Objective To study the trend of antimicrobial resistance to cnical isolates of Klebsiella pneumoniae and Escherichia coli.Methods VITEK-32 automated analysis system was used for bacteria differentiation and drug resistance determination.Results TS From 2005 to 2008,the prevalence of ESBLs in isolates of K.pneumoniae and E.coil were increasing,their were 36.6% ,40.6% ,41.5% ,41.0% each year separately.The ESBLs-producing bacteria,multiple-drug-resistant to the third generation cephalesporin,aminoglycosides,quinolones and sulfonamides were also increased.Conclusion There is an increasing trend of ESBLs produces and resistences in K.pneumoniae and E.coli,It is important for clinical physicians to understand the distribution and the resistance characteristics of ESBLs producing K.pneumoniae and E.coli were to antibiotics,and to control the ESBLs spread.

Objective To study the expression of dihydrodiol dehydrogenase (DD) in prostate cancer and its significance. Methods With reference to expression of ?-actin gene,the expression level of a human dihydrodiol dehydrogenase isoform (DD2) mRNA was examined in prostate cancer tissues (11 cases) and normal prostate tissues (10 cases) by reverse transcriptive-polymerase chain reaction(RT-PCR). Quantitative determination of relevant band densities was performed using densitometry-scanning techniques. Results Strong expression of DD2 mRNA was detected in prostate cancer tissures with absorbance in the range of 0.550 to 1.018 (median,0.726),and low expression of DD2 mRNA in normal prostate tissues with absorbance in the range of 0.248 to 0.420 (median,0.333). The difference of the expression of DD2 mRNA between cancer and normal prostate was significant ( P

Objective To validate the Partin table 1997,2001 and 2007 for their accuracy in predicting pathologic stage in Chinese prostate cancer patients.Methods From January 1997 to June 2007,109 consecutive patients with clinically localized prostate carcinoma underwent open retropubic or laparoscopic radical prostatectomies and met all inclusion criteria well enrolled.Receiver operating characteristic(ROC)analysis was performed tO test the predictive accuracy of organ confined disease (0CD),extraprostatic extension(EPE),seminal vesicle involvement(SVI)and lymph node involvement(LNI). Results OCD,EPE,SVl and LNl were noted in 70%,17%,13%and 0%of cases respectively.The area under curve(AUC)of ROC for Partin table 1997 was 0.727,0.654 and 0.811for 0CD.EPE and SVl respectively,and was 0.693,0.633 and 0.835 for Partin table 2001 and 0.669.0.611 and 0.778 for Partin table 2007.Conclusions Partin tables 1997,2001 and 2007 are able to accurately predict the pathologic feature of seminal vesicle involvement.However,only Partin table 1997 can more accurately predict organ confined disease in this external validation for Chinese patients.

Objective To evaluate the application and risk of hematogenous tumor dissemination of intraoperative autologous blood salvage on radical nephrectomy for renal carcinoma with inferior vena cava tumor thrombus.Methods Between July 1999 and October 2005,19 patients with renal cell carcinoma invading inferior vena cava were used by the intraoperative autologous blood salvage.Preoperative and postoperative clinical data were analyzed and compared.The blood sparing effect and follow-up were evaluated.Results The intraoperative autologous blood salvage of all cases was successful.The levels of HCT,Hb and RBC on the 1st and 7th postoperative day were significantly lower than preoperative day.Although the level of PLT decreased on the 1st postoperative day,it recovered on the 7th day.The markers of liver and renal function did not change during treat time.Packed red blood cells were collected during surgery with a mean value of 1 765 ml(300～6 000 ml) per patient.The average amount of allogenic transfusion per patient was 2 247ml(0～8000 ml).The perioperative mortality rate was 10.5%(2/19).The postoperative metastasis rate was 35.3%(6/17).No difference was found in the prognosis between two groups.Conclusion The intraoperative autologous blood salvage does not markedly change the clinic test data and not increase the recurrence and metastasis of renal cell carcinoma.

