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Objective: To evaluate the efficacy and safety of Nocardia rubra cell wall skeleton (Nr-CWS) in the treatment of persistent cervical high-risk human papillomavirus (HR-HPV) infection. Methods: A randomized, double blind, multi-center trial was conducted. A total of 688 patients with clinically and pathologically confirmed HR-HPV infection of the cervix diagnosed in 13 hispital nationwide were recruited and divided into: (1) patients with simple HR-HPV infection lasting for 12 months or more; (2) patients with cervical intraepithelial neoplasia (CIN) Ⅰ and HR-HPV infection lasting for 12 months or more; (3) patients with the same HR-HPV subtype with no CINⅡ and more lesions after treatment with CINⅡ or CIN Ⅲ (CINⅡ/CIN Ⅲ). All participants were randomly divided into the test group and the control group at a ratio of 2∶1. The test group was locally treated with Nr-CWS freeze-dried powder and the control group was treated with freeze-dried powder without Nr-CWS. The efficacy and negative conversion rate of various subtypes of HR-HPV were evaluated at 1, 4, 8, and 12 months after treatment. The safety indicators of initial diagnosis and treatment were observed. Results: (1) This study included 555 patients with HR-HPV infection in the cervix (included 368 in the test group and 187 in the control group), with an age of (44.1±10.0) years. The baseline characteristics of the two groups of subjects, including age, proportion of Han people, weight, composition of HR-HPV subtypes, and proportion of each subgroup, were compared with no statistically significant differences (all P >0.05). (2) After 12 months of treatment, the effective rates of the test group and the control group were 91.0% (335/368) and 44.9% (84/187), respectively. The difference between the two groups was statistically significant ( χ 2 =142.520, P <0.001). After 12 months of treatment, the negative conversion rates of HPV 16, 18, 52, and 58 infection in the test group were 79.2% (84/106), 73.3% (22/30), 83.1% (54/65), and 77.4% (48/62), respectively. The control group were 21.6% (11/51), 1/9, 35.1% (13/37), and 20.0% (8/40), respectively. The differences between the two groups were statistically significant (all P <0.001). (3) There were no statistically significant differences in vital signs (body weight, body temperature, respiration, pulse rate, systolic blood pressure, diastolic blood pressure, etc.) and laboratory routine indicators (blood cell analysis, urine routine examination) between the test group and the control group before treatment and at 1, 4, 8, and 12 months after treatment (all P >0.05); there was no statistically significant difference in the incidence of adverse reactions related to the investigational drug between the two groups of subjects [8.7% (32/368) vs 8.0% (15/187), respectively; χ 2 =0.073, P =0.787]. Conclusion: External use of Nr-CWS has good efficacy and safety in the treatment of high-risk HPV persistent infection in the cervix.

Objective: The aim of this study is to investigate the effect of G9a inhibitor BIX-01294 on attenuating cell proliferation in human lung adenocarcinoma A549 cell line and the underlying molecular mechanism. Methods: Treated with BIX-01294, the growth and proliferation of A549 cells were detected by MTT assay and colony formation assay, and its impact on cell apoptosis was analyzed using flow cytometry. By Western blot, we explored the alterations in the expression of apoptosis-related proteins and the G9a catalysate, H3K9me and H3K9me2. In addition, in the pretreatment with caspase inhibitor Z-VAD-FMK, we detected the apoptotic dependence of BIX-01294 attenuating impact on A549 cell proliferation. Results: Compared with the control group, the histone methyltransferase G9a inhibitor BIX-01294 attenuated cell proliferation in A549 cells in a dose- and time-dependent manner. There were 42.5±8.7 colonies after BIX-01294 (10 μmol/L) treatment for 7 days, while 172.7±23.0 colonies in the control group, with a statistical significance ( P <0.05). After treatment with BIX-01294 (10 μmol/L) for 24 hours, the cell apoptotic rate was(47.6±8.4)%, with a significant difference in comparison with the control group [(7.2±3.6)%, P <0.05]. The expression of G9a catalysate, H3K9me and H3K9me2 was downregulated, the same with anti-apoptotic protein Bcl-2, while the proteins in mitochondrial apoptosis pathway, Bax, Bak and cleaved caspase-9, were upregulated, so was the expression of cleaved caspase-3 and cleaved PARP, and there was no alteration in the expression of cleaved caspase-8, which is a protein related with death receptor apoptosis pathway. Furthermore, after Z-VAD-FMK pretreatment, the cell apoptotic rate was decreased significantly, and the expression of apoptosis-related proteins were downregulated. Conclusions: Our results indicate that BIX-01294 can attenuate cell proliferation in lung adenocarcinoma, and it can be considered as one of the underlying mechanisms, the apoptosis may be induced by activating mitochondrial pathway.

