Objective To compare the clinical efficacy of different trough concentrations of vancomycin in patients.Methods A retrospective study in patients having at least one trough concentration of vancomycin for enrollment between January 2009 and December 2013 was carried out.The eligibility patients were divided into 3 groups according to the level of trough concentrations namely group A (＜ 10 mg/L),Group B (10 ～ 15 mg/L),and Group C (＞ 15 mg/L).The clinical efficacy,clearance of pathogens and in-hospital mortality were analyzed with the help of SPSS Statistics 17.0.The comparison of dosing days,length of hospital stay and time consumed from initial dosing to the appearance of recovery signs of survivors among the 3 groups.Results There were no significant difference among 3 groups in terms of clinical efficacy (55.6％ vs.33.3％ vs.51.7％),clearance of pathogens (38.9％ vs.25％ vs.24.1％) and in-hospital mortality (44.4％ vs.25％ vs.27.6％).After adjusting by age,the in-hospital mortality decreased along with the trough concentrations vancomycin.Along with increase in the trough concentrations vancomycin,the dosing day (14.90 ± 6.44 vs.18.75 ± 7.23 vs.17.93 ± 9.42) and length of hospitalization [(33.70 ± 18.17) vs.(79 ±45.53) vs.(66.20 ±52.48)] increased,and time required from dosageinitial dosing to the appearance of recovery signs of survivors among the 3 groups [(4.82 ± 2.62) vs.(3.75 ± 0.50) vs.(4.07 ± 3.20)] shortened.Conclusions Improving the trough concentrations of vancomycin could not increase clinical efficacy rate or bacterial clearance rate,but could lower in-hospital mortality.However,it might enhance the financial burden on patients as well.

AIM:To observe the efficacy and safety of ropivacaine supplemented with midazolam for sacral block in pediatric operation.METHODS:40 cases of patients aged 1-6 years old,who were going to be operated in hypogastrium,perineum and lower limb,were randomly and double-blindly divided into four groups with ten cases each:control group(bupivacaine 2.5 mg/kg),low dosage group(ropivacaine 2.5 mg/kg),middle dosage group(ropivacaine 3.5 mg/kg)and high dosage group(ropivacaine 5.0 mg/kg).Sacral block was performed after induction of inhalation anaesthesia with sevoflurane.Sedation was induced by midazolam(0.2 mg/kg)administered through mainline 5 min before the surgical procedure.RESULTS:In a certain dosage range,ropivacaine supplemented with midazolam anesthesia for sacral block showed a slight influence on diastolic blood pressure,mean arterial pressure,heart rate and pulse oxygen saturation.Those parameters remained in the physiological normal range,though they dropped slightly during the operative period.Compared with bupivacaine group,the postoperative analgesic period was similar in the high and middle ropivacaine groups,while it was shorter in low ropivacaine group.There was no significant adverse effect in all groups except for operative stretch reflex and postoperative vomiting in individual patients.CONCLUSION:Ropivacaine supplemented with midazolam anesthesia for sacral block has a slight influence on hemodynamics,prolongs the postoperative analgesic period,and shows less adverse effect.

Objective:To explore the histogenesis and differentiation of dermatofibroma (DF) and dermatofibrosarcoma protuberans (DFSP). Methods: Clinical information and microscopic characteristics of 26 cases of DF and 26 cases of DFSP were investigated. The immunohistochemical study was performed on microarray sections by a panel of antibodies including FactorⅩⅢa, HLA-DR, CD34, CD14, S-100, MSA, and Ki67. Probe was labeled by in vitro transcription. The mRNA expression levels of TGF-? and bFGF were investigated by in situ hybridization. Results: All cases showed positive for Factor ⅩⅢa,HLA-DR and CD34 to different extent. The medians of positive rates in DF were FactorⅩⅢa 90%, HLA-DR 70%, and CD34 5%, and in DFSP were FactorⅩⅢa 10%, HLA-DR 5%, and CD34 80%. CD14 was positive in 3 cases of DF and 1 case of DFSP. S-100 was positive in 6 cases of DFSP and 2 cases of DF. MSA was positive in 5 cases of DFSP and 3 cases of DF. In all cases, positive rate of Ki67 was less than 5%. The mRNA expression levels of TGF-? was elevated in DF in comparison with DFSP. Conclusion: Both DF and DFSP can differentiate to dendritic cells (DC) in different degree. Considering the character of microscopic features and immunohistochemical phenotype, cells of DF are much similar to mature DC, while those of DFSP much similar to immature dermal reserve cell (DRC). The differences of cell differentiation between DF and DFSP result in different prognosis. DF is a benign tumor, while DFSP a low grade malignant tumor. The different expression of FactorⅩⅢa and CD34 may be helpful to differential diagnosis of DF and DFSP.

Objective To observe the clinical efficacy of point injection at Xialiao point (BL 34) for levator ani syndrome. Methods A hundred levator ani syndrome patients were randomly allocated to a treatment group and a control group, 50 cases each. The treatment group received point injection at Xialiao point (BL 34) and the control group was intervened by biofeedback therapy. The Visual Analogue Scale (VAS), component scores of the MOS 36-item Short-From Health Survey (SF-36), anal resting and squeeze pressures were recorded in the two groups before and after the treatment. The therapeutic effects and therapy costs were compared between the two groups.Results The VAS, component scores of SF-36, anal resting and squeeze pressures were significantly changed after intervention in the two groups (P<0.05). After treatment, the VAS, a part of the SF-36 score [physiological function (PF), body pain (BP), vitality (VT) and social function (SF) scores], anal resting and squeeze pressures in the treatment group were significantly different from that in the control group (P<0.05). The total efficacy rate was 88.0% in the treatment group versus 80.0% in the control group, and the difference was statistically significant (P<0.05). The therapy costs in the treatment group were (327.31±13.42) RMB and (408.45±21.56) RMB in the control group, and the difference was statistically significant (P<0.01).Conclusions Point injection at Xialiao point (BL 34) is an effective method for levator ani syndrome.

