Objective To investigate the distribution and antimicrobial resistance of Enterobacter cloacae complex(ECC)isolated from a tertiary hospital in Shanghai.Methods Clinical ECC isolates were collected from 2018 to 2020.Antimicrobial susceptibility test was performed with broth microdilution and agar dilution methods.PCR was applied to detect five carbapenemase genes(blaKPC,blaNDM,blaIMP,blaVIM and blaOXA-48).Results A total of 222 ECC isolates were collected from 2018-2020,including 36 strains(16.2％)from general surgery department.The strains were mainly isolated from sputum(41.0％)and urine(20.3％).MIC results showed that the isolates were highly resistant to trimethoprim-sulfamethoxazole,the second-and third-generation cephalosporins,aztreonam and quinolones(31.1％-71.2％resistant),but low resistance rates to tigecycline,amikacin,mecillinam,and ceftazidime-avibactam(0.5％-9.0％resistant).About 9.5％and 10.4％of the strains were resistant to meropenem and imipenem,respectively.A total of 34 ECC strains were carbapenem-nonsusceptible strains,of which 23 strains were resistant to carbapenems.Among the 34 carbapenem-nonsusceptible strains,25(73.5％)strains were susceptible to mecillinam,including 15 strains producing metallo-β-lactamase.PCR assay identified carbapenemase genes in 21 of the 34 carbapenem-nonsusceptible strains,including blaNDM(14 strains),blaIMP(5 strains)and blaKPC(2 strains).Compared with the strains isolated in 2018,the ECC strains isolated in 2019 and 2020 showed significantly higher resistance rates to imipenem and ceftazidime-avibactam(P＜0.05),primarily associated with the production of NDM.Among the ECC strains resistant to third-generation cephalosporins,20.4％were resistant to imipenem and meropenem,while 4.9％and 8.7％were resistant to amikacin and mecillinam,respectively,and 9.7％were nonsusceptible to tigecycline.Conclusions The ECC isolates in 2019 and 2020 showed increasing resistance rates to carbapenems and ceftazidime-avibactam due to the production of metallo-β-lactamases.Some of the metallo-β-lactamase-producing ECC isolates were susceptible to mecillinam.

ObjectiveTo analyze and construct a curriculum framework and content system of the vocational college rehabilitation therapy technology exercise therapy technology course, based on World Health Organization (WHO) International Classification of Functioning, Disability and Health (ICF) and rehabilitation competency framework (RCF). MethodsUsing educational psychology and curriculum theory, and applying the ICF and RCF, the curriculum system for rehabilitation therapy technology curriculum system was constructed. A systematic analysis of the existing exercise therapy technology course content was conducted to identify the core elements related to ICF and RCF. Through the design of course modules, these core elements were integrated into theoretical courses, skills training and practical courses to form a comprehensive curriculum structure. ResultsCombining the ICF and RCF, a curriculum system for rehabilitation therapy technology curriculum system was constructed, covering theoretical courses, skills training and practical courses. This system enabled students to systematically master rehabilitation assessment and treatment techniques and develop clinical decision-making abilities and interdisciplinary collaboration skills. The introduction of the ICF framework allowed students to acquire knowledge, skills and abilities in the field of exercise therapy technology through the course. Developing competency-oriented courses based on RCF framework helped students develop comprehensive professional competencies through learning. ConclusionBy integrating the ICF and RCF, a curriculum for exercise therapy technology course in vocational colleges has been constructed. Based on the ICF framework, the content of the course has been aligned with the bio-psycho-social theory of functioning and health, covering three levels: body function, activity and participation, and environmental factors. The curriculum content should include the analysis, assessment and intervention of these functioning. RCF provides a theoretical structure and methodology for developing competency-oriented courses. When designing the course modules, teaching objectives have been established based on the core competency framework, aiming to develop students' comprehensive professional competence and professionalism through theoretical courses, practical training and clinical internships.

