Objective To establish the rational antibiotic treatment by accurate screening of highlevel aminoglycoside (HLA) resistant enterococci in clinical laboratory. Methods A single HLA gentamicin 500 μg/ml and streptomycin 200 μg/ml for agar dilution method, and gentamicin 120 μg/disk and streptomycin 300 μg/disk for disk diffusion method were used as parallel screening tests to detect high-level aminoglycoside resistance in 172 enterococci strains. Antibiotic time-kill test was performed to verify the accuracy and reliability of both methods. Results The resistant rates of the two methods for HLA gentamicin were 60.0％ and 59.3％, respectively. While for HLA streptomycin, both were 61.1%. In disk diffusion tests of 172 enterococci strains, the resistant rates for penicillin, ampicillin and vancomycin were 16.9 %,14.0%, and 1.7%, respectively. β-lactamase from 80 strains enterococci were all negative. Conclusion High-concentration aminoglycoside disk diffusion method is a simple, reliable method for screening the HLA resistant enterococci in clinical laboratory. The results can provide a rational base for physicians to treat enterococcal infections.

In order to investigate the relationship between lichen planus pemphigoides (LPP) and bullous pemphigoid (BP) and to determine whether the LPP antigen is the classical BP antigen. Four LP patients who were found to have blisters or subepidermal bullae by clinical and histopathological findings were investigated using DIF, IIF, immunoblotting methods. The results showed that there were linear deposition of IgG along the BMZ in three cases, C3 granular deposition in four cases, and linear fibrin deposition in 3 cases. Two out of these patients showed circulating IgG anti-BMZ antibody with titers 1:80 and 1:320, and lmol/L NaCl split section showed that the antibody was bound to the epidermal side, as did control BP antisera. Western blotting of the epidermal extracts using the sera of these 4 patients showed that all 4 patients'sera reacted with the epidermal antigen, and the sera of 2 patients reacted with 200kD antigen which is different from classical bullous pemphigoid antigen. With a review of literature we suggest that LPP is not the overlapping of BP and LP.

Objective To establish the rational antibiotic treatment by accurate screening of high level aminoglycoside (HLA) resistant enterococci in clinical laboratory. Methods A single HLA genta micin 500 ?g/ml and streptomycin 200 ?g/ml for agar dilution method, and gentamicin 120 ?g/disk and streptomycin 300 ?g/disk for disk diffusion method were used as parallel screening tests to detect high level aminoglycoside resistance in 172 enterococci strains. Antibiotic time kill test was performed to verify the accuracy and reliability of both methods.Results The resistant rates of the two methods for HLA gentamicin were 60.0% and 59.3%,respectively. While for HLA streptomycin, both were 61.1%. In disk diffusion tests of 172 enterococci strains, the resistant rates for penicillin, ampicillin and vancomycin were 16.9%, 14.0%, and 1.7%, respectively. ? lactamase from 80 strains enterococci were all negative. Conclusion High concentration aminoglycoside disk diffusion method is a simple, reliable method for screening the HLA resistant enterococci in clinical laboratory. The results can provide a rational base for physicians to treat enterococcal infections.

Objective To evaluate one-stage arthroscopic reconstruction of anterior crueiate ligament (ACL)and posterior cruciate ligament(PCL)using Achilles tendon-bone allografts. Methods From July 2000 to February 2005.we treated 15 patients(11 males and 4 females)whose ACL and PCL were ruptured at one knee but the eontralateral knee was intact.Their associated meniscus injuries were treated arthroscopically according to established procedures prior to ligament reconstruction.Thirty Achilles tendon-bone allografts were used to reconstruct torn ACL and PCL in 15 knees at one stage.Reconstruction of both ligaments was performed at subacute or chronic phase(>3 to 8 weeks)in 12 casses,and at acute phase in 3 cases(<3 weeks).All knees were graded pre-and postoperatively using the International Knee Documentation Committee(IKDC)and Lysholm scoring systems.At follow-up,functions were evaluated for all patients and compared with those of the contralateral healthy knee. Results All patients were followed up for a minimum of 3 years(mean,38 months).Preoperatively,the IKDC ratings showed all the injured knees were severely abnormal.At final postoperative f0Uow-up,9 knees received a normal rating,5 a nearly normal one and 1 an abnormal one.The differences in Lysholm score were statistically significant (t=15.660,P<0.05)between pre-and postoperative analyses.The most noticeable postoperative complication was a short localized fever coupled with arthroedema in 1 case. Conclusions Achilles tendon-bone allograft offers an alternative for simultaneous arthroseopic reconstruction of ACL and PCL.However,problems inherent in allograft tissues entail further investigation to ensure future application.

