Objective To investigate clinical features,drug resistance,risk factors and prognosis of extended-spectrum beta-lactamases (ESBLs)-producing Escherichia coli infection in hospitalized newborns.Methods Sixty eight newborns infected with ESBLs-producing Escherichia coli admitted in Neonatal Ward of Ningbo Women and Children's Hospital during.January 2010 and January 2013 were enrolled in the study; 81 newborns infected with multiple resistant non-ESBLs-producing Escherichia coli served as controls.The drug sensitivity of the isolated ESBLs-producing Escherichia coli was tested using K-B method.Clinical data including birth weight,gestational age,mode of delivery,site of infection and disease outcome were analyzed.Logistic regression analysis was performed to study the risk factors for ESBLs-producing Escherichia coli infection.Results The highest positive rate of ESBLs-producing Escherichia coli was detected in sputum samples (49/68,72.1％),followed by blood (7/68,10.3％) and urine (6/68,8.8％) samples.Strains were highly resistant to ampicillin,cefotaxime,ceftazidime and cefepime (61.8％-100.0％),but the resistant rates to cefoxitin,cefoperazone/sulbactam and amikacin were low (2.9％-10.3％),and were completely sensitive to carbapenems.Lower respiratory tract infections were most popular in both groups,but in ESBLs-producing Escherichia coli infected group,lower respiratory tract infection rate in late newborns was higher than that in early newborns (x2 =12.879,P ＜ 0.05).Multivariate logistic regression analysis showed that gestational age ＜ 37 weeks (Exp (B) =0.352,95％ CI:0.134-0.929),cesarean section (Exp (B) =0.488,95 ％ CI:0.243-0.984),invasive procedures (Exp (B) =0.363,95 ％ CI:0.142-0.927),use of hormones and/or antibiotics one week before birth (Exp (B)=0.325,95％ CI:0.127-0.833) were independent risk factors for ESBLs-producing Escherichia coli infection.Conclusions Respiratory tract infection is popular in ESBLs-producing Escherichia coli infection in hospitalized newborns.The strains are highly resistant to most antibiotics.Reducing invasive procedures,strict control of cesarean section and prenatal use of hormones and antibiotics may reduce the infection of ESBLs-producing Escherichia coli in newborns.

Objective To investigate the significance of thyroid function screening in high-risk pregnant women with gestational diabetes (GDM) in early pregnancy.Methods A total of 194 cases with GDM were selected as our subjects.The patients were divided into group A(three normal items,a total of 109 cases),group B (one abnormal item,a total of 57 cases) and group C (two abnormal items,a total of 28 cases).The levels of serum anti-thyroglobulin antibody (TGAb),anti-thyroid peroxidase antibody (TPOAb),serum three triiodothyronine(TT3),thyroxine (TT4),free three triiodothyronine (FT3),free thyroxine (FT4) and thyroidstimulating hormone (TSH) were screened.Results TSH levels in group A was (1.45 ± 0.43) mU/L,significantly lower than in group B and group C((1.77±0.53),(1.89±0.74) mU/L).FT4 levels in group A was (11.62±0.98) nmol/L,significantly higher in group B and group C((10.23±0.75),(9.87±0.88) nmol/L)).Proportion of TPOAb,TGAb positive in group A were 9.17％(10/109) and 21.05％(12/57),significantly lower than that of group B and group C((28.57％(8/28) and 3.67％(4/109),7.02％(5/57) and 17.86％(5/28)).And the differences were significant (P＜ 0.05).And TPOAb + TGAb in group A was 0.92％(1/109),significantly lower than that of group B and group C(7.02％ (4/57),17.86％ (5/28);P ＜0.05).Conclusion The importance of screening thyroid function in early pregnancy in women at high risk for gestational diabetes is worthy of clinical promotion.

