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新冠病毒感染疫情严重威胁着世界各国人民的生命健康。目前，对病毒感染的防治研究主要集中在抑制病毒与分子受体的结合上。AXL作为新发现的严重急性呼吸综合征冠状病毒2型（SARS-CoV-2）受体，在协助病毒感染人体呼吸系统中发挥着重要作用，是未来临床干预的潜在靶点。本研究对已发表的单细胞测序数据进行整理和分析，发现AXL在年轻人肺细胞中的表达水平明显高于老年人。人胚肺二倍体成纤维细胞（2BS）是衰老研究的公认细胞株。本文采用2BS细胞构建复制性细胞衰老模型，发现年轻细胞中AXL的蛋白水平明显高于衰老细胞，据此推测年轻人感染的风险可能更高，需要注意防护。我们发现一种羊栖菜褐藻多糖硫酸酯组分（SFW-3）可显著下调年轻2BS细胞中AXL的表达水平，表明SFW-3具有一定的抗SARS-CoV-2感染的研究价值，同时表明2BS细胞株也可作为潜在的SARS-CoV-2体外感染模型。
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Humanos , SARS-CoV-2 , Sargassum/metabolismo , Diploide , Sulfatos/metabolismo , COVID-19 , Polissacarídeos/farmacologia , PulmãoRESUMO
Objective To investigate the distribution and transmission characteristics of vancomycin -resistant Enterococcus faecium (VREF) carrying both vanA and vanM in the intensive care unit.Methods VREF strains were isolated from patients in the intensive care unit of Jinshan Hospital , Fudan University in Shanghai from 2013 to 2017.Antimicrobial susceptibilities of the VREF strains to nine antibiotics , including vancomycin, teicoplanin, linezolid and chloromycetin , were tested by broth microdilution method.Multiple polymerase chain reaction (PCR) was used for van genotyping and pulsed field gel electrophoresis (PFGE) was used for homology analysis.Results Thirty-five strains were mainly isolated from urine (16 strains), blood (11 strains), feces ( five strains ), bile ( two strains ) and pleural effusion ( one strain ).All the strains (100.00%) were resistant to vancomycin , ampicillin and levofloxacin , but only 40.00% were resistant to teicoplanin.All the strains were sensitive to linezolid.The results of van genotyping showed that 33 (94.3%) strains belonged to vanA and vanM dual genotype VREF, and the other two were vanA type VREF.PFGE results showed that 35 strains could be divided into 14 PFGE patterns, and seven out of 10 strains isolated in 2014 were identical and the other three belonged to three different PFGE patterns.Conclusions A dual genotype VREF carrying both vanA and vanM has been emerging and spreading in the intensive care unit of Jinshan Hospital , Fudan University in Shanghai.
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Objective@#To analyze the longitudinal change of serum total cholesterol concentration in 733 rural residents in Shanxi province.@*Methods@#Based on the residents of five rural areas in Shanxi province who participated in China nutrition and health survey in 2002, a follow-up survey was conducted in 2015. Fasting venous blood of the participants was collected and serum TC concentration was tested by cholesterol oxidase method.@*Results@#Of 733 participants, 332 were male and 401 were female. In 2002 baseline survey, the age of the participants was (42.6±9.5) years old, 76.2% of male and 83.8% of female had junior middle school education or below. Proportion of smoking were 65.7% and 1.2%, drinking were 26.8% and 4.0%, obesity were 6.3% and 12.0%, and central obesity were 27.1% and 31.9%, respectively in male and female. The follow-up age of participants in 2015 was (55.8±9.5) years old, proportion of smoking changed to 48.2% and 1.5%, drinking were 49.7% and 3.0%, obesity increased to 11.8% and 18.2% and central obesity increased to 41.6% and 53.6%, respectively in male and female. The overall serum TC level increased from (3.82±0.89) mmol/L to (4.72±0.97) mmol/L with an average increase of 27.2%, which increased from (3.84±0.94) mmol/L to (4.54±0.93) mmol/L in male with an average increase of 22.7%, and increased from (3.81±0.84) mmol/L to (4.86±0.98) mmol/L in female with an average increase of 30.9%. The serum TC levels in 18-, 30-, 40-, and 50-59 years old group increased from (3.42±0.83), (3.72±0.77), (3.90±0.83) and (4.00±1.03) mmol/L to (4.38±1.01), (4.79±0.92), (4.73±0.99) and (4.76±0.96) mmol/L, with average increase range of 31.4%, 32.1%, 25.2% and 22.6%, respectively. The mean serum TC levels between two years all had statistically significant difference among groups of gender, age, education, marital status, family history of cardiovascular disease, smoking, drinking, BMI and waist circumference after paired t-test and ANOVA analysis (P<0.01).@*Conclusion@#The longitudinal serum TC level of rural residents in Shanxi province increased rapidly.
