Objective To evaluate the sensitivity and specificity of DNA micro-array in early detection of infectious pathogens on burn wounds,including 9 species of potential infectious pathogens namely Staphylococcus aureus,Escherichia coli and Pseudomonas aeruginosa,etc.Methods Serial dilutions of each targeted bacteria in saline were examined with VITEK automated microbial test systems(routine methods) as well as by DNA micro-array to compare the sensitivity between these two methods.Sixty-two strains of infectious pathogens collected from burn wounds,were identified by routine methods,and they were also subjected to DNA micro-array examination to determine coincidence.One hundred and three examinations of smear specimens collected from fresh burn wounds were performed with both methods synchronously.The difference in positive result of identification of bacteria between routine method and micro-array technology in sensitivity and specificity was compared.Results The identification of bacteria by micro-array was more convenient and rapid than that by routine method.A 10 to 100 fold higher sensitivity was found in bacterial identification by DNA micro-array than by routine methods.The positive and negative coincidence of bacterial identification was 100% between these two methods.All the strains found by the routine methods were successfully identified by DNA micro-array.In a few instances,more strains of bacteria were detected with micro-anay method than rowtine method.Conclusion The extremely high coincidence and sensitivity of micro-array method with the routine method was confirmed.The detection of bacteria from burn wounds and other contaminated or infected wounds using micro-array method has a bright prospect though some improvements are still necessary.

Objective To investigate the relationship between antibiotic administration and the changes in constituent ratios of preponderant pathogens in infection of burn wounds in our burn unit. Methods The consumption of different kinds of antibiotics [expressed as the number of defined daily doses (DDD)/100 patient-day], as well as the constituent ratio of Staphylococcus aureus and Pseudomonas aeruginosa, and percentage of methicillin-resistant S. aureus (MRSA) among all positive cultures of S. aureus were calculated from 1995 to 2004, and their correlation was analyzed. Results Within this period, it was found that the consumption of first and second-generation cephalosporins and aminoglycosides, including cefazolin and amikacin, was decreased remarkably, while the consumption of antibiotics combined with lactamase inhibitor, third-generation cephalosporins, quinolones, including ceftazidime, levofloxacin and fosfomycin, was increased significantly. At the same time, the constituent ratio of P. aeruginosa declined to certain extent, while the constituent ratio of S. aureus gradually rase, but no increase was found in percentage of MRSA in S. aureus. The constituent ratios of S. aureus and P. aeruginosa were correlated to consumption of more than ten kinds of antibiotics or antimicrobial agents. Conclusions The results suggested that more cefazolin or amikacin and less antibiotics with lactamase inhibitor or third generation cephalosporins were used in the treatment of burn infection might help decrease the infection caused by S. aureus, and that when more carbopenem or cefoperazone/sulbactam were used there might be a tendency of declination of P. aeruginosa infection.

OBJECTIVE:To explore the role of clinical pharmacists participating in the individualized treatment for purulent meningitis. METHODS:Clinical pharmacists participated in the therapy for a patient with purulent meningitis complicated with Staphylococcus aureus infection. According to patient's condition,clinical pharmacists assisted physicians to formulate preliminary therapeutic plan. Reviewing relevant guidelines,domestic and foreign literatures,clinical pharmacists suggested to combine with dexamethasone so as to relieve inflammatory reaction. According to the results of drug sensitivity test,based on vancomycin plasma concentration monitoring and population pharmacokinetics model fitting,clinical pharmacists suggested to reduce the dose of vanco-mycin to 0.5 g,ivgtt,q12 h. The pharmaceutical care were conducted throughout the therapy,including efficacy evaluation of an-ti-infective therapy,ADR monitoring,renal function monitoring,etc. RESULTS:Physicians adopted some suggestions of clinical pharmacists. The disease condition of the patient was recovred,and no ADR related to vancomycin was found. On the 16th day, the patient was discharged from the hospital. CONCLUSIONS:Clinical pharmacists participate in treatment of purulent meningitis, assist physicians to optimize therapy plan based on relevant guideline,literature,etiological examination,blood concentration moni-toring and pharmacokinetics model fitting results. It not only guarantee therapeutic efficacy of anti-infective therapy,but also pre-vent and reduce the occurrence of ADR.

