Objective To investigate the strain distribution of ascitic pathogens in patients with spontaneous bacterial peritonitis (SBP) and the changes of sensitiveness to antibacterials from 2009 to 2016.Methods The medical records of SBP patients who were hospitalized in Beijing Youan Hospital from 2009 to 2016 were collected.The results of ascites bacterial culture of SBP patients were all positive.The results of ascites culture, pathogen identification, and the drug sensitivity test were recorded.The changes of distribution of ascitic pathogens and the sensitiveness to antibacterials were analyzed according to the time interval of every two years.Results A total of 1 107 SBP patients were enrolled in the study.Of them, 816 patients were male with average age (54±10) years, 291 patients were female with average age (57±13) years.There were 1 042(94.1%) patients with positive bacterial culture of ascites and 65 patients (5.9%) with positive fungal culture of ascites among the 1 107 patients, respectively.There were 920(83.11%) patients with end-stage liver disease, 113 (10.2%) with biliary tract disease, and 74(6.68%) with other diseases in the 1 107 patients.A total of 1 441 strains of pathogenic bacteria were identified, comprised of gram negative (G-) bacteria 637 (44.2%) strains, gram positive (G+) bacteria 739(51.3%) strains, and fungi 65(4.5%) strains.During 2009 to 2016, the top four number of strains of G-bacteria in SBP patients'ascites from high to low were Escherichia coli [213(14.8%)], Klebsiella pneumoniae [146 (10.1%)], Pseudomonas aeruginosa[52(3.6%)] and Enterobacter cloacae[38(2.6%)];the top four strains of G(+) bacteria were Enterococcus faecium[176(12.2%)], Staphylococcus epidermidis[132(9.1%)], Staphylococcus haemolyticus [130(9.0%)] and Enterococcus faecalis [75(5.2%)];and the top 2 of fungi in SBP patients' ascites were Candida albicans[36(2.5%)] and Candida glabrata[12(0.8%)].Compared with the time interval of 2009-2010, the constituent ratio of G(-) bacteria in 2015-2016 was decreased significantly [49.3%(73/148)vs.39.4% (196/498), P=0.031] , the constituent rate of fungi was increased significantly [6.4%(32/498) vs.2.0% 3/148), P=0.038].There were no statistical significance in G(+) bacteria's constituent ratio among different time intervals.The constituent rate of extended spectrum beta-lactamases (ESBL) in Escherichia coli was higher in the time interval of 2015-2016 than that in the time interval of 2009-2010 [57.4% (35/61) vs.32% (8/25), P=0.033].The drug resistance of Escherichia coli to imipenem and meropenem were increased significantly during the same period (P=0.026, P=0.025).The results of drug sensitivity tests showed that G(-) bacteria was sensitive to imipenem, meropenem, amikacin and piperacillin/tazobactam;G(+) bacteria was sensitive to linezolid, teicoplanin and vancomycin.Conclusions The distribution of ascitic pathogens in SBP patients who were hospitalized in Beijing Youan Hospital from 2009 to 2016 present the tendency of decreasing of G(-) bacteria and increasing of fungi.The main pathogenic bacteria of SBP are drug-resistant.The resistance rates of Escherichia coli to imipenem, meropenem and cefotaxime have increased year by year.

