OBJECTIVE To study the change in drug-resistance to antibiotics in Gram-negative bacteria in Jinhua region in order to guide clinical application of antibiotics reasonably.METHODS The antibiotics resistance of Gram-negative bacteria from clinical samples in four general hospitals in Jinhua region during from Jan 2005 to Dec 2007 was studied retrospectively.RESULTS The detecting rates of extended-spectrum ?-lactamases in Escherichia coli and Klebsiella pneumoniae were rising from 41.0%and 25.3% in 2005 to 56.0%and 53.2% in 2007,respectively.Furthermore,0.8% isolates were resistant to carbapenemase from all E.coli and K.pneumoniae strains.The rate of antimicrobial resistance to carbapenemase was 20.0% in Pseudomonas aeruginosa and was increased from 27.0% in 2005 to 41.0% in 2007 in Acinetobacter baumannii.CONCLUSIONS The drug-resistance rate in Gram-negative bacteria hase increased obviously in past three years in Jinhua region.It suggests that there be an urgent need for surveillance of Gram-negative bacterial resistance in different hospitals and rational antibiotics usage be emphasized during clinical therapy.

Neutrophil gelatinase associated lipocalin(NGAL),also known as lipocalin 2,has close relationship with human neoplasias,which is up-regulated in a number of malignancy and involves in the process of tumor development.But it appears to exist paradoxical effects attributed to NGAL in human neoplasias.For instance,through protecting MMP9 from autodegradation,NGAL has a clear pro-tumoral and pro-metastatic effect,as has already been observed in breast cancer and esophageal cancer.However,on the contrary,for pancreatic cancer and ovarian cancer,NGAL can inhibit FAK phosphorylation and vascular epidermal growth factor synthesis,having an anti-tumoral and anti-metastatic effect.This review summarizes the current knowledge about the dual effects of NGAL in the process of tumor development,and attempts to explore the possible underlyins mechanism.

Objective To analyze the postoperative complications in aged patients receiving pancreaticoduodenectomy. Methods Pancreaticoduodenectomy was employed for the treatment of 52 aged patients. Of the 52 patients with a mean age of 70.5(65-76), 32 were male and 20 female. Postoperative pathological examination confirmed that 24 patients suffered from Vater,s ampullary and duodenal cancers, 16 from pancreatic carcinoma and 12 from cholangiocarcinoma. Results The mortality was 7.7%. Severe complications included bleeding (upper gastrointestinal tract or abdominal cavity),MOF, ARDS, postsurgical gastroparasis syndrome(PGS), mental disorder, pancreaticogastrostomy leak and biliary-enteric anastomotic leak et al. Conclusion MOF is the main lethal complication. Incidence of PGS and mental disorder is high.

AIM: To establish the fingerprint analysis of Yadanzi Youru Injection(Fructus Bruceae) and to provide the quality information by capillary gas chromatography(CGC). METHODS: The CGC method was used.The capillary column was Supelcowax~(TM)-10(30 m?250 ?m?0.25 ?m),The detector was FID. RESULTS: The result showed that 4 peaks were common and the content of oleic acid in Yadanzi Youru Injection was determined.The linear ranges were within(0.34)～(2.07) ?g/L,r=0.999 9 n=5; CONCLUSION: The method is simple,accurate and reproducible.It can be applied to the quality control of Yadanzi Your Injection.

Objective To investigate the expression and significance of survivin in hepatocellular carcinoma(HCC).Methods All reports published in the past 13 years on survivin and hepatocellular carcinoma (HCC) were reviewed.A Meta-analysis was conducted on these studies and it was used to determine the prognostic significance of the expression of survivin on patients with HCC.Results 18 studies were included into this Meta-analysis.There were 1 021 HCC patients and 208 normal controls.There was a significant difference between the positive rate of survivin in hepatocellular carcinoma and in normal tissues (0R =30.61; 95％ CI:16.67-56.23).The expression of survivin correlated with clinical staging,pathological differentiation,tumor metastasis,portal vein tumor thmmbus,and survival (P ＜ 0.05).There was no correlation with gender,age,AFP,HBsAg,tumor diameter,and tumor capsule (P ＞ 0.05).Conclusiom Survivin can be used as a molecular marker for the definitive prognosis of HCC.It is also a reliable marker in the choice of standardized and individualized therapy.

