Using 16S rDNA Sequencing Technology to Preliminarily Analyze Intestinal Flora in Children with Mycoplasma pneumoniae Pneumonia.

Objective: We investigated changes in the intestinal flora of children with Mycoplasma pneumoniae pneumonia (MPP). Methods: Between September 2019 and November 2019, stool samples from 14 children with MPP from The Fourth Hospital of Baotou city, Inner Mongolia Autonomous Region, were collected and divided into general treatment (AF) and probiotic (AFY) groups, according to the treatment of "combined Bifidobacterium, Lactobacillus, Enterococcus, and Bacillus cereus tablets live". High-throughput 16S rDNA sequencing was used to identify intestinal flora. Results: Intestinal flora abundance and diversity in children with MPP were decreased. Both Shannon and Simpson indices were lower in the AF group when compared with healthy controls ( P < 0.05). When compared with healthy controls, the proportion of Enterorhabdus was lower in the AF group, while the proportion of Lachnoclostridium was higher ( P < 0.05). The proportion of Bifidobacteria and Akkermansia was lower in the AFY group but Enterococcus, Lachnoclostridium, Roseburia, and Erysipelatoclostridium proportions were higher. The proportion of Escherichia coli- Shigella in the AFY group after treatment was decreased ( P < 0.05). Conclusions: The intestinal flora of children with MPP is disturbed, manifested as decreased abundance and diversity, and decreased Bifidobacteria. Our probiotic mixture partly improved intestinal flora disorders.

Data mining and systematic pharmacology to reveal the mechanisms of traditional Chinese medicine in Mycoplasma pneumoniae pneumonia treatment.

Traditional Chinese Medicine (TCM) is widely used in the treatment of Mycoplasma pneumoniae Pneumonia (MPP) in East Asia. However, our current understanding of the underlying molecular mechanism remains dispersive and promiscuous. In this study, a systematic pharmacological approach combined with literature data mining was applied for drug similarity evaluation, drug half-life evaluation, oral bioavailability prediction, drug target exploration, Gene Ontology (GO) analysis, KEGG pathway enrichment and network construction, thus providing the rationale for its clinical performance. Five mostly studied herbs, including Ephedra Herba, Amygdalus communis Vas, Platycodon grandiforus, Licorice and Scutellariae Radix, were selected from the literature. Total ninety-three active ingredients, which are expected to be the effective components for MPP treatment, were screened out. Interrelationship between active compounds, drug targets and signaling pathways were analyzed to reveal the therapeutic effect of TCM in detail. Of importance, we found that TNF, ß2AR and PTGS2 play pivotal role in TCM mediated MPP inhibition. And mechanistically, epithelial apoptosis (defensive barrier function), GPCR signaling (symptom amelioration) and immune pathways (innate signaling and adaptive Th17 response) are critically involved. Our work, achieved through systematic pharmacology and data mining, enlarges the knowledge of TCM in MPP therapy, and could provide valuable insights for further drug discovery studies.

Mycoplasma pneumoniae Macrolide Resistance and MLVA Typing in Children in Beijing, China, in 2016: Is It Relevant?

OBJECTIVE: The aim of this study is to investigate the macrolide resistance rate and molecular type with multiple-locus variable-number tandem-repeat analysis (MLVA) of Mycoplasma pneumoniae of Beijing in 2016 in pediatric patients. METHODS: Real-time quantitative polymerase chain reaction (PCR) was used to identify M. pneumoniae, and MLVA was performed. The domain V of the 23S rRNA was sequenced to detect macrolide-resistant point mutations. We also investigated the activities of antibiotics against M. pneumoniae isolates in vitro. RESULTS: The PCR detection rate of M. pneumoniae in children in Beijing was 40%, and the macrolide resistance rate was 66%. The A2063G mutation in the 23S rRNA V region is the dominant mutation (137/146, 93.84%), whereas the A2064G mutation is rare (9/146, 6.16%). Seventy-three samples were typed successfully by MLVA typing, including 86.3% (63/73) were MLVA type 4-5-7-2, and 13.7% (10/73) were MLVA type 3-5-6-2. No other types were found. No strains were resistant to levofloxacin or tetracycline. CONCLUSION: In 2016, a specific decrease in the macrolide resistance rate occurred in Beijing. The detection rate and macrolide resistance rate of outpatients are lower than those of inpatients. The A2063G mutants M. pneumoniae have high levels of resistance to erythromycin and azithromycin. The primary MLVA type is 4-5-7-2, followed by 3-5-6-2. No other MLVA types were detected. No strains resistant to tetracycline or levofloxacin were found in vitro.

