Objective　To shorten the detection time of Staphylococcus aureus (SA), this study established a rapid detection method for the thermostable nuclease nuc gene and mecA resistance gene of SA based on recombinase aided amplification (RAA) combined with lateral flow strips (LFS). Methods Efficient RAA primers and probes were designed and screened based on the conserved sequences of the nuc gene in the SA genome and the mecA gene on the staphylococcal SCCmec removable genetic element, and then, the reaction temperature and for the simultaneous detection of nuc and mecA genes by time of RAA-LFS were verified. Sensitivity, specificity, and comparison with quantitative real-time PCR (qPCR) were also assessed. A prospective evaluation was conducted using 52 vials of non-repeat positive blood cultures from two tertiary hospitals. Results The RAA-LFS was able to amplify both nuc and mecA genes under the reaction conditions of 20-45 °C for 15-30 minutes, with a detection limit of 10² CFU/mL. A total of 50 clinically isolated non-SA strains were validated with 100% specificity for both nuc and mecA genes. Of the 30 methicillin-resistant Staphylococcus aureus (MRSA) and 30 methicillin-susceptible Staphylococcus aureus (MSSA) strains preserved in our laboratory, all were positive for the nuc gene, and 30 strains were positive for the mecA gene. The positive and negative concordance rates with qPCR were both 100%, with a consistency test Kappa value of 1. In a prospective analysis of the 52 vials of positive blood cultures, the identification and antibiotic susceptibility test results of 16 strains of MSSA and 6 strains of MRSA showed a 100% concordance rate with the results obtained using the Mérieux VITEK-2 compact microbiological detection system. Conclusions We combined nucleic acid release agents, RAA, and lateral flow strips to develop a simple, rapid, and highly sensitive assay applicable for SA and mecA resistance gene detection in colonies or positive blood culture bottles.

Objective:To investigate the personality traits of patients with anxious depression and the relationship between personality traits and clinical symptoms.Methods:From December 2011 to October 2014, 177 first-episode untreated patients with depression from the psychiatric department of the First Affiliated Hospital of Kunming Medical University and 185 healthy controls(HC group) recruited by the community were included.All patients were divided into anxious depression group ( n=92) and non-anxious depression group ( n=85) according to whether the anxiety/somatization factor score ≥7.The simplified version of Neuroticism Extraversion Openness Five-Factor Inventory (NEO-FFI) and the Hamilton depression scale-17 (HAMD-17) were used to assess all the subjects.Statistical analyses were conducted in SPSS 21.0.Analysis of covariance was used to compare the differences of the scores on personality dimensions among the three groups.The relationship between personality dimensions and anxious depression was confirmed by Logistic regression, linear regression analysis and generalized linear models. Results:The differences of the scores on the four dimensions of neuroticism ( F=108.863, P<0.01), extraversion ( F=86.357, P<0.01), agreeableness ( F=50.615, P<0.01), and conscientiousness ( F=24.730, P<0.01) among the three groups were statistically significant.Further pairwise comparision showed, the score of neuroticisms was higher in the anxious depression group(43.05±8.92) and non-anxious depression group(39.85±7.21) than that in the HC group (30.16±6.25)( P<0.01, Bonferroni corrected). The scores of extroversion (31.22±6.33, 32.61±6.83), agreeableness (38.66±5.80, 39.46±6.19) and conscientiousness (39.75±6.89, 38.85±7.26) were lower in the anxious depression group and non-anxious depression group than those in the HC group (40.29±5.37, 44.79±4.68, 44.09±5.66, all P<0.01, Bonferroni corrected). The score of neuroticisms in anxious depression group was higher than that in non-anxious depression group, and the difference was statistically significant ( P<0.01, Bonferroni corrected). Logistic regression analysis with age, gender and years of education controlled showed that the score of neuroticism ( B=0.082, OR=1.085, 95% CI=1.020-1.154, P=0.009) and conscientiousness ( B=0.060, OR=1.062, 95% CI=1.006-1.120, P=0.028) were risk factors for anxiety symptoms in patients with depression.Linear regression analysis showed that the scores on neuroticism had positive predictive effects on the anxiety/somatization factor score ( B=0.055, 95% CI=0.021-0.089, P=0.002) and cognitive impairment factor score ( B=0.074, 95% CI=0.023-0.125, P=0.005) in the anxious depression group. Conclusion:Compared to non-anxious depression, patients with anxious depression show higher level of neuroticism, and the level of neuroticism can positively predict the symptoms of anxiety and cognitive impairment.The high level of neuroticism and conscientiousness may be risk factors for the occurrence of anxiety symptoms in patients with depressed.

