Objective To evaluate the clinical value of self-designed big cup membranate stent on restenosis after stenting for carcinoma of esophago-cardia. Methods 12 cases of restenosis after stenting for carcinoma of esophago-cardia were involved in the study. Self-designed big cup membranate stent made by Nanjing Weichuang Company(the length of the cup was 3.5 cm)was placed into the constricted stent under guidance of fluoroscopy. Clinical effect, restenosis, and complications were observed during followed up. Results All the 12 cases of big cup membranat stent placement went along smoothly without indigitation of the cup of the stent. Follow-up of 1.5-8 months showed that 2 cases developed severe restenosis on the big cup of the stent, resulting in third grade difficult deglutition. Among them, one occurred 1 month after stenting, caused by hyperplasia of large amount of granulation tissue; another occurred 6 months after stenting, caused by growth of tumor tissue. 3 cases developed mild to moderate restenosis, 2.3-7 months(mean: 4.6 months)after stenting, with result of first grade difficult deglutition. The remaining 7 cases(mean5.6 months follow-up) did not have difficulty during deglutition. Conclusions Application of big cup membranate stent on restenosis after stenting for carcinoma of esophago-cardia can effectively prevent the stent from moving downwards and thus lower down the rate of restenosis, and postpone the occurrence of restenosis.

Objective To investigate the correlation between auditory steady state responses(ASSR)and click audiotory brainstem respone(cABR)of infants as a function of different ages below 36 months.Methods 299 infants(497 ears from 1 to 36 months)were divided into 5 groups:208 ears in group 1(1~ month old),81 ears in group 2(4~ months old),47 ears in group 3(7~ months old),53 ears in group 4(13~ months old),and 108 ears in group 5(19~36 months old).The correlation analysis of the thresholds of 2 kHz and 4 kHz between ABR and ASSR were conducted,respectively with SPSS.Results In group 1,the correlation coefficient at 2 kHz between ABR and ASSR was 0.499,the correlation coefficient at 4 kHz between ABR and ASSR was 0.541,the correlation coefficient of the means of 2 kHz and 4 kHz between ABR and ASSR was 0.531.In group 2,these three correlation coefficients were 0.678,0.705 and 0.726,for group 3,0.792,0.717 and 0.777;for group 4,0.934,0.880 and 0.915,for group 5,0.817,0.810 and 0.867.Conclusion For infants of 1~18 months old,the correlation between ABR and ASSR increases as a function of ages.

Objective To develop a novel multiplex polymerase chain reaction (PCR) to detect multidrug-resistant Acinetobacter baumannii.Methods One hundred and five strains of multidrug-resistance A. baumannii were isolated from January 2006 to April 2007. The bacterial DNA was obtained by boiling the pure growth of A. baumannii. All isolates were subjected to the multiplex PCR to detect genes of blaOXA-23-like,blaOXA-24-like,blaOXA-51-like,blaOXA-58-like,intI 1 and intI 2.Results Among 105 isolates,76 were positive for blaOXA-51-like,blaOXA-23-like,and intI 1,18 were positive for blaOXA-51-like and intI 1,10 were positive for blaOXA-51-like and blaOXA-23-like,1 was positive for blaOXA-51-like and blaOXA-23-like,1 was positive for blaOXA-51-like,blaOXA-23-like,and blaOXA-58-like,and all were negative for blaOXA-24-like and intI 2.Conclusion The presence of OXA carbapenemase and integrase genes was correlated with multidrug resistance in A.baumannii.

