Matrix assisted laser desorption ionization time of flight mass spectrometry (MALDI-TOF MS) is an emerging tool for detecting microorganisms. It can be used not only for rapid identification of microorganisms, but also for the research of resistance mechanisms. Producing β-lactamase is the main mechanism for resistance of β-lactam antibiotics in Gram-negative bacilli. Currently using MALDI-TOF MS for rapid detection of bacterialβ-lactamase has been widely reported, including detection of β-lactam hydrolysis activity of β-lactamase, direct detection of β-lactamase molecule, peptide and relevant proteins, and detection of the single nucleotide polymorphisms (SNPs) of β-lactamase gene. This paper reviews current application of MALDI-TOF MS to the detection of β-lactamase based on the latest research findings.

OBJECTIVE:To evaluate the economics of alendronate sodium preventing osteoporotic fractures in postmenopausal women,and to provide reference for osteoporotic and osteopenia patients to select economical and effective therapy plan. METH-ODS:Using Markov economic model,TreeAge Pro 2011 software was used for cost-utility analysis using RCTs literature data of basic medication(calcium and vitamin D3)and basic medication combined with alendronate sodium as baseline data. Using quality adjusted life years(QALYs)and incremental cost utility ratio(ICUR)as economics evaluation indexes,the stability of established model was investigate by single factor sensitivity analysis. RESULTS:QALYs of the basic treatment group was 0.704 years,and QALYs of drug combination group was only 0.708 years. However,ICUR of two groups reached 714252.44. For the late period of hip fracture and other fractures,drug combination group was in high cost and low benefit,obviously had no economic advan-tage. For vertebral fractures,the cumulative probability of fracture in drug combination group was significantly lower than basic treatment group,and ICUR of the two groups was only 13902.17,with economic advantage. For hip fracture,the cumulative prob-ability of fracture in basic treatment group was the same as drug combination group,and ICUR was 19109.00,with economic ad-vantage. For wrist fractures,curative effect and economy needed further study. CONCLUSIONS:For the low-risk population with osteoporotic fractures,calcium and vitamin D3 are more economical in preventing osteoporosis fractures. For the high-risk popula-tion with vertebral and hip fractures,alendronate sodium combined with basic treatment is effective and economical.

Objective To investigate the clinical manifestation, diagnosis, therapies and medical economics of cesarean scar pregnancy (CSP). Methods From Jan. 2005 to Dec. 2008, 96 patients with CSP treated in Obstetrics and Gynecology Hospital of Fudan University were studied retrospectively. Those cases were divided into 3 groups. Thirty-three patients were treated with methotrexate (MTX) 50 mg/m2 intravenously guttae in group A. Among that 18 cases were treated with MTX, after 5 - 10 days they underwent dilation and curettage of uterus; 15 cases were given by dilation and curettage first if the level of serum human chorionic gonadotrophin-β(β-hCG) descent less than 30% in every 48 hours for 3 times after curettage, then MTX (50 mg/m2) intravenously guttae. Sixty patients were treated with MTX 100 mg bilateral uterine artery injection and embolization in group B. After 2 days, they underwent curettage.Group C: 3 patients were treated with laparotomy lesion excision. The following clinical parameters were compared, including blood loss( M), lesion diameter (-x±s), blood β-hCG level (M)before treatment, the number of cases with myometrial thickness anterior to the CSP ≤3 mm, the resistant index (RI) ≤0. 5,expense(-x ± s), hospital days(-x ±s) in those 3 groups. The correlation of blood loss with lesion diameter and blood β-hCG level was studied. Results ( 1 ) Clinical manifestation: bleeding loss were 20 ml in MTX +curettage of group A, 10 ml in curettage + MTX of group A, 12 ml in group B and 200 ml in group C. The volume of bleeding loss in group C was significantly higher than those in group A or group B ( P ＜ 0. 01 ).The lesion diameter were ( 23 ± 15 ) mm in curettage + MTX of group A and ( 30 ± 14 ) mm of group B ,which were higher than ( 16 ± 8 ) mm of MTX + curettage of group A (P ＜ 0. 01 ). The lesion diameter of (52 ± 7 )mm in group C were significantly bigger than those in the other groups ( P ＜ 0. 01 ). The level of blood β-hCG levels were 21 592 U/L in MTX + curettage of group A, 979 U/L in curettage + MTX of group A,which reach statistical difference ( P ＜0. 05). The level of blood β-hCG levels were 11 312 U/L in group B and 101 U/L in group C. Among 28 cases with Rl≤0. 5,there was 8 cases in group A (24% ,8/33),18 cases in group B ( 30%, 18/60) and 2 cases in group C (2/3). Among 23 cases with myometrial thickness anterior to the CSP ≤ 3 mm, there was 21 cases in group B (35%, 21/60 ), which were significantly higher than 2 in group A (6%, 2/33 ) and none in group C ( P ＜ 0. 05 ). The expense were ( 5578 ± 3679) yuan in MTX + curettage of group A and (5346 ± 2765 ) yuan in curettage + MTX of group,which did not reach statistical difference (P＞0. 05). The expense were (7860 ±2104) yuan in group B,which were significantly higher than those in group A and (5004 ± 421 ) yuan in group C (P ＜ 0. 05 ). The hospital days were ( 15 ±8) days and ( 19 ± 14) days of group A, ( 16 ± 10) days in group B and ( 17 ±8)days in group C, there was no significant difference among those treatments ( P ＞ 0. 05 ). (2) Correlatin:there was positive correlation between bleeding loss and lesion diameter( r = 0. 31, P ＜ 0. 05 ) or blood β-hCG level ( r = 0. 35, P ＜ 0. 05). Conclusions MTX intravenously guttae, MTX uterine artery injection and embolization, and laparotomy lesion excision were all properly used in treatment of CSP. MTX uterine artery injection and embolization was recommended for those with big lesion, high β-hCG level, less myometrial thickness anterior to the CSP or plentiful blood supply of the lesion but the expense might be high.

