Objective To investigate the production of carbapenemase and 16S rRNA methylase in five isolates of pan-drugs resistant E.cloacae recovered in Ruijin hospital.Methods MICs of the five isolates to 10 antibiotics were determined by E test.Six kinds of 16S rRNA methylase genes and a series of β- lactamase genes were amplified by PCR.Shotgun cloning was performed to detect carbapenem resistance determinant.The conjugal transfer of carbapenemase gene and 16S rRNA methylase gene was performed in broth culture with E.coli J53 as the recipient.Pulsed-field gel electrophoresis (PFGE) was carried out to analyse the genotyping.IEF was performed to detect β-1actamases.Southern blot was performed to determine the location of carbapenem resistance determinant.Results The MICs of 10 antibiotics were ＞32 mg/L.Four β-1actamases with pIs of 5.4 ( TEM-1 ),6.7 ( KPC-2 ),8.2 ( SHV-12 ),8.4 (CTX-M-14) were determined.The insertion sequence in the recombinant plasmid was blaKPC-2 flanked by a transposon.blaKPC-2 was located on a large non-conjugative plasmid whereas armA was located on an other conjugative plasmid.PFGE patterns of 5 isolates were identical.Conclusion KPC-2 was responsible for carbapenem resistance in pandrugs resistant Enterobacter cloacae.There was no relationship between blaKPC-2 and armA.Although pandrug resistant Enterobacteriaceae remain rare,the emergence of this group of organism merits monitoring.

BACKGROUND:Percutaneous pedicle screw fixation has been applied in the treatment of thoracolumbar fracture,and has achieved satisfactory clinical efficacy.Injectable calcium sulfate holds good biocompatibility,degradability and fast curing.OBJECTIVE:To explore the clinical efficacy of percutaneous pedicle screw fixation combined with calcium sulfate cement for single-level thoracolumbar fracture.METHODS:Clinical data of 40 patients with single-level thoracolumbar fracture without nerve injury were analyzed retrospectively.All fractured vertebrae were compressed more than 30％ and at least one pedicle was complete.All patients were treated with percutaneous pedicle screw fixation combined with calcium sulfate cement.The Visual Analog Scale and Oswestry Disability Index scores were recorded at baseline,3 months postoperatively and last follow-up;the height of the fractured vertebra body and sagittal Cobb angle were measured on X-ray;the patient's satisfaction and healing rate were recorded.RESULTS AND CONCLUSION:(1) The Oswestry Disability Index at 3 months postoperatively and last follow-up was 16.3％ and 4.4％,respectively.Compared with baseline,the Cobb angle and Visual Analog Scale scores were significantly reduced,and height of the fractured vertebra body was significantly increased after surgery (P ＜ 0.01).(3) The healing rate at last follow-up was 95％,nonunion was not found,and the patients' satisfaction reached 95％.(4) The loss of vertebral height and Cobb angle was found at last follow-up compared with 3 months postoperatively,but had no significant difference (P ＞ 0.05).(5) These results indicate that percutaneous pedicle screw fixation combined with calcium sulfate cement is safe and reliable for single-level thoraclumbar fracture,which not only restores the vertebral height and relieves pain,but also has satisfactory long-term curative efficacy and high healing rate.

