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.

Objective To investigate the difficulty, safety and clinical efficacy of the pterional approach from the side of open A2 plane vs the approach from the side of closed A2 plane for anterosuperior-pointing anterior communicat?ing artery aneurysms (ACoAA). Methods Forty-two patients with anterosuperior-pointing ACoAA treated by microsurgi?cal clipping were divided into two groups of the approach from the side of open A2 plane (n=22) and the approach from the side of closed A2 plane (n=20). Primary objective endpoints were rates of gyrus rectus aspiration, displacement of the ipsilateral A2 and surgical-related complications, clipping results, incidence of cognitive function impairment and Glasgow Outcome Scale (GOS) at 6 months after treatment. Results The incidence of gyrus rectus aspiration and dis?placement of the ipsilateral A2, cognitive impairment at 6 months after treatment and the surgical-related complications was also significant lower in the approach from the side of open A2 plane than in the approach from the side of closed A2 plane [4(18.2%) cases vs. 11(55.0%) cases, χ2=6.185, P<0.05;4(18.2%) cases vs. 10(50.0%) cases, χ2=4.773, P<0.05;1 (4.5%) case vs. 7(35.0%) cases, χ2=4.481 P<0.05]. There were no significant differences in postoperative clipping results and GOS at 6 months after treatment between two approaches (P>0.05). Conclusions The pterional approach from the side of open A2 plane in patients with anterosuperior-pointing ACoAA allows the aneurysmal necks to be secured safely, decreases operation difficulty and prevents surgical-related complications.

Objective To investigate the levels and clinical value of the peripheral blood CD154 and CD4+CD25+FoxP3+ regulatory T cells in patients with ankylosing spondylitis (AS).Methods 20 patients with AS and 20 healthy donors were studied.Flow cytometry was used to analyze the levels of the peripheral blood CD154,CD4+CD25+FoxP3+ regulatory T cells and HLA-B27.And T-test,Spearman correlation analysis were used in statistical analysis.Results The level of the peripheral blood CD154 was significantly higher in AS patients than that in normal controls [(4.38 ± 1.64) ％ vs.(1.92 ± 1.13) ％ (t =5.836,P ＜ 0.05)],and the level of the peripheral blood CD4+CD25+FoxP3+ regulatory T cells was lower in AS patients than that in normal controls [(3.87 ± 1.11) ％ vs.(6.30 ± 1.46) ％ (t =6.254,P ＜ 0.05)].There was negative correlation between the peripheral blood CD154 and CD4+CD25+FoxP3+ regulatory T cells in AS (r =-0.539,P ＜ 0.05).No relationship of the peripheral blood CD154,CD4+CD25+FoxP3+ regulatory T cells with laboratory parameters were found in AS.Conclusion The levels of the peripheral blood CD154 and CD4+CD225+FoxP3+ regulatory T cells in AS are abnormal,and may be involved in the immunological pathogenesis of AS.

Background and purpose:Positron emission tomography-computed tomography (PET/CT) is playing an increasingly important role in the diagnosis, therapy and follow-up of lymphoma patients. This study aimed to explore clinical and pathological features and bone marrow infiltration status in lymphoma patients with diffused high bone marrow glucose uptake on18F-FDG PET/CT.Methods:It was a retrospective study. Bone marrow infiltration status, pathological and clinical data from 62 cases of pathologically diagnosed lymphoma and diffused high bone marrow glucose uptake were analyzed.Results:Distribution of histopathological subtype in those cases was in accordance with that in previously reported Chinese lymphoma patients. Significant difference was demonstrated in standard uptake value (SUV) between pa-tients with aggressive and indolent histopathological subtypes (8.43vs 5.38,P=0.048), patients with and without B symp-toms (8.30vs 5.72,P=0.033), and patients with and without bone marrow infiltration (8.78vs 6.96,P=0.020). 32 patients were diagnosed as “bone marrow infiltration” by bone marrow biopsy. There was significant difference in histopathologi-cal subtype distribution between patients with and without bone marrow infiltration (P=0.001). In patients with bone marrow infiltration, there were higher proportions of mantle cell lymphoma, nodal marginal zone B cell lymphoma, Burkitt’s lym-phoma and anaplastic large cell lymphoma. In contrast, patients without bone marrow infiltration suffered more from diffuse large B-cell lymphoma, peripheral T cell lymphoma, enteropathic T cell lymphoma and extranodal NK/T-cell lymphoma (nasal type). False positive results in bone marrow glucose uptake may be caused by fever or anemia.Conclusion:Diffused high bone marrow glucose uptake on18F-FDG PET/CT should be evaluated in combination with the uptake values, clinical features and histological subtypes, to minimize the misdiagnosis and to better guide staging and therapy of lymphoma.

