Objective To probe the pathogenesis of ventilator associated pneumonia (VAP) and their resistance to antibiotics of children in pediatric intensive care unit (PICU). Methods A clinical trial in 308 VAP episodes of 134 patients in PICU receiving mechanical ventilation was made. The pathogens and their drug resistance were analyzed. Results A total of 498 pathogen strains were isolated by bacterial culture. The major pathogenic bacteria in VAP were the gram-negative bacilli accounting for 416 strains (83.5%); the gram-positive bacteria were 66 strains (13.2%), staphylococcus aureus 35 strains (7.0%); methicillin-resitant staphylococcus aureus 22 strains (4.4%); staphylococcus epidermidis 19 strains (3.8%); methicillin-resitant staphylococcus epidermidis 11 strains (2.2%); all staphylococcus were sensitive to vancomycin; the fungi were 16 strains (3.2%). Among pathogens, the most common pathogens associated with VAP were klebsiella pneumoniae 155 strains (31.1%), aci netobacter baumanii 56 strains (11.2%), pseudomonas aeruginosa 54 strain (10.8%), escherichia coli 39 strains (7.8%) and staphylococcus aureus 35 strains (7.0%). Their multiple drug-resistance to antibiotics was serious. Drug sensitivity tests indicated that the gram-negative bacilli had lower drug-resistance to such antibiotics as imipenem, amikacin, piperacillin/tazobactam, ceftazidime, cefepime, cefoperazone/sulbactam, ciprofloxacin and amoxycillin/clavulanate. Drug sensitivity tests indicated that the gram-positive bacilli bad lower drug-resistance to such antibiotics as vancomycin, cefazolin, rifampicin, cefaperazone/sulbactam and bad higher drug-resistance to penicillin G and amoxycillin/clavulanate. Polymicrobial pathogens were more isolated in late-onset VAP than those in early-onset VAP. Conclusions The major pathogens in VAP are gram-negative bacilli and there are often multiple drug-resistant and fungus infection was common. It was suggested that the adequate initial empiric antimicrobial treatment should base on the surveillance of etiology and resistance.

This survey was to assess physicians' quality of life within tertiary hospitals in Beijing.SF-36 was used to analyze and compare 160 physicians with normal models. There was significant difference in mental health score between out-patient physicians and general populations (P<0.01). However, there was significant difference in general health (P<0.05), vitality (P<0.01), social function (P<0.01),and mental health (P<0.01) scores between emergency physicians and general populations. There was significant difference in general health (P<0. 05), vitality (P<0.01), social function (P<0. 01), and mental health (P<0.01) scores between emergency physicians and out-patient doctors. Out-patient doctors' quality of life is better than emergency physicians. Emergency physicians might live in sub-health status.

Objective To investigate the effect of atorvastatin calcium in the treatment of cerebral infarction and its onhighsensitive C-reactive protein (hs-CRP), tumor necrosis factor α (TNF-α). Methods Selected 122 patients with cerebral infarction treated in our hospital from January 2014 to January 2016, patients were randomly divided into observation group (n=69) and control group (n=53),the control group was given conventional treatment, the observation group was given atorvastatin calcium on the basis of conventional treatment,observed the National Institutes of Health Stroke Scale (NIHSS) and the daily life ability Barthel index (BI) score in the two groups after treatment,detected hs-CRP, TNF-α and carotid artery intima media thickness.Results After treatment, the NIHSS score of the observation group was (13.41 ±1.43), significantly lower than that of the control group (15.52±1.61) (P < 0.05), while the BI score was (43.82 ± 11.21), significantly higher than that of the control group (39.04±9.82 ) (P <0.05). The observation group after treatmenths-CRP and TNF-α were (6.71 ± 1.50) mg/L and (7.41 ± 2.08) ng/mL, significantly lower than the control group(10.02±1.78)mg/L and(10.10±2.32)ng/mL (P < 0.05). The observation group after treatment carotid artery intima media thickness was (1.10±0.27) mm, significantly lower than the control group (1.36±0.21)mm (P < 0.05). The incidence of adverse reactions in the observation group was 5.80%, the adverse reaction rate of the control group was 5.66%, the difference was not statistically significant. Conclusion Atorvastatin calcium has a good effect in the treatment of cerebral infarction, can reduce serum hs-CRP and TNF-α level, promote nerve function and daily life ability recovery, improve the thickness of the carotid artery.

