Objective To explore the drug fast mechanism on carbapenems of Acinetobacter baumannii,it is important for clinicians to choose appropriate antibiotics.Methods The influence of active efflux inhibitors carbonyl cyanide m -chlorophenylhydrazone (CCCP)on minimal inhibitory concentration (MIC)of Acinetobacter baumannii to imipenem(IMP)was measured by agar dilution method.Results At the concentration of 10mg/L,CCCP had obvi-ously effects on carbapenems MICs,the rate of resistance of imipenem decreased from 64.39% to 34.38%.In vitro CCCP enhanced the activities of imipenem.Efflux mechanism existed not only in IMP resistant strains,but also in IMP sensitive strains.But the affection of CCCP against IMP resistant strains was much stronger than that of IMP suscepti-ble strains.Conclusion Efflux pump may be one of the main mechanisms of Acinetobacter baumannii resistance to IMP,while efflux pump inhibitors may partly reduce the resistance.

Objective To explore the clinical significance of changes of serum.IL-6,IL-18 and C-reactive protein(CRP) in patients with hypoxic ischemic encephalopathy (HIE).Methods Serum IL-6,IL-18 and CRP levels were measured by ELISA and immunity turbidimetry respectively in 100 patients with HIE and 100 health control.Results The HIE group serum IL-6,IL-18 and CRP levels were higher than the healthy control group,and Serum levels of IL-6,IL-18 and CRP increased when the clinical manifestation gradually increased.The CRP were positive correlation with serum levels of IL-6 and IL-18(r=0.663,0.725,all P<0.01).and the serum level of IL-6is positive correlation with IL-18(r=0.783,all P<0.01).Conclusion The serum IL-6,IL-18 and CRP may play an important role in the development process of HIE.Which were correlate to the severity of the disease and clinical change,measurements of their serum concentrations may help to predict these pathogenetic condition and prognosis criterion of the disease.

Objective To evaluate the clinical value of 131 I in the treatment of senile hyperthyroid heart disease .Methods 95 ca-ses of elderly hyperthyroid heart disease were orally treated by 131 I .The thyroid function was detected before 131 I therapy and in 3 months ,6 months and 1 year after treatment .The gated blood pool imaging was performed before treatment and in 1 year after treatment for evaluating the therapeutic effect .Results The cure rate was 97 .89% for hyperthyroidism ,100 .00% for paroxysmal atrial fibrillation and 84 .00% for persistent atrial fibrillation .FT3 ,FT4 and TSH levels had statistical difference between before treatment and in 3 ,6 ,12 months after treatment (P<0 .05) .The left ventricular systolic and diastolic function parameters had sta-tistical differences between before treatment and in 1 year after treatment (P< 0 .05) .The left ventricular systolic and diastolic function was improved significantly .Conclusion Selecting radioactive 131 I for treating elderly hyperthyroid heart disease is the key to improve hyperthyroid heart disease ,can effectively control the FT3 ,FT4 and TSH levels and improve the heart function .

OBJECTIVETo investigate the validity and feasibility of consecutive three-stage surgical technique of combining auricle reconstruction with external auditory canal atresia reconstruction in patients with congenital microtia-atresia, and to assess the post-surgery results by cosmetic and hearing aspects.

METHODSFrom Sep. 2007 to Jun. 2011, all 74 patients (79 ears) with congenital microtia-atresia treated in our department were enrolled in this study. They consecutively accepted the following three-stage surgical technique: The first stage was Brent' s technique as follows, rib cartilage graft harvest, framework fabrication, and implantation. The second stage combined transfer of the lobule with meatoplasty and tympanoplasty. The third stage was the elevation of the reconstructed auricle. Both the cosmetic and functional hearing results were recorded at follow-ups.

RESULTSAmong these patients, 60 patients (78.5%), 62 ears, acquired extremely satisfactory cosmetic results; 10 patients (16.5%), 13 ears, acquired acceptable cosmetic results; while the remaining 4 patients (5.1%) acquired unsatisfactory cosmetic results. However, the height of elevation of the newly performed auricle framework was not enough due to the existence of newly formed external ear canal. Regarding the hearing results, there were 69 ears with followup audiograms. An air-bone gap (ABG) improvement of 12.5 dB was achieved. The air-conduction hearing threshold improved (10.9 ± 8.2) dBHL, 37 ears (53.6%) achieved serviceable hearing after surgery, with ABG less than 30 dB. There were multiple complications occurred after surgery with the incidence of 49.4% (39/79).

