OBJECTIVE： To find out the change of drug resistance of Shigella shigae in our hospital during recent five years.METHODS： To collect the stool of suspectable cases of clinical bacillary dysentery and to carry out bacterial culture and drug sensitive test.RESULTS： The resistance rates of Shingella shigae to ampicillin and fluoroquinolones raised obviously， but the bacilli were still sensitive to amikacine and cefobid.CONCLUSION： It is important to strictly control the indications in using antibiotics and to prevent the emergence of drug resistance of bacteria.

Objective To study the chemical constituents from the stems of Acanthopanax gracilistylus.Methods Thechemical constituents of the plant were isolated and puried by column chromatography and their structures wereelucidated on the basis of physicochemical properties and spectral data.Results A new ent-kaurane glycoside,named kaurane acid glycoside A { 16α,17-dihydroxy-ent-kauran-19-oic 19-[β-D-glucopyranosyl-(1→2)-β-Dglucopyranosyl]ester}(1),was isolated from the n-butanol part.Conclusion Compound 1 is a new one.

Objective To study the distribution characteristics of radon progeny at different air quality index (AQI) and evaluate health risks for the exposed population.Methods EQF3120 Monitor was used to monitor the concentration of radon and its daughters.The relevant air quality data was provided by the environmental monitoring station at Suzhou Industrial Park.SPSS 16.0 software was used for statistical description,principal component analysis and simple correlation analysis.Environmental radon exposure-caused effective dose to lung region was estimated by using the radon dose formulas.Results Radon progeny in fog haze weather in winter of Suzhou Industrial Park had relationships with NO2,SO2,O3,PM10 and PM2.5.The correlation coefficient of 214Bi were 0.741,0.681,-0.431,0.597 and 0.675.The correlation coefficient of radon progeny with PM2.5 was greater than that with PM10.When AQI ＞ 200,the effective dose to residents outdoor from radon and its short-lived progeny was 0.63 mSv/a.Conclusions Higher AQI results in higher concentration of attached radon progeny.There is little variation in concentration of unattached radon progeny.Fog and haze can increase exposure of the population to inhalated radon.

Objective To explore the improvement of cardiopulmonary resuscitation (CPR) efficiency by rescue team through the clinical access to pre-hospital care.Methods Mter establishment of clinical approaches to cardiac arrest,the training program of first line personnel of rescue teams in the Hangzhou Emergency Center was carried out with practice on simulated patients and scenario.A total of 45 eligible teams were randomly enrolled for study by observing the performance of some essential resuscitation techniques before and after training.Result The efficiency of resuscitation performed by rescue team for cardiac arrest was generally not good enough before training evidenced by the shortage of application of ECG monitoring,endotracheal intubations and establishing intravenous line which were only 8 (17.8％),5(11.1％),6 (13.3 ％),respectively,and the interruption time of chest compression during the first three minutes was (102.13 ± 13.68) seconds and the successfully artificial respiration ratios by assistant members was (0.37 ± 0.09),and ratios of ECG forensics and written inform consent were 8 (17.8％) and 6 (13.3％) respectively,CPR and forensics done simultaneously was only 2 (4.4％).The efficiency of rescue for cardiac arrest was obviously improved after training by the clinical approaches proved by the increase in application of ECG monitoring,endotracheal intubations,intravenous line set up reached to 45 (100％),43 (95.6％),43 (95.6％),respectively,and the interruption time of chest compression during the first three minutes was shorten to (69.7 ± 7.7) seconds and the successfully artificial respiration ratios done by assistant members was (0.57 ±0.12) after training.The ratios of on-site ECG forensics and written inform consent were 40 (88.9％) and 43 (95.6％),respectively,and CPR and evidence obtained simultaneously was up to 36 (80.0％).The efficiency of work done by teams was obviously improved and the risk of miserable events was controlled.Conclusions The clinical approaches to cardiac arrest in prehosptial care is the efficient strategy to rescue the patient with cardiac arrest and it is worthy to popularize at present.

