In recent years,more and more Macrolide resistance of Mycoplasma pneumoniae becomes a hot research.The current studies suggest that the mechanisms of Macrolide resistance are drug-binding site mutations,ribosome methylation,drug efflux,and drug related fire-fighting,in which the drug target 23srRNA gene 2063,2064 mutation is significant.It has been reported that drug-resistant patients have the poor effect,including the long total febrile days and high dressing.For treatment of drug-resistant patients,most studies still use the macrolide,early use of corticosteroids may be effective.It is uncertain whether the increase in resistant strains is related with the use of macrolide.It is significant to carry out future researches in this area for clinical therapy and put off the prevalence of drug-resistant strains.

Objective To investigate the clinical and pathological features of Churge-Strauss syndrome(CSS) combined leukocytoclastic vasculitis.Methods The clinical data of 1 patient with CSS combined leukocytoclastic vasculitis was analyzed retrospectively.Results The main symptoms of the case were peripheral nerve damage,violation of the skin lesions,gastrointestinal tract,lung,and central nervous system;peripheral blood eosinophil count was high.The pathological examine showed vessel wall and skin organizations had a large number of eosinophils infiltration,small vessel walls,as well as granuloma formation around multiple segmental fibrinoid necrotizing vasculitis.Eventually died of multiple organ failure.Conclusion The clinical manifestations of CSS combined leukocytoclastic vasculitis have vasculitis and peripheral neuropathy mainly;the pathological features are that vessel wall and skin organizations have a large number of inflammatory cells infiltration;the late multi-system are involved,and the prognosis is poor.

Objective To evaluate the effect of meglumine cyclic adenosine (MAC) on heart rate variability (HRV) in aged-patients with coronary heart disease (CHD).MethodsSeventy six aged-patients with CHD were randomly divided into control group (n =36) and treatment group (n =40).The patients in control group were treated with nitrate,ozagrel,calcium antagonist,aspirin enteric-coated tablets,low molecular heparin,angiotensin-converting enzyme inhibitor ( ACEI ) or angiotensin receptor antagonist ( ARB ) and lipidlowering agents according to patients' conditions.Based on this,the patients in treatment group were treated with MAC 90 mg intravenous injection once a day for two weeks.The 24 h dynamic electrocardiogram was recorded.pre-ard post-treatment,and the changes of HRV indexes were observed.Results There was no statistical significance in HRV between the two groups before treatment ( P ＞ 0.05 ).However the HRV in two groups improved significantly after treatment ( P ＜0.01 ).The improvement of HRV was more significant in MAC group than that in control group (P ＜0.01 ).Conclusion MAC can significantly improve HRV in aged-patients with CHD.

Objective To explore the mechanism of shengmai injection on relieving ischemia reperfusion injury and antagonizing systemic inflammatory response syndrome by regulating cytokines when it was applied at the early stage of cardiopulmonary resuscitation(CPR).Methods 40 cases suffering from cardiac arrest and had their heart beat recovered through CPR for more than 24 hours were randomly divided into SMI group and control group(20 cases for each).The patients in the two groups were treated with common therapeutics based on the CPR,but the patients in SMI group were intravenously dropped with SMI in the early period of PLS phase,then the changes of serum concentration of TNF-α and IL-81h,2h,6h,12h and24h after CPR in the two groups was compared.Results The concentrations of serum TNF-α and IL-8 stepped up gradually after resuscitation and the levels of TNF-αand IL-8 in SMI group were lower than that of the control group at 1h,2h,6h,12h and 24h after resuscitation(P＜0.05).Conclusion SMI functions to relieve ischemia reperfusion injury by regulating cytokines and antagonizing systemic inflammatory response syndrome.

Objective To study the characteristic of operation design and analyze curative effect of laser sub-epithelial keratomileusis (LASEK) on low and midrange myopia in aged patients. Method Fiftyeight patients ( 114 eyes) no less than 35 years old were treated with LASEK by monoblepsis. The subjects were examined and analyzed at 3 days, 7 days, 1 month,3 months and 6 months after operation. Results Seventy-one corneas(62.28%) recovered well at 3 days after operation. At 1 month after operation, the acuity of vision of all patients achieved or exceeded corrected vision before operation,and lasted to 6 months after operation. The break up time of 63 eyes were lower than normal at 3 months after operation,but 6 months after operation all of them recovered to normal. The satisfaction of patients raised gradually. Conclusions LASEK is effective for no less than 35 years old myopic patients. Make operation plan refer to monoblepsis and patients' needs can receive more satisfaction.

Objective To explore the best time interval to extubate catheter for the postoperative gastric cancer patients,and provide the basis for early extubation after operation.Methods To collect 108 cases with gastric cancer in Department of Forensic Surgery of Yuncheng Central Hospital from March 2013 to February 2014 with indwelling catheter preoperatively.According to the admission sequence,they were divided into the observation group and the control group with 54 cases in each group,the observation group began clipping catheter in 10-15 hours after operation,extubating catheter within 24 hours after operation;the control group began clipping catheter on the second day after operation,and extubating catheter during 48-72 hours after operation.The time of extubation,urinary tract irritation symptoms,resetting catheters and the incidence of early postoperative ambulation in patients of two groups were observed.Results The incidence of urinary tract irritation was lower in the observation group than that of the control group [3.7％ (2/54) vs 16.7％(9/54)],the difference was statistically significant (x2=4.960,P＜0.05).Early ambulation compliance of the observation group was higher than that of the control group (complete compliance 52 vs.40,partial compliance 2 vs.8,no compliance 0 vs.6),the difference was statistically significant (x2 =10.565,P ＜0.05).Conclusions The method of extubation catheter within 24 hours after gastric canter operation can reduce the incidence of urinary tract irritation and improve early ambulation compliance.

