Objective To evaluate 5 drug sensitivity tests in detecting carbapenem resistance of KPC-possessing Enterobacteriaceae.Methods Thirty-six Enterobacteriaceae isolates were collected from the First Affiliated Hospital,Cofiege of Medicine,Zhejiang Univeristy,including 32 of Klebsiella pneumoniae,1 of Escherichia coli,1 of Citrobacter freundii,1 of Klebsiella oxytoca,and 1 of Serratia marcescens,and the cacbapenemase producing was confirmed with PCR.Resistance to imipenem,meropenem and ertapenem was determined by agar dilution and disk diffusion tests,that to imipenem and meropehem was determined by ATB with G-5 panel,that to imipenem by BD Phoenix 100 with NMIC-109 panel,and that to imipenem and ertapenem by VITEK 2 Compact with AST-GN13 card.Results The resistance to imipenem determined by ATB,BD Phoenix100,VITEK 2 Compact,agar dilution and disk diffusion tests were 13.9%(5/36),11.1%(4/36),13.9%(5/36),22.2%(8/36)and 69.4%(25/36).ATB,agar dilution and disk diffusion tests reported 22.2%(8/36).55.6%(20/36)and 47.2%(17/36)as resistant to meropenem.VITEK 2 Compact,agar dilution and disk diflusion tests reported 69.4%(25/36),77.8%(28/36)and 88.9%(32/36)as resistant to ertapenem.The MICs of ertapenem determined by VITEK 2 Compact and agar dilution were≥2 μg/mL.Conclusion The sensitivity of agar dilution and agar disk diffusion is higher than other automatic methods in the identification of KPC-mediated carbapenem resistance,and ertapenem is a more sensitive indicator than mempenem and imipenem for screening KPC-possessing isolates.

A 4-year-old girl presented with generalized papules, erythema, desquamation, subcuta-neousnodules around large joints, as well as a 3-year-history of progressive eye damage. Three months after her birth, papules developed on the lower limbs, and gradually spread to involve the whole body. Eye damage appeared after a high fever and she was diagnosed with keratoleukoma, old iritis, and posterior synechia. Physical examination revealed sharply demarcated corneal opacity, shallow anterior chamber, obscure irides, and posterior synechia; pupils were not round. No superficial lymphadenectasis was observed. Dermatological examination showed ichthyosis-like coarse skin with generalized papules, erythema and desquamation, increased wrinkles and absence of sweat. Skin temperature was higher than normal. There were soft, irregu-larly sized, non-tender, movable subcutaneous masses at the wrist, ankle and knee joints without inflamma-tion or warmth. Type-B uitrasonography of both eyes disclosed vitreous opacification, posterior detachment of vitreous, extravasation at the posterior vitreous membrane, and decreased intraocular pressure. Histopathology of lesions on the back, waist, and back of hands as well as subcutaneous nodules on the wrists showed epidermal acanthosis and infiltration with a large number of histiocytes, foam cells and multi-nucleated giant cells in the dermis. No abnormal findings were observed from other examinations. This case was diagnosed as Blau syndrome, which is an autosomal dominant inherited disease; currently, there is no effective therapy for it.

To investigate the effect of Yiqi Huoxue Capsule (YHC) in treating early ventricular remodeling after myocardial infarction.Ninety cases of acute myocardial infarction (AMI) were randomized to two groups: YHC group (A) and placebo group (B). Groups A and B were treated with YHC and placebo respectively on the basis of thrombolytic treatment and/or routine western treatment. Interventricular septum (IVS) thickness, left ventricular posterior wall (LVPW) thickness, left ventricular dimension in end-diastole (LVDd), scoring of local ventricular wall function and left ventricular ejection fraction (LVEF) were observed 1 and 8 weeks after treatment. Eight weeks after treatment, IVS thickness, LVPW thickness and LVDd were increased and scoring of local ventricular wall function was also increased in group B as compared with those one week after treatment;no obvious changes were found in group A and the difference was significant between the two groups (P

