OBJECTIVE:To analyze the distribution characteristics and drug resistance of pathogens in Shandong Dong’e and to provide reference for local physicians to choose antimicrobial agents. METHODS:Detected pathogens in Dong’e coun-ty of Shandong province during Jan. 2014-Dec. 2015 were analyzed statistically in respects of type,distribution and drug re-sistance. RESULTS:A total of 25 562 specimens were collected from Dong’e county of Shandong province during 2014-2015,and there were 6 302 positive samples with positive rate of 24.65%. The samples with high positive rate included respiratory samples(positive rate of 34.52%)and secretion,pus(positive rate of 33.79%). A total of 6 350 pathogens were detected,among which there were 3 707 strains of Gram-positive bacterias (58.38%),mainly including Escherichia coli, Pseudomonas aeruginosa and Klebsiella pneumonia;2 042 strains of Gram-negative bacterias (32.16%),mainly including Staphylococcus aureus and Streptococcus pneumonia;601 strains of fungus. E. coli,S. aureus,P. aeruginosa,K. pneumonia, Acinetobacter baumannii and Proteus mirabilis mainly distributed in ICU,and S. pneumonia and Hemophilus influenza mainly distributed in pediatric department. Sensitive rates of E. coli and K. pneumonia to piperacillin sodium and tazobactam sodium, imipenem,amikacin and tigecycline were higher than 90%;the strain resistant to or intermediate to tigecycline was not found. Sensitive rate of P. aeruginosa to aminoside antimicrobial agents was higher than 90%. Resistant rates of A. baumannii to vari-ous antimicrobial agents were higher than 70%,and resistant rate of it to minocycline was 96.67%. S. aureus was sensitive to vancomycin,quinupristin/dalfopristin and tigecycline,and S. pneumonia was sensitive to rifarnpin,linezolid and vancomycin, with sensitive rate of 100%. A total of 264 strains of MRSA were detected,and detection rate was 39.28%;a total of 200 strains of penicillin-resistant S. pneumonia were detected,and detection rate was 35.13%. CONCLUSIONS:The samples from Dong’e county of Shandong province during 2014-2015 were mainly respiratory samples,detected pathogens were mainly Gram-negative bacterias and resistant rate of them were lower than related domestic reports. The distribution characteristics and drug resistance of pathogens should be considered before using antimicrobial agents to improve the rationality and perti-nence of drug use.

Objective To explore the effect of the island flap application on repairing large scale defects on the face.Methods Based on the defect size,shape and location,preauricula narrow stem side geny-neck flap,submental island flap,angular artery flap,eyelid musculus orbicularis flap and nasolabial groove island flap were used to repair the large scale defects of the face in a one-stage operation.Results All flaps survived well without any obvious complications.35 patients were followed up for 1 to 36 months.Repaired tissues were well matched with the surrounding tissue.Resulting facial contour and appearance were good,and cosmetic results overall were satisfactory.Conclusion The application of island flaps to repair the large scale defects on the face in a one-stage operation is a better method that can achieve good contour and satisfactory cosmetic results.

Objective To investigate the of 5-fluorouracil effects on the expression of Smad7,TGF-β receptorⅠ,Bcl-2 and Bax in keloid fibroblasts.Methods After primary culture of keloid fibroblasts,4-6 passages of cells were inoculated in 5 different concentrations of 5-fluorouracil(10,20,40,80,160μmol/L)for 24,48 and 72 hours.Proliferative ability of keloid fibroblasts was detected by MTT assay.Expression of Smad 7,TGF-βreceptorⅠ,Bcl-2 and Bax in keloid fibroblasts was measured by Western blot.Results During MTT,5-fluorouracil did not affect cell viability at 24 hour at the concentration of 10 and 20 μmol/L.Compared with the control group,no significant difference was detected(P＞0.05).At other concentrations,fibroblast death was visible in each group(P＜0.01).Western blot analysis showed that the expression of Smad7 significantly decreased and the expression of TGF-β receptor Ⅰ significantly increased in the TGF-β1 group compared with the blank control group(P＜0.0 1).5-fluorouracil could significantly enhance the expression of Smad7(P＜0.01).There was a remarkable decrease of the Bcl-2 expression and marked increase of the Bax expression in different concentrations of 5-fluorouracil compared with the control group(P＜0.05).But,5-fluorouracil did not show any effect on the synthesis of TGF-β receptor Ⅰ.Conclusion 5-fluorouracil could inhibit proliferation and induce apoptosis on human keloid fibroblasts in vitro.

