The risk factors of Clostridium difficile infections increased in recent years , such as the underlying disease, hospitalization duration, age, the use of antibiotics, the use of proton pump inhibitors and so on.The rate of Clostridium difficile infection and recurrence are still high despite the appear of new antibiotics such as rifaximin, nitazoxanide, tigecycline, ramoplanin, fidaxomicin, and non-antimicrobial such as drugs toxin neutralizer chamber , biological therapeutic agents , fecal transplantation , systemic antibody method , intravenous immunoglobulin and so on.The vaccine is the most ideal way of prevention and treatment of Clostridium difficile infection.The research in Clostridium difficile vaccine lasted for nearly 20 years.Except the monoclonal antibody vaccine and toxoid vaccine against toxin A and toxin B have achieved better results in the human , some recombinant vaccines against the toxin receptor and the key pathogenic factor of Clostridium difficile also achieved good effect in animal.

OBJECTIVETo investigate the effect of local administration of recombinant adenovirus of human adiponectin (hAPN) Ad-hAPN-EGFP on tibial defect repair of SD rats.

METHODSTibial defect (2 mm) models of 36 SD rats (72 sides) were randomly divided into three groups (A, B, and C; n=24). The three groups were injected with Ad-hAPN-EGFP, Ad-EGFP, and normal saline, respectively, during operation and the day after operation. A week after the operation, the expression of hAPN and osteogenesis-related factors were detected by real-time polymerase chain reaction. Three weeks after operation, the tibias were examined by micro-computed tomography, hematoxylin-eosin staining, and Masson staining to evaluate the restoration of bone defects.

RESULTS1) The hAPN expression was detected in group A but not in groups B and C. Osteogenesis-related factors expression of group A was significantly higher than that of the other groups (P<0.05). 2) Osteogenesis (including bone mineral density, relative bone volume, trabecular number and trabecular thickness) in group A were more evident than those in groups B and C (P<0.05). No significant differences were found between groups B and C (P>0.05).

CONCLUSIONLocal administration of recombinant adenovirus Ad-hAPN-EGFP may be an effective strategy to improve the restoration of bone defects in vivo.

Adenoviridae ; Adiponectin ; Animals ; Bone Density ; Bone and Bones ; Humans ; Osteogenesis ; Rats ; Rats, Sprague-Dawley ; Real-Time Polymerase Chain Reaction ; X-Ray Microtomography

Objective To explore the effect of strengthening behavior modification intervention on the rehabilitation of patients with schizophrenia.Methods 97 patients with schizophrenia,who were in the rehabilitation period by the hospitalization therapy,were randomly divided into the study group and the control group.The study group Was given enhanced behavior modification intervention,besides the antipsychotics and conventional care.While the control group Was given only anti-psychotic drugs and routine care.The nurse-patient observation Scale(NOSIE)and the rehabilitation of hospitalized mental patients Rating Scale(IPROS) were used to evaluate the rehabilitation states of six weeks in the two groups.Results Six weeks after the intervention.the differences of the total score of NOSIE and the scores of each factor were significant compared nwith the control group.Especially,social competence(18.08±2.63),social interest(16.23±3.21),personal hygiene(17.13±1.54)and the total score had a very significant progress and improvement(P

Objective To observe distribution and antimicrobial resistance of pathogens from blood culture of chil-dren with leukemia,and study risk factors.Methods From September 2013 to November 2016,species and antimi-crobial resistance types of 131 strains of pathogens isolated from blood culture of 110 children in a pediatric hemato-logy ward were analyzed,childrens'clinical data were also analyzed statistically.Results 131 strains(5.23%)of pathogens were isolated from 2 505 blood culture specimens,gram-negative bacilli and gram-positive cocci accounted for 52.67% and 43.51% respectively,the top 3 pathogens were Escherichia coli(15.27%),Klebsiella pneumoniae (15.27%),and Staphylococcus hominis(12.98%). Gram-negative bacilli were highly resistant to ampicillin,ce-fazolin,ceftriaxone,and ampicillin/sulbactam,but sensitive to amikacin,cefoperazone/sulbactam,piperacillin/tazobactam,and carbapenems;gram-positive cocci had higher resistance to penicillin,oxacillin,erythromycin,and clindamycin,but were sensitive to tigecycline,linezolid,vancomycin,and quinupristin/dalfopristin. Univariate analysis showed that mixed infection,diarrhea,Pseudomonasaeruginosa infection,and Acinetobacterbaumannii in-fection were related to mortality due to bloodstream infection in children with leukemia.Conclusion Pathogens cau-sing bloodstream infection in children with leukemia is widely distributed,antimicrobial resistance rate is high,it is very im-portant to take active precaution and rational treatment according to antimicrobial susceptibility testing result.

