OBJECTIVE To discuss the distribution of pathogens isolated from the hospitalized patients of lower respiratory infection in the department of respiratory medicine and their drug resistance to help reasonably utilize the antibiotics.METHODS By the retrospective methods,we analyzed the pathogens isolated from the sputa of the hospitalized patients with lower respiratory tract infection in the department of respiratory medicine from 2002 to 2006 and their drug resistance.RESULTS Gram-negative bacteria were 46.5-56%,Pseudomonas aeruginosa and Escherichia coli were 15.0% and 8.9%,respectively,the drug resistance ratio to imipenem,piperacillin/tazobactam and amikacin was 2.0-35.6%;Gram-positive bacteria were 23.1-36.3%,Staphylococcus aureus and coagulase negative Staphylococcus were 17.3% and 7.5%,respectively,only to vancomycin were without resistance.Fungi were 15.3-24.7%.CONCLUSIONS Gram-negative bacteria are the main ones in lower respiratory tract infection,Gram-positive bacteria have a rising tendency and fungi occupy a fixed ratio.The drug resistance increases constantly.So it is very important to utilize antibiotics reasonably and pay attention to supervising drug resistance.

Objective To investigate the clinical efficacy of combined use of acupuncture and medicine in treating spasmodic torticollis.Method Thirty patients were randomly allocated to a treatment group of 15 cases and a control group of 15 cases. The treatment group received combined use of acupuncture and medicine, and the control group, acupuncture alone.Result Clinical observation lasted one year. There was a statistically significant pre-/post-treatment difference in the Tsui score in the two groups at 6 and 12 months after treatment (P<0.01). There was a statistically significant difference in the Tsui score between at 6 and 12 months after treatment in the two groups (P<0.01); the Tsui score decreased gradually after treatment. There was a statistically significant post-treatment difference in the Tsui score between the two groups at 12 months after treatment (P<0.05); the Tsui score decreased more in the treatment group.Conclusion The cure and marked efficacy rate of combined use of acupuncture and medicine for spasmodic torticollis is higher than that of acupuncture alone. A longer course is needed for acupuncture treatment of spasmodic torticollis and the patient should persevere with the treatment.

Objective To study the relationship of the antepartum foramen ovale (FO),the ratios of foramen ovale and aorta (FO/AO) and postpartum ostium secundum atrial septal defect (ASD).Methods Nine hundred fifty-eight fetuses were divided into 5 groups by gestational age,18-22 weeks,23-26 weeks,27-30 weeks,31-34 weeks,35-40 weeks.The diameter of FO and aortic (AO) and FO/AO were measured by fetal echocardiography,the postpartum echocardiography were followed up more than 12 months after birth.ANOVA was used to compare FO,AO,FO/AO with different gestational age.Regression equation estimate was used to compare the relationship of FO and AO with gestational age.Independent sample T test was used to compare FO and FO/AO with postpartum ostium secundum ASD and postpartum normal heart.Results There was significant difference in FO and AO among 5 groups(P =0.000),FO and AO increased with increasing gestational age.There was significant difference in antepartum FO,FO/AO between postpartum ostium secundum ASD and postpartum normal heart (P =0.000).Conclusions Antepartum FO and FO/AO provide clinical value in observing postpartum ostium secundum ASD.

Objective To evaluate the diagnostic accuracy of two dimensional echocardiography combining with enhanced flow (e-flow) imaging for fetal heart malformation.Methods 1580 cases were screened for fetal heart malformation.The diagnostic accuracy was evaluated by comparing the results fetal echocardiography with those of postpartum echocardiography,surgery or autopsy.Results Antepartum and postpartum data were obtained in 1286 of the 1580 fetuses (81.39％).Among the 1286 cases,the sensitivity,specificity,mistake diagnostic rate,omission diagnostic rate was 98.0 ％,99.3 ％,2.0 ％,0.7％,respectively.The consistency evaluation of fetal heart malformation by two dimensional echocardiography combining with e-flow concluded that the valve of Kappa was 0.970 (P =0.000).Conclusions Two dimensional echocardiography combining with e-flow is an accurate and reliable method for diagnosing fetal heart malformation,it has a high sensitivity and specificity.

