Objective:To explore the influences of times of venous thromboembolism (VTE) drug prophylaxis in formation of deep vein thrombosis (DVT) in patients with severe craniocerebral injury after surgical treatment.Methods:Ninety patients with severe craniocerebral injury, admitted to our hospital from February 2021 to December 2021, were chosen in our study; they were divided into early group ( n=47, less than 48 h from the time of admission) and late group ( n=43, more than 48 h from the time of admission) according to the times of initiation for VTE drug prophylaxis (low molecular weight heparin calcium injection [LMWH] 100 IU/Kg was injected subcutaneously once a d). One week after injection, the DVT formation in the lower limbs, intracranial rebleeding, gastrointestinal bleeding and death were compared in the two groups. Results:The times of initiation for drug prophylaxis in the early group and late group were (28.91±4.50) h and (71.56±8.89) h. The DVT formation in the early group was significantly lower than that in the late group (12.8% vs. 34.9%, P<0.05). There was no difference in the incidence of intracranial rebleeding, mortality or gastrointestinal bleeding between the two groups ( P>0.05). Conclusion:Early initiation of VTE drug prophylaxis can significantly reduce the incidence of DVT in patients with severe craniocerebral injury after surgical treatment, enjoying high safety.

Objective: To rapidly identify triazole(fluconazole, voliconazole, iriconazole) drug resistance and sensitiveCandida tropicalusing matrix-assisted laser desorption/ionization-time-of-flight mass spectrometry(MALDI-TOF MS) platform data analysis and machine learning algorithms. Methods: A total of 191Candida tropicalwere collected from various clinical specimens, 71 of which were triazole-resistantCandida tropicaland 120 were triazole-sensitiveCandida tropicalstrains. Data acquisition was performed using the MALDI-TOF MS platform, and the mass and charge ratio features of resistant and susceptible strains were classified and selected based on the Mann-Whitney Rank-sum Test(Mann-WhitneyU-test) and the importance score obtained by the Random Forest(RF) algorithm. The classification model was constructed using the RF algorithm and a nonlinear support vector machine with a radial basis function kernel(RBF-SVM), calculating the accuracy, sensitivity, specificity, F1 value and the area under the subject worker curve(AUC) of the RBF-SVM model under the same experimental data to evaluate the model discrimination performance. Results: All strains obtained 76 unique mass spectrum peaks after analysis on the MALDI-TOF MS platform. Among them, six peaks 3 481,7 549,6 500,3 048,6 892,2 596 m/z were selected as the model feature peaks established by the feature dimensionality reduction treatment. The accuracy of both the RBF-SVM and RF models was 0.84, and the AUC scores were 0.930 5 and 0.927 3, respectively. Conclusion Machine learning algorithms combined with the MALDI-TOF MS platform for data analysis can serve as a possible method to rapidly distinguish triazole-resistantCandida tropicaland triazole-sensitive strains.

Objective To compare the safety and clinical efficacy of transcatheter closure for ruptured aortic sinus aneurysm (RASA) with those of surgical treatment.Methods A total of 31 successive patients with RASA,who were treated in a single center during the period from October 2003 to May 2017,were enrolled in this study.Among them,11 patients received transcatheter closure therapy,their mean age was (36.64±10.87) years old;20 patients received surgical closure,their mean age was (28.90± 10.06) years old.The technical success rate,complications,residual shunt,operation time,hospitalization days,amount of blood transfusion,medical expenses,etc.were compared between the two groups.Results No statistically significant differences in age,sex and preoperative cardiac functional grading established by the Heart Disease Association of New York (NYHA) existed between the two groups (P＞0.05).The technical success rates in transcatheter closure group and surgical closure group were 100％ (11/11) and 95％ (19/20)respectively (P＞0.05).The amounts of blood transfusion in transcatheter closure group and surgical closure group were 0 ml and (427.25±331.36) ml respectively (P＜0.01).The time spent for operation in transcatheter closure group and surgical closure group was (60.00±00.00) min and (205.50±129.35) min respectively (P＜0.05).Days staying in intensive care unit (ICU) in transcatheter closure group and surgical closure group were 0 day and (1.50±0.61) days respectively (P＜0.01).The residual shunt rates in transcatheter closure group and surgical closure group were 9.09％ (1/11) and 10.00％ (2/20) respectively.None perioperative death occurred in both groups.No statistically significant differences in hospitalization days and in medical expenses existed between the two groups (P＞0.05).Conclusion Both transcatheter closure and surgical closure are safe and effective for the treatment of ruptured RASA,although transcatheter closure therapy has more advantageous in aspect of minimally-invasive management,operative time and length of hospital stay.For patients with a RASA which position is suitable for percutaneous interventional management,transcatheter closure therapy should be employed as a preferred therapy.

