OBJECTIVE To approach pathogens and precaution strategy of nosocomial pneumonia in patients with myasthenia gravis.METHODS Forty cases of myasthenia gravis from Jan 2003 to Dec 2006 in a certain hospital were involved in the retrospective review.Patients with myasthenia gravis and nosocomial pneumonia were selected out in accordance with diagnostic criteria of nosocomial pneumonia.Risk factors and pathogens of infection were analyzed.Precaution strategy was formulated.RESULTS There were 26 patients with nosocomial pneumonia among 40 cases of myasthenia gravis.Pathogens isolated from sputum culture were all drug resistant strains.Gram-negative bacteria such as Klebsiella pneumoniae,Pseudomonas aeruginosa,Escherichia coli,etc were the most,accounted for 51.85%(84 strains).The next was Gram-positive bacteria,accounted for 33.33%(54 strains).Fungi ranked the third,accounted for 14.81%(24 strains).CONCLUSIONS Precaution and cure measurement should be adopted to prevent and control the occurrence of nosocomial pneumonia in patients with myasthenia gravis.

Objective To discuss the effect of health education to family members of patients with chronic heart failure. Methods 150 patients with family members as accompanies were divided into the observation group and the control group with 75 patients in each group. Health education was given to patients as well as their family members in the observation group, while health education was given only to the patients in the control group. The mastering of disease-related knowledge by family members of the observation group was observed after 15 days. The rehospitalization of the two groups by telephone follow-up was carried out six months after discharge. Results The mastering of disease-related knowledge by family members of the observation group was better compared with before health education. The rehospitalization rate of the observation group was 13.3%, which was lower than 44.0% of the control group. Conclusions Health education to family members of patients with chronic heart failure can increase treatment effect of patients, decrease disease relapse and lower rehospitalization rate.

Objective To investigate the morphologic characteristics of neuron-like cells induced from the rat mesenchymal stem cells(MSCs). Methods The rat MSCs from bone marrow were cultured by being adhered to the culture dish.The thirdgeneration of the MSCs were induced by the neonate rat brain homogenate supernatant for 48 hours.The morphological characteristics and the ultrastructures of both non-induced and induced MSCs were observed under the inverted microscope and the electron microscope.The property of the induced cells was identified by using immunocytochemical method. Results Under the inverted microscope MSCs showed spindle or polygon-shaped cell bodies and the nuclei with one or two nucleoli were located in the middle of the cells.After the inducement the cells appeared neuron-like with axonlike and dendrite-like processes.The neuron-like cells were neuron special endolase(NSE),neurofilament protein(NF) positive and glial filbrillary acidic protein(GFAP) negative by irnmunocytochemical staining.Under the electron microscope the MSCs had plentiful cytoplasm and organelles and had an obvious nuclei containing a nucleoli.There were a lot of microvilli on the surfaces of the MSCs.The neuron-like cells had plentiful cytoplasm and irregular nuclei with one to three nucleoli.There were also plenty of microvilli on the cell surfaces.Conclusion MSCs are one kind of multipotent stem cells and can differentiate neurons with matured organelles induced by the neonate rat brain homogenate supernatant.

Objective To observe the influence of optimized nursing process on the clinical effect and quality of life of patients with cerebral infarction received intravenous thrombolysis.Methods Sixty-two cerebral infarction patients with thrombolytic therapy in Panzhihua Central Hospital were treated as control group from January 2013 to June 2014,74 cases cerebral infarction patients with thrombolytic therapy as the observation group from July 2014 to October 2015.The control group received routine nursing,the observation group were given optimized nursing process on the basis of routine nursing.The clinical effect and quality of life were compared between the two groups.Results The triage time,referral time and hospital stay time of the observation group were significantly shorter than the control group,the differences were statistically significant (P ＜0.05).The effective rate in the control group was 70.97％,that of the observation group was 87.84％,the effective rate in observation group was significantly better than that of the control group,the difference was statistically significant (P ＜0.05).Compared with before treatment,the life quality of two groups were significantly improved after treatment,the difference was statistically significant (P＜0.05);after treatment,the quality of life in observation groups were better than that of the control groups,the difference is statistically significant (P＜0.05).Conclusion Nursing process optimization can effectively improve the therapeutic effect for the patients with cerebral infarction intravenous thrombolytic therapy,shorten the treatment time and hospitalization time,and can significantly improve the patient' s quality of life.It is valuable for clinical application.

