Objective To investigate the clinical distribution of carbapenem-resistant Enterobacteriaceae(CRE)strains separated in this hospital and the situation of its production of carbapenem enzyme.Methods The production of carbapenem enzyme by CRE strains was confirmed by using modified Hodge test,the situation of the production of metallo-beta-lactamases by CRE strains was screened by using imipenem-EDTA double-disk synergy test,and the clinical distribution of CRE strains was retrospectively ana-lysed.Results 37 strains of CRE isolated in this laboratory were screened by using instrument method and verified by using disk diffusion (K-B)method.It showed an increasing trend from 2012 to 2014 in the amount of CRE strains.In terms of bacterial spe-cies,K.pneumonia(1 6 strains)was the main kind of carbopenems-resistant strains,followed by E.coli(6 strains),Ser.marcescens(6 strains)and E.cloacae(4 strains).CRE strains were mainly isolated from geriatric ward and intensive care unit(ICU).Sputum,u-rine and blood specimen were key sources of CRE strains.Modified Hodge test confirmed that 36 strains of CRE were the strains that can produce carbapenemase,including 4 strains of K.pneumonia,3 strains of E.cloacae,and 1 strain of E.asburiae,and strains producing metallo-beta-lactamases were confirmed by using imipenem-EDTA double-disk synergy test.Conclusion Elderly patients with underlying diseases are susceptible population of CRE hospital infection and are primary preventive targets.The principal mechanism of carbapenem-resistant CRE strains in this hospital is the production of carbapenemase and production of metallo-β-lac-tamases in a small number of strains.

· AlM:To investigate the effect of compound anisodine on fundus blood circulation after vitrectomy with face-down position.
· METHODS: Sixty patients ( 60 eyes ) with rhegmatogenous retinal detachment received vitrectomy with silicone oil tamponade operation, who were randomized divided into treatment group ( 30 eyes ) and control group ( 30 eyes ) .The patients in the treatment group received the subcutaneously injection of compound anisodine hydrobromide by the superficial temporal artery once daily for 14d since postoperative first day.Retinal microcirculation blood flow parameters were recorded with Heidelberg retinal flowmeter postoperative 1d, 1 and 2wk, and were compared between two groups.
·RESULTS: The blood flow parameters ( Vol, Flw, Vel) of control group postoperative 1 and 2wk were significantly less than those postoperative 1d.Otherwise the parameters of treatment postoperative 1 and 2wk were significantly more than those postoperative 1d. The parameters between two groups were significant different ( P<0.01) .
· CONCLUSlON: Facing down after vitrectomy with
silicone oil tamponade may reduce retinal blood supply, consequently lead to retinal ischemia; compound anisodine can effectively improve the retinal and choroidal microcirculation after vitrectomy with face-down posture, reduce retinal ischemia, and enhance the visual function.

Objective To evaluate the image quality of dynamic three-dimensional contrast enhanced ultrasonography(3D-CEUS) in liver tumors.Methods Twenty-five patients were examed with 2D-CEUS and dynamic 3D-CEUS.Contrast-enhanced computed tomography or magnetic resonance imaging(CECT/MRI) were performed early or late.Two readers reviewed the images of both modalities and graded the images according to diagnostic criteria as follows:tumor blood fusion in arterial phase(unclear-score 0,moderate-score 1,clear-score 2),tumor boundry and relationship with periphery tissues (unclear score 0,moderate-score 1,clear-score 2).The concordance between the two modalities for showing liver tumors was evaluated by Kappa test.Results Twenty-three of 25 danymic 3D-CEUS were displayed successfully versus total objects in CECT/ MRI.Among them,for showing blood fusion,16 lesions scored 2,7 lesions scored 1,2 lesions scored 0 in danymic 3D-CEUS,meanwhile 18 lesions scored 2,7 lesions scored 1,0 lesion scored 0 in CECT/MRI,the Kappa value was 0.65.For showing tumor boundry and relationship with peripherytissues,16 lesions scored 2,7 lesions scored 1,2 lesions scored 0 in danymic 3D-CEUS,meanwhile 21 lesions scored 2,4 lesions scored 1,0 lesion scored 0 in CECT/MRI,the Kappa value was 0.52.Conclusions Danymic 3D-CEUS was shown to be useful for displaying tumor blood fusion,boundry and relationship with periphery tissues in single liver tuomor,the concordance between dynamic CEUS and CECT/MRI for single liver tuomor was fair.For huge liver tumor and multi-tumors,3D-CEUS can not give overall information.