Objective: To explore in vivo the expression of insulin-like growth factor-Ⅰ(IGF-Ⅰ)under stress, and to analyze changes of the local expression related to recombinant human growth hormone(rhGH)treatment., Methods: Forty Wistar rats were randomly divided into control and growth hormone groups, 20 in each group. A force of 0.49 N was applied to move the right upper first molars mesially. The growth hormone group and control group received daily subcutaneous injections of rhGH and equivalent volumes of saline, respectively. The rats were sacrificed on days 1, 3, 7 and 14. Micro-CT-reconstructed images were used to survey root resorption, and horizontal sections of the maxillae were prepared for tartrate-resistant acid phosphate(TRAP)and immunohistochemistry staining., Results: Tooth moved faster in the growth hormone group([0.291±0.017], [0.513±0.111]mm)than in the control group([0.245±0.033], [0.368± 0.052]mm)on days 7 and 14(P<0.05). More osteoclasts on day 3, and fewer osteoclasts on day 7 were observed in the growth hormone group([4.0±0.7], [2.6±0.6]cell/high-power field)than in the control group([2.8±0.6], [3.8±0.8]cell/high-power field)(P<0.05). The number of IGF-Ⅰ positive osteoclasts in the growth hormone group([4.7 ± 0.7]cell/high-power field)was significantly greater than that in the control group([2.7±0.5]cell/high-power field)(P<0.01)on day 3. Compared with the control group([18.6±1.5], [23.3± 3.8]cell/high-power field), IGF-Ⅰ positive PDL cells increased on days 7 and 14 in the growth hormone groups([29.6±3.4], [37.5±6.1]cell/high-power field)(P<0.01)., Conclusions: rhGH could stimulate IGF-Ⅰ expression in PDL, and accelerate bone remodeling and tooth movement.

Objective: Quantifiably and located measure the methylation rate of 21 cytosine-phosphate-guanosine (CpG) sites in the 3' region of L1 gene and long control region (LCR) gene of HPV16 DNA in asymptomatic patients, cervical intraepithelial neoplasia (CIN) patients, and cervical cancer patients. To analysis the relationship between HPV16 methylation and it's pathogenicity., Methods: Chosen 30 cases with HPV16 positive in each group. Firstly, extract DNA from the remaining cells of liquid-based cytology specimen and bisulfite treatment DNA, then amplify the 3' region of L1 gene and LCR gene, test the methylation rate of 21 CpG sites of HPV16 DNA in three groups., Results: All of the 5 CpG sites in E6/E7 promoter (31, 37, 43, 52, 58) were hypomethylation in cervical cancer group (21.86%, 28.15%, 21.37%, 26.15%, 15.48%, respectively), hypermethylation in asymptomatic group, and middle-methylation in CIN group, in which there were significant difference among three groups (all P < 0.01). The CpG site in 7032, 7091, 7136 of the 3' region of L1 gene was also different methylated among three groups (all P < 0.01). Hypermethylation was found in cancer group (18.89%, 27.72%), hypomethylation was found in asymptomatic group (2.71%, 6.95%) in 7032 and 7091. In 7136, the highest methylation was detected in CIN (66.45%), the lowest in asymptomatic (34.85%), middle in cancer group (46.43%)., Conclusion: The methylation status of CpG sites in the 3' region of L1 gene and E6/E7 promoter of HPV16 is significant different among three groups, which is likely to anticipate the pathogenesis of CIN and cervical cancer.

