Objective To investigate the changes of antibiotic resistance and its correlations with antibiotics use density (AUD) in intensive care unit (ICU) after implementation of antimicrobial stewardship. Methods Data on AUDs and synchronous antibiotic resistance in ICU of the Affiliated Hospital of Taishan Medical University during 2010 and 2014 were retrospectively reviewed.Autoregressive integrated moving average ( ARIMA) model was used to identify the correlation between AUDs and antibiotic resistance.Results The total AUD which stood at 163.46 DDDs· 100 person-1 · d-1 in the year 2010 decreased to 68.20 DDDs · 100 person-1 · d-1 in 2014, and the most significant decreases were found in quinolones, imidazole, carbapenems, aminoglycosides, other beta lactam and macrolides. Synchronously, a wide range of improvements in antibiotic resistance of major pathogens were also observed from 2010 to 2014, and the improvements were positively correlated with the decrease of AUDs.However, antibiotic resistance in 2014 was not significantly improved compared with that in 2013. The rate of ciprofloxacin resistance in Pseudomonas aeruginosa and the resistant rates of amikacin, imipenem, and meropenem in Acinetobacter baumannii even increased in 2014.Conclusions With the implementation of antimicrobial stewardship, antibiotic consumption in ICU was decreasing, and antibiotic resistance rate in major pathogenic bacteria was decreasing.But the rebound in antibiotic resistance in some types of bacteria was also observed and should be put on enough caution.

Objective To determine the prevalence of pain beyond the osteoporotic vertebral com-pression fracture (OVCF) in patients undergoing percutaneous vertebral augmentation and the response of pain to the treatment. Methods A retrospective study of 104 patients undergoing percutaneous vertebral augmentation (pereutaneous vertebroplasty and pereutaneous kyphoplasty) was performed to examine the lo-cations and severities of pain beyond the OVCF before and after operation. The Visual Analog Sscale (VAS,10-point scale) and Activities of Daily Living (ADL, 5-point scale) were used. Results Of the 104 patients, 48 (46.2%) suffered pain beyond the OVCF. The pain was firstly located in the sacrococeygeal region and buttocks (26.0%), secondly in the abdomen and sub-xiphoid process (10.6%) and thirdly in the flank, ribs and chest (9.6%) . For all the cases, the mean VAS score decreased from 8.9±0. 8 before vertebral augmentation to 2.9±1.4 after augmentation (t=37.410, P=0.000), and the mean ADL score decreased from 4.1±0.6 before operation to 2.0±0.7 after operation (t=25.331, P =0.000) . For the patients suffering pain beyond the OVCF, the mean VAS score decreased from 8.8±0.9 before vertebral augmentation to 2.8±1.5 after augmentation (t=23.722, P=0.000), and the mean ADL score decreased from 4.2±0.7 before operation to 2.0±0. 7 after operation (t=15.373, P=0.000). The decreases in VAS and ADL scores were not affected by the pain. Conclusion The pereutaneous vertebral augmentation can effectively relieve the pain beyond the OVCF.

Wnt/β-catenin signaling pathway plays an important role in the initiation and progression of colorectal cancer. The key to its carcinogenicity is related to the inhibition of β-catenin degradation, and the subsequent cytoplasmic accumulation and nuclear translocation of β-catenin, which activates the transcription of downstream target genes such as coding region instability determinant-binding protein (CRD-BP). In cancercells ,the expression of CRD-BP mediates the stabilization of β-Trcp, which in normal cells regulates the degradation of β-catenin. The activation of Wnt/β-catenin signaling pathway, overexpression of β-catenin and CRDBP, and the upregulation of β-Trcp by CRD-BP play important roles in the initiation, progression, and metastasis of colorectal cancer.

