Clinical investigation of ultrasound-guided percutaneous nephrolithotomy accessed by SVOF-principle and two-step puncture techniques / 中华外科杂志

Objective@#To evaluate the safety and effectiveness of ultrasound-guided percutaneous nephrolithotomy (PCNL) accessed by SVOF-principle and two-step puncture techniques.@*Methods@#A total of 838 cases with upper urinary stones underwent percutaneous nephrolithotomy successfully accessed by ultrasound-guided between June 2007 and December 2015 at Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology. Of all cases were divided in two groups: hydronephrosis calyces puncture group include 425 cases and SVOF-principle puncture group include 413 cases. The access establishment time, operation time, stone free rate (SFR), postoperative complications, and postoperative hospitalization time between the two groups we compared by t test or χ2 test.@*Results@#Statistically significant differences were observed between hydronephrosis calyces puncture group and SVOF-principle puncturegroup in the first access establishment time ((16.5±8.4) minutes vs. (11.2±5.9) minutes, t=3.931, P=0.013), one-stage SFR (74.3% vs. 85.7%, χ2=16.868, P=0.000), postoperative hospitalization time ((6.4±2.1) days vs. (4.8±1.8)days, t=4.574, P=0.000), transfusion rate (7.1% vs. 2.9%, χ2=8.027, P=0.006), and embolization rate (3.3% vs. 1.0%, χ2=5.390, P=0.020). There were no statistically significant differences in operation time, total SFR, postoperative fever and sever infection between these two groups (all P>0.05). In both two groups, no serious complications such as peripheral organ injury and death occurred.@*Conclusions@#PCNL accessed guided by ultrasound with SVOF-principle and two-step puncture techniques has advantages of quick puncture location, high stone free rate, fewer complications and fast recovery. This technique is an effective and safe treatment option for upper urinary stones and deserved promotion and application in clinic.

The safety and efficacy for percutaneous ureteroscopic laser deroofing in the management of renal cysts / 中华泌尿外科杂志

Objective To assess the safety and efficacy of a novel technology referred to as percutaneous ureteroscopic laser deroofing in the management of renal cysts.Methods From November 2014 to August 2016,59 patients having surgical indications with renal cysts were enrolled and evaluated by ultrasound and CT scan.Of all the 59 patients,36 were males and 23 were females.Their mean age was 46 years (ranging 35-64 years).41 patients complained about the reported flank and abdominal pain.18 patients were found by imaging examination.Their mean diameter of cyst was 6.3cm(ranging 4.9-9.1cm).In regards to the 59 patients,include 6 patients suffered with parapelvic cysts and 4 patients suffered with renal cyst complicated with ipsilateral renal calculi.Their mean stone surface area was 5.7 cm2 (ranging 3.4-9.8 cm2).All of the patients received combined spinal and epidural analgesia or paravertebral nerve block anesthesia.Patients were placed in the prone position for percutaneous puncture and tract dilation.Under ultrasound guidance,an eighteen gauge needle was placed inside the cyst cavity percutaneously,a metal guidewire was introduced followed by sequential dilation up to F26-28.9.8F rigid ureteroscope was inserted through the Amplazt access sheath and advanced into the cyst cavity.Then sheath and ureteroscope both returned to the exterior cyst together.Cyst wall was dissociated from perirenal adipose tissue by used ureteroscope.A majority of the collapsed cyst wall was grasped and gently pulled towards the Amplazt sheath interior using grasping forceps and incised using either Thulium (Power 40 ～50W) or Holmium laser(Power 60 ～70W) and was taken for pathological examination.Nephrostomy tube was left in place for 2-3 days and removed before discharge.For parapelvic cysts patients,ureter stent was inserted into the renal pelvis i n the dorsal lithotomy position firstly.Patients were then placed in the prone position for percutaneous puncture and tract dilation.Laser was used to incise cyst wall towards identified pelvis to create a permanent communication between the cyst and adjacent renal collecting system.F6 double-J stent was inserted into the cyst cavity at the end to prevent auto-closure for at most two months.F22 nephrostomy tube was left in renal pelvis for two weeks.For renal cyst complicated with ipsilateral renal calculi patients,a puncture was created targeting the stone through the cyst,after fragmenting and extracting the stone,the same laser was used to deroof the cyst.More than 50％ reduction in cyst volume was considered a success.The perioperative complications,hospitalization days and the effective rate of surgery were evaluated.Results All operations were conducted without intraoperative complications such as bleeding,urinary leakage or injury of the renal parenchyma and the adjacent organs.The hospital stay after the surgery was 2-4 days (mean 2.5 days).After 3-12 months follow-up (mean 8.1 months),patients underwent imaging examinations.42 out of 59 cases were completely resolved,15 were reduced to less than 50％,the total effective rate for the operation is 96.6％ (57/59).4 patients with ipsilateral renal calculi were completely clear.However,two cases failed probably due to incomplete resection and follow treated with laparoscopic renal cyst deroofing.Conclusions Percutaneous ureteroscopy renal cyst laser deroofing is a safe,effective,less invasive,which can be performed in any endourological center without the need of special instruments and training.