Objective: To investigate the resistance profiles and the trend of bloodstream-infecting pathogens isolated from hospitalized patients during 2004-2010., Methods: The bloodstream isolates were collected from 18 hospitals in 17 cities. Minimum inhibition concentrations (MIC) were determined using the agar dilution method recommended by CLSI (Clinical and Laboratory Standards Institute), and susceptibility results were analyzed according to the 2011 CLSI guideline., Results: Among the 2004-2005, 2007-2008 and 2009-2010 periods, the proportions of clinical isolates were similar; 43.1% (149 isolates), 34.0% (151 isolates) and 47.5% (776 isolates) for Gram positive strains, 56.9% (197 isolates), 66.0% (293 isolates) and 52.5% (858 isolates) for Gram negative strains, respectively. The isolating rate of MRSA was 54.1% (20/37) in 2007-2008, which was the highest among the 3 periods during 2004 to 2010, while it decreased in 2009-2010 (36.5%, 62/170). The MRCNS proportions were similar across the 3 periods. One (1.8%) vancomycin-resistant Enterococcus faecium and 1 linezolid-resistant Enterococcus faecalis were found. Although the isolating rates of penicillin non-sensitive strains (oral) were similar between 2009-2010 and 2007-2008 [54.5% (6/11) and 53.9% (7/13), respectively], the resistant rates increased from 0% in 2007-2008 to 30.8% (4/13) in 2009-2010. The results were similar according to the non-meningitis criterion (IV), and the susceptibility rates decreased from 100.0% (11 isolates) in 2007-2008 to 84.6% (11/13) in 2009-2010. ESBL-harboring strains in E. coli were similar among the 3 periods during 2004 to 2010 [66.7% (30/45), 73.2% (71/97) and 67.9% (233/343), respectively]. ESBL-producing strains in Klebsilla pnuemoniae decreased year after year, 72.4% (21/29), 50.0% (18/36) and 41.1% (65/158) in 2004-2005, 2007-2008 and 2009-2010, respectively. Except that the sensitive rate of Enterobacter cloacae to ertapenem was 80% (32/40), the sensitive rates of other strains to carbapenems were still above 90% and the resistance rates were less than 5%. Acinetobacter baumannii had the highest multi-drug resistance rate (81.8%, 81/99). One strain (1.0%, 1/99) of Acinetobacter baumannii isolated in 2009-2010 was reported to be pan-resistant., Conclusions: We are facing a more serious situation of bacterial resistance. Acinetobacter baumannii resistance was most serious, usually with the characteristics of multiple drug resistance, and even pan-resistance. Carbapenems remain to be the most effective against enterobacteriaceae. Strains resistant to novel antibiotics (linezolid and tigecycline) have emerged.