Objective To explore the molecular mechanism of bilirubin in the hippocampus of the newborn rats with hyperbilirubinemia. Methods Hyperbilirubinemia model was established. The expression levels of Fas protein and N methyl D aspartate (NMDA) receptor and the apoptosis rate of nerve cells in rat hippocampus were detected with immunochemistry, TUNEL method and cytometry. Results Histological changes of nerve cells were found in hippocampal area of rats with hyperbilirubinemia. Significantly increased expression levels of Fas protein and NMDA receptor and apoptosis rate of nerve cells were positively correlated with the bilirubin level in rat brain tissues. Conclusion The bilirubin neurotoxicity is mediated by the excessive activation of NMDA receptor and participation of Fas system, which induces the apoptosis of nerve cells.

Objective To investigate the functional characteristic of adolescents with conduct disorder (CD) in the resting state.Methods Resting-sate fMRI (rs-fMRI) scans were administered to 28 male adolescents with CD and 28 age-,gender-and IQ-matched healthy controls (HCs).The rs-fMRI data were subjected to amplitude of low-frequency fluctuation (ALFF) analysis and ALFF values were compared between the two groups.Additionally,the region ROIs showed significant difference and correlation analysis was conducted between ALFF in each ROI and Barratt's scores.Results ① Compared to HCs,the CD group showed decreased ALFF (P＜0.005) bilaterally in the superior frontal gyrus,right middle frontal gyrus,right posterior cingulate gyrus,right inferior parietal lobule (MNI coordinates:-21,48,27;21,24,48;36,24,33 6,-36,39;48,-45,57 respectively) as well as increased ALFF (P＜O.005) in the left thalamus and left lingual gyrus (MNI coordinates:-15,-27,-3;-18,-87,-12 respectively).② There was no significant correlation between ALFF and Barratt's scores in ROIs.Conclusion The results suggest that CD is associated with abnormal intrinsic brain activity,mainly in frontal-parietal-occipital-limbic cortices,which is related to emotional and cognitive processing and behavioral functions.

Objective To analyze the antimicrobial resistance profile of clinical isolates in Shanghai Xinhua Hospital Chongming Branch affiliated to Shanghai Jiaotong University School of Medicine , a member of China Antimicrobial Resistance Surveillance System, during 2015, for the purpose to facilitate rational antimicrobial therapy. Methods Strain identification?and?susceptibility?testing?were?carried?out?for?the?clinical?isolates?using?MicroScan?WalkAway?96?Automated?Systems and Kirby-Bauer method. Results In 2015, a total of 1815 isolates were collected, including gram-negative bacteria (73.2 %) and gram-positive bacteria (26.8 %). The top three frequently isolated species were Escherichia coli, Klebsiella pneumoniae, and Pseudomonas aeruginosa. ESBL-producing strains were found in 36.3 % of the Escherichia coli isolates, 12.6 % of the Klebsiella (K. pneumoniae and K. oxytoca) isolates, and 28.0 % of the Proteus mirabilis isolates. The prevalence of carbapenem-resistant strains was 0.69 % in Enterobacteriaceae isolates. The prevalence of methicillin-resistant strain was 29.1 % in S. aureus, and 61.4 % in coagulase-negative Staphylococcus isolates. No more than 15 % of the Enterobacteriaceae isolates and no more than 20 % of the P. aeruginosa and Acinetobacter isolates were resistant to carbapenems. No vancomycin-or linezolid-resistant strains were found in Enterococcus or Staphylococcus. Conclusions Antibiotic-resistant clinical isolates are a serious threat for clinical antimicrobial treatment. We should pay more attention to such urgent situation and rational use of antibiotics.

