Objetive To elucidate the mechanism of antibiotic resistance of Pseudomonas aeruginosa(P.a.) in an effort to provide a basis in clinical combined use of antibiotics against P.a.infection in clinical settings.Methods All P.a.strains were isolated by routine procedures and identified with VITEK-2 automatic bacterial identification console.The minimum inhibitory concentration(MIC) was detected using dilution method on agar plate following the instruction of CLSI.Results Ninety-two strains of P.a.were isolated from clinical infection specimens,most of them were obtained from respiratory tract(88.04%).Of the 92 strains,45(48.91%) were metallo-?-lactmases positive,and 25(27.17%) were AmpC positive.When treated with a combination of meropenem and imipenem,MIC≥1 was found in 17 strains(18.48%).The bacteriostatic rate of polymixin B and meropenem was 95.65% and 80.43%,respectively,that of amikaein,piperacillin/tazohaetam(PIT) and imipenem was 48.91%-71.74%,and that of cefoperazone/sulbactam(SUP) was 36.96%.The synergistic action of PIT,and SUP with amikacin was 60.87% and 58.70%,respectively,and that of PIT,SUP with minocycline were 44.57% and 43.48%,and of PIT,SUP with PLB were 28.26% and 7.61%,respectively.Conclusions P.a.strains in this study are mainly isolated from respiratory tract infection specimens.Multiple drug-resistant mechanisms are involved in the drug resistance of P.a.Enzyme inhibitors,such as PIT or SUP,with amikacin or polymixin B should be first selected for clinical treatment of P.a.caused infection.Meanwhile,antibiotics should be rationally administered in accordance with the seriousness of disease,and with the drug-resistant phenotype of the isolated strains.

Objective To identify the factors related to the influence of medical research papers. Methods The influence of 1146 research papers by the hospital in the period 1996-2003 and its relationship with such factors as the backgrounds of the authors and the quality of the papers were studied u-sing regression analysis. Results Nine factors, including the impact factor, the status of the paper (being or not being one based on fund-supported research or representing research achievements), and the status of the author (being or not being chosen for talent cultivation and undertaking or not undertaking research projects), were significantly correlated with the influence of the papers. Conclusion In order to enhance the influence of medical research papers, it is necessary for research' management departments not only to encourage research personnel to publish papers in journals with high impact factors but also to step up efforts to better personnel cultivation, degree education, and project and achievement management so as to set up a quality and distinguished research contingent.

Objective To investigate the predialysis education on dialysis timing of patients with end-stage renal disease (ESRD). Methods 129 patients with chronic renal failure (CRF) and serum creatinine(Scr)＞442μmol/L, endogenous creatinine clearance rate (Ccr)＜20 ml/min were randomly divided into the experimental group(70 cases) and the control group(59 cases), the experimental group received predialysis education, the control group received routine care.The basic situation, dialysis timing, depression and quality of life on the 6th,12th months after dialysis were assessed. Results There was no significant difference in age, sex, education background, health care payment manners, employment, serum creatinine, endogenous creatinine clearance rate before education.For the timing of dialysis, Ccr for the experimental group was (9.49 ± 0.77)ml/min, Ccr for the control group was (4.54 ±1.79) ml/min,the difference was significant, depression and quality of life between two groups after 6,12 months of dialysis was also statistically different. Conclusions Strengthening predialysis education is conducive to a timely start of dialysis and can effectively improve the quality of life in patients with ESRD.

Objective To explore the condition of cortistatin (CST)expression in human renal tissue and the changes in the level of CST in IgA nephropathy (IgAN)of different degrees.Methods Ten tumor adjacent normal renal tissue samples were collected.The mRNA and protein expressions of CST in human renal tissue were detected by reverse transcription-polymerase chain reaction (RT-PCR)and Western blotting,respectively.Immunohistochemisty (IHC)was performed to locate the expression of CST in renal tissue.According to the grading system of Lee et al,IgAN was divided into three groups:grade Ⅰ -Ⅱ (group A),grade Ⅲ -Ⅳ (group B),and grade Ⅴ (group C),and ten renal biopsy tissue samples were collected for each group.IHC was performed to detect the change in the level of CST in normal and IgAN renal tissue of different degrees.The effect of clinical indices on the level of CST in IgAN renal tissue was assessed by multiple linear regression analysis.Results RT-PCR and Western blotting showed that CST was expressed in renal tissue and IHC showed that CST was expressed on renal tubular epithelial cells.In IgAN,the higher the pathological grade was, the higher the expression of CST in renal tubules was.Multiple linear regression analysis showed that the pathological grade was associated with the expression of CST in renal tissue (r =0.875,P <0.01).Conclusion CST may participate in the inflammatory reaction of IgAN pathological injury and exert anti-inflammation effects.