Objective: To investigate the drug-resistance rates of community-acquired respiratory tract pathogens isolated from adults in China during 2009 and 2010., Methods: A total of 1793 strains (S. aureus 421, S. pneumoniae 420, K. pneumoniae 404, H. influenzae 313, other Streptococcus. spp 149, and M. catarrhalis 86) of non-duplicated community-acquired respiratory tract pathogens were isolated from 11 hospitals in 6 cities. The MIC values were determined by the broth microdilution method, and the production of β-lactamase was tested using a nitrocefin-based test., Results: All of the S.aureus isolates were methicillin-sensitive (MSSA). Of the MSSA isolates, less than 1% (4/421) was resistant to β-lactamase inhibitor combinations, about 13.1% (55/421) and 9% (38/421) resistant to levofloxacin and moxifloxacin, and 57% (240/421), 53.2% (224/421), and 88.7% (373/421) resistant to azithromycin, clarithromycin, and penicillin, respectively. No S. aureus isolates resistant to vancomycin were detected in this study. Based on different criteria, the percentages of penicillin-sensitive S. pneumoniae (PSSP), penicillin-intermediate S. pneumoniae (PISP), and penicillin-resistant S. pneumoniae (PRSP) were 24.4% (102/420), 27.3% (115/420), 48.3% (203/420) (Oral) and 1.9% (8/420), 9% (38/420), 89.1% (374/420) (parenteral), respectively. The resistance rates of S. pneumonia to azithromycin, clarithromycin, cefaclor, cefuroxime, ceftriaxone and amoxicillin with clavulanic acid were 88.2% (370/420), 87.4% (367/420), 45.3% (190/420), 41.9% (176/420), 10.2% (43/420), and 5.2% (22/420), respectively. About 2.6% (11/420) and 0.2% (1/420) of S. pneumonia isolates were resistant to levofloxacin and moxifloxacin. More than 70% (104/149) of β-hemolytic streptococci isolates were resistant to azithromycin and clarithromycin, and about 10.1% (15/149) of isolates were resistant to levofloxacin. The resistance rates of K.pneumonia to most antibiotics were > 20% (81/404), and that of ceftazidime was lower than cefuroxime, cefaclor, and ceftriaxone. The mean prevalence value of ESBL producing K. pneumonia was 38.8% (157/404), with significantly regional variations. More than 90% of H. influenza and M. catarrhalis were susceptible to most antibiotics, with resistance rate of < 5% (16/313, H. influenza; 4/86, M. catarrhalis). The mean productions of β-lactamase in H. influenza and M. catarrhalis were 13.1% (41/313) and 91.7% (79/86), respectively., Conclusions: The percentage of PRSP increased significantly, and the resistance rates of community-acquired respiratory tract pathogens to common antibiotics such as macrolide and cephalosporins increased gradually. New fluoroquinolones such as moxifloxacin showed a high antimicrobial activity against most of the respiratory pathogens.

Objective: To investigate the clinical characteristics, pathological and biological behaviors of oral squamous cell carcinomas (OSCC) originated from oral submucous fibrosis (OSF)., Methods: A total of 528 patients with OSCC treated at Department of Oral and Maxillofacial Surgery, Xiangya Hospital, Central South University from 2002 to 2010 were divided into two groups, OSCC originated from OSF and OSCC not originated from OSF. The clinical data regarding age, gender, location, pathological type, metastasis and recurrence rate of these patients were analyzed retrospectively., Results: The mean age of the group of OSCC originated from OSF (45.8 years) was younger than that of the group of OSCC not originated from OSF (55.9 years). The male female ratio of the group of OSCC originated from OSF (32.3:1) was higher than that of the group of OSCC not originated from OSF (2.3:1). The metastasis and recurrence rate of the group of OSCC originated from OSF (13.5%, 39.1%) was higher than that of the group of OSCC not originated from OSF (7.6%, 27.8%.)., Conclusions: OSCC originated from OSF occurs at younger age and more in male, and is clinically more invasive and metastatic.