Objective To observe the clinical effects of open kinetic chain and closed kinetic chain exercise in the early period of anterior cruciate ligament reconstruction rehabilitation,provide the theoretical and clinical experiences for the early rehabilitation of the anterior cruciate ligament reconstructed knee.Methods From February 2009 to June 2010,60 patients undergoing single-bundle anterior cruciate ligament reconstructions by using hamstring tendon allograft were enrolled in the study,and were divided into two groups:open kinetic chain group(30 cases,30 knees)and closed kinetic chain group(30 cases,30 knees).In accordance with the rehabilitation procedures for six months,no statistically significant differences were found between the two groups in Lysholm scores,International Knee Documentation Committee(IKDC)scores and one-leg hop test preoperative.The active and passive range of notion,Lysholm scores,IKDC scores,one-leg hop test and KT-1000 were evaluated three and six months after surgery.Results Three months after surgery,no significant differences were found in passive range of motion,Lysholm scores,IKDC scores,but significant differences were found in active range of motion,one-leg hop test and KT-1000,and the closed kinetic chain group was significantly better than the open kinetic chain group.Six months after surgery,no significant differences were found in active range of motion,passive range of motion,one-leg hop test,Lysholm scores,IKDC scores,but significant difference in KT-1000,and the closed kinetic chain group was significantly better than the open kinetic chain group.Conclusion Closed kinetic chain exercise is benefit for recovery of muscles strength,proprioception and protect the graft in the early rehabilitation period after anterior cruciate liganent reconstruction.

Objective To observe the effects of secreted protein,acidic and rich in cysteine (SPARC) on the expression of TGF-β1 and collagen type Ⅰ in cultured human keloid fibroblasts by real-time fluorescence quantitative RT-PCR.Methods In vitro keloid fibroblasts were stimulated by different concentrations of recombinant human SPARC,and with the control group for comparison,real-time fluorescence quantitative RT-PCR to detect expression of TGFβ1 and collagen type Ⅰ.Results Compared with the control group,the expression of TGF-β1 and collagen type Ⅰ was significantly increased in the experimental group.Conclusions SPARC could enhance the expression of TGF-β1 and collagen type Ⅰ in keloid fibroblasts significantly.

Purpose To investigate the clinicopathologic features and immunophenotype as well as its association with EBV infection of lymphoepithelioma-like gastric carcinoma (LLGC). Methods The clinical pathological data were reviewed, morphological changes were observed and immunohistochemical staining was done in 6 cases of LLGC. The expression of EBV-encoded small RNA ( EBER) in the 6 cases of LLGC were carried out by in situ hybridization. Results All of the six patients were male, the age was arranged 47 to 68 years, with mean of 55 years. All of the six cases, the lesions were located in gastric body. Microscopically, the undifferentiated carcinoma cells were arranged in cords and nests, scattering in the lymphoid-rich stroma, occasionally poor development tubular struc-tures were seen in the near surface of mucosa. Lymphoid follicles could be seen with lack of fibrous tissues reaction in the tumor stro-ma. Immunohistochemical staining and in situ hybridization showed the tumor cells were diffusely positive for CKpan, CK19, CEA and EBER, but negative to CK7, CK20, CK5/6 and LMP1; interstitial lymphocytes expressed CD3 or CD20, while lost expression of EBER. Follow-up for 6-57 months, all of the 6 patients were survived without tumor. Conclusions The LLGC is a rare and unique subtype of gastric carcinoma with good prognosis, which is often associated with EBV infection.

Objective To study the anti-fatigue effects of enzymatic hydrolyzed protein from Pinctada martensii.Methods Swimming time,contents of liver glycogen and serum urea nitrogen after swimming were determined.Results Three dosages of EPA were all able to prolong swimming time and decrease liver glycogen consumption and serum urea nitrogen content after exhausted swimming in various degree.Conclusion The EAP has evident anti-fatigue effects.

Objective To investigate the application of the frontal branch of superficial temporal vessels pedicled flap in repairing lower eyelid ectropion.Methods Eight cases were collected from patients diagnosed with lower eyelid ectropion in our hospital from April 2012 to April 2015.In phase 1 of operation,the dilators were implanted into the frontal branch of superficial temporal vessels and fully expanded by normal saline injection;In phase 2,the scar of lower eyelid was incised,and the expanded forehead flaps were transferred to cover the wound after the lower eyelid released back to normal anatomy location;In phase 3,the flap delay operation was manipulated 3 weeks after phase 2,and the left wound after scar excision was finished by pedicle division 1 week later.Results All patients in the study showed a good appearance and function of lower eyelid.There were no complications such as flap congestion and necrosis occurred.Meantime there were no relapses observed according to the follow-ups ranging from 6 months to 1 year.Conclusions The application of the frontal branch of superficial temporal vessels pedicled flap shows a promising procedure in treatment of lower eyelid ectropion.

