Objective To investigate the detection of monocyte chemotactic protein 1 (MCP-1),macrophage stimulating protein (MSP) and carcinoembryonic antigen (CEA) in differential diagnosis of pulmonary tuberculosis and lung cancer.Methods Thirty four patients with pulmonary tuberculosis,45 patients with pathologically confirmed lung cancer admitted in Quzhou People' s Hospital during December 2009 and December 2011,and 30 healthy controls were enrolled in the study.MCP-1 and MSP in serum and pleural effusion were determined by enzyme linked immunosorbent assay (ELISA),and CEA was detected by chemiluminescence method.Receiver operating characteristic method was used to determine the cut-off values of MCP-1,MSP and CEA in diagnosis of pulmonary tuberculosis or lung cancer.Results Serum MCP-1,MSP and CEA levels in pulmonary tuberculosis patients and lung cancer patients were higher than those in healthy controls.Compared with lung cancer patients,patients with pulmonary tuberculosis had higher serum MCP-1 and lower CEA levels (t =2.69 and 0.89,P ＜ 0.05),but there was no significant difference in serum MSP levels between two groups (t =2.89,P ＞ 0.05).While in pleural effusion,patients with pulmonary tuberculosis had higher MCP-1 level (t =3.54,P ＜ 0.05),lower MSP and CEA levels than those with lung cancer (t =3.47 and 3.48,P ＜ 0.05).Serum MCP-1 level was of the highest specificity (95.6％) with the cut-off value of 240 pg/mL in diagnosis of pulmonary tuberculosis,while MSP level in pleural effusion was of the highest specificity (94.1％) with the cut-off value of 1100 pg/mL in diagnosis of lung cancer.Conclusion Detection of MCP-1,MSP and CEA in serum and pleural effusion can be used for the differential diagnosis of pulmonary tuberculosis and lung cancer.

Objective To determine the distribution and drug resistance of pathogens isolated from wounds in orthopedic patients.Methods Wound samples were collected from 999 orthopedic patients in the Third Hospital of Hebei Medical University during July 2010 and June 2012.Pathogens were isolated and identified.The antimicrobial susceptibility test was performed by Kirby-Bauer method.Extended spectrum β-1actamases (ESBLs) were detected by double-disk diffusion test,and methicillin-resistant Staphylococcus aureus (MRSA) was detected by cefoxitin disk diffusion test.WHONET 5.4 was used for drug resistance analysis.Results A total of 1056 strains of pathogens were isolated,of which gram-positive cocci,gramnegative organisms and fungi accounted for 69.98％ (739/1056),28.79％ (304/1056),and 1.23％(13/1056),respectively.The top 5 pathogens were Staphylococcus aureus (265.25.09％).Pseudomonas aeruginosa (245,23.20％),Acinetobacter baumannii (199,18.84％) and Escherichia coli (86,8.14％).The resistant rates of Pseudomonas aeruginosa to cefoperazone/sulbactam,ciprofloxacin,levofloxacin and piperacillin/tazobactam were 13.58％,21.25％,21.67％ and 22.45％,while the highest resistance rate was to compound sulfamethoxazole (98.04％).Acinetobacter baumannii was highly resistant to most antibacterial agents except cefoperazone/sulbactam (14.29％),and 11 out of 199 strains were pandrug resistant.Enterobacteriaceae were completely susceptible to imipenem and meropenem,and their resistance rates to cefoperazone/sulbactam,piperacillin/tazobactam and amikacin were 1.16％-28.12％.ESBLs positive rates of Escherichia coli and Klebsiella pneumoniae were 48.84％ (42/86) and 34.38％(11/32),respectively.Staphylococcus aureus were susceptible to vancomycin,teicoplanin and linezolid,but were highly resistant to ampicillin (100.00％),penicillin G (99.25％) and erythromycin (80.06％).The rate of MRSA was 41.51％ (110/265).Enterococcus were highly resistant to erythromycin,rifampin,levofloxacin,high-concentration gentamicin,minocycline and nitrofurantoin,but were susceptible to teicoplanin and linezolid,and the rate of vancomycin intermediate strain was 4.55％ (1/22).Conclusions The pathogens of wound infections in orthopedic patients were of wide variety.Staphylococcus aureus,Pseudomonas aeruginosa,Acinetobacter baumannii,Escherichia coli and Enterobacter cloacae were the most prevalent pathogens,and most strains were multi-drug resistant.

