OBJECTIVE To study antibiotic-resistant phenotypes and genotypes of ESBLs-producing Escherichia coli,Klebsiella pneumoniae and Klebsiella oxytoca isolated from children with pneumonia in Urumqi,to know the distribution and difference of these three Gram-negative bacilli from 2003 to 2007.METHODS Bacterial strains were identified by VITEK32,ESBLs were detected by confirmatory test recommended by CLSI.Microarray technique was used to determine the genotypes of ESBLs.RESULTS Antibiotic-resistant phenotypes showed ESBLs-producing K.oxytoca decreasing from 84.3% to 35.3%,K.pneumoniae stabling in 50-60%,E.coli increasing from 34.4% to 72.1% during the five years;genotypes indicated there were most of ctx-m-9 and tem+ctx-m-9 in E.coli,tem and shv in K.pneumoniae,and the most of tem+ctx-m-3 in K.oxytoca.CONCLUSIONS There is high percentage of ESBLs production from children in Urumqi;resistant phenotypes and genotypes of ESBLs are different in three Gram-negative bacilli;and must further enhance the regional epidemiology surveillance about ESBLs.

Objective: To compare the clinical effects of autologous semitendinosus tendon and allogenic tendon arthroscopic anatomical reconstruction of anterior talofibular ligament (ATFL) combined with calcaneofibular ligament (CFL) in the treatment of chronic lateral ankle instability. Methods: A retrospective analysis was made of 55 patients with chronic lateral ankle instability who underwent arthroscopic reconstruction of ATFL combined with CFL from January 2012 to June 2017. A total of 28 cases were treated with autologous semitendinosus tendon (autologous group), including 19 males and 9 females, with an average age of 28.5±8.03 years (range, 16-46 years). A total of 27 cases were treated with allogenic tendon (allogenic group), including 17 males and 10 females, with an average age of 27.48±7.89 years (range, 16-46 years). ATFL/CFL was reconstructed by the same method in both groups. The reconstruction methods were the same between the groups. The talus and calcaneus were fixed with absorbable compression nails. Results: The operation duration in the autologous group was 94.07±7.83 min, which was longer than that in the allogeneic group 63.56±7.96 min (t=14.51, P<0.001). Fever days 5.26±0.90 days in allogeneic group were longer than 2.46±0.74 days in autologous group (t=-12.55, P<0.001). Wound healing duration in allogeneic group was 13.44±3.33 days longer than that in autologous group 10.32±2.34 days (t=-4.01, P<0.001). In the autologous group, 28 cases were followed up for 34.54±16.04 months, and 27 cases in the allograft group were followed up for 42.74±17.79 months. The mean AOFAS score improved from 63.64±11.20 before operation to 90.21±4.48 after operation in the autologous group, and that improved from 63.93±10.59 before operation to 89.56±5.15 after operation in the allogeneic group with no significant difference between the two groups after operation (t=0.506, P=0.615). The mean VAS score decreased from 5.79±1.79 before operation to 1.54±1.35 after operation in the autologous group, and from 5.89±1.78 before operation to 2.04±1.32 after operation in the allogeneic group. There was no significant difference between the two groups after operation (t=-1.396, P=0.168). Tegner score increased from 4.07±1.39 to 6.43±1.14 in the autologous group and from 3.85±1.06 to 6.52±0.85 in the allogeneic group with no significant difference between the two groups after operation (t=-0.333, P=0.740). Stress radiographic showed that the talar tilt angle decreased from 15.60°±3.86° to 6.01°±2.64° in the autologous group, 16.99°±3.78° to 7.14°±3.34° in the allogeneic group, and there was no significant difference between the two groups after operation (t=-1.382, P=0.171). Anterior talar displacement reduced from 10.82±3.12 mm to 4.03±1.69 mm in the autologous group, from 10.10±2.02 mm to 4.17±1.52 mm in the allogeneic group, and there was no significant difference between the two groups after operation (t=-0.326, P=0.746). No donor tendon dysfunction was found in the autologous group. At the end of follow-up, there was no difference in ankle dorsiflexion, plantar flexion and hind foot mobility between autologous group and allogeneic group. Conclusion Arthroscopic autologous tendon and allogeneic tendon reconstruction of AFTL combined with CFL can obtain satisfactory short-term results. The autologous tendon group was superior to the allogeneic group in terms of fever, wound healing time. However, there was no significant difference in clinical effects between the two groups.

