Objective To study the variation of acute blood pressure in different subtypes of first ischemic stroke,and investigate the influence on the prognosis.Methods A total of 710 patients with first ischemic stroke were selected.The blood pressure levels were monitored during the initial 7 hospital days.Clinical outcome was based on the combined analysis of Barthel index and the National Institute of Health Stroke Scale (NIHSS) score on the 180th day.In the subtypes of large artery atherothrombosis(LAA),cardioembolism (CE),small artery disease occlusion (SAO) were 400,160,150 cases.Logistic regression model was used to estimate the influencing factors on the prognosis.Results An U-shaped effect was observed in different subtypes between blood pressure on admission,average acute blood pressure and prognosis.In the subtypes of LAA and CE,those who had a basehne systolic blood pressure (SBP) of 140-159 mm Hg (1 mm Hg =0.133 kPa) or a baseline diastolic blood pressure (DBP) of 90-99 mm Hg on admission got good prognosis.In the subtypes of SAO,those who had a baseline blood pressure of 130/95 mm Hg on admission got good prognosis.In all subtypes,the average blood pressure of 150/95 mm Hg got good prognosis.In the subtypes of LAA and CE,those who had a baseline SBP of 120-159 mm Hg or a baseline DBP of 80-99 mm Hg within 7 d after admission got good prognosis.In the subtypes of SAO,those who had a baseline blood pressure of 140/90 mm Hg within 7 d after admission got good prognosis.In all subtypes,the average blood pressure of 140/90 mm Hg within 7 d after admission got good prognosis.Logistic regression analysis revealed that the decrease of blood pressure during the first 24 hours,deterioration within 7 d after admission,acute complication,NIHSS score on admission were the independent risk factors of prognosis,while antihypertensive therapy in the acute phase was the independent protection factor in the subtypes of LAA and CE.In the subtypes of SAO,acute complication was the independent risk factor of prognosis.Conclusions An U-shaped effect is observed in different subtypes between blood pressure on admission and prognosis.In the subtypes of LAA and CE,the decrease of blood pressure during the first 24 hours,deterioration within 7 d after admission,acute complication,NIHSS score on admission are the independent risk factors of prognosis.

Objective To explore the risk factors of the recurrence of ischemic stroke and to supply theoretical basis for secondary prevention.Methods 612 patients with ischemic stroke were enrolled in the study and they were followed-up for 2 years to record the stroke recurrence.According to whether the recurrent stroke occurred,all the patients were divided into the recurrent group and the non-recurrent group.Logistic regression model was used to analyze the risk factors.Results Of 612 patients,90 patients suffered from recurrent stroke and the recurrence rate after 2 years was 14.7％.In the recurrent group,age,smoking,hypertension,diabetes,fibrillation atrial history and homocysteine level were significantly higher than those in non-recurrent group (P ＜ 0.05),compliance of anti-platelet drugs was significantly lower than that in non-recurrent group (P ＜ 0.01).Multivariate analysis suggested that age,smoking,hypertension,diabetes,atrial fibrillation history,homocysteine level and compliance of anti-platelet drugs were associated with recurrence of ischemic stroke (OR value =11.14,47.38,53.11,111.12,53.11,40.98,90.12,all P ＜ 0.05).Conclusion Age,smoking,hypertension,diabetes,atrial fibrillation history,homocysteine level and compliance of anti-platelet drugs are the independent risk factors of recurrent stroke.To enhance the interference of these risk factors are helpful for preventing the recurrence of stroke.

