Application of the “TST-IGRA” two-step method in screening close contacts of active tuberculosis patients among three high schools / 公共卫生与预防医学

Objective To explore the application of the TST-IGRA two-step method in the screening of close contacts of active tuberculosis patients among three high schools in Jinshan District in 2020-2021，and to provide evidence for improving the prevention and control of tuberculosis in schools. Methods Three school tuberculosis outbreaks in Jingshan District from 2020 to 2021 were included in the present study. After excluding active tuberculosis, tuberculin skin test and γ-interferon release assay (IGRA) were conducted to screen latent infection of Mycobacterium tuberculosis in close contacts, and the necessity of the two-step method was analyzed. Results A total of 362 close contacts were screened in the three outbreaks, and 350 people were tested by TST. Comparing the results of TST and IGRA among different types of close contacts, it was found that the positive rate of TST in teachers was higher than that in students（54.84% vs 20.38%，P<0.05）. The positive rate of TST among students from high-burden areas of pulmonary tuberculosis in Shanghai was higher than that of local students（24.71% vs 18.80%，P<0.05). IGRA detection was performed on those with moderate and strong positive TST results, and the results showed that the positive rate of IGRA in those with strong positive TST results was only 17.7%, with Kappa value of 0.3. Conclusion The prevention and control of tuberculosis in school should strengthen the annual health examination of teachers and staff, promote timely medical treatment for suspected tuberculosis symptoms, reasonably increase the screening frequency of students in high-burden areas of tuberculosis in Shanghai, and collect students’ previous history of tuberculosis exposure. When screening close contacts, after excluding active tuberculosis, it is recommended that TST and IGRA should be combined to determine latent Mycobacterium tuberculosis infection and achieve accurate intervention.

The new quality control mode for authorized distribution of traditional Chinese medicine pieces / 药学实践杂志

Objective To improve the quality for authorized distribution of traditional Chinese medicine pieces, reduce patient complaints and increase patient satisfaction. Methods Patient’s complaints against different drug dispensing modes were analyzed. PDCA cycle was used for quality improvements. Results The new quality control mode includes pre monitoring measures, such as pharmacist resident in pharmaceutical factories and unannounced factory inspections, the fast-track handing measures for the problems occurred in patients, pharmacies, pharmaceutical factories and express delivery companies, and retrospective measures, such as evaluation of pharmaceutical factories and quarterly pharmaceutical factory communication meetings. Conclusion Three years after the new quality control mode, patient’s complaints were significantly reduced. The authorized distribution quality for traditional Chinese medicine pieces was greatly improved.

Initial practice on quality control tests and action limits setting of birdcage head coils / 中国医学影像技术

Objective To establish clinical quality control method with testing the birdcage head coils and setting up the action limits.Methods Three different MR devices (GE 1.5T HDi,GE 3.0T HD and GE 3.0T 750W) and corresponding birdcage coils were tested.Axial T1WI was performed to scan ACR phantom.SNR,percent image uniformity (PIU) and percent signal ghosting (PSG) were measured for six times,and the mean values and standard deviations (SD) were calculated.Based on the results,the action limits for each parameter were set.Results The mean value of SNR for the three devices was 262.14,280.47 and 474.24,and SD was 18.43,29.67 and 29.95,respectively;the action limits were ≥225.28,≥221.13 and ≥414.34,respectively;the mean value of PIU for the three devices was 95.00％,83.17％ and 84.33％,SD was 0.63％,1.17％ and 0.82％,respectively;the action limits were ≥93.74％,≥82.00％ (corrected) and ≥82.69％,respectively.The mean value of PSG for the three devices was 0.11％,0.07％ and 0.14％,SD was 0.12％,0.03％ and 0.11％,respectively;the action limits were ≤0.35％,≤0.13％ and ≤0.36％,respectively.Conclusion All of SNR,PIU and PSG for three MR devices were consistent with the action limits in this study.