Prognostic significance of lymphovascular invasion in bladder cancer after surgical resection: A meta-analysis / 华中科技大学学报（医学）（英德文版）

Bladder cancer remains a commonly diagnosed malignancy worldwide, bringing huge economic burden and high morbidity for patients. Assessment of prognostic significance of lymphovascular invasion (LVI) is a critical issue in the surgical management of bladder cancer after transurethral resection or radical cystectomy. A systematic search of PubMed, Embase and Cochrane Library was performed up to Oct 10, 2014 to identify eligible studies. Outcomes of interest were collected from studies comparing overall survival (OS), cancer specific survival (CSS) and recurrence free survival (RFS) in patients with the LVI. Results of studies were pooled, and combined hazard ratios (HRs) with corresponding 95% confidence intervals (CIs) for survival were used as the effect size estimation. Funnel plots were done to show the publication bias, while the forest plots and subgroup analyses were used to limit the heterogeneity. A total of 20 studies (10 663 patients) met the eligibility criteria and were included for this meta-analysis. Our pooled results showed that there were significant differences in OS (pooled HR, 1.71; 95%CI, 1.52-1.92; P<0.00001), CSS (pooled HR, 2.25; 95% CI, 1.80-2.81; P<0.00001) and RFS (pooled HR, 1.91; 95% CI, 1.57-2.32; P<0.00001) between the patients with LVI and the patients without LVI. There were significant heterogeneities observed in the studies concerning the relationship between LVI and CSS, RFS. There was no clear evidence of publication bias. When tumor stage was beyond T3, LVI lost its predictive value for CSS and RFS. For the patients who had negative lymph nodes, LVI was still an adverse predictor. Our pooled results demonstrate that LVI indicates poor prognosis of patients with bladder cancer after surgical procedures, and it can be of particular importance in clinical practice. However, these results need to be further confirmed by more adequately designed prospective studies.

Over-expression of LRIG3 suppresses growth and invasion of bladder cancer cells / 华中科技大学学报（医学）（英德文版）

The purpose of this study was to investigate the impact of leucine-rich repeats and immunoglobulin-like domains 3 (LRIG3) on the biological features of bladder cancer cell lines. The plasmids of over-expressed LRIG3 and the blank plasmid serving as control were transfected into the bladder cancer cell lines, T24, EJ and BIU-87, and the expression levels of LRIG3 mRNA and protein were detected by using real-time PCR and Western blotting. The changes in the cell cycle and apoptosis were examined by using flow cytometry. The invasive ability was measured by Transwell assay, and CCK-8 assays were used to measure the proliferation of cells. As compared with the control group, the LRIG3 mRNA and protein expression levels in LRIG3 cDNA-transfected group were raised significantly (P<0.05). The average number of cells with up-regulated LRIG3 passing through the inserted filter was decreased significantly as compared with the control group (P<0.05). Up-regulation of LRIG3 also could inhibit proliferation and induce apoptosis of T24, EJ and BIU-87 cells. Except BIU-87, the T24 and EJ cells transfected with LIRG3 cDNA were arrested in G(0)/G(1) phase compared to the control group (P<0.05). In conclusion, the over-expression of LRIG3 could influence the cell cycle and invasion, inhibit proliferation and induce apoptosis in the three bladder cancer cell lines.

