Objective To evalue the ability of detecting the resistance of cefoxitin-sensitive,penicillin-resistant Staphylococcus by different methods and analyze the antibiotic susceptibility spectrum of coagulase-negative Staphylococcus which are non-mecA-mediated oxacillin resistance. Methods All the isolates were collected from Huashan hospital between 2007 and 2009. The isolates were recovered from various clinical sources, including respiratory tract, urine, secretion and sterile fluids samples. The oxacillin susceptibility of Staphylococcus aureus was determined by cefoxitin disk diffusion test, cefoxitin MIC test,oxacillin disk diffusion test and oxacillin MIC test Likewise, the oxacillin susceptibility of coagulasenegative Staphylococcus was determined by cefoxitin disk diffusion test and oxacillin MIC test. All the isolates with sensitive to cefoxitin were screened for the mec A gene by PCR Finally, the MIC of non-mecA-mediated oxacillin-resistant Staphylococcus were determined. Results Among 255 cefoxitin disk diffusion test sensitive and penicillin-resistant Staphylococcus aureus, 6 isolates were intermediated to oxacillin and 4 were resistant by oxacillin disk diffusion test, but all the isolates were sensitive by the cefoxitin disk diffusion test,cefoxitin MIC test and oxacillin MIC test. Among 75 cefoxitin disk diffusion test sensitive and penicillin-resistant coagulase-negative Staphylococcus, 16 isolates were resistant to oxacillin by oxacillin MIC method and 4 carried mecA gene. Among 12 non-mecA-mediated oxacillin-resistant Staphylococcus, the susceptible isolates of gentamicin is 10, clindamycin is 8, ciprofloxacin is 11, erythrornycin is 6, trimethoprim/sulfamethoxazo]e is 11 ,and cephalosporins, teicoplaninl, vancomycin, piperacillin/tazobactam, tetracycline are all 12. Conclusions The cefoxitin disk diffusion test can reliably predict mecA-mediated oxacillin resistant Staphylococcus aureus. It would be best to combine cefoxitin disk diffusion test and oxacillin MIC test to improve accuracy of detection of mecA-mediated oxacillin resistant coagulase-negative Staphylococcus.Furthermore, infections due to the non-mecA-mediated oxacillin resistant coagulase-negative Staphylococcus can be treated by penicillinase-stable penicillins, β-lactam/β-lactam inhibitor combinations, relevant cephems and carbapenems.

OBJECTIVETo establish the HPLC fingerprint of Angelica polymorpha.

METHODThe 10 batches of A. polymorpha were measured by HPLC with isoimperatorin as a reference substance and the chromatographic experients were performed on Kromasil 100A C18 column (4.6 mm x 250 mm, 5 microm), eluted with acetonitrile and water as mobile phase in gradient mode. The flow rate was 1.0 m x min(-1) and the detection wavelength was 254 nm.

RESULTThe common mode of the HPLC fingerprints were set up. There were 8 common peaks in the fingerprint of 10 samples, and the similarity of the 10 samples was more than 0.9.

CONCLUSIONThe method is simple, accurate and have a good reaptability. The quality of A. polymorpha can be controlled effectively by the HPLC fingerprint.

Angelica ; chemistry ; China ; Chromatography, High Pressure Liquid ; methods ; Drugs, Chinese Herbal ; chemistry ; isolation & purification ; Furocoumarins ; chemistry ; Plant Roots ; chemistry ; Plants, Medicinal ; chemistry ; Quality Control ; Reference Standards ; Reproducibility of Results

