Urinary tract infections (UTI)is a childhood disease.With the use of extended spectrum antibiotics,resistant strains have increased every year,especially Escherichia coli(E.coli).The mechanisms of drug resistance are as follows:hydrolase,target gene mutations,efflux pumps and membrane permeability change.Of which producing extended-spectrum β-lactamase(ESBL) is increasing.So it presents a huge challenge to clinical antibiotic selection.According to the resistance genes (blaTEM,blaSHV,blaCTX-M,etc.),the ESBL can be classified into different types (TEM type,SHV-type,CTX-M type,etc.).The drug-resistant genes play an important role in spreading and prevalence of the resistance genes.It's necessary to do a review of the currently known genotypes.It is both in favor of scientific research work and providing guidance for clinical work.

Objective:To investigate the high flux hemodialysis (HFD) on the application effect of severe renal failure patients the level of inflammatory factors, blood lipid and protein. Methods:In 2012 January to 2013 December was performed in 80 patients with severe renal failure in the treatment of MHD, were randomly divided into two groups, study group 40 cases by high-throughput MHD treatment, 40 cases in the control group using conventional MHD treatment. Results: There was no significant difference in two groups before treatment of various inflammatory factors difference (P>0.05); after the treatment, two groups of patients with TNF- α, IL-6 and hs-CRP levels were significantly lower(t=14.138, t=5.891, t=11.093;P<0.01), and lower levels of TNF-α, IL-6 and hs-CRP levels than the control group after treatment, the study group, with statistical significance correlation between data comparison of difference (t=17.913, P<0.05). Comparison of the plasma protein levels had no significant difference between the two groups before treatment (P>0.05);after the treatment, patients in study group were TP, ALB andβ2-M compared with those before treatment were significantly improved, ALB of control group had obvious improvement than before treatment (P<0.05); improve study group for plasma proteins relevant indexes are the control group was significant (t=2.515, t=59.923, t=3.474, P<0.01). No significant differences between the level of each lipid index (P>0.05);after the treatment, patients in study group TC and TG compared with those before treatment were significantly improved after treatment, and compared with the control group index improved significantly (t=2.963, t=6.914; P<0.01). Conclusion:High throughput MHD therapy based on conventional MHD filtration of small molecular toxin traits on patients with severe renal failure, increase the filtration range, clear promote inflammatory molecules, plasma proteins, blood lipid molecules, such as in large molecules, so as to achieve a better therapeutic effect.

Objective　To investigate the relationship between the apnea events and the correspondent sleep stage. Methods 68 normal volunteers were studied with polysomnography to confirm the sleep stage of the apnea events. Results Sleep apnea events were found in each different sleep stage. The events happened frequently in light sleep stage, most in stage 2. There were no significant sleep stage distribution difference in different sex .The number and severity of apnea events were also not relative with the sleep stage distribution. Conclusion Apnea events happened most frequently in light sleep stage. The reason is still unclear.

Objective To study the epidemiological features of patients for emergency transport so as to enhance the control level of pre hospital emergency treatment. Methods Investigations were made of 956 cases of patients for emergency transport in the authors hospital in 2000～2001 and their epidemiological features analyzed. Results Among the 956 cases, males outnumbered females, patients within the age group of 20 to 39 numbered 391, accounting for 40.9%, and patients within the age group of 50 to 69 numbered 400, accounting for 41.8%. Of all the cases, ordinary ones numbered 671(70.2%),critical ones numbered 241(25.2%), and cases that died numbered 44(4.6%). The first three diseases demanding emergency transport were successively craniocerebral wound(17.4%), cerebrovascular disease(16.0%), and cardiovascular disease(13.5%). The periods for emergency transport ranged mainly from 9:00 to 12:00 and from 15:00 to 18:00. The sources of emergency cases were successively township hospitals(53.8%), hospitals at the county level(26.0%), and hospitals at the city level(20.2%). Conclusion Control of pre hospital emergency treatment needs to be strengthened according to the epidemiological features of patients for emergency transport.

Objective To investigate the risk factors of diabetic foot by observing the changes of the relative index. Methods 134 pa-tients were randomly divided into non-diabetic foot (NDF) group and diabetic foot (DF) group,the changes of blood glucose,HbA1c,creati-nine,uric acid,microalbuminuria and the complications of diabetes were observed. Results There no difference in blood glucose level be-tween 2 groups (P>0. 05). The HbA1c levels of DF group was higher,with a significant difference(P<0. 05). The levels of uric acid in fe-male of DF group was higher than those in female of NDF group(P<0. 05). there was significant differernces in levels of microalbuminuria (P<0. 05),but no statistic difference in levels of potassium and sodium between 2 groups. Conclusion The changes of HbA1c,uric acid and microalbuminuria could indicate the diabetic foot in clinic.

