Objective To evaluate the impact of carvedilol and metoprolol on left ventricular (LV)dyssynchrony in idiopathic dilated cardiomyopathy(IDC).Methods In this study,we randomly assigned 65 IDC patients from January 2009 to June 2011 to re-ceive carvedilol or metoprolol succinate.All patieats were divided in to carvedilol group(n=33)and metoprolol group(n=32)Echo-cardiographic measurements and N-terminal pro-brain natriuretic peptide levels were obtained at baseline and 6 month after thera-py.Then long-term follow up the survival rate of patients were observed.Results In carvedilol group,reduction in LVEDS and in-crease in LVEF was higher compared to metoprolol group.Also improvement in LV dyssynchrony achieved and survival rate with carvedilol was higher than metoprolol.However,Improvements in LV mechanical dyssynchrony was similar in two groups.Im-provements in LV mechanical dyssynchrony achived with both drugs were accompanied by reduction in NT-pro-BNP levels in both carvedilol and metoprolol groups(P >0.05).Conclusion Carvedilol is an effective drug improves the intraventricular dyssynchro-nyfor for IDC patients with left ventricular dyssynchrony,and could increasea the survival rate.

Objective To explore the effects of SLC concentration gradient on suppression of tumor immune escape. Methods According to different SLC concentration, there were six groups. The HLA-Ⅰexpression and apoptosis of MCF-7 were detected with FCM,and intracellular BCL-2 expression was analyzed by western blot. The production of TGF-? was detected with ELISA. Results In a certain range of concentration gradient, following SLC increase, HLA-Ⅰexpression level on MCF-7 was improved, and apoptosis was induced but BCL-2 expression was enhanced. Moreover, the secretion of TGF-? was suppressed. Conclusion SLC inhibites tumor immune escape.

Objective To investigate the influence of enteral nutrition (EN) emulsion containing slowrelease starch on blood sugar level in patients with craniocerebral injury. Methods Totally 120 patients with severe craniocerebral injury complicated with hyperglycemia joined this open study and were randomized into control group and study group. Study group was given EN emulsion containing slow-release starch ( Fresubin Diabetes)and control group was given routine EN emulsion ( Fresubin), both for 15 days. Fasting blood glucose (FBG),2-hour postprandial glucose (2hPG), and glycosylated hemoglobin (HbA1c) were examined before EN support and 7 days and 15 days after EN support. Results In the study group, the levels of 2hPG before EN support and on the seventh and fifteenth day after EN support were ( 12.26 ± 2. 36 )mmol/L, (9.76 ± 2.90 ) mmol/L, and (9.78 ± 1.86) mmol/L, respectively. The levels of 2hPG after EN support were both significantly lower than that before EN support (P ＜ 0. 05). However, the levels of FBG and HbA1c in the study group were not significantly different before and after EN support ( P ＞ 0. 05 ). In the control group, the levels of 2hPG on the seventh and fifteenth day after EN support were ( 11.70 ± 2. 80) mmol/L and ( 11.39 ± 2. 44 ) mmol/L, respectively, which were significantly higher than those in study group ( P = 0. 033, P = 0. 020). The levels of FBG and HbA1c werenot significantly different between the study group and the control group ( P ＞ 0. 05 ). Conclusion EN emulsion containing slow-release starch may promote the control of blood sugar in patients with craniocerebral injury complicated with hyperglycemia and improve the level of postprandial blood sugar in those patients.