Objective To investigate the molecular characteristic,the virulence factors and antimicrobial resistance of Methicillin-resistant Staphylococcus aureus (MRSA) isolated from pediatric patients.Methods Ninety-eight non-duplicate strains of and 49 non-duplicate strains of Methicillinsusceptible Staphylococcus aureus (MSSA) isolated from the three children's hospitals in Shanghai in 2008 were investigated.Panton-valentine leukocidin (PVL) gene was detected by polymerase chain reaction (PCR).The genotypes of staphylococcal cassette chromosome mec (SCCmec) of the MRSA isolates were confirmed by multiplex PCR.The sequence type (ST) of each strain was determined by multilocus sequence typing (MLST),and the algorithm eBURST was used to identify groups of clonal complex (CC).The minimal inhibitory concentrations (MIC) of fourteen antibiotics for all isolates were determined by agar dilution method.Results Among 98 isolates of MRSA,the positive rate of PVL genes was 6.1％ (6/98).In contrast,the positive rate of PVL genes was 4.1％ (2/48) of the MSSA strains.Among 98 isolates of MRSA,4.1％ (4/98),23.5％ (23/98),53.0％ (52/98) and 15.3％ (15/98) of the strains harboured SCCmec types Ⅱ,Ⅲ,Ⅳ and Ⅴ,respectively. The remaining four isolates (4.1 ％) presented a unique SCCmec pattern that could not be classified to any known types by the employed typing assays.Combining the ST and SCCmec type,the predominant clones were ST59-SCCmec Ⅳ (30 strains) and ST239-SCCmec Ⅲ (23 strains),followed by ST5-SCCmecⅣ and ST1-SCCmecⅣ (8 strains for each clone),ST239-SCCmec Ⅴ (6 strains),ST88-SCCmecⅤ (5 strains),ST5 SCCmecⅡ (4 strains),ST59-SCCmec Ⅴ (3 strains),ST8-SCCmecⅣ and ST88-SCCmecⅣ (2 strains for each clone),ST22-SCCmecⅣ,ST910-SCCmecⅣ and S45-SCCmec Ⅴ (1 strain for each clone),eBURST analysis distributed the MRSA isolates into several CC.ST8 and ST239 belonged to ST8 CC,ST1 belonged to ST15 CC,ST910 belonged to ST 30 CC,ST59,ST5,ST88,ST45,ST22,ST9 and ST7 were the origin of their own CC.The results of MIC showed that the 67 strains of MRSA harboring SCCmec type Ⅳ or SCCmec type Ⅴ were more susceptible to various non-β-lactam antibiotics than 27 strains of MRSA harboring SCCmec type Ⅱ or SCCmec type Ⅲ,and no vancomycin-resistant strain was found.Conclusions In three children's hospitals in Shanghai,the PVL gene-positive rate of MRSA isolates is relatively low,SCCmec type Ⅳ and SCCmec type Ⅴ could spread among hospitals to cause a small scale epidemic and have a variety of ST.

Objective To understand the erythromycin resistance rate and the erythromycin resistant gene spectrum in Streptococcus pyogenes strains isolated in Shanghai.Methods The outpatient children who were diagnosed with scarlatinal in the Children's Hospital of Fudan University from November 2004 to June 2006 were enrolled and 100 strains of Streptococcus pyogenes were isolated by pharyngeal swab culture.The distributions ofermA,ermB,mefA genes were determined by polymerase chain reaction(PCR)amplification.The relationship between ermA,ermB,mefA genes and erythromycin resistance were also analyzed.Results The erythromycin and clindamycin resistance rates of Streptococcus pyogenes in Shanghai were 98%and 95%,respectively;the concordance rate of these two drugs was 97%.Among 100 strains of Streptococcus pyogenes,94 strains(94%)contained ermB gene,with 100%of erythromycinresistance rate.Sixteen(16%)contained mefA gene,with 100% of erythromycin resistance rate.ermA was not detected inall the 100 strains.The ermB and mefA genes were not found in 5 strains,among which,2 were susceptible to erythromycin and 3wereresistant to erythromycin.Only 1%of isolates was mefA genesingle positive.Conclusions There is a high erythromycin resistance rate of Streptococcus pyogenes strains isolated inShanghai,and the cross resistance to clindamycin is high.TheermB gene is important erythromycin resistancedeterminants of Streptococcus pyogenes in Shanghai.

