Objective To evaluate the preliminary outcome of cannulated screw internal fixation in treatment of the tarsometatarsal joint injuries.Methods From January 2005 to October 2010,21 patients(14 males and 7 females)with the tarsometatarsal joint injuries were treated.Their age ranged from 21 to 62 years(average 38.2 years).According to anatomical three-column classification,there were four patients with single medial column injury,four with medial and middle column injuries,three with middle and lateral column injuries,two with single lateral column injury and eight with three column injuries.The injury causes included traffic injury in nine patients,machine injury in eight and fall from height injury in four.The period from injury to admission was 2-15 hours(mean 5 hours).During operation,open reduction was performed,followed by internal fixation with the cannulated screw.X-ray examination was done in the regular follow-up and function was evaluated by using Maryland scoring system.Results Of all,19 patients were followed up for 4-47 months(mean 20 months),which showed no infection,loosing or breakage of the internal fixation.According to the Maryland scoring system,the clinical outcome was rated as excellent in eight patients,good in seven,fair in two and poor in two,with excellence rate of 79％.Conclusions The three-column theory plays an important role in clinical diagnosis and therapy of the tarsometatarsal joint injuries.Open reduction and cannulated screw internal fixation may attain satisfactory clinical results in treatment of the tarsometatarsal joint injuries.

Objective To investigate the prevalence rate of healthcare-associated infection(HAI)in a hospital,so as to provide reference for making HAI control measures.Methods The cross-sectional survey on HAI was carried out among all hospitalized patients on May 26,2010,December 12,2012 and December 4,2013,respectively,sur-veyed data were analyzed.Results The prevalence rate was 6.66%(n =116),6.67%(n =113)and 6.33%(n =120)in 2010,2012 and 2013 respectively,and case rate was 7.29%(n=127),7.38%(n=125)and 6.97%(n=132) respectively,intensive care unit(ICU )had the highest infection rate,internal medicine ICU was up to 71 .43%. The main infection site was lower respiratory tract(44.53%),followed by surgical site infection (9.11 %)and uri-nary tract infection (9.11 %).The isolation rate of gram-negative bacteria,gram-positive bacteria and fungi was 60.81 %,20.38% and 18.81 % respectively.Usage rate of antimicrobial agents in three years was 32.95%, 29.87% and 25.59% respectively (χ2 = 13.16,P <0.01 ).Conclusion Prevalence rate of HAI in this hospital is high ,the main pathogen is gram-negative bacteria,the main infection site is lower respiratory tract ,antimicrobial use decreased year by year.Monitor on high risk departments,main sites and pathogens should be intensified.

Objective To explore the differences and similarities of the cervical lesions and mechanism between Asian variant E6 T178G and European variant E6 T350G, A442C and other variants. Methods We selected 300 clinic or hospitalized patients in our hospital during the period of May 2011 to October 2012. Cervical exfoliated cells were harvested by Thinprep cytologic test (TCT). A PCR sequencing assay was performed to detect HPV16 E2, E6 and E7 gene variants. One year later, the test was repeated. The patients with persistent infection underwent cervical biopsy by colposcopy for pathological examination. SP immunohistochemical method was applied to detect E7 protein expression level in all the patients. Results After one year, of 292 patients who were successfully sequenced, 259 were chronic cervicitis, 32 were cervical intraepithelial neoplasia grade I (CINI), and one was cervical intraepithelial neoplasia grade II (CINII). E7 protein expressed in each variant. But the expression of E7 protein in patients with different variant infection had no significant difference from each other. Conclusions E7 protein may be play a role in the early stages of HPV16?induced cervical lesions. But E7 protein may not be a reference index of the different carcinogenic mechanism between different HPV16 variants.

Objective To investigate clinical features and treatment strategy for pancreatic duct stent displacement complicated with acute pancreatitis.Methods Ten cases of pancreatic duct stent displacement complicated with acute pancreatitis were retrospectively analyzed.All the cases were confirmed by lab examination,X-ray examination,endoscopy and computed tomography (CT) examination.After operation,the clinical symptoms of patients were observed.Time consumed for stent removing and blood amylase level before endoscopic retrograde cholargio-pancreatography (ERCP) and 1st,4th,7th day after ERCP were recorded.Clinical features,the time of stent displacement,time of clinical cure and therapeutic strategy were summarized.Results The average age of the ten cases (four male and six female) was 55.9 years.All the displaced pancreatic duct stents were pancreatic duct stent with side wing,length five to seven cm.Obstruction was observed in one case.The end of the pancreatic duct stent of two cases dislocated at the neck of pancreats,seven cases at the head of pancreas and one at the body of pancreas.Ten cases presented with abdominal pain,seven with nausea and vomiting and one with fever.The average time of the occurrence of pancreatic duct stent displacement was 2.9 months.All the stents were successfully taken out,which of two cases were removed with balloon,seven cases with forcep and one with snare,and the average time duration was 17.7 min.After the stents taken out,pancreatic duct stent was replaced in one case and the left nine cases received nasal-pancreatic drainage treatment.After the operation,no severe complications such as pseudocyst of pancreas,pancreatic abscesses,pancreatic necrosis and gastrointestinal bleeding were observed in all the patients.Average blood amylase level at 1st,4th and 7th day after ERCP was 508 U/L,137 U/L and 86 U/L,respectively.The average time of recovery was 6.7 days,and the average time of keeping the nasal-pancreatic tube was 8.6 days.Conclusions For patients with pancreatic duct stent displacement complicated with acute pancreatitis,it is safe and effective to take out the stent and perform pancreatic duct drainage by ERCP as soon as possible,which could improve the symptoms in a short time.

