Objective To evaluate the effect and clinical value of ultrasonography-guided Argon-Helium targeted ablation on treatment of liver tumor.Methods By means of ultrasound inducing,217 patients of liver tumors were selected for percutaneous Argon-Helium targeted cryoablation.Results All of liver hemangioma shrank in different degrees after cryoablation; 12 cases of small hepatic cancer were followed up for over one year,the one-year survival rate was 83.3% (10/12). 82.1% (165/201) advanced patients became better and clinical symptom ameliorated.One hundred and seventy-five cases of advanced patients were followed up for over one year,the one-year survival rate was 69.7% (122/175).The common complications after Argon-Helium cryoablation treatment were hemorrhage( 3.7% ,8/217), pleural effusion( 2.8% , 5/217). Conclusions Ultrasound-guided Argon-Helium targeted ablation in treatment of liver tumor is simple,safe and effective.

Objective To investigate the causes of upper gastrointestinal bleeding (UGB), and some relative factors. Methods The UGB in 1 869 patients examined endoscopically between 1982－ 1996. Results 1.The most common causes of UGB were peptic ulcer (31.5％ ), gastric cancer(19.3％ ), and AGML(17.5％ ), and the rate of severe bleeding was highest in esophageal varices(49.4％ ). 2.Between 1982－ 1986,1987－ 1991,and 1992－ 1996, the rates of UGB were 22.3％ ,12.0％ ,and 13.4％ respectively. 3. The rate of UGB in male and female patients were 17.5％ and 8.9％ ; their difference is statistically significant(P

OBJECTIVE To observe the feasibility and safety of cryoablation of cervical lymph node metastases for nonsurgical candidates.METHODS The procedure was performed after achievement of local anesthesia for 15 cases.In this clinical study,local anesthesia with no sedation was performed to all the patients.In all cases,patients underwent two freeze/thaw cycles.RESULTS Tumors of 14 patients were thoroughly covered by ice balls.In one patient,96% of the tumorous lesion was covered by ice balls.In these patients,no complicated complication was observed during the treatment.CONCLUSION Percutaneous cryoablation therapy for cervical lymph node metastases under ultrasonic guidance is a feasible and minimally invasive method with satisfactory local control.

OBJECTIVE To investigate the ESBLs-producing isolates and their resistance and genotypes in Escherichia coli and Klebsiella in three hospitals of Wannan area.METHODS The MIC of 13 antimicrobials against 79 strains of E.coli and Klebsiella were determined by 2-fold agar dilution method.The confirmation test was used to detect ESBLs-producing strains according to CLSI 2005.PCR method was used to amplify beta-lactamases of ESBLs-producing isolates by 8 premiers,PCR products were purified and then sequencing was performed.RESULTS The ESBLs-producing rates in E.coli and Klebsiella in three hospitals of Wannan area were 61.5% and 45.0%,respectively.The resistance rates to CRO,CTX,CAZ,CIP and LEV of ESBLs-producing strains were 81.0%,81.0%,47.6%,71.4% and 50.0%,respectively,all isolates were susceptible to meropenem and imipenem.PCR indicated that CTX-M1,CTX-M13,TEM and OXA1 types of beta-lactamases were the four major genotypes of the three hospitals in Wannan area.CONCLUSIONS The isolation rates of ESBLs-producing E.coli and Klebsiella as well as their resistance rates to cephalosporins and quinolones in the three hospitals in Wannan area are quite high.Monitoring ESBLs-producing isolates should be strengthened in clinic and laboratory.

