Objective To evaluate the effectiveness and safety of recombinant human endostatin combined with concurrent chemoradiotherapy versus concurrent chemoradiotherapy for advanced non small cell lung cancer ( NSCLC) . Methods Electronic databases including the Cochrane library, PubMed, the Chinese biomedical literature database, China national knowledge internet(,EMbase,VIP and Wanfang database system were searched,until August,2013. The inclusion criteria was efficacy and safety studies of randomized controlled clinical studies in which recombinant human endostatin combined with concurrent chemoradiotherapy was compared with concurrent chemoradiotherapy alone for patients with advanced NSCLC. Cochrane handbook 5. 1. 0 was applied in evaluating the quality of included trials and RevMan 5. 1. 0 software was used for data analysis.Results Five studies including 217 cases of advanced NSCLC were included. The results of the meta-analysis exhibited that compared with concurrent chemoradiotherapy alone, recombinant human endostatin combined with concurrent chemoradiotherapy could increase effective rate [OR=2. 62,95%CI(1. 41,4. 86),P=0. 002]. But there were no significant differences in clinical benefit rate [OR=2. 08,95%CI(0. 92,4. 73),P=0. 08],one year survival rate [OR=1. 18,95%CI(0. 53,2. 66),P=0. 68], improvement in quality of life [OR=1. 57,95%CI(0. 40,6. 07),P=0. 52],rate of leucopenia [OR=1. 25,95%CI(0. 72,2. 17), P=0.43],radioactive esophagitis [OR=1. 16,95%CI(0. 42,3. 21),P=0. 77] and radiation pneumonitis [OR=2. 47,95%CI (0. 34,17. 68),P=0. 37]. Conclusion Compared with concurrent chemoradiotherapy alone,recombinant human endostatin combined with concurrent chemoradiotherapy may be more effective for advanced NSCLC,whereas improvement of life quality and toxicities are similar. For the quality restriction and possible publication bias of the included studies,more high quality randomized controlled trials are required to further verify this conclusion.

Objective To analyze the distribution and antimicrobial resistance of pathogenic strains in wound infec-tion,and provide scientific evidence for rational use of antimicrobial agents in treatment of wound infection as well as reducing the emergence of drug-resistant organisms.Methods Data about pathogenic strains isolated from wound specimens of patients with wound infection in a hospital between June 2011 and April 2014 were analyzed retrospectively.Results A total of 965 pathogenic strains were isolated from wound specimens,the main infection sites were limbs(50.47%);infected patients mainly distributed in department of orthopaedic surgery(44.97%);trauma and incisional wound infection were the major infection types(47.98%,36.48%,respectively).Among iso-lated pathogens,gram-positive bacteria,gram-negative bacteria,and fungi accounted for 37.20%,59.59%,and 3.21 % respectively.The main gram-positive bacteria were highly susceptible to vancomycin,teicoplanin,and linezolid,the main gram-negative bacteria were highly resistant to most commonly used antimicrobial agents except cefoperazone/sulbactam,piperacillin/ tazobactam,imipenem,and meropenem.Conclusion Patients with wound infection are mainly distributed in department of orthopedics,the main infection types are trauma and surgical site infection,antimicrobial resistant rates of the major gram-positive and gram-negative bacteria are both high.Sur-geons,especially orthopedics surgeons,should pay attention to the culture of pathogens and monitoring of antimi-crobial susceptibility,use antimicrobial agents rationally,and strengthen the prevention and control of surgical site infection,so as to reduce the infection incidence and occurrence of drug-resistant organisms.

OBJECTIVETo study the multidisciplinary cooperation in surgical treatment of complex head and neck tumors.

METHODSThe data from 22 patients with head and neck tumors who had been given neurosurgery, orthopaedic surgery, plastic and otological surgery were reviewed from April 1995 to June 2000.

RESULTSEight of 14 cases of benign tumors had been resected radical; 5 of 8 malignant cases had been moval of macroscopic tumor and 3 received operation for symptom improvement. No surgical death and serious complications were observed. The recurrence rate benign tumors was 21.4% (3/14), all of which were operated on at other hospitals. Follow-up for a year showed that in 8 cases of malignant tumors, 3 were tumor free, 2 survived with tumor, and 3 died.

CONCLUSIONSTo obtain good outcome in treatment for patients with complex tumors of head and neck, cooperative efforts between multidisciplinary surgery are necessary.

Adolescent ; Adult ; Aged ; Child ; Female ; Head and Neck Neoplasms ; surgery ; Humans ; Male ; Middle Aged ; Surgical Procedures, Operative ; methods

OBJECTIVETo investigate the capable use of transmaxillary approach for surgical removal of invasive skull base tumors, the indications and the key points of this approach.

