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.

Three-dimensional virtual surgery experiment is the application of virtual reality technology in the medical field.Doctors use the information in the virtual environment to develop surgical planning,surgical drills.surgical teaching,surgical skills training,to lead the surgical technique and postoperative rehabilitation,and the information is available for surgery every sur-gical member to share.Virtual Surgery experiments combined with the real operation together constitute complete experimental teaching system,making telemedicine experimental teaching methods and teaching content rich and varied.

Osteoporosis complicated with fracture is a common and severe condition. This paper summarizes present advances and new concepts in its treatment. Since the secondary osteoporosis will likely develop after fracture treatment with immobilization, more and more bone mass will get lost in addition to primary osteoporosis. A vicious cycle will be established and influence the fracture healing. Therefore, the key to the treatment is to block the vicious cycle to stop or decrease the bone loss. As a routine measure, to do exercises and weight- bearing activities as early as possible is as important as to take medicines for osteoporosis treatment. Stable internal fixation and prosthetic replacement should be firstly chosen for treatment of most fractures. In drug treatment, calcitonin, bisphosphonate (alendronate), HRT (Livial), vitamins D2 and D3, and calcium are indicated.

Objective To study the value of color Doppler ultrasonography in assessing the severity of deep venous insufficiency of the lower extremities.Methods Forty-five patients (46 lower extremities) in patient group confirmed as venous insufficiency by descending phlebography and 20 volunteers (40 lower extremities) in control group were assessed by color Doppler ultrasonography. The results of 45 patients were compared with those of 20 volunteers.Results The diameters of superficial femoral vein measured by color Doppler ultrasonography were correlated with the severity of venous reflux showed in phlebography(r=(0.771),P(0.05)).Conclusions The reflux distance in superficial femoral vein is a useful parameter in assessing the degree of venous insufficiency.

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 explore the effect of multi-disciplinary management for aneurysmal subarachnoid hemorrhage treated with clipping surgery. Methods 123 subjects admitted to hospital in April 2005 to March 2007 and received traditional management were named as the control group.62 subjects in the control group who admitted to neurology department first and then transferred to neurosurgery when diagnosed as aSAH by DSA were named as the transfer group. 61 subjects who admitted to neurosurgery directly and diagnosed as aSAH by DSA were named as the surgery group. 101 subjects who received multidisciplinary management from April 2007 to March 2009 were named as the experimental group. The waiting time before DSA, waiting time before surgery, hospital stay and hospitalization costs were compared between the three groups. Results Compared with the transfer group and the surgery group, the experimental group was lower in waiting time before DSA, waiting time before surgery, hospital stay and hospitalization costs, but there is no significant difference between the three groups in postoperative neurological function score and incidence rate of complications. The mortality rate was not significantly higher in the experimental group than the transfer group, but was significantly lower than the surgery group. Conclusions Multi-disciplinary management can reduce the "inappropriate hospital stay" of aSAH patients for early surgery. It can reduce the average hospital stay, hospital cost, in order to reduce the burden on families and society.

Objective To study the effects of cytokines Th1 and Th2 in Class V lupus nephritis (V-LN). Methods Serum concentration of Th1 cytokines (IFN-γ, IL-1, IL-2 and TNF-α) and Th2 cytokines (IL-4, IL-5, IL-6, IL-10 and IL-13) were simultaneously analyzed using fast quant human Th1/Th2 protein array, and Pearson analysis was used to evaluate the association between cytokines and clinical parameters. Results ① Cytokine profiling: Among the 9 cytokines detected simultaneously by fast quant human Th1/Th2 protein array, the expression of four cytokines was up-regulated obviously, namely, Th1 cytokines (IL-2) and Th2 cytokines (IL-4, IL-10 and IL-13); that of IL-10 was 10 times above the normal control. ② Pearson correlation analysis: There was a positive correlation between IL-10 and SLEDAI (r=0.877, P<0.01), but a negative correlation between IL-10 and hemoglobin concentration (r=-0.856, P<0.01). There was also a negative correlation between IL-4 and 24h urine protein (r=-0.754, P<0.05), between IL-13 and 24h urine protein (r=-0.769, P<0.05). Besides, IL-1 and creatinine were positively correlated (r=0.784, P<0.05). Conclusion There were extensively abnormal Th2 cytokines in V-LN patients, suggesting that anti-Th2 therapy may produce a marked effect on V-LN.

