Objective To observe the clinical results that application improvement lumbar-puncture.Methods (1)Puncture point was always fixed;(2)To keep "perpendicular" concept,and emphasize the action coherent;(3)To reduce to cause the puncture-direction and puncture-point to be partial to move as far as possible of action;(4)To increment enters needle to the complement with "the feeling of obstruct",making the judgment standard by "end up in nothing feeling" not only;(5)To reduce anesthetic dosage.Results Among the 100 patients with the new method to be lumbar puncture,the success rate was 87%.Of the 100 patients with the traditional method,the number was 67%.Conclusion The method of the lumbar puncture techrique can raise success rate indeed,deserving expansion.

Objective To study the expression of p53 and vascular endothelial growth factor(VEGF) in bladder transitional cell carcinoma(BTCC) tissue and its relationship with the clinicopathologic parameters,and to understand the role of p53 and VEGF in the progression of tumors.Methods The expression of p53 and VEGF in 86 cases of BTCC were determined by immunohistochemical LDP methods.Results The positive expression rates of p53 and VEGF in 86 cases of BTCC were 46.51% and 66.28%,respectively.The positive correlation was noted between p53 expression and VEGF expression(P

Objective To investigate the malnutrition status among the elderly in age care institutions in Shanghai suburb and analyze its potential influential factors.Methods The MiniNutritional Assessment (MNA) was adopted to evaluate the nutritional status of the 190 elderly people in age care institutions.The dietary supply by the institution canteen and the quantity of residual food left by the malnourished elderly people were weighted.Results In the age care institutions,the malnutrition rate reached 23.7％,47.9％ of the elderly people were at the risk of malnutrition,and only 28.4％ of the elderly people were well nourished.Logistic regression analysis showed that the major influential factors for malnutrition in the elderly people were food intake ability,mobile capability,chewing and swallowing ability,ageing and mental Illness.The malnourished elderly people had the most residual meat and vegetables,and insufficiency of nutrient intake was the main cause for the malnutrition in the elderly people.Conclusions The elderly people in age care institutions in Shanghai suburb have the higher risk of malnutrition.The malnutrition occurs under influence of many factors,of which some are unavoidable,however,some factors like dietary factors can be changed to improve the nutritional status of the elderly people in age care institutions.

Objective To investigate the etiological characteristics of Streptococcus pyogenes that caused scarlet fever in different periods in Guangdong province.Methods 22 isolates from different periods were analyzed through emm typing,PCR detection for super antigen genes,antibiotic susceptibility test and pulsed-field gel electrophoresis (PFGE).Results All isolates were susceptible to cefotaxim,levofloxacin and penicillin.Streptococcus pyogenes isolated after the year 2000 were 100％ resistant to erythrocin and clindamycin,but the resistant rate for strains isolated before the year 2000 was 9.1％ (1/11).There were 3 emm types indentified from 22 isolates including emm12.0 (59.09％,13/22),emm6.0 (36.36％,8/22) and emm1.0 (4.55％,1/22),which were detected in the isolates from the year 1997 and 2011,from 1978 and 1986,and from 2008,respectively.The positive rates for speA,speB,speC,speF,speG,speH,smeZ,and ssa genes detected by PCR were 54.55％,100％,100％,100％,100％,54.55％,0％,and 86.36％ respectively.Among all strains,95.45％ of the isolates carried 6 superantigen genes simultaneously.Three clusters of 10 PFGE subtypes were identified in 22 isolates.Cluster Ⅰ consisted of all strains from 1997 and one strain from 2011.Cluster Ⅱ consisted of strains isolated from 1978 and 1986.Cluster Ⅲ consisted of nine strains from 2011 and one from 2008.Conclusion S.pyrogenes isolates in Guangdong province were susceptible to penicillin but resistant to erythrocin.emm 12.0 accounted for the majority of the three types and there was a high frequency of super antigen genes.

