The aim of informed consent is to regard patients as the centre of medical service.Physician-patient communication is an effective way to improve the construction of a harmonious physician-patient in medical practice,so more attention should be paid to the communication.

Objective To realize the distribution and change in antimicrobial resistance of common pathogens causing acute lower respiratory tract infection (LRTI)in children,and provide evidence for rational use of antimicrobial agents. Methods Data about pathogens from children with LRTI in a hospital between January 2011 and December 2013 were ana-lyzed statistically.Results Of 934 isoalted pathogenic strains,728 (77.94%)were gram-negative bacteria,the major were Klebsiella pneumoniae (n =278),Escherichia coli (n =216),Enterobacter cloacae (n =85 ),and Pseudomonas aeruginosa (n=63).The isolation rate of gram-positive bacteria was 20.87%(n=195),the major were Staphylococcus aureus (n=132)and Streptococcus pneumoniae (n=49).Antimicrobial susceptibility testing results revealed that sensitive rate of gram-negative bacteria to imipenem,meropenem,and amikacin were all 100.00%,to ceftazidime/clavulanic acid and piperacillin/tazobactam were relatively low,to cephalosporins increased year by year.Sensitive rates of the main gram-positive bacteria to vancomycin were both 100.00%, to erythromycin and clindamycin were relatively low. Conclusion The major pathogenic bacteria causing LRTI in pediatric department are gram-negative bacteria,antimicrobial resistance rates increased year by year,management of antimicrobial use in children should be strengthened to prevent the occurrence of multidrug-resistant organism infection.

Objective To explore the application of lentil lectin‐reactive alpha‐fetoprotein ratio (AFP‐L3% ) applied in the dif‐ferential diagnosis between hepatitis B infection of primary liver cancer and benign liver disease .Methods We included 108 cases of chronic HBV infection ,including 50 cases of primary liver cancer ,42 cases of cirrhosis ,16 cases of chronic hepatitis .Chemilumines‐cence detection was used to detect alpha‐fetoprotein (AFP) and AFP‐L3 content ,AFP‐L3 and the ratio of AFP (AFP‐L3% ) was calculated .Results AFP≥400 ng/mL as primary liver cancer diagnostic threshold ,the sensitivity and specificity were 36% ,84% , when used AFP‐L3% ≥ 10% as primary liver cancer diagnostic threshold ,the sensitivity and specificity were 62% ,83% . Conclusion AFP‐L3% is a better clinical indicator to distinguish between primary liver cancer and benign liver disease .AFP‐L3%can be used as a clinical indicator to differential diagnosis between HBV infection of primary liver cancer and benign liver disease .

Objectives:The purpose of this study was to investigate the effects of soybean oil emulsion on stress response and immune function after surgery for esophageal cancer. Mehtods:Patients who underwent esophagectomy with thoracotomy were divided into two groups.Group A(15 patients) received fatfree parenteral nutrition(PN) as the control group.Group B(18 patients) were fed by PN with soybean oil emulsion.There was no significant difference between the two groups in regard to either clinical backgrounds,nutritional parameters, or proteins measured before and after the operation. Results:The serum levels of cortisol and IL6 were significantly higher on the first and third postoperative days(P

BACKGROUND:The autologous oxygen-delivering biomimetic nanoscaffold is composited with chondrocytes in simulated microgravity to construct the active tissue-engineered bone, which not only has excel ent osteogenic potential characteristics, but also has autologous releasing oxygen, and additional y can effectively prevent early transplant failure caused by sufficient revascularization and hypoxia. OBJECTIVE:To investigate the effects of autologous oxygen-delivering biomimetic nanoscaffold composited with chondrocytes on repairing different types of temporomandibular joint condylar fractures. METHODS:Total y 30 Sprague-Dawley rats were randomly divided into control group, experimental groups 1 and 2 (n=10 per group). The autologous oxygen-delivering nano-hydroxyapatite/chitosan scaffold composited with chondrocytes were transplanted into rats with temporomandibular joint condylar longitudinal fracture in the experimental group 1 and those with temporomandibular joint condylar transverse fracture in the experimental group 2, respectively. At 1, 3 and 6 weeks after transplantation, the number of proliferating cel nuclear antigen-positive cel s was detected by immunofluorescence assay;the chondrocyte apoptosis was detected using TUNEL method, and expressions of col agen type II, Sox9 and vascular endothelial growth factor were observed by RT-PCR technology. RESULTS AND CONCLUSION:The number of proliferating cel nuclear antigen-positive cel s in the experimental groups 1 and 2 were significantly higher than that in the control group at different time points after transplantation (P<0.05). At 3 and 6 weeks after transplantation, the number of apoptotic chondrocytes in the experimental groups 1 and 2 was significantly lower than that in the control group (P<0.05);significantly higher and highest expressions of col agen type II, Sox9 and vascular endothelial growth factor were found in the experimental groups 2 and 1 compared with the control group, respectively (P<0.05). Additional y, compared with the experimental group 2, the number of proliferating cel nuclear antigen-positive cel s was significantly lower in the experimental group 1 at 3 and 6 weeks after transplantation (P<0.05);the number of apoptotic chondrocytes was significantly lower in the experimental group 1 at 3 weeks after transplantation (P<0.05). These results indicate that autologous oxygen-delivering biomimetic nanoscaffold composited with chondrocytes to repair different types of temporomandibular joint condylar fractures presents some different outcomes.

