Objective To investigate the serotype distribution and antimicrobial resistance of the S.pneumoniae strains isolated from children in Humen,and evaluate coverage of the serotypes by several vaccines,especially PCV7.Methods A total of 229 S.pneumoniae strains were isolated from the children treated in our hospital during January 2011 and December 2012. Capsular typing was performed by Quellung reaction.Antimicrobial susceptibility was determined by ATB STREP 5.The data were analyzed by WHONET 5.5 software according to CLSI 2010 breakpoints.Results The main serotypes identified from the 229 S.pneumoniae strains were 19F (146,63.8%),23F (49,21.4%),6B (12,5.2%)and 14 (8,3.5%).The coverage of these serotypes was 95.2% by PCV7,95.2% by PCV11,and 97.4% by PCV13.Of all the S.pneumoniae strains,penicillin susceptible S.pneumoniae (PSSP)accounted for 92.6% (212/229),penicillin intermediate S.pneumoniae (PISP)accounted for 5.7% (13/229)and penicillin resistant S.pneumoniae (PRSP)accounted for 1.7% (4/229).About 95.6%,93.0%, 88.2%,86.5%, 7.0%, 2.2% and 0.9% of the isolates were resistant to erythromycin, clindamycin, tetracycline, trimethoprim-sulfamethoxazole,chloramphenicol,cefotaxime and amoxicillin,respectively.No strain was found resistant to vancomycin or levofloxacin.Conclusions The serotypes 19F, 23F, 6B and 14 are the main prevalent serotypes of S. pneumoniae in children in Humen.PCV7 could cover 95.2% of these S.pneumoniae,indicating its appropriateness for vaccination in Humen area.These S.pneumoniae strains were highly sensitive to vancomycin,levofloxacin and penicillin,but relatively more resistant to erythromycin, clindamycin, tetracycline and trimethoprim-sulfamethoxazole.

The differential diagnosis of inguinal and scrotal emergencies in children is difficult and misdiagnosis might be associated with danger or even mortality.Early diagnosis and proper treatment are very important and explorational surgery should be carried out when diagnosis is in doubt.

The elements in blood or serum, including calcium, magnesium, copper, zinc, chromium, manganese, nickel, selenium, lead and cadmium were determined in the normal and patients in Nanjing by atomic absorption spectrophotometry. The method used was proved to be reliable being checked by the reference bovine serum and the data obtained in this paper was coincident with those reported by the other authors previously. The relationship between the concentrations of elements and the ages as well as the sexes in the normal was discussed briefly. The concentrations of several of the elements of the patients were significantly different from those of the normal in the same ages.

Objective To study the relationship between cytokine gene polymorphisms and chronic rejection in kidney allograft recipients and their donors.Methods The cytokine genotypes in- cluding TNF-?,IL-6,IL-10,TGF-?_1 and IFN-?in 144 consecutive first cadaveric kidney allograft re- cipients and 65 corresponding donors were detected by PCR-SSP method.The recipients were followed up for 5 years.The relationship between the TGF-?_1 genotypes of the recipients and donors and the chronic renal allograft rejection was analyzed.Results The incidence of chronic rejection in the recipi- ents with TGF-?_1 high producer genotype(39/91,42.9%)was significantly higher than in those with TGF-?_1 middle or low producer genotype(9/53,17.0%,P0.05).The incidence of chronic rejection in the recipients and donors with TGF-?_1 high producer genotype(4/4)was significantly higher than in those with other genotypes(31/110,28.2%,P

Objective To discuss the clinical curative effects of Kaihoujian spray in the treatment of acute suppurative tonsillitis in children. Methods 120 cases of pediatric patients with acute suppurative tonsillitis were selected and randomly divided into the observation group and the control group (60 cases in each group); the control group were given conventional western medicine treatment, while the observation group received Kaihoujian spray on the basis of the control group treatment; clinical symptoms and curative effects of the two groups were evaluated and compared. Results In the observation group, sore throat and fever disappearance time, purulent secretion, tonsil swelling disappearance time and hemogram recovery time were all significantly shorter than those in the control group (P<0.05); after 3 courses of treatment, in the two groups, children temperature, sore throat, tonsil fester and tonsil swollen main symptom scores were all significantly decreased (P<0.05), but the observation group decreased more obviously (all P<0.05). After treatment, C-reactive protein, white blood cell count, neutrophils of the two groups all significantly reduced (P < 0.05), but the observation group decreased more obviously (all P<0.05). Conclusion Using Kaihoujian spray to treat acute suppurative tonsillitis could significantly improve the clinical symptoms and signs, whose clinical curative effect is good, and has no adverse reactions.

