Prevalence of Autism Spectrum Disorder in China: A Nationwide Multi-center Population-based Study Among Children Aged 6 to 12 Years / 神经科学通报·英文版

This study aimed to obtain the first national estimate of the prevalence of autism spectrum disorder (ASD) in Chinese children. We targeted the population of 6 to 12-year-old children for this prevalence study by multistage convenient cluster sampling. The Modified Chinese Autism Spectrum Rating Scale was used for the screening process. Of the target population of 142,086 children, 88.5% (n = 125,806) participated in the study. A total of 363 children were confirmed as having ASD. The observed ASD prevalence rate was 0.29% (95% CI: 0.26%-0.32%) for the overall population. After adjustment for response rates, the estimated number of ASD cases was 867 in the target population sample, thereby achieving an estimated prevalence of 0.70% (95% CI: 0.64%-0.74%). The prevalence was significantly higher in boys than in girls (0.95%; 95% CI: 0.87%-1.02% versus 0.30%; 95% CI: 0.26%-0.34%; P < 0.001). Of the 363 confirmed ASD cases, 43.3% were newly diagnosed, and most of those (90.4%) were attending regular schools, and 68.8% of the children with ASD had at least one neuropsychiatric comorbidity. Our findings provide reliable data on the estimated ASD prevalence and comorbidities in Chinese children.

Prevalence of Autism Spectrum Disorder in China: A Nationwide Multi-center Population-based Study Among Children Aged 6 to 12 Years / 神经科学通报·英文版

This study aimed to obtain the first national estimate of the prevalence of autism spectrum disorder (ASD) in Chinese children. We targeted the population of 6 to 12-year-old children for this prevalence study by multistage convenient cluster sampling. The Modified Chinese Autism Spectrum Rating Scale was used for the screening process. Of the target population of 142,086 children, 88.5% (n = 125,806) participated in the study. A total of 363 children were confirmed as having ASD. The observed ASD prevalence rate was 0.29% (95% CI: 0.26%-0.32%) for the overall population. After adjustment for response rates, the estimated number of ASD cases was 867 in the target population sample, thereby achieving an estimated prevalence of 0.70% (95% CI: 0.64%-0.74%). The prevalence was significantly higher in boys than in girls (0.95%; 95% CI: 0.87%-1.02% versus 0.30%; 95% CI: 0.26%-0.34%; P < 0.001). Of the 363 confirmed ASD cases, 43.3% were newly diagnosed, and most of those (90.4%) were attending regular schools, and 68.8% of the children with ASD had at least one neuropsychiatric comorbidity. Our findings provide reliable data on the estimated ASD prevalence and comorbidities in Chinese children.

