OBJECTIVE To analyze the multi-drug resistant genes(genes encoding extended-spectrum ?-lactamases,outer membrane protein gene oprD2,aminoglycoside-modifying enzyme genes,sulfonamides and disinfectant-resistance gene and plasmid-mediated quinolone resistance gene) of Pseudomonas aeruginosa clinical strains.METHODS The drug-resistance to 15 antibiotics was detected by the disc agar diffusion(DAD) and microdilution broth method in 32 P.aeruginosa strains isolated from Jun to Dec 2006.Twenty-eight related drug-resistant genes and outer membrane protein gene oprD2 were examined by PCR method.RESULTS The resistance rate of 32 P.aeruginosa strains to amikacin,ceftazidime,ciprofloxacin,cefepime,cefoperazone/sulbactam,imipenem,meropenem,levofloxacin,piperacillin/tazobactam,aztreonam and piperacillin were 9.4%,25%,59.4%,68.7%,68.8%,78.1%,81.1%,81.3%,84.4% and 94.4%,respectively,and that to others antibiotics were 100%.The detective rate of aminoglycoside-modifying enzyme genes(aac(6′)-Ⅱ,aac(3)-Ⅱ,aac(6′)-Ⅰ,aph(3′)-Ⅵ,ant(3″)-Ⅰ and aac(3)-Ⅰ) were 68.8%,62.5%,21.9%,9.4%,9.4% and 6.3%,and the genes encoding extended-spectrum ?-lactamases(blaFOX,blaIMP,blaVIM and blaDHA) were 37.5% 15.6% 6.3% and 9.3%,respectively.Twenty-two(68.8%) of them were detected in oprD2 and 9(28.1%),but positive in qacE?-sul1 gene.CONCLUSIONS The detective rate of aminoglycoside-modifying enzyme genes,extended-spectrum ?-lactamases genes and the loss rate of outer membrane protein gene oprD2 are high in these 32 multi-drug resistant P.aeruginosa clinical strains.

Objective To evaluate results of surgical treatment for patients with acute type A aortic dissection using Sun’s operation and triple-branched stent graft. Methods According to the operation mode, thirty-three patients with type A aortic dissection were divided into Sun’s operation group (n=22) and triple branches aortic arch stent-graft placement op?eration (triple-branched) group (n=11). Preoperative examinations included cardiac ultrasound, aortic CT angiography (CTA), hepatic and renal functions and blood routine test in all patients. Intraoperative monitoring included the index about cardiopulmonary bypass and blood loss. The perioperative hepatic and renal functions and complications were also recorded. Survival and recovery rates were evaluated by follow-up between two groups of patients. Results There were six periopera?tive death in Sun’s group, and three patients died in triple-branched group. In triple-branched group, the intraoperative blood loss was significantly increased than that in Sun’s group [(3 586.4±2 926.8) mL vs. (2 630.5±1 821.2) mL, P<0.05]. Postoperative echocardiographic examinations revealed that the left ventricular size (LVEDd) and the aortic diameter were decreased while the left ventricular ejection fraction (LVEF) was elevated after surgery in Sun’s group [(50.9±6.9) mm vs. (55.0±7.5) mm,(28.2±1.6) mm vs. (48.8±11.0) mm, 0.620±0.031 vs. 0.469±0.104, P<0.05]. Whereas, only the aortic diame?ter was decreased after surgery in triple-branched group [(28.6±3.9) mm vs. (50.9±9.2) mm, P<0.05]. Kaplan-Meier surviv?al curve showed that five-year survival rate of Sun’s group was similar with that of triple-branched group (Log-rank χ2=0.095,P>0.05). At 5 year after operation, there were no significant differences in the recurrence of new aortic dissection, the incidence of cerebral infarction and mortality between Sun’s group and triple-branched group (P>0.05). Conclusion Sun’s operation can significantly decrease patient’s intraoperative blood loss and improve cardiac function. But its survival rate and long term results need advanced observation.

Objective We have revised the Sunnybrook facial nerve grading system which has been widely recog?nized in the world to a Chinese version and verified its credibility and validity. Methods First we translated and edited the Sunnybrook facial nerve grading system using Chinese.Nine doctors, who were selected from different hospitals, then scored twice on the same video of 90 patients with facial nerve palsy using the Chinese version of the Sunnybrook facial nerve grading system and grading standard separately at one month interval. The consistency and the repeatability of the Chinese version of the Sunnybrook facial nerve grading system were evaluated. Results The Cronbach 's alpha value was 0.92 and the average coefficient of repeatability (CR) was 12.72, indicating that the Chinese version of the Sunny?brook facial nerve grading system had a high degree of internal consistency and repeatability. The ICC values on the as?sessment and evaluation for the internal measurement were 0.97 and 0.98, respectively. The scored results were compara?ble between doctors who were not familiar with this disease and those who were very familiar with the disease. The aver?age ICC was 0.97(95%CI:0.95~0.99). Conclusions The Sunnybrook facial nerve grading system has good reliability and consistency and hereby recommend Chinese doctors to use it.

