficiency and decrease the incidence of complicating diseases.This therapy can improve the patients' general quality of survival and is worth to be popularized in clinic.

Colorectal cancer is one of the most common malignancies. Various studies have focused on differences between colon can-cers on the left and right sides. These types of colon cancer differ in terms of their molecular features, embryologic origin, anatomy, pathogenesis to physiological functions, clinical features, treatment response, and prognosis. Therefore, the left-and right-side colon cancers are regarded as different diseases. These differences have significant effect on clinical decision-making and personalized medi-cine.

Objective To investigate the effect of using evidence - based nursing (EBN) in the course of nursing patients with severe craniocerebral injury combined pulmonary diseases. Method Divided 160 patients into research group and control group randomly, there were 80 patients in each group. Using EBN in the research group, and routine nursing measures was used in the control group, and then compare the rehabilitation of patients in 2 groups. Result The condition of rehabilitation in research group was significant better than that of in control group, P

Objective To isolate and identify the methicillin-resistant Staphylococcus aureus (MRSA) strains carrying Panton-Valentine leukocidin genes (pvl+-MRSA) from clinical samples and to further understand their molecular characteristics and infections caused by them.Methods Drug susceptibility test was performed to detect the drug resistance in 259 MRSA strains.pvl+-MRSA strains were screened out from those MRSA strains using cefoxitin slip test and mecA gene detection by PCR.Multiple PCR and multilocus sequence typing (MLST) were used for SCCmec and ST typing.Pulsed-field gel electrophoresis (PFGE) and cluster analysis were used to understand the genetic and epidemic features of the pvl+-MRSA strains.Different types of infections and diseases caused by the pvl+-MRSA strains were analyzed.ResultsAmong the 259 MRSA strains, 51 pvl+-MRSA strains were identified (19.7%, 51/259), of which 29 and 22 strains were respectively isolated from patients with community-acquired and hospital-acquired infections.ST59-SCCmecⅢ (35.3%, 18/51) was the predominant type of the 51 pvl+-MRSA strains, followed by ST59-SCCmecⅣ(25.5%, 13/51).But no predominant clone among those strains was revealed by the result of PFGE.Children, young-and middle-aged patients (≤44 years old) had a significantly higher positive rate of pvl+-MRSA than patients aged ≥45 years (P<0.05).Skin and soft tissue infection (47.1%, 24/51) was the most common disease caused by the pvl+-MRSA strains (P<0.05), followed by pneumonia (17.6%, 9/51).The pvl+-MRSA strains showed lower resistance to levofloxacin, gentamycin and rifampicine (7.8%-21.6%).No moxifloxacin-, nitrofurantoin-or linezolid-resistant pvl+-MRSA strains were identified.Conclusion The rate of pvl+-MRSA infection is high in the local population.ST59-SCCmecⅢ and ST59-SCCmecⅣ are the predominant types of pvl+ MRSA strains.Children, young-and middle-aged persons are the susceptible population.Skin and soft tissue infection and pneumonia are the common diseases caused by pvl+-MRSA.

Objective To evaluate the effect of maternal separation stress on the behavior of neonatal rd mice.Methods Neonatal rd mice were divided into maternal separation (MS) group (n=9) and control group (n=9).MS-stress was induced in the MS group by 4-hour-separation per day for 28 days.Open field test,elevated plus maze test,forced swim test and tail suspension test were used to evaluate the anxiety-like and depression-like behavior of the neonatal rd mice.Results The stay time and distance travelled of MS group in the central zone were 0.88％ and 28.17±5.65 cm,respectively,significantly shorter than that of the control group (2.61％,109.9±9.79 cm.P =0.04,P =0.001).Compared with the control group,the stay time in open arms of the MS group was significantly decreased (P<0.01),while the immobility time in forced swim test and tail suspension test of the MS group were 126.5±10.22 s and 21.56±6.83 s,significantly longer than that of the control group (77.75±16.83 s,P =0.02,7.37±3.22 s,P =0.03).Conclutions The 28-day maternal separation stress can significantly increase the anxiety-like and depression-like behavior in neonatal rd mice.