Objective To evaluate the value of CT in diagnosis of adnexal abscess retrospectively.Methods The characteristic CT findings in 26 patients with adnexal abscess proved by histopathology were reviewed retrospectively.Results Of 26 patients,the adnexal abscess was presented in unilateral lesions(n=6) and bilateral lesions(n=20).There were total 46 lesions,which were pyosalpingitis (n=33) and tubo-ovarian abscess (n=13),respectively.CT findings of pyosalpingitis included dilated, thick-walled, enhancing fallopian tubes containing complex fluid.CT findings in tubo-ovarian abscess were thick-walled and multiloculated cystic masses,which had thick mural enhancement with multilayered appearance (n=10).Reactive inflammation of adjacent structures(n=21) manifested as haziness and stranding of the pelvic fat,thickening of the uterosacral ligaments, and pelvic peritonitis.Small or large bowel ileus (n=5) and hydroureter (n=3) resulted from adjacent inflammation of tubo-ovarian abscess.Endometritis was seen in 19 patients and ascites in 18 patients.Conclusion Familiarity with the CT appearances is important for timely diagnosis and treatment of adnexal abscess and its complications.

Objective To investigate antifungal activities of AMB, ICZ, VRC, CBF against 72 strains of filamentous fungi in vitro. Methods Based on CLSI M38-P and M38-A scheme, MIC of antifungal drugs were determined. The growing inhibitory concentration of 100%, 100%,≥80%, for AMB, VRC ,ICZ act as respective MIC. For caspofungin, the minimal effective concentration (MEC) was determined as the lowest drug concentration showing morphology change of filaments. The fractional inhibitory concentration (FIC) was used to evaluate the effect of combination therapy. FIC was calculated by the following equation: FIC = MICcombination/MICA drug alone+ MICcombination/MICB drug alone. Results MIC90 of AMB, ICZ, CBF, VRC against 72 isolates of filamentous fungi were 8 μg/ml, 4 μg/ml, 2 μg/ml, 8 μg/ml, respectively. MICs range of combined AMB + ICZ, AMB + VRC, ICZ + VRC were 0. 125-16. 97, 0. 2452-1.25, and 0.0625-8. 25 μg/ml respectively. The percent of synergistic interaction of AMB + VRC against filamentous fungi (20.0%-88.9% ) was higher than those of AMB + ICZ ( 10.0% -62.5% ) and ICZ + VRC ( 20.0% - 44.4% ) ( P=0.007 <0.05 ). Conclusions The antifungal activities of four kinds antifungal drugs against 72 strains of filamentous fungi vary in vitro. The therapy of AMB combined with VRC is maybe better than AMB + ICZ and ICZ + VRC for severe fungi infection.

BACKGROUND:Elderly patients with degenerative lumbar degeneration often appear insufficient holding power of pedicle screw in spine surgery, which is prone to occur de-pinning and leads to insecure fixation. How to increase the holding power of screws has become a hot research. OBJECTIVE:To observe the early clinical effect of pedicle screws with cement augmentation for treating lumbar degenerative diseases in elderly patients. METHODS:A total of 65 old patients with lumbar degenerative diseases received a treatment between August 2012 and April 2014, and were divided into two groups according to the treatment strategy:treatment group (n=24;internal fixation of pedicle screws with cement augmentation) and control group (n=41;routine internal fixation of pedicle screws). General conditions of patients in two groups were observed and compared. Visual analog scale (VAS) and Japanese Orthopaedic Association (JOA) score system were used for evaluating the lumbar and back pain, and restoration of neurological function in lower limbs respectively. RESULTS AND CONCLUSION:Al of the patients successful y received the surgery and then were fol owed up from 3 to 20 months. The anterioposterior and lateral X-ray film revealed no loosening, loss, fracture of the screws, and no loss of intervetebral space height was found. There was no significant difference in the blood loss and hospital stay between two groups (P>0.05). JOA at postoperative 3 and 6 months, and VAS score at postoperative 3 months were significantly improved after the treatment of pedicle screws with cement augmentation, when compared to control group (P<0.05). VAS scores showed no difference at 6 months postoperatively in two groups (P>0.05). Pedicle screws with cement augmentation for treating lumbar degenerative diseases have the advantages of improving the screws holding strength, reconstructing the stability of lumbar vertebra and obtaining clinical efficacy on degenerative spine.

