Objective:To explore the distribution of integrons in Escherichia coli isolated from community patients with urinary tract infections and their relationship with the phylogenetic groups and antimicrobial resistance. Methods:From November 2015 to December 2018, 152 isolates of E. coli that collected without repetition from the urine samples of outpatients in nephrology of Fengxian District Central Hospital in Shanghai, were studied retrospectively. Bacterial identification and antimicrobial susceptibility analysis was carried out by Phoenix 100 automatic microbiological analyzer. Class 1, 2 integron integrase genes, variable regions of integrons and the phylogenetic groups of isolated E.coli were screened by PCR. The type of promoters and gene cassette arrays of variable regions were determined by sequencing. The relationship of intergon with the phylogenetic groups and antimicrobial resistance was also analyzed. Results:The resistance rate of 152 E. coli to ampicillin was 70.39% (107/152), and the resistance rates to other antibacterial drugs were all less than 40.00%. Among the 152 E. coli isolates, class 1 integron integrase gene intI1 was detected in 65 isolates (42.76%), 8 gene cassette arrays and 14 antimicrobial resistance gene cassettes were detected in 68 class 1 integrons. The most popular gene cassette array was dfrA17-aadA5 (51.47%, 35/68), while the variable regions of class 1 integrons were failed to detected in 12 intI1-positive isolates. Five variable region promoters were detected in 68 class 1 integrons, with the relative weak promoter PcH1 to be the most popular type (77.94%, 53/68). The gene cassette array arr- 2-cmlA5-bla OXA-10-aadA1 was also detected in this study. 65 intI1-positive isolates were mainly belonged to group B2 and D. The class 2 integron integrase gene intI2 was detected in 4 isolates (2.63%,4/152), and their variable region gene cassette arrays were all dfrA1-sat2-aadA1. Conclusions:Class 1 integrons were closely related to antimicrobial resistance in E. coli isolated from community patients with urinary tract infection. Most of the variable region promoters of class 1 integrons were relatively weak promoters. The distribution of each phylogenetic group in the intI1-positive isolates was consistent with the distribution of the overall isolates. The gene cassette array arr-2-cmlA5-bla OXA-10-aadA1 was detected in E. coli.

Objective To investigate the clinical value of large platelets (P-LCR) and mean platelet volume (MPV) in acute cerebral infarction patients with type 2 diabetes. Methods 627 patients with acute cerebral infarction from January 2012 to May 2015 were enrolled and divided into type 2 diabetes and non-type 2 diabetes groups. The hemocytometer was used to detect the changes of P-LCR and MPV. Results The levels of P-LCR and MPV in the type 2 diabetes group were significantly higher than those of non-type 2 group (P <0.05). Logistic regression analysis showed that there was a statistically significant association between P-LCR, hypertension and hyperlipemia and the cute cerebral infarction patients with type 2 diabetes. Conclusion The levels of P-LCR and MPV could be used as important indexes for prognosis and early diagnosis of acute cerebral infarction patients with type 2 diabetes.

