Optimal peritoneal cancer index cutoff point for predicting surgical resectability of pseudomyxoma peritonei in treatment-naive patients.

BACKGROUND: The peritoneal cancer index (PCI) has been used to predict surgical outcomes for pseudomyxoma peritonei (PMP). The present study aimed to establish the optimal cutoff point for PCI to predict surgical resectability of PMP. METHODS: A total of 366 PMP patients were included. The patients were divided into low-grade and high-grade groups. Based on the completeness of the cytoreduction (CC) score, both low-grade and high-grade PMP patients were further divided into complete cytoreductive surgery (CRS) and maximal tumor debulking (MTD) subgroups. The ability to predict surgical resectability of total and selected PCI (regions 2 + 9 to 12) was analyzed through receiver operating characteristic (ROC) curves. RESULTS: Both total and selected PCI demonstrated excellent discriminative ability in predicting surgical resectability for low-grade PMP patients (n = 266), with the ROC-AUC of 0.940 (95% CI: 0.904-0.965) and 0.927 (95% CI: 0.889-0.955). The corresponding optimal cutoff point was 21 and 5, respectively. For high-grade PMP patients (n = 100), both total and selected PCI exhibited good performance in predicting surgical resectability, with the ROC-AUC of 0.894 (95% CI: 0.816-0.946) and 0.888 (95% CI: 0.810-0.943); correspondingly, the optimal cutoff point was 25 and 8, respectively. The discriminative ability between total and selected PCI in predicting surgical resectability did not show a statistical difference. CONCLUSIONS: Both total and selected PCI exhibited good performance and similarity in predicting complete surgical resection for both low-grade and high-grade PMP patients. However, the selected PCI was simpler and time-saving in clinical practice. In the future, new imaging techniques or predictive models may be developed to better predict PCI preoperatively, which might assist in confirming whether complete surgical resection can be achieved.

Molecular characterization and biofilm formation ability of Enterococcus faecium and Enterococcus faecalis bloodstream isolates from a Chinese tertiary hospital in Beijing.

To investigate the molecular characteristics and biofilm-forming ability of 116 Enterococcus faecium (Efm) and 72 Enterococcus faecalis (Efs) isolates obtained from patients with bloodstream infections (BSI) at a Chinese hospital between July 2011 and March 2018. The presence of glycopeptide resistance genes and five virulence genes (esp, gelE, asa1, hyl, and cylA) was screened using two multiplex PCR. MLST was used to assess the clonality. Crystal violet staining was used to detect biofilms. Vancomycin resistance was detected in 30.1% of Efm and 2.8% of Efs isolates, respectively. All VRE strains carried the vanA gene. The esp, gelE, asa1, and cylA genes in 72 Efs strains were detected at 62.5%, 84.7%, 84.7%, and 69.4%, respectively. Among the 116 Efm isolates, 74.1% and 25.8% carried esp and hyl, respectively. The esp gene was significantly associated with vancomycin-resistant Efm (VREfm) compared to vancomycin-susceptible Efm (VSEfm). In total, 91.7% of Efs and 20.0% of Efm produced biofilms. Twenty-six STs were identified among the 72 Efs isolates, with ST4 (29.2%) being the predominant. In total, 116 Efm strains were grouped into 26 STs, with ST78 (46.6%) being the predominant. Both VREfm (41.7%) and VSEfm (48.8%) were dominant in ST78. There is no clear evidence suggesting that some STs are associated with vancomycin resistance or biofilm formation. Both Efm and Efs BSI isolates showed a polyclonal pattern with a dominant clone and many unique types, implying the coexistence of clonal dissemination and an influx of new clones. The horizontal transmission of resistance genes may play a more important role in VREfm prevalence than clonal expansion.

Nomogram to Predict Incomplete Cytoreduction for Pseudomyxoma Peritonei.

