Objective To study the etiolgy and clinical features of pathological fracture in femur. Methods 17 cases of pathological fracture in femur,including 10 males and 7 females with average age 39.5(13～74),were all treated surgically and their pathological diagnosis were achieved,which were consistent with the clinical diagnosis.Results 12 patients (70.59%) suffered from fracture resulted from malignant tumor,of which lung cancer and breast cancer were the commonest with 3 cases respectively (50%).The fracture of proximal end accounted for 65%.8 cases of spontaneous fracture and 2 cases of multiple fracture were all malignancy sufferers.Conclusion Malignancy is the main cause of pathological fracture in femur,of which lung cancer and breast cancer are the commonest.Proximal end of femur is the most frequent part to which fracture happens.Both spontaneous and multiple fractures are resulted from malignancy.

Objective To study the expression of HER4 in renal cell carcinoma and elucidate therelationship between HER4 expression and the clinical features of renal cell carcinoma. Methods Seventy-five cases of paraffin-embedded tissues from renal eell carcinoma were tested for the expres-sion of HER4 by immunohistochemistry.Forty-six cases were male,29 cases were female,the median age was 49 years old.All of these cases were diagnosed as renal cell carcinoma(51 cases of clear cell carcinoma,1 5 cases of granular cell carcinoma,and 9 cases of papillary adenocarcinoma).The control group was 20 cases of normal renal tissue 5 am away from the tumor.Descriptive analysis was applied to compare the differences used the x2.test.Statistical analysis was done by SPSS 10.0. Results HER4 was overexpressed in 78.7%RCC(9 cases with weak positive,18 cases moderate positive,41 caseS intensive positive and 7 cases negative)cases.The expression of HER4 was negative in all nor-mal tissue.The overexpression of HER4 was correlated with the lymph node metastasis and TNM staging(P<0.05). Conclusions HER4 overexpressionis correlated with Stage of RCC.

Objective To investigate the clinical distribution and drug resistance of Pseudomonas aeruginosa in Ningbo area .Methods Pseudomonas aeruginosa strains isolated from the Affiliated Hospital of Ningbo University School of Medicine , Ningbo First Hospital , and Ningbo Ninth Hospital during January 2010 and December 2013 were collected .The clinical distribution of the strains was analyzed , and the antimicrobial susceptibility was determined with Kirby-Bauer method.WHONET 5.6 software was used for data analysis.Results A total of 1 757 Pseudomonas aeruginosa strains were collected in 4 years, accounts for 6.6% (1 757/26 544) of total bacterial strains isolated.Among 1 757 strains, 622 (35.4%) were isolated from intensive care unit ( ICU), and 322 (18.3%) from respiratory department.Most strains (1 045/1 757, 59.5%) were isolated from sputum specimens , followed by urine and succus prostaticus (148/1 757, 8.4%), bronchoalveolar lavage fluid (116/1 757, 6.6%), pus and wound secretion (237/1 757, 4.6%) .Strains were highly resistant to most commonly used antibiotics , and the resistance remained steady during four years.While the positive rates of carbapenem-resistant Pseudomonas aeruginosa (CRPA) were increased, which were 35.8%,45.8%,44.5% and 54.3% in each year.Conclusion Pseudomonas aeruginosa presents a wide clinical distribution and high resistance to multiple antibiotics in Ningbo area .

OBJECTIVE To evaluate the clinical efficacy of cefoperazone/sulbactam(Sulperazon) for acute exacerbation of chronic obstructive pulmonary disease(AECOPD).METHODS A total of 136 cases of AECOPD were randomized into cefoperazone/sulbactam group and ceftazidime group,and sputum culture of each case was underwent before and after treatment.RESULTS The total efficacy rates and bacterial clearance rates in cefoperazone/sulbactam group and ceftazidime group were 91.18%,96.67% and 70.59%,75.86%,respectively,and the differences between the two groups were statistically significant.CONCLUSIONS It suggested that cefoperazone/sulbactam be a more effective drug for AECOPD.

OBJECTIVE To evaluate the clinical efficacy of piperacillin/tazobactam for severe community acquired pneumonia(CAP) among elderly.METHODS Seventy-six elderly cases of severe CAP were randomized into piperacillin/tazobactam group and ceftriazone group,and the sputum culture was underwent for each case before and after treatment.RESULTS The total efficacy rates and bacterial clearance rates in piperacillin/tazobactam group and ceftriazone group were 92.11% and 88.89%,and 73.68% and 58.82%,respectively,and the differences between the two groups were statistically significant.CONCLUSIONS It suggestes that piperacillin/tazobactam be a more effective drug for severe CAP among elderly in old age.