Objective: To evaluate the value of plasma 1, 3-β-D-glucan (G), serum mannan, galactomannan (GM) and cryptococcus capsular antigen assays for diagnosis of invasive fungal infections (IFI) in non-neutropenic adult patients., Methods: This was a prospective case control study. Plasma and serum samples from 25 patients with IFI (candidiasis, aspergillosis, cryptococcosis, zygomycosis, pneumocystis carinii pneumonia), 27 patients with bacterial infections, and 25 healthy adults were collected from February 2007 to February 2009 in Beijing Hospital. The serum antigenic assays were performed and their sensitivity and specificity were analyzed. Optimal cut-off level of G test and mannan was established with receiver operating characteristic curve (ROC)., Results: The concentration of G test in plasma of patients with IFI [89.4 (25.8, 336.9) ng/L] was significantly higher than that of patients with bacterial infection [8.1 (5.0, 34.9) ng/L, U = 120.5, P < 0.001] and healthy adults [3.8 (3.8, 26.0) ng/L, U = 76.5, P < 0.001]. The area under curve (AUC) was 0.858, and the optimal cut-off value was 71.7 ng/L. The sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) were 65.0% (13/20), 92.3% (48/52), 76.5% (13/17) and 87.2% (48/55) respectively. The concentration of mannan in serum from patients with candidiasis [1.13 (0.44, 1.22) µg/L] was significantly higher than that from patients with non-candidiasis IFI [0.21 (0.14, 0.27) µg/L, U = 19, P < 0.05], bacterial infection [0.26 (0.22, 0.32) µg/L, U = 36.5, P < 0.001] and healthy adults [0.25 (0.22, 0.30) µg/L, U = 29.5, P < 0.001]. The AUC was 0.894, and the optimal cut-off value was 0.41 µg/L. The sensitivity, specificity, PPV and NPV were 83.3% (10/12), 90.4% (47/52), 66.7% (10/15) and 96.0% (47/49) respectively. The sensitivity, specificity, PPV and NPV of GM antigen to diagnose aspergillosis were 25.0% (1/4), 96.1% (50/52), 33.3% (1/3) and 92.6% (50/54) respectively. The sensitivity, specificity, PPV and NPV of cryptococcus capsular antigen to diagnose cryptococcosis were all 100%., Conclusions: 1,3-β-D-glucan, mannan and cryptococcus capsular antigen were useful for diagnosis of IFI in non-neutropenic adult patients. GM antigen did not show a good sensitivity for diagnosis of aspergillosis in non-neutropenic adult patients.

Objective: To study the related factors of right recurrent nerve nodal involvement in esophageal cancer., Methods: 280 patients with thoracic esophageal cancer received esophagectomy and right recurrent nerve node dissection. The clinicopathological data were analyzed retrospectively. Univariate data were analyzed by chi-square test, and multivariate data were analyzed by logistic regression., Results: The right recurrent nerve nodal metastasis was found in 76 cases (27.1%, 76/280). In the 979 excised right recurrent nerve nodes, metastases were found in 118 nodes (12.1%). The tumor staging, the total number of involved lymph nodes, vascular invasion, the number of lymph node metastases in the thorax, the number of lymph node metastasis in the abdomen, subcarinal node metastasis, and peri-esophageal lymph node metastasis were independent risk factors of right recurrent nerve node metastasis in esophageal carcinoma., Conclusion: Right recurrent nerve lymph nodes should be dissected in those patients with high risk factors of lymph node metastasis in thoracic esophageal carcinoma.

Objective: to study the characteristics of volatile organic compounds (VOCs) in exhaled breath of lung cancer patients, and therefore to explore its use in the diagnosis of the disease., Methods: from February 2007 to September 2009, 55 patients with lung cancer, 21 patients with benign lung diseases and 30 healthy controls were enrolled in our study. The VOCs in exhaled breath were detected by the SPME (solid phase microextraction)-GC (gas chromatography) system., Results: heptanal was detected in 45 patients of the lung cancer group, 1 of the benign lung disease group, and 1 of the healthy control group. The positive rate was higher in the lung cancer group as compared to the benign lung disease group and the healthy group combined (P < 0.05). The detection of heptanal was not related to age, smoking, histological type and staging (P > 0.05)., Conclusion: heptanal maybe a useful marker in VOCs from patients with lung cancer.

