Objective To explore the key points of the diagnosis and treatment of severe pneumonia following renal transplantation in the elderly. Methods The clinical data of 28 patients with severe pneumonia following renal transplantation were retrospectively analyzed, including 20 cases aged <60 years (<60 years old group) and 8 cases aged ≥60 years (≥60 years old group). Results In <60 years old group, the severe pneumonia occurred during 1-13 months after the renal transplantation. All the patients had fever. 10 cases coughed and 8 cases had expectoration. 6 cases had type I respiratory failure (RF) and 3 cases experienced type 11 RF. 6 cases had lobar pneumonia and 13 cases occurred interstitial pneumonia. One case experienced lung consolidation. The pathogens of 16 cases in <60 years old group were identified, including 4 cases with bacterial pneumonia, 4 cases with cytomegalovirus (CMV) pneumonia, 2 cases with pneumocystis carinii pneumonia, Ⅰ case with mycoplasma infection, Ⅰ case with tuberculosis infection, and 4 cases with mixed infection (2 cases infected by bacteria plus CMV, 1 case by bacteria plus fungi and 1 case by bacteria plus tuberculosis). Combined drugs (broad-spectrum antibiotic, antivirus and antifungal agent) were administered on the initial stage and sensitive drugs were used later according to the pathogens. Hormone or immunoglobulin was used when other drugs were useless. 17 cases were cured and 3 cases died. In ≥60 years old group, the severe pneumonia occurred during 1-9 months after renal transplantation. All 8 patients had fever, too. 5 cases coughed and 3 cases had expectoration. 3 cases experienced type ⅠRF and 1 case experienced type Ⅱ RF. 3 cases had lobar pneumonia and 5 casesoccurred interstitial pneumonia. The pathogens of 5 eases were identified. Among them, 2 cases were affected by bacterial pneumonia, 1 case by CMV pneumonia and 2 cases by mixed pneumonia (one by bacteria plus CMV, one by bacteria plus fungi). Similar modality was applied, and 5 cases were cured and 3 cases died. Conclusions Most of severe pneumonia occur during 1-9 months after renal transplantation in the elderly. The main pathogens are bacteria and CMV. Medications for all of the most common pathogens and assisted ventilation should be used early. Specific narrow-spectrum antibiotic or antiviral drugs could be used quickly after pathogens were identified, and hormone or immunoglobulin could be administered to patients when the infection is severe or the pathogens are uncertain.

Objective To understand current situation of surgery grading management in 22 hospitals from Beijing Municipal Administration of Hospitals,and to discuss the problems and to make suggestions for better application and management.Methods Based on general survey,Surgery of Grading Conditions of All Municipal Hospitals was issued to 22 municipal hospitals to make related staff fill related data.Results Except for 3 specialty hospitals,19 hospitals have launched the surgery grading management,while they are in different steps of implementing hierarchical directory,surgeon permission and dynamic management.These hospitals have different reference standards of making hierarchical directory.84.2％ hospitals give surgeons authorities according to levels of operations evaluated by professional title,surgery grade and doctors' technical skills.There are 14 hospitals applying information management on surgery grading.Conclusion Uniform criteria of hierarchical directory,extension of surgeon permission system and implementation of surgery grading information management will contribute to regulation fulfillment.

OBJECTIVE To determine the drug resistance phenotype and genotype of plasmid-mediated AmpC ?-lactamase in Klebsiella pneumoniae isolated from Harbin.METHODS Isolates of K.pneumoniae with an inhibition ring to cefoxitin of ≤18 mm diameter were used.Antimicrobial susceptibilities were determined by disc diffusion method.AmpC genes were detected by PCR with six pairs of primers.RESULTS Sixty-three isolates had an inhibition ring to cefoxitin of ≤18 mm diameter and 26(11.3%)were detected to be AmpC-producing in a total of 231 clinical isolates of K.pneumoniae.Seventy-six percent,70.2%,53.8%,50.5%,57.7%,38.5% and 7.7% of AmpC-producers were resistant to cefoxitin,cefotaxime,ceftazidime,amoxicillin/clavulanic cid,ciprofloxacin,amikacin and imipenem,respectively.ACT,DHA and CIT types of AmpC beta-lactamase were detected in 13,8 and 5 isolates,respectively.No ACC,MOX and FOX were detected.CONCLUSIONS The AmpC ?-lactamase in Harbin is mainly in the types of ACT,DHA and CIT.AmpC-producing K.pneumoniae shows decreased susceptibilities to cefoxitin and third generation cephalosporins.

