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Objective:To report the results of national surveillance on the distribution and antimicrobial resistance profile of clinical Gram-negative bacteria isolates from bloodstream infections in China in 2022.Methods:The clinical isolates of Gram-negative bacteria from blood cultures in member hospitals of national bloodstream infection Bacterial Resistant Investigation Collaborative System（BRICS）were collected during January 2022 to December 2022. Antibiotic susceptibility tests were conducted by agar dilution or broth dilution methods recommended by Clinical and Laboratory Standards Institute（CLSI）. WHONET 5.6 and SPSS 25.0 software were used to analyze the data.Results:During the study period，9 035 strains of Gram-negative bacteria were collected from 51 hospitals，of which 7 895（87.4%）were Enterobacteriaceae and 1 140（12.6%）were non-fermenting bacteria. The top 5 bacterial species were Escherichia coli（ n=4 510，49.9%）， Klebsiella pneumoniae（ n=2 340，25.9%）， Pseudomonas aeruginosa（ n=534，5.9%）， Acinetobacter baumannii complex（ n=405，4.5%）and Enterobacter cloacae（ n=327，3.6%）. The ESBLs-producing rates in Escherichia coli， Klebsiella pneumoniae and Proteus spp. were 47.1%（2 095/4 452），21.0%（427/2 033）and 41.1%（58/141），respectively. The prevalence of carbapenem-resistant Escherichia coli（CREC）and carbapenem-resistant Klebsiella pneumoniae（CRKP）were 1.3%（58/4 510）and 13.1%（307/2 340）；62.1%（36/58）and 9.8%（30/307）of CREC and CRKP were resistant to ceftazidime/avibactam combination，respectively. The prevalence of carbapenem-resistant Acinetobacter baumannii（CRAB）complex was 59.5%（241/405），while less than 5% of Acinetobacter baumannii complex was resistant to tigecycline and polymyxin B. The prevalence of carbapenem-resistant Pseudomonas aeruginosa（CRPA）was 18.4%（98/534）. There were differences in the composition ratio of Gram-negative bacteria in bloodstream infections and the prevalence of main Gram-negative bacteria resistance among different regions，with statistically significant differences in the prevalence of CRKP and CRPA（ χ2=20.489 and 20.252， P<0.001）. The prevalence of CREC，CRKP，CRPA，CRAB，ESBLs-producing Escherichia coli and Klebsiella pneumoniae were higher in provinicial hospitals than those in municipal hospitals（ χ2=11.953，81.183，10.404，5.915，12.415 and 6.459， P<0.01 or <0.05），while the prevalence of CRPA was higher in economically developed regions（per capita GDP ≥ 92 059 Yuan）than that in economically less-developed regions（per capita GDP <92 059 Yuan）（ χ2=6.240， P=0.012）. Conclusions:The proportion of Gram-negative bacteria in bloodstream infections shows an increasing trend，and Escherichia coli is ranked in the top，while the trend of CRKP decreases continuously with time. Decreasing trends are noted in ESBLs-producing Escherichia coli and Klebsiella pneumoniae. Low prevalence of carbapenem resistance in Escherichia coli and high prevalence in CRAB complex have been observed. The composition ratio and antibacterial spectrum of bloodstream infections in different regions of China are slightly different，and the proportion of main drug resistant bacteria in provincial hospitals is higher than those in municipal hospitals.
