Adult ; Aged ; Burnout, Professional ; epidemiology ; Female ; Humans ; Male ; Middle Aged ; Occupational Exposure ; Radiology Department, Hospital ; statistics & numerical data ; Sampling Studies ; Surveys and Questionnaires ; Young Adult

Objective: To observe the clinical efficacy of acupuncture plus bloodletting therapy in treating insomnia in people with blood stasis constitution. Methods: Seventy-two patients were randomized into a treatment group and a control group by using the random number table, 36 cases each. The treatment group received acupuncture plus bloodletting therapy, while the control group was intervened by oral administration of estazolam. One-week treatment was taken as a course, for 3 successive courses in total. A follow-up study was conducted 3 months later. The Pittsburgh sleep quality index (PSQI) was evaluated before and after the intervention, as well as in the follow-up. The clinical efficacies were also compared. Results: The total effective rate was 88.9% in the treatment group versus 83.3% in the control group, and the between-group difference was statistically significant (P<0.05). After the intervention, the PSQI scores dropped significantly in both groups (both P<0.05); the between-group difference in PSQI score was statistically significant (P<0.05). The follow-up study showed that the between-group difference in the global score of PSQI was statistically significant (P<0.05). Conclusion: Acupuncture plus bloodletting therapy can produce a more significant efficacy than oral administration of estazolam in treating insomnia in people with blood stasis constitution.

Apoptosis ; Ceramides ; biosynthesis ; Sphingomyelins ; metabolism

The aim of this study was to comprehensively investigate the correlations between foliar fungal endophyte communities and effective components accumulations in Salvia miltiorrhiza. Foliar samples of S. miltiorrhiza were collected in 5 different areas. Their fungal endophyte communities and effective component contents were determined by denaturing gradient gel electrophoresis (DGGE) and high performance liquid chromatography (HPLC), respectively. The results showed that, for characteristics of foliar fungal endophyte communities and effective component contents, there were both similarities and differences among the five samples. Correlation analysis of DGGEs' band and 24 effective components revealed a significant correlations (P < 0.01). For examples, 4 bands (15, 18, 23 and 26) were all significantly correlated with the accumulations of caffeic acid, salvianolic acid B, salvianolic acid C and dihydrotanshinone I.
Chromatography, High Pressure Liquid ; Cluster Analysis ; Denaturing Gradient Gel Electrophoresis ; Endophytes ; chemistry ; Fungi ; chemistry ; Salvia miltiorrhiza ; chemistry ; microbiology

BACKGROUND: Several antibiotics can be used to treat ventilator-associated pneumonia caused by carbapenem-resistant A. baumannii (CRAB-VAP) including high-dose sulbactam. However, the effectiveness of high-dose sulbactam therapy is not well known. We report our experience with high-dose sulbactam for treatment of CRAB-VAP. METHODS: Medical records of patients with CRAB-VAP who were given high-dose sulbactam between May 2013 and June 2015 were reviewed. RESULTS: Fifty-eight patients with CRAB-VAP were treated with high-dose sulbactam. The mean age was 72.0 ± 15.2 years, and the acute physiology and chronic health evaluation II (APACHE II) score was 15.1 ± 5.10 at the time of CRAB-VAP diagnosis. Early clinical improvement was observed in 65.5% of patients, and 30-day mortality was 29.3%. Early clinical failure (odds ratio [OR]: 8.720, confidence interval [CI]: 1.346-56.484; p = 0.023) and APACHE II score ≥ 14 at CRAB-VAP diagnosis (OR: 10.934, CI: 1.047-114.148; p = 0.046) were associated with 30-day mortality. CONCLUSIONS: High-dose sulbactam therapy may be effective for the treatment of CRAB-VAP. However, early clinical failure was observed in 35% of patients and was associated with poor outcome.
Acinetobacter baumannii* ; Acinetobacter* ; Anti-Bacterial Agents ; APACHE ; Diagnosis ; Humans ; Medical Records ; Mortality ; Pneumonia, Ventilator-Associated* ; Sulbactam*

Humans ; Neck Injuries ; therapy ; Vertebral Artery ; injuries ; Vertebrobasilar Insufficiency

Objective: To evaluate left atrial (LA) function and synchrony in lone atrial fibrillation (LAF) patients by two-dimensional speckle tracking echocardiography (2D-STE) and to explore the predictive value of 2D-STE parameters for AF recurrence after ablation procedure. Methods: Our research included in 2 groups: LAF group,n=50 patients diagnosed in our hospital from 2013-06 to 2015-05; it was further divided into 2 subgroups as Non-LA enlargement subgroup,n=34 and LA enlargement subgroup,n=16 and Control group,n=35 healthy subjects. With sinus rhythm, 2D-STE was conducted to obtain LA peak ventricular systolic longitudinal strain (PALS), strain rate (SRs) and atrial contraction longitudinal strain (ACLS), strain rate (SRa). Standard deviation for the time to peak (TPSD) of regional strain was calculated. TPSD during ventricular systole was named as SDs and TPSD during ventriculardiastole was named asSDa. Results: Compared with Control group, LAF group had reduced PALS (28.34±8.57) vs (38.73±6.13), SRs (1.17±0.31) vs (1.57±0.25), ACLS (14.11±4.91) vs (18.86±3.57 ) and SRa (-1.41±0.58) vs (-1.90±0.30), allP<0.05; while elevated SDs (8.11±3.00) % vs (4.67±1.48) % and SDa (5.57±2.26) % vs (3.11±1.13) %, bothP<0.05. Furthermore, Compared with Control group, Non-LA enlargement subgroup had decreased PALS, SRs, ACLS and SRa, allP<0.05; while increased SDs and SDa, bothP<0.05. Logistic regression analysis indicated that compared with traditional parameters, SDs and SDa could more effectively distinguish LAF patients from normal subjects (SDs with the sensitivity 83%, speciifcity 72% and SDa with the sensitivity 81%, speciifcity 76%). Elevated SDa and SDs were the best predictors for post-operative AF recurrence (SDs with the sensitivity 80%, speciifcity 71% and SDa with the sensitivity 86%, speciifcity 79%). Conclusion: 2D-STE may detect LA dysfunction and dyssynchrony in LAF patients, abnormal parameters could be found in LAF patients without LA enlargement. SDs and SDa were the best predictors for post-operative AF recurrence.

