OBJECTIVE To investigate the resistance of Pseudomonas aeruginosa strains to 5 ?-lactams.METHODS Susceptibility of 218 P.aeruginosa strains isolated from Anhui Province in 2005 to ceftriaxone,cefotaxime,ceftazidime,aztreonam,and piperacillin were tested by agar dilution method.RESULTS The resistance rate to ceftriaxone,cefotaxime,aztreonam,piperacillin,and ceftazidime were 59.2%,57.3%, 56.0%,51.8%,and 39.0%,respectively.There was statistically significant difference between ceftazidime and other 4 ?-lactams(P0.05).CONCLUSIONS Ceftazidime is the most susceptible antibiotic to P.aeruginosa strains among 5 ?-lactams tested.

Objective To investigate the effects of long proximal femoral nail antirotation (PFNA-long) in treating long-segment fracture in middle-up part of femoral. Methods From June 2006 to December 2013, we treated 139 cases long-segment fracture in middle-up part of femoral with long proximal femoral nail antirotation (PFNA, 320-380 mm) by minimally invasive per-cutaneous fixation and autogenous iliac bone graft. Data of 139 patients (104 male and female 35;ages 18 to 86 years, with an aver-age age of 48.8 years). Type IA 58 cases (41.73%, 58/139), type IB 25 cases (17.99%, 25/139), type IC 4 cases (2.88%, 4/139), type II 28 cases (20.14%, 28/139), type IIIA 12 cases (8.63%, 12/139), type IIIB in 5 cases (3.60%, 5/139), type IV 7 cases (5.04%, 7/139). The duration from injury to surgery was 3 hours to 12 days, with an average of 4.2 days. The postoperative follow-up was at 1, 2, 3, 6, 9, 12 months, and annually at least. The clinical efficacy was evaluated with Harris hip function score. The postoperative pain was evaluated with visual analogue scale (VAS). Results The operative time of 139 cases was from 35 to 90 minutes, averaged 45 minutes and the blood loss during surgery averaged 78.6 ml (ranged from 30 to 200 ml). All patients walked by walking aid appliance after 4 to 10 days postoperatively, apart from 16 cases with serious long grinding fracture. All patients had been followed up for 3 to 37 months (mean 19 months). No complications, such as infection, lower limb vein infarction, cut-out and breakage of the implants, occurred. However, there were 4 patients with nail broken and 6 patients with hip internal rotation who were treated by secondary operation. There were 5 cases with slight hip external rotation and 8 cases with hip internal reverse-lamb shortening malformation. All fractures healed after 2.8-6.8 months (mean 3.9 months). According to Harris criteria, the clini-cal results were best in 108 cases, better in 22 cases, good in 8 cases, and bad in 1 case. The excellent and good rate was 93.53%(130/139). The score for VAS was 0-6 (mean 0.8), 93 cases in which no pain, mild pain in 33 cases, moderate pain in 13 cases, 25 cases occasionally need to take non-steroidal analgesics. Conclusion Closed reduction or limited open reduction with PFNA-long is an effective treatment for long-segment fracture in middle-up part of femoral, with higher strength in fixation, higher rate of fracture union, early functional recovery and lower rate of complications.

ObjectiveTo assess the characteristics of left ventrlcular ( LV) systolic syncnrony before and 6 days after percutaneous transluminal septal myocardial ablation(PTSMA)in patients with hypertrophic obstructive cardiomyopathy (HOCM) using two dimensional speckle tracking imaging(2DSTI),and to investigate correlation between the LV systolic synchrony and LV outflow-trace gradient (LVOTG).MethodsLVOTG were measured before and 6 days after PTSMA in 21 patients with HOCM.The two dimensional loop-cinec were obtained in three levels of the short axis views of LV (mitral valve,papillary muscle and cardiac apex).The time from the onset of QRS complexes to systolic peak strain from the radial vectors (TRs) was recorded using 2D-STI.The standard deviation of the TRS of 18 segments (TRsSD) were calculated as indicator of LV systolic synchrony.Results Six days after PTSMA,LVOTG decreased significantly from (84.3 ± 19.1)mm Hg to (40.6 ± 8.3)mm Hg( P ＜0.01).TRS of the base and middle segments of anteroseptal were prolonged dramatically( P ＜0.05) 6 days after PTSMA compared with that before.There were no significantly differences in TRs-SD of LV between before and 6 days after PTSMA ( t =1.03,P ＞ 0.05).Decreased LVOTG correlated moderately to prolonged TRS of the base segments of anteroseptal ( r =0.657,P ＜0.05).Conclusions2D-STI can detect exactly the characteristics of LV systolic synchrony before and 6 days after PTSMA in patients with HOCM.

