Objective To establish better reaction factors for rep-PCR and to investigate if the extended spectrum ?-lactamase(ESBL)+ Escherichia coli isolated from different patients in the respiratory ward have the same origin by using rep-PCR.Methods The ESBL confirmation was taken by double disc confirmatory test.The susceptibility testing was performed with K-B test.By applying the widespread enterobacter repetitive intergenic consensus as a primer,the stains were typed by rep-PCR following electrophoresis in agarose gel.Results The analysis of the PCR productions indicated that it would create useful DNA ban-prints and all these 22 ESBL(+)Escherichia coli strains were of three origins.Conclusion The method of rep-PCR is practical for epidemiological research in nosocomial infection.

OBJECTIVETo compare the efficacy difference in the treatment of functional dyspepsia between acupuncture at the acupoints selected by pattern/syndrome differentiation and domperidone.

METHODSSeventy cases were randomized into an acupuncture group (35 cases) and a western medication group (35 cases). In the acupuncture group, Zusanli (ST 36) and Neiguan (PC 6) were selected. Taichong (LR 3) and Neiting (ST 44) were added for excess syndrome while Gongsun (SP 4) and Yinlingquan (SP 9) were added for deficiency syndrome. A pair of electrodes was attached to one acupoint and an assistant point (2 mm next to the acupoint centripetally) and stimulated with disperse-dense wave at 2 Hz/100 Hz, once a day. In the western medication group, domperidone was prescribed for oral administration, 10 mg each time, three times a day. In the two groups, the treatment of 5 days made one session and 4 sessions were required totally. Nepean dyspepsia index (NDI) was compared after treatment, 1, 2, 3, 4 and 5 months after treatment between the two groups respectively.

RESULTSThe score of symptom and score of life quality in NDI after treatment and at each follow-up time point were improved obviously in the acupuncture group as compared with those before treatment (all P < 0.01). In the western mediation group, the score of symptom and the score of life quality in NDI after treatment and in follow-up of 1, 2 and 3 months were improved obviously as compared with those before treatment (all P < 0.01), but the differences were not significant in follow-up of 4 and 5 months (both P > 0.05). Compared with the western medication group, the symptom score of NDI was reduced obviously after treatment and in each time point of follow-up in the acupuncture group (P < 0.05, P < 0.01), and the score of life quality was increased obviously (P < 0.05, P < 0.01).

CONCLUSIONAcupuncture at the acupoints selected by pattern/syndrome differentiation and domperidone are effective in the treatment of functional dyspepsia. Domperidone is unsatisfactory in the long-term effect, but acupuncture achieves the positive short-term and long-term effects on functional dyspepsia.

Acupuncture Points ; Acupuncture Therapy ; Adult ; Aged ; Dyspepsia ; diagnosis ; psychology ; therapy ; Female ; Humans ; Male ; Middle Aged ; Quality of Life ; Time ; Treatment Outcome ; Young Adult

Objective To evaluate the images of MRCP acquired by adjusting 0.3 Tesla MR unit heavy T 2-weighted scanning parameters and altering scanning angle and diagnostic correctivity to biliary obstructive disease.Methods Routine MR T 1WI,T 2WI scanning were performed axial in 50 cases of patients with biliary obstruction.All of them were divided into two groups,20 cases of them were scanned coronal with FSE T 2-weighted fixed parameters,30 cases of them were scanned with altering scanning angle,increasing scanning slices,decreasing distance of two near slices,reducing signal collection times(NSA),shortening scanning time.Results The acquired images through adjusting FSE T 2-weighted scanning parameters were visualized clearly.The boundary of cholangiopancreatie ducts were showed clearly.The display rate of biliary and pancreatie ducts was elevaled from 20% to 83.3%.The accuracy of it for evaluating the causes of obstruction was increased from 88.9% to 93.3%.The accuracy of it in the detection of the location of bile duct obstruction was 100%.Conclusion Through adjusting scanning purameters low field MRCP is very helpful in improved images quality and reflecting veliable signs of biliary and pancreatie duct obstruction disease combined with MRI T 1-weighted T 2-weighted message.This method can increased the diagnostic accuracy of the causes of obseruction and supply the reliable ground for clinical treatment.