Objective: To report a case of infection with methicillin resistant Staphyloccus aureus (MRSA) carrying Staphylococcal chromosome cassette mec (SCCmec) type V, and to identify the origin of the isolates., Methods: A case of infection with MRSA carrying SCCmec type V was reported. The clinical characteristics of this patient were described. Screening for methicillin and other antibiotic resistant phenotypes by VITEK II compact was carried out. PCR was used to determine the MRSA mecA gene, and multiplex PCR assay was used for characterization of SCCmec., Results: The 73-year old male patient was admitted to our hospital for exfoliative dermatitis, but the condition got worse with sepsis and hospital acquired pneumonia, and finally the patient died of septic shock. The isolated Staphyloccus aureus from peripheral blood and sputum showed resistance to beta-lactams alone, and susceptible to clindamycin, intermediate to moxifloxacin and gentamicin. The isolates were confirmed to be MRSA carrying SCCmec type V., Conclusion: A case of healthcare-acquired MRSA infection was identified, but the isolates also showed some characteristics of MRSA of the community origin.

Objective: To apply the bioinformatics tools for analyzing the differentially expressed genes in oral submucous fibrosis (OSF) to obtain the implied biological significance., Methods: By using DAVID and Onto-express bioinformatic tools, 865 differentially expressed genes in OSF were analyzed and the analysis of chromosome location, gene ontology (GO) and genetic-association diseases were performed., Results: A majority of the differentially expressed genes were located on chromosome 1,2,5,6,7,11,12 (P < 0.01). GO classification of the differentially expressed genes identified the biological process subgroups, including genes involved in immune response, defense response and so on. The cellular component subgroups were associated with extracellular matrix, cytoskeleton and membrane, molecular function subgroups related to protein binding, extracellular matrix structural constituent and signal transducer activity. The diseases genetically associated with these genes included infection, immune and cardiovascular diseases., Conclusions: Bioinformatics can provide the quick and parallel analysis of massive data got from gene microarrays and enable the function classification of the differentially expressed genes, which provides new ideas on the research of pathogenesis and epidemiology of OSF.

Objective: To analyze the clinical characteristics of haematogenous disseminated tuberculosis in pregnant women after in vitro fertilization and embryo transfer (IVF-ET)., Methods: Six cases of haematogenous disseminated tuberculosis after in vitro fertilization pregnancy from January 2001 to December 2005 were retrospectively analyzed., Results: The clinical manifestations of pulmonary miliary tuberculosis were non-specific. All cases presented with fever for several weeks, but typical respiratory manifestations were lacking. Chest X-ray showed typical miliary and infiltrate lesions. The onset of fever was at an average of 53.2 days after embryo transfer. Miscarriage occurred in 5 patients within 2 to 4 weeks after the onset of fever., Conclusion: The main symptom of miliary tuberculosis in pregnant women after IVF-ET was fever, and the prognosis of the pregnancy was poor. Physician should be alert to the occurrence of haematogenous disseminated tuberculosis, especially in pregnant women with long-term fever.

Objective: To determine the clinical characteristics and management of ovarian tumor in infertility women., Methods: During the period from Jan. 1 1999 to Dec. 31 2004, 110 infertility women with ovarian tumor were analysed retrospectively, in terms of clinical and pathological features. According to the histological findings, the tumors were divided into three groups: epithelial tumor, teratoma and others., Results: Among 110 cases, 49 cases were epithelial tumor, 42 cases were teratoma, and 19 cases were others. A total of 97 cases were small ovarian tumor, and the maximal diameter was less than 5 cm. In epithelial tumor group only 29% were diagnosed before operation, significantly lower than the other two groups (P < 0.01). In epithelial tumor group 61% were complicated with pelvic inflammatory disease (PID), significantly higher than teratoma group (26%, P < 0.01). A total of 102 cases (91%) were followed-up for 1.5 to 5 years. A total of 45 patients (44%) had become pregnant. Among them 18 conceived spontaneously, 21 underwent in vitro fertilization-embryo transfer, and 6 received artificial insemination., Conclusions: Most ovarian tumors found in infertility women are small cysts and only a few epithelial tumors are diagnosed before the operation. Physicians should be alert of infertility women with ovarian mass and laparoscopy should be performed as early as possible. Our data show the incidence of PID in epithelial tumor group is higher than others. After treatment by surgery and assisted reproductive technology, those infertility women with ovarian tumor may achieve fair pregnancy outcomes.

