Objective To discuss the clinical distribution and antibiotic resistance of 1909 strains of Pseudomonas aeruginosa(PA)to 19 antibiotics.Methods To collect and isolate clinical specimens from Jan to Dec in 2007,and analysis the drug resistance of 1909 stains of PA.Results The top three departments of infection rnte are Senior Officials inpatient Ward(38.9%),Neurology Department(28.1%)and Pneumology Department(19.58%).The drug with the highest level of antibiotic resistance is Trimethoprin/Sulfa(96.3%),the second one is Tetracycline(95.3%),and drugs with low level antibiotic resistance are imipenem(39.8%),Ceftazidime(29%),Piperacillin/Tazobactam(28%),amikacin(14%),respectively.Conclusion PA is a main pathogenic bacteria for bedridden patients and critically ill patients in ICU.It's important to choose antibiotics reasonably,and it's necessary to acontrol the path of hospital-acquired infection.

Objective to investigate the relationship between CRP,IL-12 and gestational diabetes mellitus.Methods Fifty normal pregnant women (NGT group) and forty with GDM (GDM group) were enrolled in the study.The serum IL-12、fasting blood sugar、CRP were mesured respectively.Results GDM fasting blood glucose,fasting insulin,insulin resistance index (IRI),CRP,IL-12 were higher than those in the control group [(4.95 ± 0.76 vs 4.57 ± 0.58) mmol/L,(13.65 ± 1.74 vs 8.78 ± 1.65) uIU/ml,(2.91 ± 1.05vs 1.72 ± 0.87),(5.56 ± 1.24 vs 3.25 ± 1.13) mg/L,(71.47 ± 4.35 vs 56.03 ± 4.06) PG,/ml,P ＜ 0.05),the results of single factor analysis of CRP showed a positive correlation with IRI (r =0.865,P ＜ 0.05),IL-12 was positively correlated with IRI (r =0.913,P ＜ 0.05).Conclusions Our study show inflammatory cytokins take part in the genesis of gestational diabetes.Serum levels of IL-12 and is one factor in pathogensis of GDM.

Slow coronary flow phenomenon(SCFP) is an angiographic observation characterized by delayed distal vessel opacification in the absence of significant epicardial coronary disease. Only limited studies have been focused on the etiologies, clinical manifestations and treatment of this unique angiographic phenomenon. In our case report, we described an 85-year-old man who came with significant ST segment elevation in leads V1-V4 and V3R-V5R without increase in myocardial enzyme. The patient also developed respiratory failure requiring intubation and mechanical ventilation. Coronary angiography revealed only mild atherosclerosis without spasm or thromboembolic occlusion. Slow flow was seen in all coronary arteries, especially in the left anterior descending and right coronary arteries. This case speculated that transmural myocardial ischemia with ST segment elevation might be resulted from slow coronary flow. Transmural myocardial ischemia can occur owing to abnormalities of the coronary microcirculation.

Objective To study the nosocomial infection in the patients with systemic lupus erythematosus (SLE). Methods A prospective survey of nosocomial infection in 456 cases with SLE was carried out for 84 months.Result Incidence of nosocomial infection in patients with SLE was 36 4%,infection of respiratory tract accounted for 45 2%,infection rates in urinary tract,skin and other regions were 16 0%,12 6% and 26 2% respectively.Gram negative bacilli were the predominant pathogens and the pathogens had higher frequency of multiple antibiotic resistance. Conclusion The factors related to nosocomial infection were the use of broadspectrum antibiotics,prednisone and administration of immunosuppressant,etc.

Objective To study the characteristics of cosmetic dermatosis and to determine the allergens for cosmetic dermatosis. Methods Unwanted effects of cosmetics in the 989 patients were observed and the patch test was performed in all patients with Bianmin standard screening patch test kit. Results Of them 698 (70.58 %) were contact dermatitis, 109 (11.02 %) were hyperpigmentation, and 79 (7.99 %) were acne like lesions. One hundred and eighty-nine kinds of cosmetics were suspected to be responsible for the dermatosis. 653 out of 989 patients tested were positive (66.03%). Conclusions Cosmetic dermatosis such as contact dermatitis and hyperpigmentation can be prevented and cured by guidance of patch test. The patch test should be performed in patients with cosmetic dermatosis.