Objective To investigate the effects and possible mechanisms of decitabine on heat-shock protein 22 (HSP22) expression in hematopoietic tumor cell lines and bone marrow samples from patients with hematopoietic tumor.Methods The expression of HSP22 in 13 hematopoietic tumor cell lines,20 primary patients' samples and 10 normal donor' samples were detected by semi-quantitative reverse transcription polymerase chain reaction (RT-PCR).After HSP22 induction with a demethylating agent decitabine (2 μmol/L),the methylation of the HSP22 promoters in hematopoietic tumor cell lines,healthy donors and bone marrow samples from patients with hematopoietic tumor were detected by methylation specific PCR (MSP).Results Expression of HSP22 was not detected in 13 hematopoietic tumor cell lines,20 primary patients' samples or 10 healthy donors' samples.Decitabine can induce the expression of HSP22 in hematopoietic tumor cell lines and bone marrow samples from patients with hematopoietic tumor.Decitabine can maintain partially demethylation of HSP22 promoters in hematopoietic tumor cell lines.HSP22 promoters were highly methylated in BMMC of the healthy donors and patients with hcmatopoictic tumor.Conclusion Decitabine can induce the expression of HSP22 in hematopoietic tumor cells partly by demethylation of HSP22 promoters.

Objective:To explore the relationship among serum neutrophil gelatinase associated lipocalin (NGAL), cystatin C (Cys-C) levels and cardiac, renal function;and diagnostic value of NGAL and Cys-C for early renal damage in aged patients With coronary heart disease (CHD).Methods:According to NYHA cardiac function classi-fication,a total of 84 aged CHD patients Were divided into class I group (n=30),class Ⅱ group (n=28)and classⅢ-Ⅳ group (n=26).Another 31 aged healthy objects Were selected as healthy control group.Serum N terminal pro B-type natriuretic peptide (NT-proBNP),NGAL and Cys-C etc. levels Were measured,and the correlation a-mong serum NGAL,Cys-C levels and cardiac function,estimated glomerular filtration rate (eGFR)Were analyzed. The accuracy of serum NGAL and Cys-C diagnosing renal insufficiency Was evaluated by receiver operator character-istic curve (ROC).Results:Along With NYHA class increased,there Were significant increase in serum levels of NGAL [(36.96±21.23)μg/L vs.(87.80±61.40)μg/L vs.(141.21±92.96)μg/L vs.(198.15±98.46)μg/L] and Cys-C [(0.75±0.64)mg/L vs.(1.40±1.88)mg/L vs.(2.33±2.03)mg/L vs.(3.45±1.81)mg/L]in healthy control group,NYHA I,Ⅱ,Ⅲ-Ⅳ groups,and they Were highest in NYHA class Ⅲ-Ⅳ group,there Was significant difference in serum NGAL level betWeen any tWo groups among the four groups (P<0.01),and so Was serum Cys-C level (P<0.05 or <0.01)except healthy control group and NYHA class I group (P>0.05). Pearson correlation analysis indicated that serum NGAL and Cys-C levels Were positively correlated With NT-proBNP (r=0.842,0.718,P<0.01 both),and negatively correlated With eGFR (r=-0.689,-0.448,P<0.01 both), and serum NGAL level had closer correlation With NT-proBNP and eGFR.Area under ROC of serum NGAL and Cys-C Were 0.884 and 0.744 respectively in diagnosing renal insufficiency.Conclusion:Serum NGAL and Cys-C lev-els have good correlation With cardiac and renal function in aged CHD patients,Which are sensitive and accurate in-dexes for diagnosing early renal damage.

Objective: To observe the effect of amlodipine on bone marrow endothelial progenitor cell (EPC) mobilization, neo-vascularization and cardiac function in diabetic rats after myocardial infarction (MI) with the possible mechanisms.
Methods: A total of 60 male SD rats were divided into 2 groups. Normal group, n=20. Diabetic group, n=40, the rats were fed with high fat diet (HFD) for 4 weeks and then received streptozotocin followed by left anterior descending coronary artery ligation to establish MI model, those rats were further divided into 2 sub-groups:Control group, the rats received sodium carboxymethylcellulose 1 ml/day with HFD and Treatment group, the rats received amlodipine 2 mg/kg/day with HFD, n=20 in each sub-group, all animals were treated for 4 weeks. The EPC level in peripheral blood CD45-/low+/CD133+/KDR+ at before and 1, 3, 5, 7, 14, 28 days after operation were examined by lfow cytometry, plasma vascular endothelial growth factor (VEGF) level was measured by ELISA, capillary density in MI area was determined by CD31 staining, EPC related protein expressions were detected by western blot analysis and the cardiac function was evaluated by echocardiography.
Results: EPC in CD45-/low+/CD133+/KDR+in Treatment group at 7 days after operation was increased than Control group at 5 days after operation (112 ± 30/106) vs (55 ± 10/106), plasma VEGF in Treatment group was higher than Control group (5.63 ± 1.33) ng/L vs (3.68 ± 0.98) ng/L; Treatment group presented increased expressions of protein kinase B, endothelial nitric oxide synthase (eNOS) and matrix metallopeptidase-9, increased capillary density in MI area, higher LVEF and left ventricular fractional shorting, all P<0.05-0.01.
Conclusion: Amlodipine improves EPC mobilization, neo-vascularization and cardiac function in diabetic-MI rats, it may be related to VEGF/eNOS cascade activation.

