Objective To approach the strategies of prevention and treatment of elderly patients with diabetic foot by analyzing the common pathogens and their drug- resistance.Methods136 isolated strains of drug resistance pathogens from 68 elderly patients with infected diabetic foot were retrospectively studied in our hospital from January 2008 to June 2010.Results Bacterial pathogens and fungal pathogens accounted for 92.6％ and 7.4 ％,respectively.The bacterial pathogens included gram-positive bacteria (58.7％) and gram-negative bacilli (41.3％).Among the gram-positive bacteria,staph were most common.Furthermore,the incidence of methicillin resistant staphylococcus aureus (MRSA) and methicillin resistant coagulase negative staphylococcus (MRCNS) increased year by year.Vancomycin-resistant gram-positive bacteria did not appear.Among the gram-negative bacilli,enterobacteriaceae were the most common pathogens.Patients with mixed infections accounted for 61.8％.Fungous infections were all in the form of mixed infection,increasing with years.Conclusions Pathogenic bacteria and its drug resistance should be timely monitored to control and prevent the diabetic foot in the elderly patients.

Based on the hospital information systems and the hospital network,a software for patients with peripherally inserted central catheter (PICC) was developed and applied in clinical practice,which achieved the share of PICC information within the hospital,saved nursing time effectively,made the clinical data more standardized,systematical and objective.

OBJECTIVE To improve the compliance of medical institutions in the prevention and treatment of influenza A(H1N1) by introduction of game theory.METHODS Solving the mixed strategy Nash equilibrium with the application of game theory model.RESULTS There was inevitable relationship between the proportion of inspections,amercement amount and compliance of prevention and treatment.CONCLUSIONS If the health administration departments decrease the proportion of inspection,the probability will be reduced on the attitude of the medical staff;If the health administration departments increase the proportion of inspection,the probability will also be increased.

Objective To explore the clinical characteristics of treatment?resistant depression ( TRD) and of its relevance with thyroid hormones. Methods 43 patients with TRD and 48 patients with non?TRD were as?sessed with 17?item Hamilton depression scale ( HAMD?17) and Hamilton anxiety scale ( HAMA) . The serum lev?el of thyroid?stimulating hormone ( TSH) ,total triodothgronine ( TT3) ,total thyroxine ( TT4) ,free triodothgronine ( FT3) and free thyroxine ( FT4) were determined by radioimmunoassay. χ2 test and t test were used for statistic a?nalysis. The quantitative relation of FT3 level with TRD was analyzed and the value of FT3 level in TRD diagnosis was evaluated by ROC curve.Results Compared with non?TRD patients,the TRD patients showed a younger dis?ease onset age ((16.98±2.25)years vs (23.50±3.38)years) and a longer disease course ((10.14±6.47)years vs (5.48±4.15)years) for total disease course;(60.35±23.64)months vs (5.00±3.40)months for current disease course),and had shorter education years ((8.53±1.72)years vs (11.04±2.07)years) and higher HAMD total scores (19.09±1.59 vs 15.69±2.38) and behavior retarding factor scores (8.72±0.98 vs 4.98±1.63). In addition, the FT3 level of TRD patients was lower than that of non?TRD patients ((3.92±0.15)pmol/L vs (4.16±0.20) pmol/L).All the above differences between two groups were statistically significant (P<0.05). The logistic regres?sion analysis showed that the risk of suffering TRD increased by 1. 006?fold when FT3 level reduced 0. 1 pmol/L (OR=2.006,95%CI=(1.501,2.681). The area under ROC curve was 0.821 (P<0.001) with its 95% confidence interval of (0.734,0.907). Conclusion Compared with non?TRD patients,TRD patients have a longer disease course,a younger disease onset age, a lower education level, higher HAMD total scores, more severe retardation symptoms,and a lower FT3 level. The serum FT3 level has a high reference value in diagnosis of TRD.

