Objective To investigate the mechanism of fluoroquinolone resistance in clinical isolates of Enterococcus faecium. Methods The MICs of six fluoroquinolones(norfloxacin,ciprofloxacin,ofloxacin,levofloxacin,gatifloxacin and moxifloxacin) against 35 clinical isolates of E.faecium from eight hospitals in Tianjin were determined by agar dilution method in the absence or presence of multidrug resistance efflux pump inhibitor reserpine.The quinolone-resistance determining region(QRDR)of parC and gyrA were amplified and sequenced.Results No less than twofold decrease in MIC values of the six fluoroquinolones in the presence of reserpine was observed in 35,29,1,0,6 and 2 of the 35 strains of E.faecium respectively.One fluoro- quinolone-susceptible isolate and five fluoroquinolone-resistant isolates were selected randomly to analyze the QRDR of parC and gyrA.All five fluoroquinolone-resistant isolates had single amino acid alteration in both GyrA and ParC.Ser-80 in ParC was substituted by lie(4 isolates)or Arg(1 isolates).Glu-87 in GyrA was replaced by Lys(2 isolates)or Gly(2 isolates). The other one had an Ser-83-to-Ile substitution.The one fluoroquinolone-suseeptible isolate had no alteration in the QRDR of either ParC or GyrA.Conclusions Both target alteration and active efflux are responsible for the resistance to fluoroquinolone in clinical isolates of E.faecium.

Objective To investigate the safety and efficacy of retroperitoneal laparoscopy for adrenal tumor and report the experience with this procedure for adrenal surgery.Methods From June 2003 to March 2007,we performed 24 laparoscopic tumorectomy via the retroperitoneal approach.Results All procedures were successful. The average operative time was 1.7 hours(ranging from 1 to 3.5 hours).All patients had no need of transfusion and no complication.All patients recovered.The average hospital stay was 4.5 days(ranging from 3 to 8 days).Patholog- ic diagnosis:10 cases of nonfunctional adenoma,6 cases of primary aldosteronism,4 cases of adrenal cyst,2 cases of pheochromocytoma,2 cases of Cushing's adenoma.Conclusions Retroperitoneal laparoscopic surgery for adrenal oc- cupying lesion had such advantages as minimal invasive,safe and effective,early recovery and shorter stay in hospital. It should be the flint choice of treatment for adrenal occupying lesion.

Objective To explore the effects of overexpression of hypoxia inducible factor 1? (HIF 1?) mRNA on vascular endothelial growth factor (VEGF) and novoendotheliasis in venous autografts Methods Wistar rats were randomly divided into two groups with 28 rats in each group A rat experimental model of autogenous vein graft was established by transplanting the right external jugular vein into between the interrupted right common carotid artery The transplanted vein in the experimental group was first immersed into a solution containing recombinant adeno associated virus (rAAV) HIF 1? for 45 minutes Vein grafts and blood simples were taken at 7 or 14 days after transplantation RT PCR, ELISA, immunohistochemistry were used to detected HIF 1? mRNA and VEGF expression Results HIF 1? mRNA and VEGF protein remarkably increased in experimental group, and serum level of E selectin significantly decraesed at day 14 The novoendotheliasis and myo endothelium junction in vein grafts were remodeled at day 14 in the experimental group Conclusion Re establishment of the structure and function of the autograft vein graft endothelium was accelerated by overexpressed HIF 1? mRNA

OBJECTIVETo improve the outcome of the face-lift with a craniofacial contouring procedure.

METHODSThirty-seven patients aged 29-53 years (31 in female, 6 in male) were treated through a bicoronal incision. The facial tissue was lifted through a subperiosteal procedure and the facial skeleton was remodeled in three dimensions by osteotomies.

RESULTSThe results were satisfactory after the 3-12 months of the follow-ups.

CONCLUSIONSThe Face-lift combined with the facial aesthetic sculpturing may be more effective for the aging-face rejuvenating.

Adult ; Esthetics ; Female ; Humans ; Male ; Middle Aged ; Rhytidoplasty ; methods

OBJECTIVETo study the color reappearance effect of metal-ceram restoration and foundry-ceram restoration using Crystaleye spectrophotometer.