Objective To investigate the antimicrobial resistance pattern of non-typhoidal Salmonella isolated from diarrhea cases in Guangdong province,China.The multidrug-resistant strains were analyzed by pulsed field gel electrophoresis(PFGE) typing.Methods All the non-typhoidal Salmonella strains isolated between 2009 and 2011 were serotyped,then the antimicrobial resistance was detected by the disk diffusion method and molecular typed by PFGE.Results 91.76％ (256/279) S.typhimurium isolates were multiple resistant to 3 and more antimicrobials.Forty S.typhimurium isolates were multiple resistant to 9 and more antimicrobials and 3 out of which were multiple resistant to all the 12 antimicrobials in vitro.96.91％ (94/97) Salmonella I4,5,12:i:-isolates were multiple resistant to 3 and more antimicrobials.Nine Salmonella I4,5,12:i:- isolates were multiple resistant to 9 and more antimicrobials and I out of which was multiple resistant to all the 12 antimicrobials1 in vitro.47％ (47/100) S.enteritidis isolates were multiple resistant to 3 and more antimicrobials.Only 1 S.enteritidis isolates was multiple resistant to 9 and more antimicrobials.4.27％ (27/632) non-typhoidal Salmonella isolates was resistant to ciprofloxacin,including 17 S.typhimurium and 6 Salmonella 14,5,12:i:- isolates.Also,there were 3 1.96％ ( 202/632 ) non-typhoidal Salmonella isolates was intermediary to ciprofloxacin.The PFGE patterns of the predominant strains which were highly resistant and multidrug-resistant had different genotypes and demonstrated significant genetic diversity.Conclusion The situation about the multiple antimicrobial resistances of non-typhoidal Salmonella in Guangdong province has showed the prevalent problem.The PFGE types of the multiple drug-resistant strains prompted these strains were come from different clones.This requires that we continue to strengthen the resistance monitoring and control of the rational use of antibiotics.

OBJECTIVETo evaluate the efficacy of Prostat in the treatment of NIH category IIIA prostatitis.

METHODSAn open clinical trial was conducted among 106 NIH category IIIA prostatitis patients. For each patient 1 tablet of Prostat (70 mg P5 + 4 mg EA10) was orally administered twice a day.

RESULTSSubjective symptoms of the patients were significantly improved, particularly those of frequent micturition, urgent urination and peripheral region pains. Objective parameters also showed significant improvement. No adverse reaction associated with the medication was observed.

CONCLUSIONProstat was shown to be an appropriate medicine in the treatment of NIH category IIIA prostatitis, with good curative effect and high safety.

Objective:To explore concordance between preoperative core needle biopsy(CNB)and resection specimen(RS)in evaluat-ing biomarkers and molecular subtypes with immunohistochemical method.Methods:A retrospective study was performed on 324 breast cancer patients who underwent modified radical mastectomy at the Tianjin Medical University Cancer Institute and Hospital be-tween August 2015 and November 2016.All patients who had received neoadjuvant systemic therapy were excluded.The aim of this analysis was to report concordance between CNB and surgical specimens in evaluating biomarkers,such as ER,PR HER-2,Ki-67,and molecular subtypes.Results:There was concordance between estrogen receptor(ER)assessment on CNB and RS in 94.1%(305/324) of the patients(κ=0.84).Concordance of the progesterone receptor(PR)and the human epidermal growth factor receptor 2(HER-2) assessments were observed in 90.7%(294/324,κ=0.76)and 61.1%(198/324,κ=0.38)patients,respectively.Evaluation of Ki-67 re-vealed an accordance rate of 86.7%(281/324,κ=0.34),and the concordance for immunohistochemistry detection for assessing breast cancer(BC)molecular subtypes was 73.4%(91/124,κ=0.64).Conclusions:Although CNB showed good accuracy for evaluating hormon-al receptor status and BC molecular subtypes,its evaluation of HER-2 and Ki-67 statuses was less accurate than other biomarkers. Therefore,we should combine immunohistochemical results with both CNB and RS samples in order to improve accuracy when diag-nosing molecular subtypes.Moreover,improved diagnoses can provide the basis for more effective systemic therapies.

Objective To investigated the etiologic characteristics of Shigella (S.) sonnei strains causing outbreaks and sporadic cases in some areas of Guangdong province and Guangxi Zhuang Autonomous Region during 2014-2016. Methods Fourteen S. sonnei strains isolated from outbreaks and 6 S. sonnei strains from sporadic cases from Guangdong and Liuzhou of Guangxi Zhuang Autonomous Region were tested for antimicrobial resistance and analyzed by pulsed-field gel electrophoresis (PFGE). Six typical strains were selected for whole genome sequencing typing and compared with 51 strains isolated both at home and abroad from NCBI genome database. Results The antibiotic resistance test indicated the isolates had high resistance rate to ampicillin, tetracycline, gentamicin, trimethoprim/sulfamethoxazole and nalidixic acid, while sensitive to azithromycin, chloromycetin and imipenem. PFGE showed high similarity (93.2%) among the strains isolated from different areas. The whole genome sequencing analysis also revealed that all the typical strains wereclustered into a same evolution branch, close to some strains from Korea. Conclusions The S. sonnei strains isolated from some areas of Guangdong and Guangxi Zhuang Autonomous Region showed high resistance to commonly used antibiotics, but they were sensitive to azithromycin, chloramphenicol and imipenem. The isolates in this study also showed similar PFGE patterns and close phylogenic evolution.

