Expert Consensus on Polymyxin Antimicrobial Susceptibility Testing and Clinical Interpretation / 中国医学科学杂志(英文版)

The polymyxins are important antimicrobial agents against antibiotic-resistant gram-negative bacilli. In 2020, the Clinical and Laboratory Standards Institute modified the clinical breakpoints for polymyxin susceptibility test by eliminating the "susceptible" interpretive category, only reporting intermediate (≤2 mg/L) and resistant (≥4 mg/L). However, the European Committee on Antimicrobial Susceptibility Testing recommended the use of clinical breakpoints of ≤2 mg/L as susceptible and >2 mg/L as resistant. The first-line laboratorians and clinicians in China have been perplexed by the inconsistence of international polymyxin clinical breakpoints and discouraged by the difficulty of conducting polymyxin susceptibility testing. Therefore, it is urgently needed to make it clear for the laboratorians in China to know how to accurately carry out polymyxin susceptibility testing and standardize the interpretation of susceptibility testing results. To this end, the experts from relevant fields were convened to formulate this consensus statement on the testing and clinical interpretation of polymyxin susceptibility. Relevant recommendations are proposed accordingly for laboratorians and clinicians to streamline their daily work.

Clinical and Laboratory Characteristics of Disseminated Non-tuberculous Mycobacterial Disease / 中国医学科学院学报

Objective To explore the clinical and laboratory characteristics and the prognosis of disseminated non-tuberculous mycobacteria(NTM)diseases in human immunodeficiency virus(HIV)negative patients. Methods Cases of disseminated NTM disease were retrospectively collected in Peking Union Medical College Hospital from January 2012 to October 2018.Clinical manifestations,laboratory findings,treatment,and prognosis of these cases were retrieved from the electronic medical record system. Results Among the 23 HIV negative patients with disseminated NTM disease,21 had underlying diseases,with rheumatoid immune disease(n=7)as the most common one.The main clinical manifestation was fever(n=23).Laboratory tests showed anemia [hemoglobin(85.78±25.47)g/L],hypoalbuminemia [albumin 29(27-32)g/L],elevated erythrocyte sedimentation rate [(85.73±43.78)mm/h] and hypersensitive C-reactive protein [(112.00±70.90)mg/L],and reduction of lymphocyte count [0.69(0.29-2.10)×10 /L].Lymphocyte subset analysis indicated reduction in CD4 T cells [213(113-775)/μl],CD8 T cells [267(99-457)/μl],B cells [39(4-165)/μl],and NK cells [88(32-279)/μl] and elevation of human leukocyte antigen-D related(HLA-DR),and CD38 expression in CD8 T cells [HLA-DR CD8 /CD8 ,60(40-68)%;CD38 CD8 /CD8 ,81(65-90)%].The most common species of NTM was Mycobacterium intracellular(n=6).Lymphocyte,CD8 T cell,B cell,and NK cell counts were significantly lower in dead patients than surviving patients(P =0.045,P=0.045,P=0.032,and P=0.010,respectively). Conclusions Disseminated NTM disease in HIV negative patients is mainly manifested as fever,anemia,hypoalbuminemia,and elevated inflammatory indicators.It is more likely to occur in immunocompromised patients.Patients with decreased lymphocytes,CD8 T cells,B cells and NK cells tend to have a poor prognosis.

Infection Status of Human Papilloma Virus,Ureaplasma Urealyticum, Chlamydia Trachomatis,and Neisseria Gonorrhoeae / 中国医学科学院学报

Objective To analyze the infection status of human papilloma virus (HPV),Ureaplasma urealyticum (UU),Chlamydia trachomatis (CT),and Neisseria gonorrhoeae (NG) in clinical patients.Methods The laboratory specimens including urine,urethral swabs,and cervical swabs from 870 patients from January 1st 2014 to December 31st 2017 were retrospectively analyzed. HPV-DNA was detected by multiplex fluorescent PCR,and the UU-RNA,CT-RNA,and NG-RNA were determined by isothermal nucleic acid amplification. The positive rate of each pathogen and the distribution of positive rate between male and female patients were calculated. The samples were further divided into HPV-positive group and HPV-negative group,and the positive rates of UU-RNA,CT-RNA,and NG-RNA in these two groups were compared.Results The highest positive rate was 53.68%(467/870) for UU-RNA,followed by HPV-DNA [32.41%(282/870) ]and NG-RNA [2.18%(19/870)]. The total positive rate of high-risk (HR)-HPV(subtypes:16,18,31,33,35,39,45,51,52,56,58,59,and 68) [31.52%(209/663)]and UU in female patients [60.93%(404/663)] was significantly higher than that in male patients [17.39%(36/207),30.34%(63/207)](both P<0.001). The male patients had significantly higher CT positive rate in HR-HPV-positive group than in HR-HPV-negative group [22.58%(7/31) vs. 4.54%(8/176)](P<0.001). The female patients had significantly higher CT positive rate in HR-HPV-positive group than in HR-HPV-negative group [10.5%(21/200) vs. 5.61%(26/463)](P=0.024). The UU-RNA positive rate of females in the low-risk (LR)-HPV (subtypes:6 and 11) positive group was significantly higher than that in LR-HPV negative group [70.83%(34/48) vs.2.11%(13/615)](P<0.001).Conclusions Women are more susceptible to HR-HPV and UU infections. HR-HPV-positive patients are more likely to experience CT infection. In contrast,co-infection with UU is more common in LR-HPV-positive females.

