Objective To investigate the distribution and antimicrobial resistance of clinically isolated pathogens from geriatrics department of a hospital in 2013,so as to provide reference for clinical antimicrobial use.Methods Distribution and antimicrobial resistance of pathogens isolated from patients in a geriatrics department between Janu-ary and December 2013 were analyzed statistically.Results Of 1 896 pathogenic strains,1 289(67.99%)were gram-negative bacteria,439 (26.00%)were gram-positive bacteria,and 114(6.01%)were fungi;the top 4 isolated pathogens were Klebsiella pneumoniae ,Pseudomonas aeruginosa ,Acinetobacter baumannii ,and Escherichia coli .Extended-spec-trumβ-lactamase (ESBL)-producing Escherichia coli and Klebsiella pneumoniae accounted for 53.26% and 31.10% of Escherichia coli and Klebsiella pneumoniae respectively;Of Staphylococcus aureus and Staphylococcus epidermidis strains,methicillin-resistant isolates (MRSA and MRSE)accounted for 22.47% and 80.00%,respectively,of Enterococ-cus strains,vancomycin-resistant isolates (VRE)was 3.10%,Klebsiella pneumoniae and Enterobacteriaceae were highly sensitive to imipenem,meropenem and ertapenem.Resistant rate of Acinetobacter baumannii to imipenem and meropenem was 79.48% and 80.35% respectively,Pseudomonas aeruginosa had the lowest resistant rate to amikacin (10.70%). Gram-positive bacteria were highly sensitive to vancomycin and linezolid.Conclusion The major pathogens isolated from the elderly patients are gram-negative bacteria,and antimicrobial resistance is serious,surveillance of antimicrobial resist-ance is important for rational use of antimicrobial agents and control of pathogen resistance.

Objective To study the clinical significance of a novel marker of platelet clumps count provided by hematology analyzer in differentiating true thrombocytopenia from EDTA-dependent pseudothrombocytopenia (EDTA-PTCP). Methods Samples from 65 cases of thrombocytopenia (including 15 EDTA-PCTP samples and 50 random samples of true thrombocytopenia) and 50 healthy controls were analyzed using hematology analyzers, and samples with low platelet counts were checked by replacing citric acid and using manual microscope observation to identify true thrombocytopenia from EDTA-PTCP. A novel marker of platelet clumps count was used to differentiate the two diseases for samples anficoagulated with EDTA or citric acid. Results In 65 patients with thrombocytopenia, platelet counts were (48±11)×109/L detected by automatic hematology analyzers. Fifty of 65 cases were true thrombocytopenia which showed low platelet counts [(48±10)×109/L by automated analyzer and (46±11)×109/L by manual assay]. No significance was observed between them (t=-1.26, P0.05). Platelet clumps counts were 86±15. No platelet clamps were detected under microscope. The other 15 cases were EDTA-PTCP [platelet counts were (48±12)×109/L and platelet clumps counts (840±184) were increased significantly by automated analyzer and using EDTA anticoagulant] which showed obviously platelet clumps and no less platelet counts under microscope. After replacing citric acid, platelet counts [(141±13)×109/L by automated analyzer and (134±17)×109/L by manual microscope assay] were increased significantly. No significance was observed between them (t=-1.29, P0.05). Platelet clumps counts (75±12) were decreased obviously compared with EDTA anticoagulant method (t=-6.82, P<0.001). No platelet clumps were detected under microscope. Conclusion Platelet clumps counts may be a useful clinical indicator for monitoring of platelet aggregates, especially for EDTA-PTCP caused by platelet clumping.

Objective To systematically evaluate the effects of compression stockings for preventing post-thrombotic syndrome after giant surgery in department of orthopaedics.Methods Randomized controlled trials about compression stockings were searched and analyzed no matter written in Chinese or English.The effects of compression stockings is determined by Meta-analysis with Review Manager 5.0.Results 4 papers were included in this research,among which,one was domestic,and another three were abroad.Heterogeneity was small when the data was merged,which suggested that compression stocking for preventing post-thrombotic syndrome was effective.Conclusions Compression stockings can be safely used to prevent post-thrombotic syndrome after giant surgery in department of orthopaedics.

Objective To understand the effects of "total quantity control" indexes on community health services and the residents' use of them so as to provide scientific basis for furthering reform in the medical insurance system.Methods A survey was made on the operation of the 3 community health centers of Jiangbin Xincun,Huashanwan and Hejianong in Jingkou District of Zhenjiang by means of direct inquiry and literature review.Results The average annual quantity of medical insurance plans allocated to the centers in the last 4 years involved 810 thousand yuan,the quantity actually fulfilled involved(953.5) thousand yuan,and the estimated annual quantity the centers were capable of fulfilling was valued at(1.45) million yuan,nearly 500 thousand yuan more than the quantity actually fulfilled. Conclusion Total quantity control on community health centers not only hinders the healthy development of community health services and the enthusiasm of the medical workers but also adversely affects the residents'use of health services and their health maintenance.