Objective:To evaluate the staging and grading valut of Ki-67,TP53,Cyclin D1,HER-2 in non-muscle invasive bladder cancer (NMIBC).Methods:Retrospective analysis was performed on the clinicopathologic characteristics of 184 Ta,T1 stage NMIBC patients who underwent transurethral resection of the bladder(TURBT)at the Tianjin Medical University Cancer Institute and Hospital from January 2015 to December 2016.The expression of Ki-67,TP53,Cyclin D1 and HER-2 was evaluated by immunohistochemical assay.Then,the association between immunohistochemical indicators expression,staging and grading of NMIBC were assessed by univariate analysis.The independent factors of staging and grading in NMIBC were assessed by multivariate Logistic analysis,and their sensitivity and specificity were compared. Results:Univariate analysis showed a positively correlation between tumor size and T1 and G3 of NMIBC(P<0.05).The high expression of Ki-67 and HER-2 was positively correlated with tumor staging and grading(P<0.05)in T1,G3 NMIBC tissues.The high expression of CyclinD1 was negatively correlated with tumor staging and grading(P<0.05)in Ta stage tissues.Logistic multivariate analysis showed that high expression of Ki-67 and low expression of Cyclin D1 were independent predictors of T1 in NMIBC.High expression of Ki-67,high expression of HER-2 and low expression of Cyclin D1 were independent predictors of G3 in NMIBC.The Ki-67 expression had high sensitivity and specificity for predicting tumor staging and grading in NMIBC.The sensitivity were 81.40%(48/59)and 76.80%(96/125),and the specificity were 76.83%(63/82)and 86.30%(88/102),respectively.Conclusions:Detection of Ki-67 expression could predict staging and grading in NMIBC,and provide the basis for appropriate treatment.

Objective: To evaluate the feasibility and short-term efficacy of a novel and simplified closure method developed by our team for the defect closure after endoscopic full-thickness resection (EFTR) for gastric submucosal tumors (SMT) in the gastric wall. Methods: A prospective single-arm clinical study was used. Inclusion criteria: (1) the lesion was located in the fundus or the greater curvature of the stomach, and was confirmed to originate from the muscularis propria layer; (2) the diameter of the tumor was ≤3.5 cm, and the tumor had no extensive adhesion to the peritoneal tissues and organs in extraperitoneal cavity; (3) the tumor had no malignant features under ultrasound endoscopy; (4) the patient agreed to participate in the study; (5) patients with severe complications were excluded. Based on the above criteria, 20 patients with gastric SMT at the Endoscopy Center of Zhongshan Hospital of Fudan University from January 2015 to March 2018 were enrolled in this study, including 5 males and 15 females with mean age of 61.1 (38 to 70) years. Grasping forceps-assisted endo-loop snare ligation device which is called "Shao-Mai" method was used to close the defect site. All the patients underwent EFTR and "Shao-Mai" method to perform defect closure. After successful tumor resection by EFTR, an endo-loop was anchored onto the edge of the gastric defect with grasping forceps assistance and closed tightly. The observation indicators included tumor size, en bloc resection, operation time, postoperative complications and hospital stay. The follow-up indicators included tumor residual, local recurrence, and metachronous lesions. Results: All the 20 lesions were located in the muscularis propria with a size of 0.5-3.5 (mean 1.4) cm. Three of them were located in the greater curvature of the mid-upper gastric body, 17 were located in the fundus. The endoscopic "Shao-Mai" closure was successfully performed after EFTR in all the 20 cases. Endoscope was used uniquely through the entire process, without laparoscopic assistance. The operative time was 20-100 (mean 43.8) minutes, while the "Shao-Mai" closure procedure took a range of 3-30 (mean 10.1) minutes. The en bloc resection rate was 100%. The pathological diagnosis included 17 gastrointestinal stromal tumors and 3 leiomyomas. No major complications occurred during or after surgery. All the patients were discharged 1-11 (mean 3.1) days after operation. The wounds of all the cases were healed completely six months after operation and only scar was observed without ulcer. No residual lesion, tumor recurrence or metastasis, leakage or fistula of digestive tract were found during the follow-up period of 15-54 (median 41) months. Conclusion The endoscopic "Shao-Mai" closure method is a simplified novel way, which is feasible, effective, and safe for closing the gastric defect after EFTR.