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Objective:To report cases of multiple mitochondrial dysfunction syndrome 2 (MMDS2) caused by BOLA3 gene mutation, hoping to help clinical diagnosis. Methods:The medical records of a child with MMDS2 admitted to the Department of Neurology, Guangzhou Women and Children′s Medical Center in November 2021 were analyzed, and the clinical, imaging characteristics and prognosis of MMDS2 were summarized by literature review.Results:This 1 year and 9 months old male had a disease that started in childhood, with motor function regression and hyperlactatemia. Head magnetic resonance imaging indicated white matter lesions, and gene examination indicated the homozygous variation of BOLA3 gene c.295C>T(p.Arg99Trp). The diagnosis of MMDS2 was clear for the child. After treatment, the clinical symptoms and imaging of the child recovered significantly. Through literature review, 13 children with MMDS2 reported in 7 English literatures were reviewed. These cases had similar manifestations with the case reported in this study. Among them, 1 case recovered and 8 cases died in infancy. Conclusions:MMDS2 patients often show nervous system dysfunction such as motor regression, elevated lactate and white matter lesions, which often cause multiple system disorders. Some children die early, but some of them can be recovered.
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Objective:To analyze the characteristics of drug resistance genes in a Klebsiella pneumoniae strain coproducing carbapenemases KPC-2 and NDM-5. Methods:Klebsiella pneumoniae KPN-hnqyy was separated from the stool specimen of a patient in the Hematology Department of Affiliated Cancer Hospital of Zhengzhou University. The strain was identified with a BD Phenix-M50 automated microbiology system and the minimum inhibitory concentration against the strain was measured as well. The genotypes of the carbapenemases were tested by enzyme immunochromatographic assay and PCR method. The transferability of related plasmids was analyzed by conjugation test. Whole-genome sequencing of the strain was conducted using PacBio and Illumina platforms. The MLST type, resistance gene and plasmid type of the strain were retrieved in BacWGSTdb. The genome and open reading frame sequence of the strain were compared using Easyfig_2.2.3. Visual cycle graphs were generated using BRIG v0.95. Results:Klebsiella pneumoniae KPN-hnqyy was resistant to carbapenem antibiotics. It belonged to ST11 and carried two carbapenemase genes of blaKPC-2 and blaNDM-5. The conjugant only harbored the blaKPC-2 gene. Whole-genome sequencing revealed that the strain contained one chromosome and three plasmids. Its chromosome genome shared more than 99.9% similarity with that of Klebsiella pneumonia KP69 and KP19-2029. Moreover, a similar IncR and IncFⅠ resistance gene fusion region was contained in different types of plasmids carried by them: the blaKPC-2 gene was located in a structure—which evolved from the Tn3-△Tn4401-Tn1721/Tn1722 sequence—inside this fusion region with its ends inserted into the transposase IS26 gene; the blaNDM-5 gene was located on a transposon containing the special plasmids of the insertion fragment in phages, with its ends inserted into the transposase IS26 gene too. Conclusions:The IncR and IncFⅡ resistance gene fusion region of blaKPC-2 carried by Klebsiella pneumoniae ST11 might be widely coexistent with the chromosomal genome. The blaNDM-5 gene carried by special plasmids might be accidentally obtained through gene recombination mediated by transposable element IS26. The wide transmission of Klebsiella pneumoniae ST11 carrying the blaKPC-2 gene in China and its ability to obtain other carbapenemase genes through transposable element IS26 were well worth attention.
