Aged ; Catheter Ablation ; adverse effects ; Echocardiography ; Heart Atria ; Humans ; Male ; Postoperative Complications ; diagnostic imaging ; Tachycardia, Supraventricular ; diagnostic imaging ; surgery ; Thrombosis ; etiology

OBJECTIVE To study the resistant characteristics and the resistant mechanisms of Gram-negative bacilli(G-) to ?-lactam antibiotics in the local nosocomial infections.METHODS The effects of efflux pump inhibitor on MICs were determined.Phenotypes and isoelectric points of ?-lactamases(Bla) were determined.Bla Genes were amplified and sequenced.RESULTS Of all tested isolates,the resistant rates to the most antibiotics were high.Besides 10.5% isolates with the efflux pumps,all tested isolates produced Bla,among which extended spectrum ?-lactamases(ESBLs),cephalosporin ?-lactamase(AmpC Bla) and metallo-?-lactamase were responsible for 42.1%,17.5% and 7.0% isolates,respectively.The complete nucleotide sequences of the ampC genes in 8 Enterobacter cloacae isolates had very high homology with the ampC gene in E.cloacae ECLC074.CONCLUSIONS The production of Bla is the main resistant mechanism of G-to ?-lactam antibiotics.ESBLs are the most frequent Bla.All of the ampC genes of AmpC Bla-producing E.cloacae originate from the ampC gene in E.cloacae ECLC074.Imipenen is the best choice for the treatment of the infections caused by multidrug resistant G-.Piperacillin/tazobactam and cefoperazone/sulbactam can be used to treat the infections caused by drug-resistant non-fermentative bacilli.Amikacin is effective to treat the infections caused by AmpC Bla-producing E.cloacae.

OBJECTIVETo compare clinical outcomes of bilateral transpedicular balloon kyphoplasty for the treatment of ordinary osteoporotic vertebral compressive fracture (OVCF) and severe osteoporotic vertebral compressive fracture.

METHODSFrom Junary 2009 to Febuary 2011, 60 patients (70 vertebrae) with osteoporotic vertebral compressive fracture were included. All patients were treated by bilateral transpedicular balloon kyphoplasty combined with postural reduction, including 10 males and 50 females aged from 59 to 90 years old with an average of 72.1 years old. In ordinary osteoporotic vertebral compressive fracture group, there were 38 patients (44 vertebrae) including 7 males and 31 females aged from 59 to 87 years old with an average of (71.8±6.1) years old. There were 6 patients with two vertebral fractures, 1 vertebra in T9, 5 vertebrae in T10, 7 vertebrae in T11, 13 vertebrae in T12, 9 vertebrae in L1, 4 vertebrae in L2, 4 vertebrae in L3, 1 vertebra in L4. While in severe osteoporotic vertebral compressive fracture group, there were 22 patients (26 vertebrae) including 3 males and 19 females aged from 63 to 90 years old with an average of (72.6±7.2) years old. There were 4 patients with two vertebral fractures, 1 vertebra in T9, 2 vertebrae in T10, 3 vertebrae in T11, 9 vertebrae in T12, 6 vertebrae in L1, 3 vertebrae in L2, 2 vertebrae in L3. Operative time, volume of bone cement injection, and vertebral height and changes of Cobb angle before and after operation were observed and compared. Postoperative average recovery rate of vertebral height and correct degree of Cobb angle were caculated and compared, VAS scoring were used to evaluate therapeutic effect.

RESULTSAll operations were completed sucessfully, and pain were relieved at 72 h after operation. All patients were followed up from 6 to 13 months with an average of 10.1 months. Postoperative vertebral height, Cobb angle and VAS score were improved better than that of before operation (P<0.05). Operative time in ordinary group was shorter than severe group, while volume of bone cement injection was more than that of severe group. Average recovery rate of vertebral height and correct degree of Cobb angle in ordinarty group was better than that of in severe group (P<0.05). There was no significant differences between two groups in VAS scores before and after operation (P> 0.05). Three cases (3 vertebrae) ocurred bone cement leakage in ordinarty group, while 5 cases (5 vertebrae) ocurred bone cement leakage in severe group, and there was no meaning between two groups (P>0.05).

CONCLUSIONKyphoplasty could receive satisfied curative effect in treating ordinary and servere patients with osteoporotic vertebral compressive fracture, but recovery of vertebral height and correct degree of Cobb angle in ordinary gourp was better than that of in servere group.

