Objective To evaluate the anti-bacteria effects of polymyxin B combined with meropenem against 30 strains pan-drug resistant pseudomonas aeruginosa that separated in clinic. Methods The minimal inhibitory concentration (MICs) of 30 strains pan-drug resistant pseudomonas aeruginosa after treated with polymyxin B and meropenem as single-use or combination use were determined by both microdilution method and checkerboard method. The FIC index was calculated, then the type of combination effect was determined according to FIC index, which was used to determine whether there was synergistic or antagonistic effects. Results The MICs of pan-drug resistant pseudomonas aeruginosa were reduced significantly after polymyxin B combined with meropenem when compared with single-use. The percentages of the FIC index that less than 0.5 and the index between 0.5 and 1 were 60%and 30%respectively. Conclusion The results indicate that the combinations of polymyxin B with meropenem have good synergistic and additive effects against pan-drug resistant pseudomonas aeruginosa, there is no antagonism.

Objective To analyze the clinical features of subacute thyroiditis (SAT ) manifested as fever of unknown origin (FUO) for early diagnosis .Methods The clinical and laboratory data were retrospectively reviewed for 20 SAT patients manifected as fever of unknown origin from October 2009 to February 2013 .Results A total of 20 patients were finally diagnosed as subacute thyroiditis ,about 3% of the 661 FUO patients .Only 5 SAT patients had complained of angina or pain in the anterior region of neck .Thyroid enlargement and tenderness were observed in 14 SAT cases .Elevated serum thyroid hormone and a very low serum level of thyroid stimulating hormone were seen in 17 patients with SAT .Ultrasound scan of thyroid showed inhomogenous hypoechongenic texture in 14 patients .99m Tc pertechnetate scan of thyroid showed extremely low radiopharmaceutical uptake in all the 20 cases .All patients had received antibiotic treatment prior to admission .Conclusions Subacute thyroiditis is an uncommon but important cause of FUO .Detailed history ,physical examination and laboratory evaluation can help minimize the chance of misdiagnosis and unnecessary antibiotic therapy .

Objective To evaluate the clinical effects of percutaneous vertebroplasty (PVP) with high-viscosity bone cement in treatment of severe osteoporotic vertebral compression fracture (OVCF).Methods This study involved 176 patients with severe OVCF treated by PVP with high-viscosity bone cement between January 2013 and January 2015.There were 61 male and 115 female patients,aged 58-78 years (mean,67.7 years).Ninety-four patients were injured in a fall,31 patients in a bumping condition,and 61 patients with no obvious causes.A total of 204 vertebrae were involved,including 23 T10,22 T11,49 T12,43 L1 and 29 L2.Thirty patients suffered vertebral posterior wall damage.All the vertebral bodies were compressed more than 2/3.Vertebral height,kyphotic Cobb angle,visual analogue scale (VAS) and Oswestry disability index (ODI) were recorded.Bone cement filling and leakage were detected.Results Bone cement leakage was detected in 64 patients,with a leakage rate of 36.3％.Seven patients were found with cement leakage in paravertebral veins,38 patients in intervertebral spaces,and 19 patients in prevertebral soft tissues.Five patients with back pain got partial remission.Four patients experienced burning sensation in the lower extremity 5 minutes after bone cement filling and were relieved 10 minutes later.No severe adverse events were observed,including spinal cord compression,epidural hematoma,pulmonary infection,pulmonary embolism,bedsores,and cerebrovascular accident.After operation,improvements were observed in ODI [(31.73 ± 7.98) ％ vs.(75.40 ± 8.17) ％] and VAS [(2.33 ±0.91)points vs.(7.23 ±0.88) points] (P＜0.05).Conclusion PVP with highviscosity bone cement can significantly relieve pain and improve motor function and hence is effective in the treatment of patients with severe OVCF.

Objective To observe the spinal stability of regrafting the posterior ligamentous complex after spinal canal tumor resection. Methods The data of 43 cases with spinal canal tumor in our department from July 2008 to July 2013 were retrospectively analyzed,who were fixed the free of the lamina by mini titanium-plate. Results The operation time was 130 to 220 min,the average time was 150 min. The blood loss volume was 200 to 750 mL,with average volume 340 mL. All patients were followed up for 6 to 42 months. No iatrogenic spinal cord injury nor complications such as artery injury,spinal cord and spinal nerve root local anomalies hydrops occurred. By Flexion-extension radio-graphs,regrafting of the posterior ligamentous complex after the resection of spinal cord tumors preserved spinal mobility well. Conclusion The mini titanium-plate fixation treatment of spinal canal tumor has good superiority and clinical feasibility by regrafting the posterior ligamen-tous complex and reconstructing the spinal stability.

