OBJECTIVE To find out the changes of pathogens and their sensitivity to antibiotics in bile samples of patients with biliary tract infection of our hospital during last six years. METHODS The data of 359 strains of microbes found in 371 patients with positive bile culture from Jan 2001 to Dec 2006 and their sensitivity to antibiotics were statistically analyzed. RESULTS There were 84 and 188 positive samples respectively in 140 samples during the first half of this study (2001-2003)and 231 ones during the second half (2004-2006) as well as 105 and 254 strains cultured. Respectively, Gram-negative bacteria accounted for 60.0%, and 50.8% and Gram-positive cocci 34.3%, and 40.2% and fungi 5.7%, and 9.0%; Escherichia coli was the major one and accounted for 36.2%, and 31.1%, with the increasing incidence of the positive rates of its ESBLs (34.2% vs 60.8%, P

Objective To evaluate the effect of laparoscopic adrenalectomy for adrenal tumors by transperito-neal or retroperitoneal approaches. Methods Atotal of 41 laparoscopic adrenalectomy for adrenal tumor patients were pertormed,inchiding 16 patients by transperitoneal approach and 25 patients by retroperitoneal approach. The tumor size,operative time,intraoperative blood loss, postoperative hospital stay, postoperative ambulatory day and postopera-tive complications were observed. Results Of the 41 cases ,3 cases were transferred to open surgery and the other 38 cases were achieved successful operations. No significant differences( all P>0.05) were found in tumor size,intraop-erative blood loss, postoperative hospital stay, postoperative ambulatory day between the transperitoneal group and ret-roperitoneal group ,but there were significant differences( P<0.05) in operative time and intraoperative blood loss be-tween the two group. Conclusion Both the transperitoneal and retroperitoneal laparoscopic approaches are feasible and safe for adrenal tumors, and the latter has more advantages in operative time, but the operative approach still should be chosen based on the pathological changes,tumor size and position as well as the individual conditions of the patients.

Objective To compare the characteristics and differences of the activation of the brain regions between the digital memory span task and digital working memory task.Methods 12 right-handed volunteers participated in a test of 7-digit memory span and a test of 2-digit working memory respectively, while the functional MR imaging (fMRI) data were recorded by a Seimens 1.5 T MR machine. Two control tasks were performed respectively and stimulation paradigms was block-design. SPM 99 was used to analyze the data and to localize the activated brain regions.Results The Brodmann area (BA) 6, 9 and 47 regions in the frontal lobe, the BA 7 and 40 regions in the parietal lobe, the cingulate gyrus, the hippocampus structures, the striatum and the cerebellum were activated by both tasks in comparison to their control tasks. Bilateral BA 18 and 19 regions of the occipital lobe without hemisphere predominance were the most activated regions by the digital memory span task, and the BA 37 region of the temporal lobe was also activated. However, the frontal lobe with left predominance was the most activated region by the digital working memory.Conclusion Different brain regions play distinct roles in different short-term digital memory tasks, and might be involved in different stages. The fMRI is a good tool for exploring the process of digits in the brain.

Objective:To observe whether there is abnormal expression of tetrodotoxin-resistant (TTX-R)hNa v1.8 channel protein in demyelinated fibers of the affected nerves in patients with trigeminal neuralgia(TN), and to explore the relationship between ectopic discharges and TN.Methods: Six affected inferior alveolar nerves obtained from patients with idiopathic TN were studied. One great auricular nerve and one normal inferior alveolar nerve were used,which were obtained from patients undergoing combined radical neck dissection with glossectomy (negative control) and mandibulectomy (normal controls) . One rat spinal nerve was used as positive control. Immunohistochemical method and electron microscope were used to observe the expression of TTX-R hNa v1.8 channel protein in all groups. Results: Strong expression of hNa v1.8 channel protein was found in the demyelinated fibers of the affected nerves in patients with TN, weak expression in the neuraxon of rat spinal nerve,and none in the normal inferior alveolar nerve and the great auricular nerve. Conclusion: Abnormal expression of hNa v1.8 channel protein in the demyelinated fibers in patients with TN may play an important role in the pathogenesis of TN.

