Objective To explore the distribution and drug resistance of extended-spectrum beta-lactamase (ESBLs)producing Klebsiella pneumoniae in elderly and young and middle-aged patients,and provide reference for rational use of antibiotics for clinicians.Methods Specimens of elderly (≥ 60 years old) and young and middle-aged (18-59 years old) patients who with various clinical infection in Shengjing Hospital of China Medical University from January 2016 to December 2016 were collected as the research object.ESBLs-producing Klebsiella pneumoniae was isolated from 125 patients (60 elderly patients and 65 young and middle-aged patients).The preliminary screening and phenotypic confirmatory test of ESBLs were carried according to the method which was recommended by American Clinical and Laboratory Standards Institute.The drug resistance of ESBLs-producing Klebsiella pneumoniae was analysed and the resuh of the two groups were compared.Results The specimens of ESBLs-producing Klebsiella pneumoniae strains of elderly patients were mainly from urine (36.67％),sputum (33.33％) and whole blood (11.67％);the specimens of young and middle-aged patients were also mainly from urine (24.62％),sputum(24.62％) and whole blood (15.38％).There was statistical significance in the distribution of ESBLs producing Klebsiella pneumoniae in the specimens secretions between the elderly patients and the young and middle-aged patients(P ＜0.05).There was no statistical significance in the distribution of ESBLs producing Klebsiella pneumoniae in the specimens of urine,sputum,whole blood,bile,pus,drain,cerebrospinal fluid,ascitic fluid and catheter between the elderly patients and the young and middle-aged patients (P ＞ 0.05).ESBLs-producing Klebsiella pneumoniae strains of elderly patients were mainly isolated from department of respiration (20.00％,12/60) and department of urinary surgery (18.33％,11/60);the ESBLs-producing Klebsiella pneumoniae strains of young and middle-aged patients were mainly isolated from department of intensive care (16.92％,11/65) and department of neurosurgery (16.92％,11/65).There was statistical significance in the distribution of ESBLs producing Klebsiella pneumoniae in the department of respiration and obstetrics and gynecology between elderly patients and young and middle-aged patients(P ＜ 0.05);there was no statistical significance in the distribution of ESBLs producing Klebsiella pneumoniae in the department of urinary surgery,general surgery,intensive care,neurosurgery,rheumatoid immunology,invasive technology,oncology,digestion,infection,kidney,orthopaedics,rehabilitation,hematology,neurology and other department between elderly patients and young and middle-aged patients(P ＞ 0.05).The drug resistance rates of ESBLs-producing Klebsiella pneumoniae to beta-lactam antibiotic in elderly and young and middle-aged patients were more than 90.00％;the drug resistance rates of ESBLs-producing Klebsiella pneumoniae to carbapenems were nearly 0.00％ in elderly and young and middle-aged patients.There was significant difference in the drug resistance rates of ESBLs-producing Klebsiella pneumoniae to ceftazidime and gentamicin between elderly patients and young and middle-aged patients(P ＜ 0.05);there was no significant difference in the drug resistance rate of ESBLs-producing Klebsiella pneumoniae to another antibiotic between elderly patients and young and middle-aged patients (P ＞ 0.05).Conclusion Both elderly and the young and middle-aged patients can be infected with ESBLs-producing Klebsiella pneumoniae.There was no significant difference in the distribution of ESBLs-producing Klebsiella pneumoniae in most clinical departments (except respiratory and obstetrics and gynecology).The most effective antimicrobial drugs at present for the treatment of ESBLs-producing Klebsiella pneumoniae was carbapenems.There is no significant difference in the drug resistance rates of ESBLs-producing Klebsiella pneumoniae to common antibiotics between elderly patients and young and middle-aged patients.Clinicians should rationally use antibiotics according to the results of susceptibility tests.