BACKGROUND: Thoracolumbar fracture is most common seen in spinal fractures. The paraspinal muscle is subjected to extensive detachment and traction in traditional posterior approach, so the muscular ischemia and denervation lead to muscle atrophy further inducing intractable low back pain. Thereafter, minimally invasive spinal surgery becomes more and more popular.OBJECTIVE: To investigate the clinical efficacy of pedicle screw fixation through Wiltse approach combined with injectable calcium sulfate bone cement for single-level thoracolumbar fracture.METHODS: Clinical data of 52 patients with single-level thoracolumbar fracture without nerve injury were analyzed retrospectively, and were then assigned to observation (n=28) and control groups (n=24) according to the treatment method. The patients in the observation group were treated with pedicle screw fixation through Wiltse approach plus implanted with injectable calcium sulfate bone cement, and those in the control group were subjected to pedicle screw fixation through posterior approach plus implanted with injectable calcium sulfate bone cement. The operation time, blood loss and hospitalization time were compared between two groups. The low back pain was observed at baseline, 1 week and 3 months postoperatively, and the percentage of anterior vertebral height revealed on X-ray was observed at baseline, before ambulation, and during last follow-up. Moreover, the complications, loosening and rupture of the screws were recorded.RESULTS AND CONCLUSION: (1) All patients were followed up, and the follow-up time was 16-24 months. (2) The operation time, blood loss and hospitalization time in the observation group were significantly less than those in the control group (P < 0.05). (3) The postoperative visual analogue scale scores in the two groups were significantly lower than those before surgery, and the scores showed significant differences between two groups (P < 0.05). (4) The percentage of anterior vertebral height before ambulation and during last follow-up in the two groups was significantly improved, and the percentage showed significant difference between two groups at each time point (P < 0.05). (5) These findings suggest that based on strict indications, the pedicle screw fixation through Wiltse approach combined with injectable calcium sulfate bone cement is safe for single-level thoracolumbar fracture, which restores the anterior vertebral height rapidly, alleviates pain and exhibits satisfactory long-term efficacy. Furthermore, it holds shorter operation time and less blood loss than the traditional approach.

Objective To investigate the correlation between serum homocysteine(Hcy)level and left ventricular geometric patterns in essential hypertensive patients.Methods Three hundred and sixteen patients with essential hypertension attending in Shanxi Dayi Hospital from January 2013 to June 2016 were enrolled in the study.Serum Hcy levels were measured and echocardiography was performed to measure left ventricular mass index (LVMI)and relative wall thickness(RWT).According to Hcy level patients were divided into H type hypertension group(Hcy≥10 μmol/L,group A)and non-H type hypertension group(Hcy<10 μmol/L, group B).The correlation of Hcy level with RWT and LVMI was analyzed.Results The percentages of concentric remodeling and concentric hypertrophy in group A were higher than those in group B(30.7% vs.25.3% and 24.7%vs.18.7%,χ2=3.342 and 3.894, P=0.033 and 0.025).Hcy level was positively correlated with RWT and LVMI(r=0.819 and 0.725,P=0.005 and 0.008).Conclusion Serum Hcy level is associated with left ventricular geometry in patients with essential hypertension.

Abstract:Objective To evaluate the outcome of surgical treatment for congenital coronary artery fistulas (CAF) in 52 patients seen between May 1988 and July 1999.Methods Fifty-two patients ranging in age from 9 months to 58 years (mean 15.7±16.4 years) were studied. Thirty-six patients had no other cardiac defects, 9 of those patients were more than 20 years old and presented with symptoms. Only one of 36 patients less than 20 years old had clinical findings before surgery. Sixteen patients had associated cardiac lesions. The site of fistula origin was the right coronary artery in 37 patients (71.2%), and the left coronary artery in 15 patients (28.8%). The sites of CAF drainage were the right ventricle, right atrium, left ventricle, left atrium and pulmonary artery in 22 (42.3%), 16 (30.8%), 6 (11.5%), 3 (5.8%), and 5 (9.6%) patients, respectively. The mean diameter of the fistula in 43 patients with single ostium was 7.34±4.12?mm.Results Cardiopulmonary bypass was used in all patients and no patient died. An arteriotomy was made on the anomalous coronary artery and the proximal opening of a fistula was closed within the vessel in 10 patients. Closure of the distal opening of a fistula draining into a cardiac chamber or pulmonary artery was performed in 26 patients. In 16 patients, both the proximal and distal opening were closed. Two and 3 distal opening of a fistula were found in 6 and 3 patients, respectively. No residual shunt was found before patients were discharged from the hospital. Forty patients were followed up for a mean period of 3.14±1.84 years. The remaining 12 patients could not be contacted during follow-up. No clinical symptoms were found in those patients during follow-up but one patient still presented with ST-T change. Conclusion Early and properly surgical management is safe and effective for congenital coronary fistula.

OBJECTIVETo summarize the experience in surgical treatment of De Bakey type III aortic dissection and discuss the operative indications, techniques, and methods for spinal cord protection.

