Objective To evaluate the in vitro antimicrobial activity of tigecycline in combination with imipenem against multi-drug resistant and pan-drug resistant Acinetobacter baumannii isolates,so as to discuss the feasibility of drug combination and provide the basis for chnical rational use of antimicrobial agents.Methods Sixteen multi-drug resistant and pan-drug resistant Acinetobacter baumannii isolates were collected between January and April in 2015 from all kinds of infected specimens of Nanjing Drun Tower Hospital.The protocol was designed by checkerboard method,and the minimum inhibitory concentration (MIC) of antibiotics was determined by microdilution broth method,and the fractional inhibitory concentration (FIC) index was calculated according to MIC results.Results The average value of MIC (MICG),MIC50,MIC90 of tigecycline and imipenem single were 1.73,1,4 μg·mL-1and 31.00,32,64 μg·mL-1.When tigecycline was combined with imipenem,MICG,MIC50,MIC90 of tigecycline and imipenem were 0.24,0.25,0.50 μg·mL-1 and 8.16,8.00,16.00 μg·mL-1,respectively.Compared with the drug single use groups,MIC was significandy decreased in the drug combination group.In 6 strains (37.50％),synergy effect (FIC≤0.5) was observed,and in 10 strains (62.50％),additive effect (0.5 ＜ FIC ≤ 1) was found.No negative and independent effects were shown.Conclusion Both additive and synergistic action is observed when tigecyclineis combined with imipenem against multi-drug resistant and pan-drug resistant Acinetobacter baumannii isolates.No negative and independent effects are shown.This combination use against multi-drug resistant and pan-drug resistant Acinetobacter baumannii may be an effective therapy for clinical treatment.

The use of tourniquets in total knee arthroplasty (TKA) helps to obtain a blood-free operating space and clear anatomical landmarks, reduce the operation time and intraoperative bleeding and facilitate bone cement fixation. Arterial calcification is relatively common in the elderly people. There is still no consensus on whether it is safe to use tourniquets in patients with arterial calcification in total knee arthroplasty. Some studies showed that the use of tourniquets in patients with vascular calcification does not increase postoperative complications. Other studies showed that the use of tourniquets in patients with calcification will increase postoperative vascular complications. This article reviews the use of tourniquets in patients with vascular calcification. It is recommended that patients with vascular calcification should undergo detailed lower extremity vascular and cardiovascular assessments before surgery. The consult to a vascular surgeon is important. For patients with extensive vascular calcification, It's better to avoid the use of tourniquets during TKA to reduce possible complications.

Objective To investigate the effect of celastrol on space learning capability and expressions of beta-amyloid (Aβ) 40 and Aβ42 in hippocampus in APPswe/PS1dE9 double transgenic mouse after partial hepatolobectomy.Methods The 3-month-old APPswe/PS1dE9 double transgenic mice (n =96) were randomly divided into three groups according to the random number table method.Surgery group (group S, partial hepatolobectomy;n =32), celastrol group (group C, injections of dimethyl sulphoxide/DMSO and celastrol for 3 days before undergoing partial hepatectomy, on the surgery day, and for a further 4 days after surgery;n =32), and DMSO group (group D, injections of DMSO for 3 days before undergoing partial hepatectomy, on the surgery day, and for a further 4 days after surgery;n =32).Eight mice were selected randomly in each group and were Morris-water maze trained for continuous 5 days.Theirs learning and memory abilities were evaluated at 1,3, 7 and 14 d after surgery, respectively.Hippocampus was collected and the changes of β40 and Aβ42 were measured by enzyme-linked immunosorbent assay (ELISA) at the time set in advance in each group.Results The average escape latency of group C was significantly shorter than groups S and D at 3, 7 and 14 d after partial hepatectomy (P ＜ 0.05).Times of passing through the platform groups S and D were significantly less than group C (P ＜ 0.05).The expressions of Aβ40/Aβ42 in group C were lower than group S and group D at 1, 3, 7 and 14 d after partial hepatectomy (P ＜ 0.05).Conclusions Through decreasing the expressions of Aβ40 and Aβ42 in hippocampus,celastrol improves the space learning capability in APPswe/PS1dE9, the double transgenic mouse after partial hepatolobectomy.