OBJECTIVE To study the antimicrobial susceptibility and molecular epidemiology of imipenem-resistant Pseudomonas aeruginosa isolated from patients in burn wards in a hospital of Guangzhou. METHODS A total of 48 imipenem-resistant isolates were collected,antimicrobial susceptibility was tested by KirbyBauer disk diffusion method.Random amplified polymorphic DNA(RAPD) typing was carried out to analyze the homology. RESULTS All isolates were multiresistant,the orders of sensitivity rates of antibiotics were CIP,TOB,AMK,GEN,and FEP.Forty eight strains were classified into types A,B,C,and D based on RAPD pattern,types A and B were the most epidemic clones. CONCLUSIONS The prevalence of imipenemresistant P.aeruginosa in burn wards of the hospital is due to nosocomial infection.The prevalent strains are multiresistant.

OBJECTIVE To analyze homology,antimicrobial susceptibility and metallo-?-lactamase gene type of metallo-?lactamase producing Pseudomonas aeruginosa in burn wards.METHODS Antimicrobial susceptibility tests were performed with E-tests.Using 2-mercaptoethanol disc synergy test to screen metallo-?-lactamase(positive) strains from imipenem-resistant P.aeruginosa in burn wards.Metallo-?-lactamase gene and integrase gene were amplified and sequenced.Resistance plasmid transfer and curing experiments were implemented to study the transfer of imipenem resistance and plasmid DNA was extracted and purified with Qiagen Plasmid Mini Kit.Random amplified polymorphic DNA(RAPD) typing was carried out to analyze the homology of the isolates.(RESULTS) Six strains of P.aeruginosa were suggested to produce metallo-?-(lactamase) by 2(-mercaptoethanol) disc synergy test.Using primers described for bla(VIM),the amplifications were observed among all 6 isolates and a VIM-2 metallo-?-(lactamase) gene was identified by sequencing.All isolates which producing VIM-2 metallo-?-(lactamase) had class 1 integrase gene and derived from a same clonal origin.CONCLUSIONS(VIM-2) metallo-?-(lactamase) producing P.aeruginosa is prevalent in burn wards,all isolates which producing VIM-2 metallo-?-(lactamase) have class 1 integrase gene.

Objective To investigate the distribution and drug resistance of bacterial pathogens isolated from orthopedic wounds.Methods Data of bacterial strains isolated trom orthopedic wounds in the Third Hospital of Hebei Medical University from January 2008 to December 2012 were retrospectively analyzed.Strains were identified by using French bioMérieux Vitek32 identification system,and the drug susceptibility was tested by Kirby-Bauer method.Chi-square test for linear trend was performed to reveal the changes of distribution and drug resistance of the strains.Results A total of 2 456 bacterial strains were isolated,vith 1 652 (67.26％) gram-negative bacilli,777 (31.64％) gram-positive cocci,26 (1.06％) fungi,and 1 (0.04％) gram-positive bacillus.The top five pathogens were Staphylococcus aureus (666 strains,27.12％),Pseudomonas aeruginosa (606 strains,24.67％),Acinetobacter baumannii (355 strains,14.45％),Escherichia coli(188 strains,7.65％) and Enterobacter cloacae (187 strains,7.61％).The positive rate of Acinetobacter baumannii was on the rise during 2008 and 2012 (x2 =35.266,P ＜ 0.0l).The rates of pan-drug resistant strains in Acinetobacter baumannii and Pseudomonas aeruginosa were 6.20％ (22/355) and 0.17％ (1/606),respectively.The rates of extended-spectrum β-lactamases positive strains in Escherichia coli and Klebsiella pneumoniae were 39.89％ (75/188) and 29.23％ (19/65),respectively.The rates of methicillin-resistant strains in Staphylococcus aureus and coagulasenegative Staphylococcus were 40.69％ (271/666) and 52.38％ (22/42),respectively.The rate of vancomycin-intermediate strains in Enterococci was 3.70％ (2/54).The positive rate of methicillin-resistant &aphylococcus aureus was on the rise during 2008 and 2012 (x2 =18.317,P ＜ 0.01).Staphylococcus aureus were sensitive to teicoplanin,vancomycin and linezolid; Resistance rates to rifampicin and amikacin were 11.29％-33.33％; Resistance rates to penicillins and erythromycin were 76.80％-100.00％; Resistance rates to cefazolin,cefuroxime,cefoxitin,amikacin and levofloxacin were on the rise (P ＜ 0.05) ; And resistance rates to sulfamethoxazole (28.11％-48.35％) were on the decline in the same period (P ＜ 0.01).Resistance rates of Pseudomonas aeruginosa to imipenem,meropenem and sulfamethoxazole were on the rise (P ＜ 0.05) ; Resistance rates to ciprofloxacin,levofloxacin,amikacin,gentamicin and piperacillin/ tazobactam were on the decline (P ＜ 0.05) ; Resistance rates to cefoperazone/sulbactam were the lowest (9.15％-20.51％).Resistance rates of Acinetobacter baumannii to imipenem,meropenem,levofloxacin,piperacillin/tazobactam,sulfamethoxazole were on the rise (P ＜ 0.01); Resistance rates to cefoperazone/ sulbactam were the lowest (11.86％-19.70％).Escherichia coli and Enterobacter cloacae were sensitive to imipenem and meropenem,and the resistance rates to cefoperazone/sulbactam and piperacillin/tazobactam were low (0-14.29％); Resistance rates of Escherichia coli to piperacillin,cefepime,amikacin,levofloxacin,cefoperazone/sulbactam were on the decline (P ＜ 0.05) ; Resistance rates of Enterobacter cloacae to cefoxitin were on the rise (P ＜ 0.01),while the resistance rates to piperacillin,ceftazidime,cefoperazone,ceftriaxone,levofloxacin were on the decline (P ＜ 0.05).Conclusion During 2008 and 2012,the predominant bacterial pathogens of orthopedic wound in patients of the Third Hospital of Hebei Medical University are Staphylococcus aureus,Pseudomonas aeruginosa,Acinetobacter baumannii,Escherichia coli and Enterobacter cloacae,and most strains are multiple drug resistant.