ObjectiveTo analyze the clinical features of tertiary hyperparathyroidism. MethodsThe data including symptoms, past history, bone and joint X-ray, bone mass density, bone SPECT, blood routine, serum calcium, phosphorus, alkaline phosphatase, parathyroid hormone ( PTH), as well as parathyroid ultrasonic or CT,parathyroid ECT, and parathyroid pathology were collected from seven patients with tertiary hyperparathyroidism.ResultsThe first symptom in 6 patients was bone ache, one of them was thirsty, and 1 patient had fracture. Four patients had past history of gallbladder stone or renal stone. Four subjects presented with osteoporosis and 2 of them had fractures. All 7 patients suffered from hypercalcaemia, along with high PTH level, 6 with hypophosphataemia and 6 with high alkaline phosphatase level. The enlarged parathyroid glands were detected in five patients by ultrasonic or CT. Tc99 scans of parathyroid gland revealed hyperfunctioning nodes in 3 subjects. Six patients were operated, and pathological results showed adenoma in parathyroid gland in 5 patients and adenocarcinoma in 1 patient. Serum calcium and PTH levels returned to normal in all the operated patients.ConclusionsPatients who present bone ache, osteoporosis, spontaneous fracture, past history of gallbladder stone or renal stone, high serum calcium, and PTH levels, should be aware of the probability of tertiary hyperparathyroidism. The confirmed diagnosis depends on pathological result.

Objective To compare effects of both ends of the injection cesarean section anesthesia differ-ences.Methods ASAⅠ-Ⅱgrade cesarean section 226 cases were selected and randomly divided into the observa-tion group and control group on the basis of number characterization.Observation group:After the success of epidural puncture needle oblique injection of 1.7% for the end of lidocaine carbonate 5mL,then needle bevel steering head end 3-5min without observing all spinal abnormalities such as re-injection of 5mL of 1.7% lidocaine carbonate,fol-lowed by epidural catheter inserted,modified supine position to continue after injection of 1.7% lidocaine carbonate 5mL;Control group:after the success of epidural catheter tip administered by traditional teaching methods.Two groups of maternal range block plane , intraoperative pain intensity and time of delivery of the fetus were recorded .intraoperative changes in vital signs and Apgar score after the fetus were observed.Results The block wide range for anesthesia of the observation group[(14.43 ±1.21)points]were significantly higher than that of the control group,and intraopera-tive pain was (1.61 ±0.92)points,fetal childbirth lengthwas (1.8 ±0.6)minutes,which were better than those in the control group(t=12.76,13.07,12.86,all P<0.05);The MAP,HR,R,SpO2 between the two groups showed no significant differences(F=4.32,2.73,3.54,3.06,all P<0.05);Intraoperative vital signs and Apgar score was con-firmed no difference between the two groups(all P>0.05).Conclusion Both ends of the epidural injection for ce-sarean section is better than the traditional mode of administration of anesthesia.

Objective To strengthen the training effect of the neuro-interventional surgeons using staged target teaching method. Methods A total of 39 neurosurgeons from all over the country were trained at the Department of Interventional Radiology,Xuanwu Hospital,Capital Medical University from March 2012 to March 2013. In the one-year training period,the training was divided into 4 stages (each stage for 3 months). All the learning contents were phased to focus on teaching and set the target at each stage,which had a clear purpose. Questionnaires were sent to the refresher doctors at 6 months and 12 months after they returned to their original work in order to obtain the conditions about their independent work after training. Results All the 39 neurosurgeons achieved their desired goal from theory to practical operation. They mastered the holistic treatment principles of ischemic cerebrovascular disease and were familiar with and mastered the whole brain DSA and stenting techniques. At the fourth stage,as an operator, everyone had finished at least 5 extracranial artery stentings. The recovered questionnaires after the end of training showed that 95. 8%(23/24)neurosurgeons were able to perform whole brain DSA independently and held≥5 surgeries monthly;87. 5%(21/24)neurosurgeons could complete stenting independently (1 patient/month). Conclusion The staged target teaching method is a practical and effective teaching means for special technical training of neurointervention.