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Objective To investigate the expression of TLR4 mRNA and NF-κB p65 in colorectal carcinomas and adjacent normal colon tissue, and evaluate their roles in the pathogenesis and development in colorectal carcinoma. Methods Sixty-three colorectal carcinoma samples and respective adjacent normal colon tissue samples ( well differentiated : 23 cases; moderately differentiated: 17 cases; poorly differentiated:20 cases; other differentiated type: 3 cases; lymph node metastasis: 27 cases; no lymph node metastasis:36 cases; Dukes A: 18cases;Dukes B: 14 cases Dukes C: 22 cases; Dukes D: 9 cases) were collected. The expression of TLR4 mRNA in colorectal carcinomas and adjacent tissue were detected by RT-PCR. The expression of NF-κB p65 was detected by WB. Results The expression of TLR4 mRNA in colorectal carcinomas and adjacent tissue were 86.42 ± 15.16 and 32.74 ± 9.44. It was significantly higher in carcinoma tissue than that in adjacent tissue ( t = 22.354, P ＜ 0.01 ). The expression of TLR4 mRNA in well, moderately and poorly differentiated coiorectal carcinomas were 69.58 ± 11.27, 64.57 ± 13.91 and 97.12 ± 15.44 respectively. TLR4 mRNA in poorly differentiated colorectal carcinomas was significantly higher than that in well, moderately differentiated ones ( t = 11.304 and 12.223, P ＜ 0.01 ). There was no difference between lymph node metastatic carcinomas ( 89.91 ± 13.33 ) and carcinomas without metastasis (81.16±13.59,t =0.959,P＞0.05). The expression of TLR4 mRNA in the Dukes A stage tumors (59.05±11.66) was lower than that in Dukes B(90.34 ±0.08),C(91.41 ± 15.21), D(101.46 ±17.43), respectively ( t = 8.708,9.664,9.525, P ＜ 0.05 ). The expression of NF-κB p65 in colorectal carcinoma(0.63 ±0.11) was significant higher than that in adjacent tissue(0.34 ±0.08,t = 18.266,P ＜0.01 ). The expression of NF-κB p65 in well, moderately and poorly differentiated colorectal carcinomas were 0.46 ± 0.09, 0.72 ± 0.11 and 0.77 ± 0.14, respectively. The experssion of NF-κB p65 in well differentiated colorectal carcinomas was obviously lower than the woderately and poorly differentiated carcinomas (t = 11.223 and 10.875, P ＜0.01 ). There was significant difference between the expression of p65 in lymph node metastatic carcinomas(0.82 ± 0.17) and non-metastatic carcinomas(0.57 ± 0.12, t =18.269,P＜0.05). The expression of NF-κB p65 in Dukes A colorectal carcinomas (0.39 ± 0.06) was lower compared with the Dukes B(0.72 ±0.12), C(0.69 ±0.14) and D carcinomas(0.76 ±0.13,t =10.442, 9.889 and 9.721, P ＜ 0.01 ). Conclusions The enhanced expression of TLR4/NF-κB p65 are closely associate with clinical stage and pathologic grade. NF-κB p65 may be an molecular marker of lymph node metastatic. The increased expression of TLR4/NF-κB p65 promote the pathogenesis and development of colorectal carcinoma.
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ObjectiveTo investigate the application value of negative pressure sucking technique in the elderly after nasal septal reconstruction. MethodsForty elderly patients after nasal septal reconstruction were divided into two groups randomly, with twenty patients in each. The cases in observing group received negative pressure sucking technique while those in controlling group received nasal packing with vaseline gauze following the surgery. The amount of bleeding of the first 24 hours after operation, the comfort degrees evaluated by using visual analogue scale (VAS),hematoma of nasal septum, edema in nasal cavity and duration of hospitalization after operation were compared between the two groups. ResultsThe amount of bleeding of the first 24 hours afteroperation was more in observing group than in controlling group[(14.2±8.1)ml vs. (7.2±4.1)ml, P<0.05]. The VAS score and the number of cases who felt discomfortable moderately or severely were significantly less in observing group than in controlling group at 6 h, 12 h and 24 h after operation(all P<0.05). The nasal cavity gap were significantly wider in observing group at the 3rd day after operation(P=0.001), and the duration of hospitalization after operation was significantly shorter in observing group [(4.5±0.9) d] than in controlling group [(5.42±0.9) d](P=0.042)Conclusions Negative pressure sucking technique applied in the elderly after nasal septal reconstruction can significantly relieve the distress of patients, reduce the edema in nasal cavity and shorten the duration of hospitalization, but does not increase the risk of hemorrhage.
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Objective:To investigate the clinical significance of soluble thrombomdulin (sTM)、endothelial protein C receptor (sEPCR) and von Willebrand factor (vWF) in patients with renal transplantation and reject reaction.Methods:The plasma levels of sTM, sEPCR and vWF were successively determined by double antibody sandwich enzyme linked immunoadsordent assay (ELISA) in 42 patients with renal transplantation and reject reaction, and were compared with normal groups.Results:The levels of sTM, sEPCR and vWF in postoperative of renal transplantation patients were higher than those in preoperative ( P 0 05). In patients with renal transplantation, the levels of sTM, sEPCR and vWF each have positive correlation(r=0 595 P