OBJECTIVE:To evaluate the effects of arginine-enriched total parenteral nutrition(TPN)on the nutritional and immune parameters of patients undergoing abdominal surgery.METHODS:67 patients undergoing abdominal surgery were randomly assigned to receive routine TPN(control group,n=24),TPN plus 15 g arginine(n=25,trial group Ⅰ)or TPN plus 30 g arginine(n=18,trial group Ⅱ)for 3 days postoperatively.RESULTS:Arginene-enriched TPN significantly improved postoperative nitrogen balance,promoted the recovery of plasma-albumin and total protein,and elevated the levels of CD4+ and CD4+/CD8+,but no significant difference was noted for immunoglobulin,complement C3 and complement C4 during trial period.CONCLUSION:Arginene-enriched TPN can improve patients' postoperative nutritional and immune parameters and enhance the efficacy of TPN support.

Objective To investigate the antibiotic resistance and resistance genes of carbapenem-resistant Enterobacteriaceaes (CRE) isolated from 5 hospitals in Northeast China.Methods This study collected 85 CRE isolates during January 2013 to June 2015 from five hospitals in Northeast China.Drug sensitivities of 14 antimicrobial agents were determined by the broth microdilution method.The phenotypes of carbapenemases were screened by modified Hodge test and EDTA test respectively.The genotypes of carbapenemases and other extended spectrum β-lactamases (ESBL) were detected by PCR gene amplification and DNA sequencing method.Using the PCR result as gold standard, the performances of other two carbapenemase detection methods were evaluated.Results Among the 85 CRE strains collected in this study, Klebsiella pneumoniae was the most frequently isolated species (61/85,71.8%).The results of antimicrobial agent sensitivity showed that the 85 CRE strains had resistance rate of cephalosporin and β-lactams/enzyme inhibitor (piperacillin-tazobactam) over 80.0%.The resistance rate of carbapenem was high, with ertapenem 100.0% (85/85), meropenem 65.9% (56/85), imipenem 71.8% (61/85).There were 36 isolates resistant to both meropenem and imipenem.For fluoroquinolones, the resistance rates of levofloxacin and ciprofloxacin were 72.9% (62/85) and 65.9% (56/85), respectively.The resistance rate to fosfomycin and amikacin were 65.0% (55/85) and 54.1% (46/85), respectively.The resistance rate of colistin (21.2%, 18/85) and tigecycline (20.5%, 17/85) were low.Forty-nine strains were modified Hodge test positive and 12 strains were EDTA test positive.By PCR gene amplification and DNA sequencing method, 64 strains carried carbapenemase-encoding genes, of which KPC-2 was the main type (53/85, 62.4%), followed by IMP-4 (10/85, 11.8%), NDM-5 (7/85, 8.2%) and NDM-6 (1/85, 1.2%).At the same time, 85 CRE isolates had the ESBL gene detection and 47 isolates were CTX-M type ESBLs (47/85, 55.3%), with no TEM or SHV type.Conclusions Klebsiella pneumoniae is the majority of CRE strains from 5 large hospitals in Northeastern China.The CRE strains are resistant to most of antimicrobials.Most carbapenemases-producing isolates have the KPC-2 type.Nearly half of the carbapenemase-producing strains also carry ESBL genes, which makes the resistance mechanisms more complicated.

Objective To explore the application of 3D printing technology in clinical apprenticeship teaching in spinal surgery. Methods 38 eight-year clinical medical students admitted to the Department of Spine Surgery were randomly divided into experimental group (19 patients) and control group (19 patients). Taking odontoid fracture as an example. The traditional method is used for teaching, and the experimental group is taught with traditional teaching method combined with 3D printing technology . After the apprenticeship, the students of the two groups were tested in theory and simulated operation to evaluate the teaching effect. SPSS 17.0 was used for statistical analysis. The measurement data was expressed as mean ± standard deviation, and the t-test was used to compare the measurement data between two groups. Results The results showed that the scores of immediate examination and one month after class in the control group were (82.23 ±7.52) and (72.36 ±6.39) points respectively. The scores of immediate examination and one month after the class in the experimental group were (85.58 ±6.32), (80.87 ±6.23). The scores of the two examinations in the experimental group were significantly higher than those in control group , and the differences were statistically significant (P<0.05). Conclusion The 3D printing technology can significantly improve the teaching effect in the clinical apprenticeship teaching of spine surgery, and it has a bright prospect for application.