A 62-year-old female with hepatitis C and decompensated cirrhosis received oral sofosbuvir 400 mg and daclatasvir 60 mg once daily.She developed edema of lower extremities about 18 weeks after beginning antiviral drugs.Two weeks later, the patient developed edema of face.Laboratory tests revealed the following results: serum creatinine 91 μmol/L, eGFR 54 ml/(min·1.73 m2), serum β2 microglobulin 4.42 mg/L, 24-hour urine protein 0.394 g.She received treatments including diuretic and liver protection.Sofosbuvir and daclatasvir was continued at the same dose as before.Eight days later, the edema of the face and lower extremities were further aggravated with decreased urine volume.Serum creatinine increased to 124 μmol/L, eGFR decreased to 37 ml/(min·1.73 m2), and serum β2 microglobulin was 5.06 mg/L.She received an IV infusions of human albumin.Two weeks later, the serum creatinine increased to 220 μmol/L, eGFR decreased to 19 ml/(min·1.73 m2), and 24-hour urine protein was 0.417 g.Acute kidney injury was diagnosed.Sofosbuvir and daclatasvir were withdrawn.An IV infusion of terlipressin 1 mg twice daily was given.After 3 days of discontinuation of sofosbuvir and daclatasvir, the edema of face was basically subsided, edema of lower extremities significantly subsided, serum creatinine decreased to 97 μmol/L, eGFR increased to 50 ml/(min·1.73 m2), and 24-hour urine protein was 0.398 g.After 8 weeks, the edema of lower extremities disappeared completely, serum creatinine was 64 μmol/L and eGFR was 85 ml/(min·1.73 m2).

A 62-year-old female with hepatitis C and decompensated cirrhosis received oral sofosbuvir 400 mg and daclatasvir 60 mg once daily.She developed edema of lower extremities about 18 weeks after beginning antiviral drugs.Two weeks later, the patient developed edema of face.Laboratory tests revealed the following results: serum creatinine 91 μmol/L, eGFR 54 ml/(min·1.73 m2), serum β2 microglobulin 4.42 mg/L, 24-hour urine protein 0.394 g.She received treatments including diuretic and liver protection.Sofosbuvir and daclatasvir was continued at the same dose as before.Eight days later, the edema of the face and lower extremities were further aggravated with decreased urine volume.Serum creatinine increased to 124 μmol/L, eGFR decreased to 37 ml/(min·1.73 m2), and serum β2 microglobulin was 5.06 mg/L.She received an IV infusions of human albumin.Two weeks later, the serum creatinine increased to 220 μmol/L, eGFR decreased to 19 ml/(min·1.73 m2), and 24-hour urine protein was 0.417 g.Acute kidney injury was diagnosed.Sofosbuvir and daclatasvir were withdrawn.An IV infusion of terlipressin 1 mg twice daily was given.After 3 days of discontinuation of sofosbuvir and daclatasvir, the edema of face was basically subsided, edema of lower extremities significantly subsided, serum creatinine decreased to 97 μmol/L, eGFR increased to 50 ml/(min·1.73 m2), and 24-hour urine protein was 0.398 g.After 8 weeks, the edema of lower extremities disappeared completely, serum creatinine was 64 μmol/L and eGFR was 85 ml/(min·1.73 m2).

Objective To investigate the strain distribution of ascitic pathogens in patients with spontaneous bacterial peritonitis (SBP) and the changes of sensitiveness to antibacterials from 2009 to 2016.Methods The medical records of SBP patients who were hospitalized in Beijing Youan Hospital from 2009 to 2016 were collected.The results of ascites bacterial culture of SBP patients were all positive.The results of ascites culture, pathogen identification, and the drug sensitivity test were recorded.The changes of distribution of ascitic pathogens and the sensitiveness to antibacterials were analyzed according to the time interval of every two years.Results A total of 1 107 SBP patients were enrolled in the study.Of them, 816 patients were male with average age (54±10) years, 291 patients were female with average age (57±13) years.There were 1 042(94.1%) patients with positive bacterial culture of ascites and 65 patients (5.9%) with positive fungal culture of ascites among the 1 107 patients, respectively.There were 920(83.11%) patients with end-stage liver disease, 113 (10.2%) with biliary tract disease, and 74(6.68%) with other diseases in the 1 107 patients.A total of 1 441 strains of pathogenic bacteria were identified, comprised of gram negative (G-) bacteria 637 (44.2%) strains, gram positive (G+) bacteria 739(51.3%) strains, and fungi 65(4.5%) strains.During 2009 to 2016, the top four number of strains of G-bacteria in SBP patients'ascites from high to low were Escherichia coli [213(14.8%)], Klebsiella pneumoniae [146 (10.1%)], Pseudomonas