Objective To evaluate the influence of percutaneous coronary intervention (PCI) on NT-proBNP and Hs-CRP level of the elderly with coronary heart disease. Methods Twenty-four patients who underwent PCI, and thirty patients who underwent coronary angiography (CAG) were enrolled in this study. Plasma NT-proBNP and Hs-CRP concentrations before and at 0, 1 h, 24 h and 72 h after PCI were assayed in all patients. Results There were no significant difference in plasma NT-proBNP level at baseline level between the PCI and CAG group, and also no significant change in the CAG group after the procedure. Plasma NT-proBNP level was increased significantly from 231.31?233.52 pg/mL to the peak concentration of 663.75?614.93 pg/mL at 24 h after PCI. Statistical differences were observed between the baseline levels and at 24 h as well as 72 h after the operation in the PCI group. Plasma NT-proBNP concentrations also showed significant differences between the PCI and CAG group at each time point after the procedures. Remarkable elevation in plasma Hs-CRP level was observed at 72 h after procedure in all patients. Conclusion Elevation of plasma NT-proBNP concontrations might be induced by transient myocardial ischemia in PCI. NT-proBNP may be a marker of myocardial ischemia and may be useful to detect untypical ischemia in the elderly. Plasma Hs-CRP increased at 72 h after PCI and CAG, which may be related to inflammation reaction induced by vessel puncture.

Objective To deepen the understanding about Heyde's syndrome by investigating the clinical characteristics and prognosis of the patients with aortic valve stenosis complicating with gastrointestinal bleeding.Methods Patients with aortic valve stenosis and gastrointestinal bleeding coincidently admitted to our hospital from 2001 to 2011 were retrieved and analyzed.Results In all the 443 157 in-patients,474 patients were diagnosed with aortic valve stenosis (0.11％,474/443 157) and 14 patients (9 males and 5 females,aged 53-87 years old) with gastrointestinal bleeding coincidently (2.95 ％,14/474).Among the 14 patients,3 were moderate aortic valve stenosis,11 severe aortic valve stenosis.The aortic valve peak flow velocity was 324-709 (480.54 ± 188.25) cm/s and the mean aortic valve pressure gradient was 21.04-91.56 (56.93 ± 29.90) mm Hg (1 mm Hg =0.133 kPa).Heavy gastrointestinal bleeding was manifested in all the 14 patients with 1 of haematemesis and 13 of hematochezia.Hemoglobin (Hb) and red blood cell (RBC) count were significantly lower than the normal range [(69 ±28) g/L and (2.71 ±2.04) × 1012/L,P ＜0.05].Their mean corpuscular volume(MCV),mean corpuscular hemoglobin (MCH),mean corpuscular hemoglobin concentration (MCHC),platelet (PLT) count,prothrombin time (PT) and international normalized ratio (INR) were in normal range [(90.21 ± 2.94) r,(29.39 ± 1.99) pg,(327.57 ± 14.82) g/L,(185.13 ±22.55) × 109/L,(11.4 ± 1.04) s and 1.22 ±0.44,respectively].Among all the 14 patients,13 were over 65 years old and they all accepted gastrointestinal imaging (13/14).Vascular malformation of intestine was found in 6 patients with 4 lesions located in descending colon and 2 located in sigmoid colon.Hemorrhage foci were found in 2 patients with one of colon cancer,and another of duodenal ulcer,while no definite hemorrhage foci were found in the other 11 patients.A total of 6 patients with severe aortic valve stenosis underwent aortic valve replacement (AVR) successfully (6/11) and no recurrent gastrointestinal bleeding was ever found.Conservative treatment was performed in the other 5 patients with severe aortic valve stenosis (5/11) and resulted in sudden death in 2 patients (2/5).Conclusions Prompt echocardiography and gastrointestinal endoscopy should be performed in the elderly patients with obscure gastrointestinal bleeding to facilitate the early diagnosis and treatment of Heyde's syndrome.AVR is a fundamental procedure to improve the prognosis of Heyde's syndrome.