Study on molecular mechanism of double hydrogen artemisinin inducing apoptosis of bile duct cancer cells / 国际检验医学杂志

Objective To study and discuss the effect of double hydrogen artesunate on Mcl-1 expression and its inducing effect on cancer cell apoptosis in the patients with cholangiocarcinoma.Methods Bile duct cancer cell lines QBC939 preserved in our hospital from June 2010 to December 2014 were randomly selected and divided into the control group and observation group for conducting experiments.The cells were cultured by using the conventional cultivation and double hydrogen artemisinin culture.Then the Mcl-1 expression and apoptosis of cancer cells were performed the statistical analysis and comparison.Results Statistical comparison showed that the expressions of MCL1-001 and-MCL1 201 at 12,24,48 h in the observation group were significantly higher than those in the control group,the comparison between groups were statistically significant (P0.05),but which at 48 h in the observation was significantly higher than that in the control group,the difference was statistically significant(P<0.05).And the mortality rate at 6,12,24,48,72 h in the observation group was significantly higher than that in the control group,the difference was statistically significant (P<0.05).Conclusion Double hydrogen artemisinin has obvious up-regulation effect on Mcl-1,moreover can effectively induces bile duct cancer cell apoptosis.

Stability tests and action limits setting for central frequency and transmitter gain of MRI scanners / 中国医学影像技术

Objective To test the central frequency (CF) and transmitter gain(TG) of MRI scanners,and set up their action limits.Methods Three different MRI devices (GE 3.0T HD,GE 1.5T HDi and GE 3.0T 750W) were tested by scanning American College of Radiology (ACR) phantom with the axial T1WI series.In the pre-scanning of T1WI series for the ACR phantom,the CF and TG were recorded.It was tested for eight times when MRI scanners were in good condition.The action limits of CF and TG were calculated based on mean values and standard deviations.Results The mean values of CF for three devices were (127 725 772.38±39.68)Hz,(63 875 740.13± 34.15)Hz,and (127 771 958.38±12.19)Hz,respectively.Their action limits were ≤119.04 Hz,≤68.30 Hz,and ≤36.57 Hz,respectively.The mean values of TG for three devices were (125.25±1.28)dB,(101.75±1.98)dB,and (113.25±0.89)dB,respectively.Their action limits were (125.25±2.56)dB,(101.75±3.96)dB,and (113.25±1.78)dB,respectively.Conclusion The CF and TG for three MRI scanners are all consistent with the action limits in this study.The CF and TG action limits will provide criterions for the clinical quality control.

Status and tendency of clinical quality control procedure and regulation for MRI equipment / 中国医学影像技术

Clinical quality control of MRI equipment is a significant part of quality assurance.The purpose of quality control is to assure the performance and specification stability of MRI scanner,and to provide high quality images for clinical diagnosis.Many foreign countries have already developed and established highly sophisticated quality control procedure and regulation for MRI system,and the application is also relatively popular.However,this work has just begun in China,need to be further developed.The current status and future trend of clinical quality control procedure as well as regulation for MRI equipment were reviewed in this article.

Initial practice on cross-talk tests for MRI scanners / 中国医学影像技术

Objective To detect the cross-talk RF signal interference of three MRI scanners,in order to deepen the understanding of cross-talk RF signal interference.Methods Three different GE magnetic resonance imaging scanners (GE 1.5T HDi,installation time:2012;GE 3.0T HD,installation time:2006;GE 3.0T 750W,installation time:2016) were tested.The axial T1-weighted sequence was used to scan ACR phantom.Slice gaps with 5.0 mm,1.0 mm,0.5 mm and 0 were performed,respectively.SNR values were also recorded.Based on the results,the percentage change charts of SNR with slice gaps were made.Test standard was set as SNR decreased less than 20 ％ when the slice gap reduced from 5 mm to 0.Results When slice gap was reduced from 5 mm to 0,SNRs for three scanners decreased by 18.16 ％,23.57％ and 10.75％,respectively.Both the results of cross-talk obtained with GE 1.5T HDi and GE 3.0T 750W scanner met the test standard,while the result obtained with GE 3.0T HD (used for more than 10 years) was below the standard.Conclusion The cross-talk RF signal interference still exists for three MRI scanners.The test result of the scanner used for the longest time is unqualified.The quality control test of cross-talk should be done in the daily work.