OBJECTIVETo explore the correlation between pathological characteristics of target organs and excess evil syndrome in IgA nephropathy.

METHODSData were collected in multicenter cooperation. Totally 266 IgA nephropathy patients were typed into exogenous wind-heat affection syndrome (49 cases), lower energizer damp-heat syndrome (100 cases), damp-phlegm syndrome (43 cases), and blood stasis syndrome (74 cases). Meanwhile, percutaneous renal biopsy was performed in all patients for Hass classification, Oxford classification, Katafuchi integral, and Jiang's classification methods. The correlation between excess evil syndrome and pathological index was analyzed.

RESULTSFour syndrome types were correlated with their Hass levels (r = 0. 341, P <0. 01). Affection of exogenous wind-heat syndrome was correlated with segmental proliferation of endothelial cells and damaged active lesions of segmental capillary loops. Lower-energizer damp-heat syndrome was associated with Hass III level, destroying active lesions of capillary loops, segmental proliferation of endothelial cells, glomerular segmental lesions, focal interstitial infiltration of inflammatory cells, focal interstitial fibrosis and tubular atrophy. Blood stasis syndrome was associated with Hass IV level, glomerular sclerosis, segmental glomerulosclerosis (S)/adhesion, mesangial hypercellularity (M), angiohyalinosis, multi-foci interstitial infiltration of inflammatory cells, multi-foci interstitial fibrosis and tubular atrophy. Phlegm-damp syndrome had higher proportions of Hass I and III levels, but with no association with other pathological parameters.

CONCLUSIONSExcess evil syndrome was associated with partial pathological characteristics of IgA nephropathy. It could reflect pathological damage degree of target organs, activities, chronic lesions, and prognosis of IgA nephropathy to certain extent. Correlated pathological characteristics and its evolution could indicate excess evil syndrome types and their evolution rules.

Capillaries ; Fibrosis ; Glomerulonephritis, IGA ; pathology ; Glomerulosclerosis, Focal Segmental ; Humans ; Kidney Glomerulus ; Medicine, Chinese Traditional ; Prognosis ; Syndrome

Objective To investigate the distribution and antimicrobial resistance of Pseudomonas aeruginosa (P.aeruginosa) from intensive care units(ICUs) and general wards of a hospital,and provide scientific basis for rational use of antimicrobial agents in clinic.Methods Identification and antimicrobial susceptibility testing of clinically isolated bacteria in this hospital in 2016 were performed by VITEK 2 Compact automatic microbial analysis system,difference in antimicrobial resistance of P.aeruginosa between ICUs and general wards was compared.Results The tested specimens were mainly sputum in both ICUs and general wards,accounting for 78.7％ and 66.5％ respectively.There was no significant difference in the isolation rate of P.aeruginosa between ICUs and general wards (11.7％ vs 11.0％,P＞0.05).P.aeruginosa isolated from ICUs had the highest resistance rate to aztreonam (73.8％),resistance rates to piperacillin/tazobactam,cefoperazone/sulbactam,ceftazidime,imipenem,and meropenem were all up to more than 50％;P.aeruginosa detected in general wards had the highest resistance rate to aztreonam(59.6 ％),followed by piperacillin/tazobactam and imipenem,accounting for 48.0 ％ and 44.3 ％ respectively;resistance rates of P.aeruginosa isolated from ICUs to 12 kinds of antimicrobial agents were all higher thanthose of general wards(P＜0.05).Conclusion Resistance rate of P.aeruginosa from ICUs is higher than that in general wards,which should be paid attention,antimicrobial agents should be selected for clinical treatment of infection according to the results of antimicrobial susceptibility testing result.

OBJECTIVE: To investigate the relationship between emergence of AmpC enzyme and drug resistance in the gram-negative bacilli in Xiangya Hospital and to provide information for the treatment of antibiotics. METHODS: The bacteria were identified; the susceptibility was determined by Microscan microbiological identification system; and the AmpC enzyme was detected by disc diffusion method. RESULTS: Of the 204 gram-negative strains, the positive rate of AmpC enzyme was 19.61%; AmpC-positive strains resisted to ceftriaxone, piperacillin, ceftazidime, cefotaxime, cefoperazone, aztreonam, piperacillin/tazobactam, cefuroxime, ceftazidime/clavulanic, and cefotaxime/clavulanic. But AmpC-negative strains were susceptible to those antibiotics. There were significant differences, between the two groups (All P < 0.05). Both groups were susceptible to cefepime, imipenem, meropenem, cefoperazone/sulbactam, levofloxacin, and amikacin. CONCLUSION The detection of AmpC enzyme is helpful to the screen of drug resistant strains. Most bacilli with AmpC enzyme show the resistance to third-generation cephosporins, aztreonam, and the beta-lactamase inhibitors, but susceptible to imipenem, cefepime, meropenem, cefoperazone/sulbactam, levofloxacin, and amikacin, which provides the information for the antibiotic therapy.
Adolescent ; Adult ; Aged ; Aged, 80 and over ; Bacterial Proteins ; analysis ; Child ; Child, Preschool ; Drug Resistance, Microbial ; Drug Resistance, Multiple, Bacterial ; Female ; Gram-Negative Bacteria ; drug effects ; enzymology ; Humans ; Infant ; Male ; Microbial Sensitivity Tests ; Middle Aged ; beta-Lactamases ; analysis

