OBJECTIVE To investigate the drug resistance of pathogens in pediatric ICU and discuss how to treat infections caused by these resistant strains.METHODS After genus identification,bacterial susceptibility test was carried out using Kirby-Bauer disk method.RESULTS A total of 270 clinical isolates were analyzed including 194(72%) strains of Gram-negative bacilli and 76(28%) strains of Gram-positive cocci.From them 182(67%) strains were isolated from sputum,78(29%) strains from blood and 10(4%) strains from secretion.The most common bacilli were Klebsiella spp,coagulase negative Staphylococcus,Escherichia coli,Enterococcus spp and Pseudomonas aeruginosa.About 66.7% of E.coli and 91.1% of Klebsiella spp isolates produced ESBLs,the isolating rate of MRCNS was 83.9%.CONCLUSIONS The characteristics of pathogen distribution and drug resistance surveillance must be understood in order to use antibiotics rationally,to control the increasing trend of drug resistance pathogens and to forbid the break out of nosocomial infections.

BACKGROUND:Some scholars suggest that the nerve root palsy after cervical spinal stenosis treated with
decompression and implant internal fixation is related with the cervical stability and cervical lordosis, but there is controversial.
OBJECTIVE:To explore the C 5 nerve root palsy and stability after cervical spinal stenosis treated with posterior laminectomy lateral mass fixation and single-door decompression laminoplasty.
METHODS:Twenty-nine cervical spinal stenosis patients were selected and treated with posterior
decompression and implant internal fixation. Posterior laminectomy lateral mass fixation for the treatment of
cervical spinal stenosis:C3-6 lateral mass and C7 pedicel screw internal fixation was performed and caused rough surface on the facet joint;the unstable segment was confirmed according to the preoperative anteraposterior
plain film and dynamic radiographs combined with MRI and CT images, and then the corresponding segments were treated with lateral mass internal fixation, single-door decompression laminoplasty and laminoplasty.
RESULTS AND CONCLUSION:Al the 29 cervical spinal stenosis patients were fol owed-up for 8 months to 2.3 years. Among them, 14 cases were treated with posterior laminectomy lateral mass fixation, two cases had nerve root palsy in the early stage after implantation, three cases had incomplete paralysis after long-term symptom recurrence and treated with second surgery of scar remove and decompression;15 cases were treated with single-door decompression
laminoplasty, and one case had C 5 never root palsy and shoulder abduction dysfunctionafter treatment, no preoperative symptom recurrence. The nerve root palsy wil restored in 6 weeks for shortest and 9 months for longest. As the limitation of the case number, it is not clear whether there were significant differences in the correlation between C 5 nerve root
palsy and segmental stability, cervical lordosis, spinal decompression degree and the range for spinal cord shift, as wel as the nerve root palsy degree and the cervical spinal stenosis recurrence caused by forward scar between two
treatment methods, so accumulation observation of the cases and clinical experience are needed.

Objective To study the clinical treatment methods for properties of unknown in elderly patients with atypical squamous cell of undertermind significant and above cervical lesions.Methods According to the clinical grouping of ASCUS in elderly patients with cervical lesions of different treatment methods,observation group 1 (348 cases) underwent colposcopy;observation group 2(316 cases) for high-risk human papillomavirus(HPV) detection,HPV positive colposcopy ;observation group 3 (129 cases) of cervical cytology examination regularly,squamous intraepithelial lesion colposcopy,compared three groups of clinical treatment.Results Liquid based cytology and three groups of 574 patients (TCT) and colposcopy and cervical biopsy,the results of intraepithelial neoplasia(C IN) above cervical lesions in 223 cases(38.9%),in which CIN Ⅰ 136 cases(23.7%),CIN Ⅱ in 64 cases(11.2%),CIN Ⅲ 20 cases(3.5%),3 cases of carcinoma in situ(0.5%) ;the group1 were observed in 348 cases,348 cases underwent colposcopy biopsy(100%),CIN Ⅱ above 36 cases(10.3%) were observed in the group 2;213 cases of colposcopy biopsy(67.4%),CIN Ⅱ above 38 cases (12%) were observed in the group 3 ; colposcopy examination in 13 cases (10.1%),3 cases of biopsy CIN Ⅱ of the cases(2.3%).Biopsy of CIN Ⅱ above the detection rate,the observation group 1,observation of the 2 groups had no significant differences(P ＞ 0.05),and observe the difference between the 3 groups was statistically significant(x2 =7.014,9.156,all P ＜ 0.05).Conclusion High-risk HPV detection of shunt ASCUS can reduce cervical lesions treatment process misdiagnosis,missed diagnosis and treatment of the problem of excessive.

