Objective To investigate the types of staphylococcal cassette chromosome mec (SCCmec)gene and an-timicrobial resistance of community-acquired methicillin-resistant Staphylococcus aureus (CA-MRSA)isolated from outpatients and inpatients in a hospital.Methods MRSA strains isolated between May 2011 and August 2015 in a hospi-tal and the relevant case data were collected,polymerase chain reaction(PCR)method was used to identify mecA gene of MRSA and SCCmec gene of CA-MRSA,antimicrobial susceptibility testing of CA-MRSA were performed and analyzed. Results A total of 305 MRSA isolates were collected,296 of which were mecA positive,29.73% (88/296)were CA-MR-SA. The genotyping of CA-MRSA showed that 48 strains were SCCmec type Ⅳ,36 were SCCmec type V,the other 4 strains were undefined. Antimicrobial susceptibility testing results showed that susceptibility rates of CA-MRSA to vanco-mycin,linezolid,and tigecycline were all 100% ,resistance rates to penicillin and oxacillin were both 100% ;resistance rates of SCCmec type IV and SCCmec type V CA-MRSA strains to levofloxacin,rifampicin,and ciprofloxacin were all signifi-cantly different (all P<0.05),to ampicillin/sulbactam,furantoin,and erythromycin were all >58% .Conclusion The main SCCmec type of CA-MRSA are type IV and type V in this hospital,antimicrobial resistance rate is high,clinicians should pay high attention,and use antimicrobial agents according to antimicrobial susceptibility testing results.

Objective To investigate the influence of diabetes on the early complications after pancreaticoduodenectomy in patients with pancreatic cancer,and to provide reference for clinical diagnosis and treatment.Methods A total of 179 patients with pancreatic cancer confirmed by pathology underwent pancreaticoduodenectomy were divided into 81 cases of diabetes group and 98 cases of non-diabetes group according to the level of blood sugar.The fast blood glucose of patients in diabetes group were controlled at 5.6-11.2 mmol/L before surgery,the clinical and pathological data,surgery-related complications and systemic complications of two groups were compared.Results Of 179 patients,5 patients (2.79％) died of severe infection combined with cardiac and respiratory failure.Firm pancreatic texture occurred more in diabetes group than that in non-diabetes group(79.0％ vs 42.9％,x2 =13.62,P＜0.01),but no statistically significant difference in duration of operation,total bleeding,length of stay in hospital,diameter of pancreatic duct,tumor size,pathological pattern,whether reserved pylorus and methods of anastomosis between the two groups (P ＞0.05).There was no statistically significant difference in the incidence of pancreatic fistula,delayed gastric emptying,hemorrhage and infection between diabetes group and non-diabetes group (P ＞ 0.05),but the incidence of respiratory failure (4.9％ (4/81)),cardiac failure (9.9％ (8/81)) and renal failure (1.2％ (1/81)) in diabetes group were significantly higher than that in non-diabetes group (2.0％ (2/98),3.1％ (3/98),0(0/98);P=0.031,0.014,0.007).The incidence of pancreatic fistula was 26.3％ (47/179),and that of patients combined with diabetes (38.3％ (18/47)) and firm pancreatic texture (40.4％ (19/47)) were statistically lower than patients without diabetes and soft pancreatic texture (x2 =8.53,P ＜ 0.05;x2 =11.20,P＜0.01).Conclusion Pancreatic cancer has a big risk in pancreaticoduodenectomy,and those with diabetes would not increase the risk of pancreatic fistula,delayed gastric emptying,hemorrhage and infection when blood glucose is well controlled before surgery,but it has severe impact on systemic complications,so the perioperative blood glucose should be well controlled.

Objective To study the therapeutic effect of the thrombus suction and direct percutaneous coronary intervention (PCI) for elderly patients with acute ST segment elevation myocardial infarction (STE‐MI) .Methods A total of 124 elderly pa‐tients with acute STE‐MI in our hospital from September 2012 to September 2014 were collected and divided into two groups(under the agreement of patients and family members) ,the experimental group (56 cases) was treated with thrombus suction and direct PCI ,while the control group (68 cases) was only treated with PCI treatment ;the postoperative immediate TIMI flow of coronary artery ,postoperative corrected TIMI frame count (CTFC) ,levels of myoglobin ,cTnT and CK‐MB ,percentage of ST elevation back over 50% ,postoperative 6-month follow‐up situation were observed in the two groups .Results The percentage of postoperative ST segment elevation drop>50% at postoperative 1 h in the experimental group was significantly higher than that in the control group (P<0 .05);the levels of myoglobin ,cTnT and CK‐MB ,postoperative corrected CTFC frames and rate of no reflow in the ex‐perimental group were significantly lower than those in the control group (P<0 .05);during postoperative 6 -month follow up , there were no statistically significant differences in major adverse cardiac events (such as angina pectoris ,myocardial infarction ,re‐vascularization ,etc) between the two groups(P>0 .05);the percentage of LVEF>50% in the experimental group was significantly higher than that in the control group(P<0 .05) ,moreover the percentage of LVEF>50% in the two groups had statistical differ‐ence between before and after operation(P<0 .05) .Conclusion Clinical curative effect of thrombus suction and direct PCI for eld‐erly patients with acute STE‐MI is superior to simple direct PCI treatment .