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Objective To study the association between blood pressure related dietary pattern and cognitive impairment in the elderly.Methods In 2015,all participants who were aged ≥60 and participated in the Nutrition and Chronic disease family cohort were involved in the study.Information on demographic variables,lifestyle and health status was collected.Cognitive performance was assessed by the Mini Mental State Evaluation (MMSE) scale.Blood pressure,height and weight were measured by trained medical personnel and fasting venous blood samples were collected for testing on serum level of triglycerides and total cholesterol.Both SBP and DBP were used as response variables when dietary patterns were identified by reduced rank regression method.Logistic regression models were fit to explore the associations of scores on blood pressure-related dietary pattern and cognitive impairment.Results Two blood related dietary patterns were identified.The first one was characterized by high consumption of vegetables and less meat,eggs and dessert (Pattern 1),while the second one was with high consumption of meat,soy products,wine and fried foods and less intake of dairy (Pattem 2).Data showed that the Pattern 1 was associated with the risk of cognitive impairment.Comparing with the lowest quartile of score of this dietary pattern,the risk of cognitive impairment in the highest quartile group showed a significant (P＜0.01) increase,with OR=1.94 (1.21-3.11) and showing significant (P=0.002) linear trend.However,no significant association was observed (P＞ 0.05) with cognitive impairment in the second dietary pattern.Conclusion Blood pressure-related dietary pattern was positively associated with cognitive impairment.
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Objective To study the association between blood pressure related dietary pattern and cognitive impairment in the elderly.Methods In 2015,all participants who were aged ≥60 and participated in the Nutrition and Chronic disease family cohort were involved in the study.Information on demographic variables,lifestyle and health status was collected.Cognitive performance was assessed by the Mini Mental State Evaluation (MMSE) scale.Blood pressure,height and weight were measured by trained medical personnel and fasting venous blood samples were collected for testing on serum level of triglycerides and total cholesterol.Both SBP and DBP were used as response variables when dietary patterns were identified by reduced rank regression method.Logistic regression models were fit to explore the associations of scores on blood pressure-related dietary pattern and cognitive impairment.Results Two blood related dietary patterns were identified.The first one was characterized by high consumption of vegetables and less meat,eggs and dessert (Pattern 1),while the second one was with high consumption of meat,soy products,wine and fried foods and less intake of dairy (Pattem 2).Data showed that the Pattern 1 was associated with the risk of cognitive impairment.Comparing with the lowest quartile of score of this dietary pattern,the risk of cognitive impairment in the highest quartile group showed a significant (P＜0.01) increase,with OR=1.94 (1.21-3.11) and showing significant (P=0.002) linear trend.However,no significant association was observed (P＞ 0.05) with cognitive impairment in the second dietary pattern.Conclusion Blood pressure-related dietary pattern was positively associated with cognitive impairment.
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Objective To investigate the resistance profile of Klebsiella pneumoniae isolates in Huashan Hospital, Fudan University. Methods The MICs of fluoroquinolones were determined by agar dilution method against 112 clinical strains of K. pneumoniae. Multilocus sequence typing (MLST) were applied to 48 K. pneumoniae strains. The characteristic sequence type (ST) associated with antibiotic resistance was identified by PCR. Results Lower percentage (＜40％) of K. pneumoniae strains were susceptible to fluoroquinolones. Majority (86.2％) of ciprofloxacin non-susceptible K. pneumoniae strains belonged to CC1 (ST11), ST494 or CC4 (ST15 and ST655), indicating the potential of clonal dissemination. ST494 (18.8％) was the second commonest sequence type, next only to ST11. ST494 strains harbored the genes encoding beta-lactamases, oqxAB, qnrD, aac-(6')-lb-cr and armA and had a single point mutation in gyrA. Therefore, ST494 strains were highly resistant to cephalosporins, fluoroquinolones and aminoglycosides and 22％ of the strains were resistant to carbapenems. However, all the ST494 strains were susceptible to tigecycline and tetracycline. Conclusions ST11 and ST494 are the commonest STs of K. pneumoniae conferring multidrug resistance in this hospital. These STs may contribute to the high resistance rates of K. pneumoniae to fluoroquinolones. The susceptibility of ST494 strains to tigecycline and tetracycline allows us to consider the promising potential of such drugs in managing K. pneumoniae infections.