Clinical analysis of 103 children with Angelman syndrome / 中华实用儿科临床杂志

Objective To investigate the correlation between clinical phenotype,electroencephalogram(EEG) characteristics and genotype in children with Angelman syndrome(AS). Methods A total of 103 children with AS at Department of Neurology,Children′s Hospital of Fudan University from June 2017 to June 2018,were included in this study. The information of clinical characteristics,EEG manifestations,genotypes as well as the epileptic outcome were collected retrospectively. The correlations between clinical phenotype,genotype,and epileptic outcome were evaluated. Results (1)Of the 103 cases,48 were male(46. 6﹪)and 55 were female(53. 4﹪).(2)Genotypes on AS criti﹣cal region were maternal chromosome 15q11. 2－q13[86. 4﹪(89/103 cases)],paternal uniparental disomy[3. 9﹪(4/103 cases)],imprinting defects[1. 9﹪(2/103 cases)],and mutations in the maternal copy of UBE3A[7. 8﹪(8/103 cases)].(3)Apparent happy demeanor or smile and general developmental delay were observed in all AS children. Dyskinesia accounted for 98. 1﹪(101/103 cases),followed by oral movement or suck disorders[97. 1﹪(100/103 cases)]and abnormal posture[67. 0﹪(69/103 cases)]. The proportion of acquired small head circumfe﹣rence or microcephaly,flat occiput or occipital groove and wide－spaced teeth were 61. 2﹪(63/103 cases),85. 4﹪(88/103 cases)and 44. 7﹪(46/103 cases),respectively.(4)Behavioral problems like fascination with water,sleep problems and feeding difficulties were found in 86. 4﹪(89/103 cases),89. 3﹪(92/103 cases)and 85. 5﹪(88/103 cases)of the children,respectively. Sleep disorders[94. 4﹪(84/89 cases)νs. 57. 1﹪(8/14 cases)]and feeding difficulties[93. 3﹪(83/89 cases)νs. 35. 7﹪(5/14 cases)]were more frequently seen in children with maternal ab﹣sence group,compared those with no absence,and the differences were statistically significant(all P＜0. 05).(5)Epi﹣lepsy was present in 77. 7﹪(80/103 cases)of children with onset age varying from 8 to 72 months and 80. 8﹪(59/73 cases)were developing seizures prior to 3 years old. Children with maternal absence showed more multiple seizure types than those with no absence[41. 7﹪(32/68 cases)νs. 0(0 case)],and the difference was statistically significant (P＜0. 05). Children with well－controlled epilepsy had more atonic seizure,compared with those with poorly con﹣ trolled seizure[48. 3﹪(14/29 cases)νs. 18. 5﹪(4/27 cases)],and the difference was statistically significant( P＜0. 05). Conclusions Sleep disorders,feeding difficulties in infancy and multiple seizure types are more commonly seen in AS children with maternal absence. Atonic seizure is easier to be controlled over other types of seizures.

Clinical analysis of 103 children with Angelman syndrome / 中华实用儿科临床杂志

Objective@#To investigate the correlation between clinical phenotype, electroencephalogram (EEG) characteristics and genotype in children with Angelman syndrome(AS).@*Methods@#A total of 103 children with AS at Department of Neurology, Children′s Hospital of Fudan University from June 2017 to June 2018, were included in this study.The information of clinical characteristics, EEG manifestations, genotypes as well as the epileptic outcome were collected retrospectively.The correlations between clinical phenotype, genotype, and epileptic outcome were evaluated.@*Results@#(1) Of the 103 cases, 48 were male (46.6%) and 55 were female (53.4%). (2) Genotypes on AS critical region were maternal chromosome 15q11.2-q13 [86.4%(89/103 cases)], paternal uniparental disomy [3.9%(4/103 cases)], imprinting defects [1.9%(2/103 cases)], and mutations in the maternal copy of UBE3A [7.8%(8/103 cases)]. (3) Apparent happy demeanor or smile and general developmental delay were observed in all AS children.Dyskinesia accounted for 98.1% (101/103 cases), followed by oral movement or suck disorders [97.1%(100/103 cases)] and abnormal posture [67.0%(69/103 cases)]. The proportion of acquired small head circumfe-rence or microcephaly, flat occiput or occipital groove and wide-spaced teeth were 61.2%(63/103 cases), 85.4%(88/103 cases) and 44.7%(46/103 cases), respectively.(4) Behavioral problems like fascination with water, sleep problems and feeding difficulties were found in 86.4%(89/103 cases), 89.3%(92/103 cases) and 85.5%(88/103 cases) of the children, respectively.Sleep disorders [94.4%(84/89 cases) vs.57.1%(8/14 cases)] and feeding difficulties [93.3%(83/89 cases) vs.35.7%(5/14 cases)] were more frequently seen in children with maternal absence group, compared those with no absence, and the differences were statistically significant (all P<0.05). (5) Epilepsy was present in 77.7% (80/103 cases) of children with onset age varying from 8 to 72 months and 80.8% (59/73 cases) were developing seizures prior to 3 years old.Children with maternal absence showed more multiple seizure types than those with no absence[41.7%(32/68 cases) vs.0(0 case)], and the difference was statistically significant(P<0.05). Children with well-controlled epilepsy had more atonic seizure, compared with those with poorly controlled seizure [48.3%(14/29 cases) vs.18.5%(4/27 cases)], and the difference was statistically significant(P<0.05).@*Conclusions@#Sleep disorders, feeding difficulties in infancy and multiple seizure types are more commonly seen in AS children with maternal absence.Atonic seizure is easier to be controlled over other types of seizures.

