OBJECTIVETo analyze the change in drug resistance of Staphylococcus aureus (SAU) in the PLA general hospital from January 2008 to December 2012, and to provide solid evidence to support the rational use of antibiotics for clinical applications.

METHODSThe SAU strains isolated from clinical samples in the hospital were collected and subjected to the Kirby-Bauer disk diffusion test. The results were assessed based on the 2002 American National Committee for Clinical Laboratory Standards (NCCLS) guidelines.

RESULTSSAU strains were mainly isolated from sputum, urine, blood and wound excreta and distributed in penology, neurology wards, orthopedics and surgery ICU wards. Except for glycopeptide drugs, methicillin-resistant Staphylococcus aureus (MRSA) had a higher drug resistance rate than those of the other drugs and had significantly more resistance than methicillin-sensitive Staphylococcus aureus (MSSA) (P < 0.05). In the dynamic observation of drug resistance, we discovered a gradual increase in drug resistance to fourteen test drugs during the last five years.

CONCLUSIONDrug resistance rate of SAU stayed at a higher level over the last five years; moreover, the detection ratio of MRSA keeps rising year by year. It is crucial for physicians to use antibiotics rationally and monitor the change in drug resistance in a dynamic way.

Anti-Bacterial Agents ; pharmacology ; Drug Resistance, Multiple, Bacterial ; Humans ; Methicillin-Resistant Staphylococcus aureus ; drug effects ; Staphylococcal Infections ; drug therapy ; Staphylococcus aureus ; drug effects

Objective To evaluate the effectiveness of noninvasive positive pressure ventilation(NPPV) as a weaning strategy in patients with acute respiratory failure after failure to wean from invasive positive pressure ventilation(IPPV). Method A prospective randomized and controlled clinical trial of weaning of IPPV was carried out in patients mechanically ventilated in mode of IPPV for more than 48 hours with failure in a spontaneous breathing trial(SBT: PSV 6 cmH_2O). Patients with contraindications to NPPV were excluded. After failure the SBT, patients were randomly divided(random number) in two groups. Patients in NPPV group were extubated after being ventilated with high pressure support for 30 minutes and then placed on NPPV. Patients in IPPV group were weaned following conventional procedure. Arterial blood gases, maximal inspiratory pressure, respiratory rate,tidal volume, rapid shallow breathing index, heart rate, arterial blood pressure, and peripheral oxygen saturation were measured before and after failing the SBT. The rate of complications, including pneumonia and tracheotomy duration mechanical ventilation, days of hospital stay and outcome were observed. Findings of the two groups were vompared using the Student t test and the chi-square test. Results The percentage of complications in the NPPV group was lower(22.9% versus 72.2%, P <0.01) ,with lower incidences of pneumonia(6.1%,36.1%; P <0.01) and tracheotomy. Compared between the two groups, days of ICU stay( 14.16(3.45) d vs. 22.57( 7.71 ) d; P <0.01) and total days of mechanical ventilation(14.88±3.76 days vs. 20.68± 2.79 days, P <0.01) of NPPV group are shorter than IPPV group. Conclusions NPPV is a good alternative to the mechanically venti-lated patients who fail in initial weaning attempts. The key to successful NPPV weaning is the proper selection of weaning candidates and using NPPV as soon as possible after extubation.

Objective To investigate the diagnostic value of the instant gastrointestinal ultrasound contrast agent in the digestive diseases. Methods Five hundred and seventy-nine patients received the examination of the color Doppler after they drinked the ultrasonic contrast agent. Then the results were analyzed by consistency analysis. Results There was high consistency between the two examinations in the normal control, gastritis, peptic ulcer, gastric cancer and gastric leiomyoma. The Kappa value was 0.768, 0.913, 0.925, 0.939 and 1.000, respectively. But the consistency in the gastric polyp was low , the Kappa value was 0.368. Conclusion The color Doppler through the instant gastrointestinal ultrasound contrast agent has high diagnostic value in the common diseases of the digestive system.

OBJECTIVETo establish the steriod-induced osteoporosis model with the type of Kidney-Yin deficiency.

METHODSTotally 45 female Kunming mice were randomly divided into normal group,model group and Liuwei Dihuang pills(Chinese character: see text)group. The model was established by intramuscular injecting of Dexamethasone. Liuwei Dihuang pills (Chinese character: see text) group was administered orally with Liuwei Dihuang pills (Chinese character: see text). The signs and symptoms of mice were observed dynamically. All the animals were sacrificed at the end of the 6th weeks. The level of ACTH, cAMP, cGMP, TSH and E2 in serum were detected to evaluate deficiency of Kidney-Yin. Morphological changes and bone density were observed to evaluate osteoporosis.