Objective To investigate the molecular epidemiology of methicillin-resistant Staphylococcus aureus in China in 2005.Methods From January to December 2005,395 consecutive and non-repetitive isolates of methicillin-resistant Staphylococcus aureus were collected from 17 teaching hospitals in 14 cities.The genotypes of SCCmec were determined by multiplex PCR pulsed-field gel electrophoresis (PFGE)was used to type the chromosome DNA of MRSA.Muhilocus sequence typing(MLST)was used to type the housekeeping genes.Fifty-three strains were selected for MLST typing according to the antimicrobials susceptibility patterns,PFGE types,SCCmec types and the distribution of the regions.The toxin gene was detected by PCR.Results Among 395 isolates of MRSA,SCCmec Ⅲ,untypeable type and type Ⅱ accounted for 61.5%(243/395),24.3%(96/395)and 14.2%(56/395)respectively.In Shenyang,60.7%(17/28)of the isolates were SCCmec Ⅱ,which was significantly higher than other areas. Twenty-four different types and 42 subtypes were found by PFGE typing.Clone A accounted for 50.1%, existing in 13 teaching hospitals in 12 cities and clone R accounted for 23.5%,existing in 9 teaching hospitals in 8 cities.Six sequence types(ST)were found in these isolates with ST239 and ST5 accounting for 75.5% and 17.0% among these isolates,respectively.The prevalence of pvl gene was 2.5% among 395 isolates of MRSA.Conclusions The most types of SCCmec in China were Ⅲ and Ⅱ,and distribution of SCCmec types differed among regions.MRSA outbreaks caused by epidemic multiple-drug resistant clones occurred in big teaching hospitals in China.Meanwhile,the same PFGE pattern may spread among areas. Several international epidemic MRSA clones may exist in China.

Objective:To investigate the mechanism of PE_PGRS60 protein in the pathogenesis of Mycobacterium tuberculosis infection. Methods:The cloned and purified PE_PGRS60 protein from Mycobacterium tuberculosis was used to stimulate RAW264.7 cells. The expression of cyclooxygenase 2(COX2) mRNA and protein was detected by qRT-PCR and Western blot, respectively. The signal pathways that may regulate the expression of COX2 were screened, and the expression of inflammatory cytokines induced by PE_PGRS60 was detected by ELISA. The level of cell death was measured by lactate dehydrogenase(LDH) release test and flow cytometry PI staining. Western blot was used to detect the expression of COX2 in Peripheral blood mononuclear cell(PBMC) from active tuberculosis patients. Results:PE_PGRS60 protein was found to promote the expression of COX2 in RAW264.7 cells and activate the three major members of the mitogen-activated protein kinase(MAPK) family: extracellular regulated protein kinase(ERK), p38 and c-Jun N-terminal kinase(JNK). Interestingly, only JNK-IN-7, the inhibitor of JNK was observed to suppress the up-regulation expression of COX2 induced by PE_PGRS60. This up-regulated expression of COX2 was also found in PBMCs from active tuberculosis patients. The COX2 inhibitor celecoxib can effectively block the expression of the inflammatory factors IL-1β, TNF-α and IL-6 induced by PE_PGRS60 and promote macrophage death.Conclusions:PE_PGRS60 can promote macrophages to release inflammatory factors by activating JNK/COX2 signal axis. Some macrophages still die under the protection of COX2.

Objective To detail our early experience on a modified two-stage revison using articulating antibiotic-loaded cement spacer (AALCS) for late periprosthetic infection of total knee arthroplasty (TKA).Methods From January 2006 to February 2009,a series of 21 patients (21 knees) underwent twostage revision knee arthroplasty for late infected TKA.There were 8 males and 13 females,aged from 56 to 83 years (average,64.4 years).In the first stage,each patient underwent radical debridement,removal of all components and cement,and implantation of articulating cement spacer containing vancomycin.Graduated knee motion and partial weight bearing activity were encouraged in the interval period.Each patient received an individual systemic organism-sensitive antimicrobial therapy for 4.9 weeks (range,2-8 weeks) followed by a second-stage revision TKA.All the patients were regularly followed-up using the American Knee Society Scoring System.Results All patients were followed up for 17 to 54 months (average,32.2 months).At final follow-up,the knee society score,function score,pain score and range of motion (ROM) of knee were significantly improved compared with those before operation.Meanwhile,there was no significant increase in the degree of extension lag.The average interval period was 11.5 weeks (range,6-32 weeks).No change of bone defect volume was found between two stages.There were no complications such as recurrent infection,hepatic and renal dysfunction,and deep venous thrombosis.Conclusion Treating infected TKA with AALCS can avoid spacer-related bone loss,preserve knee function between two stages,and eradicate infection effectively without significant complications.The early clinical results are inspiring.Radical debridement,individual application of systemic antibiotics,and reasonable juncture for the second revision are all key factors related to a successful outcome.