Objective:To investigate the anti-inflammation effects by activation of the cholinergic anti-inflammatory pathway and its mechanisms in non-alcoholic steatohepatitis (NASH)model mice.Me-thods:6-week-old male C57BL/6J (B6)mice were randomly divided into four groups:the first group was normal mice,injected with saline;the second group was normal mice,injected with nicotine;the third group was NASH model mice,injected with saline;the fourth group was NASH model mice,injec-ted with nicotine.The experimental mice were fed with either standard chow (SC)or high-fat and high-fructose (HFHF)for 17 weeks to generate an NASH model mice.The mice received injection once daily for 3 weeks [nicotine dose,400 μg/kg].Then,their pathological characteristics and function of the liver were assessed.The expressions of interleukin-6 (IL-6)and tumor necrosis factor-α(TNF-α)in se-rum were analyzed by enzyme linked immunosorbent assay (ELISA).The expressions of alpha 7 nicotinic acetylcholine receptors (α7nAChR),Toll-like receptors-4 (TLR-4)and nuclear factor κB of phosphory-lation (p-NF-κB)in Kupffer cells were determined by Western blot and immunofluorescence assays.Re-sults:We successfully generated NASH model mice by imitating the high-fat and high-fructose dietary style of NASH patients.The results of our investigation demonstrated that nicotine could reduce signifi-cantly the levels of IL-6,and TNF-αin serum (P <0.05).The expression of p-NF-κB protein in the group which was NASH model mice injected with nicotine declined significantly as compared with the group which was NASH model mice injected with saline (P <0.05).And the expression of α7nAChR protein elevated significantly conversely (P <0.05 ).Conclusion:Activation of the cholinergic anti-inflammatory pathway could inhibit the release of inflammatory factors as TNF-αand IL-6 in NASH model mice,and the mechanism for the inhibition of inflammatory was mediated by NF-κB pathway.

Objective To explore the clinical application value of ultrasound-guided intrahepatic biliary puncture combined with internal double biliary stenting under DSA in elderly patients with malignant hilar biliary obstruction (MHBO).Methods Totally 108 elderly MHBO patients received interventional treatment were analyzed retrospectively.Half of patients were treated with ultrasound-guided intrahepatic biliary puncture (ultrasound group),and another 54 patients were treated with DSA intrahepatic biliary puncture (DSA group).After successful puncture,the patients received percutaneous transhepatic cholangial drainage (PTCD) with 4 methods under DSA guidance,namely internal double biliary stenting,contralateral external PTCD with single biliary stenting,complete external PTCD and external PTCD on the dominant side.The recent complications of intrahepatic biliary puncture at two groups and the curative effect with four methods were observed.Results The frequency of intrahepatic biliary puncture,the dosage of contrast agent,the incidence of pain at the puncture point and hemobilia in ultrasound group were all lower than those in DSA group (all P＜0.05),the successful rate of intrahepatic biliary puncture in first time was significantly higher compared with DSA group (P＜0.05).The liver function indicators at 14 days postoperation and total bilirubin at 21 days postoperation had statistical differences between any two biliary drainage methods (all P＜ 0.05).Conclusion Ultrasound-guide intrahepatic biliary puncture combined with internal double biliary stenting under DSA can significantly benefit elderly patients with MHBO.

Objective To evaluate the effect of acupointhot compress with warming moxibustion bag on treating radiation proctitis caused by radiotherapy in cervical cancer. Methods 78 patients of cervical cancer with acute radioactive proctitis caused by radiotherapy were divided into two groups according to the length of hospital stays. The experiment group was given compress Tianshu acupoint with warm moxibustion bag every day, along with drug and retention enema, while the control group was treated with drug and retention enema only. Then observe and evaluate the effect of different treatment on each group. Results The total effective rate of treating radiation proctitis in experimental group was 94.44%(34/36) which was superior to 76.19% (32/42) of the control group (χ2=4.962, P<0.05). The influence of tumor radiotherapy in experimental group was also superior to the control group, nine patients were forced to suspend to radiotherapy by (6.11 ± 1.96) days in the control group, while five cases were suspended to radiotherapy by (2.20±1.09) days in the experiment group (t=4.066,P<0.05). Conclusions Acupoint hot compress with warming moxibustion bag combine with retention enema have an advantage over retention enema only on radiation proctitis caused by radiotherapy in cervical cancer.