Objective To assess the differences in the specificity and the sensitivity in detecting specific IgM by indirect ELISA and capturing-ELISA methods,and to analyze the possible causes of those differences.Methods The HBc-IgM and EHF-IgM level in serum samples from activity Hepatitis B patients and hemorrhagic fever patients with renal syndrome were determined by both indirect-ELISA and capturing-ELISA methods,and the differences in the positive rate,positive threshold value and the specificity between those two methods were compared. Results Specific murine IgM diluted in PBS were detected by indirect-ELISA and capturing-ELISA,and the specificity and sensitivity of those two methods were similar.Results showed that sensitivity of indirect-ELISA was lower than capturing-ELISA in detecting specific IgM in serum from patients with activity Hepatitis B and hemorrhagic fever patients with renal syndrome.The IgM level in hepatitis B and hemorrhagic group treated with thioglycol became negative detected by those two methods,suggesting that both of them have the anti-IgM epitope-specificity.Cross reaction results demonstrated that the reagent detecting IgM from the two methods had the specificity to the specific antigen. Conclusion It is recommended to detect IgM level by capturing-ELISA method for the early diagnosis of acute infectious disease,pathological changes,immune reaction and prognoses of chronic continuous infectious disease.Applying the indirect-ELISA method to detect IgM level to diagnose acute infectious disease is to discuss in the future.

BACKGROUND: The assessment of chronic nerve root injury is mainly depend on indirect evidences of imaging results.OBJECTIVE: This study is designed to find out the relationship between the degrees of the pathological changes of nerve roots and motor evoked potential (MEP) changes due to chronic compression.DESIGN: A self-controlled trial with animals as subjects.SETTING: Spine Surgery Department of the Second Clinical Hospital of Jinan University.MATERIALS: The trial was completed in the Spinal Surgery Department of the Second Clinical Hospital of Jinan University from October 2001 to May 2003. The subjects were 30 healthy cats of either gender weighing 3 to 5 kg.INTERVENTIONS: The compression model was established by wedging a Ⅴ-shape bone flap into the right intervertebral foramens between C7, C8 and T1 vertebrae. The left foramens served as controls. The cats underwent CT examination on the 2nd, 4th, 8th and 12th postoperative week to show the foramen changes. Six randomly selected cats underwent magnetic stimulation MEP each time on the 2nd, 4th, 8th, 12th and 24th week. The injuries to the compressed nerve roots were assessed according to Mackinnon Standard and they were compared with the MEP wave.MAIN OUTCOME MEASURES: Whether the superficial magnetic stimulated MEP monitoring result was in correspondence with the pathological changes of the chronically compressed nerve roots.RESULTS: The MEP did not show any abnormal changes for Grade Ⅰ injury prolonged to 9.6- 10. 2 ms. There was almost no evoke potential at all stimulation points for grade Ⅴ nerve root injury.CONCLUSION: That the injured nerve root presents dysesthesia and normal MEP results suggests grade Ⅰ injury. Prolonged latency including prolonged F wave suggests grade Ⅱ injury. And additional amplitude decrease together with widened and unclassifiable waves implies the injury be grade Ⅲ. The prominent features of grade Ⅳ nerve injury is much more decreased amplitudes and more prolonged latency. For grade Ⅴ injury there is always disappearance of whole MEP or some potential components. The superficial magnetic stimulated MEP monitoring results are in correspondence with the pathological changes of the nerve roots due to chronic compression, which means MEP monitoring results could serve as the quantitative indication to pathological changes of nerve injury.