Objective To explore the effect of PGE1 on the cognitive impairment and the expression of VEGF and BDNF in the hippocampus after bilateral common carotid artery occlusion in adult rats. Methods Forty-eight rats were randomly divided into PGE1 group (10μg·kg-1·d-1, iv), PGE1+VEGFR antagonist group (PGE1, 10μg·kg-1·d-1, iv;SU5416, 25 mg·kg-1·d-1, ip), saline group and sham group (n=12 each). Morris Water Maze test (MWM) was used to examine cognitive function in rats. Drugs and saline were given to VD rats at 24 d for 7 consecutive days following opera?tion. Half of the rats in each group were sacrificed for Western Blot at 6 days after MWM test. Western Blot was conduct?ed to examine the relative expression levels of VEGF and BDNF in the hippocampus. Results Compared to saline and PGE1+VEGFR antagonist groups, the escape latency in PGE1 group was shorter (P<0.05), and the times that rats swam across the platform location and time percentage in previous platform quadrant in PGE1 group was longer (5.77±0.83 vs.2.88 ± 0.47 vs. 2.63 ± 0.44, P<0.01;32.28%± 4.56%vs. 20.42%± 5.50%, 23.08%± 5.06%, P<0.05). Compared with saline group and sham group, PGE1 group had higher levels of VEGF (0.057±0.005 vs. 0.038±0.002 vs. 0.027±0.002, P<0.05) and BDNF (0.481±0.049 vs. 0.339±0.021 vs. 0.224±0.04, P<0.05). but the increase in VEGF expression in PGE1 group was no significant (0.057±0.005 vs. 0.053±0.003, P>0.05) compared with PGE1+VEGFR antagonist group, while the aug?ment of BDNF in PGE1 group was remarkable (0.481±0.049 vs. 0.373±0.034, P<0.05). Conclusions PGE1 can upregu?late VEGF and BDNF expression and modify cognitive impairment in VD rats, while the effects of PGE1 on cognitive function and BDNF expression can be partially blocked by VEGFR antagonist SU5416.

Objective To investigate the risk factors,severity and infarct site features and clinical characteristics of the elderly patients over 80 years with cute cerebral infarction.Methods One hundred and sixty-two patients with acute cerebral infarction in Red Cross Hospital of Guangzhou,The Forth Affiliated Hospital of Medical College of Jinan University from January 2012 to May 2015 were enrolled and randomly divided into the elderly patients (≥ 80 years old) and the middle aged patients (＜ 60 years old).The risk factors,national institutes of health stroke scale (NIHSS) scores and Oxfordshire community stroke project (OCSP) criteria were compared between the two groups.Results Coronary artery disease,atrial fibrillation and NIHSS in the elderly patients (25％ (22/88),13.6％ (12/88),7.74 ± 4.986) were significantly higher than those of the middle aged group (12.2％ (9/47),4.1％ (3/74),5.04± 4.305),and the differences were significant (x2 =4.281,4.393,t =-3.649;P＜ 0.05 or P＜ 0.001).The logistic regression analysis finally showed that smoking,hyperlipemia,NIHSS scores and gender(male) were the independent risk factors(OR=3.851,3.609,1.100 and 2.670;P＜0.05).There were more LACI patients in the elderly group than he middle aged group ((40.9％,36/88) vs.(60.8％,45/74),x2 =6.369,P ＜ 0.05).Conclusion Compare to the middle aged patients,occurrence of the elderly patients with acute cerebral infarction is more severe,and the clinical features and risk factors have its particularity.Secondary prevention strategy should be emphasized on the control of different risk factors based on the patients' age.

OBJECTIVE To synthesize[3H]labelled trantinterol and determine the mass balance in rats and the profile of trantinterol and its metabolites in excreta. METHODS [3H]Trantinterol was synthesised from the intermediate1-(4-amino-3-chloro-5-trifluoromethyl-phenyl)-2-bromo-ethanone through reduction by sodium borotritide and aminolysis by t-butylamine. Following an oral dose of[3H] trantinterol(45.5 MBq·kg-1)to bile duct cannulated(BDC)rats and normal rats. Bile,urine and faeces were collected individually before and after dosing at different times. Liquid scintillation counter(LSC) was used to detect total radioactivity recovery and HPLC/radio-detector for metabolite profiling in urine and bile. RESULTS The majority(73.6%)of the administered radioactivity was recovered in the first 24 h postdose with 48.3%in urine and 25.4%in faeces. It was cumulated to(84.7±6.8)%till 168 h. In BDC rats,29.3%of the dose was recovered in the bile 3 d post-dose. According to the peak area ratio determined by HPLC/radio-detector,only 4.7%and 9.5%of the radioactive dose were excreted as the parent drug in urine and bile,respectively,while the majority of the remaining radioactivity was excreted in the form of various metabolites. CONCLUSION Following oral administration in rats,trantinterol is completely absorbed,extensively metabolized and rapidly excreted mainly in urine as various metabolites.