OBJECTIVE To analyze the sequence of IMP-4 metallo-?-lactamases(MBLs) encoding gene from clinical isolates of multiple-drug-resistant Klebsiella oxytoca strains and attempt to know the integrons composing the drug resistance gene box.METHODS The antibiotic sensitivity test of multi-resistant K.oxytoca strains was done according to Kirby-Bauer method of CLSI 2005,and the double disk synergy test and Etest were for detecting their MBLs.The Class 1 integrons were detected by PCR.The purified amplicons of Class l integrons were sequenced.The type and order of gene cassettes in integrons were analyzed by searching GenBank.RESULTS The K.oxytoca was resistant to carbapenems,the third-generation cephalosporins,cefoxitin,quinolones,cefoperazone/sulbactam,sulfamethoxazole/trimethoprim,amoxicillin/clavulanate,ticacillin/clavulanate,piperacillin,cefepime,rifampicin and piperacillin/tazobatam,only susceptible to amikacin and polymyxin B.The IMP-4 metallo-?-lactamases,aadA1,AmpC,CTX-M-14,qacE△1-sull and intI1 were positive.CONCLUSIONS Integrons are important molecular mechanism in the development of multidrug resistance.There are resistance gene boxes in them.

Objective To evaluate the performance and clinical utility of Verigene gram-negative blood culture ( BC-GN ) assay for a rapid identification of gram-negative bacteria and resistance genes . Methods Non-repetitive blood culture samples containing gram-negative bacteria were collected from inpa-tients in the Second Affiliated Hospital of Zhejiang University School of Medicine from June to October , 2013 .BC-GN assay was performed to identify the species and genetic resistance determinants of gram -nega-tive bacteria directly from the positive blood culture bottles .VITEK MS and the VITEK 2 Compact were used for species identification and antimicrobial susceptibility test , the results of which were considered as gold standards.The resistance genes were further validated by PCR amplification and sequencing analysis .A comparison of the results and time between the BC-GN assay and routine methods was conducted . Results The detection range of BC-GN assay almost covered all of the common gram-negative bacteria .BC-GN assay showed an advantage of high accuracy in the identification of Escherichia coli (13/13), Klebsiella pneumoniae (19/24), Klebsiella oxytoca (9/9), Pseudomonas aeruginosa (39/39), Serratia marcescens (4/5), Enterobacter spp.(6/8), Citrobacter spp.(11/11), Proteus spp.(6/6) and Acinetobacter spp. (24/24) with an overall accuracy of 94.24%for the identification of mono-microbial blood culture samples . Moreover , BC-GN assay accurately identified all of the bacteria and resistance genes from the two multi -mi-crobial samples .Species identification and resistance profiles could be 42 hours earlier available by using BC-GN assay than those by using routine methods .Conclusion BC-GN assay could simultaneously and ac-curately identify bacteria and resistance determinants from blood cultures within 2 hours.More time for clini-cally effective therapy could be achieved by using BC-GN assay for the reduction of mortality associated with bloodstream infection .

Objective To investigate the causes and risk factors of postpartum hemorrhage (PPH) in hepatitis B virus (HBV) infected parturient.Methods Retrospective analysis was performed on the 1021 HBV infected parturient from Shanghai Public Health Clinical Center from July 2005 to June 2011.The comparisons were done by chi-square test.Results Among 1021 cases of HBV infected parturient,868 (85.01％) were asymptomatic and the PPH rate was 2.76％ (24/868) ;the remaining 153 cases (14.99％) were chronic active hepatitis B and the PPH rate was 16.99％(26/153).The difference between two groups was statistically significant (x2 =56.541,P＜0.01).The total incidence rate of PPH was 4.89％ (50/1021) and 17 cases (34.00％) were postpartum hemorrhage＞1000mL.The causes of PPH included uterine inertia (30/50,60.00％),abnormal placenta (11/50,22.00％),dysfunction of coagulation (5/50,10.00％) and lesion of birth canal (4/50,8.00％).The risk factors of PPH included delivery mode (x2 =6.528,P=0.038),abortion times (x2 =16.269,P=0.000),delivery times (x2 =6.990,P=0.008),ALT levels (x2=56.541,P=0.000) and HBV DNA (x2 =64.706,P=0.000).Conclusions The main causes of PPH in HBV infected parturient include uterine inertia,abnormal placenta,lesion of birth canal and dysfunction of blood coagulation.PPH is correlated with abortion times,delivery times,delivery mode,liver function and HBV DNA.The incidence of PPH in parturient with chronic active hepatitis B is higher than asymptomatic parturient.