aeruginosa[52(3.6%)] and Enterobacter cloacae[38(2.6%)];the top four strains of G(+) bacteria were Enterococcus faecium[176(12.2%)], Staphylococcus epidermidis[132(9.1%)], Staphylococcus haemolyticus [130(9.0%)] and Enterococcus faecalis [75(5.2%)];and the top 2 of fungi in SBP patients' ascites were Candida albicans[36(2.5%)] and Candida glabrata[12(0.8%)].Compared with the time interval of 2009-2010, the constituent ratio of G(-) bacteria in 2015-2016 was decreased significantly [49.3%(73/148)vs.39.4% (196/498), P=0.031] , the constituent rate of fungi was increased significantly [6.4%(32/498) vs.2.0% 3/148), P=0.038].There were no statistical significance in G(+) bacteria's constituent ratio among different time intervals.The constituent rate of extended spectrum beta-lactamases (ESBL) in Escherichia coli was higher in the time interval of 2015-2016 than that in the time interval of 2009-2010 [57.4% (35/61) vs.32% (8/25), P=0.033].The drug resistance of Escherichia coli to imipenem and meropenem were increased significantly during the same period (P=0.026, P=0.025).The results of drug sensitivity tests showed that G(-) bacteria was sensitive to imipenem, meropenem, amikacin and piperacillin/tazobactam;G(+) bacteria was sensitive to linezolid, teicoplanin and vancomycin.Conclusions The distribution of ascitic pathogens in SBP patients who were hospitalized in Beijing Youan Hospital from 2009 to 2016 present the tendency of decreasing of G(-) bacteria and increasing of fungi.The main pathogenic bacteria of SBP are drug-resistant.The resistance rates of Escherichia coli to imipenem, meropenem and cefotaxime have increased year by year.

Objective To compare the clinical characteristics between the children and adults patients with drug-induced liver injury( DILI). Methods "Drug-induced liver injury" was selected as the key word and all the medical records in Beijing You'an Hospital Medical Records Management Center from February 2002 to June 2011 were collected. The patients who were ≤14 years were enrolled into the child group. The patients who were ≥15 years were enrolled into the adult group. The medical records of patients in the two groups were collected and analyzed retrospectively. The main analysis parameters included use of medication,clinical manifestation,and clinical pathological classification of DILI. Results The main drugs which can cause DILI in child group were antibacterial drugs( 13 cases,42%),traditional Chinese medicines(9 cases,29%),and antipyretic analgesics(6 cases,19%). The main drugs which can cause DILI in the adult group were traditional Chinese medicines( 79 cases,69%),antipyretic analgesics(12 cases,11%),and antibacterial drugs(8 cases,7%). Twenty-six patients(84%)in the child group and 114 patients(100%)in the adult group developed weak,loss of appetite,aversion to fats, nausea,vomiting and yellow urine 3 to 90 days[mean(18 ± 15)days]and 5 to 90 days[mean(30 ± 20) days] after drug admission, respectively. Part of patients developed fever, erythema and increased eosinophils. There were no significant differences in the levels of serum alanine transaminase( ALT ), aspartate aminotransferase( AST),and glutamyltranspetidase between the two groups. But the level of serum alkaline phosphatase(ALP)in the child group was higher than that in the adult group(P<0. 05). The number of mixed DILI,hepatocellular DILI and cholestasis DILI were 15(48. 4%),8(25%)and 8 (25%)cases in 31 patients in the child group,respectively. The number of hepatocellular DILI,mixed DILI,and cholestasis DILI were 69(60. 5%),26(22. 8%)and 19(16. 7%)cases in 114 patients in the adult group,respectively. The proportion of mixed DILI in child group was significantly higher than that in the adult group(P<0. 01). The proportion of hepatocellular DILI in the child group was significantly lower than that in the adult group(P<0. 01). The drugs were withdrawn immediately after the symptoms of DILI appeared in the patient in the two groups. All the patients in the adult group and 27 children in the child group were improved and discharged. There were 2 cases with depravation of primary diseases,1 case discharged himself and 1 case died due to hepatic failure in the child group Conclusions The main drugs causing DILI are different in children and adult;in children,antibacterial drugs ,while in adults traditional Chinese medicine mainly. The mainly liver injury type in children is mixed DILI. The mainly liver injury type in adults is hepatocellular DILI. It should be vigilant towards DILI when the child or adult treated with antibiotics or traditional Chinese medicine.

