OBJECTIVE To investigate the pathogens of HAP and their drug resistance in our hospital,the impact of duration of hospitalization on etiology,and the risk factors for the resistant pathogens.METHODS The respiratory tract secretion was collected from HAP patients to culture and analyze the susceptibility of antimicrobials,compare the etiology of early-onset and late-onset HAP including prior antibiotics exposure and severity of HAP to drug resistant bacteria.RESULTS During the period of study,there were 1.04% of patients suffering from HAP.Early-onset HAP was commonly caused by G+ cocci while the main agents of late-onset HAP were G-bacilli.Most of the HAP pathogens were resistant to the antimicrobials commonly used in clinic with the prior antimicrobials exposure and the severe HAP increased the resistant bacteria rate(P

Objective To evaluate the clinical characteristics and surgical risks for elderly patients with gastric cancer. Methods The clinical data from 607 patients, who received surgical therapy for gastric cancer between January 2006 and December 2009, were retrospectively analyzed.Among them, 267 patients were over 65 years of age, and the other 340 patients (≤65 years of age)were served as control. Complete surgical resection was done by doctors in same group. The preoperative complications such as cardiopulmonary disease and post-operative complications as well as pathologic patterns were compared between two groups. Results Coexisted diseases were found more in elderly patients than in controls (68.91% vs 31.63 %, P＜0.01). Whereas there was no significant difference between two groups with respect to post-operative complication [28. 19% (75/267)vs 25.59 % (87/340)]. However, the incidence of cardiopulmonary complications, especially pulmonary infection, was higher in elderly patients than in controls (17.23% vs 5.29% ,P＜0.01). The digestive tract complications were related to the pattern of radical operation. Post-operative complication occurred less in patients treated with D1 radical operation than those with D2 and D3 radical operation.Conclusions The incidence of post-operative complication in elderly patients with gastric cancer was closely related to the surgical method. The elderly patients may has less complications if they were operated with D1 radical method which can reduce risk of complication and improve the quality of life.

Objective To explore the relationship between K-ras gene and cholangiocarcinoma by detecting the K-ras gene mutation of bile duct tissues.Method We studied all the patients who presented to our hospital from June 2010 to June 2012 with stenosis of the bile duct.There were 17 cases of cholangiocarcinoma and 17 cases of benign stenosis.From the DNA extracted from the paraffin tissues,we used the HRM assay for K-ras gene mutation.Result We found that the HRM method and the DNA typing had exactly the same result for the DNA content which confirmed the effectiveness of the HRM assay.Of note,the K-ras mutation rate was found to be significantly higher in the cholangiocarcinoma cases (11/17) when compared with the benign cases (3/17).Conclusion The mutation of the K-ras gene was closely related to cholangiocarcinoma.Our results suggest a new way to diagnosis cholangiocarcinoma.

Objective:To compare the bone dimensional changes following tooth extraction alone with extraction plus ridge preservation ( using deproteinized boving bone mineral Bio-Oss? and bioresorbable collagen mambrane Bio-Gide?) in periodontal compromised extraction sockets .Methods: Eighteen molars of sixteen subjects requiring tooth extraction because of periodontal destruction were enrolled in this study .The subjects were assigned to the control group ( extraction alone , EXT) or to the test group ( ridge-preservation procedure with Bio-Oss? and Bio-Gide?, RP) .Parallel periapical X-rays and cone-beam computed tomography ( CBCT ) scans were taken immediately after tooth extraction alone or plus ridge-preservation ( baseline ) and 6 months later .The changes of horizontal ridge width and vertical ridge height were assessed .Results:At the central buccal aspect , the ridge height increased 2 .9 mm in RP group, and reduced 1.0 mm in EXT group.At the distal buccal aspect , the ridge height increased 1.45 mm in RP group, and reduced 1.45 mm in EXT group.The differences between the groups reached statistical significance (P<0.05).The mean ridge width increased at the 1 mm below the crest (the horizontal ridge width was measured with grafting material at three levels at 1 mm below the most coronal aspect of the crest,HW1), which amounted to 3.40 to 5.80 mm in RP group, and 1.45 to 2.90 mm in EXT group.The mean ridge increased at the 4 mm below the crest ( the horizontal ridge width was measured with grafting material at three levels at 4 mm below the most coronal aspect of the crest ,HW4 ) , which amounted to 0.40 to 3.50 mm in RP group, and reduced 0.10 to increased 0.15 mm in EXT group.The test group and the control group were not significantly different (P>0.05).Conclusion:The ridge-preservation approach using Bio-Oss? in combination with Bio-Gide? can significantly increase vertical ridge height and horizontal ridge width after tooth extraction compared with extraction alone in periodontal compromised molars .