METHODSFrom November 1998 to July 2001, 27 consecutive patients with skull base tumor were operated through transmaxillary approach, including 6 patients with nasopharyngeal carcinoma, 5 with nasopharyngeal angiofibroma, 5 with nasopharyngeal cystadenocarcinoma, 2 with olfactory neuroblastoma, 2 with poorly differentiated carcinoma, 2 with sarcoma, 1 with maxillary carcinoma, 2 with schwannoma, and 2 with chordoma. Most of them (18/27) were recurrent tumor and 17/27 tumors involved important intracranial structures. All patients were followed up 2 - 33 months (average 16 months) and the clinical data was reviewed.

RESULTSThe tumors could be totally removed in all patients. There were no operative mortality and morbidity. After operation, 2 patients died of cancer recurrence in 5 and 8 months separately. One patient had metastasis to the lungs 11 months after operation. Two patients had local recurrence in 7 and 12 months postoperation seperately and live with the tumor now. The rest patients are back to their routine life.

CONCLUSIONSTransmaxillary approach facilitates the surgical removal of invasive skull base tumors. The exposure is wide. The lesion as well as the important anatomy structures can be viewed directly and clearly. The tumor removal could be done more thoroughly and safely. This approach is suitable for the patients in whom tumor involves the skull base extensively and may be difficult to deal with by other approaches.

Adolescent ; Adult ; Aged ; Child ; Female ; Humans ; Male ; Middle Aged ; Nasopharyngeal Neoplasms ; mortality ; pathology ; surgery ; Neoplasm Invasiveness ; Neurosurgical Procedures ; Skull Base Neoplasms ; mortality ; pathology ; surgery

OBJECTIVE:To provide reference for rational drug use and hospital infection control. METHODS:AmpC enzyme-producing Enterobacter cloacae were isolated from non-sputum specimen of a hospital during Jan. 2011-Oct. 2017. Drug sensitivity test was conducted by using MIC. The situation of AmpC enzyme production was confirmed by three dimensional test, and that of ESBLs-producing stain was detected with double-disk synergy test. RESULTS:There were 546 strains of AmpC enzyme-producing E. cloacae isolated from non-sputum specimen of the hospital,accounting for 4.80% of non-sputum specimen (546/11 375)and 38.97% of E. cloacae(546/1 401). Top 3 non-sputum samples in the list of detection rate were wound secretion (27.29%),midstream urine(25.82%)and blood(21.79%),and the departments with high detection rate were ICU(22.89%), neurosurgery department(18.68%)and general surgery department(16.67%). Resistance rate of AmpC enzyme-producing E. cloacae to most commonly used antibiotics was higher than 40%. There was statistical significance in resistant rate of the bacteria to ceftriaxone, cefotaxime, gentamicin, nitrofurantoin, levofloxacin, piperacillin/tazobactam, cefoperazone, ceftazidime,cefepime,tobramycin and minocycline among different years (P<0.05). The resistant rate to imipenem and meropenem was lower than 2%. Among 546 strains of AmpC enzyme-producing E. cloacae,68 strains of ESBLs were detected,and detection rates were 5.77%,6.06%,8.70%,10.26%,13.79%,17.35%,18.75% during 2011-2017. CONCLUSIONS:AmpC enzyme-producing E. cloacae are mainly isolated from samples as wound secretion and midstream urine,and mainly come from ICU and neurosurgery department. The drug resistance of the bacteria is severe,and drug resistance of the bacteria to antibiotics as β-lactams and quinolones is increased significantly. The detection rate of ESBLs-producing strain increases year by year. The bacteria are sensitive to carbapenems antibiotics,which can be regarded as first choice. It is necessary to strengthen drug resistance and enzyme production monitoring of AmpC enzyme-producing E. cloacae,select antibiotics combined with results of drug sensitivity test so as to prevent or delay the rapid increase of its resistance rate.

Morita therapy has been bom for more than 100 years.Inpatient Morita therapy is highly oper-able and easy to master.It can improve many refractory neuroses through four-stage treatment.But more neuroses are treated in outpatient clinics,and Morita therapy cannot be used in hospitalized patients.Therefore,the formula-tion of expert opinions on outpatient operations is particularly important.This paper is based on domestic and for-eign references,and after many discussions by domestic Morita therapy experts,and then drew up the first version of the expert opinions on operation of outpatient Morita therapy.Meanwhile the operation rule of Morita therapy in three stages of outpatient treatment was formulated:in the etiological analysis stage,under the theoretical guidance of Morita therapy,analyze the pathogenic factors,to improve treatment compliance and reduce resistance;during the operating stage,guide patients to engage in constructive and meaningful actions,realizing the achievement of letting nature take its course principle;in the cultivating character and enriching life stage,pay attention to positive infor-mation,expanding the scope and content of actions,improving the ability to adapt to complex life,and preventing recurrence caused by insufficient abilities.It will lay a foundation for the promotion of Morita therapy in domestic outpatient clinics,so that more patients with neurosis and other psychological diseases could receive characteristic Morita therapy treatment in outpatient clinics.