Objective To investigate the effect of self-management program on low vision patients and the role of intrinsic motivation.Methods A total of 160 low vision patients were assigned into 2 groups by random digits table method with 80 cases each.The control group was given routine doctor's advice and health education,and the observation group was given a self-management program guided by well trained medical personnel on the basis of the control group.The General Self-efficacy Scale (GSS) and Chinese-version Low Vision Quality Of Life questionnaire (CLVQOL) was conducted before and after intervention.The patients' intrinsic motivation also was evaluated by Intrinsic Motivation Inventory (IMI) after intervention.Results The total score and scores of interest/fun,inner selectivity,subjective ability and stress/strain dimensions of IMI were (62.25±3.74),(18.43 ±3.67),(16.13 ± 1.53),(16.05 ±7.34),(11.64 ±2.74)points、in observation group and(50.24±4.32),(13.53±2.78),(13.67±1.75),(13.52±2.42),(9.52±1.77) points in control group,and there were significant differences (t=5.813-18.800,P＜ 0.05).The scores of GSS and CLVQOL in observation group after intervention were (27.49±3.41),(64.30±7.04) points,which were higher than those in control group:(16.54±2.25),(34.86±3.99) points,and there were significant differences (t=23.973,32.540,P ＜ 0.05).After intervention,the total score and interest/fun,inner selectivity,subjective ability and stress/strain dimensions of IMI in observation group were positively associated with the score of GSS (r=0.663-0.739,P ＜ 0.05).The total score of IMI was positively associated with the total score of CLVQOL (r=0.765,P ＜ 0.05).In addition,a positive association was observed between the total score and each dimension of CLVQOL and inner selectivity,subjective ability and stress/strain dimensions of the IMI (r=0.661-0.765,P ＜ 0.05).Conclusions A self-management program can improve low vision patients'self-efficacy and quality of life,intrinsic motivation is the important factor influencing the effect of selfmanagement program.

Testicular macrophages and Leydig cells were isolated from rat testis withtrypsin and collagenase treatment respectively.Peritoneal macrophages were obtainedfrom same species by peritoneal cavity lavage.When the testicular macrophages wereco-cultured with Leydig cells,the testosterone secretion was increased and themagnitude of the increased testosterone secretion was directly related to the numberof macrophages added to the cultures(control:6.3?1.5 pmol/10~6 cells,co-culture:9.1?0.9 pmol/10~6 cells,mean?SE,p

Objective To investigate the risk factors of thrombopenia(TP)in septic patients complicated with acute kidney injury (AKI).Methods Two hundred and sixty five septic patients complicated with AKI admitted in Intensive Care Unit ICU of Zhejiang Provincial People''s Hospital during January 2012 and December 2016 were enrolled in the study.The clinical data, results of laboratory tests, Acute Physiology and Chronic Health Evaluation (APACHEII) scores, Sequential Organ Failure Assessment (SOFA) scores, therapeutic intervention, and 28-day mortality were documented.Among 265 patients, TP occurred within 7 days in 112 cases (TP group) and did not occur in 153 cases (non-TP group).Multivariable Logistic regression analysis was performed to analyze the risk factors of TP.Results The 28-day mortality rate in TP group was higher in TP group than that in non-TP group (47.3% vs.33.3%, χ2=5.307,P<0.05).Univariate analysis showed that age, C-reactive protein (CRP), procalcitonin (PCT) and APACHEII score, SOFA score, continuous renal replacement therapy (CRRT), heparin anticoagulation, shock, usage of linezolid and bloodstream infections were associated with TP in septic patients with AKI(all P<0.05).Multivariable Logistic regression analysis showed that age≥65 (OR=4.53, 95%CI 1.23-9.24,P<0.05), CRRT(OR=5.24,95%CI 2.14-14.56,P<0.01), heparin anticoagulation(OR=4.56,95%CI 2.13-8.46,P<0.01), usage of linezolid(OR=2.35,95%CI 1.25-5.24,P<0.01), shock(OR=2.15,95%CI 1.03-4.96,P<0.01)and bloodstream infections(OR=4.26,95%CI 1.36-12.48,P<0.01)were independent risk factors for septic patients with TP.Conclusion For septic patients with AKI having these risk factors, the platelet counts should be closely monitored, and intervention measures should be given to reduce the occurrence of TP.

Objective To explore the acquired deficiencies of vitamin K-dependent coagulation factors in etiology, clinical characteristics and treatment. Methods Retrospective analysis was performed on the data of etiology, clinical manifestations of 45 patients with acquired deficiencies of vitamin K-dependent coagulation factor. All patients were treated with Vitamin K1 10 -40 mg/d, i. v. , for three months. Some patients with severe blooding were additionally treated with fresh freezing plasma or prothromibin complex. Prothrombin time(PT) and activated partial thromboplastic time(APTT) were measured using Stago automatic blood coagulation analyzer before and after treatment. Ⅱ , Ⅶ, Ⅸ and Ⅹ were measured in some patients. Results Among the 45 cases, no certain cause was found in 19 cases (42.2%), anticoagulant rodenticides poison was a common cause ( 11 cases,42.3% ). The main presentations was hemorrhage, the most common bleeding sites were mucosa (77.8%) (35/45)and hematuria (46.7%) ( 21/45 ). After vitamin K1 treatment, PT and APTT had shortened remarkably from ( 110.35 ± 35.36 ) s,(98.91 ±48.98)s to (13.48 ±2. 17)s,(33.25 ±6.95)s,respectively(t=19.10 and 6.19,Ps ＜0.01)and the activities of factor Ⅱ、Ⅶ、Ⅸ、Ⅹ had rapidly increased from ( 17.48 ± 10.93 ) %, ( 10.23 ± 5.68 )%, ( 11.98 ±4.69)%,(12.93±7.48)% to (70. 12 ±21.31)%,(92.76 ±29. 15)%,(88.64 ±40. 21)%,(63.97 ±20.11)%(t=12.13,14.43,13.27and9. 74,respectively,Ps＜0. 01).Conclusions The histories of patients with acquired deficiencies of vitamin K-dependent coagulation factors are usually hiding, therefore it is easily misdiagnosed. It is worth of detecting PT and APTT in diagnosis and monitoring. Using vitamin K1 10 -40 mg/d is effective and safety.