Objective To investigate the effect of exogenous stromal cell-derived factor-1 α (SDF-1 α) on angiogenesis peri-infarct region in cerebral cortex in adult rats and its possible mechanisms.Methods Twenty-four adult male Sprague-Dawley rats were randomly divided into four groups:sham operation,solvent control,SDF-1α treatment,and SDF-1α + CXCR4 antagonist (n =6 in each group).A model of focal infarct in the cerebral cortex was induced by permanent ligation of the cortical branch of the right middle cerebral artery with temporary clip occlusion of both common carotid arteries.At 1 h after cortical branch occlusion of the right middle cerebral artery,SDF-1 α (1 μg/d) or equal volume of normal saline were injected via the lateral ventricle in the SDF-1α treatment group and solvent control group,and continued for 6 days.CXCR4 antagonist AMD3100 (1 mg/d) was injected subcutaneously before injecting SDF-1 α in the SDF-1 α + CXCR4 antagonists group,and continued for 6 days.Before all the rats were sacrificed,5-bromo-2-deoxyuridine (BrdU) was injected intraperitoneally and their newly proliferated cells were labeled.At day 7 after modeling,the rats were sacrificed after neurological scores.Immunofluorescence staining was used to detect the vascular density,the numbers of neovasculature endothelial cells and the CXCR4 + cells in the peri-infarct regions or sham operation regions.Results At 7 d after modeling,the neurological function of the SDF-1α treatment group was improved significantly compared with those of the solvent control group and the SDF-1α + CXCR4 antagonist group (all P＜ 0.01).The vascular densities in the peri-infarct or sham operation regions in the groups of sham operation,solvent control,SDF-1α treatment,and SDF-1α+ CXCR4 antagonist were 2.1±0.3％,7.0±0.3％,10.0 ±0.9％ and 7.1 ±0.3％,respectively (F=232.469,P＜0.001),and that in the sham operation was significantly lower than that in the SDF-1α group (P ＜0.001),SDF-1 α group significantly higher than both groups of solvent control (P =0.002) and SDF-1oα + CXCR4 antagonist (P =0.001).The numbers of BrdU+/laminin+ cells in the peri-infarct regions in the groups of sham operation,solvent control,SDF-1α treatment,and SDF-1α + CXCR4 antagonist were 21.7 ± 3.1,79.7 ± 6.0,176.0 ± 12.5 and 90.3 ± 6.9,respectively (F=391.550,P＜0.001),and that in the sham operation was significantly less than that in the SDF-1 α group (P ＜ 0.001),SDF-1 α group was significantly more than both groups of solvent control and SDF-1 oα + CXCR4 antagonist (all P ＜0.001).The numbers of CXCR4 + cells in the peri-infarct regions in the groups of solvent control,SDF-1α treatment,and SDF-1α+ CXCR4 antagonist were 59.3± 4.5,120.3 ± 13.9 and 62.9 ± 5.9,respectively (F =85.052,P ＜ 0.001),and that in SDF-1α group was significantly more than those in the both groups of solvent control and SDF-1 α + CXCR4 antagonist (all P ＜ 0.001).Conclusions SDF-1α treatment may improve the neurological function after focal infarction in the cerebral cortex in adult rats and promote angiogenesis in peri-infarct region.The SDF-1/CXCR4 signal pathway may play an important regulatory role in the process of angiogenesis after cerebral infarction.

