BACKGROUND: Neurological complications after coronary artery bypass grafting still have a high incidence rate, and the etiology is multiple.OBJECTIVE: To retrospectively investigate the occurrence and relevant factors of severe neurological complications after coronary artery bypass grafting (CABG).METHODS: A total of 761 consecutive patients with undergoing CABG were included in this study from September 2002 to August 2009 at the Nanjing Drumtower Hospital, including 443 males and 318 females, aged from 32-89 years. All patients were grouped according to age(more than or less than 70-year-old) and on pump or off pump coronary surgery. Disclose the relationship between the risk factors and the neurological complications by statistics analysis.RESULTS AND CONCLUSION: Totally 41 patients had serious neurological complications in this study. There was a higher complication incidence in 570-year-old group patients (n=22) than < 70-year-old group (n=19)(14.9% vs. 3.1%, P< 0.001). The neurological complications incidence was similar in on-Pump CABG group (n =7) and off-Pump CABG group (n = 34) (5.3% vs.5.4%, P=0.39). The incidence rate of severe neurological complications was high in carotid artery stenosis > 50% patients. A total of 8 cases died, 2 for massive hemorrhage of gastrointestinal tract; 1 for severe sepsis; 4 for multiple organ dysfunction syndrome;1 for epilepsia gravior postoperatively. Finally, 33 cases survived. The average time of follow up was 3 years, 3 cases died, 3 cases recovery from limitation of limb or hand movement partly, and 1 case had severe mental retardation. Results displayed that elderly patients(= 70 years) undergoing CABG are at higher risk of neurological dysfunction. Carotid artery stenosis is the most risk factor. There are no significant effects on postoperative complications between on-pump CABG and off-pump CABG.

Objective To compare the circumferential approach and suprapubic approach for correcting the concealed penis. Methods Thirty-four patients received circumferential approach (group A,18 cases)or suprapubic approach(group B,15 cases)randomly for the concealed penis.The length of penis without erection before and after surgery treatment,patients'satisfaction and surgical complications were evaluated.All the patients were followed at least 6 months after operation.Results The penile length before and after surgery in group A were(1.78±0.41)cm vs(3.97±0.47)cm,the length of the postoperative penis was significantly longer than that of the preoperative penis(P<0.01).83%of those in group A(15 cases)were satisfied with the cosmic results.The length of preoperative and postoperative penis in group B were(2.07±0.53)cm vs(4.05±0.81)cm respectively,the length of the postoperative penis was significantly longer(P<0.01).Satisfaction was 87%(13 cases).The postoperative penile length between the 2 groups was not different(P> 0.05).Prepuce edema was reported to Occur in 56%and 13%in group A and group B and spontaneously disappeared within 3 months.Fat synchysis occurred in 2 of group B. Conclusions The cosmic effect of the 2 surgical approaches is similar,but circumferential approach is simpler.There is no serious complication in those receiving circumferential approach.

0.05).At week 52,there was significant difference in the undetectable HBV DNA rate between group C and group B(P0.05),and the rate of drug resistant genotype was 21.9%(7/32)、0、0(P

ObjectiveTo evaluate the efficacy and safety profiles of enteeavir (ETV) in patients with advanced schistosomiasis and hepatitis B virus (HBV) co-infection.Methods Totally sixty patients with advanced schistosomiasis and HBV co-infection were enrolled in this study.The patients were divided into ETV treatment group (n=30) and rhubarb treatment group who refused to receive antiviral treatment (n=30).The patients were treated with ETV or rhubarb thelepus ball on the basis of routine supportive therapy for 52 weeks.The hepatic fibrosis markers (e.g.hyaluronic acid,type Ⅲ procollagen,type Ⅳ collagen,laminin and fibronectin),alanine transaminase (ALT),HBV DNA,Child-Pugh score between two groups were compared.Intention to treat (ITT) population was used for analysis.The measurement data and the enumeration data were analyzed by t test and x2 test,respectively.ResultsAfter 52-week treatment,the hepatic fibrosis markers (hyaluronic acid,type Ⅲ procollagen,type Ⅳ collagen,laminin and fibronectin) were significantly improved in ETV treatment group compared to the rhubarb treatment group (t =3.952,3.765,3.857,3.122 and 3.735,respectively; all P＜0.05),and the fibrosis of liver tissue in ETV treatment group was significantly improved compared with rhubarb treatment group (x2 =11.207,P＜0.05).The ALT level,HBV DNA,Child-Pugh score after 52-weeks treatment in ETV treatment group were statistically reduced compared with rhubarb treatment group (t =3.287,4.382 and 3.872,respectively; all P＜0.05),meanwhile,the ALT normalization rate and HBV DNA undetectable rate were significantly increased in ETV treatment group (x2 =17.376 and 39.095,respectively; both P＜0.05).In addition,no obvious adverse reaction was observed during ETV treatment.Conclusion Entecavir is safe and effective in patients with advanced schistosomiasis and HBV co-infection.

