OBJECTIVE To study the existence of integron and metallo-?-lactamase in Stenotrophomonas maltophilia in our hospital.METHODS The antibiotic susceptibility was tested by K-B method.The genomic DNA and their plasmids were extracted.The integron and metallo-?-lactamase gene were amplified by polymerase chain reaction(PCR).RESULTS L1 and L2 genes were amplified in chromosomes and plasmids.Integrons Ⅰ and Ⅱ were detected in genomic DNA.CONCLUSIONS Existence of metallo-?-lactamase is one of reasons of multi-drug resistance in S.maltophilia.S.maltophilia can receive integrons and gain its multi-drug resistance from other strains.

OBJECTIVETo investigate the short-term clinical outcome of unicompartmental knee arthroplasty for the treatment of spontaneous osteonecrosis of the knee.

METHODSFrom September 2013 to April 2014,5 patients with spontaneous osteonecrosis of the knee underwent unicompartmental knee arthroplasty, included 3 males and 2 females, aged from 65 to 80 years old with an average of 74 years. The courses of disease was from 1 to 6 years with the mean of 3 years. According to the radiographic staging criteria of Koshino, 1 case was stage II, 2 cases were stage III, 2 cases were stage IV. Clinical effects were assessed by VAS score, HSS score, and knee range of motion, tibiofemoral angle before and after operation.

RESULTSAll the patients were followed up from 6 to 7 months with an average of 6.4 months. All incisions obtained primary healing, and there were no complications such as infection, thrombosis, fracture of lower limbs. All 5 patients' pain relieved and their knee function improved significantly after operation, but knee range of motion had no obviously improved. Postoperative HSS scores, VAS scores, tibiofemoral angle were significantly improved than that of preoperative.

CONCLUSIONThe short-term effect of unicompartmental knee arthroplasty in treating spontaneous osteonecrosis of the knee is satisfactory.

Aged ; Aged, 80 and over ; Arthroplasty, Replacement, Knee ; methods ; Female ; Humans ; Joint Diseases ; physiopathology ; surgery ; Knee Joint ; Male ; Osteonecrosis ; physiopathology ; surgery ; Range of Motion, Articular

Purpose To investigate the expression of Par3, Par6 and aPKC in gastric carcinoma and their significance. Method Ex-pression of Par3, Par6 and aPKC, by using immunohistochemistry, was detected in different sites of gastric carcinoma ( including the gastric carcinoma in gastric mucosa, the central area and the invasive front of gastric carcinoma) and the lymph node metastasis, using normal gastric mucosa as controls. Results Expression of Par3, Par6 and aPKC in different sites of gastric carcinoma was lower than in that of normal gastric mucosa (P<0. 01). Expression of Par3, Par6 and aPKC was obviously lower in gastric carcinoma with gastric phenotype than in that with intestinal phenotype and mixed phenotype of gastric carcinoma (P<0. 05, P<0. 01, P<0. 01);the rate of down-regulation of Par6 and aPKC in gastric carcinoma with invasion to ectoptygma and out of ectoptygma was obviously higher than that in gastric carcinoma which located at mucosa and under mucosa (P both<0. 01), and the rate of down-regulation of Par6 in gas-tric carcinoma with lymph node metastasis was obviously lower than that with no lymph node metastasis ( P>0. 05 ) . Conclusions The down-regulation expression of Par3, Par6 and aPKC may promote the carcinogenesis and progression of gastric carcinoma.

Objective To explore the surgical intervention outcomes of necrotizing enterocolitis (NEC)pa-tients with different extent of the disease.Methods The data of 25 pediatric patients with NEC who were treated with surgical intervention in Shanghai Children′s Hospital from December 201 1 to December 201 5 were retrospectively ana-lyzed.According to the extent of the disease,the patients were divided into 3 groups:focal disease(F),multisegmental disease(M),and pan -involvement(P).The information including operation style,survival rate and time for close osto-my was analyzed.Results There were 1 1 cases with F,8 cases with M,and 6 cases with P.All patients received lapa-rotomy surgery,colostomy,or peritoneal drainage.There were 1 2 patients with very low birth weight,7 patients with low birth weight,6 patients with normal birth weight in this study.There were 1 7 cases with gastrointestinal perforation (9 cases with pneumoperitoneum,8 cases without pneumoperitoneum),8 cases without digestive tract perforation (4 cases without pneumoperitoneum,4 cases with enterostenosis after conservative treatment).In this study,close ostomy was commonly conducted 3 -6 months after the operation,except for 3 cases who received 2 or more times of operation.The survival rate in F group was 1 00.0%(1 1 /1 1 cases),higher than those in the Mgroup with 62.5%(5 /8 cases)and P group with 1 6.7%(1 /6 cases)(χ2 =4.898,1 0.31 2,all P <0.05).However,there was no difference between Mgroup and P group (χ2 =1 .367,P >0.05).Conclusions The extent of disease is correlated to the outcomes of surgical in-tervention,as F had a better outcome than Mand P.Low birth weight is a risk factor for NEC.Protecting the edge of the bowel is a key factor to ensure the survival and improve the quality of life of NEC patients.Close ostomy should be con-sidered when the patients are in a stable condition (liver function and intestinal function recovery,good nutrition condi-tion,etc),and under special circumstances to conduct early or delayed closure of fistula.

