Objective To evaluate the value of plasma N-terminal pro-B-type natriuretic peptide (NT-proBNP),C-reactive protein(CRP) and D-dimer(D-D) in prognosis of elderly patients confined to bed.Methods The clinical data of 150 elderly patients confined to bed were reviewed retrospectively,and 35 patients were in dead group and 115 patients were in survival group.The level o f plasma NT-proBNP,CRP and D-D were measured before treatment,during treatment and after treatment.Their characteristics and dynamic change were analyzed,and the value of NT-proBNP,CRP and D-D was evaluated in prognosis of elderly patients confined to bed.Results The level of NT-proBNP,D-D and CRP in dead group before treatment,during treatment and after treatment were significantly higher than those in survival group (P ＜ 0.05 or ＜ 0.01).The peak level of NT-proBNP,D-D and CRP in dead group emerged after treatment.By the way,the peak level of NT-proBNP,D-D and CRP in survival group emerged before treatment.Incidence of two or three markers positive in dead group [37.1％ (13/35),54.3％ (19/35)] was significantly greater than that in survival group [20.9％ (24/115),8.7％ (10/115)] (P =0.032,0.008).Multivariate Logistic regression analysis showed that the level of NT-proBNP,D-D and CRP were independent predictors of 28-day mortality (P ＜0.05).Conclusions The level of NT-proBNP,CRP and D-D are increased in severe elderly hospitalized patients.The level of above indexes have a dynamic change and reach peak before death.They are the independent prognostic markers of hospital mortality.Combined detection of NT-proBNP,D-D and CRP can improve the predictive value of hospital mortality in elderly patients confined to bed.

BACKGROUND: Both pulse pressure (PP) and aortic stiffness are the predictors of coronary artery disease (CAD). The relationship between aortic PP and atherosclerosis may be bi-directional. Some investigations have tested the relationship between coronary arteriongraphy-diagnosed coronary heart disease and aorta pulse pressure (APP).OBJECTIVE: To observe the relationship between coronary atherosclerosis and APP in patients with primary hypertension.DESIGN: Case control observation.SETTING: Department of Cardiology, Xuanwu Hospital, Capital University of Medical SciencesPARTICIPANTS: A total of 300 patients with primary hypertension who received the treatment in the Department of Cardiology, Xuanwu Hospital, Capital University of Medical Science between July 2002 and January 2005. The patients were all untreated hypertensive patients who were referred for a first diagnostic coronary angiography. All of them met the diagnostic criteria of international hypertensive association. Secondary hypertension, myocardial disease, valvular disease of the heart (VDH), heart failure, liver and renal insufficiency and so on were excluded. The patients, 170 male and 130 female, were aged (61±11 )years. Informed consents were obtained from all the patients.METHODS: A total of 300 untreated hypertensive patients were recruited for a first diagnostic coronary angiography. According to whether having coronary artery disease (CAD), the patients were divided into CAD group (143 in total, 92 male, 64%) and non-CAD group (157 in total, 82 male, 52%). Informed consents were obtained from all the patients.The following data were collected: invasive intra-aortic systolic blood pressure (ASBP) and intra-aortic diastolic blood pressure (ADBP), extent of coronary artery disease, and basic clinical materials of the patients. All the observed index were expressed as Mean±SD. Independent sample t test was used in the comparison between two groups, and P ＜ 0.05was set as significant difference.MAIN OUTCOME MEASURES: ASBP, ADBP and BP, ratio of stroke volume (SV), which reflects aortic stiffness, to aortic pulse pressure (APP); The number of branch and stegnotic extent of coronary artery disease (Cases with stegnotic extent ＜ 50% were included in non-CAD group; Basic clinical indexes and routine biochemical indexes of patients after admission (including fasting blood glucose, serum creatinine, blood lipid and so on).RESULTS: The enrolled 300 patients with hypertension all participated in the result analysis. In the whole population, ASBP and PP were significantly higher in CAD group than non-CAD group [(150.3±26.5) vs. (145.6±23.3) mm Hg, P ＜ 0.05;(77.1±22.7) vs. (70.4±19.3) mm Hg, P ＜ 0.05)]. The ratio of APP to SV in CAD group was markedly higher than that in non-CAD group(1.20±0.44) vs. (0.96±0.33), P ＜ 0.05]. Fasting blood glucose of patients in the CAD group was significantly higher than that in the non-CAD group [(1.38±0.27) vs. (1.08±0.28) mmol/L, P ＜ 0.01]. Serum creatinine of patients in the CAD group was significantly higher than that of non-CAD group [(11.98±2.15) vs. (11.19±1.58) μ mol/L, P ＜0.01]. High-density lipoprotein cholesterol of patients in the CAD group was significantly lower than that in the non-CAD group [(0.54±0.13) vs. (0.62±0.18) mmol/L, P＜ 0.01].CONCLUSION: Atherosclerosis may further aggravate the aortic stiffness and then cause the increase of APP in patients with primary hypertension.

