Objective To understand the epidemic trend and drug susceptibility of pathogenic bacteria in children with lower re-spiratory tract infection to provide the basis for clinical rational drug use.Methods The sputum culture specimens in these two hospitals during 2013 were performed the pathogenic bacterial culture and the drug susceptibility test respectively.The results were conducted the comparative analysis.Results 6124 strains of bacteria were isolated from the children lower respiratory tract sputum specimens in our hospital during 2013,including 5 121 strains of Gram negative bacteria,accounting for 62.7%,which were domina-ted by Haemophilus influenzae,Klebsiella pneumoniae,Escherichia coli,Bauman Acinetobacter and Pseudomonas aeruginosa;Gram positive bacteria were 2734 strains,accounting for 33.5%,the top two were Streptococcus pneumoniae and Staphylococcus aureus;311 strains of fungi,accounting for 3.8%,and Candida albicans was predominant.1600 strains of bacteria were isolated from the lower respiratory tract sputum specimens in Nanjing Brain Hospital during 2013,including 1 134 strains of Gram negative bacteria, accounting for 70.9%,which were dominated by Klebsiella pneumoniae,Escherichia coli,Pseudomonas aeruginosa and Acinetobact-er Bauman;296 strains of Gram positive bacteria,accounting for 18.5%,Staphylococcus aureus was predominant;170 strains of fungi,accounting for 10.6%,Candida albicans was predominant.The sensitive drugs to Gram-negative bacilli were piperacillin /tazobactam and imipenem,while the sensitive drugs to Gram-positive bacilli were linezolid and vancomycin.Conclusion The Gram negative bacteria are the main pathogens of lower respiratory infection in children,and strengthening bacterial culture and drug re-sistance monitoring is necessary for rational use of antibacterial drugs.

Objective To assess the safety and effectiveness of laparoscopic implantation of three-dimensional (3D)-printed extravascular stent for treatment of nutcracker syndrome (NCS).Methods The clinical data of NCS in our hospital were prospectively collected from August 2015 to August 2016.Doppler ultrasound and CT examination were performed before the operation of all the patients who were in line with the diagnostic criteria of NCS.The 3D model of extravascular stents with especial device to prevent migration was designed and was made by 3D metal printer with titanium alloy.The left renal vein(LRV) was exposed completely up to the inferior vena cava,then the stent was placed around the compressed LRV.Results 10 patients were enrolled in the study,including 9 males and 1 females,age (21.5 ±4.6) years.Among these patients,there were 4 cases with severe hematuria,1 case with proteinuria,5 cases with left lumbago,and 5 cases with left severe varicocele.The preoperative doppler ultrasound examination showed the diameter of the the compressed LRV was (1.57 ± 0.25) mm,and flow velocity was (164.40 ± 55.27) cm/s;the diameter of the LRV at the renal hilum was (8.7 ± 1.59) mm,and flow velocity was (10.70 ± 2.21) cm/s.The average operation time was (75 ± 11) min,and the average hospital stay after operation was 7 d.All symptoms were relieved at 3-7 d after operation.All patients were asymptomatic and all stents were stable after follow-up.At 12 months after surgery,the diameter of the LRV at the renal hilum was (8.23 ± 1.90) mm on doppler ultrasound,and there was significant decrease (P ＜ 0.01);the flow velocity was (21.20 ±3.88) cm/s,and there was significant increase (P ＜ 0.01).Conclusions Laparoscopic three-dimensional printed extravascular stent placement is a safe,effective and minimally invasive technique for treatment of NCS.

Objcetive To investigate the relationship between blood β-hydroxybutyric acid and urine ketone in the di-agnosis of diabetic ketosis (DK). Methods Peripheral blood β-hydroxybutyric acid and urine ketone were detected when the peripheral blood glucose was more than 13.9 mmol/L in patients with diabetes. Results (1) In 81 diabetes pa-tients with blood glucose more than 13.9 mmol/L, the incidence of DK was 13.58% and the incidence of diabetic ke-toacidosis (DKA) was 9.88%. (2) The peripheral blood glucose was positively correlated with β-hydroxybutyric acid (r=0.330, P=0.003), but it was not correlated with urine ketone. (3) The peripheral blood β-hydroxybutyric acid was posi-tively correlated with urine ketone (r=0.516, P=0.000). (4) In patients with DK or DKA, 5.26%(1/19) of those were with urine ketone(-) or (+-), whereas 36.84% (7/19) of those were with blood β-hydroxybutyric acid less than 1 mmol/L. (5) When urine ketone was used as the reference test for diagnosis of DK, the optimal value of blood β-hydroxybutyric acid was 0.35 mmol/L. Conclusion For missed diagnosis of DK may be happend if blood β-hydroxybutyric acid or urine ketone is used alone, the co-monitoring of blood β-hydroxybutyric acid and urine ketone can reduce the inci-dence of missed diagnosis of DK. The urine ketosis may have existed when the blood β-hydroxybutyric acid is slightly elevated (≥0.35 mmol/L). In the situation, the urine ketone should be tested in order to avoid missed diagnosis of DK.

