Mycoplasma, Chlamydia, Rickettsia, Spirochetes and Actinobacteria were generally called "four pathogens and one bacterium". It was always difficult to be denominated and classified rightly in textbooks, while it was also a key interfering with students to grasp the concept of bacteria exactly. So we raise the question and hope to learn from each other by an exchange of views here.

Objective To observe the effect of exclusive pregnancy food exchange method on biochemical index and pregnancy outcome on pregnant women with abnormal glycometabolism,and evaluate its effectiveness on dietary guidance.Methods Sixty-seven pregnant women with abnormal glycometabolism who accepted physical examination and gave birth,were divided into traditional food exchange group (control group,33 cases) and exclusive pregnancy food exchange group (observation group,34 cases),and were given respective intervention until the childbirth.The blood biochemical indexes and the pregnancy outcome between two groups were compared.Results Fasting blood glucose (FBG),2 h postprandial blood glucose (PBG),glycosylated hemoglobin (HbA1c) and triglyeride (TG) in observation group after treatment were significantly lower than those before treatment (P ＜ 0.05 or ＜ 0.01).PBG,HbA1c and TG in control group alter treatment were significantly lower than those before treatment (P ＜ 0.01).After treatment,PBG,HbA1c and TG in observation group were significantly lower than those in control group (P＜ 0.01),after 3 months follow-up,differences still existed (P ＜ 0.01).The total incidence of pregnant women complications in observation group was much lower than that in control group [14.71％(5/34) vs.36.36％(12/33),P ＜ 0.05],there was no significant difference between two groups on neonatal complications (P ＞ 0.05).Conclusions Exclusive pregnancy food exchange method can improve pregnant glycometabolism and lipid metabolism of pregnant women with abnormal glycometabolism,and reduce the incidence of pregnant women and infant adverse pregnancy outcome.It is great worthy to popularize and apply in dietary guidelines.

Objective To observe the outcome of patients with ocular cicatricial pemphigoid (OCP) after amniotic membrane grafting or penetrating keratoplasty.Design Retrospective,noncomparative case series.Participants 3 consecutive OCP patients (4 eyes),were included.Methods For 3 patients (4 eyes) in this study,preoperative visual acuity was from HM/5 cm to HM/10 cm.The symblepharon (gradeⅢ) of 2 patients (3 eyes) were detached and amniotic membrane was transplanted,and bandage contact lens were used till 2 months after operations.The other patient (1 eye) was undergone penetrating keratoplasty with glycerol-cryopreserved cornea because of corneal ulcer and perforation.Main Outcome Measures Visual acuity,recovering of conjunctiva and cornea.Results Am- niotic membrane dissolved about 1 month after operation in 2 patients (3 eyes).Symblepharon changed from gradeⅢto gradeⅡ,visual acuity increased to 0.04-0.05,central corneal epithelium was regenerated significantly,and a little new vessel appeared at corneal lim- bus in 2 patients (2 eyes).The graft deliquesced in the patient with penetrating keratoplasty at 20 days after operation and undergone penetrating keratoplasty again after 1 month.In this patient,the graft molten induced the ocular contents run-off and became eyeball at- rophy eventually.Conclusion Our small sample study shows that the symblepharon detachment and amniotic membrane transplantation is effective for improving visual acuity in OCP with ocular surface dysfunction.However,because of various factors,penetrating kerato- plasty is ineffective for OCP with perforating corneal ulcer.

Objective To explore the risk factors of severe hand,foot and mouth disease(HFMD) that progressed to critical illness among children.Methods The clinical data of 100 cases with severe and critical HFMD(82 cases were severe HFMD and 18 cases were critical)treated in the First Affiliated Hospital of Guangxi Medical University from January 2009 to September 2010 were analyzed retrospectively.We used univariate and multiple non-conditional Logistic regression analysis to compare the differences of the clinical features and laboratory examination between two groups,survey the risk factors of severe HFMD progressing. Results Most of the patients in both groups were under 5 years old,mainly under 3 years old which accoun-ted for 85.4% of severe HFMD cases and 88.9% of critical HFMD cases.The dominant sex was male in both groups,the sex ratio were 2.28∶1 and 8.00∶1 .The main pathogen was enteral virus 71 .Fever and rash were found in most of the severe and critical patients.The main neurological symptoms were myoclonus, tremors,limb asthenia,somnolence,vomiting and convulsion.Nervous system symptoms in critical cases were even worse to develop to coma and accompany with serious respiratory and circulatory manifestations.Univa-riate analysis showed that age ﹤2 years,tachycardia,tachypnea,elevated leukocyte count,platelet count and blood glucose level,persistent high fever,limb asthenia,pulmonary moist rales and changes on chest radio-graph were the risk factors that progressed to critical illness.The multiple non-conditional Logistic regression analysis showed that age ﹤2 years,tachycardia,limb asthenia and pulmonary moist rales were independent risk factors for severe HFMD cases progressing to critical illness.Conclusion The patients aged ﹤2-year-old,tachycardia,limb asthenia and pulmonary moist rales are closely related to severe HFMD cases progress-ing to fatal condition.

