Objective To explore the value of detection of systemic and local oxidation antioxidation level of ascites in the differential diagnosis of benign and malignant ascites.Methods Thirty-five patients with malignant ascites hospitalized in the Yidu Central Hospital of Weifang from December 2012 to November 2013 as the malignant ascites, and 35 cases of benign ascites as the control group.The ascites of malignant ascites group and plasma total antioxidant capacity (T-AOC) level of two group were detected by ferric ion reduction method.Plasma malonaldehyde (MDA) level of two group were detected by thiobarbituric acid content assay.Peripheral blood mononuclear cell (PBMCs) and tumor associated lymphocytes (TALS) in ascites were isolated by Ficoll density gradient centrifugation,the DNA damage of PBMCs and TALS were detected by single cell gel electrophoresis (SCGE) , expressed in the tailing rate.The value in the diagnosis of benign and malignant ascites was judged according to the analysis of above indexes.Results (1) The difference analysis : the levels of T-AOC in plasma in malignant ascites group was (9.26 ± 1.88)mM, significantly lower than that in benign ascites group((11.26± 1.78) mM, t =16.520,P =0.000);T-AOC levels of malignant ascites group ascites was (6.59± 1.38) mM, significantly lower than the plasma levels of T-AOC ((9.22± 1.86) mM, t =13.869, P =0.000);the MDA level of malignant ascites group was (6.26± 1.83) nM, significantly higher than that of serum benign ascites((3.26±1.12) nM,t=18.267,P=0.000);tailing rate of PBMCS in malignant ascites group was (17.9 ± 6.7) ％, significantly higher than that in benign ascites group ((9.6 ± 5.3) ％, P＜ 0.01);tailing rate of TALS in malignant ascites group was (442.6± 10.8) ％, significantly higher than that of PBMCS ((17.2±6.1)％ ,P＜0.01).(2)The correlation analysis: there was a negative correlation between plasma T-AOC and MDA in malignant ascites group (r =-0.518, P ＜ 0.01), tailing rate of T-AOC and TALS ascites (r =-0.566,P＜0.01) ,tailing rate of plasma T-AOC and PBMCS(t =-0.472,P＜0.01);there was a positive correlation between the tailing rate of plasma MDA and PBMCS (r =0.476, P ＜ 0.05).Conclusion In the malignant ascites group, there is oxidative stress in the whole body and the ascites, and the local oxidative stress in the ascites is more obvious.The sensitivity and accuracy of the diagnosis of malignant ascites can be increases by detected by the detection of the local oxidation resistance of the whole body and the ascites.

Objective To investigate the drug-resistance of Pseudomonas aeruginosa which producing K lebsiella pneumoniae carbapenemases(KPC) .Methods Pseudomonas aeruginosa strains were derived from two sputum samples .VITEK 2 COMPACT Automated Microbial Identification/Susceptibility Analyzer was employed to identify the bacterial strains .Polymerase chain reaction (PCR) and gene sequencing were adopted to identify the genotypes of KPC enzyme ,Broth dilution method was used to measure the minimal inhibitory concentration(MIC) of antimicrobial agents .Results Both Pseudomonas aeruginosa strains were resistant to β-lactam antibiotic and levofloxacin ,and were intermediary to ciprofloxacin ,and sensitive to gentamicin ,netilmicin ,tobramycin ,colistin and multi-polymyxin B .One of them was sensitive to tigecycline .Carbapenemase produced by the two stains was not metal β-lacta-mase ,with the subtype of KPC-2 .Mating experiments failed to prove the bla K PC gene could be transferred to E .coli J53 .Conclu-sion Appearance of KPC-producing Pseudomonas aeruginosa poses serious challenges to clinical anti-infective therapy .

Objective Mechanisms of pulmonary vein isolation (PVI) for atrial fibrillation remain controversy.This study aimed to investigate the impact of PVI on vagal modulation to atria.Methods Eighteen adult mongrel dogs under general anesthesia were randomly divided into two groups.Bilateral cervical sympathovagal trunks were decentralized and sympathetic effects was blocked by metoprolol administration.Atrial electrical remodeling (AER) was established by rapid right atrial pacing at the rate of 600 bpm for 30 minutes.PVI was performed in group A.Atrial effective refractory period (ERP),vulnerability window (VW) of atrial fibrillation,and sinus rhythm cycle length (SCL) were measured at baseline and during vagal stimulation before and after atrial rapid pacing with and without PVI at fight atrial appendage (RAA),left atrial appendage (LAA),distal coronary sinus (CSd) and proximal coronary sinus (CSp).Results (1) Effects of PVI on vagal modulation:Shortening of SCL during vagal stimulation decreased significantly after PVI compared with that before PVI in group A (P＜0.001).Shortening of ERP during vagal stimulation decreaseed significantly after PVI compared with that before PVI (P＜0.05).VW of atrial fibrillation during vagal stimulation decreased significantly after PVI compared with that before PVI (P＜0.05).(2) Effects of PVI on AER:shortening of ERP before and after atrial rapid pacing increased significantly at baseline and vagal stimulation in group B compared with that in group A (P＜0.05).VW during vagal stimulation increased significantly after atrial rapid pacing in group B (P＜0.05).Conclusion PVI attenuates the vagal modulation to the atria,thereby decreases the susceptibility to atrial fibrillation mediated by vagal activity.PVI releases AER,which maybe contributes to the vagal denervation.Our study indicates that PVI not only can eradicate triggered foci but also modify substrates for AF.(J Geriatr Cardiol 2008;5:28-32)