Pylorus obstruction caused by foreign bodies in the gastric anrum and granulomatous inflammation is rarely seen.The clinical symptoms of this disease are unspecific.Combination of X-ray radiography,computed tomography and gastroscopy could make definite diagnosis.Differential diagnosis between pylorus obstruction and peptic ulcer,gastric cancer and duodenal obstruction should be done before operation.On April 13,2012,a patient with pylorus obstruction caused by foreign bodies in the gastric anrum and granulomatous inflammation was treated at the Second Hospital of Jiaxing,the imaging characteristics of the disease were summarized to provide referrence for the diagnosis and treatment of this disease.

Formulas, which are applied to the space magnetic induction of circular permanent magnet, are deduced from BiotSavart-Laplaces law in electromagnetics. The calculating methods of the formulas are set up with numerical integral and computer program. The space quantity distribution of magnetic induction of a circular permanent magnet is obtained through an objective example. These provide theory basis for the magnet application in the field of magnetic biology effect.

BACKGROUND: Femoral head necrosis can be induced in adult rabbits when a large dose of steroid has been used for a long time. However, the pathogenesis of steroid-induced femoral head necrosis needs further study.OBJECTIVE: To probe into the mechanism of the disease by light microscope and transmission microscope from morphological perspective based on the model of femoral head necrosis in rabbits.DESIGN: A randomized controlled observation.SETTING: Laboratory of Morphology; Teaching and Research Division of Pathology; Laboratory of Surgery, Weifang Medical College.MATERIALS: The experiment was carried out at the Experimental Center of Morphology, Weifang Medical College, between March 2002 and March 2003. Totally 40 adult New Zealand white rabbits were randomly divided into control group (n=10), dexamethasone group (n=10) and horse serum group (n=20).METHODS: Control group was given intravenous injection of normal saline of 10 mL/(kg·d) for 7 consecutive days. Dexamethasone group was given intramuscular injection of dexamethasone of 10 mL/(kg ·d)for 7consecutive days. Horse serum group was given intravenous administration of horse serum of 10 mL/kg; 3 weeks later the same volume of horse serum was injected once again, followed intramuscular injection of dexamethasone of 10 mL/(kg·d)for 7 consecutive days. Inferior sections of cartilage of the femoral head necrosis in the experimental animals were obtained 5 and 10weeks later, and then histological and ultrastructural changes were observed under the light microscope and transmission microscope.MAIN OUTCOME MEASURES: ① Histo-morphological observation of the animals in each group. ② Ultrastructural changes.RESULTS: All the experimental animals survived and entered the result analysis. ① Histo-morphological observation: The cells of inferior sections of cartilage of the femoral head necrosis of the experimental animals in control group were arranged regularly and had a small volume of elliptical bone cells. The cell body was located at bone lacuna, blood vessel arranged well in the medullary cavity of bone. Lesion haracteristics of femoral head in dexamethasone group and horse serum group were similar:Hematopoietic adipose in the medullary cavity of bone was significantly decreased while fat adipose obviously increased; bone trabecula of metaphysis and the inferior sections of cartilage of femoral head were found with ered, and so was the bone nucleus. The number of lacuna of bone was increased. ② Ultrastructural changes: Normal bone cells in control group were elliptical, located at bone lacuna. Nucleus was at one end of the cell with complete karyotheca and many mitochondria in the cytoplasm. In dexamethasone group and horse serum group there were lipid droplets in the osteocytes, narrowed blood capillary in the medullary cavity of bone and injured vascular endothelial cells.CONCLUSION: Corticotropin can induce necrosis of femoral head; the hormone causes accumulated fat adipose in the medullary cavity of bone.The increased internal pressure in the medullary cavity leads to ischemia of femoral head, thus inducing the necrosis of osteocytes.

