Objective To explore the effective of minimally invasive techniques for diagnosis and treatment of the spinal fungal infec-tions. Methods The clinical data of 6 patients with spinal fungal infection in our hospital from January 2012 to June 2014 was reviewd. All patients were taken biopsy diagnosis for spinal fungal infection by percutaneous endoscopic lumbar discectomy. Along with the oral antifungal drugs treatment,all the patients received the interbody fusion surgery by percutaneous pedicle screw fixation and debridement. The clinical and image data were collected during the 6 months following period. Results The symptoms of all the patients was relieved after surgery and no complications occurred. All the patients were followed up for 6 months. The value of ESR and CRP decreased to normal level at the first month after operation. The VAS scores decreased from (7. 0 ± 0. 8) to (0. 8 ± 0. 7) and the ODI scores decreased from (56. 1 ± 7. 7) to (5. 7 ± 2. 1). The X-ray image confirmed solid fusion at the 6 months after surgery. Conclusion The minimally invasive technique of spine is a good way to treat spinal fungal infection.

OBJECTIVE To acquire the information about the gene type and epidemic condition of the hospital to provide scientific proof for monitoring and controlling nosocomial infection.METHODS Meticillin-resistant Staphylococcus aureus(MRSA) was identified by its resistance to cefoxitin of disk diffusion and mecA PCR,randomly amplified polymorphic DNA(RAPD) was carried out with the optimization condition.RESULTS The rate of MRSA infection was 72.15% and the main gene type was A in the hospital.CONCLUSIONS The nosocomial infection may exist in the hospital and the hospital must take effective measure to decline nosocomial infection of the MRSA;RAPD is suitable for molecular epidemiology with high powerful discrimination,simplicity and rapidness.

OBJECTIVE To investigate the drug resistance and the prevalence of inducible clindamycin resistance in clinical isolates of Staphylococcus aureus and evaluate the clinical value of cefoxitin disk diffusion method and oxacillin disk diffusion for detection of meticillin-resistant S.aureus(MRSA).METHODS Bacteria identification and susceptibility test were performed by VITEK-2 system and K-B disk method.The PBP2a was detected by latex agglutination and MRSA was identified by cefoxitin disk diffusion method and oxacillin disk diffusion.The inducible resistance of erythromycin to clindamycin was checked by D-test according to the standards of CLSI(NCCLS).The statistical analysis was performed by WHONET 5.4 and SPSS 13.0 software.RESULTS Resistant rate to penicillin and ampicillin was 98.9% and 100.0%,respectively.Vancomycin-resistant(VRE) or intermediate strains were not found.Of the 93 S.aureus isolates,MRSA and meticillin-sensitive S.aureus(MSSA) were 58(62.4%) and 35(37.6%),respectively.The resistant rate of MRSA to 11 antibiotics was higher than MSSA.The sensitivity and specificity of cefoxitin disk diffusion method were 98.3% and 97.1%,respectively,those of oxacillin disk diffusion were 75.9% and 94.3%.Of the 9 isolates resitant to erythromycin but susceptible to clindamycin,5(55.6%) showed inducible resistance to clindamycin.CONCLUSIONS Resistance of S.aureus is quite serious.Cefoxitin disc diffusion method is a simple and reliable method for the detection of MRSA.The inducible resistance of erythromycin to clindamycin in S aureus should be checked by D-test in clinical microbiology laboratory routinely.

