0.05).CONCLUSIONS The rising rates of the drug-resistant Uu strains may be resulted of no-standard treatments.The treatment time will be shortened and the curative effects will be better if the treatments are based on the results of the susceptibility test.

Objective:To investigate the effect of vitamin E, selenium and quercetin on the expression of zf-9 mRNA of hepatic stellate cells (HSC) during early acute liver injury in rats. Methods:90 healthy SD rats were randomly divided into four groups: normal control, pathological control, VE 20 mg/(kg bw﹒d) + Se 16 ?g/(kgbw﹒d) supplement, and quercetin 50 mg/(kg bw﹒d) supplement through intragastric way for 15 d respectively. The normal control group was injected with normal saline, the others were given intraperitonal CCl4 once to induce acute liver injury model. The serum levels of MDA, SOD, ALT and AST were determined at 3 h, 6 h, 12 h and 24 h after CCl4 injection respectively. The pronase-collagenase perfusion of liver was used to isolate HSC, and the expression of zf-9 mRNA was examined by RT-PCR. Results: Serum levels of MDA were lower in VE+Se supplement group and quercetin supplement group than pathological group. Supplementation with VE+Se and quercetin could decrease the level of ALT and AST and down-regulate the expression of zf-9 mRNA. Conclusion:Dietary supplementation of VE,Se and quercetin could effectively down-regulate the expression of zf-9 mRNA in HSC during early acute liver injury in rats.

Objective:To explore the efficacy of etanercept combined leflunomide to treat ankylosing spondylitis (AS) and its safety.Methods:90 cases with AS patients admitted in our hospital from June 2016 to January 2015 were selected.The patients were divided into observation group and control group by random number table method,45 cases in each group.Observation group was treated with etanercept combined with leflunomide,the control group were treated by leflunomide only.Morning stiffness time,AS activity index (BASDAI),AS measurement index (BASMI) were recorded before and after treatment in two groups,the total effective rate and adverse reaction were compared between the two groups.Results:After treatment,the BASDAI and morning stiffness time,BASMI of two groups of patients compared with before treatment were decreased,and the indexes above of the observation group were significantly lower than the control group,the difference was statistically significant (P＜0.05);The effective rate of the observation group was significantly higher than that of the control group,the difference was statistically significant (P＜0.05);During the course of treatment,the main adverse reactions occurred in patients with liver function damage,diarrhea and allergic skin rash,but there was no significant difference in the incidence of adverse reactions between the two groups (P＞0.05).Conclusion:Etanercept combined with leflunomide can obtain ideal effect,and low incidence rate of adverse reaction,it is worth popularizing in clinical use.

OBJECTIVE:To study the effects of etanercept combined with cyclophosphamide on related indexes of patients with rheumatoid arthritis complicated with interstitial pneumonia (RA-IP).METHODS:A total of 84 RA-IP patients were randomly divided into control group (42 cases) and observation group (42 cases).Control group was given Etanercept for injection 25 mg subcutaneously twice a day.Observation group was additionally given Cyclophosphamide tablets 50 mg orally,once a day,increasing by 50 mg every 7 d later,with maximum dose lower than 100 mg,for consecutive 2 weeks,2 weeks later repeated,on the basis of control group.Both groups were treated for 3 months.The number of joint tenderness and joint swelling,morning stiffness time,VAS score,DAS28 score,CRP,ESR,serum rheumatoid factor (RF),TNF-α,p (O2),VC,clinical score,imaging score,physiological score and the occurrence of ADR were observed in 2 groups before and after treatment.RESULTS:After treatment,the number of joint tenderness and joint swelling,morning stitffness time,VAS score,DAS28 score,the levels of CRP,ESR,RF and TNF-α,clinical score,imaging score,physiological score in 2 groups were significantly lower than before treatment;the observation group was significantly lower than control group.p(O2) and VC of 2 groups were significantly higher than before treatment,and the observation group was significantly higher than the control group,with statistical significance (P＜0.05).There was no statistical significance in the incidence of ADR between 2 groups (P＞0.05).CONCLUSIONS:Etanercept combined with cyclophophamide in the treatment of RA-IP can improve clinical symptom,signs,life quality and lung function without increasing the occurrence of ADR.

