Objective To investigate the antimicrobial resistance of E.faecalis and E.faecium isolated from the Hospital from 2009 to 2013.Methods Minimum inhibitory concentration method was used for antimicrobial susceptibility test of the clinical iso-lates.Results were judged according to Clinical and Laboratory Standards Institute′s 2013 version of criterias.Results A total of 819 nonduplicated E.Faecalis and 726 nonduplicate E.faecium isolates were collected.The strains were still highly susceptible to linezolid and vancomycin,to which the drug-resistance rates were both less than 1.5%.The prevalence of vancomycin-resistant E. faecalis and E.faecium was 0.1% and 1.5%,respectively.The ratio of E.faecalis resistant to ampicillin,penicilin and nitrofuran-toin was 4.3%,1.6% and 1.6%,respectively.More than 87% E.faecium strains were resistant to ampicillin and penicillin,and the E.faecium strains were more resistant to most drugs tested than E.faecalis .Conclusion There was an obvious difference of anti-biotic resistance beween E.Faecalis and E.Faecium isolates.Therefore,Continuous monitoring the drug resistance is helpful to guide the clinical rational drug use.

Using 133Xe-inhalation technique quantitative measurements the regional cerebral blood flow (rCBF) was performed in 20 patients with unilateral ischemic lesion in one hemisphere according to cranial CT scan and in 10 normal subjects. Twenty patients had an Ultrasound Doppler examination of neck vessels half a day after rCBF examination. The results showed that rCBF in ischemic hemisphere before and during 3% CO, stimulation was lower than that in normal subjects or in non-ischemic hemisphere of the patients. It suggests that dilative responsibility to CO, in cerebral artery of stroke hemisphere is reduced. That is to say the cerebrovascular reserve capacity in stroke hemisphere was reduced too, but cerebrovascular reserve capacity in the non-stroke hemisphere and in normal subject of control group was normal. We also found cerebrovascular responsibility to CO, or cerebrovascular reserve capacity correlated with severity of clinical cerebral thrombotic illness and extent and degree of internal carotid artery obstruction. It was poor in severe illness or internal carotid obstruction and/or narrow in both sides of the patient group taken by Ultrasound Doppler examination of neck vessels.

Pulmonary arterial hypertension(PAH)is caused by pulmonary vascular remodeling, pulmonary arteriolar spasm, proliferation of vascular endothelial cells and smooth muscle cells, which gradually increase the pulmonary arterial pressure(PAP), eventually leads to right heart failure and even death.In recent years, due to the research of pathogenesis and the development of new drugs, the prognosis of patients with PAH has been significantly improved.The targeted drugs of PAH mainly act on different targets in three classic pathways of nitric oxide(NO), prostacyclin I 2(PGI 2)and endothelin-1(ET-1). Its application, combined application, surgical treatment and other methods have significantly improved the survival rate and life quality of patients with PAH.Compared with adults, children are more likely to have PAH associated with congenital heart disease(PAH-CHD)and idiopathic PAH(IPAH). As the onset age is young and pulmonary vascular lesions have not yet emerged, children can have a better prognosis.This paper reviews new treatment in children with PAH.

OBJECTIVE:To prepare Stemoninine orally disintegrating tablets,and to optimize its formulation and preparation technology. METHODS:Direct powder compression method was used to prepare Stemoninine orally disintegrating tablets. Using material angle of repose,disintegration time and taste evaluation as index,single factor test was used to screen several factors as bulking agent,disintegrating agent,glidant and flavoring agent;using disintegration time as index,L9(34) orthogonal test was used to optimize the formulation with ratio of MCC+mannitol,PVPP,silica powder and aspartame+stevia as factors. Validation test was also conducted. RESULTS:Optimized formulation was that MCC+mannitol(1∶1)was 50%,PVPP was 20%,silica powder was 2% and aspartame+stevia(10∶1)was 7%. 3 batches of prepared Stemoninine orally disintegrating tablets were smooth in sur-face and good in taste;their disintegrating time was(22.6±2.1)s,and weight variation,hardness,contents were within the speci-fied range (all RSD≤0.97%,n=3). CONCLUSIONS:The formulation and technology of Stemoninine orally disintegrating tab-lets are reasonable,and the quality indexes are all in line with the requirements of orally disintegrating tablets.

