Objective To investigate the isolation and antimicrobial resistance of hypermutable Pseudomonas aeruginosa strains.Methods The cultured bacteria were identified by API 20NE system.The susceptibilities of bacteria were detected by disk diffusion method and the results were confirmed with the rules of NCCLS/CLSI.The hypermutable strains were identified byhigh concentration of rifampin-resistant growth assay.Results Among analyzed 100 strains,37 strains(37.0%) were hypermutable.The resistant rates of hypermutable strains to imipenem,meropenem,cefoperazone/sulbactam,piperacillin/tazobactam,ceftazidime,cephfime,aztreonam,amikacin and ciprofloxacin were significantly higher than those of non-hypermutable strains.The multidrug resistance rates of hypermutable strains were also higher than those of non-hypermutable strains.Conclusion The hypermutable strains of Pseudomonas aeruginosa sourced from chronic respiratory tract infections dominantly.The hypermutable strains were hyper-resistant and multidrug resistant to many antibiotics,so strengthened monitoring should be encouraged to control the prevalence of hypermutable Pseudomonas aeruginosa strains.

Objective To discuss the hemodynamics and treatment of silent patent ductus arteriosus (PDA) Methods The heart catheterizations were performed in seven silent PDA patients Results The mean pulmonary artery pressure of seven patients was (16?2 4) mm?Hg The mean Qp/Qs was 1 08?0 02 The mean size of the left right shunt was (0 32?0 08) L/min The proportion of left right shunt size in pulmonary blood flow was 0 098?0 024 on average The mean PDA at its narrowest segment was (0 9?0 2) mm We performed neither surgery nor interventional treatment in all patients In 9 5 months follow up (clinical findings, electrocardiography, echocardiography), no atrioventricular chambers enlargement, pulmonary hypertension, infective endoarteritis and infective endocarditis happened Conclusion In silent PDA patients, there is less size of left right shunt and smaller effect on hemodynamics Its treatment with surgical and interventional closure is under discussion

Objective To evaluate the effectiveness and safety of transcatheter closure of membranous ventricular septal defect (MVSD) using Amplatzer membranous VSD occluder (AMVSO). Methods The patients, who were clinically diagnosed with VSD were recommended for further transthoracic echocardiographic assessment using multiple standard views. If there were left to right shunts across ventricular septum, the margin of defects to the aortic valve was more than 1mm and that to tricuspid valve was more than 3 mm. If there was an aneurysm, it should not interfere with the function of outlet of right ventricule. Finally, if the diameter of VSDs wasless than 14mm, catheter closure of VSDs was suggested in these patients. The patients, having residual shunt after surgical closure of VSD, were included. All procedures were performed under local or general anesthesia. Transthorac echocardiography and X ray were used continuously to monitor the procedure. Transthoracic echocardiography was performed immediately after the release of devices, 24 hours, and 3 months after the procedure, respectively.Results From June 2002 to March 2003, 32 consecutive patients (15 females), underwent transcatheter closure of MVSD. The mean diameters of VSDs measured by echocardiography was 5.1 mm (3～8 mm) and, while that by angiography was 4.4 mm (3～8 mm). The mean size of the occluder was 7.6 mm(4～12 mm). The successful rate of device implantation was 100% (32/32). The residual shunt immediately after the closure was 11.5%, whereas after 24 hours it was only 7.7%, which was not serious. After 3 months′ follow-up, only 3.8% trivial residual shunt existed. No death occurred during and after the procedure. Atrial tachycardia, ventricular tachycardia, and bundle (right and left bundle) branch block, which was considered to relate to catheter manipulation inside the chamber of ventricle, were common and transient. One aortic regurgitation and tricuspid insufficiency became severe after the procedure, but they were not serious. One patient developed III degree A-V block 24 hours after the procedure, and EKG became LBBB 3 days after the temporary pace making. Hemolysis was observed in one patient, and he recovered 7days after the medication therapy. Conclusion Transthoracic echocardiography was very much effective in catheter closure of MVSD. The asymmetric self-expanding nitinol double-disc Amplatzer device designed for the transcatheter closure of MVSD is implanted easily and stably. Due to low ratio of residual shunt and few serious complications, the Amplatzer device is a good choice for the transcatheter closure of MVSD.

