Objective To investigate the prevalence of 16S rRNA methylase genes in Klebsiella pneumoniae isolates from Guangzhou.Methods K-B test was used to determine the resistant rates of these stains.Five 16S rRNA methylase genes,armA,rmtA,rmtB,rmtC,and rmtD,were detected by PCR.Results All 55 K.pneumoniae isolates showed resistant to arbekacin,gentamicin,tobramycin,and neomycin.Susceptibility rates were 5.5%,20.0%,72.7%,and 100% to ceftazidime,ciprofloxacin,piperacillin/tazobactam,and imipenem respectively.ESBLs were positive in 52 of 55 (94.5%) isolates.Among 55 K.pneumoniae isolates,34 were positive for armA and 1 for rmtB.Conclusions In K.pneumoniae resistant to arbekacin,the positive rate of 16S rRNA methylase genes was high,predominantly with armA positive.These strains were highly resistant to some antibiotics.

BACKGROUND:Fast track surgery, also cal ed enhanced recovery after surgery, is a series of optimal measures adopted during the perioperative period on the basis of evidence-based medicine, to reduce the physical and mental trauma brought to the patient and accelerate their recovery. It has become the research focus of orthopedic clinic as the surgery and anesthesia skil s are improved a lot in recent years, especial y the articular surgery, which has been widely used in clinics. OBJECTIVE:To summarize the clinical study of the application of optimal measures in joint replacement surgery both at home and abroad in recent years. METHODS:The first author searched related articles in PubMed and Chinese Journal Ful-text Database from January 1997 to September 2016. The key words were“joint replacement, enhanced recovery after surgery, multi-mode analgesia, diet management, steroid hormones”. 81 articles were found at last and one monograph was included. RESULTS AND CONCLUSION:(1) We found that the recovery plan reduced the hospital stays of the patients from 4-12 days to 1-3 days, including pre-operative health education, shortening fasting and water-depriving duration before surgery, super-anesthesia before surgery and do not place catheter;adopting general anesthesia and appropriate adductor canal to relieve the pain, and stopping bleeding using tranexamic acid during operation;multi-mode analgesia, faster function exercise after anesthesia recovery, and drinking water in early phase after surgery during the perioperative period of joint replacement surgery conducted by the cooperation of surgeon, anesthetist, nurse and nutritionist. There were no significant improvements of postoperative complications rate and rehospitalization rate. (2) The research found that, enhanced recovery after surgery is suitable for most of the patients receiving joint replacement surgery, including those in advanced age, combined heart and lung disease before surgery, type 2 diabetes and smoking and drinking before surgery.

Many factors contribute to a successful total knee arthroplasty, and postoperative coronal lower limb alignment has always been a focus of joint surgeons. Previous researches have suggested that neutral alignment can bring higher prosthesis survival rate and better knee function. However, the theory has been challenged in recent years.In this article, the author introduces the axis, alignment and osteotomy of total knee arthroplasty briefly and reviews the studies on the neutral alignment and kinematic alignment of recent years in order to provide some advice for the clinical operation.