OBJECTIVE:To investigate the mechanism of imipenem-resistance in clinical isolates of Pseudomonas aeruginos (PA). METHODS: 55 strains of PA had been isolated from sputum specimen in clinic and their drug sensitivity to imipenem was tested by K-B slip diffusion method. Their amount of outer membrane protein OprD2 was analyzed by SDS-PAGE with outer membrane protein profiles. Metallo-?-lactamases (MBLs) was detected by double-disk synergy test (DDST). RESULTS: 36 strains of imipenem-resistant and 19 strains of imipenem-sensitive PA isolated were studied. The amount of OprD2 showed a various degree of reduction in all resistant isolates, and the relative amount of OprD2 in resistant isolates were significantly lower than in sensitive isolates (P

Objective To explore the clinical value of myocardial enzyme on diagnosis of cardiac insufficiency in patients with severe acute pancreatitis (SAP). Methods Fifty patients with SAP were classified as cardiac insufficiency group (n=14) and non-cardiac insufficiency group (n=36). The serum biochemical markers, such as cardiac troponin I (cTnI), myoglobin (MYO), creatine kinase, MB form (CK-MB), lactate dehydrogenase (LDH) and aspartate aminotransferase (AST) were examined in two groups. ROC curve was used to evaluate the diagnostic sensitivity and specificity for cardiac insuffi-ciency using myocardial enzyme. The APACHEⅡscore was also calculated. The relationship between myocardial enzyme and APACHEⅡscore was analyzed in two groups. Results The levels of cTnI, LDH and AST were significantly increased in cardiac insufficiency group than those in non-cardiac insufficiency group (P<0.05). There were no significant differences in MYO and CK-MB between two groups of patients. The area under ROC curve for cTnI was 0.940, with a cut-off value of 0.07μg/L. The sensitivity and specificity of cTnI for diagnosing cardiac insufficiency in patients with SAP were 0.857 and 1.000, respectively. The area under ROC curve for LDH and AST was more than 0.7, with the low sensitivity for LDH (0.571) and the specificity for AST (0.778). The area under ROC curve for MYO and CK-MB was less than 0.7. APACHEⅡscore was positively correlated with cTnI, CK-MB and LDH (r= 0.639, 0.451 and 0.552,respectively, P<0.05). Conclusion The serum cTnI level can be used as the index for the diagnosis of cardiac insufficiency in patients with SAP, and can prefer-ably reflect the severity of SAP.

Objective To investigate the prevention of intestines adhesion about sodium hyaluronic acid in postoperative intestines adhesion.Methods Eighteen cases of adhesive intestine obstruction were done intestinal release or bowel resection.2～4mL sodium hyaluronic acid was put to the wound,anastigmatic and rough surface of peritoneal.Gastrointestinal decompression,anti-infective and infusion were taken after oper-ations.Followed up 8～24 months.Results Obstructive symptoms haven't happened,the effective rate is 100%.Only 2 cases have intermittent abdominal pain without obstruction,the incidence was 11%.Conclu-sion Sodium hylauronic acid is effective to prevent the adhesion of postoperative intestines adhesion,simp-ler use,fewer side-effects and great value to appliance.

Objective To investigate the clinical characteristic and surgical treatment of MGIST. Methods 40 cases MGIST surgical meterials were retrospectively analyzed. Results All cases were used surgery,the situation of the tumor is clear and most of them are not coated clearly. The diameter of the tumor is 5～16cm, in average (8.6±2.4)cm ;no lymph nodes metastasis during the surgery. No serious postoperative complications. Follow-up the pa-tients for 8～68 months, 14 of them died. Conclusion There is no specific characteristic on MGIST clinical perform-ance, pathological examination is the basis for the diagnosis. Surgical resection is the main treatment method.

Objective To evaluate the value of Bolus chase technology for angiography of lower extremity. Methods 12 cases with diabetes foot or leg pain were examined with Bolus chase technology. Results Low extremity artery thrombosis was found in 12 cases. Conclusion Bolus chase technology is better than standard DSA in the display of lower extremity vessel.

Objective To summarize the clinical experience of laparoscopic repair of acute perforation for gastroduodenal ulcer. Methods From June 2003 to December 2007, 13 patients underwent laparoscopic repair of pedorated peptic ulcers. Results Five patients were suffered from pedorated duodenal bulbar ulcer, one patient was suffered from pyloric canal ulcer, and seven patients were suffered from perforated gashie antrum ulcer. The diameter of the perforation was 0. 3-0. 7cm, peritoneal fluid 600-1200ml, the operafive time was 80-180min, only one was shifted to open surgery diagnosed gastric cancer by pathology examination, another twelve laparoscopic operations were successful. Postoperative recovery was smooth, ten surgical incisions were class A healing and two were class B healing, the length of hospitalization were 7-10 days after surgery. With one year followed-up, all deers had healed well by Gastroscopy, we hadn't found reperforation, abdominal infection, ankylenteron, ileac passion ect. operative complications. Conclusions Laparoscopic repair of acute perforated gastroduodenal ulcer is as safe and effective as the open repair. We must do intraoperative rapid pathologic examination, if it was malignant disease we shifted to open surgery.