AIM: To explore the effects and mechanism of interleukin-2 (IL-2) on the positive effect of isoproterenol (ISO) in the isolated rat cardiomyocytes. METHODS: Enzymatically isolated cardiomyocytes were used. Peak twitch amplitude and maximal velocity of shortening/relaxation (?dL/dt_~max ) in the isolated cardiomyocytes were recorded with a microscope coupled to a charge-coupled device camera and [Ca~2+ ]i transients were determined with a fluorometric ratio method by using Fura-2/AM as Ca~2+ indicators. RESULTS: ① ISO increased the peak twitch amplitude and ?dL/dt_~max of the isolated cardiomyocytes. Perfusion for 15 min with IL-2 at 2?103 U/L, which had no effect at all, attenuated the enhancing effect of ISO on the peak twitch amplitude and ?dL/dt_~max . ② ISO increased the [Ca~2+ ]i transients of the single ventricular myocytes in a dose dependent manner and the corresponding EC_~50 values of ISO was (0.12?0.01) ?mol/L. Perfusion for 15 min with IL-2 at 2?103 U/L, which had no effect on the ~[Ca~2+ ]i transient at all, attenuated the enhancing effect of ISO and the corresponding EC_~50 was (0.44?0.06) ?mol/L. ③ The electrically induced [Ca~2+ ]i transient was significantly increased by pretreatment with 20 mg/L cholera toxin for ~12 h. The elevation of the [Ca~2+ ]i transient induced by cholera toxin was significantly attenuated by 2?103 U/L IL-2. ④ Forskolin (1 ?mol/L), the activator of adenyl cyclase, significantly increased the electrically induced [Ca~2+ ]i transient, which was attenuated by IL-2 at 2?103 U/L. CONCLUSION: IL-2 inhibits the positive effect of isoproterenol in the isolated single ventricular myocytes, in which Gs protein and adenyl cyclase are involved. [

Objective To investigate the accuracy of serum neuron-specific enolase (NSE)predicting malignant middle cerebral artery infarction(mMCAI).Methods A total of 40 patients with acute massive cerebral infarction within 24 hours after symptom onset were recruited.Blood samples were collected at 24,36 and 48 hours after symptom onset.Serum NSE concentration was determined by automatic electrochemiluminescence analyzer.mMCAI was defined as hernia signs in clinical practice,and CT/ MRI showed mass effect.The receiver operating characteristic curve was used to analyze the accuracy of serum NSE concentration in predicting mMCAI at 3 time points.Results Sixteen patients(40%)developed mMCAI.The serum NSE concentration for predicting the accuracy of mMCAI was poor at 24 hours after symptom onset;the serum NSE concentration for predicting the specificity of mMCAI was high (96%)at 36 hours after symptom onset,but the sensitivity was lower(69%);the serum NSE concentration for predicting the specificity(92%)and sensitivity(88%)of mMCAI were high at 48 hours.Conclusions The serum NSE conoentration and its dynamic changes may predict the occurrence of mMCAI,and the predicting time points are appropriate from 36-48 hours after symptom onset.

Objective To investigate the possibility and accuracy of predicting malignant middle cerebral artery infarction (mMCAI) with bedside electroencephalography (EEG). Methods Thirty-five patients with massive hemispheric infarction (MHI) underwent bedside EEG monitoring within 48 h of onset. The EEG indicators were interpreted blindly, and the clinical, laboratory and imaging parameters were analyzed. The patients were divided into mMCAI group and non-mMCAI group according to whether they had occurred mMCAI or not within 7 days of onset. The differences of EEG indicators, clinical, laboratory and imaging parameters between the 2 groups were compared. When the parameters of significant difference and statistical significance appeared the odds ratio (OR) of occurring mMCAI were analyzed, and their accuracy of predicting mMCAI was calculated. Results Of the 35 patients with MHI, 20 were in the mMCAI group and 15 were in the non-mMCAI group. There were significant differences in the EEG indicators (infarction on the contralateral side, including disintegration of occipital α rhythm, generalized slow-wave, dominant frequency wave low amplitude, regional attenuation without delta [RAWOD]pattern, and absence of EEG reactivity), clinical parameters (nausea accompanied with vomiting), and imaging parameters (the infracted area more than the entire MCA territory, and midline shifting 3 to 5 mm at the level of septum pellucidum) between the 2 groups (P < 0. 05). Of those, the risk of mMCAI was the highest in patients with disintegration of occipital a rhythm on the contralateral side of infarction (P = 22. 67, 95% CI 3. 89-132. 10). The sensitivity of predicting mMCAI was 85. 0%, the specificity was 80.0%, the positive predictive value was 85.0%, and the negative predictive value was 80. 0%, which were superior to other EEG indicators and clinical or imaging parameters. Conclusions Bedside EEG indicators can early predict mMCAI, moreover, the predictive accuracy is superior to the clinical and imaging parameters.