Objective To explore clinical application of neotype controllability artificial nephrohydrosis in percutaneous nephrolithoto-my. Methods 400 patients with renal lithiasis or superior segment ureter lithiasis in our hospital were divided into group A and group B. 200 cases of group A received neotype controllability artifiicial nephrohydrosis;200 cases of group B received conventional artificial nephro-hydrosis. The puncture duration, amount of bleeding and times of puncture of the two groups were compared. Results 195 cases in Group A were developed renal tract for PCNL effectively,157 cases were developed renal tract for PCNL effectively in Group B. The puncture duration, amount of bleeding and times of puncture of group A and group B were respectively (1. 8 ± 0. 7) vs. (2. 5 ± 1. 2) min,(112. 7 ± 51. 0) vs. (270. 2 ± 89. 3) mL,(1. 1 ± 0. 2) vs. (1. 8 ± 0. 7) times. The differences were significant. Conclusion Neotype controllability artificial nephrohydrosis can develop renal tract for PCNL effectively.

Objective To summarize the experience in early diagnosis and emergency treatment for combined thoracoabdominal injury (CTI). Methods Clinical data of 58 cases of CTI admitted to our hospital from June 2001 to August 2009 were analyzed retrospectively.All the patients were treated by closed drainage of thoracic cavity,of which 12 cases were treated with thoracotomy,31 with laparotomy,seven with thoracic and abdominal incisions and three with combined thoracoabdominal incision.Internal fixation for long limb bones was performed in 27 cases,spinal laminectomy and pedicle screw fixation in five and amputation in one. Results After operation,six cases were found to have adult respiratory distress syndrome (ARDS) and 12 cases were complicated with multiple organ dysfunction syndrome (MODS).Fifty-three cases were cured and five died. Conclusions CTI based multiple injuries are severe and complicated.CT scan in the early stage plays a significant role in the diagnosis of CTI and closed drainage of thoracic cavity is an important assurance of the security of abdominal operation.Early diagnosis,correct choice of operation procedures and reasonable handling order of injured organs can improve the successful rescue rate for multiple injury patients.

Objective To investigate the effects of source to image receptor distance (SID) on the image quality and entrance surface dose (ESD) in the chest digital radiography (DR) for infants.Methods Anthropomorphic chest phantoms were exposed to 60 kVp and different values of SID ( 150 -80 cm with the interval of 10 cm,totally 8 groups) so as to record the values of mAs and ESD.The SID values of 110 cm and 90 cm with the moderate and low ESD values were selected for clinical test.Forty-two hospitalized infants,aged 12 months (8 months to 2 years) underwent chest DR with the SID of 110 cm before admission and 90 cm before discharge respectively.The values of ESD were recorded and compared.Three experienced experts assessed the quality of 84 pieces of images.Results The values of mAs and ESD decreased gradually along with the decrease of the SID from 150 cm to 80 cm.All the 84 images from the 42 infants met the demands for diagnosis.There was no significant difference in the score of image quality of the group with the SID of 110 cm (4.4±0.3) and 90 cm(4.2±0.4) (t=0.453,P＞0.05).The value of ESD of the group with the SID of 90 cm was significantly lower than that of the group of SID of 110 cm by 0.003 4 mGy ( t =12.001,P ＜ 0.05 ).Conclusions The image quality of chest DR could meet the demands for diagnosis in spite of the value of SID,however,the SID value in chest DR significantly might influence the ESD.The SID value of 90 cm shoud be recommended in chest DR for infants.

Objective To investigate the antibiotic resistance and the phenotype and genotype of metallo-β-lactamase in clinical isolates Chryseobacterium spp.Methods The MIC of 18 antibiotics in 50 Chryseobacterium spp.isolates was detected by agar dilution method.Phenotype of metallo-β-laetamase was detected by three-disc synergy test and modified three dimension test.Polymerase chain reaction(PCR)detection for metallo-β-lactamase gene was conducted for all isolates,and then the DNA sequence analysis was conducted for the PCR products which are positive for metallo-β-lactamase and identify genotype.conjugation experiment was used to study the transmission of metallo-β-lactamase encoding gene.pIs of β-lactamase was measured by isoelectric focusing assay. Results The antibiotic resistance of 50 clinical isolates of Chryseobacterium spp.against imipenem,Meropenem was 82.0%and 82.0%respectively.However,these isolated had high resistance to gatifloxacin.levofloxacin and rifampin compared with other antibiotics.Phenotype detection showed 33 isolated produced metallo-β-lactamase using three-disc synergy test and modified three dimension test,and the incidence of producing metallo-β-lactamase was 66.0%.Twenty isolateds producing Chryseobacterium indologenes were detected to have metallo-β-laetamase genotype by PCR amplification,among them 9 isolates containing blaIND-1 genotype and 10 isolateds containing blaIND-2 genotype.Strain CI-25 was identified to represent blaIND-LIKE genotype.Fourteen Chryseobacterium meningosepticum were detected to have metallo-β-lactamase genotype by PCR amplification,including 15 blaB and 2 blaGOB. The number of strain producing blaB1,blaB2,blaB3 and blaB11 in Chryseobacterium meningosepticum was 2,5,4 and 4,respectively. Conjugation experiments showed that metallo-β-lactamase encoding gene cannot be transfered. The extracted plasmid of 4 strains did not harbor metallo-β-lactamase gene.Strain C-5 was proved to have blaIND-1 gene,but its phenotype and IEF of metallo-β-lactamase was negative.Conclusions Chryseobacterium spp.had high frequency of multidrug resistance and high incidence for producing metallo-β-lactamase,and thus it was difficult to be treated.The gene of metallo-β-lactamase located on chromosome of Chryseobacterium spp.and cannot be transfered.There was negative or low lever of expression of blaIND-1.