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Objective To profile 16S rRNA methylase genes and the flanking sequences in extensively drug resistant (XDR) Pseudomonas aeruginosa. Methods A total of 59 strains of XDR P. aeruginosa were collected. MICs of antimicrobial agents against these strains were determined by agar dilution method. The genes encoding 16S rRNA methylase (armA, rmtA, rmtB, rmtC, rmtD, rmtE, and npmA) were analyzed by PCR. The homology of strains was studied by enterobacterial repetitive intergenic consensus-polymerase chain reaction (ERIC-PCR). The structure of armA and rmtB flanking regions were characterized. Results The overall prevalence of armA or rmtB genes was 62.7％ (37/59) in XDR P. aeruginosa isolates, specifically armA positive in 17 strains and rmtB positive in 22 strains. The rmtA, rmtC, rmtD, or npmA gene was not identified in any strain. ERICPCR generated 19 types (or clones) from the 59 strains. The 17 armA-positive strains were distributed in 3 clones, and 88.2％ of the armA-positive strains (15) belonged to clone D. The rmtB gene was dispersed in 9 clones. Flanking sequence analysis demonstrated that armA gene was located in a mobile element carrying multiple transposases. The sequence of the mobile element showed 99％ similarity with the sequence of armA-positive plasmid carried by E. coli and A. baumannii. The rmtB gene was also located in a mobile element containing multiple transposases. The sequence of the mobile element was highly consistent with that of rmtB-positive plasmid carried by E. coli and K. pneumoniae. Conclusions The genes encoding 16S rRNA methylase are prevalent in XDR P. aeruginosa strains. All the genes were identified in high-level gentamicin-resistant strains. Clonal dissemination may explain the spread of armA among P. aeruginosa isolates.
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Objective To determine the genotype and molecular typing of vancomycin-resistant Enterococcus (VRE).Methods Seventeen clinical isolates of VRE were collected in 2016.The strains were identified to species and confirmed by 16S rRNA sequencing.The minimum inhibitory concentration of antimicrobial agents was determined by microdilution method and agar dilution method.Multilocus sequence typing (MLST) was used for molecular typing.Results The VRE strains were confirmed as Enterococcusfaecium by 16S rRNA sequencing.All strains were resistant to vancomycin,but only 12 strains were resistant to teicoplanin.The vanA gene was identified in 13 of the 17 strains.The vanM gene was detected in 9 strains.Both vanA and vanM genes were identified in five of the 17 strains.Six MLST types were identified in the 17 strains,including ST78 (n=8),ST80 (n=4),ST555 (n=2),and one each for ST117,ST262 and ST341.Conclusions The van genotype was primarily vanA (76.5％) and vanM (52.9％) in clinical isolates of VRE.The VRE strains carrying both vanA and vanM were found for the first time.
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Objective To summarize the etiology,diagnosis and treatment of three cases of duodenal perforation. Methods The data of 3 cases of children with duodenal perforation in our hospital from September 14,2016 to June 20,2017 were retrospectively analyzed. The causes,clinical features and treatment of children's duodenal perforation were summarized. Results A total of 2 males and 1 females aged 2 years,3 years and 5 years were included in the 3 cases. All 3 cases had fever history of upper respiratory tract infection before onset. Acute abdominal pain occurred after oral administration of ibuprofen several times,and all the abdominal plain films prompted pneumoperitoneum. Three cases of perforation sites were duodenal anterior wall,diameter were 0. 5-1 cm. Two cases of small amount of pneumoperitoneum were explored and repaired the duodenal perforation by 3D laparoscopic,1 case underwent laparotomy to repair the duodenal perforation due to a large number of liquid pneumoperitoneum and severe shock. Repair of 3 cases were covered with omentum. Three cases were all cured without anastomotic fistula, ulcer, adhesive intestinal obstruction or other complications. Followed-up in the department of gastroenterology,3 cases had no Helico-bacter pylori infection. Conclusion Repeatedly oral administration of ibuprofen can cause duodenal perfora-tion in children in the short term. Once the digestive tract perforation confirmed,emergency surgical explora-tion is needed. Laparoscopic repair of duodenum perforation is safe and effective and may have a faster recov-ery. We can choose exploratory laparotomy if conditions are not allowed.