Objective To summarize the computed tomography (CT) features of small intestinal obstruction caused by primary abdominal cocoon and investigate the essentials of diagnosis and differential diagnosis.Methods The retrospective descriptive study was adopted.The clinical data of 1 patient with small intestinal obstruction caused by primary abdominal cocoon who was admitted to the Second Affiliated Hospital of Jiaxing University on October 6,2014 were collected.The patient underwent abdominal CT on admission and at 10 hours after admission.The patient received emergency exploratory laparotomy after preoperative preparation,and then postoperative regular symptomatic treatment and pathological examination.Results of abdominal CT were observed,including imaging features of abdominal masses,extent of small intestinal obstruction,situation of intestinal tube within the masses,vessel distribution in the mesentery and fibrous capsules around the mesentery.Situation of operation,routine blood test,biochemical indicator,blood coagulation indexes,postoperative recovery,complications,results of pathological examination and situation of patient during follow-up were recorded.The follow-up by telephone interview and outpatient examination was applied to the patient till October 31,2015,including detecting the dietary,with or without symptoms of abdominal pain and distension,haematemesis and hematochezia,routine blood retest,liver function,renal function and CT.Results Results of abdominal CT on admission:(1) coronal plain scan of abdominal CT showed that there were signs of incomplete intestinal obstruction,and local small intestinal dilatation and gas accumulation in left abdominal region without specific sign.(2) Plain scan of abdominal CT showed that there were the coated sign with thickened fibrous capsules around the intestinal tube, banana shape ' with agglomerate and expanding-distortion intestinal tube and aggregative,stretching and twisting mesentery with abnormal vessel distribution.(3) Sagittal reconstruction images of abdominal CT showed that a huge mass consisted of fibrous capsules as cocoon and agglomerate and expanding-distortion intestinal tube was petal-like and fixed on posterior abdominal wall.(4) Coronal reconstruction images of abdominal CT showed that agglomerate and expanding-distortion intestinal tube was annularly surrounded by uneven thickness fibrous capsules with abnormal vessel distribution in the mesentery.Results of abdominal CT at 10 hours after admission:(1) coronal plain scan of abdominal CT showed that small intestinal obstruction was obviously exacerbated and expanding intestinal tubes were increased and aggravated.(2) Plain scan of abdominal CT showed that a typical sign of small intestinal obstruction was exacerbated and there were multiple air-fluid levels in the agglomerate and expanding-distortion intestinal tube with fluid and gas accumulation.Patient underwent successful enterodialysis + resection of fibrous capsules.During operation,a huge mass in the intestine from suspensory ligament of duodenum to ileocecum was fixed on posterior abdominal wall and surrounded by dense,smooth and white fibrous capsules,partial colon was also surrounded by fibrous capsules and greater omentum was missing.Patient received the postoperative supporting treatments of fasting,anti-infection and inhibition of acid.Number of white blood cells,absolute value and percentage of neutrophils,levels of high-sensitivity C-reactive protein and procalcitonin were 17.10 × 109/L,15.70 × 109/L,91.5％,127.49 mg/L and 1.370 μg/L by blood routine retest at postoperative day 1,respectively.Patient had normal liver,renal and coagulation functions.Fluid diet intake at postoperative week 1 was gradually replaced by normal diet intake.Patient had normal liver and renal functions by blood routine retest at postoperative day 10 and a good recovery without intestinal fistula,abdominal and pulmonary infections and other complications.Postoperative pathological examination showed that gross specimen was mainly composed of cocoon-shaped,grayish white and tough fibrous capsules.Fibrous capsules were consisted of proliferative fibrofatty tissues by microscope observation,with small vascular hyperplasia and large numbers of the inflammatory cell infiltration.Patient was diagnosed with small intestinal obstruction caused by primary abdominal cocoon after operation,and followed up for 1 year with normal diet intake and without abdominal pain and distension,nausea and vomiting,melena and discomfort.There was normal blood routine retest,liver and renal functions and distribution of the intestine in abdomen by CT examination.No dilatation of the intestinal tube was found and strip-like high density shadow in ileocecum was detected and considered as remnant fibrous capsules.Conclusion Imaging features of small intestinal obstruction caused by primary abdominal cocoon include agglomerate and expanding-distortion intestinal tube fixed on abdomen,partial intestinal tubes dilatation,intestinal fluid accumulation and air-fluid level,aggregative,stretching and twisting mesentery with abnormal vessel distribution,thickened fibrous capsules around intestinal loops and among intestinal tubes.

