Objective To study the drug resistance and production status of highly producing AmpC enzymes, extended-spectrum β-lactamases (ESBLs) and drug resistance in Acinetobacter bau-mannii. Methods Drug sensitivity test was performed with Kirby-Bauer method. ESBLs were detected with phenotype confirmatory test (double-disk synergy test), and highly producing AmpC enzymes were measured with phenotype screening method. Results 93 strains of Acinetobacter baumannii were mainly obtained from respiratory department and neurosurgery, and isolated from sputum/pharyngeal stab, raw surface/wound secretion and urine samples. 15 strains (16.1%) of highly producing AmpCenzyme-producing Acinetobacter baumannii were detected, so were 10 strains (10. 8%) of ESBLs-pro-ducing isolates. All enzymes-producing strains displayed multi-resistant, and their resistant rates to the third cephalosporin, penicillins and aztreonam were much higher than enzymes non-producing ones. None was detected resistant to imipenem. Conclusion Occurrence of highly producing AmpC en-zymes and extended-spectrum β-lactamases (ESBLs) is one of causes for Acinetobacter baumannii multi-resistance. It suggests that detection of ESBLs-producing isolates should be strengthened so as to prevent their outbreak and spread.

Objective Comprehensive geriatric assessment is the core technology,this paper describes the concept of comprehensive geriatric assessment,objects,content,assessment methods,interventions and research pro-gress,provide experience to carry out comprehensive geriatric assessment in Tibet,the Tibet region to explore for com-prehensive geriatric assessment mode.

Objective To analyze the effect of cigarette smoking on replantation of amputed digit, investigate the pathologic mechanism of vascular crisis(VC) caused by smoking. Methods 1)The replantation risk factor such as smoking to VC and blood insufficiency of replanted digit was reviewed in 1 685 cases of digit replantation. 2)The complications after digit replantation in short and long terms among patients smoking were compared with those not smoking after operation. The results of management and time of appearance VC was assayed. 3)The possible pathologic mechanism of VC caused by smoking was analyzed. Results 1)A significant correlation between the ratio of VC, blood insufficiency of replanted digit and smoking index(SI, the number of cigarette in a day multiplies the years of smoking) was found. 2)The rate of VC, wound infection and unhealing in short term and the feeling of pain, numbness and cool in the long term in patients smoking after operation (92.6%,55.6%,48.1% and 71.6%) was obviously more than that in non smoking patients(17.8%,9.3%,2.0% and 3.0%,P

Objective To explore a novel operative management for irreducible atlantoaxial dislocation. Methods Fifty-four patients, which as 32 males and 22 females aged from 7 to 63 years old with a mean of 32 years, were diagnosed with irreducible atlantoaxial dislocation, including 18 patients with os odontoideum, 22 occipitalization, 5 malunion of odontoid fracture and 9 relaxation of transverse ligament of atlas. Forty patients presented signs and symptoms of myelopathy or spinal cord injury. All of the patients underwent the operation of open reduction and release by transoral approach. The longus collies muscles, longus capitis muscles, anterior longitudinal ligament, atlantoaxial articular capsules, the apical odontoid ligament and alar odontoid ligaments may be included, were transected, followed by arthrodesis via posterior approach in one stage. Different methods of posterior arthrodesis were conducted as followed: C1,2 transarticular screw fixation in 5 cases, occipitocervical fixation using pedicle screws of axis and occipitocervical plate in 37 cases, and C1,2 joint fixation with plates and screws in the lateral masses of the atlas and axis in 12 cases. Results A complete reduction was achieved in 41 cases, and the other 13 patients obtained partial reduction. Forty-eight patients were followed up from 4 to 40 months, 15.7 months at the average. All of them achieved solid arthrodesis. According to Odom's scoring system, among the 38 patients with preoperative upper cervical myelopathy, 15 patients were assessed as excellent, 14 good, 8 fair and 1 poor. During the operation, cerebral spinal fluid leakage occurred in 1 case, and pedicle screwing failed in 1 case. After the operation, respiratory failure was found in 1 case, nasal sound in 3 cases, dysphagia in 1 case. One patient became quadriplegia due to myelitis caused by septicemia at two weeks after the operation. The internal fixation loosened in 1 case at 2 months postoperatively. Conclusion Transorally surgical release for reduction and posterior arthrodeses could achieve satisfactory outcomes in patients with irreducible atlantoaxial dislocation.

Objective To investigate the usefulness of percentage of free prostate specific antigen(FPSA/TPSA)/PSA density[(F/T)/PSAD]in the diagnosis of prostate cancer of PSA level in 4~10ng/ml. Methods 88 patients of PSA level in 4~10ng/ml were carried out transrectal ultrasound guided prostate biopsy. Among them,21 patients were proved to be suffering from prostate cancer,and other 67 patients were identified as benign prostate hypertrophy. The effect of F/T ratio,PSAD and(F/T)/PSAD in the diagnosis of prostate cancer were investigated. Results The mean value of(F/T)/PSAD of prostate cancer were significantly lower than benign prostate hypertrophy for patients with PSA levels in 4.0-10ng/ml, This difference has arrived statistical significance(P

Objective To evaluate the relationship between hypertriglyceridemia and acute pancreatitis.Methods Data was analyzed from 41 patients with acute pancreatits from Apr.1998 to Oct.2000 in our hospital.Of the 13 patients(GroupⅠ) with plasma TG level being higher than 11.3 mmol/L, 8 accompanied with gallstone(61.5%)and 5 without gallstone(38.5%)of the 28 patients (GroupⅡ) with plasma TG level being lower than 11.3 mmol/L,19 accompanied with gallstone(47.3%)and 9 without gallstone(52.7%)RANSON score,morbidity of complications and the level of ALT and AST were compared between two groaps.The correlation between TG and RANSON score was analysed.Results There were significant difference between the two groups on RANSON score,morbidity of complications and level of ALT and AST(P0.05).Conclusion There is an close relationship between hypertriglyceridemia and acute pancreatitis,the high level of plasma TG plags a key a role in acute pancreatitis,patients with acute pancreatitis with hypertriglyceridemia are more likely to have higher morbidity of complications and liver function aggravating.