Objective To investigate the clinical significance of anti-nuclear envelope protein antibody (gp210),anti-soluble acid resistant nucleoprotein (sp100) and anti-mitochondrial antibody M2 subtype (AMA-M2) in sjogren syndrome (SS) and primary biliary cirrhosis (PBC).Methods A total of 241 hospitalized patients diagnosed with connective tissue disease (CTD) were recruited.Anti-gp210,anti-sp100 and AMA-M2 were detected by indirect immunofluorescence.Results (1) Positive rate of AMA-M2,anti-sp100 and antigp210 in 241 cases CTD patient were 10.4％ (25/241),3.3％ (8/241) and 2.9％ (7/241) respectively.(2) There were 16 cases with SS,5 cases with SS-PBC overlap syndrome and 17 cases with PBC in 241 patients with CTD.Distinction among groups of PBC,SS,SS overlapping PBC of positive incidence of AMA-M2 antibody (x2 =6.584,P =0.03) and anti-gp210 (x2 =8.735,P ＜ 0.01) were significantly different,while there was no apparent difference about positive rate of anti-sp100 among the three groups (x2 =3.343,P =0.18).(3) Positive expression of either antibody of anti-gp210 or anti-sp100 in the three groups of SS,SS overlapping PBC,PBC were 3 cases,4 cases,4 cases respectively.The positive rates of any of three autoantibodies in three groups of were 8 cases,5 cases,13 cases respectively.(4) There were significant difference in terms of serum ALB(t =3.858,P＜0.000 1),TSB(t =5.473,P＜0.000 1),ALT(t =2.235,P=0.026),AKP(t =3.141,P =0.002) and γ-GT (t =2.317,P =0.021) in liver damaged patients of all CTD between AMA-M2 positive and negative patients (P ＜ 0.05).However,serum TSB in anti-sp100 positive and negative patients were differed (t =7.892,P ＜ 0.000 1).Serum AKP was different between anti-gp210 positive and negative patients (t =2.451,P =0.015).Conclusion Positive rate of anti-gp210,anti-sp100 and AMA-M2 are the highest in patients with SS overlap of the PBC among CTD patients.Combined detection can improve the sensitivity of diagnosis.Antisp100 and anti-gp210 are valuable for the diagnosis of SS-PBC overlaps syndrome with negative AMA-M2.

Objective To investigate the application of multi-slice spiral computed tomography(MSCT) in the diagnosis of solid pseudopapollary tumor of the pancreas (SPTP). Methods Clinical data and CT films of 12 patients with SPTP were retrospectively analyzed from January 2003 to December 2008. Results SPTP presented a typical cystic lesion with well-limited silhouette and no intensification in the cyst on enhanced CT scan. However, a slight to moderate enhancement in the solid components and a markedly enhanced envelope could be seen. Three dimensional images of MSCT can reveal clearly an anatomic relationship of the lesions with surrounding organs and blood vessels. Of 12 cases, there was one case showed that the envelope was incomplete, 3 with duodenal invasion, 2 with superior mesenteric vein involvement, and 1 with closed adhesion with spleen. All 12 patients underwent surgery and had only one tumor, tumor diameter ranged from 4 cm to 18 cm. The location of tumor in pancreas, the relation with surrounding tissue and the pathological presentation were helpful to make peroperative diagnosis. Three dimensional imaging technology of MSCT can offer important referrence for the preroperative evaluation and increase the diagnosis accuracy.

Objective To investigate the relationship between complement C3 level and the degree of disease activity in patients with systemic lupus erythematosus(SLE).Methods A total of 1 012 patients with SLE were enrolled in this study from January 2006 to December 2013 at department of rheumatology and immunology,the first affiliated hospital of Anhui medical university.Serum complement C3 level was detected by rate erythenephelometry assay.The relationship between reduction of complement C3 and SLE was analyzed.Results Serum complement C3 clearly decreased in 782 patients,accounted for 77.27％.There were significant differences concerning serum complement C3 level among different groups of disease activity (F =131.275,P＜0.01).The low serum complement C3 level was correlated with the high degree of disease activity (r =-0.517,P ＜0.01).Patients with SLE had a severe disease activity (SLE disease activity index ≥ 15) when the level of serum complement C3 was less than 0.57 g/L.Serum complement C3 levels were positively correlated with serum complement C4 (r =0.845,P ＜ 0.01),peripheral blood leukocyte count (r =0.115,P ＜ 0.01),hemoglobin (r =0.069,P ＜ 0.01),platelet count (r =0.177,P ＜0.01) and albumin level (r =0.091,P ＜ 0.01).There was also a negative association of serum complement C3 with 24 h urinary protein (r =-0.228,P ＜ 0.01).101 patients whose average level of serum complement C3 was(0.48 ±0.26)g/L,were treated with glucocorticoid pulse therapy as high degree of disease activity.Conclusions There is a close relationship between serum complement C3 level and the degree of disease activity in SLE.Serum complement C3 less than 0.57 g/L might be seen in SLE with severe disease activity.

