Objective To investigate pathogens distribution and their drug resistance of hospital acquired pneumonia (HAP) in local elderly paraplegic patients,and to help to gain experience in early using antibiotics.Methods One hundred and thirty six elderly patients diagnosed as HAP from January 2007 to December 2010 in our hospital were selected.Pathogens distribution and their drug resistance were detected.Results One hundred and fifty two pathogens are isolated from the 136 patients,and most of them are gram negative bacteria which accounts for 70.4％.The first three pathogens are Klebsiella pneumonia(24.3％),Escherichia coli (20.4％) and Pseudomonas Aeruginosa (18.4％).Gram-positive cocci accounts for 25.0％ in total pathogens,among them,staphylococcus aureus and streptococcus pneumoniae account for the most,and the number of Fungi is the fewest.Drug resistance rate of gram-negative bacteria is higher than that of Gram-positive bacteria.Gram-negative bacteria has higher resistance to ampicillin,cefoperazone,ciprofloxacin,levofloxacin and eotrimoxazole.Gram-positive bacteria has higher resistance to penicillin,cefazolin and gentamicin.Conclusion To elderly paraplegic HAP patients,the main pathogenic flora is gram-negative bacterium which shows multiple resistances.Being familiar with the features of pathogens and their drug resistance will provide better guidance on early treatment and improve prognosis of elderly paraplegic HAP patients.

The postoperative recurrence rate of gastrointestinal cancer is high. The therapeutic effect of traditional chemotherapy is not satisfactory, such as chemotherapy through vein and intestine perfusion and so on, and the side effects are obvious. In recent years, researchers in and abroad have begun to study the effect of intraperitoneal chemotherapy. Whether early postoperative intraperitoneal chemotherapy affect the healing of anastomotic stoma is still controversial. Intraperitoneal chemotherapy combined with medicine can achieve a better therapeutic effect. This article reviewed current issues of intraperitoneal chemotherapy, espe-cially its validity and safety.

Objective To investigate the protective effect of rhein lysinate (RHL)on the liver of the models with diabetic rats,and to provide basis for research on treatment of fatty liver in the patients with diabetes mellitus. Methods The models of diabetic rats were established by intraperitoneally injecting streptozotocin(STZ).40 rats were divided into control,model,25 mg·kg-1 RHL,and 50 mg·kg-1 RHL groups(n=10).The levels of malonaldehyde (MDA)and the activities of superoxide dismutase (SOD)and glutathione peroxidase (GSH-Px) were detected by thiobarbituric acid method, pyrogallol autoxidation method, and NADPH coupling method, respectively.The pathological changes of liver tissue were observed by hematoxylin and eosin (HE)staining;the content of fat in liver tissue was observed by Nile red staining;the expression levels of fat synthesis-related proteins were detected by Western blotting method.Results Compared with control group,the body weight of the rats in model group was decreased and the levels of blood glucose,total cholesterol(TC)and triglyceride(TG)were increased (P<0.05);the activities of SOD and GSH-Px in liver tissue were decreased (P<0.05);there were a plenty of fat vacuoles and fat accumulation in liver tissue. The signal pathway of fat synthesis-related ERK1/2-SREBP-1c was activated in model group;compared with model group,it was inhibited in 25 and 50 mg· kg-1 RHL groups (P<0.05).Compared with model group,the blood glucose,TC and TG of the rats in 25 and 50 mg ·kg-1 RHL groups were decreased (P<0.05);the activities of SOD and GSH-Px were increased (P<0.05);however the body weight had no change. Compared with model group, the fatty vacuoles and the fatty accumulation of liver tissue in 25 and 50 mg·kg-1 RHL groups were decreased. Conclusion The hepatic protection of RHL is correlated with the inhibition of oxidative stress, fat degeneration and fatty accumulation of liver tissues.

Objective To investigate the mRNA expression of breast cancer resistance protein (BCRP) in cervical cancer (CC).Methods The expression of BCRP mRNA was detected by real-time PCR from tissues of 12 normal and 47 cases with CC.Results The expression of BCRP mRNA was 0.59±0.26 in CC and 0.19±0.17 in normal cervical tissues.But it was significantly higher in CC than those in normal tissues (P ＜ 0.05).The expression of BCRP mRNA was not correlated with histological types,tumor differentiation degree and clinical stages (P ＞ 0.05).Conclusion BCRP mRNA over-expresses in CC,wich might play a major role in the intrinsic MDR of CC.Detection of BCRP mRNA expression may the guidance of individualized chemotherapy for patients with CC.

