Objective To investigate the clinical characteristics, risk factors and prevention measures of carbapenem-resistant Klebsiella pneumoniae (CRKP) infection. Methods Thirty-nine cases whose CRKP isolation and culture were positive and who were confirmed with nosocomial infection in 2nd affiliated hospital medical school of Zhcjiang University between July 2006 and July 2008 were retrospectively investigated. Results There were 22 (56.4%) sputum specimens among CRKP samples. The average age of the patients was 64.0 years old and the average length of staying in hospital was 80.8 days. There wcre 36 patients who had been in intensive care unit (ICU) within 2 weeks and 26 were conscious disturbance,38 received urethral catheterization, 34 inserted with central venous catheter, 32 received tracheal intubation and 30 assisted with mechanical ventilation. There were 27 (69. 2 % ) patients who were co-infected with other bacteria and 8 were co-infccted with fungi. The mortality was 46. 2% in patients with CRKP infection. Before CRKP-positive culture, 27 (69.2%)experienced ＞4 kinds of antibiotics with the majority of β-lactams/β-lactamase inhibitors and carbapenems.Conclusions CRKP infection frequently occurrs in elder and patients who prolonged stay in hospital,especially patients in ICU. Invasive procedures could increase the infection opportunities.

Rabbits were intoxicated with hypodermic injection of 0.8% CdCl2 in normal saline every other day for 3 months,and the blood level of urea nitrogen (BUN) and creatinine (Cr) and the activities of Na/K-ATpase,Ca-ATPase,and ?-GT in the renal cortex were determined.It was found that there were no remarkable changes of BUN and Cr level but significant reduction of the activities of the 3 enzymes.It is believed that the reduction of the enzyme activities is one of the factors to initiate the functional disturbances and morphological damages of the kidneys and plays an important role in the mechanism of renal failure if it is not promptly corrected.

Objective Little is known about the influence of congenital heart disease on the phannacodynamies of neuromuscular blocking agents. The aim of this study was to compare the pharmacodynamics of rocuronium in children with cyanotic and acyanotic heart disease. Methods The study was conducted in two parts. In part Ⅰ , 36 children with congenital heart disease scheduled for open heart surgery were allocated into 3 groups (n=12) : acyanotic group; slightly cyanotic group and severely cyanotic group. Neuromuscular blockade was monitored after administration of 0.6 mg ? kg-1 rocuronium. In part Ⅱ , 40 children with congenital heart disease were allocated into acyanotic and cyanotic group ( n = 20). The children in each group were further divided into 4 subgroups of 5 patients according to the dose of rocuronium the children received : 120, 180, 240 and 300 ?g? kg-1 . The dose- response curve for neuromuscular blockade was constructed and ED50 , ED90 and ED95 were calculated. SPSS 8.0 software was used for statistical analysis.Results In part Ⅰ the onset time (the time from injection of rocuronium to 95% depression of neuromuscular transmission) was significantly longer in severely cyanotic group [(2.25 ? 1.27) Min] than in acyanotic group [(1.17 ? 0.15) min] . There was no significant difference in the duration of action and recovery time among the 3 groups. In part Ⅱ the dose-response curve shifted to the right in cyanotic group compared with acyanotic group. ED50, ED90 and ED95 were significantly higher in cyanotic group than in acyanotic group. Conclusion The onset time of rocuronium is prolonged and the sensitivity of the patients to rocuronium is decreased in patients with cyanotic heart disease.

