OBJECTIVE To study the classification and distribution of the ?-lactamases produced by Escherichia coli in diabetic patients.METHODS To detect the ?-lactamases produced by E.coli in diabetic patients with a multi-disk synergy test.RESULTS Forty-nine strains of 60 strains in our study produced the ?-lactamases with total positive rate of 81.67%,From them 5 strains were producing penicillinases,17 strains producing BSBLs(28.33%),and 27 strains were producing ESBLs(45.00%),no carbapenem-hydrolyzing ?-lactamases were detected.In 27 strains producing ESBLs,the sensitivities to the ceftazidime,aztreonam and cefotaxime were similar.CONCLUSIONS The types of ?-lactamases produced by E.coli in diabetic patients are mainly BSBLs and ESBLs,without carbapenem-hydrolyzing ?-lactamases;the sensitivities to the ceftazidime,aztreonam and cefotaxime are similar.

Müller cells, as the special radial glial cells in the retina, span the entire retina, contact with neurons, microvessels and processes in the retina and play a significant role in protecting retinal structure and function.Diabetic retinopathy (DR) is a major ocular complication of diabetic patients.In the progression of DR, diabetic macular edema (DME) is the main cause of vision loss.During the occurrence of DME, the morphological and structural changes of Müller cells including severer swelling and vacuolation of cell bodies, increased apoptosis, and abnormal secretion of cytokines, etc.damage the blood-retinal barrier (BRB), increase the permeability of BRB and accelerate the exudation of subretinal fluid.In addition, Müller cells can disrupt the regulation of K + and water transportation, obstruct the fluid absorption in the subretinal space and promote the formation of DME.However, in the early stage of DR, neurotrophic factors secreted by Müller cells can protect the retina by alleviating retinal edema and protecting optic ganglion cells, suggesting that Müller cells can be used as targets for DME treatment.Therefore, new strategies can be provided by fully exploring the role and mechanism of Müller cells in the formation of DME.In this paper, the mechanism of Müller cells in DME and its protective role in the progression of DME were reviewed.

Objective To evaluate the safety and effectively of transfusion plan guided by POTTS in gynecological patients with Hb level ranged from 60 to 100 g/L. Methods 114 gynecological patients with perioperative Hb level ranged from 60 to 100 g/L were randomly divided into POTTS group ( n=57 ) and control group ( n=57 ) . Patients in POTTS group received transfusion under the guidance of POTTS. Patients in control group received transfusion according to doctor's experience. The proportion of injecting RBCs,the amount of RBCs, the incidence of serious complications and mortality,ICU occupancy rate, postoperative Hb recovery, incision healing, hospitalization time, blood transfusion related costs and costs of hospitalization were observed and compared. Results The transfusion rate and volume in POTTS group were significantly lower than the control group ( P<0. 01 ) . Neither severe com-plications nor any mortality were found in each group. The transfusion costs in POTTS group were significantly less than the control group (P<0. 01). Two groups had no postoperative ICU admission;the postoperative Hb recovery, incision healing, hospitalization time and costs of hospitalization in two groups were not statistically significant. Conclusion POTTS could be safety and effectively used in gynecological patients with Hb level ranged from 60 to 100 g/L, also effectively save the blood, reduce the costs of blood transfusion, not increase perioperative mortality and the incidence of various complications.

Digestive diseases, are various types of frequently encounted clinical disorders .at present, diagnosis and differential diagnosis of digestive diseases , in addition to laboratory tests (biochemistry, immunology, cytology and bacterial genetics , etc.), to a large extent still rely on imaging studies.Flow cytometry is a function of the level of single cells or other biological particles for quantitative analysis and sorting means of detection , which can be tens of thousands of high -speed analysis of cells and can simultaneously from a cell a plurality of measured parameters , high speed, high precision, accuracy, etc., become the most advanced cellular quantitative analysis techniques .In recent years, flow cytometry is widely used in the diagnosis and treatment of gastrointestinal cancer , liver cirrhosis, Crohn′s disease, ulcerative colitis and other digestive diseases.

Objective To explore the value and methods of echocardiographic application in percutaneous left atrial appendage(LAA) closure for stroke prevention in patients with nonvalvular atrial fibrillation.Methods 6 male patients with nonvalvular atrial fibrillation were enrolled for percutaneous LAA closure,the mean age was (68.7 ± 5.6) years old,the mean CHADS2 (congestive heart failure,hypertension,age≥75 years,diabetes mellitus,and prior stroke or transient ischemic attacks) score was 3.2 ± 1.0.Rheumatic valvular diseases were excluded by transthoracic eehocardiography(TTE) before closure procedure.Transesophageal echocardiography(TEE) was performed to guide the punctures of the atrial septum and then monitored the operation all through the closure procedure.Diameter of LAA orifice was measure by TEE to help choosing the closure device.Immediate results of closure and complications were inspected by TEE simultaneously.24 hours,7 days,3 months,6 months and 1 year follow-up were performed using TTE.Results All the 6 patients underwent LAA closure successfully.3 LAmbre(Lifetech Scientific,Shenzhen) devices and 3 Watchman(Boston Scientific,Natick,Massachusetts) devices were implanted respectively in the 6 patients.Mean diameter of the LAA orifice was (22.4 ± 3.3)mm,and mean size of the closure devices was (28.0 ± 2.9) mm.2 mm in width residual flow at the inferior edge of closure device existed in 1 ease.No complication was observed.Post-procedure 24 hours and 7 days post-procedure followup showed optimal results in all cases.Conclusions Implantation of both LAA closure devices can be performed with high success rates in patients with nonvalvula ratrial fibrillation,with high risk for stroke,and who either had contraindication or were not willing to accept oral antieoagulation.Echocardiography plays a core role all through the closure procedure and can make it safer and more efficient.