Objective To analyze the imaging features of hepatic angiomyolipoma (HAML) on computed tomography (CT) and magnetic resonance imaging (MRI).Methods The imaging fingdings of 18 tumors which were pathologically diagnosed as HAML after surgery were analyzed retrospectively.Before operation,twelve and ten patients underwent CT and MRI non-contrast and dynamic enhanced scans,respectively,and 4 patients received both examinations.The imaging characteristics including the number,diameter,location,appearance of the lesions,plain and dynamic enhancement mode were analyzed.Results Eighteen HAML lesions were found in 18 patients with a diameter ranging from 1.5 cm to 17.2 cm (mean 5.3 cm).Five lesions manifested fatty content,and one showed hemorrhage and necrosis.Five HAMLs enhanced in a fast-in and fast-out mode,eleven in a fast-in and slow-out mode and two other lesions in an irregularly discrete mode.The arterial supply was found in 11 HAMLs in the hepatic arterial phase,all coming from intrahepatic arteries.Intratumoral vessels were observed in 12 HAMLs.Early draining veins to the hepatic vein (n =3) and portal vein (n =1) were detected in 4 HAMLs.One lesion demonstrated delayed enhancement in the pseudocapsule.Conclusion The detection of arterial supply and intratumoral vessels in a hypervascular hepatic tumor on contrast CT and MRI in a patient with a non-cirrhotic liver and normal AFP helps to make a diagnosis of HAML.

Objective To investigate the related risk factors caused the retained common bile duct (CBD)stones after laparoscopic cholecystectomy,to provide the evidence for preventing from retained common bile duct stones of laparoscopic cholecystectomy.Methods Selected 654 cases of laparoscopic cholecystectomy patients as the objects whom hospitalized in Beijing Chuiyongliu Hospital from January 2002 to June 2013.All cases were divided into the group of retained CBD stones (27cases) and the group of non-retained CBD stones (627 cases).Collected the potentially relevant factors of two groups with the retained CBD stones,including medical history of jaundice and pancreatitis,common bile duct internal diameter (B Ultrasound) ≥ 8 mm,acute cholecystitis,emergency surgery,gallbladder removal order,calot triangle adhesion,sludge calculus,stones neck incarcerated,fulltype stones,cystic duct thickening,cystic duct reserved≥ 1 cm,the minimum diameter stones ≤5 mm,the number of gallbladder stones ≥ 5,partial cholecystectomy,purulent bile.Statistics analyses was proceeded using the IBM SPSS 20.0.Result Through dichotomy logistic regression analysis to the univariate analysis results with statistical significance,sorted the results according to the influence degree,found the independent risk factors:common bile duct internal diameter (B Ultrasound) ≥8 mm,gallbladder removal order (retrograde removal),medical history of jaundice pancreatitis,cystic duct reserved ≥ 1 cm,sludge calculus,in total of 5 indexes,which caused the retained CBD stones after laparoscopic cholecystectomy.Conclusion There are several independent risk factors for retained CBD stoes after LC such as medical history of jaundice and pancreatitis,common bile duct internal diameter (B Ultrasound) ≥ 8 mm,the order of cholecystectomy (retrograde remoral),shudeg calculus and the remaining length of bile duct ≥ 1 cm.The surgeons should pay close attention to them and take appropriate measures in the preoperation and intraoperation of LC,which contribute to preventing the acurence of postoperative retaimed CBD stone.

Objective To investigate the impact and the associated parameters of malnutrition and inflammation status on hospitalization and mortality of maintenance hemodialysis (MHD) patients. Method A total of 118 MHD patients were included in the study with 1 year's follow-up.The malnutrition and inflammation parameters were compared between the hospitalized patients and out-patients.Cox's proportional hazard regression model was used to explore the malnutrition and inflammation parameters which could forecast the risk of hospitalization and mortality. Result The hospitalization rate of MHD patients with mild,moderate and severe malnuttition was 32.93％,56.67％ and 83.33％ respectively,and the mortality was 3.66％,6.67％ and 80.00％ respectively.The hospitalization rate of MHD patients with or without microinflammation status was 56.45％ and 46.43％,and the mortality was 14.29％ and 1.61％.Inpatients had a higher malnutrition-inflammation score(MIS,8.36 vs 5.86,P＜0.05) and subjective global assessment of nutrition (MQSGA,14.49 vs 12.88,P＜0.05),a lower creatinine level (886.83 μmol/L vs 991.76 μmol/L,P＜0.05 ) and a lower albumin level (38.57 g/L vs 40.27 g/L,P＜0.05) than out-patients.Inpatients also had a higher level of TNF-α (65.41 μg/L vs 59.76 μg/L,P＜0.05) than out-patients.Cox proportional hazard model analysis showed that MIS and TNF-α were associated with patient's first hospitalization risk. Conclusions For the MHD patients,the more severe the malnutrition and micro-inflammation status is,the worse the clinical outcome is.The higher levels of MIS and TNF-α result in greater risk of hospitalization.