Objective To investigate the impact of graft position shift on anterior cruciate ligament reconstruction induced by femoral fixation of interference screw. Methods Nineteen fresh cadaveric knees were used and assigned to three groups. 1) Study of graft position shift: 5 knees were randomly selected, interference screws of 7 mm, 8 mm and 9 mm were used in autologous tendon fixation, then the graft position shift were measured. 2) Study of isometry: 7 knees were randomly divided into the isometric reconstruction group (D group). In the D group, Retrobutton, interference screw and interference screw in location-corrected bone tunnel were used respectively as fixation. The isometry of grafts was evaluated. 3) Study of tibia anterior translation: 7 knees were randomly divided into the anatomic reconstruction group (J group). In the J group,the tibia anterior translation was measured in four different conditions in the same joint: intact knee joint,knee joint without ACL, ACL anatomic reconstruction by interference screw fixation, and ACL anatomic reconstruction by interference screw fixation with corrected bone tunnel location. Results 1) With 7 mm, 8mm and 9 mm interference screw fixation, graft position shift were (2.36±0.11) mm, (2.72±0.06) mm and (3.00±0.06) mm respectively. 2) Graft length change: graft length change in Retrobutton group and corrected bone tunnel group were less than 3 mm, while graft length change in those fixed with interference screw were stretched in more than 3 mm. 3) Study of tibia anterior translation: there was no difference among the intact group, the anatomic group and the corrected group at 0° and 15°. However, the difference was found between the intact group and other groups at 30°、60° and 90° of flexion, as well as between these two reconstructed methods at 20° joint flexion (P＜0.05). Conclusion In both isometric and anatomic ACL reconstruction with interference screw, the graft is pushed tightly toward the femoral tunnel wall, which shifts the graft away from the desired position. In our study we find out that the corrected location of the femoral bone tunnel significantly improves the isometry of ACL reconstruction and anatomic reconstruction.

BACKGROUND:The ankle joint is capable of flexion and extension, including plantar flexion and dorsiflexion, to act as a support and a lever. An ankle injury, often accompanied by fracture and ligament injury, seriously threatens the ankle joint function. Previous diagnosis of ankle injury mainly relied on clinical signs and X-ray examination. However, X-ray examination is not accurate enough for ankle injury diagnosis because it cannot clearly diagnose damage to the surrounding ligaments, tendons and other soft tissues except for obvious fractures. Mutlisequence and multiplanar MRI is currently the optimal noninvasive method for high-resolution determination of soft tissue deformations, but little has been reported on the diagnostic accuracy of ankle ligament and tendon injury. OBJECTIVE:To observe the diagnostic value of MRI for ligament and tendon injury of the ankle in its normal position, and during complete plantar flexion and dorsiflexion. METHODS:It is a single-center, prospective, diagnostic trial that wil be completed at the First Hospital of Hebei Medical University, China. Sixty cases were recruited, including 30 cases of normal ankle joint and 30 cases of ankle ligament and tendon injury. MRI scans of the ankle joint in normal position, complete plantar flexion and complete dorsiflexion were performed in al the cases, and the multi-position MRI results were compared. The primary outcome measure is the sensitivity of MRI to ligament and tendon injury of the ankle during complete plantar flexion. The secondary outcomes include the specificity, positive predictive value, negative predictive value, positive likelihood ratio, and negative likelihood ratio of MRI to ligament and tendon injury of the ankle during the complete plantar position as wel as rate of correct diagnosis;specificity and sensitivity, positive predictive value, negative predictive value, positive likelihood ratio, and negative likelihood ratio in normal position or during the complete dorsiflexion as wel as rate of correct diagnosis;the morphology of the ankle on the multi-position MRI. This study design was registered at ClinicalTrial.gov (03049423) on February 8, 2017. This study protocol has been approved by the Medical Ethics Committee of Qinghai University Affiliated Hospital of China (approval No. 2015076) and wil be performed in accordance with the guidelines of the Declaration of Helsinki, formulated by the World Medical Association. Signed informed consent regarding trial procedure and treatment was obtained from each volunteer. DISCUSSION:This study aims to determine the rate of correct diagnosis of ankle ligament and tendon injury using the MRI, to clarify the diagnostic value of MRI for ankle ligament and tendon injury, and to provide a quantitative MRI diagnostic standard for developing a reasonable surgical treatment.