T were also detected in the controls.Conclusion Nephrotic syndrome may be associated with NPHS2 identified in children.

Objective To observe tigecycline (TGC),minocycline (MH)and polymyxin B (PB)in vitro antibacterial activity of pan-resistant Acinetobacter baumannii (PDR-Ab)for clinical treatment,provide the basis for infection control.Methods Collected 76 patients’clinical specimens used for no repeat count of isolation and identification with pan-resistant Acineto-bacter baumannii in Shaanxi Provincial People’s Hospital from October 2013 to March 2013.Used tigecycline,minocycline and polymyxin B to do susceptibility testing with disk diffusion method (KB).Results 76 pan-resistant Acinetobacter bau-mannii ,sensitive to the rate for tigecycline and polymyxin B were 100% sensitivity rate of minocycline and intermediary rates were 67.11%,27.63%.Conclusion Tigecycline,minocycline and polymyxin B for the Pan-resistant Acinetobacter bau-mannii had good in vitro antibacterial activity.It provide a reference for clinical pan-resistant Acinetobacter baumannii infec-tions caused by diseases treatment.

BACKGROUNDMagnetic resonance spectroscopy (MRS) is one method that can examine noninvasively the alive specimen of the organ, metabolism of the organ and cell, and the biochemistry change. MRS provides the biochemistry information that may be used to diagnose tumors or differentiate the malignant tumor from benign. The objective of this study is to investigate the benign and malignant bone and soft tissue tumors by 1H-MR spectroscopy ((1)H-MRS) on a 3 Tesla MR scanner, then to assess the usefulness of (1)H-MRS in diagnosing bone and soft tissue tumors and distinguishing benign from malignant tumors.

METHODSFifty-six patients with bone and soft tissue tumors proved clinically and pathologically were examined with (1)H-MRS. (1)H-MRS was performed to study malignant musculoskeletal tumors, benign tumors and normal muscle adjacent to lesions to analyze the characteristics, and single-voxel point-resolved spectroscopy sequence was used. Proton brain exam-single voxel of (1)H-MRS which directly appeared in the spectrum, was observed to find the peak height of choline compounds (Cho) opposite to the creatine (Cr), and whether there was a Cho peak. Metabolite values were calculated automatically from the area under each metabolite peak by the Functool 3.1 software. Metabolite ratios of Cho/Cr were manually calculated. Then according to the results, it was judged whether there existed benign or malignant tumors. The Kappa statistical test was used to analyze the MRS results, the histopathology data and the surgical situation. Statistics processing was performed using the software package SPSS11.5 for Windows.

RESULTS(1)H-MRS spectra style of bone and soft tissue tumors was different from that of normal muscle, and differences also existed between benign and malignant tumors. Choline level in malignant tumor was markedly higher than that in benign tumors. Cho/Cr in malignant tumor was higher than in benign tumor significantly (P < 0.05). The true positive rate of bone and soft tissue between benign and malignant tumors was 34/36, the true negative rate was 15/18, the false positive rate was 3/18 and the false negative rate was 2/36. Therefore in the group, sensitivity of the (1)H-MRS was 94% (34/36), specificity was 83% (15/18), positive predictive value was 92% (34/37), negative predictive value was 88% (15/17) and the accuracy rate was 91% (49/54). The MRS results and the histopathology inspection conclusions had very good uniformity. The kappa value was 0.76 +/- 0.10 (P < 0.01).

CONCLUSIONSThe increase of Cho level measured by (1)H-MRS is related to the bone and soft tissue malignant tumor. Cho/Cr in malignant tumor was higher than in benign tumor, so they will play a vital role in the diagnosis and differential diagnosis of bone and soft tissue tumors.

Adolescent ; Adult ; Aged ; Brain Neoplasms ; diagnosis ; Choline ; metabolism ; Creatine ; metabolism ; Female ; Humans ; Magnetic Resonance Imaging ; Magnetic Resonance Spectroscopy ; methods ; Male ; Middle Aged ; Soft Tissue Neoplasms ; diagnosis ; Young Adult

OBJECTIVETo establish a probabilistic model for evaluation of dietary exposure to lead and construct age-related exposure centiles for the residents in Jiangsu.

