Objective To investigate the infection and risk factors of multidrug-resistant Pseudomonas aeruginosa in diabetic foot.Methods Totally 85 strains of Pseudomonas aeruginosa were isolated from 428 samples of diabetic foot ulcers in Tianjin Metabolic Diseases Hospital from Jan 2008 to Dec 2010.Drug sensitivity tests were performed and multivariate logistic regression analysis was used to examine the risk factors of multidrug-resistant Pseudomonas aeruginosa infection. Results In 85 strains of Pseudomonas aeruginosa, 28 (32.94％ ) were multidrug resistant. Multidrug-resistant Pseudomonas aeruginosa showed high resistance to 3rd generation cephalosporins,quinolones and aminoglycosides with resistant rates of 42.86％-67.86％,32.14％ -57.57％,and 42.86％-67.86％,respectively. Logistic analysis indicated that previous antibiotic treatments, hypertension and anemia were associated with multidrug-resistant Pseudomonas aeruginosa infection ( OR =5.758,0.257 and 0.270,P =0.006,0.014 and 0.013 ). Conclusion Multidrug-resistant Pseudomonas aeruginosas isolated from diabetic foot are highly resistant to several commonly used antibiotics,and previous antibiotics use,hypertension and anemia are risk factors for multidrug-resistant Pseudomonas aeruginosa infections.

The pharmaceuticals have been playing an important role in insuring human health and stockbreeding for decades. However incompletely absorbed pharmaceuticals will find their way into the wastewater in their original structure or metabolites. The ineffective operation of wastewater-treatment plants makes it possible that the widespread appearance of pharmaceuticals in the aquatic environment. The pharmaceuticals become the kind of "persistent" pollutants in the aquatic environment since they have been widely and continually used in daily life although their half-lives are relatively short. Their occurrences threaten the aquatic ecological safety and human’s health. In recent years, European and North American countries have focused on the research of pharmaceuticals in the aquatic environment, while the related reports are scarce in China. This article comprehensively analyzed and discussed the effects of pharmaceuticals pollution in the aquatic environment on aquatic organism and human health. It will present an important reference for future related research as well as establishing ecological risk assessment of pharmaceuticals in aquatic environment in China.

Objective To investigate the serum expressions and clinical significance of Dickkopf-1 in patients with rheumatoid arthritis (RA). Methods The clinical data of 139 patients with RA were retrospectively analyzed, including the disease history, tender joint count (TJC), swollen joint count (SJC), platelet, erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), rheumatoid factor (RF), anti-nuclear antibody (ANA), antikeratin antibody (AKA), anti-perinuclear factor (APF), anti cyclic citrullinated peptide antibody (anti-CCP), Dickkopf-1 and radiological (X-ray) staging. The disease activity scale (DAS) was evaluated, and the ESR and CRP levels were included. The relationship between Dickkopf-1 and the clinical data of RA, DAS44 score was analyzed. Results The serum level of Dickkopf-1 in patients with RA was (2.70 ± 0.46) μg/L. There was no relationship between serum Dickkopf-1 level and gender, age, course of disease, CRP, platelet, ANA, AKA, APF, RF, radiological staging in patients with RA (P>0.05). The serum Dickkopf-1 level was significantly associated with TJC, SJC, ESR, DAS44-ESR score, DAS44-CRP score and anti-CCP (r = 0.200, 0.291, 0.178, 0.222, 0.199 and 0.278, P = 0.019, 0.001, 0.037, 0.009, 0.028 and 0.012). Conclusions The serum Dickkopf-1 expression level is closely related to the occurrence and development of RA. Dickkopf-1 may contribute to diagnose the disease activity in patients with RA.

Objective To investigate the effect of polyphenol of salvia miltiorrhiza polyphenols combined with collagen sponge in the treatment of diabetic foot.Methods A total of 115 patients with type 2 diabetic foot were randomly divided into treatment group (55 cases) and control group (60 cases).Salvia miltiorrhiza polyphenols and collagen sponge treatment group were treated with conventional treatment plus type 2 diabetes treatment of salvia miltiorrhiza polyphenol combined with collagen sponge;4 weeks as a treatment course, observation of 8 weeks, ulcer and other adverse reactions were recorded and compared.Results After 4 weeks of treatment, 17 cases (30.91%) with 30% or more reduction in foot ulcer area in treatment group,33 cases (60.00%) after 6 weeks treatment and the number of cases with 30% or more reduction in foot ulcer area,49 cases (89.09%) after 8 weeks of treatment, and the number of cases and the proportion of cases with 30% or more decrease of ulcer area in the control group after 4, 6 and 8 weeks were 12(20.00%), 22 (36.67%) and 39 (65.00%).There was no statistical difference between the two groups for the healing time of foot ulcer at three time points.After 8 weeks of treatment, the cure rate was 38.18% in salvia miltiorrhiza polyphenol combined with collagen sponge group. The effective rate was 50.91% and 45.00% for the two groups, the difference was not statistically significant; while the total effective rate was also significantly higher(89.09% vs.65.00%,P<0.01).Conclusion Salvia miltiorrhiza polyphenol combined with collagen sponge has a good effect on diabetic foot treatment, especially it can improve the cure rate, which is superior to the routine therapy.