Objective The aim of this study was to assess the distribution histogram of arm circumference (AC) in adult hypertensives in Beijing area, and to establish which size of cuffs is most appropriate in clinical practice. Methods We conducted a cross-sectional survey in a cohort of 424 (male 61.6%) consecutive hypertensives patients. Arm circumference was measured at the mid-point of the right upper arm. Subjects were stratified in three groups: group 1 with AC between 22-26 cm (small size), group 2 AC between 27-34 cm(medium size), and group 3 AC great than 34 cm (large size). Using AC of 32 cm as cutoff point, patients were subdivided as group A (AC

Objective To investigate the satlsfaction of senior outpatients over 60 years old,and explore the factors associated with their satisfaction so as to provide scientific references for improving quality of care at the hospital Methods A questionnaire survey was made by random sampling at the hospital.The outcomes subject to Ordinal regress Results The general satisfaction was as high as 82.77％ among these outpatients.Results of the Ordinal regression model showed seven factors significantly affecting such satisfaction rate,namely waiting time for registration,correct statement of medicine information,patience to hear patient's concerns,carefulness of inspection,time for doctor-patient communication,request for comments on therapy,and outpatient clinic seating conditions.Conclusion Senior outpatients tend to emphasize medical skills and medical service than waiting time at the hospital.This suggests better medical skills and service attitude as key to higher general satisfaction rate of senior outpatients.

Objective To study the drug resistance mechanism and homologous relationship of four clinical strains of carbapen-em-resistant Klebsiella pneumoniae isolated from different sites of the same one patient.Methods Four carbapenem-resistant K .pneumoniae strains were isolated from blood,urine,sputum and pelvic drainage of a patient after cystectomy in clinical mi-crobiology lab of Xinhua Hospital in March 2012.① Modified Hodge test was used to detect the expression of carbapenemase.② PCR amplification assay and DNA sequencing were used to detect resistance-related genes.③ SDS-PAGE analysis was per-formed to analyze outer membrane porin components of the four carbapenem-resistant K .pneumoniae isolates.ERIC-PCR as-say was used to analyze the homology of these carbapenem-resistant isolates.Results Modified Hodge test demonstrated that all the four carbapenem-resistant K.pneumoniae expressed carbapenemase.KPC-2 gene was identified in all the four isolates by PCR test and DNA sequencing.SDS-PAGE analysis indicated an outer membrane porin alteration common to all the four iso-lates which is distinct from that of the strain sensitive to antibiotics.The identical DNA fingerprinting of the four strains was confirmed by ERIC-PCR analysis.Conclusions The antibiotic resistance mechanism of the four carbapenem resistant K.pneu-moniae associated with this case includes the expression of KPC-2 and altered outer membrane permeability induced by abnormal expression of outer membrane porin.These four strains belong to one common clonal group.

Objective: To observe the inhibitory effect of gefitinib combined with DNA vaccine targeting EGFR against implanted Lewis tumors in mice.Methods: Chicken EGFR L2 domain and rabbit IgG Fc domain fusion pVAX1/cEGFR-rFc DNA vaccine was injected into mice and the titer of anti-EGFR in serum was determined by ELISA.The growth of Lewis cells was measured by MTT.Lewis lung cancer mouse models were established and were randomly divided into vaccine,gefitinib,gefitinib+vaccine,and control groups.The tumor volume and weight and survival of mice were examined in different groups.Results: The titer of anti-EGFR in mice vaccinated with pVAX1/cEGFR-rFc plasmid was 1∶1 000.The proliferation of Lewis cells in anti-EGFR combined with gefitinib was significantly inhibited compared with those in anti-EGFR and gefitinib groups(P