Over-expression of LRIG3 suppresses growth and invasion of bladder cancer cells / 华中科技大学学报（医学）（英德文版）

The purpose of this study was to investigate the impact of leucine-rich repeats and immunoglobulin-like domains 3 (LRIG3) on the biological features of bladder cancer cell lines. The plasmids of over-expressed LRIG3 and the blank plasmid serving as control were transfected into the bladder cancer cell lines, T24, EJ and BIU-87, and the expression levels of LRIG3 mRNA and protein were detected by using real-time PCR and Western blotting. The changes in the cell cycle and apoptosis were examined by using flow cytometry. The invasive ability was measured by Transwell assay, and CCK-8 assays were used to measure the proliferation of cells. As compared with the control group, the LRIG3 mRNA and protein expression levels in LRIG3 cDNA-transfected group were raised significantly (P<0.05). The average number of cells with up-regulated LRIG3 passing through the inserted filter was decreased significantly as compared with the control group (P<0.05). Up-regulation of LRIG3 also could inhibit proliferation and induce apoptosis of T24, EJ and BIU-87 cells. Except BIU-87, the T24 and EJ cells transfected with LIRG3 cDNA were arrested in G(0)/G(1) phase compared to the control group (P<0.05). In conclusion, the over-expression of LRIG3 could influence the cell cycle and invasion, inhibit proliferation and induce apoptosis in the three bladder cancer cell lines.

Nosocomial bloodstream infection in patients caused by Staphylococcus aureus: drug susceptibility, outcome, and risk factors for hospital mortality / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Previous studies have different viewpoints about the clinical impact of methicillin resistance on mortality of hospital-acquired bloodstream infection (BSI) patients with Staphylococcus aureus (S. aureus). The objective of this study was to investigate the mortality of hospital-acquired BSI with S. aureus in a military hospital and analyze the risk factors for the hospital mortality.</p><p><b>METHODS</b>A retrospective cohort study was performed in patients admitted to the biggest military tertiary teaching hospital in China between January 2006 and May 2011. All included patients had clinically significant nosocomial BSI with S. aureus. Multivariate Logistic regression analysis was used to identify the risk factors for hospital mortality of patients with S. aureus BSI.</p><p><b>RESULTS</b>One hundred and eighteen patients of more than one year old were identified as clinically and microbiologically confirmed nosocomial bacteraemia due to S. aureus, and 75 out of 118 patients were infected with methicillin-resistant S. aureus (MRSA). The overall mortality of nosocomial S. aureus BSI was 28.0%. Methicillin resistance in S. aureus bacteremia was associated with significant increase in the length of hospitalization and high proportion of inappropriate empirical antibiotic treatment. After Logistic regression analysis, the severity of clinical manifestations (APACHE II score) (odds ratio (OR) 1.22, 95% confidence interval (CI) 1.12 - 1.34) and inadequacy of empirical antimicrobial therapy (OR 0.25, 95%CI 0.09 - 0.69) remained as risk factors for hospital mortality.</p><p><b>CONCLUSIONS</b>Nosocomial S. aureus BSI was associated with high in-hospital mortality. Methicillin resistance in S. aureus has no significant impact on the outcome of patients with staphylococcal bacteremia. Proper empirical antimicrobial therapy is very important to the prognosis.</p>