Objective To investigate the distribution of qnr and aac(6')- Ⅰ b-cr genes of clinical isolates resistant to ciprofloxacin in Enterobacteriaceae in Wenzhou. Methods From August 2005 to April 2008 a total of 461 clinical isolates resistant to ciprofloxacin in Enterobacteriaceae (370 isolates of Escherichia coli, 39 isolates of Enterobacter cloacae and 52 isolates of Klebsiella) were collected from the First Affiliated Hospital of Wenzhou Medical College. qnr and aac(6')- Ⅰ b genes were detected by PCR for all the clinical isolates, DNA sequencing was used for qnr and aac(6')-Ⅰ b-cr identification and conjugation experiment was proved to find ways of transmission of antimicrobial resistance. Results Fifteen qnr-positive isolates were detected among 461 Enterobacteriaceae isolates, including 5 qnrA-positive isolates (4 Enterobacter cloacae isolates and 1 Klebsiella ornithinolytica isolate), 4 qnrB-positive isolates( 2 Klebsiclla paeunoniae isolates and 2 Escherichia coli isolates), 6 qnrS-positive isolates(2 Klebsiella pneunoniae isolates and 4 Escherichia coli isolates). Fifty-two among 461 Enterobacteriaceae isolates harbored aac(6')- Ⅰ b-cr gene, including 42 Escherichia coil isolates, 4 Enterobacter cloacae isolates and 6 Klebsiella isolates. DNA sequencing for 15 qnr-positive isolates found they harbored aac(6')- Ⅰ b-cr gene simultaneously. Fifteen qnr-positive isolates were susceptible to imipenem but resistant to some other drugs. Conjugation experiments were successfully carried out in 7 of 15 isolates harbored qnr and aac(6')-Ⅰ b-cr genes, and their resistance to quinolones and aminoglycosides was partly transmitted to the recipient isolates. Conclusion The qnr genes are few in clinical isolates resistant to ciprofloxaein in Enterubacteriaceae in Wenzhou, however the aac(6')- Ⅰ b-cr gene is popular.

Objective To determine the efficacy of individual cognitive training (CT) in the treatment of cognitive and neuropsychiatric symptoms in patients with mild to moderate Alzheimer disease ( AD). Methods A randomized, controlled, rater-blind clinical trial recruited 32 AD patients. AH patients were assigned to a CT group (n = 16) or a control group (a time and attention control, n = 16) for 10 weeks. All outcome measures were administered at baseline and follow-up. The cognitive status was evaluated using the Mini Mental State examination (MMSE) , a clock-drawing test (CDT) , Fuld's object memory evaluation (FOME) , a rapid verbal retrieval (RVR) , digit span assessments (DS) , block designing (BD), and the A version of the trail making test (TMTA). The patients' functional status was evaluated using an activities of daily living (ADL) scale. Any psychological and behavioural disorders were evaluated with the Neuropsychiatry Inventory ( NPI). Results Patients receiving CT showed greater average improvements in NPI total score, TMT-A score and MMSE total score than the controis at week 10. There was no statistically significant benefit for CT-treated patients in terms of ADL score. Conclusions Cognitive training can raise the NPI total scores and MMSE total scores of patients with mild to moderate AD.

ObjectiveTo investigate the characteristics of spontaneous activities throughout the whole brain with Alzheimer's disease (AD) by resting state functional magnetic resonance imaging ( fMRI ).Methods The subjects included 23 AD patients and 21 normal controls (NC),who underwent a neuropsychological test battery including MMSE and Auditory Verbal Learning Test (AVLT) and restingstate fMRI using GE Signa 3.0 T MR scanner.The neuropsychological scores were compared between two groups.Regional homogeneity (ReHo) method was used to explore the different regional spontaneous activities throughout the brain between normal controls and patients with AD.Results In AD group,clinical variables (MMSE scores:20 ±4,AVLT-Immediate Recall:2.6 ± 1.6,AVLT-Delay Recall:0.4 ±0.7,AVLT-Recognition:5.8 ± 3.7 ) were lower than NC group( 29 ± 1,5.9 ± 1.2,5.5 ± 2.0,9.2 ± 1.1,T =10.58,7.21,10.99,3.96,all P ＜ 0.01 ).With the threshold of P ＜ 0.01 for each voxel and a cluster size of at least 100 voxels,decreased ReHo indexes were found in default mode network (DMN) including the medial prefrontal cortex,posterior cingulate gyrus/precuneus,right superior temporal gyrus and bilateral superior parietal lobule/inferior parietal lobule in AD,while increased ReHo indexes were found in left putamen and thalamus compared with controls.ConclusionThe DMN are damaged in AD and spontaneous activities of putamen and thalamus are reinforced as compensation response of subcortical structures.

Objective To study the functional connectivity (FC) pattern of thalamus in patients with Alzheimer' s disease (AD).Methods In the present study,resting state functional magnetic resonance imaging (MRI) data were obtained from 30 patients with AD and 26 subjects with normal cognition (NC).The altered functional connectivity pattern in AD was evaluated by comparing to NC.Then a correlation analysis was performed between the strength of FC of the identified regions and various clinical variables for evaluating the relationships between the strength of FC and the cognitive abilities (MMSE,immediate recall and delayed recall of Auditory Verbal Learning Test) of the AD patients.Results The MMSE(19.7 ± 4.1),immediate recall (2.8 ± 1.7) and delayed recall (0.7 ± 1.3) of Auditory Verbal Learning Test in AD patients were lower than NC group (28.8 ± 1.0,5.9 ± 1.2,5.7 ± 2.2 ; t =11.09,8.09,10.51,all P ＜0.05).Compared to NC,AD patients showed decreased FC between the left thalamus and several regions of brain including right posterior/middle cingulate cortex (PCC/MCC.R),left medial prefrontal cortex (MPFC.L) and right superior frontal gyms/medial prefrontal cortex (SFG/MPFC.R).For the right thalamus,decreased FC was found in SFG/MPFC.R,PCC/MCC.R and right hippocampus.We also found increased FC between the bilateral thalamus and many regions of brain including inferior temporal gyrus,medial temporal gyrus,SFG,postcentral gyrus,paracentral lobule,inferior frontal gyms and insula.Significant correlations between the fitted FC strength and clinical variables were also detected.Conclusions FC pattern of thalamus in AD group is impaired.Increased FC in AD may indicate the presence of a compensatory mechanism.The alteration is related with cognitive function in AD.

