Objective To evaluate economic benefits and clinical effects of internal fixation treatment of severe rib fracture so as to provide objective basis for improving medical treatment for rib fracture.Methods A retrospective review was made on clinical data of 50 patients with severe rib fracture hospitalized from January 2009 to April 2014.With varied treatment modalities,the patients were assigned to operative group (n =13) and non-operative group (n =37).Variables were recorded including length of stay,total hospital charges,length of ventilatory support,off-bed time,duration of antibiotic use and incidence of complications and used to perform cost-efficiency analysis.Results Between operative and non-operative groups,length of hospital stay was (25.9 ± 8.2) days vs (35.4 ± 7.0) days,total hospital charges were (121 676.2 ± 10 991.1) yuan vs (148 724.5 ± 21 254.3) yuan,length of ventilatory support was (7.9 ± 2.8) days vs (14.1 ± 3.3) days,off-bed time was (14.3 ± 4.9) days vs (26.1 ± 6.5) days,duration of antibiotic use was (12.4 ± 3.3) days vs (21.2 ± 6.2) days and complications occurred in 2 cases vs 13 cases respectively.The findings were length of ventilatory support,off-bed time and duration of antibiotic use differed significantly between the two groups (P ＜ 0.05).Cost-effectiveness ratios based on subjective and objective measures were superior in operative group (1 962.52 and 3 925.03) over those in non-operative group (1 931.48 and 3 718.10),suggesting operative treatment could yield higher economic returns.Conclusion Internal fixation can accelerate bone healing in patients with severer rib fracture and cut down medical expense,which should be promoted in medical treatment.

Objective To analyze the changes of distribution and drug resistance of isolated pathogens for ventilator-associated-pneumonia (VAP) in seven intensive care units from January 2013 to December 2015,so that provides information for clinical antibiotic treatment.Methods Collected the patient records diagnosed with VAP to get the distribution and drug resistance of isolated pathogens for VAP in ICU from January 2013 to December 2015.Compared the distribution of isolated pathogens for VAP among three year with Chi-square tests,and compared the drug resistance of main isolated pathogens with Nonparametric tests.Results 177 patients were diagnosed with VAP from January 2013 to December 2015.A total of 192 strains of pathogens were isolated from the VAP patients in ICU.Among which the gram-negative bacteria were dominant.It took up 90.6％.There was no significant statistical difference for the distribution of pathogens (x2 =2.372,P=0.668＞0.05).Analyzed the drug resistance rate and trends for the primary pathogens like Acinetobacter Bauman,Pseudomonas aeruginosa and Staphylococcus aureus,among which,the drug resistance of Acinetobacter Bauman from 2013 to 2015 made statistical difference.Conclusion The major pathogen isolated from VAP patients was gram-negative bacteria from January 2013 to December 2015,especially for Acinetobacter Bauman.Drug resistance of Acinetobacter Bauman was serious.Should administrated appropriate to treat the VAP infection resulted from Acinetobacter Bauman.

to common antifungal drugs.

Objective To study the effect and mechanism of increase in radio sensitivity of kidney cancer cells(GRC-1) induced by ?-elemenen in vitro. Methods GRC-1 cells were divided into 3 groups, blank group (added with 2 mL culture medium), emulsion group (added with 2 mL blank emulsion culture medium) and drug group (added with 2 mL 50 mg?L -1 ?-elemenen culture medium). After been cultivated for 24 hours, the cells were irradiated using 6MeV X-linear accelerator in different doses at the rate of 400cGy per minute. Number of cell clones was counted, and radiation-survival curve of GRC-1 cells was drawn. Flow cytometry (FCM) was used to measure cell cycle and apoptosis. Cells of climbing flake were dyed by immunocytochemical method, the gene expression of bcl-2 and PCNA was measured by imaging system. Results The cell cycle showed that the G 2M blocking caused by 50 mg?L -1 ?-elemenen was enhanced with time increase. It reached peak at 24 hours. FCM showed that the level of apoptosis increased with increase in drug dose and action time. The gene expression of bcl-2 was decreased by 20% in drug group than that in blank group, but there was no expression of PCNA in the two groups. Conclusion The radiosensitivity of GRC-1 cells can be enhanced by ?-elemenen. The mechanism of effect may be associated with the cell cycle blocking, inducing cell apoptosis and down-regulating expression of bcl-2 gene.

