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 value of two-dimensional speckle tracking imaging (2D-STI) in assessing left ventricular global and regional myocardial function in normal rats. Methods Echocardiography was performed during low-dose dobutamine stress in 20 normal adult male Wistar rats. High frame rate of 2D images were recorded from the left ventricular short-axis views at the papillary muscle level. Peak systolic radial strain (PRS) and circumferential strain (PCS) of each segment, left ventricular global peak systolic radial strain (G_(PRS)) and circumferential strain (G_(PCS)) were measured at EchoPAC work station. Left ventricular internal diameter at diastole (LVIDd), systole (LVIDs), fractional shortening (FS) and ejection fraction (EF) were measured with anatomical M-model echocardiography. Dynamic changes of each index during stress experiment were observed. The correlations between EF and left ventricular global two-dimensional strain (G_(PRS), G_(PCS)) were analyzed respectively. Results PRS was similar in all segments of mid-ventricular in short-axis view (P>0.05) at baseline, while PCS of each segment showed heterogeneity, with the anteroseptal and anterior wall showing the largest value and the inferior wall showing the lowest value (P<0.05). G_(PRS), G_(PCS), PRS and PCS of each segment increased correspondingly when the dobutamine dose increasing, as well as FS and EF, whereas LVIDd and LVIDs decreased. When dobutamine dose was 10.0 μg/(kg·min), these parameters were not significantly different compared with those of 5.0 μg/(kg·min) (P>0.05). Conclusion With good reproducibility, 2D-STI can noninvasively and easily assess global and regional left ventricular myocardial deformation of normal rats at rest and during low-dose dobutamine stress.

Objective To study the effect of simvastatin on the mouse model of sclerotic skin. Methods A total of 44 mice were divided into two groups, i.e., early administration group (n=24) and post-induction administration group (n=20), and the former was classified into three subgroups, including negative group, model group and simvastatin-treated group, and the latter into two groups, namely blank control group, simvastatin-treated group. The mouse model of sclerotic skin was established by local injec-tions of bleomycin in the back of BALB/c mice. Simvastatin was administered by gavage at a dose of 5 μg per kilogram body weight per day for 4 weeks to mice at the same time when bleomycin was injected in the early group or after 4-week bleomycin injection in the post-induction group. Skin sections were prepared 24 hours after the last administration of simvastatin for histopathological examination and measurement of derma l thickness with HE staining, determination of hydroxyproline content via colorimetry, and mRNA expression of procollagen α1 (Ⅰ) by RT-PCR. Results In the early administration group, a significant increment was observed in the diameter of dermal collagen, skin thickness, and hydroxyproline content in model group compared with the negative control group (all P <0.01), whereas decreased dermal thickness, hydroxyproline content and mRNA expression of procollagen α1(Ⅰ) were noticed in simvastatin-treated group in comparison with the model group (P<0.05, 0.01 and 0.05, respectively). No obvious improvement was achieved in dermal thickness or hydroxyproline content in simvastatin-treated group compared with blank control group (both P0.05), but the mRNA expression of procollagen α1 (Ⅰ) was inhibited in the former group (P<0.05). Conclusion Skin sclerosis is relieved significantly by administration of simvastatin at the induction of scle- rosis but not by that after the induction of sclerotic skin.

Pharmaceuticals were chosen as the entry point to analyze the status and characteristics of China′s pharmaceutical exports. An export competitiveness evaluation system was comprehensively constructed by selecting the scale, quality and progress of international trade as three dimensions. Net exports, export contribution rate, international market share, display comparative advantage index, competitive advantage index, Michaely index and export advantage growth index as seven indices. In order to avoid the discrepancy caused by the different angles of each index, the indicators were abstracted into two comprehensive ones through principal component analysis, to measure the export competitiveness of the world′s leading countries and regions in pharmaceuticals import and export directly. The result shows that China′s exporting competitiveness of pharmaceuticals ranks the sixth among the 10 major import and export countries in the world. On this basis, dialectical reference is made from Switzerland with strong export competitiveness of pharmaceutical products, in order to promote the long-term development of the export of pharmaceutical products in China.