OBJECTIVE To investigate the distribution and antibiotic susceptibility of pathogens causing urinary infection,for the guide of rational use of antimicrobial agents in clinic. METHODS The bacteria isolated from the middle segment urine sample were identified by ATB system,and K-B method was used to study the antimicrobial resistance.The data were analyzed by WHONET 5.3. RESULTS Escherichia coli was one of the most common bacteria in the urinary tract infection(57.6%),and then were Enterococcus(14.4%).The results of antibiotic susceptibility test in vitro showed the susceptibility rate of Enterobacteriaceae and Acinetobacter baumannii to imipenem,was 100.0%,but the resistance rate of Pseudomonas aeruginosa was 13.6%.Gram-positive cocci were sensitive to glycopeptide antibiotics and linezolid. CONCLUSIONS Clinician should pay attention to the kinds of pathogenic bacteria causing urinary tract infection and their susceptibility to clinically common used antibiotics for reasonable use of drugs.

Objective To investigate the drug resistant genes against carbapenems,aminoglycosides and quinolones and the molecular epidemiology of clinical isolates of Acinetobacter baumannii.Methods Forty non-duplicate strains of Acinetobacter baumannii were collected from clinical specimens in First Affiliated Hospital of Wenzhou Medical University.The identification of strains was conducted by Vitek 2 Compact system.The susceptibilities to antimicrobials commonly used were determined by agar plate dilution method and broth microdilution method.The presence of class B metalloenzyme-encoding genes (blaIMP,blaVIM,blaNDM,blaSIM,blaGIM),class D cabapenemase-encoding genes (blaOXA-23,blaOXA-48,blaOXA-58),16S rRNA methylase genes (armA,rmtB) and quinolone resistance-determining regions (QRDR) in gyrA and parC were detected by polymerase chain reaction (PCR) and sequenced.Chromosomal or plasmid location of blaOXA-23 and armA genes were assessed by Southern blot.Multiple loci sequence classification (MLST) was performed to analyze the molecular epidemiology of these strains.Results All of the 40 isolates were multi-drug resistant Acinetobacterbaumannii (MDR-AB) and showed high level resistance to all of the tested antimicrobial agents excluding colistin and tigecycline.The positive rates of blaOXA-23 and armA were 90％ and 95％,respectively.All of the 40 isolates carried QRDR mutations in gyrA and parC genes,leading to the Ser83→ Leu and the Ser80→ Leu amino-acid substitutions,respectively.Southern blot showed the chromosomal location of blaOXA-23 and armA genes.Six different ST (ST191,ST381,ST373,ST426,ST208 and ST207) were assigned for these isolates by MLST and the most dominant clones were ST191 (23/40) and ST381 (10/40).Conclusions The predominant cabapenemase-encoding gene and 16S rRNA methylase gene of Acinetobacter baumannii isolates in First Affiliated Hospital of Wenzhou Medical University are blaOXA-23 and armA,respectively,which may be located on the chromosome and vertically transmit the drug resistance.ST191 MDR-AB with blaOXa-23 and armA gene clonally spread in this hospital.