Investigation and practice of magnetic field homogeneity evaluation methods for MRI equipment / 中国医学影像技术

Objective To explore the evaluation methods of magnetic field uniformity and the practical operations,in order to provide references for clinical quality control.Methods Based on MRS phantom and 32 cm uniform spherical phantom,the evaluation methods of magnetic field uniformity were used to detect MRI equipment in department of radiology,including spectral peak and the bandwidth difference.Results The full width at half maximum (FWHM) of MRS phantom was 0.08 ppm,the inhomogeneity values on coronal,sagittal and axial detected by the bandwidth difference method was 0.15 ppm,0.08 ppm and 0.18 ppm,respectively.Conclusion The magnetic field homogeneity of the above mentioned MRI equipment is favorable,which accords with magnetic field uniformity detection standard.

Short-term follow-up for unruptured wide-necked intracranial aneurysms treated with Pipeline embolization device / 中国脑血管病杂志

Objective To evaluate the short-term effect of Pipeline embolization device (PED)for the treatment of unruptured wide-necked intracranial aneurysms. Methods From October 2015 to September 2016,15 consecutive patients with unruptured wide-necked intracranial aneurysm (aneurysm neck and aneurysm body ratio ≥0. 5)treated with PED at the Department of Neurosurgery,the Second Affiliated Hospital of Nanchang University were enrolled retrospectively. Their clinical and imaging data were analyzed. Kamran scale was used to evaluate the embolization rate of aneurysms and the changes of the parent arteries. DSA examination was performed again at 6 -12 months after operation. Results Fifteen PED were implanted in 15 patients with unruptured wide-necked intracranial aneurysms,including 13ophthalmic artery aneurysms,1 posterior communicating artery aneurysm,and 1 cavernous sinus aneurysm. The technical success rate was 100% . Immediately after PED implantation,Karman rating of 15 cases were aneurysm grade 2 embolization,parent artery grade A (grade 2a). DSA examination was performed again at 6 - 12 months after operation showed that 14 patients were aneurysm grade 4,parent artery was grade A (grade 4a). One patient (ophthalmic artery aneurysm)underwent the second DSA examinations at 6 and 12 months after operation showed that the residual development of aneurysms. The aneurysm embolization was grade 3, and the parent artery was grade A (grade 3a). No branch artery occlusion was observed. Non of them had neurological deficit. The modified Rankin scale score was 0 in all 15 patients. Conclusion The use of PED in the treatment of unruptured wide-necked intracranial aneurysms has a higher occlusion rate. Its long-term effect still needs further follow-up.

Malaria awareness among residents and students during malaria elimina-tion phase in Jinshan District,Shanghai City / 中国血吸虫病防治杂志

Objective To understand the awareness status of knowledge on malaria control among residents and students,so as to evaluate the effectiveness of health education during the elimination phase of malaria in Jinshan District ,Shanghai City. Methods In 2010 and 2014,the stratified sampling and cluster sampling methods were taken to select the investigation sites, including 3 villages,1 middle schools,1 primary school,then the residents above 15 years old and the students in the above se?lected sites were investigated by questionnaires to understand their awareness status on malaria control. Results In 2010,the general awareness rates of malaria control knowledge of the study objects were 74.22%,and those of the residents,middle school students,and primary school students were 75.68%,61.86%and 72.20%,respectively. There was no significant differ?ence between the awareness rates of objects with different gender(χ2=1.755,P>0.05). The rate of the residents was higher than that of the students(χ2=59.838,P<0.01). From 2010 to 2014,a series of health education on malaria control was car?ried out. In 2014,the general awareness rate of knowledge on malaria control was 96.03%,and those of the residents,middle school student,and primary school students were 92.28%,98.59%and 99.49%,respectively. The awareness rate of the stu?dents was higher than that of the residents(χ2=275.794,P<0.01). Conclusion Through the health education and communi?ty advocacy,the awareness rates of knowledge on malaria control among residents and students have improved and met the quali?fication of malaria elimination in Jinshan District.

