Objective To examine the efficacy and safety profile of vancomycin in treatment of pneumonia caused by methicillin‐resistant Staphylococcus aureus (MRSA)in the elderly patients .Methods The clinical data were retrospectively analyzed for 40 elderly patients with MRSA‐induced pneumonia .The patients were analyzed in terms of treatment regimen ,vancomycin (n=25)or linezolid (n= 15) .Vancomycin was administered intravenously at dose of 0 .5 g every 8 hours for 10‐14 days ,while linezolid was given intravenously at dose of 0 .6 g every 12 hours for 10‐14 days .The clinical efficacy and adverse events were compared between the two groups .Results The overall efficacy rate was 72 .0% in vancomycin group ,and 86 .7% in linezolid group (P>0 .05) .After treatment ,the clearance rate of MRSA was 76 .0% in vancomycin group ,and 80 .0% in linezolid group (P>0 .05) .Reduction of platelet counts by more than 25% was found in 3 (20 .0% )patients treated with linezolid ,but none patient in vancomycin group .Acute renal dysfunction was reported in 4 (16 .0% )patients in vancomycin group but not identified in linezolid group .Conclusions Vancomycin has positive effect in the treatment of MRSA pneumonia in the elderly . Vancomycin treatment is associated with lower risk of thrombocytopenia ,but relatively higher risk of acute renal dysfunction .

Objective To find the way of inducing the bone marrow mesynchymal stem cells(MSCs)into cardiac cells with pacemaking function in vitro.Methods Dissociate the rat MSCs and induce them with 5AZA,bFGF+EGF,HGF,SCF and lysate of the sinoatrial cells respectively.The morphological changes were observed,and the expressing of protein cTnT,connexin 43 and HCN2/4 were analyse by immunohistologic and flowcytometry techniques.The pacmaking current If were evaluted by patch clamp techniques.Results All the methods can induce the bone marrow MSCs to differentiate into cardiac cells,which expressing cardiac cell specific protein and HCN2.Cells induced by 5AZA,bFGF+EGF and SAN CMs show higher rate of HCN2 expressing(22.9%,22.3%,11%).The cells of these groups have the pacmaking current If.Conclusion Lysate of the sinoatrial cells are ideal methods of inducing the bone marrow MSCs to differentiate into cardiac cells with pacemaking function in vitro.HCN is a promising marker protein to select pacmaking cells out of the differentiated cells.

Objective To explore the clinicopathological features of adult pulmonary sequestration and summarize the misdiagnosis experiences.Methods Data of 16 cases of adult pulmonary sequestration ( 18 years),who were confirmed by surgery and biopsy in our hospital were collected and reviewed.Results The median age of all the patients was 38.5 years.The female seemed to be more likely to suffer from adult pulmonary sequestration ( n =12) with cough to be the most frequent symptom ( n =9 ).CT scans revealed most of the lesions were located in the left lower lobes of the lungs ( n =9 ).Half of the lesions were characterized by pulmonary cyst-like changes and/or multiple cystic bronchiectasis ( n =8 ),followed by soft tissue mass in or out of the lung fields ( n =7).Enhanced CT scans showed abnormal arteries from the systemic circulation.Only two cases were diagnosed as pulmonary sequestration correctly in the primary diagnosis.The remaining were mostly misdiagnosed as pulmonary cyst-like changes with bronchiectasis ( n =6) or tumors (n =6).According to the findings during surgery,13 cases were intralobar pulmonary sequestrations; 3 cases were extralobars,whose tissues were all detected dysplasia and chronic inflammatory by histopathological examinations.Conclusions The misdiagnosis rate of pulmonary sequestration is high because of its non-specific clinical symptoms.Since it is characterized by abnormal arteries and pulmonary dysplasia,enhanced CT scans should be used as a preferred screening method for suspected cases,especially for those middleaged patients with cystic or mass-like lesions in the left lower lobes of the lungs.

Objective To evaluate the clinical efficacy of inhaled corticosteroids combined with Streptococcus pneumoniae vaccines for acute exacerbation of chronic obstructive pulmonary disease in elderly patients.Methods A total of 150 elderly patients with chronic obstructive pulmonary disease were enrolled in this study from February 2014 to May 2016 at our hospital.All patients were randomly divided into three groups with 50 cases in each group.All patients received routine therapy.Meanwhile,patients in Group A were also treated with inhaled corticosteroids,patients in Group B were given pneumococcal vaccines,and patients in Group C received inhaled corticosteroids combined with Streptococcus pneumoniae vaccines.Clinical symptom improvement,pulmonary function,frequency of acute attacks,mortality and adverse reactions were compared between the three groups.Results There were no severe adverse reactions observed in Group C after vaccination.After treatment,incidences of cough,asthma and expectoration in both Group B and Group C were significantly lower than those in Group A (P＜ 0.05).However,there was no statistically significant difference between Group C and Group B(P＞0.05).Before treatment,levels of FEV1 and FEV1/FVC were comparable between the three groups(P＞0.05).However,after treatment,FEV1 (F =2.301,P =0.396) and FEV1/FVC (F =1.290,P =0.266) of the three groups were significantly improved compared with pre-treatment levels.Moreover,FEV1 and FEV1/FVC in Group B and Group C were significantly higher than those in Group A,and FEV1 and FEV1/FVC in Group C were significantly higher than those in Group B(P＜0.05).In addition,the incidence of acute exacerbation,the frequency and duration of hospitalization in Group B and Group C were significantly lower than in Group A,and acute attack intervals in Group B and Group C were significantly longer than inGroup A (all P ＜ 0.05).Furthermore,the incidence of acute exacerbation,the frequency and duration of hospitalization in Group C were significantly lower than in Group B,and acute attack intervals in Group C were significantly longer than inGroup B(all P＜0.05).During follow-up,there were not statistically significant differences in mortality between the groups(P＞0.05).Conclusions The combination of inhaled corticosteroids with Streptococcus pneumoniae vaccines is effective and safe for the treatment of acute exacerbation of chronic obstructive pulmonary disease in elderly patients.