Survey on physicians who engage in cancer diagnosis and treatment from third-grade class A hospitals regarding the perceptions of cancer patients' fertility preservation / 上海交通大学学报（医学版）

Objective · To explore the perceptions and current practice barriers of Chinese physicians who engage in cancer diagnosis and treatment from third-grade Class A hospitals regarding cancer patients' perceptions of fertility preservation (FP).Methods · A study was conducted in physicians from 4 third-grade Class A hospitals with different clinical specialties assisting cancer patients through a structured self-report questionnaire between January 2017 and December 2017.A total of 179 medical oncologists,77 radiation oncologists and 79 surgeons were included.Their information on gender,age,title,education background and perceptions of FP was obtained.Logistic regression analysis was used to examine the correlation between the recommendation of FP and risk factors.Results· There were 335 physicians,including 88 male physicians and 247 female physicians,with an average age of (35.94±6.27) years (range from 23-59 years) in the current study.Although 96.4％ of the physicians knew that chemotherapy and radiation had a profound effect on impairment of fertility and 85.1％ of them thought it was necessary to recommend FP,only 28.1％ of them gave FP-related recommendations to the cancer patients.The oncologists and surgeons,female physicians,and those with higher professional titles and education background were more likely to make the FP recommendation.Among 63.3％ of the physicians knowing male FP,only 37.9％ and 21.2％ of them noted the exact methods and place for FP,respectively.Similarly,for the 65.1％ of the physicians knowing female FP,the percentage was 49.9％ and 24.5％,respectively.When it came to the barriers of FP decision-making,32.8％ of the oncologists reported their concerns on whether cancer patients were suitable to reproduce.Secondly,the physicians honestly admitted that they lacked expertise in FP and worried about that FP would delay cancer treatment.Conclusion· Physicians who engage in cancer diagnosis and treatment lack the awareness and knowledge background of FP recommendation for cancer patients.It is important to improve the perceptions of cancer patients' FP through standardize training.

Clinical and Laboratory Characteristics of Patients with Nontuberculous Mycobacterium Bloodstream Infection in a Tertiary Referral Hospital in Beijing, China / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Nontuberculous Mycobacterium (NTM) bloodstream infection (BSI) is relatively rare. We aimed in this study to evaluate the clinical characteristics, laboratory evaluation, and outcomes of patients with NTM BSI.</p><p><b>METHODS</b>We retrospectively reviewed the clinical records of inpatients with NTM BSI at our institution between January 2008 and January 2015 and recorded clinical parameters including age, gender, underlying disease, clinical manifestation, organs involved with NTM disease, species of NTM, laboratory data, treatment and outcome of these patients. We also reviewed the reported cases and case series of NTM BSI by searching PubMed, EMBASE, and Wanfang databases. Data of normal distribution were expressed by mean ± standard deviation (SD). Data of nonnormal distribution were expressed by median and interquartile range (IQR).</p><p><b>RESULTS</b>Among the ten patients with NTM BSI, the median age was 51 years (IQR 29-57 years) and three patients were males. Eight patients were immunocompromised, with underlying diseases including human immunodeficiency virus (HIV) infection (one patient), rheumatic diseases (two patients), breast cancer (one patient), myelodysplastic syndrome (two patients), and aplastic anemia (two patients). Other organ(s) involved were lung (two patients), endocardium (two patients), brain, spinal cord, and soft tissue (one each patient). The median lymphocyte was 0.66 × 109/L (IQR 0.24-1.93 × 109/L). The median cluster of differentiation 4 (CD4) cell count was 179/mm3 (IQR 82-619/mm3). Five patients died (three with hematological diseases, one with breast cancer, and one with rheumatic disease), three recovered, and two were lost to follow-up.</p><p><b>CONCLUSIONS</b>We reported all cases in our hospital diagnosed with bloodstream NTM infection that was rarely reported. In this group of patients, patients usually had a high fever and could have multiple organ involvements. All patients with poor prognosis had underlying diseases.</p>

