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Objective:To assess the bacterial profiles and antimicrobial susceptibility patterns in uropathogens, and help to inform the empiric treatment decisions for urinary tract infection in outpatient settings.Methods:A single institutional retrospective analysis was performed on positive urine cultures from outpatient settings between January 1998 and December 2018. To analyze changes over time, trends analysis were undertaken on bacterial profiles, antimicrobial susceptibility and resistance.Results:A total of 1.172 pathogenic bacteria were isolated after exclusion of duplicate strains originated from the same patient, including 991(84.6%) Gram-negative bacterial strains and 181(15.4%) Gram-positive strains. The most common Gram-negative uropathogens were Escherichia coli (60.8%) and Klebsiella pneumonia (8.1%). Enterococcus faecalis (4.6%) was the predominant Gram-positive strain. The detection rate of Escherichia coli increased significantly, from 50.8% to 63.2% ( χ2=7.978, P=0.046), and no significant difference was observed in the distribution of major uropathogenic bacteria over the 20 years (all P>0.05). The proportion of extended-spectrum β-lactamase (ESBLs) producing strains increased significantly across the 20 years ( P<0.05). The resistance rates of Escherichia coli to amoxicillin and clavulanate potassium, aztreonam, ceftazidime, ciprofloxacin and sulbactam + cefoperazone increased significantly (all P<0.05). All the isolates sustained high susceptibility to tazobactam + piperacillin, amikacin, imipenem and nitrofurantoin (95.0%, 95.7%, 97.9% and 91.1%). Similar to those of Escherichia coli, Klebsiella pneumoniae remained a high and stable sensitivity to tazobactam+piperacillin, amikacin and imipenem during the 20 years (79.1%, 88.0% and 80.3%). However, the proportion of ESBLs producing strains increased significantly ( P<0.05). Among Gram-positive bacteria isolates, the sensitivity rates of Enterococcus faecalis to ampicillin, nitrofurantoin and penicillin G were 100.0%. No vancomycin resistant strain was detected in Gram-positive bacteria. Conclusions:From 1998 to 2018, Escherichia coli and Klebsiella pneumoniae are the most common Gram-negative bacteria uropathogens obtained in outpatient settings. Significant increases of resistance to some antimicrobial agents such as second- and third-generation cephalosporins and fluoroquinolones are observed during the 20 years and high susceptibilities to tazobactam+piperacillin, amikacin, imipenem and nitrofurantoin sustain over time. Local treatment strategies of urinary tract infections on outpatient basis should be made according to epidemiology of drug resistance and individual characteristics to control the spread and curb the prevalence of drug resistant.
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Objective@#To explore the clinicopathological features and the renal biopsy process of a case of IgG4-related chronic interstitial nephritis with perirenal capsule involved and review associated literature to improve the clinician's understanding for this disease and to perform a better renal biopsy.@*Methods@#The onset, diagnosis and treatment course of the disease were described and associated literature were reviewed to summary the clinicopathologic features and key points in renal biopsy.@*Results@#The data of the patient showed that the urine specific gravity was 1.011, with urine protein ± and urine sugar 3+. The concentration of hemoglobin was 53 g/L, serum creatinine was 1665 μmol/L, and IgG4 was 9.39 g/L. Computed tomography showed that both kidneys enlarged slightly with decreased density and low density shadow around the kidneys. On contrast-enhanced scan, irregular low-density enhancement areas were found in both kidneys, and the edge of the boundary was not clear. For the first renal biopsy, no renal parenchyma was found except mainly hyaline collagen fibrils. At the second time, 3 pieces of tissues were obtained, which showed chronic interstitial glomerulonephritis. The IgG4 positive plasma cells were about 60/HPF and the IgG4+/IgG+cells ratio was more than 40%. The diagnosis of IgG4-related chronic interstitial glomerulonephritis was confirmed. After corticosteroid treatment, the serum creatinine decreased to 502 μmol/L after the patient got rid of dialysis.@*Conclusions@#There are various manifestations of renal damage caused by IgG4-related disease. It is necessary to pay attention to the involvement of the perirenal capsule, and to balance the risk of bleeding and poor sampling in renal biopsy.