Objective To observe the growth inhibition effect of sustained-release fluorouracil implantation in nude mice with human colorectal carcinoma and to discuss its influence on caspase-3 expression .Methods The colorectal carcinoma subcutaneous transplanted model with LoVo cell in BALB/c nude mice was established and divided into 4 groups randomly :the tail intravenous injection of PBS (A group) ,the tail intravenous injection of 5-FU group (B group) ,the intratumor injection of 5-FU group (C group);and the implant of sustained-release fluorouracil group(D group) .After 15 d of medication ,the tumor weight and tumor volume were recorded ,the tumor inhibiting rates were calculated .The tumor tissues were observed by HE staining and detected the expression of caspase-3 by immunohistochemistry (IHC) .Results Sustained-release fluorouracil could suppress the transplantation tumor growth significantly ,the tumor weight and tumor volume in the D group had statistical differences compared with the A ,B and C groups(P<0 .05) ,which could up-regulated the expression of caspase-3 ,the differences between the D group with the A ,B and C groups (P<0 .05) .Conclusion Sustained-release fluorouracil can inhibit the grow th of colorectal carcinoma transplantation tumor more effectively than conventional fluorouracil and up-regulate the expression of caspase-3 ,which prompts that sustained-re-lease fluorouracil may play the anti-tumor role by inducing the tumor cell apoptosis via apoptosis pathway .Its definite tumor-inhibi-ting effect deserves to be promoted in clinical chemotherapy .

ObjectiveTo evaluate the safety and efficacy o f microvascular deco mpression in the management of primary trigeminal neuralgia.Methods We review ed 13 patients with unilateral primary trigeminal neuralgia treated by microvasc ular decompression. Conventional spin-echo (SE) sequence and 3-D fast inflow wit h steady-state precession (3-D-FISP) sequence MRI scans were used preoperatively to find evidence of neurovascular compression. The operation was accessed by re trosigmoidal approach and the nerve root was separated away from pressure vessel s by artificial vascular patch.ResultsDuring operations it w as found that tr igeminal nerves were pressed on by blood vessels in all the cases (by the superi or cerebellar artery in 11 cases; by the basilar artery and the superior cerebel lar artery in 1 case; and by the vein in 1 case). Complete pain relief was achie ved in all the patients without mortality or permanent complications. Eleven pat ients were clinically followed for 6～24 months with a mean of 13 months, and no recurrence was seen. ConclusionsMicrovascular decompression is a safe and effective procedure in the treatment of primary trigeminal neuralgia.

ObjectiveTo evaluate the significance of pirif orm aperture enlarge ment in transsphnoid approach microsurgery for pituitary macroadenomas.MethodsTranssphnoidal approach microsurgery through enlarged pyrifor m aperture was ca rried out in 96 patients with pituitary macroadenoma from March 1997 to October 2000.ResultsAmong the 96 patients, 65 (67 7%) underwent tot al removal of the tumor, 25 (26 0%) underwent subtotal removal (80%～90%), and 6 (6 3%) partial removal (

Recently,increasing cancer researches focus on antibody-drug conjugates(ADCs) which can improve the anti-tumor potency with less adverse effect while benefiting patients in the future. However,safety evaluation of ADCs is a big challenge because of complex components as well as in experience in preclinical studies. In this review,the authors reviewed the mode of action,hazard risks,and toxicity observed in preclinical/clinical studies of ADCs,summarized the preclinical studies of Adcetris(brentuximab vedotin)and Kadcyla(ado-trastuzumab emtansine),and suggested a better strategy of ADCs in preclinical safety evaluation.