Screening of differentially expressed genes in the jejunum of rats with idiopathic hyperoxaluria / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Idiopathic hyperoxaluria (IH) may be caused by increased endogenous formation or exogenous absorption of oxalic acid. Characterization of the molecular pathogenesis of IH has been hampered by the lack of an ideal animal model. We therefore established a stabile rat IH model in order to analyze variation in gene expression profile in the jejunum and to investigate the association between IH pathogenesis and exogenous absorption of oxalic acid.</p><p><b>METHODS</b>A rat model of IH was established and three female rats with IH were assigned to the study group, while three normal rats served as controls. Total RNA was isolated from the jejunum of rats in the two groups and mRNA was purified, reversely transcribed, labeled with Cy5 or Cy3 and hybridized to 27K Rat Genome Array. Differences in gene expression profile between the 2 groups were analyzed by bioinformatics methods.</p><p><b>RESULTS</b>Comparative analysis revealed that the expression of 517 genes was up-regulated and that of 203 genes was down-regulated by at least two-fold in the jejunum of rats with idiopathic hyperoxaluria. These genes are related to many functions including cell signal transduction, DNA binding and transcription, ATP binding, ion binding and transport, cell receptors, immunity, cyclins, cytoskeleton structure, and metabolic proteins. Kyoto encyclopedia of genes and genomes (KEGG) signaling pathway analysis revealed that the variations of 239 pathway functional changes are statistically significant (P < 0.05).</p><p><b>CONCLUSIONS</b>cDNA microarray can be used effectively to screen differentially expressed genes in the jejunum of rats with idiopathic hyperoxaluria. These differentially expressed genes may underlie idiopathic hyperoxaluria pathophysiology and provide a platform for further studying molecular pathogenetic mechanisms.</p>

Medium-term follow-up of clinically insignificant residual fragments after minimally invasive percutaneous nephrolithotomy / 中华泌尿外科杂志

Objective To discuss the outcomes of the clinically insignificant residual fragments after minimally invasive percutaneous nephrolithotomy. Methods 75 patients (11％) with CIRF among 655 who underwent initial MPCNL from January 2008 to December 2010 were diagnosed by CT scan.Clinical data of 68 patients (39 male and 29 female) were analyzed retrospectively.Previous open surgery hadbeen performed in 13 and ESWL in 20 cases.The median residual fragment size was 1.8 mm.The anatomical distribution of CIRF was 9 at upper pole,14 at middle,34 at lower,9 at renal ureteropelvic junction and 2 at upper and lower pole.Stone analysis showed 40 cases of calcium oxalate calculi,15 of calcium oxalate calculi mixed with carbonate calculi,2 calcium oxalate calculi mixed with uric acid,3 calcium oxalate calculi mixed with struuvite stone,3 struuvite stone,2 uric acid stone and 3 carbonate apatite mixed with struvite stone.Mean follow up was 23 months (12-36).Follow-up consisted of physical examination,serum routine,urine routine and CT imaging. Results 14(21％) patients (3 upper pole,1 middle pole,4 lower pole and 6 ureteropelvic junction) had symptomatic episodes,including 9 hematuria,2 renal colic pain,5 lower urinary tract symptoms,12 with size of CIRF ＞ 4 rmm.8 patients required surgical procedures.5 patients (1 middle,2 upper pole and 2 renal pelvis) underwent ESWL.3 patients with ureteral CIRF were performed ureteroscopic lithotripsy.The CIRF were clear after surgeries.4 paticnts with CIRF ＞ 4 mm did not have symptoms.These patients were recommended to conservational treatments.2 patients with ureteral CIRF had renal colic pains.The stones were excluded after spasmolytic analgesic treatments.27％ (3/11)CIRF located in upper pole had symptom,compared with 4％ (1/14) in middle pole,11％ (4/36) in lower pole and 67％ (6/9) in ureteropelvic junction. Conclusions CIRF can be located variously in the kidney and ureter.Most CIRF are calcium oxalate calculi and locate in the lower pole.Patients with the history of previous open surgery or SWL are more likely to get CIRF.Medium-term follow-up of CIRF revealed that CIRF located in the renal ureteropelvis junction are more likely to have clinical symptoms.

Relationship between aberrant methylation of FAS promoter and biological behavior of bladder urothelial carcinoma / 华中科技大学学报（医学）（英德文版）

