Objective To investigate the distribution and antimicrobial resistance of clinically isolated pathogens from geriatrics department of a hospital in 2013,so as to provide reference for clinical antimicrobial use.Methods Distribution and antimicrobial resistance of pathogens isolated from patients in a geriatrics department between Janu-ary and December 2013 were analyzed statistically.Results Of 1 896 pathogenic strains,1 289(67.99%)were gram-negative bacteria,439 (26.00%)were gram-positive bacteria,and 114(6.01%)were fungi;the top 4 isolated pathogens were Klebsiella pneumoniae ,Pseudomonas aeruginosa ,Acinetobacter baumannii ,and Escherichia coli .Extended-spec-trumβ-lactamase (ESBL)-producing Escherichia coli and Klebsiella pneumoniae accounted for 53.26% and 31.10% of Escherichia coli and Klebsiella pneumoniae respectively;Of Staphylococcus aureus and Staphylococcus epidermidis strains,methicillin-resistant isolates (MRSA and MRSE)accounted for 22.47% and 80.00%,respectively,of Enterococ-cus strains,vancomycin-resistant isolates (VRE)was 3.10%,Klebsiella pneumoniae and Enterobacteriaceae were highly sensitive to imipenem,meropenem and ertapenem.Resistant rate of Acinetobacter baumannii to imipenem and meropenem was 79.48% and 80.35% respectively,Pseudomonas aeruginosa had the lowest resistant rate to amikacin (10.70%). Gram-positive bacteria were highly sensitive to vancomycin and linezolid.Conclusion The major pathogens isolated from the elderly patients are gram-negative bacteria,and antimicrobial resistance is serious,surveillance of antimicrobial resist-ance is important for rational use of antimicrobial agents and control of pathogen resistance.

Objective To study the clinical significance of a novel marker of platelet clumps count provided by hematology analyzer in differentiating true thrombocytopenia from EDTA-dependent pseudothrombocytopenia (EDTA-PTCP). Methods Samples from 65 cases of thrombocytopenia (including 15 EDTA-PCTP samples and 50 random samples of true thrombocytopenia) and 50 healthy controls were analyzed using hematology analyzers, and samples with low platelet counts were checked by replacing citric acid and using manual microscope observation to identify true thrombocytopenia from EDTA-PTCP. A novel marker of platelet clumps count was used to differentiate the two diseases for samples anficoagulated with EDTA or citric acid. Results In 65 patients with thrombocytopenia, platelet counts were (48±11)×109/L detected by automatic hematology analyzers. Fifty of 65 cases were true thrombocytopenia which showed low platelet counts [(48±10)×109/L by automated analyzer and (46±11)×109/L by manual assay]. No significance was observed between them (t=-1.26, P0.05). Platelet clumps counts were 86±15. No platelet clamps were detected under microscope. The other 15 cases were EDTA-PTCP [platelet counts were (48±12)×109/L and platelet clumps counts (840±184) were increased significantly by automated analyzer and using EDTA anticoagulant] which showed obviously platelet clumps and no less platelet counts under microscope. After replacing citric acid, platelet counts [(141±13)×109/L by automated analyzer and (134±17)×109/L by manual microscope assay] were increased significantly. No significance was observed between them (t=-1.29, P0.05). Platelet clumps counts (75±12) were decreased obviously compared with EDTA anticoagulant method (t=-6.82, P<0.001). No platelet clumps were detected under microscope. Conclusion Platelet clumps counts may be a useful clinical indicator for monitoring of platelet aggregates, especially for EDTA-PTCP caused by platelet clumping.

Despite different opinions on its definition and classification in the past,a consensus has gradually been reached regarding the na-ming,classification,and clinical diagnosis of liver failure.The classification of liver failure is described,and the definition and natural his-tory of severe exacerbation of hepatitis B are summarized.Antiviral treatment and artificial liver support in the early stage are beneficial for clinical outcomes and prognosis.