Objective To investigate the applicative value of acoustic radiation force impulse imaging (ARFI) in the differential diagnosis of small hypoechoic thyroid nodules.Methods 31 patients were pathologically confirmed as having a total of 44 small hypoechoic thyroid nodules ≤ 1 cm in diameter,followed by analyses of the characteristics of their ARFI images,including virtual touch tissue imaging (VTI) and virtual touch tissue quantification (VTQ).Based on VTI images of the nodules,the hardness of small hypoechoic thyroid nodules was respectively scored,and the ratios of VTI images to gray scale image areas were calculated.With pathological diagnosis as the gold standard,VTI scores,area ratios and VTQ values of the ROC curve in diagnosis of thyroid malignant nodules were sketched so as to explore the optimal cut-off points in VTI scores,area ratios and VTQ values in the diagnosis of malignant nodules.Results By the ROC curve test,VTI score of 3 was determined as the cut-off point of areas ratio,with the sensitivity and specificity of diagnosing thyroid cancer being 96.0 ％ and 94.7％,respectively.There were 34 nodules with VTI score greater than 3 (including 9 benign nodules and 25 malignant nodules) and 10 nodules with VTI score of 3 or less (all benign nodules).Malignant thyroid nodules had higher ratio of VTI images to gray scale image area than that of the benign nodules (1.58 ± 0.18 vs 1.30 ± 0.10,P ＜0.05).When 1.47 was set as the cut-off point of areas ratio,the sensitivity and specificity of diagnosing thyroid cancer were 80.0％ and 94.7％,respectively.The VTQ value of 2.76 m/s in diagnosis of thyroid malignant nodules was designated as the cut-off point,with a sensitivity of 88.0 ％,specificity of 94.7 ％.Conclusions The ARFI technique is able to provide information of thyroid nodule hardness,which guarantees its high applicative value in the differential diagnosis of small hypoechoic thyroid nodules.

Objective To investigate and evaluate the pregnancy outcomes and fetal loss after fetal reduction of triplets to twins or singleton pregnancy. Methods 282 cases of triplets who received multi-fetal pregnancy reduction (MFPR) at Shandong Provincial Hospital affiliated to Shandong University were recruited from Sep 2001 to Mar 2014. According to the remaining fetal number after MFPR, 231 cases were opted to reduce to twins (twins group) while 51 cases were opted to singleton pregnancy (singleton group).The indication of the former group was fetal abnormalities under ultrasound or on patients′ demand; while the indication for the later group included dichorionic triamniotic (DCTA) triplets or patients′ aspiration. Potassium chloride was injected into the targeted fetal heart until cardiac standstill was obtained. The pregnancy outcomes, gestational age at delivery, birth weight of newborns of the two groups were recorded. Successful pregnancy was defined as take-home at least one baby. Results (1)The overall rate of successful pregnancy was 91.5%(258/282).There were 413 neonates in the twins group, including 4 neonatal deaths and 409 live babies, with the successful rate of 90.5%(209/231). There were 49 neonates in the singleton group, including 2 cases of fetal loss. Thus the successful rate was 96.1%(49/51). There was no difference of successful pregnancy rate between the two groups(P>0.05).(2)The mean gestational age at operation for the twins group and singleton group were(16.5±3.5)weeks and (14.2±2.0) weeks, respectively. Each group was divided into three periods,11-13+6 weeks, 14-16+6 weeks and≥17 weeks.In the twins group, the cases in each time period were129(55.8%,129/231), 50(21.6%,50/231)and 52(22.5%,52/231), respectively. While in the singleton group, the cases in each time period were 27(53%,27/51), 16(31%, 16/51)and 8(16%,8/51).There was no difference between the two groups at each time period(P>0.05). (3)The fetal loss rate in the twins group were 7%(9/129), 12%(6/50), 10%(5/52) at each time period, respectively. While for the singleton group they were 4%(1/27), 0(0/16)and 1/8, respectively. There was no significant difference between the two groups at each time period(P>0.05).(4)The mean birth weight of the twins group was lower than the singleton group [(2 555±447) g vs (3 084±550) g, respectively, P<0.05].The rates of low birth weight infants(<2 499 g)in the twins group and the singleton group were 45.5%(188/413)and 8%(4/49), respectively(P<0.05).The rate of very low birth weight infants(≤1 499 g) was 3.9%(16/413)in the twins group compared with 0(0/49)in the singleton group(P>0.05).(5)The gestational age at delivery of the twins group was earlier than the singleton group [(36.2 ± 2.4) weeks vs(38.3 ± 2.2)weeks, respectively,P<0.05]. The labor rate of the two groups was significantly different for both 34-36+6 weeks and≥37 weeks(P<0.05).The full-term delivery rate in the twins group was 47.6%(110/231), and was 88.2%(45/51)in the singleton group(P<0.05). The fetal loss rate before 28 weeks did not differ between the two groups[8.7%(20/231)vs 3.9%(2/51), P>0.05].Conclusions Reduction to one fetus led to significantly better outcome than two fetuses, with no significant difference in fetal loss rate. It is better to advise patients with triplets reduce to singleton pregnancy.