Objective To investigate the diagnostic value of three-dimensional time-of-flight magnetic resonance angiography(3D-TOF-MRA)in combination with three-dimensional fast imaging employing steady-state acquisition with phase cycling (3D-FIESTA-C),using multiplanar reconstruction and image fusion technology in preoperative evaluation of vascular compressive trigeminal neuralgia (TN) and to improve the diagnostic accuracy.Methods 3D-TOF-MRA and 3D-FIESTA-C images using MPR and image fusion technology of 70 patients with TN confirmed by surgery were reviewed retrospectively,and compared with intraoperative findings separately and together.Results Microvascular decompression (MVD)surgery was performed in all 70 patients.Compared with surgical results, 3D-TOF-MRA showed presence of the offending vessel around the cisternal segment of trigeminal nerve in 55 cases with a positive rate of 79%.3D-FIESTA-C showed the presence of the offending vessel in 60 cases with a positive rate of 85%.65 cases were found when combining both 3D-TOF-MRA and 3D-FIESTA-C images,with a positive rate of 93%.No positive imaging findings were seen in 5 cases.Operation showed that offending vessels were small arteries in 3 cases and were petrosal veins in 2 cases.The main offending vessels were superior cerebellar artery and basilar artery.Conclusion Combining images of 3D-TOF-MRA and 3D-FIESTA-C using MPR and image fusion technology can show the relationship between offending vessels and the trigeminal nerve clearly in patients,and provide guidance for MVD surgery.There are still some deficiencies in the display of venules,and other sequences of MRI (such as CE-3D-FIESTA sequences)may be helpful.

Objective: To investigate the prevalence and resistance changes of carbapenem-resistant Enterobacteriaceae (CRE) strains isolated from children patients of Chinese Bacterial Resistance Surveillance Network (CHINET) from 2005 to 2017. Methods: Antimicrobial susceptibility testing was carried out by disk diffusion method (KB method) and automated systems. Results were analyzed according to the Clinical and Laboratory Standards Institute (CLSI) 2017 edition standards. Results: Among the 4 481 CRE clinical strains, the overall prevalence of CRE in children was 6.4%, including 8.8% in neonatal period, 7.3% in infancy, 3.8% in early childhood, 4.0% in preschool, 4.7% at school age and 7.4% of puberty. The CRE prevalence of citrobacter spp. remained stable in 2005-2017, whereas other bacteria showed an upward trend, which was higher than that of the adult group (P<0.01). Among the 4 481 CRE strains, there were 2 905 strains of Klebsiella spp. (64.8%), 813 strains of Escherichia coli (18.1%), 549 strains of Enterobacter spp.(12.3%), and 65 strains of Citrobacter spp.(1.5%). Among the 4 481 CRE strains, 20.7%, 13.3%, and 11.8% were from the intensive care unit (ICU), neonatal department and internal medicine wards, respectively. Specimens were distributed as respiratory (42.8%), urine (26.3%), and blood (14.9%). The results of antimicrobial susceptibility testing exhibited that the CRE strains were highly resistant to most commonly used antimicrobial agents in clinical practice, such as imipenem, meropenem and ertapenem, as well as penicillins and cephalosporins, etc. Conclusion The prevalence of CRE strains in children is increasing year by year, and their antimicrobial resistance to common antibacterial agents in clinical practice is extremely serious, to which serious attention needs to be paid. According to the results of antimicrobial susceptibility testings, the antibacterial agents should be rationally selected to effectively control the spread of CRE.

