Bacterial resistance to antibiotics is currently a serious health concern.According to the data from the surveil-lance of bacterial resistance in China ( CHINET) ,the isolation rates of gram-negative bacteria have been rising annually. Among the gram-negative organisms, the isolation rate of Carbapenem-resistant enterobacteriaceae, especially extensive drug-resistant strains,has been increasing rapidly.The isolation rate of extensive drug-resistant or pandrug-resistant non-fermenting bacteria,es-pecially Acinetobacter baumanii,is still relatively high.These extensive drug-resistant gram-negative bacteria cause high mortality, which has drawn great attention in clinical settings.On the part of multidrug-assistant gram-positive bacteria,the isolation rate of vancomycin-resistant enterococci remains stable but rates of methicillin-resistant Staphylococcus aureus and coagulase-negative staphylococci are still high.Staphylococcal strains have not yet been found resistant to vancomycin in China.Understanding the epi-demiology of local drug-resistant bacteria facilitates the development of appropriate antibiotic strategies. The mortality of patients with severe infection may be improved by early use of antibiotics and appropriate de-escalation therapy.Rational use of antibiotics and recognition of the influence factors,such as antibiotic-induced endotoxin release,may maximize the efficacy of antibiotics and minimize the adverse reactions.

Objective To analyze CT portal venography (CTPV) manifestations of portal collateral circulation in patients with cirrhosis by using a 16-detector row spiral CT scanner. Methods CTPV was performed in 36 patients with portal hypertension due to cirrhosis, the diagnosis was proved by clinical data, hepatic function findings and imaging signs. By using post-processing reconstruction technique, 3D images of portal venous system and portal collateral circulation were obtained. Results CTPV images displayed the portal venous system and its collateral circulation stereoscopically. Of 36 patients, left gastric varices were seen in 29 (80.6%), lower esophageal varices in 18 (50.0%), short gastric or posterior gastric varices in 15 (41.7%),paraesophageal varices in 9 (25.0%), gastro-renal or splenorenal shunts in 8 (22.2%), sponge-like transformation of portal vein in 7 (19.4%), paraumbilical and abdominal wall varices in 6 (16.7%), congenital cavernous in 6 (16. 7%) and paravertebral venous shunts in 4 (11.1%). Conclusion CTPV can well display the site, extent and severity of the portal collateral circulation in patients with portal hypertension due to cirrhosis, which is of great clinical importance for judging the patient's condition, for selecting therapeutic protocols and for estimating prognosis.

Brown and white adipocytes have different metabolism characteristics.White adipocytes promote the formation and development of atherosclerosis.However, brown adipocytes contribute to the control of atherosclerosis.Brown and white adipocyte phe-notypes can transform mutually.This article will elaborate the pathogenesis of the transformation between brown/white adipocyte pheno-types regulated by transcription factors(such as PPARγ, PRDM16, PGC-1α), co-regulators, hormones, proteins, signal molecules, oxidative stress and miRNAs.

Objective To develop a quantitative assay method for the determination of tissue factor. Methods Lyophilized prothrombin complex was used as the source of factor Ⅶ,Ⅹ. Synthetic chromogenic substrate (S2222)was hydrolyzed into p nitroaniline. The absorbency of p nitroaniline measured spectrophotometrically at 405 nm is proportional to TF quantity in logarithm ( r =0.998). Results The linear range was from 10 U to 10 5 U. Low and high coefficients of variation were 10.3%, 6.6% within day and 18.1%, 10.2% day to day. Conclusions The method is very simple, sensitive, with good linearity, and applicable to quantitation of TF activity quickly.