Objective To explore the change of cerebral microcirculation before and after clipping of intracranial aneurysm using CT perfusion (CTP)imaging.Methods CTP images of 70 patients diagnosed intracranial aneurysm by CTA were retrospectively an-alysed.They were divided into four groups according to have or not intracranial arterial spasm:A group:Preoperative CVS,postop-erative CVS (4 cases),B group:Preoperative CVS,postoperative nCVS (13 cases),C group:Preoperative nCVS,postoperative CVS (20 cases),D group:Preoperative nCVS,postoperative nCVS (33 cases).CBV/CBF/MTT were measured in four groups be-fore and after surgery,and analyzed statistically.Results (1)The postoperative CBV/CBF/MTT was compared with the preopera-tive data.There were statistically significant in CBVA/B/C/D/CBFA/B/D/MTTA/B during the surgery (P <0.05 ).There were no statistically significant in the CBFC and MTTC/D during the surgery (P >0.05).(2)There were statistically significant in the△CBVBC/BD/△CBFAB/BC/BD/△MTTAB/BD (P < 0.05 ).△CBVAB/AC/AD/CD/△CBFAC/AD/CD/△MTTAC/AD/BC/CD were no statistically significant (P >0.05).Conclusion CTP can early and accurately predict the change of cerebral microcircu-lation after surgery.

Objective To explore the clinical characteristics of Waldenstrom macroglobulinemia (WM) and enhance the level of diagnosis and treatment. Method The data of 15 patients with WM in our 68.5(60-79) years, male/female =2.75/1. Main clinical manifestations were fatigue, loss of weight, splenomegaly and lymphadenopathy. All the patients accepted the treatment of alkylating agents, purine nucleoside analogs, bortezomib or thalidomide respectively. The follow-up period for the patients was 4 months to 10 years and the median follow-up time was 82 months. Conclusion WM may often be seen in old male patients with varied clinical manifestations. The primary treatment is chemotherapy, but the disease is incurable. Bortezomib and thalidomide may improve the therapeutic effect.

