Recent years, rehabilitation for the children with cerebral palsy raises certain concerns for the society and government. Butthere are still problems existing during the enforcement of a series of measures for early intervention and rehabilitation training. The rehabilitationservice system and security system for children with cerebral palsy should be strengthened and regulated during the "TwelfthFive-Year Plan".

Objective To investigate the mechanism of drug resistance mediated by micF gene and outer membrane porin F ( OmpF) in Shigella strains. Methods Shigella strains were isolated from stool samples of patients who presented to the Second Hospital of Tianjin Medical University with acute diar-rhea in 2015. Antibiotic susceptibility test was performed to screen out the multidrug-resistant and non-multi-drug-resistant strains. The ompF gene was amplified by PCR. The micF and ompF genes at transcriptional levels in the two groups of strains were detected by quantitative real-time RT-PCR. Intracellular concentra-tions of ciprofloxacin in the two groups of Shigella strains were measured by automatic microplate reader. Re-sults According to the result of antibiotic susceptibility test, 13 strains that were resistant to 3 or more than 3 antibiotics were classified into the multidrug-resistant group, while the other 8 strains that were sensitive to all antibiotics used in this study or only resistant to 1 or 2 antibiotic were classified into the non-multidrug-re-sistant group. All of the 21 Shigella strains carried the ompF gene. Compared with the non-multidrug-resist-ant strains, the multidrug-resistant strains showed higher expression of micF gene, but lower expression of ompF gene. The differences in micF and ompF genes between the two groups were statistically significant. The result of correlation analysis suggested that there was a negative correlation between micF and ompF genes (r=-0. 244). The intracellular concentrations of ciprofloxacin in multidrug-resistant strains were low-er than those in the non-multidrug-resistant strains (P<0. 001). Conclusion The decreased expression of OmpF was one of the possible mechanisms of multidrug-resistance in Shigella strains. The micF gene was negatively related to the expression of OmpF. Moreover, the decreased intracellular concentrations of cipro-floxacin in multidrug-resistant strains might be related to the decreased expression of OmpF.

Objective To evaluate the influences of femoral rotation on dynamic alignment of the lower extremity in TKA by computer assisted surgical technology.Methods From July 2013 to August 2013,76 consecutive patients with knee osteoarthritis undergone primary-single TKA in our hospital were enrolled,including 46 males and 30 females,aged from 64 to 78 years (average,71 years).All surgeries were completed by the same professional doctor.The PFC (fixed-bearing posterior stabilized) Sigma rotating-platform was selected for all patients,and computer navigation system (Stryker(R) Navigation System Ⅱ-Cart (Stryker corporation,Kalamazoo,Michigan,USA) was used.External rotation osteotomy of the distal femur during TKA was completed according to the pre-operative external rotation angle (ERA),intraoperative transepicondylar axis (TEA) and anteroposterior (AP) line.Passive dynamic alignment of the lower extremity during knee flexion was recorded.The variation trend of hip-knee-ankle (HKA) alignment and the influences of femoral external rotation osteotomy were analysed.Results ERA calculated by the computer navigation system according to Whiteside line,TEA and the mean of Whiteside line and TEA was 5.54°±2.86°,5.21°±2.60° and 5.34°±2.38°.Compared with the ERA measured by CT,no method was better than the other two.Postoperative deviation of HKA alignment from 0° to 90° flexion was associated with the rotational alignment of the femoral component.Trend of HKA alignment during knee flexion tended to be varus,valgus or neutral according to different angles of external rotation osteotomy of the distal femur.Conclusion The HKA alignment changes during the knee flexions.External rotation osteotomy of the distal femur played a crucial role in determining dynamic HKA alignment in TKA.

OBJECTIVE To discuss the efficiency method of improving consciousness and action for occupational infection protection among grass root medical staff.METHODS To conduct multiform health education,found restrict system,inspect and supervise,optimize protection flow,consummate protection establishment,and strengthen important link management in key departments in order to realize the system intervention among grass root medical staff.RESULTS Due to the system intervenion,the understanding rate of occupational infection protection knowledge improved from 48% to 96%,the average rate of occupational infection protection improved from 56.6% to 97.7% with significant differences(P