With the increasing incidence rates of metabolic diseases such as obesity and type 2 diabetes, the incidence rate of nonalcoholic fatty liver disease (NAFLD) has also gradually increased year by year. NAFLD has complex underlying pathogeneses which have not yet been fully clarified. As the carrier of intercellular communication, exosomes play an important role in the development and progression of liver diseases. This article summarizes the mechanism of action of exosomes in the pathogenesis of NAFLD and their effect on lipid metabolism, insulin resistance, liver inflammation, and fibrosis, and it is pointed out that exosomes have great potential in the diagnosis and treatment of diseases, which will be the focus of future research.

Objective:To evaluate the efficacy and safety of combination therapy of eltrombopag, recombinant human thrombopoietin (rhTPO) , and standard immunosuppressive therapy (IST) for severe aplastic anemia (SAA) .Methods:A total of 16 cases with SAA treated with IST combined with eltrombopag and rhTPO were retrospectively analyzed.Results:At 3 months, the total response rate was 81.3%, and the complete hematological response rate was 37.5%. At 6 months, the total response rate was 87.5%, and the complete hematological response rate was 50.0%. The median time of platelet transfusion independence was 35 (16-78) days, the median time of red blood cell transfusion independence was 47.5 (15-105) days, the median platelet transfusion was 5.5 (3-20) U, and the median red blood cell transfusion was 6.5 (2-16) U.Conclusion:The combination of eltrombopag and rhTPO can improve the hematological response rate of IST for SAA and the quality of hematological remission with minimal toxic effects.

Objective To study the effects of Vitamin D (VitD) supplementation on growth and immune function in neonatal mice.Methods A total of 120 mice were divided into four groups (30 mice in each group) according to dose of VitD.The high-dose group,medium-dose group and low-dose group was given 3.44,1.72,0.86 IU VitD drops,respectively.The control group was not treated with VitD drops.Rat body weight,level of peripheral blood 25-(OH)D3 were observed.The cellular immune function (determined by using delayed hypersensitivity reaction experiment),humoral immune function (assessed by antibody producing cells counts and HC50 determination) and mononuclear-macrophage phagocytic function (assessed by mouse peritoneal macrophage phagocytosis of chicken red blood cells test and carbon clearance test) were detected.The flow cytometry assay was carried out to differentiate T lymphocyte subsets.Results With the increase of dose of VitD,levels of peripheral blood 25-(OH)D3 and calcium ion were gradually increased,there were statistically significant differences when compared with the control group(P＜0.05);the body weight and body length were gradually increased,while no statistically significant difference was found among the groups treated with VitD(P＞0.05).Compared to the control group,the toes swelling,phagocytic percentage,number of antibody producing cells,serum soluble HC50 in the high-dose group and medium-dose group were increased significantly,while carbon clearance test phagocytic index were decreased significantly (P＜0.05).With the increase of dose of VitD,the number of CD4+,CD8+ T lymphocytes and the CD4+/CD8+ ratio were gradually increased.Conclusion VitD could promote the growth and development of offspring mice,and enhance the immune function of the body.

Objective To discuss the method, therapeutic effect and safety of CT-guided 125I radioactive seed implantation for the treatment of cervical lymph node metastasis. Methods CT-guided 125I radioactive seed implantation was performed in 32 patients with pathologically proved cervical lymph node metastasis Results The local effective control rates of the cervical lymph node metastasis at one, 3, 6 and 12 months after the treatment were 81.3%(26/32), 84.4%(27/32), 93.7%(30/32) and 87.5%(28/32) respectively. Conclusion For the treatment of cervical lymph node metastasis, CT-guided 125I radioactive seed implantation is technically simple and clinically safe with reliable curative effect; this treatment is very effective in improving local tumor control rate.