Objective To detect the expression of T helper 17 (Th17) cells in the peripheral blood of patient with ankylosing spondylitis (AS),and discuss its role in thc pathogenesis of AS.Methods Twenty AS patients and fifteen healthy controls were enrolled in the study.Th17 (IL-17),Th1 (IFN-γ),Th2 (IL-4)cells and HLA-B27 of their peripheral blood were analyzed by flow cytometry,at the same time,the levels of ESR and CRP were also measured in order to analyze thc relation of Th17 and HLA-B27,ESR as well as the CRP level.The statistical analysis was carried out with single-sample t-test and Speraman's correlation test.Results The level of Th17 cells was significantly higher in the perpipheral blood of AS patients[(2.6±0.8 )%] than those in healthy controls[ (1.1±0.4)% ] (P＜0.01).The level of Th 1 cells was significantly lower in the peripheral blood of AS patients[(3.9±0.8)%] than those in healthy controls[(5.1±1.3)%] (P＜0.01)and the level of Th2 cells was not different in the peripheral blood of AS patients[(4.1±1.6)%] when compared to healthy controls[ (3.1±1.4)% ] (P＞0.05).Th 17 cells was not significantly correlated with the percentage and mean fluorescent intensity of HLA-B27,ESR,CRP(P＞0.05); but there was a tendency that increased expression level of Th17 cells was associated with elevated percentage and mean fluorescent intensity of HLA-B27.Conclusion The level of Th1 cells is decreased,but Th17 is increased in the peripheral blood of AS patients.Th cells are imbalance in AS,patients.The change of Th17 cells may be an important part of the pathogenesis of AS.

Objective:To invest the risk factors associated with delayed hemorrhage after pancreaticoduodenectomy occurred.Methods:A retrospective analysis was performed from January 2012 to June 2015 Shengjing hospital 511 cases of patients who accepted pancreaticoduodenectomy.Results:The incidence of PD postoperative delayed hemorrhage was 8.81％ (45/511).Univariate analysis shows:Preoperative bilirubin levels,pancreatic fistula,biliary fistula,postoperative abdominal infection are all the meaningful related factors(P＜0.05).With the application of multivariate logistic regression analysis,pancreatic fistula (OR=2.158) and abdominal infection (OR=3.051) were independent risk factors for postoperative delayed hemorrhages (P＜0.05).Conclusion:Dealing with the postoperative complications of PD like pancreatic fistula,abdominal infection and others,early detection and rapid diagnosis and correct treatment can effectively reduce the incidence of delayed hemorrhage.

Objective To investigate the role and value of interleukin (IL)-17,receptor activator of nuclear factors κB-ligand (RANKL),osteoprotegerin (OPG) in the pathogenesis of AS by detecting the expression of IL-17,RANKL,OPG.Methods IL-17,RANKL,OPG in 44 AS and 15 healthy controls were measured by ELISA.HLA-B27 was measured by flow cytometry.T-test,Spearman's correlation analysis were used for statisical analysis.Results ① Serum IL-17 [(45±12) pg/ml],RANKL [(354±96) pg/ml] levels and RANKL/OPG [(6.5±3.4) pg/ml] ratio were significantly higher in AS patients than those in normal controls (t=11.18,P＜0.05; t=18.66,P＜0.05; t=15.48,P＜0.05),and the serum RANKL levels was higher in AS patients in middle and late period than that in AS patients in early stage (t=47.02,P＜0.05).The serum OPG levels was higher in AS patients in middle and late period than that in AS patients in early stage (t=15.48,P＜0.05).② There were positive linea correletion,respectively,between the serum levels of IL-17 and RANKL (r=0.532,P=O.021),and between serum levels of IL-17 and disease activities of BASDAI (r=0.625,P=0.023),between serum levels of RAN KL and disease activities of BASDAI (r=0.431,P=0.016).Conclusion The surem levels of IL-17 and RANKL are increased in AS patient.