Chinese medicine has developed rapidly in the world, but the international standard system has not been established, further affecting the healthy development of Chinese medicine. Technical status of the member states are closely related to the current legislation and regulations in the development of Chinese medicine, which is important for developing international standards for TCM strategies. By the findings of ISO Technical Committee of Traditional Chinese Medicine (ISO/TC249) 7 European P member (Participating countries) International Traditional/Alternative Medicine (TM/CAM) legislative status, herbal medicine in each member country has a large market, a good environment for the development of some countries. After“The EU Traditional Herbal Medicinal Products Directive 2004/24/EC”issued by the member states for the registration and management in European, regulation of herbal products become more stringent. There are relatively small quantity of TM/CAM practitioners, lack of education for practitioners and standardized management.

Objective To investigate the cognition and behaviors of sun-protection and the facial photoaging in a Nanjing population, and to analyze the relationships between them. Methods The objects being investigated in Nanjing (n=974) were divided into 10 groups according to age. The ordinary information, knowledge and behavior of sun-protection and Glogau photoageing type of face were studied by questionnaires. The results were analyzed by a logistic regression model to select the related factors to photoageing. Results The risk of skin photoageing increased with age. Most of the 46-65 years old crowds were type Ⅲ photoageing. Most of the objects being investigated had some knowledge and active awareness of sun-protection and could use some ways to protect themselves from sun. However, most people did not use the sunscreen correctly. Those who had higher level awareness and knowledge of sunprotection suffered less risk from skin photoageing. Sunbath without sunscreen for a long time outside activity was a high risk factor of development to skin photoageing. Shade, broad-brimmed hat and sun-protection in autumn were the protective factors. Conclusion Active awareness and correct methods could help prevent skin photoageing. In order to avoid the damages to skin from ultraviolet efficiently, the accurate ways of using sunscreens should be well understood.

Objective To prepare nanobubbles and analysis its application for enhanced ultrasound imaging of small-cell lung cancer (SCLC). Methods Nanobubbles were prepared using a thin-film hydration-sonication method. MTT assay was used to evaluate the cytotoxicity of the nanobubbles for SCLC H446 cell line. The contrast-enhanced ultrasound (CEUS) of xenografted SCLC tumors in 10 nude mice was performed using nanobubbles and micro-scale microbubbles, and compared with livers. The time-intensity curve (TIC) was obtained using the Gamma variate and the following parameters were calculated, including area under the curve, time to peak, arrival time, peak intensity, and half-peak time. Results Nanobubbles with spherical shape distributed homogeneously, without obvious aggregation, the mean diameters was (392.1 ±48.6) nm and average zeta potential was (-16.8 ±2.9) mV. The MTT results indicated that the nanobubbles had no obvious cytotoxicity toward H446 cell line within the concentrations used for in vivo ultrasound imaging with nanobubbles (5 μg/ml). CEUS with the nanobubbles showed significantly higher peak intensity, and half-peak time [(18.14 ±0.62) s, (141.55 ±8.21) s] in comparison with the micro-scale microbubbles [(14.82 ±0.51) s, (120.43 ±8.73) s] (P= 0.033, 0.040). There was no significant difference in time to arrival, area under the curve and time to peak (all P>0.05). Compared with livers, the nanobubbles in xenografted SCLC tumors showed significantly shorter time to peak, lower peak intensity and area under the curve, and higher half-peak time (all P < 0.05). There was no significant difference in time to arrival (P > 0.05). Conclusion Nanobubbles ultrasound enhanced contrast agent shows good stability and contrast-enhancement effect in vitro, and provides an experimental basis for targeting ultrasound imaging and therapeutics of SCLC.