BACKGROUNDS: The completeness of cytoreduction is one of the most important prognostic factors for patients with pseudomyxoma peritonei (PMP). To date, no nomograms have been established to predict incomplete cytoreduction (IC) for patients with PMP. The current study therefore proposed a nomogram to predict individual IC risk for PMP patients. METHODS: Between 1 June 2013, and 22 November 2019, 144 consecutive PMP patients who underwent cytoreductive surgery (CRS) combined with hyperthermic intraperitoneal chemotherapy (HIPEC) for the first time in our center were included in a retrospective study. Possible predictors of cytoreducibility were analyzed using logistic regression modeling to predict IC for PMP patients. A nomogram was developed based on the multivariate analysis and further investigated for internal validation. RESULTS: After CRS, the 144 participants were divided into complete CRS (CCRS) (n = 46) and IC (n = 98) subgroups. Four independent predictors (sex, disease duration, anemia, and carbohydrate antigen 19-9 (CA 199)) were included in the prediction model. Then, a nomogram predicting IC was established based on the aforementioned variables, which demonstrated good predictive accuracy (C-index, 0.837; 95 % confidence interval [CI], 0.764-0.894). The predicted probability was close to the actual observed outcome according to the calibration plot. CONCLUSIONS: The current work led to the development of a nomogram capable of predicting IC for PMP patients who demonstrated good performance. Risk stratification by the established nomogram had ability to optimize individual IC prediction and help physicians to establish meticulous preoperative plans.

Preoperative plasma D-Dimer level is correlated with peritoneal cancer index of patients with pseudomyxoma peritonei.

PURPOSE: Accurate assessment of preoperative tumor burden contribute to formulate a scientific surgical plan for patients with pseudomyxoma peritonei (PMP). Present study aimed to assess whether the preoperative plasma D-Dimer level could reflect tumor burden for PMP patients. METHODS: A total of 253 PMP patients were included between June 1, 2013 and March 1, 2022. According to the peritoneal cancer index (PCI), all participants were divided into extensive (PCI ≥ 28) and none-extensive (PCI < 28) subgroups. The D-Dimer and tumor markers were compared between the two subgroups. The correlation between the abovementioned biomarkers and PCI will be calculated, and further compared with each other. Two-sided P value less than 0.05 is considered statistically significant. RESULTS: The level of D-Dimer (ng/ml) between extensive and none-extensive subgroup were 600 (328, 1268) vs. 339 (128, 598), Z = -5.425, p < 0.001. The Spearman correlation between D-Dimer, carcinoembryonic antigen (CEA), carbohydrate antigen 125 (CA 125), CA 19 - 9 and PCI were 0.487, 0.509, 0.469, and 0.499, respectively (all p < 0.001). The correlation coefficients were compared with each other according to Meng, Rosenthal and Rubin's method, however, there was no significant difference. CONCLUSION: Preoperative plasma D-Dimer could moderately reflect tumor burden for PMP. In the future, a multivariate prediction model will be developed to help surgeons to formulate a more precise surgical plan for the PMP patients.

Modified square timing error detector with large chromatic dispersion tolerance for optical coherent receivers.

Clock recovery plays an important role in the digital signal processing (DSP) chain of modern coherent optical receivers. It references the local sampling clock with the signal baudrate and finds the optimal sampling instances by performing endless timing error corrections. At the core of clock recovery, a timing error detector (TED) is used to provide instantaneous error tracking. However, usual TEDs suffer from effects such as chromatic dispersion (CD) and polarization rotation, thus requiring additional efforts to remove those effects before TED. Here we propose a modified square TED based on the signal's cyclic autocorrelation function (CAF), which generalizes its classical counterpart and exhibits a much larger CD tolerance. It provides a time-domain solution of the CD-tolerant TED. The previously analyzed equivalence among the time-domain and the frequency-domain TEDs is reestablished in the framework of spectral correlation. The modified square TED demands a minimum extra complexity. Both numerical simulation and experiments are performed to study the performance of the proposed TED.

Chromatic dispersion equalization FIR filter design based on discrete least-squares approximation.

Chromatic dispersion (CD) equalization is one of the core tasks of the digital signal processing (DSP) chain in modern optical coherent receivers. A conventional impulse-invariant method for designing the CD equalization filter is revisited, improved by proper weighting, and reinterpreted as a Fourier series. To improve upon a direct evaluation of the passband least-squares (LS) approximation, we propose to design a CD equalization finite impulse response (FIR) filter based on a discrete LS approximation. The proposed method avoids numerical evaluation of nontrivial functions and relies only on Fourier transform. Its flexibility is corroborated by a filter design demonstration of joint matched filtering and CD equalization.

