Amino Acid Metabolism, Inborn Errors ; diagnosis ; genetics ; therapy ; Brain ; diagnostic imaging ; metabolism ; pathology ; Brain Diseases, Metabolic ; diagnosis ; genetics ; therapy ; Child, Preschool ; Diagnosis, Differential ; Glutarates ; metabolism ; Glutaryl-CoA Dehydrogenase ; deficiency ; genetics ; Humans ; Infant ; Infant, Newborn ; Lysine ; metabolism ; Magnetic Resonance Imaging ; Multiple Acyl Coenzyme A Dehydrogenase Deficiency ; diagnosis ; genetics ; therapy ; Mutation ; Neonatal Screening ; methods ; Radiography

Animals ; Calcium ; analysis ; physiology ; Cells, Cultured ; Motilin ; pharmacology ; Myocytes, Smooth Muscle ; drug effects ; physiology ; Rats ; Rats, Sprague-Dawley

Objective To explore the risk factors of severe pneumonia caused by multi-drug resistant Klebsiella pneumonia,and antimicrobial drug resistance among these isolates.It may help to prevent and control the disease and promote to rational use of antibiotics.Methods We conducted the case-control study in our PICU.It included 89 patients with severe pneumonia caused by multi-drug resistant Klebsiella pneumonia as case group and 68 patients with severe pneumonia caused by Klebsiella pneumonia as control group during the same period.To compare the two groups on irrationality use of antibiotics (especial for third generation cephalosporin),length of stay,tracheal cannula,time of mechanical ventilation and underlying conditions (malnutrition,congenital heart disease,heredity and metabolic disease).Antimicrobial susceptibilities among 89 multi-drug resistant Klebsiella pneumonia isolates were analyzed.Results There were 63 cases (70.79％) for irrationality use antibiotics in case group,while there were 27 cases (39.70％) in control group (P ＜ 0.01).The cases for length of stay over 7 days in case group (48 cases,53.93％) were more than those cases with the same situation in control group (12 cases,17.65 ％) (P ＜ 0.01).Thirty-eight cases (42.69 ％) needed mechanical ventilation therapy in case group,while 16 cases (23.53％) needed mechanical ventilation therapy in control group (P ＜ 0.01).The cases for duration of mechanical ventilation over 5 days in case group (18 cases,20.22％) were more than those cases in control group (5 cases,7.35％) (P ＜0.05).The cases with underlying disease in case group (13 cases,14.61％) were more than those cases in control group (2 cases,2.94％) (P ＜ 0.05).Multi-drug resistant Klebsiella pneumonia isolates demonstrated that high-level resistance for penicillins,cephalosporins,aminoglycosides and quinolones,but still susceptible to carbapenems.Conclusion Several risk factors are associated with severe pneumonia caused by multi-drug resistant Klebsiella pneumonia,including irrational use of antibiotics (especial for third generation cephalosporin),long term of length of stay,endotracheal intubation,long term of mechanical ventilation,and having underlying disease (malnutrition,congenital heart disease,heredity and metabolic disease).Multi-drug resistant Klebsiella pneumonia isolates demonstrated that high-level resistance for penicillins,cephalosporins,aminoglycosides and quinolones,but still susceptible to Carbapenems.Carbapenems should be used as first-line drugs for severe pneumonia caused by multi-drug resistant Klebsiella pneumonia.

Objective To profile the phenotype and pathogens of cutaneous and mucous mycoses in a dermatology outpatient clinic in Nanchang region. Methods A review was performed to assess cutaneous and mucous mycoses diagnosed in the dermatology outpatient clinic of Dermatology Hospital of Jiangxi Province from 2006 to 2008. The relationship of clinical phenotype and pathogens to season, patients' age and gender was analyzed. Results A total of 7251 cases were collected, and the ratio of male to female patients was 2.3: 1. The most prevalent mycoses included tinea cruris (2702, 37.1%), pityriasis versicolor (1505, 20.8%) and tinea manus (727, 10.0%). In total, 4953 fungal strains were isolated from all the patients except for those with pityriasis versicolor, of them, Trichophyton rubrum accounted to 69.9%, Candida to 20.4%, and Trichophyton violaceum to 4.5%. Season, patients' age and gender were found to be associated with clinical phenotypes and pathogens of mycoses. Conclusions In the dermatology outpatient clinic of Nanchang region, tinea cruris is the most common superficial fungal disease, with the predominant pathogen being Trichophyton rubrum. Trichophyton violaceum is the primary pathogen of tinea capitis, which is different from other reports.

