Objective To investigate the distribution and variety of quinolone-resistance genes in a group of multiple resistant Klebsiella.Methods A total of 20 strains of multiple resistant Klebsiella were collected from inpatients in Huai' an First People' s Hospital of Nanjing Medical University during February 2010 and March 2012.Strains were identified by molecular identification,and quinolone target genes (gyrA,ParC) and quinolone-resistance genes mediated by mobile genetic elements (qnrA,qnrB,qnrS,aac (6′)-Ⅰ b-Cr,qepA) were analyzed with polymerase chain reaction (PCR).Results In 20 strains of Klebsiella,19 were Klebsiella pneumonia,and 1 was Klebsiella variicola.gyrA and parC genes were found in all 20 strains,and gyrA mutation was found in 11 strains (55.0％),andparC mutation was also found in 11strains (55.0％).aac(6′)-Ⅰ b-cr was positive in 10 strains (50.0％),qnrA was positive in 1 strain (5.0％),and qnrB was positive in 3 strains (15.0％).gyrA and parC in strain No.6 and No.10 were both novel variants (GenBank registration number:JX123016,JX123017,JX144393,JX144394).Conclusion Quinolone-resistance-determining region plays a key role in resistance to quinolones in this group of Klebsiella,and it is the first report on the emergence of novel variants of gyrA and parC in one Klebsiella pneumonia in China.

Objective To explore the clinical effect of cognitive function training joint hydrochloride donepezil in the treatment of cerebral stroke cognitive dysfunction.Methods 60 cerebral stroke patients with cognitive dysfunction were divided into two groups randomly,each group 30 cases.The patients of the two groups were given corresponding improving circulation and other conventional treatment measures,including giving hydrochloride donepezil treatment to A group and cognitive function training on the based treatment of group A to group B.Before treatment and after treatment 1 month,3 months,clinical dementia rating scale(CDR),simple mental state scale of mini-mental state examination (MMSE) and daily life events scale (ADL) ability evaluation were compared between the two groups.Results Of the two groups,CDR scores [(2.3 ± 0.5) points,(1.9 ± 0.6) points] and ADL [(43.3 ± 12.5) points,(39.6 ± 12.2) points] were lower than those before treatment [(2.6 ± 0.6) points,(2.6 ± 0.5) points,(49.6 ± 11.2) points,(48.3 ± 12.5) points] (all P ＜ 0.05),and MMSE scores [(20.6 ± 3.2) points,(21.0 ±3.5) points] were no different to those before treatment [(19.3 ± 3.5) points,(19.6 ± 3.2) points] ;3 months after treatment,CDR scores [(1.6 ± 0.5) points,(1.3 ± 0.5) points],MMSE scores [(23.3 ± 3.5) points (25.6 ±3.2)points] and ADL scores[(39.6 ± 11.2)points (33.3 ± 12.5)points]were significandy improved,and which of B group improved obviously.Conclusion Cognitive function training joint hydrochloride donepezil in the treatment of cerebral stroke cognitive dysfunction is more effective than hydrochloride donepezil alone,and can more obviously improve the symptoms of patients,and promote the quality of life,and it is worth for clinical application.

Objective To investigate low frequency repetitive transcranial magnetic stimulation (rTMS) on acute cerebral infarction (ACI) patients movement function recovery,in order to provide certain reference basis about the further research on low frequency rTMS treatment ACI and clinical application.Methods Sixty patients of ACI with unilateral limb movement function disorder were divided into low frequency rTMS group and control group by table of random digit with 30 cases each.Two groups were given the conventional drug treatment and rehabilitation training,low frequency rTMS group added low frequencyrTMS treatment 10 d on the basis of the above.Before treatment and after treatment 10 d and 40 d in patientswith the U.S.national institutes of nerve function defect score (NIHSS),Fugl-Meyer motion scale (FMA)score and Barthel index (BI) score changes were observed.Results Before treatment the NIHSS,BI score,FMA score in low frequency rTMS group were (16.44 ± 3.29),(36.69 ± 5.97),(31.06 ± 7.43) scores,incontrol group were (16.38 ±4.01),(35.98 ±6.41),(30.87 ±8.56) scores,there was no significantdifference between the two groups (P ＞ 0.05).After treatment 10 d the NIHSS,BI score,FMA score in lowfrequency rTMS group were (8.13 ± 2.18),(56.04 ± 5.21),(48.42 ± 7.73) scores,in control group were(11.23 ± 1.97),(50.12 ±4.88),(42.12 ±8.61) scores.After treatment 40 d the NIHSS,BI score,FMAscore in low frequency rTMS group were (3.11 ± 0.53),(73.29 ± 5.34),(61.63 ± 8.36) scores,in controlgroup were (5.62 ±0.98),(63.96 ±4.46),(52.45 ±7.61) scores.The NIHSS in the two groups aftertreatment 10 d and 40 d was significantly lower than that before treatment (P ＜ 0.05),BI score and FMAscore was significantly higher than that before treatment (P ＜ 0.05).There were significant differences in theNIHSS,BI score,FMA score after treatment 10 d and 40 d of two groups (P ＜ 0.05).Conclusion Lowfrequency rTMS on ACI patients movement function recovery has obvious role in promotion.