OSNR monitoring based on a low-bandwidth coherent receiver and LSTM classifier.

Optical signal-to-noise ratio (OSNR) monitoring is one of the core tasks of advanced optical performance monitoring (OPM) technology, which plays an essential role in future intelligent optical communication networks. In contrast to many regression-based methods, we convert the continuous OSNR monitoring into a classification problem by restricting the outputs of the neural network-based classifier to discrete OSNR intervals. We also use a low-bandwidth coherent receiver for obtaining the time domain samples and a long short-term memory (LSTM) neural network as the chromatic dispersion-resistant classifier. The proposed scheme is cost efficient and compatible with our previously proposed multi-purpose OPM platform. Both simulation and experimental verification show that the proposed OSNR monitoring technique achieves high classification accuracy and robustness with low computational complexity.

Nomogram to predict overall survival of patients with pseudomyxoma peritonei of appendiceal origin: A retrospective cohort study.

BACKGROUND: Pseudomyxoma peritonei (PMP) is a rare disease, with the rate of overall survival (OS) influenced by many factors. The present study aimed to define independent predictors and establish a nomogram for individual risk prediction in PMP patients. METHODS: One hundred forty-seven PMP patients were consecutively included between June 1, 2013, and November 22, 2019. The log-rank test was used to compare the OS rate between groups; subsequently, variables with p < .10 were subjected to multivariate Cox modeling for defining independent prediction indicators. Finally, a nomogram was established based on independent prognosticators and assessed for internal validation. RESULTS: Multivariate Cox analysis showed that D-dimer level, carbohydrate antigen (CA) 125 level, CA 19-9 level, degree of radical surgery, and histological grade were all independently associated with OS in PMP patients. A nomogram was plotted and underwent internal validation. The discrimination ability of the nomogram revealed a good predictive ability as indicated by the C-index value (0.825), and calibration plots confirmed good consistency between the predicted and observed survival probabilities. CONCLUSIONS: Five independent prognostic factors for predicting the survival of PMP patients were identified, and the nomogram based on these independent indicators showed a reasonable discrimination ability for individual risk prediction.

Propagation properties of radially and azimuthally polarized chirped Airy-Gaussian vortex beams through slabs of right-handed materials and left-handed materials.

By using Huygens-Fresnel diffraction integral formula and the transfer matrix method, the analytical expression of radially and azimuthally polarized chirped Airy-Gaussian vortex beams through left-handed materials and right-handed materials can be obtained. We study the effects of the chirp factor and the distribution factor on the radially and azimuthally polarized chirped Airy-Gaussian vortex beams in the propagation process, including the light intensity, the phase distribution, the propagation path, the peak intensity, and the radiation force. The focal position of the beams can be adjusted by the chirp parameter.

Transient EDTA-Dependent Pseudothrombocytopenia Phenomenon in a Patient with Antiphospholipid Syndrome.

Antiphospholipid syndrome (APS) is an autoimmune disorder associated with arterial/venous thrombosis and pregnancy loss; thrombocytopenia is another common manifestation of APS. In the present study, we discovered a transient ethylenediaminetetraacetic acid-dependent pseudothrombocytopenia (EDTA-PTCP) phenomenon in APS, which has not yet been reported in the literature.

Urinary Myeloperoxidase to Creatinine Ratio as a New Marker for Diagnosis of Urinary Tract Infection.