Hirudin as a novel anticoagulant and antithromotic agent, is a kind of protein that is obtained from the salivary gland secretion of one kind blood-sucking leech.It increases the difficulty extraction and purification of hirudin that composition of no anticoagulant activity of peseudo-hirudin in the body of leech and a large number of complex material from the salivary gland secretion of one kind blood-sucking leech.This article focuses on reviewing the structure of hirudin, genetic makeup, extraction and purification of hirudin according to the related research.Analysis of the pros and cons of various extraction and purification methods.Looking forward to its developing tendency, so as to provide reference for extraction and purification of Hirudin.

Objective To study the prevention and treatment of complications occurring in anterior cervical spinal surgery.Methods3163cases with cervical spondylotic meylopathy,spinal injury,spinal tu-mor and spinal tuberculosis treated by anterior cervical surgery,were included in this study.Trephination,corpectomy,disectomy and debridement were used for decompression,iliac bone autograft,BAK cage,cubic shaped cages and titanium mesh cages were used for bone grafting,while anterior cervical spine locking plates were performed in some of the cases.1848cases were followed-up from6months to8years with an aver-age of 2years and3months.646cases suffered from operative complications,372cases were immediate due to anterior cervical surgery,and the incidence of morbidity was11.76%.Results26cases of transient laryn-geal nerve or superior laryngeal nerve injury recovered in4to12weeks without special treatment.Most of 16cases with cervical hemotoma were caused by bleeding of smaller blood vessels and obstruction of drainage.13cases of spinal cord or nerve root irritation or injury were treated with medicine for dehydration,12of them had good result.11cases of CSF leakage were cured with cervical spinal immobilization and moderate local compression.8cases of local infection were cured with antibiotics or combined with debride-ment and suturing.2cases of esophagus perforation were repaired and healed.8cases of grafted bone dis-placement were re-operated on the day or second day of occurring.17cases of pseudoarthritis had revision surgery.6of 35cases of adjacent segments degeneration with new symptoms of spinal cord compression were treated with anterior cervical decompression again,and had good results.Most of 342cases of iliac donor side com plications were local pain or lateral femoral cutaneous nerve injury,infection occurred in some cases.Compli cations related to instruments included10cases of BAK subsidence,1case of plate breakage,1case of screws and plate back-out and7cases of titanium mesh cage subsidence.216cases of cervical axial pain were cured3to6months later with medicine.There was1case of sudden death in this group.Conclusion Many kinds of operative complications could occur in anterior cervical surgery.A standardized procedure in diagnosis and surgery methods are the key points to decrease and prevent operative related complications.

Objective To study whether physiological and psychological stresses during parachuting jumps may result in biochemical changes of plasma in parachutists. Method Differences in the levels of hormones (cortisol, growth hormone, insulin, pancreatic glucagon, endothelin, angiotonin I and II, aldosterone), activities of enzymes (superoxide dismutase, glutathione peroxidase, glutathione S transferase), levels of the free radical damage indicator malondialdehyde (MDA), tumor necrosis factor alpha (TNF-α), and the main heat stress protein, HSP70,in the plasma and serum were investigated in control (non-parachuting) and parachuting paratroops. Result Significantly higher levels of serum hormones such as growth hormone, insulin, angiotonin I, renin activities, as well as MDA and plasma TNF-α and HSP70 were observed in the parachuting group. Conclusion Whether these changes can potentially serve as useful biomarkers to assess possible abnormal stress in parachutists and to evaluate the health condition and to select parachutists remains to be further studied.