Objective To investigate the protective role of hydrogen sulfide and the expression of cystathionine gamma-lyase/hydrogen sulfide pathway in a mouse model of myocarditis induced by Coxsachie -virus B3(CVB3).Methods A total of 110 five-week-old BALB/c male mice were randomly divided into four groups:the control group, viral myocarditis group, sodium bisulfide (NaHS) group (50 μmol/kg) and DL-propargylglycine (PAG) group (40 mg/kg).The experimental model of viral myocarditis was induced by intraperitoneal injection of CVB 3.Then the four groups were respectively administered with PBS , PBS, NaHS and PAG from day 1 to day 10 after infection.Blood and heart specimens were harvested from 10 mice of each group on day 4 and day 10 for evaluation of myocardial edema .The pathological changes in heart tis-sues were observed through hematoxylin-eosin staining.Levels of H2 S, IL-6 and TNF-αwere measured by ELISA.The expressions of CSE and CVB 3 at mRNA level were determined by quantitative real time PCR ( qRT -PCR ) analysis and the expression of CSE at protein level was detected by Western blot .Results Compared with the control group , the levels of H2 S and the expressions of CSE at mRNA and protein levels were down-regulated in mice with CVB 3-induced myocarditis .With the treatment of NaHS , the levels of H 2 S in serum and tissue were both up-regulated , and the histopathological damage was alleviated .However , PAG as an irreversible CSE inhibitor inhibited the expressions of H 2 S and CSE and aggravated myocardial injury , inflammatory cells infiltration and interstitial edema .Moreover , the RT-PCR analysis also showed that the expression of CVB3 at mRNA level was inhibited by NaHS but enhanced by PAG .Conclusion The expres-sion of CSE/H2 S pathway is down-regulated in mice with CVB 3-induced viral myocarditis .PAG could pro-mote virus propagation and exacerbate the disease through inhibiting the production of endogenous H 2 S, while NaHS as a H2 S donor has a protective effect on infected myocardium by suppressing virus replication at an early stage .

Objective To investigate the value of two-dimensional speckle tracking imaging (STI) in assessing regional myocardial dysfunction and myocardial fibrosis in a mouse model of myocardial infarction.Methods Twenty C57/B6 mice were randomly divided into two groups:myocardial infarction (MI) group (n =10) and sham-operation (SO) group (n =10).Echocardiography was performed four weeks after surgery.High frame rate two dimensional images were recorded in the left ventricular short axis views at the papillary muscle level and analysised at EchoPac workstation.Peak radical strain (PRS) and peak radical strain rate (PRSR) of each segment were measured at systolic period.Percent segmental fibrosis (PSF) was assessed from histological left ventricular cross sections stained by Masson trichrome.Results Compared with SO group,PRS and PRSR decreased significantly in all segments of MI group (P ＜ 0.01),especially in anterosepetal,anterior and lateral segments (P ＜0.05).PSF of anterosepetal,anterior,lateral and posterior segments in MI group increased significantly than those in SO group(P ＜0.01),and were negatively correlated with PRS and PRSR of these segments(r =-0.88,P ＜0.001 ; r =-0.77,P ＜0.001).Conclusions STI could accurately quantify regional myocardial function in a mouse model of myocardial infarction.Segmental radial strain and strain rate measured by STI were significantly correlated with PSF,which can be a non-invasive tool for monitoring myocardial fibrosis after myocardial infarction.

Objective To evalute the incidence and epidemiologic characteristics of Kawasaki disease (KD) in Wenzhou,China.Methods We used a questionnaire survey and reviewed the medical records and reports of all patients with KD diagnosed during the 10 year periods from January,2001 to December,2010.Results We studied 827 inpatients diagnosed with KD during the 10-years period from 2001 to 2010.There were 613 cases (74.12％) with complete KD.The ratio of male to female ratio was 2.28∶1.Age at onset ranged from 37 days to 13 years old,and the peak age group was 1 year old.The disease occurred in all of the seasons,but the peak was from April to June.The incidence of cardiovascular damage in acute KD was 34.6％,and the most common sequela was coronary artery dilatation.There were16 patients with coronary aneurysm.Fifty-three patients did not respond to immunoglobulin (6.4％),and 12 patients (1.5％) developed recurrent KD.After treatment,114 cases (13.8％) developed neutropenia.There were no deaths during hospitalization.Conclusion Patients with KD has become more and more in Wenzhou.Cardiovascular damages were similar to those in Beijing and Guangzhou,but higher than that reported in Japan.

Although previous studies have shown functional efficacy of myelotomy for the treatment of spinal cord injury (SCI), the underlying mechanism remained unknown. This study aimed to determine the relationship between myelotomy-mediated neuroprotection and autophagy following SCI by evaluating the expression of microtubule-associated protein light chain 3 (LC3-II) and mammalian target of rapamycin complex 1 (mTORC1). Ninety-nine adult female rats were randomly assigned to either sham-operated group (SG), model group (MG), or 24 h-myelotomy group (MTG). SCI at T10 was induced with a New York University impactor, and myelotomy was performed 24 h after SCI. Functional recovery was evaluated via the open-field test. The protein expression of LC3-II was analyzed by Western blot, and the mRNA expression of LC3-II and mTORC1 were detected by real-time quantitative reverse transcriptase polymerase chain reaction. Rats in the MTG exhibited significantly better performance in the hind limbs compared to those in the MG on day seven and fourteen post-injury. Myelotomy suppressed the protein and mRNA expression of LC3-II on day three, seven and fourteen post-injury and increased the mRNA expression of mTORC1 in the MTG on day three and seven post-injury. The LC3-II protein expression was significantly and negatively correlated with BBB scores at day seven and fourteen post-injury. These results showed that myelotomy-induced neuroprotection in a rat model of SCI was likely mediated by inhibition of autophagy by activation of the mTORC1 signaling pathway