OBJECTIVE To investigate the genes of carbapenemases and integrases in multi-drug resistant Acinetobacter baumannii(MDRAba).METHODS PCR was used for detection of genes of carbapenemases: OXA-23-like,OXA-24-like,OXA-51-like,and OXA-58-like,and integrases Ⅰand Ⅱ from 70 clinical strains of carbapenem-resistant A.baumannii(CRAba).PCR products of OXA-23-like and OXA-58-like were analyzed by sequencing.Agar dilution method was carried out for antimicrobial susceptibility test.RESULTS Genes for OXA-23-like and OXA-51-like were positive from 56 and 69 isolates,accounted for 80.0% and 98.6%, respectively;gene of OXA-58-like was detected from only one strain.Sixty one strains showed positive for integrase Ⅰ gene.OXA-23 or OXA-58 was the exact gene type by sequencing.All 70 strains were highly resistant to ciprofloxacin,ceftazidime,and gentamicin,but susceptible to polymyxin B.CONCLUSIONS CRAba strains distributed in General Hospital of PLA mainly possess OXA-23 type carbapenemase and integraseⅠ.

Objective To evaluate the feasibility,safety and efficacy of surgical treatment of the thoracic and thoracolumbar disc herniations through the posterior far lateral approach,Methods From April 2005 to June 2010,24 consecutive patients with thoracic or thoracolumbar disc herniations were treated surgically,using the posterior far lateral approach.There were 15 males and 9 females with the mean age of 53.6 years old(range,25-69 years).The levels of herniated discs were located in T4-s,T5-6,T6-7 for 1 case,in T9-10 for 1 case,in T10-11 for 2 cases,in T10-11,T11-12,T12L1 for 1 case,in T11-12 for 3 eases,in T11-12,T12L1 for 3 cases,in T12L1 for 4 cases,in T12L1,L1-2 for 3 cases,and in L1-2 for 6 eases.There were one level disc herniation in 16 cases,two levels disc herniation in 6 cases and three levels disc herniation in 2 cases.16 out of 24 cases had "bony protrusions",including bony separation of the endplate,bony spur,disc calcification or OPLL.The average preoperative Cobb angle of localized kyphosis was 10.5°.According to the Frankel grading system,5 cases were classified as C,16 as D,and 3 as E,preoperatively.Results Average operation time was 3.5 h(2.0-4.5 h),and mean blood loss was 800 ml(300-4000 ml).Postoperative localized kyphosis was an average of 4.6°,with average correction rate of 56.2%.24 cases were followed up for 1 to 62 months,with an average of 18 months.According to Japanese Orthopaedic Association(JOA)criteria system,there were 12 cases(50.0%)with excellent outcome,9 cases(37.5%)with good outcome,and 3 cases(12.5%)with fair outcome.The postoperative Frankel grading were C for 1 case,D for 2 cases,and E for 21 cases.There were no complications intraoperatively and postoperatively.The symptoms were improved in all patients.Conclusion By using "safe triangular zone" and dekyphosis stabilization,the posterior far lateral approach was a relatively safe,reliable,effective and better view surgical procedure for the treatment of the thoracic and thoracolumbar disc herniations.

Objective Establishing an employee satisfaction indicator system for tertiary hospitals in Beijing.Methods Evaluation indicators are built on theory research,and questionnaires are designed for survey.Such methods as principal component factor analysis,and verification factor analysis are called into play to test the construct validity and establish in the end the employee satisfaction indicators system.Results Such indicators comprise five grade-1 dimension and 34 grade-Ⅱ dimension,such as hospital management satisfaction indicator.Conclusion This self-designed scale ideally mirrors the employee satisfaction of tertiary hospitals in Beijing,proving the indicators to be objective and reasonable.

Employment related with the quality of life and the development of occupation of the people with mental retardation(MR).This paper compared the employment of MR native and abroad,suggested the strategy referencing to the supportive employment theory.

