Objective To summarize local experience and skills of using Bard 3DMax mesh with-out fixation in lapamscopic total extraperitoneal inguinal hemioplasty(TEP) to treat patients with inguinal hernia.Methed From August 2006 to December 2007,38 patients suffered in inguinal hernia underwent TEP under general anesthesia,with using Bard 3DMax mesh without ixation.Results Thirty-eight cases had been performed 42 sides TEP.The operating time was 25 to 90 min.The mean operating duration was (35±13) min for unilateral hernia and (58±22) min for bilateral ones.The patients did not need analgesics after operation.The patients stayed time after operation was 1-4 days with the mean of (2.5±1.5) days.Hematnrrms occurred in 2 cases.There was no chronic inguinal pain,foreign body sensation cases and no recurrence after (13.0±5.5) months follow-up.Conclusions Using Bard 3DMax mesh without fixation in lapamscopic TEP can be performed safely and reliably.It also helps to shorten the operating time and reduces the complication rates of the operation.The procedure has advantages of faster postoperative recover,less pain,lower complications and recurrence rate.

Objective To investigate the dynamic changes of platelets (PLT) and white blood cells (WBC) after traumatic brain injury (TBI) and discuss its clinical significance. Methods The number of PLT and WBC were examined in 63 patients with TBI by using cytoanalyze and also analyzed together with Glasgow Outcome Scale and concurrent infection, in the meantime, enzyme-linked immu-nosorbent was used to investigate concentration changes of C reactive protein (CRP) and thrombospondin 1 (TSPI) and analyze the correlation between CRP and TSP1. Results The number of WBC in all pa-tients, whether concurred with infection or not, was significantly increased within 24 hours after TBI (P < 0.01), with no statistical difference between patients without infection at day 4 and normal patients (P >0.05). However, the number of WBC was decreased to below 10 × 109/L in patients without infec-tion, which was significantly higher than that in normal patients (P < 0.05). In patients with infection and unfavorable prognosis, the number of WBC was increased again ay days 7-14, whereas that of PLT rose significantly at days 14-21 (P <0. 01). The concentration of TSPI was positively correlated with that of CRP (r = 0.720, P < 0.01). Conclusions Monitoring the dynamic changes of PLT and WBC is promising. The change of WBC at day 4 post injury is a key indicator to provide evidences of prophylactic antibiotic usage. Much attention should be paid to the dynamic change of PLT at days 14-21 post injury so as to evaluate the condition of hypercoagulability that can be potentially caused by inflammation response. Secondary increase of WBC and later increase, of PLT may affect prognosis of the patients. TSP1 and CRP may participate in thrombosis formation induced by inflammation.

Objective To investigate the drug resistant genes and genotypes of carbapenem-resistant Klebsiella pneumoniae in Tianjin First Center Hospital. Methods A total of 52 strains of carbapenem-non-susceptible Klebsiella pneumoniae were collected from 2012 to 2015. The MICs of antimicrobial drugs were detected using agar dilution methods. Phenotypes of carbapenemases were screened using modified Hodge test. Drug resistant genes were detected by multiplex-PCR assay. Multilocus sequence typing ( MLST) was used to determine the genotypes and homology of these carbapenem-resistant Klebsiella pneumoniae strains. Results Susceptibility of antimicrobial agents indicated that all these strains with multiple drug resistance. The resistance rate to piperacillin/tazobactam, ceftriaxone, ceftazidime, cefepime, aztreonam imipenem,meropenem was 100%( 52/52 ) . The resistance rate of ST11 type to amikacin was 93. 5%( 43/46), ciprofloxacin was 97. 8%(45/46), levofloxacin was 97. 8%(45/46), compound sulfamethoxazole was 17. 4%(8/46), tigecycline was 0. The resistance rate of ST101 type to amikacin was 3/3, ciprofloxacin was 2/3, levofloxacin was 3/3, compound sulfamethoxazole was 3/3, tigecycline was 0. The resistance rate of ST709 type to amikacin was 1/1, ciprofloxacin was 1/1, levofloxacin was 1/1, compound sulfamethoxazole was 1/1, tigecycline was 0. The resistance rate of ST1393 type to amikacin was 1/1, ciprofloxacin was 1/1, levofloxacin was 1/1, compound sulfamethoxazole was 1/1, tigecycline was 0. The resistance rate of ST2068 type to amikacin was 1/1, ciprofloxacin was 1/1, levofloxacin was 1/1, compound sulfamethoxazole was 1/1, tigecycline was 0. PCR results showed that 43 isolates were blaKPC-2 positive and 5 isolates were blaOXA-48 positive, 1 isolate was blaDNM-1 positive. There were 46 strains of ST11 type. The 43 strains of Klebsiella pneumoniae producing KPC-2 type carbapenemase were all ST11. While among 5 strains of Klebsiella pneumoniae carrying OXA-48 carbapenem resistant gene, 3 strains were ST101, 1 was ST709, 1 was ST1393. One strain of Klebsiella pneumoniae harboring DNM-1 type carbapenemase was ST2068. Conclusions Drug resistant genes of carbapenem-resistant Klebsiella pneumoniae were KPC-2 dominant, OXA-48 and DNM-1 were sporadical;the genotype was mainly ST11 by MLST in the hospital. The research provided effective basic and reference for the hospital infection t control.