METHODSLead contamination data were obtained from the national food contamination monitoring program during 2001 - 2006 and 2791 samples from 232 food products in Jiangsu were included. Food consumption data were from the national diet and nutrition survey conducted in 2002, including 3938 subjects in Jiangsu. A non-parametric probabilistic model using Monte Carlo simulation was applied to derive the intake distribution. The intake data was then analyzed using the LMS method, which constructs exposure percentiles adjusted for the median (M), the coefficient of variation (S) and the skewness (L) of the intake distribution.

RESULTSThe median and P(99) of the lead exposure for the residents in Jiangsu were 1.02 µg×kg(-1)×d(-) and 9.29 µg×kg(-1)×d(-1), respectively.6.38% of the total population showed to have a lead intake exceeding the tolerable limit, which for the urban and rural population were 4.31% and 7.06%, respectively. The exceeding rate for children of 2 - 10 years old from the urban and rural areas were 13.17% and 17.70%, respectively.

CONCLUSIONThere was a large variation in the lead exposure level of the population in Jiangsu; People in rural areas are in greater risk for higher lead exposure than urban people; The dietary exposure to lead for children and the high-end population was serious.

Child ; Child, Preschool ; China ; Environmental Exposure ; Food Contamination ; analysis ; Humans ; Lead ; analysis ; Risk Assessment

OBJECTIVETo evaluate the value of magnetic resonance dynamic contrast-enhanced (MR-DCE) and magnetic resonance diffusion-weighted imaging (MR-DWI) in the differentiation of benign and malignant musculoskeletal tumors.

METHODSSixty-three patients with pathologically confirmed musculoskeletal tumors were examined with MR-DCE and MR-DWI. Using single shot spin echo planar imaging sequence and different b values of 400, 600, 800 and 1000 s/mm(2), we obtained the apparent diffusion coefficient (ADC) of the lesions. ADC values were measured before and after MR-DCE, with a b value of 600 s/mm(2). The 3D fast acquired multiple phase enhanced fast spoiled gradient recalled echo sequence was obtained for multi-slice of the entire lesion. The time-signal intensity curve (TIC), dynamic contrast-enhanced parameters, maximum slope of increase (MSI), positive enhancement integral, signal enhancement ratio, and time to peak (T(peak)) were also recorded.

RESULTSADC showed no significant difference between benign and malignant tumors when the b value was 400, 600, 800, or 1000 s/mm(2), and it was not significantly different between benign and malignant tumors in both pre-MR-DCE and post-MR-DCE with b value of 600 s/mm(2). TIC were classified into four types type1 showed rapid progression and gradual drainage; type2 showed rapid progression but had no or slight progression; type 3 showed gradual progression; and type 4 had no or slight progression. Most lesions of type1 or type2 were malignant, whereas most lesions of type 3 or type 4 were benign. When using type1 and type 2 as the standards of malignancy, the diagnostic sensitivity and specificity was 87.23% and 50.00%, respectively. The types of TIC showed significant difference between benign and malignant musculoskeletal tumors(χ(2)=17.009,P=0.001). When using MSI 366.62 ± 174.84 as the standard of malignancy, the diagnostic sensitivity and specificity was 86.78% and 78.67%, respectively. When using T(peak)≤70s as the standard of malignancy, the diagnostic sensitivity and specificity was 82.89%and 85.78%, respectively. Positive enhancement integral and signal enhancement ratio showed no significant difference between benign and malignant musculoskeletal tumors.

CONCLUSIONSTIC, MSI and T(peak) of MR-DCE are valuable in differentiating benign from malignant musculoskeletal tumors. T(peak) has the highest diagnostic specificity, and TIC has the highest diagnostic sensitivity. The mean ADC value are no significant difference between benign and malignant tumors.

Adolescent ; Adult ; Aged ; Bone Neoplasms ; diagnosis ; Child ; Diagnosis, Differential ; Female ; Humans ; Magnetic Resonance Imaging ; methods ; Male ; Middle Aged ; Muscle Neoplasms ; diagnosis ; Young Adult

OBJECTIVETo investigate the effect and the possible mechanism underlying the promotional effect of Astragalus membranaceus and Panax notoginseng on the transformation of bone narrow stem cells and proliferation of EPC.