Objective To analyze the antibiotic susceptibility, ESBL genotype of clinical Klebsiella pneumoniae strains isolated from People′s hospital and facilitate the control of resistance spread. Methods Identification and antibiotic susceptibility tests of 1 205 strains from 2001 to 2007 were done by VITEK-2 system.The antibiotic susceptibility results were analyzed by whonet5.3.The ESBL gene was detected by PCR and the Chi-square test was used for statistical analysis.Results The rate of ESBL-producing strains in klebsiella pneumoniae has increased from 2001 to 2007[18.8% (40/213) in 2001, 20.9% (53/253) in 2002, 32.8% (42/128) in 2003, 33.6% (45/137) in 2004, 36.6% (60/164) in 2005, 45.3% (68/150) in 2006 and 45.6% (73/160) in 2007].The SHV gene was the most dominant in ESBL genotypes.There were 83.3% (50/60) ESBL strains in 2005 with SHV gene, 82.3%(56/68) in 2006 and 83.6%(61/73) in 2007.The rated of strains with CTX-M gene were increasing.There were 26.7%(16/60) ESBL strains with CTX-M gene in 2005, 36.7%(25/68) in 2006 and 54.8%(40/73) in 2007.The isolates with more than one type of ESBL gene were increasing.There were 45%(27/60) ESBL strains in 2005 with two types of ESBL gene, and no one had more than two types of ESBL gene in that year.There were 47.9%(35/73) ESBL strains in 2007 with two types of ESBL gene.In 2007 there were 9.6%(7/73) and 2.7%(2/73) ESBL strains with three types and four types of ESBL gene respectively.There was a statistical difference between the antibiotic resistance rates of cefotaxime, ceftriaxone and ceftazidime in SHV-gene-phore strains (χ2=13.22, P＜0.01).The strains with SHV gene were more resistant to cefotaxime than ceftriaxone and ceftazidime.There also was a statistical difference of the antibiotic resistance rate of cefotaxime, ceftriaxone and ceftazidime between strains with TEM gene (χ2=9.91, P＜0.01) and CTX-M gene (χ2=34.84, P＜0.01) respectively.None of the strains with CTX-M gene was sensitive to cefotaxime, and they were more resistant to ceftriaxone than ceftazidime.The strains with TEM gene were more resistant to cefotaxime than ceftriaxone and ceftazidime.There were statistical differences of the antibiotic resistance rate to cefotaxime (χ2=29.65, P＜0.01), ceftriaxone (χ2=20.26, P＜0.01) and ceftazidime (χ2=20.26, P＜0.01) between the strains with SHV gene only and strains with SHV and CTX-M gene concurrently.There were also statistical differences of the antibiotic resistance rates to cefotaxime (χ2=11.01, P＜0.01), ceftriaxone (χ2=9.93, P＜0.01) and ceftazidime (χ2=7.01, P＜0.01) between the strains with SHV gene only and strains with SHV and TEM gene concurrently.The antibiotic resistance rates to cefotaxime (χ2=11.54, P＜0.01), ceftriaxone (χ2=17.58, P＜0.01) and ceftazidime (χ2=14.11, P＜0.01) were statistically different between the strains with SHV gene only and strains with SHV and OXA gene concurrently.The antibiotic resistance rates to ceftazidime (χ2=23.61, P＜0.01) were statistically different between the strains with CTX-M gene only and strains with SHV and CTX-M gene concurrently. There was no statistical difference in antibiotic resistance rates to cefotaxime (χ2=3.55, P＜0.01) and ceftriaxone (χ2=3.35, P＜0.01) between the strains with CTX-M gene only and strains with SHV and CTX-M gene concurrently. The antibiotic resistance rates to ceftazidime (P=0.01) were statistically different between the strains with only TEM gene and strains with SHV and TEM gene concurrently, and there was no statistical difference of the antibiotic resistance rates to cefotaxime (P=0.29) and ceftriaxone (P=0.26) between the strains with TEM gene only and strains with SHV and TEM gene concurrently. ConclusionsThe producing rate of ESBL is increasing year after year and the SHV type of ESBL is the dominant one.Strains with more than one type of ESBL gene are increasing.The antibiotic resistance rates to cefotaxime, ceftriaxone and ceftazidime are statistically different between strains with same ESBL genotype.

Objective To explore factors associated with emergency room(ER)length of stay and provide basis for the emergency managers about the development of relevant measures.Methods Data of critically ill patients from the emergency room in a tertiary teaching hospital from January 2010 to June 2011 were retrospectively studied.Binary Logistic regression analysis was used to determine possible factors and further compare the clinical characteristics of the patients.Results(1)From January 2010 to June 2011 a total of 11 468 patients were seen in the emergency department,the median ER length of stay was 11 h,a number of 6 525 patients(56.9％)stayed in ER more than 6 h.(2)Binary Logistic regression analysis showed that the main factors contributing to length of stay more than 6 hours were types of wards,green channel,treatment time,followed by admitted to ICU,traffic,sent by 120,the number of initial diagnosis,destinations of disposition,sex,holiday visit,visit month.While age,occupation,residence were not factors.Conclusions The patients in this hospital has a prolonged length of stay.The associated factors included types of wards,green channel,treatment time deserves a further study.

