OBJECTIVE To investigate the disinfectant and antibiotic resistance genotypes in 60 strains of Escherichia coli isolated from urine.METHODS Sixty strains of E.coli isolated from inpatients′ urine were collected from Jan 2006 to Oct 2008.Antibiotic susceptibility tests for fifteen antibiotics were performed by Kirby-Bauer method.And three kinds of disinfectant and antibiotic resistance genes(qacE△1,tehA,merA)were analyzed by polymerase chain reaction(PCR) and DNA sequencing.RESULTS More than 70.0% of the sixty strains of E.coli were susceptible to imipenem,piperacillin/tazobactam,cefoxitin,amikacin and gentamicin,and less than 50.0% were susceptible to the other ten antibiotics.There were 42 strains with qacE△1 gene(70.0%),10 strains with merA gene(16.7%) and all strains with tehA gene.The sequence of the first strain was different from those reported in GenBank,so it was a new subtype.CONCLUSIONS There are 70% of E.coli strains isolated from urine samples with qacE△1 gene.And disinfectant resistance may be one of the main factors for hospital infection in the future.

Objective To investigate the nursing points of the mechanical ventilated patients after percutaneous endoscopic gatrostomy (PEG). Methods The nursing approaches of 28 mechanical ventilated patients after percutaneous endoscopic gatrostomy in our department was analyzed retrospectively. Results The nutritional status of the 28 patients was improved to different degree after enteral nutrition (EN) support by PEG. Thereby, the nutritional requirement of the mechanical ventilated patients was ensured effectively. Among these patients, 4 patients could take food by mouth after taking off ventilator and extubation and stoma tube was pulled out, 15 patients were discharged carrying with stoma tube and convalescent care was continued, 3 patients died of primary diseases. Conclusions The PEG is a simple,safe and cost-effective approach of nutritional support for EN of mechanical ventilated patients. The key point of insuring EN of severe patients is intensive nursing and to prevent and reduce the complication of PEG.

Objective To study the early clinical outcome of patients undergone minimally invasive direct coronary bypass(MIDCAB) surgery,and the mid-term patency of left internal mammary artery(LIMA)-left anterior descending(LAD) anastomosis.Methods From Jannuary 2007 to May 2014,47 cases underwent MIDCAB surgery in our department,with 35 males and 12 females,aged 48-76 years,with the average of (62.9 ± 8.1) years old.Types of LAD lesions were as followed:1 case was ostial total obstruction,28 severe stenosis at proximal segment,10 long and severe stenosis,3 calcified lesion with severe stenosis,5 myocardial bridge.All patients had symptomatic angina,typical myocardial ischemia could be detected by electrocardiogram for all patients with myocardial bridge.Comorbidities included:hypertension 38 cases,27 diabetes mellitus,3 COPD and 3 chronic kidney disease.Results All surgery went well without transfer to mid-sternotomy.LIMA harvest time was 38-53 minutes,mean LIMA flow rate was(22 ± 6) ml/min after anastomosis.Surgery duration was 117-143 minutes,blood loss was less than 100 ml for each operation.No blood transfusion was required.Tracheal intubation time was 4-16 hours,ICU stay time was 22-45 hours,hospital stay time was 6-10 days.There was no peri-operative death,either no myocardial infarction or cerebral vessel accident.During follow-up,all LIMA-LAD appeared to be patent by coronary CT angiography.Conclusion High patency rate of LIMA-LAD anastomosis could also be obtained during MIDCAB surgery.It was reserved as a safe and effective surgery for well-selected patients.