Objective To understand the level of urinary iodine of schoolchildren and salt iodine content of their families in a primary school and to analysis influence between salt iodine content and urinary iodine level in Haimen City,Jiangsu Province.Methods A cross-sectional study was conducted in a primary school of Haimen City in 2012.With the method of stratified cluster sampling,all students aged 9 ～ 12 were extracted in grades 3-5,urine samples and salt samples of their family were collected.Urinary iodine and salt iodine were determined according to Method for Determination of Iodine in Urine by As3+-Ce4+ Catalytic Spectrophotometry (WS/T 107-2006) and Direct Titration of Universal Test method in Salt Industry (GB/T 13025.7-1999).Results Totally,452 students from grades 3-5,including 233 boys and 219 girls were selected by cluster-stratified sampling.The median of children's urinary iodine was 231.90 μg/L,while the median of boys and girls was 235.40 and 222.60 μg/L,respectively.The median of urinary iodine of 9,10,11 and 12 year old students was 253.65,195.70,236.40 and 241.70 μg/L,respectively.The proportion of less than 100 μg/L and ≥300 μg/L was 7.7％ (35/452) and 27.7％ (125/452),respectively.There were no significant differences between different gender and age students.Among the 452 salt samples collected the median of salt iodine was 27.50 mg/kg.The coverage rate of iodized salt,the qualified rate of iodized salt and the intake rate of qualified iodized salt were 98.9％ (447/452),95.1％ (425/447) and 94.0％ (425/452),respectively.After consumptionn of non-iodized salt (＜ 5 mg/kg),unqualified iodized salt(5 ～ ＜ 20 mg/kg or ＞ 50 mg/kg) or qualified iodized salt [(35 ± 15)mg/kg],the median of urinary iodine of children was 177.30,211.95 and 232.90 μg/L,respectively.Correlation analysis showed that there was no relationship between iodine content of salt and urinary iodine level of schoolchildren (r =0.085,P ＞ 0.05).Conclusions Current nutritional level of schoolchildren in Haimen City is higher than the appropriate amount.Household salt iodine content of edible salt does not affect urinary iodine level of the children significantly.

Objective:To assess the effect of combined cognitive rehabilitation training on improving cogni-tive dysfunction in amphetamine-type stimulant dependent patients.Methods:Subjects who met the clinical diagno-sis of ATS dependence by DSM-IV in compulsory isolation detoxification institute were randomly assigned into in-tervention group (n =30 )and control group (n =26 ).Control group received a regular education.Intervention group also received a combined cognitive rehabilitation training besides regular education,including psychological and physical rehabilitation for 24 weeks.The Chinese version of CogState Battery (CSB)was used to assess cogni-tive function at baseline and 24 weeks after the intervention.Results:No significant difference was found on all sub-scales scores of CogState Battery between two groups at baseline.At 24 weeks after the intervention,compared to control group,the intervention group had more improvements in three sub-scale scores,i.e.,One Card LearningTask [(0.06 ±0.12)vs. (-0.03 ±0.14),P<0.05],Two-back Task [(0.12 ±0.15)vs. (0.01 ±0.19),P<0.05]and Continuous Paired Association Learning Task [(-0.46 ±0.35)vs. (-0.15 ±0.49),P<0.05].No difference was found on improvements in the rest 5 sub-scale scores,i.e.,Detection Task,Identification Task,Inter-national Shopping List Task,Groton Maze Learning Task and Social Emotional Cognition Task (P >0.05 ).Conclusion:The combined cognitive rehabilitation training could improve amphetamine-type stimulant dependent patients'visual learning and memory,working memory and spatial working memory,while have no significant im-provement on other cognitive functions.

Objective To investigate the significance of anti-mutated citrullinated vimentin(MCV)an- tibody in rheumatoid arthritis(RA)and study the correlation among anti-CCP,other antoantibodies and clinical manifestations of RA.Methods Anti-MCV antibody was detected by enzyme-linked immunosorbent assay (ELISA)in 166 serum samples including 74 from RA(18 cases with early RA and 56 cases with late RA),50 from non-RA rheumatic diseases and 42 cases of healthy blood donors.At the same time,other antuoantibod- ies were detected by different techniques,and their clinical meaning was investigated with the corresponding clinical data.Results Anti-MCV was found in 78%(58/74)of RA.The sensitivity and specificity of Anti- MCV in RA were 78% and 95%.The positive and negative predictive value was 97% and 71%.The average cut off concentration of Anti-MCV was(552?380)U/ml in RA,(162?63)U/ml in non-RA and(63?46)U/ml in healthy control.Anti-MCV was strongly correlated to anti-CCP(r=0.502,P=0.000),then AKA(r=0.408)anti APF(r=0.369).No differences was found between Anti-MCV and other clinical/laboratory parameters(P＞0.05). Conclusion Anti-MCV antibody may be a valuable diagnostic parameter for RA.Anti-MCV is more strongly correlated to anti-CCP than APE and AKA.It may not relate to disease activity and/or severity.