RESULTS(1) Compared with control group, mice in model group appeared obvious Kidney-Yin deficiency symptoms, including hair dry, restlessness, excitability, hard stool, and yellow. (2) Compared with control group,the weight of mice in model group gained slower (P<0.01); the index of adrenal gland,liver and spleen decreased (P<0.01, P<0.01 ,P<0.01); the level of ACTH and TSH increased (P<0.01 ,P<0.01), the level of E2 decreased (P<0.01) and the ratio of cAMP/cGMP increased (P< 0.05). (3)Compared with control group,the bone density of lumbar vertebra and femur in model group were significantly decreased (P<0.01, P<0.05); HE staining revealed osteoporosis in model group mice. (4)However, the Liuwei Dihuang pills (Chinese character: see text) group can partly antagonize the inhibition of the HPA axis, alter the disordered sex hormone and the ratio of cAMP/cGMP, and reverse the osteoporosis partly.

CONCLUSIONthe model of osteoporosis with type of Kidney-Yin deficiency could be established by Dexamethasone intramuscular injection. With less interference, it wight be a stable and reliable modeling method for integration of disease and syndrome in TCM.

Animals ; Bone Density ; Dexamethasone ; toxicity ; Disease Models, Animal ; Female ; Kidney Diseases ; etiology ; Medicine, Chinese Traditional ; Mice ; Osteoporosis ; chemically induced ; Yin Deficiency ; complications

Objecfive To investigate the association between the exon 2,3,4 of MHC class Ⅰ chain-related gene-B(MICB)and ulcerative colitis(UC)in Chinese Han.Methods Using polymerase chain reaction single-stranded conformation polymorphism,allele frequency of MICB exon 2,3 and 4 in 105 patients with UC and 213 age and sex matched healthy controls were genotyped.All of the studied individuals were Chinese Han.Results Allele frequency of MICB 0106 was increased in patients with UC as compared with normal controls(19.0%vs 8.9%,P=0.000,Pc＜0.001,OR=2.402,95%CI:1.488-3.879).The frequency of MICB 0106 was increased significantly in patients with extensive colitis (24.4%vs 8.9%,P=0.000,Pc＜0.001,OR=3.294,95%CI:1.800-6.027),moderate and severe disease(24.1%vs 8.9%,P=0.000.Pc＜0.001,OR=3.294 95%CI:1.893-5.576)and in those with extra intestinal manifestations(20.5%vs 8.9%,P=0.002,Pc=0.012,OR=2.626,95%CI:1.418-4.861).Furthermore,MICB 0106 allele was higher in frequency in the male patients with UC (22.1%vs 8.0%,P=0.001,Pc=0.006,OR=3.276,95%CI:1.737-6.178)and the patients more than 40 years old(28.8%vs 8.3%,P=0.000,Pc＜0.001,OR=4.500,95%CI:2.381-8.504)as compared with healthy controls.Conclusion MICB 0106 allele is positively associated with UC,especially with extensive colitis,moderate and severe disease,presence of extra intestinal manifestations,male gender and age of more than 40 years in Chinese Han in Hubei province.

Objective To investigate the effect of transplantation of bone marrow mesenchymal stem cells (MSCs) in subarachnoid space on chronic neuropathic pain in rats. Methods One hundred and forty female SD rats weighing 180-200 g were used in this study. Chronic neuropathic pain (NP) was induced by ligation and separation of tibial and common fibular nerves (SNI). Two weeks after the surgery the animals were randomly divided into4 groups (n=35 each):group Ⅰ NP; group Ⅱ NP+ MSC (MSCs); group Ⅲ NP+ phosphate buffer saline (PBS) and group Ⅳ NP+ bone marrow monocyte (BNMCs). MSCs 10 μl, PBS 10 μl and BNMCs 10 μl were injected into subaraclmoid space at 2 weeks after surgery in group Ⅱ , Ⅲ and Ⅳ respectively. Paw withdrawal threshold to yon Frey filament stimulation (PWT) was measured before surgery (T0, baseline), at 2 weeks after surgery (T1) and 1, 2, 3, 4 and 5 weeks after subarachnoid injection (T2-6). Five animals were killed at T1-6 in each group and their lumbar enlargements were removed for determination of BDNF mRNA expression. Results PWT was significantly decreased by SNI at T1 in all 4 groups, and at T2-6 in group Ⅰ , Ⅲ and Ⅳ as compared with the baseline at T0 (P ＜ 0.05). Subarachnoid MSC transplantation significantly reduced mechanical hyperalgesia at T2-6 and up-regulated BDNF mRNA expression at T2-4 as compared with that at T1 (P ＜0.05). There was no significant change in PWT and BDNF mRNA expression after subarachnoid PBS and BNMCs injection in group Ⅲ and Ⅳ (P ＞ 0.05). Compared with group Ⅰ , PWT was significantly increased and BDNF mRNA expression was up-regulated in group Ⅱ (P ＜ 0.05), but no significant change in PBS and BNMCs was found in group Ⅲ (P ＞ 0.05) .Conclusion Up-regulation of BDNF mRNA expression in the spinal cord may be involved in the amelioration of chronic neuropathic pain by subarachnoid bone marrow mesenchymal stem cell transplantation.