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Objective:To analyze the characteristics of plasmids in KPC-2-producing Serratia marcescens ( S. marcescens) isolates. Methods:Four carbapenem-resistant S. marcescens strains were isolated from four patients admitted to the hepatobiliary ward of Affiliated Cancer Hospital of Zhengzhou University in 2016. BD Phenix-100 was used to identify the strains and detect the minimum inhibitory concentrations (MICs). Homology analysis was performed using pulsed-field gel electrophoresis (PFGE). The modified Hodge test was used to detect the phenotypes of carbapenemase. PCR and gene sequencing were used to detect the types of carbapenem resistance genes. The transferability of plasmids was detected by conjugation test. The characteristics of plasmids were analyzed by genomic alignment method after whole genome sequencing. DNAMAN V9 software was used to compare the amino acid sequences of the replication initiation proteins. A phylogenetic tree was constructed with neighbor-joining method using MEGA7.0. Results:All of the four S. marcescens strains were resistant to carbapenem antibiotics. They were highly homologous according to PFGE. Hodge test results were all positive and the carbapenemase genotype was blaKPC-2. Conjugation test results were positive. The plasmid was a circular DNA of 42 742 bp in length. It had the similar skeleton of incX6 plasmid and the similar amino acid sequence of replication initiation protein. Moreover, it and incX6 plasmid were at the same node in the phylogenetic tree. The blaKPC-2 was located in the core of drug resistance, which was composed of insertion elements including Tn3 family transposons, recombinant enzyme genes, △ISKpn6 and ISKpn27. Conclusions:The plasmid was incX6-like. The blaKPC-2 gene was located in the transposon of △Tn6296. More attention should be paid to the bacteria carrying KPC-2 in incX plasmids.
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Objects: To clarify the risk factors of candidemia and to assess the clinical differences that may exist between infection with Candida parapsilosis and that with other Candida species in cancer patients. To statistically analyze the clinical characteristics of Candi-da albicans candidemia and C. parapsilosis candidemia and risk factors for their infections. We aimed at a timely intervention through this type of analysis to avoid susceptible factors and improve the prognosis of patients with candidemia. Methods: We retrospectively included 323 patients with candidemia in Affiliated Cancer Hospital of Zhengzhou University between March 2012 and February 2018 and analyzed the clinical characteristics of these patients to establish the risk factors of candidemia. We performed a comparative anal-ysis of the clinical characteristics of C. parapsilosis infections and non-parapsilosis Candida spp. infections and of C. albicans infections and non-albicans Candida spp. infections. In addition, drug sensitivity tests and analyses were performed with the common antifungal drugs used in Candida infections by a micro-broth dilution method. The statistical software SPSS version 22 was used for the analyses. Results: A total of 323 patients were enrolled and analyzed in this study. Of the isolates, 34.37% were C. albicans and 65.63% were non-albicans Candida spp. Multivariate regression analysis showed that the following factors were associated with the occurrence of C. parapsilosis candidemia: parenteral nutrition (P<0.001), neutropenia (P<0.001), history of receiving chemotherapy (P=0.002), and history of previous antifungal use (P<0.001). Parenteral nutrition was found to be an independent risk factor for C. albicans candi-demia (OR=0.183; 95%CI:0.098?0.340; P<0.001). Conclusions: C. parapsilosis was found to be the primary pathogen in cancer patients with candidemia. Total parenteral nutrition in the intensive care unit at diagnosis and abdominal surgery were independent risk factors of candidemia, and parenteral nutrition was an independent risk factor of C. parapsilosis candidemia. At present, C. parapsilosis is sur-passing C. albicans as the main pathogen of candidemia in cancer patients at our hospital. This study emphasizes the need to assess the possible risk factors for candidemia in cancer patients and aims at strengthening and developing a hospital-based control strategy to prevent the spread of candidemia.
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Objective To investigate the normal development of anterior and posterior acetabulum in children through measuring anterior and posterior acetabular indexes with the baseline from the thinnest point of acetabulum to the center of femoral head.Methods MRI data in 165 normal children aged 0-12 years were collected.The baselines were drawn from the center of the femoral head to the thinnest point of acetabulum (method 1) and from the one midpoint of Y cartilage to the contralateral (method 2),then the anterior or posterior bony acetabular index (A/PBAI) and anterior or posterior cartilaginous acetabular indexes (A/PCAI) were measured.The consistency of above parameters measured using two methods and between two observers was observed,and the correlation with parameters-gestational ages was analyzed.Results The consistency of ABAI (ICC=0.832) measured with two methods was good,and the consistency of ACAI (ICC=0.535),PBAI (ICC=0.565) and PCAI (ICC=0.472) was fair.The consistency between two observers was good (all ICC＞0.75).ABAI,ACAI and PBAI were negatively correlated with age (r=-0.762,-0.475,-0.368,all P＜0.001),and PCAI had no correlation with age (r=-0.190,P＜0.005).Before 4 years old,ABAI gradually decreased with age and gradually stabilized after 4 years of age.ACAI and PBAI decreased slightly with aging.PCAI did not change obviously with aging.Conclusion The measuring method of anterior and posterior acetabular indexes with the baseline from the thinnest point of acetabulum to the center of femoral head can accurately evaluate the normal development of anterior and posterior acetabulum in children.