Objective To investigate the protective mechanism of trace element-selenium(Se) on the myocardium by against free radical superoxidation during myocardial ischemia/reperfusion(I/R) period in patients undergoing pulmonary bypass.Methods 46 patients with ASD or VSD were divided into control(23 patients) and Se administration(23 patients) groups.Before heart surgery,patients in the Se group orally received 400?g Se supplementation per day,for 7 days.The blood and myocardium samples were collected before clamping and after release respectively during pulmonary bypass.Biochemistry,electron spin resonance spectrometer(ESR),atomic absorption,RT-PCR and cDNA sequencing,were used to measure Se concentrations,MDA level,glutathione peroxidase(GPX) activity,GPX mRNA expression and GPX cDNA sequence in blood and myocardium.Results In Se group,before clamping,Se contents in blood cells and plasma, were not changed,but at reperfusion 30 minute,myocardial Se concentrations was evidently increased by about 1.1-fold,contrary to reduction 41% in blood cells.In Se administration group,at myocardial reperfusion 10 minute,free radical levels of the coronary sinus blood were significantly decreased 28%.No significantly changes in myocardial GPX activity or MDA level were found till reperfusion 30 minute.However,Se group had a higher myocardial GPX mRNA expression than that in controls in both before ischemia and after reperfusion.Conclusions Se supplementation can enhance Se content,expression of GPX-mRNA in myocardial tissue,and protect myocardium from radical lipooxidation damage.

Objective To investigate the value of micro-course in colostomy patients in self-care. Methods A total of 120 patients with colostomy patients were divided into the intervention group and the control group with 60 cases each according to the first time in the hospital bed and odd number. The intervention group was given micro-course in colostomy patients discharge health education. The control group was taken the traditional health education missionary single conduct health education of discharged. The self-efficacy (divided stoma care effectiveness and social effectiveness of two dimensions and six separate entries, score 28-140 points. Using five no confidencethere a little confidence some of confidencequite confident or very confident scoring 1-5 points) and stoma care skills (including two parts, a total of 18 entries, each entry method using Likert scale of 51-5 points representing very unskilledsomewhat skilledordinary skillskilled and very skilled, score 18-90 points, higher scores indicate better skills) of patients after 3 months of discharge between the two groups were compared and evaluated. Results After 3 months of discharge, the self- efficacy scores of the intervention group were evaluated with respect to stoma care, social performance, diet choice, confidence in sex life, confidence in sexual life, confidence in physical activity, confidence in vitality and confidence in self-care (53.17±3.54), (38.62±5.25), (3.45 ± 1.06), (2.43 ± 1.06), (2.22 ± 0.86), (2.88 ± 0.94), (3.52 ± 0.89), (3.88 ± 0.64) points, respectively, compared with the control group (50.45 ± 4.79), (35.33 ± 3.42), (3.03±1.15), (1.77±0.81), (1.78±0.72), (2.47±0.96), (3.02±0.70), (3.40±0.81) points, there were significant differences (t=-4.366--2.076, all P<0.05) . According to the comparison of stoma nursing skills, the score of stoma care and the related knowledge of stoma care were (36.33±4.21), (37.13±3.85) points in the intervention group, and (34.22±3.87), (31.32±4.95) points in the control group, and there were statistically significant difference (t=-3.140,-7.741, P < 0.05). Conclusions Colostomy patients discharged from hospital health education classes in the use of micro-course, can effectively improve patients' self-efficacy and ostomy care capacity, enhance the quality of life.

Objective To study the processing method,extraction technology and quality evaluation analysis of Paeonialactiflora Pall, so as to provide reference for selecting the best method and improving its quality .Methods One year and 3 years Chinese herbal medicine Paeonialactiflora Pall was used.The use of raw materials and cooked products for processing methods to paeoniflorinas the representative , and the content was determined by high performance liquid chromatography.With the optimization of orthogonal test, the methods for the determination of effective components of radix paeoniaealba were summarized and the quality control methods were analyzed .Results The content of paeoniflorin in raw paeonialactiflora pall was (6.33 ±0.52)%,and the content of paeoniflorinin cooked Paeonialactiflora Pall was (5.74 ±0.45)%, which was with statistical significance(P <0.05).The content of paeoniflorin in raw paeonialactiflora pall was (5.90 ±0.38)%,and 4.85 ±0.45% in three years cooked paeonialactiflora pall, and the differenceswere with statistical significance(P<0.05).Extracted three times with 70% ethanol, time 65 min, 6 times the amount of solvent,the paeoniflorin high cream rate was highest.By means of induction, several active ingredients should be screened out to control the content of paeonialactiflora pall to publish multiple indicatorsquality control methods .Conclusion The preparation method of Chinese herb paeonialactiflora pall has showed that the active ingredient content is morein raw herb.To establish quality control method of multiple indicators of paeonialactiflora pall based on raw herb,gradually improve the quality of more comprehensive paeonialactiflora pall quality control model.To optimize the extraction of Chinese herbal medicine,provide scientific reference for the sustainable utilization and industrial production of paeonialactiflorapall.