Objective To evaluate the efficacy of pegylated interferon α-2a and entecavir (ETV) combination therapy for patients with HBeAg positive chronic hepatitis B (CHB).Methods Fifty eight HBeAg positive CHB patients were assigned to two groups:29 patients received ETV 0.5 mg daily for 72 weeks (ETV group) and 29 patients received ETV and pegylated interferon α-2a 180 μg weekly for 48 weeks followed by ETV alone for 24 weeks (combination group).Serum samples were collected from all patients every 12 weeks for assessment of biochemical,virological and serological responses to treatment.Results Fifty four patients completed the 72-week study,including 28 in ETV group and 26 in combination group.There were no significant differences in week 24,week 48 and week 72 of ALT normalization [72％ (21/29)vs.93％ (27/29),x2 =2.104;90％ (26/29) vs.97％ (28/29),x2 =0.269;90％ (26/29) vs.97％ (28/29),x2 =0.269],HBV DNA undetectable rate [31％ (8/26) vs.46％ (13/28),x2 =1.391;62％ (16/26) vs.57％ (16/28),x2 =0.108;77％ (20/26) vs.75％ (21/28),x2 =0.027],HBeAg loss rate[12％(3/26) vs.25％ (7/28),x2 =0.850;31％ (8/26) vs.32％ (9/28),x2 =0.012;46％ (12/26) vs.36％(10/28),x2 =0.609] and HBsAg levels (log10 IU/ml) (3.63 ± 0.45 vs.3.36 ± 1.18,t =-1.066;3.45 ±0.43 vs.3.23 ± 1.15,t =-0.915;3.36 ± 0.58 vs.2.88 ± 1.28,t =-1.762) between two regimens (all P ＞ 0.05).Among 58 patients,15 were HBeAg and anti-HBe double-positive (26％)and 43 were HBeAg mono-positive patients.The baseline HBV DNA level [(5.07 ± 1.50) vs.(6.40 ± 1.47) log10 IU/ml,t =2.858,P ＜ 0.05] and HBeAg titer [14 (4-45) vs.732 (296-1 012) S/CO,Z =-5.031,P =0.05] in double-positive patients were lower than those in mono-positive patients.The HBV DNA undetectable rate of double-positive patients was significantly higher than that of mono-positive patients in 24 weeks [10/15 vs.26％ (10/39),x2 =7.819,P ＜0.05] and 72 weeks [15/15 vs.69％ (27/39),x2 =4.287,P =0.05].The HBeAg loss rate of double-positive patients was higher than that of mono-positive patients in 12 weeks [6/15 vs.10％ (4/39),x2 =4.533,P =0.05] and 48 weeks [9/15 vs.26％ (10/39),x2 =5.608,P =0.018].This tendency was more significant in the combination therapy group,but the difference was not statistically significant.(5/6 vs.4/9,P =0.065).Conclusions Compared with Entecavir monotherapy,entecavir combined with interferon may not improve the therapeutic effect in HBeAg positive chronic hepatitis B patients.However,the therapeutic response of HBeAg/anti-HBe double-positive patients may better than that of HBeAg mono-positive patients.

Despite different opinions on its definition and classification in the past,a consensus has gradually been reached regarding the na-ming,classification,and clinical diagnosis of liver failure.The classification of liver failure is described,and the definition and natural his-tory of severe exacerbation of hepatitis B are summarized.Antiviral treatment and artificial liver support in the early stage are beneficial for clinical outcomes and prognosis.

Adolescent ; Adult ; Aged ; Child ; Female ; Foreign Bodies ; diagnostic imaging ; Head ; Humans ; Male ; Middle Aged ; Neck ; Tomography, Spiral Computed ; Tomography, X-Ray Computed ; Young Adult