Objective:To evaluate the effect and safety of penehyrclidine hydrochloride when it was applied preoperatively in outpatient.Method:240 patients were randomly divided into two groups.Group P(120 cases)was treated with penehyclidine hydrochloride 0.5mg before the anesthesia as Group A(120 cases)with Atropine 0.25 mg.Sedation scale was observed just 5 and 15 minutes after drug administration.Analge scale,the degree of the patient's dry-mouth and PONV were also recorded.Time of recovery and leaving were studied too.Result:Group P had significantly better analgesic efficacy than Group A(P0.05).The degree of the patients dry-mouth were statistical difference between 2 group both 15min and 4h postoperation(P

BACKGROUND:Cartilage is an avascular tissue and has a limited capacity for self-repair after injury. There are various methods for the treatment of articular cartilage injury ranging from conservation therapy to invasive surgery. With the development of tissue engineering technology, it provides a new way for treating articular cartilage injury. OBJECTIVE:To review the new development of tissue engineering technology for repairing articular cartilage injury. METHODS:The PubMed database and CNKI database were retrieved for articles from 2000 to 2013 by the first author with computer in May 2013. The key words were“cartilage tissue engineering, cartilage defect, stem cell, scaffold, growth factor”in English and Chinese. A total of 64 articles were included which related to cartilage regeneration and cartilage tissue engineering. For the articles in the same field, those published recently or in authorized journals were selected. RESULTS AND CONCLUSION:The three elements of cartilage tissue engineering, seed cells, scaffolds and cytokines, must be coordinated and mutual y beneficial development. At present, the research of tissue engineering for repairing articular cartilage injury has made a great progress. But the application in clinic has not enforced yet which is limited in experimental exploration stage. With the continuous development of new materials, the new tissue engineering cartilage repair materials should meet the requirement of material science and biological science, thus making the materials closely meet the biological characteristics of the self tissues. The animal studies wil turn to clinical experiments with the support of new technique, which make a breakthrough in the treatment of articular cartilage injury.

Purpose　To judge the value of CT in the diagnosis of acute pancreatitis. Methods　74 cases of acute pancreatitis confirmed by operation were reviewed. All patients underwent CT plain and contrast -enhanced scanning. Oral contrast agents were used. Results　According to clinical diagnosis, they were devided into edematous type(n=53),and necrotic type(n=21). 7 cases were complicated with abscesses, and 5 cases died. According to CT finding, Grade A,n=10; Grade B,n=16; Grade C,n=19; Grade D,n=16; Grade E, n=13. Conclusion　 CT is valuable in the diagnosis of acute pancreatitis, and CT grade is referable.

Imbalance of energy metabolism is a major cause for metabolic syndrome. AMP-activated protein kinase AMPK is a central component of a protein kinase cascade that plays a pivotal role in the regulation of intracellular energy status.AMPK activity is a response to the ratio of AMP/ATP in the cell.When a stress causes an inhibition of ATP production or an increase of ATP consumption,cellular AMP/ATP ratio increases,AMPK is activated.Once activated,AMPK initiates a series of responses to restore the energy balance within the cell.AMPK switches on catabolic pathways,such as fatty acid oxidation and glycolysis,to generate ATP,and switches off anabolic pathways,such as fatty acid synthesis and protein synthesis,to reduce ATP-consumption.Therefore,AMPK functions in an ideal position not only as an energy sensor at cellular level,but also as a pivotal player in the regulating pathways that control both energy expenditure and energy intake,in particular by mediating the effects of hormones and cytokines such as leptin,adiponectin and ghrelin.The recent finding that anti-diabetic drug metformin and TZD regulates glucose metabolism through the activation of AMPK suggested a possible role of AMPK in protecting the body from metabolic diseases such as metabolic syndrome,obesity and type 2 diabetes.Thus,further work in this field in the next several years will be necessary in order to fullyunderstand the role of AMPK in regulating the balance of energy storage and expenditure in different tissues and at the whole body level.Targeting to AMPK cascade would also have potentially pharmaceutical application for obesity and metabolic syndrome.