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Objective To explore the diagnostic value of MSCT in tumors of intra-abdominal cryptorchidism in children.Methods MSCT findings of 8 children with tumors of intra-abdominal cryptorchidism confirmed by surgery and pathology were analyzed retrospectively.Results Six tumors located in the right,2 (1 tumor of left cryptorchidism turned to the right abdominal) in the left.Eight children showed ovoid soft tissue tumor in abdomen.Three children displayed the long axis of the tumors consistent with regular descending course of embryonic testes.Six teratomas manifested as the cystic and solid mass with fat,calcification (ossification) insidey.Two yolk sac tumors manifested as the large cystic and solid mass with irregular necrosis and abundant tumor vessels.Conclusion The pathologic types of tumors for intra-abdominal cryptorchidism in children are different from adult.Most of them are teratomas or yolk sac tumors,and have some characteristics in MSCT.MSCT is helpful in diagnosis of tumor for intra-abdominal cryptorchidism with medical history.
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Objective To study plasmid-mediated transfer,plasmid replicon typing,and genetic environment of blaNDM-1 gene in Enterobacteraerogenes(E.aerogenes).Methods E.aerogenes HN-NDM0711 was used as the subject of this research,the transferable properties of plasmid were analyzed by conjugation testing,conjugant was performed stability testing,plasmid type was determined by PCR-based replicon typing (PBRT),downstream and upstream of blaNDM-1 were sequenced using chromosome walking method,genetic context was analyzed by BLASTN and BALSTP,as well as annotated using Vector NTI 11.5.1 software,sequence pipeline graph was made,the sequence was submitted to Genbank through software Banklt.Results The conjugation testing of E.aerogenes pHN-NDM0711 was positive,after positive conjugant was conducted 4-day passage,minimal inhibitory concentrations (MICs) of imipenem and meropenem to all the cloned strains didn't change,blaNDM-1 were all positive.The replicon type was IncA/C;blaNDM-1 gene was localized between ISAba14 and IS91,at upstream of the blaNDM-1,class 1 integron and Tn3 transposon were identified,class 1 integron contained a new mosaic structure of a drug-resistant resistance gene cassette.Conclusion E.aerogenes pHN-NDM071 1,bearing blaNDM-1 gene in IncA/C plasmid,derived from gene recombination under different antimicrobial selection pressure.Antimicrobial use in clinical,industrial and agricultural area should be strictly controlled,so as to reduce the emergence of such bacteria.
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To investigate the effects of cigarette smoking in different manners on acute lung injury in rats.The commercially available cigarettes with tar of 1,5, 11 mg were smoked in Canada depth smoking (health canada method, HCM) manner, and those with tar of 11 mg were also smoked in international standard (ISO) smoking manner. Rats were fixed and exposed to mainstream in a manner of nose-mouth exposure. After 28 days, the bronchoalveolar lavage fluids from left lung were collected for counting and classification of inflammatory cells and determination of pro-inflammatory cytokines IL-1β and TNF-α. The right lungs were subjected to histological examination and determination of myeloperoxidase (MPO) and superoxide dismutase (SOD) activities and glutathione, reactive oxygen species (ROS) and malondialdehyde (MDA) levels.In both HCM and ISO manners, the degree of lung injury was closely related to the tar content of cigarettes, and significant decrease in the body weight of rats was observed after smoking for one week. In a HCM manner, smoking with cigarette of 11 mg tar resulted in robust infiltration of macrophages, lymphocytes and neutrophils into lungs, significant increase in IL-1β and TNF-α levels and MPO activities, and significant decrease in GSH levels and SOD activities and increase in ROS and MDA levels (all<0.05). Smoking with cigarette of 5 mg tar led to moderate increase in IL-1β and TNF-α levels, and MPO activities (all<0.05), and moderate decrease in GSH levels and SOD activities and increase of ROS and MDA levels (all<0.05). However, smoking with cigarette of 1 mg tar affected neither inflammatory cell infiltration nor IL-1β and TNF-α levels.Cigarette smoking in nose-mouth exposure manner can induce acute lung injury in rats; and the degree of lung injury is closely related to the content of tar and other hazards in cigarettes.
