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Objective:This work aims to investigate the phenotype-characteristics of drug resistance and the possible mechanisms of extensively drug-resistance Klebsiella pneumoniae(XDRKP). Methods:Screened by the previous drug susceptibility results, 116 clinical Klebsiella pneumoniae isolates were collected from Shanxi Bethune Hospital from January 2018 to December 2020. Matrix-assisted laser desorption/ionization time of flight mass spectrometry (MALDI-TOF MS) rapid microbial identification system and VITEK-compact 2 were used. The modified carbapenem inactivation method (mCIM) combining with EDTA carbapenem inactivation method (eCIM) was used to identify the strains′ carbapenemase phenotypes, which were compared with subsequent qPCR results. The qPCR amplification combining with agarose gel electrophoresis were carried out to detect various drug-resistant related genes, including: carbapenemase genes: blaKPC, blaNDM, blaVIM, blaIMP, blaOXA; aminoglycosides resistance genes: ① 16S rRNA methylase genes: rmtA, rmtC, rmtD, rmtG, rmtH, armA, npmA, rmtB, rmtE, rmtF, ② variant of aminoglycosides acetyltransferase gene: aac(6′)-Ib-cr; quinolone resistance genes: DNA gyrase protection protein qnr family: qnrA, qnrB, qnrC, qnrD, qnrS, efflux pump protein gene: oqxAB, qepA, variant of aminoglycoside acetyltransferase gene: aac(6′)-Ib-cr; and tigecycline-resistant Tet protein genes: efflux pump protein gene: tet (A), tet (L), ribosome protection protein gene: tet (M), tigecycline modified enzyme gene: tet (X). Each isolate′s phenotype and resistance gene result were compared and analyzed correspondingly. Results:A total number of 116 XDRKP isolates were collected in 3 years, 115 of which are identified as carbapenem resistant. Both cephalosporins and quinolones resistant rate were 100%, while the resistant rate of aminoglycosides antibiotic gentamicin, tobramycin and amikacin was 95.69% (111/116), 94.83% (110/116), or 88.79% (103/116) respectively. Sulfonamide antibiotics and tigecycline showed a relatively lower resistant rate. Compared with PCR amplification results, mCIM combining with eCIM phenotype testing had a high conformity, up to 95.65% (110/115). Positive rate of each resistance related gene was: blaKPC 90.52% (105/116), blaNDM 10.34% (12/116), rmtB 81.90% (95/116), armA 2.59% (3/116), oqxAB 65.52% (76/116), qnrB 6.03% (7/116), qnrS 12.93% (15/116), aac(6′)-Ib-cr 7.76% (9/116), or tet(A) 21.55% (25/116), respectively. Other resistance related genes were not detected. Corresponding analysis between the resistant phenotypes and resistance related genes indicated that a total of 65 XDRKP didn′t have a matched pairs, i.e. bacteria′s resistance to specific antibiotic could not be interpreted by carrying some associated resistant genes.Conclusions:The wide distribution of resistant genes and multiple-antibiotic-inactivated trait of some genes(such as aac(6′)-Ib-cr and oqxAB) in XDRKP are potential causes of the generation of extensively drug resistant phenotype. Different XDRKP isolates may carry one or more resistant genes in responding to specific antibiotic. In addition, there are some bacteria with an unmatched phenotype-gene feature indicating that both resistance genes′ regulation and some other mechanisms also play a role in development of XDR.
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Objective@#To explore the characteristic indexes of patients with schizophrenia trees drawing projection through the extraction and quantitative analysis of the projection index of the tree-drawing painted by schizophrenic patients and provide the basis for the diagnosis of schizophrenia.@*Methods@#A tree-drawing test was performed on 69 schizophrenic patients and 59 healthy subjects without psychotic symptoms using the control study design.Computer image recognition and data acquisition was used to quantitatively research on tree projection drawing, and the data were analyzed between the two groups.@*Results@#There were 6 tree-drawing test quantitative indexes had statistical significance between schizophrenia patients and healthy subjects: crown height ((7.4380±3.7939)cm vs (8.9587±3.6632)cm, t=-2.386, P=0.018), crown width ((9.3441±4.7054)cm vs (12.1024±4.7836)cm, t=-3.281, P<0.01), trunk width ((2.3391±2.3857)cm vs (3.7313±2.2822), t=-3.357, P=0.001), crown area ((65.1007±56.2188)cm2 vs (90.8369±61.9536)cm2, t=-2.463, P=c.015), trunk area ((12.8060±17.3851)cm2 vs (19.3813±15.3874)cm2, t=-2.248, P=0.026), the total area ((82.3225±71.7906)cm2 vs (114.5269±73.8087)cm2, t=-2.497, P=0.014), meanwhile 7 quantitative indexes were not statistically significant: the total height of trees ((13.9728±5.8815)cm vs (15.8957±5.4399)cm, t=-1.908, P=0.059), trunk height ((6.4989±5.8861)cm vs (6.4311±3.0242)cm, t=0.080, P=0.936), root height ((0.7321±1.2916)cm vs (0.4780±1.0912)cm, t=1.191, P=0.236), root width ((1.7597±3.5406)cm vs (2.2041±4.8122)cm, t=-0.600, P=0.549), root area ((4.3920±10.8128)cm2 vs (4.3774±12.4586)cm2, t=0.007, P= 0.994), trunk and crown height ratio ((9.0236±15.1846) vs (5.1478±9.0970, t=-0.526, P=0.600), trunk crown width ratio (9.0236±15.1846 vs 5.1478±9.0970, t=1.489, P=0.14).@*Conclusion@#There are significant traits in the area of crown, trunk and tree in the tree drawing projection test between schizophrenics and healthy subjects.After future large sample follow-up study, it can provide quantitative assistance for clinical diagnosis.
