In recent years,more and more Macrolide resistance of Mycoplasma pneumoniae becomes a hot research.The current studies suggest that the mechanisms of Macrolide resistance are drug-binding site mutations,ribosome methylation,drug efflux,and drug related fire-fighting,in which the drug target 23srRNA gene 2063,2064 mutation is significant.It has been reported that drug-resistant patients have the poor effect,including the long total febrile days and high dressing.For treatment of drug-resistant patients,most studies still use the macrolide,early use of corticosteroids may be effective.It is uncertain whether the increase in resistant strains is related with the use of macrolide.It is significant to carry out future researches in this area for clinical therapy and put off the prevalence of drug-resistant strains.

Objective To explore the best time interval to extubate catheter for the postoperative gastric cancer patients,and provide the basis for early extubation after operation.Methods To collect 108 cases with gastric cancer in Department of Forensic Surgery of Yuncheng Central Hospital from March 2013 to February 2014 with indwelling catheter preoperatively.According to the admission sequence,they were divided into the observation group and the control group with 54 cases in each group,the observation group began clipping catheter in 10-15 hours after operation,extubating catheter within 24 hours after operation;the control group began clipping catheter on the second day after operation,and extubating catheter during 48-72 hours after operation.The time of extubation,urinary tract irritation symptoms,resetting catheters and the incidence of early postoperative ambulation in patients of two groups were observed.Results The incidence of urinary tract irritation was lower in the observation group than that of the control group [3.7％ (2/54) vs 16.7％(9/54)],the difference was statistically significant (x2=4.960,P＜0.05).Early ambulation compliance of the observation group was higher than that of the control group (complete compliance 52 vs.40,partial compliance 2 vs.8,no compliance 0 vs.6),the difference was statistically significant (x2 =10.565,P ＜0.05).Conclusions The method of extubation catheter within 24 hours after gastric canter operation can reduce the incidence of urinary tract irritation and improve early ambulation compliance.

Objective To evaluate the effect of meglumine cyclic adenosine (MAC) on heart rate variability (HRV) in aged-patients with coronary heart disease (CHD).MethodsSeventy six aged-patients with CHD were randomly divided into control group (n =36) and treatment group (n =40).The patients in control group were treated with nitrate,ozagrel,calcium antagonist,aspirin enteric-coated tablets,low molecular heparin,angiotensin-converting enzyme inhibitor ( ACEI ) or angiotensin receptor antagonist ( ARB ) and lipidlowering agents according to patients' conditions.Based on this,the patients in treatment group were treated with MAC 90 mg intravenous injection once a day for two weeks.The 24 h dynamic electrocardiogram was recorded.pre-ard post-treatment,and the changes of HRV indexes were observed.Results There was no statistical significance in HRV between the two groups before treatment ( P ＞ 0.05 ).However the HRV in two groups improved significantly after treatment ( P ＜0.01 ).The improvement of HRV was more significant in MAC group than that in control group (P ＜0.01 ).Conclusion MAC can significantly improve HRV in aged-patients with CHD.

Objective To explore the mechanism of shengmai injection on relieving ischemia reperfusion injury and antagonizing systemic inflammatory response syndrome by regulating cytokines when it was applied at the early stage of cardiopulmonary resuscitation(CPR).Methods 40 cases suffering from cardiac arrest and had their heart beat recovered through CPR for more than 24 hours were randomly divided into SMI group and control group(20 cases for each).The patients in the two groups were treated with common therapeutics based on the CPR,but the patients in SMI group were intravenously dropped with SMI in the early period of PLS phase,then the changes of serum concentration of TNF-α and IL-81h,2h,6h,12h and24h after CPR in the two groups was compared.Results The concentrations of serum TNF-α and IL-8 stepped up gradually after resuscitation and the levels of TNF-αand IL-8 in SMI group were lower than that of the control group at 1h,2h,6h,12h and 24h after resuscitation(P＜0.05).Conclusion SMI functions to relieve ischemia reperfusion injury by regulating cytokines and antagonizing systemic inflammatory response syndrome.

Objective To investigate the clinical and pathological features of Churge-Strauss syndrome(CSS) combined leukocytoclastic vasculitis.Methods The clinical data of 1 patient with CSS combined leukocytoclastic vasculitis was analyzed retrospectively.Results The main symptoms of the case were peripheral nerve damage,violation of the skin lesions,gastrointestinal tract,lung,and central nervous system;peripheral blood eosinophil count was high.The pathological examine showed vessel wall and skin organizations had a large number of eosinophils infiltration,small vessel walls,as well as granuloma formation around multiple segmental fibrinoid necrotizing vasculitis.Eventually died of multiple organ failure.Conclusion The clinical manifestations of CSS combined leukocytoclastic vasculitis have vasculitis and peripheral neuropathy mainly;the pathological features are that vessel wall and skin organizations have a large number of inflammatory cells infiltration;the late multi-system are involved,and the prognosis is poor.