Objective: To explore risk factors including prostate-specific antigen (PSA) kinetics for the prediction of castration-resistant prostate cancer (CRPC), and to build a practical model for predicting the progression to CRPC after androgen deprivation therapy(ADT) so as to facilitate clinicians in decision-making for prostate cancer patients receiving ADT.Methods: A total of 185 patients with prostate cancer who had received ADT as the primary therapy in Department of Urology of Peking University First Hospital from 2003 to 2014 were enrolled retrospectively.All the patients were diagnosed with prostate cancer via prostate biopsy and followed up every four weeks from the initiation of ADT.All the patients received ADT with luteinizing hormone-releasing hormone agonists (LHRH-A) or surgical castration accompanied with an antiandrogen (bicalutamide or flutamide, combined androgen blockade).The clinical information of the patients were collected including age, clinical TNM stage, Gleason score (GS), risk groups of prostate cancer, PSA at the initiation of ADT, PSA nadir after ADT, PSA decline velocity, and the time to PSA nadir.The end point of this study was the diagnosis of CRPC, which was based on the European Association of Urology (EAU) Guideline 2016.Cox proportional hazards regression models were established to analyze and estimate their effects on the time of progression to CRPC.Results: In this study, 185 patients with prostate cancer who had received ADT as the primary therapy were included.The mean age was (71.02±8.67) years.The median time to progression to CRPC in this cohort was 38 months (ranging from 4 to 158 months).On univariate analysis, we found clinical T stage, N stage, the metastasis state before ADT, risk groups of prostate cancer, PSA decline velocity, and PSA nadir were all related to the time to CRPC progression, P<0.01 for all the above variables.And on multivariate analysis, the presence of distant metastasis before ADT (HR=6.030, 95% CI: 3.229-11.263, P=0.001), higher PSA nadir (HR=1.185, 95% CI: 1.080-1.301, P=0.001), higher PSA decline velocity>11 μg/(L·month) (HR=2.124, 95% CI: 1.195-3.750, P=0.001), and time to PSA nadir ≤ 9 months (HR=3.623, 95% CI: 1.640-4.817, P=0.004) were found to be significantly associated with an increased risk of progression to CRPC.Conclusion: Patients with rapid decreasing of PSA in the initial ADT were more likely to progress to CRPC.

Objective To investigate the effect of paclitaxel and gemcitabine on the expression of nucleosomal binding protein 1(NSBP1) in bladder cancer cell line T24 and its significance. Methods Reverse transcription PCR(RT-PCR) and western blotting were used to detect the expression of NSBP1 in bladder cancer cell T24 treated by different concentration(10% ,40% ,80% IC50) of paclitaxel and gemcitabine for 48 hours. Results RT-PCR showed that relative optical density (OD) of NSBP1 in bladder cancer cell T24 treated by 0%, 10%,40% and 80% IC50 paclitaxel were 0.392 ±0.024, 0.227±0.037, 0.135±0. 063 and 0.091 ±0.017, respectively (P＜0.05). Relative OD of NSBP1 in bladder cancer cell T24 treated by 0%, 10%, 40% and 80% IC50 gemcitabine were 0.492±0.044, 0.262±0.031, 0.151±0.014 and 0.089±0.011, respectively. Western blotting showed that relative OD of NSBP1 in bladder cancer cell T24 treated by 0%, 10%,40% and 80% IC50 paclitaxel were 0.473±0.017, 0.252±0.041, 0.194±0.023 and 0.118±0.016, respectively. Relative OD of NSBP1 in bladder cancer cell T24 treated by 0, 10%, 40% and 80% IC50 gemcitabine were 0.581±0.014, 0.201±0.033, 0.135±0.021 and 0.114±0.011, respectively(P＜0.05). Conclusion Paclitaxel and gemcitabine can decrease the expression level of NSBP1 in bladder cancer cell line T24 both in mRNA and protein levels, so NSBP1 may be one of the targets of chemotherapy.

Objective To investigate the effects of different clipping time of first time using permanent aneurysm clips on common carotid artery wall in rabbitsMethods Sixty healthy male Japanese white rabbits were selected.The first time permanent aneurysm clips were used to clip common carotid artery for 30 min or 60 min respectively according to the random number method (n=30 in each group).Thirty segments of common carotid artery specimens clipped by aneurysm clips were collected respectively.Mean-Whitney U test was used to conduct the comparison of histopathological damage grade of vascular wall.Results The aneurysm clips were use to clip 30 min and 60 min caused vascular wall injury could observe the middle elastic plastic plate deformation and endothelial denudation.The vascular walls in the clipping 60 min group had local necrosis with inflammatory response,and even rupture of vascular wall.There were significant differences in overall damage degree of vascular wall (U=324.00,P=0.045) and severe injury rate (0%[0/30] vs.20.0%[6/30],P=0.031) between the clipping 30 min group and the clipping 60 min group (all P<0.05).Conclusion The vascular wall injury of using disposable permanent aneurysm clips for clipping 60 min was more severe than 30 min.Attention should be paid to shortening the time of carotid artery occlusion in operation.