Objective To observe the effect of metoclopramide combined with early enteral nutritional on patients with mechanical ventilation after craniocerebral operation.Methods A prospective randomized control study was conducted.56 patients with mechanical ventilation after craniocerebral operation were randomly divided into metoclopramide combined with early enteral nutritional group (observation group) and parenteral nutrition group (control group),28 in each group.The patients in the observation group received early enteral nutrition (24-48 h after operation),and intramuscular injection of metoclopramide (10mg Q8H) for 7 days.The patients in the control group received parenteral nutrition.The nutritional parameters,mechanical ventilation (MV) time,success rate of the ventilator weaning and the occurrence rate of pneumonia associated with ventilation (VAP) in one week,the incidence of adverse reaction were compared between the two groups.Results After 1 week therapy,the nutritioual parameters of the two groups showed no statistical significance(P ＞ 0.05);the observation group compared with the control group,3 、7days of blood glucose(P1 、P2) decreased significantly[(8.9 ± 1.6) mmol/L vs (11.4 ± 3.2) mmol/L,(8.2 ± 1.3) mmol/L vs (10.6 ± 2.1) mmol/L] (P1 =0.002,P2 =0.011),Mechanical ventilation (MV) time (P3) and the occurrence rate of VAP(P4) in one week also declined[(6.5 ±2.3)d vs (8.9 ±3.1)d,21.4％ vs 46.4％] (P3 =0.022,P4 =0.048),but within a week of success rate of the ventilator weaning improved (67.9％ vs 39.3％,P5 =0.032).Return rate (P6),gastrointestinal bleeding (P7) was significantly lower than those of the control group (17.9％ vs 42.9％,14.3％ vs 42.9％,P6 =0.042,P7 =0.038),but abdominal distention,diarrhea were no significant contrast (P ＞ 0.05).Conclusion Metoclopramide combined with early enteral nutritional may obviously improve the nutrition parameters,shorten the MV time,decrease the occurrence rate of VAP,not increase in side effects.

Objective To study the ultrastructural changes of hypertrophic scars and animal wound healing models induced by radionuclide 90 Sr exposure and to get the most effective dosage and time in the prevention and treatment of scars. Methods The clinical hypertrophic scars and animal wound models were exposed using 90 Sr applicator in this study. The exposure doses were 200 800 cGy and 200 4 000 cGy. Then the fibroblastic ultrastructure of the tissues from the experimental and control groups were observed with transmission electron microscope. Results Compared with the control groups, capillaries and fibroblasts obviously increased in small and medium doses (200 600 cGy) groups and fibroblastic function was activated. The fibroblasts decreased and fibroblastic function was inhibited in large dose (800 2 000 cGy) groups. Conclusions Small and medium dose of 90 Sr can accelerate wound healing, and can therefore be used in the treatment of early wounds (2 3 days after wounded) ; large dose of 90 Sr can prevent scars from hyperplasia, and can be used in the wounds of the first week after operation; 1 000 2 000 cGy 90 Sr can cure the old hypertrophic scars or keloids; It is useless that 90 Sr exposes before operation for prevention of scars.The most effective method to prevent scars from hyperplasia is large dose of 90 Sr exposure after operation.

Objective To evaluate the killing efficacy of chlorine-releasing agents (CRAs) with different concentrations on multidrug-resistant Acinetobacter baumannii.Methods Totally 30 clinical strains of multidrug-resistant Acinetobacter baumannii were collected from November 2008 to December 2009.Killing efficacy of CRAs on these strains was evaluated by quantitative suspension test.The one-way analysis of variance was performed.Results The log values of killing to 30 strains of multidrug-resistant Acinetobacter baumannii were all ≥5.00,when the bacteria were exposed to available chlorine concentrations 400 mg/L of CRAs for 10 min,600 mg/L for 10 min,800 mg/L for 3 min and 1000 mg/L for 1 min,respectively.And effective rates were all 100％. Furthermore,there were significant differences among different available chlorine concentrations exposed for the same time ( except 10 min) ( F =72.72,64.79 and 32.33,P =0.00),and among different exposure time in the same available chlorine concentration ( except 1000 mg/L) ( F =110.42,20.41 and 3.20,P=0.00,0.00 and 0.03).Conclusion Satisfactory killing efficacy of CRAs to multidrug-resistant Acinetobacter baumannii can be achieved with available chlorine concentration 500 mg/L to 1000 mg/L and exposure time 10 min to 30 min.