Objective To explore the differences of serum expression of cystatin C,macrophage migration inhibitory factor (MIF)and matrix metalloproteinase-1 (MMP-1)in elderly patients with coronary artery disease.Methods 120 cases of senile cor-onary heart disease patients in the department of cardiovascular medicine from July 2010 to August 2012 were selected and divided into the control group (n=30),stable angina pectoris group(SAP group,n= 34),unstable angina group (UA group,n=28)and a-cute myocardial infarction group (AMI group,n=28)according to the results of coronary arteriography combined with the electro-cardiogram and myocardial enzyme spectrum test.The serum levels of cystatin C,MIF,MMP-1 and C reactive protein (hs-CRP) were compared among the four groups,and correlations of the four indicators were analysed as well.Results There were significant differences in the serum levels of cystatin C,MIF,MMP-1 and hs-CRP among the four groups(P <0.05).The serum levels of cys-tatin C,MIF and MMP-1 were gradually increased with the progression of disease,and significant differences were found between any two groups(P <0.05).There were significant differences in the levels of hs-CRP between the AIM group and the other three groups(P <0.05).While among the control group,SPA group and UA group,no significant differences were found in the levels of hs-CRP between any two groups(P >0.05).The significant positive correlations were observed among cystatin C,MIF and MMP-1.Conclusion The serum levels of cystatin C,MIF and MMP-1 have a gradually increasing trend with disease progression in pa-tients with coronary heart disease,which could be important indicators of disease evaluation.

Objective To compare the adverse reactions and efficacy of dose-dense biweekly EC-T regimen with three-weekly TEC regimen in adjuvant chemotherapy for high risk breast cancer patients. Methods Fifty-one patients with high-risk breast cancer were divided into two groups according to random number table method. 27 cases in EC-T group: epirubicin 90 mg/m2, d1, cyclophosphamide 600 mg/m2, d1, every 2 weeks for 4 cycles followed by paclitaxel 175 mg/m2, d1, every 2 weeks for 4 cycles; 24 cases in TEC group: docetaxel 75 mg/m2, d1, epirubicin 75 mg/m2, d1, and cyclophosphamide 500 mg/m2, d1, every 3 weeks. All the patients in both groups received prophylactic granulocyte-colony stimulating factor 5 μg/(kg·d) from d3 of chemotherapy according to treatment protocol. The adverse reactions, disease-free survival (DFS) and overall survival (OS) were compared between the two groups using χ2 test. Results After a median follow-up of 31 months, the median DFS in the two groups were 28 months and 26 months, the 2-year DFS rates were 85.2 % and 79.2 %, and the 2-year OS rates were 100.0 % and 95.8 %. The EC-T group had higher median DFS, 2-year DFS and 2-year OS than the TEC group, but the differences were not statistically significant (all P> 0.05). The EC-T group had lower incidence of grade 3-4 leukopenia and neutropenia, grade 2-3 diarrhea than the TEC group, and no febrile neutropenia was observed in the EC-T group, the differences were statistically significant (all P< 0.05).However, the incidence of neurotoxicity, myodynia and arthrodynia were significantly higher in the EC-T group than those in the TEC group, the differences were statistically significant (both P< 0.05). Other adverse reactions, including anemia, nausea and vomiting, alopecia, liver dysfunction, and cardiac toxicity were similar between the two groups (all P > 0.05). Conclusion EC-T dose-dense biweekly regimen is well tolerated in adjuvant chemotherapy for high risk breast cancer patients with a trend to improve the DFS and OS when compared with the TEC regimen.