Tumors of the sacrum are rare.The valve of adjuvant is uncertain,and en bloc tumor resection remains the primary mode of treatment.But en bloc tumor resectiong often leads to unstability of the pelvic ring.Therefore,the most factor providing the successful outcome in the management of sacral tumor is how to establish stability in the lumbo-sacrai junction.The various spinopelvic reconstruction techniques are reported in the literature.This includes various methods triangular frame reconstruction,or lilac rod or iliac screw fixation,modified galveston,custom-made prosthesis and so on.The authors review the modes of reconstruction after sacral tumor resection and discuss the outcomes.

Objective To compare the clinical characteristics and antibiotics resistance of neonatal sepsis caused by Klebsiella pneumoniae and Escherichia coli in order to provide guidance for early diagnosis and appropriate treatment. Methods Forty-two newborns with Klebsiella pneumoniae sepsis and 50 newborns with Escherichia coli sepsis in the neonatal intensive care unit of Yuying Children's Hospital of Wenzhou Medical College from January 2000 to October 2009 were enrolled into this study. The clinical data, laboratory examinations and prognosis of these newborns were retrospectively analyzed and compared. The antibiotic resistance data of different onset age of the two diseases were compared. Early-onset sepsis was defined as the age at the onset ≤3 days, and late-onset sepsis was defined as the age at the onset ＞3 days. Results (1) Comparison of clinical characteristics: Klebsiella pneumoniae sepsis caused higher incidence of apnea or gasp compared with Escherichia coli sepsis (61.9% vs 6.0% ,x2= 17. 34, P＜0. 05); the time of developing to multiple organ dysfunction syndrome or disseminated intravascular coagulation of the newborns with Klebsiella pneumoniae sepsis [(40±28) h] was shorter than that of the newborns with Escherichia coli sepsis [(89±26) h] (t= -3.17, P＜0.05); while the incidence of purulent meningitis of Klebsiella pneumoniae sepsis was lower ( 4. 8% vs 30. 0 %, x2 = 9.65, P ＜ 0. 05 ). ( 2 ) Comparison of non-specific laboratory examinations: compared with Escherichia coli sepsis, Klebsiella pneumoniae sepsis caused higher incidence of the leucocyte count ＞ 25 × 109/L (42. 9% vs 22.0%, x2 = 4. 60,P＜0. 05), platelet count ＜ 100 × 109/L (52.4% vs 18.0%, x2 = 12.07, P＜0. 05) and C-reaction protein ＞8 mg/L (95.2% vs 76.0% ,x2 =6. 55, P＜0. 05). (3) Comparison of results of antibiotic resistance: the resistance rate of Klebsiella pneumoniae (81.8%00-100. 0%) to Cephalosporins was higher than that of Escherichia coli (17. 2%-63. 2%) (x2 =6.97-11.92, P＜0. 05); the resistance rates of late-onset sepsis of Klebsiella pneumoniae to Amoxicillin/clavulanic-acid and Cefoperazone/sulbactam were higher than those of Escherichia coli (75.0% vs 0.0%, x2 =26.67, P＜0. 05;83. 3%vs 0. 0%, x2 = 12.53, P＜0. 05 respectively); no resistance to Imipenem were found. The percentages of extended spectrum β-lactamases (ESBLs) positive Escherichia coli and Klebsiella pneumoniae were obviously higher in neonates with late-onset sepsis than those early-onset ones (65.0% vs 17. 8%,x2 = 11.06, P＜0. 05; 100. 0 % vs 30. 0 %, x2 = 20. 22, P＜0. 05 respectively); and positive ESBLs rate of the late-onset Klebsiella pneumoniae sepsis was higher than that of Escherichia coli sepsis (100. 0% vs 65.0%, x2 =9.16, P＜0. 05). (4) Comparison of mortality rate: the mortality rate of Klebsiella pneumoniae sepsis was higher than that of Escherichia coli sepsis (21.4% vs 4. 0%,x2=6.59, P ＜ 0. 05 ) . Conclusions Compared with Escherichia coli septicemia, Klebsiella pneumoniae septicemia has more severe symptoms, developed to multiple organ dysfunction syndrome or disseminated intravascular coagulation quicker, and has higher mortality rate. The percentage of ESBLs positive Escherichia coli and Klebsiella pneumoniae increased rapidly. The clinical use of antibiotics should be rationale.