This study examined the promoter methylation of APO-1/CD95 (Fas) gene in bladder urothelial carcinoma and analyzed the relationship between the Fas promoter methylation and the biological behavior of bladder cancer. Promoter methylation of Fas gene was detected by methylation-specific PCR (MSP) in 4 bladder cancer cell lines, 50 human bladder urothelial carcinoma samples and l0 normal bladder tissue samples. Correlation of the aberrant methylation of Fas promoter with the clinicopathological parameters was statistically analyzed. The results showed that Fas was down-regulated at both mRNA and protein level in bladder cancer cell lines and tissue samples of bladder urothelial carcinoma. The positive rate of Fas protein expression in bladder urothelial carcinoma was 34.0% (17/50), significantly lower than that in normal bladder tissues (70.0%, 7/10) (P<0.01). Fas promoter methylation was detected, and the positive rate of Fas promoter methylation in bladder urothelial carcinoma was 42.0% (21/50), which was obviously higher than that in normal bladder tissues (0.0%, 0/10) (P<0.01). The aberrant methylation of Fas promoter was reversely correlated with Fas protein expression (P<0.05). Furthermore, the positive rates of Fas promoter methylation in high-grade and low-grade bladder urothelial carcinoma were 73.3% (11/15) and 34.2% (12/35), respectively, with significant difference shown (P<0.05). No statistical significance was found in the Fas promoter methylation among different clinical stages of bladder cancer. It was concluded that Fas promoter hypermethylation plays an important role in the pathogenesis of bladder urothelial carcinoma and may serve as a prognostic indicator of bladder urothelial carcinoma.

Genotyping on 47 Staphylococcus aureus strains associated with bloodstream infection / 中华流行病学杂志

Objective To investigate the molecular epidemiological characteristics of Staphylococcus aureus associated with bloodstream infection in hospital. Methods 47 Staphylococcus aureus strains isolated from bloodstream in PLA General Hospital were collected from January 2006 to December 2008. Susceptibility of the strains to 11 antimicrobial agents was detected and DNA homology of them was analyzed with Rep-based DiversiLab~(TM) Microbial Typing System. Panton-Valentine leukocidin (PVL)gene was determined by PCR. For methicillin-resistant Staphylococcus aureus (MRSA) strains,the genotypes of SCCmec were determined and ST239 clone was screened with multiplex PCR. Multilocus sequence typing (MLST) was used to determine the STs of the selected isolates. Results In the 47 Staphylococcus aureus isolated from blood,methicillin-resistant strains accounted for 51.1%,all belonged to SCCmec Ⅲ type,with only 2 pvl gene positive strains identified. 12 different patterns (A-L) were found among 47 strains with Rep-PCR. All MRSA strains clustered in the A and B subtypes. Conclusion Most MRSA strains isolated from blood in PLA General Hospital belonged to ST239-MRSA-SCCmec Ⅲ clone. DiversiLab~(TM) Microbial Typing System could provide a rapid and effective method to investigate the molecular epidemiological characteristics of Staphylococcus aureus in the hospital settings.

Quantitative PCR for diagnosis of invasive fungal infections in patients with hematologic malignancies / 中国实验血液学杂志

This study was aimed to establish the method of quantitative PCR (q-PCR) of fungi in peripheral blood for diagnosis of invasive fungal infections in patients with hematologic malignancies, and to preliminarily assess the diagnostic value of this method. The 18S rDNA-ITS1 area of high consensus sequence of fungi was selected to design primer and probe, the DNA of fungal species was extracted and q-PCR was performed to evaluate the sensitivity and specificity of the primer and probe. The standard product of fungal DNA was prepared by using pGEM-T plasmid and the fungal DNA in blood of patients was quantitatively detected. The results showed that the positive was found in 12 Aspergillus and 14 Candida species according to q-PCR detection, while there was no significant difference of fungal distribution between plasma, mononuclear cells and leukocytes (p<0.05). Receiver-operating characteristic analysis of q-PCR showed that the cut-off value for clinical diagnosis of invasive fungal infection was 8 copies/ml whole blood, its sensitivity, specificity, positive and negative predictive value and kappa were 0.84, 0.9, 0.955, 0.692 and 0.679 respectively. It is concluded that the fungal q-PCR assay may be used as an early diagnostic method for invasive fungal infections in patients with hematologic malignancies.