Objective To explore the changing trend of Ia on monocyte, lymphocyte apoptosis rate, TNF-α and IL-6 in abdominal aorta of burned rats with delayed resuscitation and the influence of application of carbachol on them. Methods Adult male Wistar rats were randomly divided into normal control group(n =8), scald group(n =48) and scald with carbachol treatment group(n =48). In latter two groups, rats were inflicted with 30% total body surface area (TBSA) full-thickness scald and delayed fluid resuscitation. All scald rats were sacrificed at the 6th hours or 1st, 2nd, 3rd, 7th, 14th day after scald, with 8 rats at each time point. Expression of Ia antigen on monocyte and lymphocyte apoptosis rate were determined by direct immunofluorescence on a flow cytometer, and TNF-α and IL-6 was measured by ELISA. Results Expression of la on monocyte was obviously lower than that of controls. The lowest levels were recorded on the 6th hours and 1st day after scald. Subsequently, Ia was elevated gradually, but still lower than that of normal rats(P <0. 01). After administration of carbachol, Ia expression was obviously promoted, compared with the simple scald group (P <0. 01). Lymphocyte apoptosis rate, TNF-α and IL-6 was higher than that of controls(P <0. 01). After administration of cavachol, , lymphocyte apoptosis rate and TNF-α and IL-6 was obviously down-regulated on the 6th hours, 1st day, 2nd day and 3rd day after scald injury, compared with the simple scald group (P < 0. 01 or 0. 05). Conclusion After severe burn with delayed fluid resuscitation, there is a low la expression, high lymphocyte apoptosis rate and increased releasing of proinflammatory cytokine. Immune function was suppressed. Carbacho] could improve the immune function of scald rats with delayed fluid resuscitation.

Flavanoids are important phytochemistry compositions in foods and traditional Chinese medicines (TCM) and are mainly oxidized by CYP1A family in vivo. Some methoxyflavones could also be metabolized through demethylation. Usually, flavanoids own one or more phenolic hydroxyl group in their molecular structures, which facilitate conjugation with glucuronic acid and sulphuric acid, forming metabolites with good water-solubility to excrete. Natural flavanoids mainly exist in glycoside, and after oral ,they would be easily metabolized to aglycone by hydratase in gut microflora and then absorbed into blood. Besides, many flavanoids have strong inhibitory actions on Cytochrome P450 enzymes, which are significant mechanisms in cancer precaution and tumor inhibition. In this paper, we reviewed lots of articles and summarized metabolism characteristics of flavanoids and metabolism interaction with Cytochrome P450 enzymes.
Animals ; Cytochrome P-450 Enzyme Inhibitors ; Cytochrome P-450 Enzyme System ; metabolism ; Drug Therapy ; Flavonoids ; metabolism ; pharmacology ; therapeutic use ; Humans

OBJECTIVETo investigate the relationship between the use of antibiotics in a burn unit and the change in the drug - resistance of Staphylococcus aureus (S. aureus).

METHODSBy calculating the defined daily doses (DDD) of accumulated consumption of antibiotics per unit time and expense consumption, the use of different kinds of antibiotics in a burn unit in recent five years was analyzed, and correlation analysis between the change of antibiotics consumption amount and the change in drug - resistance level of S. aureus were carried out.

RESULTSAmikacin, gentamycin and cephazolin were the commonest antibiotics used in our burn unit. They were relatively cheaper than some other antibiotics. The consumption amount of compound antibiotics application was negatively correlated with the penicillin resistance level of S. aureus. Seven correlation coefficients between the consumption of first generation cephalosporins and seven coefficiences of resistance rate of S. aureus were negative. The consumption amount of the 3rd generation of cephalosporin application was positively related to the resistance of S. aureus to erythromycin and oxacillin.