Objective To study the characteristic of operation design and analyze curative effect of laser sub-epithelial keratomileusis (LASEK) on low and midrange myopia in aged patients. Method Fiftyeight patients ( 114 eyes) no less than 35 years old were treated with LASEK by monoblepsis. The subjects were examined and analyzed at 3 days, 7 days, 1 month,3 months and 6 months after operation. Results Seventy-one corneas(62.28%) recovered well at 3 days after operation. At 1 month after operation, the acuity of vision of all patients achieved or exceeded corrected vision before operation,and lasted to 6 months after operation. The break up time of 63 eyes were lower than normal at 3 months after operation,but 6 months after operation all of them recovered to normal. The satisfaction of patients raised gradually. Conclusions LASEK is effective for no less than 35 years old myopic patients. Make operation plan refer to monoblepsis and patients' needs can receive more satisfaction.

To assess the clinical effect of HA regimen on newly diagnosed patients in chronic phase of chronic myeloid leukemia (CML). Ninety four cases of CML patients were grouped in accordance with the requirements on the basis of treatment regimens and Sokal risk index, and the clinical effects of HA regimen wer evaluated. We found that HA regimen showed satisfactory immediate effect on CML in chronic phase. CR rates achieved in high risk and medium risk groups(77 4%,20 0%) with HA were higher than that with Hu regimen(35 0%,0%). However, HA regimen was incapable of extending the duration of CML. So HA should not be used as first line treatment in the treatment on newly diagnosed patients in chronic phase of CML, except for high risk group whose symptoms could not be controlled with other regimens.

Objective To find a solution to the long-term storage of enormous amount of imaging data in hospital picture archiving communication system (PACS). Methods Medical imaging data collected by devices of Digital Imaging and Communications in Medicine-3 (DICOM3) and non-DICOM3 were transformed into the storage format, metadata instance, and expression pattern of digital images standardized by DICOM3. Based on the requirements of data utilization and storage system and the optimal principle of function and value, the reasonable flow of imaging data in PACS network were scientifically allocated by application of on-line, near-line, and off-line storage patterns and by reasonable allocation of the volume and clusters of storage devices. Results The PACS storage system established by our method, characterized by super capacity of error tolerance, permanent unrestricted storage, quick in retrieval, and quick, convenient and reliable in storage and reading, could meet the requirements of long-term storage and management of enormous amount of medical imaging data. Conclusion Grading storage is the effective method for long-term storage of enormous amount of medical imaging data in PACS.

Objective To study the risk values of glycosylated hemoglobin ( HbA1c) screening patients with diabetes mellitus(DM) and pre-diabetes(PreD) in different age and sex.Methods HbA1c results from10 840 in Taizhou Hospital in 2012 were retrospectively collected , and CHAID analysis of decision tree was used in preliminary hierarchy .Age was further divided into five groups according to the preliminary results , then one-way ANOVA and linear regression were utilized to determine the differences between age groups and the prediction intervals (PI) of HbA1c,respectively.The upper limit value of 95%PI of HbA1c was set as diabetes risk values ( DRVs).By comparison of the sensitivity of DM patients screening by DRVs in 1 889 cases whose HbA1c were between 6.0%to 6.5%and the upper limit value of traditional HbA1c reference intervals to verify the screening value ofDRVs .Then the DRVs of HbA1c were utilized to screen DM in the population whose HbA 1c is were 6.0%-6.5% in 2008,and followed their re-examination records toverify the screening value of the DRVs toin PreD patients. Results (1) On the basis of the initially root of decisiontree by age , the populationwas divided into 9 groups ( P =0.000, F =231.462).By calculatingthe 95% confidence interval(CI) of each group and merging reasonably,it was finally divided into 5 groups:20-30years,31-40years,41-50years,51-60years and >60years (F=434.342, P=0.000).(2)Using the method of linear regression , the 95% PI of HbA1c of the 5 groups showed as following:20-30 years, males 4.6%-5.9%, females 4.6%-5.9%.31-40 years, males 4.8%-6.0%, females 4.7%-6.0%.41-50 years, males 4.9%-6.2%, females 4.8%-6.1%.51-60 years, males 5.0%-6.3%, females 4.9%-6.2%.>60 years, males 5.1%-6.4%, females 5.0%-6.3%.The traditional HbA1c reference interval was4.8%-6.3%.(3) The screening sensitivity of DM by the upper limit value of traditional HbA1c reference interval and DRVs in group which HbA1c was between 6.0%-6.5% were 34.5%and 48.1%,respectively.(4) Reviewing of the group with HbA1c between 6.0%-6.5% and not diagnosed as DM in 2008, 49 hadnegative DM screening results by using the upper limit value of traditional HbA1c reference interval but were positive in our setting DRVs , and 13 have developed to DM now , which accounted for 26.5%.Conclusion HbA1c DRVs need to be set hierarchically between different age and sex groups as a supplement to the traditional reference interval , which has a great significance for the diagnosis and treatment of DM and also forthe screening and intervention of PreD patients.