Objective To determine whether urinary myeloperoxidase to creatinine ratio (MCR) can serve as a marker for diagnosis of urinary tract infection (UTI).Methods Patients suspected of UTI were consecutively enrolled and further divided into the culture positive and the sterile groups according to urine culture results. Subsequently, MCR, white blood cell (WBC) and bacteria in the urinary samples from patients were detected and compared between the two groups.Results Finally, 253 patients were enrolled including 157 urine culture positive patients and 96 urine culture negative patients (sterile group). After logarithmic transformation in 2 as the base, the MCR, WBC, and bacteria were separately presented as log2 MCR, log2 WBC(quantitative) , and log2 bacteria. The values of log2 MCR(8.6±2.5 vs. 5.4±1.5, t=-12.453, P=0.001), log2 WBC(quantitative) (8.0±2.5 vs. 5.2±1.8, t=-10.332, P=0.001), log2 bacteria (11.4±2.5 vs. 8.2±2.8, t=-9.297, P=0.001) and WBC (semi-quantitative) [2 (interquartile range 1, 3) vs. 1 (interquartile range 0.5, 1), Z=-7.580, P=0.001] showed significant difference between the urine culture positive group and the sterile group. Among the urine culture positive group, the values of log2 MCR of the gram positive and gram negative subgroups were 7.2±2.5 and 9.0±2.4 (t=4.016, P=0.001), respectively. The correlation between log2 MCR and log2 WBC (quantitative), log2 bacteria, WBC (semi-quantitative) was 0.708 (Pearson correlation, P=0.001), 0.381 (Pearson correlation, P=0.001), and 0.606 (Spearman correlation, P=0.001), respectively. Conclusions MCR is positively correlated with WBC counts and could be served as a promising biomarker for diagnosis of UTI. MCR could be even used for initial inference of infectious bacteria types of UTI.

Association of lysosomal protein transmembrane 4 beta gene polymorphism with pancreatic carcinoma susceptibility in the Chinese population.

Pancreatic carcinoma is an aggressive malignancy with particularly low 5-year survival rate. In order to improve the dismal survival rate, identification of new potential susceptibility risk factors for the prevention and early detection of pancreatic carcinoma is of utmost importance. Lysosomal protein transmembrane 4 beta has two alleles designated as LAPTM4B*1 and LAPTM4B*2. The aim of this study was to investigate the association between lysosomal protein transmembrane 4 beta gene polymorphism and the risk of pancreatic carcinoma in China. A population-based case-control analysis was performed in 233 patients with pancreatic carcinoma and 842 control subjects. The genotypes of lysosomal protein transmembrane 4 beta were determined by utilizing polymerase chain reaction based on specific primers. The χ2 test was used to analyze the differences of categorical variables and Hardy-Weinberg equilibrium. Odds ratio and 95% confidence intervals were computed using an unconditional logistic regression model. A significant difference in the frequency of LAPTM4B*2 was observed between the patients and the controls (33.05% vs 27.55%, p = 0.03). LAPTM4B*2 had a 1.33-fold (95% confidence interval: 1.04-1.71) higher risk for developing pancreatic carcinoma when compared with LAPTM4B*1 carriers. We found that the frequency of LAPTM4B*1/2 + *2/2 in pancreatic carcinoma group was higher than that in the control group (57.94% vs 48.34%, p = 0.01). However, no significant association was observed between lysosomal protein transmembrane 4 beta genotypes and gender, age, family history of cancer, smoking/alcohol status, histopathological differentiation, lymph node metastasis, clinical stage, or serum cancer antigen 19-9 level. These findings indicate that the LAPTM4B*2 allele is associated with the high risk of pancreatic carcinoma and carrying LAPTM4B*2 may be a susceptible factor to Chinese pancreatic carcinoma patients.

Mean Platelet Volume Could Reflect Disease Activity of Adult Patients With Systemic Lupus Erythematosus.

BACKGROUND: In recent years, research regarding mean platelet volume (MPV) has been expanded to numerous diseases. The aim of the present study was to assess whether MPV could reflect disease activity of adult patients with systemic lupus erythematosus (SLE). METHODS: A total of 128 adult patients with SLE were enrolled in the present study and allocated into two subgroups (99 with active phase and 29 with inactive phase) according to SLE disease activity index (SLEDAI). Demographic data, MPV, complement 3 (C3), and complement 4 (C4) were recorded. Independent sample t-test was used for comparison of quantitative variables between the active and inactive groups. Pearson's correlation test was used to evaluate the correlation between the above laboratory indices and the SLEDAI score. RESULTS: The mean MPV level in active patients was significantly higher than inactive subjects (8.3 ± 1.3 vs. 7.7 ± 0.7, p < 0.001). The correlation between MPV level and SLEDAI score was moderate (r = 0.520, p < 0.001). CONCLUSIONS: MPV might be a promising marker to reflect disease activity of adult patients with SLE.