Objective To compare clinical effect of unipolar versus bipolar radiofrequency ablation in treating atrial fibrillation (AF) in elderly patients and discuss the correlated risk factors.Methods From October 2008 to December 2013,a total of 50 elderly patients with organic heart disease and AF underwent radiofrequency ablation surgery.All patients were divided into 2 groups of unipolar (group A,n=20) and bipolar (group B,n=30 patients) radiofrequency ablations.The variations of electrocardiogram (ECG) and ultrasonic cardiogram (UCG) in patients were collected and the complications and the NYHA class of the patients were recorded at 3,6 and 12 months after surgery.The total 43 elderly patients were divided into sinus group and non-sinus group according to their ECG at 12 months after surgery.Results The recovery rates of sinus rhythm at 3,6 and 12 months after surgery were 73.7％(14/19),66.7％(12/18) and 61.1％ (11/18)respectively in group A and 82.8％(24/29),85.2％(23/27)and 88.0％(22/25) respectively in group B.Two groups of the recovery rate of sinus rhythm had a statistically significant difference between the two groups (P＜0.05) at 12 months after surgery.The complication rate in group A was higher than in group B [55.0％ (11 cases) vs.26.7％ (8 cases),P＜0.05].Preoperative history of AF and left atrial diameter were the influencing factors for the sinus rhythm recovery rates (P＜0.05).Conclusions Bipolar radiofrequency ablation for AF is safe and has less complications and high success rate of restoring sinus rhythm.The patients with long preoperative history of AF and left atrium distension have a low success rate of restoring sinus rhythm with a high recurrence rate.

Objective To evaluate the efficiency and toxicities of Gemcitabine combined with S -1 cap-sule in the treatment of advanced esophageal cancer .Methods Twenty-nine patients with advanced esophageal cancer were treated with S-1 capsule 80 mg/m2 ,twice daily for 14 days and Gemcitabine (1 000 mg/m2 ) was in-travenously administrated on day 1 and 8.The chemotherapy was repeated every 21 days.After two consecutive treatment circles ,the short term efficacy ,adverse effects and follow -up condition were evaluated .Results One case showed complete remission (CR),11cases showed partial remission (PR),9 cases showed stable disease (SD),8 cases showed progressive disease(PD).The responsive rate(CR+PR)was 41.4%;the illness control rate(CR+PR+SD)was 72.4%.The major adverse events were myelosuppression ranging from grade Ⅰto Ⅲ, hand-foot syndrome,disgusting and the damage of liver function .Some patients displayed the damage of liver function.The median time to progress ( mTTP) was 6.9 months.The median 1-year survival rate was 64.3%. Conclusion The combination of Gemcitabine and S -1 capsule is an effective and well -tolerated method for the patients with advanced esophageal cancer .

Objective To investigate the diagnosis,preoperative examination and surgical treatment of carotid body tumor(CBT).Methods From December 2008 to December 2012 80 patients of carotid body tumor were treated in our center.The average age was(43:±:12)years,33 cases were male,47 cases were female.The lesions were unilateral in 68 cases and bilateral in 12.All tumors were surgically resected.In 26 of Shamblin Ⅰ,32 of Shamblin Ⅱ and 19 of Shamblin Ⅲ tumors were simply resected.One Shamblin Ⅱ and 2 Shamblin Ⅲ cases underwent tumor resection combined with external carotid embolization.3 Shamblin Ⅱ and 8 Shamblin Ⅲ cases were treated by tumor resection combined with internal carotid reconstruction,1 Shamblin Ⅲ was done with tumor resection combined internal carotid repair.Results All of 80 patients with 92 tumors were successfully resected.There was no death case during peroperative period,while one case developed hemiplegia and 14 cases suffered cranial nerve injuries.68 cases (85％) were followed-up from 1 year to 6 years.Thera were 14 patients with cranial nerve injuries,2 of them were lost to follow-up,11 with complete or partial recovery and 1 was still doing poorly.Conclusions Tumor size and its relation to the carotid artery form the basis upon which appropriate operation is adopted.