Objective To study the pathogenic bacteria species and drug resistance rate in the intensive care unit(ICU)in county hospital to guide clinical rational use of antibiotics. Methods 263 various specimens were chosen from January 2013 to December 2013 in the ICU of Zigui County People's Hospital in Hubei Province,these were applied to perform the bacterial culture and identification,and disc AGAR diffusion method was used to test the in vitro drug susceptibility and observe the specimens distribution,pathogenic distribution and the rate of drug resistance. Results In the 263 specimens,the top three isolated were 131 sputum(49.8%),49 blood(18.6%) and 38 ascites specimens(14.4%)respectively,and the pleural effusion was the least isolated with 5(1.9%). A total of 125 strains bacteria were isolated with positive detection rate of 47.5%(125/263). In the 125 strains,80(64.0%) were Gram-negative(G-)bacilli at the pioneer position,and the top four were:Klebsiella pneumonia 23(18.4%), Acinetobacter Baumanni 19(15.2%),Escherichia coli 18(14.4%)and Pseudomonas aeruginosa 12 strains(9.6%). There were 33 strains(26.4%)of Gram positive(G+)cocci including mainly Staphylococcus aureus 25 strains(20.0%);fungi strains were 12,the least(9.6%). The drug resistance rates of the top four G- bacillus were as follows:the rate of Klebsiella pneumoniae to ampicillin sodium was the highest(100%),while its rate to imipenem,meropenem and ciprofloxacin was 0;the rates of Acinetobacter baumannii to tobramycin and ceftriaxone were very high(100%, 92.3%),while to imipenem,meropennem were much lower respectively(26.3%,15.4%);the rates of Escherichia coli to ampicillin sodium and piperacillin were relatively high(88.9%,83.3%),while the rates to amikacin,imipenem, meropennem respectively were 0;the rates of Pseudomonas aeruginosa to ceftriaxone,cefotaxime sodium were very high(both 100%),while the resistant rate to levofloxacin was 0. The G+ cocci had no drug-resistance to linezolid, teicoplanin and vancomycin;the rates of Staphylococcus aureus to azithromycin,clindamycin,erythromycin and penicillin were higher than 80%,and those of Excrement enterococcus to erythromycin,gentamycin,levofloxacin were also higher than 80%. Conclusions The ICU infection of our hospital is primarily respiratory tract infection, the pathogenic bacteria are mainly G- bacilli and the antibacterial drug resistance is very serious. Therefore it is necessary to monitor the trend of bacterial resistance closely,and according to the results of bacteria identification and drug susceptibility,the antimicrobial agents are reasonably chosen to effectively reduce and control the ICU hospital infection.

Objective To discuss early and standard treatment of open calcaneal fractures so as to lower incidence of amputation and osteomyelitis. Methods From October 2005 to October 2006,16 cases of 17 open calcaneal fractures were treated in our department.There were 12 males(13 fractures)and 4 females at a mean age of 31 years.All cases were treated with the sanle early treatment protocol,including emergent debridement,and lavaging with normal saline,H2O2 and iodide solutions.All cases were immobilized with plaster or multiple K-wires according to systemic condition and fracture type.With detumescence of the soft tissues.open reduction and internal fixation was done via lateral incision.The patients were followed up for mean six months and the incidence rate of complications evaluated bv American Orthopaedic Foot and Ankle Society(AOFAS)scale. Resuits No amputation was found.but there was one case with osteomyelitis.one with superficial infection and one with deep infection.Delayed skin union was found in one case and plantar skin necrosis in one. Conclusion Early and standard treatment of open calcaneal fractures can minimize the infection,prevent osteomyelitis and provide sound soft tissue for secondary surgical management.

Objective To explore the short-term clinical outcomes of ankle arthrodesis for the treatment of posttraumatic ankle arthritis.Methods Retrospectively study the data of 47 patients with posttraumatic ankle arthritis who were followed up after receiving ankle arthrodesis from January 2008 to May 2012.There were 28 males and 19 females,with an average age of 44 years (range,14-72 years).All of them wereclassified into stage-3 arthritis according to Morrey-Wiedeman,among whom 31 had obvious foot varus deformity or equines deformity,and 16 were almost normal in appearance.The ankle joint function of patients were assessed by Kofoed,American Orthopaedic Foot and Ankle Society (AOFAS) ankle and hindfoot score,Maryland foot score systems and visual analog scale (VAS) preoperatively and at the last follow-up.Results The patients were followed up from 5 to 52 months (average,25 months).All the ankles got fused at the last follow-up,with one receiving removal of internal fixation and debride because of infection.Forty-three patients were satisfied with or without reservations; the others thought it so.The satisfaction rate was 91.5％(43/47).The Kofoed,AOFAS,Maryland foot scores and VAS were significantly improved from 48.11 ±5.00,53.38±5.52,49.74±5.71,7.89±0.87 to 80.96±6.07,82.21±4.26,88.94±5.14,2.28±1.10 respectively at the last follow-up.The normotopia X-ray of ankle joint showed that there were 22 cases in which the ankle got fused at neutral position,19 cases in which the eversion was less than 5°,3 cases in which the eversion was between 5° to 10°,2 cases in which the varus was less than 5°,and 1 case in which the varus was between 5° to 10°.Lateral X-ray showed that there were 32 cases in which the ankle got fused in dorsiflexion neutral position,12 cases plantar flexion 5°,and 3 cases plantar flexion 5° to 10°.Conclusion Ankle arthrodesis is still the preferable surgical treatnent option in patients with end-stage ankle arthritis,which shows high reliability and effectively in correcting deformity,pain relieving and function improvement.