Objective To evaluate feasibility and reliability of using Simplified Acute Physiology Score Ⅱ (SAPS Ⅱ)in predicting mortality in critically ill patients with neurological diseases.Methods All 653 patients hospitalized in neurological intensive care unit (N-ICU) from Jan 2005 to Dec 2007 were retrospectively studied.SAPSⅡ scores were scaled upon admission at 24,48 and 72 h,and possibility of hospital mortality (PHM) was calculated based on SAPS Ⅱ score.Neurological diseases diagnosis made initially at time of hospitalization was classified into five categories:intracranial hemorrhage,cerebral infarction,neurologic infection,neuromuscular diseases and other neurologic diseases.At each of four time points,the SAPSⅡscores were compared between the survival group and death group,and the relationship of SAPS Ⅱ score and prognosis were analyzed.The calibration of the SAPS Ⅱ were accessed with the Hosmer-Lemeshow goodness-of-fit chi-squared statistic and the discrimination with area under the receiver operating characteristic curve (AUROC).Multivariate logistic regression was used to analyze the relationship between disease category and prognosis.Results SAPS Ⅱ scores in the death group (46.53±12.22,47.28±13.84,48.58±14.18 and 49.06±14.61)at each time point were significantly higher than those in the survival group (34.70±11.78,30.28±12.24,29.79±12.36 and 29.69±12.96;t=11.12,14.02,14.43 and 13.49 at 0,24,48 and 72 h,respectively,P＜0.01).Furthermore,univariate logistic regression analyses demonstrated that SAPS Ⅱ score was correlated with prognosis (OR=1.080,1.100,1.109,1.100 at 0,24,48 and 72 h,respectively,P＜0.01).The scores at 48 and 72 h were more accurate in predicting mortality.SAPS Ⅱ had good calibration at each time points (x2=5.305,7.557,6.369 and 8.540,P＞0.05),however,the consistency of expected mortality with observed mortality was satisfactory only at 48 and 72 h(82.6%,83.4%),so was the discrimination ( AUROC=0.825,0.847 respectively).There was no correlation between disease categories and outcome.Conclusion SAPS Ⅱ scoring,best evaluated at 48 and 72 h after hospitalization,can be used as a reliable predictor of probability of mortality in patients hospitalized in N-ICU and prediction can be applied in these patients with all different neurology diseases.

Objective To explore the related factors of diabetes insipidus and disorders of sodium and water after surgery of sellar region tumor,and to find nursing strategy and improve the prognosis of sellar region tumors.Methods In this study,we retrospectively reviewed 150 cases of sellar region tumor from January 2005 to January 2011 in our department,including 67 cases of pituitary adenoma,53 cases of meningioma,30 cases of craniopharyngiona.Approaches were depended on the size and growing pattern of the tumors.Related factors of postoperative diabetes insipidus and disorders of sodium and water were analyzed.Results Large tumor size,the pathology of tumor,preoperative endocrine dysfunction,preoperative visual field and vision disorders and surgery approach were related to such complications.Conclusions Finding the related factors of these complications in patients and adopting care measures play an important role in improving the prognosis of sellar region tumors.