Objective:To investigate the efficiency of Agrobacterium tumefaciensmediated transfor-mation of Aspergillus fumigatus by using pyrG as a recessive selectable marker.Methods: FAP1 and SHO1 genes target sequences,composed of a selectable marker pyrG and the flanking sequences of the FAP1 and the SHO1 genes,were cloned into a binary plasmid pDHt/sk,respectively.The produced plasmids were transformed into A.tumefaciens.The A.tumefaciens and uracil auxotroph A.fumigatus were cocultured in induction medium without uricil and uridine at 24 ℃ for 48 h.To inhibit growth of A.tumefaciens and to select transformants,the cultures were transferred to 37 ℃ and incubated for another 48 h.Results: In this study,A.tumefaciens-medidated transformation of A.fumigatus produced high homologous recombination rates,which was 44%(7 of 16) for FAP1 and 35%(7 of 20) for SHO1.Conclusion: Our study showed that A.tumefaciens-medidated transformation by using pyrG as a recessive selectable marker is an efficient tool for target gene deletion of A.fumigatus.

Objective To evaluate the susceptibility of itraconazole-resistant Aspergillus fumigatus isolates to four other antifungal drugs.Methods Six strains of Aspergillus fumigatus were serially isolated from a patient with lung aspergilloma,who was resistant to itraconazole therapy.Clinical Laboratory Stan- dard Institute broth microdilution method M38-A and E-test were applied to test the susceptibility of A.fumi- gatus strains to amphotericin B,itraconazole,voriconazole,caspofungin and micafungin.Results With M38-A method,the minimal inhibitory concentration(MIC)of itraconazole was 0.5?g/mL for 2 strains and more than 16?g/mL for the other 4 strains;the MICs of amphotericin B and voriconazole were 1?g/mL and 0.25-1?g/mL respectively for all the 6 strains;and the minimal effective concentration(MEC)of caspofungin and micafungin were no more than 0.03?g/mL for all the 6 strains.Moreover,E-test results also revealed that caspofungin and voriconazole had a good antifungal activity against all the strains,including the 4 itraconazole-resistant ones.Conclusion The itraconazole-resistant A.fumigatus strains isolated from a patient with lung aspergilloma are susceptible to amphotericin B,voriconazole,caspofungin,and micafungin.

Objective To investigate the levels of miR-1 9a and miR-1 9b expressions in cancer tissues and serum of patients with non-small cell lung cancer (NSCLC),and evaluate the potential of miR-1 9a and miR-1 9b as biomarkers of NSCLC.Methods Real time-PCR was used to detect the expressions of miR-1 9a and miR-1 9b in serum of normal people and patients with NSCLC and in cancer tissues and their corresponding non-tumor tissues. The diagnostic value of miR-1 9a and miR-1 9b for NSCLC was assessed by receiver operator characteristic (ROC) curve.Results The expression levels of serum miR-1 9a and miR-1 9b were significantly higher in patients with non-small cell lung cancer than in normal people (P <0.05 ).The expressions of miR-1 9a and miR-1 9b in NSCLC were much higher than in the adjacent normal tissues.For miR-1 9a the area under ROC curve was 0.989,and the sensitivity and specificity were 95.1 and 94.0.The area under ROC curve for miR-1 9b was 0.983,and the sensitivity and specificity were 93.4 and 94.0.Conclusion The high expressions of miR-1 9a and miR-1 9b are found in cancer tissues and serum from NSCLC patients.Therefore,they may be used as noninvasive biomarkers for diagnosis and prognosis of NSCLC.

Objective To establish an animal model of dermatophytosis and to evaluate antifungal efficacy on dermatophytosis with this model. Methods Animal models of dermatophytosis were established by inoculating dermatophyte suspension onto abraded skin on the back of guinea pigs. Thirty- eight healthy guinea pigs were randomly and equally divided into 2 groups, namely, Trichophyton mentagrophytes group (infected with T. mentagrophytes), and Microsporum canis group (infected with M. canis), and each group was classified into three subgroups, i.e., itraconazole group treated with oral itraconazole of 4 mg per kilogram body weight per day from day 0 to day 14 after infection, terbinafine group treated with oral terbinafine of 5 mg per kilogram body weight per day from day 0 to day 14 after infection, and untreated group receiving no therapy. The therapeutic effect was evaluated according to skin lesion score and fungal examination results on day 8, 11 and 14 after infection. Results Obvious lesions were observed and fungal examination was positive in untreated, infected pigs on day 8 after infection. In T. mentagrophytes-infecyted pigs, the skin lesion score on day 8, 11, 14 was 9, 1 and 0 in itraconazole group, 8, 5, and 1 in terbinafine group, 48, 52, 40 in untreated group, respectively, and there was significant difference between treated and untreated groups on the three time points (all P<0.01); the mycological cure rates on the above time points were 66.7%, 83.3%, 83.3%, in itraconazole-treated pigs, 83.3%, 83.3%, 83.3%, in terbinafine-treated pigs, 0, 0, 0 in untreated pigs, respectively, with no significant difference between itraconazole and terbinafine group (all P>0.05) but statistical difference between untreated and treated groups (all P<0.01) on all time points. Meanwhile, in M. canis-infected pigs, the skin lesion score on day 8, 11, 14 reached 3, 0, 0 in itraconazole group, 9, 2, 0 in terbinafine group, 46, 47, 39 in untreated group, respectively, and mycological cure rates 83.3%, 83.3%, 83.3% in itraconazole group, 83.3%, 83.3%, 83.3% in terbinafine group, 0, 0, 0 in untreated group, respectively; significant difference was noticed in the two parameters between the treated and untreated groups (all P<0.01) but not between the two treated groups (all P>0.05). Conclusion Itraconazol and terbinafine exhibit similar excellent antifungal activity in routine model of T. mentagrophytes-and M. canis-dermatophytosis.