OBJECTIVE To survey the distribution of class Ⅰ integron in extended-spectrum beta-lactamases(ESBLs)-producing Escherichia coli and Klebsiella pneumoniae and its contribution in horizontal transfer of ESBLs genes.METHODS The presence of class Ⅰ integron among 230 ESBLs-producers and 197 non-ESBLs-producers of E.coli and K.pneumoniae were detected by PCR.The correlation and co-transfer between integron and genes coding for SHV,CTX and TEM were studied. RESULTS One hundred and thirty-seven(59.6%) isolates were positive for intⅠ gene among ESBLs-producers,contrasted to 48(24.4%) in non-ESBLs-producers(P

Objective To assess the efficacy and safety of drug therapy alone and stenting for symptomatic intracranial atherosclerotic stenosis (sICAS) in order to provide the best evidence for clinical practice.Methods PubMed,EMbase,Cochrane Library,CBM,CNKI,and Wanfang database were retrieved.The randomized controlled trials (RCTs) on the efficacy and safety of drug therapy and stent-assisted therapy for sICAS were enrolled.The RevMan 5.3 software was used for the meta-analysis.Results A total of 6 RCTs and 782 patients were enrolled.The results of meta-analysis showed that there were no significant differences in stroke or death (odds ratio [OR] 1.61,95％ confidence interval [CI] 0.89-2.91;P=0.12) and fatal stroke within l year (OR 1.60,95％ CI 0.96-2.67,P=0.07) between the stenting group and the drug therapy group.The risks of symptomatic intracerebral hemorrhage (OR 9.51,95％ CI 2.89-31.29;P＜0.01) and any stroke or death (OR 2.15,95％ CI 1.21-3.82;P＜0.01) in the stenting group were higher than those in the drug therapy group.The subgroup analysis showed the risks of any stroke or death within 30 d in the stenting group were significant higher than those in the drug therapy group (OR 2.94.95％ CI 1.55-5.60;P ＜0.01),and there were no sig-nificant differences in anv stroke or death within 1 year (OR 1.90,95％ CI 0.50-7.61;P=0.35) and 2 years (OR 1.38,95％ CI 0.91-2.08;P=0.13);the risks of symptomatic intracerebral hemorrhage within 30 d (OR 10.15,95％ CI 1.92-53.64,P ＜0.01) and within 1 year (OR 8.80,95％ CI 1.60-48.25,P =0.01) in the stenting group were higher than those of the drug therapy group.Conclusions The risks of symptomatic intracerebral hemorrhage and any stroke or death in the stenting group were significantly higher than those in the drug therapy group,therefore,the preferred stenting was not recommended in patients with sICAS.However,stenting still can be considered in patients who failed regular drug therapy and who may benefit greater from stenting.

detec-tion by IHC.

adjunct to cytology screening, especially high-risk patients.

YOU Zaijing,a doctor of Wumen region,and a famous expert of Treatise on Pathogenic Diseases, also made great achievements in warm diseases. He cleared the source of cold pathogenic diseases and warm diseases, distinguish the difference between them. He put forward the importance of correcting and understanding the disease nomenclature. He explained the names of warm diseases,wind-warm disonder, pestilence,damp-warm disease,warm toxin and warm malaria.He divided warm diseases into newly acquired warm disease, warm disease caused by incubating pathogens, warm disease mixed with dampness and pestilence.He used pungent and cool natured drugs and the method of regulating lung to treat wind warm diseases.In the treatment of warm toxin, he used the method of venting pathogen with cool-scattered natured drugs. In the treatment of warm disease caused by incubating pathogens,he used the method of clearing away heat, nourishing yin and venting pathogen. In the treatment of dampness-warm disease, he used the method of eliminating dampness and heat separately. In the treatment of pestilence, he took the location of disease as the core.According to the different disease locations of the pestilence, different treatment methods and prescriptions were selected.He listed five methods of treating pestilence and established a theoretical framework for the treatment of pestilence,embodying the thought of guiding the trend along the development.He put forward the theory of Six Channels directing Cold and Warm early.He tried to use the syndrome differentiation of six channels system to direct all exogenous diseases such as cold pathogenic diseases and warm diseases. He was the pioneer advocator of the cold-warm combined theory. His views on warm diseases had a profound impact on later doctors. This paper summarizes his main points, analyzes his theory, and provides inspiration for the diagnosis and treatment of warm diseases.