Objective To evaluate the role of emergency and staged hepatectomy in peritoneal metastasis associated with ruptured hemorrhage of resectable hepatocellular carcinoma (HCC) patients,and investigate the impact of surgery timing-selecting on peritoneal metastasis of postoperative HCC patients.Methods A retrospective analysis was conduct on the pooled data from 38 HCC patients with spontaneously ruptured hemorrhage treated in our hospital from August 2011 to January 2016.These patients were divided into emergency group who underwent hepatectomy within 24 hours at admission,and staged group who underwent the procedure one week after admission.Perioperative events,overall survival (OS) and disease-freesurvival (DFS) rates,incidence of recurrent and metastatic disease were compared between the two groups.Results The perioperative blood loss and transfusion were much more in emergency group than staged group (both P ＜ 0.05).Nevertheless,the incidence of postoperative mortality was not significantly different (6.0％ vs 0％,P ＞ 0.05).The median survival was 22.5 months in emergency group versus 14.2 months in staged group.The 6-month,1-year,3-year OS rates in emergency group were 88.2％,82.4％ and 30.3％ respectively,and 6-month,1-year,3-year DFS rates were 81.3％,54.7％ and 27.3％.The 1-year OS and 6-month DFS rates were higher than those of staged group (both P ＜ 0.05).The incidence of peritoneal metastasis in staged group was higher than that in emergency group,but it was not significantly different (38.1％ vs 29.4％,P ＞ 0.05).Univariate and multivariate analysis indicated that tumor diameter ≥ 10 cm and AFP ＞ 10 000 μg/L were the risk factors for peritoneal metastasis after hepatectomy for HCC patients with spontaneously ruptured hemorrhage.Conclusions Emergency hepatectomy would warrant a better short-term prognosis compared with staged hepatectomy for the HCC patients with spontaneously ruptured hemorrhage.Staged hepatectomy would not raise the possibility of postoperative peritoneal metastasis.The predictors of tumor diameter ≥ 10 cm and AFP ＞ 10 000 μg/L were risk factors for peritoneal metastasis after hepatectomy for spontaneously ruptured HCC patients.

Objective:To explore CT and MRI features of the endolymphatic sac tumor (ELST).Methods:The CT and MRI morphology confirmed by surgical pathology for 19 patients with ELST were retrospectively analyzed from June 2011 to May 2019 in Eye & ENT Hospital of Fudan University. The features of CT and MRI included location, size, adjacent structures invasion, CT values, bone destruction, features of T 1WI and T 2WI, enhancement distribution characteristics, dynamic enhancement curve morphology, DWI signal characteristics. The ADC values of the lesions and ipsilateral medial pterygoid muscles were compared using a paired t test. Results:Nineteen ELST patients (one with bilateral diseases) were included. Totally 20 ears (right 9 and left 11) of 13 females and 6 males were studied. The masses with slightly high-density and obscure boundary were located around the vestibular aqueduct at the posterior edge of the petrosal bone. Bone destruction involved mastoid process of the middle ear (16 ears), jugular foramen (11 ears), semicircular canal (10 ears), facial nerve canal (7 ears) and internal auditory canal (9 ears). A large amount of residual bone could be found in the interior of nineteen masses. The CT value was (78.6±21.9) HU. The lesion showed central iso-intensity and peripheral hyperintensity on T 1WI and T 2WI in 16 ears, while no obvious hyperintensity on T 1WI in the other 4 ears. The hyperintensity on T 1WI was around the margin of the lesion in 10 ears, situated at lateral side in 5 ears and all over the lesion in 1 ear. Flow voids signals could be seen in 9 ears as well. Liquid-liquid plane was seen on T 2WI in 2 ears. The solid mass portion which showed iso-intensity on both T 1WI and T 2WI presented marked enhancement on contrast-enhanced T 1WI, while other part of the mass no enhancement. DWI of 14 ears illustrates no evidence of restricted diffusion, and the ADC value [(1.25±0.08)×10 -3 mm 2/s] was slightly higher than that of the medial pterygoid muscles ( t=4.437, P=0.001). The style of time-signal intensity curves of the dynamic contrast-enhanced MRI was rapidly ascending followed by descending curves in 2 ears. Conclusion:Imaging findings of ELST have some characteristics, including located around the vestibular aqueduct at the posterior edge of the petrosal bone, bone destruction, peripheral hyperintensity on T 1WI and no restricted diffusion, which is helpful for its diagnosis.