[Purpose]To analyze the incidence and mortality trends,and survival of gallbladder cancer in Nantong City of Jiangsu Province from 2013 to 2017.[Methods]The gallbladder cancer incidence and mortality data from 2013 to 2017 were collected from Nantong cancer registries.The crude incidence/mortality rates,age-standardized incidence/mortality rates by Chinese and world standard population(ASIRC/ASMRC,ASIRW/ASMRW)were calculated by sex,age and regions(urban and rural).Joinpoint software was used to analyze the incidence and mortality trends of gallbladder cancer.The observed survival rate and relative survival rate were calculated by using life table method and Ederer Ⅱ method.[Results]From 2013 to 2017,the gallbladder cancer crude incidence and mortality rates were 6.36/105 and 4.91/105,ASIRC and ASMRC were 2.62/105 and 1.94/105,respectively.The crude incidence and mortality,and ASMRC showed an upwards trend(all P＜0.05).The ASIRC for men and women was 2.43/105 and 2.83/105,the ASMRC for men and women was 1.74/105 and 2.16/105,respectively.ASIRC and ASMRC in women were higher than those in men.The ASIRC in urban and rural areas was 2.40/105 and 2.69/105,and the ASMRC was 1.61/105 and 2.05/105,respectively.ASIRC and ASMRC in rural areas were higher than those in urban areas.The average age of onset was 70.33 years old and the average age of death was 71.86 years old.The 5-year observed survival rate was 12.90％,and the 5-year relative survival rate was 14.47％.Both the 5-year observed survival rate and relative survival rate showed an upwards trend(both P＜0.05).[Conclusion]The incidence and mortality rates of gall-bladder cancer in Nantong City are relatively high and the survival rate is generally low.It is sug-gested that targeted prevention and control measures of gallbladder cancer in Nantong City should be strengthened,particularly in rural areas and for middle-aged and elderly women.

Objective:To analyze the current situation and trend of spinal cord injury rehabilitation nursing research in China, and to provide evidence for spinal cord injury rehabilitation nursing and related research.Methods:Using CNKI and Wanfang database as data sources, CiteSpace V software was used to visually analyze the literature published between January 1, 2000 and December 29, 2019.Results:A total of 2 329 literatures were included. The number of publications showed a rapid increase from 2016. Research mainly focuses on complications, neurogenic bladder, quality of life, rehabilitation training and so on.Conclusions:In China, the total number of articles published on rehabilitation nursing of spinal cord injury is low. The number of articles published by research authors is small, and the distribution of publishing institutions is uneven. The research hotspots are complications, neurogenic bladder, quality of life, rehabilitation training, etc. The following step is to strengthen the cooperation among spinal cord injury rehabilitation and nursing institutions in different regions and carry out multi-center, large-sample and interdisciplinary research. It is the trend of further research to carry out more in-depth and broader dimension research on rehabilitation nursing of spinal cord injury.

Objective:To systematically evaluate and Meta-synthesize qualitative studies on the home management needs of patients with spinal cord injury (SCI) to understand their actual self-management needs and improve the quality of home management for patients with SCI in China.Methods:A comprehensive search was conducted in databases including CNKI, Wanfang, CBM, PubMed, Embase, Web of Science, CINAHL, and Cochrane Library for qualitative research on the home management needs of patients with SCI, with a search timeframe up to November 30, 2023. The methodological quality of the included studies was evaluated using the Joanna Briggs Institute (JBI) Qualitative Assessment and Review Instrument (2016). Results were integrated and analyzed using Meta-synthesize methods.Results:A total of 15 studies were included, from which 58 distinct research findings were extracted. These were categorized into 10 new categories, which were further integrated into four main results: the need for positive emotional support, daily living-related needs, healthcare service needs, and social support needs.Conclusions:Healthcare providers should deeply understand the home management needs of patients with SCI. Utilizing artificial intelligence technology, an integrated support model encompassing hospital, home, and society can be constructed. Establishing a comprehensive home rehabilitation platform for patients with SCI can focus on psychological issues and enhance social support levels, thereby improving patients' quality of life.

