Objective:To investigate the epidemiological characteristics of bacteria and their susceptibility to antimicrobials and to establish a basis for empirical treatment of the neonatal infections. 　Methods:Identification of bacteria were performed according to the National Standard of Clinical Microbiological Test. Disk diffusion were used for antimicrobial susceptibility test.　Results: A total of 2,244 strains were isolated from the samples collected in our neonatal ward from Jan. 1987 to Dec. 1998. The predominant species ranked the first three were Staphylococcus epidermidis, Staphylococcus saprophyticus and Escherichia coli in the group I (infections acquired outside of hospital). Escherichia coli, Klebsiella and pseudomonas aeruginosa ranked the first three in the group Ⅱ(nosocomial infections). The resistance rates of bacterial isolates from group Ⅱ to antimicrobial agents including penicillin and ampicillin were significantly higher than that from group I (P＜0.05). The sensitivity rate was 82.2% by using amikacin only, but raised to 89% when combined with penicillin. 　Conclusion: Gram-negative bacteria were the main pathogens of nosocomial infections of neonates in our hospital but Gram-positive bacteria were the main pathogens of infections acquired outside of hospital. The nosocomial pathogens were more prone to developing drug resistance. It is recommended that the combinative use of amikacin and penicillin be employed as primary antibiotics for treatment of neonatal infections.

According to the goal of promoting all-round ability and the core idea of PRICE,the Medical School of Shanghai Jiao Tong University improves the curriculum,teaching method,experimental teaching,multidimensional examination to explore the new system of teaching reform for eight-year clinical medical education.

Objective To study the etiologies of long duration fever in neonates and to provide clinical evidence for early diagnosis and intervention. Methods From January 1st, 2004 to December 31st, 2013, data from neonates admitted to the Department of Neonatology, Childrenˊ s Hospital of Chongqing Medical University were retrospectively analyzed. Results Among 238 neonates with long duration fever, 165 cases were male and 73 female. Pneumonia(n = 196), skin / mucosa infection (n =67), sepsis (n = 46), meningitis/ encephalitis (n = 25) and neonatal necrotizing enterocolitis (n = 24) were the most common etiologies. Diabetes insipidus was the only noninfectious cause of fever in this study. The incidence of high fever in cases diagnosed with meningitis/ encephalitis, sepsis, diabetes insipidus, immunodeficiency or urinary tract infection were significantly higher than other causes (P <0. 05) . Continuous fever or other special fever types were more common in cases diagnosed with pneumonia ( χ2 = 4. 581, P = 0. 032 ) . Incidences of sepsis, infectious diarrhea or meningitis/encephalitis in late neonates were significantly higher than early neonates ( P < 0. 05 ) . Conclusions Long duration fever in neonates is most likely caused by infectious diseases and diabetes insipidus is the only noninfectious cause of neonatal fever in our study.

Self-directed learning(SDL)is an important learning form for the future educational development and the continued medical education.SDL facilitates the learning effects of advanced studying doctors in neonatology.This article investigates the major developments and influencing factors relative to self directed learning,and provides insight into the practice and progress of self directed learning of the advanced studying doctors in neonatology.

Objective To discuss the feasibility of laparoscopic closure of the internal ring and high ligation of the hernial sac in children with indirect inguinal hernia.Methods Laparoscopic closure of the internal ring and high ligation of the hernial sac was conducted in 21 children with indirect inguinal from January 2003 to December 2004 in this hospital.A 5-mm 30? laparoscope was introduced through the umbilicus.The internal ring and the posterior crus(PC) on the side of hernia were identified.A 3-mm dissection forceps was placed on the midline between the umbilicus and pubic symphysis.At the skin projection of the internal ring on the side of hernia,a round-tip needle with 3-0 Prolene suture grasped by a regular needle holder was passed directly into the abdominal cavity to suture the posterior crus and then penetrate out of the abdomen via the roof of the internal ring through the musculoaponeurotic arch of the transversus abdominis.Then the Prolene suture was cut off,and passed by using the Endoclose device into the extraperitoneal cavity at the skin projection of the internal ring.The dissection was continued from without outward around the sac to encircle the neck and an extracorporeal high circumferential ligation of the sac was finished.Results The operation was successfully completed in all the 21 cases.The operating time was 16~50 min(mean,32.9 min),the postoperative duration in hospital was 1~2 d,and the time to normal activity,1~4 d(mean,1.4 d),respectively.No postoperative bleeding,hematoma of scrotum,or incisional infection occurred.Follow-up checkups in the 21 cases for 1~24 months(mean,15 months) showed no recurrence.Conclusions Laparoscopic closure of the internal ring and high ligation of the hernial sac is a novel,feasible,reliable and effective herniorrhaphy for the treatment of pediatric indirect inguinal hernia.