METHODS58 metal-ceram restorations and 58 foundry-ceram restorations according to the result of the Crystaleye spectrophotometer were made respectively. The deltaE between restorations and natural teeth as referenced were analyzed. And satisfaction of dentists and patients were evaluated.

RESULTSThe deltaE between metal-ceram restorations and natural teeth was 7.13 +/- 0.74. The deltaE between foundry-ceram restorations and teeth was 1.47 +/- 0.84. There were statistical differences between the deltaE (P < 0.01). The satisnatural faction of dentists and patients to the foundry-ceram restorations were higher than to the metal-ceram restorations (P < 0.05).

CONCLUSIONCrystaleye spectrophotometer can provide accurate reference for foundry-ceram restoration, but for metal-ceram restoration it is not accurate.

Color ; Humans ; Metals ; Spectrophotometry ; Tooth

OBJECTIVETo bring forward a method to improve the prominence of the forehead contour.

METHODS16 patients(age 29-53 years, female 11, male 5) were treated through a bicoronal incision. Following the incision, the forehead soft tissues are reflected down to the level of the superior orbital rims with the protection to the supraorbital neurovascular bundles. To adjust the forehead contour, both superior orbital rims and frontal bossing was reduced by burring down the excess bone or removing the anterior wall of the forehead.

RESULTSThe operative effect were satisfactory during 3-12 months of follow-up. No recurrence or osteogenesis were found in the cases. Nasofrontal angle and forehead angle were normal. The prominence of the supraorbital ridges disappeared and forehead became nature.

CONCLUSIONCranioplasty via an osteomy or burring of the outer line of forehead bone are safe, compact and effective way to improve the prominence of the superior orbital rims or frontal bossing.

Adult ; Female ; Forehead ; surgery ; Humans ; Male ; Middle Aged ; Reconstructive Surgical Procedures ; methods

Objective To explove the replantation and repairing methods of specified tissues and or- gans.Methods Seven cases of amputated external ear,2 cases of avulsed penis and testicle,1 amputated tongue and 1 amputated nose had been treated by microsurgery replantation,temporary ectopic implantation, and reconstruction by flap transfer.Results Those success in 5 cases of external ear replantation,2 earflap reconstruction with flap,and 2 replantation of penis and testicle,while failure in 1 case of external ear tempo- rary ectopic implantation,1 replantation of tongue and 1 nose.Conclusion For amputated special tissues and organs,shape and function of amputated tissues and organs can be well reestablished by microsurgery re- plantation.Skilled technique of microvascular anastomosis and satisfactory braking are most important to suc- cess.

OBJECTIVETo investigate the compatibility of a modified prescription of Simiao Pill in the treatment of acute gouty arthritis and to verify the clinical efficacy and safety of the drug through a clinical trial.

METHODSA randomized and controlled clinical trial was designed based on clinical epidemiological principles. A total of 107 patients with acute gouty arthritis were enrolled and randomly assigned to four groups. The first group (Group I) included 27 patients taking gout prescription I; the second group (Group II) included 27 patients taking gout prescription II; the third group (Group III) included 28 patients taking gout prescription III; and the fourth group (control group) included 25 patients taking indomethacin and Benzobromarone as a control group. The duration of the treatment in all 4 groups was two weeks. After the treatment, the index of blood uric acid, blood leukocyte count, score of clinical symptoms, etc. were observed and measured.

RESULTSThe total clinical effective rate of the three different modified prescriptions of the Simiao Pill was above 96%, significantly superior to that of the control group (68%, P<0.05). In terms of the improvement of main symptoms, the scores of four symptoms in all TCM treatment and control groups decreased after treatment, with statistically significant differences (P<0.05). Moreover, the scores markedly fell more so in the three Chinese herb groups than in the control group, and especially in Group III (P<0.05). There was a statistically significant difference in blood uric acid values before and after the treatment in the same group but no significant inter-group difference was seen.

