Objective To investigate the distribution and antimicrobial resistance profile of clinical gram-negative bacterial isolates in the First Afifliated Hospital of Nanjing Medical University during 2014.Methods Bacteria identiifcation was performed by API system or the VITEK-2 Compact automatic identiifcation system. Disk diffusion susceptibility testing or VITEK-2 Compact automatic identification system was used to determine the susceptibility to antimicrobial agents. All data were analyzed using WHONET 5.6 software.Results Among the total 7 931 clinical isolates in 2014, gram-negative bacteria accounted for 64.2% (5 088/7 931). The top three pathogens wereE. coli,A. baumannii andK. pneumoniae. Notably, during the year 2014, 195 strains of carbapenem-resistantEnterobacteriaceaewere isolated, about 6.9% of all theEnterobacteriaceae isolates. Meanwhile, 613 (66.5%) strains of multiple drug resistantA. baumannii and 197 (28.7%) strains of multiple drug resistantP. aeruginosa were isolated.Conclusion During the year 2014, the resistance of the gram-negative bacteria in this hospital is mainly characterized by carbapenem-resistantEnterobacteriaceae, multiple drug resistant A. baumanniiand multiple drug resistantP. aeruginosa. Surveillance of antimicrobial resistance is beneifcial for rational use of antibiotics.

Objective:To observe the clinical efficacy and safety of cranial suture acupuncture plus paroxetine in treating depression,and to discuss the action mechanism of this acupuncture method.Methods:One hundred depression patients were allocated to an observation group and a control group according to the random number table,with 50 cases in each group.The control group was intervened by oral administration of paroxetine tablets,20 mg each time,once a day for successive 6 weeks;the observation group was additionally given cranial suture acupuncture,once a day for 6 weeks.They were scored by Hamilton depression scale-17 (HAMD-17) before the treatment and respectively after 1-week,2-week,4-week and 6-week treatment.The clinical efficacy and safety were also observed.Results:After 6-week treatment,the total effective rate was 94.0％ in the observation group versus 78.0％ in the control group,and the between-group difference was statistically significant (P＜0.01).The HAMD-17 scores respectively after 1-week,2-week,4-week and 6-week treatment were significantly lower than the score before the treatment in the observation group (all P＜0.05);the HAMD-17 scores respectively after 2-week,4-week and 6-week treatment were significantly different from the score before the treatment in the control group (all P＜0.05).There were significant differences in the HAMD-17 score between the two groups respectively after 4-week and 6-week treatment (both P＜0.05).Conclusion:Cranial suture acupuncture plus paroxetine can ease the symptoms of depression,with faster onset and more significant therapeutic efficacy compared with paroxetine alone.

OBJECTIVE: To explore the efficacy of blue light-emitting diodes(LEDs) as a novel light source for phototherapy. METHODS: Equimolar bilirubin standard albumin solutions were irradiated with two light sources; LEDs and single side conventional blue light( sCBL). Light intensity was measured with a light meter. The emission intensity of LEDs was the same as sCBL. To estimate the effects of the two light sources, the change in bilirubin isomer before and during phtotherapy was determined using high-performance liquid chromatography. RESULTS: The effects of different light sources on equimolar bilirubin standard albumin solutions, the lumirubin (LR) and 4Z, 15E-Bilirubin IX alpha(ZE) formation of LEDs was the same as sCBL(P>0.05). CONCLUSION: LEDs is equally effective as single sCBL for phototherapy in vitro.

OBJECTIVETo analyze the existence and the dynamic cell frequencies of human cells in goats transplanted in utero with human hematopoietic stem cell (hHSC) by using fluorescence in situ hybridization (FISH) technique.

METHODSInterphase FISH (IFISH) with human-specific 17-chromosome satellite DNA and/or human-specific Y-chromosome satellite DNA as probes was performed to analyze the presence and proportions of human cells in 13 transplanted goats. Samples were peripheral blood cells, bone marrow smears and liver touch imprint preparations.

RESULTSOf the 13 transplanted goats, eleven were identified to present human cells. Among them, two goats transplanted with human male HSC were found to have human male cells. The results demonstrated that these transplanted goats were human/goat HSC xenogeneic chimeras. Human cell frequencies decreased with the goat age (months), but the longest survival reached 21 months. During the detected life periods of goats, human cell frequencies in peripheral blood, bone marrow and liver tissues were less than 1@1000, but local human cell frequencies of 207.92@1000 and 392.41@1000 were detected in the liver tissues of 2 transplanted goats.

CONCLUSIONSThe existence and long-term survival of human cells in transplanted goats detected by FISH indicated that goats were appropriate recipients for hHSC in utero transplantation. The lower human cell frequencies in blood and bone marrow, and the higher local human cell frequencies in liver tissues suggested that the microenvironment of goat liver tissues might favor the survival, proliferation and differentiation of human cells.