Objective To assess the antimicrobial actitivity of econazole nitrate in comparison with other six antibacterial drugs. Methods The minimal inhibitory concentrations (MICs) of econazole nitrate (Eco), neomycin (Neo), erythromycin (E), penicillin (P), cefotaxime sodium (Cef), ciprofloxacin (Cip) and amikacin (An) to 222 strains of Staphylococcus spp isolated from the lesions of patients with eczema and atopic dermatitis were determined by using the broth dilution method. Results MIC50 values of Eco were similar to Neo, Cip, An and Cef, and lower than those of P and E on methicillin-sensitive Staphylococcus aureus (MSSA); significantly lower than those of the other six antibacterial drugs on methicillin-resistant Staphylococcus aureus (MRSA); similar to An, Cip and P, and lower than those of Neo, Cef and E on methicillin-sensitive and coagulase-negative Staphylococcus (MSCNS); and similar to An, Cip P or Neo, and lower than Cef and E on methicillin-resistant and coagulase negative Staphylococus (MRCNS). Based on the NCCLS standards, the resistance rates of Cip, P and E were very high to either Staphylococcus areus or coagulase-negative Staphylococcus (CNS). The resistance rates of An and Cef of were lower to MSSA, but higher than 50% to MRSA. MIC90 value of Eco was similar to its MIC50, and lower than the MIC value reported in the literature. The MIC90 value of neomycin was muich higher than the MIC50 value of econazole. Conclusion Econazole nitrate has antibacterial activity to both Staphylococcus areus and CNS. MIC90 value of Eco is similar to its MIC50, and no resistance to Eco was found.

Objective To study the activation of Janus protein tyrosine kinase (JAK)/signal transducer and activator of transcription 1 (STAT1) signaling pathway and its inhibitor-signal transducer and activator of transcription-1(SOCS-1) in patients with systemic lupus erythematosus. Methods A total of 45 patients with active systemic lupus erythematosus (SLE) and 30 healthy controls were randomly selected. Western blot was performed to measure the expression of Stat1 protein and phospho-Stat1 protein (an activated form of Stat1 protein) in the monocytes after stimulation with recombinant high mobility group box1 (rHMGB1) at various time points. Expression of Stat1 protein in the skin or lesional skin was also detected. Phasic expressions of SOCS-1 mRNA in the monocytes after rHMGB1 stimulation were detected by real-time reverse transcription-polymerase chain reaction. SOCS-1 gene expression in the skin or lesional skin was also detected. Results The expression level of Stat1 proteins in the monocytes from patients with SLE was higher than that from healthy controls (t=9.16,P＜0.01) and positively correlated with SLE disease activity index (SLEDAI) (r=0.59,P＜0.01). Expression of phospho-Stat1 in the monocytes from SLE patients was time-dependently upregulated after stimulation with rHMGB1 at various time points, while expression of SOCS-1 mRNA remained unchanged(all P＞0.05). Expressions of phospho-Stat1 protein and SOCS-1 mRNA in the monocytes from healthy controls were increased transiently after stimulation with rHMGB1(all P＜0.05). Both expressions of phospho-Stat1 protein and SOCS-1 gene in the lesional skin from patients with SLE were upregulated compared with those in normal skin from healthy controls (all P＜0.01). Conclusion There are hyperactivation of JAK-STAT1 signaling pathway and negative feedback down-regulation of SOCS-1 in patients with systemic lupus erythematosus. HMGB-1 may be partly involved in the pathogenesis of SLE by the abnormal mediating function of JAK-STAT1 signal transduction pathway.

Objective To study the anatomy basis and biomechanical stability of euthyphoria reduction and percutaneous cannulated screw fixation for sacroiliac dislocation,and to evaluate the primary clinical efficacy of this method.Methods The distances from the anterior branches of the nerve roots at L4,and L5 and obturator nerve on the superior border of sacral ala to the sacroiliac joint were measured on 12 adult cadavers (24 sides) fixed and preserved by formalin.Models of sacroiliac dislocation were made on six pelvic specimens of fresh cadavers.A comparison of stability was made on the six models between the fixation studied here and the traditional fixations by posterior percutaneous sacroiliac screws and by anterior sacroiliac joint plates.At the same time,17 patients with type C Tile fracture were treated with our method.The clinical efficacy was analyzed for the 17 patients.Results The distances from the anterior branches of the nerve roots at L4,and L5 and obturator nerve on the superior border of sacral ala to the sacroiliac joint were 20.24?1.20mm,23.80?1.43mm,and 16.26?2.07 mm respectively. There was no statistically significant difference in stability between our method and the traditional fixation by posterior percutaneous sacroiliac screws,though ours seemed better.Follow-ups for the 17 cases averaged 2.2 years,re- vealing fine functional recovery in all according to Matta scoring.Conclusions Euthyphoria reduction and per- cutaneous cannulated screw fixation can lead to sufficient biomechanical stability for the sacroiliac joint and effec- tively avoid nervous injuries.In addition,our method is simple and clinically effective,It is recommendable for small and middle-sized hospitals.

