Objective To understand the clinical characteristics of systemic lupus erythematosus with Antiphospholipid syndrome (SLE-APS).Methods The clinical data of 39 cases of SLE-APS were collected and analyzed retrospectively. Results Thirty-one patients had 48 thrombosis episodes in total, among which the most common presenting manifestations were deep venous thrombosis and stroke. 12 of 26 married women had fetal morbidity. The prevalence of anticardio lipin antibody (aCL) and lupus anticoagulant ( LA) was 72% and 41% , respectively. 24 patients had SLE at first,on an average of 9. 5 years later they had the characteristics of APS, 12 patients had thrombosis episodes or fetal morbidities ,4. 8 years later they developed into SLE,and 3 patients had the characteristics of SLE and APS from the onset The SLEDAI was less than 5 in five cases when they had thrombosis episodes or fetal morbidities.Conclusions The incidence of thrombosis episodes or fetal morbidities increased in SLE-APS patients. APS occurred before, after or at the same time with SLE. SLE patients might have the clinical features of APS during the steady stage. It's very important to ask the medical history in detail and measure aCL in lupus patients to find the risk factor of APS and prevent the APS' occurrence.

By analyzing and summarizing the previous research results regarding acupuncture for insomnia, factors influencing the efficacy of acupuncture on insomnia were discussed, and a summary was made from aspects of age, gender, duration of insomnia, use of medication, types of syndrome differentiation, acupoint selection, acupoint combination, acupuncture timing, etc. With respect to the influencing factors, precautions during the clinical syndrome differentiation were briefly reviewed, and the treatment plan of acupuncture for insomnia was optimized, which could provide new methods and thoughts for clinical and scientific research regarding acupuncture for insomnia.
Acupuncture Points ; Acupuncture Therapy ; Female ; Humans ; Male ; Sleep ; Sleep Initiation and Maintenance Disorders ; physiopathology ; therapy

Objective To study the isolation and antimicrobial resistance of pathogens isolated from patients with brain damage in hyperbaric oxygenation department,so as to provide reference for clinical anti-infective treatment.Methods Bacterial culture and antimicrobial susceptibility testing results of pathogens isolated from blood,sputum,and urine specimens of 975 patients with brain damage in the hyperbaric oxygenation department of a hospital between January 2013 and December 2014 were analyzed retrospectively.Results A total of 1 328 strains of pathogens were detected,877(66.04%)of which were gram-negative bacteria,213(16.04%)were gram-positive bacteria,and 238(17.92%)were fungi.The top five isolated pathogens were Pseudomonas aeruginosa,Klebsiella pneumoniae,Escherichia coli,Acinetobacter baumannii,and Candida albicans.Specimens mainly isolated from sputum and urine,accounting for 58.59%and 35.24%respectively,resistance rates of Klebsiella pneumoniae,Pseudomonas aeruginosa,Acinetobacter baumannii,and Escherichia coli to imipenem were 16.67%,81.82%,82.44%,and 4.65%respectively.Vancomycin-resistant strains was not found among gram-positive bacteria,resistance rates of Enterococcus faecalis to most antimicrobial agents were lower than those of Enterococcus faecium.Conclusion Respiratory and urinary tract infection account for most of the infection in patients with brain damage in hyperbaric oxygenation department,gram-negative bacteria are the predominant pathogens causing infection.

Objective To type Acinetobacter baumannii using infrequent restriction site PCR (IRS PCR). Methods Strain specific electrophoretic patterns from PCR products by amplifying DNA sequences flanking infrequent restriction sites of 15 strains of Acinetobacter baumannii were compared with the results of biotyping and antimicrobial susceptibility. Results The 15 bacteria were divided into 5 gene types with IRS PCR, but 3 with biotyping, and 4 with antimicrobial susceptibility. Conclusion IRS PCR method for typing Acinetobacter baumannii is of strong sensitivity, high recognition, good repeatability, convenient operation, and wide range of application.

Objective Retrospective investigate the significant application of bone marrow (BM)morphology in exploring the causes of anemia,and observed the changes of anemia disease spectrum in the past 10 years.Methods BM smears of 1 528 anemia patients from Shanghai Jiao Tong University Affiliated Shanghai First People's Hospital were stained with Wright's staining and cvtochemical staining and observed with microscope.Combined with relevant clinical data,we analyzed the changes of disease types from 1998 to 2002 and from 2008 to 2012.Results 1 139 cases (74.54％) were diagnosed with hematopoietic and lymphatic system diseases.Iron-deficiency anemia,megaloblastic anemia and leukemia were the three main causes of anemia.The BM morphology of 389 patients displayed infection anemia or descriptive diagnosis.Anemia disease spectrum changed a lot,iron-deficiency anemia decreased from 30.34％ (139/458) to 18.69％ (200/1 070),leukemia increased from 13.31％ (61/458) to 21.77％ (233/1 070),descriptive diagnosis of BM increased from 15.72％ (72/458) to 21.86％ (234/1 070).Conclusion BM examination is critical for finding the cause of anemia,which contrihutes to effective treatment.

