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Objective:To evaluate the efficacy of glucocorticoid sinus stents implanted 2 weeks after functional endoscopic sinus surgery（FESS） for the treatment of chronic rhinosinusitis with nasal polyps（CRSwNP）. Methods:CRSwNP patients with similar bilateral lesions were randomly divided into two groups, with a stent group of 25 patients and a control group of 24 patients. Patients in the stent group had glucocorticoid sinus stents implanted into the bilateral ethmoid sinuses 2 weeks after FESS, while the control group underwent postoperative debridement only. Follow-up assessments occurred at postoperative weeks 2, 4, 8, and 12. Patients were asked to assess their sensation of nasal symptoms using a 10-point visual analog scale. Efficacy was assessed by endoscopic evaluations. Sinus obstruction, crusting/coagulation, polyp formation, middle turbinate position, adhesions, mucosa epithelialization, and postoperative intervention were assessed as efficacy outcomes. GraphPad Prism 9 was applied for statistical analysis. Results:At 4 and 8 weeks postoperatively, the stent group showed significant improvement in VAS scores of nasal congestion and runny nose compared with the control group（P<0.05）. No significant difference was observed in the VAS scores of head and facial stuffiness, loss of smell, or nasal dryness/crusting between the two groups（P>0.05）. Compared with the control group, the stent group had a lower rate of polypoid formation at 4, 8, and 12 weeks postoperatively. At postoperative week 12, the rate of mucosal epithelialization in the ethmoid cavity was significantly higher in the stent group. During the follow-up, the frequency of postoperative intervention was significantly lower in the stent group than in the control group（P<0.05）. Besides, a lower incidence of middle turbinate lateralization was found in the stent group at 8 and 12 weeks postoperatively. At 8 weeks postoperatively, the stent group had a percentage of adhesion lower than that of the control group（all P<0.05）. Conclusion:Implantation of glucocorticoid sinus stents after FESS can maintain sinus cavity patency, improve the inflammatory status of the operative cavity, reduce postoperative interventions, and promote benign regression of the operative cavity.
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Humans , Nasal Polyps/surgery , Ethmoid Sinus/surgery , Glucocorticoids/therapeutic use , Rhinitis/surgery , Sinusitis/surgery , Paranasal Sinuses/surgery , Endoscopy , Stents , Chronic Disease , Treatment OutcomeABSTRACT
Objective To evaluate the effect of matrix-assisted laser desorption ionization-time of flight mass spectrometry (MALDI-TOF MS)on the detection of carbapenemase producing enterobacteriaceae. Methods A total of 21 carbapenem non-susceptible enterobacteriaceaeclinical strains were collectedfrom the Second Affiliated Hospital of Soochow University during January to May, 2018, including 11 strains of Klebsiella pneumonia, 3 strains of Klebsiella oxytoca, 3 strains of Enterobacter cloacae, and 4 strains of Escherichia coli. All the isolates were incubated with 0.5g/L meropenem solution for 2 hours. The supernatant was centrifuged and collected for MALDI-TOF MS detection. The characteristic peaks were captured to determin whether the strain was producing carbapenemase or not. And then, the results were compared with PCR results by Kappastatistical analysis. Results The PCR results showed that all the strains were positive for carbapenmase genes, among them 15 isolates were encoding KPC genes, 6 isolates encoding GES genes, 2 isolates encoding NDM genes, 1 isolate encoding VIM genes, 4 isolates encoding GIM and 1 isolate encoding SIM. And the strains could carry one or more carbapem-resistant determinants. MALDI-TOF MS showed that meropenem were hydrolyzed by 21 isolates and a characteristic drug hydrolysis peak appeared at 199 m/z, as a result of carbapenemase produced by enterobacteriaceae. The assay of MALDI-TOF MS was highly consistentwith PCR results. Conclusions The investigation showed that MALDI-TOF MS can directly detect the carbapenemase by capture the characteristic drug hydrolysis peak.