mTOR Modulates Lymphocyte Differentiation through T-bet and Eomesodermin in Response to Invasive Pulmonary Aspergillosis in Rats / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Aspergillosis infection is common in the patients with insufficient immunity. The role of mammalian target of rapamycin (mTOR), T-box expressed in T-cells (T-bet), and eomesodermin (EOMES) in mediating T lymphocytes differentiation in response to Aspergillus fumigatus infection in immunocompromised rats was investigated in this study.</p><p><b>METHODS</b>Invasive pulmonary aspergillosis (IPA) of immunosuppressive twenty male rats were established and sacrificed at 24 h (n = 5), 48 h (n = 5), 72 h (n = 5), and 96 h (n = 5) after A. fumigatus infection. In addition, control (n = 5), cyclophosphamide (CTX) (n = 5), and aspergillosis (n = 5) group were also established the tissues and pathology of lung tissue was examined by hematoxylin and eosin staining. CD8+ T-cells was sorted by flow cytometry. Serum mTOR, S6K, T-bet, and EOMES were quantified by enzyme-linked immunosorbent assay.</p><p><b>RESULTS</b>Histology of lung tissue indicated severe lung tissue injury including infiltration of inflammatory cells, alveolar wall damage or degradation, blood congestion, and hemorrhage in the CTX, IPA, and CTX + IPA rats. Hyphae were seen in the IPA, and CTX + IPA groups. The proportion of CD8+ T-cells was significantly increased in the animals of CTX + IPA. Memory CD8+ T-cells was significantly increased in early stage (24 h and 48 h, P < 0.001), but decreased in the late phase of fungal infection (72 h and 96 h) in the animals of CTX + IPA. In addition, at early stage of fungal infection (24 h and 48 h), serum mTOR (P < 0.001), S6K (P < 0.001), and T-bet (P < 0.05) was significantly higher, while EOMES was significantly lower (P < 0.001), in CTX + IPA group than that in control, CTX alone or IPA alone group. Conversely, serum mTOR, S6K, T-bet, and EOMES showed opposite changed in the late stage (72 h and 96 h). Pearson's correlation analysis indicated that mTOR and S6K were significantly correlated with T-bet (r = 0.901 and 0.91, respectively, P < 0.001), but negatively and significantly correlated with EOMES (r = -0.758 and -0.751, respectively, P < 0.001).</p><p><b>CONCLUSIONS</b>mTOR may regulate transcription factors of EOMES and T-bet, and by which mechanism, it may modulate lymphocytes differentiation in animals with immune suppression and fungal infection.</p>

Prevalence and features of pathogenic bacteria in the department of hematology without bone marrow transplantation in Peking Union Medical College Hospital from 2010 to 2012 / 中国医学科学院学报

<p><b>OBJECTIVE</b>To investigate the incidence, pathogens, and clinical features of infection in consecutive cases from 2010 to 2012 in Peking Union Medical College Hospital.</p><p><b>METHOD</b>The incidence, pathogen, treatment, and outcomes of patients with hematological diseases who had positive findings of bacterium in their samples from 2010 to 2012 were retrospectively analyzed.</p><p><b>RESULTS</b>There were 449 positive samples (5.8%) from 4 890 patients during this period, among which 388 were proved to be with pathogenic bacteria. Samples separated from patients with community-aquired infections accounted for 8.4% of all positive samples. Most community-aquired infections were caused by Gram-negative bacteria (75%), although no multidrug-resistant bacteria was observed. Samples separated from patients with nosocomial infections accounted for 91.6% of all positive samples. Respiratory tract (49.4%) and peripheral blood (32.6%) were the most common samples with positive results. Skin soft tissues (10.4%), and urine (3.7%) were less common samples. Most of the pathogenic bacteria of the nosocomial infections were Gram-negative (66.9%). The most common Gram-negative bacteria included Escherichia coli (13.8%), Pseudomonas aeruginosa (12.1%), and Klebsiella pneumonia (12.1%), while Staphylococcus aureus (10.4%), Enterococcus faecium (7.0%), and Staphylococcus epidermidis (5.1%) were the most common Gram-positive bacteria. Gram-negative bacteria consisted of most of sputum samples and peripheral blood samples. Samples from the surface of skin wound and anal swab were composed largely by Gram-positive bacteria (63.8%). The detection rates of extended-spectrum beta-lactamase-producing Klebsiella pneumonia/Klebsiella oxytoca, Escherichia coli, and Proteus mirabilis were 24.0%, 87.9% and 38.4%, respectively. The resistance to Acinetobacter baumannii was serious. Multidrug-resistant, extensive drug resistant and pan drug resistant A. baumannii acountted for 74% of all A. Baumannii infections. Stenotrophomonas maltophilia showed low resistance to sulfamethoxazole/trimethoprim, levofloxacin and minocycline. Also, 22 methicillin-resistant Staphylococcus aureus and 9 methicillin-resistant Staphylococcus Epidermidis were detected, which were only sensitive to vancomycin, teicoplanin, and linezolid. All patients were treated in the haematology wards and most of them were under agranulocytosis or immunosuppression. Finally, 22 patients reached clinical recovery through anti-infective therapy, whereas 49 patients died. Among those deaths, 42 patients attributed to severe infections and infection-associated complications. Fourteen of all the deaths might be infected with drug-resistance bacteria. There were 61 samples proved to be bacteria colonization. Nonfermenters such as Acinetobacter baumannii and Stenotrophomonas maltophilia made up for a large amount of bacteria colonization.</p><p><b>CONCLUSIONS</b>The pathogens of nosocomial infections in the hematology ward are mainly Gram-negative bacteria. The incidences and pathogens vary from different infection sites. Nosocomial infection still has a higher mortality rate. Once nonfermenters are detected positive, the pathogenic or colonial bacteria should be distinguished.</p>