Objective To compare the purification process of two types of ceramic hydroxyapatite(CHT I and CHT II)to remove the aggregates from two monoclonal antibodies(mAb 1 and mAb 2).Methods All the chromatography runs were performed on AKTA AVANT 150 with Tricon 10/50 column.The dynamic binding capacity( DBC) of two types of CHT was studied firstly, and then purification research was carried out selecting the suitable DBC.The column was equilibrated with 5 mmol/L sodium dihydrogen phosphate pH 6.5, and then was eluted with gradient buffers which were 10 mmol/L sodium dihydrogen phosphate pH 6.5 and 2 mol/L sodium chloride pH 6.5.Aggregate content in loading and elution pool was evaluated by size exclusion chromatography.Scale-up process was carried on 20 cm height chromatography column XK16/40.Results DBC of CHT I for mAb 1 was 40 mg/mL and mAb 2 was 45 mg/mL.After purity, monomer content of mAb 1 reached 98.6% and yield was 92.5% and monomer content of mAb 2 reached 98.8%and yield was 91.5%.DBC of CHT II for mAb1 was 16 mg/mL and mAb 2 was 20 mg/mL.After purity, monomer content of mAb 1 reached 99.8% and yield was 91.8% and monomer content of mAb 2 reached 99.9% and yield was 92.2%.Conclusion Two types of CHT both can remove aggregates effectively from monoclonal antibodies when aggregate content reaches more than 10%, and results conform to the regulations.CHT I has higher dynamic binding capacity than CHT II, and CHT II is superior to CHT I in removing aggregate efficiency.The purification process is simple and can be easily scaled up in pilot and manufacture.Therefore, it meets the requirement pilot and scale production.

Objective:To evaluate bone formation in human extraction sockets with absorbed surrounding walls augmented with Bio-Oss(R) and Bio-Gide(R) after a 6-month healing period by histologic and histomorphometric analyses.Methods:Six fresh molar tooth extraction sockets in 6 patients who required periodontally compromised moral tooth extraction were included in this study.The six fresh extraction sockets were grafted with Bio-Oss(R) particle covered with Bio-Gide(R).The 2.8 mm × 6.0 mm cylindric bone specimens were taken from the graft sites with aid of stent 6 months after the surgery.Histologic and histomorphometric analyses were performed.Results:The histological results showed Bio-0ss(R) particles were easily distinguished from the newly formed bone,small amounts of new bone were formed among the Bio-Oss(R) particles,large amounts of connective tissue were found.Intimate contact between the newly formed bone and the small part of Bio-Oss(R) particles was present.All the biopsy cylinders measurement demonstrated a high inter-individual variability in the percentage of the bone,connective tissues and BioOss(R) particles.The new bone occupied 11.54％ (0-28.40％) of the total area;the connective tissues were 53.42％ (34.08％-74.59％) and the Bio-Oss(R) particles were 35.04％ (13.92％-50.87％).The percentage of the particles,which were in contact with bone tissues,amounted to 20.13％ (0-48.50％).Conclusion:Sites grafted with Bio-Oss(R) particles covered with Bio-Gide(R) were comprised of connective tissues and small amounts of newly formed bone surrounding the graft particles.

Objective:To investigate the changes of the vertical height and width of the alveolar bone six months after the alveolar ridge preservation in periodontal compromised molar sites of severe alveolar bone defects with clinical direct measurement,parallel periapical radiographs,and cone-beam computed tomography (CBCT),and to analyze the effect of the three different methods of measurement.Methods:In this study,20 subjects requiring tooth extraction on account of periodontal disease with a total of 23 ex-tracted molars were enrolled.Extractions were performed atraumatically and patients were received alveo-lar ridge preservation procedure with Bio-Ossand Bio-Gide.Clinical direct measurements were taken after tooth extraction and during the implant surgery 6 months later,CBCT scans and parallel periapical radiographs were taken immediately after ridge preservation and 6 months later.The changes of alveolar ridge width and vertical height after six months were measured and analyzed through the above-mentioned three methods and the similarities and differences of the measured effect were compared.Results:There were no significant difference of alveolar vertical height in the center of the extraction sites,the center of distal aspect,and distobuccal aspect between the clinical direct measurements and the CBCT measure-ments (P>0.05),alveolar vertical height in other points and alveolar width measurements were statical-ly significant (P<0.05).After 6 months,1 0 sites of 1 0 subjects were received a flap and re-entered to perform dental implants surgery.The vertical height in the center of alveolar increased significantly and the changes of alveolar vertical height of clinical direct and CBCT measurement were (6.1 5 ±1 .73)mm and (6.59 ±2.53)mm,respectively.The measurements of the width of the alveolar bone were (8.45 ± 1 .1 8)mm and (8.52 ±1 .27)mm,respectively.The measurements of the two methods were not statisti-
cally significant (P>0.05).The change of the alveolar height in the center of the extraction socket after six months measured by parallel periapical was (5.84 ±4.28)mm,which was closed to the clinical di-rect measurement and the CBCT measurement.Conclusion:Clinical direct measurement and CBCT measurement were largely consistent in the evaluation of the alveolar bone height and width after the alveolar ridge preservation using deproteinized boving bone mineral (DBBM,Bio-Oss)and bioabsor-bable collagen membrane (Bio-Gide)in periodontal compromised molar sites of severe bone defects.