Objective To compare the outcomes of bone marrow stimulation techniques-drilling by a Kirschner needle versus microfracturing technique in the treatment of small osteochondral lesions of the talus.Methods From February 2014 to June 2017,57 patients were treated at Department of Orthopaedics,Sun Yat-sen Memorial Hospital for small osteochondral lesions of the talus.Of them,26 were treated by arthroscopic drilling with a Kirschner needle.They were 15 males and 11 females,aged from 20 to 57 years.The areas of osteochondral lesion ranged from 0.6 to 1.4 cm2.By the Berndt & Harty classification of ankle osteochondral lesions based on X-ray films,there were 9 cases of stage Ⅰ,8 cases of stage Ⅱ,6 cases of stage Ⅲ and 3 cases of stage Ⅳ.The other 31 patients of them were treated by arthroscopic microfracturing technique.They were 17 males and 14 females,aged from 24 to 55 years.The areas of osteochondral lesion ranged from 0.5 to 1.5 cm2.By the Berndt & Harty classification of ankle osteochondral lesions based on X-ray films,there were 10 cases of stage Ⅰ,11 cases of stage Ⅱ,8 cases of stage Ⅲ and 2 cases of stage Ⅳ.The 2 groups were compared in terms of visual analogue scale (VAS),the American Orthopaedic Foot and Ankle Society (AOFAS) score,the ankle activity score (AAS) and the Berndt & Harty staging of osteochondral lesions based on ankle X-ray films at the final follow-up.Results All the 57 patients were followed up for 13 to 27 mouths.The VAS,AOFAS and AAS scores and Berndt & Harty stages at the final follow-up were significantly improved in all the patients compared with their preoperative values (P ＜ 0.05).There were no significant differences between the 2 groups in the VAS (2.2 ± 1.6 versus 2.1 ± 1.4),AOFAS (89.1 ±6.3versus 90.4±5.8) or AAS scores (6 versus 6) at the final follow-up (P ＞ 0.05).There was no significant difference between the 2 groups either in the excellent and good rate by the AOFAS ankle-hindfoot scoring [88.5％ (23/26) versus90.3％ (28/31)] at the final follow-up (x2 =0.052,P=0.820).Conclusion In the treatment of small osteochondral lesions of the talus,both arthroscopic drilling with a Kirschner needle and microfracturing technique can achieve satisfactory short-term curative effects,but the long-term effects need to be further studied.

The construction of medical knowledge platform is a core value of the intelligent construction of electronic medical records. The hospital-wide knowledge base construction covers a wide range of content, including multiple healthcare scenarios such as medicine, testing, inspection, surgery, blood transfusion and nursing. This article introduced how Jiangsu Province People′s Hospital used knowledge graphs and rule engine to construct a hospital knowledge management platform, realize the integration of knowledge-based knowledge base and a non-knowledge-based knowledge base, and embed clinical diagnosis and treatment rules into the information system for different flexible application scenarios.Finally, a multi-dimensional knowledge base was formed to realize the unified knowledge information integration of various clinical expert knowledge, and to provide integrated display and decision support for all departments, as well as realizing real-time data verification, prompting and control in each link.

Objective:To evaluate the preliminary clinical application of our self-designed posterior reduction forceps for atlantoaxial dislocation in the reduction and fixation of irreducible atlantoaxial dislocation with simple posterior screw-rod system.Methods:Our posterior reduction forceps was self-designed and developed to assist simple posterior screw-rod system in the treatment of irreducible atlantoaxial dislocation based on the posterior atlantoaxial screw-rod system. A retrospective study was conducted to analyze the clinical data of 5 patients with irreducible atlantoaxial dislocation who had been treated from January 2021 to October 2022 at Department of Spine Surgery, General Hospital of Southern Theatre Command of PLA with our self-designed posterior reduction forceps. There were 2 males and 3 females, aged 53, 62, 45, 32 and 48 years, respectively. Diagnosis: 1 case of free odontoid process combined with atlantoaxial dislocation, 2 cases of atlantoaxial dislocation, and 2 cases of old odontoid process fracture combined with atlantoaxial dislocation. Respectively, their preoperative Japanese Orthopaedic Association (JOA) scores were 9, 11, 12, 13 and 10 points and their atlanto-dental intervals (ADI) 9.8, 7.4, 6.6, 6.4 and 8.5 mm. Postoperatively, atlantoaxial reduction and spinal cord compression were evaluated by X-ray, CT, and MRI examinations, and internal fixation, atlanto-axial sequence, and bone graft fusion by X-ray and CT examinations. One week after surgery, the JOA scores were used to evaluate the patients' neurological function and the ADI was measured to evaluate the atlantoaxial reduction.Results:The surgery was successfully performed in the 5 patients, with no intraoperative complications like neurovascular injuries to the spinal cord. The postoperative atlantoaxial reduction was satisfactory, the position of internal fixation was good, the compression to the spinal cord was relieved, and the clinical symptoms were significantly improved. At 1 week after surgery, respectively, the JOA score: 13, 14, 14, 15 and 13; the ADI: 2.6, 2.1, 1.8, 1.5 and 2.2 mm; the follow-up time: 3, 6, 12, 9 and 6 months; the bone fusion time: 3, 3, 6, 6 and 3 months. Follow-ups revealed no loosening or fracture of internal fixation, good atlanto-axial sequence, and no recurrence of dislocation.Conclusion:Our self-designed posterior reduction forceps for atlantoaxial dislocation can assist the simple posterior screw-rod system to treat irreducible atlantoaxial dislocation, leading to good preliminary clinical outcomes.