Objective To evaluate and compare yeast identification ability between Bruker Microflex matrix-assisted laser desorption ionization-time of flight mass spectrometry( MALDI-TOF MS) and Vitek 2 Compact automatic microbial analysis system.Methods Retrospective study.Totally 742 strains of yeast isolated from clinical specimens during March 2013 to March 2014 in Xinhua Hospital, Shanghai Jiao Tong University School of Medicine were identified by Bruker Microflex MALDI-TOF MS and Vitek 2 Compact automatic microbial analysis system simultaneously.The strains with discordant results were validated by gene sequencing.Results The coincidence rate of 699 Candida identified by Bruker Microflex MALDI-TOF MS or Vitek 2 Compact system was 100.0%(699/699) and 99.6%(696/699) to the species level, respectively and the coincidence rate of 43 yeast-like fungi strains identified was 90.7%(39/43) and 79.1%(34/43) to the species level, respectively.Penicillium marneffei could not be identified by both two instruments, but protein profile of Penicillium marneffei by MALDI-TOF MS was established.Conclusions The coincidence rate of yeast identified by Bruker Microflex MALDI-TOF MS is higher than that of Vitek 2 Compact system.Using Bruker Microflex MALDI-TOF MS to identify yeast especially Candida and yeast-like fungus is fast, simple, low-cost, accurate, and it can be used in routine work of ordinary yeast identification in clinical microbiology laboratory.

Objective To determine the pharmacokinetic parameters of P-methoxybenzyl alcohol from Gastrodiae Rhizoma in plasma of rats by HPLC. Methods Gavage and intravenous injection were employed for administration. HPLC was used to determine the concentrations of P-methoxybenzyl alcohol from Gastrodiae Rhizoma in plasma of rats in different time points. The pharmacokinetic parameters were computed by DAS3.0. Results The linear range of P-methoxybenzyl alcohol in plasma was 0.63-321.17 μg/mL, r 2=0.994 5. Intra-day accuracy, inter-day accuracy, absolute recovery and stability were in specified range. Conclusion The method is simple and accurate for the determination of the pharmacokinetic parameters of P-methoxybenzyl alcohol from Gastrodiae Rhizoma in plasma of rats.

This study is to report the establishment of an UPLC-MS/MS method for the determination of plasma concentration of UA carried in self-microemulsifying drug delivery system (SMEDDS) and its pharmacokinetics in rats. It was used for determination and analysis when serum with internal standard was extracted from C18 solid-phase column. Acquity UPLC BEH C18 column (100 mm x 2.1 mm, 1.7 microm) was used for separation. The mobile phase was acetonitrile -0.1% ammonia with gradient elution at the flow rate of 0.2 mL x min(-1). The column temperature was 40 degrees C and the detection wave length was 210 nm. It was detected by negative ion using electrospray ionization source (ESI) and scanned by multiple reaction ion monitoring (MRM) mode. The liner relationship of UA was very good in the range of 1.19-3 815.00 ng x mL(-1) (r = 0.999 0). Recovery rate of different concentrations were 87.42%-89.95%. The precision of inter-day and intra-day were less than 11%. The method developed in our study was proved to be sensitive, rapid and simple. It is suitable for the pharmacokinetic study of UA-SMEDDS in rats.

Objective To investigate the correlation between atypical respiratory pathogens infection and serum total IgE levels . Methods Serum IgM level was detected in 1 913 blood samples of children with atypical respiratory infection by using indirect im‐munofluorescence assay ,including mycoplasma pneumonia(MP) ,legionella pneumophila (LP) ,rickettsia Q(QFR) ,chlamydia pneu‐monia(CPn) ,adenovirus (Adv) ,respiratory syncytial virus (RSV) ,influenza A virus (IAv) ,influenza B virus (IBv) and parainflu‐enza virus (PIV)1/2/3 .The serum total IgE level was detected by immune scatter turbidimetry .Software SPSS 17 .0 was used in data statistical analysis .Results A total of 991 out of 1 913 samples of respiratory inflected children exhibited positive(positive group) ,while 922 exhibited negative(negative group) in indirect immunofluorescence assay .650 out of the 991 positive samples (65 .59% ) contained MP infection and the combination of MP infection and other virus infections .The serum total IgE level in posi‐tive group was significantly higher than that of the negative group ,and the serum total IgE level in samples with MP infection was higher than that in samples with IBv infection ,Adv infection ,and RSV infection .In the samples in which serum total IgE level was higher than the clinical reference range (100 kU/mL) ,the infection rate of MP infection alone was 31 .29% ,which was evidently higher than that in samples of low IgE level(< 100 kU/mL ,21 .30% ) .On the other hand ,the infection rate of RSV alone was 1 .88% and the infection rate of Adv alone was 3 .13% ,which were both evidently lower than those in samples with normal serum total IgE level(both 6 .53% ) .Conclusion MP is the most common pathogen in children with atypical respiratory pathogen infec‐tion ,and can lead to higher serum total IgE levels .