A Meta-analysis of effect comparison between interventional embolization and surgical clipping in treatment of ruptured intracranial aneurysms / 重庆医学

Objective To compare the efficacies between interventional embolization and surgical clipping in treatment of ruptured intracranial aneurysms to provide an evidence‐based basis for selecting the clinical treatment scheme .Methods The related randomized controlled trail(RCT) literatures on the effects of interventional embolization and surgical clipping were retrieved from the databases of Pubmed ,Cochrane ,Medline and Embase .The screening was independently performed by two researchers according to the including and excluding criterion .The occurrence rate of adverse reactions ,postoperative 1‐year mortality rate ,re‐bleeding rate ,occurrence rate of vasospasm and ischemic cerebral infarction served as the measurement indicators .The data were extracted and performed the meta analysis by the RevMan5 .3 software .Results Sixteen RCT literatures were included for conducting analy‐sis ,involving 7 373 patients ,in which 3 092 cases adopted interventional embolization and 4 281 cases adopted surgical clipping .The occurrence rate of adverse events(OR=1 .25 ,95% CI ,1 .12-1 .40 ;P<0 .000 1) and re‐bleeding rate(OR=0 .43 ,95% CI ,0 .28 -0 .66 ;P=0 .000 1) in the interventional embolization group were lower than those in the surgical clipping group ;however ,there were no statistical differences between the interventional embolization group and surgical clipping group in the postoperative 1‐year mortality rate(OR=1 .13 ,95% CI ,0 .92-1 .39 ;P=0 .23) ,incidence rate of vasospasm (OR=1 .41 ,95% CI ,0 .99-2 .02 ;P=0 .06) and incidence rate of ischemic cerebral infarction(OR=0 .66 ,95% CI ,0 .42 -1 .05 ;P=0 .08) .Conclusion The current clinical re‐search evidences indicate that using the interventional embolization in treating ruptured intracranial aneurysms can obviously reduce the occurrence rate of adverse events than the surgical clipping ,but increases the re‐bleeding rate .The postoperative 1‐year mortali‐ty rate ,incidence rate of vasospasm and incidence rate of ischemic cerebral infarction have no obvious difference between these two kinds of operation .

Development of Special Drive Pediatric Ventricular Assist Device / 中国医疗器械杂志

This paper uses AVR16 SCM, programming to achieve the software of PWM (pulse width modulation) control of intelligent H bridge chip LMD18200 driver of high speed DC motor, makes special speed tablet, obtains speed signal of high speed for photocoupler PC817, through the A/D conversion and processing circuit, and realizes the LED LCD digital display speed scheme. The driver for the pediatric ventricular assist device has been used at the laboratory trial, has high performance and wide application prospect.

Analysis of the transcriptome in a multi-drug resistant uropathogenic Escherichia coli strain treated with water decoction of rhizoma coptidis by using RNA-seq / 中华微生物学和免疫学杂志

Objective To investigate the molecular mechanism of the inhibitory effects of rhizoma coptidis on multi-drug resistant uropathogenic Escherichia coli.Methods High-throughput RNA sequencing ( RNA-seq ) was performed to investigate the transcriptome in a multi-drug resistant uropathogenic Escherichia coli strain (NB8) treated with water decoction of rhizoma coptidis .Agar dilution test was used to determine the minimal inhibitory concentration ( MIC) of water decoction of rhizoma coptidis against the NB 8 strain.A growth curve was drawn to evaluate the effects of water decoction of rhizoma coptidis on the growth of NB8 strain.Total RNAs were extracted from the NB 8 strain after treated with the water decoction of rhizo-ma coptidis for 30 minutes and then synthetized to cDNA by reverse transcription after screening out the rRNAs.The HiSeq 2000 sequencing system was used for transcriptome sequencing .The TopHat software was used to map and analyze the RNA-Seq reads, and then Cufflinks was run to assemble transcripts and es-timate their abundances .The differential expression , GO enrichment and KEGG metabolic pathway were fur-ther analyzed .The NB8 strain dealt with normal saline was used as negative control .Results The MIC of water decoction of rhizoma coptidis to NB 8 strain was 12.5 mg/ml.There were 3665 genes expressed in NB8 strain treated with water decoction of rhizoma coptidis and 3430 genes expressed in NB8 strain treated with normal saline .The number of differentially expressed genes was 1428 including 921 up-regulated genes and 507 down-regulated genes .Those differentially expressed genes mainly enriched in the modules of binding and catalysis.The genes concerning cell adhesion , apoptosis and multicellular process were up-regulated, while those concerning the regulation of enzyme activities were down-regulated.Results of the KEGG meta-bolic pathway enrichment analysis showed that the genes concerning synthetic pathway of LPS were signifi -cantly up-regulated as well as those encoding the repair polymerase Ⅲthat was involved in DNA replication . However , the genes concerning fatty acid metabolism , histidine metabolism , thiamine metabolism , folate metabolism and iron carrier in ribosome synthesis showed overall down-regulation.Conclusion The tran-scriptome in uropathogenic Escherichia coli strain treated with rhizoma coptidis was profiled .The main mo-lecular mechanism of the inhibitory effects of rhizoma coptidis on uropathogenic Escherichia coli was to de-stroy the cell wall of Escherichia coli, affect the replication of DNA and regulate the transcription and transla-tion of proteins .This study illustrated that the inhibitory effects of rhizoma coptidis on uropathogenic Esche-richia coli were achieved in multiple levels .