Background Atrial electrical remodeling(AER)plays an important role in the pathogenesis and maintenance of atrialfibrillation.However,little is known about modulation of vagal activilty to AER.This study aimed to investigate the relationshipbetween vagal moduation and AER. Methods Twenty four adult mongrel dogs under general anesthesia were randomized into 3groups.Sympathetic activity was blocked by administration of metoprolol in 3 groups.The changes in vagal modulation to atria afterAER were observed in 10 dogs without vagal interruption in group A.The effects of vagal intervention on AER were investigated in 8dogs with administration of atropine in group B.The impact of aggressively vagal activity on AER was studied in 6 dogs with bilateralcervical vag sympathetic trunLks stimulation during AER in group C.Bilateral cervicall vagosympathetic trunks were decentralized.Multipolar catheters wereplaced into high right atria(RA),coronary sinus(CS)and rightventricle(RV).AER was induced by 600 bpmpacing through RA catheter for 30 minutes.Attial effective refractory period(ERP)and vulnerability window (VW)of atrial fibrillationwere measured with and without vagal stimulation before and after AER.Results In group A,ERP decreased significantly at baselineand during vagal stimulation after AER compared with that beforeAER(all P＜0.05).In group B,ERP remaind unchanged at baselineand vagal stimulation after AER compared with tbat before AER (all P＞0.05).In group C,ERP shortened significantly at baseline andvagal stimulation after AER compared with that before AER(all P＜0.05).ERP shortening after AER in Groups A and C increasedsignificantly than that in group B (all P＜0.05).Atrial fibrillation could not be induced at baseline(VW close to 0) before and after AERin three groups.VW became widen significantly during vagal stimulation after AER compared with that before AER in Groups A and C(all P＜0.05),while VW remained unchanged in group B (VW close to 0).Conclusions Short-term AER results in the decrease inERP.AER is accompanied by the increases in atrial vagal modulation.The increased vagal activity and vagal stimulation promote AER,thereby increase the susceptibility to atrial fibrillation.The interrupted vagal activity attenuates AER.thereby suppresses the atriaIfibrillation mediated by vagal stimutlation.

0.05]. Conclusion:Besides the enlargement of LA,the volume of LAA and the area of LAA ostium were significantly increased in AF patients.Preprocedural assessment of LAA ostium should be helpful for the selection of occlusion devices.Because LAA is be very close to LCX,the selection of AF ablation strategies should be carefully taken to avoid possible damage of LCX.

The Long-term Thromboembolic Event Analysis in Atrial Fibrillation Patients With Radiofrequency Catheter Ablation
Objective: To observe the thromboembolic event in atrial fibrillation (AF) patients with long-term successful radiofrequency catheter ablation (RFCA), and to study the relationship between thromboembolic event and CHA2DS2-VASC score in order to guide the anticoagulation strategy for AF patients.
Methods: A total of 321 AF patients who received RFCA in our hospital from 2000-01 to 2009-05 were studied. There were 261 patients with paroxysmal AF and 60 with persistent AF, they were followed-up for (66.7±26.9) months. The patients were divided into 2 groups according to AF recurrence condition as Non-recurrence group, n=204 and Recurrence group, n=117. The relationship between thromboembolic event and CHA2DS2-VASC score was studied.
Results: The Non-recurrence group had significantly lower rate of thromboembolism than that in Recurrence group (1.96% vs 7.69%), P=0.017. In both groups, the patients with CHA2DS2-VASC score < 2 had much lower rate of thromboembolism than those with CHA2DS2-VASC score ≥ 2, (0% vs 5%), P=0.023 and (4.45% vs 17.24%), P=0.041. The patients with CHA2DS2-VASC score<2 in Non-recurrence group had lower rate of thromboembolism than those in Recurrence group (0%vs 4.45%), P=0.029. The rate of thromboembolism had no statistic meaning between 2 groups in patients with CHA2DS2-VASC score≥2 (5%vs 17.24%), P=0.054.
Conclusion: The AF patients who received RFCA without AF recurrence in long-term follow-up had the lower rate of thromboembolic event, CHA2DS2-VASC score was important for evaluating such event. The patients with CHA2DS2-VASC score < 2 could consider stopping warfarin anticoagulation, while the patients with CHA2DS2-VASC score ≥ 2 might be beneifted for warfarin anticoagulation.