Objective To investigate the expressions of ALCAM,IL-17RA and PIK3CA in patients with non-small cell lung cancer,and to investigate the correlation between the above-mentioned indexes and patients′ prognosis.Methods A total of 65 patients with non-small cell lung cancer admitted to the third People′s Hospital in Liaocheng City were selected and were served as study objects.Immunohistochemical staining(S-P) method was used to detect the expression of ALCAM,IL-17RA and PIK3CA in tissues to analyze the difference of expression between different pathological parameters.And 65 patients were followed up after the operation to compare the survival time of patients in the negative expression group and the positive expression group,and to analyze the correlation between ALCAM,IL-17RA and PIK3CA and the prognosis of the disease.Results Among the 65 cases of patients,47 cases were positive for ALCAM with the positive rate of 72.3%,34 cases were positive for IL-17RA with the positive rate of 52.3%;31 cases were positive for PIK3CA with the positive rate of 47.7%.There was significant difference in the expression of ALCAM,IL-17RA and PIK3CA in patients with different pathological types,TNM staging and lymph node metastasis(P<0.05).There was no significant statistical difference in the expression of patients with different genders and ages(P>0.05).The median survival time of patients with positive results of ALCAM,IL-17RA and PIK3CA were lower than those of negative group,and the differences were statistically significant(P<0.05).Conclusion The expression of ALCAM,IL-17RA and PIK3CA increased in non-small cell lung cancer tissues to remind the higher degree of malignancy and poor prognosis.

Objective To observe the effects of high glucose and anoxia on Amot expression in vascular endothelial cells (VECs),and explore its role in angiogenesis.Methods VECs were incubated with different glucose concentrations for 48 h,and then cultured at normal oxygen concentration or anaerobic condition for 24 h.The protein expressions of p130-Amot and p80-Amot were detected by Western blot.After Amot expression was downregulated in VECs by siRNA,wound healing experiments and angiogenesis experiments were performed to test the effect of decreased Amot expression on angiogenesis.Results pl30-Amot protein expressions in low glucose (5.5mmol/L) plus normal oxygen group and low glucose plus anaerobic group were higher than those in high glucose (30mmol/L) plus normal oxygen group,high glucose plus anaerobic group,middle glucose (15 mmol/L) plus normal oxygen group,and middle glucose plus anaerobic group (all P＜0.01).Compared with low glucose plus anaerobic group,p130-Amot expression was higher in low glucose plus normal oxygen group (P ＜ 0.01).However,the expression of p80-Amot showed no statistically significant difference among different groups (P＞0.05).Compared to the normal VECs,the cells with decreased Amot expression by siRNA exhibited an attenuated cell migration in the wound healing experiments and a lesser tube formation in the angiogenesis experiments.Conclusions High glucose exerts a more significantly negtive effect on the Amot expression than anoxia in VECs.The downregulation of Amot expression inhibits migration and angiogenesis of VECs.

OBJECTIVE:To investigate the role of clinical pharmacists in the drug treatment of infected patients in neurosur-gery department. METHODS:Clinical pharmacists participated in the formulation of anti-infective treatment plan for a infected case after meningioma surgery. According to drug antibacterial spectrum,result of laboratory and image examinations and disease condition of patients,etc.,the patient was given cefoperazone sodium and sulbactam sodium (3 g,ivgtt,q8 h),rifampicin (0.45 g,ivgtt,q12 h)and vancomycin(1 g,ivgtt,q12 h);the body temperature of the patient increased again and clinical pharmacist suggested meropenem 1 g,ivgtt,q8 h and vancomycin 1 g,ivgtt,q12 h. RESULTS:After 53 d treatment,infection was timely brought under control. The patient was discharged from hospital after improved on 72th day. CONCLUSIONS:Through the partici-pation of clinical pharmacists in pharmaceutical care for anti-infective drug treatment in neurosurgery department contribute to ratio-nal drug use in the clinic and guarantee the safety of drug use.