Mobile internet and cloud computing promotes the development of electronic health record / 中华全科医师杂志

Currently, electronic health records (EHR) are largely created and maintained by physicians, and used just as an electronic record. In future, EHR will be a tool of information sharing and patients may participate in decision making for their own health with this tool. This article summarizes the concept of EHR, the problems it faces and how the mobile internet and cloud computing can promote the development of EHR.

Performance of the Autism Spectrum Rating Scale and Social Responsiveness Scale in Identifying Autism Spectrum Disorder Among Cases of Intellectual Disability / 神经科学通报·英文版

The Autism Spectrum Rating Scale (ASRS) and the Social Responsiveness Scale (SRS) have been widely used for screening autism spectrum disorder (ASD) in the general population during epidemiological studies, but studies of individuals with intellectual disability (ID) are quite limited. Therefore, we recruited the parents/caregivers of 204 ASD cases, 71 ID cases aged 6-18 years from special education schools, and 402 typically developing (TD) children in the same age span from a community-based population to complete the ASRS and SRS. The results showed that the ID group scored significantly lower on total and subscale scores than the ASD group on both scales (P < 0.05) but higher than TD children (P < 0.05). Receiver operating characteristic analyses demonstrated a similar fair performance in discriminating ASD from ID with the ASRS (area under the curve (AUC) = 0.709, sensitivity = 77.0%, specificity = 52.1%, positive predictive value (PPV) = 82.2%) and the SRS (AUC = 0.742, sensitivity = 59.8%, specificity = 77.5%, PPV = 88.4%). The results showed that individuals with ID had clear autistic traits and discriminating ASD from ID cases was quite challenging, while assessment tools such as ASRS and SRS, help to some degree.

Ventilator-associated pneumonia among premature infants <34 weeks′ gestational age in neonatal intensive care unit in China: a multicenter study / 中华儿科杂志

Objective@#To investigate the incidence and pathogen distribution of ventilator-associated pneumonia (VAP) among preterm infants admitted to level Ⅲ neonatal intensive care units (NICU) in China.@*Method@#A prospective study was conducted in 25 level Ⅲ NICU, enrolling all preterm infants <34 weeks gestational age admitted to the participating NICU within the first 7 days of life from May 2015 to April 2016. Chi-square test, t test and Mann-Whitney U test were used for statistical analysis.@*Result@#A total of 7 918 patients were enrolled, within whom 4 623(58.4%) were males. The birth weight was (1 639±415) g and the gestational age was (31.4±2.0) weeks; 4 654(58.8%) infants required non-invasive mechanical ventilation and 2 154(27.2%) required intubation. Of all the mechanically ventilated patients, VAP occurred in 95 patients. The overall VAP rate was 7.0 episodes per 1 000 ventilator days, varying from 0 to 34.4 episodes per 1 000 ventilator days in different centers. The incidence of VAP was 9.6 and 6.0 per 1 000 ventilator days in children′s hospitals and maternity-infant hospitals respectively, without significant differences (t=1.002, P=0.327). Gram-negative bacilli (76 strains, 91.6%) were the primary VAP microorganisms, mainly Acinetobacter baumannii (24 strains, 28.9%), Klebsiella pneumonia (23 strains, 27.7%), and Pseudomonas aeruginosa (10 strains, 12.0%).@*Conclusion@#The incidence of VAP in China is similar to that in developed counties, with substantial variability in different NICU settings. More efforts are needed to monitor and evaluate the preventable factors associated with VAP and conduct interventions that could effectively reduce the occurrence of VAP.

