Distribution and transmission characteristics of thirty-five dual genotype vancomycin-resistant Enterococcus faecium carrying both vanA and vanM in an intensive care unit / 中华传染病杂志

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.

Clinical Significance of Myeloid-Related Protein 8/14 as a Predictor for Biological Treatment and Disease Activity in Rheumatoid Arthritis.

OBJECTIVES: To investigate the serum level of Myeloid-Related Protein 8/14 complex (MRP8/14) and to predict and monitor the response to biologic treatment in rheumatoid arthritis (RA) patients. METHODS: Each patient underwent clinical examination and blood sampling for assessment of serum high-sensitivity C-reactive protein (hs-CRP) levels, erythrocyte sedimentation rate (ESR), rheumatoid factors (RF), anti-cyclic citrullinated protein antibodies (anti-CCP), and serum concentrations of MRP8/14 protein complexes (myeloid-related proteins, MRP8/14) were measured at baseline, and weeks 4 and 12 (after initiation of treatment). RESULTS: Serum MRP8/14 protein complex levels correlated with DAS28 and anti-CCP antibody. MRP8/14 protein complex levels decreased significantly after 12 weeks treatment with biological therapy: mono-rhTNFR-Fc active group. rhTNFR-Fc plus methotrexate (MTX) decreased MRP8/14 protein complex levels from 11839±1849 ng/ml to 5423±1130 ng/ml (p<0.01) a reduction of 54.2% compared with 32.9% in the rhTNFR-Fc group. CONCLUSIONS: MRP8/14 protein complex levels were increased in active stage RA patients. MRP8/14 levels were decreased with rhTNFR-Fc treatment, suggesting serum concentrations of MRP8/14 protein complex might be a promising biomarker to predict responses to biological therapy in active RA patients at baseline and could be used to monitor responses to treatment across different mechanisms of action.

Clinical Significance of Red Blood Cell Distribution Width and Inflammatory Factors for the Disease Activity in Rheumatoid Arthritis.

BACKGROUND: To evaluate the significance of red blood cell distribution width (RDW) and other factors for the disease activity in rheumatoid arthritis (RA). METHODS: Each patient underwent clinical examination and blood sampling for assessment of serum high-sensitivity C-reactive protein (hs-CRP) levels, erythrocyte sedimentation rate (ESR), hemoglobin concentration (Hb), hematocrit (HCT), RDW, and other erythrocyte parameters (mean corpuscular volume [MCV], mean cell Hb [MCH], mean corpuscular Hb concentration [MCHC]). Rheumatoid factors (RF-IgA, -IgG, -IgM) and anti-cyclic citrullinated protein antibodies (anti-CCP) were purified from the plasma and detected by ELISA. RA patients were divided into two groups based on DAS28 scores: active RA group (DAS28 > 5.1) and inactive RA group (DAS28 2.6 - 3.2). RESULTS: Patient samples were within normal ranges for Hb (15.2 ± 1.3 g/L), HCT (29.9 ± 2.2%), and other red blood cell (RBC) parameters (MCV 80.3 ± 12.1 fL, MCH 26.6 ± 3.5 pg, MCHC 323 ± 25 g/L). The RDW was higher in the active RA group than in the inactive group (16.5 ± 3.2 vs. 13.9 ± 1.5%, p < 0.01). Similarly, the proportion of patients positive for RF and anti-CCP was higher in the active group than in the inactive group (RF 62 vs. 53%, CCP 83 vs. 61%). RF and anti-CCP were present at higher titers in patients with active RA. The bone erosion rate in the 110 RA patients was 67%. Patients with erosion had higher RDW than those without erosion (17.1 ± 2.2 vs. 13.9 ± 3.5%). High titers of anti-CCP and RF-IgM, -IgG, and -IgA were also associated with high bone erosion rates (67%, 77%, 67%, and 73%, respectively). CONCLUSIONS: Our results suggest an association between RDW and levels of inflammatory factors and autoantibodies in RA. This association may be linked to the underlying proinflammatory state and increased oxidative stress, both of which correlate with impaired erythrocyte maturation. RDW, RF, and anti-CCP are key players in the proinflammatory and proatherogenic status of RA, and they may represent useful markers to improve characterization of disease activity in RA patients, thereby helping the clinician to define more appropriate therapeutic strategies.

Factors accounting for HIV antibody test false positive results in patients with rheumatoid arthritis / 中华检验医学杂志

Objective To investigate if immunological factors associated with the false HIV screening test results in RA.Methods Subjects who attended the Rheumatology Outpatient Clinic -Internal Medicine Unit of Guanghua Integrative Hospital , from October 2013 to October 2014, who met the American College of Rheumatology /European League Against Rheumatism Criteria for RA were recruited for the study . 100 subjects with RA were recruited.Each patient underwent clinical examination and blood sampling for assessment of serum HIV screening test and Rheumatoid factors ( RF-IgA, -IgG, -IgM) and anti-cyclic citrullinated protein antibodies (anti-CCP) were purified from the plasma and detected by ELISA , Samples were collected and processed using standard protocols and were stored in the same freezer before analysis . RA patients were divided into two groups based on the titters of RF and anti -CCP:RF 300 U/ml /anti-CCP >500 U/ml group.HIV screening tests were determined by three methods: ELISA、Immuno-colloidal Golden Method and ECLIA.The positive results were confirmed by the Changning Centers for Disease Control , Shanghai through western -blotting test.Results 100 samples detected by ELISA and Immuno-colloidal Golden Method were given negative results , 16 positive results existed in ECLIA group.There were1,12,3 positive cases in RF-IgM 300 U/ml group(2.7%,32.4%,13.6%;P 500 RU/ml groups there were 2 and 4 positive results(4.7%,24.6%;P <0.01).Conclusions Different HIV screening test methods would give different results , according to operation requirement using second method to determine the HIV screening result.HIV False-positivity was associated with the titers of anti -CCP and RF in RA.