Objective:To investigate epidemiological and clinical characteristics of botulism, and the adverse events among those received botulinum antitoxin treatment.Methods:Patients with discharge diagnosis as botulism in the Second Affiliated Hospital of Xinjiang Medical University were enrolled between 2017 and 2021. The epidemiological and clinical characteristics were evaluated. Infection and mechanical ventilation as in-hospital outcomes according to baseline characteristics were analyzed. Patients with and without the interested outcomes were compared. The adverse outcomes among those received botulinum antitoxin treatment were investigated. Those with and without the adverse outcomes were also compared.Results:Sixty-seven cases of botulism were enrolled, and most cases got sick between January and March (32/67, 47.8%); among them 62 cases were Han ethnicity (92.5%); prevalence was highest in Aksu region (15/67, 22.4%); commonly seen symptoms and signs included fatigue (58/67, 86.6%), dysphagia (48/67, 71.6%), dizziness (42/67, 62.7%), ptosis (42/67, 62.7%), blurred vision (41/67, 61.2%), and limb weakness (35/67, 52.2%). Compared with patients without in-hospital infection ( n=52), patients with in-hospital infection ( n=15) were more likely to have severe botulism (0/52 vs 5/15, χ 2=19.79, P<0.001), diplopia (16/52, 30.8% vs 11/15, χ 2=8.77, P=0.003), dysarthria (17/52, 32.7% vs 11/15, χ 2=7.91, P=0.005), consciousness disorder (1/52, 1.9% vs 4/15, χ 2=10.32, P=0.008). Compared with patients without mechanical ventilation (62/67, 92.5%), patients with mechanical ventilation (5/67, 7.5%) were more likely to have severe botulism (5/5 vs 0/62, χ 2=41.17, P<0.001), and consciousness disorder (4/5 vs 1/62, 1.6%, χ 2=29.58, P<0.001). Among 67 cases of botulism, 19 cases (28.4%) had adverse events after receiving antitoxin treatment, with an average of 6.5 days from the antitoxin treatment beginning to the adverse event onset; among the 19 cases, 18 cases (94.7%) had rash. Age, sex, and severity did not differ between the groups with ( n=19) and without adverse events ( n=48) after receiving antitoxin treatment. Conclusions:Fatigue, dysphagia, dizziness, ptosis were the most frequent symptoms and signs in the botulism in Xinjiang Uygur Autonomous Region, China. Infection was a commonly seen complication of botulism, and proactive prevention and close monitoring were needed. Adverse events after receiving antitoxin were prevalent, and might not be associated with age, sex, and severity of botulism.

Objective To summarize the international current status of anesthesia nursing research. Methods The nursing papers were searched across the databank of PubMed and Web of science between 1946 and 2017 and 2012 and 2017,respectively to look into the external characteristics of international anesthesia nursing publications. Using the methods of common words analysis, cluster analysis and citation analysis, we analyzed high frequency subjects and highly cited articles from 2012-2017, analyzing the highlights in the anesthesia nursing. Results 5,041 articles from 1946-2017 were included. The number of articles in anesthesia nursing field was relatively small in first 30 years,increasing year by year since 1970s and speeding up since 1990s.The average number of articles from 2012-2017 was all above 150.The 5,041 articles distributed in 1,260 journals.The top 10 journals accounted for 24.36% of the total number (1228/5041).The articles were mainly published in the developed countries in Europe and America.The hot spots in anesthesia nursing research included anesthesia management and pain management,professional skills of anesthesia nurses and medical team collaboration,intervention on psychological status and complications among perioperative patients. Conclusions The research of anesthesia nursing aboard has attracted more and more attention and formed several research highlights.Domestic research in the field is still at the early stage and in the future,domestic scholars can draw on foreign research highlights to carry out relevant research.