Prepraation and detection of in vitro dis solution of if nasteridec oated dispre sible tablets / 药学实践杂志

Objective To optimize the prescription and preparation technology of finasteride dispersible tablets .Methods Wet granulation technique was applied to optimize the formulation and technology of finasteride tablets .Results The formulation of fi-nasteride tablets was that microcrystalline cellulose and lactose acts as diluent , 5% of low-substituted hydroxypropyl cellulose acts as disintegrant , 5%of povidone in alcohol water mixture acts as adhesive and 15%of opadry 85 G type acts as coating solution .The per-centage of dissolution was more than 90%in 45 miniutes.Conclusion The self-made finasteride tablets had stable quality , reliable process and were suitable for industrialized mass production .

Whole-genome sequence-based analysis of Klebsiella pneumoniae JM45 / 中华临床感染病杂志

Objective To investigate the distribution of β-lactamase genes in a pan-drug resistant Klebsiella pneumoniae isolate JM45.Methods Klebsiella pneumoniae JM45 was isolated from the blood sample of a patient admitted in the intensive care unit,the Second Affiliated Hospital,Zhejiang University School of Medicine on April 7,2010.The susceptibilities to 26 antibiotics were tested using E-test method.Cica-β-Test was performed to detect β-lactams,and modified Hodge test was performed to detect carbapenemase.Resistant genotypes were detected using PCR,DNA sequencing and BLAST algorithm.Whole genome sequencing (complete graph) was performed by high throughput Roche 454 sequencing approach to analyze the distribution of β-lactamase genes.Results Except polymyxin B and tigecycline,JM45 was resistant to other 24 kinds of antibiotics including cephalosporins and carbapenems.Several β-lactamases were positive in Cica-β-Test,and modified Hodge test was positive.Based on PCR typing,TEM-1,SHV-11,CTX-M-24 and VEB-3 were positive,but carbapenemase genes and metallo-β-lactamase genes were negative.A complete genome (chromosome) sequence (GenBank accession number:CP006656) and 2 plasmids sequences (GenBank accession number:CP006657,CP006658) were obtained by wholegenome sequencing.CTX-M-24 (Locus tag:N559_5233),TEM-1 (Locus tag:N559_5242) and VEB-3 (Locus tag:N559_5248) were positive in plasmid 1.CTX-M-24 located in insertion sequence (IS903-CTXM-24-ISEcp1),while TEM-1 and VEB-3 located in transposons (tnpA-TEM-1-rmtB and VEB-3-tnpA).SHV-11 (Locus tag:N559_2715) was positive in genome (chromosome),and 4 putative β-lactamase genes or β-lactamase domains were obtained:(1) metallo-β-lactamase domain protein (Locus tag:N559_0119,780 bp) ; (2) putative β-lactamase (Locus tag:N559_1633,1308 bp) ; (3) β-lactamase domain protein (Locus tag:N559_2279,813 bp); (4) β-lactamase domain protein (Locus tag:N559_3769,1101 bp).No insertion sequence or transposase gene was observed near SHV-11.Conclusion The resistance to antibiotics including cephalosporins and carbapenems is correlated with TEM-1,SHV-11,CTX-M-24,VEB-3 and 4 kinds of putative β-lactamase genes or β-lactamase domains.