Objective To investigate the application of ultrasound and blood indicators in diagnosis of early liver cirrhosis (S4) for patients with chronic hepatitis B (CHB).Methods Data of blood and ultrasound examinations of 631 patients with CHB who received liver biopsy in the Sixth People' s Hospital of Shenyang during April 2002 and March 2011 were collected.Logistic regression analysis was performed to determine the factors independently correlated with early liver cirrhosis,and the diagnostic model was established using these indicators.The diagnostic value of the established model was assessed by using area under receiver operating characteristic curve (AUROC) and compared with FIB-4 index,aspartate aminotransferase (AST)/platelet (PLT) ratio index (APRI) and S index.Results Logistic regression analysis indicated that age,PLT,albumin globulin ratio (A/G) and splenic square area (SPS) in ultrasound findings were independently correlated to early liver cirrhosis (Wald =10056,46.236,3.751 and 10.669,P ＜0.01).AUROC of the model based on the above factors in diagnosing early liver cirrhosis was 0.908,which was higher than those of FIB-1 index,APRI index and S index (Z =8.322,4.334 and 4.087,P ＜ 0.05).Taking 0.063 as cut-off value,the sensitivity,specificity,positive predict value and negative predict value of the established model in diagnosis of early liver cirrhosis were 90.1％,77.8％,50.0％ and 97.1％,respectively.Taking ＜0.060 and ≥0.110 as the cut-off values to exclude,and diagnose early liver cirrhosis,69.7％ (440/631) patients could avoid liver biopsy.Conclusion The model based on age,PLT,A/G and SPS can effectively predict early liver cirrhosis,and can reduce liver biopsy.

BACKGROUND:Mouse nerve growth factor can promote the repair and regeneration of injured nerves, but current experimental research shows that the effects of different treatment methods are stil controversial.
OBJECTIVE:To evaluate the effect of mouse nerve growth factor injection via different ways on the treatment of peripheral nerve injury.
METHODS:Total y 52 patients with peripheral nerve injury were randomly assigned into two groups:experimental group (local injection of mouse nerve growth factor, n=27) and control group (systemic administration of mouse nerve growth factor, n=25). The treatment was performed once a day, and lasted for 4 weeks. Then, the clinical efficacy and recovery of neurological function were compared.
RESULTS AND CONCLUSION:The good and effective rates were 85%(n=23) and 93%(n=25) in the experimental group, while 72%(n=18) and 84%(n=21) in the control group, respectively, which were significantly better in the experimental group than the control group (P<0.05). In the experimental group, 13 cases developed transient pain at injection site, including one case of remission undergoing oral analgesics;in the control group, 12 cases had transient pain at injection site, without any treatment. The results suggest that both local and total body injection of mouse nerve growth factor are safe and effective for treatment of peripheral nerve injury, but local injection is superior to systemic administration.

s:Objective To explore the anatomical distribution characteristics of pelvic endometriosis lesion, size of the cyst, tissue ad-hesion degree and the correlation with the pain symptoms in patients with ovarian endometriosis cyst. Methods 342 cases of patients with o-varian endometriosis cyst who has underwent gynecologic laparoscopic surgical treatment in our hospital were selected as the research objects. According to the pain symptoms, they were divided into the pain group (195 cases) and the painless group (147 cases). The influence of cyst growth area and size on the pain symptoms were compared, and whether there were cyst adhesion and the relationship between adhesion area and pain were analyzed. Results The operation time of pain group was longer. The average operation time was 81. 2 min in pain group while it was 62. 1 min in painless group. The bleeding volum was 74. 3 mL in pain group which was higher than 56. 2 mL in the painless group. The average diameter of cyst was 11. 26 cm in the Pain group, and it was 6. 10 cm painless group. Rate of adhesions in patients of pain group was significantly higher than that of the painless group. Adhesion occured most frequently in ovary, followed by the fallopian tubes. Conclusion Pain symptoms have a close relation with cyst diameter and degree of surrounding tissue adhesion. As the cyst diameter get larger and the surrounding tissue adhesions grow broader, the pain symptoms would be more significant in patients .

Objective To assess the biomechanical stability and vertebra strain distribution of asymmetrical posterior internal fixation for minimally invasive transforaminal lumbar interbody fusion ( MI-TLIF) . Methods Range of motion ( ROM) and strain distribution testing were performed in 8 fresh-frozen calf lumbar spine motion segments in flexion/extension, lateral bending, and axial rotation using 5. 0 Nm torques at the L4-5 motion segment. The sequential test configurations included intact motion segment, TLIF with unilateral pedicle screw ( UPS) , TLIF with UPS plus transfacet pedicle screws ( UPS+TFPS) , and TLIF with bilateral pedicle screw ( BPS) . The ROM was deter-mined to assess the construct stability. Strain distribution was recorded along with flexion and lateral bending configurations. Results In flexion/extension, lateral bending, and axial rotation, there was no significant difference in the ROM between BPS and UPS+TFPS fixation after TLIF. After TLIF, the UPS construct provided less segment stability than BPS and UPS+TFPS fixation in flexion, lateral bending. Strain distribution under UPS+TFPS fixation was respectively 21. 8% and 24. 2% higher than that under BPS fixation along with flexion and lateral bending. Conclusion UPS+TFPS fixation provides stability comparable to that of MI-TLIF with bilateral PS, with better load share with the vertebrae body.