Objective To investigate the prevalence and plasmid size of qnrD determinant in Morganella morganii (M.morganii) isolates.Methods A total of 100 non-duplicated M.morganii clinical isolates were collected from inpatients.Standard ager dilution method was used to determine the minimum inhibitory concentrations (MICs) of fluoroquinolones against M.morganii isolates.PCR were performed to detect plasmid-mediated quinolone resistance determinants (PMQRs) in M.morganii isolates and the prevalence of extended-spectrum β-lactamase (ESBL) genes and AmpC β-lactamase genes in PMQRs-positive M.morganii strains.The homology analysis among qnrD-positive M.morganii strains were conducted by using pulsed-field gel electrophoresis (PFGE).The location of qnrD gene and the size of plasmid carrying it were determined by southern hybridization.The transferability of qnrD gene was determined by conjugation experiment.Results Thirty out of 100 M.morganii isolates (30％) were found carrying PMQRs including 17 qnrD-positive strains,14 aac (6')-Ib-cr-positive strains and 5 qepA-positive strains.PCR and sequencing confirmed that thirty PMQRs-positive isolates carried blaDHA-1.Among them,six isolates were positive for ESBLs genes (four for blaCTX-M-14,one for blaCTX-M-3 and one for blaCTX-M-24) and four isolates were positive for blaTEM-1.Almost all PMQRs-positive M.morganii isolates showed reduced susceptibility to fluoroquinolones.Moreover,seventeen qnrD-positive M.morganii isolates harbored blaDHA-1 including five (29.4％) harboring aac(6')-Ib-cr gene,four (23.5％) harboring blaCTX-M-14,two (11.8％) harboring blaTEM-1 and one harboring aac(6')-Ib-cr gene,blaCTX-M-14 and blaDHA-1.PFGE analysis showed that the 17 qnrD-positive M.morganii isolates were divergent from each other and not clone-related.Southern hybridization analysis showed that qnrD genes of all M.morganiiis isolates were mainly located in a 2.7 kb plasmid,but only a few of them were located in a size of 5.1 kb plasmid.M.morganiiis isolates failed to transfer qnrD gene to E.coli EC600 through conjugation.Conclusion PMQRs were widely distributed in M.morganiiis isolates.qnrD gene was the predominant determinants with a high prevalence rate of 17.0％,followed by aac(6')-Ib-cr gene.qnrD gene was located on a non-conjugative plasmid of approximately 2.7 kb or 5.1 kb.One qnrD-positive M.morganii isolate carrying aac(6')-Ib-cr gene,blaCTX-M-14 and blaDHA-1 was detected.

Wistar rats were intragastrically administered with different doses (2, 5 and 10 g / kg body weight) of haematitum. 1H NMR-based metabonomic analysis coupled with multivariate statistical analysis (principal component analysis and partial least squares-discriminant analysis) was used to analyze the metabolic profiles of the urine samples collected from the treated rats. Univariate analysis on the 1H NMR spectra of urine (1 d before administration, 1-5 d post administration) was used to screen out the potential features of haematitum. Significant treatment related changes were observed for the levels of citrate, tuarine, creatinine,α-ketoglutarate, succinate and dimethylglycine, which could be used as potential features of haematitum. A trend of recovery in connection with dose levels was observed overtime. Such biochemical changes indicated that haematitum treatment at the dose of 2, 5 and 10 g / kg body weight affected the Krebs cycle and glucose metabolism, energy metabolism, choline metabolism and dimethylglycine metabolism in rats. These changes may attribute to the disturbances of hepatic function in 10 g / kg body weight group.

Objective To investigate the phenotypes and genotypes of extended -spectrum β-lacta-mases (ESBLs) and AmpC β-lactamases produced by cefoxitin-resistant Shigella strains isolated from Zhe-jiang province and the virulence of those strains .Methods Kirby-Bauer antibiotic testing was performed to screen cefoxitin-resistant strains from 356 Shigella isolates.The serotypes of the cefoxitin-resistant strains were detected .The phenotypes of ESBLs and AmpC β-lactamases from cefoxitin-resistant strains were detec-ted by ESBLs confirmatory test and AmpC-three-dimensional test ,respectively .The genotypes of ESBLs and AmpC β-lactamases were analyzed by PCR and sequence analysis .The virulence genes ( virA, ial, iapH, set1A, set1B and sen) in the cefoxitin-resistant strains were screened by PCR .Results Eight cefoxitin-re-sistant strains were identified from 356 Shigella isolates.Among them,six strains were identified as Shigella flexneri (S.fleaneri) strain (four F2a,one F2b and one F2c),and the rest were identified as Shigella sonnie (S.sonnei) strain.Among all eight cefoxitin-resistant strains,five strains showed positive results for ESBLs confirmatory test and two strains showed positive results for AmpC-three-dimensional test .Seven out of the eight strains harbor ESBLs genes (CTX-M-14,15,57 and/or OXA-30),two of which were positive for AmpC genes (DHA-1 and CMY-2).Five out of the eight cefoxitin-resistant strains carried all of the six tested viru-lence genes,while the other three strains possessed four virulence genes except for set1A and set1B.The two strains producing both ESBLs and AmpC β-lactamases were susceptible only to imipenem .Conclusion ESBLs positive isolates are prevalent strains of cefoxitin-resistant Shigella with potential high virulence .Some of them also produce AmpC β-lactamases ,and the DHA-1 type of AmpCβ-lactamase is identified for the first time in China .