Objective To study the anatomy basis and biomechanical stability of euthyphoria reduction and percutaneous cannulated screw fixation for sacroiliac dislocation,and to evaluate the primary clinical efficacy of this method.Methods The distances from the anterior branches of the nerve roots at L4,and L5 and obturator nerve on the superior border of sacral ala to the sacroiliac joint were measured on 12 adult cadavers (24 sides) fixed and preserved by formalin.Models of sacroiliac dislocation were made on six pelvic specimens of fresh cadavers.A comparison of stability was made on the six models between the fixation studied here and the traditional fixations by posterior percutaneous sacroiliac screws and by anterior sacroiliac joint plates.At the same time,17 patients with type C Tile fracture were treated with our method.The clinical efficacy was analyzed for the 17 patients.Results The distances from the anterior branches of the nerve roots at L4,and L5 and obturator nerve on the superior border of sacral ala to the sacroiliac joint were 20.24?1.20mm,23.80?1.43mm,and 16.26?2.07 mm respectively. There was no statistically significant difference in stability between our method and the traditional fixation by posterior percutaneous sacroiliac screws,though ours seemed better.Follow-ups for the 17 cases averaged 2.2 years,re- vealing fine functional recovery in all according to Matta scoring.Conclusions Euthyphoria reduction and per- cutaneous cannulated screw fixation can lead to sufficient biomechanical stability for the sacroiliac joint and effec- tively avoid nervous injuries.In addition,our method is simple and clinically effective,It is recommendable for small and middle-sized hospitals.

Objective To detect gene mutations associated with dapsone-,rifampicin-and ofloxacinresistance in lesions of patients with recurring or treatment-resistant leprosy collected from 2010 to 2011.Methods Clinical data and lesional specimens were collected during 2010-2011 from patients with recurring or treatment-resistant leprosy who were diagnosed and reported by provincial centers for leprosy control.Mycobacterium leprae DNA was extracted from the specimens and subjected to PCR for the amplification of folP1,rpoB and gyrA genes.The PCR products were directly sequenced and BLAST program was used to compare the sequence of isolated strains with the reference sequence in GenBank.Results Twenty-four patients were enrolled in this study,including 13 with recurring leprosy and 11 with treatment-resistant leprosy.Twenty-one patients showed positive PCR results in all the three regions.Of these PCR-positive specimens,3 from 1 patient with recurring and 2 patients with resistant leprosy harbored a point mutation,acc (threonine)→gcc (alanine),at codon 53 in the floP1 gene,1 from a patient with recurring leprosy harbored a missense mutation,gat (aspartic acid) → aac (asparagine),at codon 441 in the rpoB gene.Conclusions Mutations are detected in the folP1 and rpoB genes,which are associated with the resistance to dapsone and rifampicin respectively,but not in the ofloxacin resistance-associated gyrA gene,in Mycobacterium leprae isolates from patients with recurring or treatment-resistant leprosy.

Objective To compare the efficacy of uniform multi-drug therapy (UMDT) versus routine multi-drug therapy (RMDT) for the treatment of multi-bacillary (MB) leprosy patients based on bacterial index changes and frequencies of leprosy reaction.Methods This study recruited newly diagnosed leprosy patients after taking informed consent in three districts of Guizhou province as well as in one district of Yunnan province from November 2003 to June 2005.The patients received 6-month UMDT or 2-year RMDT.Clinical follow up and bacterial reexamination were carried out once a year.Changes of bacterial index (BI) and frequencies of leprosy reaction were compared between the patients receiving RMDT and UMDT.Results A total of 166 patients received UMDT and 170 received RMDT in this study.Among the UMDT-treated patients,114 were skin smear positive,and 83 had been followed up for 42 months; of the RMDT-treated patients,149 underwent all the bacterial examinations during a 48-month follow up.The mean bacterial index decreased from 2.84 before treatment to 0.33 at the end of the 42-month follow up in the 83 patients,and from 2.55 to 0.26 at the end of the 48-month follow up in the 149 patients,with no significant difference in the changes of bacterial index between the two groups (t =0.77,P ＞ 0.05).Bacterial index became negative in 73.5％ (61/83) of the UMDT-treated patients and in 77.2％ (115/149) of the RMDT-treated patients (x2 =0.40,P＞ 0.05)at the end of follow up.During the follow up peroid,the incidence of type Ⅰ leprosy reaction was 14.6％ (13/89) in the UMDT group,significantly higher than that in the RMDT group (3.4％ (5/149),x2 =10.08,P＜ 0.01 ).Conclusions There is no significant difference in mean bacterial index changes and bacterial clearance rate during the follow up peroid between UMDT- and RMDT-treated patients.The incidence of type Ⅰ leprosy reaction is higher in the UMDT group than in the RMDT group,and further investigation is needed to clarify the mechanisms underlying the phenomenon.