Objective To investigate the efficacy and toxicity of bortezomib in combination with ifosfamide, methylprednisolone, thalidomide (V-CMPT) for the treatment of multiple myeloma (MM). Methods Twenty-four patients with newly diagnosed or relapsed/refractory MM were treated with V-CMPT. This regimen was repeated every three weeks as one cycle, and each case received two cycles. We adopted the examination of bone marrow and M protein and other hematological markers to evaluate the condition of disease and the therapeutic response. Results Of the nine patients with newly diagnosed MM, three achieved a complete remission (CR), five of a partial response (PR), and 1 of a minor response (MR). Of the patients with relapsed/refractory MM, two achieved a CR, two had a near CR (nCR), three had a PR, six had a MR, and two were no chang (NC). There was no obvious difference in the two groups (P = 0.511, P = 1.000). The overall response rate (ORR) was 91.7 %, and the CR/nCR rate was 29.2 %. After two cycles, the levels of hemoglobin, the serum albumin and the serum β2-microglobulin were obviously improved. The main adverse events were transient, including gastrointestinal reaction, thrombocytopenia, neuropathy, which could be controlled during the interval of chemotherapy or by symptomatic treatment and had no influence on the chemotherapy.Conclusion V-CMPT regiman was effective against the newly diagnosed and relapsed/refractory MM and could improve the related hematological markers with high response rate and tolerable toxicities.

Objective To obserue that bortezomib lead to hepatic impairment and even hepatic insufficiency. Methods Four multiple myeloma patients with hepatic impairment in velcade therapy were analyzed. All of 4 patients ranged from 46 to 60-year-old were relapsed and refractory, including 3 cases of male and 1 of female; 2 of K light chain type, 1 of non secretion type and 1 of IgGλλ biclonal type; 3 in stage ⅢB and 1 in stage ⅢA. Results Four patients had normal hepatic function before bortezomib therapy, but all appeared hepatic impairment during therapy. ALT and aspartate aminotransferase were increased by 2-80 and 1.5-70 times compared with before the chemotherapy, respectively, and bilirubin and alkaline phosphatase in 2 patients and glutamyltranspeptidase in 1 patient were increased. Hepatic function restored normally after patients were given liver securing drug and discontinued bortezomib therapy. Conclusion It isn't rare that bortezomib causing hepatic impairment in the patients with multiple myeloma.

Objective To research the resilience and influencing factors of the plateau soldiers.Methods Resilience Scale for Adult (RSA),Symptom Checklist (SCL-90),Eysenck Personality Questionnaire (EPQ) and General Self-Efficacy Scale (GSES) was used in this study to 756 plateau soldiers.Results ①The high resilience has been found in plateau soldiers (2.78 ± 0.47 ).There were significantly differences in three education levels of the plateau soldiers in planned of future (F =3.261,P =0.039 ),family cohesion (F =6.428,P =0.002 ),structure style(F=4.135,P=0.016) and RSA scores(F=4.162,P=0.016),and college ＞ senior high school ＞ junior high school.②Compared to the lower group in the RSA,the higher group scored significantly higher in extraversion ( t =13.004,P =0.000) and self-efficacy ( t =12.956,P =0.000 ),while lower in SCL-90 ( t =10.308,P =0.000) and neuroticism( t =11.297,P =0.000).③Resilience had significantly positive relation with self-efficacy ( r =0.48 ) and extraversion ( r =0.46 ),and negative relation with neuroticism ( r =- 0.42 ) andSCL-90( r =-0.41 ).The self-efficacy extraversion and neuroticism have nice predictive ability (42％).Conclusion The Resilience of plateau soldiers are good condition,self-efficacy,extraversion,and neuroticism are important influencing factors for plateau soldiers.