Objective To investigate the safety and efficiency of thoracic laminectomy with dekyphosis for thoracic myelopathy due to multi-segmental ossification of the posterior ligaments.Methods The clinical data of five cases of thoracic myelopathy due to multi-segmental ossification of longitudinal ligaments who were surgically treated in our hospital between August 2012 and March 2013 were retrospectively analyzed,among which two were male and the other three were female,with an average age of 52 (range,45-56) years old.The pre-operative duration ranged from 2 months to 6 years.All five cases were suffering from progressive bilateral partial paraplegia with an average preoperative JOA score 3.8 (range,3-6),an average segment-number of ossification of the posterior ligaments 7.6 (range,5-10),and also an average segment-number of 5.0 (range,2-10) ossification of the ligamentum flavum.All the five cases showed different kyphosis at the stenotic area of thoracic spine,with an average kyphotic angle (Cobb) of 35.8° (range,22°-56°).Their pre-operative Japanese Orthopaedic Association score (JOA) was 3.8 averagely (range,3-6).Clinical features,operation time,blood loss,perioperative complications and postoperative outcome were recorded.Results The segment number of laminectomy of these five cases was 8.2 averagely.The segment number of dekyphosis was 2 for 2 cases and 1 for the other 3 cases,with a average dekyphotic degree of 7.8° (range,2°-15°).The average operation time was 6.3 hours (range,5.5-7.0 hours) and the average blood loss was 3900 ml.The perioperative complications included cerebrospinal fluid leakage in 4 cases who were treated conservatively,and epidural hematoma in 1 case who underwent reoperation for removing the hematoma.All cases were followed up for 21 to 27 months,and their average final JOA score was 10,with an average recovery rate of 85.6％,and a rate of excellent or good was 100％ by the modified Epstein standard.Conclusion The result of thoracic laminectomy combined with dekyphosis for thoracic myelopathy due to multi-segmental ossification of longitudinal ligaments is quite satisfying,however this procedure is demanding with a long operation time,a huge blood loss and a high complication rate.

0.05).Our results showed that,for recommended oral doses of ciprofloxacin and moxifloxacin,44.2% of E.coli isolates from the intestine of the health population,and 29.5%,18.7% and 10.7% of isolates from the three sterile sites of the patients,would be selected as resistant mutants.When ciprofloxacin and moxifloxacin were taken by injection route,the ratio of the selection of resistant mutants would be 9.3% for E.coli isolates from the intestine of the health population and 8.2%,6.2% and 8.9% for the three sterile sites of the patients,respectively.The maximum attainable concentration of levofloxacin in serum showed little distinction between the oral and the other routes.CONCLUSIONS The values of MIC and MPC of three fluoroquinolones in E.coli isolates from different populations and sites show no association.The values of MPC couldn't be predicted by the MIC.The values of MPC and MPC90 of three drugs show no significant discrepancy for tested isolates,these E.coli strains are isolated from the intestine of heath persons,and from the blood,ascites,bile of patients.

Osteoporosis is a common metabolic bone disease in the elderly. It may be one of the factors which contributes to instrumentation failure in spinal surgery. Bone cement augmentation of the pedicle screw is a technique to enhance fixation strength, and it is now mainly applied in patients with osteoporosis and revision surgery, as well as spinal tumor surgery. According to clinical studies, bone cement augmentation can decrease screw loosening rate, prevent correction loss of the spine deformity, and increase the fusion rate. Pedicle screw fracture and pulloutare rare following screw augmentation surgery. The pedicle screw loosening rates following screw augmentation surgery with bone cement are higher in patients with osteoporotic vertebral fracture and lower in patients with spinal degenerative diseases. The main material for bone cement augmentation is Polymethylmethacrylate, and the volume for each screw is about 1-3 ml. Some researchers suggest less volume use in thoracic vertebrae than lumbar vertebrae. Both traditional and cannulated screws can be applied as the augmented pedicle screws, as well as the expandable pedicle screw. Cannulated screws can decrease the risk of bone cement extravasation compared with traditional screws. The mini-mally invasive technique of screw augmentation with bone cement can be used both in primary spinal surgery and augmentation of loosed screws. The main complications of the bone cement augmentation technique are cement leakage and pulmonary cement em-bolism. X-ray fluoroscopy is generally used to detect cement extravasation during the bone cement procedure. The 3D navigation and neurological monitoring are also recommended to reduce cement leakage in some studies. Most local cement leakage events are asymptomatic and need no treatment. Management of pulmonary cement embolism depends on the clinical presentation and the position of the emboli, including regular follow-up, oxygen inhalation, anti-coagulation therapy and embolectomy.