Objective: To evaluate the depression and anxiety in patients with sleep apnea-hypopnea syndrome (SAHS). Methods: Fifty patients with SAHS were diagnosed with polysomnography (PSG) and 30 healthy controls underwent whole-night PSG monitory and evaluated by Zung Self-rating Depression Scale (SDS) and Zung Self-rating Anxiety Scale (SAS). Results: The total scores of SAS and SDS in SAHS group were significantly higher than those in control group ( P

Objective To investigate the expression of Interleukin 6 ( IL-6 ) and interleukin 10 (IL-10) in cerebrospinal fluid(CSF) in patients with primary central nervous system lymphoma.Methods Forty cases of primary central nervous system lymphoma ( PCNSL) , 11 cases of secondary central nervous system lymphomas( SCNS) , 20 cases of brain metastase, 20 cases of central nervous system infection and 16 cases of other nervous system disease( ONSD) were collected during the period from July 2013 to December 2015 in Fudan University Hua Shan Hospital North.Enzyme linked immunosorbent assay was used to detect the levels of IL-6 and IL-10 in serum and cerebrospinal fluid.The overall level of each group was compared using Kruskal-Wallis test.Two independent samples were compared by U Mann-Whitney test.The diagnostic value of IL-6 and IL-10 levels for PCNSL was evaluated by ROC curve.Results In PCNSL group, BM group, SCNSL group, CNSI group and ONSD group, the serum levels of IL-6 and IL-10 were not statistically significant ( H values were 4.165 and 5.368, respectively, P>0.05).IL-6 levels in CSF were significantly higher in CNSI[623.73 (1018.77-184.37) pg/ml] than those in other groups ( ZPCNSL =51.36, ZSCNSL =28.18, ZBM =51.50, ZCNSI =85.45, ZONSD =42.16, P<0.05 ) .The levels of IL-10 in CSF were significantly higher in CNSI and PCNSL than those in other groups ( ZPCNSL =74.50, ZSCNSL =34.68, ZBM =35.35, ZCNSI =72.95, ZONSD =15.66, P<0.05).The levels of IL-10 in CSF in PCNSL group[64.88(20.03-206.14)pg/ml]was significantly higher than in SCNSL group[6.28(2.78-18.87)pg/ml, Z=-3.753,P<0.05], BM group[7.30(3.72 -14.49) pg/ml, Z=-5.034,P<0.05] and ONSD group [3.14(2.931-4.20)pg/ml, Z=-5.786,P<0.05].The area under the ROC curve of IL-6 and IL-10 levels in CSF was 0.461 and 0.806 respectively for the diagnosis of PCNSL.When IL-10 was 19.62 pg/ml, the sensitivity was 77.5% ( 31/40 ) and the specificity was 70.1% ( 47/67 ) .The area under the ROC curve of CSF IL-6 and IL-10 levels was 0.861 and 0.718 respectively for the diagnosis of CNSI.When IL-6 was 155.12 pg/ml, the sensitivity was 80.0% (16/20) and the specificity was 90.8% (79/87).When IL-10 was 26.76 pg/ml, the sensitivity was 80.0% ( 16/20 ) and the specificity was 66.7% ( 58/87 ) . Conclusion The expression levels of IL-6 and IL-10 in CSF can be used as an indicator for the differential diagnosis of primary central nervous system lymphoma.

[Objective]To introduce the experience and key points of percutaneous reduction combined with bone graft to treat calcaneal fractures.[Method]Percutaneous reduction and internal fixtion combined with bone graft was performed from April 2004 to April 2006 on 15 cases(16 sides) with intra-articular calcaneal fractures including 13 males (14 feet)and 2 females(2 feet),with average age of 36.6 years(24～61 years).All patients underwent radiography including lateral and axial views for calcaneus,oblique view for foot and three-dimensional CT imaging reconstruction. According to Sanders classification,there were 12 feet of type Ⅱ(three type Ⅱa,three type Ⅱb and eight type Ⅱc)and 2 feet of type Ⅲac. The length of caicaneus was recovered through traction by Steinmann pin which passed through calcaneal tubercle perpendicularly and the posterior facet was elevated until reduction by a curve scissors through an 0.5 cm incision along the primary fracture line of lateral calcaneus. The calcaneus was fixed with different cannulated cancellous screws according to the type of fractures.Then bone graft was injected to fill the defect of calcaneus through lateral incision.[Result]All patients were followed up for an average of 18.4 months (ranged,12 to 34 months).No complication such as wound infection,screw breakage and calcaneum varus was found postoperatively. The average time for bone healing was 10 weeks. The results were excellent in 12 cases, good in 4 cases according to the American Orthopaedic Foot and Ankle Society(AOFAS) hindfoot score. The rate of excellent and good clinical results was 100%. Radiography showed basic restoration of Bhler's angle,Gissane's angle and calcaneal shape.[Conclusion]The combination of percutaneous reduction and injectable bone graft is suitable for surgical treatment of Sanders II and III type calcaneal fractures,with advantages of simple operation,fewer complications and good clinical results.