Objective To evaluate the short-term prediction of high-sensitivity cardiac troponin T (hs-cTnT) and other cardiovascular risk biomarkers in patients undergoing maintenance hemodialysis (MHD).Methods We conducted a cohort survey in 296 consecutive MHD patients whose clinical data were retrospectively analyzed.Before MHD,hs-cTnT and other relative cardiovascular biomarkers were detected.The end point (all-cause death) and time of occurring were recorded in the next 13 months.The differences between survival and all-cause death were analyzed by t-test,Mann-Whitney test and x2 test.The best two percentile cutoff point was calculated by X-tile and the survival rate was calculated by Kaplan-Meier Logistic regression analysis was applied to analyze the odd ratio between high risk and non-high risk hs-cTnT group.Non-high risk group was divided into intermediate risk and low risk group based on the 99th percentile of hs-cTnT in healthy population,to further evaluate its short-term prediction value for MHD patients.The short-term significance of hs-cTnT was proved to be independently associated with all-cause death by Logistic regression analysis.Results The mean value of serum hs-cTnT in survival group was 0.05 (0.03～0.07) ng/mL,while in the death group it was 0.07 (0.04～0.14) ng/mL,which had statistical significance (P =0.027).The best two percentile cutoff of hs-cTnT in MHD patients was 0.1 ng/mL.The survival rate in high risk group (hs-cTnT＞0.1 ng/mL) is lower than it in non-high risk group (hs-cTnT≤0.1 ng/mL) (76.67％ vs.96.62％,P ＜0.05).The odd ratios for high risk group and non-high risk group was 7.288 (P＜ 0.001).Moreover,further grouping the non-high risk group by hs-cTnT =0.014 ng/mL,intermediate risk group (hs-cTnT＞0.014 ng/mL) group has lower survival rate than low risk group (hs-cTnT≤0.014ng/mL),while there wasn't any death case occurred in the low risk group.Conclusions Hs-cTnT is an independent risk factor to all-cause death.Thus hs-cTnT can be a strong indicator of short-term prediction and prognostic evaluation.

Objective To investigate and evaluate the quality of Cortex Ilicis Rotundae medicinal materials in Chinese herbal medicine market. Methods Twenty-two batches of Cortex Ilicis Rotundae commercial medicinal materials were identified and analyzed by characteristic identification, microscopic identification, thin layer chromatography ( TLC) and extractives determination, and the contents of syringin and pedunculoside were detected by high performance liquid chromatography (HPLC) according to the Chinese Pharmacopoeia published in 2010. And then the quality of the medicinal material of Cortex Ilicis Rotundae was evaluated comprehensively. Results Of the 22 batches of Cortex Ilicis Rotundae medicinal materials, 2 batches were adulterated with fake Cortex Ilicis Rotundae, one batch was inferior and was mixed with counterfeits, and the quality of 12 batches was also poor. Conclusion At present, the quality of Cortex Ilicis Rotundae medicinal materials in Chinese herbal medicine market varies greatly, and adulterants and the inferior are common.

Objective To investigate the relationship between single nucleotide polymorphism (SNP) of Fas ligand (FasL) and fulminant hepatitis B in Han Chinese. Methods HBV infected subjects were enrolled in this case-control study, including 233 cases of inactive HBsAg carrier, 68 patients with fulminant hepatitis B,100 cases of spontaneous hepatitis B clearance, 102 patients with hepatitis B virus (HBV) related cirrhosis and 112 patients with HBV related primary hepatocellular carcinoma. The blood samples and clinical data were collected. FasL-844T/C polymorphisms of enrolled subjects were examined by TaqMan real time fluorescent genotyping polymerase chain reaction (RT-PCR). A adjusted odds ratios (OR)and 95% confidence intervals (CI)were calculated using the Logistic regression model. Results After adjusting the factors of gender and age, binary Logistic regression analyses indicated that the genotype frequencies of FasL-844 CC,CT,TT in inactive HBsAg carriers were 50. 64% ,39. 91% and 9. 44% respectively, and those in cases of fulminant hepatitis B were 79. 41%, 17. 65% and 2. 94%, respectively. The analysis also revealed that FasL-844CC genotype in inactive HBsAg carriers was high risk factor of developing fulminant hepatitis B (OR =4. 729,95%CI:0. 510 - 21. 282,P = 0. 043), while there were no statistic significances in other cases (P>0. 05). Conclusion The inactive HBsAg carriers harboring FasL-844CC may have greater susceptibility to fulminant hepatitis B, which need arouse high attention.