Objective The purpose of the study was to investigate clinical manifestation and the characters of diagnosis and treatment among children with primary angiitis of the central nervous system (cPACNS) in order to improve awareness of the disease.Methods Clinical data of 5 children with cPACNS in the First People's Hospital of Yunnan Province from January 2009 to December 2013 were collected,and the clinical manifestations and laboratory test results were analyzed and summarized.Results Five cases of children with cPACNS were misdiagnosed at the first clinic visit,and were confirmed a clear diagnosis on the average of (4±6) months; clinical manifestations of five cases of varying degrees of headache,one case with severe headache,2 patients with decreased visual acuity,a cases with hearing were loss,two cases with secondarily generalized seizures; five cases with mild abnormal cerebrospinal fluid examination; 1 case with elevated ESR and CRP level,1 case with elevated immunoglobulin IgG level; 5 cases with abnomal MRI examinations,which showed multiple bilateral lesions,diffuse,lesions,involving the cortex and deep white matter; 4 cases had vascular abnormalities on MRA,treated with corticosteroids alone or in combination with cyclophosphamide and achieved good results.Conclusion Children of primary central nervous system vasculitis is ar are autoimmmune disease primarily involving the central nervous system.It is difficult for the clinical diagnosis.Children need to be wary of the major manifestation of headache associated with vision loss,hearing loss,seizures and other focal neurological system damage.

A method for simultaneous determination of 12 kinds of chlorinated disinfection byproducts (DBPs) in drinking water was developed based on liquid-liquid extraction gas chromatography equipped with electron capture detector (GC/ECD).The procedural standard calibration was adopted to eliminate the interference of different matrix.The method detection limits for 12 DBPs were 0.08-0.21 μg/L and the entire analytical procedure was finished in 21.50 min.The recoveries were in the range of 80.9%-115.7% and the relative standard deviations (RSD) were between 0.9% and 9.9% at different concentration levels (5 and 50 μg/L) in tap water and surface water.The correlation coefficients for all 12 kinds of DBPs were greater than 0.99 in the linearity range of 0.5-200 μg/L.The method was applied to determine DBPs in drinking water and source water.This method was rapid and competent for detection of volatile DBPs in drinking water.

Objective To evaluate the influencing factors of compliance and the compliance changes before and after intervention on chronic hepatitis B patients who oral nucleos(t)ide analogue (NA), by using the continuing care service items provided by WeChat platform. Methods A total of 67 patients with chronic hepatitis B were selected from January 2013 to June 2015. WeChat health care teams and WeChat groups were established to conduct continuing care intervention for 6 months by providing services, such as authoritative scientific diagnosis and treatment information, online consulting service, expert outpatient appointment, etc. Results The score of Morisky Medication Adherence Scale (MMAS-8) in patients of different culture levels of illiteracy (4.75 ± 2.20) points, primary school or junior high school graduate (5.73±1.87) points,high school or vocational school graduate (6.31±1.45) points,university diploma and above (7.24 ± 1.23) points were significant difference (χ2=22.113, P < 0.01). The score in patients previous used of nucleoside drugs (5.76±1.89) points was lower than that in patients not previous used of nucleoside drugs (6.62±1.60) points, and there was a significant difference between the two groups(Z=-2.636, P<0.01). Significant difference (χ2=10.844, P<0.01) was shown between groups of≥3 kinds drugs combined with the score 7.02 ± 1.08, 1-2 kinds drugs combined with the score 7.02 ± 1.08 and no combined medication with score 6.04±1.95. Different medical insurance types of free of charge (7.60±0.48) points,residents medical insurance (6.54 ± 1.52) points,new rural cooperative (5.17 ± 2.34) points and self-paying medical service (5.93±1.91) points showed significant difference(χ2=15.630, P<0.01). The scores in other diseases showed no significant difference (Z=0.401, P > 0.05) both in combination or non-combination. Compared to 6.45 ± 1.69 of pre-intervention, the total compliance score 6.86 ± 1.53 showed significant increased after intervention (Z=-2.551, P < 0.05), and the number of people with high compliance after the intervention increased while the number of people with middle and low compliance after the intervention decreased, and significant differencewas observed in two groups (χ2=9.521, P<0.01). Conclusions After the intervention of continuing care based on WeChat platform, the patients' compliance with nucleoside antiviral drugs were significant improvement than those of pre-intervention.