Objective To establish antigen capture ELISA methed to detect Kaposi's sarcoma-as-sociated herpesvirus(KSHV)antigen,and to evaluate its feasibility for clinical application.Methods The BALB/c mice and New Zealand white rabbits were injected with purified recombinant KSHV gpK8.1 proteins to prepare the monoclonal antibody(McAb)and polyclonal antibody(PcAb)anti-gpK8.1,respectively.A new antigen capture ELISA method was established for KSHV antigen detection.The detection reproducibili-ty as well as the sensitivity and specificity of this new assay were determined by the optimization test,which antibody pairs were analyzed to choose the best coating antibody and detecting antibody.The 3 KSHV posi-tive patients sera and 257 patients sera from sexually transmitted disease,cancers or gynecological diseases were detected with this assay to evaluate its value for clinical application.Results When the McAb as coat-ing antibody at concentration of 5 μg/ml and PcAb as detecting antibody at concentration of 1.6μg/ml were selected,the highest P/N value could be obtained.The sensitive analysis of this test could detect recombi-nant KSHV gpK8.1 antigen of 31.28 ng/ml.Meanwhile,it is highly specific to detect KSHV antigen with-out cross reaction to Epstein-Barr vims(EBV),herpes simplex virus(HSV)-1 or HSV-2.All of three KSHV-positive sera and 4 sera from 257 clinical samples were positive with this new assay.which indicated that it could be used for capturing KSHV antigen.Conclusion A sensitive and specific McAb-based anti-gen capture ELISA method to detect KSHV antigen were established successfully.It is of great potential val-ue to develop reagent for KSHV clinical serologic dingnosis.

OBJECTIVE: To investigate the clinical features, therapeutic methods and therapeutic efficacy of imflammatory myofibroblastic tumor(IMT)of the nasal cavity and paranasal sinuses. METHOD: Clinical data of 14 cases diagnosed as IMT by pathology were retrospectively analyzed. There were 8 males and 6 females,age ranging from 18 to 77 years. 12 cases of them were treated by surgery while 2 cases received postoperative radiotherapy. RESULT: All cases were operated. All the patients were followed up for a period of 1 to 7 years after operation and two cases were proved low grade IMT pathologically. Eight cases survived with no recurrence until the last follow-up and 6 cases relapsed, of which 4 cases died and 2 were alive with tumor. CONCLUSION IMT of the nasal cavity and paranasal sinuses is very rare. The diagonosis of IMT is based on pathology and immunohistochemistry. Proper diagnosis is essential to avoid mutilating and disfiguring surgical procedures. Radical excision is still the first choice of treatment for IMT of the nasal cavity and paranasal sinuses. Chemotherapy and radiotherapy may not be helpful to prevent recurrence after operation. Due to high recurrence rate, long-term follow up is necessary after operation.
Adolescent ; Adult ; Aged ; Female ; Humans ; Immunohistochemistry ; Male ; Middle Aged ; Nasal Cavity ; pathology ; Neoplasm Recurrence, Local ; Neoplasms, Muscle Tissue ; pathology ; radiotherapy ; surgery ; Paranasal Sinus Neoplasms ; pathology ; radiotherapy ; surgery ; Paranasal Sinuses ; pathology ; Retrospective Studies ; Young Adult

OBJECTIVETo investigate the metabolic changes on proton magnetic resonance spectroscopy (¹H-MRS) in patients with first left basal ganglia infarction and their relationship with depression.

METHODSTwenty-two patients with first left basal ganglia infarction and 10 matched healthy controls were recruited in the study. Patients and controls underwent (1)H MRS scan and the spectrum of N-acetyl aspartic acid (NAA), choline (Cho) and creatinine (Cr) was recorded at the first week (D7) and 1 month after onset (M1), respectively. National Institutes of Health Stroke Scale (NIHSS), Ability of daily life (ADL), Hamilton Depression Scale (HAMD) were evaluated at D7, M1 and M6 after onset. The patients were classified into two groups: post-stroke depression (PSD) and non-post-stroke depression (NPSD) according to the result of HAMD.The differences of (1)H-MRS between these two groups were compared and their relationship with NIHSS and ADL was analyzed.

RESULTSAmong 22 patients 10 were diagnosed as PSD and 12 were NPSD. Compared to controls, NAA/Cr was significantly lower and Cho/Cr was significantly higher (P <0.05)in left prefrontal white matter and left basal ganglia in patients with infarct. Patients with PSD showed a lower NAA/Cr and higher Cho/Cr than NPSD patients (P <0.05). At M1 after onset, NAA/Cr in the left prefrontal white matter was significantly correlated with NIHSS (r=-0.551, P =0.032), while Cho/Cr was correlated with ADL (r=0.682, P=0.005)in PSD patients.

CONCLUSIONMetabolic changes shown on (1)H-MRS in patients with basal ganglia infarction may predict the occurrence of PSD.