The methylation status of GNAS1 gene in pseudohypoparathyroidism type Ib patients was detected by methylation-specific PGR technique. There was an abnormal methylation of 1A region in all seven PHPIb patients. Loss of exon 1A methylation (imprinting defect) seems to be the cause of PHPIb.

Objective To explore the correlation between the replacing time of plasma drainage bag and the bacterial growth rate among orthopaedic surgery patients , and to control or reduce the risk of catheter-related infection.Methods The convenient sampling method was used to select 100 patients with postoperative serum drainage tube and disposable drainage bag , from September 2012 to August 2013.Patients were randomly divided into the control group (group A, 33 cases) and the observation group (group B, 32 cases; group C, 35 cases).The amount of drainage were recorded every 24 hours of the three groups of patients , and then the drainage bags were emptied .Group A replaced the drainage bag regularly every day; Group B replaced the drainage bag every 48 hours;Group C did not replace the drainage bag .The outside mouth of the drainage tube and the drainage liquid were taken to bacterial culture . The positive rate of bacterial culture , patients'postoperative body temperature and the rate of incision infection were compared within groups .Results Twenty-four hours after operation, the results of bacterial culture among three groups were negative .However, after 48 hours, six patients (18.1%) in group A, two patients (6.4%) in group B showed positive results of the bacterial culture .None of the patients in group C had the positive results .The comparison among three groups was statistically significant (χ2 =10.32,P<0.05).After 72 hours, eight patients (24.2%) in group A, two patients (6.4%) in group B showed positive results of the bacterial culture .None of the patients in group C had the positive results.The comparison among three groups was statistically significant (χ2 =11.82,P<0.05). The incidence of incision infection of group A , group B and group C were 15.1%(5/33), 6.3%(2/32) and 0.0%(0/35), respectively.There was a significant difference among three groups (χ2 =11.18,P<0.05).The body temperature of the three groups showed no significant difference (F=7.53,P>0.05).Conclusions With the increase of drainage bag replacement frequency , the positive rate of bacterial culture , as well as the drainage bag and drainage tube mouth bacteria culture positive rate increase .Therefore, for orthopaedic patients , the plasma drainage tube and disposable drainage bag should be emptied every 24 hours after the measurement of drainage liquid, but do not have to be replaced every 48 hours or every 24 hours.

To identify the anti-bacterial compound(s) from Streptomyces hygroscopicus 17997, a geldanamycin producer, silica gel thin layer chromatography (TLC) TLC was used to separate the secondary metabolites of S. hygroscopicus 17997. Compound(s) from the silica gel TLC with anti-Gram positive bacteria activity and becoming red upon color reaction by 2.0 mol/L NaOH was analyzed by HPLC. The UV absorption profile and the retention time of a peak of HPLC were identical to those of authentic elaiophylin. A conserved region of dTDP-glucose-4,6-dehydratase (Tgd) gene was amplified by PCR from the genomic DNA of Streptomyces hygroscopicus 17997. DNA sequence analysis of the amplified DNA fragment indicated that it should be the tgd gene of elaiophylin biosynthetic gene cluster. These results implied that the compound in the peak of HPLC was elaiophylin, a macrodiolide antibiotic. The compound was then confirmed to be elaiophylin by LC-(+)-ESI-MS, which revealed that Streptomyces hygroscopicus 17997 was an elaiophylin producer. At the same time, a fast procedure, which consisted of silica gel TLC, color reaction, HPLC, PCR detection and DNA sequence analysis of tgd gene, and LC-(+)-ESI-MS, was established for rapid identification of elaiophylin and its producer.
Benzoquinones ; metabolism ; Chromatography, Liquid ; methods ; DNA, Bacterial ; genetics ; Hydro-Lyases ; genetics ; Lactams, Macrocyclic ; metabolism ; Macrolides ; analysis ; isolation & purification ; metabolism ; Mass Spectrometry ; methods ; Sequence Analysis, DNA ; Streptomyces ; genetics ; isolation & purification ; metabolism