Objective To explore the value of placental alpha-microglobulin-1 in vagina liquid to diagnose premature rupture of membranes. Methods A prospective observational study to initial evaluation included both the standard clinical evaluation for rupture of membranes and placental alpha-microglobulin-1 immunoassay. Rupture of membranes was diagnosed if fluid was seen leaking from the cervical os or if two of the following three conditions were present: pooling of fluid, positive nitrazine test, or feming. Rupture of membranes was diagnosed definitively on review of the medical records after delivery. Results Placental alpha-microglobulin-1 immunoassay confirmed rupture of membranes at initial presentation with a sensitivity of 100% (89/89), specificity of 91% (10/11), positive predictive value of 99% (89/90), and negative predictive value of 100% (10/10),false positive rate of 9% (1/11). Placental alpha-nricroglobulin-1 immunoassay was better than the conventional clinical assessment in confirming the diagnosis of rupture ofmembranes (P<0.01). Conclusion Measurement of placental alpha-microglobulin-1 in cervicovaginal secretions is superior to conventional clinical assessment in the diagnosis of rupture of membranes.

Objective To investigate the down regulation of phosphatase and tensin homolog deleted on chromosome 10 ( PTEN) gene by adenovirus mediated short hairpin RNA ( shRNA) on the adhesion in activated hepatic stellate cells( HSC ) in vitro and the related signal transduction mechanism .Methods The recombinant adenovirus ( Ad-shRNA/PTEN) with shRNA targeting PTEN and expressing green fluorescent protein ( GFP) were transient trans-fected into the cultural activated HSC in vitro.The experimental group as follows:1)Control group, viral medium was replaced by DMEM at virus transfection step .2 ) Ad-GFP group , HSC were infected with adenovirus expressing GFP alone.3)Ad-shRNA/PTEN group, HSC were infected with adenovirus both taking shRNA targeting PTEN and expressing GFP.PTEN mRNA expression was detected by RT-qPCR, and western blot was used for detecting pro-tein expressions of PTEN , focal adhesion kinase ( FAK) and phosphorylated FAK ( Thr397 ) [ p-FAK( Tyr397 ) ] in HSC.The toluidine blue stain method and MTT colorimetric method were used to determine the adhesion ability of HSC.Results When HSC were infected by adenovirus for 48 hours, PTEN protein and mRNA expressions in Ad-shRNA/PTEN group significantly decreased ( P<0.05 ) , compared to control group and Ad-GFP group, and the expressions of p-FAK ( Tyr397 ) in Ad-shRNA/PTEN group were significantly higher than those in control group and Ad-GFP group ( P<0.05 ) .The adhesion cell counting and the adhesion rate of HSC in Ad-shRNA/PTEN group significantly increased as compared with control group and Ad-GFP group ( P<0.05 ) .Conclusions The down-regulation of PTEN expression can promote the adhesion by increasing the activation of FAK signaling trans -duction in activated HSC in vitro.

Small scale restricted online course (SPOCs)+flipped classroomteaching is expected to become an important complement to the traditional teaching of dermatology. In this teaching mode, first of all knowledge nodes are divided separately according to the syllabus and for each node, 7 to 10 minutes of micro video or micro-lecture is made, which enables students to make best use of fragmented time through the network to master relevant knowledge independently before the trainee. In the flipped classroom, based on the difficulties and misunderstandings of learning reflected from the network monitor data, teacher can make full use of time on demonstrating typical cases, organizing discussion, grouping students to take diag-nostic and therapeutic exercise, answering targeted questions, teaching clinical thinking, experience and doctor-patient communication skills. Through this teaching mode, the new teaching idea can be imple-mented that students are in dominant position while teachers are in leading position, which contributes to deepening the understanding , absorption and application of knowledge and improving students' ability of communication, cooperation, diagnosis and treatment.

