ObjectiveTo evaluate the safety and efficacy of the refractive effect produced by the implantation of intrastromal corneal ring （ICR）．MethodsEach of the 60 eyes （30 rabbits） received an ICR．The thickness of the ICRs varied from 0.19mm to 0.41mm．Each eye underwent a preoperative and postoperative examinations at the lst，3rd，7th and 14th day；the lst，3rd and 6th month．Slit-lamp biomicroscopy and an ORBSCANTM slit scan corneal tomography／pachymetry system were performed at predetermined intervals throughout the follow-up periods．ResultsThe decrease of corneal curvature was observed after ICR implantation in all of the eyes．There was a direct relationship between the ICR thickness and the degree of corneal flattening achieved．The equation is：D＝1.4353－32.87×thickness．The postoperative refractive effect was stable．Wound healing was uncomplicated and central cornea remained transparent．ConclusionThe ICR implantation is safe and effective and the refractive effect is predictive and stable．

[Objective]To analyze the results of distal tibial pilon fractures treated with individual management based on severity of soft tissue injury.[Method]From January 2005 to September 2008,29 Pilon fractures were treated.There were 22 males and 7 females aging from 23 to 63,with an average of 41.4.According to Ruedi-Allgower classification system of Pilon fracture,16 cases were type Ⅱ,13 type Ⅲ.According to Tscherne-Gotzen graduation system of soft tissue injury,22 cases were close fracture,8 grade 0,4 grade 1,8 grade 2,2 grade 3,and 7 cases were open fracture,3 grade 1,2 grade 2,2 grade 3.Individual management was based on severity of soft tissue injury.[Result]All patients were available for follow-up at an average of 28.6 months(range,12 to 56 months) after surgery.There were 10 excellent,13 good,4 fair,and 2 poor results according to the ankle score of Mazur.The complications occurred in 5 patients(17.2%),including wound superficial infection(n=2),skin necrosis(n=1),deep infection(n=1),and pin tract infection(n=1) with external fixation.[Conclusion]Individual management based on severity of soft tissue injury for Pilon fracture has advantages of fewer complications and good function.

OBJECTIVE To approach the pathogenic distribution of nosocomial infection and drug-resistance in tumor department to formulate the intervention strategy.METHODS Prospective monitoring and retrospective investigation were performed to analyze the 198 cases of nosocomial infection in tumor department.RESULTS The lower respiratory tract infection was the main infection in tumor department,accounted for 68.2%.The urinary tract infection rated the second,accounted for 16.7%.Pathogenic bacteria mainly included Pseudomonas aeruginosa(20.2%),Klebsiella pneumoniae(19.2%),Escherichia coli(16.2%),Staphylococcus aureus(10.6%),etc.Above pathogenic bacteria were all multidrug-resistant.Detection rate of extended spectrum ?-lactamases(ESBLs) producing Enterobacteriaceae strains was 45.7%.Detection rate of meticillin-resistant staphylococci(MRS) was 40.6%.CONCLUSIONS The drug-resistance status of nosocomial infection is very serious in tumor department.Comprehensive intervention strategy should be adopted to decrease the infection rate.

OBJECTIVE To investigate drug resistance status of the pathogens of nosocomial pulmonary infection in stroke patients and to provide the scientific reference for clinical prevention of nosocomial infections and reasonable use of antibiotics.METHODS By the methods combining prospective monitoring and retrospective review,patients′ clinical data were analyzed statistically.Referring to National Rules of Procedures in Clincal Laboratory,the strains were identified.The antibiotic susceptibility test was performed by K-B method and the results were read according to CLSI 2006.RESULTS The main pathogens of nosocomial pulmonary infection in stroke patients were Klebsiella Pneumoniae(22.0%),Pseudomonas aeruginosa(18.4%),Acinetobacter baumannii(12.7%),Staphylococcus aureus(12.3%) and Escherichia coli(11.4%).The detection rate of extensive-spectrum beta-lactamase(ESBLs) producing E.coli and K.pneumoniae was 43.2%.Meticillin-resistant S.aureus(MRSA) accounted for 39.0%.Pan-drug resistant strains were found in A.baumannii.CONCLUSIONS Drug resistance status of pathogens of nosocomial pulmonary infection in stroke patients is very serious.We should take intervention measures to prevent and control the onest and prevalence of resistant strains.