Objective To analyze the relationship between the serum B-cell activating factor (BAFF) levels and clinical characters and pathological features in children with lupus nephritis (LN). Methods ELISA was used to detect the serum BAFF (sBAFF) levels of the 54 LN children diagnosed in the First Affiliated Hospital, Sun Yat-sen University during October 1, 2014 to December 31, 2016 and with complete clinical data. According to whether glucocorticoid or immunosuppressive agents has been used at their first admission, patients were divided into treated group (n=44) and non-therapy group (n=10). According to the renal response after induction treatment for 6 months, patients were divided into remission group (n=20) and non-response group (n=34). According to whether there was renal recurrence, they were divided into recurrence group (6 cases) and non-recurrence group (48 cases). According to renal biopsy, patients were divided into class-Ⅲ, class-Ⅳ and class-Ⅴ group. Another 15 healthy children were taken as a control group. The correlations between sBAFF and clinical manifestation, laboratory examination, renal biopsy and clinical outcome were analyzed. Results (1) Compared with the control group, the sBAFF was significantly increased in LN group (t=3.821, P<0.001). Compared with the non- neuropsychiatric systemic lupus erythematosus (NPSLE) group, sBAFF was significantly increased in NPSLE group (t=2.202, P=0.032). (2) Compared with that in treated group, sBAFF was significantly higher in untreated group (LSD - t=2.309, P=0.025). Compared with non-response group, sBAFF was significantly decreased in response group (LSD-t=2.035, P=0.046). (3) No significant difference was observed between class-Ⅲ, class-Ⅳ and class-Ⅴpathological classification group (F=1.080, P=0.459). sBAFF in LN children was not significantly correlated with the active index (AI) or chronic index (CI) of Austin index (r=-0.273, P=0.063; r=0.150, P=0.314). (4) In LN children, sBAFF has positive correlation with ESR and IgG level (r=0.289, P=0.036; r=0.340, P=0.017) and negative correlation with WBC (r=-0.337, P=0.013). Multiple linear regression model showed that serum IgG level (β'=0.517, P=0.001) and renal response (β'=-0.271, P=0.037) were independent influencing factors of sBAFF level. Conclusions Renal remission and serum IgG levels in LN children are influencing factors of sBAFF levels. sBAFF is helpful to clinical assessment on renal response of LN children.

Objective:To analyze the application value of narrative education model in clinical teaching of nurses in operating room.Methods:A total of 90 nursing students in the Department of Operating Room, Shanghai Tenth People's Hospital from January 2018 to January 2020 were selected as the research objects and randomly divided into observation group and control group, 45 in each group. The control group was taught by traditional mentoring method, and the observation group was taught by narrative education model. The two groups of nursing students practiced for 4 weeks. After the teaching, the scores of theoretical knowledge and operation were compared between the two groups. The scores of career identity scale and caring ability evaluation scale of the two groups were compared, the scores of each dimension of Chinese registered nurse core competence scale (CIRN) were evaluated, and the feedback of the two groups of nursing students on the teaching methods was analyzed. SPSS 22.0 was used to conduct t-test and chi-square test. Results:The scores of theoretical knowledge and operation in the observation group were (94.52±5.34) points and (88.67±3.98) points, respectively, which were significantly higher than those [(85.67±5.26), (82.24±4.16)] in the control group ( t=7.92, 7.49, all P<0.001). The scores of professional identity scale and caring ability evaluation scale in the observation group were (39.12±5.12) points and (193.14±11.24) points, respectively, which were significantly higher than those [(34.21±4.23), (180.23±11.35)] in the control group ( t=4.96, 5.42, all P<0.001). The scores of various dimensions of CIRN in the observation group were significantly higher than those in the control group ( t=4.72, 7.57, 4.13, 4.66, 6.19, 4.27, 5.48, all P<0.001). The feedback of nursing students in the observation group on teaching methods was significantly better than that in the control group ( χ2=4.29, 6.48, 12.26, 4.44, 7.60, 5.03, P<0.05). Conclusion:Narrative education model can significantly improve the internship effect of operating room interns, with clinical value.

Objective:To analyze the clinical efficacy and safety of camrelizumab combined with apatinib as a second-line therapy for unresectable hepatocellular carcinoma (HCC).Methods:Ninety-four cases with mid-and advanced-stage HCC who received camrelizumab combined with apatinib as second-line treatment were enrolled. Routine blood test, blood biochemical indexes, tumor stage, tumor imaging characteristics, previous treatment strategies and other clinical data before treatment were documented. Imaging examination follow-up results and adverse reactions during treatment were followed up until the end of follow-up or loss of follow-up or death. Kaplan-Meier method was used to analyze the clinical efficacy.Results:As of the last follow-up, 94 cases with mid-and advanced-stage HCC had received camrelizumab combined with apatinib as second-line treatment. Among them, 15 cases were lost to follow-up, 31 cases died, and 48 cases survived. The overall remission rate was 31.9%. The overall disease control rate was 71.3%. The median time to disease-free progression was 6.6 months. The median time to disease progression was not yet available. The 1-year cumulative survival rate was 62.3%. Grade 3 and above adverse reactions mainly included were thrombocytopenia (7.4%), abdominal pain (4.3%), active hepatitis (4.3%), leukopenia (4.3%), diarrhea (3.2%), hand-foot syndrome (3.2%). All adverse reactions were effectively controlled.Conclusion:Camrelizumab combined with apatinib can effectively prolong the survival period of patients with mid-and advanced-stage HCC, and it is well tolerated.