Objective To investigate the influence of gonadotropin-releasing hormone (GnRH) analogues on ovarian cancer and ovarian function in vivo.Methods ES-2 cells were cultured and xenotransplanted into 36 nude mice,which were divided into 6 groups:normal saline (NS) group:NS 0.1 nd/day subcutaneous injection,and then NS 0.2 ml/week peritoneal injection; cisplatin (DDP) group:NS 0.1 ml/day subcutaneous injection,and then DDP 5 mg/kg ( diluted to 0.2 ml ) per week peritoneal injection; goserelin group:100 μg goserelin ( diluted to 0.1 ml) per day subcutaneous injection,and then NS 0.2 ml/week peritoneal injection; goserelin + DDP group:100 μg goserelin ( diluted to 0.1 ml) per day subcutaneous injection,and DDP 5 mg/kg (diluted to 0.2 ml) per week peritoneal injection; cetrorelix group:100 μg cetrorelix (diluted to 0.1 ml) per day subcutaneous injection and NS 0.2 ml/week peritoneal injection; cetrorelix + DDP group:100 μg cetrorelix (diluted to 0.1 ml) per day subcutaneous injection and DDP 5 mg/kg ( diluted to 0.2 ml) per week peritoneal injection.All the peritoneal injection started from subcutaneous injection one week later.To compare the weight of nude mice,the volumes of transplanted tumors,the expression of Ki-67 antigen in transplanted tumors,the estrus,the ratio of atretic follicles,the ratio of primary and preantral follicles,the levels of serum anti-Mullerian hormone ( AMH ),folliclestimulating hormone ( FSH),estradio ( E2 ) and progesterone (P) in each group.Results There were no significant difference in the weight of nude mice among 6 groups ( P ＞ 0.05 ),which on day 29 in NS group was ( 19.8 ±2.2) g,DDP group (20.5 ± 1.4) g,gosereline group ( 19.6 ±0.9) g,goserelin + DDP group ( 19.7 ± 1.6) g,cetrorelix group (20.7 ±2.2) g,and cetrorelix + DDP group ( 19.0 ± 1.7) g.The tumor volumes of different groups on the 12th day:NS group (241 ± 179) mm3,DDP group (78 ±20) mm3,gosereline group (78 t±55) mm3,goserelin + DDP group (64 ±48) mm3,cetrorelix group (78 ±64) mm3,or cetrorelix + DDP group (70 ± 19) mm3,in which there were significant difference between NS group and the other groups ( P ＜ 0.05 ) ; and the same result was obtained on day 15,19,22,26 and 29 ( P ＜ 0.05 ).The expression of Ki-67 in NS group was ( 33 ± 10 ) ％,in which it was higher than those in DDP group 3.5％,goserelin group 8.8％,goserelin + DDP group 1.5％,cetrorelix group (23 ± 11 ) ％,or cetrorelix + DDP group ( 8 ± 6 ) ％ ( P ＜ 0.05 ).The ratio of primary and preantral follicles in goserehn group was (71.5 ± 8.1 ) ％,in goserelin + DDP group was (62.4 ± 4.1 ) ％,in cetrorelix group was (71.2 ± 7.4) ％,and in cetrorelix + DDP group was (63.8 ±3.1 )％,in which they were much higher than that in DDP group ( 47.0 ± 4.8 ) ％ ( P ＜ 0.05 ).The level of AMH in goserelin group was ( 98 ± 27 ) ng/ml,which was much higher than that in NS group (66.2 ± 17.4) ng/ml (P ＜0.05),while there were no difference in the levelsof FSH,E2 or P among different groups ( P ＞ 0.05).Conclusion GnRH analogues could inhibit the growth of transplanted tumors in nude mice,meanwhile increase the secretion of AMH,decrease the frequencies and prolong the lasting time of estrus,decrease the ratio of atretic follicles,raise the ratio of primary and preantral follicles,which may be protect the ovarian function of nude mice.

Objective To investigate the clinical characteristics, prognosis and treatment of pleural effusion of multiple myeloma. Methods From Jun 2005 to March 2010, of 162 patients with multiple myeloma treated in our department were complicated with pleural effusion, whose the proportion male to female was 8:7 and the median age was 56.8 (37-68) years. The diagnosis of malignant pleural effusion was dependent on physical examination, chest X ray, pleural aspiration and pleural fluid cytology. According to internatinal system stages and Durie-Salmon stages, the patients were staged. Results The results of pleural fluid cytology showed that the myeloma cells were positive in 13 patients and was negative in the other 2 patients. All patients received the chemotherapy regimen including bortezomib, large dose of glucocorticoids and cisplatin, cyclophosphamide, etoposide or prednisone (DECP). Although pleural effusion was controlled in some degrees, but were quickly relapsed. Eleven patients died, 2 of steady disease and 2 follow-up. Conclusion Multiple myeloma with myelomatous pleural effusion was very poor in the prognosis. Myelomatous pleural effusion was taken as a late manifestation in multiple myeloma or prediction of the aggressive behavior of the disease.