Objective To explore the dynamic changes of D-dimers during pregnancy and early puerperium (within 3 days postpartum). Methods A retrospective study was performed among 8 367 healthy women who had term singleton delivery in Women′s Hospital, School of Medicine, Zhejiang University from January 2007 to December 2014. D-dimers concentrations during pregnancy and early puerprium of all the cases were collected. Data of 21 065 D-dimers tests were assigned to 5 groups according to the time of sampling, including early pregnancy (≤12 gestation weeks), middle pregnancy (12-28 gestation weeks), late pregnancy (>28 gestation weeks), 1 postpartum (within 48 hours postpartum) and 2 postpartum (48-72 hours postpartum). The D-dimers concentrations in different groups were compared. The effect of delivery mode on D-dimers of early pureperium was analyzed. The correlation between D-dimers and the thromboembolic disease was also explored. In this study, Student′s t-test and Wilcoxon rank sum test were used for statistical analysis. D-dimers concentration≤0.5 mg/L was used as the normal range. Results (1) D-dimers concentrations during pregnancy were higher than the non-pregnant women (P<0.01), but there was no statistical difference between early pregnancy and late pregnancy (P=0.820). D-dimers concentration in the 1 postpartum group was higher than that of early pregnancy group or late pregnancy group (P<0.01). But in the 2 postpartum group, it was lower than early pregnancy, late pregnancy and 1 postpartum groups. (2)D-dimers in cesarean section cases was significantly higher than in vaginal delivery cases in each period of pregnancy and early pueprium.(3)The 95%CI of D-dimers in early pregnancy, late pregnancy, 48 hours after vaginal delivery, 48-72 hours after vaginal delivery, ≤48 hours after cesarean section, 48-72 hours after cesarean section were 0.58-8.28, 0.47-11.52, 1.04-9.59, 0.87-5.22, 1.07-11.58 and 1.00-6.23 mg/L, respectively.(4)In 6 cases with thromboembolic disease, D-dimers was 6.89-19.89 mg/L, with the mean value of 13.66 mg/L. It was significantly higher than normal range. In 3 cases, all after cesarean section, with lower extremity vein thrombosis within 48 hours postpartum, the D-dimers concentrations, 9.77, 8.65 and 6.89 mg/L respectively, were in the 95%CI of the study population after cesarean section. Conclusions D-dimers concentration of 0.5 mg/L is not suitable for venous thromboembolism screening during pregnancy. D-dimers concentration in pregnancy and early puerprium is higher than non-pregnancy. It increases in the very early period postpartum and decreases with time. D-dimers should not be a routine screening test to exclude thromboembolic disease in pregnant women without high risk factors and clinical manifestation of thromboembolic disease.

Objective To investigate the effects of partial hepatectomy on spatial learning and memory abilities and the expression of spinophilin,which was used as a marker to quantify changes in dendritic spine density in the hippocampus of APP/PS1 transgenic mice.Methods 3-month-old and 6-month-old male APP/PSI transgenic mice and 3-month-old wild-type male littermates were divided into five groups based on their genetic background:3-month-old control (group A,n =8),anesthesia (group B,n =32),surgery (group C,n =32),littermates control(group D,n =8),6-month-old control (group E,n =8).According to the different time points at day 1,3,7,14 after anesthesia or surgery,group B and C were divided randomly into 4 subgroups:B1,B3,B7,B14 and C1,C3,C7,C14.The spatial learning and memory abilities were detected by Morris water maze test in each group at the corresponding time points.Meanwhile,spinophilin expression was detected by Western blot and Immunocytochemistry in the hippocampus.Results Compared with the same time point subgroup B,the latency to find a hidden platform was longer and the frequency of passing through the platform was decreased in Group C at day 3,7,14(P ＜ 0.05).No significant differences were found among group A,group D,and group B (P ＞ 0.05).The grey value and Western blot relative integrated optical density of spinophilin in group A(1 609 453 ±92 801/0.471±0.015),approached the Group D(1 329 398.4±77 783/0.434±0.008)(P＞0.05),were significantly increased compared with that(801 678 ± 10 505/0.053 ± 0.003) in group E (P ＜ 0.01).Compared with the Group A,the same time point subgroup B and subgroup C14,the grey value and Western blot relative integrated optical density of spinophilin were decreased in Group C at day 1,3,7 (P ＜ 0.05).Conclusion Partial hepatectomy can impair spatial learning and memory abilities of the APP/PS1 transgenic mice,which is closely related to the decrease expression of spinophilin in hippocampus.