Objective:To study the diagnosis and treatment of osteoporotic fractures in the elderly in two third Grade A hospitals in Shenyang and Dalian, and to provide scientific basis for prevention and treatment of osteoporotic fractures in Dalian and Shenyang.Methods:Patients of osteoporotic fractures over 60 years old from January 2015 to December 2015 in the Second Hospital of Dalian Medical University and the People′s Hospital of Liaoning Province were chosen, and the basic characteristics, fracture site, the number of fracture site, diagnosis treatment and secondary prevention of osteoporosis fractures of them were analyzed.Results:Among the patients of osteoporotic fractures over 60 years old in the hospitals of Shenyang and Dalian, women were more than men ( P = 0.00). The predilection sites of elderly osteoporotic fractures in two hospitals were both followed by the hip, spine, ulnar and radial distal, proximal humerus. The rates respectively were 38.26%(295/771), 34.63% (267/771), 9.34%(72/771), 5.71%(44/771). The rate of fracture-again was 10.89%(84/771). The rates of in-hospital diagnosis, in-hospital treatment and treatment of discharged medical advice among osteoporosis were 13.88%(107/771), 24.64%(190/771) and 18.81%(145/771). There were 0.65% (5/771) patients who had diagnosis of osteoporosis, basic osteoporosis treatment (vitamin D 3 and calcium) and anti-osteoporosis treatment in both in-hospital and discharged medical advice. Conclusions:The rates of in-hospital diagnosis, in-hospital osteoporosis treatment and anti-osteoporosis treatment in discharged medical advice are both very low in the two third Grade A hospitals. The secondary prevention of osteoporosis fractures in the elderly has not been taken attention, and the situation of prevention and treatment are serious.

OBJECTIVE Cognitive deficit is a com-mon comorbidity in temporal lobe epilepsy(TLE)and that is not well controlled by current therapeutics.Currently,how epileptic seizure affects cognitive performance remains largely unclear.The subiculum is the major out-put of the hippocampus,which projects to entorhinal cor-tex and other more distinct brain regions.Physiologically,the subiculum codes spatial working memory and naviga-tion information including place,speed,and trajectory.Importantly,prior studies have noted the importance of the subiculum in the beginning,spreading,and generaliz-ing process of hippocampal seizure.How seizure-activated neurons in subiculum participate in cognitive impairment remains largely elusive.METHODS In this study,we sought to label the subicular seizure-activated c-fos+ neu-rons with a special promoter with enhanced synaptic activity-responsive element E-SARE in the subiculum,combined with chemogenetics and designer receptors exclusively activated by designer drugs(DREADDs),Ca2+ fiber photometry approaches,and behavioral tasks,to reveal the role of these neurons in cognitive impairment in epilepsy.RESULTS We found that chemogenetic inhibi-tion of subicular seizure-tagged c-fos+ neurons(mainly CaMK Ⅱ α+ glutamatergic neurons)alleviates seizure generalization and improves cognitive performance in the hippocampal CA3 kindling TLE model.While inhibition of seizure-labeled c-fos+ GABAergic interneuron shows no effect on seizure and cognition.As a comparison,che-mogenetic inhibition of the whole subicular CaMK Ⅱ α+ neuron impairs cognitive function in na?ve mice in basal condition.Notably,inhibition of subicular seizure-tagged c-fos+ neurons enhances the recruitment of cognition-responsive c-fos+ neurons via increasing neural excitability during cognition tasks.CONCLUSION Our results dem-onstrate that subicular seizure-activated c-fos+ neurons contribute to cognitive impairment in TLE,suggesting sei-zure-tagged c-fos+ neurons as the potential therapeutic target to alleviate cognitive impairment in TLE.

Fatigue is the second most common symptom in patients with chronic obstructive pulmonary disease (COPD) . It has a high incidence and interferes with patients' normal working life. This article reviews the concept and pathogenesis of fatigue, as well as the predisposing factors and treatments of fatigue symptom in patients with COPD. This article provides a reference for medical staff to deepen their understanding of fatigue in order to take effective measures to relieve fatigue and improve patients' quality of life.