Community health-care service is a dynamic and comprehensive primary health care for a given population.The increasing health-care information needs to be dynamically managed and fully utilized.The comprehensive and networking management of the medical care information with computer in community is scientific and effective in community health care service.Accordingly,The working principle of network computer information management system for community health-care service is made and the regarded functional models are established.The data in the system is convenient for work summary and scientific research.The work protocol based on the system can help realize the standardized management to community health-care service.

0.05). Conclusion The assumable reasons for the dominance of heterozygous ADH2 genotype were a relatively small size of samples or gene mutation etc,which needed further researches to be confirmed.The proportion of individuals carrying about "susceptible genotypes of alcohol_related diseases"in female child_bearing ages was more than one half (0.617),which called on the reinforce of the surveillance on and prevention of alcohol_related birth (ARBD).

Objective To observe the effect of febuxostat on IL-1β, TNF-αand COX-2 in gout patients.Methods 82 patients with gout in our hospital from August 2015 to August 2016 were divided into the groups of 40 mg/day of febuxostat and 80 mg/day of febuxostat randomly, 41 cases respectively.Select the same period in our hospital health examination of 41 cases.The levels of serum uric acid were measured before and after one week, two weeks and four weeks after treatment.Serum levels of IL-1β, TNF-αand IL-1βin serum were measured by enzyme-linked immunosorbent assay (ELISA) COX-2 levels.Results The levels of serum uric acid in the group of 40 mg/day vs 80 mg/day of febuxostat were (570.4 ±70.5) μmol/L and (572.8 ±71.2) μmol/L, significantly higher than the normal group (296.5 ±9.7) μmol/L (P<0.05), serum uric acid level decreased gradually with the time of administration, and the serum uric acid levels of the two dosages of fosobutamol at one,two,four weeks were significantly lower than before treatment (P<0.05), but not to below the normal level.The IL-1βof 40 mg/day and 80 mg/day of febuxostat was (40.5 ±6.8) pg/mL and (41.7 ±7.2) pg/mL, COX-2 were (15.5 ±1.7) pg/mL and (15.8 ±1.8) pg/mL respectively, significantly higher than the normal group (8.8 ± 1.7) pg/mL (P<0.05), The expression of IL-1βwas significantly decreased at the second week of IL-1βdecreasing as the time of IL-1βdecreased gradually (P<0.05); TNF-αin 40 mg/day group and 80 mg/day group was significantly lower than that before treatrment (P<0.05), but not to below the normal level.Conclusion Febuxostat can significantly reduce serum uric acid levels in patients with gout, and may reduce IL-1β, TNF-αand COX-2 and other cytokine levels.

Objective To investigate the effects of hemoglobin concentration on portal hypertension associated with hyperdynamic state.Methods According to blood hemoglobin level below or above 110g/L,55(nontreated) portal hypertension patients were divided into anemic and nonanemic groups,and the relevant(hemodynamic) and clinical data were examined and analyzed retrospectively.In order to avoid the effects of differences in hepatic function,data were analyzed separately according to the Child class.Results(Compared) to the nonanemic group,the anemic group had markedly increased cardiac output [(7.4?(1.7L))/min vs(6.3?1.9L)/min,P=0.028] and increased free portal pressure [(29.1?3.1)mmHg vs(26.8?3.3)mmHg,P=0.012],and a markedly decreased mean arterial pressure [(84?10.7)mmHg vs(97.1?12)mmHg,P

Objective To study the pathogenesis, clinical characteristics, laboratory tests, treatments and prognosis of con-genital factorⅦdeficiency. Methods The clinical data of two cases of congenital factorⅦdeficiency diagnosed at the Chil-dren’s Hospital of Fudan University and 9 cases reported in the past 10 years retrieved from Pubmed, Web of Knowledge and CNKI, Wangfang database by using the factorⅦdeficiency , congenital, newborn and case report as keyword were reviewed and analyzed. Results All cases were full term birth with normal birth weight (>2 500 g), including 4 females and 7 males. Pa-rental consanguinity was found in 3 cases, and a family history was found in 3 cases. The laboratory tests were characterized by significantly prolonged prothrombin time, normal partial thromboplastin time, and decreased coagulation factorⅦactivity. The coagulation factorⅦactivity of 10 cases were less than 5%. Five cases (45.5%) were treated with human recombinant activated factorⅦ. Four cases (36.4%) treated with plasma or human recombinant activated factorⅦare currently in normal growth and development. Four cases (36.4%) died during the hospitalization. Conclusions A diagnosis of congenital factorⅦdeficiency should be considered in the neonates with severe bleeding, prolonged prothrombin time, normal partial thromboplastin time, and being intractable to vitamin K treatment. Human recombinant activated factorⅦis the first choice of the treatment of congenital factorⅦdeficiency. The further study of gene mutation type will be of great significance for disease screening, diagnosis, treat-ment and prognosis prediction.

