Objective To evaluate the immediate results and the 6 month angiographic restenosis rate after repeat percutaneous intervention for in stent restenosis (ISR) Methods The acute and 6 month follow up outcomes of 156 patients with ISR who were treated by repeat PTCA or stenting were analyzed in this retrospective study Quantitative coronary angiography analyses (QCA) were performed before and after repeat intervention for in stent restenosis and on a average 6 month coronary angiogram to assess the recurrent restenosis rate Results All the patients were treated successfully Balloon angioplasty was performed in 134 patients (85 9%) and repeat stenting in 22 patients (14 1%) The six month follow up coronary angiogram showed the recurrent restenosis rate was 24 3% The recurrent restenosis rate was higher in 40 diffuse ISR lesions than that in 96 focal ISR lesions: 45% vs 18%, P75% was also the risk factor of recurrent restenosis Conclusion For the most patients with ISR, repeat PTCA or intracoronary stenting seems to be an effective and safe method The overall restenosis rate after repeat intervention for ISR is the same as that of initial intracoronary stenting

OBJECTIVE To investigate the relationship between phenotypes and genotypes of clinical isolates of ESBLs-producing Klebsiella pneumoniae.METHODS Agar dilution method was used to test the MICs of 11 antibiotics against 67 ESBLs-producing K.pneumoniae strains.PCR was performed for amplifying ?-lactamase-encoding genes of SHV-,TEM-,and CTX-M-type,and the PCR products of some strains were cloned and sequenced to identify their gene serotypes.RESULTS With no imipenem-resistant strains among 67 strains,their resistant rates to 10 kinds of antibiotics were 10.45-89.55% The cross-resistant rates to aminoglycosides of 60 strains and to ?-lactams of 44 strains were 88.33% and 40.91%,respectively.The positive rates of SHV-,TEM-,and CTX-M-type for 67 strains were 91.04%,56.72% and 28.36%,respectively,and SHV-12,TEM-1 and CTX-M-3 genotypes were found in 7 strains by cloning and sequencing.CONCLUSIONS Sixty seven strains of ESBLs-producing K.pneumoniae present a clear feature of multi-resistance and cross-resistance to most of antibiotics except imipenem,among them there are 7 strains producing SHV-12 and CTX-M-3 extended-spectrum ?-lactamase coexistent with TEM-1 broad-spectrum ?-lactamase.

Objective To investigate the prevalence of feeding intolerance (FI),and to explore the FI within 7 days of ICU admission in association with clinical outcome in critically ill patients.Methods The adult patients from 14 general ICUs in Zhejiang Province with an expected admission to ICU for at least 24h were recruited from March 2014 to August 2014,and all clinical,laboratory,and survival data were prospectively collected.The AGI (acute gastrointestinal injury) grade was daily assessed based on gastrointestinal (GI) symptoms,feeding details and organ dysfunction within the first week of ICU stay.The intra-abdominal pressures (IAP) was measured using AbViser device.Results Of 550 patients enrolled,418 were assessed in GI symptoms and feeding details within 7 days of ICU stay.The mean age and SOFA score were (65.1 ± 18.3) years and (8.96 ±4.10),respectively.Of them,355 patients (84.9％) were under mechanical ventilation support,and 37 (8.85％) received renal replacement therapy.The mean length of time for enteral feeding was (30.8 ±26.2) h,and the prevalence of FI on the 3rd and 7th day of ICU stay accounted for 39.2％ and 25.4％,respectively.Compared to those with FI within 7 days of ICU stay,the patients without FI had higher rate of successively weaning from mechanical ventilation (21.3％ vs.5.7％,P =0.003) and higher rate of withdrawal of vasoactive medication (45.5％ vs.20.0％,P =0.037),as well as lower mortality rate of 28-day (24.4％ vs.38.7％,P =0.004) and 60-day (29.6％ vs.44.3％,P =0.005).In multivariate Cox regression model with adjustment for age,sex,participant center,serum creatinine and lactate,AGI grade on the first day of ICU stay,and comorbidities,the FI within 7 days of ICU stay (x2 ≥ 7.24,P ＜ 0.01) remained to be independent predictors for 60-day mortality.After further adjusted for SOFA score,the FI within 7 days of ICU stay (HR =1.71,95％ CI:1.18-2.49;P =0.006) and AGI grade on the first day of ICU stay (HR =1.33,95 ％ CI:1.07-1.65;P =0.009) could provide independent prognostic values of 60-day mortality.Conclusions There is high rate of FI occurred within 7 days of ICU stay,and is significantly associated with worse outcome.In addition,this study also provides evidence to further support that measurement of gastrointestinal dysfunction could increase value of SOFA score in outcome prediction for the risk of 60-day mortality.