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.

The occurrence and development of cognitive impairment after stroke has a serious impact on the life ability and quality of life of patients, prolonging the rehabilitation cycle of patients, and increasing the burden of patients and their families. This paper summarizes the main factors that affect the cognitive impairment of post-stroke patients, including demographic factors, lifestyle, disease-related factors, psychological factors, cognitive intervention factors, and social support factors, which provide reference for the development of prevention programs of cognitive impairment after stroke.

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 investigate the status of follow-up service of discharged patients from ClassⅡ or ClassⅢ comprehensive hospitals in China. Methods? In June 2018, we selected 150 clinical departments and 228 nurses of 89 ClassⅡ or ClassⅢ comprehensive hospitals in 17 provinces, Municipality and autonomous regions by convenience sampling. The self-designed questionnaire was used to investigate the ways, contents, existing problems and suggestions of follow-up of discharged patients. Results? Follow-up service was mainly carried out by nurses including ward primary nurses and full-time nurses. Besides, the follow-up was mainly with the telephone follow-up, and its content tended to disease health education and consultation. The main existing problems of discharged patients in follow-up service were "follow-up form was too simple and lacking specialty characteristics", "follow-up way was single and follow-up effects were unsatisfactory", "human resources limits and lack of special follow-up staff", "follow-up effects lacking aggregate and analysis" and"nursing problems existing in follow-up lacking following and evaluation". Nurses suggested that "aggregate as well as feedback of follow-up data should be done regularly", "increase follow-up center unified management for discharged patients", "follow-up form should reflect specialty characteristics" and "develop multidisciplinary teamwork". Conclusions? Follow-up service has great significance for improving rehabilitation and quality of life among discharged patients. There are a lot of problems in follow-up service system for discharged patients. We should perfect the common discharged follow-up forms applied to specialties, construct multidisciplinary support platforms and make follow-up management system scientific and informative.

Objective? To investigate the significance,evaluation methods and blocking factors of evaluating continuous care for stroke, and to explore the evaluation strategies, so as to provide reference to improve and standardize the effect evaluation of continuous care for stroke. Methods? By convenience sampling, 125 nursing staff from 60 communities, 15 regions in Shanghai were selected in October of 2018 as the research objects, the self-designed questionnaires: Significance of Evaluation of Continuous Care for Stroke, Effect Evaluation of Continuous Care for Stroke Questionnaire, Blocking Factors of Effect Evaluation Questionnaire were used in the investigation, SPSS 20.0 software was used to analyze the data. Results? The top three most-chosen items in Significance of Evaluation of Continuous Care for Stroke were:"improving the ability of family nursing" (92.0%,115/125), "promoting the improvement and improvement of nursing quality"(86.4%,108/125) and "promoting patient's disease self-monitoring" (80.8%,101/125); in the Importance of Evaluation Content of Continuous Care for Stroke, the dimensions ranked from high to low were:"health outcome of patients" (4.63±0.43), "the outcome of caregivers" (4.58±0.51), and "the implementation rate of nursing services" (4.56±0.46); in the aspect of evaluation subjects, 74.4% of nursing staff thought that it should be evaluated by specialist nurses, 32.0% by quality control staff and 26.4% by patients; the main blocking factors of effect evaluation were: "shortage of human resources" (96.0%,120/125), "heavy workload" (88.0%, 110/125) and "patients' and family members' noncooperation"(81.6%,102/125). Conclusions? The evaluation of the effect of continuous care for stroke is of great significance to hospitals, patients and family caregivers. It is necessary to pay more attention to the evaluation of the effect of continuous care for stroke. The content of the evaluation should be standardized from the aspects of patients' health outcomes, home caregivers' outcomes and the implementation rate of nursing services. The advantages of evaluation subject, scientific selection of evaluation subject, strengthening the support of health policy, and eliminating the blocking factors of effect evaluation.

Objective? To investigate the status quo of quality of life (QOL), cognitive function and activities of daily living (ADL) in patients with ischemic cerebral stroke, explore cognitive function and ADL on QOL, and provide a reference for improving QOL in patients with cerebral stroke. Methods? Totally 140 patients with ischemic cerebral stroke hospitalized in the Department of Neurology of a hospital in Shanghai from September 2018 to January 2019 by convenient sampling and investigated with the demographic information questionnaire, Mini-Mental State Examination (MMSE), Barthel Index (BI) andWHO Quality of Life-BREF (WHOQOL-BREF). SPSS 22.0 and AMOS 22.0 were used to analyze the effects of cognitive function and ADL on QOL. Results? The total WHOQOL-BREF, BI and MMSE scores of the 140 patients with ischemic cerebral stroke was (52.56±5.34), [55 (40.00,67.25)]and[26 (23.25, 28.00)], respectively. Patients's QOL was positively correlated with ADL (r=0.173,P＜0.05) and cognitive function (r=0.276,P＜0.05). The path analysis revealed that both cognitive function and ADL had positive predictive power for QOL, whose path coefficient was 0.29 and 0.38. Conclusions? The QOL of patients with ischemic cerebral stroke stands at a medium level. Patients' cognitive function and ADL affect their QOL, which should draw attention in clinical practice, and measures should be taken for rehabilitation training of cognitive function and systematic interventions of ADL.