Objective To analyze risk factors of nosocomial pneumonias due to ESBL-producing Klebsiella pneumoniae.Methods From July 2001 to December 2004,38 patients with ESBL-producing K. pneumoniae and 63 patients with non-ESBL-producing K. pneumoniae were enrolled. ESBL-producing strains were detected by confirmed test.Results Hospital duration,ICU stay,tracheal intubation or tracheotomy,indwelling catheters,mechanical ventilation and use of cefotaxime were found to be risk factors in the acquisition of K. pneumoniae with ESBLs by univariate analysis. Cefotaxime use remained as risk factors by multivariate analysis with logistic regression. Conclusion The reasonable use of cefotaxime is an important measure to control the prevalence of ESBLs-producing strains of Klebsiella pneumoniae.

AIM: To investigate the effect of hypoxia on the invasion and migration of lung carcinoma cells. METHODS: Lung carcinoma cell H128 was exposed to normoxia (air, 5% CO 2), hypoxia (5% O 2,5% CO 2,90% N 2) or anoxia (95% N 2,5% CO 2) conditions for 48 hours. The migration ability of the cells was assayed by wound healing methods. The invasiveness ability was determined with HABM-HEM model. The cells exposed to hypoxia were inoculated under skin in nude mice, and then the growth of the tumor and the rate of metastasis to lymph node or lung were observed. The expression of E-cadherin and ?1-integrin on the cells were also assayed by flow cytometry. RESULTS: Compared with normoxic group, the invasiveness and migration in hypoxic group were increased. The rates of tumorgenesis and metastasis to lung in anoxic group were evidently decreased. The expression of E-cadherin was decreased, and the expression of ?1-integrin was increased in hypoxic group. In anoxia group, the invasiveness, migration, the expression of E-cadherin and ?1-integrin were all decreased. CONCLUSIONS: Moderate hypoxia down-regulated the expression of E-cadherin, up-regulated the expression of ?1-integrin, and increased the invasiveness and metastasis of carcinoma cells. Serious hypoxia decreased the expression of adhesive molecules, and the proliferation, invasiveness and migration were also decreased.

Objective To explore the role of intercellular adhesion molecule-1(ICAM-1) in the metastasis of lung cancer.Methods The expression of ICAM-1 in the tissue and the serum ICAM-1(sICAM-1) level in the 52 cases of primary lung cancer were detected with immunohistochemical staining method(SP) and enzyme linked immunosorbent assay(ELISA),with 20 cases of adjacent non-cancerous tissue as the control.Results The positive rate of ICAM-1 expression in lung cancer was significantly higher than that of adjacent non-cancerous tissue.The expression of ICAM-1 in the cases with lymph node metastasis was higher than that of no lymph node metastasis.The expression of ICAM-1 in stage III+IV was higher than that of stage I+II,and that in adenocarcinoma was higher than that of squamous cell carcinoma.The level of sICAM-1 in patients with lymph node metastasis was higher than that without lymph node metastasis.The sICAM-1 level in patients of adenocarcinoma was higher than that of squamous cell carcinoma,and that in patients with positive expression of ICAM-1 in tissue was higher than that of negative expression of ICAM-1.Conclusion The expression of ICAM-1 may be associated with the metastasis in lung cancer.The sICAM-1 level reflects the expression of ICAM-1 in tissue and may be used as a tumor marker of metastasis and prognosis in lung cancer.

Kushenhuangqi Injection is made from Chinese herb medicine flavescent sophora and astragalns roots.Seventy-one patients with malignant pleural effusion were randomly divided into two groups: 36 patients were treated with both intrathoracic Kushenhuangqi Injection and chemotherapeutic agent cisplatin (treatment group) and 35 patients were treated with cisplatin alone.The response rate of treatment group was significantly higher than that of control group (31/36 vs 20/35,u=3.020,P<0.01).The rate of adverse reaction (leucopenia,nausea,vomiting etc.) in treatment group was significantly lower that that of control group.The results indicate that Kushenhuangqi Injection can enhance the therapeutic effect of chemotherapeutic agent and reduce its adverse reaction in treatment 0f malignant pleural effusion caused by carcinoma of the lungs.

