OBJECTIVE To analyze the isolation rate and four consecutive years′(2004-2007) antibiotic-resistance trend of extended-spectrum ?-lactamases(ESBLs) producing Escherichia coli in urinary tract infection and to provide evidence for anti-infection therapy.METHODS The anti-microbial susceptibility test results of E.coli cultured from the midstream urine of outpatients and inpatients of our hospital from 2004 to 2007 were collected.Whonet 5.4 statistical analysis software was used for analysis.RESULTS During four years,no apparent change has been shown about antibiotic resistant rate of ESBLs producing E.coli.The isolation rate of this kind of E.coli increased year by year from 31% to 44% and showed high resistance to third generation cephalosporins and quinolones antibiotics,but was 100% sensitive to imipenem.CONCLUSIONS With the ESBLs-producing E.coli increasing year by year,the antibiotic-resistance rate of E.coli isolated from urinary tract infection is apparently increased and thus screening of antibiotics sensitive to enzyme-producing bacterial is the key point when the empirical therapy especially when the third and fourth generation cephalosporins are ineffective.

Because the influence of fibrin on the reaction of plasm inogen activation by various plasminogen activators is different, the kinetic co nstant of the reaction of plasminogen activation catalyzed by InB with and witho ut fibrin were detected. The result is: Kfibrinm＝4.2 μmol*L -1，greater than the normal Km=0.379 μmol*L-1; kfib rincat＝0.107 s-1，greater than the normal kcat=0.0165 s-1. The results suggest that existence of fibrin in the reaction system of plasminogen activation depress the affinity between InB and plasminog en, but accelerates the hydrolysis of plasminogen by InB. The count up effect is inhibition.

ObjectiveTo explore the morbidity rate of deviation of nasal septum about personnels who take part in physical examination in the enterprise and facilities of Qinhuangdao,and clinic symptom.MethodsTransverse questionnaire investigation and normal physical examination were adopted.2604 personnels who take part in physical examination were choiced.ResultsMorbidity rate of deviation of nasal septum was 17.6％.The rate of men' s exceeds that of women' s.ConclusionMorbidity rate of deviation of nasal septum was rather high,clinic symptom of snuffle was primary.

Objective To study the strategy of expanding standard donor heart application and to analyze the clinical effect on applying expanding standard donor heart in heart transplantation.Methods 146 patients received heart transplantation in Fuwai Hospital Bering from June 2004 to February 2009.Expanding standard donor heart was defined as prolonged ischemic time over 6 h,advanced age up to 40,and blood type ABO mismathched.Blood type examination and PRA test were done before operation.The donor heart was preserved by sequential perfusion with cold St.Thomas and HTK solution.The patients were divided into groups according to different oversize body weight,ischemic time,and donor age Results There were 11 deaths after operation.Ischernic time of donor heart was 262.1±120.8 min,and that of 21 donors was over 360 min(the longest one was 605 min).There was no significant diffeFence in recipient properties before transplantation.and also there was no significant difference in mortality,heart function,heart rejection,and main morbidity after transplantation and during follow-up.Conclusion These data support continued aggressive utilization of expanding standard donor hearts in heart transplantation.Our experience demonstrates thatproperly expanding standard cardiac allografts application has no effects on the short- and long-term clinical outcome following heart transplantation.

10.3969/j.issn.1000-3606.2013.06.004

Objective To analyze the clinical characteristic s of an infant with congenital lipoid adrenal hyperplasia (CLAH),and to sequence the acute regulatory protein (steroid acute regulatory,StAR) gene of the infant patient and her pedigree.Methods Physical examination,laboratory tests,and imaging examination of the 11-month-old patient with CLAH were collected.DNA was extracted from blood samples of the patient and her parents.The 7 exons of StAR gene were amplified by PCR and then sequenced.Results Dark skin,girl vulva,and one each 1.0 cm×1.0 cm palpable lump in inguinal area bilaterally were observed.The adrenocorticotropic hormone (ACTH) was 253 pg/ml,cortisol was 27.6 nmol/L at 8 am,17-hydroxyprogesterone was 3 nmol/L.Uhrasound showed that sign of testicular ultrasonography existed in bilateral inguinal regions.Karyotype analysis showed 46,XY.Sequencing of PCR amplified fragments showed that there were two heterozygous mutations c.229C ＞ T,p (Gln77X) and C.659A＞G,p (His220Arg) of StAR gene in this patient.By rectifying the disturbance of electrolyte,and treating with hydrocortisone and 9α fludrocortisone,etc,the patient has been stable so far.Conclusion The patient presents typical clinical manifestations.Two heterozygous mutations including c.229C ＞T,p (Gln77X) from maternal and C.659A＞G,p (His220Arg) from paternal of StAR gene were detected.Wherein the c.659A＞G,p.(His220Arg) as a novel point mutation of StAR gene,has not been reported so far.