Objective To investigate the clinical significance of serum P-selection,TNF-α,hs-CRP,IL-1β, ICAM in patients with diabetic renal microangipathy, and the therapeutic mechanism of Simvastatin combined with aspirinon in treating renal microangipathy. Methods The serum levels of P-selection,TNF-α, hs-CRP, IL-1β, ICAM were determined by ELISA in all groups. Patients with diabetic renal microangipathy treated with simvastatin and as-pirinon. Results ① The serum levels of P-selection,TNF-α,hs-CRP,IL-1β,ICAM in DM groups were higher than those of normal controls(P<0.01). ②After treatment with simvastatin and aspirinon for 8 weeks in patients with di-abetic nephropathy,the serum levels of P-selection, TNF-α, hs-CRP, IL-1β, ICAM were all decreased significantly compared with those before treatment respectively (P<0.01). After treatment for 16 weeks the above indices re-mained decreased until treatment for 21 weeks (P<0.01). Conclusion ①The plasma levels of Poselection,TNF-α and hs-CRP, IL-1β, ICAM are correlated to the occurance and development of diabetic renal microangiopathy, becom-ing predicted factors in early stage of diabetic renal microangiopathy. ②The therapeutic mechanism of simvastatin and aspirinon in patients with diabetic nephropathy lies probably in the inhibition of these factors expression, thus di-rectly or indirectly affecting the prolffer-ation of mesangial cells and mesangial matrix.

Calponin is an actin filament-associated regulatory protein expressed in smooth muscle and many types ofnonmuscle cells.Three calponin isoforms 1,2,and 3 are encoded by three homologous genes CNN1,CNN2 and CNN3 in vertebrate species with cell type-specific expression and functions.Besides modulating the activity of smooth muscle myofilaments and contractility,calponin also regulates the functions of actin cytoskeleton in non-muscle cells during cell proliferation,adhesion,migration,differentiation,phagocytosis and fusion.This review focuses on the evolution,tissue and cell type-specific expression,structure-function relationships,transcriptional regulation and relevant mechanisms.

OBJECTIVE:To observe the efficacy and safety of tripterygium glycosides combined with mizolastine in the treatment of dermatitis and eczema. METHODS:138 patients with dermatitis and eczema were randomly divided into control group (69 cases) and observation group (69 cases). Control group received Mizolastine sustained release tablet 10 mg,orally,once a day. Observation group additionally received Tripterygium glycosides tablet 20-30 mg,orally taking after a meal,3 times a day. All patients treated for 3 weeks,patients’life way remained unchanged during treatment. Clinical efficacy,total score of symptoms, IL-2,IL-6,CRP levels and the incidence of adverse reactions in 2 groups were observed. RESULTS:The total effective rate in observation group was significantly higher than control group,with significant difference (P<0.01). After treatment,the total score of symptoms,IL-2,IL-6,CRP levels in 2 groups were significantly lower than before,and observation group was lower than control group,with significant differences(P<0.05 or P<0.01). The incidence of adverse reactions in observation group was significantly lower than control group,with significant difference (P<0.05). CONCLUSIONS:Tripterygium glycosides combined with mizolastine shows better efficacy than mizolastine alone in the treatment of dermatitis and eczema,with better safety.

AIM：To investigate the role of NF-κB in the activation of inducible nitric oxide synthase (iNOS) gene by tumor necrosis factor alpha (TNF α) and lipopolysaccharide (LPS) in endothelial cells and effect of antioxidant on the induction of iNOS. METHODS：Rat pulmonary microvascular endothelial cell (RPMEC) was cultured and the cells were identified with antiendothelial cell antibody CD31 using immunohistochemistry(ABC). The concentration of nitrite in the culture media was determined based on Griess reaction. iNOS mRNA was analyzed using RT-PCR and Northern blot. NF-κB in cell nuclei was detected with electrophoresis mobility shift assay (EMSA). RESULTS：A marked production of nitrite in RPMECs was found after 24 hours treatment with TNF α(105 U/L) and LPS (1 mg/L) (P＜0.01). The level of iNOS mRNA increased significantly after adding TNF α(105 U/L) and LPS (1 mg/L) to the cell media for 2 hours (P＜0.05). Pretreatment with cycloheximide (CHX, 10 mg/L) or antioxidant, PDTC (0.1 mmol/L) or NAC (20 mmol/L) significantly decreased nitrite production and iNOS mRNA expression induced by TNF α(105 U/L) and LPS (1 mg/L) (P＜0.05). Furthermore, there was a dose-effect relationship between PDTC/NAC and inhibitory effect. TNF α (105 U/L) and LPS (1 mg/L) triggered the activation and translocation of NF-κB. This effect was blocked by adding PDTC (0.1 mmol/L) or NAC (20 mmol/L) to the cell media for 1.5 hours.CONCLUSION：1.TNFα and LPS may induce iNOS gene expression at transcriptional or posttranscriptional level. The upregulation of iNOS depends on new protein synthesis. 2. The induction of iNOS gene expression by TNFα and LPS is dependent on the activation of NF-κB. 3. Antioxidants may inhibit the induction of iNOS gene through the inhibition of NF-κB activation.