CONCLUSIONAccumulated DDD might be one of the ideal indices of reflecting antibiotic use. The changes in the consumption amount of the 1st and 3rd generation of cephalosporins containing beta-lactamase-inhibitor might affect the drug-resistance levels of S. aureus to some degree.

Anti-Bacterial Agents ; pharmacology ; therapeutic use ; Burn Units ; statistics & numerical data ; Burns ; drug therapy ; Drug Resistance, Microbial ; Drug Utilization ; statistics & numerical data ; trends ; Humans ; Staphylococcus aureus ; drug effects

Objective:To explore the clinical effectiveness of arthroscopic treatment of tibial eminence avulsion fracture by four-point fixation with suture anchors.Methods:A retrospective analysis was performed of the 58 patients with tibial eminence avulsion fracture who had been treated by the same group of surgeons using four-point fixation technique with suture anchors under arthroscopy at Department of Sports Medicine, The Affiliated Hospital to Qingdao University from January 2015 to December 2018. They were 33 males and 25 females, with an average age of 18.4 years (from 14 to 32 years). By the modified Meyers-McKeever classification, 15 fractures were type Ⅱ, 19 type Ⅲ and 24 type Ⅳ. Recorded and compared were knee Lysholm scores, International Knee Documentation Committee (IKDC) scores and tibial eminence height between preoperation and one year postoperation; recorded at the last follow-up were range of knee motion and results of Lachman and pivot-shift tests.Results:The 58 patients were followed up for a mean of 20.7 months (from 12 to 33 months). Bony union was achieved in all patients within 12 weeks after operation. In this cohort, the Lysholm score (85.2±4.9) and IKDC score (86.2±4.3) at one year postoperation were significantly higher than the preoperative values (43.2±5.2 and 51.2±4.9), and the post-operative tibial eminence height [(9.1±1.2) mm] was significantly lower than the preoperative value [(12.6±1.2) mm] (all P<0.05). The correlation coefficients between the tibial eminence height and the Lysholm & IKDC scores at one year postoperation were -0.16 and -0.17, respectively. The last follow-up showed a 132°±5° range of knee motion for all patients, a positive result of pivot-shift test (grade Ⅱ) for 3 and a positive result of Lachman test (grade Ⅰ) for 2. Conclusion:Arthroscopic treatment of tibial eminence avulsion fracture by four-point fixation with suture anchors can lead to satisfactory effectiveness, showing advantages of minimal invasion, anatomic reduction, reliable fixation, and little impact on the epiphysis plate.