Objective The expression of agr and sigB regulation system in Staphylococcus aureus with different infection types were assessed by analyzing the characteristics of m /z value generated by MALDI-TOF-MS.Methods A total of 50 isolates with specific genotypes were collected from Tianjin First Center Hospital during Jun 2013 to Feb 2014 for retrospective study .The pattern profiles of these isolates were obtained by MALDI-TOF-MS with RUO model, and the m/z value was also analysed to evaluate the expression the agr and sigB regulation system .The phylogenetic tree based on mass spectrum peak feature was constructed using SARAMIS software .Results A total of 50 strains of Staphylococcus aureus were divided into two groups: acute infection and chronic persistent and recurrent infection .The expression of delta toxin in acute infection and in chronic infection was 99.2 ±4.1 and 60.5 ±10.1 ( t =16.83, P<0.05), respectively.The regulation of stress proteins of sigB system was enhanced in chronic persistent and recurrent infections , and the expression intensities of SAS 030, SAS049 and SA0772 were 27.1 ±14.7, 54.8 ±21.5 and 51.6 ±19.2, respectively; while in acute infections , those were 4.9 ±1.9, 12.4 ±2.8 and 15.7 ±6.9, respectively.The t values between the two groups were -6.88 (P<0.05),-8.98 (P<0.05) and -1.87 (P<0.05), respecitively.The expression of phenol-soluble modulins (PSMs) was inconsistent , and the relative strength of PSMα3 was 100%in the colony variants small strains .Conclusions Different types of the Staphylococcus aureus infections could be evaluated through the assessment of the agr and sigB regulation system .The m/z value obtained by MALDI-TOF mass spectrometry is a marker for the expression of agr and sigB regulation system .The application of this technology needs further development .

OBJECTIVETo explore the therapeutic effect of grain-sized moxibustion at "Xinshu" (BL 15) and "Shenshu" (BL 23) on early-stage Alzheimer's disease (AD) in transgenosis AD mice.

METHODSThe genotyping of amyloid precursor protein/presenilin 1(APP/PS1I) double-transgenic AD mice were detected by PCR method. Seventeen 1.5-month female transgenic (Tg 6799) mice were randomly divided into a model group (9 cases) and a treatment group (8 cases). Nine female C57BL/6J wild-type mice with identical age and background were selected into a normal group. The treatment group was treated with grain-sized moxibustion at bilateral "Xinshu" (BI. 15) and "Shenshu" (BL 23), once a day, ten treatments were considered as one course, and total 9 courses were given. The model group and normal group were treated with stimulus such as grabbing, immobilization and non-ignited moxa cone. Morris water maze (escape latency, crossing times and dwell time in the target quadrant) was applied to evaluate the learning and memory ability. Hematoxylin-Eosin (HE) staining was used to observe morphology changes in the brains of AD mice. beta-amyloid protein 1-42 (Abeta(1-42)) in the area of prefrontal cortex and hippocampus was detected by immunohistochemical method.

RESULTSAfter the treatment of grain-sized moxibustion, learning and memory ability in the treatment group was increased; compared with the model group, the escape latency was shorten, crossing times was increased, and dwell time in the target quadrant was prolonged (all P<0. 05). The crossing times and dwell time in the target quadrant in the treatment group were not significantly different from those in the normal group (both P>0.05). Compared with the normal group, the positive area and integral optical density of Abeta(1-42) in prefrontal cortex and hippocampus in the model group were increased (all P<0.01). Compared with the model group, the positive area and integral optical density of Abeta(1-42) in prefrontal cortex and hippocampus in the treatment group were reduced (P<0.01, P<0.05).

CONCLUSIONThe grain-sized moxibustion at "Xinshu" (BL 15) and "Shenshu" (BL 23) could significantly improve the learning and memory ability in APP/PS1 double- transgenic AD mice, and inhibit the over expression and accumulation of Abeta(1-42).