Objective To explore the related factors of diarrhea onset in critically ill patients during early enteral nutrition (EEN). Methods Thirty Zhejiang Provincial Emergency Intensive Care Units (EICU) and ICU to implement EEN support for critically ill patients from July 2016 to August were enrolled, and the incidence of diarrhea within 1 week after EEN administration was observed. The patients were divided into a diarrhea group and a non-diarrhea group according to whether diarrhea occurred or not during EEN. The basic status data [sex, age, body mass index (BMI), albumin, acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ), nutritional risk screening (NRS2002), major disease diagnosis], and EN status (feeding route, infusion method, EN type, amount of EN on days 4 and 7), and clinical treatment (applying following treatments or not: mechanical ventilation and its duration, vasoactive drugs, gastrointestinal motility drugs, probiotics) and clinical outcomes (survival after discharge or not) were collected in two groups. Multivariate Logistic regression analysis was performed on the indexes with statistically significant differences obtained from the univariate analysis to screen out the relevant risk factors of occurrence of diarrhea in critically ill patients during EEN administration. The receiver operating characteristic curve (ROC) was drawn to analyze the predictive value of each risk factor for occurrence of diarrhea in critically ill patients with EN therapy. Results Of the 510 critically ill patients who underwent EEN, 156 had diarrhea, 70.5% (110/156) had diarrhea within 4 days of EEN, most diarrhea lasts for 3 days and most frequency of diarrhea was 3-4 times a day. The univariate analysis showed that the age of patients in the diarrhea group was significantly higher than that in the non-diarrhea group (years:69.42±17.94 vs. 65.76±17.69), the mechanical ventilation time and ICU hospitalization time were significantly longer than those of non-diarrhea group [mechanical ventilation time (days): 8 (5, 14) vs. 8 (4, 9), ICU hospitalization time (days): 11.5 (8.0, 19.0) vs. 9.0 (6.0, 14.0)], the proportion of probiotics used and the proportion of feeding by nasal tube were significantly higher than those of non-diarrhea group [proportion of probiotics: 26.9% (42/156) vs. 14.4% (51/354), proportion of nasal tube feeding: [26.9% (42/156) vs. 14.4% (51/354)]. Multivariate Logistic regression analysis showed that the use of probiotics was a protective factor for diarrhea during EEN in critically ill patients [odds ratio (OR) = 0.447, 95% confidence interval (95%CI) = 0.273-0.730, P = 0.001]. ROC analysis showed that the area under the curve (AUC) of probiotics predicting diarrhea was 0.598 (95%CI = 0.554-0.640), P < 0.001, sensitivity was 35.9%, and because AUC was less than 0.7, the accuracy and sensitivity of predicting diarrhea with probiotics was considered to be relatively poor. Conclusion The incidence of diarrhea is high in EEN in critical illness patients and its occurrence is related to various factors. The addition of probiotics can reduce the incidence of diarrhea.

Objective The current manipulator with double parallel quadrilateral mechanism should be connected in series with a flexible degree of freedom (DOF) mechanism, which increases the volume of the manipulator, decreases the motion flexibility and creates the interference between the mechanical arms that hold the mirror and the device. Aimed at solving this problem, a novel mechanical arm was put forward to enhance the motion flexibility and reduce the volume of the manipulator. Methods The mechanical arm was designed by using the mechanism of five-link, slider and slide rail lower pair and wire transmission to realize the telescopic movement of the end effector. The kinematics model of the manipulator was established, and the MATLAB was used as the simulation tool to verify the correctness of the D-H parameters under the specific zero joint angle, and the motion equation of the manipulator was solved. Meanwhile, the three-dimensional workspace of the end effector was obtained by using Monte Carlo algorithm, and the preoperative plan of animal experiment for 3 arms was performed. Finally, cholecystectomy and other operations were acted in pigs, to verify the rationality and maneuverability of the design of double 5-link 2-DOF manipulator. Results The working space of Monte Carlo algorithm under MATLAB environment was -650.4 mm＜x＜649 mm, 163.8 mm＜y＜1 202 mm and -254.6 mm＜z＜829.8 mm. Sixteen cases of pig cholecystectomy were successfully completed, with an average operation time of 51 minutes. Conclusions The novel double 5-link 2-DOF manipulator could successfully complete cholecystectomy and other operations in pigs, which had no other symptoms after the operation. There was no interference between the mechanical arms, which fully verified the feasibility of the design scheme of the robot manipulator for minimally invasive surgery.