Objective To investigate the effects of bedside blinding method of active indwelling of nasojejunal tube combined with the nasogastric tube gastrointestinal decompression for patients with severe stroke.Methods 50 patients with severe stroke were selected and divided into two groups by using random number tables,which are the observation group and the control group,with 25 cases in each group.The patients in the observation group were treated with bedside blinding method of active indwelling of nasojejunal tube combined with the nasogastric tube gastrointestinal decompression,while the patients in the control group simply received bedside indwelling of nasogastric tube.The enteral nutritional goal -rate of target feeding volume on the 7th day and the 14th day after admission and trace the incidence of gastric stasis,the reflux and aspiration,the aspiration pneumonia in the patients of the two groups within 14 days and the situation of the days of mechanical ventilation,the days in ICU and the 30 -day mortality of patients were compared in the two groups.Results The enteral nutritional goal -rate of target feeding volume on the 7th day and the 14th day in the observation group were superior to those of the control group[The goal -rate of target feeding volume on the 7th day:88% vs.64%,χ2 =3.947,P =0.047;the goal -rate of target feeding volume on the 14th day:80% vs.52%,χ2 =4.367,P =0.037].Meanwhile the incidence of gastric stasis,the reflux and aspiration,the aspiration pneumonia in the patients of the observation group within 14 days were significantly lower than those in the patients of the control group within 14 days[The gastric retention rate:8% vs.56%(14 /25 ),χ2 =10.784,P =0.001;the reflux rate:0% vs.24%(6 /25),χ2 =4.735,P =0.03;the aspiration rate:8% vs.32%,χ2 =4.500,P =0.034;the incidence of aspiration pneumonia:24% vs.68%,χ2 =9.742,P =0.002].The days of mechanical ventilation and the days in ICU of the patients in the observation group are far less than those of the patients in the control group[The days of mechanical ventilation:(11.16 ±4.86)d vs.(13.72 ±3.67)d,t =-2.101,P =0.041;the days in ICU:(15.36 ±5.66)d vs.(18.72 ±2.99)d,t =-2.625,P =0.012].While there was no significant difference between the two groups on the 30 -day mortality(24% vs.32%,χ2 =0.397,P =0.529).Conclusion The bedside blinding method of active indwelling of nasojejunal tube combined with the nasogastric tube gastrointestinal decompression can significantly improve the enteral nutritional goal -rate of target feeding volume for patients with severe stroke and greatly reduce the incidence of gastric stasis,the reflux and aspiration,the aspiration pneumonia,and limit the days of mechanical ventilation and the days in ICU.Accordingly,it has the value of popularization in the clinical application.

Objective To investigate the effects of rhein lysinate (RHL)on the expressions of TNF-α,IL-6 and NF-κB in the kidney tissue of senescence accelerated mouse prone 10 (SAMP 10)mice.Methods We selected 1 8 male mice (SAMP 1 0 )aged 7 months for the study and randomly divided them into blank control group and groups of different concentrations of RHL;six senescence accelerated mouse resistance 1 (SAMR 1 )served as the young control group.After 6 weeks’ treatment,HE staining was used to detect the pathological changes of the kidney.The expressions of TNF-α,IL-6 and NF-κB at the protein level were detected by immunohistochemistry and Western blotting.Results RHL treatment did not affect the body weight of SAMP 10 mice (P>0.05 ). Compared with SAMR 1 mice, contracted and destroyed renal glomeruli and infiltration of mononuclear macrophages were observed in control SAMP10 mice.However,this pathological process was blocked by RHL (25 mg/kg and 50 mg/kg ) treatments. In addition, the overexpressions of TNF-α, IL-6 and NF-κB and the phosphorylation of NF-κB in the kidney tissue of SAMP 10 mice could be inhibited by RHL treatments (P<0.05). Conclusion RHL inhibits the inflammatory reaction of the kidney tissue,which may be one of the mechanisms by which RHL exerts its kidney-protecting and anti-aging effects.

Objective To investigate the protective effects of rhein lysinate ( RHL) on cardiac tissue damage in-duced by paraquat in experimental mice , and to clarify its mechanism .Methods In this study mice were assigned to the following three groups: control, paraquat model, and RHL-treated groups.The model of oxidative damage mice was established by intraperitoneal injection of paraquat .RHL-treated group was given RHL ( 50 mg/kg ) by gavage for one week before performing model .The other two groups were given equal volume of distilled water .For making model , paraquat was intraperitoneally injected in the paraquat model and RHL-treated group .The content of MDA was detected by thiobarbituric acid assay .The activities of SOD and GSH-Px were detected by biphenyl three phenolic autoxidation assay and NADPH coupling method respectivly .The pathological profile of cardiac tis-sue was observed by hematoxylin and eosin ( HE) staining and reactive oxygen species was observed by DCFH-DA staining .The change of proteins related to myocardial damage detected by Western blot .Results Compared with control group, the activities of SOD and GSH-Px decreased (P<0.05) and the content of MDA increased (P<0.05) in paraquat model group .However , these changes were attenuated byr RHL treatmen ( P<0.05 ) .The pathologi-cal examination indicated the structure of cardiac tissue was damaged and reactive oxygen species of cardiac tissue was increased after paraquat was given , however , these changes were attenuated after RHL treatmen .It was shown in western blot analysis that compared with control group , the expression of SIRT1 decreased, the acetylation of P53 and the expression of P 53 and P66 increased in paraquat-treated group .These changes were attenuated by RHL treatmen ( P<0.05 ) .Conclusions RHL may attenuate paraquat-induced cardiac injury in mice .