Animals ; Female ; Goats ; Hematopoietic Stem Cell Transplantation ; Humans ; In Situ Hybridization, Fluorescence ; Male ; Transplantation, Heterologous ; Uterus ; surgery

Objective To examine the expression of miR-210,miR-155 and miR-34a in the peripheral blood of patients with systemic lupus erythematosus (SLE) and to analyze their clinical significance.Methods One hundred and teenty-six SLE patients were divided into the stable group (n=35),mild active group (n=49),medium and severe active group (n =42) based on systemic lupus erythematosus disease activity index (SLEDAI) score.Meanwhile,40 subjects for healthy check-up were selected as controls.The clinical data of patients were collected.Complete blood count,liver and kidney function and immunological indexes were tested in patients and the lupus activity index was assessed.The expression level of miR-210,miR-155 and miR-34a were determined by real-time polymerase chain reaction.Furthermore,the correlation between their levels and clinical parameters such as erythrocyte sedimentation rate (ESR),C-reactive protein (CRP),SLEDAI score,were analyzed.The expression levels of miR-210,miR-155 and miR-34a in each group were compared by one-way analysis of variance (ANOVA).Correlation analysis was performed by non parametric Spearman test.The difference was statistically significant if P＜0.05.The diagnostic value of SLE was evaluated by the subjects characteristic (ROC) curve.Results The levels of miR-210 and miR-155 were no significantly differencet between the stable group (0.017±0.012);(0.150±0.101) and the control group (0.015±0.010);(0.071±0.034),but they were increased in mild active group (0.502±0.166);(1.521±1.138),medium and severe active group(1.237±0.584),(13.589±9.827) (F=124.321,70.065,P＜0.05).The average expression level of miR-34a in the control group,the stable group,the mild active group and the moderate and severe active group were (0.005±0.003),(0.249±0.137),(2.981±1.762) and (9.625±5.873) respectively,and showed a trend of increase in turn (F=75.688,P＜0.05).The expression level of miR-210,miR-155 and miR-34a was not significantly different between the LN group and the non LN group (P＞0.05).The R values of miR-210,miR-155,miR-34a and each index were IgG (0.347;0.518;0.482);IgA (0.463;0.635;0.379);IgM (0.287;0.392;0.336),ESR(0.317;0.428;0.369),C3(0.243;0.429;0.381),C4(0.317;0.513;0.429),ANA titer (0.462;0.594;0.527),Anti-ds-DNA antibodies (0.391;0.586;0.483),SLEDAI scores (-0.412;-0.558;-0.493),and there were significant correlations (P＜0.05).In patients with SLE,there was no significant correlation between hormone therapy alone or hormone plus immunosuppressive therapy (P＞0.05).The sensitivity and specificity of miR-210,miR-155,miR-34a in combination for the diagnosis of SLE reached 75.7％ and 72.3％,respectively.Conclusion The levels of miR-210,miR-155 and miR-34a in combination may be used as bio-markers for the diagnosis of SLE.

OBJECTIVE: To investigate the clinical characteristics and genetic variant in a Chinese pedigree affected with thiamine pyrophosphokinase deficiency (TPKD). METHODS: Clinical data of the pedigree were analyzed retrospectively and summarized from the perspectives of clinical manifestation, magnetic resonance imaging (MRI), and genotype. Relevant literature was also reviewed. RESULTS: The proband, a female, has developed paroxysmal ataxia with dystonia at the age of 2-year-and-8-month. The ataxia has recurred for 7-8 times. The child had died at 11 years old due to recurrence and aggravation of the disease. MRI showed diffuse symmetrical lesions of brain parenchyma and spinal cord. Her brother had similar symptoms and died at 6. The parents were consanguineous but healthy. Genetic testing revealed that the girl has carried homozygous c.161C>T variants of the TPK1 gene, suggesting the diagnosis of TPKD. So far 15 cases of TPKD have been reported, among which 9 were from consanguineous marriages. The disease usually occurs before the age of 3, and most patients had featured paroxysmal encephalopathy and recurrent infections. Symmetrical celebral cortex, basal ganglia and cerebellum lesions were common. Missense mutations of the TPK1 gene were common. Vitamin B1 was effective in some cases. CONCLUSION For infants featuring encephalopathy, ataxia, dystonia and other phenotypes, early genetic testing should be recommended in order to provide guidance for clinical treatment and genetic counseling.
Child ; China ; Female ; Genetic Testing ; Humans ; Infant ; Magnetic Resonance Imaging ; Male ; Mutation ; Pedigree ; Retrospective Studies ; Thiamin Pyrophosphokinase/genetics*

OBJECTIVE: To compare the agreement of anterior chamber angle examination by ultrasound biomicroscope (UBM), slit lamp optical coherence tomography (SL-OCT), and gonioscopy in angle recession and angle closure. METHODS: The anterior chamber angle was measured with UBM, SL-OCT and gonioscopy in turns for temporal, nasal, superior and inferior quadrant in the same dark room. The results were compared with the agreement of the three methods in angle recession and angle closure by χ2 test and Kappa test. RESULTS: There were no statistically significant differences of the three methods in testing angle closure and angle recession (P>0.05). The consistency of UBM and gonioscopy was better (Kappa value of 0.882) than that of SL-OCT and gonioscopy (Kappa value of 0.624). CONCLUSION When testing angle recession, UBM is better than SL-OCT with gonioscopy as the standard. When testing angle closure, UBM, SL-OCT and gonioscopy have good agreement.
Anterior Chamber ; Glaucoma, Angle-Closure ; Gonioscopy ; Humans ; Intraocular Pressure ; Microscopy, Acoustic ; Slit Lamp ; Tomography, Optical Coherence

OBJECTIVEMedically unexplained dyspnea is common in adult and accounts for 14% patients complaining of dyspnea. Its occurrence in children is seldom recognized. In the present paper, 34 children with medically unexplained dyspnea (age 10 to 18 years) seen in Peking Union Medical College Hospital from 1996 to 2002 are reported.