Objective To investigate the correlation between serum level of insulin growth factor 1 (IGF-1) and the degree of liver fibrosis in patients with chronic hepatitis C (CHC) complicated to type 2 diabetes mellitus (T2DM). Methods The cases were divided into CHC with T2DM (39 cases), CHC (96 cases), T2DM (60 cases), and healthy control (60 cases) groups. Their human data were collected and the fasting blood glucose, insulin and insulin-like growth factor-1 levels were detected, and the insulin resistance index ( HOMA-IR) wwer calculated. The serum levels of alanine transaminase ( ALT) , aspartate transaminase ( AST) , hepatitis C virus ( HCV) RNA load and HCV genotypes were detected simultaneously in patients with hepatitis C, and liver stiffness were measured ( LSM) by transient elastography ( TE) and aspartate aminotransferase-to-platelet ratio index ( APRI) score was performed. Results ⑴ There was no significant difference between CHC with T2DM group and CHC group in diabetes family history(P>0. 05), but two groups were significantly lower than that of T2DM group (P<0. 05). ⑵The levels of fasting insu-lin (FI) and HOMA-IR in CHC with T2DM group and T2DM group were significantly higher than those in the other two groups (P<0. 05), while the levels of IGF-1 in two groups were significantly lower than those in the CHC group, and were more lower than the control group (P<0. 05). ⑶Compared the serum ALT, AST and HCV RNA load between CHC with T2DM group and CHC group, there had no significant differ-ence (P>0. 05);however, the proportion of 1b genotype, LSM and APRI score of CHC with T2DM group were significantly higher than those in CHC group(P<0. 05). ⑷ The level of serum IGF-1 was negatively correlated with HOMA-IR, LSM and APRI in CHC with T2DM group (r= -0. 71, -0. 75, -0. 69, P<0. 01). Conclusions The degree of hepatic fibrosis and the damage of IGF-1 synthesis in CHC patients with T2DM were significantly higher than those in non T2DM patients, which might be related to the insulin resistance caused by 1b genotype HCV infection.

OBJECTIVETo explore the anesthetic effects of repeated administration of propofol combined with vitamin C in mice.

METHODSForty mice were subjected to daily intraperitoneal injections of 80 mg/kg propofol (P80 group), 70 mg/kg propofol and 50 mg/kg vitamin C (P70+Vc50 group), 55 mg/kg propofol and 100 mg/kg vitamin C (P55+Vc100 group), or 50 mg/kg propofol and 200 mg/kg vitamin C (P50+Vc200 group) for 6 consecutive days, and the anesthesia induction time and anesthesia duration were recorded.

RESULTSCompared with the P80 group, the mice in P55 + Vc100 group and P50 + Vc200 group showed significantly shorter anesthesia duration on the first 3 days (P<0.05). In all the groups, anesthesia duration was significantly shortened in the following days compared with that on day 1 (P<0.01); anesthesia duration was shorter on day 3 than on day 2 in P50 + Vc200 group (P<0.01), and was shorter on days 4, 5, and 6 than on day 2 in all the groups (P<0.01). In all the groups, the rate of loss of righting reflex (LORR) decreased gradually with time in a similar pattern.

CONCLUSIONVitamin C can reduce the dose of propofol without obviously affecting the anesthetic effect to reduce the incidence of drug tolerance and potential dose-related side effects of propofol.

Anesthesia ; Anesthesia Recovery Period ; Anesthetics, Intravenous ; administration & dosage ; pharmacology ; Animals ; Ascorbic Acid ; administration & dosage ; pharmacology ; Drug Tolerance ; Mice ; Propofol ; administration & dosage ; pharmacology

OBJECTIVETo investigate the expression of matrix metalloproteinase-9 (MMP-9) in the arachnoid membrane around posterior communicating artery aneurysms.

METHODSTwelve patients with posterior communicating artery aneurysms undergoing surgical intervention in our hospital between November, 2010 and November, 2011 were enrolled as the case group along with 6 concurrent patients with severely head trauma or epilepsy as controls. The expression of MMP-9 in the aneurysmal walls and the arachnoid membrane was examined in immunohistochemistry, and HE staining and Sirus red staining were performed to examine the pathological changes.

RESULTSThe perianeurysmal arachnoid membrane showed tissue destruction and disruption of the connections between the membrane and the artery wall with local detachment. Compared with that in the control group, the level of MMP-9 in the arachnoid membrane was significantly higher in the case group (P<0.05), but significantly lower than that in the aneurysm wall within the same sample (P<0.05). No differences were found in the levels of MMP-9 in the aneurysm patients with different ages or Hunt-Hess scale scores.

CONCLUSIONMMP-9 is closely related with the formation of posterior communicating artery aneurysms by causing degradation of extracellular matrix of the vascular wall and the arachnoid membrane.

Adult ; Arachnoid ; metabolism ; pathology ; Case-Control Studies ; Female ; Humans ; Intracranial Aneurysm ; metabolism ; pathology ; Male ; Matrix Metalloproteinase 9 ; metabolism ; Middle Aged