Objective:To investigate the etiological characteristics and drug resistance patterns of multidrug-resistant organism (MDRO) infection in patients after cardiac surgery, so as to help clinicians rationally prescribe antimicrobials recommended by guidelines, increase the success rate of empirical antibacterial therapy and improve the prognosis of inpatients.Methods:Clinical data of 409 patients diagnosed with nosocomial infection (NI) after cardiac surgery from January 2018 to October 2021 were retrospectively collected. According to the results of culture, these cases were divided into two groups: MDR bacterial infection group (MDR, n=176) and non-MDR bacterial infection group (non-MDR, n=233). The etiological characteristics of MDRO infection and the patterns of drug resistance to commonly used clinical antibiotics were analyzed. Meanwhile, the etiological distribution, drug resistance and clinical outcome corresponding to different surgical types and clinical infection types were statistically analyzed. Results:A total of 306 strains of MDR bacteria were detected. Among the 176 patients, 97 (55.1%) were infected with more than one kind of MDRO and the mix infections were mainly caused by Klebsiella pneumoniae, Acinetobacter baumannii and/or Pseudomonas aeruginosa. Carbapenem-resistant (CR) bacteria accounted for 69.6% (213/306). Regardless of surgical type and clinical infection type, Acinetobacter baumannii (114/306, 37.3%) was the most common pathogenic bacteria, followed by Klebsiella pneumoniae (72/306, 23.5%) and Pseudomonas aeruginosa (55/306, 18.0%). Most of the clinical specimens were sputum specimens (528/601, 87.9%) and most of the isolated strains were carbapenem resistant, MDR and extensively drug-resistant (XDR). The positive rates of MDR bacteria were 53.7% and 53.1% in patients undergoing coronary artery bypass grafting (CABG) and aortic surgery, respectively, while the positive rates of pandrug-resistant bacteria were relatively low. In vitro drug sensitivity test results showed that MDR bacteria were highly resistant to levofloxacin (64.4%) and cefepime (61.4%), and then to ciprofloxacin (54.6%), ceftazidime (53.9%) and cotrimoxazole (52.4%). However, the resistance rates to polycolistin (5.5%) and amikacin (7.2%) were low. Compared with non-MDR bacteria, MDR bacteria were less susceptible to ceftazidime (χ 2=156.663, P<0.001), ceftriaxone (χ 2=27.844, P<0.001), cefepime (χ 2=210.181, P<0.001), imipenem (χ 2=173.242, P<0.001), levofloxacin (χ 2=201.521, P<0.001), ciprofloxacin (χ 2=180.187, P<0.001), amikacin (χ 2=16.661, P<0.001), gentamicin (χ 2=46.047, P<0.001), tobramycin (χ 2=106.546, P<0.001), piperacillin (χ 2=7.325, P=0.007), ampicillin/sulbactam (χ 2=5.415, P=0.020), piperacillin/tazobactam (χ 2=139.506, P<0.001), cefoperazone/sulbactam (χ 2=102.832, P<0.001), cotrimoxazole (χ 2=121.217, P<0.001), aztreonam (χ 2=6.977, P=0.008) and minocycline (χ 2=53.107, P<0.001). Although there was no significant difference in the detection rates of pathogenic bacteria between patients undergoing different types of surgery or having different types of infection, the mortality rate of NI after cardiac surgery, especially MDR bacterial infection, was as high as 30.0%. Moreover, the mortality rate was closely related to the types of clinical infection. The all-cause mortality of common pulmonary infection and bloodstream infection (BSI) was 10.0% to 20.0%, and once the patient′s condition was not under control and progressed to severe infection or even septic shock, the all-cause mortality would double. Conclusions:MDR bacterial infections would bring great challenges to patients after cardiac surgery, especially gram-negative bacteria (GNB) such as Klebsiella pneumoniae, Acinetobacter baumannii and Pseudomonas aeruginosa. More than half of the patients would have mixed infections caused by carbapenem resistant, XDR or even pandrug-resistant bacteria, resulting in limited choice of anti-infective drugs and poor prognosis in hospitalized patients.

Objective To investigate the mechanism of astragaloside Ⅰ,the active constituent of milkvetch root,in inhibiting podocyte injury and improving diabetic kidney disease.Methods According to the body weight,60 male db/db mice were randomly divided into the model group,astragaloside Ⅰ low-dose group(10 mg/kg),astragaloside Ⅰ medium-dose group(20 mg/kg),astragaloside Ⅰ high-dose group(40 mg/kg),and valsartan group(10mg/kg),with 12 mice per group.Twelve db/db littermate control db/m mice were used as the control group.The drug was administered by gavage for 8 weeks.Transmission electron microscope was used to observe the ultrastructure of the kidney;immunohistochemistry and Western blotting were used to detect the expression of nephrotic protein(nephrin),a marker of renal podocytes;enzyme-linked immunosorbent assay was used to detect the contents of interleukin-1β(IL-1β)and interleukin-18(IL-18)in the serum of mice;Western blotting was used to detect the protein expressions of NOD-like receptor thermoprotein domain-related protein 3(NLRP3),cysteinyl aspartate specific proteinase 1(Caspase-1),and Gasdermin D(GSDMD)in kidney tissue.Results Compared with the control group,the glomeruli of the model group showed obvious podocyte loss and foot process fusion;the protein expression of nephrin was decreased(P＜0.05);the contents of IL-1 β and IL-18 in serum were increased(P＜0.05);the protein expressions of NLRP3,Cleaved-Caspase-1,and GSDMD-N were increased(P＜0.05).Compared with the model group,the renal pathological damage in the astragaloside Ⅰ administration groups were alleviated;the protein expression of nephrin was increased(P＜0.05);the contents of IL-1β and IL-18 in serum were decreased(P＜0.05);the protein expressions of NLRP3,Cleaved-Caspase-1,and GSDMD-N were decreased(P＜0.05).Conclusion Astragaloside Ⅰ may play a role in intervening diabetic kidney disease by inhibiting pyroptosis and improving podocyte injury.

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