Application of Lean Six Sigma theory in clinical medicine / 中华全科医师杂志

One of the effective methods to resolve the conflict between the ever-increasing medical demands and relatively limited medical resources is to improve the work efficiency of the medical institutions as well as to effectively control their operating cost through continuous reforms and improvements of the management modes in the medical industry.The Lean Management and Six Sigma Management theories which have been applied in manufacturing industry and service industry are now gradually being introduced to clinical medicine.This article systematically describes the Lean Management and Six Sigma Management theories and illustrates some examples of its application in health management renovation and the effects achieved.

Distribution of peripheral arterial stiffness and endothelial function as well as their correlations with cardiovascular risk factors in children and adolescents / 中华流行病学杂志

Objective To investigate the distribution of peripheral arterial stiffness,endothelial function and their correlations with cardiovascular risk factors in the 7-17 year-olds.Methods Normal weight and obese subjects aged 7-17 years with completed data on questionnaires,anthropometric and blood biochemical tests,were recruited from a cross-sectional population-based study on childhood hypertension in Minhang district of Shanghai.Automatic waveform analyzer (BP-203RPE-I) and Endopat 2000 were used to measure the arterial stiffness.Endothelial function with brachial-ankle pulse wave velocity (baPWV) and reactive hyperemia index (RHI) were recorded.BaPWV and RHI were standardized by age.Skewed biochemical variables were log transformed.Linear correlation analysis was performed to observe association between baPWV,RHI and other measured variables.Results A total of 452 normal-weight and 94 obese subjects were recruited,including 299 males.Data showed that baPWV and RHI increased with age in normal weight subjects (r=0.33,P＜0.01;r=0.36,P＜0.01).Results from Linear correlation analysis revealed that baPWV was positively correlated with BMI (r=0.13,P=0.002),systolic blood pressure (SBP) (r=0.20,P＜0.01),diastolic blood pressure (DBP) (r=0.27,P＜0.01),triglycerides (TG) (r=0.11,P=0.010),insulin (r=0.21,P=0.004) and the HOMA insulin resistance index (r=0.21,P=0.005),but negatively correlated with high-density lipoprotein cholesterol (r=-0.09,P=0.039).RH1 was positively correlated with BMI (r=0.10,P=0.018) but negatively correlated with DBP (r=-0.10,P=0.016).Males had higher baPWVs than females (P=0.04).However,RHI did not differ between genders.Conclusions The fact that baPWV and RHI increased along with age,indicated that the arterial stiffness and endothelial function continued to develop in normal weight childhood and adolescence.Arterial stiffness was correlated with cardiovascular risk-related parameters whereas endothelial function was not.BaPWV might be more sensitive in evaluating the cardiovascular risk in children and adolescents than RHI did.

Distribution of peripheral arterial stiffness and endothelial function as well as their correlations with cardiovascular risk factors in children and adolescents / 中华流行病学杂志

Objective To investigate the distribution of peripheral arterial stiffness,endothelial function and their correlations with cardiovascular risk factors in the 7-17 year-olds.Methods Normal weight and obese subjects aged 7-17 years with completed data on questionnaires,anthropometric and blood biochemical tests,were recruited from a cross-sectional population-based study on childhood hypertension in Minhang district of Shanghai.Automatic waveform analyzer (BP-203RPE-I) and Endopat 2000 were used to measure the arterial stiffness.Endothelial function with brachial-ankle pulse wave velocity (baPWV) and reactive hyperemia index (RHI) were recorded.BaPWV and RHI were standardized by age.Skewed biochemical variables were log transformed.Linear correlation analysis was performed to observe association between baPWV,RHI and other measured variables.Results A total of 452 normal-weight and 94 obese subjects were recruited,including 299 males.Data showed that baPWV and RHI increased with age in normal weight subjects (r=0.33,P＜0.01;r=0.36,P＜0.01).Results from Linear correlation analysis revealed that baPWV was positively correlated with BMI (r=0.13,P=0.002),systolic blood pressure (SBP) (r=0.20,P＜0.01),diastolic blood pressure (DBP) (r=0.27,P＜0.01),triglycerides (TG) (r=0.11,P=0.010),insulin (r=0.21,P=0.004) and the HOMA insulin resistance index (r=0.21,P=0.005),but negatively correlated with high-density lipoprotein cholesterol (r=-0.09,P=0.039).RH1 was positively correlated with BMI (r=0.10,P=0.018) but negatively correlated with DBP (r=-0.10,P=0.016).Males had higher baPWVs than females (P=0.04).However,RHI did not differ between genders.Conclusions The fact that baPWV and RHI increased along with age,indicated that the arterial stiffness and endothelial function continued to develop in normal weight childhood and adolescence.Arterial stiffness was correlated with cardiovascular risk-related parameters whereas endothelial function was not.BaPWV might be more sensitive in evaluating the cardiovascular risk in children and adolescents than RHI did.