Felids are the unique definitive host of Toxoplasma gondii. The intestine of felid is the only site for initiating Toxoplasma gondii sexual reproduction. T. gondii excretes millions of infectious oocysts from the intestine, which are the primary source of infection. There are many difficulties in developing vaccines and drugs to control oocyst excretion due to the lack of an appropriate experimental model. Here, we established an in vitro feline intestinal epithelial cell (IEC) infection system and an efficient animal model of T. gondii Chinese 1 genotype, Wh6 strain (TgCtwh6). The Kunming mice brain tissues containing TgCtwh6 cysts were harvested 42-day post-infection. The bradyzoites were co-cultured with cat IECs in vitro at a ratio of 1:10. Five 3-month-old domestic cats were orally inoculated with 600 cysts each. The oocysts were detected by daily observation of cat feces by microscopy and polymerase chain reaction. We found that the parasite adhered and invaded cat IECs in vitro, transformed into tachyzoites, and then divided to form rose-like structures. These parasites eventually destroyed host cells, escaped, and finished the asexual reproduction process. Schizonts associated with sexual reproduction have not been observed during development in vitro cultured cells. However, schizonts were detected in all infected cat intestinal epithelial cells, and oocysts were presented in all cat feces. Our study provides a feasible cell model and an efficient infection system for the following studies of T. gondii sexual reproduction, and also lays a foundation to develop drugs and vaccines for blocking excretion and transmission of oocysts.

[Objective]To understand the current status of human immunodeficiency virus(HIV),Treponema palli-dum(TP),hepatitis C virus(HCV)and hepatitis B virus(HBV)infections among patients undergoing screening tests in a specialized cancer hospital in South China,and to analyze the completion of further testing for confirmation,so as to pro-vide a reference for management of common infectious diseases and prevention of nosocomial infections.[Methods]We ana-lyzed the positive rates of HIV antigen/antibody combination assay(HIV-comb),TP antibody(anti-TP),HCV antibody(anti-HCV)and hepatitis B surface antigen(HBsAg)among the outpatients and inpatients who underwent the screening tests in 2022.Then we examined the percentage of those patients with seropositivity for further confirmation.[Results]In patients who underwent the screening tests,the positive rate,percentage of patients for further confirmation test and over-all prevalence for HIV-comb were were 0.07%,100%and 0.06%,respectively;for Anti-PT 1.99%,100%and 0.51%,respectively.Positive rate of anti-HCV was 0.90%and 26.61%of patients completed further HCV RNA quantitative as-say,in 26.44%of whom,HCV RNA levels were above the detection limit.Positive rate of HBsAg was 21.06%and 54.40%of patients completed further HBV DNA quantitative assay,in 51.60%of whom,HBV DNA levels were above the detec-tion limit.As for the nucleic acid testing among the suspected hepatitis patients,we found smaller coverage in outpatients than in inpatients and larger coverage in liver cancer patients than in other patients.[Conclusions]Compared with general population,patients in this specialized cancer hospital had similar infection levels of HIV and syphilis,and 100%of them completed further confirmation testing.Hepatitis C and hepatitis B infections were at a relatively high level,but which could not accurately reflect the level of virus replication due to insufficient coverage of nucleic acid testing.Specialized can-cer hospitals should prompt medical staff to attach more importance to screening and further confirmation of common infec-tious diseases among tumor patients.While offering anti-cancer treatment,hospitals should also actively refer the con-firmed cases with infectious diseases to designated or general hospitals for a better outcome and quality of medical services.

Objective: To explore the effects of n-butylphthalide (NBP) on mitochondria in hippocampus and learning and memory abilities in rats with chronic alcoholism. Methods: 60 male SD rats were randomly divided into three groups on average, including normal group, model group and treatment group, with 20 rats in each group.Rats of model group and treatment group are given 6% (V/V) alcohol solution continuously for 28 d to establish the model of chronic alcoholism.Rats in the treatment group were given butylphthalide for 14 days from the fourteenth day after giving alcohol solution.The Y type electric maze was used to test the learning and memory ability of rats, the content of H₂S in the hippocampus and the activity of mitochondrial ATP enzyme were measured by spectrophotometry, and the protein expression of F-actin was detected by Western blot. Results: Compared with the normal group, the learning and memory ability of the rats in the model group were decreased, the content of H₂S in the hippocampus were increased, and the activity of mitochondrial ATP enzyme and the expression of F-actin protein were decreased, and most of the mitochondria were damaged under the electron microscope.The training times of the rats in treatment group(61.88±3.61)was lower than that of the model group(82.19±4.87), the ability of learning and memory was improved(P<0.05). Compared with the model group ((1.50±0.07)U/mgprot, (0.08±0.01)), the activity of the mitochondrial ATP enzyme((1.84±0.11)U/mgprot) and the level of F-actin protein(0.12±0.01)in rat hippocampus of treatment group were increased, the difference was statistically significant(both P<0.05). The level of H₂S in rat hippocampus of the treatment group ((34.56±2.47) nmol/g) was lower than that of the model group ((44.55±3.71) nmol/g), the difference was statistically significant(P<0.05). Compared with model group, the mitochondrial damage of the hippocampus in the treatment group was improved under electron microscope. Conclusion NBP can abate mitochondrial damage and improve learning and memory abilities in chronic alcoholism rats.