Objective To compare the clinical characteristics between the children and adults patients with drug-induced liver injury( DILI). Methods "Drug-induced liver injury" was selected as the key word and all the medical records in Beijing You'an Hospital Medical Records Management Center from February 2002 to June 2011 were collected. The patients who were ≤14 years were enrolled into the child group. The patients who were ≥15 years were enrolled into the adult group. The medical records of patients in the two groups were collected and analyzed retrospectively. The main analysis parameters included use of medication,clinical manifestation,and clinical pathological classification of DILI. Results The main drugs which can cause DILI in child group were antibacterial drugs( 13 cases,42%),traditional Chinese medicines(9 cases,29%),and antipyretic analgesics(6 cases,19%). The main drugs which can cause DILI in the adult group were traditional Chinese medicines( 79 cases,69%),antipyretic analgesics(12 cases,11%),and antibacterial drugs(8 cases,7%). Twenty-six patients(84%)in the child group and 114 patients(100%)in the adult group developed weak,loss of appetite,aversion to fats, nausea,vomiting and yellow urine 3 to 90 days[mean(18 ± 15)days]and 5 to 90 days[mean(30 ± 20) days] after drug admission, respectively. Part of patients developed fever, erythema and increased eosinophils. There were no significant differences in the levels of serum alanine transaminase( ALT ), aspartate aminotransferase( AST),and glutamyltranspetidase between the two groups. But the level of serum alkaline phosphatase(ALP)in the child group was higher than that in the adult group(P<0. 05). The number of mixed DILI,hepatocellular DILI and cholestasis DILI were 15(48. 4%),8(25%)and 8 (25%)cases in 31 patients in the child group,respectively. The number of hepatocellular DILI,mixed DILI,and cholestasis DILI were 69(60. 5%),26(22. 8%)and 19(16. 7%)cases in 114 patients in the adult group,respectively. The proportion of mixed DILI in child group was significantly higher than that in the adult group(P<0. 01). The proportion of hepatocellular DILI in the child group was significantly lower than that in the adult group(P<0. 01). The drugs were withdrawn immediately after the symptoms of DILI appeared in the patient in the two groups. All the patients in the adult group and 27 children in the child group were improved and discharged. There were 2 cases with depravation of primary diseases,1 case discharged himself and 1 case died due to hepatic failure in the child group Conclusions The main drugs causing DILI are different in children and adult;in children,antibacterial drugs ,while in adults traditional Chinese medicine mainly. The mainly liver injury type in children is mixed DILI. The mainly liver injury type in adults is hepatocellular DILI. It should be vigilant towards DILI when the child or adult treated with antibiotics or traditional Chinese medicine.

Objective To study the effects of rehabilitation interventions on the earthquake injured to reduce the incidences of disability,to improve the recovery of overall function of the wounded in the earthquake and to guarantee their return to family and society.Methods The rehabilitation team·work provided one-month comprehensive intervention on 92 fracture patients after earthquake and assessed with scale of participate and activities ability,before,after and in the middle of intervention.Results The ability of understanding and communication,moving body,taking care of oneself,getting along with others,undertaking daily activities.social participating and the scores from the scale of participate and activities ability improved significantly(P<0.05).Conclusion Rehabilitation interventions with team-work can effectively enhance the abilities of the earthquake injured to participate in activities and improve quality of life.