Objective To analyze the distribution of common pathogenic bacteria and their drug resistance ,in children with bron‐chial pneumonia ,and provide reference for making antimicrobial treatment strategies .Methods 857 hospitalized pediatric patients with bronchopneumonia from January to December 2014 were enrolled in the study ,bacterial culture and drug susceptibility test were performed ,and the results were analyzed .Results In the 857 pdiatric patients ,the positive rate was 36 .87% (316/857) .A‐mong them ,175 cases were gram positive bacteria(20 .42% ) ,141 cases were gram negative bacteria(16 .45% ) ,140 cases were Streptococcus pneumoniae(16 .34% ) ,70 cases were Haemophilus influenzae(8 .17% ) .The susceptibility of Streptococcus pneu‐moniae to penicillin with enzyme inhibitors ,levofloxacin and vancomycin was the highest(higher than 90 .00% ) ,followed by the third generation cephalosporin(non meningitis) ,to which the sensitivity rate were above 80 .00% .The susceptibility of Haemophi‐lus influenzae to the third generation cephalosporins ,ampicillin/Sulbactam ,levofloxacin and imipenem were the highest(more than 90 .00% ) ,while the resistance to ampicillin and cotrimoxazole was 80 .00% .Conclusion Gram positive bacteria are the most im‐portant pathogenic bacteria ,and Streptococcus pneumoniae is the most common bacteria in bronchopneumonia .In clinical treatment , the results of drug sensitivity test should be paid attention to ,so as to adjust the treatment plan and achieve the ideal effect .

ObjectiveTo investigate the influence of the midazolam sedation based on remifentanil analgesia on the occurrence of delirium in critically ill patients in intensive care unit (ICU).Methods A single-center prospective randomized controlled trial was conducted. 140 consecutive critically ill patients admitted to ICU of Peking University People's Hospital, undergoing mechanical ventilation longer than 24 hours, with the need of sedation, from February 2014 to January 2015 were enrolled. They were randomly divided into two groups by computer generated random numbers table, eachn = 70. The patients in observation group received midazolam 1μg·kg-1·min-1 for sedation, and 1 mg/mL remifentanil for analgesia with 0.05 mg/kg intravenous bolus, then continuous infusion of 0.02-0.10 mg·kg-1·h-1. The patients in control group received midazolam for sedation only. The data were recorded as follows: the main indices for observation included the occurrence of delirium and its duration; the second item for observation was consumption of drug for sedation, followed by the mean arterial pressure (MAP) before and after sedation, the time of wake-up, duration of mechanical ventilation, the length of ICU stay, and 28-day fatality rate. The 28-day survival was analyzed by Kaplan-Meier survival curve.Results The dosage of remifentanil used in observation group was (98.6±24.9) mg/d, the dosage of midazolam was significantly lower than that of the control group (mg/d: 160.6±33.3 vs. 178.9±43.4, t = 2.829,P = 0.005), the incidence of delirium was obviously lower than that of the control group [22.9% (16/70) vs. 57.1% (40/70),χ2 = 15.700,P< 0.001], and the time of delirium was slightly shorter than that of the control group (hours: 162.9±78.0 vs. 194.8±117.3,t = 0.947,P = 0.348). Among the patients with delirium, the dosage of dexmedetomidine used in observation group was significantly less than that of the control group (mg/d: 0.54±0.11 vs. 0.64±0.14,t = 2.112,P = 0.041). The MAP before sedation was similar as the MAP after sedation in both groups, and there was no significant difference between observation group and control group [mmHg (1 mmHg = 0.133 kPa), before treatment: 84.7±16.2 vs. 89.5±37.7, after treatment: 82.3±10.7 vs. 80.8±13.9, bothP> 0.05]. There was no significant difference in the time of waking-up between observation group and control group (hours: 2.3±0.9 vs. 2.4±0.8,t = 0.487,P = 0.627). The duration of mechanical ventilation (hours: 143.4±138.3 vs. 163.9±158.9, t = 0.812,P = 0.418), the length of ICU stay (days: 8.8±7.7 vs. 10.0±7.8,t = 0.917,P = 0.361) and 28-day fatality rate [11.4% (8/70) vs. 20.0% (14/70),χ2 = 1.941,P = 0.245] in observation group were slightly lower than those of the control group without significant difference. Kaplan-Meier survival curve showed that the cumulative 28-day survival rate in observation group was slightly higher than that of control group (χ2 = 1.647,P = 0.199). ConclusionAnalgesia based on sedation may reduce the occurrence of delirium and its severity, furthermore, even if delirium occurs, it may be less severe.