Objective To investigate the value of dual-energy virtual unenhanced and dual-energy iodine value distribution diagram type of kidney cancer.Methods A retrospective analysis of 35 cases of renal cell carcinoma dual-energy CT scan data,compared to kidney pathology data,analyze the image quality and radiation dose dual-energy virtual unenhanced and dual energy distribution of iodine in clear cell carcinoma and non-clear cell carcinoma the differences that exist.Results Unenhanced and virtual unenhanced image quality was quite,CT value (routine unenhanced renal parenchyma 31.90±4.10 HU,abdominal aortic 45.60±6.30 HU,psoas 50.00±6.6 HU3,kidney 1.410±17.06 HU; virtual unenhanced renal parenchyma abdominal aortic 33.20±5.50 HU,48.30±8.00 HU,52.40±10.63 HU psoas kidney 0.87±17.48 HU),signal to noise ratio (routine unenhanced renal abdominal aorta 3.22±1.49,5.13±2.57,4.56±2.12 psoas kidney 3.24±2.27 virtual unenhanced renal abdominal aorta 2.73±1.08,3.79±1.64,3.23±1.35 psoas kidney 2.18± 1.57) had not significantly different (P ＞ 0.05).Clear cell carcinoma of the skin medullart junction of iodinedistribution of images Iodine (2.75±1.05) mg/ml was higher than non-clear cell carcinoma (1.25±0.72) mg/ml,the difference was statistically significant (t =7.048,P ＜ 0.05).Conclusions CT examination in patients with renal cell carcinoma virtual unenhanced image quality is similar with routine unenhanced image quality,it reduces radiation dose.The distribution of iodine can provide more diagnostic information that can help us be more intuitive and accurate judgments of the blood supply and kidney cancer subtypes.

ObjectiveTo analyze the distribution and antibiotic resistance of bacteria isolated from cerebrospinal fluid. Methods569 cerebrospinal fluild specimens were analyzed. ResultsPathogens were isolated from 93 specimens (16.3%), in which 52 were Gram positive bacteria and 38 were negative, 3 were fungi. All the Gram positive cocci were sensitive to vancomycin and linezolid, while the Gram negative bacteria were resistant to routine antibiotics such as cefotaxime and ceftriaxone, but sensitive to carbapenems. ConclusionThe prevailing pathogens in intracranial infection are Gram positive cocci, especially Staphylococcus epidermidis and Staphylococcus aureu.

AIM:To investigate the role of nuclear factor ?B (NF ?B) in the induction of iNOS gene by TNF? and LPS in endothelial cells and the effect of antioxidant on the induction of iNOS. METHODS:Nitrite was determined based on Griess reaction. iNOS mRNA was analyzed using Northern blot. NF ?B in the cell nucleole was detected with electrophoretic mobility shift assay.RESULTS:(1)NO production and iNOS mRNA expression induced by LPS and TNF? was blocked by pyrrolidine dithiocarbamate(PDTC) or N-acetylcysteine(NAC). (2)LPS and TNF? triggered the activation and translocation of NF ?B, and PDTC or NAC inhibited the activation of NF ?B induced by LPS and TNF?.CONCLUSIONS:(1)The induction of iNOS gene by TNF? and LPS is dependent on the activation of NF ?B.(2)Antioxidants may inhibit the induction of iNOS gene through the inhibition of NF ?B activation.