Objective To investigate the resistance profile of clinical bacterial isolates to antibiotics in Shanghai during 2016.Methods Antimicobial susceptibility testing was carried out for the clinical isolates collected from 47 hospitals according to a unified protocol using Kirby-Bauer method or automated systems.The participating hospitals included 28 tertiary hospitals and 19 secondary hospitals across Shanghai.Results were analyzed according to CLSI 2016 breakpoints.Results A total of 122 548 clinical isolates were collected,including 35 522 (29.0％) strains of gram positive cocci and 87 026 (71.0％) strains of gram negative bacilli.Overall,28.9％ of the isolates were from secondary hospitals and 71.1％ from tertiary hospitals.Gram positive and gram negative isolates accounted for 25.8％ and 74.2％ in secondary hospitals,30.3％ and 69.7％ in tertiary hospitals,respectively.The overall prevalence of MRSA in Staphylococcus aureus was 48.7％ and 77.2％ of MRCNS in coagulase-negative Staphylococcus.The average prevalence of MRSA and MRCNS was 55.9％ and 73.3％ in secondary hospitals,45.9％ and 78.6％ in tertiary hospitals.No strains were found resistant to vancomycin in Staphylococcus.About 77.4％ of the 1 111 strains of non-meningitis S.pneumoniae isolated from children were penicillin-susceptible (PSSP),13.2％ were penicillin-intermediate (PISP) and 9.4％ were penicillinresistant (PRSP).The prevalence of PSSP,PISE and PRSP was 97.8％,2.2％,and 0 in secondary hospitals,76.5％,13.7％,and 9.8％ in tertiary hospitals.Of the 285 strains isolated from adults,94.0％,4.2％ and 1.8％ were PSSP,P1SP and PRSP,respectively.The prevalence of PSSP,PISP and PRSP among the isolates from adults was 93.7％,5.3％,and 1.0％ in secondary hospitals,94.2％,3.7％,and 2.1％ in tertiary hospitals.Overall,37 strains of vacomycin-resistant E.feacium (14 from secondary hospitals and 23 from tertiary hospitals) and 25 strains of vacomycin-resistant E.feacalis (all from tertiary hospitals) were identified.PCR and sequencing analysis indicated that most of these resistant strains were vanA type.The overall prevalence of ESBLs-producing srains was 52.2％ in E.coli,30.9％ in Klebsiella pneumoniae and 29.8％ in Proteus mirabilis.Specifically,the corresponding prevalence of such strains was 55.1％,33.6％ and 34.0％ in secondary hospitals,51.0％,29.7％ and 28.0％ in tertiary hospitals,respectively.Enterobacteriaceae strains were still highly susceptible to carbapenem antibiotics.Overall,8.9％ and 9.1％ of the Enterobacteriaceae strains were resistant to imipenem and meropenem,respectively.The figure was 6.6％ and 7.1％ in secondary hospitals,9.9％ and 10.0％ in tertiary hospitals.Extensively drug-resistant strains were identified in A.baumannii,K.pneumoniae,P.aeruginosa,and E.coli,specifically,223,63,10,and 4 strains in secondary hospitals;224,201,22,and 9 strains in tertiary hospitals.Conclusions Antibicotic resistance is still very serious in the common clinical strains,which poses a critical threat to healthcare facilities.This issue should be taken seriously and effective infection control measures must be put in place.

Objective To explore the differences of degrees of immune inflammatory response in patients with different TOAST subtypes of acute cerebral infarction and their relations with infection risk after cerebral infarction.MethodsOne hundred and fifty-four patients with acute cerebral infarction who were free of detectable infection on admission, admitted to our hospital from October 2017 to June 2018, were recruited as patient group; according to TOAST subtypes, these patients were divided into large-artery atherosclerosis group (LAA,n=72), cardioembolic group (CE,n=38), and small-artery occlusion group (SAO,n=44); 45 healthy subjects enrolled at the same period were selected as control group. Fasting blood samples were taken on the next day of admission or during physical examination. Treg％ (percentage of CD4+CD25+CD127[low] regulatory T cells [Treg] in CD4+ lymphocytes) was measured by flow cytometry. Interleukin (IL)-6, IL-10, and hypersensitive C-reactive protein (hsCRP) levels were measured by ELISA or Turbidimetric inhibition immuno assay. Spearman correlation analysis was performed to investigate the relations of Treg％ and related inflammatory factors with TOAST subtypes of acute cerebral infarction and post-stroke infection risk. Receiver operating characteristic (ROC) curve was used to analyze the predictive values of Treg％ and inflammatory factors in post-stroke infection. Univariate Logistic regression analysis and multivariate Logistic regression analysis were used to screen the risk factors of infection after cerebral infarction.Results(1) Treg％ in LAA group was significantly lower than that in control group (P<0.05), and Treg％ in CE group was statistically higher than that in control group (P<0.05); patients in the LAA and CE groups had significantly higher IL-6 and hsCRP levels as compared with those in the control group (P<0.05); patients in the LAA, CE and SAO groups had significantly lower IL-10 level than those in the control group (P<0.05); patients in the LAA and SAO groups had significantly decreased IL-6 and IL-10 levels as compared with those in the CE group (P<0.05); patients in the SAO group had significantly lower hsCRP level as compared with those in the CE group (P<0.05). Spearman correlation analysis showed that Treg％ was negatively correlated with LAA (rs=-0.488,P=0.000) and positively correlated with CE and SAO (rs=0.355,P=0.000;rs=0.200,P= 0.013); the levels of IL-6, IL-10 and hsCRP were positively correlated with CE (rs=0.578,P=0.000;rs= 0.508,P=0.000;rs=0.299,P=0.015), and negatively correlated with SAO (rs=-0.404,P=0.001;rs=0.394, P=0.001;rs=0.308,P=0.012). (2) There were 36 patients who developed infection associated with cerebral infarction in the patient group; as compared with those in the non-infection group, Treg％, IL-6, IL-10 and hsCRP levels in the infection group were significantly increased (P<0.05); Spearman correlation analysis showed that Treg％ and hsCRP were positively correlated with infection after cerebral infarction (rs= 0.305,P= 0.007;rs=0.653,P=0.000). The area under the curve of hsCRP for prediction of post-stroke infection was 0.943 (95％ confidence interval [CI]: 0.895-0.992,P=0.000), that of Treg％ was 0.707 (95％CI: 0.548-0.866,P=0.008), and that of combination of hsCRP and Treg％ was 0.958 (95％CI: 0.918-0.998,P=0.000). (3) Multivariate Logistic regression analysis showed that hsCRP was an independent risk factor for post-infarction infection (P<0.05).ConclusionsThere are differences in the degrees of immune inflammatory response among patients with different TOAST subtypes of acute cerebral infarction. Treg％ and hsCRP can be used as early warning markers of infection after cerebral infarction.