Objective,This study was designed to evaluate the predictive value of pre-procedure Cardiac troponin I(cTnI)and CRP levels in patients with acute coronary syndrome(ACS)undergoing percutaneous coronary intervention(PCI).Methotis cTnI and CRP were determined on admission in 335 consecutive patients with ACS who underwent primary PCI.Blood samples were obtained within 6-10 h after onset of symptom.The concentration of cTnI was determined by an automated chemiluminescence immunoassay.CRP was measured by immunoassay assay.According to the admission cTnI(＜0.1,0.1-0.5,＞0.5μg/L)and CRP(≤3,＞3 mg/L)divided into different groups.The pre-procedure cTnI and CRP status associated with 30 days cardiac mortality and major adverse cardiac events(MACE.including cardiac death.non-fatal recurrent MI.heart failure.readmission for any reason)were analyzed.The cardiac mortality at follow.uD period of 2 years were analyzed.Results Muhivariate logistic regression analyses revealed preoperative cTnI predicted 30 days cardiac mortality(OR=3.5,95%CI 2.2-5.3,P＜0.01),and recurrent MI rate(OR=1.5,95%CI 1.1-2.6,P＜0.05),independent of other known prognostic factors such as age,gender,hypertension,Hypercholestemlemia,diabetes and smoking.The pre-procedure CRP was independently related to 30 days cardiac mortality(OR=1.6,95%CI 1.1-2.3.P＜0.05),whereas there was no relationship to the MI rate.In ACS,levels of CBP≤3 mg/L,the three different risk groups (cTnI＜0.1,0.1-0.5,＞0.5μL)with corresponding 30 days MACE rates of 4.3%,11.7%,18.8%(X~2=4.829,P=0.028),CRP＞3 mg/L,the three groups mth corresponding 30 days MACE mtes of 5.5%,13.2%,21.1%(X~2=5.862,P=0.015),respectively.Patients were followed up for 2 years,Kaplan-Meier survival analysis demonstrated a significantly reduced survival at 2 years in patients witll a cTnI ＞0.5μg/L(80.0%versus 89.1%for a cTnI of 0.1-0.5μg/L and versus 92.2%flor cTnI＜0.1μg/L;X~2=7.571,P＜0.05 by log-rank).Conclusions The levels of CRP and cTnI in Acs of onset in 6-10 h provide an even better risk stratification after the PCI.and closely correlate with 30 days MACE.Elevated cTnI provides long-term prognostic information regarding cardiac mortality.Therefore.The combination of CRP and cTnI measurement should be taken into consideration for risk stratification to decide about the management strategies in ACS patients.

Objective To investigate the prevalence of aac(6')-Ib-cr in clinical isolates of Klebsiella pneumoniae.Methods A total of 337 isolates of Klebsiella pneumoniae were isolated from clinical specimens in our hospital from Jan,2006 to Sep,2007.Gentamycin,amikacin or tobramicin was used to screen the isolated with aac(6')-Ib-cr.aac(6')-Ib and class 1 interase gene(intl1)was determined by PcR All PCR products of aac(6')-Ib were sequenced for determination of aac(6')-Ib-cr. MICs of antibiotics were determined by agar dilution method.The ESBLs-producing isolates were determined by the CLSI-recommended confirmatory tests.Conjugation test was used to detect the transfer of plasmid.Results Of the 337 clinical isolates of Klebsiella pneumoniae,64(19.0%),28(8.3%)and 55(16.3%)isolates were resistant to gentamycin,amikacin and tobramycin,respectively.Among 64 gentamycin-resistant isolates,24(37.5%)were positive for aac(6')-Ib-cr,including 13 ciprofloxacin-resistant isolates and 11 ciprofloxacinsusceptible isolates.The prevalence of aac(6')-Ib-cr in ciprofloxacin-resistant and-susceptible isolates were 54.2%(13/24)and 27.5%(11/40).The positive rates of ESBLs and intl1 in the 24 isolates carrying aac(6')-Ib-cr were 79.2%(19/24)and 91.7%(22/24).Plasmids carrying aac(6')-Ib-cr of 13 isolates were successfully transferred to E.coli J53.Plasmids of all transconjugants were positive for aac(6')-Ib-cr and intl1.All transconjugants were ESBL producing strains.Conclusions aac(6')-Ib-cr exists widely in clinical isolates of Klebsiella pneumoniae.aac(6')-Ib-cr and ESBL gene usually coexist in a selftransmissible conjugative plasmid by class 1 integron.