METHODSFrom January 1994 to January 2000, 49 patients with De Bakey type III aortic dissection were operated on. Of these patients, 35 were subjected to partial thoratical aorta replacement, 4 partial thoratical aorta replacement and plasty, 8 total thoratical aorta replacement, and 2 thoracoabdominal aorta replacement. In the 35 patients, the operations were performed by using the technique which preserved blood was transfused back by pump via the femoral artery.

RESULTSHospital mortality in this group was 6.1% (3/49). Eight patients received emergence operation, and 1 patient died. Paraparesis developed in one patient (2.0%). Other complications included re-exploration for bleeding in 3 patients, and wound infection in 5.

CONCLUSIONSThe rate of mortality and complication is high in patients with De Bakey type III aortic dissection. Appropriate operative techniques and methods of spinal cord protection are essential to resolve this problem.

Adult ; Aged ; Aneurysm, Dissecting ; surgery ; Aortic Aneurysm ; surgery ; Female ; Humans ; Male ; Middle Aged ; Vascular Surgical Procedures ; adverse effects ; methods

Objective To investigate antimicrobial resistance among nosocomial gram-negative bacilli in 2016 across China.Methods About 1 394 consecutive and non-repetitive gram-negative bacilli were isolated from 14 teaching hospitals from March to August in 2016 across China.All of these isolates were sent to the central laboratory for reidentification and susceptibility testing.The minimal inhibitory concentration(MICs)of meropenem and other antibacterial agents were determined by agar dilution method.The data were analyzed by using WHONET-5.6 software.Results The activity of antimicrobial agents against Enterobacteriaceae was as follows in descending order of susceptible rate: meropenem (95.2%,891/936), amikacin (94.6%,885/936), ertapenem (92.1%,862/936), piperacillin/tazobactam (88.1%,825/936), imipenem (88.0%,823/936), cefoperazone-sulbactam (83.1%,778/936), cefepime (72.2%,676/936), cefiazidime (72.2%,676/936), levofloxacin(68.8%,644/936), ciprofloxacin (63.2%,592/936), minocyline (62.9%,589/936), cefiriaxone (54.9%,514/936), cefotaxime (54.0%,505/936), cefoxitin (44.3%,415/936).The sensitivities of E.coli to carbapenems, amikacin, piperacillin-tazobactam, polymyxin B and cefoperazone-sulbactam were over 80%.The more sensitive antibiotic to Klebsiella pneumoniae was polymyxin B (99.0%), followed by amikacin (84.9%), meropenem (84.4%) and imipenem (82.0%).The prevalence of extended-spectrum β-lactamase was 62.8%(137/218)in Escherichia coli and 28.3%(58/205)in Klebsiella pneumonia.The activity of antimicrobial agents against E.cloacae, E.aerogenes and Citrobacter freundii was as follows in descending order of susceptible rate: meropenem (97.0%-98.5%), amikacin (95.8%-98.3%), imipenem (94.5%-97.5%), polymyxin B (96.4%-100%), cefoperazone-sulbactam (76.5%-90.0%), ertapenem (73.3%-90.1%), piperacillin/tazobactam (82.4%-88.3%).The most active agents against Pseudomonas aeruginosa were polymyxinB (100%), followed by amikacin (89.3%) and ciprofloxacin (82.4%).The most active agents against Acinetobacter baumannii were polymyxinB (100%).The sensitivities of Acinetobacter baumannii to meropenem, imipenem, minocycline and cefoperazone-sulbactam were 20.3%(39/202), 19.3%(41/202), 66.3%(134/202) and 24.8%(50/202), respectively.Conclusions Carbapenems remain high sensitive against Enterobacteriaceae.Controlling carbapenem resistant Klebsiella pneumoniae is urgent.Drug antimicrobial resistance in A.baumanni is a still serious problem.