Objective To investigate the effectiveness of intermittent pneumatic compression (IPC) devices combined with anticoagulants for the prevention of deep vein thrombosis (DVT) after joint replacement surgery.Methods All of 400 patients were involved in this prospective randomized control study with 100 total knee arthroplasty (TKA) patients and 100 total hip arthroplasty (THA) patients in each group.All patients were operated under the general anesthesia.Patients in the control group received 10 mg of rivaroxaban per day beginning 6-8 hours after the surgery.Besides the prescription of rivaroxaban, IPC devices were used just after the anesthesia in the operating theater and lasted for 48 hours in the experimental group.The diagnosis of DVT in the lower extremities was made by color Duplex sonography on the second postoperative day.The incidence rate of DVT and symptomatic pulmonary embolism was recorded.The incidence rates of total DVT, proximal DVT (p-DVT, proximal to the trifurcation of the popliteal vein), distal DVT (d-DVT, in the anterior tibial vein, posterior tibial vein or peroneal vein) and intermuscular DVT were recorded.CT pulmonary angiography was used to confirm the pulmonary embolism if it was suspected.Results The incidence rates of overall, proximal, distal and intermuscular DVT were 9.5％, 0.5％, 0.5％, 8.5％ in the experimental group and 30％, 0.5％, 5.5％, 24％ in the control group respectively.The incidence rates of total DVT, distal DVT and intermuscular DVT were significantly lower in the experimental group.The incidence rate of DVT in TKA patients and THA patients were significantly lower in the experimental group than in the control group respectively.For patients with DVT, enoxaparin was used instead of rivaroxaban, and DVT was found disappeared by color Duplex sonography 10-12 days postoperatively.Conclusion Compared with the use of rivaroxaban alone, IPC devices combined with anticoagulants can significantly reduce the incidence rate of distal DVT and intermuscular DVT in the early postoperative period after joint replacement surgery.

Chronic kidney disease (CKD) is becoming a global social problem. It is important to slow down the progression of CKD for economic and social concerns. In recent years, it has been found that colon is one of the vital organs which produce uremic toxins. And enterogenous uremic toxins are closely related to the prognosis of CKD. Theory of gut-kidney axis for the slowdown of CKD progression was raised by foreign scholars and became the research hot spot. Colon therapy with traditional Chinese medicine (TCM) has been widely used in clinical practice and is believed to slow down the progression of CKD by numerous clinical reports. However, low re-search quality and ambiguous results limited its further application. Under the guidance of senior TCM Professor Huang Chunlin, who emphasized the method of draining turbidity through bowels in the management of CKD, from the Nephrology Center, Guangdong Provincial Hospital of Chinese Medicine, as well as the modern theory of gut-kidney axis, we had carried out a series of exploratory researches which will provide data and methodology support for further confirmatory studies and improve its effectiveness.

Objective To detect plasma interleukins-35 (IL-35 )level in the patients with active tuberculosis complicated with bronchiectasis and to analyze its clinical significance.Methods Peripheral blood of patients with active tuberculosis from depart-ment of Dongguan 6th People′s hospital were collected,assigned to the active tuberculosis complicated with bronchiectasis group and active tuberculosis group.The healthy volunteers served as the control group.The plasma IL-35 level was measured by ELISA, and peripheral blood neutrophils and lymphocytes were detected by hematology analyzer.Results The levels of plasma IL-35 signif-icantly increased in both patients with active tuberculosis complicated with bronchiectasis and patients with active tuberculosis.The level of plasma IL-35 of patients with active tuberculosis complicated with bronchiectasis was significantly higher than that of the patients with active tuberculosis.The absolute value and percentage of peripheral blood neutrophils of patients with active tubercu-losis complicated with bronchiectasis were significantly higher than those of healthy volunteers.However,the percentage of periph-eral blood lymphocytes of patients with active tuberculosis complicated with bronchiectasis was significantly lower than that of healthy volunteers.Pearson correlation analysis showed that the absolute value of peripheral blood neutrophils of patients with ac-tive tuberculosis was positively correlated to the level of plasma IL-35.Conclusion IL-35 may play an important role in the progres-sion of active tuberculosis complicated with bronchiectasis.The determination of IL-35 may be helpful to the diagnosis of patients with active tuberculosis complicated with bronchiectasis.