Study on the influence of parenterai nutrition on nutritional status and immune function in breast cancer patients undergoing postoperative chemotherapy / 中国基层医药

Objective To explore the influence of parenterai nutrition(PN) on nutritional status and immune function in breast cancer patients undergoing postoperative chemotherapy.Methods 94 patients with breast cancer postoperative patients were randomly divided into the treatment group(47 cases) and the control group(47 cases).All the patients were given chemotherapy with VBP.The treatment group was given glutamine fortified PN,and the control group was given normal nutrition support,respectively.The nutritional status and immune function before and after chemotherapy,and main toxicities were observed.Results Compared with those before chemotherapy,there were no significant decrease on the level of ALB,PA and HB in treatment group(all P ＞ 0.05),while those indicators in control group was significantly decreased (all P ＜ 0.05).After chemotherapy,CD4,CD8,CD4/CD8 and IgA,IgG,IgM levels of the two groups were lower than those before chemotherapy (all P ＜ 0.05),and the levels of immune indicators of the treatment group were significantly higher than those of the control group(all P ＜ 0.05).The main toxicities in two groups were nausea and vomiting,diarrhea and mild bone marrow suppression,and the body weight in control group decreased (0.91 ± 0.53)kg,while it increased (0.45 ± 0.21)kg in treatment group (t =5.53,P ＜0.05).Conclusion PN treatment for breast cancer patients during chemotherapy can improve nutrition status and immune function,enhance the tolerance of chemotherapy,so as to improve curative effect and prognosis.

Molecular evolution of carbapenemases KPC-12 and molecular docking analysis of β-lactams / 中华临床感染病杂志

Objective To analyze molecular evolution of carbapenemase KPC-12 and its binding free energies with β-lactams.Methods Class A beta-lactamases were divided into 2 clusters:those with carbapenemase activities and those without.Minimum Evolution method in MEGA4.1 software was used to analyze molecular evolution of class A beta-lactamases with carbapenemase activity,including KPC-2 to KPC-13,SFC-1,SME-1,IMI-1,NMC-A,and class A beta-lactamases without carbapenemase activity,including TEM-1,SHV-1.Then,tertiary structure of KPC-12 was predicted by homology modeling as reported in SWISS-MODEL database depending on tertiary structure of KPC-2.Moreover,DOCK module in ArgusLab 4.1 software was used to perform molecular docking of KPC-12 to 10 kinds of beta-lactams substrates,and the binding free energies (△ G) were calculated.Results Molecular evolution between KPC-12 and KPC-2 was the closest.The top three decline in binding free energies of β-lactams were penicillin G sodium salt (△G =-8.45149 kcal/mol),ertapenem (△G =-8.36383 kcal/mol) and ampicillin (△G =-8.19326 kcal/mol),while the last two decline in binding free energies of β-lactams were aztreonam (△G =-6.50614 kca]/mol) and clavulanic acid (△G =-6.88533 kcal/mol).Conclusion Carbapenemase KPC-12 has high catalytic activities to penicillin G sodium salt,ertapenem and ampicillin,while has low catalytic activities to aztreonam and clavulanic acid.