BACKGROUND: The reaction of osteoblasts is important role in the reconstruction of osteocytes, and the mechanism of bone remodeling can be known from the cytological level through analyzing the mechanical reaction of osteoblasts under different loading.OBJECTIVE: To analyze the effects of low frequency vibration on the proliferation and differentiation as well as the matrix excretion of cultured human osteoblasts.DESIGN: A comparative observation.SETTING: Department of Orthopaedics, Nanfang Hospital of Southern Medical University.MATERIALS: The experiment was carried out in the laboratory of Nanfang Hospital from January to December in 2002. Human osteoblasts were isolated from the iliac cancellous bone of adults.METHODS: The osteoblasts were cultured for 48 hours, and then treated with low frequency vibration of 0.1, 0.2, 0.5, 2 and 5 Hz. The proliferation of the osteoblasts was detected with flow cytometry, and the activity of alkaline phosphatase (ALP) and content of osteocalcin were assayed by spectrophotometric methods and radioimmunoassay respectively.MAIN OUTCOME MEASURES: ① Effects of low frequency vibration on the ALP activity and osteocalcin excretion of osteoblasts; ② Effects of low frequency vibration on the proliferation of osteoblasts detected with flow cytometry.RESULTS: ① 0.2 and 0.5 Hz vibrations could markedly increase the ALP activity of osteoblast (P ＜ 0.01), but that of 5 Hz obviously decreased the ALP activity (P ＜ 0.01). 0.1 and 2 Hz vibrations had no obvious effects on the ALP activity of osteoblasts. ② 0.2 and 0.5 Hz vibration could significantly increase number of osteoblasts at S phase from 10.4% to 12.45% and 16.12%, and the proliferative index increased from 20.14% to 26.21% and 28.75%; 0.1 and 2 Hz vibration has not obvious effects in osteoblast proliferation index; 5 Hz vibration obviously decreased the proliferative index value to 13.22% (P ＜ 0.05). 0.1 and 2 Hz vibrations had no obvious effects on the proliferative index of osteoblasts (P ＞ 0.05). ③ 0.2 and 0.5 Hz vibrations could obviously increase the amount of osteocalcin excretion to 1.87 μg/L and 2.47 μg/L(P ＜ 0.05), but 2 and 5 Hz vibrations decrease the amount of osteocalcin excretion (P ＜ 0.05), and that of 0.1 Hz had no obvious effect on amount of osteocalcin excretion (P ＞ 0.05).CONCLUSION: Low frequency vibrations of 0.2-0.5 Hz could accelerate the proliferation and differentiation as well as the excretions of active materials of osteoblasts, and it plays an instructive role for low frequency vibration to treat fracture.

OBJECTIVE To investigate the qacA/B genes in meticillin-resistant Staphylococcus aureus(MRSA) and their significance.METHODS Totally 221 MRSA strains were clinically isolated.The genes of qacA/B were analyzed using polymerase chain reaction(PCR).RESULTS From them 101 strains were found the qacA/B genes,the positive rate of qacA/B genes was 45.7%.And 71 strains were selected for qacA PCR detection,20(28.2%) were with qacA gene and 27(38.0%) were with qacA/B gene,suggesting that the seven strains be with qacB gene.CONCLUSIONS MRSA strains have emerged the high-frequency qacA/B disinfectant resistance gene.Application of chlorhexidine and other disinfectants to prevent postoperative nosocomial infections must be reassessed.The efficacy of existing disinfectants or disinfection methods should arouse our wider attention.Disinfectant resistance gene detection technology provides a practical means for the research of the disinfectant-resistant bacteria and the clinical application of the molecular epidemiology research.