Aged ; Aged, 80 and over ; Female ; Fractures, Compression ; surgery ; Humans ; Kyphoplasty ; methods ; Male ; Middle Aged ; Osteoporotic Fractures ; surgery ; Spinal Fractures ; surgery

OBJECTIVE: To study the causes of false-positive hyoid fractures and forensic identification. METHODS: Twelve cases of false-positive hyoid fractures were collected and analyzed. RESULTS: Improper dissection technique (4 cases) and congenital separation (8 cases) were the main reasons for false-positive hyoid fractures. CONCLUSION True fractures can be differentiated from false-positive hyoid fractures. False-positive hyoid fracture caused by improper dissection technique can be identified through examination of peripheral muscle, soft tissue hemorrhage, and the characteristics of fracture end.
Autopsy ; Cell Differentiation ; Diagnostic Errors ; Fractures, Bone/diagnosis* ; Humans ; Hyoid Bone/injuries* ; Muscles

ObjectiveTo analysis the different types of bacteria in patients with a varying severity of acute cholangitis.Methods241 patients who presented with actue cholangitis between Jan 2008 to Oct 2011 to our hospital were retrospectively studied.These patients were divided into three groups according to the Tokyo Guideline.The bile specimens were obtained intraoperatively.The parameters were compared by SPSS 16.0 package program for statistical analysis.Results75.1 percent of the patients were positive for bacteria in the bile.There were 241 strains of bacterium which included 139 Gram-positive bacteria,99 Gram-negative bacteria and 6 strains of microzyme.Escherichia coli,Enterococcus faecalis,Enterococcus casseliflavus,Pseudomonas aeruginosa and Klebsiella species were the most frequently isolated bacteria.The positive rates for bacteria were significantly different between patients with mild and severe cholangitis (P＜0.05).There was no significant difference between patients with moderate and mild cholangits (P=0.141),or moderate and severe cholangitis (P=0.647).Gram-negative bacteria were more common than Gram- positive bacteria in patients with moderate and severe acute cholangitis (P＜0.05).In patients with moderate and severe acute cholangitis,there was more patients with multiple and mixed bacterial infection.ConclusionsEscherichia coli and Enterococcus species were more common in patients with acute cholangitis.The positive rate of bacteria in the bile in severe acute cholangitis was higher than that in mild acute cholangitis.In patients with moderate and severe cholangitis,Gram-negative bacterial infections and multiple and mixed bacterial infections were more common.

Objective To observe the change of lipid metabolism during adaptive heart failure.Method The transverse aorta constriction mouse models established by minimal invasive surgery technique were evaluated for early small changes of body composition by EchoMRITM whole body composition analysis,and the different gene expression was analyzed by whole genome expression microarray.Results Three weeks after the surgery,the fat composition,in the mouse models were (0.49 ± 0.13) g,which was significantly lower than that in the sham surgery group [(0.81-±0.14) g] (P =0.002).The expression of the natriuretic peptide type A significantly increased over time (R2 =0.939,P =0.005).In addition,the levels of fatty acid desaturase,long-chain fatty acid elongase 5,and N-acylsphingosine amidohydrolase increased,and the levels of acyl-coenzyme A dehydrogenase,muscle glycogen phosphorylase,and pyruvate dehydrogenase kinase decreased,showing increased fat mobilization and decreased carbohydrate utilization.Conclusions Surgery for transverse aorta constriction can cause complex metablic changes in heart.The activated lipid mobilization maybe lead to the low body fat composition.

Objective To investigate anterior migration of spinal cord after anterior cervical decompression and reconstruction for cervical spondylosis and its mechanism.Methods Eighty-one patients with cervical spondylosis who underwent anterior decompression and reconstruction were reviewed and evaluated retrospectively.There were 44 males and 37 females,with an average age of 52.3 years (range,37-72 years).The distance from anterior margin of the spinal cord to posterior wall of the spinal canal (Da),and medium of the spinal cord to posterior wall of the spinal canal (Dm) in magnetic resonance imaging were measured preoperatively and postoperatively.The recovery rate was calculated comparing the Japanese Orthopaedic Association (JOA) scores before and after operation.Results The average following up was 20.7 months (9-48 months).According to the measure on MRI,preoperative Da and Dm were 11.11±1.59 mm and 6.30±0.84 mm respectively,which were significant different from postoperative Da 11.63±-1.47 mm and Dm 6.62±0.80 mm.The postoperative Da and Dm at C3-4,C4-5,C5-6,C6-7 levels had statistically significant differences compared to preoperative Da and Dm,except for ones at C2-3 level.The significant migration rate was 43.2％(35/81),which reached △Da ＞2 mm or △Dm ＞1.3 mm.Preoperative cervical curvature index (CCI) was 10.0％±6.3％,which was significant different from postoperative CCI 13.5％±6.5％.JOA score increased from 9.7±1.5 preoperatively to 13.7±1.1 at one week postoperatively,and 13.9±1.3 at 6 months postoperatively.But the JOA score decreased at 6 months postoperatively compared with that at 1 week postoperatively in 15 cases.Among them,14 cases got the standard of spinal cord migration based on MRI measurement.No other severe complications were found in these 81 cases.Conclusion Anterior migration of the spinal cord commonly occurred after cervical decompression and reconstruction via anterior approach,and some patients might suffer from the secondary compression of the cervical spinal cord.