Background Researches showed that CD4+CD25+ natural regulatory T cells (nTregs) play an important role in maintaining peripheral immune tolerance, while immunotherapy using in vitro-expanded induced regulatory T cells (iTregs) suppresses allograft rejection in multiple organ transplantation.The inducing method of iTregs still needs to be optimized.Furthermore,the effect of iTregs on grafts of keratoplasty is unclear.Objective This study was to investigate the inducing and expansion method of iTregs and explore its inhibitory effects on corneal allograft rejection.Methods Bone marrow-derived dendritic cells (BMDCs) were isolated from C57BL/6 mice femora and cultured.CD4+ CD25+ T cells and CD4+ CD25-T cells were isolated from mouse spleen and separated using flow cytometry.The CD4+CD25-T cells were divided into negative control group (CD4+CD25-T cells), CD3/ 28 antibody bead group (CD4+CD25-T cells+CD3/28 antibody bead) ,2.5 ng/ml transforming growth factor (TGF)-β1 induced group and 10.0 ng/ml TGF-β1 induced group.The iTregs was formed after induction of different concentrations of TGF-β1 and CD3/CD28 antibody bead (1 : 1).CD3/CD28 antibody bead (1 : 2) , interleukin-2 (IL-2) and TGF-β1 were used to expand iTregs.The phenotype and proliferation of iTregs were assayed by flow cytometry,and the inhibitory effect of iTregs on effector T cells (Teffs) was analyzed by mixed lymphocyte reaction.Allogenic keratoplasty model (C57BL/6→BALB/c) was build,and 0.1 ml iTregs or nTregs suspension or PBS was injected via posterior venous plexus of fellow eyes to assess the graft survival time.The use and care of the mice followed the ARVO statement.Results The CD4+CD25+ T cell proportions were (6±3)％ ,(91±4)％ ,(91±3)％ and (86± 6) ％ in the negative control group,CD3/CD28 antibody bead group, 2.5 ng/ml TGF-β1 induced group and 10.0 ng/ml TGF-β1induced group, showing significant increases in the CD3/CD28 antibody bead group, 2.5 ng/ml TGF-β1 induced group and 10.0 ng/ml TGF-β1 induced group compared with the negative control group (all at P＜0.01).The Foxp3+ T cell proportions of the CD3/CD28 antibody bead group,2.5 ng/ml TGF-β1 induced group and 10.0 ng/ml TGF-β1 induced group were (1.18 ±0.20) ％ , (8.70± 1.80) ％ and (21.80±3.36) ％ , showing significant increases in the 2.5 ng/ml TGF-β1 induced group and 10.0 ng/ml TGF-β1 induced group compared with the CD3/CD28 antibody bead group (both at P＜0.01).Compared with the nTregs, the expression of CD69 was lower, and the expressions of PD-1 and Foxp3 were raised in the iTregs (all at P＜0.01).The proliferation of Teffs were decreased when cocultured with iTregs in comparison with nTregs at 1 : 1,1 : 2,1 : 4,1 : 8,1 : 16 Tregs/Teffs rations (all at P＜ 0.01).The survival time of mouse corneal grafts was 4 weeks with the permanent tolerance of 50％ in the iTregs injected group,which was superior to the 3 weeks survival time and 17％ permanent tolerance in the nTregs injected group(P＜0.05).Conclusions TGF-β1 can induce CD4+ CD25-T cells to form iTregs, which highly express Foxp3.iTregs show a stronger inhibitory effect on the growth of lymphocytes than nTregs, and therefore suppress the graft rejection after keratoplasty.

Denture stomatitis is one of the most common problems appearing after patients wearing removable dentures,which appears more frequently in maxillary complete dentures. The clinical symptom is that the mucosa of the stress-bearing area of denture base broadly gets red,and forms the boundary diffusion erythema. Sometimes when the surface of denture base and the mucosa of stress-bearing area are not close well,some granules will be found at the surface of the erythema. With the world's gradually stepping into the aging society,the number of people who have to wear removable dentures is increasing,because dentition defect or edentulous affected by any reasons. As a result,how to solve the secondary disease such as denture stomatitis is becoming a hot spot which more and more researchers concern about. This paper summaries the development of prevention of denture stomatitis in prosthetic area via selection of base materials,manufacture of denture,sterilization of denture,and improvement of base.

[Objective] To discuss the surgical treatment strategy of spinal hemangioma.[Methods]Data on 33 patients with spinal hemangioma treated from October 1997 to October 2008 were reviewed.There were 19 females and 14 males.The average age was 54 years old.Chief complaints were pain(n=13),myelopathy(n=12),radiculopathy plus local pain(n=8).Nine patients without spinal cord and radial nerve compression underwent percutaneous vertebroplasty(PVP),and 24 patients with spinal cord and radial nerve compression,paravertebral soft tissue mass or spinal unstability were treated by operation.Anterior,anteroposterior and posterior approaches were used in 9,12,and 3 patients respectively.Transarterial embolization was done in 3 patients.[Results]No perioperative complication was observed in 9 patients after PVP,with a mean follow-up of 41 months.Pain was relieved.There was no perioperative death among the 24 patients who received operation.The blood loss during operation was 2739 ml and 1619 ml for anterior and posterior approaches,respectively(P=0.12).One case of paravertebral hematoma,one case of spinal canal hematoma,and one case of wound infection were observed in this group.Pain was relieved in 89%(17/19)of the patients.According to the Frankel Scale,the neurologic situation was improved in all the 12 patients with myelopathy.By a mean follow-up of 48 months,no internal fixation failure was seen.Tumor recurrence or growth was found in 4 patients,two had no symptoms and one underwent radiotherapy for pain.Repeated operation was performed in one patient with myelopathy.[Conclusion]Most patients with symptomatic spinal hemangioma could be treated successfully by surgery.Individual surgical plan should be made according to the reason causing symptoms and the general condition of the patient.