Objective To study the effect of oral chemotherapy on patients of pancreatic carcinoma undergoing Whipple′s procedure. Methods48 cases undergoing radical pancreaticoduodenectomy with regional lymphadenectomy were divided into two groups. 24 cases received oral chemotherapy consisted of 5′ DFUR and calcium folinate for a course of 6 months. ResultsThe clinicopathological features were similar between the two groups. During the period of follow up,5 cases in chemotherapy group died including motality caused by liver metastasis in 2 cases whereas 7 cases died of liver metastasis in the control group( P

ObjectiveTo evaluate the diagnosis and treatment of primary non-Hodgkin′s lymphoma (PNHL) of the pancreas. MethodThe therapeutic result of 6 cases admitted from January 1980 to March 2000 was reviewed retrospectively. ResultsThe lesion was located in the head of the pancreas in 2 cases and the body and/or tail in 4, respectively. Clinical manifestations included epigastric discomfort, loss of weight, abdominal mass and jaundice. Two cases underwent Whipple′s procedure and distal pancreatectomy respectively, the other 4 underwent laparotomy and biopsy. B cell non-Hodgkin′s lymphoma of 5 cases and T cell non-Hodgkin′s lymphoma of one were verified by pathology. One patient lost follow-up, the other 5 patients survived 58, 49, 22, 13 and 4 months respectively. Conclusion The clinical manifestation and radiological features of PNHL of the pancreas are not specific. Comprehensive therapy including surgery is beneficial to the long-term survival of patients with PNHL of the pancreas.

Deep vein thrombosis is the common complication of trafifc injury , it is one of the dififculties of forensic identiifcation to identify disability grade and the relationship between injury and disease. When post-thrombotic syndrome happens, circulatory system and leg will be dysfunction, caused by the destruction of valve and venous wall and by the blockage of thrombus. The quality of life and working ability will be seriously affected. The impact of different types of deep vein thrombosis on human body was analysised after looking up relevant literatures, then it was discussed that the identiifcation of following questions including: the relationship between injury and disease, how to identify disability grade and it’s best time.

Objective To investigate the effects of splenectomy on peripheral immune cells including Th17 cells in patients with portal hy-pertension and to analyze the influence of splenectomy on their immune function.Methods Twenty-five portal hypertension patients trea-ted with splenectomy in No.180 Hospital of PLA from June 2012 to June 2014 were selected as observation group,and 25 healthy controls who underwent physical examination in the same period as control group.Flow cytometry was used to determine the percentages of CD3 , CD4,and CD8 T lymphocytes,CD4/CD8 ratio,and percentage of Th17 cells in the peripheral blood of portal hypertension patients (1 day before operation and at 7 days,1 month,and 3 months after operation)and healthy controls.ELISA was used to evaluate the changes in ser-um interleukin-6 (IL-6),interleukin-17 (IL-17),and interleukin-23 (IL-23).Comparison between groups was made by one-way ANOVA and LSD-t test.Results Before splenectomy,the portal hypertension patients had significantly lower percentages of CD3, CD4,and CD8 T lymphocytes and CD4/CD8 ratio (P<0.01 for all)and significantly higher percentage of Th17 cells and levels of their as-sociated inflammatory cytokines (IL-6,IL-17,and IL-23)(P<0.01 for all),as compared with the control group.At 7 days,1 month,and 3 months after operation,the percentages of CD3,CD4,and CD8 T cells and CD4/CD8 ratio in portal hypertension patients first decreased and then increased,and these values were significantly lower at 7 days after operation than before operation (P<0.01 for all);at 3 months after operation,the patients showed no significant differences in the percentages of CD3,CD4,and CD8 T cells and CD4/CD8 ra-tio compared with the control group (P>0.05 for all).At 7 days,1 month,and 3 months after operation,the percentage of Th17 cells and levels of their associated inflammatory cytokines (IL-6,IL-17,and IL-23)in portal hypertension patients decreased gradually (P<0.05 for all).Conclusion Th17 cells and their associated inflammatory cytokines (IL-6,IL-17,and IL-23)are reduced in portal hy-pertension patients treated with splenectomy,so their immune function can be improved.