This paper summarizes the exploration process and academic significance of the academic thought of Zhou Zhongying,a master of traditional Chinese medicine,who took the creation of a new system of TCM pathogenesis theory as the core,and interprets its theoretical connotation.As a pioneer in the construction of higher education textbooks for traditional Chinese medicine,Professor Zhou Zhongying created the outline of TCM internal medicine viscera differentiation,persisted in carrying out innovative research on patho-genesis theory,achieved fruitful academic results,and enriched and developed the academic system of TCM theory.In the clinical di-agnosis and treatment of exogenous febrile diseases and acute and difficult internal injuries,he systematically created new pathogenesis theories such as stasis-heat theory and cancer toxicity theory.Based on this,the legislation of medication can improve the clinical effi-cacy,and it is realized that identifying the pathogenesis is the key link in syndrome differentiation and treatment.In his later years,Professor Zhou Zhongying,guided by the holistic view,proposed the"thirteen pathogenesis"and constructed a new system of TCM pathogenesis differentiation,highlighting the guiding value of complex pathogenesis and the causal chain of pathogenesis elements to complex clinical diseases and syndromes,forming a theory with the idea of"examining syndromes and seeking pathogenesis,activating syndrome differentiation"as its soul.This theory breaks through the rigid thinking of syndrome differentiation and treatment based on a single pathogenesis or fixed syndrome type,reconstructs the theoretical framework of TCM with the idea of holistic view,and is a major academic innovation in modern TCM.

Objective To investigate the correlations between the FBN1 gene mutation types and the clinical phenotype . Methods 87 probands with Marfan or Marfan-like syndromes and their family members were enrolled in this study ( total 300 cases).The clinical manifestations of each patients involving the ocular, cardiovascular system, skeletal system and other im-plicated systems were collected and evaluated .According to the clinical manifestations , these patients were divided into two groups, namely aortic dissection group and aortic root aneurysm group.Blood samples were taken from patients and DNA se-quencing was performed on each patient by the genetic aortic disease gene Panel .The detected single nucleotide variants ( SNVs)/indel were interpreted according to the ACMG guidelines, and the pathogenic variation was confirmed through Sanger sequencing.The aortic wall tissue was obtained from MFS patients who underwent surgery .The correlations between genotypes and clinical phenotypes were further explored by comparing the aortic wall tissue histological specimens of each genotype pa-tient.Results A total of 92 FBN1 mutations(31％) were detected in 300 people with Marfan syndromes or Marfan-like syn-dromes, 18 of which were undiscovered mutations.There were 49 missense mutations(53.26％), 13 splicing mutations (14.13％), 17 frameshift mutations(18.48％), and 13 nonsense mutations(14.13％).In this cohort, 24 cases had aortic dissection and 25 cases were aortic root aneurysm.Statistical analysis revealed that patients with aortic dissection mostly ap-peared in frameshift mutations(29.17％ vs.4.00％, P =0.017).However, patients with aortic root aneurysm mostly ap-peared in missense mutations(72.00％ vs.37.50％, P =0.015), and accompanied with ectopia lentis(41.67％ vs. 8.33％, P=0.008).Pathological specimens staining found that elastic fibers in the aortic wall of patients with frameshift mu-tations are sparser, and the smooth muscle cells are more deficient and more disorganized than patients with missense muta-tions.Conclusion FBN1 gene frameshift mutations result a lack of elastic fibers and disorganized smooth muscle cells in aor-tic wall and are presented more in patients with aortic dissection than aortic root aneurysm .

Objective: Summarize the anatomical features of the aortic dissection of right axillary and femoral artery cannulation in Sun's surgery. Exploring whether right axillary and femoral artery cannulation can reduce the incidence of organ malperfusion and improve patient prognosis. Methods: From January 2015 to December 2017, 181 cases with aortic dissection were treated in Beijing Anzhen Hospital affiliated to Capital Medical University, Beijing Great Blood Vessel Research and Treatment Center, 122 patients were enrolled in the right axillary and femoral artery cannulation group, and 59 patients in control group were enrolled. Retrospective analysis the data of two groups, intraoperative, and postoperative univariate were compared between the two groups. Results: A total of 17 patients died in the postoperative group, with 9 (7.38%) in the combined perfusion group and 8 (13.56%) in the control group, P=0.181. Among the complications of the two groups, 18 patients(14.75%) in combined perfusion group had renal insufficiency and 17 patients (28.81%) in the control group, P= 0.025. 0 case had stransient spinal cord injury in combined perfusion group , 3 cases(5.08%) in control group , P=0.033. Conclusion Right axillary and femoral artery cannulation can reduce the incidence of complications of postoperative organ dysfunction and improve patient prognosis.