Objective To evaluate the efficacy of locally administered dexamethasone for prevention of low back pain after labor epidural analgesia.Methods Two hundred nulliparous parturients who required labor epidural analgesia,of ASA physical status Ⅰ or Ⅱ,were randomly divided into 2 groups (n =100 each) using a random number table:control group (group C) and dexamethasone group (group D)).In group D,lidocaine 4 ml and dexamethasone 1 ml (5 mg) were injected around the puncture site.In group C,lidocaine 4 ml and normal saline 1 ml were injected around the puncture site.Epidural puncture was performed after local administration.According to the results of epidural puncture,each group was further divided into two subgroups:single puncture group (Cs subgroup,Ds subgroup) and repetitive puncture group (Cr subgroup,Dr subgroup).The patients were followed up for 72 h,and the development of low back pain was recorded.Results Compared to group C,the incidence of low back pain was significantly decreased,and pain was reduced in group D.The incidence of low back pain was significantly lower in Ds group than in Cs group,and in Dr group than in Cr group.Conclusion Locally administered dexamethasone 5 mg is helpful in reducing low back pain after labor epidural anesthesia.

Objective To observe the anti-tumor effect on human multiple myeloma cell lines U266 and KM3 with a combination of varinostat and melphalan in vitro.Methods The cell proliferation of U266 and KM3 was datected with MTT assay when treated them with vorinostat alone and melphalan alone,then calculate their IC50 values respectively.Fixed the concentrations of vorinostator melphalan,the cell proliferation was datected in combination with melphalan/vorinostat in seriesly concentrations by MTr assay.Then to calculate drug combination index(CI).Results The IC50 value of U266 was 5.0-7.5 μmol/L and that of KM3 was 2.5-5.0 μmol/L when treated by vorinostat alone,the IC50 value of U266 was 40-60 μmol/L and that of KM3 was 60-80 μmol/L treated by melphalan alone.When fixed the concentration of vorinostat(in U266 the concentration was 1.25 μmol/L,in KM3 the concentration was 1.0 μ mol/L),Synergism(CI＜0.9)was observed when the concentrations of melphalan were 20 μmol/L,40 μmol/L,60 μ mol/L and 80 μ mol/L in U266,40 μmol/L,60 μmol/L,80 μmol/L and 100 μmol/L in KM3;When fixed the concertration of melphalan (in U266,was 10 μmol/L,in KM3 was 20 μmol/L),synergism(CI＜0.9)was observed when the concentrations of vorinostat were 1.0 μmol/L,2.5 μmol/L,5.0 μmol/L and 7.5 μmol/L in U266,and 1.0 μmol/L,2.5μmol/L,5.0 μmol/L in KM3.An additive effect was observed with the czombination of vorinostat 7.5 μmol/L plus melphalan 20 μmol/L in KM3(CI=0.93).Conclusion Vorinostat had potential anti-myeloma effect alone,and had synergistic anti-tumor effect with melphalan in vitro.

Objective To investigate the value of timely duodenal papilla fenestration for reducing the incidence of pancreatitis after endoscopic retrograde cholangiopancreatography (ERCP).Methods The clinical data of 181 patients with difficult biliary cannulatian during ERCP at the Xinhua Hospital of Shanghai Jiaotong University from July 2006 to December 2009 were retrospectively analyzed.Of the 181 patients,98 patients who received traditional incubation were in the control group,and the other 83 patients who received early duodenal papilla fenestration were in the test group.The success rate of selective incubation and incidence of pancreatitis were compared between the 2 groups.All data were analyzed using the t test,chi-square test or Wilcoxon rank sum test.Results The success rate of incubation,incidences of hyperamylasemia and pancreatitis were 85.7％ ( 84/98 ),7.1％ (7/98) and 10.2％ ( 10/98 ) in the control group,and 94.0％ ( 78/83 ),18.1％ ( 15/83 ) and 2.4％ (2/83) in the test group,respectively,and there were significant differences between the 2 groups (x2 =10.12,5.03,4.41,P＜0.05).The numbers of patients with mild,moderate and severe pancreatitis were 3,5 and 2 in the control group,and 1,1,0 in the test group,respectively,and there was a significant difference between the 2 groups ( Z =- 2.11,P ＜ 0.05 ).Conclusion Timely duodenal papilla fenestration is safe and effective in reducing the incidence of pancreatitis for patients with difficult biliary cannulation during ERCP.