AIM To determine the contents of arillanin A,tenuifoliside A and tenuifoliside C in raw Polygalae Radix (root barks),Polygalae Radix duramen,Glycyrrhizae Radix et Rhizoma-processed Polygalae Radix,waterboiling Polygalae Radix and honey-processed Polygalae Radix.METHODS The analyses of 50％ methanol extracts from samples were performed on a 30 ℃ thermostatic Kromasil C18 column (250 mm ×4.6 mm,5 μm),with the mobile phase comprising of acetonitrile-0.1％ formic acid flowing at 1.0 mL/min in a gradient elution manner,and the detection wavelength was set at 330 nm.RESULTS The contents of three oligosaccharide esters were the highest in raw Polygalae Radix,followed by those in honey-processed Polygalae Radix,and those in water-boiling Polygalae Radix were the lowest.These constituents also existed in Polygalae Radix duramen,but their contents were lower than those in root barks.CONCLUSION The ester bonds of oligosaccharide esters in Polygalae Radix may be hydrolyzed during processing,followed by the generation of small molecular organic acids.The medication of whole Polygalae Radix (root barks and duramen) can be taken into consideration in clinical practice to reduce toxicity and enhance efficacy.

Objective To compare the reliability and validity of 2 incontinence- associated dermatitis (IAD) risk assessment tools (IAD risk assessment scale and PAT) in patients with incontinence, and to search for the best risk assessment tool. Methods A total of 101 IAD cases were chosen from the Affiliated Hospital of Nantong University.Reliability was evaluated by the inter- rater reliability,internal consistency,item sensitivity analysis and retest reliability; validity was evaluated by the structure validity and predictive validity. Results Cronbach α was 0.313 (IAD risk assessment scale) and 0.421(PAT);Cronbach α coefficient was the highest after the items that Change sheets and mats and relevant factors were removed respectively in two tools,which were 0.431, 0.428; The correlation between the total scores were 0.711 (P<0.01)(IAD risk assessment scale)and 0.498 (PAT)(P<0.01);Area under curve were 0.661 (IAD risk assessment scale),0.864 (PAT); the best cut-off value to forecast a poor prognosis was 53.5 (IAD risk assessment scale),6.5 (PAT). Conclusions The reliability and validity of IAD risk assessment scale and PAT are low. The change of sheets and mats and Related influencing factors are needed to be adjusted and revised.

Objective To investigate the distribution and molecular epidemiology of Candida strains isolated from vulvovaginal candidiasis in Shanghai,and conduct molecular phylogenetic analysis of the strains.Methods Candida pathogens were collected from the patients with vulvovaginal candidiasis during the period from August 2015 to February 2016 in Obstetrics and Gynecology Hospital of Fudan University,Shanghai First Maternity and Infant Hospital,and Intemational Peace Matemity and Child Health Hospital.All the strains were identified and statistically analyzed.ATB FUNGUS 3 kit was used to determine the minimum inhibitory concentration of antifungal agents against these strains in vitro.Molecular typing was conducted using multilocus sequence typing (MLST) method.Phylogenetic analysis was carried out by eBURST and MEGA 6 software.Results Of the 2 185 strains of Candida,1 988 were identified as Candida albicans,149 Candida glabrata,20 Candida tropicalis and 28 other Candida species.Overall,6.5％ of the Candida albicans strains were resistant to fluconazole.Twenty-six diploid sequence types (DSTs) were identified among the 93 strains of Candida albicans analyzed,including 50 fluconazole-susceptible strains with sporadic genotypes,but 43 fluconazole-resistant strains clustered as one clonal complex (CC 69) on the same branch (MLST Clade 1) of phylogenetic tree.Conclusions Candida albicans was the main pathogen of vulvovaginal candidiasis in the three obstetrics & gynecology hospitals in Shanghai,which showed slightly higher resistance to fluconazole.It is necessary to monitor the spread of fluconazole-resistant Candida albicans in these hospitals,especially clonal dissemination of CC 69 clone.