OBJECTIVETo investigate the effects of atorvastatin on C-reactive protein (CRP) induced Toll-Like receptor 4 (TLR4)expression on CD14+ monocyte, and the production of proinflammatory cytokines tumor necrosis factor alpha (TNFalpha), interleukin-6 (IL-6), matrix metalloproteinases-9 (MMP-9), and to study the anti-inflammatory mechanisms of statins.

METHODSThe monocytes were isolated from blood of healthy volunteers by the Ficoll density gradient and stimulated by CRP with different doses (5, 25, 50, 100 microg/ml) and different exposure time (6, 12, 24, 48 h). Cells were also incubated with atorvastatin of different doses (1.0, 2.5, 5.0, 7.5, 10.0 micromol/L) in the presence of CRP 50 microg/ml. The protein expression of TLR4 was measured by flow cytometry, mRNA expression of TLR4 and of myeloid differentiation protein (MD2)was detected by quantitative PCR. TNFalpha, IL-6, MMP-9 concentrations in supernatants of cultured medium were measured by ELISA.

RESULTS(1) Compared with the un-stimulated control group, enhanced TLR4 protein expression was already detected at a concentration of 5 microg/ml of CRP and increased in a dose-dependent manner (32.22 +/- 2.80)%, (49.94 +/- 5.58)%, (74.82 +/- 3.24)% and (90.82 +/-2.88)% at 5, 25, 50 and 100 microg/ml CRP. (2) TLR4 protein expression on 50 microg/ml CRP stimulated cells also increased in a time-dependent manner (29.80 +/- 2.70)%, (47.44 +/- 4.41)%, (81.71 +/- 2.92)% and (50.57 +/- 3.34)% after 6 h, 12 h, 24 h, 48 h. (3) When monocytes were incubated with CRP 50 microg/ml and atorvastatin (1.0, 2.5, 5.0, 7.5, 10.0 micromol/L), protein expression [(68.17 +/- 1.71)%, (52.43 +/- 1.38)%, (27.72 +/- 4.55)%, (17.46 +/- 3.20)%, (9.99 +/- 2.81)%] and mRNA expression (82.72%, 67.34%, 48.16%, 30.88%, 13.85%) of TLR4 as well as mRNA expression of MD2 (81.78%, 71.04%, 47.85%, 27.06%, 18.30%) were reduced in a dose-dependent manner. (4) Level of TNFalpha, IL-6 and MMP-9 in supernatants was significantly reduced by atorvastatin (2.5 micromol/L) compared with control group (P < 0.01). When monocyte incubated with CRP 50 microg/ml and atorvastatin 10.0 micromol/L, the level of TNFalpha, IL-6, MMP-9 decreased to (25.8 +/- 2.5) microg/ml, (128.2 +/- 14.7) pg/ml, (65.2 +/- 12.3) ng/ml, respectively.

CONCLUSIONCRP increased the protein expression of TLR4 on CD14+ monocyte in a dose-dependent and time-dependent manner. Atorvastatin can inhibit the signal transduction of TLR4 and reduce proinflammatory cytokines release induced by CRP on CD14 monocyte, and this might be one of the anti-inflammatory mechanisms of atorvastatin.

Anti-Inflammatory Agents ; pharmacology ; Atorvastatin Calcium ; C-Reactive Protein ; metabolism ; Cells, Cultured ; Heptanoic Acids ; pharmacology ; Humans ; Lipopolysaccharide Receptors ; Monocytes ; drug effects ; metabolism ; Pyrroles ; pharmacology ; Toll-Like Receptor 4 ; metabolism

The gene of mutated TNF-?D4 gene was amplified by overlap PCR and cloned into the prokaryotic expressive vector pBV220.TNF-?D4 contains two changes:substitutions of Pro8Arg,Ser9Lys,Asp10Arg,Ile157Phe,Leu29Ser,Arg31Val and a deletion of the N terminal four amino acids.The recombinant vector pBV220-TNF-?D4 was transformated into E.coli strain DH5?,and the high expression strain was obtained by screening monoclones.The level of expression was about 45% of total cell protein.After purification,the purity of fusion protein was above 90% by HPLC and relative ability was 8 ?107.TNF-?D4 was modificated by mPEG-ButyrALD。After purification,the purity of mPEG-TNF-?D4 was above 85% and relative ability was 8.6?107.The in vivo systemic toxicity of mPEG-TNF-?D4,which is indicated by LD50,is lower than that of rhTNF-?.These results strongly supported for the further study and exploitation of TNF-antitumor drug.