OBJECTIVE To observe and compare the synergistic rates of combined use of polymyxin B with 12 types of traditional antibiotics against carbapenem-resistant Klebsiella pneumoniae(CRKP)in vitro antimicrobial ac-tion.METHODS Totally 30 strains of CRKP were randomly drawn from 312 strains of CRKP that were isolated from the clinical departments of Shiyan People's Hospital between 2020 to 2023.The carbapenemases were detec-ted by Carba NP test.The six genotypes KPC,OXA-48,OXA-23,NDM,VIM and IMP were detected by means of fluorescent quantitative polymerase chain reaction(PCR),the drug resistance of the strains was detected by mi-cro broth dilution method,and the synergistic effect of polymyxin B combined with 12 types of traditional antibi-otics on in vitro antimicrobial action was detected by using micro chessboard dilution method.RESULTS All of the isolated CRKP strains produced carbapenemases,with the KPC genotype dominant.The drug resistance rates to cephalosporins,carbapenems and quinolones reached up to 100.00％,and no polymyxin B-resistant strains were detected.The synergistic rates of minocycline and rifampicin combined with polymyxin B to the in vitro antimicro-bial action were the highest,which were 73.33％and 50.00％,respectively;the synergistic rates of levofloxacin and ciprofloxacin combined with polymyxin B were the lowest,and both were 0.The synergistic rates of meropen-em and imipenem combined with polymyxin B to the in in vitro antimicrobial action were 36.67％and 30.00％,re-spectively.The synergistic rates of ceftazidime,cefepime,piperacillin-tazobactam and cefoperazone-sulbactam combined with polymyxin B to the in vitro antimicrobial action were less than 30.00％.CONCLUSIONS Polymyxin B combined with minocycline and rifampicin should be taken as the first choice for treatment of the CRKP-induced infection.The synergistic rate of the carbapenems combined with polymyxin B is higher than that of the cephalo-sporins combined with polymyxin B to the antimicrobial action.Levofloxacin and ciprofloxacin combined with pol-ymyxin B do not have synergistic effect on the in vitro antimicrobial action.

OBJECTIVE To observe and compare the synergistic rates of combined use of polymyxin B with 12 types of traditional antibiotics against carbapenem-resistant Klebsiella pneumoniae(CRKP)in vitro antimicrobial ac-tion.METHODS Totally 30 strains of CRKP were randomly drawn from 312 strains of CRKP that were isolated from the clinical departments of Shiyan People's Hospital between 2020 to 2023.The carbapenemases were detec-ted by Carba NP test.The six genotypes KPC,OXA-48,OXA-23,NDM,VIM and IMP were detected by means of fluorescent quantitative polymerase chain reaction(PCR),the drug resistance of the strains was detected by mi-cro broth dilution method,and the synergistic effect of polymyxin B combined with 12 types of traditional antibi-otics on in vitro antimicrobial action was detected by using micro chessboard dilution method.RESULTS All of the isolated CRKP strains produced carbapenemases,with the KPC genotype dominant.The drug resistance rates to cephalosporins,carbapenems and quinolones reached up to 100.00％,and no polymyxin B-resistant strains were detected.The synergistic rates of minocycline and rifampicin combined with polymyxin B to the in vitro antimicro-bial action were the highest,which were 73.33％and 50.00％,respectively;the synergistic rates of levofloxacin and ciprofloxacin combined with polymyxin B were the lowest,and both were 0.The synergistic rates of meropen-em and imipenem combined with polymyxin B to the in in vitro antimicrobial action were 36.67％and 30.00％,re-spectively.The synergistic rates of ceftazidime,cefepime,piperacillin-tazobactam and cefoperazone-sulbactam combined with polymyxin B to the in vitro antimicrobial action were less than 30.00％.CONCLUSIONS Polymyxin B combined with minocycline and rifampicin should be taken as the first choice for treatment of the CRKP-induced infection.The synergistic rate of the carbapenems combined with polymyxin B is higher than that of the cephalo-sporins combined with polymyxin B to the antimicrobial action.Levofloxacin and ciprofloxacin combined with pol-ymyxin B do not have synergistic effect on the in vitro antimicrobial action.