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Objective To investigate the antibiotic resistance pattern and molecular epidemiology of carbapenem-resistant Pseudomonas aeruginosa.Methods The antimicrobial susceptibility was measured by agar dilution method for the 104 strains of carbapenem-resistant P.aeruginosa (CRPA) collected from Huashan Hospital.The homology between these strains was evaluated by pulsed field gel electrophoresis (PFGE).Results Of thel04 CRPA strains,85.6％ were resistant to meropenem and 98.1％ to imipenem.These strains also showed various percentages of resistance to amikacin (18.3％),gentamicin (40.4％),ceftazidime (26.9％),cefepime (21.2％),ciprofloxacin (44.2％),levofloxacin (50.0％),piperacillin-tazobactam (19.2％),cefoperazone-sulbactam (26.9％),ticarcillin-clavulanic acid (52.9％),aztreonam (26.9％),and colistin (5.8％).PFGE analysis showed that these strains were divided into 48 types,belonging to 9 clones.Only 3 strains were non-typeable.Clone A was the primary epidemic strain (41.6％,42/101),which was mainly isolated from Neurosurgery,Geriatrics and General Ward.Clone B accounted for 5.9％ (6/101) of the strains.Conclusions Multiple clones of carbapenem resistant Pseudomonas aeruginosa were prevalent in Huashan hospital.Effective infection control approaches should be adopted to prevent the development and the further spreading of antimicrobial resistance.
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Objective To understand the resistance mechanism and clinical feature of linezolid-resistant S.capitis isolated from blood samples.Methods Antimicrobial susceptibility testing was carried out to determine the susceptibility of clinical strains.PCR and sequencing analysis were used to analyze cfr gene and 23S rRNA mutation,which were associated with linezolid resistance.Patterns of pulsed-field gel electrophoresis (PFGE) were analyzed in combination with clinical data to understand the clinical feature of S.capitis strains.Results Five linezolid-resistant S.capitis strains were isolated from blood samples of 3 patients.These strains were resistant not only to linezolid,but also to most of the commonly used antimicrobial agents except glycopeptides,rifampin,and trimethoprim-sulfamethoxazole.Mutation was identified in 23S rRNA genes of all the five strains and cfr gene was found in four of the five strains.PFGE typing showed the same type,which supported the homology of the 5 strains.Three patients had deep vein indwelling catheter and two of them were treated with linezolid.Conclusions Linezolid-resistant S.capitis isolates showed the phenotype of resistance to multiple antimicrobial agents.Linezolid resistance may be mediated by cfr gene and 23S rRNA mutations in S.capitis.Long-term use of deep vein indwelling catheter and linezolid treatment may increase the risk of linezolid-resistant S.capitis infection.
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Objective To develop a multiple polymerase chain reaction (PCR) technique based assay for rapid detection of vanA, vanB, vanD and vanM in high-level vancomycin-resistant enterococci.Methods After analyzing the uncleotide sequence divergence among D-Ala∶D-Lac ligase genes, an multiplex PCR assay for vanA, vanB, vanD and vanM genes in high-level vancomycin-resistant enterococci were designed.By using recombination plasmids containing vanA, vanB, vanD and vanM genes as positive control, and non-vancomycin resistant enterococci (non-VRE) common pathogenic bacterial DNA as negative control, the sensitivity and specificity of the assay were evaluated.Fifty vancomycin-resistant enterococci (VRE) isolates were detected by the assay.Fifty clinical strains of VRE were isolated from 9 hospitals in Shanghai from January 2006 to December 2014.The results were compared with the conventional PCR and sequencing methods.Results The identity of the D-Ala∶D-Lac ligase genes were 60.8%-71.3% of vanA, vanB, vanD and vanM genes.The multiplex PCR assay could identify the genotypes of the positive control samples accurately.No false positive results were found in negative control samples.Among fifty VRE strains detected by the assay, 18 were vanA genotype and 32 were vanM genotype.Comparison of the multiplex PCR assay and sequencing methods revealed sensitivity and specificity of 100%.The detection limit of the assay was 2×10 copies/PCR reaction.The experiment could be done within 3.5 h.Conclusions A multiplex PCR assay is developed to rapid identify the genotype of the high-level vancomycin-resistant enterococci, which can be used for the molecular epidemiology research and detection of VRE.