CONCLUSIONThe modified prescriptions, based on the clinical research, clinical experience and traditional Chinese medicine theory, did show a better effect than Western medicine in this clinical study. Moreover, the prescriptions were precise, with the herbs inexpensive and readily available. The patients had good compliance with less adverse reactions noted. The modified prescription has a favorable prospect for future development and is worthy of further blind trials with larger samples.

Acute Disease ; Adult ; Aged ; Arthritis, Gouty ; drug therapy ; Drugs, Chinese Herbal ; adverse effects ; therapeutic use ; Female ; Humans ; Male ; Medicine, Chinese Traditional ; Middle Aged ; Uric Acid ; blood

OBJECTIVEThis study aimed to explore the scene-trait coping style of military rescuers in Wenchuan earthquake in an effort to provide scientific evidences for mental intervention program for Chinese military personnel.

METHODSBy cluster sampling, a total of 151 military rescuers and 331 control servicemen were administered the military personnel scene-trait coping style scale (MPSTCSS).

RESULTSAll active coping factor scores, and passive coping factor scores of affection, health and economy in the rescuer group were significantly higher than those in control group (P < 0.05). The 21-above age subgroup, the 3-year plus service subgroup, and the officer subgroup had significantly higher active coping factor scores on military tasks, military experience and personal development than those of the 21-below age subgroup, 3-year minus service subgroup and the soldier subgroup, respectively (P < 0.05 or P < 0.01).

CONCLUSIONThe earthquake relief servicemen can cope with stressful situations better than control group by taking active coping style. The officers, servicemen older than 21 years, and servicemen with more service duration than 3 years could usually take active coping style.

Adaptation, Psychological ; Disasters ; Earthquakes ; Humans ; Military Personnel ; psychology ; Stress, Psychological

BACKGROUNDIn recent years, transfer of the spinal accessory nerve to suprascapular nerve has become a routine procedure for restoration of shoulder abduction. However, the operation via the traditional supraclavicular anterior approach often leads to partial denervation of the trapezius muscle. The purpose of the study was to introduce transfer of the spinal accessory nerve through dorsal approach, using distal branch of the spinal accessory nerve, to repair the suprascapular nerve for restoration of shoulder abduction, and to observe its therapeutic effect.

METHODSFrom January to October 2003, a total of 11 patients with a brachial plexus injury and an intact or nearly intact spinal accessory nerve were treated by transferring the spinal accessory nerve to the suprascapular nerve through dorsal approach. The patients were followed up for 18 to 26 months [mean (23.5 +/- 5.2) months] to evaluate their shoulder abduction and function of the trapezius muscle. The outcomes were compared with those of 26 patients treated with traditional anterior approach. And the data were analyzed by Student's t test using SPSS 10.5.

RESULTSIn the 11 patients, the spinal accessory nerves were transferred to the suprascapular nerve through the dorsal approach successfully. Intact function of the upper trapezius was achieved in all of them. In the patients, the location of the two nerves was relatively stable at the level of superior margin of the scapula, the mean distance between them was (4.2 +/- 1.4) cm, both the nerves could be easily dissected and end-to-end anastomosed without any tension. During the follow-up, the first electrophysiological sign of recovery of the infraspinatus appeared at (6.8 +/- 2.7) months and the first sign of restoration of the shoulder abduction at (7.6 +/- 2.9) months after the operation, which were earlier than that after the traditional operation [(8.7 +/- 2.4) months and (9.9 +/- 2.8) months, respectively; P < 0.05]. The postoperative shoulder abduction was 62.8 degrees +/- 12.6 degrees after transfer of the spinal accessory nerve, better than that after the traditional (51.6 degrees +/- 15.7 degrees). All the 11 patients could extend and externally rotate the shoulder almost normally.

CONCLUSIONSThe accessory nerve transfer through dorsal approach is a safe and reliable procedure for the treatment of brachial plexus injury. Its postoperative effect is confirmed, which is better than that of the traditional operation.

Accessory Nerve ; surgery ; Adolescent ; Adult ; Brachial Plexus ; injuries ; Humans ; Male ; Nerve Transfer ; methods ; Shoulder Joint ; innervation ; physiology