Objective To study microbial characteristics of pulmonary in children with community-acquired pneumonia(CAP)of different severity,in order to provide a basis for accurate diagnosis and antibiotic treatment of pneumonia children,and provide new strategies and perspectives for the diagnosis and treatment of pulmonary microbiota in pneumonia children.Methods Bronchoalveolar lavage fluid(BALF)from 64 children with CAP of different severity hospitalized in Department of Pediatrics,Jingmen People's Hospital were collected from January to December 2023,the children were divided into severe pneumonia group(n=34)and common pneumonia group(n=30).Microbiome information of the lungs of children with CAP of different severity were obtained through metagenomic sequencing of BALF,microbial structure diversity analysis,species classification analysis,and differential analysis on the microbial bioinformatics data of two groups of samples obtained were performed.Results Alpha diversity analysis showed that there were statistically significant differences(P<0.05)in the Chao1 index,ACE index,Shannon index,and Simpson index between two groups.The principal coordinate analysis(PCoA)of Beta diversity showed a statistically significant difference in the composition of microbial communities between two groups(F=4.221,P=0.005).Through species classification analysis,it was found that at the genus level,mycoplasma was the main genus in the BALF samples of severe pneumonia group,followed by Streptococcus and Haemophilus,Streptococcus was the main genus in the BALF samples of common pneumonia group,followed by Mycoplasma and Haemophilus.Children of two groups showed statistically significant differences in microbial abundance among the top 20 species at the genus level(P<0.05),including Mycoplasma,Streptococcus,Rhodococcus,Neisseria,Prevotella,Corynebacterium,and Pseudomonas.Species diversity analysis showed that at the genus level,there were 47 species with differences(P<0.05).Conclusion There are differences in the abundance,diversity,structure,and composition of pulmonary microbiota in children with CAP of different severity.The dominant microbiota varies among children with CAP of different severity.This study enriches the pulmonary microbiome data of children with CAP.

Objective To study microbial characteristics of pulmonary in children with community-acquired pneumonia(CAP)of different severity,in order to provide a basis for accurate diagnosis and antibiotic treatment of pneumonia children,and provide new strategies and perspectives for the diagnosis and treatment of pulmonary microbiota in pneumonia children.Methods Bronchoalveolar lavage fluid(BALF)from 64 children with CAP of different severity hospitalized in Department of Pediatrics,Jingmen People's Hospital were collected from January to December 2023,the children were divided into severe pneumonia group(n=34)and common pneumonia group(n=30).Microbiome information of the lungs of children with CAP of different severity were obtained through metagenomic sequencing of BALF,microbial structure diversity analysis,species classification analysis,and differential analysis on the microbial bioinformatics data of two groups of samples obtained were performed.Results Alpha diversity analysis showed that there were statistically significant differences(P<0.05)in the Chao1 index,ACE index,Shannon index,and Simpson index between two groups.The principal coordinate analysis(PCoA)of Beta diversity showed a statistically significant difference in the composition of microbial communities between two groups(F=4.221,P=0.005).Through species classification analysis,it was found that at the genus level,mycoplasma was the main genus in the BALF samples of severe pneumonia group,followed by Streptococcus and Haemophilus,Streptococcus was the main genus in the BALF samples of common pneumonia group,followed by Mycoplasma and Haemophilus.Children of two groups showed statistically significant differences in microbial abundance among the top 20 species at the genus level(P<0.05),including Mycoplasma,Streptococcus,Rhodococcus,Neisseria,Prevotella,Corynebacterium,and Pseudomonas.Species diversity analysis showed that at the genus level,there were 47 species with differences(P<0.05).Conclusion There are differences in the abundance,diversity,structure,and composition of pulmonary microbiota in children with CAP of different severity.The dominant microbiota varies among children with CAP of different severity.This study enriches the pulmonary microbiome data of children with CAP.