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Objective To investigate the clinical characteristics of the infections caused by carbapenem-resistant Pseudomonas aeruginosa (CRPA) for better prevention and treatment of CRPA infections. Methods A retrospective study was conducted to compare the features of CRPA infections (n=85) and carbapenem-susceptible P. aeruginosa (CSPA) infections (n=94) treated in Huashan Hospital from January 1, 2013 to December 31, 2013. Results? The?proportion?of?CRPA?infections?was?significantly?higher?than CSPA in Neurosurgery (40.0% versus 16.0%) and Intensive Care Unit (22.4%, 9.6%). Traumatic brain injury (30.6%) and vascular accidents (21.2%) were the main underlying diseases in CRPA patients, which was higher than in CSPA patients (11.7%and?8.5%,?respectively).?CRPA?infection?was?associated?with?significantly?higher?incidence?of?fever,?altered?mental?status,?and?severe hypoproteinemia than CSPA infection. Multiple bacterial infection was found in more CRPA patients (45.9%, 39/85) than in CSPA patients (24.5%, 23/94). Fewer CRPA patients showed positive treatment response (44.7%, 38/85) than CSPA patients (78.7%, 74/94). CRPA was associated with significantly more cases of disease progression (55.3%, 47/85) and more deaths (16.5%, 14/85) than CSPA (21.3% and 1.1%, respectively). Logistic regression analysis indicated that stay in Department of Neurosurgery, prior carbapenem use, peripherally inserted central catheter, nasal feeding, and mechanical ventilation were the risk factors for CRPA infection. Conclusions No specific clinical manifestation is associated with CRPA infection, which poses a therapeutic challenge and results in unfavorable prognosis. Rational use of antibacterial agents and appropriate supporting treatments are essential for control of CRPA in Huashan Hospital.
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Objective To investigate the distribution and antimicrobial susceptibility of clinical strains ofEnterobacteriaceae isolated from Huashan Hospital in 2014.MethodsEnterobacteriaceae were isolated from January to August 2014. Antimicrobial susceptibility testing was performed by agar dilution method. TheblaKPC gene was screened by PCR and DNA sequencing. Results were analyzed by WHONET 5.6 software.Results A total of 719 strains ofEnterobacteriaceae were collected, of whichKlebsiella spp., andE .coli accounted for 43.8% (315/719) and 30.4% (219/719), respectively. Resistance rates ofKlebsiella spp.,E. coli, andCitrobacter spp., to polymyxin B and polymyxin E were low (<3%). The percentage of theEnterobacter strains resistant to polymyxin B and polymyxin E was 10.9% and 11.1%, respectively. About 47.5% and 44.7% of theSerratia strains were resistant to polymyxin B and polymyxin E, respectively. More than 90% of theMorganella andProteus isolates were resistant to polymyxin B or polymyxin E. The carbapenem-resistantEnterobacteriaceae strains were mainly identiifed inKlebsiella isolates, more than 40% of which were resistant to meropenem and ertapenem, but only 2.9% and 2.6% were resistant to polymyxin B and polymyxin E, respectively. Ertapenem resistance was identified in 27.8% of theCitrobacter isolates and 17.9% of theSerratia isolates. Less than 10% of the otherEnterobacteriaceae strains were resistant to carbapenem. Overall, 20.7% (149/719) of the isolates wereblaKPC positive, mainly inK. pneumoniae (129/315, 41.0%). Seven strains ofSerratia marcescens and 2 strains ofK. Pneumoniae were resistant to both carbapenems and polymyxin.Conclusions The clinical isolates ofKlebsiella, E. coli, Enterobacter andCitrobacter in 2014 were still highly susceptible to polymyxin antibiotics.