Objective:To evaluate the effectiveness of integrated pediatric training course of extracorporeal membrane oxygenation(ECMO)based on simulation teaching.Methods:The instructors of ECMO team of Children′s Hospital of Fudan University developed the teaching curriculum.Team members as a unit were recruited to study simulation-based courses, whose theoretical knowledge, skills and teamwork were assessed, and feedback from the trainees were gathered.Results:Since May 2018, 22 teams of pediatric specialized hospitals or general hospitals have taken part in our ECMO simulation, with totally 132 participants, including 45 ICU doctors(34.1%), 60 ICU nurses(45.5%), 23 thoracic surgeons(17.4%) and four anesthesiologists(3.0%). Twelve of them(9.1%)had a little ECMO experience.After training, the trainees had a high evaluation on each part of the course, with average score more than four, of which the theoretical score was lowest.Their self-evaluation on the theory, skills, teamwork and confidence in the implementation of ECMO had been significantly improved.Most(80.3%)of the trainees were confident to carry out ECMO in their local hospitals.The trainees′ baseline score of theoretical knowledge was 55.2±7.6, and increased to 67.1±7.3 after training( P<0.001). The average teamwork score of the 22 teams was 70.2±8.2, and the qualified rate was up to 86.4%.The most prominent skill problems in operation assessment were no albumin and blood priming(90.9%), non-skill problems were extremely anxious during the overall assessment(84.8%)of the participants, poor team work(74.2%), poor leadership(68.2%). For the feedback of the whole course, 97.0% and 94.7% of the trainees thought that integrated training and simulation teaching were the highlights of the course.At present, 13(59.1%)units have successfully developed ECMO technology after the course, and the number of children treated has been up to 83, with a survival rate of discharge of 54.2%.However, it was found that the skill level of some participants decreased about 2 weeks after the course. Conclusion:As a new attempt of ECMO teaching, this curriculum has achieved certain efficiency in both teaching and clinical practice.At the same time, our study also plays a role in promoting the development of ECMO in pediatrics.

Quorum sensing is an important gene regulatory mechanism in Pseudomonas aeruginosa and controls the expression of numerous virulence factors. We designed and constructed a screening system for quorum-sensing inhibitors. We developed the system by using the lasI and rhlA promoters fused with promoterless sacB as reporters. Using this system we screened a number of Chinese herb extracts, and identified three herb extracts containing inhibitors to the quorum-sensing system and to its regulated genes. The screening system developed was highly efficient and sensitive. It could serve as a useful tool to identify herb compounds that block infections but unlikely render antibiotic resistance in pathogens.
Acanthaceae ; chemistry ; Anti-Bacterial Agents ; pharmacology ; Drug Evaluation, Preclinical ; methods ; Drugs, Chinese Herbal ; pharmacology ; Genes, Reporter ; Promoter Regions, Genetic ; Pseudomonas aeruginosa ; drug effects ; genetics ; Quorum Sensing ; drug effects ; Valerianaceae ; chemistry

This paper reports a case of multiple myeloma complicated with Primary systemic light chain amyloidosis peripheral neuropathy.Patient was a male,60 years old with subacute onset of peripheral neuropathy.Patient had previous history of hypertension,coronary heart disease and stable angina pectoris.His urine routine examination 2 months ago showed urine protein(+++).The first clinical symptom with peripheral neuropathy characterized by progressive numbness and weakness of both lower limbs.The diagnosis was made after completing electromyography,lumbar puncture,renal puncture,bone puncture and other related examinations,and relevant treatment was given.As a rare disease of nervous system,the incidence rate is low.Early diagnosis is an important step to reduce mortality and improve prognosis.However,the disease is easily misdiagnosed as diabetic peripheral neuropathy and chronic inflammatory demyelinating polyradiculoneuropathy,thereby delaying diagnosis and treatment.