Objective To investigate the resistance of clinical Stenotrophomonas maltophilia isolates from 15 hospitals in several regions of China during 2011.Methods Fifteen repre-sentative general hospitals were involved in this program. Bacterial susceptibility testing was carried out by means of a unified protocol using Kirby-Bauer method and MIC determi-nation.Results were analyzed according to CLSI 2011 break-points.Results Majority (93.3%) of the 1 889 clinical strains of S.maltophilia were isolated from inpatients.On-ly 6.7% of the isolates were from outpatients.About 62.9% of these S .maltophilia strains were isolated from old patients whose age was 60 years or older.Only 8.2% of the strains were from the patients younger than 18 years old.Sputum and re-spiratory tract secretion were the most common specimen source,accounting for 82.6%.Another 4.2% isolates were from blood,abdominal fluid and other sterile body fluids.The percentage of the S .maltophilia strain resistant to trimethoprim-sul-famethoxazole,levofloxacin and minocycline was 16.6%,10.0% and 1.8%,respectively.The strains resistant to cefopera-zone-sulbactam accounted for 19.0%.About 37.1% of the strains isolated from blood or sterile body fluids were resistant to trimethoprim-sulfamethoxazole,significantly higher than the strains from urine or wound specimens (P < 0.01).Conclusions S.maltophilia strains are mainly isolated from inpatients.The most common source is sputum and other respiratory speci-mens.Most of the patients with S.maltophilia isolate are 60 years of age or older.The S.maltophilia strains are constitu-tively resistant to several antibacterial agents,but showed relatively lower resistance to trimethoprim-sulfamethoxazole,levo-floxacin and minocycline.Cefoperazone-sulbactam is still active against these strains.The antimicrobial therapy targeting S. maltophilia infections should be selected cautiously according to the results of antimicrobial resistance surveillance.

Objective To investigate the antimicrobial resistance of clinical strains of K lebsiella spp .isolated from 15 hospitals in China CHINET during 2012 .Methods Kirby-Bauer method and automatic microbiology analysis system were employed to study the antimicrobial resistance . WHONET 5 .6 software was applied for data analysis according to Clinical and Laboratory Standards Institute (CLSI) 2012 breakpoints .Results A total of 9 621 clinical K lebsiella isolates were analyzed ,including 8 772 strains of K . pneumoniae and 804 strains of K . oxytoca . About 54 .9% (5 285/9 621) of the K lebsiella strains were isolated from sputum ,and 16 .3% (1 564/9 621) were isolated from pediatric patients .Antimicrobial susceptibility testing showed that about 8 .9% ,10 .8% and 12 .9% of the strains were resistant to imipenem ,meropenem and ertapenem ,respectively .About 14 .1% and 17 .0% of the strains were resistant to piperacillin-tazobactam and cefoperazone-sulbactam , respectively . Carbapenem-resistant K lebsiella strains were identified from all the 15 hospitals ,including 945 strains of K .pneumoniae and 45 strains of K .oxytoca ,which were resistant to either imipenem ,meropenem or ertapenem .Conclusions The Klebsiella isolates collected from 15 hospitals in China during 2012 are relatively sensitive to carbapenems ,cefoperazone-sulbactam and piperacillin-tazobactam .The prevalence of carbapenem-resistant strains is still increasing in China ,about 10 .3% in 2012 ,and relatively higher in Eastern China .More efforts should be made to control the superbug .