A Real-Time PCR Assay Based on 5.8S rRNA Gene (5.8S rDNA) for Rapid Detection of Candida from Whole Blood Samples.

The prevalence of Candida in bloodstream infections (BSIs) has increased. To date, the identification of Candida in BSIs still mainly relies on blood culture and serological tests, but they have various limitations. Therefore, a real-time PCR assay for the detection of Candida from whole blood is presented. The unique primers/probe system was designed on 5.8S rRNA gene (5.8S rDNA) of Candida genus. The analytical sensitivity was determined by numbers of positive PCRs in 12 repetitions. At the concentration of 10(1) CFU/ml blood, positive PCR rates of 100 % were obtained for C. albicans, C. parapsilosis, C. tropicalis, and C. krusei. The detection rate for C. glabrata was 75 % at 10(1) CFU/ml blood. The reaction specificity was 100 % when evaluating the assay using DNA samples from clinical isolates and human blood. The maximum CVs of intra-assay and inter-assay for the detection limit were 1.22 and 2.22 %, respectively. To assess the clinical applicability, 328 blood samples from 82 patients were prospectively tested and real-time PCR results were compared with results from blood culture. Diagnostic sensitivity of the PCR was 100 % using as gold standard blood culture, and specificity was 98.4 %. Our data suggest that the developed assay can be used in clinical laboratories as an accurate and rapid screening test for the Candida from whole blood. Although further evaluation is warranted, our assay holds promise for earlier diagnosis of candidemia.

Preparation of multifunctional ceramic foams for sound absorption, waterproofing, and antibacterial applications.

Using porous materials for sound absorption is an effective approach to alleviating noise pollution, although their hydrophilic properties potentially cause concerns regarding public safety and health risks. This work provides a facile strategy for establishing a multifunctional ceramic system by using sponges as the sintering template, adjusting the pore structure of ceramic foams by varying the ceramic slurry weights and fluorinating the sintered ceramic foams via hydrolysis and condensation processes to provide low surface energy. The obtained porous ceramic foams demonstrate sound-absorbing, waterproof, and antibacterial properties. The results reveal that the increase in ceramic slurry weight decreases the pore size and porosity due to the formation of more compact structures, and the decrease in porosity compromises the sound absorption performance. In the middle-range sound frequency, the maximum sound absorption coefficient reached 0.92. In addition, the fluorination of the rough ceramic surfaces endows the ceramic foams with waterproof properties, which enables them to float on water and display the silver mirror phenomenon. In addition, due to the waterproof property reducing the contact area between the ceramic surface and the bacterial suspension, as well as the lipophilic fluorine chain disrupting the bacterial structures, these ceramic foams exhibited antibacterial rates above 95%. In addition, the mechanisms underlying the sound-absorbing, waterproof, and antibacterial properties of these porous ceramic foams are elucidated. Therefore, this work provides a facile approach to developing a multifunctional ceramic system. Their practical features make these ceramic foams more significant in the field of noise reduction.

Can Cytokine Detection Predict the Occurrence and Outcome of aGVHD after Allo-HCT? A Retrospective Study.