Objective To compare the clinical curative effect of allogeneic bone ring and titanium mesh in repairing adolescent spinal tuberculosis kyphosis.Methods Forty-four cases of kyphosis after adolescent spinal tuberculosis operation in this hospital from January 2012 to January 2015 were selected as the study subjects and divided into the control group and observation group ac-cording to the treatment types,22 cases in each group.The control group was repaired with titanium mesh,while the observation group was given allogeneic bone ring fusion repair.Postoperative follow up lasted for 2 -5 years.The perioperative indexes,repair material and vertebral fusion and neurological score,preoperative and postoperative Cobb angle,ESR,CRP and postoperative com-plications occurrence were compared between the two groups.Results There was no statistically significant difference in periopera-tive indexes between the two groups(P>0.05).The fusion time,occurrence rate of local pain and motion limitation had statistical differences between the two groups(P<0.05).The occurrence rate of material loosening had no statistical difference(P>0.05). No grade A and B spinal injury appeared in both groups.The incidence rate of grade D and E in the observation group was signifi-cantly lower than that in the control group,the difference was statistically significant(P<0.05).The postoperative Cobb angle, ESR and CRP had no statistical difference between the two groups(P>0.05),moreover no significant adverse reactions and post-operative tuberculosis recurrence occurred.Conclusion Allogeneic bone ring and titanium mesh have satisfactory effect for repairing juvenile spinal tuberculosis kyphosis,allogeneic bone ring fusion time is longer,early stability is worse than the titanium mesh,the brace protection is needed in the early time,but the clinical effect of patients is more significant,which is worthy of being promoted and applied in clinical treatment.

Objective:To analyse the clinical characteristics and antiviral therapy in immunosuppressed hospitalized patients with influenza.Methods:The clinical data of 273 patients with positive influenza A or B virus nucleic acid admitted in Peking University People’s Hospital from November 2015 to March 2022 were retrospectively analyzed. Among them, 123 were immunosuppressed and 150 were non-immunosuppressed. The clinical characteristics and antiviral therapy in immunosuppressed patients with influenza were analyzed. SPSS 22.0 software was used to analyze the data.Results:Chemotherapy for malignancies was the most common cause of immunosuppression (61.8%, 76/123), followed by haemopoietic stem cell transplantation (24.4%, 30/123). The common symptoms were fever (93.5%, 115/123) and cough (41.5%, 51/123). The proportions of co-infections (22.8%, 28/123) and complications (43.9%, 54/123) in immunosuppressed hospitalized patients were higher than those in non-immunosuppressed patients ( χ2=9.365 and 7.496, both P<0.01). Compared with single drug therapy, combination of antiviral drugs did not shorten the fever time, negative conversion time of virus nucleic acid and the length of hospital stay, and reduce the death ( U/ χ2=312.5, 356.0, 749.5 and 0.185, all P>0.05). Compared to patients without corticosteroids use, the use of corticosteroids did not increase mortality in immunosuppressed patients ( χ2=2.508, P=0.113). Conclusions:Classical symptoms may be absent in immunosuppressed patients with influenza, and early detection of influenza virus is still an important means of early diagnosis. Co-infections and complications are more common in immunosuppressed influenza patients. Immunosuppressed influenza patients did not benefit from the combination of antiviral therapy.

Objective To investigate the homology of carbapenem-resistant Klebsiella pneumoniae (CR-KPN) isolates by multilocus sequence typing (MLST) method,and profile CR-KPN infections in terms of MLST sequence types (STs).Methods A total of 61 CR-KPN isolates were collected in five hospitals from Liaoning Province from January 2013 to June 2015.The MICs of 14 antimicrobial agents against these isolates were determined by broth microdilution method.The genotypes of carbapenemases were analyzed by PCR and DNA sequencing techniques.The homology of CR-KPN isolates were analyzed by MLST method.The clinical data of patients with CR-KPN infection were reviewed to characterize CR-KPN infections.Results A total of 18 STs were identified among the 61 CR-KPN strains according to MLST data.More than 50 ％ of the isolates belonged to ST11 (53.3 ％).ST11 strains showed higher resistance rate to carbapenems and higher prevalence of KPC-2 type carbapenemase.Univariate analysis indicated that more ST 11-infected patients were treated in ICU and with mechanical ventilation than non-ST11 CR-KPN-infected patients (P＜0.05).ST2033,ST2135,ST2193,ST2194,ST2195 and ST2196 were the STs firstly registered in the world.The eBURST analysis showed that ST2193,ST2194,ST2195 and ST 11 were closely related.Clinical data indicated that the prevalent CR-KPN strains during the same period in the same hospital usually belonged to the same ST clone.Conclusions MLST of CR-KPN showed 18 sequence types,of which ST11 was the predominant type.Clinical data indicated that the prevalent CR-KPN strains during the same period in the same hospital usually belonged to the same ST clone.This suggests the potential of local CR-KPN outbreak.The ICU patients and those receiving mechanical ventilation may be prone to CRKPN (especially ST11) infection.Such patients should be managed appropriately.