Colloidal gold and dot-ELISA rapid tests for screening influenza A virus / 南方医科大学学报

<p><b>OBJECTIVE</b>To evaluate the diagnostic efficiency of colloidal gold and dot ELISA rapid tests in clinical screening of influenza A virus.</p><p><b>METHODS</b>The pharyngeal swabs were collected from 297 outpatients suspected of influenza between June and October, 2009 for detection with colloid gold and dot ELISA rapid test, with real-time PCR as the golden methods. The discrepant results of colloid gold and dot ELISA methods were confirmed by sequencing, and the diagnostic efficiency of the two methods was evaluated.</p><p><b>RESULTS</b>Among the 166 samples with influenza A virus infection as confirmed by real-time PCR and sequencing, the diagnostic sensitivity of dot ELISA and colloid gold methods was 54.82% (91/166) and 4.22% (7/166), respectively. The total concordance rate with PCR was 66.67% (Kappa value of 0.35). Among the 133 samples negative for influenza A virus, the specificity of dot ELISA and colloid gold methods was 81.68% (107/131) and 98.47% (129/131), respectively, with a total concordance rate with PCR of 45.79% (Kappa value 0.02). Of the 99 H1N1 influenza samples confirmed by real-time PCR, the detection rate of dot ELISA was 67.3%, whereas that of colloid gold was 5.1%. Out of the 107 dot ELISA-positive but colloid gold-negative samples, 84 were confirmed to be influenza A virus-positive by real-time PCR and sequencing. One sample negative for dot ELISA but positive for colloid gold test was confirmed to be influenza A virus-negative. The detection rate and diagnostic concordance rate for influenza A virus by dot ELISA were significantly higher than those of colloid gold (P<0.05).</p><p><b>CONCLUSION</b>Dot ELISA is better than colloid gold in influenza A virus detection and shows great prospect in clinical screening.</p>

Expression profile in the liver of rats with idiopathic hyperoxaluria / 中华泌尿外科杂志

Objective To investigate differentially expressed genes in the liver of rats with idio-pathic hyperoxaluria by cDNA microarray. Methods Three male rats with idiopathic hyperoxaluria were set as study group, 3 normal ones as control. Total RNA was isolated by one-step protocol from the liver of rats in the 2 groups and mRNA was purified, reversely transcribed, labeled with Cy3 or Cy5 and hybridized to gene chip containing 26 962 target genes of rat. The differences in gene expres-sion profile between the 2 groups were analyzed by bioinformatics methods. Results Comparative a-nalysis revealed that the expression of 123 genes was up-regulated and 24 genes was down-regulated by two-fold in the liver. These genes were associated with cell receptor, immune, cell signal transduc-tion, amino acid metabolism, protein translation, cell proliferation and others. Conclusion cDNA microarray could be used effectively to screen differentially expressed genes in the liver of rats with idi-opathic hyperoxaluria in which many different kinds of genes were involved.

Effects of nanosized titanium dioxide on the reproductive system of male mice / 中华男科学杂志

<p><b>OBJECTIVE</b>To investigate the in vivo effects of nanosized titanium dioxide (TiO2) on the main organs, particularly the reproductive system, of male mice.</p><p><b>METHODS</b>Forty-five male ICR mice aged 6 weeks were equally and randomly divided into 2 experimental groups and a control group, intraperitoneally injected with 200 and 500 mg/kg nanosized TiO2 and equal volume of saline, respectively, every other day for 5 times. One week after drug cessation, we obtained the coefficients of the main organs, serum biochemical parameters and the levels of gonadal hormones (T and E2), analyzed the pathological changes of the main organs by HE staining, observed sperm count, motility and abnormality under the microscope, and detected germ cell apoptosis by TUNEL.</p><p><b>RESULTS</b>Compared with the control, the low-dose (200 mg/kg) group showed no significant changes in the above parameters, while the high-dose (500 mg/kg) group exhibited a decrease in the coefficients of the liver, heart and kidneys, and a significant increase in such serum biochemical parameters as ALT, ALT/AST and BUN (P < 0.05). The high-dose group also showed significantly reduced sperm density and motility, increased sperm abnormality and germ cell apoptosis (P < 0.05), but no obvious pathological changes in the liver, kidney spleen, testis and epididymis.</p><p><b>CONCLUSION</b>Low-dose nanosized TiO2 has no obvious effect on male mice, but high-dose may significantly reduce their sperm count and function and induce germ cell apoptosis, although its damage on the liver and kidney function is slight.</p>

Current approaches to diagnosis and treatment of invasive fungal infection in HSCT recipients / 中国实验血液学杂志