Objective This research is to observe the treatment effects of hip bath and oxygen blowing on severe neonatal diaper rash.Methods 289 neonates with severe diaper rash were randomly divided into three groups.91 cases in the flat tube group,102 cases in the round tube group and 96 cases in the control group.Three groups of neonates were cleaned on the hips and perineuma after poops and then dried with wet tissues and Mupirocin Ointment.The control group was treated with the above-mentioned method.The oxygen blowing groups were treated with hip bath of 1:5000 chameleon solution twice a day.Blowing the hips with oxygen five minutes every time after hip bath.The method of blowing oxygen was that oxygen humidifying containers as normal oxygen aspiration facilities was not filled with water,whose oxygen flowing volume standed at 10 L/min and whose tube blew at the afflicted parts until being dry.The oxygen blower held the oxygen exit and blowed at the afflicted parts in the round tube group and the oxygen blower flattened the oxygen exit and blew at the afflicted parts in the fiat tube group.The treatment effects will be compared among the three groups four days later.Results The cure period of the round tube group was obviously shorter than that of the control group,and the cure period of the fiat tube group was remarkably shorter than that of the round tube group.The total effective rate in the round tube group was obviously higher than that of the control group and the total effective rate in the fiat tube group was obviously higher than that in the round tube group.The difference had a statistical significance.Conclusions The treatment effects for the severe neonatal diaper rash with hip bath and oxygen blowing are remarkable and the oxygen blowing effects with fiat tubes are better than those with round tubes.

Objective To discuss the cognition of the nursing disputes in undergraduates and the college nursing students in internship in Changchun and to provide some basis for them to improve the nursing quality in clinic.Methods The investigation was carried out to survey the cognition of the nursing disputes in 266 undergraduates and the college nursing students in internship in Changchun,and the results underwent analysis.Results Most undergraduates and college nursing students held the opinion that at present the relationship between patients and nurses was on a tight rope.94 people accounting for 72.3％ in undergraduate students,89 people accounting for 65.4％ in the college nursing students.Relevant factors which caused nursing disputes were related with the different education backgrounds.Conclusions We should make clear the causes of nursing disputes,and put forward the corresponding proposals according to nursing students with different education degrees.

Objective To compare the effect of L-T4 taken in the morning vs bedtime on serum thyroid hormone in patients with hypothyroidism.Methods Seventeen patients with primary hypothyroidism were prospectively included.They took L-T4 in the morning for 2 months followed by L-T4 taken during the bedtime for 2 months.Thyroid hormone levels and cholesterol,triglyceride,albumin,creatinine and heart rate were measured.Wilcoxon test and paired t test were used to compare the data.The correlation between the changes of TSH and FT3,FT4 was analyzed respectively by Pearson correlation analysis.Results TSH,FT3,FT4 were:(12.10±7.19) vs (3.90±3.47) mU/L,(4.14±0.86) vs (5.24±1.11) pmol/L,(12.72± 4.40) vs (18.48±2.87) pmoL/L for L-T4 taken in the morning and during the bedtime respectively (t value:6.371,-3.166,-5.435,all P＜0.01).There was no correlation between the changes of TSH and FT3,FT4(r=O.12,0.22,both P＞0.05),respectively.The averaged changes were (8.20±5.31) mU/L,(1.09± 1.42) pmol/L and (5.76±4.37) pmol/L.Triglyceride,cholesterol,albumin,creatinine levels and heart rate were not significantly different with L-T4 taken in the morning and during bedtime (t=0.240,0.017;z=0;t=-0.610,1.588,all P＞0.05).Conclusions L-T4 taken during the bedtime by patients with hypothyroidism would reduce TSH and increase FT3,FT4 levels.This method can maintain the stability of TSH level with no need to increase the dose.

Objective To investigate the changes of airway resistance before and after Bronchial Diulation Test in patients with senile asthma and the effect of age on the degree of airway resistance. Methods A total of 29 (> 60 years)senile asthma patients and 21 younger(< 60 y)patients were enrolled in the study. The status of their pulmonary function was determined by MEFV(Maximum expiratory flow?volume curve)and an IOS(impulse oscillometry) system before and after Bronchial Diulation Test,The spirometric indexes such as forced vital capacity,total respiratory impedance,respiratory resistance and respiratory system reactance were collected and analyzed. Results Significant decreases of indexs were found after Bronchial Diulation Test compared with those before Bronchial Diulation Test in the study group(P<0.05,respectively). No significant difference in improvement of indexs was found between the group of patients with senile asthma(age > 60 years)and the group of healthy control(age < 60 years ). Each index of the airway resistance has a very good correlation with FEV1%,with the highest degree of relation is X5%. Conclusion The airway resistance of senile asthmatic patients was significantly improved after diuslation test and these indexes IOS would be valuable in evaluating the changes of airway resistance of senile asthma.