Objective To investigate the incidence and its related factors of apathy in patients with acute ischemic stroke. Methods A total of 100 consecutive cases of ischemic stroke patients and 50 health controls were recruited in the present study. Apathy was assessed using modified apathy evaluation scale (MAES). According to the MAES score, acute ischemic stroke patients were divided into apathy group (MAES was more than 14 points) and non-apathy group. The differences of general information, clinical data, national institutes of health stroke scale (NIHSS), Montreal cognitive assessment (MoCA), Hamilton depression scale (HAMD), modified rankin scale (mRS) and the lesion location were compared between the two groups. Differences that showed statistical significance (P<0.05) went into the multi-factor analysis. The Logistic regression analysis was used to estimate the influence factors of apathy. Results There were 34 cases of apathy in patient group (34.00%), which was significantly higher than those of control group (3 cases of apathy, 6.00%, P<0.001). The age, incidence of diabetes, NIHSS score, HAMD score, lesions in brain stem and multiple lesions were significantly higher in apathy group than that of non-apathy group, while educational level, MoCA score were significantly lower ( P<0.05). The Logistic regression analysis showed that the higher MoCA score was a protective factor for apathy, while higher NIHSS score, lesions in brain stem and multiple lesions were risk factors for the incidence apathy. Conclusion The cognitive impairment, severity of neurological deficits, brainstem lesions and multiple lesions may be the risk factors of apathy after the occurrence of acute ischemic stroke.

Objective To investigate the clinical significance of WT1 gene expression in the urine. Methods The expression of WT1 gene in the urine of patients with chronic glomerular nephritis(CGN), rheumatic diseases,diabetes mellitus(DM) and healthy subjects was detected by semi-nested PCR. Results The positive rates of WT1 gene expression in CGN with proteinuria,DM with proteinuria, DM without proteinuria and rheumatic diseases were 46.7% (14/30),44.4% (16/36),5.95% (5/84) and 16%(4/25), respectively. WT1 expression in the urine was not related to the degree of proteinuria, hematuria, renal function or clinical course of diseases. WT1 expression in the urine of the healthy subjects or cystitis patients was negative. Conclusion The measurement of WT1 mRNA in the urine could play an important role in early diagnosis of progressive renal damage.

Objective To investigate the application of endovascular distal parent artery occlusion in vertebral artery dissecting aneurysms involving the posterior inferior cerebellar artery.Methods The clinical and follow-up data of 5 patients with vertebral artery dissecting aneurysms involving the posterior inferior cerebellar artery who received the endovascular distal parent artery occlusion were retrospectively analyzed.Results Complete occlusion of dissected arterial and aneurysm segments was achieved in 4 patients.After followed up 6-12 months,angiography showed no recurrence or neurological deficit.Continued filling of the dissected aneurysm was observed in 1 patient's follow-up angiography,but without rehaemorrhagia or neurological deficit.Conclusions The endovascular distal parent artery occlusion is a safe and efficient choice for treating vertebral artery dissecting aneurysms involving the posterior inferior cerebellar artery,which keeps the posterior inferior cerebellar artery flowing unobstructed while clipping the dissecting aneurysm.

Objective To study the effect of wild type p53 gene on centrosome hyperamplification in bladder cancer cells.Methods A wild type p53 gene recombinant adenovirus vector AdCMVp53 was constructed,and then trangfected into the human bladder cancer cell line T24.The cells were stained with the monoclonal antibody against pericentrin by indirect immunofluorescence method.The change of centrosome hyperamplification was observed under the fluorescence microspcope.Results Introduction of wild type p53 could suppress the centrosome amplification of T24 cell line.Conclusion p53 might play an important role in the regulation of centrosome hyperamplification.The loss of p53 might be one of the mechanisms involved in chromosome instability and contribute to the genesis and development of the bladder carcinoma.

Objective The modified Blalock-Taussig shunt (MBTS) is considered a low-risk management option for palliation in patients with severely cyanotic heart anomalies in advanced heart centers in western countries.But the morbidity and mortality associated with MBTS remains challenge in developing countries.Methods 106 patients with severely cyanotic complex heart anomalies underwent 110 modified Blalock-Taussig shunts(B-T shunts) between October 2000 and August 2012.The mean age was (3.8 ± 1.1) months (1 day-37.2 months).The mean weight of the babies was (5.0 ± 2.1) kg (2.3 kg-12.0 k g).The cardiac anatomy was as follows:pulmonary atresia with intact ventricular septum in 25,pulmonary atresia with ventricular septum defects in 45,tricuspid atresia in 11,tetralogy of Fallot in 7,complex single ventricle physiology in 18.All patients were deeply cyanotic,and preoperative prostaglandin E1 was needed in 78 patients to ensure ductus patent and maintain oxygen saturations prior to the shunt operation.The shunts were accomplished with 3.0 mm polytetrafluoroethylene grafts in 8 patients,3.5 mm in 11,4 mm in 65,5mm in 26.Results The duration of mechanical ventilation was 4 hours-7 days,cardiac intensive care unit stay was 1-12 days,hospital stay after operation was 1-18 days.There were 3 deaths (2.6％),immediate post-operative shunt block in 1,severe hypoxidosis in 1 and heart failure in 1.Oxygen saturation increased from 68.5％ preoperatively to 79.2％ postoperatively.Four patients had shunt block,additional shunt was created respectively.There was 2 late death.Follow-up of 94 patients revealed satisfactory systemic oxygen saturation of 0.81 ± 0.10 (0.63-0.92).86 cases received further operations,including 7 in TOF radical operation,31 in Rastelli,25 in Glenn,18 in Fontan.Conclusion With an encouraging early shunt patent rate and oxygen saturation increasing,we can now adopt MBTS as an alternative in patients with severely cyanotic heart anomalies.Modified B-T shunt is a good palliation for patients with cyanoti cheart anomalies,which can increase pulmonary blood flow.Excellent surgical skills and perioperative treatment contribute to good operation results,and to low morbidity and low mortality.