OBJECTIVE To study the classification of the ?-lactamases produced by Citrobacter freundii.METHODS To detect the ?-lactamases produced by 33 strains of C.freundii with nitrocefin test,a multi-disk test(synergy test and antagonized test) for the inducible AmpC ?-lactamases(IABLs),AmpC ?-lactamases(ABLs) phenotype test,extended-spectrum ?-lactamases(ESBLs) screening test,and carbapenem-hydrolyzing ?-lactamases(CHBLs).RESULTS In the 33 strains,29 strains produced the ?-lactamases(87.9%);the nitrocefin tests of 27 from the 29 strains were positive(81.8%);two strains produced penicillinases,3 strains produced cephalosporinases,5 strains produced broad-spectrum ?-lactamases(BSBLs),11 strains produced ESBLs alone,and 6 strains produced ESBLs+ high-productive ABLs,the rate of ESBLs produced by the 33 strains of C.freundii was 51.5%,and 2 strains produced CHBLs(all produced ESBLs+ metallo-?-lactamase).CONCLUSIONS The rate of ?-lactamases,rate of ESBLs and co-produced rate is very high.There are six kinds of ?-lactamases produced by the 33 strains of C.freundii,mainly BSBLs and ESBLs.

OBJECTIVE To study the classification the ?-lactamases produced by Providencia spp.METHODS To detect the ?-lactamases produced by 19 strains of Providencia spp with nitrocefin test,a multi-disk test(synergy test,antagonized test for the inducible AmpC ?-lactamases(IABLs),AmpC ?-lactamases(ABLs) phenotype test and extended-spectrum ?-lactamases(ESBLs) screening test,carbapenem-hydrolyzing ?-lactamases(CHBLs).RESULTS The nitrocefin tests of all of 19 strains were positive,producing the ?-lactamases(100.0%);eight strains produced broad-spectrum ?-lactamases(BSBLs,42.1%) and ESBLs(42.1%),respectively,one strain produced overexpression of AmpC,3 strains produced CHBLs.CONCLUSIONS The rate of ?-lactamases produced by the 19 strains of Providencia spp is very high,there are three kinds of ?-lactamases,mainly BSBLs and ESBLs.

The embryo quality and endometrial receptivity is the two important factors that affects human implantation. Many patients with infertility caused by the disorder of endometrial receptivity fails in embryo implantation. Improving the receptivity of endometrium to improve clinical pregnancy rate has become a hot issue of research in recent years. In this paper, the current use of drugs and surgery on the measures to improve the receptivity of endometrium was summarized, in order to provide references for improving the success rate of assisted reproductive technology.

Objective To observe the effects of nursing intervention on the treatment compliance in elderly hypertensive patients. Methods A total of 117 cases of elderly hypertensive patients were randomly divided into observation group and control group.All patients in two groups were given routine drug treatment and care.On this basis,the patients in the observation group were interfered according to the treatment compliance,such as medication time,monitoring blood pressure,health education and so on.The evaluation was done 6 months after discharge. Results The treatment compliance of the observation group was much higher than that of the control group.The treatment compliance effect of the observation group showed much better than that of the control group with significant difference(P＜0.01).In the blood pressure of admission,there was no significant difference between the two groups.The blood pressure of the observation group was significantly decreased than that of the control group after 6 months follow- up with significant difference(P＜0.05). Conclusion The nursing intervention can significantly improve the treatment compliance and antihypertensive effect in elderly hypertensive patients.

Objective To observe the effects of nursing intervention on elderly patients with chronic obstructive pulmonary disease(COPD). Methods A total of 60 patients with COPD were given specific nursing intervention when their conditions were stable after the routine care. Results After 12 months of nursing intervention,their symptoms were relieved or disappeared,such as cough,sputum and shortness of breath.Physical strength improved significantly,partial pressure of oxygen elevated,carbon dioxide partial pressure reduced with significant difference(P＜0.01).Lung functions FEV1(%)and FEV1/FVC(%)were improved,and 6MWD(m)was significantly increased after intervention(P＜0.01). Conclusion The nursing intervention can significantly improve lung function and quality of life in elderly chronic obstructive pulmonary disease.

Objective To investigate the effects of submucosal resection by guidance under esophageal endoscopic ultrasound. Methods 79 cases ofsuspected upper gastrointestinal submucosal tumors were found by endoscopic ultrasonography,transesophageal endoscopic ultra-sound showed lesions under muscularis mucosa,after informed consent,they were underwent endoscopic mucosal resection. Pathological diag-nose of the lesions were found out after resection. Results Compared with pathological results showed that endoscopic ultrasound accurately determine tumor location in the hierarchy;through endoscopic mucosal resection to remove all lesions,5 patients were found bleeding postop-erative,6 patients were found esophageal stricture,the prognosis was good after treatment. Conclusion Endoscopic ultrasonography can accu-rately determine submucosal myoma,it can be used to guide resection of submucosal myoma.