Objective To investigate the influences of anesthetic meltod on setting up the animal model of orthotopic liver transplantation(OLT) in rats, in order to properly select the anesthetic method. Methods OLT was performed by modified two-cuff technique in Sprague Dawley rats. 100 rats were randomly divided into 5 groups: control group, ether group, ketamine group, chloral hydrate group and pentobarbital group. The anesthetic process, the influences of anesthetic method on physiologic parameters and hepatic function, and the mortality during anhepatic phase of each group were observed. Results The anesthetic process of each anesthetic method was different,ether anesthesia had fewer impacts on physiologic parameters, and the pentobarbital had great hepatotoxicity. High mortality happened in ketamine group, chloral hydrate group and pentobarbital group during anhepatic phase, while no animal died in ether group. Conclusions Each anesthetic method has significant influences on the OLT rat. Ether anesthesia has fewer effects on physiologic parameters and liver function, and has low mortality during anhepatic phase of OLT rats.So it is the best anesthetic method in setting up the animal model of OLT in rats.

AIM:To examine and compare the effects of several ARBs that are widely used in clinics , on the ACE-Ang II-AT1 receptor and the ACE2-Ang(1-7)-Mas axis during the development of cardiac remodeling after pressure overload .METHODS: All of the mice used in the study underwent transverse aortic constriction (TAC) or sham operation for 2 or 4 weeks.A solution of either ARBs or sa-line was administered through a stomach tube 3 days before the operation .Meanwhile , to eliminate the influence of Ang II , a recombi-nant adenovirus expressing small interfering RNAs targeting angiotensinogen ( Ad-ATG siRNA) was injected via the tail vein .The sur-gery was then performed and the drug was administered as mentioned above .Cardiac function and remodeling were evaluated by echo-cardiography , hemodynamic measurements and cardiac histology .Western blotting was used to determine the protein expression levels . Meanwhile , we performed similar experiments using ARBs with or without ATG siRNA in cardiomyocytes induced by mechanical stretch.RESULTS:Although all of the six ARBs , none of which repressed the elevation of left ventricular pressure after TAC , attenu-ated the development of cardiac hypertrophy and heart failure in the wild-type mice, the degree of attenuation by Olmesartan , Candesar-tan and Losartan tended to be larger than that of the other three drugs tested .Additionally , the degree of downregulation of the ACE-Ang II-AT1 axis and upregulation of the ACE2-Ang(1-7)-Mas axis was higher in response to Olmesartan, Candesartan and Losartan administration in vivo and in vitro.Additionally, Olmesartan had a larger influence when administered long term .However, the expres-sion of ACE was not influenced by the administration of ARBs in vivo and in vitro.Moreover, in angiotensinogen-knockdown mice, TAC-induced cardiac hypertrophy and heart failure were inhibited by Olmesartan , Candesartan and Losartan but not by Telmisartan , Valsartan and Irbesartan administration .Furthermore , only Olmesartan and Candesartan could downregulate the ACE-Ang II-AT1 axis and upregulate the ACE2-Ang(1-7)-Mas axis in vitro.CONCLUSION: Olmesartan, Candesartan and Losartan could effectively in-hibit pressure overload-induced cardiac remodeling even when with knockdown of Ang II , possibly through upregulation of the expres-sion of the ACE2-Ang(1-7)-Mas axis and downregulation of the expression of the ACE-Ang II-AT1 axis.In contrast, Telmisartan, Valsartan and Irbesartan only played a role in the presence of Ang II , and Losartan had no effect in the presence of Ang II in vitro.