Objective To evaluate the value of diffusion weighted imaging in differential diagnosis of endometrial carcinoma stagedⅠa.Methods A retrospective analysis of 18 patients with endometrial carcinoma staged Ⅰ a which was confirmed by pathology. Other 22 patients with benign endometrial diseases were also enrolled in the study including endometrial hyperplasia in 9,endometrial polyp in 8 and degenerative submucous myoma in 5.DWI with b value of 0 s/mm2 and 1 000 s/mm2 was performed with single shot sequence of EPI,and the ADC values were measured.Results The mean ADC values of endometrial carcinoma staged Ⅰa,endome-trial hyperplasia,endometrial polyp and degenerative submucous myoma were (0.89±0.21)×10 -3 mm2/s,(1.45±0.19)×10 -3 mm2/s, (1.29±0.32)×10 -3 mm2/s and (1.32 ±0.29)× 10 -3 mm2/s,respectively.There were statistical significant differences between them (F =48.021,P =0.00).Furthermore,statistically significant differences also existed between endometrial carcinoma and other groups (P <0.05).Conclusion ADC value shows a good value in differential diagnosis of endometrial carcinoma staged Ⅰa.

Objective:To investigate the relationship between the gene polymorphism cluster of differentiation 14 (CD14)-159C/T (rs2569190),and interleukin-8 (IL-8)-251A/ T (rs4073)and the susceptibility of necrotizing enterocolitis (NEC),to clarify the influencing factors of susceptibility of NEC and to provide genetics theory basis for the research on the pathogenesis of NEC. Methods:Total 28 newborns with NEC and 41 newborns without NEC were selected.The amplification of peripheral blood DNA was conducted by PCR.The genotypic and allelic frequencies of CD14-159C/T and IL-8-251A/T of the patients were detected by Sanger DNA sequencing method. The relationship between them and the susceptibility of NEC was studied.Results:The distribution of genotypic frequencies of CD14-159C/T and IL-8-251A/T was consistent with Hardy-Weinberg equilibrium (P >0.05).There were no significant differences of the allelic and genotypic frequencies of CD14-159C/T,or genotypic frequencies of IL-8-251A/T between two groups (P >0.05).While in NEC group,the T allelic frequency of IL-8-251A/T site was higher than that in control group (χ2 = 4.184, P = 0.041, OR = 2.14, 95% CI: 1.03 - 4.46 ). Conclusion:The polymorphism of CD14-159C/T is irrelevant to the pathogeny of NEC,but T allelic frequency of IL-8-251A/T site might be related to the susceptibility of NEC.So T allele in IL-8-251A/T may be one of the danger factors of NEC.

Objective To investigate the potential change of cellular cholesterol efflux and the functional changes of ABCA1 on macrophages from diabetes animals. Methods High energy diet was given to golden hamster to make animal model of hyperlipidemia. Diabetes was induced by a single intraperitoneal injection of STZ (30 mg/kg). Macrophages were isolated and incubated with apoA-I or 8-br-cAMP in vitro. Cellular cholesterol content was measureal before and after treatment by HPLC. Results Intracellular cholesterol content of diabetic animals was higher than that in high energy diet and normal controls. Expression of ABCA1 mRNA was upregulated in diabetic group after incubation with apoA-I and cAMP. When macrophages were incubated with apoA-I, cholesterol efflux increased with the prolongation of incubation time.The amount of intracellular cholesterol efflux in 3 groups of animals showed the following relationship: diabetic animals exceed high energy diet fed animals, and the latter exceeds normal animals. Conclusion Intracellular lipid efflux depends mainly on the presence of extracellular apoA1 as well as membrane ABCA1 protein. The deposition of cholesterol in the macrophage of diabetic and insulin resistant animals may be related to the characteristic changes of quantity and function of apoA1 in these animals.

Objective To summerize the clinical experience of 23 cases of carotid cavernous fistula(CCF) and discuss the treatment strategy. Methods Retrospectively analyzed 23 patients(11 males and 12 females) of CCF,including 14 patients with Barrow type A,1 with type B,1 with type C and 7 with type D. Results Vascular approach for embolization was undertaken in 20 cases by transarterial access and 2 via venous route while 1 case was given up. Among them,9 cases obtained complete occlusion by simple balloon embolization and 5 were treated by direct occlusion of internal carotid artery. Another 5 cases used NBCA glue for the occlusion,1 case was embolized by gelatin-sponge particulates combined with compression of carotid artery,2 cases were treated by coil embolization of cavernous sinus and 1 case was only managed by carotid compression maneuver. We achieved satisfactory clinical results with 21 patients cured and 2 patients improved. Conclusion Complexity and refractory are the characteristic of CCF,and endovascular treatment should be the major choice of treatment. (J Intervent Radiol,2006,15: 323-326)