Object To report the one arm external fixator with skeletal traction of calcanus in treatment of comminuted fractures of tibia and fibula. Method 186 cases of fractures of tibia and fibula were treated by the one arm external fixator with skeletal traction of calcaneus. 42 cases were open fractures, and 142 cases were closed fractures.185 cases were followed up. Results 183 cases of fracture united, and the average healing time was 6 months. By Johner Wrichs score 113 were rated as excellent, 69 good, 2 poor. The infection rate was 17.5%. Conclusion It is convenient and effective to use one arm external fixator with skeletal traction of calcaneus to treat comminuted tibia and fibula fractures.

Objective To evaluate the effects of curcumin on the activity of NR2B and NR1 in the spinal dorsal horn in a rat model of diabetic neuropathic pain (DNP).Methods Diabetes mellitus was induced by high-sucrose and high-fat diet and intraperitoneal streptozotocin 35 mg/kg,then confirmed by fasting blood glucose level ≥ 16.7 mmol/L 3 days later in male Sprague-Dawley rats.DNP was confirmed by the mechanical paw withdrawal threshold (MWT) and thermal paw withdrawal latency (TWL) measured on day 14 after streptozotocin administration ＜ 80％ of the baseline value.The rats were then randomly divided into 3 groups (n =27 each) using a random number table:DNP,DNP+ curcumin group (group DCur)and DNP + solvent control group (group DSC).Curcumin 100 mg· kg-1 · d-1 and corn oil 4 ml· kg-1 · d-1 were injected intraperitoneally for 14 consecutive days starting from 14 days after administration of streptozotocin in DCur and DSC groups,respectively.Another 27 normal male Sprague-Dawley rats served as control group (group C) and were fed with normal forage.At 3,7 and 14 days after curcumin injection,MWT and TWL were measured and the lumbar segments (L4-6) of the spinal cord were removed.The expression of pTyr1472-NR2B and pSer896-NR1 in the spinal dorsal horn was determined by immunohistochemistry and Western blot.Results Compared with group C,MWT was significantly decreased,TWL was shortened,and the expression of pTyr1472-NR2B was up-regulated at each time point in group DNP.Compared with group DNP,MWT was significantly increased,and TWL was prolonged at 7 days after curcumin injection,and the expression of pTyr1472-NR2B was down-regulated at 3 days after curcumin injection in group DCur.There was no significant difference in each parameter between DNP and DSC groups,and in the expression of pSer896-NR1 between the four groups.Conclusion The mechanism by which curcumin mitigates neuropathic pain in type 2 diabetic rats may be related to inhibition of up-regulation of pTyr1472-NR2B expression,while unrelated to pSer896-NR1 expression in the spinal dorsal horn.

Objective To determine the nutrients contents in muscle of Culter erythropterus and evaluate its nutritive value. Method The nutrients composition was analysed by general method. Results The contents of moisture, crude protein, total fat, total sugar and ash were 78.29%, 18.31%, 0.97%, 1.18% and 1.17%, respectively. The total amount of AA, EAA, NEAA and FTAA was 71.93%, 31.61%, 40.32% and 25.57%, respectively. 26 kinds of FA were identified. There were 6 kinds of SFA, 20 kinds of UFA. The contents of SFA, MUFA and PUFA were 26.26%, 29.61% and 39.91%, respectively. The contents of DG, TG, FFA, Cho and PL were 3.69%, 11.71%, 23.60%, 0.54% and 60.46%, respectively. Conclusion The crude protein and PUFA were high in muscle of Culter erythropterus. It was beneficial for health to eat it regularly.