[Objective]To compare spontaneous correction of the unfused thoracic curves after selective anterior versus posterior fusion in Lenke5 adolescent idiopathic scoliosis(AIS). [Method]A total of 72 Lenke5 AIS patients were rescruited from May 1997 to October 2005.Out of them,40 received selective anterior fusion(group A) and 32 received selective posterior fusion(group B).All had a minimum of 2-year follow-up.[Result] No complication were found in both groups at the latest follow-up.The thoracic curve was corrected from 30? to 16? for group A,33? to 18? for group B.Both groups had a better spontaneous correction of the unfused thoracic curves.The correction rate had no significant difference between groups.However,the thoracic curve was increased in four patients(2 in each group;group C),which resulted in trunk imbalance.The thoracolumbar/lumbar thoracic(TL/L:T) Cobb's ratio averaged 1.09 in the four patients whereas 1.59 in other 68 patients(group D).The flexibility of the thoracic curve had significant difference in group C and D(34.2% vs 57.3%).[Conclusion]Both of the surgical treatments can get a better spontaneous correction of the unfused thoracic curves.It is important to evaluate the.thoracolumbar/lumbar–thoracic(TL/L:T) Cobb's ratio and the flexibility of the thoracic curve before selective fusion.

Objective In this study, we tested the ability of platelet-rich plasma to enhance bone consolidation during distraction osteogenesis in a rabbit model of leg lengthening. Methods Twenty New Zealand white rabbits, which were randomly divided into two groups, the PRP treated group and the control group (n=10). Osteotomy will be made under the tibiofibular junction of left tibia, and 1cm tibia shaft will be removed through a second osteotomy. The tibia will be shorted for 1cm and then fixed by Orthfix unilateral lengthener with 4 pins. Lengthening will start 7 days after the osteotomy surgery, at a rate of 1.0 mm/day, in two steps, for 10 days. 500ul PRP were respectively injected into the distraction gaps at the end of the 10-day lengthening and at 10 days before termination. No management in the control group. The animals were terminated at day 20 following final lengthening. Serial radiographs will be taken at the day of surgery, day 12, day 17, day 27, day 37, using a C-arm radiography system. The excised bone specimens were scanned by X-ray and Micro-CT, and the bone mineral content(BMC) and the bone mineral density(BMD) of the regenerates were calculated and compared. Results The regenerate of PRP treated group was significantly better than the control group. The X-ray figures showed that the regenerate was significantly more than the control group. The figures of micro-CT 3D reconstruction showed that the growth and remodel of the regenerate in PRP treated group was better than the control group. Micro-CT examination of regenerates demonstrated a significantly greater bone mineral content(BMC) and the bone mineral density(BMD) in the PRP treated group compared to the control group(P

The gene and the amino acid sequence of the structural and regulatory region of the Pseudomonas aeruginosa with different resistance patterns were analyzed. Six strains with different resistance patterns were selected and the AmpC beta-lactamase was identified. The objective gene fragment was amplified by colonies PCR. The sequences of the PCR-products were analyzed. The DNA sequence of the structural gene ampC and the regulatory genes ampR, ampD and ampE was detected. The 6 strains and the wild-type Pseudomonas aeruginosa are highly homogeneous in structural and regulatory region. Some new mutant points were found.
Bacterial Proteins/*genetics ; DNA, Bacterial/genetics ; Point Mutation/*genetics ; Pseudomonas aeruginosa/enzymology ; Pseudomonas aeruginosa/*genetics ; Sequence Analysis, DNA ; beta-Lactam Resistance/*genetics ; beta-Lactamases/*genetics