OBJECTIVE To investigate the distribution and drug resistance of common bacteria isolated from our hospital in 2001-2005,and to guide the appropriate use of antibiotics.METHODS The resistant patterns were analyzed by retrospective analysis from 2001 to 2005.RESULTS There were 268 Gram-positive strains(27.21%) and 717 Gram-negative strains(72.79%).The most prevalent isolated strains were Escherichia coli,Pseudomonas aeruginosa,Staphylococcus aureus,Stenotrophomonas maltophilia,Klebsiella pneumoniae and Staphylococcus epidermidis,which were increasing year by year.Imipenem was the most sensitive for Gram-negative rods,and vancomycin was the most sensitive for Gram-positive cocci.The resistance rate of E.coli to imipenem and ceftazidime was below 30%.All S.aureus strains were susceptiple to vancomycin.CONCLUSIONS The rapid emergency of nosocomial multidrug resistant strains presents significant therapeutic challenges and therefore,the rational use of antibiotic therapy based on susceptibility tests should be emphasized.Understanding the distribution of isolates and drug susceptibility test results of different bacteria could help doctors to decide the rational antimicrobial therapy.

Currently adopted surgical approaches of laparoscopic combined organ resection for gastrointestinal cancer include laparoscopic pancreaticoduodenectomy and gastrectomy, laparoscopic gastrectomy combined distal pancreatectomy and splenectomy, laparoscopic gastrectomy and cholecystectomy, laparoscopic rectal anterior resection and total hysterectomy with bilateral salpingo-oophorectomy, and laparescopic colorectal and hepatic metastases resection. Satisfactory clinical outcomes of these procedures for gastrointestinal cancer were obtained in the reported cases. However, the number of cases in current studies on laparoscopic combined organ resection for gastrointestinal cancer was too small and no control groups involved, and multicenter clinical trials were not yet conducted. In conclusion, the future of laparoscopic combined organ resection for gastrointestinal cancer is promising, while its feasibility and safety require further investigation.

Sentinel lymph node (SLN), the hypothetical first regional lymph node or group of lymph nodes to received lymphatic drainage from a primary tumor, can predict the likelihood of further nodal involvement. SLN mapping was initially applied to the treatment of breast cancer and melanoma, and it also shows gratifying effect on thyroid cancer, pancreatic cancer and gastrointestinal tumors. The development of SLN mapping in colorectal cancer has brought us a new approach to design personalized operation and adjuvant therapy plans. However,various SLN mapping techniques in colorectal cancer available present fluctuant navigation performances, which need to be replaced by an economical, convenient and accurate tracing technique. Hopefully the optimized SLN mapping can play a more important role in the management of increasing occurred early colorectal cancer.

Dilatation ; Humans ; Tracheostomy ; methods

Objective To seek an effective and safe therapy for acute variceal hemorrhage of patients with Child class C cirrhosis. Methods One hundred and nine Child class C cirrhotic patients with an acute hemorrhage from esophageal varices were reviewed. Sixty - one patients received medical therapy;29 patients were underwent sur- gical operations and 19 patients received TIPSS. Results The surgical group had a higher mortality rate during hos- pitalization(65. 5 % ) than either of the other groups(36. 1 % and 26. 3 % respectively ). The rebleeding rates during hospitalization were 24. 1 %, 36. 1 % and 15. 8 % respectively in the surgical group, medical group and TIPSS group. Rebleeding rate during following- up period were 33. 0%, 36. 1 % and 21 .4% respectively. The rebleeding rate was significantly higher in the medical group than that in either of the other groups during the two phases. Kaplan - Meier survival analysis didn' t show significant difference among the three groups. Conclusions The results showed that TIPSS is a good alternative to surgical or medical therapy for patients with Child class C cirrhosis and acute vericeal bleeding.

Objective It has been unclear how osteopontin, one of metastasis-associated genes, could be regulated in HepG2 cells. The aim of this study was to investigate the effect of protein kinase B(Akt) on the expression of osteopontin in HepG2 cells, and to explore the relationship between Akt and osteopontin expression. Methods HepG2 cells were transfected with constitutively active Akt and dominant negative Akt by lipofectmine, and transfectants were confirmed using Western blot for Akt. Osteopontin expression was detected by Northern blot and Western blot. Results HepG2 cells were successfully transfected with Akt genes including constitutively active Akt and dominant negative Akt, and overexpression of exozegenes Akt could be detected in HepG2 cells by Western blot. Using Northern blot and Western blot, we found that Akt gene regulated osteopontin expression in RNA level and protein level. In serum-free condition, HepG2 cells constitutively expressed low levels of osteopontin. Transfection of constitutively active Akt increased osteopontin mRNA and protein expression. Transfection of dominant negative Akt decreased osteopontin expression.Conclusions The fact that osteopontin gene expression can be regulated by Akt indicates that osteopontin synthesis can be blocked by inactivation of Akt gene and that metastasis of liver cancer might be inhibited by this intervention.