Objective To explore the effects of exogenous glutathione on arsenic distribution and nitric oxide (NO) metabolism in the brain of mice exposed to arsenite through drinking water. Methods Female Kunming mice were randomly divided into 5 groups, eight in each, and the mice were exposed to sodium arsenite through drinking water at doses of 0 mg/L (control) and 50 mg/L arsenic for 4 consecutive weeks, on the fourth week, with the exposure of arsenic, glutathione was given through intraperitoneal injection at doses of 200 mg/kg b.w, 400 mg/kg b.w or 800 mg/kg b.w, respectively for 7 days. In the end of treatment, the samples of blood and brain were collected. Levels of inorganic arsenic (iAs), monomethylarsonic acid (MMA) and dimethylarsenic acid (DMA) were determined by HG-AAS method. Activities of nitric oxide synthase (NOS) and the concentrations of NO were determined with kits. Results Compared with those in single arsenic group, glutathione significantly decreased levels of iAs, MMA and total arsenic levels (TAs) in the blood and levels of DMA and TAs in the brain. Activities of NOS and levels of NO in As group were significantly lower than those in control, however administration of glutathione could ameliorate these toxic effects, and NOS activities in groups treated with 400 mg/kg b.w and 800 mg/kg b.w glutathione were significantly higher than those in single arsenic group. Conclusion Exogenous glutathione may promote methylation of arsenic, therefore reduce arsenic levels in both blood and brain. Moreover, it is proposed that administration of exogenous glutathione can ameliorate the adverse effects of arsenic on NO metabolism in the brain via decreasing the brain arsenic burden.

Objective To study the effects of costimulatory blockade with anti-inducible costim- ulator antibody(ICOS mAb)in combination with CTLA4Ig on prevention of islet allograft rejection. Methods Experimental animals were randomly divided into 4 groups(10 rats in each group).CT- LA4Ig + ICOS mAb group(group A):intraperitoneal injection of CTLA4Ig on day 0,2,4 and ICOS mAb on day 1,3,5 after islet transplantation;ICOSmAb group(group B):intraperitoneal injection of ICOS mAb on day 1,3,5 after islet transplantation;CTLA4Ig group(group C):intraperitoneal injection of CTLA4Ig on day 0,2,4 after islet transplantation;control group(group D):simple islet transplantation.The islet allograft survival and pathological changes in the transplanted islets after transplantation were observed.By using RT-PCR,the expression of IL-2 and IL-10 mRNA in the transplanted islets was detected.The expression of CD4~+ and CD8~+ T cell was detected by flow cy- tometry.Results In group A,the survival time was obviously prolonged as compared with other three groups and the transplanted islets were near normal under a light microscope.As compared with other three groups,the expression of IL-2 mRNA was significantly decreased in group A(P0.05).The expression of CD4~+ and CD8~+ T cell was not obviously up-regulated on the day 21 after transplantation.Conclusion The blockade of costimulatory signals with ICOS mAb in combination with CTLA4Ig has a favorable effects to restrain the rejection of islet transplantation.