Adult ; Basal Ganglia ; pathology ; Case-Control Studies ; Cerebral Infarction ; complications ; Depression ; diagnosis ; etiology ; metabolism ; Female ; Humans ; Magnetic Resonance Spectroscopy ; methods ; Male ; Middle Aged ; Protons

The laryngopharyngeal reflux disease (LPRD) is a general term for a series of symptoms and signs caused by reflux of the stomach contents to the upper part of the esophageal sphincter. In recent years, the laryngopharyngeal reflux (LPR) is getting more and more attention as laryngeal precancerous lesions and risk factors of laryngeal cancer. Laryngeal precancerous lesions plays a important role in the development of laryngeal cancer process. This article will review the role and mechanisms of LPR in the laryngeal precancerous lesions, and the status of anti-reflux in the treatment of laryngeal precancerous lesions.

OBJECTIVE: To investigate the clinicopathological features, therapeutic methods and therapeutic effects of neuroendocrine carcinoma in nasal and laryngeal region. METHOD: Six cases with neuroendocrine carcinoma of the nose and the larynx were analyzed retrospectively. All cases were proved by pathology and immunohistochemistry. One case was treated by only radiotherapy, and five cases by combined treatment (surgery followed by radiotherapy and chemotherapy). RESULT: All the patients were followed up for a period of 11-84 months. Two cases showed recurrence after operation. Three cases occurred cervical lymph node metastasis, of which 2 cases received neck dissection and 1 case received chemotherapy and radiotherapy due to no surgical indications. Three cases occurred local recurrence, cervical lymphadenopathy, liver or lung metastases. Until the last follow up, four patients died of tumor, while two patients lived with no evidence of disease. CONCLUSION Nasal and laryngeal neuroendocrine carcinoma is composed of a group of different morphology and prognosis lesions. Corrent diagnosis depends on clinical characteristic, electron microscopic and immunohistochemical examination. CT and MRI examination could be helpful to understand the extent of disease and lesion nature. The prognosis and treatment method of neuroendocrine carcinoma were vary with different pathological types. Combined treatment based on surgery should be adopted to the disease.
Adult ; Aged ; Carcinoma, Neuroendocrine ; Female ; Humans ; Laryngeal Neoplasms ; Male ; Middle Aged ; Nose Neoplasms ; Retrospective Studies

Objective To investigate the value of short diameter of lymph nodes combined with neutrophil to lymphocyte ratio(NLR)in evaluating lymph node metastasis of cervical cancer by enhanced CT.Methods A total of 82 patients with cervical cancer were selected and divided into metastatic group(n=13)and non-metastatic group(n=69)according to whether lymph node metas-tasis occurred.The clinicopathological features of the two groups were compared,and the relationship between NLR and clinicopath-ology was analyzed.Logistic regression was used to analyze the influencing factors of lymph node metastasis of cervical cancer.The short diameter of lymph nodes and serum NLR were compared between the two groups.Receiver operating characteristic(ROC)curve,DeLong test and compare the area under the curve(AUC)analysis was used to evaluate the value of lymph node metastasis in cervical cancer.The diagnostic efficacy of the above indexes were compared between the two groups.Results The short diameter of lymph nodes and NLR in the metastatic group were(0.686±0.120)cm and 2.23±0.41 respectively,while thosein the non-metastatic group were(0.602±0.106)cm and 1.76±0.30 respectively.The difference between the two groups was statistically signifi-cant(P＜0.05);There was no significant difference in age,growth pattern and vascular infiltration between the metastatic group and the non-metastatic group(P＞0.05).There were significant differences in clinical stage,maximum diameter of tumor,NLR and short diameter of enhanced CT lymph nodes(P＜0.05);The NLR was related to clinical stage,pelvic lymph node metastasis,and the short diameter of lymph nodes on enhanced CT scan(P＜0.05);Clinical stage Ⅲ,maximum diameter of tumor≥4 cm,NLR＞1.80 and short diameter of enhanced CT lymph nodes≥0.632 cm were independent risk factors for cervical cancer lymph node metastasis(P＜0.05);The ROC curve analysis showed that the AUC of the combined detection of cervical cancer was 0.871,higher than that of the enhanced CT lymph nodes short diameter and serum NLR(0.645,0.795),and its specificity was better than that of the independent detection.The best cutoff values of the enhanced CT lymph nodes short diameter and serum NLR were 0.630 cm and 1.91,respectively.Conclusion The short diameter of lymph nodes and the serum NLR can predict lymph node metastasis of cervical cancer,and the combined detection can improve the evaluation efficiency.