Alzheimer Disease ; genetics ; metabolism ; psychology ; therapy ; Amyloid beta-Peptides ; genetics ; metabolism ; Animals ; Disease Models, Animal ; Female ; Hippocampus ; metabolism ; Humans ; Learning ; Male ; Memory ; Mice ; Mice, Inbred C57BL ; Mice, Transgenic ; Moxibustion ; Peptide Fragments ; genetics ; metabolism ; Prefrontal Cortex ; metabolism

Objective To evaluate the method of PSM-mec detection by Vitek MS for nosocomialacquired methicillin-resistant Staphylococcus aureus (MRSA) identification.Methods Totally 167 isolates of MRSA and 100 isolates of methicillin-sensitive Staphylococcus aureus (MSSA) used in this research were non-repetitively and prospectively collected between June 2012 and December 2013,two different SCCmec genotyping methods were applied for the MRSA strains,Vitek MS was used for identification of the isolates,the acquisition mass-spectrogram and the result mass-spectrogram at Myla system were analyzed among the different SCCmec type of MRSA.Results The 167 isolates of MRSA were classified into 5 major SCCmec types,among which SCCmec Ⅰ accounting for 3.6％ (6 isolates);SCCmec Ⅱ 6.0％ (10 isolates);SCCmec Ⅲ and Ⅲa 84.4％ (141 isolates);SCCmec Ⅳand Ⅳ a 4.8％ (8 isolates);SCCmec Ⅴ 1.2％ (2 isolates),respectively.The peak adjacent to the horizontal axis of a m/z 2 500 could be visually identified between the SCCmec Ⅱ and Ⅲ MRSA,of which the delta toxin peak were presented at m/z 3 005-3 009 or m/z 3 037-3 056,while the strains without delta toxin peak and the other types of MRSA or MSSA had no characteristic peak at the same position.Conclusions Nosocomial-acquired MRSA of the drug-resistant condition could be rapidly differentiated and forecasted by Vitek MS.Vitek MS could serve as a routine clinical assistance for epidemiological investigations of nosocomial-acquired MRSA in local area.

BACKGROUND:Lysophosphatidic acid (LPA) had 3 kinds of receptors in vitro. Some researches had showed that LPA1, LPA2 and LPA3 receptors distributed widely in mouse cerebral cortex, nephritic external medulla layer and internal medulla layer, spermary, thymus, heart, lung, stomach, spleen, whereas less in liver, small intestine and skeletal muscles. Whether there are various LPA receptors in mouse VSMC membrane deserves further study.OBJECTIVE: To observe the mRNA expression of LPA receptors in vascular smooth muscle cells (VSMC).DESIGN: Observational comparative experiment.SETTING: Tongji Medical College, Huazhong University of Science and Technology.MATERIALS: A total of 24 C57BL/6 mice aged 7-8 weeks, of either sex, with the body mass of approximately (25±3) g,were purchased from the Animal Department of Tongji Medical College, Huazhong University of Science and Technology. Trizol was purchased from America Invitrogen; dNTP Mix, Rnasin were obtained from TaKaRa; M-MLV reverse transcriptase and buffer system were from Promega; Taq DNA-polymerase and buffer system were from Biostar.Oligo(dT)18 primer were from Sangon, Shanghai. Primer sequences were designed referring to literature and nucleotide sequence database and synthesized by Sangon, Shanghai.METHODS: The experiment was conducted at the Comprehensive Laboratory, Tongji Medical College, Huazhong University of Science and Technology between August 2005 and January 2006. Mice were anaesthetized by abdominal cavity with 20 g/L ketamine (5 mL/kg). Thoracic aorta was obtained sterilely, and VSMC was cultured with adherence method. The 4th-6th passage cells were used in the trial. Cell purity was over 95%. Reverse transcriptase-polymerase chain reaction (RT-PCR) was applied to determine the mRNA expression of LPA receptors gene in mouse VSMC.MAIN OUTCOME MEASURES: Detection of mRNA expression of LPA receptors in mouse VSMC and comparison of receptor types.RESULTS: There were no significant differences between the expressions of LPA1 receptors and LPA2 receptors (P ＞ 0.05). Compared with LPA1 receptors and LPA2 receptors (0.79±0.05,0.82±0.06), the LPA3 receptor expression was lower (0.53±0.05, q =23.78,26.53, P＜ 0.01 ).CONCLUSION: There are 3 kinds of LPA receptors in VSMC, and their molecular masses are 600 bp, 463 bp and 899 bp,respectively. There are no differences for the expressions between LPA1 receptors and LPA2 receptors, while the LPA3 receptor expression is less.