Invasive fungal infections (IFI) are a kind of the most severe complications after hematopoietic stem cell transplantation (HSCT), Candida and Aspergillus are common causes. Because of immunosuppressive therapy, ablative conditioning regimen, acute or chronic graft-versus-host disease, long-term treatment of broad-spectrum antibiotics and cytomegalovirus infection, IFI has increased in the past few years. Invasive mould infection is a major cause of morbidity and mortality in HSCT recipients. Methods for early diagnosis of IFI include clinical and laboratory examinations, as well as characteristic radiography. Voriconazole is the first-line antifungal agent for prevention of IFI. Combination therapy of two antifungal compounds such as azoles or amphotericin B with echinocandins have shown a good effectiveness and may be a promising future strategy for antifungal treatment. In this review, the early diagnosis and treatment of IFI in HSCT recipients are summarized. As for early diagnosis of IFI, the laboratory diagnosis techniques such as GM test, G test and PCR techniques are discussed. As for prophylaxis and treatment of IFI, the prophylaxis treatment, empirical treatment, preemptive treatment, targeted treatment, combined treatment and immunologic treatment are discussed.

Study on the molecular characteristics of multidrug-resistant Acinetobacter baumannii / 中华流行病学杂志

Objecfive To investigate antibiotic resistance,carbapenemase genotype and the molecular epidemiology of multidrug-resistant Acinetobacter baumannii (Aba) collected from 3 military hospitals in China.Methotis The minimum inhibitory concentrations (MIC) were examined by ager dilution method.Genotypes of carbapenemases were amplified by multiplex PCR and its products were sequenced.PCR was used to detect per gene,Homology of the resistant isolates was analyzed by pulse-field gel electrophoresis(PFGE).Results Among the 64 MDRA strains,78.1%(50)strains possessed blaOXA-23 gene,89.1%(57) carried Class 1 integrase gene,39.1% (25) with blaPER-1 gene,and 1 strain with blaOXA-58-like gene.PFGE showed that 13(A,B,C,D,E genotype) different clones were identified in these strains.A,B,and U clones were the predominant clones in three hospitals,respectitively.Conclusion OutbreaEs of muitidrug-rcsistant Aba occurred at 3 military hospitals with the most prevalent carbapenemase as OXA-23 enzyme.OXA-58 type of carbapenemase and per-1 in Aba were also isolated.

Transmission and molecular characteristics of carbapenem-resistant Acinetobacter baumannii / 中华流行病学杂志

<p><b>OBJECTIVE</b>To study the mode of transmission and molecular characteristics on carbapenem-resistant Acinetobacter baumannii strain. Strains were isolated from different parts of samples in various patients.</p><p><b>METHODS</b>Clinical information of carbapenem-resistant Acinetobacter baumannii isolates were stored and analyzed by WHONET 5.4 software. The transmission and pathopoiesis of the strains were learned through case file review. Genotypes of isolates were identified by pulse-field gel electrophoresis (PFGE) and genes of carbapenemase were detected by multiple PCR, in order to find molecular characteristics and relatedness between strains.</p><p><b>RESULTS</b>29 stains of Acinetobacter baumannii resistant to carbapenem were isolated from 2 or more kinds of samples among 13 patients'. Two genotypes were identified by PFGE: genotype A was obtained from 22 isolates in 11 patients and genotype B was obtained from 7 isolates in 4 patients. PCR amplification showed that all strains possessed OXA-23 gene except 1, and all strains possessed Integrase gene I except 3.</p><p><b>CONCLUSION</b>There were 2 different genotypes from 29 strains of carbapenem-resistant Acinetobacter baumannii with Genotype A as the main type. OXA-23 carbapenemase gene and integrase gene I were detected from most of the isolates. All the strains could be easily transmitted in the body of the patients and among patients, hence becoming the epidemic pathogen of iatrogenic infection.</p>

Study on CMY-2 AmpC ?-lactamase mediated by plasmid in Escherichia coli / 中华检验医学杂志