Objective:To integrate qualitative research on the real experience of patients with spinal cord injury (SCI) returning to society after discharge, so as to provide a basis for developing transitional care intervention program, and promote patients' reintegration into society.Methods:Qualitative research on the real experience of patients with SCI returning to society after discharge was electronically retrieved on China National Knowledge Infrastructure, WanFang Data, VIP, China Biomedical Literature Service System, Cochrane Library, PubMed, Embase, Web of Science, CINAHL, and so on .The search period was from database establishment to August 30, 2023. The quality evaluation criteria for qualitative research of the JBI Evidence-Based Health Care Center (2016) was used to assess the quality of literature, and Meta-synthesis was used to integrate the results.Results:A total of 16 articles were included, and 51 research results were extracted. Similar research results were summarized and combined to form 12 new categories, which were then synthesized into four integrated results, including experiencing physical and mental discomfort following discharge, facing challenges in reintegrating into society, seeking social support, and adapting to social life through self-adjustment role changes.Conclusions:Patients with SCI have multiple psychological experiences in the process of reintegration into society. Medical and nursing staff should attach importance to their inner needs, help them overcome stress and challenges, provide them with personalized continuous care, and promote their role adaptation and reintegration into society.

Objective:To observe and analyze the ocular clinical features and pathogenic genes of Alstr?m syndrome (ALMS).Methods:A retrospective clinical study. From October 2020 to July 2022, 3 patients and 5 normal family members from 2 families affected with ALMS who visited in the Ophthalmology Department of Henan Children's Hospital were enrolled in the study. These 2 families were without blood relationship. The medical history and family history were inquired. Best corrected visual acuity (BCVA), fundus color photography, full-field electroretinogram (ERG), frequency domain optical coherence tomography (OCT) and systemic examination were performed. 3 ml peripheral venous blood of patients and their family members were collected, and the whole genomic DNA was extracted. The second generation sequencing analysis was performed on these members. The suspected pathogenic mutation sites were verified by Sanger, and the pathogenicity of the gene mutation sites were determined by bioinformatics analysis.Results:Three patients from two families all developed nystagmus and photophobia in infancy. In the family 1, the BCVA of both eyes of the proband was no light perception. The fundus examination revealed vascular attenuation and retinal pigment abnormality. OCT showed retinal thinning, loss of photoreceptor layer and atrophy of the retinal pigment epithelium layer. ERG examination showed extinguished. The BCVA of the proband’s younger brother was 0.04 in the right eye and 0.02 in the left eye. The fundus examination revealed vascular attenuation but the pigment distribution was roughly normal. OCT showed blurred photoreceptor layers in both eyes. ERG examination showed extinguished. Two patients developed sensorineural deafness, obesity, acanthosis nigricans, insulin resistance/diabetes, and abnormal liver function. In addition, the proband also had left heart enlargement, hyperlipidemia and abnormal kidney function. The results of genetic testing showed that the proband and his younger brother had compound heterozygous mutations in exon 8 (c.1894C>T/p.Gln632*, M1) and exon 10 (c.9148_9149delCT/p.Leu 3050 Leufs*9, M2) of ALMS1, which were both known mutations. The father of the proband was a carrier of M1 and the mother of the proband was a carrier of M2. The proband of the family 2 had a normal fundus at 23 months old. The amplitude of ERG b wave under the stimulation of the dark adaptation 0.01 and a, b wave under the stimulation of dark adaptation 0.3 were all mild reduced. The amplitude of ERG a, b wave under the stimulation of the light adaptation 0.3 was severity decreased. At 4 years old, the BCVA was 0.01 in the right eye and 0.05 in the left eye. The fundus examination revealed vascular attenuation and bilateral blunted foveal reflex. In addition to severely diminished of a, b wave under the stimulation of dark adaptation 0.3, the rest showed extinguished. There were no systemic abnormalities. The results of genetic testing showed that the proband had compound heterozygous mutations in exon 11 (c.9627delT/p.Pro3210Glnfs*22, M3) and exon 5 (c.1089delT/p.Asp364Ilefs*13, M4) of ALMS1, which were both novel mutations. The father of the proband was a carrier of M3 and the mother of the proband was a carrier of M4. Conclusions:Nystagmus and photophobia are often the first clinical manifestations of ALMS. In the early stage, the fundus can be basically normal. As the disease progresses, the fundus examination reveals vascular attenuation and retinal pigment abnormality, and the reflection of the fovea is unclear. OCT shows the photoreceptor cell layers are blurred or even lost. The final ERG is extinguished. M1, M2, and M3, M4 compound heterozygous mutations may be the pathogeny for family 1 and family 2, respectively.