Objective: To select and identify the target genes related to oral squamous cell carcinoma (OSCC) and provide target genes for designing oligo-nucleotide functional microarray of OSCC., Methods: Genes possibly related to oral squamous cell carcinoma were selected from the 5 years' published data of differently expressed profiles with microarray testing in OSCC. Then mRNA expression of selected genes were evaluated by real time quantitative polymerase chain reaction (RT-PCR) in 22 cases of OSCC, including tumor tissues and paried normal mucosas and quantified according to an internal control GAPDH., Results: Eight genes were tested. The overexpression of SPARC, PDGF-A, SERPINE1, TGF-beta(1) and VEGF-C genes were measured in 16, 18, 16, 20, 18 cases of tumor specimens, respectively. The expression of CK15 gene was lower than that of its normal tissue. There were overexpression of CCND1, BIRC3 in tumor tissues, but there was no significant difference of CCND1 and BIRC3 expression between tumor tissue and normal tissue (P > 0.05)., Conclusions: SPARC, PDGF-A, SERPINE1, TGF-beta(1), VEGF-C and CK15 genes were closely related to tumor progress of OSCC. They can be used as the target genes for designing oligo-nucleotide functional microarray of OSCC.

Objective: To evaluate the clinical results, the selection of time and procedures of surgery and preoperative evaluation of the phacoemulsification or small incision cataract surgery with intraocular lens implantation (PSI) in senile cataract patients with cardiovascular disease., Methods: The authors performed a retrospective study in 218 senior patients (255 eyes) with cardiovascular disease, which were treated by PSI in the past 5 years., Results: Thirteen cases (14 eyes) did not have PSI due to surgical contraindication or impossible to tolerate the operation or impossible to obtain an improvement of visual acuity after operation. Two hundred and five cases (241 eyes) with cardiovascular disease were treated with PSI. After follow up for 1 - 18 months (mean 6.3 months), 165 cases (193 eyes) had a best corrected visual acuity (BCVA) equal or more than 20/60 (80.5%); 32 cases (39 eyes) had BCVA of 20/400 or less than 20/60 (15.6%); and 8 cases (9 eyes) had BCVA less than 20/400 (3.9%). There were no severe complications during the operation. One case developed inhalation pneumonia postoperatively and was transferred to internal medicine for rescue., Conclusions: Senile cataract patients with cardiovascular disease must be evaluated before performing PSI. The advantages of general hospital should be utilized to treat patients with cardiovascular disease before, during and after the operation. The use of sedatives, adrenalin and steroids must be individualized; high-risk patients should be monitored by EKG and supplied by constant inhalation of low dose oxygen to minimize the surgical risk. In senile cataract patients with cardiovascular disease and IV grade or more lens nucleus, small incision cataract surgery with intraocular lens implantation is better than phacoemulsification with intraocular lens implantation.