Ansamycins, such as rifamycin and ansamitocin, usually consist of a group of structural similar components. Geldanamycin, a benzenic ansamycin, has been found to consist of four structural similar components. We analyzed the geldanamycin (GDM) preparation from Streptomyces hygroscopicus 17997 by LC-ESI(+)-MS/MS, and discovered five novel and one known GDM analogues in trace amounts. Based on the ESI(+)-MS/MS spectra of these GDM analogues, and the present understanding of GDM biosynthesis, we proposed the possible chemical structures of these GDM analogues. Three novel GDM analogues, all having the same molecular formula of C29H42N2O10, were GDM biosynthetic derivatives with one of the three C-C double bonds between C2-C3, C4-C5 and C8-C9 in GDM changed to mono-hydroxylated C-C single bond. The other two novel GDM analogues, having the same molecular formula of C28H38N2O8, were 17(or 12, or 4)-desmethoxylgeldanamycin and 4,5-dihydro-10,11-dehydrate-17-desmethyl-17-hydroxylgeldanamycin, respectively. The known GDM analogue, having the molecular formula of C29H42N2O9, was 4, 5-dihydrogeldanamycin, an intermediate in GDM biosynthesis. The discovery of novel GDM analogues provided us new insights in understanding the biosynthetic details of GDM, and clues of obtaining GDM derivatives by gene-disruption and combinatorial biosynthesis.
Anti-Bacterial Agents ; chemistry ; Benzoquinones ; analysis ; chemistry ; Chromatography, Liquid ; methods ; Lactams, Macrocyclic ; analysis ; chemistry ; Tandem Mass Spectrometry ; methods

Spiramycin and midecamycin are 16-membered macrolide antibiotics with very similar chemical structures. Spiramycin has three components, namely spiramycin I, II and III. Spiramycin II and III are, respectively, the O-acetyl and propionyl derivatives at C3-hydroxyl group of spiramycin I. Midecamycin has four components, and the C3-hydroxyl group of midecamycin is all O-propionylated. The enzyme adding acyl group(s) at the C3-hydroxyl group during the biosynthesis of spiramycin and midecamycin is 3-O-acyltransferase. The 3-O-acyltransferases for spiramycin and midecamycin are also very similar, and presume to function when exchanged. To explore whether the 3-O-acyltransferase for midecamycin biosynthesis hold still the character of selective and efficient propionylation for spiramycin I at its C3-hydroxyl group, we inserted mdmB, the 3-O-acyltransferase gene from Streptomyces mycarofaciens ATCC 21454 for midecamycin biosynthesis, into a mutant strain of S. spiramyceticus F21, in which the 3-O-acyltransferase gene for spiramycin biosynthesis, sspA, was deleted; and the mdmB was integrated exactly into the chromosomal site where the sspA was deleted. We name this "hybrid" strain as SP-mdmB. HPLC analysis of the spiramycin produced by SP-mdmB showed that spiramycin I was still the major component, although the relative proportions of both spiramycin II and III increased significantly. We thus conclude that MdmB from Streptomyces mycarofaciens ATCC 21454 for midecamyicn biosynthesis do not hold the character of selective and efficient propionylation for spiramycin I within S. spiramyceticus F21, and this character is possibly limited in Streptomyces mycarofaciens ATCC 21454 for midecamycin biosynthesis.
Acylation ; Acyltransferases ; genetics ; metabolism ; Culture Media ; Genes, Bacterial ; Genetic Engineering ; methods ; Leucomycins ; biosynthesis ; Spiramycin ; biosynthesis ; Streptomyces ; enzymology ; genetics ; Substrate Specificity