Objective: To study the possibility of liposomes to ta rget hepatocytes af ter being linked with asialofetuin(AF). Methods: The biodistribu tions in differen t cells in liver as well as in blood, in various organs such as heart, spleen, l ung and kidney of mice, of traditional sterically stabilized liposomes(SSL) , AF-linked normal liposomes(AF-NL) and AF-linked sterically stabilized lipos ome s(AF-SSL) were studied by radioisotopic labeling. Results: The half-live s of SSL, AF-NL and AF-SSL were 14.44, 4.73 and 11.49 h， respectively. The di strib ution of liposomes in liver was AF-NL>AF-SSL>SSL. There was significant differenc e among these three formulations. In hepatocytes and non-hepatocytes, the conce ntr ations of the liposomes were both in line with the sequence AF-NL>AF-SSL>SSL( P <0.05). However, the ra tios of the concentrations in hepatocytes to that of non-hepatocytes were AF-N L≈AF -SSLSSL( P <0.05). Conclusion: After being labeled with asi alofetuin, liposomes can target hepatocytes very we ll， whether in long-circulation or not.

Using the APAAP method, we detected IL 4 producing cells in the peripheral blood of 9 patients with multiple myeloma and 11 normal subjects and lound that positive cell in MM (7.6%?2.1%) were significantly less as compared to normal subjects (15.36% ?4.1%), (P

Objective To compare the therapeutic effect and complication of immediate and selective interlocked intramedullary nailing in treatment of open tibial shaft fractures. Methods A total of 123 open tibial shaft fractures of 102 cases were treated with immediate fixation with interlocked intramedullary nailing after debridement (Group A) and with selective fixation with interlocking intramedullary nailing after debridement and closing the wound (Group B). Results The follow up for more than half a year showed that all fractures were healed, with excellent joint function of knee and ankle. Of all, 12 cases with skin necrosis and defect but without deep infection were healed after pedicle flap reconstruction. The result of Group A was much better than that of Group B in regard of total operation time, hospital stay, cost, amount of antibiotics used and partial weight bearing. No statistical difference in therapeutic effects and complications was found between two group. Conclusion Infection is not the contra-indication of interlocked intramedullary nailing in open tibial fractures. Immediate operation can be done after thorough debridement.

Objective to probe into whether head-simulator teaching can enhance tooth cavity preparation compared with traditional preclinical teaching program.Method Questionnaires were conducted among the Grade 2002 students who had been trained by head-simulator teaching and were practicing in oral cavity section of our school.Result Majority of students think it's a good method and they have got better results than those trained in traditional experiment teaching.Conclusion The head-simulator teaching has improved the teaching quality of tooth cavity preparation but there exist some disadvantages which need further improvement and extension.

Objective To study the hypoxia-inducible factor-1α (HIF-1α) expression in the col-lagen induced arthritis(CIA) model and its role in rheumatoid arthritis (RA) pathogenesis. Methods We established CIA model, and taked CIA model of the ankle joint to have them HE staining and HIF-1α immu-nohistochemistry staining, then the HIF-1α expression in the tissues of RA was observed. Results The ex-pression of CIA synovial membrane of rat and the lower synodal both was expressed in HIF-1α. The positive expression of HIF-1α reached the highest volume in the first 21 days. Then, with the disease progression, the expression gradually decreased, which was in significantly positive relation with the synovial pathology score, synovial hyperplasia and angingenesis rating score, however, the expression was no positively correla-ted with the inflammatory infiltration. Conclusion The expression of HIF-1α in RA tissue is positively re-lated with inflammation severity, It indicates that HIF-1α is closely related to the occurrence and develop-ment of RA.