Early changes of procalcitonin predict bacteremia in patients with intensive care unit-acquired new fever / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Rapid detection of bacteremia is important for critically ill patients. Procalcitonin (PCT) has emerged as a marker of sepsis, but its characterization for predicting bacteremia is still unclear. This study aimed to investigate the role of change of PCT within 6 to 12 hours after new fever in predicting bacteremia.</p><p><b>METHODS</b>An observational study was conducted in the ICU of our hospital from January 2009 to March 2010. Adult patients with new fever were included and grouped as bacteremia and non bacteremia group. Serum PCT concentration was measured at admission and within 6 to 12 hours after new fever (designated PCT0 and PCT1). Other results of laboratory tests and therapeutic interventions were recorded. Multivariate Logistic regression analysis was used to identify the risk factors of bacteremia. The area under the ROC curve (AUC) was constructed to evaluate the discriminative power of variables to predict bacteremia.</p><p><b>RESULTS</b>Totally 106 patients were enrolled, 60 of whom had bacteremia and 46 did not have bacteremia,. The acute physiology and chronic health evaluation II (APACHE II) and sequential organ failure assessment (SOFA) scores were 13.1 ± 7.8 and 5.0 ± 2.2 at admission, respectively. There was no significant difference in PCT0 between the bacteremia group and nonbacteremia group; 1.27 µg/L (range, 0.10 - 33.3) vs. 0.98 µg/L (range, 0.08 - 25.7), (P = 0.157). However, the PCT1 and the rate of change of PCT were significantly higher in bacteremia group; PCT1 was 6.73 µg/L (1.13 - 120.10) vs. 1.17 µg/L (0.10 - 12.10) (P = 0.001), and the rate of change was 5.62 times (1.05 - 120.6) vs. 0.07 times (-0.03 - 0.18) (P < 0.001). The area under the ROC curve (AUC; 95% confidence interval) of the rate of change of PCT was better for predicting bacteremia than that of PCT1; 0.864 (range, 0.801 - 0.927) vs. 0.715 (range, 0.628 - 0.801), (P < 0.05). The AUCs of PCT0 and other parameters (such as WBC count, granulocyte percentage and temperature) were not significantly different (all P > 0.05). The best cut-off value for the rate of change was 3.54 times, with a sensitivity of 88.5% and a specificity of 98.0%. It was also an independent predictor of bacteremia (odds ratio 29.7, P < 0.0001) and wasn't correlated with the presence or absence of co-infection, neutropenia or immunodeficiency (P > 0.05).</p><p><b>CONCLUSION</b>The rate of change of PCT is useful for early detection of bacteremia during new fever and superior to the PCT absolute value and other parameters in non-selected ICU patients.</p>