Objective To understand the adherence to current treatment guidelines after training in man-agement of acute exacerbation of chronic obstructive pulmonary disease (AECOPD) in emergency department (ED),and to assess the patients' prognosis. Methods Were ED doctors trained with a standard management flow-sheet for AECOPD. The treatment of 152 AECOPD patients recruited from November 1,2008 to April 30,2009 in our hospital and their prognosis were compared to those of 133 AECOPD patients who were treated between Novem-ber 1,0007 to April 30,2008. Results After training, the ED doctors' management of AECOPD is more standard. The rate of the combination of inhaled anticholinergics and short-acting β_2-agonists was increased from 12.0% (16/133) to 27.6% (42/152), the use of inhaled glucocorticosteroids was increased from 52.6% (70/133) to 88.8% (135/152), and the early use of noninvasive imermittent positive pressure ventilation(NIPPV) for the mod-erate to severe was increased from 10.5% (14/133) to 16.4% (25/152). The use of theophylline was decreased from 69.2% (92/133) to 49.3% (75/152). The in-ED mortality rate was decreased from 15.8% (21/133) to 12.5% (19/152). All the difference were significant (P< 0.05). The rate of inhaled β_2-agonists was increased from 78.2% (104/133) to 82.9% (126/152), the use of systemic glucocorticosteroids was decreased from 63.2% (84/133) to 56.6% (86/152),the use of antibiotics was increased from 88.0% (117/133) to 92.8% (141/152), and the use of invasive mechanical ventilation was increased from 14.3% (19/133) to 15.1% (23/152) ,the in-hos-pital mortality rate was decreased from 6.0% (8/133) to 5.3% (8/152), the average days in hospital was decreased from 13.3 to 12.4 days, but the difference was not significant (P > 0.05). Conclusions There are still some differences exist between guideline recommendations and actual ED management of AECOPD. After training ED doctora with a standard flow-sheet, their management of AECOPD is improved. The rate of the combination of inhaled anticholinergics and short-acting β_2-agonists, use of inhaled glucocorticosteroids, and early use of NIPPV is increased. The use of theophylline and the in-ED mortality rate is decreased.

Objective:To investigate the protective effect of rifampicin in a rat model of global cerebral ischemia /reperfusion ( GCIR) and discuss the influence of rifampicin on microglial activation.Methods:The GCIR rat model was induced via the bilateral occlusion of the common carotid arteries and systemic hypotension.Forty-two male SD (Sprague-Dawley) rats were randomly assigned to three groups:sham group ,I/R and I/R+FRP treated group.The rats in I/R+RFP group were treated with rifampicin 20 mg/kg by intra-peritoneal injection 30 min after reperfusion , while the other groups were treated with normal saline.Morris water maze test was performed for neurobehavioral test ,HE staining was detected for pathomorphology changes of neurons in CA 1 region.Microglia was im-munohistochemically stained in CA 1 region using ionized calcium adaptive molecular 1 ( IBA-1) as the marker.The protein levels of IL-1β,IL-6 and TNF-αin the hippocampal tissues of rats were also measured by enzyme-linked immunosorbent assay.Results:Rifampin improved the behavior ,shorten the escape latency of rats following GCIR obviously ( P<0.05 ) and reduced the neuron damage in hipp-ocampal CA1 region of rats after GCIR (P<0.05).Additionally,in I/R+FRP treated group the activation of microglia also showed a significantly inhibited compared with I/R group(P<0.05).Futhermore,we also found the expression of IL-1β,IL-6 and TNF-αin hipp-ocampal reduced obviously in I/R+FRP group ( P<0.05 ).Conclusion: Rifampin have obvious protective effect in the rat model of GCIR.The underlying mechanism may be associated with inhibition the activation of microglia ,reduction the expression of IL-1β,IL-6 and TNF-αand suppression the inflammatory response finally.