Epidemiology and mechanism of drug resistance of Mycoplasma pneumoniae in Beijing, China: A multicenter study.

Mycoplasma pneumoniae (M. pneumoniae) is one of the most common causes of community-acquired respiratory tract infections (RTIs). We aimed to investigate the prevalence of M. pneumoniae infection, antibiotic resistance and genetic diversity of M. pneumoniae isolates across multiple centers in Beijing, China. P1 protein was detected by Nested PCR to analyze the occurrence of M. pneumoniae in pediatric patients with RTI. M. pneumoniae isolates were cultured and analyzed by Nested-PCR to determine their genotypes. Broth microdilution method was used to determine the minimum inhibitory concentration (MIC) of antibiotics. Out of 822 children with RTI admitted to 11 hospitals in Beijing, 341 (41.48%) were positive for M. pneumoniae by Nested PCR and 236 (69.21%) samples had mutations in 23S rRNA domain V. The highest proportion of M. pneumoniae positive samples was observed in school-age children (118/190; 62.11%) and in pediatric patients with pneumonia (220/389; 56.56%). Out of 341 M. pneumoniae positive samples, 99 (12.04%) isolates were successfully cultured and the MIC values were determined for 65 M. pneumoniae strains. Out of these, 57 (87.69%) strains were resistant to macrolides, and all 65 strains were sensitive to tetracyclines or quinolones. M. pneumoniae P1 type I and P1 type II strains were found in 57/65 (87.69%) and 8/65 (12.31%) of cultured isolates, respectively. Overall, we demonstrated a high prevalence of M. pneumoniae infection and high macrolide resistance of M. pneumoniae strains in Beijing. School-age children were more susceptible to M. pneumoniae, particularly the children with pneumonia. Thus, establishment of a systematic surveillance program to fully understand the epidemiology of M. pneumoniae is critical for the standardized use of antibiotics in China.

Establishment of a Predictive Diagnostic Model for Acute Mycoplasma Pneumoniae Infection in Elderly Patients with Community-acquired Pneumonia.

We established a diagnostic model to predict acute Mycoplasma pneumoniae (M. pneumonia) infection in elderly Community-acquired pneumonia (CAP) patients. We divided 456 patients into acute and non-acute M. pneumoniae infection groups. Binary logistic regression and receiver operating characteristic (ROC) curves were used to establish a predictive model. The following independent factors were identified: age ⋝ 70 years; serum cTNT level ⋝ 0.05 ng/mL; lobar consolidation; mediastinal lymphadenopathy; and antibody titer in the acute phase ⋝ 1:40. The area under the ROC curve of the model was 0.923 and a score of ⋝ 7 score predicted acute M. pneumoniae infection in elderly patients with CAP. The predictive model developed in this study has high diagnostic accuracy for the identification of elderly acute M. pneumoniae infection.

P1 gene of Mycoplasma pneumoniae in clinical isolates collected in Beijing in 2010 and relationship between genotyping and macrolide resistance.

BACKGROUND: Mycoplasma pneumoniae is a common pathogen that caused community-acquired pneumonia (CAP). P1 protein served as major adhesion and immunodominant protein in Mycoplasma pneumoniae, but little about P1 gene was learned and the relationship between P1 genotype and macrolide resistance has yet to be explored. METHODS: The DNA sequence of the entire P1 gene from 35 strains isolated from clinical specimens collected in Beijing, China, in 2010 was determined. The resulting sequences were checked for known macrolide resistance mutations, such as A2063G, A2064G, C2617G in domain V of 23S rRNA. Antibiotic susceptibility test was done to further identify macrolide resistant strains. RESULTS: Thirty-four clinical strains were type 1, and were identical to type 1 reference strain MP129. Only one clinical strain, MpYYM22, was type 2, and proved to be variant 2c. One synonymous point mutation in the P1 type 1 gene from two isolates was identified relative to the MP129 P1 sequence at nucleotide position (nt) 552 (C>A), while another two isolates had missense mutations at nt 2504 (G>A). This point mutation caused an amino acid change from glycine to glutamic acid. An AGT tri-nucleotide variable-number tandem repeat (VNTR), coding for serine and repeating 6-11 times, up to 15-16 times, was found in the region between the RepMP4 and RepMP2/3 elements in the 35 isolates examined. All 35 clinical strains, including MpYYM22, demonstrated macrolide resistance with the range of minimum inhibitory concentration (MIC) of erythromycin from 64 to 256 µg/ml, having an A2063G transition in domain V of the 23S rRNA gene. CONCLUSIONS: P1 type 1 was the dominant type of Mycoplasma pneumoniae in Beijing in 2010, although variant 2c strains were present. More samples are needed to determine whether there is a relationship between the P1 genotype and macrolide resistance, as the 35 strains examined did not allow a conclusive result. However, the AGT tri-nucleotide VNTR may be a more informative locus for multi-locus VNTR analysis.