Gene chip array for differentiation of mycobacterial species and detection of drug resistance / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Gene chip array can differentiate isolated mycobacterial strains using various mycobacterium specific probes simultaneously. Gene chip array can evaluate drug resistance to isoniazid and rifampin of tuberculosis strains by detecting drug resistance related gene mutation. This technique has great potential for clinical application. We performed a retrospective study to investigate the capability of gene chip array in the rapid differentiation of species and detection of drug resistance in mycobacterium, and to evaluate its clinical efficacy.</p><p><b>METHODS</b>We selected 39 patients (54 clinical mycobacterium isolates), used gene chip array to identify the species of these isolates and detect drug resistance to isoniazid and rifampin in Mycobacterium tuberculosis isolates. Meanwhile, these patients' clinical data were analyzed retrospectively.</p><p><b>RESULTS</b>Among these 39 patients whose mycobacterium culture were positive, 32 patients' isolates were identified as Mycobacterium tuberculosis, all of them were clinical infection. Seven patients' isolates were identified as non-tuberculosis mycobacterium. Analyzed with their clinical data, only two patients were considered as clinical infection, both of them were diagnosed as hematogenous disseminated Mycobacterium introcellulare infection. The other five patients' isolates were of no clinical significance; their clinical samples were all respiratory specimens. Clinical manifestations of tuberculosis and non-tuberculous mycobacterial infections were similar. Isoniazid resistance was detected in two tuberculosis patients, while rifampin resistance was detected in one tuberculosis patient; there was another patient whose Mycobacterium tuberculosis isolate was resistant to both isoniazid and rifampin (belongs to multidrug resistance tuberculosis). The fact that this patient did not respond to routine anti-tuberculosis chemotherapy also confirmed this result.</p><p><b>CONCLUSIONS</b>Gene chip array may be a simple, rapid, and reliable method for the identification of most mycobacterial species and detection of drug resistance in Mycobacterium tuberculosis. It is useful in diagnosis, treatment, and hospital infection control of mycobacterial infections, and it may have a great potential for clinical application.</p>

Effects of extremely low frequency magnetic field on anxiety level and spatial memory of adult rats / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>As the widespread use of electric devices in modern life, human are exposed to extremely low frequency magnetic fields (ELF MF) much more frequently than ever. Over the past decades, a substantial number of epidemiological and experimental studies have demonstrated that ELF MF (50 Hz) exposure is associated with increased risk of various health effects. The present study examined the effects of chronic exposure to ELF MF on anxiety level and spatial memory of adult rats.</p><p><b>METHODS</b>The 50-Hz ELF MF was used during the whole experimental procedures and the value of magnetic field (MF) was set to 2 mT. Adult rats were divided randomly to control, MF 1 hour and MF 4 hours group. Anxiety-related behaviors were examined in the open field test and the elevated plus maze; changes in spatial learning and memory were determined in Morris water maze after 4 weeks of daily exposure.</p><p><b>RESULTS</b>Rats in MF 4 hours group had increased anxiety-like behaviors with unaltered locomotor activity. In the Morris water maze test, rats had reduced latency to find the hidden platform and improved long-term memory of former location of platform without changes in short-term memory and locomotor activity.</p><p><b>CONCLUSION</b>Chronic ELF MF exposure has anxiogenic effect on rats, and the promoting effects on spatial learning and long-term retention of spatial memory.</p>

Blood collection procedures influence contamination rates in blood culture: a prospective study / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Blood culture contamination is a significant adverse event. The aim of this project was to evaluate the efficacy of a strict blood collection procedure in reducing the blood culture contamination rate.</p><p><b>METHODS</b>A prospectively controlled study was performed in two different medical areas in Peking Union Medical College Hospital (PUMCH) for 16 months (from May 2006 to September 2007). In test group, a strict blood collection procedure was carried out by trained nurses with the veinpuncture sites were scrupulously disinfected with 2.5% tincture of iodine plus 70% alcohol. In control group, commonly used procedure in PUMCH was performed with 0.45% chlorhexidine acetate plus 0.2% iodine. Blood culture positive results for 4 target organisms (Coagulase-negative staphylococci, Propionibacterium acnes, Corynebacterium species and Bacillus species) were further assessed by physicians from infectious department to determine whether a sample was true positive (pathogen) or false positive (contamination).</p><p><b>RESULTS</b>Total 9321 blood culture collections were analyzed. The blood culture contamination rate in test group was significantly lower than that in control group (5/3177 (0.16%) vs. 77/6144 (1.25%); χ(2) = 13.382, P < 0.001). The most common contaminant was Coagulase-negative staphylococcus (76.83%). The average cultural time during which contaminated samples became positive was longer than that for true pathogen samples (42.0 hours vs. 13.9 hours, P = 0.041).</p><p><b>CONCLUSION</b>Using a strict blood collection procedure can significantly reduce blood culture contamination rate.</p>