Objective To evaluate the efficacy of X-ray guided choledochoscopy via T tube tunnel and interventional treatment of residual bile duct stones.Methods Cholangiography was performed in patients suspected of residual bile duct stone with choledochoscopy via the remaining T tube tunnel,and data of 45 patients who received endoscopically treatment for the residual bile duct stones and bile duct stricture were analyzed.Results Seven patients' with adhesive bile duct stenosis were resolved by repeat rinse and dilation,but the procedure failed in 2 cases of bile duct stricture caused by scar;seven cases of common bile duct stone combined with gradeHand Ⅲ multiple hepatic cholelith were removed within 1.5 h:six cases of hepatic bile duct narrowing with multiple cholelith were taken out in 1.0 hour;six cases of grade Ⅱ and Ⅲ multiple massive choledocholith were removed with lithotrity for over 2.0 h:six cases of grade Ⅱ-Ⅳ cholelith were eliminated within 1.5 h:six cases of hepatobiliary stone were removed successfully in 30 min.Stones in 3 cases of multiple stones with intrahepatie bile duct stenosis were not taken out due to bile duct stricture;stones in 2 cases of gradeⅡand Ⅲ multiple choledocholith were not removed for T tube tunnel bleeding.Conclusion X-ray guided choledochoscopy is convenient and effective to remove residue cholelith.

ObjectiveTo explore the expression of CD3+ CD8+ human leukocyte antigen (HLA)-A2+T lymphocytes with specificity to the different hepatitis B virus (HBV) peptides in the peripheral blood mononuclear cells (PBMC)from the patients with hepatitis B associated hepatocellular carcinoma (HCC).MethodsThe HLA-A2+ PBMC from four patients with hepatitis B associated HCC were incubated with five HBV/HLA-A2 pentamers respectively,which were HBV sAg (FLLTRILTI),HBV sAg (GLSPTVWLSV),HBV sAg (WLSLLVPFV),HBV core (FLPSDFFPSV),and HBV pol (FLLSLGIHL),as well as anti-CD3-pacific blue and anti-CD8-fluorescein isothiocyanate (FITC).Then,HBV/HLA-A2-CD3-CD8 positive cells were detected by flow cytometry. The monoclonal HBV/HLA-A2-CD3-CD8+ cells were acquired by fluorescenceactivated cell sorter,and cultured and identified by flow cytometry.The anti-HBV specific T lymphocytes were then cultured with HepG2 (HLA-A2+ ) cells and the release of interferon γ (IFN-γ)were determined by enzyme-linked immunosorbent assay (ELISA),Res(a)ltsThe percentage of antiHBV T lymphoeytes with specificity to GLSPTVWLSV in total CD8+ T lymphoeytes from four patients with hepatitis B associated HCC was 1.44％±0.04％,which was higher than those to other four HBV antigen peptides (0.68％±0.08％ of FLLTRILTI,1.06％±0.09％ of FLPSDFFPSV,0.56％ ±0.04％ of FLLSLGIHL,and 0.46％ ±0.08％ of WLSLLVPFV) (t=0.001,P＜0.05).The two lines of monoclonal cell with specificity to GLSPTVWLSV both exhibited high level of IFN-γ expression after incubated with hepatic carcinoma cell line HepG2 (HLA-A2+)with HBV GLSPTVWLSV peptide.ConclusionsCD3+ CD8+ HLA-A2+ cells with specificity to the different HBV peptides exist in PBMC of patients with hepatitis B associated HCC.The expression level depends on HBV antigen peptide sequences and genomic sites.

Objective To investigate the therapeutic effect of endoscopic plastic stent and metal stent placement in relieving obstructive jaundice in patients with pancreatic cancer,and to analyse the cost effectiveness.Methods A retrospective review was performed on the clinical data of 102 pancreatic cancer patients with obstructive jaundice in General Hospital of Northern Theater Command between January 2013 to January 2014.The patients were divided into plastic stent group (n =26) and metal stent group (n =76)based on the type of biliary stent placed under endoscopy.The complication and short-term therapeutic effect were compared between two groups.The number of endoscopic stent placement,treatment interval,hospitalization cost and median survival time were recorded.Results The levels of alanine aminotransferase (ALT) and total bilirubin (TBiL) in the two groups 5-7 days after endotherapy were significantly lower than those before treatment,but the difference was not statistically significant between the two groups (P ＜0.05).No severe complication was observed.The average number of treatments in the metal stent group was significantly lower than that in the plastic stent group (1.7 times vs 2.9 times),and the treatment interval was significantly longer[(271.7 ± 42.3) d vs (113.4 ± 38.2) d].The difference above between these two groups was statistically significant (P＜0.05).However,there was no significant difference on the average total hospitalization cost (84227.2 yuan vs 86906.8 yuan) or median survival time (15.6 months vs 13.1 months)between these two groups.Conclusions Primary placement of metal biliary stents for obstructive jaundice in adult patients with metastatic pancreatic carcinoma was cost-effective than plastic stents,and their effects were comparable.