OBJECTIVE To evaluate the clinical efficacy of piperacillin/tazobactam for acute exacerbation of chronic obstructive pulmonary disease(AECOPD) with pulmonary encephalopathy.METHODS Seventy three cases of AECOPD with pulmonary encephalopathy were randomized into piperacillin/tazobactam group and ceftazidime group,and sputum culture was underwent for each case before and after treatment.RESULTS The total efficacy rates and bacterial clean rates in piperacillin/tazobactam group and ceftazidime group were 91.67% and 88.89%,75.68% and 57.89%,respectively,and the differences between the two groups were statistically significant.CONCLUSIONS It suggested that piperacillin/tazobactam be a more effective drug for AECOPD with pulmonary encephalopathy.

Objectives To explore the expression of HER4 and VEGF in NSCLC and elucidate the relationship between their expression and the characteristic of clinical pathology. Methods 82 cases of paraffin-embedded tissues from informative NSCLC were used to detect the expression of HER4 and VEGF by means of immunohistochemical assay. Results HER4 is overexpressed in 65;9%of NSCLC cases. The overexpression of HER4 is correlated with the lymph node metastasis and TNM staging. VEGF is expressed in 53.7%of NSCLC cases. The expression of VEGF is also correlated with the lymph node metastasis and TNM staging, and the expression of VEGF is correlated with the overexpression of HER4.Conclusions HER4 and VEGF are the protein to regulate the growth of NSCLC and it might be a good way for the treatment of NSCLC by suppressing the overexpression of HER4 and VEGF.

Objective To investigate the multi-drug resistance of Klebsiella strains and its mechanism.Methods Twenty strains of Klebsiella were isolated from the Affiliated Hospital of Medical College,Ningbo University from October 2009 to March 2011,in which 18 isolates were Klebsiella pneumonia and 2 were Klebsiella planticola. Drug sensitivity was determined by K-B tests. Drug resistant genes gyrA,parC (chromosome mediated) and aac( 6′)-I b-Cr,qnrA,qnrB,qnrS,qepA (plasmid mediated) were amplified by PCR and verified by direct automated fluorogenic sequencing. Results Resistance to β-1actams,aminoglycosides and quinolones was observed in 20 strains,and resistant rates were all above 80％.Klebsiella planticola strains were sensitive to imipenem and meropenem.Mutations of gyrA and parC genes existed in 18 strains (90％),and the positive rates of aac (6') -I b-C r,qnrB and qnrS were 60％ (12/20),20％ (4/20) and 20％ (4/20),respectively.Conclusion The mutations ofgyrA and parC genes may be the main cause of the resistance to quinolones in these strains.

OBJECTIVE To analyze the antimicrobial resistance of Acinetobacter baumannii.METHODS A.baumannii was collected in our hospital from Jan 2003 to Dec 2006.Antimicrobial susceptibility testing was performed by disk-diffusion method.RESULTS A total of 548 A.baumannii were collected during 4 years.Of these isolates,130(23.7%) strains were from intensive care unit(ICU),190 strains(34.7%)from surgical,and others from medical and emergency departments.Most of strains(78.5%) were isolated from sputum,next from wound.The prevalence of A.baumannii was increasing during last 4 years.Results of susceptibility test showed that imipenem was the most active antibiotic against A.baumannii.The resistance rates were high to most antibiotics.Most of the resistant strains was from the ICU and the general ward differentand had significant difference.More than 50% of isolates were resistant to all antimicrobial agents tested except imipenem and ciprofloxacin in ICU.CONCLUSIONS The prevalence of A.baumannii is increasing.A.baumannii isolates show high resistance to multiple antibiotics,especially in ICU.

Objective To determine the prevalence and treatment of chronic obstructive pulmonary diseases (COPD) among citizens in Ningbo. Methods A multi-stage stratified random sampling was applied to select 8 neighborhoods and 3 villages out of 7 districts in Ningbo, people who were older than or equal to 40 years were enrolled as subjects. Information on the prevalence rate and treatment conditions of COPD was collected through respiratory symptoms and treatment questionnaire and lung function screening. Results A total of 5865 people were screened, 5674 of them met inclusion criteria and completed questionnaire and lung function test. Among whom, 3044 people were men (53.6%, the average age is 55.7±11.4), 2630 women (46.4%, the average age was 55.3 ± 10.7);473 of them were diagnosed with COPD, the overall prevalence rate was 8.3%, including 354 cases who had never been diagnosed as COPD, accounted for 74.8% of the total cases diagnosed with COPD, mainly in stage ⅠandⅡof the disease. There were statistically significant differences between diagnosed and undiagnosed patients in the overall COPD group and among different gender groups ( stagesⅠandⅡ) and (stagesⅢandⅣ). Among the 473 COPD cases, 119 (diagnostic yield 25.2%) of whom had been diagnosed with bronchitis, only 48 (41.2%of the diagnosed) received drug treatment, only 13 patients were treated regularly with medication. Conclusion The overall prevalence rate of COPD among those over 40 years of age in Ningbo was quite high and mainly had stagesⅠandⅡof the disease. The number of the diagnostic yield and those who received regular treatment are quite low. The current situation of diagnosis and treatment are far from satisfaction, management of COPD should be strengthened to reduce the burden for family and society.