In vitro susceptibility testing of Aspergillus spp. against voriconazole, itraconazole, posaconazole, amphotericin B and caspofungin / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>During recent years, the incidence of serious infections caused by opportunistic fungi has increased dramatically due to alterations of the immune status of patients with hematological diseases, malignant tumors, transplantations and so forth. Unfortunately, the wide use of triazole antifungal agents to treat these infections has lead to the emergence of Aspergillus spp. resistant to triazoles. The present study was to assess the in vitro activities of five antifungal agents (voriconazole, itraconazole, posaconazole, amphotericin B and caspofungin) against different kinds of Aspergillus spp. that are commonly encountered in the clinical setting.</p><p><b>METHODS</b>The agar-based Etest MIC method was employed. One hundred and seven strains of Aspergillus spp. (5 species) were collected and prepared according to Etest Technique Manuel. Etest MICs were determined with RPMI agar containing 2% glucose and were read after incubation for 48 hours at 35°C. MIC(50), MIC(90) and MIC range were acquired by Whonet 5.4 software.</p><p><b>RESULTS</b>The MIC(90) of caspofungin against A. fumigatus, A. flavus and A. nidulans was 0.094 µg/ml whereas the MIC(90) against A. niger was 0.19 µg/ml. For these four species, the MIC(90) of caspofungin was the lowest among the five antifungal agents. For A. terrus, the MIC(90) of posaconazole was the lowest. For A. fumigatus and A. flavus, the MIC(90) in order of increasing was caspofungin, posaconazole, voriconazole, itraconazole, and amphotericin B. The MIC of amphotericin B against A. terrus was higher than 32 µg/ml in all 7 strains tested.</p><p><b>CONCLUSIONS</b>The in vitro antifungal susceptibility test shows the new drug caspofungin, which is a kind of echinocandins, has good activity against the five species of Aspergillus spp. and all the triazoles tested have better in vitro activity than traditional amphotericin B.</p>

Molecular characterization of vancomycin-resistant Enterococci / 中国医学科学院学报

<p><b>OBJECTIVE</b>To investigate the homology and resistant mechanism of vancomycin-resistant Enterococci (VRE) isolates.</p><p><b>METHODS</b>A total of 9 VRE isolates were collected from 2006 to 2007 at PUMC hospital. The susceptibility of these isolates to 10 different antibiotics including vancomycin was tested by E-test. These strains were processed by brain heart infusion agar screening in the presence of vancomycin (6 microg/ml), and were analyzed for genotypic characteristics using the multiplex PCR. The homology of the isolates was determined by pulsed-field gel electrophoresis (PFGE).</p><p><b>RESULTS</b>All the 9 VRE isolates were identified as Enterococci faecium. The visual analysis of PFGE patterns revealed 6 different PFGE types. The vanA gene was confirmed by PCR and sequencing in 9 VRE isolates, which were consistent between phenotype and genotype for glycopeptides resistance.</p><p><b>CONCLUSIONS</b>Only vanA genotype was detected in PUMC hospital. Clonal dissemination, horizontal gene transfer, and the selective pressure of antimicrobial agents may contribute to the increase of VRE.</p>

Clinical characteristics of methicillin-resistant Staphylococcus aureus in phlegm specimens / 中国医学科学院学报

<p><b>OBJECTIVE</b>To investigate the clinical characteristics of methicillin-resistant Staphylococcus aureus (MRSA) in phlegm specimens of positive patients, so as to provide evidences for the nosocomial infection control.</p><p><b>METHODS</b>We retrospectively analyzed the clinical data of 211 hospitalized patients who were MRSA-positive in their phlegm specimens in PUMC Hospital from January 2005 to October 2007.</p><p><b>RESULTS</b>Among the 211 patients, 196 (92.9%) had received antibiotics three months before the detection of MRSA, and 128 (60.7%) had received more than three antibiotics. Over 90% of MRSA were resistant to levofloxacin, erythromycin, clindamycin, and gentamicin, and 73.9% were resistant to rifampicin.</p><p><b>CONCLUSIONS</b>Improper use of antibiotics should be avoided. Vancomycin is the first choice for MRSA treatment.</p>

A case of Klebsiella pneumoniae outbreak in a newborn intensive care unit / 中国医学科学院学报

<p><b>OBJECTIVE</b>To investigate and take a case study on a Klebsiella pneumoniae outbreak in a newborn intensive care unit (NICU).</p><p><b>METHODS</b>Using epidemiological investigation method to cultivate bacilli and detect the homology.</p><p><b>RESULTS</b>Klebsiella pneumonia was detected in 4 NICU patients. Based on environmental sample analyses, four Klebsiella pneumonia strains were identified and confirmed to be highly homologous. The outbreak was effectively controlled after the strict implementation of hand hygiene practice and environment disinfection.</p><p><b>CONCLUSION</b>Klebsiella pneumonia outbreak in NICU may be caused by the route of hand transmission.</p>