Objective To investigate the efficacy of intracoronary tirofiban during percutaneous coronary intervention(PCI)for patients with acute myocardial infarction(AMI).Methods Seventy-six consecutive AMI patients,treated with primary coronary angioplasty in 12 hours were enrolled.They were randomly divided into two groups:tirofiban group(39 cases)and control group(37 cases).Tirofiban group was treated with intracoronary timfiban during PCI and after the operation for 48 hours.Both of them were given heparin in PCI and aspirin,clopidogrel before PCI.At the end of PCI procedure,angiographic features such as TIMI flow grade and TIMI myocardial perfusion grade(TMPG)were analyzed.The difference of two groups in complication and major adverse cardiac events(MACE) was investigated.Results The myocardial reperfusion of tirofiban group was better than that of control group[TIMI grade 3 flow 94.9%(37/39) vs 78.4%(29/37),P<0.05;TMPG 3 grade 89.7%(35/39)vs 67.6%(25/37),P<0.05].There was no significant difference between two groups in bleeding complication.The occurrence of MACE in tirofiban group was less than that in control group[7.7%(3/39)vs 18.9%(7/37),P<0.05].Conclusion Intracoronary tirofiban dunng primary PCI in patients with AMI can improve coronary flow and myocardial perfusion,and has no more bleeding and less MACE occurrence.

Objective To observe the therapeutic effect of balloon dilation in acute thrombus disease. Methods After coronary angiography, 137 patients with acute thrombus disease who were performed percutaneous coronary artery interventional therapy (PCI) from August 2010 to August 2012 were enrolled. In them, 53 patients (control group) didn′t undergo balloon dilation after PCI, and 84 patients(observation group)underwent balloon dilation after PCI. The intraoperative complications and the major adverse cardiac events (MACE) rate were observed. Results The rate of residue stenosis in observation group was lower than that in control group:(6.7 ± 1.3)% vs. (17.1 ± 1.8)%, and there was significant difference (P<0.05). The operation time in observation group was higher than that in control group:(57 ± 26) min vs.(48 ± 32) min, and there was significant difference (P<0.05). The no-reflow or slow flow after PCI in observation group was 3.8%(2/53), in control group was 3.6%(3/84), and there was no significant difference (P>0.05). The follow-up time was (0.9 ± 0.2) years. In control group, myocardial infarction occurred in 2 patients, 7 patients reviewed coronary angiography, and 2 patients underwent revascularization. In observation group, there was no MACE. Five patients reviewed coronary angiography, and no patient underwent revascularization. Conclusions The method of balloon dilation after PCI in acute thrombus disease is safe and feasible. It can reduce the incidence of MACE, and did not increase the rate of no-reflow or slow flow.

Objective:To determine the change in the dietary patterns of Hunan urban residents from1982 to 2012. Methods:A 24 hour dietary recall method was used for 3 consecutive days to collect information on food intake, and the condiment intake was collected by weighting method. Results:Rice products and potato consumption were 449.0 g per person per day and 44.0 g per person per day in 1982, and dropped to 150.0 g per person per day and 9.0 g per person per day in 2012. In 2012, vegetable (277.1 g per person per day), fruits (47.8 g per person per day), milk and dairy products (16.6 g per person per day) consumption were still insuffcient. Fat (59.3 g per person per day) and salt (10.1 g per person per day) consumption was still high. Conlusions:hTe dietary quality of urban residents in Hunan has been greatly improved, but is still seriously imbalanced. To consume more fruits, milk and dairy products and reduce fat and salt intake are very important.