Objective:To explore the characteristics of type 3 secretion system and biofilm of Pseudomonas aeruginosa in diabetic foot wound, and to analyze the relationship between these factors, as well as to the antibiotic sensitivity.Methods:Thirty-three strains of Pseudomonas aeruginosa were collected from the foot wounds of diabetic foot inpatients in Tianjin Medical University Chu Hsien-I Memorial Hospital from February 1, 2018 to December 31, 2018. Thirteen strains of Pseudomonas aeruginosa were collected from non-diabetic wounds. All strains were tested for antibiotic sensitivity. The virulence genes exoS or exoU of Pseudomonas aeruginosa and the ability of biofilm formation were tested. The characteristics of exoS or exoU and biofilm of Pseudomonas aeruginosa were analyzed. Patients′ clinical outcomes were also analyzed.Results:Pseudomonas aeruginosa with exoS gene was the major pathogen, 90.9% found in diabetic foot group and 84.6% in control group, with no significant difference( χ2=0.54, P=0.46). The drug-resistant strains of Pseudomonas aeruginosa with exoS accounted for 16.7% in diabetic foot group and 18.2% in control group, also with no significant difference( χ2=0.18, P=0.83). There were 5 strains of Pseudomonas aeruginosa carrying exoU, 3 strains in diabetic foot group, of which 1 was resistant, 2 in control group, no resistant strain. Pseudomonas aeruginosa increased the ability of biofilm formation in diabetic foot group, accounting for 57.6%, and for resistant strains, 83.3% of them increased the biofilm formation ability. Two kinds of Pseudomonas aeruginosa produced different biofilms, but they were effectiveless for carbapenem antibiotics. The times of debridement ( P<0.01), time of antibiotic use ( P<0.01) were more in biofilm wound, but the healing rate reached 75%-90%. Conclusion:Pseudomonas aeruginosa secreting ExoS is the main one in the diabetic foot wound. The ability of Pseudomonas aeruginosa to produce biofilm in DF wound is increased. Biofilm is one reason for its antibiotic resistance. Multiple debridement combined with sensitive antibiotics is an effective method to remove biofilm.

Objective To investigate the effect of exercise prescription on foot perfusion and ulcer healing in patients with diabetic foot ulcer (DFU) accompanied with peripheral arterial disease (PAD).Methods Sixty patients with DFU and PAD were divided into exercise group and control group.The patients in the exercise group took exercise therapy training,ensuring that they could follow the exercise prescription.The patients in the control group had no exercise requirements.After the treatment for 12 weeks,ankle brachial index (ABI),transcutaneous oxygen tension (TcPO2),skin temperature,body mass index (BMI),HbA1C,and the ulcer healing rate in the two groups were compared,the satisfaction and compliance in the exercise group were evaluated,and the adverse events of the treatment were recorded.Results After the treatment for 12 weeks,the ABI,TcPO2,and foot skin temperature in the two groups increased and HbA1C decreased(P＜0.05 or P＜0.01).TcPO2 increased 5.25 mm Hg(1 mm Hg=0.133kPa),skin temperature increased 0.45℃,and BMI decreased 0.69 kg/m2 in the exercise group,while TcPO2 increased 2.59 mm Hg,skin temperature increased 0.28℃,and BMI increased 0.02 kg/m2 in the control group,showing significant differences in the three index changes between two groups (P＜0.01).The healing rate in the exercise group was higher than that in the control group (53.6％ vs 25.9％,P ＜0.05).The patients'compliance and satisfaction to the exercise therapy were 90％ and 94％,respectively.The incidence of adverse events in the exercise group had no causal relationship with the exercise prescription.Conclusion The exercise prescription in the study can improve the foot perfusion,and promote ulcer healing.It has the advantage of high safety,patients'compliance and satisfaction.

Objective To observe the outcomes of toe amputations in diabetic patients and to analyze the affecting factors.Methods Two-hundred and forty-five patients were divided into 2 groups:202 cases with the wound healed after toe amputation,and 43 patients whose wound did not heal after toe amputation.The factors related to healing were analyzed.Patients with healed wounds after toe amputations ( n =202 ) were followed,regarding reappearance of new ulcers,reamputations,mortality,activities of daily life,and the affecting factors.Results The rate of wound healing was 82.4％.The rate of follow-up in the healed group was 91.6％.The rates of reappearance of new ulcers after 1,3,and 5 years of observation were 27.3％,57.2％,76.4％,respectively.The rates of reamputations after 1,3,and 5 years of observation were 17.5％,22.3％,47.1％,respectively.The mortality rates by 1,3,and 5 years after the toe amputations were 3.8％,15.1％,32.7％,respectively.Mean survival time of the fatal cases after the first amputation was 3.8 (95％ CI 3.4-4.1 )years.Multivariate analysis showed that HbA1c (＞9％)was an independent predictor of wound healing,reappearance of new ulcers,and reamputations after toe amputations,and age ( ＞ 70 years ) was an independent predictor of reamputations,mortality,and hampered daily activities.Conclusion Despite a satisfactory initial healing process after the first amputation,the long-term outcomes of the followed-up patients are not optimistic.Senile patients are often with poor prognosis,and good blood glucose control may improve the prognosis.