Pure transperitoneal laparoscopic correction of retrocaval ureter / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Retrocaval ureter is a rare congenital abnormality. Operative repair is always suggested in cases of significant functional obstruction. Laparoscopic procedures have been employed as the minimally invasive therapeutic option for retrocaval ureter. However, the laparoscopic techniques for retrocaval ureter might be technically challenging to some surgeons. The aim of this article was to present our experience and surgical techniques of pure transperitoneal laparoscopic pyelopyelostomy and ureteroureterostomy in nine patients with retrocaval ureter.</p><p><b>METHODS</b>A total of nine patients of retrocaval ureter underwent pure laparoscopic pyelopyelostomy or ureteroureterostomy. The operation was performed with the patients placed in the 70-degree lateral decubitus position via a three port transperitoneal approach with two 10-mm and one 5-mm ports. The distal part of the dilated renal pelvis was transected at the ureteropelvic junction and the ureter was relocated anterior to the inferior vena cava. The tension-free pyeloureteral or ureteroureteral anastomosis was completed with the intracorporal freehand suturing and in situ knot-tying techniques combined with interrupted and continuous fashion. A double J ureteral stent was inserted in an antegrade manner during laparoscopy. Intravenous urography or computerized tomography and renal ultrasonography were performed after 3 months postoperatively.</p><p><b>RESULTS</b>All operations were completed laparoscopically, and no open conversion was required. The mean operative time was 135 minutes (range, 70 - 250 minutes), with minimal blood loss (less than 60 ml). No intra-operative complications or significant bleeding occurred. All patients presented mild postoperative pain and quick convalescence. The symptoms disappeared and hydronephrosis decreased substantially after surgery.</p><p><b>CONCLUSIONS</b>Pure transperitoneal laparoscopic correction for retrocaval ureter was associated with an excellent outcome, minimal invasiveness and short hospital stay. It is technically feasible and reliable for retrocaval ureter treatment. Laparoscopic surgery could be the standard treatment for retrocaval ureter.</p>

Transvesical removal of seminal vesicle mass: a report of 5 cases / 中华男科学杂志

<p><b>OBJECTIVE</b>To investigate the transvesical approach to the surgical treatment of seminal vesicle mass.</p><p><b>METHODS</b>Transvesical removal of seminal vesicle mass was performed for 5 patients aged 45-69 (mean 51) years. The clinical symptoms included those involving the lower urinary tract such as frequent micturition and urgency in 3 cases (1 accompanied with dyschezia), hematospermia in 1, and lower abdominal and perineal malaise in the other. Two masses were in the left side and the other 3 in the right, ranging from 3 to 10 cm (mean 5 cm) in size, detected by transrectal ultrasonography, CT, MRI or digital rectal examination. The mean course of disease was 9 (2-18) months.</p><p><b>RESULTS</b>All the 5 patients were treated successfully and uneventfully, with a mean operation time of 75 minutes, a mean blood loss of 140 ml and a mean hospital stay of 10 days. Pathological examinations revealed 2 cases of seminal vesicle cyst with infection, 1 cystadenoma, 1 phyllode tumor and 1 prostatic hyperplasia. A 3-72 months follow-up showed that all the patients were free of symptoms and had normal sexual function.</p><p><b>CONCLUSION</b>Transvesical removal of seminal vesicle mass, with small incisal opening, good visual field and easy operation, is an effective surgical procedure for seminal vesicle disease.</p>

[Application of nested PCR and sequencing technique to detect point mutations of the 23S rRNA gene of Mycoplasma pneumoniae].