BACKGROUND:YOUMET cervical dilating rod is made of absorbent polymer materials and has non-toxic side effects, which can avoid cross-infection in one-time use. OBJECTIVE:To observe the clinical effects of YOUMET cervical dilating rod used for cervical orifice dilation before intrauterine device insertion and removal as wel as before artificial abortion operations. METHODS:Totaly 275 female subjects schedule for cervical dilation during intrauterine device insertion and removal operations, and suction abortion for pregnancy within 10 weeks were randomly divided into two groups: 137 were included in observation group in which YOUMET cervical dilating rods were applied and 138 were included in control group in which Gongshuning glue sticks were used. Their cervical softening and dilatation situation, analgesic effect, and combined reactions during operation were observed. RESULTS AND CONCLUSION:Between the two groups, no statistical significance in general biological characteristics was found; Dilating effects in intrauterine device removing operations during child-bearing period and menopause were better in the observation group than the control group (P < 0.05). Rates of pain during insertion were higher in the observation group than the control group (P < 0.05). Rates of pain during indweling period for both groups were comparatively low, which showed no statistical significance. There was no record related to the application of cervical orifice dilating products in postoperative folow-up visit. Both products were safe with no cervical injury, slow heart rate and drop in blood pressure. YOUMET cervical dilating rod has trustworthy and safe dilating effects, which can remarkably aleviate pain.

Objectives To investigate the clinical features of clomiphene citrate (CC) resisitant in patients with the polycystic ovary syndrome(PCOS). Methods A total of 145 women with PCOS were analyzed in the center for reproductive medicine of our hospital. According to the responses to CC ,patients were divided into two groups:(1)the CC resistant group(n = 32),(2)the CC response group(n = 113). The clinical features were compared between these two groups. Results (1)Body weight,body mass index(BMI),blood pressure and F?G scores were significantly higher in the CC resistant group than those in the CC response group (P < 0.05, respectively).(2)Basic antral follicle counts(AFC),C reaction protein(CRP),fasting insulin(FI)and HOMA?IR in the CC resistant group were significantly higher than those in the CC response group (P < 0.05, respectively),however,no significant difference was observed in sex hormones between these two groups. Conclusion PCOS patients with CC resistant are more likely to have higher body weight,BMI,blood pressure, insulin resistant?indexes and basic AFC ,the clinical doctors should consider these features before the treatment of ovulation induction.

Objective To evaluate the effects of dexmedetomidine on dreaming during general anesthesia in pediatric patients.Methods A total of 400 pediatric patients of both sexes,aged 5-12 yr,with body mass index of 15.2-18.1 kg/m2,of American Society of Anesthesiologists physical status Ⅰ,undergoing elective orthopedic surgery under general anesthesia,were randomly divided into control group (group C,n=200) and dexmedetomidine group (group D,n =200) according to the computer-generated random numeral order and numeral parity.Dexmedetomidine was infused intravenously in a loading dose of 0.5 μg/kg over 10 min before induction of anesthesia followed by infusion of 0.5 μg · kg-1 · h-1 until 30 min before the end of surgery in group D,while the equal volume of normal saline was given instead of dexmedetomidine in group C.The pediatric patients who regained consciousness and recovered orientation in post-anesthesia care unit were interviewed for dreaming using a modified Brice questionnaire,and the dream (emotion,hearing and behaviours in dreams,memories for dreams) was evaluated using a 5-point Likert scale.Results Compared with group C,the incidence of dreaming was significantly decreased,the memory score was decreased (P＜0.05),and no significant change was found in emotion,hearing and behaviour scores in dreams in group D (P＞0.05).Conclusion Dexmedetomidine can decrease the development of dreaming during general anesthesia and produces no effect on the content of dreams (most are pleasant) in pediatric patients.