Objective:To investigate the clinical epidemiological data of children with prolonged mechanical ventilation (PMV) in pediatric intensive care unit(PICU), and analyze the primary disease of children with PMV as well as the disease characteristics and prognosis of children with PMV under different kinds of primary disease.Methods:The clinical data of hospitalized children with PMV in PICU at Children′s Hospital of Fudan University from January 2019 to December 2020 were retrospectively collected.Results:A total of 46 children with PMV were collected.There were 18 males (39.1%) and 28 females (60.9%). The median age was 37 (8, 86) months and the median body weight was 15 (7, 20) kg.The average pediatric critical illness score at admission was 84.2±7.7, PaO 2/FiO 2 was (245.5±99.8)mmHg.The primary diseases leading to PMV were as follows: there were 14 cases of severe pneumonia, eight cases of severe encephalitis, five cases of bronchopulmonary dysplasia, three cases of upper airway obstruction/craniofacial deformity, three cases of myasthenia, three cases of brain stem tumor, three cases of mitochondrial encephalomyopathy, two cases of spinal muscular atrophy, two cases of Prader-Willi syndrome, one case of dermatomyositis, one case of severe brain injury, and one case of central hypoventilation.The causes of unable to withdraw ventilator were respiratory dysfunction in 24 cases, brain dysfunction in 16 cases, and diaphragm dysfunction in six cases.Compared with neuromuscular diseases, children with PMV caused by respiratory diseases had lower month age, higher preterm birth rate, lower PaO 2/FiO 2 ratio, higher parameters for ventilator treatment, and the differences were statistically significant ( P<0.05). Children with PMV caused by neuromuscular diseases had lower Glasgow coma score and higher coma rate, and the differences were statistically significant ( P<0.05). A total of nine (19.6%) cases underwent tracheotomy.A total of 23 (50.0%) cases were successfully extubated from ventilator, six (13.0%) cases were dependent on invasive ventilator, and six (13.0%) cases were breathing with tracheotomy tube.The median mechanical ventilation time was 33 (28, 40) days, the median PICU hospital stay was 42 (34, 56) days, and the median hospital stay was 51 (41, 65) days.A total of 27 (58.7%) cases were improved and discharged, four (8.7%) cases were transferred to rehabilitation hospital, four (8.7%) cases were transferred to local hospital, and 11 (23.9%) cases died in hospital or at home after giving up. Conclusion:The main causes of PMV in PICU children are respiratory dysfunction, brain dysfunction and diaphragm dysfunction.50.0% of the children with PMV could be discharged from the ventilator, and 23.9% died or died after giving up.

Objective To evaluate the efficacy and safety of midodrine hydrochloride in the treatment of intradialysis hypotension (IDH)in maintenance hemodialysis (MHD)patients.Methods One hundred and tburteen MHD patients from 8 dialysis centers with IDH were enrolled in the study.These patients took orMly midodfine for 4～6 weeks.Midodrine(2.5～10 mg)was given 15～30 minutes after the beginning of hemodialysis,and another 2.5～10 mg was used during hemodialysis if systolic blood pressure(SBP)increased less than 20 mm Hg.The total usage of each dialysis session was not more than 20 mg.The pre-,intra-,post-hemodialysis blood pressure and heart rate,the pre-and post-hemodialysis body weight,the uhrafiitrated volume of each dialysis,the pre-and post-treatment liver and renal function and electrocardiogram were measured and recorded.The symptoms of IDH were observed. Results Compared to those before treatment with midodrine hydrochloride,the minimum intradialysis SBP and heart rate at that time,the post-dialysis SBP and heart rate,and total uhrafiitrated volume changed significanlly (P＜0.01).The total effective rate was 84.2%.And the symptoms of IDH were improved significantly (P＜0.01).The side effects were observed in only 2 patients.Conclusion Midodrine iS safe and effective for the treatment of IDH.

Objective:To investigate the value of pericoronary adipose tissue histogram parameters based on coronary CT angiography (CTA) images for the differentiation of acute coronary syndrome and stable coronary artery disease.Methods:The clinical data and CTA images of 93 patients with coronary CTA examination in Suzhou Kowloon Hospital from 2013 to 2018 were analyzed retrospectively. There were 39 patients with acute coronary syndrome (acute coronary syndrome group) and 54 patients with stable coronary artery disease (stable coronary artery disease group). A region of interest (ROI) was drawn around the stenosis of the coronary arteries, with CT attenuation ranging from-190 to -30 HU to exclude non-adipose tissue. The CT attenuation of ROI excluding non-adipose were measured and histogram analysis was performed. The obtained parameters included the mean value, median value and the 5th, 10th, 45th, 55th, 70th and 95th percentiles. The differences in histogram parameters between the two groups were compared, and then the value of each parameter in differentiating acute coronary syndrome and stable coronary artery disease was evaluated based on receiver operating characteristic (ROC) analysis. The stepwise regression of multivariate logistic regression analysis was used to identify the useful features and establish the final prediction model. The ROC curve of the final model was calculated and its value was analyzed.Results:The mean, median and the 5th, 10th, 45th, 55th,70th and 95th percentile differences between the acute coronary syndrome group and the stable coronary artery disease group were statistically significant (all P<0.05). The ROC curve for the median and the 95th percentile had the same area under curve (AUC) of 0.73. The sensitivity, specificity and AUC of the diagnostic model established by multiple logistic regression were 82.1%, 89.1% and 0.90 respectively. Conclusion:CT attenuation histogram of pericoronary adipose tissue is of high value in differentiating acute coronary syndrome from stable coronary artery disease.