Objective To study the AmpC beta-lactarnase and its genotype mediated by plasmid in Escherichia coli.Methods AmpC beta-lactamase was detected based on that AmpC beta-laetamase can be inhibited by 3-aminophenylboronic acid(APB).MIC was ehecked by agar dilution method.Conjugation test was used to check the transfer of ampC gene.Gene chip and PCR were used to detect ampC gene.The amplified ampC gene were sequenced and analyzed by EMBOSS software.The molecular epidemiology of clinical isolates was investigated by Enterbacterial repetitive intergenic consensus(ERIC)typing method.Results In 74 strains of Escherichia coli insusceptible to cefoxtin,AmpC beta-lactamase was positive in 33 strains.8 strains possessed AmpC beta-lactamase of CIT group by gene chip and 8 transconjugants were obtained by conjugation test.CMY type ampC gene could be further amplified by specific CMY gene primers from both 8 clinical isolates of E.coli and plasmids extracted from 8 transconjugants.CMY-2 type ampC gene was found by sequencing(accession number DQ823449).The most transconjugants displayed similar MIC value(intermediate or resistant).ERIC genotyping showed 6 out of 8 isolates with CMY-2 ampC gene derived from different resource.Conclusion CMY-2 AmpC beta- lactamase mediated by plasmid could be detected in E.coli isolates from patients in the General Hospital of People Liberation Army,Beijing.The plasmid carried ampC gene could mediate multi-drug resistance.

Detection of antifungal agent activity against the filamentous fungi by Etest / 中华检验医学杂志

Objective To investigate the susceptibility of amphotericin B,itroconazol and voriconazole against filamentous fungi.Methods Etest was used to determine the MIC of amphotericin B, itroconazol and voriconazole against filamentous fungi including Aspergillus,Penicillium,Alternaria alternate,Mucor and Rhizopus species.Results The average MIC of voriconazol,amphotericin B and itroconazol against Aspergillus fumiagtus is O.29 ?g/ml,1.16 ?g/ml and 5.88 ?g/ml;the average MIC of amphotericin B and voriconazol to Aspergillus flavus is 6.39 ?g/ml and 0.22 ?g/ml;the average MIC of voriconazol,amphotericin B and itroconazol against Aspergillus niger is 0.69,2.31,and 19.75 ?g/ ml.Most of Penicillium are susceptable to amphotericin B,but 3 strains showed very high MIC to voriconazol and itroconazol.Both of the testing strains of Mucor and Rhizopus were resistant to all of the three antifungal agents.Conclusion Amphotericin B,itroconazol and voriconazole possessed different susceptibility on different types of filamentous fungi.It is important for clinical laboratories to identify the filamentous fungi to the level of genus and species to help physicians choose antifungal agents correctly.

Antibiotic resistance phenotypes and genotypes of ESBLs and AmpC ?-lactamases from Klebsiella oxytoca / 中华检验医学杂志

Objective To study antibiotic resistance phenotypes and genotypes of extended spectrum ?-lactamases (ESBLs) and AmpC ?-lactamase-producing Klebsiella oxytoca isolated from specimens of respiratory tract in children.Methods Bacterial isolates were identified by API or VITEK32. Agar dilution was used for antibiotic susceptibility test,and ESBLs and AmpC were detected by confirmatory test recommended by CLSI/NCCLS and by 3-aminophenylboronic acid (APB) disk potentiation test, respectively.Microarray was used to determine the genotypes of ESBLs and AmpC ?-lactamases.Genotypes of Klebsiella oxytoca were determined by enterobacterial repetitive intergenic consensus (ERIC)- PCR.Results ESBLs were positive in 129 out of 165 isolates (78.2%).Both ESBLs and AmpC ?- lactamases were positive in 16 out of 165 isolates (9.7%).AmpC ?-lactamase alone producer was not detected in term of phenotype and genotype.CTX-M was the most common type of ESBLs and DHA was the only type of AmpC ?-lactamase in these isolates.Most antibiotic resistant strains of Klebsiella oxytoca possessed the same genotype by ERIC-PCR.Although all strains were susceptible to carbpenem,Klebsiella oxytoca with ?-lactamases were more resistant to other antibiotic agents than those without ?- lactamases.Conclusions There is high prevalence of ESBLs production among Klebsiella oxytoca isolated from children in Urumqi.The main genotypes of ESBLs and AmpC ?-lactamases are CTX-M and DHA.