Antihypertensive Agents ; therapeutic use ; Blood Pressure Determination ; Humans ; Hypertension ; physiopathology ; therapy

Two types of elbow arthroplasties are used in current clinial practice:interpositional and implant arthroplasty.Interposition elbow arthroplasty neither completely eliminates pain nor restores full function.It may be indicated for young active patients with severe inflammatory or posttraumatic arthritis,especially those with limited elbow motion.Current implant arthroplasty has come a long way in the past three decades.Elbow implant survival data nearly approach those of knee arthroplasty.The majority of patients have significant improvement in function and marked pain relief after total elbow replacement.However,the complication rate is higher than that for total hip and knee arthroplasty,is likely inherent in the anatomic uniqueness of the elbow itself.Greater caution must be paid to prevention of the complications of total elbow replacement.This article reviews the types,indications,contraindications and results of elbow arthroplasty.

This paper not only analyzes the technology characteristic and market prospects of medical motor vehicle equipment in China,summarizes the current status of the development and standardization of medical vehicles inside and outside army,but also demonstrates the standardization system of medical motor vehicle technology in China,puts forward the solving methods and measures for the lack of medical motor vehicle equipment standards.

Lung transplantation is the unique method to cure pulmonary tuberculosis at final stage. This paper reviewed the history, indication and contraindication, method of donor and recipient selection and donor preservation, operation methods, postoperative complications and protocol for complications to well understand issues in lung transplantation. Moreover, lacking of donors and increasing mortality of patients waiting for transplantation are urgent problems. With technique development, prognosis amendment, and improvement of survival rate and quality of life, donor source becomes important. Many studies have been conducted to explore the application of cadaveric lung, and several animal trials have been successful. In addition, scope of in vivo pulmonary lobes transplantation is increasing. Based on split liver transplantation, split double-lung transplantation is developed. This method utilizes existed donor sources, and provides options for patients waiting for transplantation.

Objective To observe the short-term fusion rate of using osteophyte filled cage in ante-rior cervical disectomy and fusion. Methods From May 2007 to May 2009, 103 patients receiving anterior cervical disectomy, spine fusion by different surgeons were performed with cages containing exclusively au-tologous osteophyte collected from both anterior and posterior vertebral edges adjacent to the intervertebral space. There are 69 males, 34 females, from 25 to 77 years of age, average 53.6 years. 60 patients received one level fusion. 33 and 10 patients received two-level and three-level fusion respectively. Patients were re-viewed 3 months after operation and fusion was evaluated by X-ray film, reconstructive CT and MR. Results 1. Only 1.9% (2/103) of patients' X-ray films indicate non-fusion (internal fixation failure) while 31.7% (32/ 103) of patients' CT and 30.1% (31/103) of patients' MR indicate non-fusion or being confusing to make a diagnosis. 2. The diagnostic coherence between CT and MR as to evaluate fusion is good (kappa=0.686, P= 0.00). 3. The total fusion rate was 77.7%(80/103) while the highest fusion rate achieved by single surgeon was 90%(18/20). The total one level fusion rate was 80%(48/60) while the highest rate by single surgeon was 88.2%(15/17). The total two-level fusion rate was 78.6%(26/33) while the highest rate by single sur-geon was 90%(9/10). The total three-level fusion rate was 60%(60/100) while the highest rate by single surgeon was 100%(3/3). No statistic significant difference in fusion rate was found between any two of the three groups. Conclusion The method of using osteophyte filled cage can acquire ideal short-term fusion rate in one and two-level anterior cervical disectomy, fusion and plate fixation.

Objective To investigate the distribution of aminoglycoside modifying enzyme genes (AMEs) and 16S rRNA methylase genes in drug-resistant strains of Pseudomonas aeruginosa. Methods Twenty strains of drug-resistant Pseudomonas aeruginosa were isolated from sputum and wound secretion samples collected from the First People's Hospital of Huai' an in Jiangsu province. Eight AMEs [aac(3)-Ⅰ , aac(3)-Ⅱ, aac(6')-Ⅰb,aac(6')-Ⅱ, ant{2)-Ⅰ ,ant(3)-Ⅰ , ant(4')-Ⅰ , aph(3')-Ⅱb] and 6 16S rRNA methylase genes (armA, rmtA, rmtB, rmtC, rmtD, npmA) were analyzed by PCR and verified by DNA sequencing. Results Out of 20 strains of Pseudomonas aeruginosa, aac(6')-Ⅱ was positive in 8 strains (40.0% ) , ant2- Ⅰ in 8 strains (40.0% ) , aac(3)-Ⅱ in 5 strains (25.0% ) , aac(6')- Ⅰ b in 2 strains (10.0% ) and rmtB in 1 strains (5.0% ) , respectively. The rest 9 genes were not detected. Among 2 strains harboring aac(6')- Ⅰ b, DNA sequencing confirmed that 1 was aac(6')- Ⅰ b (the clssical type) and another was aac(6')- Ⅰ b-cr. Conclusion Gene aac(6')- Ⅰ b-cr exists in drug-resistant Pseudomonas aeruginosa, and it has modifying effect on both aminoglycosides and quinolones.

OBJECTIVE To investigate the genetic markers of integron and transposon in multidrug-resistant strains of Escherichia coli.METHODS The genetic markers of integron(qacE△1-sul1) and transposons(merA,tnpA and tnpU) were detected by polymerase chain reaction(PCR).RESULTS In 20 strains,14 strains carried qacE△1-sul1,and 3 strains carried merA.CONCLUSIONS There are high percentages of the genetic markers of integron(qacE△1-sul1) and transposon(merA) in multidrug-resistant strains of E.coli.