CONCLUSIONSThe combined three-stage surgical microtia and canal atresia reconstruction technique is a viable choice for some suitable patients with microtia-atresia. However, the incidence of complication after meatoplasty is very high and the hearing restoration is not good enough, which need further investigation for the better results.

Aged ; Congenital Microtia ; surgery ; Ear ; surgery ; Ear Auricle ; Ear Canal ; Hearing ; Hearing Tests ; Humans ; Reconstructive Surgical Procedures ; Tympanoplasty

Objective To observe the effects of the third-stage community-based rehabilitation program on functional recovery of stroke patients with hemiplegia. Methods 158 stroke patients with hemiplegia were divided into rehabilitation group and control group. Besides normal medicine and first-stage institution-based rehabilitation similar with that of control, rehabilitation group received a standardized third-stage community-based rehabilitation. They were assessed with the National Institutes of Health Stroke Scale (NIHSS), Fugl-Meyer Assessment (FMA), Modified Barthel Index (MBI) and Modified Rankin Scale (MRS) before, 1 month and 6 months after treatment. Results The scores of the FMA and the MBI of the rehabilitation group were higher than that of the control group (P<0.01), while were lower of the NIHSS and MRS in the rehabilitation group than in the control group at the end of the sixth month (P<0.01). Conclusion The third-stage community-based rehabilitation may improve the recovery of the stroke patients with hemiplegia.

Objective:To explore influence of standardized secondary prevention on prognostic outcome of patients with coronary heart disease (CHD).Methods:A total of 128 CHD patients were randomly and equally divided into secondary prevention group and routine treatment group.Routine treatment group received routine CHD therapy during hospitalization,received routine discharge guidance,and they were followed up once/six months.Secondary prevention group were served by specific physicians and received secondary prevention intervention,and they were followed up once/month after discharge.CHD patients received questionnaire to know their knowledge about CHD risk factors and compliance taking secondary prevention drugs after discharge.Risk factor control and recurrence rate of CHD etc.were assessed.Results:Compared with routine treatment group,after one-year follow up,there were significant rise in awareness rate of risk factors (34.38% vs.78.18%);control of risk factors (blood pres-sure,blood lipids,smoking,diet and exercise etc.)and administration rate of secondary prevention drugs after dis-charge (18.75% vs.87.50%),and significant reductions in clinic events [heart failures (18.75% vs.4.69%),an-gina pectoris (28.13% vs.6.25%),rehospitalization (21.89% vs.3.13%)and myocardial infarction (15.63% vs. 4.69%)]in secondary prevention group,P <0.05 or <0.01. Conclusion:Standardized secondary prevention is ef-fective in patients with coronary heart disease,which is worth clinic extending.

Objective To explore a new surgical approach to intrahepatic segmental bile ducts.MethodSurgical anatomic relationships between intrahepatic bile ducts and blood vessels in 30 adult liver specimens were studied.Results Left and right hepatic bile duct lie to the superior anterior board of the left and right trunk of the portal vein; left medial and right anterior segmental duct lie to the anterior medial edge of corresponding portal vein branches. Right posterior segmental duct lies on the visceral side of right anterior portal branches in 73%(22/30). and on the visceral side of posterior right branches in 80%(24/30). Left lateral segmental duct lies in the deep visceral side of sagittal portion of left portal vein in 93%(28/30).A new combined operational routes getting to segmental ducts from both visceral and diaphragmatic faces were designed to treat 38 patients with multiple intrahepatic calculis.Conclusion Combined operational routes from both visceral and diaphragmatic facies can easily expose and cut open intra and extra hepatic ducts and the strictures, removing calculi.

