Objective To investigate the antibacterial activity of Schisandra to Acinetobacter baumannii including metallo-β-lac-tamase(MBL)-producing and non-MBL-producing stains in vitro.Methods 75 strains of Acinetobacter baumannii were preliminary screened for clinical isolates of MBL-producing strains,to which confirmatory tests of MBL producing were performed.Drug sensi-tivities of the Acinetobacter baumannii to 14 antibacterial drugs were tested.In vitro antibacterial tests was adopted to determine the MIC of schisandra to 75 strains of Acinetobacter baumannii(including MBL and non-MBL-producing Acinetobacter baumannii).Re-sults MBL confirmatory test showed that among the 50 strains selected 38 strains were positive accounted for 76% (38/50).Con-clusion Schisandra has some antibacterial effect on Acinetobacter baumannii especially MBL-producing Acinetobacter baumannii, and can be combined with western medicine in the treatment of Acinetobacter baumannii infection.

Abstract Socioeconomic status is an important factor affecting all-cause mortality. Income, education and occupation alone or in combination have been employed as a measure of socioeconomic status; however, the study results vary in measures. Material mechanism, lifestyle mechanism, psychological mechanism and community neighborhood mechanism have been accepted as the main intermediate mechanisms for the impact of socioeconomic status on all-cause mortality; however, the contribution of these mechanisms remains controversial. Based on the international and national publications pertaining to the association between socioeconomic status and all-cause mortality from 2012 to 2021, this review summarizes the relationship between socioeconomic status and all-cause mortality in different metrics and the intermediate mechanism of the impact of socioeconomic status on all-cause mortality, so as to provide insights for further studies.

Objective To observe the change of lipid metabolism during adaptive heart failure.Method The transverse aorta constriction mouse models established by minimal invasive surgery technique were evaluated for early small changes of body composition by EchoMRITM whole body composition analysis,and the different gene expression was analyzed by whole genome expression microarray.Results Three weeks after the surgery,the fat composition,in the mouse models were (0.49 ± 0.13) g,which was significantly lower than that in the sham surgery group [(0.81-±0.14) g] (P =0.002).The expression of the natriuretic peptide type A significantly increased over time (R2 =0.939,P =0.005).In addition,the levels of fatty acid desaturase,long-chain fatty acid elongase 5,and N-acylsphingosine amidohydrolase increased,and the levels of acyl-coenzyme A dehydrogenase,muscle glycogen phosphorylase,and pyruvate dehydrogenase kinase decreased,showing increased fat mobilization and decreased carbohydrate utilization.Conclusions Surgery for transverse aorta constriction can cause complex metablic changes in heart.The activated lipid mobilization maybe lead to the low body fat composition.

Objective To compare the efficacy and indications between the biliary bypass laparotomy surgery.and the two different kinds of biliary stent insertion surgery in the palliative alleviating jaundice of cholangiocarcinoma.Methods From March 2008 to March 2013,69 patients treated with palliative alleviating jaundice therapy of cholangiocarcinoma were included,who were all came from the Third Affiliated Hospital of Guangzhou Medical University.Including 17 patients who treated with the open biliary bypass surgery and 52 patients who treated with interventional therapy.We analysed the differences between these cases of biliary drainage operations in the recent jaundice reduction rate,average stay,mortality rate,the incidence of related complications,et al.Results All these different drainage ways had good effect in alleviating jaundice,incidence of alleviating jaundice have no obvious difference (P ＞ 0.05).Compared to the open biliary bypass surgery,interventional therapy had obvious advantages in the average stay and postoperative survival (P ＜ 0.05).The pancreatitis rate was lower in Percutaneous Group than that in Endoscopic Group (P ＜ 0.05).incidence of biliary tract infection and biliary tract bleeding have no obvious difference (P ＞ 0.05).There were no significant differences between the success rates of in biliary stent insertion operation in patients with each model cholangiocarcinoma (P ＞ 0.05).Conclusions Among the therapies of the palliative alleviating jaundice of cholangiocarcinoma,the internal biliary drainage of biliary stent insertion operation was superior to the treatment of the biliary bypass laparotomy.As to biliary stent insertion operations,endoscopic biliary stenting surgery should be the preferred choice.