OBJECTIVE To investigate the clinical distribution and resistance of Acinetobacter baumannii in our hospital in order to provide evidence to proper use of antibiotic drugs in clinics. METHODS A. baumannii isolates were collected in our hospital from Jan 2004 to Dec 2006. Antimicrobial susceptibility testing was performed by disk-diffusion method,according to the standards of CLSI/NCCLS, the data were analyzed by WHONET5.4 software. RESULTS The isolating rate of A. baumannii from 2004 to 2006 was 2.5%,3.8%, and 10.9%, respectively.It was distributed mainly from ICU (29.2%), respiratory ward (19.3%) and emergency ward (10.9%). The highest appearing rate was the sputum, up to 78.0%. More than 60% of isolates were resistant to antimicrobial agents tested such as PIP, CTX, CRO and ATM. A. baumannii showed the highest susceptibility to carbopenems with about 80%. CONCLUSIONS The infection of A. baumannii is one of the most complex problems. Therefore, monitoring A. baumannii constantly and regularly, finding out resistant strains timely, and adjusting the treatment regimen are very important to the prevention of nosocomial infection. The disinfection should be strengthened for hospital environment and medical staff in order to control existence and spread of A. baumannii.

OBJECTIVE To investigate the drug susceptibility of clinical isolates in local region for using antibiotic reasonably. METHODS Totally 3 170 strains of clinical isolates were identified by API and Microscan and tested for drug resistance against antimicrobial agents by K-B method. WHONET5.4 was applied for analysis. RESULTS The commonly encountered bacteria were Pseudomonas aeruginosa (24.3%), Acinetobacter baumannii (10.9%), Klebsiella pneumoniae (10.4%), Escherichia coli (8.9%), and Staphylococcus aureus (SA,8.0%). In Gram-negative isolates, the resistance rate to meropenem was 19.7%, and to piperacillin-tazobactam was 26.5%. The incidences of E.coli and K. pneumoniae isolates producing extended spectrum beta-lactamases (ESBLs) were 49.1% and 33.5%, respectively. In Gram-positive isolates, the susceptibility rate to vancomycin and teicoplanin both was 100.0%. The oxacillin resistant rates of SA and coagulase negative Staphylococcus (CNS) were 54.2.0% and 82.3%. CONCLUSIONS The production ratio of ESBLs and oxacillin resistance of bacteria in local region are high. It is important to promote the rational use of antimicrobial agents and take effective contaminant methods to reduce resistant rates of bacteria and dissemination of multi-resistant bacteria.

Objective To compare treatment outcomes and antibiotic related costs of A. baumannii infection treated with imipenem cilastatin and ampicillin sulbactam and to provide evidence for clinical treatment of A. baumannii infection. Methods A prospective investigation was performed on 71 ICU A. baumannii infection patients treated with imipenem cilastatin and ampicillin sulbactam. The treatment outcomes and antibiotic related costs were also analyzed. Results There was no significant difference between the therapeutic efficacy of these two drugs within the same time limit. The antibiotic related costs of the patients treated with ampicillin sulbactam were significantly lower than those with imipenem cilastatin (2 113 Yuan vs 5 789 Yuan , P

ObjectiveTo investigate value of minimally invasive surgical approach in patients with hypertensive intracerebral hemorrhage in primary hospital.MethodsAccording to the operation procedure,93 cases with basal ganglia hemorrhage were divided into three groups:1.minimally invasive surgery group A (n =37 ),2.ventricular puncture and drainage,lumbar cistern drainage group B(n=10),3.usual operation group C( n =46).Estimated operation effect with computed tomography in 24 hours after operation.Case fatality rate and complication incidence were analyzed after three months of operation according to the Glasgow Outcome Scale (GOS).ResultsMinimally invasive surgery group A had the highest hematoma clearance rate (82.7 ± 8.1 ) ％,group B (78.6±6.5 ％ ),group C (50 ±10％ ).The incidence rate of rebleeding was 8.1％ in group A( n =3 ),10％ in group B ( n =1 ),34.8％ in group C (n =16).The grade Ⅳ of the GOS and the grade Ⅲ of the GOS was respectively 93.8％ and 6.5％,case fatality rate was zero.Conclusion The minimally invasive surgical operation not only lead to less tissue damage and decrease rebleeding,but also improve neurological functional recovery.

Objective To evaluate the post-puncture complications in children,and to evaluate the difference in the occurrence rate of headache and backache between patients who had 1 hour of supine recumbency and those who had 4 hours of supine recumbency,to provide evidence for the standardized lumbar puncture (LP) procedure of children.Methods Inpatients who were older than 3 and had diagnostic LP in the course of their treatment between Nov.2012 and Apr.2013 were enrolled.The LP was performed by the same investigator under the standardized institutional guideline for LP and the information of number of LP attempts,duration of LP and cerebrospinal fluid (CSF) drainage volume were recorded.After the procedure,all the children were randomly assigned into 2 groups:the test group had supine recumbency for 1 hour after LP,and the control group had it for 4 hours.For the first 5 days following LP,reports of headache and backache were recorded by another physician who didn't participate in this study.The difference in the occurrence rate of headache and backache between test group and control group was assessed by the chi-square test or Fisher's probabilities in 2 × 2 table.And a Logistic regression analysis was performed to assess the risk factors for the occurrence of the headache and backache.Results The overall frequency of headache was 4.6％ (4/87 cases).The frequency of headache was not significantly different between the test group (2.4％) and control group (6.7％) (P =0.617).And the overall frequency of backache was 19.5 ％ (17/87 cases),and it was not significantly different between the 2 groups (test group:21.4％,control group:17.8 ％,P =0.668).In a Logistic regression analysis,age (P =0.011,OR:6.884,95％ CI:1.398-33.906) and the previous history of lumbar puncture (P =0.018,0R:0.126,95 ％ CI:0.026-0.618) were significant risk factors for the occurrence of backache.The risk of backache in children with more than 2 times of LP was decreased.And the risk was higher in the children older than 6 years than those younger than 6 years.Conclusions Headache and backache were the most frequent post-puncture complications in children.There was no difference between short duration (1 hour) of supine recumbency and long duration (4 hours) in preventing the occurrence of headache and backache after LP.