In vitro antimicrobial activity of ampicillin-sulbactam,clindamycin and cefoperazone determined by E test / 中国感染与化疗杂志

Objective To investigate the in vitro antimicrobial activity of ampicillin-sulbactam,clindamycin and cefoperazone a- gainst common clinical isolates.Methods MICs of these three antibiotics were determined by E test.Results Ampicillin-sulbae- tam showed inhibition rate of 100% for methicillin susceptible S.aureus (MSSA),E.faecalis,Group A Streptococcus,H. influenzae,penicillin-susceptible S.pneumoniae (PSSP),M.catarrhalis and anaerobes (including 10 strains of Bacteroid spp.,2 strains of P.aches,1 strain of E.lentum,1 strain of Fusobacterium innocuum,and 2 strains of Peptostreptococcus spp.).Ampicillin-sulbactam was active against 86.7% of extended-spectrum?-lactamase non-producing K.pneumoniae (NES- BL-KPN) and 53.3% of non ESBL-producing E.coli (NESBL-ECO).Ampicillin-sulbactam only inhibited 23.3% of A.bau- mannii isolates and 25.0% of E.faecium isolates.For MSSA,anaerobes,PSSP and group A Streptococcus,about 60.0%, 31.2%,30.0% and 10.0% of the isolates were susceptible to clindamycin,respectively.For MSSA,NESBL-ECO and NES- BL-KPN,96.7% to 100% of the isolates were susceptible to cefoperazone.About 40.0% of P.aeruginosa isolates were sus- ceptible to cefoperazone.No A.baumannii isolate was susceptible to cefoperazone.Conclusions The ampicillin-sulbactam has good antimicrobial activity against MSSA,E.faecalis,Group A Streptococcus,NESBL-KPN,H.influenzae,PSSP,M.ca- tarrhalis and anaerobes.In this study,clindamycin is active against 60% of MSSA isolates.Most of other species are relatively resistant to clindamycin.Cefoperazone shows good activity against MSSA,NESBL-ECO,and NESBL-KPN.These three anti- microbial agents can be used as empirical treatment for community-acquired infections.

Preliminary analysis on the treatment of infection caused by pandrug-resistant Acinetobacter baumannii / 中国感染与化疗杂志

Objective To analyze the clinical features of pandrug-resistant Acinetobacter baumannii (PDR-Ab) in a hospital and compare the efficacy of different antibiotic treatments on patients with pneumonia caused by PDR-Ab.Methods Data were ret- rospectively collected from all isolated PDR-Ab strains in our hospital from February 2004 to March 2005.The clinical features and outcomes were reviewed.Results A total of 77 strains of PDR-Ab were collected, 45 of which were pathogens causing clini- cal infections (35 strains from lower respiratory tract, 6 from bloodstream, 3 from drainage fluid, and 1 from wounds).Lower respiratory tract was the most common source of PDR-Ab.More than 90% of the isolated PDR-Ab strains produced OXA-23 type?-lactamase.Cefoperazone-sulbactam plus minocyeline showed good efficacy for patients with PDR-Ab pneumonia.The total clinical cure rate was 68.4%.Bacterial eradication rate was 42.1%.The factors influencing bacterial clearance were pro- longed mechanical ventilation prior to positive culture (17.5 d vs 5.5 d).mixed infection (100% vs 12.5%) and lower GCS score (9.1?0.7 vs 13.2?2.1).Concomitant septic shock (OR=13.8) and APACHEⅡscore (OR=2.1) were independent factors of clinical outcome.Conclusions Nosocomial infections caused by PDR-Ab are not untreatable.Our analysis suggests that cefoperazone-sulbactam plus minocycline may be an effective treatment for lower respiratory tract infections caused by PDR-Ab in our hospital.

The relationship between abnormal MDR gene expression and chemotherapy response in lymphoid malignancies / 中华肿瘤杂志