Comparison of gender difference in the Chinese version of the autism spectrum rating scale / 中华实用儿科临床杂志

Objective To explore the gender difference in Chinese version of autism spectrum rating scale (ASRS)-in terms of parents and teacher rating.Methods A total of 701 children (380 boys,321 girls;6 -11 years old)were recruited from one Primary School in Minhang District of Shanghai.The parents and teachers of the children completed the ASRS.While the data were imput into the database,the software automatically calculated T -standard score according to the formula for the raw score of screening scale,treatment scale,and Diagnostic and Statistical Manual of Mental Disorders -Ⅳ -Turning Reversion scale.In the end,the gender differences in Chinese version of ASRS for both parents and teacher ratings were analyzed.Results A total of 671 parents rating scale were retrieved (response rate was 95.7%),involving 368 boys (54.8%);685 for teacher rating scale (response rate was 97.7%), involving 381 boys (55.6%).No significant difference was observed in the distribution of gender(P >0.05).Minor influence of age was found among ASRS sub -scales for both parents and teacher ratings in boys and girls (parent rating scale r =-0.219 1 to -0.124 4,teacher rating scale r =-0.328 0 to -0.120 0).In parent and teacher ver-sion of ASRS,boys had higher T -standard scores in all subscales by 1 -3 and 2 -4 points than those in girls,respec-tively,and apart from abnormal behavior,adult socialization,behavioral rigidity,and sensory sensitivity there was no sig-nificant difference(all P >0.05)in parents rating scale while others had significant differences(all P <0.05),and all sub -scales had significant difference in teacher rating scale(all P <0.01).Conclusions The T -standard scores of both ASRS questionnaire has the gender differences in ASRS subscales,so it is necessary for researchers to understand the Chinese version of ASRS questionnaire from different angles.

Chinese neonatal birth weight curve for different gestational age / 中华儿科杂志

<p><b>OBJECTIVE</b>Since 1986, the reference of birth weight for gestational age has not been updated. The aim of this study was to set up Chinese neonatal network to investigate the current situation of birth weight in China, especially preterm birth weight, to develop the new reference for birth weight for gestational age and birth weight curve.</p><p><b>METHOD</b>A nationwide neonatology network was established in China. This survey was carried out in 63 hospitals of 23 provinces, municipalities and autonomous regions. We continuously collected the information of live births in participating hospitals during the study period of 2011-2014. Data describing birth weight and gestational age were collected prospectively. Newborn's birth weight was measured by electronic scale within 2 hours after birth when baby was undressed. The evaluation of gestational age was based on the combination of mother's last menstrual period, ultrasound in first trimester and gestational age estimation by gestational age scoring system.</p><p><b>STATISTICAL ANALYSIS</b>the growth curve was drawn by using LMSP method, which was conducted in GAMLSS 1.9-4 software package in R software 2.11.1.</p><p><b>RESULT</b>A total of 159 334 newborn infants were enrolled in this study. There were 84 447 male and 74 907 female. The mean birth weight was (3 232 ± 555) g, the mean birth weight of male newborn was (3 271 ± 576) g, the mean weight of female newborn was (3 188 ± 528) g. The test of the variables' distribution suggested that the distribution of gestational age and birth weight did not fit the normal distribution, the optimal distribution for them was BCT distribution. The Q-Q plot test and worm plot test suggested that this curve fitted the distribution optimally. The male and female neonatal birth weight curve was developed using the same method.</p><p><b>CONCLUSION</b>Using GAMLSS method to establish nationwide neonatal birth weight curve, and the first time to update the birth weight reference in recent 28 years.</p>

