Aiming at the existing problems in the teaching hospital,teachers and practical students during clinical practice teaching,we explored actively in talent training and teaching base construction and promoted the improvement of clinical practice ability for medical students.

OBJECTIVE To investigate the genotype characteristics of extended-spectrum ?-lactamases(ESBLs) producing Escherichia coli and Klebsiella pneumoniae and drug resistance condition in Tianjin.METHODS A total of 218 strains of ESBLs-producing E.coli and K.pneumoniae were isolated from clinic.The drug-resistant CTX-M-1,CTX-M-2,CTX-M-8,CTX-M-9,TEM,SHV,OXA-1,OXA-2 and OXA-10 were tested by SYBR GREEN Ⅰ real-time fluorescent quantitative Polymerase chain reaction(PCR).RESULTS Among 109 strains of ESBLs-producing E.coli,the drug resistance of genotypes CTX-M-1,CTX-M-2,CTX-M-8,CTX-M-9,TEM,SHV and OXA-1 was 32.1%,0.9%,0.9%,33.9%,73.4%,27.5% and 15.6%,respectively.The strains with more than two genes were 66.1%.The positive rate of CTX-M-1,CTX-M-2,CTX-M-8,CTX-M-9,TEM,SHV,OXA-1 and OXA-10 was 49.5%,2.8%,1.8%,22.9%,78.9%,76.1%,33.0% and 0.9%,respectively.The strains with more than two genes were 82.2%.The strains were highly sensitive to imipenem.CONCLUSIONS Most of the genotypes of ESBLs-producing E.coli and K.pneumoniae in Tianjin are SHV,TEM,CTX-M-1 and CTX-M-9.The rate of OXA are increasing,and the drug resistance genes of K.pneumoniae from different hospitals are different.

Objective: To evaluate the clinical efficacy and side effects of icotinib combined with a subarachnoid space implantable pump for the treatment of leptomeningeal metastases (LM) from lung adenocarcinoma. Methods:Seven cases of LM from lung adeno-carcinoma with epidermal growth factor receptor mutation were included in the study from March 2011 to September 2015. With the aid of anesthetists, all patients were implanted with subarachnoid space implantable pumps to drain the cerebrospinal fluid (CSF) and then treated with icotinib (125 mg, three times a day) until disease progression or unacceptable toxicities. After 4 weeks, the efficacy and tolerability of icotinib were evaluated on the basis of symptoms, tumor markers from CSF, and brain gadolinium-enhanced magnet-ic resonance imaging scans. Results:Among the seven patients evaluated, no patient had complete response, two patients had partial response, four had stable disease, and one had progression. The patient who was progressive died at a month after therapy. The sur-vival time of all the other patients was more than 4 months. The common adverse effects of icotinib were skin rash and diarrhea, main-ly in grades 1 and 2. No infection of the local subarachnoid drainage tube was found in the abdominal wall. Conclusion:Icotinib com-bined with a subarachnoid space implantable pump for the treatment of LM from lung adenocarcinoma may be effective, and the tox-icities are tolerable. This method could also obviously alleviate the clinical symptoms and improve the quality of life of the patients, worthy of further study.

BACKGROUND:Total knee arthroplasty is the main treatment for end-stage knee disease.However,knee prostheses are mostly imported from overseas,making the price expensive.Furthermore,ethnic differences mean that these prostheses designed for westerners are not designed to meet the needs of Orientals.OBJECTIVE:To verify the efficacy and safety of this novel knee prosthesis in total knee arthroplasty.METHODS:We propose to conduct a prospective,single-center,randomized,positive parallel controlled,non-inferiority,clinical trial at Shiyan Taihe Hospital,China.Seventy-two patients with knee disease who are scheduled to undergo knee arthroplasty will be equally randomized into the trial group or the control group using a randomized block design.The trial and control groups will undergo knee arthroplasty with knee prostheses purchased from Wuhan Yijiabao Biomaterial Co.,Ltd.,Wuhan,China (newly developed) and Beijing AKEC Medical Co.,Ltd.,Beijing,China (approved by the China Food and Drug Administration),respectively.All patients will be followed up for 12 months.The primary outcome will be the recovery of knee function as assessed by the rate of excellent and good Hospital for Special Surgery knee scores at postoperative 12 months (± 15 days).The secondary outcomes will be:the morphology of the knee as revealed by anteroposterior and lateral radiographic views taken preoperatively,and at postoperative 2 weeks (± 5 days),6 weeks (± 15 days),3 months (± 15 days),6 months (± 15 days),and 12 months (± 15 days);the incidence of adverse reactions at postoperative 2 weeks (± 5 days),6 weeks (± 15 days),3 months (± 15 days),6 months (± 15 days),and 12 months (± 15 days);and the correlation between various types of adverse reactions and each knee prosthesis type.This trial has been registered at ClinicalTrials.gov (identifier:03184129).The study protocol has been approved by the Ethics Committee of Taihe Hospital of China (approval number:2016 (34)).All protocols will be performed in accordance with the Ethical Principles for Medical Research Involving Human Subjects in the Declaration of Helsinki.Written informed consent was provided by each patient and their family members after they indicated that they fully understood the treatment plan.DISCUSSION:Participant recruitment began in February 2017 and will be finished in September 2017.Data analysis will be completed in November 2018.Wuhan Yijiabao Biomaterial Co.,Ltd.has developed a new knee prosthesis system.This system uses cobalt-chrome-molybdenum and high cross-linked polyethylene as the active friction interface,which has excellent wear resistance.This trial is designed to verify the efficacy and safety of this novel knee prosthesis in total knee arthroplasty.