ObjectiveToinvestigatetheplasmidgenechangesinquinolone‐sensitivePseudomonasaeruginosa.Methods 31iso‐lates from January 2011 to December 2013 from various qualified clinical samples in the hospital were collected .In the 31 isolateds , 16 isolates proved sensitive to quinolones by using K‐B method were used as research objects in the study .The isolates growing ou‐side the sensitive ring of ciprofloxacin paper were selected to continuously transferred into other culture dishes until the resistance to quinolones were acquired .Plasmid transformation and extraction were performed on those isolates to confirm the existence of drug‐resistanceplasmidsacquired,andthroughPCRandgenesequenceanalysistodeterminethetypeofplasmids.Results 2iso‐lates of quinolone‐sensitive Pseudomonas aeruginosa acquired drug‐resistance plasmids qnrS and were resistant quinolones induced by continuous transferring for 9 times .Conclusion If antibiotics of inhibitory concentration were often used for the treatment of Pseudomonas aeruginosa infection ,drug‐resistance plasmids were acquired easily .

Basic life support ( BLS ) is a very important clinical skill for medical students. However,current BLS education is lack of proper BLS skills evaluation protocol to give educational feedback both to instructors and students. This article is aimed to discuss the necessity of protocol of skills evaluation in basic life support education for medical students prior to their internship.

Objective To study the setup accuracy and other factors during frameless stereotactic radiosurgery (SRS) of intracraial tumor using ExacTrac X-ray image guide system.Methods Totally 119 intracranial tumor patients from August 2014 to February 2016 underwent auto setup with infrared marker.Bilateral oblique cross field images were obtained with ExacTrac X-ray system,and went through comparison,registration and correction with the digitally reconstructed ones of the planning system.Then the translation accuracy errors at LAT,LNG and VRT directions and corresponding rotational accuracy errors were acquired,and the errors experienced extended analysis.Results The translation errors at LAT,LNG and VRT directions acquired with ExacTrac X-ray image guidance system and 6DOF couch were (0.16±0.13) mm,(0.17±0.14) mm and (0.15±0.11) mm respectively,the corresponding rotational errors were (0.21±0.15),(0.18±0.15),(0.18±0.14)° respectively,and the vector error was (0.32±0.16) mm.All of 3 translation and 3 rotational errors were in the SRS error range.Conclusion ExacTrac X-ray image guidance system combined with 6 degrees-of-freedom couch increases the treatment accuracy during frameless SRS,and thus is worthy promoting practically.

OBJECTIVE:To optimize the formulation optimization of Nicorandil sustained-release matrix tablet,and evaluate its drug release properties in vitro. METHODS:Based on single factor test,powder direct compression method was used,using nicorandil cumulative release rate (Q) in 1,4,8,12 h as evaluation indexes,central composite design-response surface method was adopted to optimize the amount of hydroxypropyl methylcellulose(HPMC)and ethyl cellulose(EC);Q values within 12 h in different pH (1.0,5.0,6.8,7.4) media were compared. RESULTS:The optimized formulation (every tablet) was nicorandil 10 mg,HPMC 150 mg,EC 90 mg,microcrystalline cellulose 80 mg,lactose 60 mg,magnesium stearate 2%. Q1 h,Q4 h,Q8 h and Q12 h of the obtained formulation were 23.6%,51.3%,83.7% and 96.9%,respectively;deviation from the predicted values were 2.1%,1.6%,1.0%,0.2%. Q values were similar in pH 1.0-7.4 at different time points. CONCLUSIONS:The obtained Nicor-andil sustained-release matrix tablet by optimal formulation shows sustained-release effect,and the change of pH 1.0-7.4 has no in-terference in the release characteristics of main drug.

Objective: To investigate the mode of cell death caused by NDV strain Changchun and NDV strain Siping. Methods: Plaque formation, cell suppression test, gel electrophoresis, and TUNEL assay were used after the cells were infected by NDV. Results: The apparently pathological changes were observed in chicken embryo fibroblasts, BHK, Hela, Hep 2, HCT and OS 732 tumor cells, but not in Wish cells. The higher suppressed effect on tumor cells was found in the NDV strain Changchun than that in the NDV strain Siping. There was no dose effect relationship between NDV and tumor cell suppression, only optimum dose NDV could cause maximal tumor cells inhibitory effect. Conclusion: The mode of cell death might be different after infection of NDV. The NDV strain Changchun killed tumor cells mainly through apoptosis, while the NDV strain Siping killed tumor cells mainly through necrosis. \[

The article probes into the approach to the interns' capability of clinical thinking and analyzing and solving problems by disscussing causes of gastrointestinal hemorrhage. Correct clinical thinking always comes from solid basis and clinical theory and knowledge, careful history taking, meticulous physical examination, rigorous logical thinking and constant summing up experiences and lessons. As a teacher, we should help interns develop clinical thinking ability during their whole peroid of medical education.Besides, theory should be combined with practice to prevent and correct vicious clinical thinking