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Objective To develop a rapid and accurate technique for pathogens identification from positive blood cultures by matrix-assisted laser desorption ionization-time of flight mass spectrometry ( MALDI-TOF MS) .Methods A total of 266 culture-positive blood samples from clinical laboratory in the Second Affiliated Hospital of Soochow University during January to July 2015 were collected.The blood was transferred into separation-gel tubes, and the bacteria were enriched and purified by differential centrifugation.MALDI-TOF MS was applied to identify the bacteria and the results were compared with conventional bacterial culture. Results Among 266 culture-positive blood samples, 260 were monomicrobial cultures and 6 were polymicrobial cultures.Of 260 monomicrobial cultures, 98.8% (257/260) and 96.2% ( 250/260 ) of organisms were identified at the genus level and the species level, respectively.Of 140 Gram-negative bacterial isolates, 99.3% (139/140) and 97.9% (137/140) were identified at the genus level and the species level, respectively.Of 120 Gram-positive bacteria isolates, 98.3%(118/120) and 94.2% (113/120) were identified at the genus level and the species level, respectively.None of the 6 polymicrobial cultures were identified.Conclusion MALDI-TOF MS can directly identify the bacteria from positive blood cultures, which provides a rapid and accurate method for the diagnosis of bloodstream infection.
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Objective To analyze hemolysin and virulence -related genes in incomplete hemolytic Staphylococcus aureus.Methods Fifty strains of incomplete hemolytic Staphylococcus aureus were isolated from patients admitted in the Second Affiliated Hospital of Soochow University during 2013 and 2014, and the isolates with complete hemolytic phenotype were also collected at the same period as the control strains . All the strains were inoculated and subcultured on four kinds of sheep blood agar plates supplied by different manufacturers to compare their hemolytic phenotype .The relative mRNA expressions of hemolysin genes (hla, hlb, hlc, hld) in standard strain, complete and incomplete hemolytic phenotype strains were detected by real-time quantitative polymerase chain reaction (RT-qPCR), and valued by 2 -△△Ct method.t test was used to compare mRNA expressions of hemolysin genes .Western blot was performed to analyze the expression of α-hemolysin.Antibiotic susceptibility test of incomplete hemolytic strains was performed using broth microdilution method.Resistant gene mecA and virulence genes pvl, tst were detected by PCR.Results The steady and hereditary incomplete hemolysis was observed in 50 strains of incomplete hemolytic Staphylococcus aureus on the sheep blood agar plates from different suppliers .Taking mRNA expression of hla, hlb, hlc, hld in standard strain as 1, the relative mRNA expressions of hemolysin genes in incomplete hemolytic strains were 0.02, 7.51, 0.06 and 0.12 respectively, there were statistical differences between standard strain and incomplete hemolytic strains (t =8.46, -56.40, 8.12 and 7.61, all P <0.05).And the expression of α-hemolysin was decreased in incomplete hemolytic strains .All the strains were identified as methicillin resistant Staphylococcus aureus (MRSA).Three strains exhibited different minimum inhibitory concentrations of teicoplanin and linezolid after subcultured , but the differences had no impact on the final results of antibiotic susceptibility test .mecA, pvl and tst genes were positive in incomplete hemolytic strains . Conclusion Staphylococcus aureus with incomplete hemolytic phenotype is methicillin resistant with higher expression of β-hemolysin and lower expressions of α-hemolysin, γ-hemolysin and δ-hemolysin.It carries plv and tst virulence genes and is of high virulence .
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Objective To investigate the biological characteristics of rpoS gene deleted mutation in Salmonella typhi under different stress conditions,so as to explore the target gene for the prevention and treament of Salmonella typhi infection.Methods rpoS gene deleted mutant of Salmonella typhi was prepared by homologious recombination.rpoS mutant and parental strains were incubated under iso-osmia and various stress conditions:acid stress(pH 4.2),high osmolarity stress(NaCl 300 mmol/L),bile stress (1.5 mmol/L sodiumdeoxycbolate)and oxidative stress(1 mmol/L H2O2).The growth curves were compared between mutant and parental strains under different incubation conditions(t test).Results rpoS gene deleted mutant of Salmonella typhi Was successfully generated.Compared with the parental strain,the survival ability of rpoS mutant was significantly compromised under the acid stress,high osmolarity stress and oxidative stress(t values at4 h were 12.864,3.594 and 12.979;t values at 14 h were6.497,3.039 and 10.440,P<0.05 or<0.01).Conclusion rpoS is important for Salmonella typhi to overcome the acid,high osmolarity and oxidative stresses,and it may be a target gene for the prevention and treatment of Salmonella typhi infection.