Objective To investigate the effect of calpeptin on diaphragmatic injury and atrophy under controlled mechanical ventilation in rats.Methods A total of 24 SPF Sprague-Dawley (SD) rats were randomly divided into anesthetized control group (CON group),24-hour controlled mechanical ventilation group (CMV group),and 24-hour CMV + treatment with calpeptin group (CMVC group),with 8 rats in each group.Animals in the CON group received an intraperitoneal injection of pentobarbital sodium without CMV and continuous infusion of pentobarbital sodium.A small-animal ventilator was used for 24 hours in rats of CMV group.Rats of CMVC were treated with a specific calpain inhibitor calpeptin (4 mg/kg).The drug was injected subcutaneously 2 hours before and 8,15 and 23 hours after mechanical ventilation.Changes in diaphragm ultrastructure,light microscopic picture,and myosin heavy chain (MHC) expression were observed.Results ① Alignment of myofilaments and normal Z-band,and the shape of mitochondria were maintained in CON group as revealed by electron microscope.The signs of misalignment of myofibrils,disruption of Z-band and vacuolar mitochondria were found in CMV group,and they were obviously improved in CMVC group.The density of muscle injury (× 10-2/μm2) in CMV group was significantly higher than that in control group (36.8 ± 13.7 vs.6.4 ± 6.3,t=6.373,P=0.001),and that in CMVC group was significantly lowered (17.6 ± 9.1 vs.36.8 ± 13.7,t=3.694,P=0.002).② In CON group,the diaphragm fibers appeared regular in cross section without pathologic change under light microscopy.Fuzzy muscle striations,irregular muscle fibers,centralized nuclei and swelling of capillary endothelial cells were observed in CMV group,while pathological changes in the CMVC group were milder significantly.③ In CMV group,the density of MHCslow and MHCfast was lower compared with that of CON group,and the gray value was lowered by 61.1％ (t=8.138,P=0.001) and 77.1％ (t=8.844,P=0.001),respectively,especially in MHCfast.However,the gray values of MHCslow and MHCfast were increased by 1.51 folds (t=4.601,P=0.010),and 1.33 folds (t=2.859,P=0.011),respectively,after treatment with calpeptin,and the elevation was more significantly in MHCslow.Conclusions Diaphragmatic injury and atrophy were found after CMV for 24 hour.Calpeptin could reverse the detrimental effects of CMV,and it suggested that calpain plays an important role in modulating the ventilator-induced dysfunction of the diaphragm.

ObjectiveTo evaluation application of MSCTA technology in pre-and pro-liver transplantation.MethodsThirty - two patients with liver transplantation were performed with multi-phase CT scanning (MSCT).In hepatic artery and portal phase vascular 3D imaging reconstruction methods include multiple planar reconstruction ( MPR),maximum intensity projection ( MIP),volume rendering (VR).MIP images were measured with these parameters (CA,LGA,CHA,PHA,PV,SV,SMV in diameter).ResultsHepatic arterial vascular imaging scan can show clearly within the scope of the abdominal aorta,gastroduodenal artery,hepatic artery,the left hepatic,celiac trunk,and its branches.Portal vascular imaging clearly showed that the portal vein system.MIP can use accurate measurement of vascular diameter abdominal aorta and portal,superior mesenteric vein,and splenic vein diameter.Control group with liver cirrhosis and liver cancer artery diameter had no significant difference in patients with portal hypertension and the portal vein [ ( 16.7 ± 2.4 ) mm ],mesenteric vein [ ( 10.8 ± 2.1 ) mm ],and splenic vein diameter [(13.1±1.9)mm] compared to the control group[(13.8 ±1.6)mm,(8.2 ±1.7)mm,(8.9±1.1)mm ],the difference was statistically significant ( P ＜ 0.05 ). Conclusions MSCTA can show the liver artery and portal vein system of the non-invasive method of checking,Joint MIP and VR application can provide more clinical liver transplant before the hepatic artery and portal vein of information,liver transplantation arteriovenous anastomoses provides for the monitoring of vascular diameter.

Objective To study the mechanism of effects of estrogen receptor (ER) on T and B lymphocytes in patients with SLE and synergistic effect of T and B lymphocytes in the pathogenesis of SLE.Methods Real-time fluorescence quantitative PCR was performed to detect the mRNA expressions of ER-α,interleukin 10 (IL-10) and B lymphocyte stimulator (BLyS) in peripheral blood mononuclear cells (PBMCs)from 40 SLE patients and 40 normal human controls. The clinical and laboratory correlation with the levels of these parameters was analyzed. Results A significant increase was observed in the relative expression levels of ER-α, IL-10 and BLyS mRNA in SLE patients compared with the normal human controls (P ＜ 0.05 or 0.01 ), in active SLE patients compared with inactive SLE patients (P ＜ 0.05 or 0.01 ). Additionally, the mRNA expression levels of the 3 parameters were significantly correlated with the presence of renal damage, proteinuria, arthritis, etc. No statistical difference was observed in the mRNA expression levels of these parameters between female and male patients or between female and male normal controls. Conclusions IL-10 and BLyS appear to be correlated with the disease activity and severity of SLE, and ER-α may play an important role in the action mechanism of T and B lymphocytes in SLE.