Objective To explore the effect and mechanism of early hyperbaric oxygen in the treatment of patients with diffuse axonal injury ( DAI ). Methods A total of 45 cases of DAI were randomly divided into hyperbaric oxygen treatment group ( n =25 ) and normal treatment group ( n =20).The changes of intracranial pressure,Glasgow Comb Scale (GCS) and prognosis were observed.Results Compared with group treated with routine therapy,early intracranial pressure scores were reduced obviously,while GCS and prognosis were increased obviously in group treated with hyperbaric oxygen therapy ( P ＜ 0.05 ). Conclusion Early hyperbaric oxygen can significantly lower the level of intracranial pressure and improve the prognosis in the treatment of DAI patients.

Objective Objective To determine the potential factors for development of post-traumatic hydrocephalus (PTH) after decompressive craniectomy (DC).Methods A retrospective study was performed on 62 patients undergone DC after craniocerebral trauma.Based on the incidence of hydrocephalus after DC,the patients were divided into hydrocephalus group (n =15) and non-hydrocephalus group (n =47).The factors including general data information,pre-operative condition,imagine manifestation,operation methods,and surgical parameters were compared between groups to identify the risk factors contributing to the development of PTH.Results No statistical differences were found between the two groups in aspects of gender,age,injury severity score (ISS),pupillary size,pupillary light reflex,Fisher scale of subarachnoid hemorrhage,volume of intracranial occupation,ambient cistern compression,midline shift,intracranial infection,and distance of superior margin of the craniectomy to midline.But there were significant differences of the two groups in whether underwent bilateral craniectomy (x2 =9.235,P ＜0.05),height of craniectomy (t =3.751,P ＜ 0.01),area of craniectomy (t =3.171,P ＜ 0.01) and whether underwent reoperation (x2 =8.335,P ＜ 0.01).Logistic regression analysis indicated that the development of PTH was significantly affected by bilateral craniectomy,large craniectomy and reoperation.Conclusion Bilateral craniectomy,large craniectomy and reoperation are risk factors for the development of PTH after DC.

Objective To investigate the prevalence and risk factor of Ofloxacin resistance among the tuberculosis patients in Shanghai.Methods Totally 447 isolates resistant to anyone of first-line drug (Isoniazid,Rifampicin,Streptomycin and Ethambutol) and 151 randomly selected isolates susceptible to all above drugs were collected from district tuberculosis(TB) hospitals in Shanghai during 2009 to 2010.All 598 isolates were subject to Ofloxacin sensitive test.Logistic regression analysis was conducted to determine risk factors of Ofloxacin resistance.DNA sequencing was applied to study the mutation characteristics in gyrA and gyrB among Ofloxacin resistant isolates.Results Seventy-two(16.1%) of the 447 drug-resistant isolates were found resistant to Ofloxacin,and the Ofloxacin resistant rate among multiple drug-resistant (MDR) isolates was 39.6%(44/111).Ofloxacin resistance was also found in 4(2.6%) of the 151 drug sensitive isolates.Logistic regression analysis showed that first-line drug-resistance MDR(resistant to at least rifampin and isoniazid) and poly-drug resistance(resistance to two or more first-line drugs but not MDR) had significant effect on Ofloxacin resistance(OR = 19.5、5.6,95% CI:6.4 - 59.4、1.7 - 18.1,all P＜ 0.05);re-treatment(OR = 2.3,95 % CI:1.2 -4.0,P＜ 0.05),and a higher age(OR = 1.03,95 % CI:1.0 1 - 1.05,P＜ 0.05)were also significantly associated with Ofloxacin resistance.Resistance mutations in the gyrA and gyrB genes were detected in 62 of 76(81.6%) isolates with phenotypic Ofloxacin-resistance. Conclusions The Ofloxacin resistance rate in Shanghai MDR-TB patients is significantly higher than the pan-susceptible TB patients.Risk factors of ofloxacin resistance are MDR,poly-resistant,retreated patients,age.Among them,MDR has the highest strength of association.

Objective To delineate the application of whole genome sequencing technology in the epidemiology of tuberculosis.Methods From 2009 to 2012,nine Mycobacterium tuberculosis that sharing identical variable number of tandem repeats genotype (VNTR) patterns were reported from two TB cases designated hospitals.Both whole-genome sequencing analysis (WGS) and epidemiologic investigations were performed to describe the transmission patterns of these Mycobacterium tuberculosis.Results By WGS analysis,two genomic clusters including 7 and 2 Mycobacterium tuberculosis were noticed,respectively.The cluster of 2 cases possessed more than 15 single nucleotide polymorphisms (SNPs) when compared to the cluster of 7 cases and suggesting that the transmission route was independent.The transmission chain based on the SNPs difference showed the process of the propagation direction and the accumulation of drug resistance mutations in each cluster.Conclusion Using a WGS-based genomic epidemiologic approach,we were able to reconstruct the tuberculosis transmission network,tracing the putative source of the transmission and determining the transmission direction or the missing links.

Objective: To analyze the clinical characteristics of hand, foot and mouth disease (HFMD) caused by coxsackievirus A6 (CV-A6) in different age groups. Methods: From January 2015 to December 2017, throat swabs were collected from children with or suspected of having HFMD then quantitative real-time PCR was performed to detect enterovirus nucleic acid. HFMD cases caused by CV-A6 were divided into different groups according to age for comparison. Results: In total, there were 467 cases of HFMD caused by CV-A6 with the age ranging from 3 months to 16 years. There were 273 cases in the infants and young children group (< 3 years old), 131 cases in the pre-school group (3-6 years old), and 63 cases in the school-age group (> 6 years old). The peak incidence was found between May and November.Fever was the common symptom, and the rate of fever in infant group was the highest (220/273, 80.5%); The proportion of cases with leucocyte elevation in the infant group was the highest (127/273, 46.5%) than that in the school-age group (17/63, 27.0%) with a statistical significance. The skin erythra of the HFMD caused by CV-A6 were diverse in forms. Over two forms of skin erythra accounted for 53.9% (257/476) of all cases, and the cases in the infant group showing more forms of skin erythra (163/273, 59.7%). The oral herpes were mainly distributed in the upper palate and pharyngeal isthmus, but the school age group had the least number of distribution sites (0.89±0.86). The cases in the infant group showed higher incidence of skin rash at the elbow joint (109/273, 39.9%), knee (88/273, 32.6%), thigh (112/273, 41%), buttock (122/273, 44.7%) than the other two groups, However, the school age group showed lower incidence of skin rash in the lower leg (0/63, 0%) and thigh (6/63, 9.5%) than the other two groups. The differences between groups were statistically significant. All cases were cured clinically, no severe cases occurred. Among the 288 cases followed up for 6 months, 33 (33/288, 11.5%) suffered from nail exfoliation. Conclusions Different age groups of HFMD caused by CV-A6 had different clinical manifestations. In the infant group, more cases had fever and the erythra were more diverse in forms and wider in distribution. In addition, the increased leukocytes in routine blood test was also more common in the infant group.