Objective To explore the clinical characteristics and emergency treatment for type 1 diabetes(T1DM) and diabetes ketoacidosis(DKA) in children under 5 years old.Methods Twenty-one children under 5 years old with T1DM with 10 years were retrospecti-vely reviewed.The onset situation,clinical feature and treatment of DKA were analyzed.Results The cases of little children diabetes might not have typical symptoms.The positivity of islet antibody was lower.High morbidity of DKA was found in little children and DKA was often caused by infection.Conclusions Infection may be involved in the onset and progress of childhood T1DM.Emergency treatment for DKA may involve the injection of small dose insulin,correction of the disorder of water and electrolysis and regulation of acid-base.

Objective To investigate the nutritional status,body composition,and energy metabolism of hepatocarcinoma patients undergoing surgical treatment and explore the relationships of the nutritional status with body composition and energy metabolism.Methods Totally 112 hospitalized hepatocarcinoma patients undergoing surgical treatment met the inclusion and exclusion criteria were enrolled as the intervention group,and another 100 patients with cholelithiasis during the the same period were enrolled as the control group.Their general clinical data including body mass index(BMI),arm circumference,grip,albumin,prealbumin,energy expenditure,and body composition were collected.The nutritional status was assessed by the scored patient-generated subjective global assessment(PG-SGA).The relationships of the nutritional status with body composition and between energy metabolism were analyzed.All the data were analysed by SPSS 16.0 software package.Results The arm circumference [(23.9±3.6)cm vs.(25.3±4.5)cm,t=2.57,P=0.014],hand grip[(31.7±6.0)kg vs.(39.2±7.6)kg,t=8.19,P<0.001],serum albumin[(32.5±4.7)g/L vs.(36.5±7.2)g/L,t=4.92,P=0.007] and prealbumin[(0.172±0.052)g/L vs.(0.263±0.077)g/L,t=10.3,P=0.004] of the intervention group were significantly lower than the control group.The total malnutrition rate of the intervention group was 37.5％(42 cases at levels B and C),and that of the control group was 14.4％(14 cases at levels B and C)(X2=19.73,P<0.001).The extracellular water significantly increased in the intervention group compared with that of the control group[(15.35±2.21)L vs.(13.51±2.73)L,t=5.54,P<0.001];however,the somatic cell mass [(27.54±4.42)kg vs.(29.03±4.38)kg,t=2.53,P=0.012],fat mass[(13.44±4.23)kg vs.(17.36±5.21)kg,t=6.18,P<0.001],and muscle mass[(43.11±6.27)kg vs.(48.17±7.13)kg,t=5.63,P<0.001] had significantly decreased compared with the control group.The measured value of rest energy expenditure(mREE)[(6 581.62±1 201.70)kJ/d vs.(6 290.73±1 071.68)kJ/d,t=1.98,P=0.042] of the intervention group was significantly higher than the control group(P=0.042),and the respiratory quotient(RQ)was also significantly higher(0.87±0.10 vs.0.85±0.06,t=2.72,P=0.027).The extracellular fluid(PG-SGA A vs.B P=0.035;A vs.C P<0.001;B vs.C P=0.042)were significantly increased,and the number of somatic cells(A vs.B P=0.015;A vs.C P=0.001;B vs.C P=0.022),fat(A vs.B P=0.026;A vs.C P=0.003;B vs.C P=0.022)and muscle mass(A vs.B P=0.029;A vs.C P=0.011;B vs.C P=0.036)were decreased with the deterioration of nutritional status,resting energy expenditure(A vs.B P=0.023;A vs.C P=0.002;B vs.C P=0.032),and RQ(A vs.C P=0.004;B vs.C P=0.012)were also increased with the deterioration of nutritional status,and there was significant difference among three groups.Conclusions The incidence of malnutrition is high in hepatocarcinoma patients undergoing surgical treatment.The patients can have lower lean body mass,more water retention,and higher energy metabolism,which may worsen along with the deterioration of nutritional status.