Objective To investigate the effects of propofol on intracellular free Ca2+ concentration and nitric oxide synthase (NOS) activity in PC12 cells exposed to bupivacaine. Methods The PC12 cells were provided by Shanghai Cell Biology Research Institute, Chinese Academy of Sciences and cultured in DMEM liquid culture medium. The cultured PC12 cells were seeded in 36 well plates and randomly assigned to one of 4 groups (n=9 wells each): group Ⅰ control (C);group Ⅱ propofol (P);group Ⅲ bupivacaine (B) and group Ⅳ propofol + bupivacaine (PB). In control group D-Hank solution was added. The cells were exposed to propofol 2 mmol/L and bupivacaine 0.09 mmol/L in group P and B respectively. In group PB the cells were incubated with propofol 2 mmol/L and bupivacaine 0.09 mmol/L simultaneously. After being incubated for 6 and 24 h the apoptosis in BC12 cells was assessed by flow cytometry. Apoptotic rate was calculated. NOS activity and intracellular free Ca2+ coneentration in PC12 cells were determined. Results Bupivacaine significantly increased the apoptotic rate of PC12 cells, the intracellular free Ca2+ concentration and NOS activity in PC12 cells in group B as compared with control group. Propofol significantly decreased the toxic effects of bupivacaine on PC12 cells in group PB compared with group B. Conclusion Bupivacaine is toxic to PC12 cells by increasing apoptosis, intracellular Ca+ concentration and NOS activity in the cells. The toxic effects can be prevented to some extent by concomitant administration of propofol.

Objective To evaluate the clinical training outcomes from two clinical practice modes for undergraduate students. Methods Total two grades 2009 and 2010,150 undergraduate students were randomly divided into two groups: 69 students in group A and 81 students in group B. The synthetic teaching mode was applied in group A,and group B received the traditional teaching mode. The Objective Structure Clinical Examination (OSCE)and a written comprehensive examination were used to evaluate the training outcomes by T test analyzed by SPSS 17.0(α= 0.05). Results The theoretical level of 2009 grade students was better than that of 2010 grade (P < 0.05). The clinical practice skills of the two groups had no significant difference(P > 0.05). There were no significant differences between two groups in theoretical and clinical training(P > 0.05). Comparing with the 2010 grade,the theoretical level of the 2009 was better,but the clinical skill level was weaker. Conclusion Synthetic teaching mode and traditional teaching mode both achieved good outcomes. In order to obtain better comprehensive progresses,the two teaching modes need to be combined. The orientation by following the requirements of oral practicing qualification examination may enhance the clinical skills of the students.

Objective To investigate the clinical outcomes in the treatment of complex acetabular fractures through a single supra-ilioinguinal approach after the application of preoperative 3D printing and rapid prototyping simulating the operative procedure.Methods From January 2013 to January 2016,24 cases of complex pelvic and acetabular fractures in our hospital were retrospectively analyzed.Among them 18 cases were male and 6 were female.The average age was 39.2+±13.8 years (range,24-68 years).According to Letoumel-Judet's classification,there were 6 cases of transverse,4 cases of T shaped,4 cases of combined anterior column and posterior hemi-transverse (ACPHT) and 10 cases of 2-column fractures.The time from injured to operation averaged 9 days (range,4-18 days).Before operation,pelvic AP view,three-dimensional CT as well as CTA of iliac blood vessels was taken routinely in all cases.The CT and CTA scan data were then imported into Mimics software for 3D reconstruction.Surgical simulation and optimal placement of internal fixations were performed on computer.After that,the individual simulated model of the pelvis was printed by the use of 3D printing and rapid prototyping technique.The order of reduction,selection and optimal position of the implants were determined.The plates were bent before operation and the length and direction of the screws were recorded.A uniform supra-ilioinguinal approach was used in all cases.Results The length of incision averaged 9 cm (range,8-13 cm).The operative time average 130 min (range,90-220 min).The blood loss averaged 600 ml (range,300-1 500 ml).Once a satisfactory reduction was obtained,single placement of the plates was achieved.In accordance with the preoperative plan,the plates were perfectly fitted to the bone surface.The 24 patients were followed for an average time of 18.3 months (range,15-30 months).The fractures healed in all cases.The average healing time was 4.2 months (range,3-6 months).According to Matta criteria,there were 16 cases of excellent,6 cases of good,2 cases of poor and the excellent rate was 91.7％ (22/24).The average modified Merle d'Aubigne score was 16.5 (range,13-18).The functional outcome was excellent in 13 cases,good in 6 cases and poor in 5 cases.The excellent rate of hip functions was 79.2％ (19/24).There were 2 cases of femoral lateral cutaneous nerve injury (recovered one month later) and another 1 case of fat liquefaction of the incision happened three days postoperatively (the wound healed completely after several dressing changes).No inguinal hernia or abdominal wall hemias was found.No other postoperative complications was found.Conclusion The application of 3D printing and rapid prototyping technique allows preoperatively simulating reduction in vitro,determining the optimal position of the implants,bending the plates and measuring the length of the screws in advance,which could largely reduce the operative time,intraoperative blood loss and occurrence of postoperative complications.Adopting supra-ilioinguinal approach for the treatment of complex acetabular fractures with a small incision and less trauma,a full exposure could be obtained,so the reduction and fixation of the anterior,posterior and middle column (also named pubo-ischiatic column) could be completed in a direct visualization,resulting in a satisfactory clinical outcomes.