Objective: To quantitatively evaluate the variation of preoperative and postoperative structure and function of mitral valve after mitral valve annuloplasty(MVP) for mitral valve prolapse by real-time three-dimensional transesophageal echocardiography(RT-3D TEE). Methods: Thirty patients with mitral valve prolapse for MVP were studied, the minimum area of the three-dimensional view of the annulus(A3Dmin), three dimensional circumference(C3D), anterolateal-to-posteromedial diameter(DAlPm), anterior-to-posteior diameter(DAP), height (H), the ratio of annulus height to anterolated-to-posteromedial diameter(H/DAlPm), aorto-mitral angle(θ), the ellipticity of the the anterior-to-posterior diameter and anterolateal-to-posteromedial diameter of the annulus(E2D), the three-dimensional exposed area of the leaflet(A3DE), prolapse height(HProl), prolapse volume(VProl), non-planarity angle(θNPA) were evaluated by RT-3D TEE before and after operation. Coaptation area(CoapA), coaptation index(CPI), annulus systolic function index were calculated. Results: Compared with the preoperation, A3Dmin, C3D, DAlPm, DAP, H, H/DAlPm, A3DE, HProl, VProl, θNPA of postoperative were reduced, E2D, CoapA, CPI, annulus systolic function index of the postoperation increased, the difference of above parameters were statistically significant (P<0.05). CPI and annulus systolic function index were negatively correlated with the area of valve regurgitation area before and aftere operation (r=-0.79, P<0.01; r=-0.67, P<0.01). Furthermore, CPI was closely correlated with annulus systolic function index (r=0.63, P<0.01). Conclusions After MPV, mitral valve three-dimensional structural parameters are significantly changed, CPI and annulus systolic function are improved. CPI is closely correlated with annulus systolic function, and RT-3D TEE can quantitatively evaluate the structure and function of mitral valve before and after MPV.

Objective To investigate the clinical application value of longitudinal peak strain( LPS ) and peak strain dispersion ( PSD ) in evaluating left ventricular systolic function and synchrony in patients with essential hypertension . Methods Fifty‐five patients with essential hypertension were enrolled , including 30 patients with non‐left ventricular hypertrophy ( NLV H ) , 25 patients with left ventricular hypertrophy ( LV H ) , at the same time , 30 healthy volunteers were selected as the control group . Echocardiography was performed in all three groups ,and two‐dimensional dynamic images of the left ventricular apical four‐chamber ,three‐chamber ,and two‐chamber′s long‐axis view s were collected for three consecutive cardiac cycles . T he myocardial layer‐specific strain was used to measure the LPS of the left ventricular myocardium of subendocardium ,the middle layer ,the subepicardium ,and the myocardial strain and the PSD of the w hole myocardial layers . Correlation analysis and ROC curve analysis were performed . Results T he LPS in the control group ,NLV H group and LV H group were decreased in turn from inner to out myocardial layers . Compared with the control group , the LPS in the subendocardial , middle , subepicardial ,and w hole myocardial layer of NLV H group were decreased ( P ＜ 0 .05 ) , and the subepicardial myocardial LPS was slightly lower than that in the control group ,the difference was not statistically significant ( P ＞ 0 .05 ) . T he LPS in the subendocardial , middle , subepicardial ,and whole myocardial layer of LV H group were all reduced ( P＜0 .05) . Between the NLV H group and LV H group , the declines of the LPS in the subendocardial and middle layer in the LV H group were statistically significant ( P ＜0 .05) ,the LPS in the subepicardial layer and the w hole myocardial layer had no significant difference ( P ＞0 .05) . Compared with the control group ,the PSD of the NLVH group and the LVH group increased ( P ＜ 0 .05 ) . Compared with the NLV H group ,the PSD of the LV H group increased ( P ＜0 .05) . Inter‐ventricular septum thickness ( IVSd) and the LPS in the subendocardial ,middle ,subepicardial , and w hole myocardial layer were negatively correlated ( r ＝ －0 .537 ,－0 .518 ,－0 .266 ,－0 .471 ; all P ＜0 .05) , left ventricle posterior wall thickness ( LVPWd ) and the LPS in the subendocardial , middle , subepicardial ,and whole myocardial layer were negatively correlated ( r ＝ －0 .539 , －0 .524 , －0 .283 ,－0 .478 ;all P ＜0 .05) . T he area under the ROC curve ( AUC) of the LPS in the subendocardial ,middle , subepicardial ,and w hole myocardial layer and PSD for the diagnosis of hypertension were 0 .685 ,0 .652 , 0 .510 ,0 .623 ,0 .995 ,respectively . T he cut‐off values were －21 .70% ,－18 .90% ,－16 .95% ,－19 .45% , 46 .50 ms , and the sensitivities were 94 .4% , 83 .3% , 77 .8% , 94 .4% , 100% , respectively , and the specificities were 47 .8% ,52 .2% ,39 .1% ,39 .1% ,95 .7% ,respectively . Conclusions T he layer‐specific strain can quantitatively evaluate myocardial longitudinal strain in patients with essential hypertension , provide a non‐invasive test for early diagnosis of hypertensive heart disease ,and the evaluation of left ventricular myocardial stratification . PSD for evaluating primary synchronous changes in left ventricular myocardial contraction in patients with hypertension has certain advantages .