OBJECTIVE: To establish a quick method to detect drug resistance of Mycoplasma pneumoniae (MP) and study the condition of drug resistance in MP infection. METHODS: MP 23S rRNA target gene in throat swab specimens from 200 patients with suspected MP infection was detected by using nested PCR and DNA sequencing. The result of 23S rRNA gene detection was confirmed by MP isolation and drug susceptibility test in vitro for reliability. RESULTS: Of the 200 clinical specimens, 64 were proved to be positive for MP through MP-IgM antibody, MP specific 16S rRNA nested PCR and MP isolation . The 23S rRNA gene was amplified and the gene sequence was compared with MP reference strain in Genbank, 26 were identical to the reference strain, 38 had a point mutation in 23S rRNA. Among them, 35 had A to G mutation at position 2063, 1 had A to C mutation at position 2063 and 2 had A to G mutation at position 2064, the percentage of drug resistance was 59.4%. The sensitivity of the gene detection method was 10(2) ccu/ml and it was confirmed to be reliable by MP isolation and drug susceptibility test. CONCLUSIONS: The gene detection method could detect MP drug resistant gene directly from clinical specimen, which has the advantages of high specificity, high sensitivity and quickness. It is of great significance for diagnosis of MP infection because MP isolation is difficult and time-consuming.

Transperitoneal laparoscopic modified lymph node dissection for clinical stage I nonseminomatous germ cell testicular carcinoma / 中华男科学杂志

<p><b>OBJECTIVE</b>To evaluate the feasibility and short-term clinical effect of transperitoneal laparoscopic modified retroperitoneal lymph node dissection (LmRPLND) in the management of clinical Stage I nonseminomatous germ cell testicular tumors.</p><p><b>METHODS</b>From October 2004 to July 2006, 7 patients aged 26-36 (mean 30) years underwent LmRPLND with modified unilateral template dissection for clinical Stage I nonseminomatous germ cell testicular tumors, which were 3.0 cm x 2.5 cm x 2.0 cm to 6.5 cm x 4.5 cm x 3.0 cm in size, 3 cases on the left and 4 on the right, all diagnosed by ultrasound, computerized tomography (CT) and chest X-ray and confirmed by biopsy following radical orchiectomy. Those with positive lymph nodes received 3 courses of chemotherapy.</p><p><b>RESULTS</b>Success was achieved in all the 7 cases, the operative time ranging from 120 to 210 min (mean 160 min), blood loss from 50 to 200 ml (mean 150 ml), and with no blood transfusion. The drainage tubes were removed 1-2 days after surgery. The mean postoperative hospital stay was 5.5 days. The follow-up lasted 6-32 (mean 14) months, which revealed normal erection and ejaculation in all the patients, but no major postoperative complications. Pathologically, lymph nodes were negative in 6 cases and positive (1/18) in 1. Normal results were obtained in HCG and AFP tests as well as in retroperitoneal ultrasound and chest X-ray examinations. The patient with positive lymph nodes was treated by adjuvant chemotherapy for 3 courses and found free of malignancy during a 6-month follow-up.</p><p><b>CONCLUSION</b>LmRPLND is a safe and minimally invasive treatment option for patients with clinical Stage I nonseminomatous germ cell testicular carcinoma. With fewer complications and faster recovery, it appears to be a desirable substitute for the open procedure.</p>

A large intrascrotal calculus / 亚洲男科学杂志(英文版)

A large stone with 8.7 cm multiply 7.2 cm multiply 6.5 cm in size and 420 g in weight dropped down spontaneously from a 93-year-old man's scrotum, who had suffered from left intrascrotal mass and pain for more than 20 years. The component of the stone was magnesium ammonium phosphate. To the best of our knowledge, it is the largest intrascrotal calculus reported in the world. We hereby present the case and discuss the diagnosis and etiology of scrotal calculi.

[Effect of zhidan huayu oral liquid on mycoplasmal pneumonia in mice].