Objective To investigate the distribution and change in antimicrobial resistance of pathogens causing blood-stream infection,so as to provide reference for rational antimicrobial use.Methods The isolation and antimicrobial resistance of major pathogens from blood culture specimens from a tertiary first-class hospital in 2012-2015 were analyzed statistically.Results A total of 4 780 isolates were detected,the top five species were Escherichia coli (n = 1 008, 21.09%),Klebsiella pneumoniae (n = 624,13.05%),Acinetobacter baumannii (n = 452,9.46%),Staphylococcus aureus (n=437,9.14%),and Pseudomonas aeruginosa (n=247,5.17%).The percentage of gram-negative bacilli, gram-positive cocci,fungi,and others were 62.05%,29.31%,7.76%,and 0.88% respectively.The resistance rates of Klebsiella pneumoniae to ertapenem and imipenem increased from 4.50% in 2012 to 46.79% and 33.94% in 2015(both P<0.01).The resistance rates of Acinetobacter baumannii to cefepime,ceftazidime,tobramycin,gentamicin,and imipenem were 86.50%,80.56%,78.10%,79.87%,and 84.29% respectively;resistance rates to amikacin in 2012-2015 were 0, 10.22%,39.85%,and 21.30% respectively(P<0.01);resistance rates to minocycline in four years were 0-7.52% (P<0.01 ).Conclusion The main pathogens causing bloodstream infection are gram-negative bacilli,Acinetobacter baumannii is highly resistant to cephalosporins and carbapenems,resistance rates of Klebsiella pneumoniae to carbapenems increased rapidly.Broad-spectrum antimicrobial agents must be used cautiously to reduce the selective pressure of antimicrobial agents.

Objective To understand clinical distribution and antimicrobial resistance of clinically isolated Serratia marcescens(S .marcescens ),and provide basis for rational use of antimicrobial agents,as well as prevention and control of infection.Methods 427 S .marcescens strains isolated between January 1 ,2012 and December 31 ,2015 were analyzed,antimicrobial susceptibility testing were performed by disk diffusion method.Results 427 S . marcescens strains were mainly from respiratory tract (70.26%),among which the majority were from sputum (64.87%).S .marcescens were primarily from intensive care unit(ICU,19.44%),department of integrated tradi-tional Chinese and Western medicine(15.46%)as well as rehabilitation department (13.58%).The resistance rates of S .marcescens to cefoperazone/sulbactam,ertapenem,cefepime,ceftazidime,amikacin,imipenem,levofloxacin, and piperacillin/tazobactam were all<10%;resistance rates to ciprofloxacin,gentamicin,tobramycin,ceftriaxone, sulfamethoxazole/trimethoprim (SMZ/TMP),and aztreonam were 10%-30%.Difference in the resistance rates of S .marcescens to cefoperazone/sulbactam,ciprofloxacin,ceftriaxone,amikacin,aztreonam,and SMZ/TMP dur-ing 4 years were statistically significant (P <0.05).In 2012-2013,resistance rates of S .marcescens to cefopera-zone/sulbactam,ciprofloxacin,ceftriaxone,aztreonam,and SMZ/TMP increased obviously,then resistance rates tend to be stable,while resistance rates to cefoperazone/sulbactam decreased.Conclusion Susceptibility of S.marcescens to most antimicrobial agents are high,but resistance had increasing tendency;susceptible rates of S .marcescens to ertapenem,ceftazidime,levofloxacin,and piperacillin/tazobactam are all high,and can be used as the empirical medication for the treatment of related infection.

spectrum beta-lactamase genes:blaOXA-128 and blaOXA-129.