BACKGROUND: Many cytokines play essential roles in the occurrence and development of acute graft-versus-host-disease (aGVHD). This study aims to validate whether 11 proinflammatory and anti-inflammatory cytokines can be a candidate for aGVHD biomarkers to predict its occurrence and outcome. METHODS: Out of 178 patients who underwent allogeneic hematopoietic stem cell transplantation, we retrospectively enrolled 32 cases into the pre-transplant cohort and 45 cases into the post-transplant cohort. The serum cytokine concentrations were determined by flow cytometry. The control and experimental groups were non-aGVHD, I-II aGVHD and III-IV aGVHD groups, respectively. Risk factors and overall survival (OS) were also evaluated. RESULTS: In the pre-transplant cohort, interleukin (IL)-2 decreased in patients with aGVHD, and IL-4 only reduced in patients with III-IV aGVHD. In the post-transplant cohort, only IL-4 increased 1.79 times more in patients with III-IV aGVHD than in the other two groups. Patients with gastrointestinal (GI) aGVHD had lower IL-2, IL-4 and IL-17F levels pre-transplant and lower IL-2 post-transplant. None of the other cytokines was significantly different. Logistic regression analysis showed that no cytokine could predict the occurrence and outcome of aGVHD. Diarrhea within 15 days post-transplant is an independent risk factor for the occurrence of aGVHD and a risk factor for a fatal outcome. Patients without diarrhea had longer survival time of 672 (586-757) days vs 444 (229-548) days and better 2-year OS (85.7% vs 46.4%) than those with diarrhea. Compared to patients with aGVHD, patients without aGVHD had a longer survival time of 618 (530-706) days vs 449 (353-545) days and better 2-year OS (76.2% vs 47.1%). CONCLUSIONS: Proinflammatory and anti-inflammatory cytokines can provide specific indications for the occurrence and progression of aGVHD. However, to truly guide the diagnosis and prognosis, cytokines with larger sample sizes, more detection time points and more accurate diagnostic efficacy need to be further studied.

Atg4B and Cathepsin B-Triggered in Situ Luciferin Formation for Precise Cancer Autophagy Bioluminescence Imaging.

Autophagy plays a crucial role in tumorigenesis and progression, but current approaches to visualize it in vivo show limited precision due to their single-analyte-responsive mode. Hence, by simultaneously employing dual autophagy enzymes Atg4B and cathepsin B to trigger the in situ formation of luciferin, we herein propose a strategy for precise autophagy bioluminescence imaging. An Atg4B-responsive peptide Ac-Thr-Phe-Gly-d-Cys (TFGC) and a cathepsin B-activatable compound Ac-Lys-Gly-Arg-Arg-CBT (KGRR-CBT) were rationally designed. During tumor autophagy, these two compounds were uptaken by cancer cells and cleaved by their corresponding enzymes to yield d-cysteine and 2-cyano-6-aminobenzothiazole, respectively, which underwent a CBT-Cys click reaction to yield d-aminoluciferin, turning the bioluminescence "on". The responsiveness of these two compounds toward the two enzymes was tested in vitro, and the ability to turn bioluminescence "on" was validated in living cancer cells and in vivo. We anticipate that our precise autophagy imaging strategy could be further applied for the diagnosis of autophagy-related diseases in the near future.

Bland-Altman agreement analysis between CT predicted and surgical peritoneal cancer index in pseudomyxoma peritonei of appendiceal origin.

Peritoneal cancer index (PCI) is the surgical variable most commonly used to quantify the extent of peritoneal metastases for pseudomyxoma peritonei (PMP) patients. The present study aimed to investigate the agreement between CT predicted and surgical PCI by the Bland-Altman method for PMP of appendiceal origin. A total of 167 PMP patients of appendiceal origin were included between 2016 and 2021. Bland-Altman analysis was performed for both total PCI and selected PCI (regions 2 + 9-12). After the Bland-Altman plot was drawn, the mean bias and its 95% limit of agreements (LoAs) was quantified. Besides, the correlation coefficients between CT-PCI and surgical PCI were also been calculated. The Bland-Altman plot showed the mean bias ± SD between total CT-PCI and surgical PCI as 0.431 ± 3.005, with the LoAs from - 5.459 to 6.321. There were nine points of difference in total PCI exceeded the 95% LoAs, with the rate of 5.39% (9/167). As for selected CT-PCI, Bland-Altman plot showed the mean bias ± SD between selected CT-PCI and surgical PCI as - 0.287 ± 1.955, with the LoAs from - 4.118 to 3.544. There were ten points of difference in selected PCI exceeded the 95% LoAs, with the rate of 5.99% (10/167). The Spearman's rank correlation coefficient between total CT-PCI and surgical PCI was 0.911, P < 0.001, as for selected CT-PCI and surgical PCI, the coefficient was 0.909, P < 0.001. Although there was a strong correlation for both total and selected CT-PCI with surgical PCI, however, the agreement is still not good in Bland-Altman analysis, which suggested that CT-PCI cannot predict surgical PCI accurately even in professional PMP treatment centers. In brief explanation, CT makes it difficult to distinguish the borderline between tumor tissue and mucus and to detect tumor lesions in the small intestine regions, which caused overestimation or underestimation by CT-PCI. In the future, a multiple linear regression model based on CT-PCI might accurately predict surgical PCI preoperatively.