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Objective To investigate thein vitro activity of tigecycline and minocycline against VanM-type vancomycin-resistant Enterococcusfaecium.Methods A total of 45 strains of VanM-type vancomycin-resistantE. faecium were obtained from hospitals in Shanghai between 2006 and 2014. Species and vancomycin resistance genotype were identiifed by PCR and sequencing analysis. Minimal inhibitory concentrations (MICs) of ten antimicrobial agents against these strains were determined.Results All the 45 isolates were VanM-type vancomycin-resistantE. faecium, and resistant to vancomycin (MIC: 128 to >256 mg/L). And 71.1%of the strains were resistant to teicoplanin. Almost all isolates showed resistance to levolfoxacin (100%) and ampicillin (97.8%). About 15.6%, 64.4% and 82.2% of the strains were resistant to minocycline, gentamicin and rifampicin, respectively.Conclusion Tigecycline and minocycline exhibit excellentin vitro activity against these VanM-type vancomycin-resistantE. faecium isolates.
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Objective To understand fosfomycin resistance and prevalence of fos gene in clinical Staphylococcus aureus strains . Methods A total of 109 clinical strains of S .aureus were isolated from the patients in Huashan Hospital from January to March in 2014 .Antimicrobial susceptibility testing was performed by agar dilution method .The genes related to fosfomycin resistance including fosA ,fosB and fosC were detected by PCR .The flanking sequences of fos gene were determined by primer walking sequencing .The multilocus sequence typing (MLST) was carried out for fos gene positive strains .Results Forty‐four strains were resistant to fosfomycin (MIC> 32 mg/L) ,including 13 positive for fosB gene .Thirteen of the 109 (11 .9% ) strains carried fosB gene .However ,no fosA or fosC gene was identified .ST1 was a dominant MLST type in the strains carrying fosB gene .The three strains positive for fosB gene and associated with high level fosfomycin resistance (MIC> 512 mg/L) belonged to three different ST types . Walking sequencing showed that the fosB gene located on a transferable element containing a transposase gene .Conclusions High prevalence of f osB gene in fosfomycin‐resistant S . aureus strains indicates that f osB gene may mediate or contribute to fosfomycin resistance .
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Objective To investigate the profile of antimicrobial susceptibility of the Mycoplasma pneumoniae (Mpn)strains isolated from pediatric patients with respiratory tract infection.Methods Antimicrobial susceptibility testing was conducted with a total of 112 Mpn clinical strains by broth microdilution method.Sequence analysis of full 23S rRNA genes was performed for all Mpn strains.Results One hundred and twelve Mpn strains were isolated from January 2009 to March 2011. Of these clinical isolates,98 (87.5%)were resistant to erythromycin and azithromycin.All macrolide-resistant Mpn strains harbored an A2063G or A2064G transition mutation in domain V of 23S rRNA genes.Mpn isolates were still very susceptible to the tetracyclines and fluoroquinolones tested.Conclusions The Mpn strains from pediatric patients are highly resistant to macrolides.The mechanism of macrolide resistance may be associated withthe transition mutation on 23S rRNA gene.
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Objective To understand the clinical features of candidemia.Methods A retrospective analysis was performed based on the data of 88 candidemia cases treated in Huashan Hospital during the period from 2007 to 2012.The clinical data were re-viewed in terms of species distribution,underlying diseases,clinical manifestations,treatment and outcomes.The prognostic factors were analyzed by chi-square test or Fisher exact probability test.Multivariate analysis was conducted by multiple Logis-tic regression.Results Candida albicans (40/88,45.5%)was the most common pathogen isolated from these candidemia ca-ses,followed by Candida tropicalis (20/88,22.7%),Candida parapsilosis (17/88,19.3%),Candida glabrata (10/88, 11 .4%),and Candida krusei (1/88,1 .1 %).Solid malignancy,diabetes,and surgical procedure were the most frequently identified underlying diseases.Fatal or deteriorative outcome was reported in 28 cases.The attributable mortality was 18.2%. Multivariate prognostic analysis indicated that presence of central venous catheter (OR:6.322,95% CI :1 .055-37.891 ,P =0.044)was independently correlated to increased mortality.Appropriate antifungal therapy was an independent predictor of de-creased overall mortality (OR:0.137,95% CI :0.039-0.480,P =0.002).Conclusions The pathogen distribution of candi-demia has changed slightly.Appropriate antifungal therapy plays a key role in the treatment of candidemia.
