Objective To evaluate the susceptibilities of different testing methods of tigecycline against IRAB. Methods MIC and inhibitory zone diameters of 32 strains of IRAB for tigecyclinc were determined by different testing methods.Data were analyzed by comparing the results from each method to those produced by the reference macro broth dilution method. Results The rates of sensitivity intermediate resistance detected by macro broth dilution method , agardilution , MTS and Vitek-2 instrument , disk diffusion method were as follows , 34.375%, 65.625%, 0%, 3.125%, 81.25%, 15.625%, 75%, 25%, 0%, 78.125%, 21.875%, 0%, 3.125%, 81.25%, 15.625%. Compared with macro broth dilution method ,the key major error rate of other methods was 0% by FDA breakpoints , but the CA and EA rates were less than 90%. Conclusions Tigecycline has good activity against the IRAB, with significant difference in susceptible rate among the different methods.

This article explores the teaching methods of laparosopic operation training of the begnners. In teaching emphasis should be put on the accumulation of the learners'operation experience,the study of the relative theory,the simulative training and the relative practice.

Education of evidence-based medicine in clinical research is important in enhancing primary hospital clinical research capacity and quality.Dongyang People's Hospital of Zhejiang Province has carried out evidence-based medicine education and training,and greatly improved the performance of clinical research and development of scientific researchers.

Clinical thinking of Clinicians in Dongyang People's Hospital is gradually shifting from ‘empirical medicine’ to ‘evidence-based medicine’ after popularizing of evidence-based medicine, training core members and implementing multi-layered, multi-channeled, comprehensive and sustainable resident doctor training mode with clear steps and purposes within three years. This paper discussed on reasonable clinical practice of evidence-based medicine in primary hospital and provided realistic basis for the further development and improvement of training of evidence-based medicine in primary hospital.

This study is to investigate the tumor invasion and metastasis inhibition effects of the immunoconjugate composed of lidamycin and anti-type IV collagenase monoclonal antibody Fab' fragment. Boyden chamber assay was used to evaluate the influence of Fab'-LDM on HT-1080 cells invasion ability, gelatinase spectrum was used to measure the change of invasion factor MMP-2 and MMP-9's secretion, and RT-PCR was adopted to determine TIMP-1 mRNA expression level. The immunoconjugate inhibition of tumor in situ metastasis was also tested in nude mice. The Fab'-LDM conjugates had dose-dependent inhibition effect on HT-1080 cells' invasion. At the concentrations of 5 and 10 nmol L(-1), the Fab'-LDM inhibited the invasion by (60 +/- 12) % and (79 +/- 11) % respectively. At the concentration of 5 and 10 nmol L(-1), the Fab'-LDM inhibited the secretion of MMP-2 by (42 +/- 8) % and (54 +/- 6) % and that of MMP-9 by (57 +/- 3) % and (87 +/- 1) %, respectively. RT-PCR indicated that conjugates increased the anti-invasion factor TIMP-1 level. The in vivo experiment showed that, compared with the control group, the tumor inhibition rate in Fab', Fab'-LDM, and LDM group equaled to (30 +/- 13) %, (86 +/- 26) %, (74 +/- 22) % respectively. In conclusion, Fab'-LDM could inhibit the invasion and metastasis of tumor and it might be a new tumor biotherapy agent.

Objective:To investigate the combining therapy which not only have cured effect but also can uphold and improve the NPC patient′s immunity function after radiotherrapy and chemotherapy.Method:90 cases randomly divided into 3 groups ①Local group (local injected with IL-2 +radiotherapy+chemotherapy);②General group(ivdrip with IL-2+radiotherapy+chemotherapy);③convention group(radiotherapy+chemotherapy).Checked and observed the immunity function around the immunotherapy and after the radiotherapy and chemotherapy.Result:Cellular immunity of 3 groups are lower and humoral immunity are hypetuntion than normal person.After treated with IL-2 the cellular immunity improves but there′s no great change of the humoral immunity. The immune status of the immune groups have not obvious change than before radiotherapy,at the same time,the cellular immunity of the convention group cut down and the humoral immunity doesn′t change obviously.Conclusion:①It has some effect to uphold and improve the NPC patient′s immunity function to treat with small dosage of IL-2 before radiotherapy and chemotherapy,general treatment is better than local injection;②The three therapies have not great influence on the patient′s humoral immunity.