In vitro antibacterial test of Chinese medicine compound preparation for common pathogenic bacteria in upper respiratory tract infection / 天津医药

Objective To observe the antimicrobial effect of a kind of Chinese medicine Qingre compound preparation on the common pathogenic bacteria of upper respiratory tract infection (URTI). Methods A total of 163 common pathogen?ic bacteria of URTI was selected in this study, including 74 non extended-spectrum β- lactamases (ESBLs)-producing Gram-negative bacteria (33 Escherichia coli, 24 Klebsiella pneumonia and 17 Pseudomonas aeruginosa), 10 ESBLs-produc?ing Gram-negative bacteria (6 Escherichia coli and 4 Klebsiella pneumoniae) and 79 Gram-positive bacteria [11 methicil?lin-resistant Staphylococcus aureus (MRSA), 46 methicillin-sensitive Staphylococcus aureus and 22 Streptococcus pneu?moniae]. Agar dilution method was adopted to perform the quantitative drug sensibility test. Agar plates that contained differ?ent concentrations of Qingre compound preparation were prepared. The bacterial suspension was planted on the plates. Then we observed the plates after incubation, and recorded the minimum inhibitory concentration (MIC). Results The antimicro?bial rates of Qingre compound preparation were 88, 176 and 22 g/L for MIC90 of Escherichia coli, Klebsiella pneumoniae, and Pseudomonas aeruginosa. The antimicrobial effects of Qingre compound preparation were coincident on the MIC 90 of ES?BLs-producing strains and non ESBLs-producing strains. The accumulated antibacterial rates of different concentrations of medicine to Pseudomonas aeruginosa were the highest. The MIC90 values of Qingre compound preparation were 11, 11 and 22 g/L for MSSA, MRSA and Streptococcus pneumoniae. The MIC90 of MRSA was coincident with MSSA, but MIC50 of MRSA was slightly higher than that of MSSA. The accumulated antibacterial rates of different concentrations of medi cine to MSSA and MRSA were all higher than those of Streptococcus pneumonia. The accumulated antibacterial rate of MSSA was similar with that of MRSA. Conclusion The Chinese medicine Qingre compound preparation could restrain common patho?genic bacteria of URTI except Klebsiella pneumoniae. The antibacterial effect of Qingre compound preparation is significant?ly better in Ggram-positive bacteria than that of Gram-negative bacteria.

Correlation of left ventricular ejection fraction as well as serum levels of NT-proBNP, Hcy and D-D with different traditional Chinese medicine syndrome types of chronic heart failure / 天津医药