OBJECTIVE To conclude and analyze epidemiology,etiology,diagnostic,treatment and prognostic factors of local adult hospitalized patients with severe pneumonia.METHODS A retrospective analysis with case-control study was designed.All the medical records of consecutive patients aged ≥18 yrs with diagnosis of pneumonia from Sep 2000 to Sep 2005 in the First Affiliated Hospital of Sun Yat-sen University were searched.Contribution of the factors to prognosis was determined by multivariate analysis with Logistic regression.RESULTS In the severe community-acquired pneumonia(SCAP) subgroup,mortality was 45.0%;and in the severe hospital-acquired pneumonia(SHAP) subgroup,mortality was 54.8%.In the SCAP subgroup,there were five factors associated with prognosis on multivariate analysis: age(≥75yrs),heart failure,intubation and septic shock were risk factors;initial combined antibiotic therapy was protective factors.In the SHAP subgroup, factors associated with prognosis on multivariate analysis were heart failure,septic shock and heart rate ≥100bpm;all were risk factors.CONCLUSIONS Septic shock and heart failure are associated with mortality both in SCAP and SHAP,which suggest that severe systemic inflammatory response associated with the pulmonary infection be an important prognostic factor in the outcome of severe pneumonia.Initial appropriate antibiotic empiric therapy was important to the prognosis.

Objective To investigate the clinical characteristics and diagnostic methods of multiple endocrine neoplasia ( MEN) 2B. Methods The clinical data collected from 4 cases with multiple endo-crine neoplasia type 2B, who had been diagnosed and treated from July .1980 to Jan.2012, were retrospec-tively analyzed.Of the 4 patients, 3 males were diagnosed at the age of 14, 24, 21, respectively, and 1 fe-male was diagnosed at age of 23.Two cases had the first diagnosis of thyroid mass during the physical exami-nation, and the adrenal tumors and hypertension were first diagnosed in other two cases , respectively.All four cases had multiple mucosal neuromata .Of whom, three cases had medullary thyroid carcinoma and pheochromocytoma , two cases had Marfan syndrome figure , and one case had pheochromocytoma and Marfan syndrome.Two cases were accompanied by paroxysmal hypertension , and the highest systolic blood pressure was over 200 mmHg (1 mmHg=0.133 KPa).Two cases of pheochromocytoma were found during follow up . Three cases had bilateral adrenal tumors .The thyroid mass was diagnosed by ultrasonography , and the pheo-chromocytoma was confirmed by ultrasonography , CT and 24-hour urine catecholamine test .Adrenalectomy and thyroidectomy were carried out during the treatment process .To clarify the RET mutation status , exons and adjacent introns from 10th to 16th of RET proto-oncogene were sequenced in two patients . Results Gene analysis of two cases confirmed the activating mutation at the sites of 918 in exon 16 of RET proto-on-cogene in which methionine was replaced by threonine ( ATG-ACG) .Among the 3 cases with medullary thy-roid carcinoma , two patients were treated by total thyroidectomy and neck lymphadenectomy , one was opera-ted by subtotal thyroidectomy .For the treatment of pheochromocytoma , adrenal tumor resection was carried out in 3 cases, but not in the other one .Patients were followed up for 2 to 15 years postoperatively , 1 case without tumor recurrence and metastasis , 2 cases with multiple metastases . Conclusions The diagnosis of multiple endocrine neoplasia type 2B mainly depends on endocrine tests , ultrasonography and CT .Surgery is the primary treatment .When pheochromocytoma coexists with other tumors , pheochromocytoma should be re-moved first .