BACKGROUND:Many studies have demonstrated that restoration of femoral offset in revision total hip arthroplasty would contribute to the recovery of joint function.OBJECTIVE:To investigate the importance of restoration of femoral offset in revision total hip arthreplasty on the recovery of joint function.METHODS:An observational study was performed at the Department of Orthopedics,Third Affiliated Hospital of Guangzhou Medical University between February 2004 and May 2007.A total of 15 patients with the revision total hip arthroplasty,including 12 males and 3 females,aging 62 75 years,averaging 67 years old,were recruited into this study.Harris evaluation system was used to evaluate joint function.The femoral neck anteversion and the femoral offset were measured by the method of Sakai.The vertical distance from the teardrop line to the most prominent point of the lesser trochanter was measured from each radiograph.References were combined to investigate the effect of restoration of femoral offset in revision total hip arthroplasty on joint function.RESULTS AND CONCLUSION:All the 15 patients were recruited into this study.The duration of follow-up ranged from 24 months to 5 years.We measured the femoral offset on pre- and post-operative radiographs,and the results indicated that the femoral offset of 4 patients were above 4 mm.The femoral offset of 11 patients was restored.The femoral offset were 22-48 (32.21±0.64) mm pre- and 22-57 (36.13±0.82) mm post-operative radiographs,respectively.The mean difference in femoral offset post-operatively was significant (t=0.424,P=0.01 ).Harris scores were good in 4 cases,passable in 2 cases,and poor in 9 cases pre-operatively,and the scores were excellent in 8 cases,good in 4 cases,passable in 2 cases,and poor in 1 case post-operatively.The score of Harris evaluation system in the patient of restoration group and failed restoration group were 88.72±5.3 (80%) and 72.32±6.5 (27%) post-operative at 1 month respectively.The mean difference of the score was significant (χ~2=1.245,P<0.05).The 3 patients had complication,one was the dislocation of hip,and two had the pain of hip.All the patients with complication were in failed restoration of femoral offset,which was above 4 mm.The restoration of femoral offset contributes to the recovery of joint function and reduce complication occurrence after total hip arthroplasty revision.

BACKGROUND:Pain is the main clinical manifestation for ankylosing spondylitis. At present, nonsteroid anti-inflammatory drugs are oral y taken, but the effects are limited and toxic and side effects are more. Thus, there is no effective scheme for treatment of pain induced by ankylosing spondylitis.
OBJECTIVE:To investigate the correlation between postoperative joint pain al eviation and al ogeneic blood transfusion, and the mechanisms.
METHODS:We retrospectively analyzed clinical data of 88 ankylosing spondylitis patients combined with kyphosis who received only one section of osteotomy surgery merging hip joint pain. We compared the visual analog scale score of hip joint and detected the variation of leucocytes, lymphocytes and immunoglobulin concentrations before and after the operation in the groups of fresh al ogeneic whole blood transfusion, autologous whole blood transfusion, and mixed transfusion of al ogeneic and autologous whole blood. Flow cytometry was used to analyze the number and ratio of peripheral blood Th17 cells and Treg cells which were both highly associated with autoimmune diseases.
RESULTS AND CONCLUSION:The symptom of hip arthralgia obviously improved in both groups transfused by fresh al ogeneic whole blood or al ogeneic-autologous mixed whole blood. However, no obvious variation was detected in leucocytes, lymphocytes and immunoglobin concentration. However, flow cytometry results indicated that Th17/Treg proportion associated with autoimmune diseases was increased remarkably in peripheral blood of ankylosing spondylitis patients. Results suggested that al ogeneic whole blood transfusion can al eviate patients’ joint pain by correcting the imbalance of Th17/Treg which may improve their immune state.