Objective: To investigate the pathogenic causes of community-acquired pneumonia (CAP) in adult patients in China, the relation of previous antibiotic use and the Pneumonia Patient Outcome Research Team (PORT) classification to microbial etiology, and the prevalence of drug resistance of common CAP bacteria., Methods: A prospective study was performed on 665 consecutive adult patients with CAP at 12 centers in 7 Chinese cities during one year. The etiology of pneumonia was considered if one of the following criteria was met: (1) valid sputum sample yielding one or more predominant strains; (2) blood cultures yielding a bacterial pathogen; (3) seroconversion, a > or = 4-fold increase or decrease titers of antibodies to Mycoplasma pneumoniae, Chlamydia pneumoniae and Legionella pneumophila. Minimum inhibitory concentration (MIC) of respiratory tract isolates was determined using the agar dilution method., Results: Pathogens were identified in 324/610 patients (53.1%) with valid serum samples and sputum cultures as follows: Mycoplasma pneumoniae (126, 20.7%), Streptococcus pneumoniae (63, 10.3%), Haemophilus influenzae (56, 9.2%), Chlamydia pneumoniae (40, 6.6%), Klebsiella pneumoniae (37, 6.1%), Legionella pneumophila (31, 5.1%), Staphylococcus aureus (23, 3.8%), Escherichia coli (10, 1.6%), Moraxella catarrhalis (8, 1.3%), Pseudomonas aeruginosa (6, 1.0%). Of 195 patients with a bacterial pathogen, an atypical pathogen was identified in 62 (10.2%) cases. The non-susceptibility rate of Streptococcus pneumoniae to penicillin, azithromycin, and moxifloxacin was 20.3%, 75.4% and 4.3% respectively., Conclusions: Atypical pathogens have important role in CAP, with Mycoplasma pneumoniae being the most common pathogen, and mixed infection of atypical pathogens with bacteria was found in 10.2% of the cases. Streptococcus pneumoniae and Haemophilus influenzae remain the most important bacteria for CAP. More than 75.0% of Streptococcus pneumoniae was resistant to macrolides and 20.3% was resistant to penicillin.

Objective: To study the influence of duration of hospitalization on etiologic agent and antibiotic-resistance of hospital-acquired pneumonia (HAP)., Methods: Cases of HAP were patients hospitalized in Fudan University Zhongshan Hospital, Ruijin Hospital, Beijing Hospital, Zhongshan University Affiliated Third Hospital, Guangzhou Medical College Affiliated Hospital and Guangdong People's Hospital. These patients were hospitalized from January 2001 to December 2003, and the diagnosis of HAP was made based on positive respiratory specimen cultures. Clinical data including time of HAP onset, severity of illness, risk factors, isolated bacteria and antimicrobial susceptibility were collected and analyzed. Statistical analysis was performed with the SPSS 12.0 software., Results: A total of 562 cases of HAP were recruited, including 136 cases of early-onset pneumonia (time of onset < or = 5 d), 326 cases of middle-onset pneumonia (time of onset 6 - 14 d) and 100 cases of late-onset pneumonia (time of onset > or = 15 d). The rate of prior antibiotic use increased from 68.4% in the early-onset group to 88.0% in the late-onset group (P = 0.002); ICU admission increased from 29.4% to 46.0% (P = 0.03), and immunosuppression increased from 1.5% to 15% (P = 0.001). A total of 918 strains of bacteria were isolated, the most common pathogens being Pseudomonas aeruginosa (18.6%), Staphylococcus aureus (16.1%), Acinetobacter spp (16.1%), Klebsiella spp (14.4%) and Enterobacter spp (8.8%). Early-onset HAP were more commonly caused by Klebstella (18.3%), while the main etiologic agents for late-onset HAP were Pseudomonas aeruginosa (24.2%) and Methicillin-resistant Staphylococcus aureus (19.3%). The rates of pneumonia caused by Haemophilus and Streptococcus were 4.3% and 2.4% respectively in the early-onset cases, but none was found in late-onset cases. The antibacterial activity of ceftriaxone was influenced by duration of hospitalization, risk factors and severity of the disease. In less severe early-onset cases without risk factors, the sensitivity of ceftriaxone was 80%. But in severe late-onset cases, it was only 50%., Conclusions: There was significant difference in the pathogen constitution and antibiotic-resistance among early-onset, middle-onset and late-onset cases of HAP. The sensitivity of ceftriaxone was high in less severe early-onset cases without risk factors.