METHODSThe diagnosis of medically unexplained dyspnea was clinical: it was based on the presence of dyspnea and other complaints which cannot be explained by an organic disease. The patients answered Nijmegen questionnaire and state and trait anxiety (STAI), and performed hyperventilation provocation test. Twenty sessions of breathing therapy were applied and 13 out of 34 children were followed up after the therapy.

RESULTSAmong the children, 75% started to have symptoms at the age of 13 to 16 years, though the age of first episode could be as early as 8 years. In most of the cases, the course was chronic clinically. In addition to marked dyspnea, their clinical profile included symptoms of hyperventilation i.e. blurred vision, dizziness, tingling, stiff fingers or arm. The symptoms of anxiety were less frequent in children and accordingly the level of anxiety evaluated by means of STAI was lower in children compared to adult patients. The precipitating psychological factors appeared to be related to middle school competition. Pressure from exams, reprimand from stern and unsympathetic teachers coupled with high parental expectation could be emotionally damaging to psychologically susceptible children. Thirteen patients were followed up after 2-3 months of breathing therapy with emphasis on abdominal breathing and slowing down of expiration. After therapy, the sum score of the Nijmegen Questionnaire was markedly decreased. Dyspnea and symptoms of hyperventilation were improved. The level of anxiety was minimally modified.

CONCLUSIONThe cases illustrated the need for careful diagnostic evaluation and treatment because of the high rate of chronicity of the disorder.

Adolescent ; Child ; Dyspnea ; etiology ; pathology ; therapy ; Female ; Humans ; Hyperventilation ; Male ; Prognosis ; Treatment Outcome

In accordance with the theory of'treating the skin diseases with the skin',skin-related Chinese medicinals are usually used for the treatment of skin diseases,which reflects the thinking mode of holistic syndrome differentiation and classification according to the manifestations in traditional Chinese medicine.With ying-yang theory as the principle of differentiation and treatment of diseases and based on the core pathogenesis of'yin-yang imbalance causing the manifestations of the skin'for the skin diseases,Chinese medical master XU AN Guo-Wei has used skin-related Chinese medicinals in the treatment of skin diseases and has given full play to their unique advantage by following the theory of'treating the skin diseases with the skin'and'balanced regulation of yin and yang'.In the clinical practice,allergic skin diseases were usually treated with Cicadae Periostracum plus Dictamni Cortex for dispelling wind and relieving itching,hypopigmentation related skin diseases were usually treated with Sojae Semen Nigrum skin plus Dictamni Cortex for dispelling wind and tonifying kidney,autoimmune skin diseases were usually treated with Moutan Cortex plus Lycii Cortex for nourishing yin,clearing heat and activating blood,and skin diseases associated with abnormal sebum secretion were usually treated with Mori Cortex plus Lycii Cortex for purging lung and nourishing kidney.Skin-related Chinese medicinals have the actions of expelling wind and promoting eruption of papules,tonifying kidney and nourishing yin.The medication method of'treating the skin diseases with the skin'will provide reference for the treatment of skin diseases.

Objective The aim of this study was to assess the long-term clinical outcome of patients with diabetes mellitus and chronic total occlusion ( CTO) underwent drug-eluting stents ( DES) implantation. Methods Data of 143 consecutive eligible patients from January, 2006 to May, 2007 were retrospectively analyzed. The endpoint of the study was the major adverse cardiac events ( MACE) , including death, myocardial infarction, target lesion revascularization. The patients were divided into two groups, event group and non-event group, according to the result of follow-up. Results Long-term follow-up was finished in 139 (97.2% ) patients. Mean follow-up duration was (19. 8 ±5. 1) months. MACE rate was 10.5% during follow-up: 3 deaths, 1 myocardial infarction and 11 repeated target lesion revascularization with PCI. Compared with the non-event group, the percentage of residual lesion [(17. 7 ± 1.8)% vs. (15. 4±5. 0)% ,P =0. 001] was significantly higher in the event group, however, the final minimal luminal diameter [(2. 14 ±0. 22)% vs. (2. 89 ±0. 37)% ,P = 0. 004] was lower. Cox regression analysis showed that final luminal diameter (OR; 0.097, 95% Cl; 0. 013-0. 694, P = 0.020) was the only dependant predictor at follow-up. Conclusion Final minimal luminal diameter is an independent predictor of MACE during follow-up for patients with diabetes and CTO underwent DES implantation.