Obgective To analyze the demographic data,non-specific items,pathogens and antibiotic sensitivity between the children with early-onset and late-onset sepsis,in order to guide the diagnosis and treatment of neonatal sepsis.Methods Three hundred and fifty-two cases with positive blood culture were retrospectively recruited and divided into an early-onset group and a late-onset sepsis group according to the onset of sepsis.Results Of 352 cases,144 cases (40.91％) were the early-onset children while 208 cases (59.09％) were the late-onset children,and in the late-onset group,108 cases occurred due to nosocomial infection.Most neonates of the early-onset term were term infants [107/144 cases (74.31％)],while the preterm infants [77/208 cases (37.02％)] and low birth weight infants[70/208 cases(33.65％)] accounted for the majority of the late-onset group.The asphyxia,perinatal intrauterine distress,meconium-staining amniotic fluid and premature rupture of fetal membranes ≥ 18 h occurred more frequently in the early-onset group [21/144 cases (14.58％),14/144 cases (9.72％),26/144 cases (18.06％),31/144 cases (21.53％)],respectively,while those in the late-onset group were [17/208 cases (8.17％),9/208 cases(4.33％),13/208 cases(6.25％),17/208 cases(8.17％)],respectively,there were significant differences (x2 =4.622,3.886,5.950,13.345,all P ＜ 0.05) between 2 groups.In the early-onset group abnormal temperature[72/208 cases(34.62％)vs 30/144 cases(20.83％)],vomiting or abdominal distention[109/208 cases (52.40％) vs 35/144 cases (24.31％)],lethargy [79/208 cases (37.98％) vs 38/144 cases (26.39 ％)] and umbilicalitis or skin pustule [33/208 cases (15.87 ％) vs 11 / 1 44 cases (7.64 ％)] occurred more frequently in late-onset group,and there were significant differences (x2 =7.853,8.763,5.153,5.265,all P ＜ 0.05).Besides,more cases in the late-onset group had elevated immature neutrophil vs total neutrophil count ratio [27/184 cases (14.67％)] and C-reactive protein value [76/206 cases (36.89％)],compared with those in early-onset group [9/133 cases (6.77％),38/143 cases(26.57％)],and there were significant differences (x2 =4.794,4.087,allP ＜ 0.05).Compared with early-onset group,patients in the late-onset group were more likely to suffer from suppurative meningitis [17.79％ (37/208 cases) vs 8.33％ (12/144 cases);x2 =6.348,P ＜ 0.05].In terms of pathogens,the main pathogens in the early-onset group were gram negative bacteria[39.58％ (57/144 cases),including detection of Klebisella pneumoniae in 21 cases and E.coli in 20 cases] and coagulase negative staphylococcus[32.64％ (47/144 cases)].In late-onset group,the main pathogens were gram positive bacteria [58.65％ (122/208 cases)],including detection of coagulase negative staphylococcus in 90 cases(43.27％) and E.coli [17.79％ (37/208 cases)].There was no significant difference in prognosis between 2 groups(x2 =1.187,P =0.552).Conclusions Early-onset sepsis and late onset sepsis differ in the clinical manifestation and laboratory findings.Distinguishing neonatal early-onset and late onset septicemia is of clinical significance in choosing appropriate antibiotics.