OBJECTIVE To investigate the genes of AmpC and ?-lactamases and antibiotic resistance of A.baumannii strains in elderly.METHODS The sensitivity to 13 kinds antibacterials was analyzed according to CLSI 2005′s Standard.The genes of AmpC and ?-lactamases were detected by polymerase chain reaction(PCR).RESULTS Most of the strains were A.baumannii.In 20 strains of A.baumannii,the positive strains of AmpC(chromosome) were 17(85%),that of TEM and PER 5 strains were 11 strains(55%) and 25%,respectively.CONCLUSIONS High positive percentages of AmpC(chromosome),TEM and PER genes in A.baumannii strains isolated from elderly are found.

Objective To study MRI volumetric measurement of hippocampal formation using statistic parametric mapping(SPM) software and to discuss the value of the method applied to Alzheimer's disease (AD).Methods The SPM software was used to divide the three-dimensional MRI brain image into gray matter, white matter and CSF separately.The bilateral hippocampal formations in both AD group and normal control group were delineated and the volumes were measured.The SPM method was compared with conventional method based on region of interest (ROI), which was the gold standard of volume measurement The time used in measuring the volume by these two methods were respectively recorded and compared by two independent samples' t test.Moreover, 7 physicians measured the left hippocampal formation of one same control with both of the two methods.The frequency distribution and dispersion of data acquired with the two methods were evaluated using standard deviation coefficient Results (1)The volume of the bilateral hippocampal formations with SPM method was (1.88±0.07) cm~3 and (1.93±0.08) cm~3 respectively in the AD group, while was (2.99 ±0.07) cm~3 and (3.02 ±0.06) cm~3 in the control group .The volume of bilateral hippocampal formations measured by ROI method was (1.87 ±0.06) cm~3 and (1.91 ±0.09) cm~3 in the AD group, while was (2.97 ±0.08)cm~3 and (3.00 ±0.05) cm~3 in the control group.There was no significant difference between SPM method and conventional ROI method in the AD group and the control group(t=1.500, 1.617, 1.095, 1.889,P> 0.05) .However, the time used for delineation and volume measurement was significantly different.The time used in SPM measurement was (38.1 ±2.0) min, while that in ROI measurement was (55.4 ±2.4) min (t=-25.918, P<0.01).(2)The average volumes of the left hippocampal formation with the two methods measured by the 7 physicians were (2.86±0.20) and (2.76±0.52) cm~3 respectively.The frequency distribution of hippocampal formation volume measured by SPM method and ROI method was different.The CV_(SPM) was 7% and the CV_(ROI) was 19%.Conclusions The borders of hippocampus formation in brain gray matter could be conveniently delineated by SPM software.The accuracy and repetition of measurement was improved by SPM method.The shorter time used in measurement made it possible for MRI volumetric measurement of hippocampal formation to be applied in assessment of relevant neuropsychiatric diseases.

Objective To investigate the distribution of β-lactamase genes in a pan-drug resistant Klebsiella pneumoniae isolate JM45.Methods Klebsiella pneumoniae JM45 was isolated from the blood sample of a patient admitted in the intensive care unit,the Second Affiliated Hospital,Zhejiang University School of Medicine on April 7,2010.The susceptibilities to 26 antibiotics were tested using E-test method.Cica-β-Test was performed to detect β-lactams,and modified Hodge test was performed to detect carbapenemase.Resistant genotypes were detected using PCR,DNA sequencing and BLAST algorithm.Whole genome sequencing (complete graph) was performed by high throughput Roche 454 sequencing approach to analyze the distribution of β-lactamase genes.Results Except polymyxin B and tigecycline,JM45 was resistant to other 24 kinds of antibiotics including cephalosporins and carbapenems.Several β-lactamases were positive in Cica-β-Test,and modified Hodge test was positive.Based on PCR typing,TEM-1,SHV-11,CTX-M-24 and VEB-3 were positive,but carbapenemase genes and metallo-β-lactamase genes were negative.A complete genome (chromosome) sequence (GenBank accession number:CP006656) and 2 plasmids sequences (GenBank accession number:CP006657,CP006658) were obtained by wholegenome sequencing.CTX-M-24 (Locus tag:N559_5233),TEM-1 (Locus tag:N559_5242) and VEB-3 (Locus tag:N559_5248) were positive in plasmid 1.CTX-M-24 located in insertion sequence (IS903-CTXM-24-ISEcp1),while TEM-1 and VEB-3 located in transposons (tnpA-TEM-1-rmtB and VEB-3-tnpA).SHV-11 (Locus tag:N559_2715) was positive in genome (chromosome),and 4 putative β-lactamase genes or β-lactamase domains were obtained:(1) metallo-β-lactamase domain protein (Locus tag:N559_0119,780 bp) ; (2) putative β-lactamase (Locus tag:N559_1633,1308 bp) ; (3) β-lactamase domain protein (Locus tag:N559_2279,813 bp); (4) β-lactamase domain protein (Locus tag:N559_3769,1101 bp).No insertion sequence or transposase gene was observed near SHV-11.Conclusion The resistance to antibiotics including cephalosporins and carbapenems is correlated with TEM-1,SHV-11,CTX-M-24,VEB-3 and 4 kinds of putative β-lactamase genes or β-lactamase domains.