Objective To investigate the correlation of left ventricular ejection fraction (LVEF) as well as serum levels of NT-proBNP, Hcy and D-Dimer (D-D) with different traditional Chinese medicine (TCM) syndrome types of chronic heart failure (CHF). Methods A total of 178 CHF patients were divided into heart function normal ejection fracture group (HF?NEF, n=86) and heart function reduction (HFREF, n=92) according to their LVEF performance. Another 35 cases with nor?mal cardiac function were included in control group. All CHF patients was also divided into 3 TCM syndrome types:both de?ficiency of Qi and Yin syndrome group(n=64),Qi asthenia causing blood stasis syndrome group(n=59) andYang defi?ciency water stop group (n=55). All patients were examined with cardiac color doppler and LVEF values were recorded. And serum NT-proBNP、Hcyand D-D levels were all quantified. Results As to serum levels of NT-proBNP, Hcy and D-D, they were higher in HFREF group than those in HFNEF group than those in control group. On the other hand, LVEF was lowest in HFREF group but highest in control group. All differences were statistically significant (P<0.05). Among patient in HFNEF group, LVEF in theYang deficiency water stop groupwas lower than that inboth deficiency of Qi and Yin syn?drome group(P<0.05). Serum levels of NT-proBNP, Hcy, and D-D were not significantly different between different TCM syndrome groups. By contrast, among patients in HFREF group, LVEF values did not differ significantly between different TCM syndrome groups. Serum level of NT-proBNP was lower inboth deficiency of Qi and Yin syndrome groupthan that inQi asthenia causing blood stasis syndrome group than that in Yang deficiency water stop group. As to serum levels of Hcy and D-D, they are higher inYang deficiency water stop groupthat those inboth deficiency of Qi and Yin syndrome group and Qi asthenia causing blood stasis syndrome group(P<0.05). Conclusion Patients with different TCM syn?drome types of CHF present different levels of serum NT-proBNP, Hcy, D-D level and LVEF. Changes of indicators in HFREF groups are more obvious than they did in HFNEF group.

Distribution and drug resistance of Klebsiella pneumoniae from 2011 to 2013 in a hospital / 国际检验医学杂志

Objective The distribution and drug resistance of Klebsiella pneumonia isolated from clinical department were ana‐lyzed in this article .It will provide evidence for the clinical rational medication and the control of nosocomial infections .Methods In this hospital ,892 strains of Klebsiella pneumonia isolated from January 2011 to December 2013 were performed a statistical analy‐sis .Results Among all the samples ,the extended spectrumβ‐lactamases(ESBLs) positive Klebsiella pneumoniae accounted for 40 . 92% .The highest detection rate in the all the clinical department is the ICU with a value of 46 .46% .The highest detection rate in the sample is the sputum with a value of 43 .51% .In addition ,the ESBLs positive strains had a trend of multiple drug resistance . The Klebsiella pneumonia was the most sensitive bacteria to imipenem ,meropenem ,piperacillin/tazobactam and cefoperazone/sul‐bactam ,no matter whether they produced ESBLs or not .Conclusion The resistant rate of ESBLs positive strains is higher than that of ESBLs negative strains .It was recommended to the rational use of antibiotics based on the duration of disease and the products with or without ESBLs .Furthermore ,it will be of great importance to reduce the incidence of multiple drug resistance ,and to con‐trol the hospital infection effectively .

Research on parameters of L-[1-~(13)C]phenylalanine breath test for quantitative assessment of liver function in adult / 中华消化杂志

Objective To investigate the feasibility of L-[1- 13 C]phenylalanine breath test to assess liver function and determine the effective parameters of the test for quantitative assessment of liver function in adult. Methods Twelve healthy volunteers served as control group, and 26 liver cirrhotic patients with hepatitis B were divided into three groups, 10 patients in Child-Pugh classification A, 8 in B and 8 in C, An oral dose of 100 mg of nonradiative tracer L-[1- 13 C]phenylalanine were administered to all the subjects. Breath samples were taken before and different intervals within 360 min after administration. 13 CO_2 enrichment was measured by isotope ratio mass spectrometer. Results After the oral administration of L-[1- 13 C] phenylalanine, 13 C excretion reached a peak within 10-30 min. The parameters of 13 CO_2 excretion rate at 30 min ( 13 CO_2ER_ 30 ) , 13 C cumulative excretion of 60 min ( 13 C_ cum60 ), 75 min( 13 C_ cum75 ), 90 min( 13 C_ cum90 ) and 13 CO_2 half excretion time ( t _ 1/2 ) were shown sensitive, which could differentiate significantly the groups( P

The correlation between P_(ET)CO_2 and cerebral blood flow, cerebral metabolism and intracranial pressure in neurosurgical patients / 中华麻醉学杂志