Aim To study the inhibitory effect of chitosan on peroxidation and monocytes adhesion to vascular endothelial cells induced by high concentration of glucose. Methods Human umbilical vascular endothelial cells (HUVEC) were treated with high glucose, and high glucose with different concentrations of chitosan for 24 h. Hydroxyl radicals (OH?) and malon-dialdehyde (MDA) were measured. Monocytes Raw 264.7 were pre-incubated with Rhodamin123, and then co-cultured with HUVEC for 30 min, followed bymicroscope observation and determination of the monocytes adhesion. Finally, the mRNA expression of vascular cell adhesion molecular-1 (VCAM-1) was evaluated by reverse transcription polymerase chain reaction (RT-PCR). Results Concentrations of OH? and MDA in HUVEC increased after incubation with high glucose. Both of the amount of adhesive monocytes and mRNA expression level of VCAM-1 in HUVEC were induced by high glucose. Inversely, chitosan inhibited these changes in a dose-dependent manner without any cytotoxicity to cells. Conclusion Chitosan can scavenge free radicals and prevent peroxidative injury on vascular endothelial cells, which further down-regulates the expression of VCAM-1 and consequently inhibits the adhesion of monocytes to endothlial cells.

Drug delivery system targeting immune system plays an important role in the treatment of inflammatory diseases.Drug delivery system targeting immune system could target immune cells or immune organs.It could be divided into active targeting mediated by the interaction of ligand-receptor or antigen-antibody and passive targe-ting mediated by pH;particles and so on.This review summarizes new progress for drug delivery system targeting immune system;which provides a theoretical reference for designing the safe and effective drug delivery system and providing efficient and safe treatment for inflammatory diseases.

Objective To investigate the clinical effects of different doses of propranolol in treatment of infantile mixed and deep hemangioma,and to provid theoretical and experimental evidence for the treatment of hemangioma. Methods The selected 62 patients with mixed and deep hemangioma were divided randomly into low dose (1.5mg·kg-1 ·d-1 )and high dose (3.0 mg·kg-1 ·d-1 )of propranolol groups,3 times a day,6 months as a course,the changes in hemangioma size and the incidence of adverse reactions were recorded.Results The efficacy was evaluated using Achauer system.The total effective rate was 80.65% in low dose of propranolol group and 93.55% in high dose of propranolol group,including 6 cases of class Ⅰ (poor),9 cases of class Ⅱ (moderate), 11 cases of classⅢ (good),and 5 cases of class Ⅳ (excellent)in low dose propranolol group;while 2 cases of class Ⅰ (poor),4 cases of class Ⅱ (moderate),10 cases of class Ⅲ (good)and 15 cases of Ⅳ (excellent)in high dose of propranolol group.The efficacy in high dose of proprandol group was significantly better than that in low dose of proprandol group (P<0.05),there were no significant differences in the efficacies between different sites and different types (P>0.05)and there was no significant difference in the incidence of adverse reaction between two groups (P>0.05).Conclusion The efficacy of oral 3.0 mg·kg-1 ·d-1 propranolol in treatment of infantile mixed and deep hemangioma is increased significantly, and there is no significant adverse reactions after increasing doses.Therefore,high dose of propranolol should be recommended in order to improve the therapeutic effect.

BACKGROUND:Wear particles-induced osteoblasts apoptosis in vitro has been documented in many studies. However, the apoptosis of osteoblasts in osteolytic bone tissue and the selective mechanisms involved in the pathogenesis of osteolysis have been studied rarely.
OBJECTIVE:To investigate the influence of endoplasmic reticulum (ER) stress on the apoptosis of osteoblasts in osteolytic bone tissue and osteolysis progression.
METHODS:The mouse model of osteolysis was induced with wear particles placed onto the calvaria. The experiment was divided into four groups:blank control group (PBS stimulation);wear particle group (nano-al oy powder suspension stimulation);ER stress positive control group (nano-al oy powder+thapsin stimulation);and ER stress inhibitor group (nano-al oy powder+sodium 4-phenylbutyrate stimulation). The histopathologic change of osteolysis was assessed by hematoxylin-eosin, toluidine blue and alkaline phosphatase staining. Osteoblast proliferation and differentiation in osteolytic craniums were measured. The expression of ER stress markers in osteolytic craniums was examined by western blot analysis. Osteoblast apoptosis was analyzed by TUNEL staining and immunohistochemistry of Caspase-3 in osteolytic craniums.
RESULTS AND CONCLUSION:Wear particles were capable of inducing osteolysis, aggravating the infiltration of inflammatory cells, and inhibiting the differentiation of osteoblasts in osteolytic craniums. Meanwhile wear particles upregulated the ER stress markers and promote the apoptosis in osteolytic craniums. Blocking ER stress with sodium 4-phenylbutyrate dramatical y reduced the severity of osteolysis, significantly reduced bone invasion and inflammatory infiltration, promoted the differentiation of osteoblasts, and dramatical y reduced the apoptosis. Along with apoptosis, the expression of ER stress marker was decreased. The present study suggests that the ER stress may be crucial for osteolysis and represent a potential therapeutic target in the prevention and treatment of patients with total joint replacement who are at high risk of early aseptic loosening development.