Objective To investigate the value and dynamic characteristics of diffusion-weighted imaging(DWI)in rabbit liver VX_2 tumor model,with correlation of pathology.Methods Forty New Zealand rabbits were included in the study and VX_2 tumor piece was implanted directly into the liver after laporotomy.Fiffteen had two intrahepatic implants while twenty-five had one implant.DWI was performed on the seventh,fourteenth and twenty-first day after implantation,while routine T_1WI and T_2WI sequences were done on the seventh and fourteenth day.Ten VX_2 tumor samples were studied by pathology.Results The lump detection rates on the seventh day after implantation of DWI,T_1WI and T_2WI were 78.7%(37/47), 10.7%(3/28)and 53.6%(15/28)respectively with statistical significance(x~2=32.61,P

OBJECTIVE: To explore the best time of intratympanic dexamethasone injection to treat sudden sensorineural hearing loss (SSNHL) as salvage therapy so that to improve the curative efficacy on sudden deafness at the utmost. METHOD: A total of 192 patients with SSNHL were included in this study, among whom 63 cases received the systemic steroid therapy throughout the study, while the other ones were treated with systemic steroid as initial treatment and were given intratympanic steroid administration as salvage treatment starting at different time point. The salvage treatment started on the 3rd day after the beginning of the initial treatment for 29 cases, on the 7th day for 38 cases, on the 14th day for 43 cases, and 1 month later for 19 cases. All the patients were followed up for 2 months. RESULT: The recovery rates and total effective rates showed no statistically significant difference between the patients received only systemic steroid therapy and the ones received intratympanic steroid administration on the 3rd, 7th day and 1 month later after the initial treatment. The recovery rate and total effective rate exhibited statistically significant difference between the patients received intratympanic steroid administration since the 14th day after the initial treatment and the ones received only systemic steroid therapy, with the numerical value of P 0. 037 and 0. 034, respectively. CONCLUSION (1) As an initial management plan, the curative effects. between the intratympanic steroid administration and the systemic steroid therapy were not significantly different. (2) As a salvage treatment, intratympanic steroid was a better choice for patients who have not completely recover from ISSNHL after failure of initial management with systemic steroid only. (3) The best time point of salvage treatment with intratympanic steroid was about 2 weeks after initial management with systemic steroid.
Hearing Loss, Sensorineural ; drug therapy ; Hearing Loss, Sudden ; drug therapy ; Humans ; Injection, Intratympanic ; Salvage Therapy ; Steroids ; therapeutic use ; Treatment Outcome ; Tympanic Membrane

OBJECTIVETo study the feasibility of application of ilium inner table to repair the articular surface defects of tibial plateau complex fractures.

METHODSTwenty-three patients with tibial plateau complex fractures included 17 males and 6 females with an average age of 28.3 years old ranging from 18 to 51 years. The area of the articular surface defects ranged from 1 cmx2 cm to 3 cmx3 cm, averaged 6.7 cm2. Taking ilium inner table with periosteum after trimmed and implanting into the articular surface defect area with the concavity upward and drilled with diameter 1.5 mm Kirschner pin interval 3 to 4 mm. Bone grafting were placed under the ilium inner table and were fixed by T-shaped or L-shaped plate. The wounded limb were braked by plaster for 4 weeks after operation.

RESULTSTwenty-three patients were followed-up for 8 months to 3 years, averaged 13.6 months. X-ray film showed solid union and the smooth articular surface in all cases. According to the Rasmussen evaluation system, the results were excellent in 11 cases, good in 8 cases,fair in 3 cases, poor in 1 case.

CONCLUSIONTaking ilium inner table to repair the articular surface defects of tibial plateau complex fractures is a good resolving measures. It can repaire major area of articular surface defects, restore the smooth articular surface and acquire good function of knee joint with easy to operate, less complications at donor area.

Adolescent ; Adult ; Bone Transplantation ; methods ; Feasibility Studies ; Female ; Follow-Up Studies ; Humans ; Ilium ; anatomy & histology ; Joints ; injuries ; transplantation ; Male ; Middle Aged ; Tibial Fractures ; pathology ; physiopathology ; surgery ; therapy ; Treatment Outcome ; Young Adult