Primary biliary cholangitis (PBC) is an autoimmune liver disease with unclear pathogenesis.The amino acid composition and sequence in the complementarity-determining region 3 of T cell receptor (TCR) and B cell receptor (BCR) are highly diverse, which forms a large antigen recognition receptor repertoire, i.e., immune repertoire.In recent years, second-generation sequencing techniques combined with multiplex PCR or amplicon rescue multiplex PCR have been used to study the features of immune repertoire in PBC patients, and it has been found that PBC patients have clonal expansion of specific CD4+ T lymphocytes, clonal diversity of B lymphocytes, somatic hypermutation, and reduction in class switch, as well as increase in clonal diversity after treatment with ursodeoxycholic acid.These findings need to be confirmed by large-scale in vivo and in vitro studies and different immune repertoire research strategies.

Objective To explore the changes and significance of blood sugar,C-reactive protein(CRP)and blood gas in children with infantile pneumonia associated with systemic inflammatory response syndrome(SIRS).Methods Levels of blood sugar,blood gas and CRP were measured in 72 children with pneumonia associated with SIRS(divided as Group A),at the same time,the measured results in Group A were compared to those in children with pneumonia of non-SIRS(Group B)and normal children(control group).Results There was insignificantly higher than control group(t=3.274,P0.05),the levels of blood sugar and CRP in Group A were all significantly higher than those in Group B(t=9.9498,P

Animals ; Cells, Cultured ; Dioxins ; pharmacology ; Insulin-Like Growth Factor II ; genetics ; metabolism ; Osteoblasts ; drug effects ; metabolism ; RNA, Messenger ; genetics ; Rats ; Rats, Wistar

ObjectiveTo detect the effect of electroacupuncture combined with acupoint injection of deer melon polypeptide on the bone morpho-genetic protein synovial, BMPs and serum rheumatoid factor IgA-RF, IgM-RF.MethodsA total of 246 patients with Rheumatoid arthritis were divided randomly into control group and combined treatment group, 123 patients in each group. The control group received the treatment of electro-acupuncture, drug and Ultrashort wave therapy, and the combined treatment group continue to receive acupoint injection of deer melon polypeptide after 30 minutes when the treatment of control group was completed. Both groups were treated for 2 weeks. The expression of BMPs, MMP-1 and the ESR, serum rheumatoid factor IgA-RF, IgM-RF were detected. The morning stiffness time, Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and visual analogue scale (VAS) were recorded for outcome assessment.ResultsCompared with control group after treatment, the positive expression rates of ESR (8.79 ±1.61 mm/hvs.12.41 ± 2.57 mm/h,t=3.654), IgM-RF (22.38% ± 5.45%vs.39.57% ± 6.18%,t=2.365), IgA RF (32.84% ± 6.57%vs.49.84% ± 4.20%,t=2.574) in the combined treatment group significantly decreased. Compared with the control group, the expression of BMPs (15.43 ± 2.94vs.7.22 ± 1.52,t=3.914) in the combined treatment group significantly increased, while MMP-1 (8.01% ± 1.54%vs. 15.34% ± 2.47%,t=2.015) in the combined treatment group significantly decreased (P<0.05). Compared with control group, the outcomes VAS (3.37 ± 0.35 vs.5.75 ± 0.39, t=3.251), WOMAC (22.36 ± 3.49vs.30.50 ± 4.11,t=4.021), and morning stiffness (34.32 ± 5.57 minvs. 49.84 ± 4.20 min,t=3.914) in the combined treatment group significantly decreased (P<0.05). The total effect rate (82.11%vs. 71.55%,χ2=12.764) of combined treatment group was significantly higher than control group (P<0.05).Conclusion Electroacupuncture combined with acupoint injection of deer and melon peptide can improve effect rate.

There are some problems with this course of medical laboratory special English, such as reference materials, teaching contents, teaching ways, the evaluation forms, etc. The department of medical laboratory of North Sichuan Medical College did exploratory reforms including 1+n teaching mode (one major teacher and several co-operational teachers in discussion section), Flipped classroom and interactive teaching, new formative assessment forms (usual performance combing final shows grade), etc. They used innovative teaching way with the purpose of establishing new teaching way , cultivating abilities of au-tonomous learning and comprehensive application.