Objective Identify CT signs of breast cancer and evaluate the value of the shaded-surface display technique in spiral CT diagnosis of breast cancer.Material:33 cases of breast cancer were analysed.Methods All of patients underwent spiral CT contrast enhanced scans in SSD technique.Results The CT appearances of breast cancer were round or irregular mass,spiculated border,duct retraction,involved coopers lignment,microcalcification,deformed adipose space and axillary lymph nodes contained metastases.Conclusion The SSD technique has proved to be of great value in spiral CT diagnoses and differential diagnoses of breast cancer.

Objective To study the CT and MRI features of primary middle ear carcinoma invading jugular foramen.Methods CT and MRI images of 7 patients with surgically and pathologically confirmed primary middle ear carcinoma invading jugular foramen were analyzed retrospectively,including high resolution CT (HRCT) scan in 6 cases,CT enhancement scan in 1 case and MR plain and enhancement scan in 7 cases.Results On HRCT,the soft tissue lesions mainly located in tympanum,tympanic sinus,the deep of external auditory canal and jugular foramen,and irregular “moth-eaten” bone destruction could be seen,including the destruction of jugular foramen in 7 cases,eustachian tube in 7 cases,facial nerve canal in 4 cases,carotid artery canal in 4 cases,external auditory canal wall in 3 cases,auditory ossicles in 2 cases,vestibular window and horizontal semicircular canal in 1 case.CT plain scan showed the density of soft tissue mass was uniform in 4 cases with CT value of 30-55 HU,and heterogeneous in 2 cases,in which small pieces high density lesions could be found.CT enhancement scan in 1 case revealed moderate and homogeneous enhancement.On MR plain scan,the soft tissue masses with hazy margins could be seen,and compared to the gray matter of brain,the lesions were isointense or slightly hypointense on T1 WI and isointense or slightly hyperintense on T2 WI.The signal was homogeneous in 5 cases and inhomogeneous in 2 cases with small pieces of hypointensity both on T1WI and T2WI.After enhancement,the lesions were enhanced moderately and homogeneously in 5 cases and inhomogeneously in 2 cases with small pieces of nonenhanced area.MRI also showed the erosion of carotid artery in 4 cases,sigmoid sinus in 1 case.Conclusion The primary middle ear carcinoma can invade the jugular foramen area extensively,which may lead to misdiagnosis.HRCT can precisely depict the bone destruction and the invasion of the important anatomic structures in the primary middle ear carcinoma,and the destruction of eustachian tube can help to reduce misdiagnosis.MRI can more clearly show the extent of tumor and the mass signal and enhancement pattern.

ObjectiveTo disclose the life quality of uremic patients undergoing hemodialysis in several bemodialysis institutions and its risk factors.MethodsLogistic model was applied to analysis between the risk factors and uremic patients by using the universal kidney disease quality of life short form (KDQOL-SFTM).Resuits①The scores of the patients kidney disease target area and short fort health survey questionnaire were worse than those of the common crowd ( RP:39.69 ± 19.56 vs 86.02 ± 18.75 ; BP:66.33 ± 21.65 vs 81.55 ±20.83 ; MH:58.92 ± 15.87 vs 73.23 ± 16.54 et al) ② The main affecting factors of the life quality for uremic patients undergoing hemodialysis was sex ( male group:female group 46.58 ± 21.67:50.37 ± 22.56,P ＜ 0.05 ),age ( ≥55y group:＜ 55y group 38.78 ± 16.78:57.78 ± 20.45,P ＜ 0.05 ),culture (above senior high school degree group:completed and below senior high school degree group 55.64 ± 21.85:42.59 ± 21.65 P ＜ 0.05 ),diabetes ( nondiabetes group:diabetes group 59.47 ± 18.69:47.67 ± 11.33,P ＜ 0.05 ),medical treatment guarantee ( unversichert group:versichert group 43.54 ± 16.85:56.56 ± 19.67,P ＜ 0.05 ),the state of earning and work ( employed group:nonemployed group,72.90 ± 12.56:60.87 ± 11.45,P ＜ 0.05 ) and so on.③The main affecting factors of the life quality for uremic patients undergoing hemodialysis were diabetes,medical treatment guarantee,age.ConclusionThe main affecting factors of the life quality for uremic patients undergoing hemodialysis are diabetes,medical treatment guarantee,age.