Objective:To report the clinical, electrophysiological and genetic features in a Chinese family with distal hereditary motor neuropathy type V (dHMN-V) and screen the pathogenic mutant gene.Methods:A family with the history of inherited peripheral neuropathy was recruited in the First Affiliated Hospital of Zhengzhou University in July 2017. The clinical features and electrophysiological data were investigated. Genetic testing on well-established genes associated with hereditary peripheral neuropathy was conducted by targeted high throughput sequencing and the candidate variant was screened in the family and normal controls.Results:There were four affected individuals in the family. The proband, a 25-year-old male, was characterized by weakness and atrophy in the distal extremities primarily affected the upper extremities without sensory impairment. Electrophysiological study showed chronic neurogenic pattern in the upper and lower limb muscles. The motor conduction showed reduced velocity and compound muscle action potential amplitude, while the sensory conduction studies results were normal. The grandfather, a maternal uncle and a cousin of the proband exhibited similar clinical manifestations and electrophysiological abnormality. Genetic testing revealed a heterozygous mutation, c.880G>A(p.G294R), in the GARS gene in the proband. Proband′s mother and two other affected individuals carried the mutation which was confirmed by Sanger sequencing. The mutation site was not found in the unaffected members from the family and 300 unrelated normal controls. The variant is a novel mutation which has not been reported in dbSNP, ExAC and 1000 Genomes Project databases. Conclusion:The results suggest that the novel c.880G>A(p.G294R) mutation of the GARS gene is responsible for the Chinese patients with dHMN-V, and the findings broaden the mutational spectrum of GARS gene.

Objective:This paper studied the classification of syndrome and the multi-level expression method of syndrome elements, to realize the processing of syndrome name wiht computer, which could be applied to the research on traditional Chinese medicine (TCM) intelligent auxiliary diagnosis system.Methods:With the guidance of TCM theory combining the syndrome differentiation and syndrome elements theory, the syndrome elements are divided into a more fine-grained way, and the hierarchical division method and multi-level expression method of syndrome elements are put forward. Than to conduct artificial analysis on the syndrome of gynecological diseases to verify the rationality of multi-level expression of syndrome elements. Based on the multi-level expression method of syndrome elements and pattern extraction method of pattern matching,form the extraction method of syndrome elements and through the batch processing of the Clinical Diagnosis and Treatment Term of TCM& Syndrome Part to verify the accuracy of the batch processing methodexpression. Results:Guided by TCM theory, this study divided the constituent elements of syndrome names into two levels and five types containing disease location elements, disease nature elements which includes basic material, etiology, pathological state and conjunctions, based on which the syndrome splitting process is constructed. Based on this, the process of syndrome name elements separation is constructed. Artificial analysis of TCM syndrome names of menstrual diseases and infertility shows that all syndrome names can be divided into one or more disease location elements, disease nature elements, and conjunctions based on that splitting process. The accuracy rate of computer batch processing is as high as 71.4% based on that splitting process.Conclusions:The multi-level representation method of syndrome elements provides a theoretical framework for mass data processing by computer, improves the efficiency and accuracy of data processing, provides a theoretical basis for the construction of training data set of syndrome differentiation model, provides support for TCM syndrome differentiation reasoning model, and can be applied to the research of TCM intelligent auxiliary diagnosis system.

Objective To analyze the clinical manifestations and genetic mutations in 3 pedigrees with hereditary spastic paraplegia (HSP).Methods Three pedigrees diagnosed as having HSP in our hospital from January 2014 to November 2015,were chosen;the clinical manifestations,electrophysiology and imaging features of the patients in these three families were analyzed.Genomic DNA was extracted from peripheral venous blood,and the targeted gene capturing was employed to identify the disease-causing genes of these patients.Results The patients from the first family was familiar HSP,and the main clinical features were progressive lower limbs weakness and abnormal gait without cognitive impairment;the patients from the second family were familiar HSP and those from the third family were HSP without family history,and the main clinical features of the two pedigrees were slowly progressive spastic paraplegia and cognitive impairment.In addition,thin corpus callosum was visible in MR imaging of family three.Genetic testing showed the first family presented with a known mutation c.715C＞T ofA TL1 exon 7 and the loci co-segregated in the family.The second family presented with novel compound heterozygous mutations in the SPG11 gene:c.3099_3103delGTTTG mutation of exon 17and c3817 3818insTGA mutation of exon 22;novel compound heterozygous mutations in the SPG11 gene in the third family were detected as follows:c.6194C ＞G mutation of exon 32 and c.5121+1C＞T splicing mutation ofintro 29.Conclusions Four novel mutations in SPG11 gene and one known mutation in A TL1 gene are found,which enriches the known HSP mutation types.Targeted gene capture is an efficient and rapid tool for identifying the causation of some complex and genetically heterogeneous neurodegenerative diseases.