OBJECTIVE:To study the spatial distribution characteristics of pharmaceutical manufacturing industry in China. METHODS:According to public data of listed company,social network analysis method was used to analyze the data of listed companies in China's pharmaceutical manufacturing industry in respect of network density analysis(including overall network density and individual network density),network centrality analysis,cohesion analysis,core-edge analysis. The discussion and suggestion was put forward. RESULTS & CONCLUSIONS:As of Sept. 30th,2015,there were 168 listed companies of national A share listed pharmaceutical manufacturing industry. Analysis of social network analysis software showed that the density of spatial city association network in China's pharmaceutical manufacturing industry was 0.021 0,and the network was also much dispersed, among which Beijing,Tianjin and Shanghai had the largest individual network. In network centrality analysis,the point outdegree of the whole network was 1.604% and the point indegree was 1.761%. The point outdegree and point indegree of Beijing were all in the forefront. The betweenness centrality of Beijing,Shanghai,Tianjin and Shenzhen was in high level relatively,and the eigenvector centrality of Beijing,Tianjin,Shanghai,Kunming,Shenzhen and Guangzhou was in high level relatively. Results of cohesion analysis were more comprehensive,the cities in the network could be divided into 8 subgroups. The whole network showed a more obvious core-edge feature. So,the coordinated development of China's pharmaceutical manufacturing industry can be promoted by paying attention to play radiation driving role of industrial center city,promoting coordinated development of regional industry and forming industrial agglomeration network.

OBJECTIVETo study the value of ROI A value in the strain ratio and the elasticity scores by the 4-score system in ultrasonic elastography in differential diagnosis of benign and malignant thyroid nodules.

METHODSA total of 124 patients with 166 thyroid nodules underwent examinations with real-time ultrasonic elastography to obtain the elasticity score and the ROI A value in strain ratio. Receiver operating characteristic (ROC) curves were used to assess the diagnostic value of ROI A value, and the best cutoff point was determined. The results of diagnosis based on ROI A value, elasticity scores, and their combination were compared with the results of pathological diagnosis.

RESULTSThe area under the ROC curve (Az) of ROI A value for differentiating benign and malignant thyroid nodules was 0.825. The best diagnostic cut-off point of ROI A value was 0.00165. In differentiating benign and malignant thyroid nodules, the sensitivity, specificity, accuracy and odds ratio were 82.93%, 72.80%, 75.30%, and 13.0 for ROI A value, 87.80%, 80.00%, 81.93%, and 28.8 for the elasticity scores, and 73.17%, 91.20%, 86.75%, and 32.1 for their combination, respectively. The odds ratio of the combined diagnosis was the highest, and the accuracy of the combined diagnosis was significantly higher than that of ROI A value (χ(2)=19.31, P<0.05) and the elasticity scores (χ(2)=12.03, P<0.05).

CONCLUSIONROI A value has moderate diagnostic value and clinical practicability in differentiating thyroid nodules. The diagnostic accuracy of ROI A value can be improved by combining with the elasticity scores.

Adolescent ; Adult ; Aged ; Child ; Child, Preschool ; Diagnosis, Differential ; Elasticity Imaging Techniques ; methods ; Female ; Humans ; Male ; Middle Aged ; ROC Curve ; Thyroid Nodule ; diagnostic imaging ; Young Adult