Objective:To introduce a reliable and easy method of philtrum crest and philtrum repairing in secondary repair of cleft lip.Methods:Lift the upper lip flap after removing the scar on upper lip. Then the superficial orbicularis oris muscle was carefully separated, which formed the abnormal muscular eminence in the affected side after the first cleft lip repair. The pedicle of the orbicularis oris muscle the reconstructing philtrum crest. The lingual orbicularis oris muscle flap was lifted and curled from outside. The superficialorbicularis oris muscle was cut in philtrum longitudinally and turned outward. The two evertedorbicularisoris muscle flaps were sutured on both sides and fixed them on the reconstructing philtrum crest. The exposed deep orbicularis oris muscle in philtrum was sutured with the upper dermis, which formed the prominentphiltrum crest and deeper philtrum.Results:We reviewed the hospital records of patients from July 2008 to November 2021. In total, 201 patients were included in this study. All of these patients underwent the reconstruction of philtrum crest and philtrum with orbicularis oris muscle intertangling and philtrum plasty in secondary cleft lip repairing. During the treatment, the patients had no complications such as infection, hematoma and flap necrosis.198 patients were observed from 1 months to 36 months (7.8 months on average). All of them improved in different degrees in early postoperative period. Most reconstructed philtrum crest was raised and basically symmetrical with the contralateral side in shape. The philtrum was clear and the scar was not obvious. The reconstructed philtrum crest would decrease with time. 91.7% (90/98) patients were satisfied with the postoperative effects after three months.Conclusions:The method of reconstruction of philtrum crest and philtrum with orbicularis oris muscle intertangling and philtrum plasty in secondary cleft lip repairing is safe and effective. The long term postoperative effect is stable with high satisfaction as well. As a result, this method can be used as the philtrum crest and philtrum correction scheme for secondary cleft lip repairing.

The aim of this study was to develop a formulation to improve the oral absorption of baicalin (BA) by combining a phospholipid complex (PC) and self-emulsifying microemulsion drug delivery system (SMEDDS), termed BA-PC-SMEDDS. BA-PC was prepared by a solvent evaporation method and evaluated by complexation percentage (CP). The physicochemical properties of BA-PC were determined. The synergistic effect of PC and SMEDDS on permeation of BA was studied in vitro with Caco-2 cells and in situ with a single pass intestinal perfusion model. The improved bioavailability of BA in BA-PC-SMEDDS was confirmed in an in vivo rat model. The CP of BA-PC reached 100% when the molar ratio of drug to phospholipid (PP) was ≥1:1. The solubility of BA-PC increased in both water and octanol, and the log P o/w of BA-PC was increased significantly. BA-PC-SMEDDS could be dispersed more evenly in water, compared to BA and BA-PC. Both the Caco-2 cell uptake and single-pass intestinal perfusion models illustrated that transport of BA in BA-PC was lower than that of free BA, while improved significantly in BA-PC-SMEDDS. The relative bioavailability of BA-PC(1:2)-SMEDDS was 220.37%. The combination system of PC and SMEDDS had a synergistic effect on improving the oral absorption of BA.

Objective To explore the chiaical value of cerebral perfusion reduction after subarachnoid hemorrhage(SAH)by multi spiral CT perfusion in rabbits.Methods 32 male Japanese big-ear rabbits of clean level were randomly divided into 2 groups:Group A(n =8),the normal group,were to obtain normal MS-CTP values of rabbit cerebrums;Group B(n =24),the SAH group was made into two-hemorrhage animal models,checked on seven day by multi spiral CT perfusion.The source data was transmitted to the post-processing workstation ADW 4.2.Perfusion parameters maps(CBF)of both sides of frontal,parietal and basal ganglia were got by computing.Each rabbit was killed immediately after scanning,and the spider blood was observed.Results The average CBF value of the two groups:The difference was not statistically significant at the frontal(t =1.740,P =0.092)and parietal(t =1.868,P =0.072); The average values of CBF were significantly decreased at the basal ganglia(t =2.481,P =0.019).Group B showed the distribution of blood clot in the basal cistern,but there was no blood clot at the frontal and parietal.Conclusion The monitor perfusion changes of rabbit brain after SAH could be detected by MS-CTP,and the lower of regional cerebral perfusion had a relationship with the distribution with the blood clot,and it could instruct the early diagnosis of cerebral perfusion,and the clinical benefit to early intervention treatment.