Objective To diagnose crossed cerebellar diaschisis (CCD) after supratentorial cerebral infarction with intravoxel incoherent motion (IVIM) magnetic resonance imaging. Methods From May, 2016 to May, 2017, 120 patients with unilateral supratentorial cerebral infarction were divided as CCD positive and CCD negative, and investigated with IVIM. Results The cerebral infarction volume (CIV) was more in CCD positive patients than in CCD negative patients in acute and chronic phase (t>13.943, P<0.05). The apparent diffusion coefficients (ADC) was significantly different between affected and unaffected lateral cerebellar in CCD positive patients (t=11.413, P<0.05), and it was significantly different between CCD positive and negative patients in unaffected lateral cerebellar (t=10.026, P<0.05). Conclusion CIV and ADC can be the indexes of IVIM to evaluate the cerebral perfusion in patients with cerebral infarction.

Objective To investigate the resistance of clinical Stenotrophomonas maltophilia isolates from 15 hospitals in several regions of China during 2011.Methods Fifteen repre-sentative general hospitals were involved in this program. Bacterial susceptibility testing was carried out by means of a unified protocol using Kirby-Bauer method and MIC determi-nation.Results were analyzed according to CLSI 2011 break-points.Results Majority (93.3%) of the 1 889 clinical strains of S.maltophilia were isolated from inpatients.On-ly 6.7% of the isolates were from outpatients.About 62.9% of these S .maltophilia strains were isolated from old patients whose age was 60 years or older.Only 8.2% of the strains were from the patients younger than 18 years old.Sputum and re-spiratory tract secretion were the most common specimen source,accounting for 82.6%.Another 4.2% isolates were from blood,abdominal fluid and other sterile body fluids.The percentage of the S .maltophilia strain resistant to trimethoprim-sul-famethoxazole,levofloxacin and minocycline was 16.6%,10.0% and 1.8%,respectively.The strains resistant to cefopera-zone-sulbactam accounted for 19.0%.About 37.1% of the strains isolated from blood or sterile body fluids were resistant to trimethoprim-sulfamethoxazole,significantly higher than the strains from urine or wound specimens (P < 0.01).Conclusions S.maltophilia strains are mainly isolated from inpatients.The most common source is sputum and other respiratory speci-mens.Most of the patients with S.maltophilia isolate are 60 years of age or older.The S.maltophilia strains are constitu-tively resistant to several antibacterial agents,but showed relatively lower resistance to trimethoprim-sulfamethoxazole,levo-floxacin and minocycline.Cefoperazone-sulbactam is still active against these strains.The antimicrobial therapy targeting S. maltophilia infections should be selected cautiously according to the results of antimicrobial resistance surveillance.

Objective To investigate the antimicrobial resistance of clinical strains of K lebsiella spp .isolated from 15 hospitals in China CHINET during 2012 .Methods Kirby-Bauer method and automatic microbiology analysis system were employed to study the antimicrobial resistance . WHONET 5 .6 software was applied for data analysis according to Clinical and Laboratory Standards Institute (CLSI) 2012 breakpoints .Results A total of 9 621 clinical K lebsiella isolates were analyzed ,including 8 772 strains of K . pneumoniae and 804 strains of K . oxytoca . About 54 .9% (5 285/9 621) of the K lebsiella strains were isolated from sputum ,and 16 .3% (1 564/9 621) were isolated from pediatric patients .Antimicrobial susceptibility testing showed that about 8 .9% ,10 .8% and 12 .9% of the strains were resistant to imipenem ,meropenem and ertapenem ,respectively .About 14 .1% and 17 .0% of the strains were resistant to piperacillin-tazobactam and cefoperazone-sulbactam , respectively . Carbapenem-resistant K lebsiella strains were identified from all the 15 hospitals ,including 945 strains of K .pneumoniae and 45 strains of K .oxytoca ,which were resistant to either imipenem ,meropenem or ertapenem .Conclusions The Klebsiella isolates collected from 15 hospitals in China during 2012 are relatively sensitive to carbapenems ,cefoperazone-sulbactam and piperacillin-tazobactam .The prevalence of carbapenem-resistant strains is still increasing in China ,about 10 .3% in 2012 ,and relatively higher in Eastern China .More efforts should be made to control the superbug .