Objective To assess the clinical application value of color Doppler ultrasound guided puncture in peripherally inserted central catheter (PICC). Methods Thirty-two patients needed long-term intravenous infusion underwent PICC. Color Doppler ultrasound was used to select the puncture vascular,the best puncture point and angle, and the entire process was monitored and guided dynamically, and the initial position of the catheter tip was located. Results Color Doppler ultrasound-guided puncture was successful in all 32 patients, and the successful rate was 100%. The guided puncture time was 22 s to 19 min, and the first puncture succeeded in 30 patients (93.75%). Conclusion Color Doppler ultrasound-guided puncture in PICC can obviously raise the success rate of puncture, shorten puncture time and reduce the complications. It is an easy, safe and certain method.

Objective To assess the effects of eszopiclone (ESZ) on the pentobarbital sodium-induced sleeping time and spontaneous activity in mice exposed to acute hypobaric hypoxia.Methods 120 mice were randomly divided into 6 groups by using two factors 2×3 levels factorial design,in which two factors were interventions (ESZ and 0.9％ sodium chloride,2 levels) and altitudes (800 m,3500 m and 6000 m,3 levels).The pentobarbital sodium-induced sleeping test and the open field test were engaged to assess the effects of ESZ on sleeping time and spontaneous activity.Results (1) The drug and altitude had no interaction in the results of both the pentobarbital sodium-induced sleeping test and the open field test(P＞0.05).(2)The time of pentobarbital sodium-induced sleeping of mice in the groups of ESZ at each altitudes were (37.77± 18.22) min,(37.02± 13.67) min,(95.67±47.68)min and in the groups of NS were(17.78± 14.10) min,(15.09± 12.46) min,(39.54±28.24) min respectively,and the sleep time in ESZ groups were significantly longer than those in the groups of NS (P＜0.05).The time of pentobarbital sodium-induced sleeping were longer in group of 6000 m than those in the other two groups,both the ESZ and NS groups (P＜0.05).(3)No significant difference was found in the open field test between the ESZ and NS groups in the same altitude(P＞0.05) ; while the mice at the altitude of 6000 m in groups of ESZ and NS decreased compared with the groups at the altitude of 800 m after the relevant drugs intra-perineally for 6 h (P＜0.05).Conclusion ESZ may prolong pentobarbital sodium-induced sleeping time especially at the altitude of 6000 m and with no influence on the spontaneous activity in mice exposed to acute hypobaric hypoxia.High altitude at 6000 m may prolong the sleep time induced by pentobarbital sodium and reduce the spontaneous activities.

Objective To study the relation along p53, p21 protein, p21 gene and their clinical significances in 40 gastric comparing with normal gastric tissues.Methods In this study, the p53 and p21 protein were investigated in 40 gastric carcinomas using IHC(Immunohistochemistry). At the same time, the possible presence of p21 gene mutation was also analyzed by silver staining PCR-SSCP method.Results The abnormal expression of p53 and p21 protein occurs only in gastric carcinoma; The expression of p53 protein and p21 is not related to the clinico pathological features. There was relationship between the expression of p53 protein and p21 protein. In 40 cases of gastric carcinoma, single strand conformational polymorphism of PCR product for p21 gene in tumor tissue shows no altered band or mobility shifting.Conclusion The abnormal expression of p53 and p21 protein occurs only in gastric carcinoma and is not related to the clinicopathological features. The expression of p21 protein is related to that of p53 protein. The mutation of p21 gene was not found in all of 40 tumor specimens. This suggests that p21 alteration in gastric carcinoma is caused through the inactivation of p53 protein rather than through intragenic mutation of the p21 gene itself.Using drugs which can stimulate p21 gene is a new method to cure gastric cancer with mutation-p53 protein.