BACKGROUND:Studies have confirmed that the active ingredients ofPaeonia lactiflora Pal. have better inhibitory effects onCandida albicans, but its monomer paeoniflorin has not been reported whether it can inhibit Candida albicans biofilm. OBJECTIVE:To observe the effect of paeoniflorin onCandida albicans biofilm in vitro. METHODS:Paeoniflorin solution at different concentrations of 4, 2, 1, 0.5, 0.25 g/L was prepared using RPMI-1640 according to 2-fold dilution method. Chlorhexidine was diluted with RPMI-1640 to different concentrations, including 2%, 1%, 0.5%, 0.25%, 0.125%. We compared the effects of different concentrations of chlorhexidine and paeoniflorin on diameter ofCandida albicans by agar diffusion method. MTT assay was used to detect the effect of different concentrations of chlorhexidine or paeoniflorin on the celladhesion of Candida albicans as wel as their inhibitory effects onCandida albicans biofilms. Confocal laser scanning microscope and LIVE/DEAD BacLight Bacterial Viability Kits were combined to observe the changes ofCandida albicans biofilms under normal or intervention conditions. RESULTS AND CONCLUSION:Both chlorhexidine and paeoniflorin possessed bacteriostatic ability, and their bacteriostatic ring diameters were positively correlated with drug concentrations. Significant differences in the bacteriostatic ring diameter were observed between chlorhexidine and paeoniflorin, except between 2 g/L paeoniflorin and 1%, 2% chlorhexidine. Paeoniflorin at different concentration could inhibit celladhesion of Candida albicans as wel as inhibitCandida albicans biofilm. The inhibition rate was also positively correlated with drug concentrations. Under normal conditions, most of bacteria in the biofilms were alive, and there was a smal amount of dead bacteria after 48 hours. After intervention with paeoniflorin, the proportion of dead bacteria in the biofilms was increasing along with the concentrations of paeoniflorin. Compared with the chlorhexidine, paeoniflorin showed a lower bacteriostatic activity. These findings indicate that paeoniflorin has an obvious inhibitory action in Candida albicans biofilms in vitro.

Objective To develop a method for measuring creatine kinase MB (CK-MB) isoforms which is rapid for clinical diagnosis of acute myocardial infarction.Methods A simple agarose gel electrophoresis was developed for CK isoforms. A suitable discontinuous buffer system separated CK-MB and CK-MM isoforms simultaneously in 30 minutes under low voltage. The results were obtained in 1 hour. 45 patients with AMI were divided into two groups: conventionally treated group (n=38) and reperfusion group (n=7). Three control groups were also studied: apparently healthy volunteers (n=40),unstable angina patients (n=30) and hospitalized adult patients with no history of myocardial ischemia (n=25).Results In 45 patients with AMI and 95 patients without AMI, we found that the ratio of MB2 to MB1 was a high sensitive index for early diagnosis of AMI. The sensitivity was 62% in the first 2 hours after onset of chest pain, 92% in 2-4 hours, and 97% in 8-12 hours.Conclusion CK-MB isoforms can be used for early diagnosis of AMI. Agarose electrophoresis is widely used in clinical laboratory.

Objective.To evaluate the role of hysterectomy for patients with gestational trophoblastic tumor.Methods.We retrospectively analyzed 68 cases of gestational trophoblastic neoplasia treated by hysterectomy from 1985～1997 at PUMC hospital. Thirty-eight cases were diagnosed of choriocarcinoma and 30 were invasive mole.Results.Twenty-three elder patients who didn't desire to preserve fertility were selected for hysterectomy after shorter courses of chemotherapy, 22 of them had a complete remission(95.6%), the total aver-age courses of chemotherapy was 4.2. Of twenty-seven chemorefractory cases who were suspected of a refractory isolated lesion in the uterus, delayed hysterectomy as an adjunct to chemotherapy was performed, 20 of them got a complete remission(74.1%), the total average courses of chemotherapy were 9.4. Emergency hysterectomy is indicated in 18 patients with uterine perforation or life-threatening hemorrhage, 17 cases had a complete remission(94.4%), the total average courses of chemotherapy were 7.6.Conclusion.Although the development of effective chemotherapy has resulted in improved survival of patients with gestational trophoblastic tumor, hysterectomy remains an important adjuncts in the treatment of a selected subset of patients; in order to operate more completely and prevent recurrence, it's better to perform extended hysterectomy for the indicated patients.

Objective To clarify the serological characteristics and predictive value of HIV antibody indeterminant and to evaluate the efficiency of 3 assays to discriminate HIV antibody indeterminant.Methods Three hundred and ninety-four HIV antibody indeterminant serum samples were collected and the Western blot pattern were analyzed.Ninety-seven HIV antibody indeterminant individuals were followed up,and the development of HIV antibody were observed.The initial serum samples of 67 followed individuals were tested by viral load,line immunoblot assay and ELISA for HIV-1 p24,with the golden standard of follow up,the efficiency of 3 kinds of assay to discriminate HIV antibody indeterminant were evaluated.Results There were 38 patterns among 394 HIV antibody indeterminant,the proportions of env,pol and gag indeterminant were 37.54%,4.04%and 58.37% respectively.Five HIV antibody indeterminant cases were converted to HIV antibody positive among 97 followed individuals,they were all env indeterminant and HIV antibody developed rapidly.HIV viral load was an ideal assay to discriminate HIV antibody indeterminant with best sensitivity.Conclusion The indeterminant of gag were most common,but were unspecific reaction.Env indeterminant were with the greatest predictive value of HIV infection,especially the gp160p24 and gp160.Viral load assay can be applied to discriminate HIV antibody indeterminant.