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Animals , Male , Rats , Acute Lung Injury , Pathology , Bronchoalveolar Lavage Fluid , Chemistry , Cell Biology , Chemotaxis, Leukocyte , Glutathione , Interleukin-1beta , Lung , Chemistry , Pathology , Lymphocytes , Pathology , Macrophages , Pathology , Malondialdehyde , Neutrophil Infiltration , Neutrophils , Pathology , Peroxidase , Reactive Oxygen Species , Smoking , Superoxide Dismutase , Tobacco Products , Classification , Tumor Necrosis Factor-alpha , Weight LossABSTRACT
Objective To investigate the dynamic changes and drug resistance of fungal infection in our hospital during 2010 -2012 for guiding the clinical reasonable use of anti-fungal drugs .Methods The related clinical data and the drug sensitivity tests re-sults of fungal infection in the hospitalized patients from 2010 to 2012 were retrospectively analyzed by the WHONET 5 .6 soft-ware .Results Candida albicans was the major pathogen causing candida infection for these 3 years .The isolated specimens were mainly sputum and blood .In the departments of internal medicine ,general surgery and integrated Chinese and Western medicine ,the number of detected candida were more than that of the other departments .Five kinds of candida showed high sensitivity to ampho-tericin B and high resistance to itraconazole .Conclusion The distribution of pathogens causing nosocomial fungal infection has changed and the drug resistance rate is continuously rising .Therefore the dynamic monitoring and the study of fungal infection should be strengthened for reducing the occurrence of fungal infection in the patients with tumor .
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ObjectiveTo investigate the flora distribution and drug resistance status of nosocomial fungal infection in cancer hospitals for providing the scientific basis for clinical prevention and control.Methods The related clinical data and results of drug sensitivity tests of fungal infection in hospitalized patients from April 2006 to November 2010 were analyzed retrospectively.ResultsA total of 1011 strains of candida were isolated in five years, in which, Candida albicans (41.6％ on average) were the highest detection rate strains.The proportion of Candida albicans declined from 53.8％ in 2006 to 31.7％ in 2010, while the other non-Candida albicans increased from 46.2％ in 2006 to 68.3％ in 2010.In the General surgery, the Internal medicine,the Hepatobiliary surgery, and the Chinese and Western medicine, the number of candida were more than the other departments.The specimens were mainly isolated from sputum and swab, followed by blood specimens.In vitro susceptibility test results showed that: voriconazole, amphotericin B and 5-fluorocytosine showed high sensitivity and itraconazole, fluconazole showed high drug resistance to albicans.Conclusion Distribution of pathogens causing nosocomial fungal infection has changed, and the rates of fungal resistance were rising,so this situation should arouse the clinician's attention.
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OBJECTIVE To study the incidence of ?-lactamases,mainly the extended-spectrum beta-lactamases(ESBLs) and metallo-beta-lactamases(MBLs) of Chryseobacterium indologenes and Ch.gleum.METHODS Agar dilution method was applied to detect minimal inhibitory concentrations(MIC) to 12 different antibiotics used frequently.Three-dimensional test was used to detect ESBLs and metallo-?-lactamases.The genes of ?-lactamases were amplified with 3 pairs of primers special for Ch.indologenes and Ch.gleum.RESULTS Among the 25 strains of Ch.indologenes and 10 strains of Ch.gleum,68%(17/25) isolates of Ch.indologenes and 90%(9/10)isolates of Ch.gleum were considered as MBLs positive strains,but no isolates were detected for the production of ESBLs.CONCLUSIONS MBLs are the important mechanism of multi-drug resistance for Ch.indologenes and Ch.gleum.