Objective To study the influences of hepatolobectomy on space learning capability and the expressions of Drebrin and PSD95 in the hippocampus in APP/PS1 transgenic mouse model of Alzheimer's disease.Methods A total of fifty-four 3-month-old APP/PS1 transgenic mouse were randomly divided into 3 groups:3-month-old control group,sham surgery group,hepatolobectomy group,3-month-old littermates control group and 6-month-old control group.Morris water maze test was used to observe space learning capability on the 1st,3rd,7th,14th day after surgery,meanwhile the expressions of Drebrin and PSD95 in hippocampus were measured by Western blotting.Results Compared with the sham surgery group,the results of the Morris water maze test were decreased in hepatolobectomy group at day 3,7,14 after surgery [(62.9±6.9) s vs.(35.7±12.2) s,(66.3± 9.5) s vs.(39.3±8.3) s,(67.1±7.5) s vs.(32.6±14.1) s],and 6-month-old control group [(75.9±12.1) s] (all P＜0.05).The escape latency were (62.9±6.9)s,(66.3±9.5)s,(67.1± 7.5)s and (75.9±12.1)s,the probe trials were (2.1±0.7) times,(1.83±1.5) times,(2.5±1.9) times and (1.8±0.8) times respectively in hepatolobectomy group at day 3,7,14 after surgery and 6-month old control group.No significant differences in the results of the Morris water maze test were found among 3-month-old control group,3-month-old littermates control group,and sham surgery group.Compared with 3-month-old control group and sham surgery group atday 1,3,7,14 after surgery the expressions of Drebrin were decreased in 6-month-old control group and the hepatolobectomy group at the same time points.Meanwhile,the expression of Drebrin in hepatolobectomy group was increasedat day 14 versus day 7 after surgery.Compared with 3 month-old control group,the expression of Drebrin was increased at day 7 after sham surgery.Compared with 3-month-old control group and sham surgery group at day 3,7 and 14,the expressions of PSD95 were decreased in hepatolobectomy group at the same time points.Compared with 3-month-old control group,the expression of PSD95 was increased in sham surgery group at 7th day (P＜0.05).Between 3 month-old control group and 3-month-old littermates control group,the expressions of Drebrin and PSD95 had no significant differences.Concltsions Hepatolobectomy can impair the capabilities of space learning and memory in 3-month-old APP/PS1 transgenic mice,which may be associated with the decreased expressions of Drebrin and PSD95 in hippocampus.

Objective To learn the cognitive status for newborns medical pain in medical workers of neonatal intensive care unit of children′s hospitals and provide clinical basis for optimizing neonatal pain management. Methods Totally 320 medical staff in neonatal intensive care units of six children′s hospital in Wuhan, Shenzhen, Shanghai, Nanjing, Zhejiang, Chongqing were investigated using medical pain management survey questionnaires by means of convenience sampling method. Results The knowledge on neonatal pain were at quite high level, accuracy rate was (80.5 ± 18.1)%;but on pain feel, pain relief rate and anodyne-use, the accuracy rate was relatively low; chest drainage, lumbar puncture and PICC placement were generally considered to cause severe pain with scores of 8.03±2.20, 7.17±2.17, 7.09 ± 2.00, respectively. Medical staff with different degrees, having children or not, different titles and with different years of working at NICU had impact on neonatal pain assessment on heel prick and venipuncture among full-term newborns. The difference was statistically significant (χ2=6.208-23.314, P<0.05). Conclusions Neonatal pain management is gradually emphasized by clinical medical staff, but there exist a certain bias on the perception and assessment of pain. So, it needs to strengthen pain-related knowledge training on health care for newborns to prevent and reduce neonatal pain, improving neonatal pain management.