Objective To investigate the value of PET-CT in TNM staging and three-conformal radiotherapy (3DCRT) in esophageal carcinoma. Methods From September 2007 to November 2008, 20 patients with pathologically confirmed esophageal carcinoma were enrolled, including 2 treated with surgery and 18 with 3DCRT. All the patients received PET-CT simulation before the treatment. The length and maximum transverse diameter of Grit based on esophagoscope, esophagography, CT, PET-CT_(SUV2.5) and PET-CT_(40%SUVmax) were compared. The TNM stages were compared based on CT and PET-CT images. Three treatment plans were produced and analyzed based on images of CT, PET-CT_(SUV2.5) and PET-CT_(40%SUVmax),respectively. Results The length of lesion on esophagoscope, esophagography, CT, PET-CT_(SUV2.5) and PET-CT_(40%SUVmax) was 4. 93 cm, 5.06 cm, 6. 67 cm, 5. 89 cm and 4. 84 cm, respectively. The corresponding maximum transverse diameter on the last 3 images was 4. 05 cm, 3.38 cm and 2. 95 cm, respectively. In all, 31, 21 and 14 positive lymph nodes were identified according to CT images, PET-CT images and the both. Five patients with CT diagnosed stage M_0 were found to have distant metastasis by PET-CT images, and 1 patient with CT diagnosed stage M_1 was excluded by PET-CT. The volumes of GTV_(CT) were similar with GTV_(SUV2.5) in 2 patients, smaller in 5 patients, and larger for the remaining 13 patients. For these 13 patients, the radiation dose of normal tissues based on GTV_(SUV2.5) was relatively lower. Conclusions The length of lesion based on PET -CT_(SUV2.5) matches the pathological length best , followed by esophagography. With PET-CT_(40%SUVmax) the actual lesion length may be underestimated. TNM stage might be changed by PET-CT, and then the target volumes and radiation doses of normal tissues might be reduced.

Objective To analyze clinical and pathological features of dermatomyositis with panniculitis as a skin manifestation.Methods Clinical data were collected from 9 cases of dermatomyositis with panniculitis as a skin manifestation in Department of Dermatology of Zhongshan Hospital affiliated to Fudan University from October 2012 to July 2016,and their clinical and pathological features were analyzed.Results Of the 9 cases,6 were female and 3 were male,and the age ranged from 28 to 73 years.Panniculitis lesions of the 9 patients all manifested as painful indurated plaques or nodules on the buttock,thigh,waist,back,abdomen,upper extremities and cheeks.These lesions occurred before,after or simultaneously with the onset of characteristic skin and muscle lesions of dermatomyositis,especially preceded the onset of characteristic lesions of dermatomyositis by 30 years in 1 case.Histopathological examination of lesions showed liquefaction degeneration of basal cells,inflammatory infiltration of lymphocytes and plasma cells around blood vessels,in the fat lobules as well as between the lobules and septa in the dermis.The necrosis and calcification of lipocytes,lipomembranous changes,fibrinoid necrosis of damaged vessel walls and microvascular occlusion were observed in some cases.Because panniculitis preceded the onset of characteristic lesions of dermatomyositis,2 patients were misdiagnosed with lupus panniculitis and morphea profunda for several times.Most patients had good response to systemic glucocorticoids combined with immunosuppressive agents,while the patients with lipomembranous fat necrosis had poor response to the combination therapy.Conclusions Panniculitis lesions of dermatomyositis are histologically characteristic,and may do not coincide with the onset of characteristic lesions of dermatomyositis.If panniculitis lesions precede characteristic lesions of dermatomyositis,patients will be easily misdiagnosed.Thus,persistent follow-up visit will be of great importance for the diagnosis.

Objective To analyze the epidemiology and clinical features of the critical congenital heart diseases in neonates,and to summarize the main points on pre-operative treatments.Methods We retrospectively analyzed all critical congenital heart disease in newborns admitted to CICU from June 2014to June 2015.Depict entity distribution,the main symptoms,and the key points on their treatments,also the indi-cation of intubation and their operation time were summarized.Results In totally 96cases,transposition of the great artery,with and without the intact ventricle septum,was the biggest category and counts for 49%in our group.Severe cyanosis was the main symptom for 62.5% of all cases.Another key symptom was the heart failure(33.3%).Eight-seven cases were intubated during their treatments,in which 41were intubated as soon as they were admitted and 40cases were done in the first 24hours after their admission.One case died before treatment due to interrupted aortic arch.All the rest received operations during their hospital stay. Conclusion Transposition of great artery is the dominating entity in critical congenital heart diseases in new-borns;severe cyanosis is the main symptom.Treatment should be based on each characteristic anatomy and hemodynamics features.Rigorous and dynamic monitoring on the homeostasis and metabolic index determines the indication of intubation and surgery time.

Objective To firstly report 4 cases of dermatomyositis characterized by painful palmar eruptions complicated by fatal rapidly progressive interstitial lung disease (RP-ILD) in China.Methods Four patients with dermatomyositis with painful palmar eruptions complicated by fatal RP-ILD were enrolled from the Department of Dermatology,Zhongshan Hospital,Fudan University between December 2014 and April 2017,and their clinical and pathological features were analyzed.Results Among these patients,3 were female and 1 was male.Their age ranged from 47 to 59 years.Of the 4 patients,3 had no muscular involvement.All of the 4 patients had multiple solid red papules or nodules on the bilateral palms,palmar and lateral surfaces of fingers,which preceded,followed or concurred with the onset of other skin lesions of dermatomyositis.The occurrence of type Ⅰ respiratory failure was preceded by 3 weeks to 5 months of painful palmar eruptions in the 4 patients.Early-stage palmar eruptions were easily misdiagnosed as contact dermatitis,eczema or erythema multiforme.Histopathological examination of the skin lesions on the finger palmar surface showed perivascular infiltration of a few lymphocytes in the dermis,and deposition of varying amounts of mucin-like substances around blood vessels and appendages.Of the 4 patients,3 showed positive staining for anti-melanoma differentiation-associated gene 5 antibody.Although the 4 patients received anti-inflammatory and immunosuppressive therapies,they all finally died of respiratory failure.Conclusions Dermatomyositis with painful palmar eruptions may indicate the occurrence of fatal RP-ILD,and early biopsy of skin lesions is needed to help to identify the disease.Immunosuppressive treatment should be performed timely to improve the prognosis in these patients.