Objective To discuss the techniques of tumor resection, pelvic reconstruction and postoperative management by reviewing the patients with malignant pelvic tumors in recent years. Methods 76 patients with primary malignant pelvic tumors were treated operatively between July 1997 and July 2003. The series comprised 47 males and 29 females. 31 cases were diagnosed as chondrosarcoma, 15 as Ewing sarcoma, 7 as osteosarcoma, 3 as lymphoma, 3 as malignant fibrohistiocytoma (MFH), 1 as hemangiopericytoma, 2 as myeloma, 13 as giant cell tumor(GCT). According to Enneking's division, the most common region of the primary pelvic tumor involved was region Ⅱ (51 cases), followed by region Ⅰ (16 cases) and region Ⅲ (9 cases). 16 cases were reconstructed with threaded pins and cement after resection of the ilium. 9 patients had local resection of pubis and ischium. 21 patients had hemipelvectomy. Among 30 patients with periacetabular tumors, 8 were reconstructed with hemipelvic prosthesis, 7 with saddle prosthesis, 6 with replantation of cauterized tumor bone and total hip arthroplasty, 9 with cemented total hip replacement after curettage of lesion. Results After 16 months to 6 years follow-up, among the 21 patients with hemipelvectomy, 4 patients had local relapse because the sacrum invaded by the tumors. 7 of 25 patients with lesions in regionⅠ or region Ⅲ had local relapse postoperatively due to the marginal incision to the acetabula. Among the 21 patients who had tumor resection and reconstruction in region Ⅱ, 4 had local relapse, 3 of which reconstructed with cauterized hemipelvis. As for functional recovery, all of the 25 patients with lesions in region Ⅰand region Ⅲcould walk postoperatively without assistance of a cane. 21 patients with acetabular reconstruction after resection of lesions in region Ⅱ could sit and stand normally and walked with a cane, some of them even had normal gait. Conclusion The major principle of treatment for primary pelvic tumor is that en bloc resection, only then the functional reconstruction of pelvic ring can be considered. Operators should be acquainted with advantages and shortcomings of different reconstructive methods of acetabulum to prevent the complications.

Objective To discuss the treatment and prognosis of multifocal osteosarcoma. Methods Between January 1998 and June 2005, nine patients(seven males and two females), six with synchronous multifocal osteosarcoma and three with metachronous multifocal osteosarcoma were treated in our department. The diagnosis of multifocal osteosarcoma was confirmed by clinical presentation, radiology and pathology. Eight of the nine patients received chemotherapy with adriamycin(60 mg/m2), cisplatinum(100 mg/m2), high-dose methotrexate(8-12 g/m2), vincristine(1.4 mg/m2), ifosfamide(12.5 g/m2), and G-CSF. Based on the response to primary chemotherapy, further chemotherapy plans were made, and different operations were done to control local lesions or to relieve symptoms. Arsenous acid, paclitaxel and VP-16 were used in patients who responded poorly to primary chemotherapy. Results One patient who given up remedy was died in systematic fail due to the cancer after 5 month, five patients who were diagnosed synchronous multifocal osteosarcoma died from progressive disease in 3.5 to 17 months (mean time was 9.8 months). Only two of them had a good response to chemotherapy and had finished at least four cycles of chemotherapy,and they had a better survival time of 15 and 17 months respectively. Three patients with metachronous multifocal osteosarcoma had a better prognosis. After a two-year follow-up, two lived with disease and one lived without disease. Conclusion The prognosis of patients with multifocal osteosarcoma is poor, and patients with metachronous multifocal osteosarcoma have a relatively better prognosis. To improve the prognosis of patients with multifocal osteosarcoma, aggressive chemother-apeutics are needed.

Objective To investigate the crosstalk between Wnt signaling pathway and TGF-? signaling pathway in prostate cancer cell line PC-3. Methods Luciferase report assay and RT-PCR methods were used to explore the crosstalk between two pathways. Results Wnt signaling pathway activated TGF-? responsive CAGA-luciferase reporter activity. ?-catenin(WT), TCF-4(WT), GSK3? (KM) activated while TCF-4(DN) inhibited CAGA reporter activity. ?-catenin(WT), TCF-4(WT) synergized to activate TGF-? signaling while TCF-4(DN) had converse effect.TGF-? signaling pathway activated LEF-1 luciferase activity through a Smad3-dependent manner.Smad7 activated LEF-1 luciferase activity,Smad3 and Smad4 also synergically activated LEF-1 reporter activity.?-catenin(WT),TCF-4(WT) cooperated with each other to the activity of cyclinD1 promoter luciferase while Smad3 inhibited cyclinD1 promoter activity.The inhibitory effect of Smad3 on cyclinD1 promoter could be partially reversed by co-transfecting ?-catenin(WT),TCF-4(WT).TGF-? induced the expression of VEGF in PC-3 cells and this effect was enchanced by LiCl addition. Conclusions Wnt signaling pathway and TGF-? signaling pathway can activate each other in prostate cancer cell line PC-3.Two pathways have crosstalk and this might be important for the development and progression of prostate carcinoma.

Objective To understand the effects of "total quantity control" indexes on community health services and the residents' use of them so as to provide scientific basis for furthering reform in the medical insurance system.Methods A survey was made on the operation of the 3 community health centers of Jiangbin Xincun,Huashanwan and Hejianong in Jingkou District of Zhenjiang by means of direct inquiry and literature review.Results The average annual quantity of medical insurance plans allocated to the centers in the last 4 years involved 810 thousand yuan,the quantity actually fulfilled involved(953.5) thousand yuan,and the estimated annual quantity the centers were capable of fulfilling was valued at(1.45) million yuan,nearly 500 thousand yuan more than the quantity actually fulfilled. Conclusion Total quantity control on community health centers not only hinders the healthy development of community health services and the enthusiasm of the medical workers but also adversely affects the residents'use of health services and their health maintenance.