Objective To investigate the value of permeability surface (PS) in predicting hemorrhagic transformation (HT) in acute ischernic stroke (AIS) using CT peffusion (CTP).Methods The study included 31 consecutive patients who presented symptoms suggestive of an AIS for 3-9 h. All patients underwent CT examination (noncontrast CT,CTP).HT was determined by follow-up CT images.According to presence of HT,the AIS was divided into HT group (PSHT,11 patients) and non-HT group(PSNo-HT,20 patients).PS,cerebral blood flow (CBF),cerebral blood volume (CBV) and mean transit time (MTT) on both sides of brains were measured.The relative PS(rPS),relative CBF (rCBF),relative CBV(rCBV) and relative MTT(rMTT) were obtained by calculating the ratio of the values of bilateral regions.The rPS between PSHT and PSNo-HT was compared with an exact Wilcoxon signed-rank test. The rCBF,rCBV,rMTT and the PS of the ischemic side between PSHr and PSNo-HT were compared with independent-sample t test.Meanwhile,Spearman rank correlation analysis was conducted to analyze the relationship between the CTP parameters and HT.ResultsThe PS value of ischemic side was (1.61±0.77) ml · min - 1 · 100 g-1 for the PSHT group,and the value was (0.91 ± 0.49) ml · min - 1 · 100 g- 1 for the PSNo-HT group.For the PSHT group,rPS,rCBF,rCBV,rMTT were 2.76 ±0.78,0.32 ±0.18,0.66 ±0.31,2.67 ±0.71,and for the PSNo-HT group,rPS,rCBF,rCBV,rMTT were 1.35 ±0.19,0.50±0.21,0.91 ±0.28,2.62 ± 1.31.Compared with PSNo-HT,PSHT had higher rPS and PS value,and there were significant statistical differences (U =0.000,t =3.070,P ＜0.01).But rCBF and rCBV values were lower in the PSHT group compared to the PSNo-HT group,and there were significant statistical differences (trCsF =2.343,trCBV =2.210,P ＜ 0.05).There was no significant statistical difference in rMTT between the two groups(t =0.118,P ＞ 0.05).Significant positive correlations were detected between the rPS and PS with HT(r=0.496,0.821,P ＜0.01).ConclusionsThe value of rPS is helpful in predicting HT in AIS.And it can be used as a predictor in determining clinical personalized treatment and thus reduce the incidence of adverse events.

Objective To evaluate perfusion computed tomography in the assessment of portal vein pressure changes in an experimental dog model of liver cirrhosis and portal hypertension.Methods The canine model of cirrhosis and portal hypertension was induced by portal vein stenosis with combination of systemic thioacetamide(TAA) feeding in drinking water.All of the Beagles in control group and cirrhotic group underwent hepatic perfusion on a spiral CT scanner.The parameters of hepatic perfusion were calculated by the method of deconvolution.The portal vein pressure was measured by a laparotomy surgery.Results ① In control group, the portal vein pressure was ( 14.5 ± 2.2) cm H2O, while it was (23.1 ± 2.8) cm H2O in PHT group, there was significant difference in the portal vein pressure between the two groups (P＜0.05).② The blood flow(BF) was (112 ±14) ml·100 g-1·min-1 in controls, while ( 96 ± 11) ml·100 g-1·min-1 in PHT group; the blood volume ( BV ) in control group and PHT group was (10 ±3) ml·100 g-1 and (11 ± 5) ml· 100 g-1, respectively; the mean transit time( MTT) was (7.1 ± 2.0) s and (10.4 ± 3.5) s, respectively; the hepatic arterial fraction (HAF) was ( 24 ± 5) % and ( 37 ± 6)% , respectively; the hepatic arterial perfusion (HAP) was(27 ±6) ml·100 g-1·min-1 and (35 ±5) ml·100 g-1·min-1, respectively; the portal venous perfusion (PVP) was (85 ± 13) ml·100 g-1·min-1 and (61 ±11) ml·100 g-1·min-1, respectively.There was significant difference in all parameters between the two groups except the parameter BV(P ＜ 0.05).③ In PHT group, the PVP and BF were negatively correlated with the portal vein pressure, while positively correlated with MTT and HAF.Portal vein pressure was negatively correlated with PVP, the equation, Y = 36.624 -0.219X, was deduced with linear regression analysis, by which the portal vein pressure in PHT Beagles was ( 23.2 ± 2.4) cm H2O, which was correlated with the observed by laparotomy value (23.1 ± 2.8) cm H2O (r = 0.843, P ＜ 0.05).Conclusion CT perfusion is a new non-invasive and effective method for assessment of portal vein pressure.