METHODThe marrow blood was collected in the patients with ischemia of lower limbs and BM-MNCs were separated and proliferated under different conditions. A. morphologic observation was performed and the ratio of CD34+ cells was measured.

RESULTThe shuttle shaped cells lined up as bunches with several round cells scattered. The ratio of CD34+ cells was significantly increased in groups treated with medium (P < 0.01) and lower (P < 0.05) dosages of A. membranaceus and medium (P < 0.01) and high dosages (P < 0.01) of P. notoginseng respectively as compared with control group.

CONCLUSIONA. membranaceus and P. notoginseng can promote the transformation and proliferation of EPC.

Antigens, CD34 ; metabolism ; Astragalus membranaceus ; chemistry ; Cell Proliferation ; drug effects ; Dose-Response Relationship, Drug ; Drugs, Chinese Herbal ; administration & dosage ; isolation & purification ; pharmacology ; Endothelial Cells ; cytology ; drug effects ; metabolism ; Ginsenosides ; administration & dosage ; isolation & purification ; pharmacology ; Hematopoietic Stem Cells ; cytology ; drug effects ; metabolism ; Humans ; Panax notoginseng ; chemistry ; Plants, Medicinal ; chemistry

OBJECTIVETo investigate the therapeautic effect of damage control orthopaedics (DCO) applicated to thoracolumbar burst fracture complicated with severe polytrauma.

METHODSTwenty-one patients with severe polytrama including 15 males and 6 females with an average age of 40-years-old ranging from 20 to 60 years, were treated by immediate fluid resuscitation and emergency simple operation so as to control the bleeding and contamination. According to Frankel grade of spinal nerves function, 3 cases were grade A, 3 were grade B, 9 were grade C, 6 were grade D. Ten cases were performed to open abdominal operation, 6 cases underwent closed negative pressure drainage thorough chest, 2 cases with lung rupture were treated by repairing operation. During operation, 9 cases were treated with by external fixation and 5 cases were skeletal traction or external fixation with plaster support for extremities fractures. After emergency operation, the patients were transported into surgical intensive care unit (SICU), and corrected the hypothermia, acidosis and coagulation. The definitive thoracolumbar operation was performed between 5 to 7 days as soon as the vital signs became stable.

RESULTSAmong 21 cases, trauma hemorrhagic shock was corrected rapidly in 18 cases and 3 cases died in 4 to 26 hours. The survival rate was about 85.7% (18/21). Eighteen patients were followed up for 6 to 14 months with an average of 10 months. According to Frankel grading, 3 cases were grade A, 2 cases were grade B, 3 cases were grade C, 3 cases were grade D, 7 cases were grade E.

CONCLUSIONIt may increase the therapy achievement rate excellently and decrease the disabled rate that performing damage control orthopaedics (DCO) timely, relifing the compression on the spinal cord and re-establishing the stability of spinal column as early as possible.

Adult ; Humans ; Lumbar Vertebrae ; injuries ; surgery ; Male ; Middle Aged ; Multiple Trauma ; etiology ; surgery ; Orthopedic Procedures ; Spinal Fractures ; complications ; surgery ; Thoracic Vertebrae ; injuries ; surgery ; Young Adult

OBJECTIVETo explore the clinical effects of delayed open reduction and locking compressing plate (LCP) plus bone-grafting in medullary cavity for the distal comminuted fractures of tibia.

METHODSTwenty-nine patients with the distal comminuted fractures of tibia were treated between March 2006 and September 2008, including 19 males and 10 females, ranging in age from 27 to 58 years with an average of 42.5 years. From wounded to hospital, the time was from 2 to 4 hours. According to AO classification, type 43-A1 were in 3 cases, type A5 in 12 cases, type A3 in 9 cases and type 43-C1 in 5 cases. Among them, there were 11 cases with open fracture (type Gustilo I in 5 cases, type Gustilo II in 6 cases) and 18 cases with closed fracture. Calcaneal traction was done in earlier stage (plaster external fixation in 5 cases), keeping the nagative liquid balance and electrolyte balance and improving the microcirculation. After the swolen limbs relieved markedly in 8 to 12 days,operating was done by open reduction and LCP internal fixation plus bone-grafting with own ilium in medullary cavity. Functional exercise was undergone in earlier stage and the wounded limbs loading weight on 10 to12 weeks after operation when the X-ray revealed the callus formed markedly.