OBJECTIVE: To study the effect of Chinese herbal medicine for activating blood circulation to remove stasis in treating mycoplasmal pneumonia (MP) in mice. METHODS: One hundered and thirty-five BALB/C mice were randomly divided into the control group, the MP model groups IF1 and IF2, the Rexithromycin treated groups LH1 and LH2, and the Rexithromycin plus Zhidan Huayu oral liquid treated groups LZ1 and LZ2. The changes of pathologic scoring, graphic analysis and thrombus counting of lung were observed. RESULTS: In the 3rd day of treatment, the pathologic scores in LH1 and LZ1 were significantly lower and their values of graphic analysis were significantly higher than those in IF1 (P < 0.01 and P < 0.05 respectively), but with inflammation of lung significantly milder than that in IF1. The difference of therapeutic effect between LH1 and LZ1 was insignificant. In the 4th day of treatment, pathologic scores in LZ2 was significantly lower and value of graphic analysis higher than those in IF2 respectively (P < 0.01), with the improvement better than that of LH2 (P < 0.05). In 3rd and 4th day of treatment, the difference of thrombus counting between the Rexithromycin treated groups and the model groups was insignificant (P > 0.05), but it was significantly lower in the combined treated groups than that in the model groups (P < 0.05). CONCLUSION: Zhidan Huayu oral liquid could assist Rexithromycin to alleviate the condition of mice with MP, its mechanism may be related with the effect of reducing thrombosis and improving microcirculation.

Twenty-eight cases report of transurethral resection of the prostate combined with repair of inguinal hernia / 中华男科学杂志

<p><b>OBJECTIVES</b>To discuss the surgical method of benign prostatic hyperplasia (BPH) with inguinal hernia.</p><p><b>METHODS</b>Twenty eight cases of BPH with inguinal hernia were treated with transurethral resection of the prostate (TURP) combined with repair of inguinal hernia by PPM at the same time.</p><p><b>RESULTS</b>All patients had been followed up for six months to four years, in which recurrence of hernia or other complications were not found. Qmax was more than 15 ml/s after operations, and IPSS were about 0-7 scores for all patients. The mean time of hospitalization was 4.2 days.</p><p><b>CONCLUSIONS</b>TURP combined with repair of inguinal hernia at the same time is a simple and effective method, which can avoid second operation, and it is more significance to the aged especially.</p>

Transurethral resection of prostate perioperative hypotension / 浙江大学学报·医学版

OBJECTIVE: To identify the factors to transurethral resection of prostate (TURP) perioperative hypotension. METHODS: The study group included 130 patients undergoing TURP. The control group included 50 patients who had suprapubic prostatectomy. Absorption of irrigation fluid was measured by determining the serum gentamycin level. Blood loss of PURP patients was calculated as the product of the irrigation fluid volume and hemoglobin concentration (determined with a photometer) divided by the preopreative blood hemoglobin concentration. Body temperature was recorded using a rectal probe. Serum electrolytes were determined pre-and postop. RESULTS: The blood loss in study group (380.2+/-98.3)ml was significantly less than in the control group (460.1+/-52.5)ml, P<0.05. However, the incidence of hypotension was significantly higher than the control group 28%, 8%), P<0.01. Factors associated with TURP hypotension included volume of irrigation fluid absorption, blood loss, reduction in core temperature, decrease of serum sodium, operating time, prostate weight and volume and history of cardiovascular disease. After Logistic regression analysis, the most significant factors were excessive absorption of irrigation fluid and rapid central cooling. CONCLUSION: In our study TURP hypotension most closely correlated with volume of irrigation fluid absorbed and reduction in core temperature.

Analysis of misdiagnosis of xanthogranulomatous pyelonephritis / 中华泌尿外科杂志

Objective To improve the diagnosis and treatment of xanthogranulomatous pyelonephri- tis(XGP).Methods The clinical data of 18 cases(5 males and 13 females;mean age,47 years)with XGP were analyzed.Of them,6 had the lesion on the left,and 12 on the right.Before operation,XGP was mis- diagnosed as renal calculus with hydronephrosis in 4 cases,ureteral calculus with severe hydronephrosis in 3 cases,renal tuberculosis in 3 cases and renal carcinoma in 8 cases.Results Of the 18 cases,7 were diag- nosed to have XGP by frozen section during operation and 11 cases had a definite diagnosis by pathological examination after nephrectomy.After a follow-up of 6-124 months,no recurrence was observed in all these 18 cases.Conclusions Preoperative diagnosis of XGP is difficult.This disease is clinically characterized by foam cells in urine smear,low-density value of kidney CT and ineffective antibiotic therapy.Combined a- nalysis of clinical data and improvement of clinical recognition of XGP is the key to avoiding delayed diagno- sis or misdiagnosis of XGP.