OBJECTIVE To investigate beta-lactamases production in multi-resistant Citrobacter strains isolated from the First Affiliated Hospital of Anhui Medical University.METHODS Standard agar dilution method was used to determine the minimal inhibitory concentration(MIC) of 52 clinically isolated Citrobacter strains,improved three-dimensional tests were performed to detect the ESBLs-producing,AmpC-producing and MBL-producing strains in 31 Citrobacter isolates,then beta-lactamases-encoding genes were amplified by polymerase chain reaction(PCR).RESULTS Thirty one Citrobacter strains were resistant to many beta-lactams antibiotics.Twenty four strains ESBLs-producing,3 AmpC-producing and 2 ESBLs-producing plus AmpC-producing strains have been detected by improved three-dimensional tests,and not found MBL-producing ones.Twenty strains had blaTEM gene and 1 strain had blaSHV gene,8 strains had blaCTX-M-1 gene,15 strains had blaCTX-M-13 gene and 5 strains had blaCIT gene by PCR.CONCLUSIONS Multi-resistant Citrobacter strains produce one or more types of ESBLs and AmpC beta-lactamase,it may be an important reason of resistance to beta-lactams antibiotics.

OBJECTIVE To investigate the antibiotical resistance and to understand the phenotype and genotype of metallo-?-lactamase in Chryseobacterium indologenes.METHODS The MIC to 25 C.!indologenes strains was detected by agar dilution method.Phenotype of metallo-?-lactamase was detected by three-disc synergy test and modified three dimension test.Polymerase chain reaction(PCR)amplification for both metallo?-lactamase and integrase gene was conducted for all isolates.Complete coding gene of metallo-?-lactamase and their DNA sequence analysis was conducted.Conjugation experiment was used to study the transmission of metallo-?-lactamase encoding gene.pIs Of ?-lactamase was measured by isoelectric focusing assay.RESULTS The antibiotical resistance of C.indologenes to imipenem and meropenem was 88.0%,respectively.However,gatifloxacin,levofloxacin and rifampin had better antimicrobiotial ability to C.indologenes compared with other antibiotics in MIC Nineteen strains were identified to produce metallo-?-lactamase using three-disc synergy test and modified three dimension test.Twenty strains were detected to have metallo-?-lactamase genotype by PCR amplification using IND-like common prime sets and four prime sets of complete coding gene.Among them,9 strains were detected to have blaIND-1 genotype and 10 strains to have blaIND-2 genotype,strain CI-25 was identified to have blaIND-like genotype.The mutation of base sequences and amino acid sequences in 5 strains were found simultaneously.Conjugation experiment showed that metallo-?-lactamase encoding gene couldn′t transfer.Nineteen strains had 1 or 2 bands on isoelectric focusing electrophoresis.Strain CI-5 was proved to have blaIND-1,but phenotype of metallo-?-lactamase was negative.CONCLUSIONS C.indologenes has high rate of metallo-?-lactamase producing,and thus it is difficult to treat.The major genotype of metallo-?-lactamase for C.indologenes is blaIND-1 and blaIND-2 in Hefei.The expression of blaIND could exist negative or low level occasionally.

In view of the characteristics of the computerized system,the key points in the quality assurance (QA) of the computerized system was discussed and summarized combined with the requirements of the GLP laboratory in Europe and America.The validation of computerized system,the control during the use of computerized system,period maintenance and safety protection of computerized system,archives of electronic data was discussed,expecting to provide reference for the management of computerized system in Chinese GLP laboratory which is generally not high currently.The experiences were obtained as follow:Through repeated inspection and review,the problem was found and set as the risk point;a targeted QA inspection plan was made focusing on the risk-based inspection and the QA inspection plan was timely adjusted according to the problems,which ensures the pertinence and validity of the QA inspection.