Drugs, Chinese Herbal ; Humans ; Rhabdomyolysis

Objective:To assess the consequences of switching aspirin dosage from 100 mg/d to 40 mg/d on cardiovascular benefit,bleeding risk and platelet aggregation in very elderly patients. Methods:Arachidonic acid induced platelet aggregation(AA-Ag)was measured in 537 patients aged 80 or older treated with aspirin (100 mg/d).In the study,100 patients with low on-treatment platelet ag-gregation and at high risk of bleeding and low risk of cardiovascular events,were switched to aspirin (40 mg/d)and their platelet aggregation was measured again 7 days later.Their bleeding and upper gastroin-testinal symptoms were also recorded in following 3 months.Results:The study observed a heterogeneous distributed aspirin 100 mg/d AA-Ag (range:0.42% to 28.78%)in the 537 very elderly patients.Aspi-rin 100 mg/d AA-Ag before the switch in aspirin 40 mg/d group was 5.00% ±2.32% and the rate of the patients with low on-treatment platelet aggregation was 71.00%.The rates of melena or occult blood positive,other minimal bleeding,upper gastrointestinal symptoms and a history of gastrointestinal bleeding in 40 mg/d group were higher than those in 100 mg/d group.On a regimen of aspirin 40 mg/d,AA-Ag increased to 11.21% ±4.95%(range:2.12% to 28.84%)with 95.00%of the patients with AA-Ag<20%and the rate of the patients with low on-treatment platelet aggregation was 15.00%.Multiple vari-able analysis revealed that aspirin 40 mg/d AA-Ag was significantly influenced by aspirin 100 mg/d AA-Ag,BMI and platelet counts.The rate of gastrointestinal bleeding decreased from 12.00% to 5.00%, and upper gastrointestinal symptoms decreased from 59.00% to 21.00% after the switch in 40 mg/d group.Conclusion:Switching aspirin dosage from 100 mg/d to 40 mg/d reduces the bleeding events and improves upper gastrointestinal symptoms,thus inhibiting platelet aggregation effectively in very elderly patients.

Objective To investigate the relationship between peripheral atheroselerosis and coronary heart disease(CHD) in the elderly.MethodsCarotid and femoral intima-media thickness (IMT),total plaque area and carotid total plaque score were measured in 152 elderly inpatients by vascular ultrasound one week before coronary angiography,meanwhile carotid atherosclerosis was classified.The severity of CHD was estimated by the number of vessel lesions and Gensini score. ResultsCarotid and femoral IMT,plaque morbidity,total plaque area and total plaque score were much higher in the patients with CHD than in those without(all P<0.05).Carotid total plaque area,total plaque score,femoral total plaque area and femoral IMT were much higher in the patients with two-vessel lesions[(1.57±0.37)mm~2,(4.595±3.39),(0.51±0.21)mm~2 and (1.07±0.15)mm] or three-vessel lesions [(1.885±0.15) mm~2,(6.67±5.90),(0.59±0.23) mm~2 and (1.15±0.14) mm] than in those with single-vessel lesion [(0.58±0.11 )mm~2,(3.82±2.11),(0.24±0.26) mm~2 and (0.97±0.11)mm,all P<0.05)].There was positive correlation between the classification of carotid atherosclerosis(r= 0.282,P< 0.01),total plaque score (r= 0.307,P < 0.01),total plaque area ( r=0.494,P<0.01) and the number of vessel lesions.There was also positive correlation between carotid total plaque area and Gensini score(r=0.472,P<0.01),between femoral IMT(r=0.415,P<0.01),total plaque area and the number of vessel lesions(r=0.692,P<0.01),and between femoral IMT(r=0.404,P<0.01),total plaque area ( r=0.648,P<0.01 ) and Gensini score.Using multiple stepwise regression analysis,the following parameters were found to be independent predictors of coronary artery Gensini score: carotid total plaque area (OR=2.2; 95% CI:0.79 ～2.46),femoral total plaque area(OR= 1.6;95% CI:O.28～1.35) and femoral IMT (OR=1.6;95% CI:1.20～15.10).Conclusions The assessment of peripheral atherosclerosis by ultrasonography is significantly associated with the prevalence and severity of CHD.