Objective To evaluate the efficacy and safety of direct stenting technique in emergent percutaneous coronary intervention(PCI)for pa?tients with acute myocardial infarction(AMI). Methods Totally 460 consecutive patients with acute myocardial infarction who underwent emergent PCI during August 2010 to July 2013 were involved,among whom 346 patients were assigned to the control group(traditional balloon dilation and stenting),114 patients were assigned to the experiment group(direct stenting). The safety and efficacy of direct stenting technique was observed. Results In the control group,7 cases had no reflow during operation,2 cases had reflow after the pre?expansion and 5 cases after stent implanta?tion,no similar cases in the experiment group(P=0.125 9). The follow?ups showed the control group had 2 cases of major adverse cardiac events including 1 case of acute stent thrombosis who required urgent revascularization,and 1 case of cardiac death at four days after operation;the experi?ment group had 1 case of stent thrombosis,there was no statistically significant difference(P=0.730 7). Conclusion Direct stenting technique may be performed selectively for certain coronary diseases when performing emergent PCI for AMI.

Objective:Human sera ACA was detected by ELISA method and some factors including the dilution rate of sera, blocking materials, temperature,ionic strength and interval time between blocking and detection,which could probablly influence the detective level of sera ACA were investigated.Methods:Human sera ACA was detected by ELISA.Results:10% NBS/PBS was more feasible than 1% bovine albumin/PBS for blocking non specific binding;the ACA titer of the same sample detected at 37℃ was lower than that of 22℃ and 25℃,the dilution rate 1∶50 for sera was suitable for the detection; time internal between blocking and detection could influence ACA level when it exceeding 2 weeks;the blinding ability of Ag with Ab was signicantly inhibited when the NaCl inonic strength was higher than 1.5 mol/L.Conclusion:The detected results of human sera ACA influenced by the dilution rate of sera,blocking materials,temperature ionic strength and internal time between blocking and detection.

BACKGROUND: Phenylketonuria is caused by gene mutation of phenylalanine hydroxylasel (PAH), which is mainly induced by permutation, short segments and insertion of base.OBJECTIVE: To evaluate the gene mutation of phenylalanine hydroxylasel in phenylketonuria in Hui nationality.DESIGN: Open study.SETTING: Urumqi General Hospital of Lanzhou Military Area Command of Chinese PLA; Capital Pediatrics Institute.PARTICIPANTS: A boy of Hui nationality in China and aged 3.1 years was selected in this study. The boy had intellect hysteresis in his one year and received medical treatment in his three years, while he was diagnosed as cerebral paralysis. After repeatedly inefficient treatment, he was hospitalized in our hospital on December 13, 2004. Iron sesquichloride in urine was strongly positive and concentration of serum phenylalanine was 1 680 μmol/L; therefore, he was diagnosed as the typical phenylketonuria.METHODS: 5 mL venous blood was selected from the boy and his parents, respectively, and anticoagulated with EDTA-Na2. DNA in gene group was extracted by using typical phenol/chloroform method. In addition, polymerase chain reaction (PCR) primer sequence of extron 7, 6, 11, 3, 12 and 5 of PAH gene was designed based on references. And then, PCR products were detected with 2% agarose gel electrophoresis. 5 μL PCR products were mixed with the same volume of degenerated buffer solution, degenerated at 97 ℃ for 5 minutes, put in iced bath and performed with 80 g/Lnon-degenerated polyacrylamide gel electrophoresis. After that, the products were dealt with sliver staining routinely, and single strand DNA banding patterns were analyzed and recorded. ABI377 automatic sequenator (PE Company) was used to detect PCR sequence and purify PCR product in Shanghai Boya Biotechnology Company.MAIN OUTCOME MEASURES: Iron sesquichloride in urine, concentration of serum phenylalanine and mutant gene types of phenylalanine hydroxylase.RESULTS: Extron 7, 6, 11, 3, 12 and 5 of PAH gene were analyzed in the boy and his parents. The results demonstrated that SSCP electrophoresis in extron 6 was different from that in the normal control group. Site of electrophoresis strip of his father was coincident with that of his mother, but different from that of the boy. Sequencing results indicated that point mutation (cytosine replaced by thymine), which was a R176X mutant heterozygote, occurred at the 526th site of cDNA of phenylalanine hydroxylase gene in his parents; however, two chromosomes of the boy had mutation at the same site, which was R176X mutant homozygote.CONCLUSION: Mutation of R176X homozygote of phenylketonurea is firstly reported in Hui nationality in China.