RESULTSThe incision healed well without severe complication. All patients were followed up for from 6 to 14 months with an average of 12 months. All cases obtained bone union. According to the Mazur's evaluation standard, the results were excellent in 25 cases, good in 3 cases, and fair in 1 case.

CONCLUSIONThe above treatment can reduce the damage of periosteum and medullary cavity, shorten the time of bone healing and decrease the rate of bone nounion markedly. The internal fixation was reliable and less complacation after surgery, but it is very important for the right preoperation assessment to soft tissue injuries and the good operation timing choice.

Adult ; Bone Plates ; Bone Transplantation ; Female ; Humans ; Male ; Middle Aged ; Postoperative Complications ; Tibial Fractures ; diagnostic imaging ; physiopathology ; surgery ; therapy ; Time Factors ; Tomography, X-Ray Computed ; Treatment Outcome

OBJECTIVETo explore the clinical effect of low dose pituitrin in children with septic shock.

METHODSA total of 48 pediatric cases with septic shock, in whom 6 hours, conventional treatment could not reverse shock from January 2008 to December 2010, were selected for this study. The patients were divided into two groups randomly (completely random design) (control group 24, remedial group 24). The conventional treatment included antibiotics/fluid resuscitation/correcting acid-base imbalance, glucocorticoid, organ (heart/lung) support, dopamine 1 - 15 µg/(kg·min) and norepinephrine 0.5 - 2 µg/(kg·min) pumped in continuously in the control group. In initial 6 hours the same treatment was given to the remedial group, while low dose pituitrin (0.01 - 0.03 U/min) was pumped additionally during the rest of time. The therapeutic effect on correcting shock was evaluated in both groups.

RESULTSThe total effective rate was 76.2% in the remedial group and 40.0% in the control group; the mortality was 33.3% and 60% respectively. The difference between both groups was significant (P = 0.025).

CONCLUSIONLow dose pituitrin could improve the clinical effect significantly in children with septic shock in whom 6 hours conventional treatment failed to correct shock, shorten the total periods of treatment, and decrease mortality.

Child ; Child, Preschool ; Female ; Humans ; Infant ; Male ; Norepinephrine ; therapeutic use ; Pituitary Hormones, Posterior ; administration & dosage ; therapeutic use ; Shock, Septic ; drug therapy ; Treatment Outcome ; Vasoconstrictor Agents ; therapeutic use

OBJECTIVETo investigate the relative factors for hidden blood loss (HBL) after primary total knee arthroplasty (TKA).

METHODSA retrospective study of 422 consecutive patients who underwent primary TKA between October 2007 and August 2009 was carried on. There were 60 male and 362 female patients with a mean age of 65.7 years. The HBL was calculated according to Gross formula. The effect of patient gender, age, body mass index (BMI), pre-operative diagnosis, unilateral or simultaneous bilateral TKA, tourniquet time, type of prosthesis, postoperative anticoagulation method and deep vein thrombosis (DVT) on the postoperative HBL were analyzed.

RESULTSThe HBL in patients underwent unilateral TKA was significantly lower than that in those underwent simultaneous bilateral TKA [(1284 ± 207) ml vs. (2248 ± 504) ml, P = 0.000]. Unvaried analysis showed that the HBL were associated with BMI, tourniquet time, prosthesis type and postoperative anticoagulation method. Multivariate linear regression analysis showed that the impact factors of postoperative HBL include BMI, tourniquet time and prosthesis type.

CONCLUSIONSBMI, bilateral simultaneous TKA, tourniquet time and intercondylar open prosthesis impact the HBL after primary TKA. However, the influence of gender, age, diagnosis, postoperative anticoagulation method and DVT on the HBL are not significant.

Adolescent ; Adult ; Aged ; Aged, 80 and over ; Arthroplasty, Replacement, Knee ; Female ; Humans ; Male ; Middle Aged ; Osteoarthritis, Knee ; surgery ; Postoperative Hemorrhage ; Regression Analysis ; Retrospective Studies ; Young Adult