Killing efficacy of chlorine-releasing agents on multidrug-resistant Acinetobacter baumannii / 中华临床感染病杂志

Objective To evaluate the killing efficacy of chlorine-releasing agents (CRAs) with different concentrations on multidrug-resistant Acinetobacter baumannii.Methods Totally 30 clinical strains of multidrug-resistant Acinetobacter baumannii were collected from November 2008 to December 2009.Killing efficacy of CRAs on these strains was evaluated by quantitative suspension test.The one-way analysis of variance was performed.Results The log values of killing to 30 strains of multidrug-resistant Acinetobacter baumannii were all ≥5.00,when the bacteria were exposed to available chlorine concentrations 400 mg/L of CRAs for 10 min,600 mg/L for 10 min,800 mg/L for 3 min and 1000 mg/L for 1 min,respectively.And effective rates were all 100％. Furthermore,there were significant differences among different available chlorine concentrations exposed for the same time ( except 10 min) ( F =72.72,64.79 and 32.33,P =0.00),and among different exposure time in the same available chlorine concentration ( except 1000 mg/L) ( F =110.42,20.41 and 3.20,P=0.00,0.00 and 0.03).Conclusion Satisfactory killing efficacy of CRAs to multidrug-resistant Acinetobacter baumannii can be achieved with available chlorine concentration 500 mg/L to 1000 mg/L and exposure time 10 min to 30 min.

Characterization of resistance to β-lactams in clinical isolates of Klebsiella pneumoniae / 中华临床感染病杂志

ObjectiveTo investigate correlation between drug-resistance related genes and mobile genetic elements of Klebsiella pneumoniae resistant to β-lactams. Methods Forty-seven strains of multidrug-resistant Klebsiella pneumoniae were collected from 6 hospitals in Hangzhou and Huzhou of Zhejiang province from August 2008 to May 2010.Modified Hodge test was performed to detect phenotypes of carbapenemases.Forty kinds of β-lactamases (class A-D),ompK35,ompK36,and 12 kinds of mobile genetic elements were detected by PCR,and the results were analyzed by index cluster.ResultsThirty-five strains were positive in modified Hodge test,and 5 kinds of β-lactamases gene ( including KPC-2-like,GenBank:HQ258934) and 9 kinds of mobile genetic elements were detected.Mutations were observed in ompK35 and ompK36 when compared with sensitive strains.Index cluster analysis showed that correlation existed between KPC-2,KPC-2-like and ISKpn6,between TEM-1 and ISEcpl,IS26,int Ⅰ 1,trbC,IS903,and between CMY-2,OXA-30,DHA-1 and tnpU,tnp513,trbC.ConclusionsFive kinds of β-1actamases genes,and mutations in ompK35 and ompK36 may be associated with the resistance to β-1actams in multidrug-resistant Klebsiella pneumoniae.

Genes related to chloramphenicol,tetracycline,rifampicin and trimethoprim-sulfamethoxazole resistance in multi-drug resistant Acinetobacter baumannii / 中华临床感染病杂志

Objective To investigate ehloramphenicol,tetracycline,rifampicin and trimethoprimsulfamethoxazole resistance and the related genes in multi-drug resistant Acinetobacter baumannii(MDR-ABA).Methods Sixty-two strains of MDR-ABA were isolated from clinical samples,and their susceptibilities to 22 antimicrobial agents were detected by Kirby-Bauer disk diffusion tests.Genes related to chloramphenicol(catB and cmlA),rifampicin(arr-2/3),tetracycline(tetA and tetB)and trimethoprimsulfamethoxazole(sull,dfrA1,dfrA5,dfrA7/17,dfrA12,dfr85)resistance and drug emux genes(tehA,emrB,emrD,emrE,smr-2,mdfA)were analyzed by PCR and verified by DNA sequencing.Results Resistant rates of these MDR-ABAs to chloramphenicol,rifampicin,tetracycline and trimethoprimsulfamethoxazole were 100.0%(62/62),100.0%(62/62),90.3%(56/62)and 82.3%(51/62)respectively,while62 strains(100.0%),46 strains(74.2%),36 strains(58.1%)and 8 strains (12.9%)were detected to carry mafA,tetB,sull and tehA genes,respectively.The lest 13 genes were all negative.tetB,sull,tehA and mafa genes(2 for each)chosen optionally from positive ones were verified by DNA sequencing and BLASTn.and all were identified as the same sequences in GenBank.Conclusions MDR-ABAs show hish resistance to chloramphenicol,tetracycline, rifampiein and trimethoprimsulfamethoxazole.Multi-drug resistant phenotypes of MDR-ABAs may be closely related to mdfA genes harboring in strains.