Objective To compare the diagnostic efficacy and complications of transperineal prostate biopsy for<10 cores biopsy vs≥10 cores biopsy. Methods Nine hundred transrectal ul-trasound-guided transperineal prostate biopsies were performed. Patients were divided into 2 groups, <10 cores group and ≥10 cores group. Patient numbers of the 2 groups were 759 and 141, respec-tively. Cancer positive rate and complications were compared between the 2 groups retrospectively. Results Cancer positive rates were 41.6%(316/759) and 51.8%(73/141) in 2 groups (P<0.05). In patients of PSA≤10.0 ng/ml, cancer positive rates were 6.8% (16/235) and 17.8% (8/45) in 2 groups (P<0.05). Gross hematuria was the most common complication associated with biopsy. There was no statistical difference between the 2 groups in post-biopsy gross hematuria rate. Conclu-sions The diagnostic efficacy is higher in≥10 cores prostate biopsy than that in <10 cores prostate biopsy, There is no difference in biopsy related complications regarding biopsy core numbers.

Objective Myofascial pain syndrome (MPS) is a common muscle function disturbance.This study was to investigate the clinical value of acoustic radiation force impulse (ARFI) imaging in assessing the therapeutic effect of acupuncture for patients with trapezius MPS.Methods A total of 116 patients diagnosed with trapezius MPS received acupuncture therapy once a day for 10 days in Pudong Hospital from August 2015 to June 2016.Using ARFI imaging, we recorded the shear wave velocity (SWV) of the trapezius and obtained the short-form McGill Pain Questionnaire (SF-MPQ) scores of the patients before, at the end of, and at 7, 15 and 30 days after treatment.Then, we analyzed the interaction and correlation between the SWV values and SF-MPQ scores of the patients at different time points.Results Both the SF-MPQ scores and SWV values were first decreased, falling to lowest values (5.19 points and 1.43 m/s) at 7 days after treatment, and then increased again.The interaction between the SF-MPQ scores and SWV values were significantly different at different time points (Finteraction=2.553, Pinteraction=0.038), and there was a strong linear correlation between the two indexes (r=0.755, P=0.000).Conclusion ARFI imaging combined with SF-MPQ has a certain clinical value in assessing the effect of acupuncture on trapezius MPS.

Objective: To investigate whether grain-sized moxibustion at Xinshu (BL15) and Shenshu (BL23) can alleviate cognitive decline and other pathologic features in early-stage Alzheimer disease (AD) using transgenic mice with 5 familial AD mutations (5XFAD). Methods: The genotype of transgenic mice was detected by polymerase chain reaction. A total of 40 transgenic mice (1.5 months old) were randomly and equally allocated to an AD model group (5XFAD group) or a grain-sized moxibustion group (5XFAD + GM group), with 20 wild-type (WT) mice (C57BL/6J) serving as the normal control group (WT group). Mice in the 5XFAD + GM group were treated by grain-sized moxibustion at bilateral Xinshu (BL15) and Shenshu (BL23). Mice in the WT group and 5XFAD group received no treatment but were restrained to ensure exposure to a similar experimental condition. Cognitive function and memory were assessed with the Morris water maze and Y-maze tests. The amyloid β 40 (Aβ40) and amyloid β 42 (Aβ42) levels in the brain were evaluated by enzyme-linked immunosorbent assay; amyloid plaque deposition in brain tissue sections was detected by thioflavin-S staining; the expression of glial fibrillary acidic protein (GFAP), cluster of differentiation 11b (CD11b), brain-derived neurotrophic factor (BDNF), and choline acetyltransferase (ChAT) in the hippocampus and prefrontal cortex was analyzed by immunohistochemistry. Results: In the Morris water maze test, compared with the 5XFAD group, mice in the 5XFAD + GM group had a shorter escape latency and more target area crossings and spent more time in the target quadrant (P<0.05). In the Y-maze test, compared with the 5XFAD group, the number of training times of the 5XFAD + GM group was significantly decreased (P<0.05), together with more correct responses (P<0.05). Compared with the 5XFAD group, the levels of Aβ40 and Aβ42 in the brain tissue of the 5XFAD + GM group were significantly lower (P<0.05); in the hippocampus and prefrontal cortex, the total number of amyloid β plaque deposition were significantly lower (P<0.05); the expression levels of GFAP and CD11b were significantly reduced (P<0.05); and the expression levels of ChAT and BDNF were significantly increased (P<0.05).Conclusion: Grain-sized moxibustion at Xinshu (BL15) and Shenshu (BL23) greatly improves learning and memory functions, decreases the levels of Aβ40 and Aβ42, inhibits amyloid β plaque deposition, decreases the expression of GFAP and CD11b, and increases the expression of ChAT and BDNF in AD mice to inhibit the progression of AD.