Objective To estimate the pharmacoeconomics of two remedy scheme in curing acute cerebral infarction. Method In 212 cases with acute cerebral infarction patients, 206 cases were adopted, and randomly divided into two group. Group A was 102 cases and Group B was 104 cases. Group A was administered with 18 ml cattle encephalon glycoside which was added into 250 ml 5%glucose injection, ivgtt, qd. After 7 days it was administered compound Butylphthalide Soft Capsules, 0.2 g qid, combined Xiaoshuantongluo capsule, 2.1 g tid until 14 days later. Group B was administered with cattle encephalon glycoside and ignotin injection 18 ml which was added into 250 ml 5%glucose injection, ivgtt, qd until 14 days. The basic therapy of two groups were same. After therapy compared the safety and clinic curative effect from European Stroke Scale(ESS) and activities of daily living(ADL).Then outcome-effectiveness was assayed in pharmacoeconomics. Results The total effective rate were 92.2 and 95.2%,and ccurrence of adverse react were 4.7 and 7.5, respectively,in the two group.The clinic total effective rate counting C/E was respectively 129.1 and 178.5;ΔC/ΔE was 1697.7. Conclusion The clinic curative effect of two group was intimate, but the cost had signiifcant difference. The sequential antimicrobial therapy in curing acute cerebral infarction had excellent advantage in outcome-effectiveness.

Objective To observe changes of motilin(MTL) levels in gastric body, duodenum and plasma in rat model of acute incisional pain.Methods A total of 156 healthy male adult SD rats,weighing 180-220 g,were randomized into two groups:control group (group C,n=78) and incisional pain group (group P,n=78),Rats in P group received incision on the right plantaris. Values of paw withdrawal mechanical threshold (PWMT) and paw withdrawal thermal latency (PWTL) at dif?ferent time points of 24 hours before operation (T0) and 1 hour (T1),6 hours (T2),24 hours(T3),48 hours (T4) and 72 hours (T5) after operation were measured in six rats chosen randomly from each group. Twelve rats were chosen from each group at T 0-5, and sacrificed. The MTL levels in plasma, the mucosal tissues of gastric body and duodenum were detected by ELISA. Re?sults Compared with group C, PWMT and PWTL were significantly decreased at T1-4 in group P. The MTL levels were sig?nificantly decreased in plasma and gastric body (P<0.05).The MTL level was significantly increased at T1-4 in duodenum (P<0.05),and no significant changes were found at T0 and T5 in P group(P>0.05). The plasma MTL levels were positively correlated with PWMT and PWTL (r=0.952,r=0.879,respectively,P<0.01) in P group. The MTL levels in gastric body were positively correlated with PWMT and PWTL(r=0.970,r=0.931,respectively,P<0.01) in P group. The MTL levels were neg?atively correlated with PWMT and PWTL(r=-0.991,r=-0.975,respectively,P<0.01) in duodenum in P group. Conclu?sion The MTL levels in plasma and gastric body are decreased in rat model of acute incisional pain, and increased in duo?denum.

Objective To analyze tumor-free survival rate and recurrence rate of radiofrequency ablation (RFA) versus surgical resection(SR) for small hepatocellular carcinoma. Methods Clinical data of 64 patients (hospitalized from October 2008 to October 2010) with small hepatocellular carcinoma(≤ 5 cm) in our hospital were retrospectively analyzed. 29 cases among them underwent RFA, and the 35 cases underwent SR, then they were further divided into two groups according to the tumor diameter (≤ 3 cm vs. ≤ 3 ~ 5 cm). The rate of complete elimination of tumor , complications , recurrence and metastasis , and survival rate out of tumor-free at year 1, 3, and 5 were compared. Accumulated survival rate of the two groups at year 1, 3, and 5 were compared. Results The rate of complete elimination of tumor, and complications in the RFA group were 89.66% and 6.9% respectively, and no statistically significant difference was found compared with the SR group (100% and 14.29%, respectively) . The rate of recurrence and metastasis and 1, 3, 5- year tumor-free rate in RFA and SR group with tumor diameter < 3 cm were 60.00%, 80.00%, 40.00%, 30.00% and 38.46%, 84.62%, 61.54%, 38.46% (P > 0.05) respectively, and for the cases with tumor diameter in 3 ~ 5 cm, these data showed no significant difference between groups (P > 0.05). No significant difference were found in tumor-free survival rate within groups, while rate of recurrence and metastasis was significantly lower in the < 3 cm group (P < 0.05). The accumulated survival rate in RFA at year 1, 3 and 5 were 100%, 62.07%, 37.93% and 100%, 62.86%, 48.57% in SR group (P > 0.05). Conclusions RFA and SR had similar medium and long term clinical effect for small hepatocellular carcinoma with tumor diameter≤ 5 cm. The larger in size of the tumor, the higher rate of recurrence and metastasis. RFA is less invasive and can avoid complications and should be considered an eligible treatment for small hepatocellular carcinoma with tumor diameter ≤ 5 cm.