0.05); When the IAP level reached 20 cm H2O, there was significant elevation (P

Objective:To summarize the CT features of ankle fracture and to analyze the relationship between the CT images and the most commonly used ankle fracture classification.Methods: With 369 cases of adult ankle fractures analyzed retrospectively,the CT images 1 cm above the ankle joint and its characteristics,the Danis-Weber classification of ankle fracture were studied,and so was the relationship between CT images and the fracture classification.Results: There were 8 forms of CT images.With a,b,and c referred to the fibular fracture,posterior malleolar fracture and interosseous tibiofibular ligament (IOL) rupture respectively.369 CT imges had 40 cases of 0 degree injury (fibula,posterior malleolus,IOL all intact);60 cases of Ⅰa degree injury (fibular fracture,posterior malleolus and IOL intact),3 cases of Ⅰb degree injury (fibula intact,posterior malleolus fracture,IOL intact),26 cases of Ⅰc degree injury (fibula and posterior malleolus intact,IOL rupture);163 cases of Ⅱab degree injury (fibula and posterior malleolus fractures,IOL intact),6 cases of Ⅱac degree injury (fibular fracture,posterior malleolus intact,IOL rupture),61 cases of Ⅱbc degree injury (fibula intact,posterior malleollar fracture,IOL rupture);10 cases of Ⅲ degree injury (fibular fracture,posterior malleollar fracture and IOL rupture).According to the Danis-Weber classification,there were 18 cases of type A,238 cases of type B,94 cases of type C,and 19 cases without fibular fracture.The prevalence of IOL rupture were 0,5.9％,and 88.3％ in types A,B,and C respectively.There was a correlation between the CT image and Danis-Weber classification,the incidence of IOL rupture was changed with the severity of Danis-Weber classification,and the difference was statistically significant after the rank correlation test (Spearman R=0.781,P<0.001).IOL rupture not determined by the fracture classification was found with the CT images and the incidence was 5.9％.Conclusion: Cross-sectional CT images 1 cm above the ankle joint can clearly determine the IOL injury pre-operatively with a good correlation with the Danis-Weber fracture classification,IOL rupture unrecognized with the fracture classification can also be noticed with the CT image.

Objective To explore the expression of Tau protein in brains of the intractable epilepsy patients and discuss its function in the pathogenesis. Methods Immunohistochemistry was adapted to test the expression of Tau protein and the mossy fiber sprouting in the hippocampus and cortex of temporal lobe from 48 intractable epilepsy patients and age-mached 48 cases of controls. Results The expression of phosphorylated Tau protein in the CA_3 areas (0.0450?0.0115) and the molecular layers of dentate gyrus (0.0463?0.0120) in intractable epilepsy patients was increased, accompanied by the hippocampus mossy fiber sprouting (3.18?0.35). No difference on the expression of total Tau protein was observed between the intractable epilepsy patients and the controls. Conclusion The present findings demonstrate that the strengthening of phosphorylated Tau protein might play an important role for the synaptic reorganization of the hippocampus. Thus, the changes of phosphorylated Tau protein could improve clinical prognosis in the intractable epilepsy patients.

Objective To compare the dosimetric differences among three-dimensional conformal radiotherapy(3D-CRT),intensity-modulated radiotherapy(IMRT)and RapidArc for prophylactic carnial irradiation(PCI)in small cell lung cancer(SCLC)patients.Methods Ten patients with SCLC were enrolled into this study.3D-CRT,9-field IMRT(IMRT)and double arc RapidArc plans were designed and optimized for each patient.The goal was to deliver 25 Gy to ≥ 95％ of the planning target volume(PTV)while the same normal-tissue dose constraints were achieved.The dose distribution and conformal index (CI),homogeneity index(HI)of target volume,the maximum dose(D2 ％),the minimum dose(D98 ％),target coverage of PTV(V95 and V100),and Dmean and Dmax of organs at risk(OAR)were analyzed by using the dose volume histogram(DVH).The monitor units and delivery time were also evaluated.Results All plans met the clinical requirements.PTV dosimetric parameters(CI,HI,D2％,D98％,V95 and V100)of RapidArc and IMRT were superior to those of 3D-CRT with significant difference(P＜0.05).The maximum doses to the optic nerves,brainstem and the mean dose to the parotid glands of the IMRT and RapidArc plans were all significantly lower than those of the 3D-CRT plan(P＜0.05),while 3D-CRT plan provided the lowest maximum doses and mean dose of the lens and eyes(P＜0.05).Compared with IMRT plan,no obvious advantage in PTV dosimetric parameters could be observed in RapidArc plans.In terms of organ sparing,no statistical difference was observed between IMRT and RapidArc plans.The number of monitor units for 3D-CRT,IMRT and RapidArc were 287.8,1388.8 and 346.6,respectively.Conclusions Compared with 3D-CRT,IMRT and RapidArc show better dosimetric quality.The 3D-CRT plan has a significantly lower dose on the lens and eyes,less MU and shorter delivery time than IMRT and RapidArc plans.

Objective To study the morphology of normal liver and tumors by breathing motion of hepatocellular carcinoma patients,through comparing the modified demons algorithm and FFD algorithm based on B-spline,and combing four-dimensional computed tomography (4DCT).Methods The 4DCT images of 8 HCC patients were segmented into 10-series which were named CT0,CT10 … CT80,CT90 according to the respiratory phases,CT0 and CT50 are defined to be end-inhale and end-exhale respectively.CT50 was chosen as the reference image.We used the modified demons algorithm and FFD algorithm based on B-spline to deform the images.Linear interpolation was used in both mode 1 and mode 2.The normalized mutual information (NMI),Hausdorff distance (dH) and registration speed were used to verify the registration performance.Results The average NMI for the end-inhale and end-exhale images of 8 HCC patients after demons registration in mode 1 improved 4.75％ with FFD algorithm based on B-spline(P =0.002).And the difference of dH after demons reduced 15.2％ comparing with FFD model algorithm (P =0.02).In addition,demons algorithm has the absolute advantage in registration speed(P =0.036).Conclusions The breathing movement for deformation of normal liver and tumor targets is significant.These two algorithms can achieve the registration of 4DCT images and the modified demons registration can deform 4DCT images effectively.