Tanshinones and phenolic acids are two major classes of effective compounds in S.miltiorrhizae Radix et Rhizoma.Accumulative levels of these compounds directly determined its quality and efficacy.Presently,for the purpose of understanding the underlying the mechanism behind the biosynthesis and regulation of effective compounds in S.miltiorrhiza,a series of progresses have been pressed ahead.Benefiting from the boost and convenience of high-throughput genomic,transcriptomic,and metabolic analysis methods,remarkable achievements have been accessed in this field.In this paper,a summary for the recent progress have been made with the provision of a reference for better understanding over the quality of S.miltiorrhiza.

Objective To explore the value of preoperative spleen-liver volume ratio (SLVR) for predicting recurrence of primary liver cancer after hepatectomy.Methods Clinical data of 86 cases of hepatocellular carcinoma undergoing hepatectomy were analyzed retrospectively from January 2009 to December 2014.According to the preoperative SLVR,these patients were divided into two groups:SLVR ＜ 0.8 group (low SLVR group) and SLVR≥0.8 group (high SLVR group).Patients were followed-up until June 2015.Cox ratio risk pattern analysis was used for the recurrent correlative factors.Results The 1-,3-,and 5-year survival rates were 95.5％,88.6％,and 81.8％ in the low SLVR group,and 73.8％,47.6％,and 40.5％ in the high SLVR group,respectively.The difference were statistically significant between two groups (P ＜0.05).Cox regression analysis revealed that SLVR≥0.8,AFP-L3％ ≥10％,the maximum diameter of the tumor ＞ 5 cm,and hepatic or portal vein tumor thrombus were independent predictors of poor disease-free survival after hepatectomy for hepatocellular carcinomas (P ＜ 0.05).Conclusions Preoperative SLVR≥0.8 is an independent adverse predictor of poor disease-free survival.

Objective To explore the safety of the laparoscopic surgery in radical resection for different stage rectal cancer.Methods Clinical data of 200 cases with rectal cancer underwent laparoscopic radical resection(observation group) were analyzed retrospectively,including 52 cases of stage 0-Ⅰ,148 cases of stage Ⅱ-Ⅲ.Two hundred cases patients with rectal cancer underwent open radical surgery were selected as control group,including 44 cases of stage 0-Ⅰ,156 cases of stage Ⅱ-Ⅲ.The length to distal resection margin,the number of harvested lymph nodes,the incidence of postoperative complications and the prognosis of recent situation were observed,the safety of the laparoscopic surgery was analyzed.Results Whether rectal cancer of stage 0-Ⅰ or Ⅱ-Ⅲ,there were no significant differences in terms of the length of distal resection margin((2.5±0.9) cmvs.(2.4±1.1) cm,t=0.490,P=0.625;(3.1±1.0) cm vs.(3.2±1.3) cm,t=0.749,P=0.454),the number of harvested lymph nodes((12.3±4.2) vs.(12.7±3.9),t=0.480,P=0.632;(13.9±5.4) vs.(15.1±4.9),t=2.369,P=0.118),the incidence of postoperative complications (17.3％ vs.18.2％,x2 =0.012,P=0.911;27.7％ vs.28.8％,x2=0.049,P=0.825),the rate of local recurrence(1.9％vs.2.3％,x2 =0.014,P =1.000;4.1％ vs.3.2％,x2=0.157,P=0.692),the distant metastasis (3.8％ vs.2.3％,x2=0.195,P=1.000;5.4％ vs.4.5％,x2=0.137,P=0.712) and 3-year survival rate (96.2％vs.95.5％,x2=0.010,P=0.808;83.8％ vs.85.3％,x2=0.132,P=0.714) between the observation group and control group (P＞0.05).Conclusion For rectal cancer of stage 0-Ⅰ,laparoscopic surgery has good safety,and worthy of popularization and application.For rectal cancer of stage Ⅱ-Ⅲ,due to its operation for a long time as well as the possible risk in postoperative anastomotic fistula,the implementation of laparoscopic surgery should be more cautious.