Objective:To explore the clinical characteristics of malignant tumors with arthritis as the first symptom in children, so as to strengthen the early recognition of juvenile idiopathic arthritis(JIA) and avoid misdiagnosis and treatment.Methods:Nine cases of children with malignant tumor with arthritis as the first symptom were collected from February 2015 to August 2019 in our hospital.The clinical manifestations, laboratory and imaging features of nine cases were analyzed retrospectively.Results:There were nine children, including five males and four females, with an average age of 6.2 years and an average course of 61.4 days.There were seven cases of acute lymphoblastic leukemia(ALL), one case of neuroblastoma(NB) and one case of anaplastic large cell lymphoma(ALCL). Joint symptoms: polyarthritis in four cases and oligoarthritis in five cases.Eight cases had extraarticular symptoms.Nine cases had elevated inflammatory indexes, six cases had mild abnormal blood routine examination, one case was positive for HLA-B27, and other rheumatoid factor, anti CCP antibody, RA33 antibody and antinuclear antibodies spectrum were negative.Bone destruction was found in five cases.There was no significant difference in clinical manifestations and examinations between nine cases of children with malignant tumor and JIA.Conclusion:Arthritis can be the first manifestation of malignant tumor in children.However, JIA lacks specific diagnostic indicators.In clinical practice, malignant tumors with the first manifestation of arthritis can be regarded as JIA and treatment will be delayed.Clinicians need to raise awareness.

Objective:To analyze the relationship between hyperphosphatemia and steroid-sensitive nephrotic syndrome(SSNS)in children.Methods:A retrospective study was carried out in 61 children with SSNS at Department of Paediatric Nephrology and Rheumatism and Immunology, Shandong Provincial Hospital Affiliated to Shandong First Medical University from January 2017 to December 2018.The changes of serum phosphorus levels during the active and remission stages were observed, and the correlation between serum phosphorus level and serum albumin, blood lipid, renal function, blood calcium, blood phosphorus, urine protein and other indicators were analyzed.Results:Serum phosphorus level of 61 children with SSNS was 1.79(1.65-1.91)mmol/L in the active phase of the disease, of which 33 patients(54.1%)had hyperphosphatemia, while serum phosphorus level was 1.64(1.46-1.79)mmol/L after the complete remission, and 15(24.6%)patients had hyperphosphatemia.Serum phosphorus level was positively correlated with ratio of urine protein/creatinine, serum lipoprotein A and calcium-phosphorus product( r=0.239, P<0.05; r=0.188, P<0.05; r=0.623, P<0.05), and negatively correlated with levels of serum albumin and serum calcium( r=-0.201, P<0.05; r=-0.195, P<0.05). Conclusion:The morbidity of hyperphosphatemia in children with SSNS is quite high during the active stage of the disease.The disorder of blood phosphorus significantly improve with remission of the disease.

ABSTRACT OBJECTIVE：To analyze spatial distribution characteristics of pharmaceutical industry in the Yangtze RiverEconomic Belt，and to provide reference for regional pharmaceutical industry planning. METHODS：Based on the central analysis，agglomerated sub group analysis and secondary assignment program analysis of social network analysis，the industrial relevancebetween regional pharmaceutical industry and regional cities were studied（using the image matrix of agglomerated sub group），using regional pharmaceutical enterprises in the Yangtze River Economic Belt as the research object. RESULTS &CONCLUSIONS：The study involved 111 listed pharmaceutical companies in 82 regional cities，and 82 urban nodes formed aregional pharmaceutical industry distribution network，which could generate 8 urban cohesion subgroups，represented by Shanghai，Chengdu and Chongqing；Shanghai and Hangzhou in the Yangtze River Delta，Chengdu and Chongqing in the Chengdu and Chongqing economic circle have more advanced position in network centrality. The centrality of Shanghai was the highest（25.926），followed by Chongqing and Chengdu（both were 19.753）. It shows that the spatial distribution of the pharmaceuticalindustry in the Yangtze River Economic Belt shows a distribution pattern dominated by the Yangtze River Delta urbanagglomeration. At the same time，the Chengdu-Chongqing urban agglomeration also shows a greater influence. The regional citiesplay different roles in industrial development. Chongqing and Taizhou have shown stronger industrial radiation capabilities，while?Shanghai and Hangzhou have shown stronger industrial absorption capacity.