Objective:To investigate the effects and mechanism of exosomes secreted by human umbilical cord-derived mesenchymal stem cells （hUC-MSCs） in repair of tendon cell injury.Methods:The hUC-MSCs which were stably subcultured were isolated and purified by a tissue block adherent method，and the immunophenotype of hUC-MSCs was detected by flow cytometry. The induction media was employed to induce the differentiation of hUC-MSCs to osteoblasts，chondroblasts and adipocytes，and cell identification was performed subsequently. The secreted exosomes of MSCs （MSCs-exosomes） were extracted using an ultracentrifugation method. The exosomes were detected by Western blot and electron microscopy，and the fusion ability of the exosome membrane was detected by PKH67 staining fluorescence. Forty Wistar rats were divided into tendon injury group （ n = 20） and normal group （ n = 20） according to the random number table. In tendon injury group，the rats were sacrificed with 100 mg/kg pentobarbital sodium one week after Achilles tendon transection，and the injured tendon cells were obtained following digestion of the Achilles tendon. In normal group，the rats were sacrificed without any treatment and the normal tendon cells were obtained concurrently. After the exosomes were co-cultured with tendon cells in vitro for 12，24，48，72 hours，the proliferation of tendon cells was detected by CCK-8 assay. After the tendon cells were treated with hUC-MSCs exosomes for 24 hours，the effects of exosomes on transforming growth factor β （TGF-β），bone morphogenetic protein （BMP），vascular endothelial growth factor （VEGF），fibroblast growth factor （FGF），interleukin（IL）-1β and tumor necrosis factor-α （TNF-α） were detected by Western blot，qPCR and immunofluorescence. Results:The hUC-MSCs were identified and hUC-MSCs-exosomes were isolated successfully. The cultured MSCs were fusiform and positive for Alanine aminopeptidase （CD13），integrin β-1 （CD29），ECTO-5'-nucleotidase （CD73），thymocyte surface antigen （CD90） and endothelin （CD105），but negative for human leukocyte DR antigen （HLA-DR），hematopoietic progenitor cell antigen （CD34） and leukocyte common antigen （CD45）. The exosomes isolated showed a round disc shape and a diameter of 30-100 nm with a depressed internal structure under the electron microscope which was verified via PKH67 staining and the motility-related protein-1 （CD9） and lysosomal associated membrane protein 3 （CD63） were highly expressed. The CCK-8 assay showed the cell viability in tendon injury group was markedly higher than that in normal group at 12 h，24 h，48 h，and 72 h following treatment of tendon cells （ P < 0.01）. The results of qPCR revealed that the mRNA expressions of TGF-β （1.850 ± 0.127），BMP （2.133 ± 0.398），FGF （1.610 ± 0.223） and VEGF （2.207 ± 0.059） in tendon injury group were markedly higher than those in normal group（1.004 ± 0.105，1.007 ± 0.145，1.007 ± 0.140，1.001 ± 0.065，respectively） （ P < 0.05）. However，the mRNA expressions of IL-1β （0.102 ± 0.009） and TNF-α （0.130 ± 0.013） in tendon injury group was markedly lower than those in normal group （1.004 ± 0.113，1.006 ± 0.134） （ P < 0.01）. The results of Western blot were consistent with those of qPCR. Conclusions:The exosomes secreted by hUC-MSCs can promote the growth of tendon cells and repair of tendon cell injury by up-regulating the expression of growth factors TGF-β，BMP，VEGF and FGF，and inhibiting the expression of inflammatory factors IL-1β and TNF-α.

Objective:To analyze the epidemiological characteristics of children with hand, foot, and mouth disease (HFMD) and herpetic angina (HA) in Wenzhou City and the influence of meteorological factors on the pathogenesis, and to provide basis for early warning and disease prevention.Methods:A total of 62 809 children diagnosed with HFMD and 56 005 with HA in the 2nd Affiliated Hospital and Yuying Children′s Hospital of Wenzhou Medical University during 2012 to 2017 were enrolled. The meteorological factors during 2012 to 2017 were collected monthly. The data were analyzed using Spearman rank correlation and multivariant linear stepwise regression model.Results:The number of cases of HFMD and HA began to rise in the spring, and decreased after reaching the peak from May to July. Then there was a secondary peak from September to December, and the incidence decreased significantly in winter. Univariate correlation analysis showed that the effects of different meteorological factors on HFMD and HA were basically the same. Multivariant linear stepwise regression analysis showed that there was a positive correlation between monthly mean temperature (X) and the number of HFMD cases. The regression equation was Y=-161.450+ 53.828X ( F=22.250, P<0.01). Monthly mean relative humidity (X 1) and temperature (X 2) were positively associated with the number of HA cases. The regression equation was Y=-3 521.196+ 46.814X 1+ 41.762X 2 ( F=18.351, P<0.01). Conclusions:The trends of onset time of HFMD and HA are similar. The meteorological factors are closely related to HFMD and HA, and their incidence trends are significantly affected by meteorological changes.