Objective:To conduct a systematic review on the implementation effects of National Essential Medi-cine System ( NEMS) since the new health care reform and provide some suggestions to further improve the NEMS. Methods:Databases and relevant international organization reports were searched to collect studies related to the im-plementation of NEMS in China. The database search occurred from January 2009 to December 2014. Results:A to-tal of 1 292 studies were finally included, encompassing 1,277 Chinese papers, 12 English papers, and 3 WHO/HAI reports. A lot of researches have been done on NEMS, but the techniques of NEMS evaluation are not perfect. The sample representativeness is poor, and the longitudinal follow-up studies of the microscopic view is insufficient. . Evi-dence-based evaluation research using big data has just started. Conclusions: The research on NEMS should be strengthened. The NEMS evaluation should not only be based on national conditions, but it should also be in combi-nation with an international, multidimensional evaluation framework in terms of availability, affordability and rational drug use, so as to provide evidences to perfect the NEMS.

Objective To investigate the prevalence and attitude of smoking and its influencing factors among residents in Hongkou District of Shanghai, so as to provide evidence for tobacco control. Methods Nine hundred and sixty residents in Hongkou District of Shanghai aged 15 to 69 years were selected by multi-level random sampling, among whom 958 completed the investigations on smoking status. Results The smoking rate and standardized smoking rate were 20. 04% and 18. 73%, respectively. The smoking rate and standardized smoking rate of males were 41.05% and 30.07%, and those of females were 0. 80% and 1. 70% , respectively. The smoking rate of males was higher than that of females (RR = 0.02, 95% CI: 0.01 -0.03). The smoking rates of age groups of 25 years old and over were higher than those of 15 to 24 years old, and the smoking rate of subjects with or above junior college education was lower than that of subjects with or below middle school education (RR=0.45, 95% CI: 0.25 -0.79). Subjects who drank alcohol smoked more than those did not (RR = 2. 68, 95% CI: 1. 76 - 4.09). Lower annual per capita income and higher knowledge on smoking hazard led to more tendance to object to smoking and agree with anti-smoking. Conclusion The prevalence of smoking of residents aged 15 to 69 years in Hongkou District of Shanghai was relatively lower. Age, gender, education status and alcohol drinking were influencing factors of smoking. Education on tobacco control among subjects aged more than 35 years should be strengthened, and more attention should be paid to those with lower education. Besides, education on alcohol control should be managed together with tobacco control.

Objective To investigate the influence of service-learning model on medical graduates' ethical behavioral tendency. Methods A self-designed questionnaire was conducted among 302 medical students who have graduated in the last five years including the basic information, ethical behavioral tendency and participation of service-learning. The acquired data was analyzed and com-pared using chi-square test and unconditional logistic multiple regression. Results 68.2%(206/302) undergraduates participated in service-learning. Undergraduates participated in service-learning be-haved more ethical than those did not participated when facing the situation of patient' vomits (P=0.037). There were statistical differences in taking bribes from patients between those participated in service-learning and those did not (P=0.031). According to the results of unconditional logistic multiple regression analysis, whether participating in the service-learning is one of significant factors influenc-ing undergraduates' attitude towards bride-taking. Conclusions Medical students educated by service-learning model will exhibited more ethically accepted medical behaviors after becoming doctors. Ser-vice-learning model, a new medical education model, is worth promoting.