BACKGROUND: Apart from anticoagulation property and suppressing platelet congregation capability, tongxinluo preparation has been proved by traditional Chinese medicine to possess certain function for protecting endothelial cells.OBJECTIVE: To observe the influence of Chinese medicinal herb "tongxinluo" compound on adhesion molecule expression in brain ischemia-reperfusion (IR) animal model.DESIGN: Randomized and controlled experiment.SETTING: Department of Neurology, Changzheng Hospital Affiliated to the Second Military Medical University of Chinese PLA.MATERIALS: This experiment was conducted at the laboratory of the Department of Neurology, Shanghai Changzheng Hospital, between October 2002 and January 2003. Totally 25 male SD rats were randomized into sham-operation group of 5 rats, model group of 10 rats and tongxinluo group of 10 rats.METHODS: Middle cerebral artery was occluded using thread-bolt method to induce focal brain IR model in rats. In sham-operation group,nylon thread was placed around the external carotid artery approximating to the branch of internal carotid artery, and the other procedure was the same as that in model group. Rats in tongxinluo group were given tongxininfusion before IR for 1 consecutive week, which was replaced by physiological saline of the same dosage in model group and sham-operation group. Brain tissues were obtained under anesthesia condition and cut into slices; conventional HE staining, immunohistochemical and in situ hybridization staining were conducted.MAIN OUTCOME MEASURES:① The number of intercellular adhesion molecule-1 (ICAM-1) and vascular cell adhesion molecule-1 (VCAM-1)positive microvessels following IR injury.② The number of ICAM-1 and VCAM-1 mRNA positive microvessels following IR injury.RESULTS:① In sham-operation group,ICAM-1,VCAM-1 protein andICAM-1 mRNA positive microvessels could not be observed in hemispheric cortex and basal ganglion at the operative side.② In model group,the positive expression of ICAM-1, VCAM-1 protein and ICAM-1 mRNA obviously increased at the ischemic side at 6-hour reperfusion following 2-hour ischemia.③ In tongxinluo medication group,the positive protein and mRNA-expressing microvessls were found remarkably reduced in number in ischemic side hemispheric cortex and basal ganglion [(10.42 ±1.98),(12.42±2.14)/HP; (8.54±2.00), (11.12±1.56)/HP] (P ＜ 0.05), but the positive VCAM-1 protein-expressing microvessels did not change remarkably (P ＞ 0.05).CONCLUSION: Tongxinluo can suppress ICAM-1 transcription and translation following rat brain IR, thus attenuating inflammatory injury induced by brain ischemia.

Complications that follow ischemic stroke are common,frequency ranging from 28% to 95%.It may either directly lead to death or prevent optimal recovery.54% of deaths after ischemic stroke are attributed to medical complications.Most complications occur during the first week,and stroke severity is the most important risk factor.The common serious medical complications are chest or urinary tract infection,deep venous thrombosis,pulmonary embolism,cardiac events,gastrointestinal bleeding,hyperglycemia,pressure sores.Falls,shoulder pain and depression are also common complications.Most of medical complications are preventable or treatable to some extent if recognized,so preventive strategies and appropriate treatment should be employed as early as possible.Prevention,early recognition,and management complications could improve short-term and long-term prognoses after ischemic stroke.

Objective:To explore the levels of adhesion molecules in peripheral blood leucocyte from patients with multiple sclerosis(MS) and after intravenous methylprednisolone(MP) treatment.Methods:The positive percentag of intercellular adhesion molecule 1(CD54)?integrin LFA 1 ? subunit(CD18)?very late antigen 4 ??? subunit(CD49d?CD29) and L selectin(CD62L) were determined on lymphocytes and monocytes by flow cytometry from 28 patients with relapsing remitting MS (relapses n=20,remission n=8) and 20 controls.Results:The positive percentage of CD49d?CD29 on lymphocytes and monocytes,CD54 and CD62L on monocytes in relapses MS group were higher than in remission MS group and controls(P0.05).Conclusion:The adhesion molecules expression on peripheral blood leucocyte were elevated in MS patients and it may be suitable to be as a marker of MS activity.