Objective To investigate the changes of liver histology and ultrastructure in aged Beagles dogs.Methods A total of fifteen healthy Beagles,1 .5 to 10.6 years old,were divided into middle-aged group (n=8,average (2.21 ±0.94)years old)and aged group (n=7,average (8.26±1 .52) years old)according to age.After intravenous anesthesia,the liver tissues of dogs were taken to compare number and morphology of hepatocytes and extra cellular matrix (ECM)of two groups under light microscope with hematoxylin-eosin staining.The number density, morphology and area fraction of mitochondria,the morphology and area fraction of endoplasmic reticulum,the changes of number density and morphology of microbody,the thickness of hepatic sinusoidal endothelial cell as well as the density and the diameter of fenestrae,the changes of morphology and number of lipofuscin in two groups were compared under electron microscope.Independent sample t-test was performed for comparison between two groups.Results Under light microscope,hepatocytes were arranged radially around the central veins,especially obvious in the middle aged group. Hepatocytes were circular or oval,most were mononuclear or binuclear.The cytoplasma of hepatocyte in middle-aged group was dense eosinophilic pink.Vacuolar lipid droplets were small and scanty.The cell boundary was clear.In aged group, cytoplasmic vacuolization of hepatocyte was more obvious,bigger vacuolated lipid droplets were observed, eosinophillic granules were scattered in the cytoplasma,cellular boundary was blurry and the number of hepatocytes significantly decreased when compared with middle-aged group ((75 .80 ±5 .76 )/high power field (HPF)vs (97.80 ±6.45 )/HPF,t = -2.510,P =0.026 ).There were no obvious infiltration of inflammatory cells in the liver tissue of Beagles dogs in both middle-aged group and aged group.Compared with middle aged group, cell gap and ECM increased in aged group. Under electron microscope, mitochondria of normal hepatocyte was oval,round or horseshoe-shaped with double membranes,ridge was observed inside and distributed around nucleus.Compared with middle-aged group,the shape of hepatocyte mitochondria in aged group was varied,the number density of mitochondria significantly decreased (0.202±0.021 vs 0.248 ±0.040,t = -2.683,P =0.020)and the area fraction remarkably reduced (0.136 ±0.015 vs 0.202 ±0.019,t = -6.083,P <0.01 ).Endoplasmic reticulum was mesh laminated arranged,scattered flake distributed and was mostly seen around nucleus in flat or stacked shape.Compared with middle aged group,the area fraction of endoplasmic reticulum of hepatocyte in aged group was obviously reduced (0.006±0.001 vs 0.011 ±0.004,t=-3.338,P =0.005).Lipofuscin was shaped as round or irregular structure without membrane and pigment unevenly distributed inside.The number of lipofuscin in aged group was significantly higher than that in middle-aged group (0.028±0.025 vs 0.001 ±0.000,t=2.880,P =0.014).The number of microbody in aged group was slightly less than that of middle aged group and the difference was not statistically significant (P =0.603).The thickness of the liver sinusoidal endothelium in aged group significantly increased compared with that in middle-aged group ((0.242±0.047)μm vs (0.114±0.075)μm,t=3.881 ,P =0.002).The diameter and density of endothelial fenestration in aged group ((1 .895 ± 0.439 )μm and (0.260 ± 0.120 )/μm)obviously decreased compared with those in middle-aged group ((3.186±0.332)μm and (0.723±0.184)/μm,t=6.345 and -4.511 ,both P <0.01).Conclusions There were significant degradations of liver in quality and quantity among aged individuals.These degradations were the structure basis of decreased hepatic reserve function and involved directly or indirectly in high prevelance of hepatic diseases among elders.