The tcdA-negative and tcdB-positive Clostridium difficile ST81 clone exhibits a high level of resistance to fluoroquinolones: a multi-centre study in Beijing, China.

Clostridium difficile infection (CDI) is the leading cause of antibiotic-associated diarrhoea worldwide. In order to gain a better understanding about the molecular epidemiology of C. difficile in Beijing, China, molecular typing, antimicrobial susceptibility testing and drug resistance gene sequencing were performed on 174 strains of C. difficile collected from four large tertiary hospitals in Beijing. In total, 31 sequence types (STs) were identified among the 174 strains. ST81 was found to be the most prevalent (26.4%, 46/174), followed by ST2 (16.7%, 29/174) and ST54 (9.8%, 17/174). All isolates were susceptible to metronidazole and vancomycin. The test strains displayed resistance rates of 97.1%, 44.3% and 44.3% for ciprofloxacin, levofloxacin and moxifloxacin, respectively. ST81 isolates displayed a drug resistance rate of 97.8% for levofloxacin and moxifloxacin, which was significantly higher than ST2 (0%), ST54 (17.6%) and ST42 (0%) isolates (P<0.05). An amino acid mutation (T82I) was identified in GyrA, and the total mutation rate of the C. difficile strains was 40.8% (71/174). The mutation rate of ST81 isolates was 95.7% (44/46). Three amino acid mutations (D426N, S366A and D426V) were identified in GyrB, and the total mutation rate of GyrB was 39.1%. A double-site mutation in GyrB (S366A+D426V) was identified in all ST81 (n=46) isolates. In conclusion, the C. difficile ST81 clone showed a high level of resistance to fluoroquinolones in Beijing, highlighting the need for nationwide surveillance of CDI.

Species Distribution and Antifungal Susceptibility of Invasive Candidiasis: A 2016-2017 Multicenter Surveillance Study in Beijing, China.

OBJECTIVE: Invasive candidiasis (IC), a life-threatening fungal infection prevalent among hospitalized patients, has highly variable regional epidemiology. We conducted a multicenter surveillance study to investigate recent trends in species distribution and antifungal susceptibility patterns among IC-associated Candida spp. in Beijing, China, from 2016 to 2017. MATERIALS AND METHODS: A total of 1496 non-duplicate Candida isolates, recovered from blood and other sterile body fluids of IC patients, were identified using matrix-assisted laser desorption/ionization time of flight mass spectrometry combined with ribosomal DNA internal transcribed spacer (ITS) region sequencing. Broth microdilution-based susceptibility testing using six antifungal agents was also conducted. RESULTS: Candida albicans was the most frequently isolated species (49.9%), followed by Candida tropicalis (15.5%), Candida glabrata (14.7%) and Candida parapsilosis (14.2%). No significant differences in species distribution were observed when compared with a 2012-2013 dataset. Overall, the rates of susceptibility to fluconazole and voriconazole were high among C. albicans (98% and 97.2%, respectively) and C. parapsilosis species complex (91.1% and 92%, respectively) isolates but low among C. tropicalis (81.5% and 81.1%, respectively) isolates. In addition, the rate of azole resistance among C. tropicalis isolates increased significantly (1.8-fold, P<0.05) compared with that observed in 2012-2013, while micafungin resistance rates were <5% for all tested Candida species. CONCLUSION: Our results suggest that species distribution has remained stable among IC-associated Candida isolates in Beijing. Resistance to micafungin was rare, but increased azole resistance among C. tropicalis isolates was noted. Our study provides information on local epidemiology that will be important for the selection of empirical antifungal agents and contributes to global assessments of antifungal resistance.