Objectives: To evaluate the safety and feasibility of ultra-low anastomosis for anal preservation in laparoscopic rectal can-cer surgery. Methods: The clinical data of 54 patients with low rectal cancer admitted to The Affiliated Hospital of Southwest Medical University from July 2014 to June 2017 were retrospectively analyzed. The short-term effect and complications were analyzed. Results:All patients underwent successful operations; conversion to laparotomy or death was not observed in any of the patients. The mean operative time was (165 ± 31) minutes, and the intraoperative bleeding volume was (12 ± 5) mL. There was no prophylactic ileostomy in all patients. Postoperative anastomotic bleeding and anastomotic leakage occurred in 2 and 3 cases, respectively; these complica-tions were managed with conservative treatment. Postoperative urination and sexual functions of the patients remained good, and most patients were satisfied with their anal function 1 year post-operation. No local recurrences or deaths were noted after follow-up for more than 2 years. However, liver metastases were detected in 3 patients 1 year post-surgery. Conclusions: Laparoscopic transab-dominal ultra-low anastomosis for rectal cancer has a good short-term effect; however, the long-term effect remains to be evaluated.

Objective To study the CT perfusion imaging features of pancreas under liver cirrhosis.Methods 191 cases including 48 normal controls(group A)and 143 patients with liver cirrhosis(group B)were randomly collected according to the inclusion and exclusion criteria.The scope of pancreatic perfusion imaging scan was determined based on conventional plain CT scan of middle and upper abdomen.All patients were injected with contrast agent at the antecubital vein tunnel group and then with normal saline at the same rate.The original perfusion images were transmitted to the workstation and were analyzed by the pancreatic perfusion software package,and the perfusion parameters were recorded for statistical analysis.Results (1)There were statistical differences in pancreatic perfusion parameter values,namely blood flow(BF),blood volume(BV)and mean transit time(MTT),between group A and group B(P<0.05).BF and BV of group B were lower than those of group A but MTT was higher than that of group A,and there was no statistical difference in permeability surface(PS)(P>0.05).(2)For group B,each pancreas part(head,body and tail)had no statistical difference in perfusion parameter values,namely BF,BV,PS and MTT(P>0.05).(3)For group B which was divided into three groups according to Child-Pugh,there were statistical differences in parameter values BF and BV(P<0.05)among the three groups and no statistical differences in BF and BV among any two of the groups(P<0.05);there were no statistical differences in PS and MTT among the three groups.(4)In group B,there was a statistical difference in BF between the subgroup with collateral circulation and the one without collateral circulation(P<0.05),the subgroup with collateral circulation showed lower BF than that of the subgroup without collateral circulation and there were no statistical differences in BV,PS and MTT(P>0.05).Conclusion Liver cirrhosis can result in microcirculation disturbance of pancreas,the change in microcirculation varies depending on the degree of liver cirrhosis, and CT perfusion imaging is helpful to the evaluation of pancreatic microcirculation in the state of liver cirrhosis.