Objective To find a solution to the long-term storage of enormous amount of imaging data in hospital picture archiving communication system (PACS). Methods Medical imaging data collected by devices of Digital Imaging and Communications in Medicine-3 (DICOM3) and non-DICOM3 were transformed into the storage format, metadata instance, and expression pattern of digital images standardized by DICOM3. Based on the requirements of data utilization and storage system and the optimal principle of function and value, the reasonable flow of imaging data in PACS network were scientifically allocated by application of on-line, near-line, and off-line storage patterns and by reasonable allocation of the volume and clusters of storage devices. Results The PACS storage system established by our method, characterized by super capacity of error tolerance, permanent unrestricted storage, quick in retrieval, and quick, convenient and reliable in storage and reading, could meet the requirements of long-term storage and management of enormous amount of medical imaging data. Conclusion Grading storage is the effective method for long-term storage of enormous amount of medical imaging data in PACS.

To assess the clinical effect of HA regimen on newly diagnosed patients in chronic phase of chronic myeloid leukemia (CML). Ninety four cases of CML patients were grouped in accordance with the requirements on the basis of treatment regimens and Sokal risk index, and the clinical effects of HA regimen wer evaluated. We found that HA regimen showed satisfactory immediate effect on CML in chronic phase. CR rates achieved in high risk and medium risk groups(77 4%,20 0%) with HA were higher than that with Hu regimen(35 0%,0%). However, HA regimen was incapable of extending the duration of CML. So HA should not be used as first line treatment in the treatment on newly diagnosed patients in chronic phase of CML, except for high risk group whose symptoms could not be controlled with other regimens.

Objective To analyze the clinical efficacy of balloon occlusion of distal abdominal aorta for patients with pernicious placenta previa and placenta accreta.Methods Data of 72 patients with pernicious placenta previa and placenta accreta were retrospectively analyzed.There were 53 cases (occlusion group) reserved balloon occlusion in abdominal aorta before cesarean section,which can temporarily blocked abdominal aortic blood flow during operation.The other 19 cases (non-occlusion group) underwent cesarean section without balloon occlusion of abdominal aorta.The intraoperative,post operative situations and the birth state of newborn of the two groups were compared.Results The bleeding,blood transfusion and hysterectomy rate during the operation in occlusion group were less than those in non-occlusion group (all P＜ 0.05).Differences of the rate of postoperative transferring to intensive care unit (ICU) and the time in ICU were statistically significant between two groups (both P ＜0.05).No statistical difference of operation time,postoperative total hospital stay time and the rate of postoperative infection was found between two groups (both P＞0.05).There was no statistical difference of newborns weight and Apgar scores (5 min and 10 min after birth) between two groups (all P＞0.05).Conclusion The balloon occlusion of distal abdominal aorta in cesarean section for patients with pernicious placenta previa and placenta accreta is safe and feasible,which can effectively reduce the intraoperative bleeding,the blood transfusion and the risk of hysterectomy.

Objective To explore the association between maternal age and perinatal outcomes.Methods Totally,3 151 women with advanced maternal age and 6 098 women younger than 35 years old who delivered in Beijing Obstetrics and Gynecology Hospital in 2016 were recruited.Their clinic characteristics and perinatal outcomes were collected to divide into 3 groups based on delivery age,Group 1 (aged 35-39 years,2 683 cases),Group 2 (aged ≥40 years,366 cases) and the control group (aged＜35 years,6 098 cases).The association between maternal age and adverse perinatal outcomes were analyzed,including hypertensive disorder complicating pregnancy,gestational diabetes mellitus (GDM),preterm birth and postpartum hemorrhage.Results The rate of cesarean section history (27.39％,33.61％,5.53％) or previous myomectomy history (2.80％,5.46％,0.72％) were compared between the advanced maternal age groups and the control group,and the differences were statistically significant (P＜0.05).The percentage of prepregnancy overweight and obesity (29.67％,27.05％,18.47％),complicated with myoma (14.83％,19.95％,5.64％) were compared among the three groups,and the differences were statistically significant (P＜ 0.05).The percentage of pregnancy through assisted reproductive technology (9.84％,15.03％,3.12％) also had statistically significant differences (P＜0.05).The incidence of fetal chromosomal abnormalities (1.23％,3.01％,0.36％) and fetal malformations (1.94％,4.37％,0.48％) increased with the maternal age,with statistically significant differences (P＜0.01).The mobidity of hypertensive disorders (9.84％,13.11％,9.23％),pregestational diabetes mellitus (1.83％,2.19％,0.72％),gestational diabetes mellitus (22.70％,28.42％,14.87％),premature rupture of membranes (25.57％,19.40％,31.42％),placenta previa (2.05％,2.46％,0.92％),preterm birth(8.35％,11.20％,5.51％),postpartum hemorrhage (25.11％,18.31％,20.27％)and forceps delivery (5.42％,2.33％,5.71％) were compared,and the differences were statistically significant (P＜0.05).The cesarean section rate in primipara (45.42％,75.74％,21.33％) and multipara (51.46％,61.54％,30.95％) had statistically significant difference (P＜0.05).The proportion of macrosomia (10.80％,8.85％,7.96％) and neonates transferred into neonatal ICU (9.63％,11.48％,5.21％) in term neonates had statistically significant difference (P＜0.05).Conclusions Women with advanced maternal age increase after new family planning policy put into effect,so do the risk of adverse perinatal outcomes.Attention and interventions should be made to cope with the occurrence of adverse perinatal outcomes.