Objective To evaluate the application value of real-time three-dimensional echocardiography (RT-3D TEE) in nonvalvular atrial fibrillation patients after transcatheter left atrial appendage closure (LAAC) with the Amplatzer Cardiac Plug (ACP).Methods The two-dimensional transesophageal echocardiography (2D TEE) and RT-3D TEE were performed in selected patients to measure the diameter of left atrial appendage ostium and landing zone,to observe left atrial appendage morphology and lobular distribution.These were also performed to guide the whole process of transcatheter LAAC with ACP,which included the atrial septal puncture,sheathing canal cruise,occluder device implantation,and verifying the stability of occluder device and releasing the device.It involved observing ACP occluder morphology,location,stability,surrounding residual shunt,whether influencing the mitral valve and left superior pulmonary vein flow,and pericardial effusion.Results A total of 15 patients (100％) successfully underwent LAAC with the ACP.The maximum diameter of left atrial appendage ostium by 2D-TEE measurement during operation was (20.5 ± 2.9)mm,located at 135°.The diameter of left atrial appendage landing zone was (17.1 ± 2.8) mm,located at 45°;(18.0 ± 4.0) mm,located at 90°;(22.1 ± 4.7)mm,located at 135°,respectively.The left atrial appendage morphology:2 had one leaf and 13 had two leaves or more,including 2 cases of bifoliate short neck shape.In 15 patients,6 cases of cauliflower type,2 cases of wind sock type,3 cases of chicken wing type,2 cases of cactus type and 2 cases of complex type.The proximal left atrial appendage morphology:3 cases of boot type,2 cases of wide mouth type,6 cases of narrow mouth type,2 cases of straight tube type,and 2 cases of bifoliate short neck type.There was no obvious residual shunt in all the patients at immediately post-operation.Conclusions In the transcatheter LAAC with the ACP,RT-3D TEE has important application value in the preoperative selection of patients,the choice of appropriate occluder,guidance of full-process monitoring during operation,the postoperative effect evaluation and so on.

Objective To compare the clinical effects of conventional incision versus oblique mini-incision in the treatment of displaced midshaft clavicular fractures. Methods A prospective randomized controlled trial was performed between August 2014 and August 2016 in 79 patients with acute displaced midshaft clavicular fracture. They were randomly divided into 2 groups to receive either conventional incision or oblique mini-incision treatment. In the oblique mini-incision group, there were 37 cases, 20 males and 17 females, with an average age of 37.4 ± 13.2 years. By the Robinson fracture classification, there were 9 cases of type 2A2, 16 ones of type 2B1, and 12 ones of type 2B2. In the conventional incision group, there were 42 cases, 22 males and 20 females, with an average age of 38.2 ± 14.5 years. By the Robinson fracture classification, there were 9 cases of type 2A2, 19 ones of type 2B1, and 14 ones of type 2B2. We recorded operation time, intraoperative blood loss, scar size, clinical complications and fracture healing time. Functional assessments were conducted at l2 months using the Disabilities of the Arm, Shoulder and Hand (DASH) and Constant-Murley scores, and a questionnaire on numbness, scar appearance and satis-faction. Results Only 58 patients finished a complete follow-up. The preoperative general data showed no statistical significance between the 2 groups (P > 0.05). All the 58 patients were followed up for 13 to 24 months (average, 15.3 months). There were no significant differences between the 2 groups in operation time, fracture healing time, the DASH or Constant-Murley score, or clinical complications (P> 0.05). However, the intraoperative blood loss in the oblique mini-incision group (20.8 ± 10.7 mL) was significantly less than that in the conventional incision group (41.6 ± 7.6 mL), the scar size in the former (3.6 ± 1.6 cm) significantly shorter than that in the latter (10.3 ± 2.6 cm), and the rate of symptoms of residual injury to the supra-clavicular nerve in the former (10.7%, 3/28) significantly lower than that in the latter (43.3%, 13/30) (P <0.05). Moreover, the oblique mini-incision group was significantly better than the conventional incision group in numbness on the shoulder or anterior chest, scar appearance and satisfaction. Conclusions The oblique mini-incision may be advantageous over the conventional incision in intraoperative blood loss, scar size and appearance, iatrogenic supraclavicular nerve damage and satisfaction. However, the 2 incisions may lead to similar functional recovery of the shoulder.

Objective: To explore the mechanism of miR-103 targeting PTEN (gene of phosphate and tension homology deleted on chromsome ten) and activating PI3K/AKT signaling pathway to promote dasatinib (DASA) resistance in lung cancer cells. Methods: DASA-resistant tissues and non-resistant tissues (35 samples for each) from patients treated in Department of Thoracic Surgery, the First Affiliated Hospital of Kunming Medical University from April 2014 to January 2018 were collected for this study. Expression of miR-103 was detected in DASA-resistant tissues and cell lines of lung cancer by quantitative Real-time polymerase chain reaction (qPCR). The effect of miR-103 knock-down on the proliferation, invasion and epithelial mesenchymal transition (EMT) ofA549/DASA cells were measured by CCK-8 assay, Transwell and Wb, respectively. Subsequently, the dual luciferase reporter gene assay was used to verify whether PTEN was a target gene of miR-103. CCK-8, Transwell and Wb assay were further used to investigate the effect of miR103 on malignant biological behaviors of A549/DASA cells via regulating PTEN-PI3K/AKT signaling pathway. Results: miR-103 was highly expressed in DASA-resistant tissues andA549/DASAcells (P<0.01). Knockdown of miR-103 significantly inhibited the proliferation, invasion and EMT ofA549/DASAcells (P<0.05 or P<0.01).Additionally, dual luciferase reporter gene assay confirmed that miR103 directly targeted PTEN and down-regulated its expression (P<0.01). Mechanistically, over-expression of miR-103 targeted and down-regulated PTEN to promote cell viability, invasion and EMT via activating PI3K/AKT pathway (P<0.05 or P<0.01), and further up-regulated the DASA-resistance inA549/DASAcells. Conclusion: miR-103/PTEN/PI3K/AKT signaling pathway plays a certain role in regulating DASA resistance of lung cancer, and knockdown of miR-103 expression may reverse the resistance of A549/DASA cells to DASA.