Objective To investigate the influence of botulinum toxin A (BTX-A) injection in detrusor muscle region and detrusor muscle combined with bladder triangle region on the symptoms severity, bladder function and quality of life in patients with neurogenic detrusor overactivity (NDO) combined with urinary incontinence. Methods Sixty patients with NDO combined with urinary incontinence were chosen in the period from March 2011 to June 2017. The patients were divided into control group and observation group according to random digits table method with 30 cases each. The patients in control group were treated with detrusor muscle region BTX-A injection, and the patients in observation group were treated with detrusor muscle combined with bladder triangle region BTX-A injection. The number of urinary incontinence for every day, detrusor muscle overactivity (DO) duration, average urine volume, bladder detrusor muscle urine storage period of maximum pressure (Pdetmax), bladder compliance (BC), volume at first involuntary detrusor muscle contraction (VFIDC), quality of life of urinary incontinence (I-QOL) score and incidences of adverse reaction before and after treatment were compared between 2 groups. Results The number of urinary incontinence every day, DO duration, average urine volume, Pdetmax, BC, VFIDC and I-QOL score after treatment in observation group were significantly better than those in control group: (2.84 ± 0.56) times vs. (6.18 ± 1.22) times, (80.05 ± 9.49) s vs. (125.16 ± 12.72) s, (378.57 ± 91.03) ml vs. (255.88 ± 75.95) ml, (30.19 ± 5.47) cmH2O (1 cmH2O=0.098 kPa) vs. (47.33 ± 7.79) cmH2O, (10.04 ± 1.71) ml/cmH2O vs. (8.09 ± 1.32) ml/cmH2O, (249.60 ± 76.19) ml vs. (195.19 ± 60.72) ml and (63.17 ± 9.60) scores vs. (54.46 ± 6.29) scores, and there were statistical differences (P＜0.05). There was no statistical difference in incidence of adverse reaction (P＞0.05). Conclusions Detrusor muscle combined with bladder triangle region BTX-A injection in patients with NDO combined with urinary incontinence relieves the symptoms severity, improves the bladder function and quality of life and not increases the adverse reactions risk.

Objective To explore the treatment methods for colorectal cancer patients combined with active tuberculosis. Methods The clinical data of 8 cases of colorectal cancer combined with active tuberculosis from September 2011 to January 2017 in the Affiliated Hospital of Southwest Medical University were analyzed retrospectively. Results All the patients received tumor radical resection after given intensive anti-tuberculotherapy for 2 to 3 weeks. From the second day after surgery, isonicotinyl hydrazide was done through intravenous infusion. When gastrointestinal function was restored, the preoperative anti-tuberculosis treatment was reused. After 2 mouths, consolidation therapy was done. There were 3 cases of complicating pneumonia and 1 case of complicating anastomotic fistula after surgery.Six courses of FOLFOX4 chemotherapy combined with anti-tuberculosis consolidation treatment were carried out for all the patients. No tuberculosis dissemination or death case occurred. Conclusions After given anti-tuberculotherapy for 2 to 3 weeks, the colorectal cancer patients combined with active tuberculosis could receive tumor radical resection. It is safe and feasible to carry out assisted chemotherapy for tumor during the consolidation anti-tuberculotherapy.

This study aims to investigate the current situation of the enrollment , training model and career planning of medical students in the targeted admission program .After analyzing the implementation process of this targeted admission policy in medical education , we raised some feasible strategies to increase the attraction and reten-tion of health professionals in rural China .The study covered 4 medical universities in central and western China .A cohort of 308 medical graduates from this targeted admission program were recruited in June 2015 .A baseline survey , including questionnaire survey , in-depth interviews and the focus group discussions , were conducted right before their graduation .The first follow-up online survey was done 6 months after their graduation .he findings of this investiga-tion show that 72.9%of the investigated students in the program used to live in rural areas before 15 years old.The average annual household income was 28,200 Yuan.The top three reasons of choosing this program were guaranteed job after graduation , low performance in the college entrance examination , and wavier of tuition fee .There were sig-nificant differences of implementation of this policy between different provinces , especially the contract-signing and job deployment .Income and working environment were the main influencing factors of the medical graduates 'job-see-king intention .Based on the findings of this study , it can be concluded that the targeted admission program is rather successful in attracting medical graduates for rural health services .However , extra efforts are needed to improve the implementation of the policy and to retain the medical graduates in rural area .

