Objective To investigate the clinical characteristics of multiple drug resistant Acinetobacter baumannii infection in respiratory elderly patients.Methods A total of 102 elderly patients infected with multidrug-resistant Acinetobacter baumannii were enrolled in our hospital from January 2014 to December 2015.At the same time,no multiple drug-resistant Acinetobacter baumannii infection elderly patients was selected as a control group.The gender,age,antimicrobial use,white blood cell count,mechanical ventilation time and other differences between the two groups of elderly patients were compared.Results There were significant differences in the days of hospitalization [(18.7±7.5) d vs.(10.0±2.7)d],the time of application of invasive ventilator[(24.6±10.3) d vs.(11.6±6.9)d] and the time of application of antimicrobial agents[(26.2±13.1) d vs.(8.0±2.6)d] (t=19.463、15.436、26.905,all P＜ 0.05).There was no significant difference in immunosuppressant use,white blood cell count,serum protein level and APACHEⅡ score (all P＞0.05).Conclusions Reasonable scientific application of antimicrobial agents,reducing invasive mechanical ventilation time and improving patient immunity can help to reduce the risk of respiratory infection in elderly patients with multiple drug resistance to Acinetobacter baumannii.

Objective: To summarize the clinical, sonographic and pathological characteristics, and the perinatal outcomes of pregnancies complicated by placental mesenchymal dysplasia (PMD). Methods: We reported the diagnosis and treatment of a case of PMD in Tianjin Union Medical Center. Pertinent Chinese literatures on PMD were reviewed to analyze the clinical features and the outcomes for mothers and infants. Results: (1) Case report: The patient was admitted to our hospital with elevated blood pressure in July 2011 and underwent caesarean section at 30⁺¹ gestational weeks indicated by severe preeclampsia and fetal distress. PMD was diagnosed by placental pathological examination. The patient was discharged from the hospital after oral antihypertensives treatment with stabilized blood pressure. Both the mother and the child were healthy during follow-ups until August 2018. (2) Literature review: A total of 14 cases of PMD were reported domestically including the index case. The average maternal age was 27.9(23-42). Of all the 14 fetuses, half were born alive and half were died in the uterus; two were male, 10 were female and two of unknown sex. Sonographic findings of 10 cases showed thickened placenta with hypoechoic areas. Human chorionic gonadotropin (hCG) was tested in five cases, and the results were all normal. One case was tested for maternal serum alpha fetoprotein (AFP), which was increased. Among the 14 cases, there were two of preeclampsia, six of intrauterine death, three of fetal distress and one of the premature rupture of fetal membranes. Four out of the seven live births were born prematurely. According to the medical record, the average weight of placentas of seven gravidas was 665 g, and eight placentas were larger than the gestational age in size. Pathological examinations showed 11 placentas were covered with grape-like cystic vesicles. No trophoblastic proliferation or stromal trophoblastic inclusion was observed in 12 cases under the microscope. Conclusions PMD is mainly characterized by enlarged and cystic placenta with hypoechoic areas in sonographic findings as well as elevated AFP and normal hCG concentrations in serum. It is more likely to occur in female fetuses with normal karyotype. Placentas with significantly increased size and weight and grape-like cystic vesicles are typical features of PMD that can be detected by pathological examinations. Some gravidas may develop hypertensive disorders of pregnancy and deliver prematurely due to fetal distress, but the maternal and neonatal outcomes are usually good. Close monitoring of the gravidas and fetuses with PMD may help to improve pregnancy outcomes.

Objective:Colorectal cancer screening was performed on a general population with age ranging between 40 and 74 years old to evaluate the screening effects of questionnaire survey, fecal occult blood (FOB) test, and colonoscopy, as well as to provide some implications of colorectal cancer screening strategies. Methods: Two-step screening model of questionnaire survey combined with FOB test was applied for the screening. Colonoscopy was conducted in a high-risk population identified through preliminary screening as final diagnosis. Results:Based on the 2,117,304 cases screened, the screening compliance was 39.72%, and 126,118 cases (5.96%) were identified as high risk. Colonoscopies were performed on 25,837 cases, of which 8,095, 1,236, 134, 112, and 336 were identified as adenoma, advanced adenoma, severe dysplasia lesions, early cancer, and advanced cancer, respectively. The early stage di-agnostic rate was 81.52%. Conclusion:The colorectal cancer screening method performed in Tianjin can significantly concentrate on the high-risk population with colorectal cancer, increase the positivity rate of total colonoscopy, and economize medical resources.

OBJECTIVE：To preliminarily investigate the improveme nt effects and mechanism of Mongolian medicine Saorilao-4 decoction on specific pulmonary fibrosis model rats. METHODS ：Male SD rats were randomly divided into normal control group ，model group ，positive control group （pirfenidone，0.163 g/kg）and Saorilao- 4 decoction low ，medium and high dose groups （0.899，1.798，3.596 g/kg），8 rats in each group. Except for normal control group ，other groups were given 6 mg/mL bleomycin intratracheally at 5 mg/kg once to induce the specific pulmonary fibrosis model. From the first day after modeling ， normal control group and model group were given normal saline intragastrically ，other groups were given corresponding drugs intragastrically，once a day ，10 mL/kg，for 4 weeks. During the experimental period ，the general condition of the rats in each group was observed and the body mass was weighed. Twenty-four h after last medication ，the appearance morphology of rat l ung in each group were observed. The morphological characteristics of lung tissues were observed by HE and Masson staining. ELISA was adopted to determine the activity of SOD and the content of MDA in serum ，the contents of hydroxyproline （HYP），IL-1β，IL-6，hyaluronidase（HA），laminin（LN）precollagen type Ⅲ（PC-Ⅲ）and collagen type Ⅳ（Col-Ⅳ）in lung tissue. RT-PCR was used to determine the mRNA 发。E-mail：bwf007007@sina.com expression of TGF-β 1，Smad3 and Smad 7 in lung tissue. RESULTS：Compared with model group ，the activity ，hair and diet of the rats in each dose group of Saorilao- 4 decoction and positive control group were significant ly improved ，and the body mass after the last administration was significantly increased ； the pathological change of lung and pulmonary fibrosis were significantly improved ，and the activity of SOD in serum was increased significantly. Serum content of MDA （except for Saorilao- 4 decoction medium dose group ），the contents of HYP （except for Saorilao- 4 decoction high dose group ），IL-1β，IL-6，HA，LN，PC-Ⅲ，Col-Ⅳ（except for Saorilao- 4 decoction high dose group）as well as mRNA expression of TGF-β1 and Smad 3 in lung tissue were significantly decreased ；mRNA expression of Smad 7 was significantly increased （P＜0.05 or P＜0.01）. CONCLUSIONS ：Saorilao-4 decoction can significantly improve the lung pathological changes ，delay and reverse the progression of pulmonary fibrosis in specific pulmonary fibrosis model rats ，the mechanism of which may be related to the inhibition of inflammatory response ， improvement of lipid peroxidation ， down-regulation of TGF-β1 and Smad 3 mRNA expression ，and up-regulation of Smad 7 mRNA expression.