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Objective:To explore and compare the clinical efficacy of lyophilized recombinant human brain natriuretic peptide (Lrh-BNP) and dobutamine (Dob) in the treatment of patients with acute heart failure (AHF) and impacts on the plasma galectin (Gal)-3,Cystatin C (CysC) and endothelin (ET-)-1 levels.Methods:114 cases of patients with AHF in our hospital from February 2015 to February 2017 were selected as the research objectives and randomly divided into two groups.Dob group was treated by Dob,while Lrh-BNP group was treated by Lrh-BNP.The cardiac function parameters,plasma Gal-3,CysC,ET-1 levels before and after treatment,clinical comprehensive efficacy and incidence of adverse reactions were compared between two groups.Results:The FS,LVEF levels of both groups at 72 hours after treatment were significantly higher than those before treatment (P＜0.01),but the LVEDD,plasma Gal-3,CysC,ET-1 levels were obviously decreased (P＜0.01),the index mentioned above of Lrh-BNP group improved more significantly than those of the Dob group(P＜0.01).The overall effective rate of Lrh-BNP group was 89.5 ％,which was significantly higher than that of the Dob group (73.7％,P＜0.05).No significant difference was found in the incidence of adverse reaction between two groups(P＞0.05).Conclusion:Lyophilized recombinant human brain natriuretic peptide was more effective in the treatment of AHF than Dobutamine with equal safety,which might be related to the decrease of plasma Gal-3,CysC,ET-1 levels.
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With increasing use of carbapenem antibiotics , carbapenems-resistant gram-negative bacteria are spreading, and carbapenemase-producing is the main mechanism of carbapenems resistance . Rapid and accurate identification of carbapenemase and its type is of great importance to timely and effective treatment and control of infections .Chromogenic /Fluorogenic culture media, modified Hodge test and double disk synergy test are traditional methods for carbapenemase detection , but all are time-consuming. Biochemical method is more time efficient and with high sensitivity and specificity , but cannot be used to identify subtypes.Now matrix-assisted laser desorption ionization -time-of-flight mass spectrometry (MALDI-TOF MS) has been successfully applied in the identification of species , subtypes and detection of drug -resistant genes.And among various carbapenemase gene detection techniques , next generation sequencing (NGS) can also be used for the detection of integrons , transposons and plasmids, which is important in both epidemiology and resistant mechanism studies .This article reviews the advantages and disadvantages of various methods for phenotype and gene detection of carbapenemase .
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Objective To study the possibility of direct identification of pathogens from positive blood cul-tures by methods of separation gel tube -centrifugation.Methods 216 cases of positive blood culture were collected from 2015.7 to 2015.12.The bacterias were purified from blood culture bottle by separation gel tube.After washing 2 times,identified by MALDI -TOF MS.At the same time,traditional culture,smears and identification were done. Compared the results of identification by two methods.Results 216 cases of positive blood culture were single bacte-rial infection.By Gram stain,89 strains were Gram positive,119 strains were Gram negative and 8 strains were fungal spores.190 cases of positive blood culture were identified by MALDI -TOF MS,it concluded 67 Gram positive strains,111 Gram negative strains,4 anaerobe strains and 8 fungus.Compared with traditional culture,the coincidence rate reached up to 87.9%,Gram positive strains 78.8%,Gram negative strains 93.2%,anaerobe strains 100.0%and fungus 100.0%.Conclusion It takes less than 30 minutes purified from blood culture bottle by separation gel tube.And the time of identification is shorter than traditional culture.This method is good for clinical diagnosis and treatment.