Objective To explore the feasibility of la pa roscopic total extraperitoneal hernia repair without the use of the balloon diss ector. Methods Laparoscopic total extraperitoneal hernia repai r using no balloon dissector was completed in 10 cases of groin hernia from Nove mber 2003 to April 2004, including 7 cases of indirect inguinal hernia, 1 case o f occult indirect hernia combined with direct inguinal hernia, and 3 cases of di rect inguinal hernia (1 of which was recurrent hernia). Results All the 10 operations were successful. The mean operation time was 69.5 min, t he mean blood loss was 11 ml, the mean postoperative hospital stay was 2.1 days , and the mean duration to normal activities, 5.2 days.Complications included 1 case of disassociated inferior epigastric artery, 1 case of operation in wrong anatomic layer, and 1 case of laceration of the peritoneum, respectively. Follow -up observations for 1~6 months found no recurrence and neuropathic pain. Conclusions Laparoscopic total extraperitoneal hernia repair without the use of the balloon dissector is feasible, safe and effective.

Objective To study computed tomography (CT) in evaluating prognosis for hypoxic ischemic encephalopathy (HIE) in infants. Methods Eighty-five infants diagnosed as HIE underwent CT one week,two months,three to six months and one to one and a half years after birth,respectively. At the same time,neonatal behavior neurological assessment (NBNA) was made at 12 to 14 days after birth. Development quotient (DQ) was used to evaluate their prognosis at age of 1 to 1.5 years. Results Rate of poor prognosis was 40.9% (9/22) in the infants with severe HIE by CT and 5.7% (3/52) in those with moderate HIE within one week after birth. Rate of poor prognosis was 60.0% in the infants with abnormal CT at age of two months. There was no significant difference in their prognosis for infants of moderate HIE with NBNA scores greater than or equal to 35 and less than 35,12 to 14 days after birth. And,72.7% (8/11) of the infants with severe HIE by CT with NBNA less than 35 showed little recovery at 12th-14th days after birth. Conclusions Combination of CT and clinical follow-up with NBNA score one month after birth could play an important role in the evaluation for therapy regime,length of treatment and prognosis in the infants with HIE.

Objective To investigate the effect of EDTA combined with ciprofloxacin on Pseudomonas aeruginose biofilm in vivo.Methods Pseudomonas aeruginosa was inhaled into the lung of guinea pigs and colonized,formed biofilm.After 7 days,the model was treated with ciprofloxacin,EDTA alone,or a combination of both for 7 days.The number of colony in the lungs is measured by agar plate.The pathological change of the lung is observed by hematoxylin and eosin (HE) staining and scanning electron microscope.Results EDTA combined with ciprofloxacin make the number of bacteria in the lungs reduced from l05 CFU/g to 10 CFU/g(t =24.67,P＜0.05),the lung lesion was less-sever histophathologically.Conclusion The combination of EDTA with ciprofloxacin has significant activity to remove mucoid PA biofilm in vivo.

Organic anion transporting polypeptide 1B1 (OATP1B1) is an important liver-specific uptake transporter, which mediates transport of numerous endogenous substances and drugs from blood into hepatocytes. To identify and investigate potential modulators of OATP1B1 from natural products, the effect of 21 frequently used natural compounds and extracts on OATP1B1-mediated fluorescein methotrexate transport was studied by using Chinese hamster ovary cells stably expressing OATP1B1 (CHO-OATP1B1) in 96-well plates. This method could be used for the screening of large compound libraries. Our studies showed that some flavonoids (e.g., quercetin, quercitrin, rutin, chrysanthemum flavonoids and mulberrin) and triterpenoids (e.g., glycyrrhetinic acid and glycyrrhizic acid) were inhibitors of OATP1B1 with IC50 values less than 16 µmol · L(-1). The IC50 value of glycyrrhetinic acid on OATP1B1 was comparable to its blood concentration in clinics, indicating an OATPlB1-mediated drug-drug interaction could occur. Structure-activity relationship analysis showed that flavonoids had much higher inhibitory activity than their glycosides. Furthermore, the type and length of saccharides had a significant effect on their activity. In addition, we used OATP1B1 substrates fluvastatin and rosuvastatin as probe drugs to investigate the substrate-dependent effect of several natural compounds on the function of OATP1B1 in vitro. Our results demonstrated that the effect of these natural products on the function of OATPlB1 was substrate-dependent. In summary, this study would be conducive to predicting and avoiding potential OATP1B1-mediated drug-drug and drug-food interactions and thus provide the experimental basis and guidance for rational drug use.