Objective To evaluate the effect of amniotic products after transcervical resection of uterine adhesions (TCRA). Methods This study was carried out in 57 patients with intensive degree of intrauterine adhesions (IUA) who had been treated by TCRA between Jun. 2013 to Jun. 2014. These patients were devided into two groups randomly. In group amnion, 29 patients were placed amniontic scaffold balloon after TCRA;in group balloon, 28 patients were placed Foley′s balloon after TCRA. The two groups′balloons were taken out after TCRA 7 days. All patients were taken artificial cycle treatment. The uterine cavity form and the menstruation of 2 groups were observed in 3 months after TCRA. Results In group amnion, IUA score dropped from 10.1±0.5 preoperatively to 3.2±1.5 postoperative (P<0.01), in group balloon, IUA score dropped from 10.1 ± 0.5 preoperatively to 6.3 ± 2.5 postoperative (P<0.01). In group amnion, the menstrual score increased from 13.3 ± 4.4 preoperatively to 32.6 ± 5.5 postoperative (P<0.01), in group balloon, the menstrual score increased from 11.1±5.8 to 26.5±5.6 (P<0.01). The menstrual improvement of group amnion was better than that of group balloon significantly (P=0.002). In group amnion, the recurrence rate of adhesion was 21%(6/29), in group balloon, the recurrence rate of adhesion was 36%(10/28). There was no significant difference (P=0.248). The pregnancy rate of group amnion was 28%(8/29), the pregnancy rate of group balloon was 21%(6/28). The difference of pregnancy rate in two groups was not significant (P=0.760). Conclusion This small sample observation indicate that amniotic products used in the treatment of intensive IUA could improve menstrual, reduce the recurrence of adhesion, but the impovement of the pregnancy rate should be confirmed by large sample observation.

Objective To investigate the relationship between homocysteine(Hcy)and blood uric acid(UA)in the patients with type 2 diabetes mellitus(T2DM)complicating hypertension.Methods 85 patients with T2DM complicating hypertension were se-lected as the groupⅠ,78 patients with simple T2DM as the group Ⅱ and 74 individuals with healthy physical examination as the group Ⅲ.Hcy,UA,TC,TG and HDL-C were measured in all the subjects.Results Compared with group Ⅲ(control),the levels of Hcy,UA,TC and TG in the group Ⅰand groupⅡwere significantly increased(P <0.05),but the level of HDL-C was significantly decreased(P <0.05).Compared with the group Ⅱ(T2DM),the levels of Hcy,UA,TC and TG in the group Ⅰwere significantly in-creased(P <0.05 ),but the level of HDL-C was obviously decreased,the difference had statistical significance (P <0.05 ).There was good positive correlation between the Hcy level and the UA level in the patients with T2DM complicating hypertension (r =0.658,P <0.05).Conclusion The levels of Hcy and UA are significantly increased in the patients with T2DM especially complica-ting hypertension.High Hcy and high UA are the important risk factors of T2DM complicating cardiocerebrovascular diseases.

Polycentric governance theory of public goods provides a new approach for the goal of Basic medical care and health service for all.From the perspective of the public goods property of basic medical care and health service,the paper analyzed the predicament brought one-center supply mode,and designed the basic medical care and health service polycentric supply mode on the basis on the polycentric governance theory.On the basis,it proposed the polycentric supply synergetic development strategies.

This article described the importance of mechanism refonil in the graduate student training and presented its contents.Also,It summarized the characteristics of the reforill proposals in some universities,and analyzed the problems required to attend and solve ia the refogln.The characteristics of the proposals included to set up innovative fund by university,to perform the student awarded police of tutor leading,to establish the scientific system in recruiting students.By analyzing the problems developed during the reform four measures were lannched,which included to establish evaluating system in assessing students,to create a good relationship between students and tutors,to improve the ability and morality of tutors,and to adjust the management method of research funding.It would be possible to reach the objective of perfecting the reform proposal during the implementation of the measures.

Lung cancer is one of the most frequent malignant tumors. Target therapy is a milestone of non-small cell lung cancer (NSCLC) treatment in the 21st century. Biomarker detections have provided a solid foundation for individualized treatment. This review mainly focused on significance of EGFR mutation detection in EGFR tyrosine kinase inhibitors (EGFR-TKIs) as first line, second line and maintenance therapy in NSCLC. Simultaneously, this review introduced predicting significance of EGFR FISH test for the response of TKI treatment, and analyzed potential predictive biomarkers for antiangiogenic agents and status of antiEGFR monoclonal antibody in NSCLC individual therapy.

Abnormalities of the inferior vena cava occur infrequently.Except a few patients,most with the abnormalities of the inferior vena cava have not symptoms and do not need surgical procedure.However,attentions should be pasd to these anomalies in operation,particularly in the retroperiwneal procedure.only when the anomalies are identified before operation,its pessible to avoid the disaster caused by side-damage.Understanding embryo development of the inferior vena cava is usdful to comprehend the generation mechanism and classification of abnormalities of the inferior vena cava and its main branches.Exact judgment to abnormalities of the inferior vens cava has the important clinical significance.