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OBJECTIVE To investigate the existence of genes for beta-lactam antibiotic resistance and for aminoglycosides modification enzymes(AMEs) in Pseudomonas aeruginosa(PAE) isolates from ICU patients and analyze the homology among strains.METHODS ?-Lactamase genes including TEM,SHV,OXA-10,PER,VEB,GES,CARB,IMP,VIM,SPM,GIM,DHA,FOX,MOX and oprD2,were detected by PCR amplication in 21 PAE isolates.The genes for AMES including aac(3)-Ⅰ,aac(3)-Ⅱ,aac(6′)-Ⅰ,aac(6′)-Ⅱ,ant(3″)-Ⅰ and ant(2″)-Ⅰwere determined by PCR amplification as well.RESULTS Among 21 isolates 21(100%),2(9.5%),1(4.8%),2(9.5%)and 4(19.0%) were positive for TEM,SHV,GES,CARB and VIM genes,respectively.The deletion of oprD2 gene was found in 14 out of 21 strains.Other ?-lactamase genes were absent in all isolates.As for AME genes,aac(3)-Ⅱ,aac(6″)-Ⅰ,aac(6)-Ⅱ,ant(3″)-Ⅰ,ant(2″)-Ⅰ and aac(3)-Ⅰgenes were present in 19.0%,23.8%,9.5%,4.8%,and 19.0% of 21 isolates,However,aac(3)-Ⅰ gene was no position in any isolates.CONCLUSIONS P.aeruginosa carries various beta-lactamase and AME genes in ICU patients.Genetic cluster analysis suggested that clonal propagation result in nosocomial infection of PAE.
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OBJECTIVE To investigate incidence and drug susceptibility of Helicobacter pylori(Hp) in local area.METHODS Strains of Hp were isolated and cultivated from gastric antrum mucosa of 141 peptic ulcer disease(PUD) patients diagnosed by gastroscope.The drug sensitive test of Hp strains was examined by K-B method.RESULTS The isolation rate of Hp in 141 PUD patients was 75.2%.Hp isolates showed a relative hypersensitivity to clinical commonly used drugs(ie furazolidone,amoxicillin,levofloxacin,cefuroxime and moxifloxacin).On the other hand,Hp isolates exhibited resistance to metronidazole and clarithromycin.CONCLUSIONS Hp is an important etiologic factor of PUD,and showing an increasing resistance to common clinical antibiotics.
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OBJECTIVE To investigate genes associated with the drug-resistance of ?-lactam antibiotics in Pseudomonas aeruginosa(PAE) isolated from clinical patients. METHODS ?-Lactamase genes including TEM,SHV,OXA-10,PER,VEB,GES,CARB,IMP,VIM,SPM,GIM,DHA,FOX,MOX and oprD2 were detected by PCR amplification in 33 PAE isolates. RESULTS TEM,SHV,GES,CARB and VIM genes were positive in 100%,6.1%,6.1%,9.1% and 12.1% of 33 isolates,respectively.The deletion of oprD2 gene was found in 22 isolates.Other ?-lactamase genes were absent in all isolates.By PCR amplification,DNA sequencing and BLASTn comparison analysis,the CARB genes of 2 strains were demonstrated to be CARB-3 and the VIM genes of 2 strains were VIM-2. CONCLUSIONS P.aeruginosa carries various beta-lactamase genes in clinical PAE patients,and the deletion ratio of oprD2 gene is high.
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OBJECTIVE To investigate genes associated with aminoglycosides modification enzymes(AMEs) in Pseudomonas aeruginosa(PAE) isolated from ICU patients.METHODS Drug-reisistant genes encoding AMEs such as aac(3)-Ⅰ,aac(3)-Ⅱ,aac(6′)-Ⅰ,aac(6′)-Ⅱ,ant(3″)-Ⅰ and ant(2″)-Ⅰ were detected by polymerase chain reaction(PCR)(amplification) in 21 PAE isolates.RESULTS The positive rates of aac(3)-Ⅱ,aac(6′)-Ⅰ,aac(6′)-Ⅱ,ant(3″)-Ⅰ,ant(2″)-Ⅰ and aac(3)-Ⅰ genes were positive in 19.0%,23.8%,9.5%,4.8%,19.0% and 0% of 21 isolates,respectively. Drug-resistant genes encoding AMEs were detected positively in 42.8% of 21 isolates.(CONCLUSIONS) AMEs genes are present in high percentage of PAE isolated from ICU patients.