Objective To investigate the spontaneons recovery of calculation and number processing in patients with stroke.Methods Assessment of calculation and number processing were performed in 30 stroke patients with stable conditions (21 cerebral infarction and 9 cerebral hemorrhage) within 3 weeks after stroke,and they were followed up for one year.Calculation and number processing was assessed using the Revised EC301 Calculation and Number Processing Battery in Chinese version at 3,6,and 12 months after stroke onset.Results The scores in the areas of numerical sequences,numerical understanding,numerical transcoding,numerical calculation,numerical knowledge and the total scores increased significantly with the passage of time (all P ＜0.001).There were significant differences between each area and total scores at 3,6,and 12 months after stroke and those at 3 weeks (all P ＜0.01),however,there were no significant differences among the three time points.The total scores and the scores in each area increased significantly with the passage of time in the cerebral infarction group and the hemorrhage group (all P ＜0.001),however,there were no significant differences in each area at the same time point between the two groups.There was significant difference in the recovery of the total scores between the cerebral hemorrhage group and the cerebral infarction group (P =0.008).Pearson correlation analysis showed that the recovery of the calculation and number processing in all patients (R =0.452,P =0.012) as well as in the cerebral infarction group (R =0.683,P=0.001) and the cerebral hemorrhage group (R =0.250,P =0.049) within one year showed a significant positive correlation with the total score of the first assessment.Conclusions The impaired calculation and number processing may partly spontaneously recover after stoke,and it shows significant improvement within 3 months after onset.The recovery in patients with cerebral hemorrhage may be better than that in those with cerebral infarction.The more serious the impairment in initial calculation and number processing,the worse the spontaneous recovery will be.

Objective To explore the effect of different types of statins combined with donepezil in the treatment of Alzheimer disease(AD).Methods According to the digital table,90 patients with AD were randomly divided into the statins A group(atrovstatin combined with donepezil) 31 cases,statins B group(simvastatin combined with donepezil)27 cases,and donepezil group(only with donepezil) 32 cases.All patients were treated for one year.The blood lipid level (including cholesterol (CH) and low density lipoprotein cholesterol (LDL-C),mini-mental state examination(MMSE),activity of daily living(ADL) and global deterioration scale (GDS) were detected and compared respectively among groups before and after treatment.Results The MMSE,ADL and GDS scores of the donepezil group were (17.00 ± 2.99) points,(60.44 ± 14.57) points,(4.28 ± 1.22) points,respectively,which were worse than those of the statins A group [(19.90 ± 3.07) points,(71.61 ± 18.50) points,(3.39 ± 1.15) points] (t =0.218,P ＜ 0.05,t =2.669,P ＜ 0.01,t =2.562,P ＜ 0.01) and statins B group [(19.88 ± 6.66) points,(71.89 ± 19.61) points,(3.37 ±l.39)points](t=l.959,P ＜0.05,t=2.991,P ＜0.0l,t=2,265,P ＜0.01).Conclusion The combination of donepezil and statins can effectively improve cognitive function and daily living ability in patients with AD,and its effect is superior to single use of donepezil.

Objective To summarize the experience of diagnosis and treatment strategy of pancreatic injury.Methods The data of 36 cases of pancreatic injurics admitted to Fujian Medical University Provincial Clinical College from 1990 to 2011 were analyzed retrospectively.Results 14 cases(39％)were diagnosed preoperatively,and the other cases were diagnosed during the laparotomy.2 cases underwent non-surgical treatment.34 cases underwent surgical treatment,among whom 23 cases underwent pancreatic debridement and drainage,6 cases underwent distal pancreatectomy(4 cases undergoing distal pancreatectomy plus splenectomy included),4 cases underwent distal Roux-Y pancreajejunostomy plus proximal pancreas closure,and 1 case underwent pancreatoduodenectomy.31 cases (86％) were cured,and 5 cases died (14％).Conclusions Most of the pancreatic injury is diagnosed through laparotomy.Surgical opcration is the main approach to treat pancreatic injury.Nonsurgical treatment is primarily limited to grade Ⅰ and Ⅱ pancreatic injury without obvious peritonitis,major pancreatic duct injury,and associated injuries.Surgical procedure should be selected based on the grading scale of pancreatic injury,associated injuries and overall conditions of the patient.

Moyamoya disease is a chronic progressive cerebrovascular disease. Its disability rate and lethality rate are higher. The direct and indirect revascularization can increase cerebral blood flow and reduce the occurrence of cerebral ischemia and cerebral hemorrhage. This article reviews the pathophysiological basis of its surgical treatment, surgical timing, indications, surgical treatment methods and efficacy.