Objective To evaluate the clinical application values of 64-row MSCT for apical hypertrophic cardiomyopathy(AHCM).Methods Twenty-one patients with AHCM were included in this study,14 patients were diagnosed by echocardiography(UCG),and 7 patients were diagnosed by MRL AU patients underwent MSCT exam,and 5 patients also had ventriculography and coronary angiography.The left ventricular wall thickness in end-systole and end-diastole phases were measured at MSCT workstation,the left ventricular apex thickening rate(LVAT)and the ratio of maximum wall thickness of the left ventrieular apex(LVA)to the left ventricular posterior wall thickness(LVA/LVPW)in end-diastole phase were calcdated.The left ventricular end-diastolie volume(LVEDV)and left venueular ejection fraction (LVEF)were quantitively evaluated with cardiac functional analysis software.The results were compared with the measurement results from the normal control group(30 volunteers).The independent-samples t test was used for the statistics.At the same time.the coronary stenosis was measured.Results Diffuse or partial thickening of the LV apical myocardium were found in the four-chamber view and two-chamber view of MSCT images.which leaded to the deformation of the left ventricle chamber.The LVEDV were(82.6±11.4)and(108.5±10.6)ml in the AHCM group and the control group,respectively;the LVA were (20.6±3.4)and(9.9±1.5)mm;LVA/LVPW were 2.1±0.5 and 1.1±0.2;the LVAT were(25.6±4.7)%and(81.5±8.5)%.There were significant differences in LVEDV,LVA,LVA/LVPW and LVAT between the two groups(t=8.32 and 15.29,P＜0.05;t=9.91 and 27.30,P＜0.05;respectively),but there were no statistical differences in LVPW and LVEF between the two groups(t=0.26 and 1.13.P＞0.05).Five patients had myocardium bridging and 4 patients had coronary stenosis.Conclusion AHCM can be diagnosed accurately with MSCT,and the cardiac anatomy.function and coronary artery are also assessed simultaneously.

Objective To investigate the clinical application of electron-beam CT(EBCT)in the diagnosis of congenital cardiovascular diverticula. Methotis Retrospective analysis of 9 patients with congenital cardiovascular diverticula confirmed by operation and pathology was done.Of them,enhanced continuous volume scan was performed on 8 patients and enhanced single slice scan was performed on one patient with an Imatron C-150 scanner.Results The group of 9 pailents included one patient with diverticulum of the left ventricle.3 patients with diverticulum of the atria and 5 patients with diverticulum of the aorta.EBCT scan and three dimensional reconstruction could demonstrate not only the origin,size,shape,Location and adjacent structure of diverticula,but also other important complicated abnormalities such as ventrieuloarterial connection disorder,cardiac sepud defect,aortic coarctation and even dissection.Conclusion EBCT is an ideal noninvasive technique in the diagnosis of congenital cardiovascular diverticula