OBJECTIVE To investigate the effect of phosphotyrosine interaction domain containing 1 (PID1, NYGGF4) on promotion of IR and HCC, and explore its underlying mechanisms. METHODS Lentivirus were used to mediate the knockdown of PID1 in HFD induced IR mouse model as well as ob/ob mice. Intraperitoneal glucose and insulin tolerance were performed 4 weeks after lentivirus injection. Hydrodynamics-based transfection was applied to inducethe liver specific overexpression of PID1. Flow cytometry was exerted to detect the proportion and function of immune cells. qRT-PCR and Western blot were used to detect the expression of downstream pathways of PID1.Immunoprecipitation was used to determine the receptor of PID1. Chromatin immunoprecipitation (ChIP) was operated to measure the modification of H3K4me3 of PID1 promoter. RESULTS PID1 restriction improved insulin resistance, hyperglycemia and fatty liver. Conversely, hepatic knockdown of PID1 attenuated liver xenografted tumor growth. Moreover, PID1 liver- specific protooncogenes via hydrodynamics- based transfection established a primary hepatocellular carcinoma mouse model, induced an immunosuppressive environment, with the reduction of CD3 +, CD4 +, CD8 +T cells, retarded maturation of dendritic cells (DCs), pronounced differentiation of regulatory T cells (Tregs), and recruitment of MDSC. In addition, PID1 overexpression activated proliferation related genes, promoted anti- inflammatory genes, suppressed pro-inflammatory genes, induced glycolysis and lipid metabolism genes to facilitate tumorigenesis in liver. Importantly, PID1 exerted its tumor-promoting function through binding to epidermal growth factor receptor (EGFR) and activation of downstream MAPK pathway. As such, PID1 exist trimethylation of histone H3 at lysine 4 (H3K4me3) modification and IR up-regulated the expression of PID1 by activation the H3K4me3 modification. CONCLUSION PID1 is a new gene that exerts both liver cancer-promoting and insulin resistance inducing function. IR accelerates liver cancer development and progression partially dependent on the activation of PID1.

Objective To examine the effects of acute hypobaric hypoxia on abilities of learning and memory,the water content in brain,the level of nitric oxide(NO) and endothelin-1 (ET-1) in hippocampus of mice.Methods The acute hypobaric hypoxia environment were made by putting the mice in a hypobaric chamber simulated at altitude of 6 000 meters for 8 hours.The capabilities of learning and memory of mice were detected by Morris water maze test.The content of water in hippocampus were examined by measuring the ratio of dry/wet weight,and the level of NO and ET-1 in brain was detected by colorimetric method.Results Morris water maze test showed that the mean escape latency of mice in the hypobaric hypoxia group were longer than that in the normobaric normoxia group((44.60±7.80) s vs (26.39±8.44)s,P＜0.01),and the target quadrant residence time were decreased((19.78±2.74) s vs (22.98±6.14)s,P＜ 0.05).Compared with the normobaric normoxia group (NO:(2.37 ± 1.07) μmol/gProt,ET-1:(38.87 ± 6.17) ng/L),the water content in brain of mice in the hypobaric hypoxia group was increased (P＜ 0.05),meanwhile,both the level of NO ((4.48 ± 1.45) μmol/gProt) and ET-1 ((52.09±6.75)ng/L) in brain were increased too(P＜0.01).Conclusion Hypobaric hypoxia can decrease the abilities of learning and memory of mice,and these changes might be related with the increased water content and the increased level of NO and ET-1 in hippocampus of mice.

Objective To explore the effect of the midwife-leading labor pain management model on the pregnancy outcomes and pain control satisfaction.Methods The randomized grouping and single blind trial design were performed.One hundred and ten pregnant women were recruited and randomized into the control group (n=55) and intervention group (n=55).The control group received the routine prenatal examination by the outpatientdepartment obstetric doctors and intrapartum nursing care during labor.On this basis the intervention group participated in the labor pain educational course in the midwife clinic,and received the repeated pain assessment and pain management intervention during labor.Results There was no statistical difference in the delivery mode between the two groups(P＞0.05).The cesarean section rate without indication in the intervention group was significantly lower than that in the control group,the difference was statistically significant(x2 =6.798,P＜0.05).The average each item score of the labor pain education and pain control satisfaction in the intervention group was significantly higher than that in the control group,the difference was statistically significant(P＜0.01).Conclusion The midwife-leading labor pain management model can reduce the cesarean section rate without indication,and improves the satisfaction of labor pain education and pain control in pregnant women and parturients.

Objective To investigate the diagnostic value of endoscopic ultrasonography (EUS) for duodenal cysts.Methods Clinical manifestations, results of conventional gastroscopy and EUS, as well as follow-up, of patients with duodenal cysts were retrospectively analyzed.Results A total of 105 patients with duodenal cysts presented with no lesion-related symptoms, but displayed characteristic imaging changes under EUS, which could reveal the origin, size and nature of duodenal cysts, and differentiate it from other submucosal lesions.A maximum follow-up of 5 years showed no changes in duodenal cysts.Conclusion Duodenal cyst is a benign disease, and EUS plays a very important role in diagnosis of the disease.