Objective To explore the influence of low-selenium diet on expression of selenium-binding protein 1 (SBP1) and selenoprotein P (Sel P) in liver,kidney and brain tissues.Methods C57BL/6 mice were randomly divided into four groups according to body weight:control group,low-selenium treatment for 4-,12-and 24-week groups,10 mice in each group,half male and half female.The control group was fed with normal diet (selenium content was 0.300 mg/kg),distilled water,and sacrificed at the 12th week; low-selenium treatment groups were fed with low-selenium diet(selenium content was 0.015 mg/kg),then sacrificed at the 4th,12th and 24th weeks,respectively.Expressions of SBP1 and Sel P in mouse liver,kidney and brain tissues were determined by Western blotting.Results Expressions of SBP1 and Sel P in low-selenium feed mouse liver tissue at the 4th,12th and 24th weeks were,respectively,as follows 0.11 ± 0.01,0.36 ± 0.01,0.59 ± 0.02 and 0.41 ± 0.01,0.39 ± 0.02,0.25 ± 0.02;in kidney,respectively,as follows 0.60 ± 0.03,0.20 ± 0.02,0.03 ± 0.01 and 0.88 ± 0.01,0.73 ± 0.03,0.85 ± 0.02; in brain,respectively,as follows 0.54 ± 0.03,0.11 ± 0.01,0.01 ± 0.01 and 0.50 ± 0.02,0.49 ± 0.03,0.38 ± 0.02.Expression of Sel P in low-selenium feed mouse liver,kidney and brain tissues was significantly decreased as compared to that of control group(1.00 ± 0.00,1.00 ± 0.00,all P ＜ 0.05),but SBP1 content was reduced at first and then rebounded in kidney,and was in decreasing trend in liver and brain tissues.Conclusion Low-selenium diet has a certain effect on expression of SBP1 and Sel P in mouse liver,kidney and brain tissues.

Background Arresting the overexpression of vascular endothelial growth factor (VEGF) will be a new approach to the inhibition of neovascularization.RNA interference (RNAi) can inhibit the expression of specific gene,and its application in eye has little interference to other gene expression.Objective This study was to investigate the effect of small interference RNA (siRNA) targeting VEGF on the expression of VEGF and retinal neovascularization in oxygen-induced retinopathy (OIR) model.Methods psi-HITM/enhanced green fluorescent protein (EGFP)/VEGF siRNA was designed and prepared in vitro.Mouse endothelioma (EOMA) were cultured in DMEM without antibiotic and divided into 5 groups.The cells were incubated in DMEM only in the blank control group;while 1 μl of LipofectamineTM 2000 + psi-HITM/EGFP,1 μl LipofectamineTM 2000 + 40,50 or 60 nmol/L of psi-HITM/EGFP/VEGF siRNA was added into DMEM in the negative control group and siRNA groups,respectively.The expression of VEGF mRNA and protein was detected by real time PCR (RT-PCR) and Western blot.The optimal effective concentration of VEGF siRNA was assessed.OIR models were established in 48 7-day-old C57BL/6J mice by raising them at an oxygen concentration of (75±2) ％ for 5 days and then to normal air.The mice were randomized into the model group,null vector group and VEGF siRNA group.1 μl of a mixture of psi-HITM/EGFP or VEGF siRNA (60 nmol/L) and LipofectamineTM 2000 was intravitreally injected,respectively,in the null vector group and VEGF siRNA group.The normal mice were used as the normal control group.Expression of VEGF mRNA and protein in the mouse retinas was detected by RT-PCR and Western blot,respectively,and FITC-dextran stretched retinal preparation was examined to evaluate the neovascularization,and retinal sections were examined to quantify the number of vascular endothelial cell nuclei extending beyond the internal limiting membrane (ILM).Results The in vitro transfection test showed that the expression of VEGF mRNA and protein in the EOMA cells was significantly different among the blank control group,negative control group and 40,50,60 nmol/L VEGF siRNA groups (F =148.890,P ＜ 0.001; F =306.960,P ＜ 0.001),and the expression of VEGF mRNA was lower in different concentrations of VEGF siRNA groups than that in the blank control group (t=73.950,119.890,156.480,all at P＜0.001).Also,the expression of VEGF protein was less in different concentrations of VEGF siRNA groups than that in the blank control group (t =15.452,23.344,42.119,all at P＜0.001).The optimal inhibitory concentration of VEGF siRNA was 60 nmol/L.In vivo study determined that compared to the model group and null vector group,the non-perfusion zones and neovascular net in the retina were decreased,and the number of vascular endothelial cell nuclei extending beyond the ILM was less in the VEGF siRNA group.The relative expression level of VEGF mRNA in the retinas was 1.23±0.18,4.02±0.16,3.98±0.19 and 1.98±0.12 in the normal control group,model group,null vector group and VEGF siRNA group,respectively,with a significant difference among them (F=369.780,P＜0.001),and the relative expression levels of VEGF mRNA in the model group and null vector group were higher than that in the normal control group (t=37.880,37.336,both P＜0.001),and the expression of VEGF mRNA in the VEGF siRNA group declined by 50.8％ (t=10.183,P＜0.001).The difference in the expression levels of VEGF protein also was assayed among the various groups (F=408.980,P＜0.001),and VEGF level in the retina was lowered by 68.0％ in the VEGF siRNA group compared to the model group (t =11.473,P＜0.001).However,VEGF level in the VEGF siRNA group remained at a high level in comparison with the normal control group (t =2.422,P＜0.001).Conclusions Intravitreal injection of VEGF siRNA can attenuate retinal neovascularization by effectively downregulate the expression VEGF mRNA and protein in the retina.