Objective To investigate the expression of heat shock protein-70(HSP70)in acute lung injury induced by paraquat poisoning.Methods A total of 72 Wistar rats were randomly divided into 3 groups(n=24 each group)and intraperitoneally injected with normal saline in group A,20 mg/kg paraquat in group B,and 40 mg/kg paraquat in group C.The lungs of rats were excised 1,3,6,12,and 24 hours after the injection,respectively.The expression of HSP70 in the lung tissue was detected by immunohistochemistry and Western blot.Results Paraquat induced acute lung injury in groups B and C.In group B,the expression of HSP70 increased at 2 hours,reached the peak at 6 hours,decreased at 12 hours,and returned to the baseline level at 24 hours.In group C,the expression of HSP70 increased at 1 hour,reached the peak at 3 hours,and returned to the baseline level at 24 hours.Conclusion Paraquat-induced acute lung injury may contribute to the enhanced expression of HSP70 in the bronchus,bronchiole,and alveolar epithelial cells,which indicates that HSP70 has a protective effect on lung injury.

Objective To investigate and analyze risk factors of re-fracture after operation of osteoporotic hip fracture.Methods Two hundred forty-seven patients receiving operation of osteoporotic hip fracture were retrospectively studied and followed up,and all patients were divided into re-fracture group (54 patients) and no-re-fracture group (193 patients).The related factors such as sex,age,body mass index (BMI),affected side,initial fracture site,operation type,perioperative blood loss,postoperative delirium,postoperative bedridden time,medical complications,Charlson comorbidity index,antiostoporosis therapy,hip function scores with Harris and functional independence measurement (FIM) scores were compared by single factor analysis and multivariate Logistic regression analysis.Results Single factor analysis and multivariate Logistic regression analysis both showed that the risk factors of re-fracture after operation of osteoporotic hip fracture included age,postoperative delirium,hypertension,diabetes mellitus,cerebrovascular disease,antiostoporosis therapy,hip function scores with Harris and FIM scores (P ＜ 0.05 or ＜ 0.01).Conclusions Risk factors of re-fracture after operation of osteoporotic hip fracture include passive factors of age,postoperative delirium and medical complications,and subjective factors of antiostoporosis therapy,hip function scores with Harris and FIM scores.Patients should receive medical treatment positively,enhance antiostoporosis therapy and rehabilitation training of hip function to prevent re-fracture.

Objective To analyze the short-term clinical efficacy of the treatment of ipsilateral femoral intertrochanteric fractures with femoral head necrosis through total hip arthroplasty combined with internal fixation.Methods From January 2011 to June 2014 a total of 28 cases of ipsilateral femoral intertrochanteric fractures with femoral head necrosis were selected,and they were all treated with open reduction and greater trochanter plate fixation combined with total hip arthroplasty.The time of operation, amount of bleeding,time of bone healing of the greater trochanteric fracture,postoperative complications, rate of internal fixation device loosening,incidence of infection,and the Harris score of the hip joint before and after operation were recorded and statistically analyzed.Results The mean operative time was (174.0±27.1)min and the mean blood loss was (530.0±132.0)mL.There were 2 cases of deep venous thrombosis in the lower extremities,and there was no serious complications occured among the remaining cases.All patients were followed up for 12 to 24 months,averagely (16.3±7.0) months.All the 28 patients get bony union of the large trochanter,with the average healing time of (5.0±1.5) months.The preoperative Harris score was (28.0±7.1) points, while it was (86.5±5.3) points after the surgery, and the difference was statistically significant(t=-21.699,P=0.000).At the end of the follow-up,there was no internal fixation device loosening, no cable breakage,and no infection cases.Conclusion Total hip arthroplasty combined with internal fixation for the treatment of ipsilateral femoral intertrochanteric fractures with femoral head necrosis, especially the large trochanteric fractures, were of reliable fracture fixation, good initial stability and good joint function recovery.And it can maintain fracture stability and early recovery of joint function,so that intertrochanteric fractures and femoral head necrosis were treated simultaneously,and its recent clinical results were satisfactory.