Objective To investigate the correlation between PaCO2 and cerebral blood flow (CBF), cerebral metabolism of oxygen (CMRO2), glucose (CMRglu) and lactate (CMRlact) and intracranial pressure during intracranial surgery. Methods Twenty ASA Ⅰ - Ⅱ patients (6 male, 6 female), aged between 26-54yr, weighing (65 ? 11) kg scheduled for elective intracranial surgery were studied. The patients were unpremedicated. Before general anesthesia radial artery was cannulated and a catheter was inserted into internal jugular vein and advanced cranially until jugular bulb. Lumber puncture was performed at L3-4 and a catheter was inserted into subarachnoid space for 3 cm, for pressure monitoring and CSF sampling. Anesthesia was induced with diazepam 10mg, fentanyl 3-4?g?kg-1, propofol 2mg?kg-1 and vecuronium 0.08mg?kg-1 iv. The patients were mechanically ventilated with a mixture of oxygen and argon (O2 : argon = 3 : 1) after tracheal intubation. Anesthesia was maintained with sevoflurane and intermittent iv boluses of vecuronium. Arterial and cerebral venous blood gases, glucose and lactate levels, CBF, ICP and CSF level of lactate were determined before anesthesia when patients were awake(Ⅰ) and during anesthesia when PETCO2 = 40, 30, 20 mm Hg (Ⅱ,Ⅲ,Ⅳ). CBF was measured by modified Kety-Schmidt inert gas saturation technique with argon. CMRO2 and CMRglu were calculated based on the difference in their arterial -cerebral venous blood levels. Results At PETCO2 20mm Hg (Ⅳ) CBF decreased by 57.75% and CMRO2 by 58.70% as compared with the baseline; CMRglu decreased by 46.93% as compared with the baseline. There was no significant change in lactate level, jugular venous blood O2 saturation and pH. ICP decreased from (22.14 ? 7.88)mm Hg( Ⅰ) to (17.57?5.03)mm Hg( Ⅱ ),(13.43?4.89)mm Hg(Ⅲ) and (10.00? 2.31)mm Hg(Ⅳ) and the differences were significant. All measurements were done when MAP and HR were stable. PET CO2 was (10? 2) mm Hg lower than PaCO2 . Conclusions Cerebral blood flow, cerebral oxygen and glucose metabolism and intracranial pressure change with changes in PET CO2 . Cerebral vascular reactivity to CO2 is not impaired by 1.3 MAC sevoflurane. Mild hypocapnia is necessary during neurosurgery.

The change in intracranial pressure during induction of anesthesia with fentanyl, propofol and succinylcyholine in neurosurgical patients / 中华麻醉学杂志

Objective To investigate the change in intracranial pressure (ICP) during induction of anesthesia with fentanyl, propofol and succinylcholine in neurosurgical patients by measuring cerebral spinal fluid (CSF) pressure at the level of lumbar spine.Methods Twenty ASA Ⅰ or Ⅱ patients (9 males, 11 females) aged 24-54 yrs scheduled for elective craniotomy for intracranial tumor were included in this study. Lumbar puncture was performed at L2,3 or L3,4 interspace with an epidural needle through which an epidural catheter was placed in the subarachnoid space to allow measurement of lumbar CSF pressure. Anesthesia was induced with fentanyl 2-3 ?g?kg-1 followed by propofol 2 mg?kg-1 and succinylcholine 1.5 mg?kg-1. CSF pressure was recorded before induction of anesthesia (baseline value), at 5 min after intravenous fentanyl injection, 1, 2, and 3 min after propofol injection, during fasciculation of muscle and immediately after intubation.Results CSF pressure was significantly decreased at 1, 2 and 3 min after i.v. propofol and during muscle fasciculation. The CSF pressure was lowest at 3 min after propofol injection. Tracheal intubation did not result in significant increase in CSF pressure as compared with the baseline value before induction. Conclusion Intracranial pressure is decreased during induction of anesthesia with fentanyl, propofol and succinylcholine in neurosurgical patients and the adverse effect of tracheal intubation on ICP is effectively blunted.