Objective To study the expression of TrkB and c-fos in rat auditory cortex after long -term ad‐ministration of sodium salicylate and the mechanisms of salicylate ototoxiclty .Methods Normal adult rats were di‐vided into three groups :normal group without any treatment ,long -term treatment group given i .m .injections , 175 mg/kg ,twice daily at 9:00 am and 6 :00 pm for consecutive 14 days and the recovered group using the same method as the chronic group except that they were sacrificed 28 days after salicylate treatment ceased .After the de‐tection of ABR ,rats were sacrificed after deep anesthesia ,and the auditory cortexes were dissected rapidly .Real-time PCR and Western-blot were explored to detect the expression of TrkB and c-fos .Results The average ABR threshold of normal rats was 36 ± 2 .23 dB SPL .The average ABR threshold of long -term group was 41 .3 ± 3 .31 dB SPL ,which was significantly increased than normal group(P<0 .01) .The average ABR threshold of the recoveredgroup was 38 .6 ± 5 .51 dB SPL .There were no differences between the recovered group and normal group(P>0 . 05) .The expression of c-fos mRNA(1 .24 ± 0 .09)and protein(0 .70 ± 0 .12)in the long -term group were signifi‐cantly increased ,when compared with the normal group .The c-fos mRNA(1 .23 ± 0 .04)and protein(0 .68 ± 0 .08) expression in the recovered group were also significantly increased compared with the normal group .The expression of TrkB mRNA(1 .26 ± 0 .10)and protein(1 .85 ± 0 .17)in the long -term group were significantly increased ,when compared with the normal group .The TrkB mRNA(1 .23 ± 0 .07)and protein(1 .80 ± 0 .08)expression in the recov‐ered group were also significantly increased compared with the normal group .Conclusion The inereased expression of c-fos in the long -term group may be related to the enhancement of central auditory function .The inereased ex‐pression of Trk-B in the long -term group might be involved in instability of synaptic plasticity in tinnitus .

Objective To explore the value of combining pulmonary rehabilitation with heat and magnetic vibration (HMV) therapy and tiotropium for patients with stable but severe chronic obstructive pulmonary disease (COPD). Methods This was a paralleled, controlled, randomized study. Thirty-seven patients with stable severe COPD were enrolled and divided into two groups at random. One was the tiotropium group (T group) , while the other combined tiotropium therapy with HMV (the T + HMV group). The time span was 4 weeks. The examinations were performed at week 0, week 2 and week 4. The examinations included pulmonary function tests, arterial blood gas analysis, the 6 minute walking test (6MWT) , Borg's score and St George's Respiratory Questionaire (SGRQ). Results Inspiratory capacity (IC) increased in both groups. Forced expiratory volume in one second ( FEV1.0) , percent predicted FEV1.0 and FEV1.0/forced vital capacity ( FVC) increased significantly only in the T + HMV group. The average parameters of the pulmonary function test in the T + HMV group were significantly higher than in the T group. In both groups, alveolar PO2 ( PaO2) improved but alveolar PCO2 ( PaCO2 ) did not change and in this there was no significant difference between the groups. The 6 minute walking distance increased and the average Borg score decreased in both groups, and there was no difference between the groups. SCRQ dropped more than 4 scores in both groups, but the decrease in the T + HMV group was significantly greater. Conclusions Tiotropium can play an important role in the rehabilitation of patients with stable severe COPD. The combination of tiotropium with HMV therapy is superior to tiotropium alone in pulmonary rehabilitation for stable but severe COPD patients.

Objective To analyze preoperative CT findings of chronic suppurative otitis media and to evaluate clinical effect of CT in diagnosing and choosing operation approach.Methods CT findings of 101 ears with chronic suppurative otitis media confirmed by surgery were analysed retrospectively and compared with the findings in the operation.Including mastoid,epitympanum,tympanic antrum,ossicular chain and tympanic mucosa disease.Results All 101 cases who underwent surgery for chronic otitis media had perforation of tympanic membrane in pars tensa.In these cases,39 cases with no soft tissue mass image in preoperative CT images underwent tympanoplasty,62 patients who had the whole and part density mass image in mastoid cavity and antrum underwent tympanoplasty(45 cases) and mastoidectomy(17 cases) respectively.Compared with findings in the operation,CT provided limited information in detecting ossicular chain and tympanic mucosa disease.Dry ear rate was 93.06% at 3 months after operation.Conclusion Preoperative CT have limitation in detecting ossicular chain and tympanic mucosa disease.The choices of surgery method should based on CT images and clinical manifestation.For some patients with chronic suppurative otitis media,the high-resolution CT with 3D reconstruction technique processing is needed in order to display complicated anatomy and pathological changes of ossicular chain.