BACKGROUND:A newly developed calcium phosphate/β-tricalcium phosphate composite bone cement with a negative surface charge (genex?) has been reported to possess osteoinductivity properties. However, to our knowledge, no previous literatures have reported genex? for vertebroplasty in the osteoporotic spine.
OBJECTIVE:To evaluate the biomechanical properties and osteogenesis of vertebral bodies injected with genex? cement in a rabbit vertebroplasty defect model.
METHODS:Thirty New Zealand rabbits were used to establish osteoporosis models. Four weeks after modeling, model rabbits had an iatrogenical y created cavitary lesion at L 3 and L 5 and were injected with either genex? cement (experimental group) or polymethyl methacrylate bone cement (control group). The L 1 vertebral body served as model group without treatment. After 3 and 6 months, 15 rats from each group were executed respectively, and three vertebral samples were taken for Micro-CT analysis and biomechanical tests.
RESULTS AND CONCLUSION:(1) The Micro-CT showed better three-dimensional structure parameters of the trabecular bone in the experimental group than the control group (P<0.05) after 3 months, which however had no difference from the model group (P>0.05). After 6 months, the structure parameters in the experimental group were superior to those in the control and model groups (P<0.05). (2) After 3 months, the vertebral body compression strength of the experimental group was lower than that of the control group (P<0.05), but higher than that in the model group (P<0.05). The vertebral stiffness of the experimental group was lower than that in control and model groups (P<0.05). After 6 months, the vertebral body compression strength of the experimental group was not different from that of the control group (P>0.05), but stil higher than that of the model group (P<0.05). The vertebral stiffness showed no difference between three groups (P>0.05). These findings indicate that genex? cement can rapidly repair osteoporotic vertebral defects and improve the bone strength. Verterbroplasty with genex? cement has adequate osteoinductivity, biocompatibility, and adequate compressive strength.

Objective To evaluate the effects of continuous application of niclosamide ethanolamine salt on Oncomelania hu-pensis snail control in a marshland,river and channel. Methods The Beiwei marshland in Houxiang Town,the Xiaoliang River in Lingkou Town and Laomiao channel in Yunyang Town in Danyang City were selected as study sites,and 4%niclosamide etha-nolamine salt and 26%niclosamide powder were used to kill the snails. Based on the historical records and field investigations, the effects of continuous application of niclosamide ethanolamine salt on snail control were evaluated. Results Compared with the first time of snail repetition,the snail areas decreased by 82.80%,63.14%and 70.00%in the Beiwei marshland,Xiaoliang River and Laomiao channel,respectively,in 2013. There was a positive correlation between the area and density of snails(r=0.931, 0.975 and 0.916,respectively;all P values < 0.05). The average densities of living snails decreased significantly by 92.34%, 87.91%and 97.66%,respectively. There was a negative correlation between the corrected mortality of snails and the average densi-ty of living snails in the following year,and a negative correlation between the reduction rate of living snail density and the average density of living snails in the following year. Conclusion Molluscicides plays an important role in compressing the snail area,re-ducing the snail density,and controlling the schistosomiasis transmission.