BACKGROUNDTo investigate the efficacy of EP regimen combined with split-course hyperfractionated accelerated irradiation for locally advanced non-small cell lung cancer.

METHODSThe treatment was composed of 3 cycles of combined chemoradiotherapy at 4-week intervals. Chemotherapy with cisplatin ( 30 mg/m²) and etoposide (60 mg/m²) was administrated intravenously on days 1-3, followed by radiotherapy on days 4-8. A course of radiotherapy consisted of 1.5 Gy per fraction, twice a day (3 Gy per day) for 5 consecutive days, for a total dose of 15 Gy. In the third cycle, additional irradiotherapy consisted of 2 Gy once a day was performed on days 11-15, for a total dose up to 55 Gy during 10 weeks. After three cycles, patients were given 2 additional cycles of chemotherapy with MVP regimen.

RESULTSOf the 43 patients, 12 had a complete remission and 22 a partial response, resulting in an overall response rate of 79.1%. Of the 152 chemotherapeutic cycles administrated, there were 40 during which grade III-IV toxicities occurred, mainly consisting of leukopenia and vomiting. The 1- and 2-year survival rates were 66.7% and 57.2%, respectively.

CONCLUSIONSEP regimen combined with split-course hyperfractionated accelerated irradiation is effective and well tolerated for advanced locally non-small celll lung cancer. It should be investigated further.

OBJECTIVETo analyze the learning curve of gastric bypass procedure on rats model by a single operator.

METHODSFrom June 2013 to September 2013, two groups (group A and group B) of rats model were performed gastric bypass surgery, 60 rats for each group. Each group was divided into 3 stages according to sequence. The operative time and postoperative survival rate were compared between A group and B group at first, then among stages of each group.

RESULTSThere were no significant differences between A and B group in operative time and postoperative survival rate. However, the operative time significantly decreased in group AII( and AIII( compared with AI(, [(78.5±2.5) and (73.3±1.4) with (127.3±3.2) min, P<0.01]. The postoperative survival rate was increased in group AII( and AIII( than in the group AI(, [75%(15/20) and 85%(17/20) with 30%(6/20), P<0.05]. All results of 3 stages in group B was similar to group A.

CONCLUSIONFor an efficient and stable rate of successful model establishment, the researcher needs to operate about 20 rats to pass the learning curve of gastric bypass procedure.

Objective To evaluate the clinical results of indirect reduction and fixation with the self-manufactured external fixator as a viable alternative in the surgical treatment of intraarticular calcaneal fractures.Methods From May 2006 to May 2009,a total of 30 patients undergone surgical treatment of intraarticular calcaneal fractures were analyzed,including 20 males and 10 females with an average age of 36 years (range,15-53).According to Sanders classification based on the computed tomography scan of intraarticular calcaneal fractures,16 patients were classified as type-Ⅲ,and 14 type-Ⅳ in this series.All fractures were treated first with the external fixator as indirect reduction and fixation device on the whole,which can enlarge the interspace of the subtalar joint significantly.Then,posterior articular facet of calcaneus was exposed and reduced through a small lateral incision.The calcaneal's length,breadth,thalamus height,maximum vertical displacement of the post-articular surface,and B(o)hler angle were measured preoperatively,3 days and 6 months after operation in X-ray film.Reduction results were evaluated by CT scan according to the standard of Buckley.Results The average follow-up time of all patients was 29 months (range,4-45).Lateral and axial roentgenograms showed satisfactory restoration of the calcaneal's anatomical structure.There were significant differences between preoperative values and those 3 days or 6 months postoperatively.There were no significant differences between values 3 days postoperatively and those 6 months postoperatively.The reduction results of posterior articular facet were evaluated by CT scan.Twenty-seven patients obtained anatomical reduction,3 patients obtained uneven articular facet within 2 mm.Conclusion This selfmanufactured external fixator is a vialbe alternative in the treatment of intraarticular calcaneal fractures,which has advantages of minimal invasion,practicality and less complications.