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Objective To study the clinical characteristics,antimicrobial restistance of bloodstream infections (bacteremia) caused by multidrug-resistant Acinetobacter and analyze the outcomes of antibacterial therapy.Methods The clinical data were reviewed retrospectively for 74 patients with bloodstream infection caused by multidrug-resistant Acinetobacter who were trea-ted in HuaShan hospital from January 2005 to December 2011 .Results During the 6-year period,74 patients were diagnosed with multidrug-resistant Acinetobacter bacteremia,73 of which were nosocomial infections.The remaining one was community-acquired. Primary bloodstream infection accounted for 51 .4% (38/74),and secondary infection 48.6% (36/74), mainly secondary to pulmonary infections (23.0%,17/74). Solid tumor was the most common underlying disease (24.3%,18/74).Prior corticosteroid therapy,indwelling deep venous catheter,surgery and invasive procedures were predisposing factors of bacteremia. Acinetobacter-related bloodstream infections were associated with higher white blood cell count,increased neutrophil percentage,higher APACHE II score and lower serum albumin level.The bloodstream infection was caused by Acinetobacter baumannii in 65 pa-tients,Acinetobacter lwoffi in 7 patients,both Acinetobacter baumannii and Acinetobacter junii in one patient.The all-cause mortality rate was 27.0% (20/74).In vitro susceptibility testing showed that 20.0% (15/75 )of the Acinetobacter isolates were resistant to cefoperazone-sulbactam,which was the lowest among all the antibiotics tested.About 40.0% to 42.7% of the isolates were resistant to carbapenems.The outcome was related to the antimicrobial restistance.Carbapenem non-suscepti-ble Acinetobacter was associated with poorer outcome compared with carbapenem-susceptible Acinetobacter (mortality 46.9%vs 11 .9%,P <0.05 ).Cefoperazone-sulbactam non-susceptible Acinetobacter was also associated with poorer outcome com-pared with cefoperazone-sulbactam susceptible Acinetobacter (mortality 40.0% vs 18.2%,P <0.05).Of the 32 patients who had infections with carbapenem-non-susceptible Acinetobacter,20 received sulbactam-containing antimicrobial agent.The mor-tality of these 20 patients was 20.0% (4/20),significantly lower than that of the 12 patients who did not receive sulbactam-containing antimicrobial agent (66.7%).Conclusions Majority of the bloodstream infections caused by multidrug-resistant Acinetobacter are nosocomial infections.Surgical operation and serious condition may predispose the patients to develop Acine-tobacter bacteremia.Acinetobacter isolates are highly resistant to commonly used antibiotics.The Acinetobacter isolates not susceptible to carbapenem or cefoperazone-sulbactam are associated with poorer outcome and higher mortality.More attention should be paid to prevention and control of Acinetobacter-related nosocomial infections.
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Objective To investigate the expression and effect of FOXC2 (forkhead box C2) and Vimentin in gastric carcinoma tissues .Methods To detect the protein expression of FOXC2 and Vimentin in 20 normal gastric tissues and 65 gastric carcinoma tissues with immunochemistry .Results FOXC2 and Vimentin were highly expressed in all gastric carcinoma tissues .In all gastric carcinoma cases ,the FOXC2 expression rate was 41 .53% ,the rate of Vimentin was 35 .38% .The average expression rates of FOXC2 and Vimentin in TNM ( Ⅲ + Ⅳ ) group were significantly higher than those in TNM (Ⅰ + Ⅱ ) group ,respectively (58 .60% vs .27 .78% ,P=0 .012 ;55 .88% vs .29 .03% ,P=0 .018) .The expression rates of FOXC2 and Vimentin in lymph node transfer group were statistically higher than those in no lymph node transfer group (51 .72% vs .22 .22% ,P=0 .013;41 .20% vs . 14 .80% ,P=0 .010) .The correlation between FOXC2 and Vimentin was positive (P= 0 .037) .Conclusion It is possible that FOXC2 and Vimentin are involved in the transformation of epithelial cells into the mesenchymal cells .And they may play an impor-tant role in the metastasis of gastric carcinoma .