Objective To study the clinical effect, safety of stains collapse of traditional Chinese medicine (TCM) combined with tumor necrosis factor-alpha (TNF-α) antagonist-a recombinant human tumor necrosis factor receptor:Fc fusion protein (rhTNF:Fc) and sulfasalazine (SSZ) in treatment of active ankylosing spondylitis (AS). Methods A total of 98 patients of AS of Gansu Provincial Hospital were divided into two groups in random, the western medicine group (rhTNF:Fc and SSZ, n=46) and the combining group (stains collapse of TCM, rhTNF:Fc and SSZ, n=52). The Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), the Bath Ankylosing Spondylitis Functional Index (BASFI), Patient Global Assessment (PGA), Visual Analogue Scale (VAS) of night pain, VAS of total pain, time of morning stiffness, TCM symptom score, distance between occipital and wall, distance between finger and ground,
thoracic activity, Schober test, and erythrocyte sedimentation rate (ESR), C reactive protein (CRP), adverse reactions before and after treatment were observed and the clinical effect was evaluated in two groups. Results A total of 86 patients achieved the study finally, 45 patients in the combining group and 41 patients in the western medicine group. The effective rate of ASAS20 was better in the combining group than that in the western medicine group(χ2=4.814,P=0.028), the Bath ankylosing spondylitis disease activity index (BASDAI) 50 showed no significant difference between the two group (χ2=0.100,P=0.752). The total effective rate in the combining group than that in the western medicine group(χ2=3.873,P=0.049). In comparison with the same group before treatment, the above indicators were improved after treatment (P<0.05). In comparison with the western medicine group after treatment, BASFI, PGA, VAS of night pain, VAS of total pain, time of morning stiffness, TCM symptom score, distance between occipital and wall, distance between finger and ground and Schober test were getting better in the combining group (P<0.05), but BASDAI, thoracic activity, ESR, CRP were not improved in the combining group (P>0.05). The adverse reactions showed no significant difference (P>0.05). Conclusions Stains collapse of TCM combined with rhTNF:Fc was more effective than single method in treatment of AS, it can alleviated the symptoms, body signs and body function, decrease indexes of inflammation, which has dramatic effect and good safety in clinic.

OBJECTIVE:To study the impact of ethanol volume fraction on the extract rate of ginsenoside monomer. METH-ODS:Water and different volume fraction of ethanol solution(20%,50%,70%,95%,V/V)were used for ginseng extract. High performance liquid chromatography-quadrupole-time of flight-mass spectrometry (Q-TOF LC/MS) was applied to identify compo-nents attributable of each peak. Especially 16 kinds of main saponins were analyzed. RESULTS:The volume fraction of ethanol had a significant impact on extract rate of ginsenoside. When the volume fraction of ethanol was 70%,extract rate of ginsenoside was the highest;however,the differences were mainly caused by protopanaxatriol saponins. The yield of protopanaxadiol ginsen-osides was similar in different volume fraction of ethanol solution. CONCLUSIONS:When the volume fraction of ethanol is differ-ent,result is not only different in the total saponin,but also different in the proportion of the monomers.

In this work, a new method of heart sound signal preprocessing is presented. First, the heart sound signals are decomposed by using multilayer wavelet transform. And then double parameters as thresholds are used in processing each layer after decomposition for denoising. Next, reconstruction of heart sound signals could be done after processing last layer. Four methods, i.e. wavelet transform, Hilbert-Huang transform (HHT), mathematical morphology, and normalized average Shannon energy, were used to extract the envelop of the heart sound signals respectively after reconstruction of heart sounds. All methods were improved in this study. We finally in our study chose 30 cases of raw heart sound signals, which were selected randomly from a database comed from The Clinical Medicine Institute of Montreal, and processed them by using the improved methods. The results were satisfactory. It showed that the extracted envelope with the original signal has a high degree of matching, whether it is a low frequency portion or high frequency portion. Most of all information of heart sound has been maintained in the envelope.
Algorithms ; Heart Sounds ; Humans ; Signal Processing, Computer-Assisted ; Wavelet Analysis