Objective Try to know the prevalence rate of ESBL-s produced by Eseherichia coil in our hospital from 2003 to 2007.Methods Antibiotic susceptibility were determined by K-B disc diffusion.Double-disk synergy tests performed on Mueller-Hinton agar plates was used for ESBL confirmation.Results There was 23.8% of our isolates can produce ESBLs in 2003,25.4% in 2004,31.3% in 2005,36.6% in 2006 and 44.9% in 2007,respectively.The situation of antibiotic resistance is more severe.Conclusion The antibiotic resistance should be well surveyed and the ESBLs must be routinely assayed.

Objective To analyze inhibitory effect on Wistar rattish hepatoma by endostatin, angiostatin,hyper-liquid hpiodol and a combination of these agents. Methods The rattish hepatoma models were randomly divided into 8 groups, including control group, lipiodol group, endostatin gene group, angiostatin gene group, endostaitin gene and angiostatin gene group, endostatin gene and lipiodol group, angiostatin gene and lipiodol group and endostatin gene, angiostatin gene and lipiodol group. Following treatment on Wistar rots with these agents or a combination of these agents, we measured the changes in tumor volume growth rate, metastases quantity rote, rattish life span, micmvessel density (MVD) value, apoptotic index(AI), vascular endothelial growth factor. Single factor variance test and Chi-square test were used for statistics. Results On the sixth day after treatment, the tumor volume growth rate of all the therapy groups were smaller than the control group. The therapeutic effect of the above mentioned two genes in combination with lipiodol was the best and the tumor volume growth rate was the smallest. On the eighteenth day after treatment, the numbers of pulmonary metastasis were(37.2±7.2)、(26.2±5.0)、(25.5±4.7)、 (26.2±3.9)、(14.9±2.6)、(19.1.4-2.8)、(20.2±2.7)and(6.1±1.2); the life span was(23.3± 4.4),(35.2±4.9),(28.2±3.6), (29.4±3.4), (38.3±6.7),(37.7±5.8), (36.4±5.5) and (59.8±9.4)days for each group respectively. The difference of the numbers of pulmonary metastases between the therapeutic groups and the control group was statistically significant(P<0.O1). The difference of the life span between the control group and the single gane group was not statistically significant, but the difference of the life span between the control group and the combination groups is statistically significant. MVD[(63.4±8.7)strip/high power field] in the lipiodol group was higher than the other therapeutic groups. However, the difference of MVD between the lipiodol group and the control group was not statistically significant. The apoptotie indexes in all the therapeutic groups were higher than the control group [(4.2±1.6)% ], the index in the two genes in combination with lipiodol group was the highest[ (19.6± 2.4)%]. The expression rate of VEGF in the control group was the highest(100%)and the rate in the two genes in combination with lipiodol group was the lowest(12.5%). Conclusions The inhibitory effect on Wistar rattish hepatoma of a combination of the above-mentioned two genes and lipiodol via transhepatic artery infusion is obviously superior to that of each individual agents.

Objective To study the homology relationship among clinically isolated imipenem-resistant klebsiella pneumoniae strains and possible transmission route of drug resistant strains to provide a basis for blocking the transmission of this kind of bacteria in clinc.Methods Clinical samples collection and bacterial culture were routinely conducted,meanwhile the hand surface of ICU medical staffs and the surfaces of patien's bedside objects were performed the sample collection for conducting the bacterial count and culture.The bacterial identification and drug susceptibility test were performed by the VITEK-2 COMPACT system.The bacterial homology detection adopted the ERIC-rep-PCR method.Results Totally 642 strains of imipenem-resistant Klebsiella pneumoniae were clinically isolated from January 2011 to December 2013.Among them,389 strains(60.59％) were derived from ICU.72 strains (11.21％) fsrom the respiratory department,53 strains (8.26％) from the neurology department,41 strains (6.39 ％) from the cardiovascular department,31 strains (4.83％) from the surgical department,11 strains (1.71％) from the gastroenterology department,5 strains (0.78 ％) from the renal department,17 strains (2.65 ％) from the emergency department and 23 strains(3.58％) from the other departments.One strain of imipenem-resistant Klebsiella pneumoniae was isolated from the IGU object surface.Among 642 clinical bacterial strains,there were 8 main clones,these 8 clone strains added up to 394 strains,which accounted for 61.37％ of whole bacterial strains,the other 248 strains were single clones.Conclusion The monoclonal prevalence of imipenem-resistant klebsiella pneumonia in this hospital actually exists.The contact transmission may be the possible transmission route of this kind of infection.