Objective To study effectiveness of System intervention to occupation burnout of medical staff.Methods Specimens were classified as interventional group and control group by 1:1 partnership rule.Systemic intervention,which came from organization,family and individual,was only applied to interventional group.The objective was to establish requirement and resource mechanism,continually increase response resource,and improve matching state of individual & job.It allowed full play to the first grade prevention(development intervention),the second grade prevention(symptom intervention)and the third grade prevention(burnout intervention).It determined effectiveness of intervention via indexes of occupation burnout,mental health and satisfaction within group or internal groups.Results Before systemic intervention,there was no significant difference between intervention group and control group(P＞0.05).After systemic intervention,the scores of burnout(emotion exhaustion(17.54±9.97)vs(14.30±11.87),P＜0.01;depersonalization(5.29±5.01)vs(4.63±5.65),P＜0.05;low personal accomplishment(6.47±4.89),(5.61±5.10),P＜0.01),check list-90(SCL-90),personal satisfaction in intervention group showed apparent difference compared with that in control group.But there was no significant difference in control group before and after intervention.Conclusion On the whole systemic intervention to health care staff obtains obvious achievement,effectively reduces emotional exhaustion,obsessive symptom and terror emotion,and enhances individual satisfaction.

Objective To study the expression of Survivin protein and its relation with the expression of Bcl-2, Bax in the tropho- blasts of human normal placenta. Methods The normal placental tissues (8 -9week ,18-23 week and 37-40week) were fixed, embed- ded, sectioned, and Survivin, Bcl-2, and Bax in the trophoblasts were detected with immunnohistochemistry. Result As the gestational age advanced , the staining intensity of Survivin in the trophoblasts was significantly decreased from the first trimester group to the second trimes- ter group to the term group (PU value: 11.74±0.8,9.95±0.43,8. 83 ~ O. 67, respectively, P <0.01 ), while the staining intensity of Bcl-2 and Bax in trophoblast was significantly increased (PU value of Bcl-2 : 4.33±0.60, 5.00±0.75,6.87±0.45, respectively, P<0.01 and PU value of Bax: 9.82±1.12,16.00±1.05,27.48±2.10, respectively, P <0.01 ). Expression of Survivin in trophoblasts has no rela- tionship with the expression of Bcl-2 and Bax (P>0.05 ). Conclusion Survivin may take part in the development of human normal pla- centa through the way of suppressing the apoptesis in trophoblasts. Expression of Survivin in trophoblasts has no relationship with the expres- sion of Bcl-2 and Bax, which indicate that they regulate apoptesis of trophoblasts via different biological pathways.

The healing training was an important method to improve living ability and quality of life of patients with schizophrenia.This article introduced a living skill training scheme applied in out-patients whose course of disease shorter than 5 years.

BACKGROUND: The clinical features and classification of various anomalous synkinetic movements related to ocular muscles caused by abnormal innervations have not been fully understood.OBJECTIVE: To report and analyze the clinical features of anomalous synkinetic movements related to ocular muscles caused by abnormal innervations, as well as to classify them according to the same neuromuscular nerves.DESIGN: A retrospective case analysis.SETTING: Department of Ophthalmology, the Affiliated Hospital of the Medical College of Qingdao University.PARTICIPANTS: The study was mainly conducted in the Department of Ophthalmology, the Affiliated Hospital of the Medical College of Qingdao University. A total of 836 cases of abnormal ocular movements were found from January 1997 to January 2002. Among them 67 cases of anomalous synkinetic movements were diagnosed.METHODS: All patients were inquired of case history and their ocular movements were examined. The anomalous synkinetic movements were found and classified into congenital and acquired. All cases were analyzed according to the same neuromuscular nerves, such as between branches of oculomotor nerve, oculomotor and abducens nerve, supranucleus and other anomalous synkinetic movements.lous synkinetic movements were determined by inquiring the history of observed.RESULTS: Sixty-seven anomalous synkinetic movements (8%) of 836 abnormal ocular movements were diagnosed; congenital anomalous synkinetic movements were the most common ones (88.06%) and were often seen in patients with Duane's syndrome. Anomalous synkinetic muscles occurred the most common between lateral and medial rectus, lateral rectus and levator palpebrae muscle (36.89% respectively) in congenital cases, and those occurred between inferior rectus and levator palpebrae muscle more commonly (30%) in acquired cases.CONCLUSION: Anomalous synkinetic movements related to ocular muscles are not infrequently seen. When we find paradoxical movements between ocular muscles, or between ocular muscles and other unrelated muscles, anomalous synkinetic movements should be considered.