Sinus histiocytosis with massive lymphadenopathy( SHML) is also called Rosai-Dorfman disease.It is a kind of benign lymphoid tissue proliferative diseases with unknown etiology.SHML appeared mostly in children and adolescent.It has diverse clinical manifestations accompanied with multiple organ inju-ry,and no clear laboratory indicators could support the disease,being a rare disease in pediatrics,easyot miss diagnosis.Thsi article reviewde the latest progress on diagnostis and treatment of SHML,to improve teh un-derstanding of the disease.

0.05),but the proportion of NRDS,the rate of mechanical ventilation dependence,and mortality had significant diffe-rences(Pa

BACKGROUND: Light-curing composite resins have been applied in the dental repair due to its beautiful color, excellent physical and chemical properties and easy to operation. However, its insufficient mechanical properties tend to cause composite fractures, resulting in undesired clinical efficacy.OBJECTIVE: To investigate the preparation, properties and biomechanical performances of filler-co-augmented photo-curable resin-based oral materials.METHODS: The nano-silica surface-grafted with poly(methyl methacrylate) (PMMA) was obtained by atom transfer radical polymerization. Co-electrospinning was used to prepare the acrylonitrile/PMMA core-shell nanofibers, and a two-dimensional lactic acid-glycolic acid copolymer nanofiber membrane with a lattice structure was obtained using a copper mesh as a receiving device. The multi-scale and multi-dimensional packing was prepared by sol-precipitation method with silane coupling agent as a raw ethyl ester precursor, and further modified using silane coupling agent. The mechanical properties, volumetric shrinkage, toxicity, and degradation properties of the light-curing resin grafted with SiO2-PMMA were compared with those of the light-curing resin combined with trapezoidal polysiloxane materials grafted with methyl methacrylate. RESULTS AND CONCLUSION: (1) Characterization of the composite resin under scanning electron microscope: the filler SiO2-PMMA core-shell nanofibers dispersed well in the light-curing resin matrix, in the presence of monodisperse phenomenon and less aggregation phenomenon. However, the trapezoidal polysiloxane material in the light-curing resin matrix dispersed unevenly, in the presence of reunion phenomenon. (2) The flexural strength, flexural modulus and fracture work of the light-curing resin graftedwith SiO2-PMMA core-shell nanofibers were significantly higher than those of the trapezoidal polysiloxane-based light-curing resin (P < 0.05). (3) The volume shrinkage of the light-curing resin grafted with SiO2-PMMA core-shell nanofibers was lower than that of the trapezoidal polysiloxane-based light-curing resin (P < 0.05). (4) Compared with the trapezoidal polysiloxane-based light-curing resin, the water absorption and cytotoxicity (absorbance value) of the light-curing resin grafted with SiO2-PMMA core-shell nanofibers were significantly higher than those of the trapezoidal polysiloxane-based light-curing resin (P < 0.05), while the solubility of the light-curing resin grafted with SiO2-PMMA core-shell nanofibers was lower (P < 0.05). It is concluded that the prepared light-curing resin grafted with SiO2-PMMA core-shell nanofibers has excellent properties and biomechanical properties.