Objective:To summarize cardiac function feature and its support method after ALCAPA(anomalous origin of left coronary arteries from pulmonary artery) operation. Analysis its early outcome and risk factors of its mortality.Methods:Review the clinical data of 108 ALCAPA cases treated in Shanghai Children Center between January 2005 and December 2017. All the cases were divided into two groups according to their ages when they received the surgery: group 1<1 yr; group 2>1yr. Adopted LVEF(left ventricle ejection fraction) and LVEDD(left ventricle end-diastolic diameter) Z-score as a parameter to describe the cardiac function change after operation. Summarize the selection and application of vasoactive agents and its score(VIS) after operation, indirectly reflect the post-operative cardiac function. Analysis the opportunityofinitiation and termination of mechanical circulation support and the timefor mechanical ventilationevacuation. Adopt the logistic analysis to find the risk factors of early death risk factors after ALCAPA operation. Results:Cardiac function had little improve in early period after ALCAPAoperation, did not attained normal range in fifth day post-operative, LVEF was 0.42 in group 1 and 0.45 in group 2, respectively. The application of vasoactive agents tended to choose α, β receptor-agonist, which epinephrine and norepinephrine is the preferred and VIS score was high in early period. Mechanical circulation support was used in 18 cases. 12 cases died in our group, mortality was 11%. Logistic regression analysis implied that low age and low level of LVEF before operation is the risk factor for mortality. Conclusion:Cardiac function was still in low level in early period after ALCAPA operation, depended on higher dosage of vasoactive agents and mechanical circulation support if necessary. We recommend the LVEF index for evacuated from mechanical circulation support and mechanical ventilation is over 0.40 and 0.35 respectively, and other clinical sign should be considered simultaneously. Low age and low LVEF level before operation is the risk factors for early death after ALCAPA operation.

Objective:To explore the safety and efficacy of Propafenone in terminating paroxysmal supraventricular tachycardia (PSVT) in children and analyze the factors influencing the effectiveness.Methods:A retrospective study was conducted on 169 PSVT children treated with Propafenone in the Department of Pediatric Cardiology, Heart Center, the First Hospital of Tsinghua University from September 2014 to October 2021.There were 118 boys and 51 girls with an average age of (2.84±2.91) years (age range: 14 days-13 years). According to age, they were divided into ≤ 1-year-old group, >1-3-year-old group, >3-7-year-old group, and >7-year-old group.Mea-surement data were compared between groups using t-test and Mann- Whitney U test.Counting data were analyzed by χ2 test. Results:Among the 169 children with PSVT, 65 cases (38.5%) were below 1 year old, 47 cases (27.8%) were >1-3 years old, 40 cases (23.7%) were >3-7 years old, 17 cases (10.1%) were above 7 years old.About 24 cases (14.2%) were combined with congenital heart disease.A total of 153 cases (90.5%) had nonspecific symptoms at the first visit.A total of 4.1% (7/169 cases) were complicated with tachycardia-induced cardiomyopathy, and their left ventricular ejection fraction increased from (44.0±4.0)% to (53.7±6.9)% after successful control of PSVT ( t=-4.700, P=0.003). The complete termination of PSVT by intravenous Propafenone was achieved in 125 of 169 cases (74.0%, 125/169 cases). The complete termination rate after multiple times of administration (74.0%) was significantly higher than that after the first intravenous injection (53.3%, 90/169 cases) ( χ2=15.657, P<0.001). There was a significant difference regarding the complete termination rate between children ≤1 year old (60.0%, 39/65 cases) and those >1 year old (82.7%, 86/104 cases) ( χ2=10.696, P=0.001). For children ≤1 year old, 1.5 mg/kg Propafenone (51.1%, 23/45 cases) showed better efficacy for PSVT termination than 1.0 mg/kg Propafenone (20.0%, 4/20 cases) ( χ2=5.519, P=0.019). For children >1 year old, there was no significant diffe-rence between 1.5 mg/kg and 1.0 mg/kg Propafenone groups (57.9% vs.62.1%) ( χ2=0.180, P=0.671). The adverse reaction rate of intravenous Propafenone was 9.5% (16/169 cases). One case presented with severe hypotension, which occurred in a child with right cardiac insufficiency with tricuspid valve depression; 15 cases showed abnormal cardiac conduction and recovered spontaneously in a short time.There was no deterioration of cardiac function in children with mildly to moderately reduced cardiac function. Conclusions:It is relatively safe and effective to terminate PSVT in children with intravenous Propafenone.The complete termination rate is 74.0%, which is related to age, dose and times of administration.Despite of low incidence of side effects, Propafenone should not be used to treat PSVT with cardiac function which is significantly impaired or unclear secondary to persistent tachycardia.Special attention should be paid to cardiac function deterioration in these patients.