Objective To investigate the therapeutic efficacy of castration with 125I brachtherapy in middle and late stage prostate cancer. Methods Sixty-six patients with prostate cancer from 2004 to 2009 were analyzed, 40 were at clinical stage C and 26 were at clinical stage D, 42 had a pathologic grade G2 and 24 had a pathologic grade G3. The first endocrinal therapy used was total androgen blockade (chemical castration and anti-androgen drugs). The therapeutic time was three months before bilateral orchidectomy and brachtherapy. A 3D radiotherapy planning system was used for brachtherapy with transrectal ultrasound-guided radioactive 125I seed uniform implantation. Follow-up endocrinal therapy was decided according to a monthly check of serum PSA (prostate specific antigen) levels. After six months, serum PSA, IPSS and volume of the prostate before and after treatment were compared. Results The operations were completed successfully in all cases. The mean number of 125I seeds implanted was 55. The mean follow-up was 10 to 62 months, with an average of 49 months. Serum PSA, IPSS and the volume of the prostate was reduced significantly six months after operation (P<0.05). Conclusions Castration with 125I brachtherapy is an effective approach in combination therapy for treating middle and late stage prostate cancer.

Objective To evaluate thedifferential diagnosis of specially cystic masses located at the area of the left adrenal gland,and to improve the understanding of the clinical symptoms and pathological features,diagnosis and treatment of gastric duplicated cyst.Methods A retrospective study,with literature review,of clinical characteristics and imaging findings of pathologically proved gastric duplicated cyst in 2 adults (2 males,28 years and 42 years)was conducted.Two patients presented no clinical manifestation.Abdominal ultrasonography and CT scan revealed a cystic lesion,in the area of the left adrenal gland,with a thickness wall,measuring 5 cm ×6 cm× 7 cm and 8 cm × 12 cm × 13 cm,attached to the greater curvature of the stomach.The lesion had septums,and the walls and septums could not be enhanced.Preoperative diagnosis of patients was misdiagnosed as a cyst of the left adrenal gland,with inflection or bleeding.Results Complete excision was performed by laparoscopic surgery in all cases.The lesion located in the area of left adrenal gland and no communication between the duplicated cyst and the lumen of stomach was detected.Postoperatively,the lesions were pathologically proved to be gastric duplicated cyst.There was no recurrence during the follow-up of 8 months and 2 years.Conclusions Preoperative definite diagnosis of adult gastric duplication cyst is very difficult.Ultrasonography and Computed Tomography are valuable imaging modality for locating the site and determining the nature of adult gastric duplicated cyst.Preoperative definite diagnosis could be made by EUS (endoscopic ultrasonography) and EUS-guided fine needle aspiration biopsy in gastric duplicated cyst.Although adult gastric duplicated cyst is an extremely rare disease entity,but this unusual developmental abnormality should be include in the differential diagnosis of cystic masses located the area of the left adrenal gland.Because of the possibility of malignancy of the cyst,laparoscopic excision is the first choice as the minimally invasive treatment.

Objective To explore the expressions of autophagy-related gene Beclin-1 and LC3 in adriamycin induced eardiomyopathy rats,to prnve that autophagy might take part in the development of adriamycin induced eardiomyopathy in rats,so as to provide experimental and theoretical evidence for preventing and treating adriamycin induced cardiomyopathy.Methods Forty-five male SD rats were randomly divided into 3 groups,control groups,ADR group and ADR+3-MA group.The model of adriamycin induced cardiomyopathy rats was established.The tissue sample taken from the left ventricle wall was checked for the morphons of autophagosome by electron microscope. The expressions of Beelin-1 and LC3 of myocardium were detected.Results The morphons of autophagosome in ADR group was significantly increased compared with that in control and ADR +3-MA groups. The expression of Beclin-1 in myocardium of ADR group was significantly inereased compared with that in control and ADR +3-MA groups (P < 0.05).The level of LC3 in myocardium of ADR group was significantly increased compared with that in control and ADR+3-MA groups (P < 0.05).Conclusions Autophagy plays an important role in adriamycin induced cardiomyopathy.

Cas9 is a RNA-guided double stranded DNA nuclease that participates in the CRISPR/Cas9 system. Wide-type Cas9 directly silences the expression of target gene by gene splicing. The engineered dCas9 protein with the mutation at D10A and H840A lacks the Cas9' s endonuclease function but keeps its DNA binding activity. dCas9 can activate special genes by fusing with transcription activator. Meanwhile,it can inhibit the gene transcription by directly binding to the target gene and stop gene transcrip?tion. Combination of light sensitive structures and CRISPR can produce light-inducible CRISPR/Cas9 system for control of gene expres?sion. This system is able to activate or inhibit gene expression via the use of controlling blue light(470 nm). In this review,we mainly discuss the development of the light inducible CRISPR/Cas9 system as well as its application in the control of gene expression.