Objective To investigate the effects of prostatitis on secretory alterations of urethral glands in rats.Methods Twenty adult Sprague-Dawley rats were randomly divided into prostatitis group and control group.The prostatitis group(n=10) was injected with 0.1 ml Freund's complete adjuvant at each lateral lobe while the control group(n=10) with 0.1 ml 0.9% physiological saline.Two weeks later the rats were killed and the urethral glands were harvested for pathologic examination and immunohistochemical staining.Results ① There was a great quantity of lymphcells and mononuclear cells infiltrating the prostate gland in prostatitis group while there was no inflammatory cells in control group.② AB-PAS pathologic examination results in urethral glands showed that the grume area,diameter,optical density in control group were significantly less than those of the prostatitis group(P

Objective To study the application of modified two-hole laparoscopic cholecystectomy ( LC) for exploring new minimal invasive LC approach. Methods 176 patients with calculous cholecystitis and polypus of cholecyst underwent LC through two abdominal holes. Results 174 gallbladders were removed successfully by modified two-hole LC. The average time of operation was 27.8±7.1minute. The average hospitalized stays of post operation were 2.7±0.8 day. There were two patients whose operation had to be converted to tradition three-hole LC. There were no complication and conversion of open cholecystectomy in all patients. During an average follow-up time of 6 monthw, ranged from 3 to 10month, there were no abdominal pain and jaundice happened to patients. Conclusions The application of modified two-hole LC is a safe and effective LC approach on the basis of skillful perform of traditional three-hole LC. It can reduce the injury to patients and advance the technique of ninimal invasive surgery further.

Objective To investigate the common reasons for intracranial hemorrhage after cranioplasty ,and to analysis the sig‐nificant perioperative factors of intracranial hemorrhage after cranioplsty .Methods Eight hundred and seventy two cases of cranio‐plasty were retrospectively analyzed ;the postoperative intracranial hemorrhage and perioperative risk factors were conducted with multiple linear regression analysis .Results Among the 872 cases ,46 cases suffered intracranial hemorrhage .We found three signifi‐cant perioperative factors of intracranial hemorrhage after cranioplasty :suspension for epidural ,not completely hemostasis and ex‐cessive drainage in ventriculoperitoneal shunt .Conclusion To avoid the three risk factors as far as possible could effectively reduce the incidence of intracranial hemorrhage after cranioplasty .

Objective To investigate the application of sympathetic skin response (SSR) in evaluation of the bladder sensation with fillingcystometry (FC). Methods 15 healthy male adults accepted FC and FC-SSR. Their first desire to void capability (FDC), maximum cystometriccapacity (MCC) and FDC/MCC under FC and FC-SSR were compared. Results The FDC was (193.8±36.9) ml and FDC/MCC was(58.9±8.03) with FC, which was less than (233.9±30.3) ml and (69.4±2.92) respectively with FC-SSR (P<0.01). Conclusion FC-SSR maybe a stable method for examination the function of bladder sensation.

Objective To detect the effect of E6AP on gastric cancer cell proliferation and migration.Methods The expression of E6AP in different gastric cancer cell lines and normal gastric mucosa epithelial cell lines was detected by Western blotting.Gastric cancer cells BGC-823 stably expressing E6AP short hairpan RNA(shRNA) were obtained by lentiviral vector of E6AP.The effect of E6AP on BGC-823 cell growth and migration was determined by CCK-8 kit, Tran-swell and wound healing assay.Results Gastric cancer cell line BGC-823 in which E6AP was stably knocked down was established.Knockdown of E6AP inhibited the proliferation and migration of BGC-823 cells.Conclusion E6AP plays a key role in gastric cancer proliferation and migration.

BACKGROUND:The repair method of proximal humeral comminuted fractures in the elderly remains controversial. OBJECTIVE:To compare the recovery of shoulder joint function using the hemiarthroplasty of shoulder and locking proximal humeral plate fixation for complex proximal humeral fracture in the elderly. METHODS:A total of 22 elderly patients with complex proximal humeral fracture, who were treated from October 2012 to October 2014, were retrospectively analyzed. 12 cases underwent hemiarthroplasty, and 10 cases received locking proximal humeral plate fixation. Al patients were folowed up after treatment. X-ray films were rechecked during the folow-up. The recovery of shoulder function was evaluated with Neer score. RESULTS AND CONCLUSION:During final folow-up, no prosthetic loosening or avascular necrosis of humeral head was found in the shoulder hemiarthroplasty group, and the Neer score was (81±5) points. In the locking proximal humeral plate fixation group, there was fixator loosening in four cases and avascular necrosis of humeral head in three cases, and the Neer score was (69±5) points (P < 0.05). During repair, mean operation time was shorter in the shoulder hemiarthroplasty group than in the locking proximal humeral plate fixation group. The amount of bleeding was higher in the shoulder hemiarthroplasty group than in the locking proximal humeral plate fixation group (P > 0.05). These data suggest that locking proximal humeral plate fixation and shoulder hemiarthroplasty are effective repair methods for complex proximal humerus fractures, but the hemiarthroplasty had the advantage of early functional exercise and good recovery of shoulder joint.