To explore the mechanism of the absorption enhancement of Angelica dahurica extract (Ade), the absorption mechanism of baicalin in the Scutcllaria water extraction as well as the effect of Angelica dahurica extract on absorption of baicalin were investigated. In order to determine the main absorption site, everted intestinal sac model was used to study the effect of Angelica dahurica extract on the absorption of baicalin at duodenum, jejunum, ileum and colon. In situ single pass intestinal perfusion model was performed to study the absorption of various concentrations of baicalin and the effect of Angelica dahurica extract on the absorption of baicalin at the main absorption site. To authenticate the consequence of perfusion by getting the blood from the hepatic portal vein and determine the concentration of the baicalin in the blood. The result showed that baicalin could be absorbed at all of the four intestinal segments with increasing absorption amount per unit as follows: ileum > colon > jejunum > duodenum. The absorption ofbaicalin in the duodenum significantly increased with Angelica dahurica extract, thus, duodenum was chosen to be the studying site. Apparent permeability values (Papp) and absorption rate constant (Ka) of baicalin in the duodenum increased gradually with higher concentrations. When the concentration of baicalin rises to a certain degree, the absorption increase had a saturable process, the absorption of baicalin may be an active transportation. Baicalin may be not a substrate of P-gp as verapamil which had not significantly affected the Papp and Ka of baicalin. The absorption of baicalin in the duodenum significantly increased (P < 0.01) in the two models with Angelica dahurica extract and the concentration of baicalin in the blood from the hepatic portal vein showed that the Angelica dahurica extract can increase the absorption of baicalin.

Objective To estimate the excess relative risk coefficients of stomach cancer for Chinese population attributable to ionizing radiation.Methods The excess relative risk and excess absolute risk coefficients of stomach cancer were estimated based on Life Span Study by using risk models developed by BEIR Ⅶ committee (Biological Effect of Ionizing Radiation).Guided by transportation methods from Life Span Study to Americans,we determined that transportation method for Chinese population includes both multiplicative and additive models with a weight of 0.7 and 0.3 respectively,on an arithmetic scale.Besides,curve fitting was used to obtain sex-age-specific stomach cancer baseline incidence based on Chinese cancer annual report.Then,Chinese excess relative risk coefficients of stomach cancer were obtained by substituting excess relative risk,excess absolute risk of Life Span Study and Chinese baseline incidence rate into risk transportation model.Results Excess relative risk coefficients of stomach cancer for Chinese population are 0.26/Sv for male and 0.64/Sv for female,whose exposure age is 30 years old and cancer age is 60 years old.Coefficients increase with decreased exposure age and cancer age.Conclusions Excess relative risk coefficients of stomach cancer for Chinese population are by larger higher than that of Life Span Study,and their sex-age tendency are similar.

Objective To estimate the averaged excess relative risk(ERR) in Chinese population based on the radiogenic cancer risk of leukemia in Japanese atomic bomb survivor cohort,and to discuss proper method suitable for risk transfer between populations.Methods Based on BEIR Ⅶ radiogenic cancer model and population transfer model,and the 2009 Chinese leukemia baseline rates given in 2012 Chinese Cancer Registry Annual Report,comparison was made of population incidences in seveal countries to adjust the weighting factors.Results The ERR of three subtypes of leukemia as a whole was obtained,and the weighting factors for risk transfer model was assumed.The additive factor for male was 0.2,and the multiplicative factor was 0.8,while the additive factor for female was 0.15,and the multiplicative factor was 0.85.Conclusions For the risk transfer between populations,weighting factor was adjusted as a whole to obtain the ERR value for estimating the risk to Chinese population.The risk transfer method suitable for Chinese population was obtained by using the incidence rate available for Chinese population to directly transfer radiation-induced leukemia risk to Chinese from Japanese.

The aim of the present research was to investigate and analyze the hunting intentions of medical students for rural grassroots in Gansu and to provide a reference for decision-making on rural health human resource . A questionnaire is the research tool which was used to investigate the views of the senior students from six medical schools , and we studied their employment willingness to rural healthcare institutions .Chi-square test and non-condi-tional logistic regression analyses were used for data analysis .A sample of 600 medical graduates was involved in this investigation.The results of this study show that more than a half (55.6%) of the students would like to work in ru-ral, but only 13.8%of which were “very willing” to work at the rural healthcare institutions .According to the out-comes of this investigation , the number of junior college students who would like to work at the grassroots was 2.3 times the number of the undergraduate students .Medical students whose monthly salary expectations were not high ,with the household registration in rural areas , and having a better understanding of the policy of rural grass-roots em-ployment were more likely to work at the rural healthcare institutions .Based on the findings of this investigation , it can be concluded that the grassroots medical career intention of medical students is not only influenced by its own fac -tors, such as education and household registration , but also the policy of the government , school employment guid-ance and social atmosphere play an important role .The above-mentioned factors should be considered by decision-making and management departments of public healthcare .The departments should introduce a reasonable recruit-ment policy and strengthen the construction of grass-roots medical technology , equipment , and infrastructure , im-prove the grass-roots of employment environment and career development opportunities and strengthen the medical students'employment guidance work to make medical students more willing to work at rural healthcare institutions .