Objective To compare the clinical efficacy between endoscopic thyroidectomy via breast approach and conventional open thyroidectomy in patients with nodular goiter.Methods A series of 75 patients with unilateral nodular goiter was divided into two groups,either receiving endoscopic thyroidectomy through breast approach(Endoscopic Group,24 cases)or conventional open thyroidectomy(Open Group,51 cases).The therapeutic efficacy was compared between the two groups.Results In the Endoscopic Group,the endoscopic operation was successfully performed in 23 cases,whereas a conversion to open surgery was needed in 1 case because of large nodule(6 cm in diameter)and extensive adhesion of infrahyoid muscles(resulted from a previous injection therapy).The operating time was significantly longer in the Endoscopic Group(100.4?26.6 min)than in the Open Group(73.5?14.5 min)(t=5.627;P=0.000).The postoperative drainage volume in the Endoscopic Group(66.7?24.9 ml)was significantly more than that in the Open Group(13.3?6.4 ml)(t=14.403,P=0.000).The postoperative hospital stay was significantly longer in the Endoscopic Group(4.3?1.1 d)than in the Open Group(3.6?0.9 d)(t=2.886;P=0.005).The Endoscopic Group had significant higher hospital costs(11 572?1675.1 yuan)than the Open Group(5015.9?1211.0 yuan)(t=19.058;P=0.000).And a satisfactory cosmetic result was achieved in significantly more patients in the Endoscopic Group(22/24 cases)than in the Open Group(34/51 cases)(?2=7.235;P=0.007).There was no significant difference in intraoperative blood loss between the Endoscopic Group(22.5?15.3 ml)and the Open Group(18.3?7.5 ml)(t=1.273;P=0.207),and in consumption of analgesics between the Endoscopic Group(9/24 cases)and the Open Group(21/51 cases)(?2=0.028;P=0.867),respectively.No severe complications were encountered,such as massive hemorrhage,injuries of the recurrent or superior laryngeal nerve,or parathyroid gland injury.During a follow-up for 6 months,none of the patients was found recurrence after surgery.Conclusions Both breast approach endoscopic thyroidectomy and conventional open thyroidectomy are safe and effective.The former gives better cosmetic outcomes but slower recovery and high hospital costs compared to the latter.

Objective To investigate the effect of unfractioned heparin and low molecular weight heparin on expression of plasma hepatocyte growth factor(HGF)during percutaneous coronary intervention(PCI).Methods Seventy four patients with unstable angina pectoris were classfied into unfractioned heparin(UFH)group(n=49)and low molecular weight heparin(LMWH)group(n=25)according to the type of heparin used during PCI.The plasma levels of HGF were measured before,during,and after PCI in the patients.Results The plasma levels of HGF before procedure were of no statistical difference between the two groups.The levels of HGF were significantly increased during and after PCI in the unfractioned heparin and the LMWH group.Comparing with the pre-procedure level,the post-procedure level of HGF in the UFH group was 13 565.60?3 768.99 ng/L(vs 1 736.09?603.95 ng/L,P

Objective To investigate the adverse reactions and survival rate of low dose of Oxaliplatin combined with transcatheter arterial chemoembolization in treatment of elderly patients with primary hepatic carcinoma.Methods A total of 84 patients with primary liver cancer were enrolled and randomly divided into low dose group and high dose group.Patients received 40 mg/m2 and 80 mg/m2 of Oxaliplatin respectively,and adverse reactions and survival rate were compared between the two groups.Results Incidence of nausea and vomiting was obviously lower and the number of patients with pain scale above 6 was significantly smaller in low dose group than in high dose group,with statistically significant differences (11.9％ vs.21.4％ and 28.6％ vs.78.6％,x2 =9.910,20.056,both P ＜ 0.05).White blood cell count was significantly higher and alanine aminotransferase (ALT) was significantly lower in low dose group than in high dose group after treatment (t =13.447,6.774,both P＜0.05).1 year and 3 year survival rate was 69.05％ and 30.95％ in low dose group and 61.9％ and 21.43％ in high dose group,respectively,with no statistically significant difference (x2 =0.474 and 0.985,P=0.491 and 0.321).Conclusions Low dose of Oxaliplatin combined with transcatheter arterial chemoembolization in the treatment of elderly patients with primary hepatocellular carcinoma is worth to be promoted in clinical application because it does not affect the patient survival rate and the toxic effects of the chemotherapy are very little.

Objective To explore the clinical significance of plasma LP (a) ,Hcy ,hs-CRP and cTnI concentrations in patients with AMI .Methods Plasma LP(a) ,Hcy ,hs-CRP and cTnI concentrations of 162 patients with AMI and 165 healthy people recrui-ted as control group were determined .Immunofluorescent dry quantitative method and electro-chemiluminescence immunoassay were used in the determination ,and statistical analysis were used in data comparison .Results Before treatment ,the plasma LP(a) , Hcy ,hs-CRP and cTnI concentrations in 162 AMI patients were significantly higher than those in control group (P<0 .01) .After treatment ,the plasma hs-CRP concentrations in 97 improved patients returned to normal (t=1 .586 ,P>0 .05) ,but the plasma cTnI concentrations significantly decreased (t=3 .322 ,P<0 .01) .The plasma Hcy ,hs-CRP and cTnI concentrations in 36 died patients were significantly higher(P<0 .01) .Conclusion Plasma LP(a) ,Hcy ,hs-CRP and cTnI determination were valuable for the diagno-sis of AMI patients ,the most valuable indicators for patient prognosis and follow-up were plasma hs-CRP and cTnI .