Adolescent ; Adult ; Aged ; Child ; Female ; Foreign Bodies ; diagnostic imaging ; Head ; Humans ; Male ; Middle Aged ; Neck ; Tomography, Spiral Computed ; Tomography, X-Ray Computed ; Young Adult

Background Researches showed that CD4+CD25+ natural regulatory T cells (nTregs) play an important role in maintaining peripheral immune tolerance, while immunotherapy using in vitro-expanded induced regulatory T cells (iTregs) suppresses allograft rejection in multiple organ transplantation.The inducing method of iTregs still needs to be optimized.Furthermore,the effect of iTregs on grafts of keratoplasty is unclear.Objective This study was to investigate the inducing and expansion method of iTregs and explore its inhibitory effects on corneal allograft rejection.Methods Bone marrow-derived dendritic cells (BMDCs) were isolated from C57BL/6 mice femora and cultured.CD4+ CD25+ T cells and CD4+ CD25-T cells were isolated from mouse spleen and separated using flow cytometry.The CD4+CD25-T cells were divided into negative control group (CD4+CD25-T cells), CD3/ 28 antibody bead group (CD4+CD25-T cells+CD3/28 antibody bead) ,2.5 ng/ml transforming growth factor (TGF)-β1 induced group and 10.0 ng/ml TGF-β1 induced group.The iTregs was formed after induction of different concentrations of TGF-β1 and CD3/CD28 antibody bead (1 : 1).CD3/CD28 antibody bead (1 : 2) , interleukin-2 (IL-2) and TGF-β1 were used to expand iTregs.The phenotype and proliferation of iTregs were assayed by flow cytometry,and the inhibitory effect of iTregs on effector T cells (Teffs) was analyzed by mixed lymphocyte reaction.Allogenic keratoplasty model (C57BL/6→BALB/c) was build,and 0.1 ml iTregs or nTregs suspension or PBS was injected via posterior venous plexus of fellow eyes to assess the graft survival time.The use and care of the mice followed the ARVO statement.Results The CD4+CD25+ T cell proportions were (6±3)％ ,(91±4)％ ,(91±3)％ and (86± 6) ％ in the negative control group,CD3/CD28 antibody bead group, 2.5 ng/ml TGF-β1 induced group and 10.0 ng/ml TGF-β1induced group, showing significant increases in the CD3/CD28 antibody bead group, 2.5 ng/ml TGF-β1 induced group and 10.0 ng/ml TGF-β1 induced group compared with the negative control group (all at P＜0.01).The Foxp3+ T cell proportions of the CD3/CD28 antibody bead group,2.5 ng/ml TGF-β1 induced group and 10.0 ng/ml TGF-β1 induced group were (1.18 ±0.20) ％ , (8.70± 1.80) ％ and (21.80±3.36) ％ , showing significant increases in the 2.5 ng/ml TGF-β1 induced group and 10.0 ng/ml TGF-β1 induced group compared with the CD3/CD28 antibody bead group (both at P＜0.01).Compared with the nTregs, the expression of CD69 was lower, and the expressions of PD-1 and Foxp3 were raised in the iTregs (all at P＜0.01).The proliferation of Teffs were decreased when cocultured with iTregs in comparison with nTregs at 1 : 1,1 : 2,1 : 4,1 : 8,1 : 16 Tregs/Teffs rations (all at P＜ 0.01).The survival time of mouse corneal grafts was 4 weeks with the permanent tolerance of 50％ in the iTregs injected group,which was superior to the 3 weeks survival time and 17％ permanent tolerance in the nTregs injected group(P＜0.05).Conclusions TGF-β1 can induce CD4+ CD25-T cells to form iTregs, which highly express Foxp3.iTregs show a stronger inhibitory effect on the growth of lymphocytes than nTregs, and therefore suppress the graft rejection after keratoplasty.

Objective To systematically evaluate the effects of compression stockings for preventing post-thrombotic syndrome after giant surgery in department of orthopaedics.Methods Randomized controlled trials about compression stockings were searched and analyzed no matter written in Chinese or English.The effects of compression stockings is determined by Meta-analysis with Review Manager 5.0.Results 4 papers were included in this research,among which,one was domestic,and another three were abroad.Heterogeneity was small when the data was merged,which suggested that compression stocking for preventing post-thrombotic syndrome was effective.Conclusions Compression stockings can be safely used to prevent post-thrombotic syndrome after giant surgery in department of orthopaedics.