Objective To investigate the antimicrobial resistance ,molecular phenotypes ,virulence gene profiles of Salmonella A gona (S .A gona) isolated from patients with acute diarrhea ,and to better understand its epidemic trend ,prevention and treatment .Methods Clinical data and stool samples of patients with acute diarrhea during April to October in 2013 and 2014 from the Second Hospital of Tianjin Medical University were collected .Enrichment culture ,biochemical identification and serotyping analysis were used to isolate and identify S .A gona strains .The isolated strains were further analyzed with antibiotics susceptibility test ,pulsed field gel electrophoresis (PFGE) ,multiple locus sequence typing (MLST ) , Quinolone resistance determining region (QRDR) .Plasmid-mediated quinolone resistance (PMQR) and β-lactamases genes (TEM ,SHV ,OXA ,and CTX-M) were amplified by polymerase chain reaction (PCR) and sequencing .The representative genes carried by Salmonella pathogenicity islands (SPI) 1 — 6 ,9 — 12 and virulence plasmids were amplified by PCR .And the clinical characteristics of S .Agona infection were analyzed .Results Among 119 non-repetitive (non-typhoidal salmonella ,NTS) isolates during the two years ,eight isolates (6 .7％ ) of S .A gona were identified . The resistance rate of S .A gona strains to streptomycin was 100 .0％ , those to ampicillin and gentamicin were 62 .5％ ,to levofloxacin ,ciprofloxacin and nalicixic acid were 25 .0％ ,to chloramphenicol ,amoxillin/clavulanic acid and piperacillin tazobactam were 12 .5％ .The strains were susceptible to other drugs .All 8 isolates had the identical ST13 genotype .PFGE showed 5 clones ,and 4 out of 5 isolates had the exact same patterns of PFGE and drug susceptibility .Two (fluoroquinolones ,FQ) resistant strains carried gyrA mutation leading to amino acid substitutions at position 87 in GyrA ,and no PMQR genes was detected ,while one of which was sensitive to ciprofloxacin by K-B method .All five ampicillin-resistant isolates were positive for TEM-1b gene and one isolate of them was resistant to β-lactam/β-lactamase inhibitor complex .The representative genes carried by SPI 1 — 6 , 9 ,11 ,12 (hilA ,sseL ,mgtC ,siiE ,sopB ,pagN ,bapA ,pagC and sspH2) were 100 .0％ positive ,while the genes carried by SPI10 (sef A ) virulence plasmids (spvB , prot6E) were negative . Two patients with FQ resistant strains infection were clinically diagnosed with bacillary dysentery ,and the remaining six cases with FQ susceptible strains infection were clinically diagnosed with acute gastroenteritis .Conclusions FQs-resistant and multi-drug resistant S .A gonaisolates have emerged in clinical settings .These isolates carry a variety of virulence genes .Resistance to FQ of S .Agonamay cause more severe illness .ST13 might be the dominant genotype of S . A gona in China ,and we should try to prevent the infection outbreak of S .A gona .

Chronic kidney disease (CKD) is a chronic renal structure change and dysfunction caused by a variety of causes.The incidence and prevalence of CKD have been on the rise,becoming a major global health problem.An increasing number of studies had shown that one of the important indicators of CKD progression was the disorder of gut microbiome and elevated levels of sernm endotoxin.Modern physicians of traditional Chinese medicine (TCM) believed that the main pathogenesis of CKD was spleen and kidney deficiency.And the therapeutic regimen was invigorating spleen and nourishing the kidney.Spleen is in the middle burner.It has the function of transportation and resistance to evil,which was extremely similar to the function of gut microbiome in metabolism and immunity.The latter might be one of the biological bases of physiological function of spleen.This comprehensive review presented the modern theoretical basis of spleen-based TCM treatment methods for CKD from the insight of modern gut microbiome and metabolism.Firstly,gut microbiome and its metabolism were associated with the spleen in TCM theory.Gut microbiome affected individual metabolism and immune function,which could provide a modern biological basis for explaining the physiological function of the spleen.Secondly,gut microbiome and its metabolism were correlated with CKD:intestinal flora disturbance occurred in CKD patients,producing enterogenous toxins as their metabolites,which become the important factors affecting prognosis.Thirdly,as for its origin,development and current status based on the spleen theory,CKD was one of various consumptive diseases.Spleen insufficiency was one of their critical pathogenic mechanisms.Therefore,tonifying the spleen should be a treatment method to maintain throughout the entire treatment.On the basis of our previous clinical studies and the hypothesis of gut microbiome and metabolism,we proposed further studies which were also based on system biology and its technology.

Objective:To explore whether the electroacupunture stimulation (ES) at acupoint Zusanli (ST36) can inhibit the bone loss caused by Staphylococcus aureus (SA) infection and its mechanism in a model of SA osteomyelitis.Methods:Twelve male C57 BL/6 mice aged 10 to 12 weeks were randomly divided into 2 even groups ( n=6) for SA infection + ES or SA infection only. After ES at ST36 was conducted for 4 weeks in the model of SA osteomyelitis, samples were harvested from the femora and tibiae. Micro-CT reconstruction was performed to detect trabecular bone volume fraction (BV/TV), trabecular number (Tb.N), trabecular thickness (Tb.Th), trabecular separation (Tb.Sp), connectivity density (Conn.Dn) to analyze changes in bone mass. Leptin receptor (LEPR) staining was performed to detect osteoblasts. Tartrate resistant acid phosphatase (TRAP) staining was used to detect the changes in osteoclasts. The changes in plasma inflammatory factors were detected by enzyme-linked immunosorbent assay (ELISA). Results:Micro-CT results showed that the BV/TV, Tb.N, Tb.Th, and Conn.Dn in the cancellous bone in the target areas in the SA + ES group were all higher than those in the SA group, LEPR immunofluorescence results indicated that the number of osteogenic precursor cells in the ES group was larger than that in the SA group, and serum ELISA indicated a decrease in inflammatory factors in the blood in the SA+ES group compared with the SA group. There were significant differences in the comparisons above ( P<0.05). There was no significant difference in the number of osteoclasts on the surface of trabecular bone between the 2 groups in TRAP staining. Conclusion:ES may slow down infectious bone destruction by inhibiting the inflammatory response induced by SA infection and by inducing aggregation and differentiation of mesenchymal stem cells into trabecular bone.