Klebsiella pneumoniae is well known as a causative agent of both community and nosocomial infections and is generally believed to be the cause of 10% of the nosocomial infection. Recently, with the widespread using of carbapenem, the isolation of carbapenem-resistant strains has been greatly increased, which bring great dififculties and challenges in clinical treat-ment. In this article, the progresses in the mechanisms of carbapenem, resistance inKlebsiella pneumoniae such as the acquisition of carbapenemases, hyperproduction of AmpC cephalosporinases or extended spectrum beta-lactamases (ESBLs) in combination with loss of the outer membrane protein, eflfux pump system, and bioiflm were reviewed.

Objective To investigate the antitumor effect of specific cytotoxic T lymphocytes induced by renal cell carcinoma multiple antigen peptide dendritic cell (DC) vaccine in vitro. Methods Dendritic cells were induced by hGM-CSF,hIL-4 from blood.Peptide of renal cell carcinoma cell line (RCC786-0)was got by citrate-phosphate buffer elution.Peripheral blood mononuclear cell was cultured.Multiple antigen peptide DC cell vaccine was obtained by acid-eluted peptide pulsed DC.The tumor antigen specific CTL was generated from activated T cell by vaccine.Killing activity of the tumor antigen specific CTL was activated by vaccine. Results Antigen peptide DC cell vaccine could show a strong cytotoxic activity of CTLs(31.93±5.05%),which was much higher than control groups(5.88±2.26%,8.03±6.70%,9.70±2.09%,9.35±3.58%). Conclusion Renal cell carcinoma antigen peptide DC vaccine could show a high antitumor effect in vitro.

Operation is one of the important ways in breast cancer treatment.With the deep basic medical research,new theory,new concept and new technology improve the operation therapy in breast cancer in more scientific and rational way Breast-conserving therapy and sentinel lymph node bipsy (SLNB) are applied,and the neoadjuvant chemotherapy make breast-conserving therapy more feasible.The progress of operation therapy in breast cancer make it critical to emphasize the individualized treatment in breast cancer.

Objective To investigate the characteristics of acoustic parameters and spectrograph of organic and functional voice disorder and evaluate the value of acoustic analysis technique by computer in the differential diagnosis of voice disorder. MethodsThe voice signals of sustained vowel "a" were measured with a microcomputer (Dr.Speech Software) in 70 healthy adults, 60 patients with varying organic diseases of vocal cords and 50 cases with functional voice disorder. The acoustic parame ters (jitter, shimmer, NNE) and spectrographic characteristics were analyzed and compared. ResultsIn 60 patients with organic diseases of vocal cords, all the acoustic parameters were significantly increased and the spectrograph showed irregularity,breakage or lack of harmonic waves and formants, and increase of noise. In 50 cases with functional voice disorder, the shimmer and NNE were significantly increased but the jitter was usually normal. The spectrograph showed pathologic changes of harmonic waves and formants in middle and high frequencies. The normal acoustic characteristics could be found in 94% (47/50) of the patients with functional voice disorder. ConcluisionThe acoustic analysis by computer technique is of value in the differential diagnosis of or ganic and functional voice disorder.

Along with the quickly popularization of Internet, the literature resource sharing mode in library has been changed. The paper introduces the current development of it, including interlibrary loan, document delivery, IC card service, proposes shortcomings and ideas for the further development of literature resource sharing.

Objective To evaluate the efficacy and toxicity of anthracycline and taxane combination regimen in the treatment of advanced breast cancer in patients who were previously treated with anthracycline and taxane.Methods Twenty-six patients who previously failed to respond to anthracycline and taxane based chemotherapy received pemetrexed and tegafur combination regimen (pemetrexed:500 mg/m2,ivgtt on the first day; tegafur:80 mg/(m2 · d),twice daily during day 1-14).The regimen was repeated at least two cycles of three weeks each and the clinical response was recorded at two weeks after treatment.Results Of the 26 patients,he tumor control rate was 65.3％ (17/26),and the overall response rate was 46.2％ (12/26),including 3 patients with complete remission and 9 patients with partial remission.The symptoms were stable in 5 patients and improved in 9 patients.There was no severe complications or death observed.The most frequent treatment-related adverse events were myelosuppression,nausea,vomitting,rash and hepatic function impairment.Conclusion Pemetrexed combined with tegafur in the treatment of patients with advanced metastatic breast cancer who did not respond to anthracycline and taxane treatment is effective with minimal adverse reactions and can be tolerated by patients.

Objective To investigate the ideal method of repair ing the abdominal defect after the TRAM flap transfer. Methods 24 cases of the abdominal defect after TRAM flap transfer were repaired by a polypropypene mesh. The anterior rectus sheaths on the pedicle were directel y sutured. Results Using of polypropylene mesh not only r epaired the abdominal defect but also achieved a superior abdominal aesthetic re sult. No ″abdominal compartment syndrome″ and infection happened d uring the ho spitalization. Mean patient follow-up was 1 year. No abdominal hernia, bulge an d laxity were encountered. The result of the abdominoplasty was continuous and t he functions of the abdomen were good. Conclusions It is an ideal method that using of polypropylene meth repairs the defect of abdomen . It keeps the integrity and the functions of the abdomen, decreases the complica tions, and at the same time gets the abdominoplasty effect.

Radiation therapy is one of the main therapeutic means of thoracic malignant tumors .When re-ceived certain radiation ,lung may cause the common complication of chest tumor radiotherapy -Radiation -in-duced Lung Injury ( RILI) ,which restricts the radiation dose for the tumor region and may affect patient outcomes . RILI is closely associated with multiple cytokines ,such as interleukin family,tumor necrosis factor,transforming growth factor,etc.Currently,research on RILI control methods has also made some breakthrough ,this article elab-orates on this individually .

Objective To study the postoperative cognitive dysfunction (POCD) in elderly patients after off‐pump coronary artery bypass grafting (OPCABG)and its risk factors ,and the association between cerebrovascular function assayed by 320 dynamic volume CT and POCD .Methods Two hundred and thirteen elderly patients selected for OPCABG were divided into patients group (n=28) and control group (n=185) .The patients underwent 320 dynamic volume CT to show their cerebrovascular ,neurological and cognitive functions .The patients were assessed on day 14 after operation .The risk factors for POCD and the association between CT perfusion imaging parame‐ters and POCD w ere comparatively analyzed .Results T he incidence of cerebrovascular disease , diabetes mellitus ,CTA‐detected severe cerebrovascular stenosis and abnormal cerebral pufusion was significantly higher in patients group than in control group (P< 0 .01) .Logistic regression analysis showed that cerebrovascular disease history and abnormal cerebral pufusion were the in‐dependent risk factors for POCD (OR= 1 .837 ,95% CI:1 .075 -3 .141 ,P= 0 .026 ;OR= 3 .224 , 95% CI:2 .073-5 .013 ,P=0 .000) .Conclusion Early detection of abnormal cerebrovascular ste‐nosis ,poor cerebral perfusion and maintainence of stable blood glucose play an important role in reducing the incidence of POCD in elderly patients after OPCABG .

0.05).However,there were significant differences between group C and A,group C and B,respectively(Pa