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Objective:To explore the protective effect of curcumin on type 2 diabetic nephropathy rats and the possible mechanism.Methods:30 Wistar rats were randomly divided into control group,the DN group and curcumin group,10 cases in each group,rats in DN and curcumin group were fed with high fat,after that they were used the streptozotocin injection to set up DN model.In addition,rats in curcumin group were given 200 mg/kg curcumin once a day,other two group were given sodium carboxymethylcellulose half-and-half.After 12 weeks,the 24 h urine were collected at the last delivery,the blood glucose(BG),total cholesterol(TC),triglyceride(TG),blood urea nitrogen(BUN),serum creatinine(Scr),microalbu minuria(mAlb) were tested,the urinary albumin excretion rate(UAER) was calculated.Furthermore,rats were sacrificed,kidney mass weighed,and the kidney index(KI) was calculated.Renal cortical was fixed with polymers cresol for hematoxylin-eosin(HE) staining,renal cortical was also made renal cortex homogenate and the SOD activity,MDA were detected,the expression of nuclear factor related factor 2(Nrf2) and heme oxygenase 1(HO-1) protein in the kidney tissues was detected with Western blot detection.Results:BG,TC,TG,KI,BUN,Scr,UAER,MDA of DN group and curcumin group were significantly higher than control group,and BM,KM,SOD was significantly lower than the control group,the amplitude raising or reducing in curcumin group were less than DN group,the difference had statistical significance(P<0.05);HE staining results showed that,compared with DN group,renal tubule degeneration in curcumin group was obviously reduced,inflammatory cells infiltration was decreased significantly;Western blot results showed that expression of Nrf2 and HO-1 protein in control group were significantly lower than DN group and curcumin group,and curcumin group was significantly higher than the DN group,the differences were statistically significant(P<0.05).Conclusion:Curcumin may play a role of kidney protection through the activation of Nrf2/ARE signaling pathway to reduce oxidative stress in diabetic nephropathy rats.
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We immobilized carbonic anhydrase (CA) onto the surface of membrane oxygenator of polymethyl pentene (PMP) to enhance the removal of carbon dioxide in blood by two steps. We first introduced hydroxyl groups onto PMP surface by water plasma treatment, and then coupled CA onto PMP surface by using cyanate bromide (CNBr) as a crosslinker. After plasma treatment, the contact angle with water and chemical composition of PMP surface were characterized by analysis system of surface contact angle and XPS. Using p-nitrophenyl acetate (p-NPA) as a substrate, the activity, concentration, storage stability and re-usability of immobilized CA on PMP hollow fibers were studied by ultraviolet spectrophotometer. The preliminary data showed that hydroxyl groups could be introduced on the surface of PMP by water plasma treatment, and CA with catalysis activity could be successfully introduced onto PMP surface in high immobilization efficiency. The activity of covalently immobilized CA increased with the increase of concentration of CNBr, and the maximum was 73% of the theoretical activity of CA spread on PMP surface in monolayer in studied range. Covalently immobilized CA showed higher reusability compared to physically adsorbed CA, and higher storage stability compared to free CA in solution at 37 degrees C. The method would be used potentially in the membrane oxygenator to improve the capacity of removal of carbon dioxide in blood in the future.
Subject(s)
Carbonic Anhydrases , Chemistry , Metabolism , Enzymes, Immobilized , Membranes, Artificial , Oxygenators, Membrane , Polyenes , ChemistryABSTRACT
Crush syndrome in patients rescued from earthquake is a complex clinical syndrome with many medical conditions.The most complications are hyperkalemia,acute kidney injury,shock,infection,ARDS,malnutrition and multiorgan dysfunction.Managing these critical issues appropriately is essential for effective treatment of the crush syndrome.
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【Objective】To observe the expression of PI3-K phosphorylated products and elucidate the correlation between PI3-K phosphorylated products and Th2 cytokine in peripheral blood mononuclear cell (PBMC).【Methods】14 patients with active lupus nephritis and 12 controls were selected,PI3-K phosphorylated products were detected by immunoprecipitation and Western blotting,RT-PCR was used to observe interleukin-6 mRNA and interleukin-10 mRNA expression.【Results】In either spontaneous condition or stimulated by anti-CD3 antibody,the expression of PI3-K phosphorylated products in patients with active lupus nephritis were higher than those of the controls(1.14±0.23 vs 0.46±(0.12，P=0.023;2.09±0.63 vs 0.65±0.14，P=0.016).The expression of PI3-K phosphorylated products in active lupus nephritis showed a positive correlation with interleukin-6 mRNA and interleukin-10 mRNA (r=0.652,P=0.008;r=0.718,P=0.007).PY294002,one of specific inhibitor of PI3-K,inhibited significantly the expression of interleukin-6 mRNA(2.32±0.51 vs 0.57±0.15,P=0.009) and interleukin-10 mRNA (1.71±0.33 vs 0.67±0.11,P=0.006) in stimulated PBMC in active lupus nephritis.【Conclusion】PI3-K can involve in the pathogenesis of lupus nephritis by inducing the overexpression of interleukin-6 and interleukin-10.
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Objective To retrospect and probe the clinical applied value and the results of iliac bone with the deep circumflex iliac vessel transplantation for the treatment of avascular necrosis of femoral head.Methods With a composite procedure including synovectomy,fenestration,curettage and vascularized iliac bone graft with pedicle of the ipsilateral deep circumflex iliac vessels.Results Follow-up period average 2 years 8 months(range:for 6 month-5 years) and all patients were roentgenographied.According to new grading treatment system four items and six grades for avascular necrosis of femoral head was evaluated.Excellent and good rate was 84 4%.Post-operative radiological assessment demonstrated that there was no incidence of deterioration or further collapse of the femoral head and certain extent of re-sphering and re-surfacing of the head was observed in all of the collapsed heads.Conclusions The results of this study suggest that the technique is suitable for the treatment of avascular necrosis of femoral head of the stage Ⅰ Ⅱ Ⅲ and younger patients of late stage.