[Objective] To investigate the clinical value of using prospective ECG-gating Helical protocol in whole aorta and coronary arteries CT angiography combined with low tube voltage,low contrast medium injection rate and dose technology.[Methods]A total of 60 patients (heart rate≤ 75 bpm and normal heart rhythm) with suspected aortic disease or post-operation were randomly divided into 2 groups:G1 (n =30;tube voltage:80 kV;contrast medium injection rate:3 mL/s;contrast medium dose:0.65 mL/kg)and G2 (n =30;tube voltage:120 kV;contrast medium injection rate:4 mL/s;contrast medium dose:1.2 mL/kg).The two groups underwent aorta angiography with prospective ECG-gating Helical protocol by using 320-detector CT.The mean CT values and standard deviation of aorta,coronaries and adjacent adipose tissue were measured,signal to noise ratio (signal-to-noise ratio,SNR)and contrast to noise ratio (contrast-to-noise ratio,CNR) were calculated.The subjective quality scoring of 3-d post-processing images were evaluated independently by 2 senior radiologists.The mean CT values and standard deviation of aorta,coronaries and adipose tissue,SNR,CNR,subjective quality scoring,contrast medium dose and radiation dose were compared and analyzed.[Results] The abnormal and normal rate of aorta in two groups were 83.33％ (25/30),16.67％ (5/30) and 86.67％ (26/30),13.33％(4/30);while the abnormal and normal rate of coronary arteries in two groups were 43.33％ (13/30),56.67％ (17/30) and 53.33％(16/30),46.67％ (14/30).SNR values of ascending aorta,descending aorta,abdominal aorta,superior mesenteric artery,bilateral renal artery,left main coronary artery,left anterior descending branch,left circumflex branch,right coronary artery and CNR values of abdominal aorta,superior mesenteric artery,bilateral renal artery,left anterior descending branch,left circumflex branch had no statistical significance,while the other indicators were significant differences between the two groups.The radiation dose and the contrast medium dose of G1 was significantly lower than G2 (P ＜ 0.05).There was no difference in the subjective image quality of 3D post-processing images between the two groups (P ＞ 0.05).[Conclusions] Using prospective ECG-gating Helical protocol in whole aorta and coronary arteries CT angiography combined with low tube voltage,low contrast medium injection rate and low contrast medium dose technology can help to reduce radiation and contrast medium dose without impacting on the imaging quality satisfactorily.

Objective To analyze the outcomes of catheter ablation for persistent atrial fibrillation(AF)and the independent risk factors for its recurrence in the elderly.Methods A total of 194 patients with persistent AF who underwent catheter ablation at our department from January 2019 to December 2021 were enrolled in this study.They were divided into elderly group(≥60 years old,99 cases)and non-elderly group(＜60 years old,95 cases).Their surgical characteris-tics,postoperative complications and recurrence were compared between the two groups,and the independent risk factors for postoperative recurrence were analyzed in the elderly group.Results Advanced age,higher B-type natriuretic peptide,larger proportions of hypertension and coronary heart disease,and increased CHA2DS2-VASc and HAS-BLED scores,while lower male ratio and estimated glomerular filtration rate were observed in the elderly group than the non-elderly group(P＜0.05,P＜0.01).The elderly group had a higher proportion of left atrial fibrosis than the non-elderly group(30.3％vs 8.4％,P=0.001).Postoperative complications in the elderly group in-cluded 1 case of pericardial effusion and 2 cases of hematoma at the puncture site,and all of these were improved after treatment.There were no significant differences in the 1-year success rate(71.7％vs 69.5％,P=0.763)or recurrence rate during blanking period(21.2％vs 21.1％,P=0.981)between the elderly and non-elderly groups.AF duration(HR=1.020,95％CI:1.007-1.032,P=0.002)and recurrence during blanking period(HR=6.781,95％CI:3.078-14.935,P=0.001)were independent risk factors for postoperative recurrence in the elderly group.Conclu-sion Catheter ablation is safe and effective in the treatment of persistent AF in the elderly.The elderly patients with long duration of AF and recurrences during blanking period are more likely to experience recurrences within 1 year after ablation.

During coronavirus disease 2019 epidemic, the treatment of severe trauma has been impacted. The Consensus on emergency surgery and infection prevention and control for severe trauma patients with 2019 novel corona virus pneumonia was published online on February 12, 2020, providing a strong guidance for the emergency treatment of severe trauma and the self-protection of medical staffs in the early stage of the epidemic. With the Joint Prevention and Control Mechanism of the State Council renaming "novel coronavirus pneumonia" to "novel coronavirus infection" and the infection being managed with measures against class B infectious diseases since January 8, 2023, the consensus published in 2020 is no longer applicable to the emergency treatment of severe trauma in the new stage of epidemic prevention and control. In this context, led by the Chinese Traumatology Association, Chinese Trauma Surgeon Association, Trauma Medicine Branch of Chinese International Exchange and Promotive Association for Medical and Health Care, and Editorial Board of Chinese Journal of Traumatology, the Chinese expert consensus on emergency surgery for severe trauma and infection prevention during coronavirus disease 2019 epidemic ( version 2023) is formulated to ensure the effectiveness and safety in the treatment of severe trauma in the new stage. Based on the policy of the Joint Prevention and Control Mechanism of the State Council and by using evidence-based medical evidence as well as Delphi expert consultation and voting, 16 recommendations are put forward from the four aspects of the related definitions, infection prevention, preoperative assessment and preparation, emergency operation and postoperative management, hoping to provide a reference for severe trauma care in the new stage of the epidemic prevention and control.