Objective To evaluate 1-week and 1-year outcomes of carotid artery stenting (CAS)using cerebral perfusion CT(PCT). Methods The clinical database of 20 patients with unilateral carotid artery stenosis( ≥60% ) who underwent CAS were retrospectively reviewed. Relative cerebral blood volume (rCBV), relative cerebral blood flow(rCBF) and relative mean transit time( rMTT) were measured by using cerebral PCT within one week before CAS and at one week and at one year after CAS. Cerebral MRI was performed within one week before CAS. The noncontrast CT was performed within one week before CAS and immediately after CAS. The arteriography was performed at one year after CAS. The variance analysis was performed to determine whether there were significant differences of rCBV, rCBF, rMTT in anterior cerebral artery area( ACA area), middle cerebral artery area( MCA area), posterior cerebral artery area( PCA area),basal ganglia area, front and back cortical watershed area( CWS area) and internal watershed area( IWS area) among the different time points. Results In the three measures, there was no significant difference of rCBV in all areas among the three time points( P ＞ 0. 05 ) , and there was no significant difference of rCBF and rMTT in PCA area( P ＞ 0. 05 ), but there were significant differences of rCBF and rMTT in all other areas among the three time ponits(P ＜0. 01). In one week before CAS, at one week and at one year after CAS, rCBF of 20 patients is 0. 86 ±0. 06, 0. 95 ±0. 04, 0. 98 ±0. 07 in ACA area, 0. 81 ±0. 04, 1.06 ±0. 04, 1.03 ±0.07 in MCA area, 0. 84 ±0. 06, 0. 97 ±0. 04, 0. 96 ±0. 04 in basal ganglia, 0. 78 ±0. 03,0. 97 ±0. 03, 0. 96 ±0. 02 in front CWS area, 0. 77 ±0. 03, 1.00 ±0. 02, 0. 98 ±0. 03 in back CWS area,and 0. 80 ± 0. 04, 0. 94 ± 0. 03, 0. 93 ± 0. 04 in IWS area ( F = 18. 95, 146. 41,63.03,540. 85,415.97,164.19, P＜0. 01). rMTT is 1.17 ±0.05, 1.04±0.04, 1.01 ±0.06 in ACA area, 1.41±0.06, 1.08±0.04, 1.07±0.04 in MCA area, 1.20±0.06, 1.06±0.04, 1.05±0.04 in basal ganglia, 1.41 ±0.05,1.10 ±0. 05, 1.09 ±0. 04 in front CWS area, 1.43 ±0. 10, 1.07 ±0. 06, 1.08 ±0. 06 in back CWS area,1.29±0.10, 1.09 ±0.05, 1.11 ±0.07 in IWS area (F=51.74, 248. 89, 70.08, 381.68, 288.94,41.53, P ＜0. 01 ). There were significant differences of rCBF and rMTT between those measured one week before CAS and one week or one year after CAS ( P ＜ 0. 01 ), but there were no significant differences of rCBF or rMTT in any area measured between those at 1 week after CAS and those measured at 1 year after CAS(P＞0.05). Conclusions Hemodynamic outcome at one year after CAS is good in the absence of contralateral carotid artery steno-occlusive disease. In addition, the coherence of results between 1-week and 1-year indicates that the outcome of one week after CAS could predict long-term hemodynamic outcome.