<p><b>OBJECTIVE</b>To investigate the expression of multidrug resistance-1 (MDR(1)), Topoisomerase II (Topo II), glucocorticoid receptor (GCR) and their correlation with relapse rate and chemotherapy response in lymphoid malignancies.</p><p><b>METHODS</b>The expression of MDR(1), Topo II and GCR in 189 patients with lymphoid neoplasms was examined by RT-PCR, slot blot and ligand-labelled methods.</p><p><b>RESULTS</b>(1) The expressions of MDR(1), Topo II, GCR in untreated and relapsed/refractory patients with ALL, NHL, NHL-L, MM were significantly abnormal at varying levels, especially in the relapsed/refractory group. (2) The complete remission (CR) rate of MDR(1) high expression group (MDR(1)(+)) was significantly lower than that of MDR(1) negative expression (MDR(1)(-)) group (P < 0.05), and the relapse rate of MDR(1)(+) group was significantly higher than that of MDR(1)(-) group (P < 0.05). In untreated patients, the relapse rate in the Topo II low expression (Topo II(-)) group was positively higher than Topo II high expression (Topo II(+)) group (P < 0.05), whereas in the relapsed/refractory patients, the CR rate of Topo II(-) group was significantly lower than that of Topo II(+) group (P < 0.05). In the untreated and relapsed/refractory patients, the CR rates of low GCR expression (GCR(-)) group was obviously lower than that in the normal GCR expression group (P < 0.05). (3) Considering mono-drug resistance mechanism, CR rate of MDR(1)(+) group was the lowest, Topo II(-) group took the second place and GCR(-) group was the highest. As multiple drug resistance mechanisms coexisted, the CR rate of MDR(1)(+) + Topo II(-) + GCR(-) group and MDR(1)(+) + Topo II(-) group (11.1% and 15.4%, respectively) were significantly lower than that of MDR(1)(+), Topo II(-) and GCR(-) group (36.7%, 48.0% and 53.8%, respectively; P < 0.05 - P < 0.001).</p><p><b>CONCLUSION</b>There are primary and acquired drug resistance in lymphoid neoplasms. The high expression of MDR(1), low expression of Topo II and GCR are positively related to low chemotherapy response rate and high 2-year relapse rate. Co-analysis of MDR(1), Topo II and GCR may play an important role on chemotherapy response and prognostic judgment in lymphoid neoplasms.</p>

Effects of irrigation volume on growth and quality of Lonicera japonica / 中国中药杂志

<p><b>OBJECTIVE</b>To study the effects of irrigation volume on the growth and quality of Lonicera japonica.</p><p><b>METHOD</b>Different volume of irrigation water was applied to the potted L. japonica before the first florescence of honeysuckle in order to keep the relative moisture content of the soil as 100%, 80%, 50%, 30%, and observe the growth and development of shoot and leaves, yield and quality of honeysuckle.</p><p><b>RESULT</b>As the of irrigation volume was reduced, the internodal elongation of shoot and the increase of the knot were restrained, and the yield of honeysuckle dropped. But the content of chlorogen acid in the buds treated by 80% irrigation volume was not affected, while that of the other treatment all decreased. The moisture contents of the leaves treated by 30% irrigation volume was significantly lower than that of the CK, while the specific leaf weight (SLW) increased significantly comparing to the CK. The content of chlorophyl in the leaves of 50% and 30% increased, while the ratio of chlorophyl A and B fell significantly. The content of dissoluble suger in the leaves of 80% and 50% irrigation volume was much higher than that in the CK. The results also showed that, the content of dissoluble protein in the leaves of 30% irrigation volume increased comparing with that in 50%, and the content of proline in leaveas of 30% irrigation volume increased significantly.</p><p><b>CONCLUSION</b>Using less irrigation volume (keeping 80% of relative moisture content of the soil) does not affect the quality of honeysuckle, but decreased dry weight of honeysuckle. It is necessary to take irrigation management during cultivation of honeysuckle.</p>

Clinical study on drug-seperated moxibustion at Shenque (CV 8) for treatment of ulcerative colitis / 中国针灸

<p><b>OBJECTIVE</b>To observe the therapeutic effect of drug-separated moxibustion at Shenque (CV 8) on ulcerative colitis (UC) and the influence on autoimmunity level, and study on the mechanism.</p><p><b>METHODS</b>Sixty cases were randomly divided into a treatment group and a control group, 30 cases in each group. The treatment group were treated with drug-separated moxibustion at Shenque (CV 8) and the control group with oral administration of sulphasalazine and metronidazole tablets. The main symptoms, pathological changes of the intestinal mucosa and the total therapeutic effect in the two groups before and after treatment, and the changes of the content of blood serum immunoglobulin, peripheral blood T-cell subgroup and NK cell were observed.</p><p><b>RESULTS</b>The markedly effective rate and the total effective rate in the treatment group were 60.0% and 86.7% respectively, much higher than the control group (P<0.05, P<0.01). IgG content in the treatment group after treatment significantly decreased with a significant difference as compared with the control group (P<0.05); there were no significant differences in IgA and IgM before and after the treatment (P>0.05). After treatment, peripheral blood T-cell subgroup and NK cell in the treatment group increased to a certain extent, which was correlated positively to the therapeutic effect.</p><p><b>CONCLUSION</b>The drug-separated moxibustion at Shenque (CV 8) is a satisfactory method for treatment of ulcerative colitis, and it exerts therapeutic effect possibly through regulating immunological function of the organism.</p>