Objective To preliminarily evaluate the value of color power doppler ultrasonography in the diagnosis of sacroiliitis in ankylosing spondylitis(AS). Methods Fifty-seven sacroiliac joints in 31 patients with active AS and 40 sacroiliac joints in 20 volunteers were detected by color power doppler ultrasonography.The color flow signs inside the sacroiliac joints were observed,and the resistance index(RI) was measured. Results In active AS,color flow signs were seen in 55 joints,and the mean RI value was 0.53?0.08 in 45 joints,while the other 10 color flow signs represented reversed phase in diastolic phase on pulse doppler ultrasonography.In the volunteers,color flow signs were seen in 16 joints,and the mean RI value was 0.97?0.01 in 6 joints,while the other 10 color flow signs represented reversed phase in diastolic phase on pulse doppler ultrasonography. Conclusion The abnormal flow signs at the sacroiliac joints can be detected by color power doppler ultrasonography.Low RI values provide diagnosis evidence for active AS.

Antigens, CD20 ; metabolism ; Epstein-Barr Virus Infections ; virology ; Female ; Herpesvirus 4, Human ; isolation & purification ; Humans ; Lymphoma, Large B-Cell, Diffuse ; pathology ; virology ; Middle Aged ; Nasopharyngeal Neoplasms ; metabolism ; pathology ; virology

Objective To investigate the efficacy of medial plantar flaps with cutaneous nerves on fixing palm skin defects for patients injured while working.Methods All cases with palm skin defects who received medial plantar flaps grafting from June 2003 to January 2013,were analyzed retrospectively.The data included 13 males and 10 females,with the mean age of 36 years old (range,18-61 years old).There were 16 cases with right hand injury and 7 cases with left,whose skin defects ranged from 3.6 cm×2.8 cm to 7.0 cru×5.5 cm.All cases had skin and soft tissue injury while 5 cases with vascular and nerve injury,3 cases with tendon involvement and being exposed,6 cases with open metacarpal fractures.15 patients were treated with emergency surgery within 8 hours after injury,while 8 patients were treated 10 days after debridement surgery.Results Altogether,23 patients who received medial plantar flaps grafting operations,with palm skin defects,were included in this study.All cases were followed up for 3 to 36 months with a average period of 18 month.The grafted flaps range from 4.6 cm×3.8 cm to 8.0 cm×6.5 cm.Among the patients,19 of them recovered excellently with healing by first intention,with 7-14 d healing time,fully-retained hand functions and palm appearance,and 4-8 mm for between two points distinguish test.Flaps survived fairly well in 3 patients because partial necrosis happened at plantar skin graft donor site.After being debrided and dressed,the wound healed at second phase with a healing time of 12-21 d and 5-9 mm for between two points distinguish test.The operated hands could flex and extend functionally in the follow-up period.Only one patient did not recovered from medial plantar flap grafting and the flap did not survive operationally.The patient recovered after another operation with groin skin grafting later.According to Gu Yudong et al' evaluation criteria,such as improved hand function,19 cases were scored as excellent recovery,3 cases as good,and 1 as poor.The excellent rate was 95.7％ (22/23).Conclusion Medial plantar flaps with cutaneous nerves are ideal flaps for palm skin defects restoration,which characterized by the advantages of fixed anatomical position,high survival rate and being good to the functional recovery and palm appearance.

Objective To retrospectively compare the safety and local efficacy of multiple-electrode switching based radiofrequency ablation (RFA) and the conventional RFA in treating single early-stage hepatocellular carcinoma (HCC).Methods A total of 82 patients with single early-stage HCC received either RFA with a multiple-electrode switching system (n =43) or conventional RFA (n =39) as the first-line treatment.The rate of initial local complete response,major complications and local tumor progression (LTP) were compared between two groups.Results The total ablation time was significantly shorter in the switching-RFA group [(16.7 ± 3.4) mins] than in the conventional RFA group [(29.8 ± 10.4) mins] (P ＜ 0.05).The rate of initial local complete response was 100％ (43/43) in the switching-RFA group and 94.9％ (37/39) in the conventional RFA group (P ＞0.05).After a mean follow-up period of (26.4 ± 21.8)months (ranging 3.0-91.6 months),the rates of LTP in the switching-RFA group and conventional RFA group were 16.3％ (7/43) and 17.9％ (7/39),respectively.The LTP rates in two groups were 16.1％ versus 11.2％ atyear1,and20.5％ versus 20.6％ at year2 (P=0.666).Conclusions The multiple-electrode switching based RFA is safe and effective with shorter ablation time in treating single early-stage hepatocellular carcinoma.