Objective To explore the incidence and distribution features of neonatal phenylketonuria(PKU) and congenital hypothyroidism(CH) in Lianyungang area.Methods The heel blood samples dried on filter paper was collected from newborns after 72 hours.As the screening indicators,PKU was detected through serum phenylalanine concentration(Phe) detection by Guthrie′s bacterial inhibition assay and CH was detected through serum thyroid stimulating hormone(TSH) levels detection by time-resolved fluorometry(TRFIA) or enzyme linked immunosorbent assay(ELISA).Results Sixty-four children with CH were diagnosed and the rate of CH was 1∶2423,41 patients were examined by thyroid gland nuclein kinescope picture,among which there were 23 patients whose thyroid glands were unusal.These patients lived in 45 towns(streets),which had no difference between men and women,city and country side.A couple of twins were screened for CH;15 cases of PKU was detected with an incidence of 1∶10 339.These patients′ parents were neither consanguineous marriage nor dominance hereditary family history.Their physical and mental development were similar to the same age children after interventive treatment.Conclusions The distribution of CH and PKU is diffuse in Lianyungang.Neonatal screening is the only valid means to find patients with CH and PKU.

Objective To investigate the pathogen distribution and susceptibility profile of fungal isolates from bloodstream infections,and valuate the clinical utility of G test in diagnosis of fungal infections for the purpose to improve antifungal therapy.Methods A retrospective analysis was carried out to analyze the fungal pathogens isolated from bloodstream infections in the First Affiliated Hospital of Nanjing Medical University during the period from January 2013 through December 2015 and their antimicrobial susceptibility.Results A total of 114 fungal strains were isolated from bloodstream infections during the 3-year period,most of which were Candida (99/114,86.8％),especially Candida albicans (30.7％).About 41.2％ (47/114) of the fungal strains were isolated from Department of Thoracic Surgery (10,5 and 4 strains in 2013,2014 and 2015),Hematology (11 strains in 2014),and ICU (7 strains in 2014).Antimicrobial susceptibility testing showed that all the fungal strains (100％) were susceptible to amphotericin B,but 83.5％ susceptible to itraconazole (the lowest).G test was positive before the result of blood culture in 13 of the 54 patients who received G test.Conclusions Candida was the most common fungus in fungal bloodstream infection.Amphotericin B is the most active antifungal agent in vitro.Blood culture combined with serological test can provide clinicians an earlier and reliable diagnosis.