Objective To quantify the correlations between Elekta XVI cone beam CT dose and various scanning protocols,providing mathematical models to assess the protocol-dependency of imaging dose during imnage guided radiotherapy.Methods Based on standard protocols and various combinations of kVp and mA on an XVI mounted on an Elekta Versa HD accelerator,the air KERMA was measured at various positions in a standard PTW CTDI body phantom using calibrated PTW 30009 kV chamber and UNIDOS webline electrometer.Weighted CT dose index (CTDIw) was computed thereafter.SigmaPlot 10.0 was used to fit the measurements against mA and/or kVp yielding empirical functions.Results Under standard protocols,the CTDIw of Varian OBI was only 11.23％ (chest) and 9.15％ (pelvis) of Elekta XVI.Using the default and other 4 investigated kVp values,the central and peripheral KERMA were both proportional to mA,and vet the slope value a varied dramatically from 0.479 to 6.679.Major affecting factors included kVp settings,measurement locations,and dosimetric mnetrics,etc.None linear regressions were used to fit kVp against KERMA at various locations and CTDIw (R2 ＞ 0.997).The differences between all coefficients were statistically significant (P ＜ 0.05).The impact of changing both mA and kVp on the dose to phantom center can be described as mGy =(5.917-0.197 ×kVp+0.002 × kVp2-5.063 × 10-6 × kVp3) × mA.Conclusions Imaging dose of Elekta XVI is strongly dependent on scanning paraneters.The proposed mathematical models can be used as efficient and robust indicators of such dependency.

In March 2017, a severely burned male patient aged 36 years with hypovolemic shock was admitted to our hospital. The patient received large quantities of antibiotics and blood products and repeated skin graft after admission, and then he suffered wound errhysis and throat congestion. The patient was healthy before without family history of bleeding or thrombosis disease. Laboratory tests showed that prothrombin time and activated partial coagulation time were remarkably prolonged, blood coagulation factor Ⅴ activity was extremely low, and the result of qualitative test of coagulation factor inhibitor was positive. Acquired blood coagulation factor Ⅴ deficiency was diagnosed. After application of dexamethasone (5 mg, twice per day) and infusion of fresh frozen plasma, blood coagulation indicators of patients recovered in 4 days, the result of qualitative test of coagulation factor inhibitor was negative, and bleeding symptoms were improved.

Objective Toexplorethevalueofdualvolumereconstructionininterventionalembolizationofwideneckedintracranial aneurysms.Methods Theclinicalandimagingdataof30patientswithintracranialwideneckaneurysmrupturedwerecollectedfrom June2016toDecember2017intheMeizhouPeople’sHospital.Thetreatmentoftheintracranialwideneckedaneurysm,theposition andopeningofthestentreleasing,therelatedcomplications,andfollow-upreviewafter6monthswereretrospectivelyanalyzed.Results Ofthe30patients,therewere35aneurysms(4 multipleaneurysms),inwhich26caseswerestentsassisted,with26stentsimplanted, and4caseswereballoonassisted.3D-DSAwasperformedimmediatelyafteroperationandevaluatedbydualvolumereconstructionon AdvantageWorkstation (AW)postprocessing workstation.(1)26casesofdenseembolism ofaneurysmswithouttumorneckor tumorresidual(86.7%),3casesofaneurysmcervicalresidual(10%)and1casesoftumorresidual(0.33%);(2)26stentswithaccurate locationsandcompletereleases(100%).(3)2caseswithvasospasmandstentthrombosisduringoperation,and1casewithsecond aneurysmruptureduringoperation.(4)DSAreexaminationsinhalfayearafteroperations:3casesrecurred (11.5%)inthe26cases ofdenseembolism;theresidualin2casesincreasedin4ofaneurysmalneckresidualand2oftumorresidual,andtherestremained;26stentsstayedinthesamepositionandthestentsin3caseswerenarrowed.2D-DSA,3D-DSAanddualvolumereconstructioncould clearlyshowthedegreeofembolizationofaneurysmsin20cases(66.7%),25cases(83.3%)and30cases(100%),respectively.The degreeofembolizationofaneurysmswassignificantlydifferentinthreeimagingmethods(P＜0.05).Conclusion Intheprocessof interventionalembolizationforintracranialwideneckedaneurysm, doublevolumereconstructioncanbeusedtoshowtheeffectof embolization,thelocationofthestentandtherelationshipwith theneckoftheaneurysm,whichprovidesanassessmentofthe situationofaneurysmembolism,thedevelopmentoftheauxiliarystentandtheobjectivefortheselectionofthesurgicalstrategy.

Objective To investigate the relationship between MRI and pathological features of uterine carcinosarcoma(UCS).Methods 13 cases of UCS which were confirmed by surgery and pathology were collected,MRI plain scan and enhanced scan were carried on all of the patients,the pathological tissue was got after operation for conventional HE and immunohistochemical staining.The MRI representation and pathological tissue composition of all the 13 cases were analyzed and summarized.Results 8 cases were occurred in uterine body,3 cases were in the cervix and 2 were involving the uterine body and cervix at the same time.The MRI manifestations of them were enlarged uterine size with irregular masses showed,intermediate or hypointensity intensity signal on T1 weighted and hyperintensity or intermediate intensity signal on T2 weighted,necrosis and cystic lesions were showed in 5 cases,2 cases hemorrhage were displaied which showed hyperintensity signal on T1 weighted,4 cases were endometrial thickening,all of the cases were heterogeneous enhancement;the pathological showed different proportion of carcinorma and sarcoma were visible in all the 13 cases of UCS.Conclusion UCS has complex components histopathologically,including both carcinoma tissue and sarcoma tissue.The heterogeneous signal of cystic degeneration,necrosis and hemorrhage within tumor in MRI could help the diagnosis of UCS.