Objective To evaluate the applicationof the double-disk synergy test(DDST) and combined disk test(CDT) in clini cal metal enzyme phenotype deteetion.To evaluate the value of multiplex PCR in detecting the metallo-β-1actamase in clinical.Methods 56 strains of metallo-β-1actamase-positive strains were identified [NDM-1(n=9),VIM(n=32),IMP(n=15)]for appraise the two methods.By optimizing the design of PCR primers,3 pairs of primers were designed and detected (IMP,VIM,NDM-1) in one tube for evaluate the method.Results The DDST was 80.36％(45/56),and 100.00％(56/56) in the CDT.The accuracy of multiplex PCR was 100.00 ％ (56/56),and the size of the amplified fragment was used to distinguish three types of metallo-β-lactamase.Conclusion The CDT is more suitable for clinical application than DDST.Multiplex PCR has the characteristics of simple,rapid and accurate in detection of metallo-β-1actamase.It is suitable for daily use of clinical microbiological laboratory,which will help the clinical timely and effective administration.

Objective:To investigate the effects of nicorandil combined with thrombus aspiration during percutaneous coronary intervention on reperfusion arrhythmia in patients with acute ST-elevation myocardial infarction.Methods:180 patients with acute ST-elevation myocardial infarction who received treatment in Yidu Central Hospital, Weifang Medical University, China between January 2019 and June 2020 were included in this study. They were randomly assigned to receive either nicorandil combined with thrombus aspiration during percutaneous coronary intervention (NPCI group, n = 90) or conventional PCI (PPCI group, n = 90). Myocardial perfusion (myocardial blush grade 3 blood flow) and the occurrence of reperfusion arrhythmia within 24 hours after treatment were compared between the NPCI and PPCI groups. Results:The incidence of myocardial blush grade 3 blood flow in the NPCI group was significantly higher than that in the PPCI group [84.44% (76/90) vs. 68.88% (62/90), χ2 = 6.01, P = 0.01]. There was no significant difference in the total incidence of reperfusion arrhythmia between NPCI and PPCI groups ( χ2 = 1.19, P = 0.27). The incidence of severe reperfusion arrhythmia in the NPCI group was significantly lower than that in the PPCI group [13.33% (12/90) vs. 27.77% (25/90), χ2 = 5.75, P = 0.02]. The influential factor of severe reperfusion arrhythmia was analyzed by logistic regression taking whether NPCI treatment was used as the variable ( OR = 0.40, 95% CI 0.18-0.89, P = 0.02). The other factors that affect severe reperfusion arrhythmia included age ( OR = 0.71, 95% CI 0.19-0.92, P = 0.04), time from onset to reperfusion of infarct related artery ( OR = 0.62, 95% CI 0.21-0.98, P = 0.02), dcuhistory of pre-infarct angina pectoris ( OR = 0.67, 95% CI 0.19-0.98, P = 0.03), admission blood glucose level ( OR = 1.96, 95% CI 1.05-5.78, P = 0.03), admission leukocyte count ( OR = 1.99, 95% CI 1.02-6.18, P = 0.03) and cardiac function ( OR = 1.71, 95% CI 1.06-6.91, P = 0.04). Conclusion:Nicorandil combined with thrombus aspiration during percutaneous coronary intervention for the treatment of acute ST-elevation myocardial infarction can not only improve myocardial perfusion, but also reduce the incidence of reperfusion arrhythmia. The combined therapy is superior to monotherapy, has certain clinical significance and is innovative.

Objective: To investigate the clinical and microbiological characteristics of Myroides odoratimimus producing MUS-1 carbapenemase. Methods: A strain of gram-negative bacterium isolated from the urine sample of one patient hospitalized in the oncology department of Affiliated Hospital of Xuzhou Medical University was identified by the Vitek 2 automatic microbial analyzer and 16S RNA sequencing, and its bla MUS-1 gene was detected with PCR. The minimum inhibitory concentrations (MICs) of antimicrobial drugs were determined by the broth dilution method. Results: One strain of MUS-1 carbapenemase producing Myroides odoratimimus was found. The drug susceptibility test showed that it was resistant to most of antibiotics conventionally used, but sensitive to minocycline and meropenem, the MIC of imipenem was 8 μg/mL, which was judged as intermediate. Conclusion The bla MUS-1 gene may be the cause leading Myroides odoratimimus to resistant carbapenems drugs.