Antifungal susceptibility profiles and drug resistance mechanisms of clinical Candida duobushaemulonii isolates from China.

Candida duobushaemulonii, type II Candida haemulonii complex, is closely related to Candida auris and capable of causing invasive and non-invasive infections in humans. Eleven strains of C. duobushaemulonii were collected from China Hospital Invasive Fungal Surveillance Net (CHIF-NET) and identified using matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI-TOF), VITEK 2 Yeast Identification Card (YST), and internal transcribed spacer (ITS) sequencing. Whole genome sequencing of C. duobushaemulonii was done to determine their genotypes. Furthermore, C. duobushaemulonii strains were tested by Sensititre YeastOne™ and Clinical and Laboratory Institute (CLSI) broth microdilution panel for antifungal susceptibility. Three C. duobushaemulonii could not be identified by VITEK 2. All 11 isolates had high minimum inhibitory concentrations (MICs) to amphotericin B more than 2 µg/ml. One isolate showed a high MIC value of ≥64 µg/ml to 5-flucytosine. All isolates were wild type (WT) for triazoles and echinocandins. FUR1 variation may result in C. duobushaemulonii with high MIC to 5-flucytosine. Candida duobushaemulonii mainly infects patients with weakened immunity, and the amphotericin B resistance of these isolates might represent a challenge to clinical treatment.

Optimization of Heat Treatment for 38Si7 Spring Steel with Excellent Mechanical Properties and Controlled Decarburization.

Optimizing the heat treatment procedure with 13 mm diameter 38Si7 spring steel is critical for developing high-performance, low-cost, large spring steel for railway clips. The effects of quenching temperature, holding time, tempering temperature, and tempering time on the microstructure and mechanical properties were investigated using an orthogonal experiment, designed with four factors and three levels. The best heat treatment settings were explored, as well as the variation laws of mechanical properties, decarburization behavior, and fracture morphology. The results demonstrated that quenching temperature and tempering temperature had the most impact on plasticity and tempering temperature, while time had the most effect on strength. The optimized heat treatment schemes made the elongation increase by up to 106% and the reduction in area increase by up to 67%, compared with the standard BS EN 10089-2002, and there were mixed fractures caused by ductility and brittleness. The fracture tests showed a good performance of 20.2 GPa·%, and the heat treatment processes' minimum decarburization depth of 93.4 µm was determined. The optimized process would obtain stronger plastic deposition and better decarburization performance. The microstructure was simply lightly tempered martensite, and the matrix still retained the acicular martensite. The optimal heat treatment process is quenching at 900 °C for 30 min (water cooling), followed by tempering at 430 °C for 60 min (air cooling). The research led to a solution for increasing the overall mechanical characteristics and decreasing the surface decarburization of 38Si7 spring steel with a diameter of 13 mm, and it set the foundation for increasing the mass production of railway clips of this size.

[Treatment of migrated lumbar intervertebral disc herniation by percutaneous spinal endoscopy through bone tunnel].

OBJECTIVE: To investigate the clinical effect of percutaneous endoscopic lumbar discectomy (PELD) through bone tunnel in the treatment of migrated lumbar intervertebral disc herniation. METHODS: The clinical data of 42 patients with migrated lumbar intervertebral disc herniation treated through PELD techniques were retrospectively analyzed from October 2015 to December 2018. There were 26 males and 16 females, aged from 39 to 71 years old with a mean of(58.55±7.16) years. There were 7 cases where the affected segment was L3,4, 24 cases of L4,5, and 11 cases of L5S1. According to modified free nucleus pulposus classification, 3 cases of type A1, 6 cases of type A2, 8 cases of type B1, 8 cases of type B2, 6 cases of type C1, and 11 cases of C2. Among these 42 cases, 22 patients were treated with transpedicular approach (transpedicular approach group), 6 cases were type A2, 6 cases were type B2 and 10 cases were type C2, and 20 cases with translaminar approach(translaminar approach group), 3 cases were type A1, 8 cases were type B1, 6 cases were type C1, 2 cases were type B2 and 1 case was type C2. The operation time, intraoperative and postoperative complications of the two groups were recorded, and the pain visual analogue scale (VAS) and Oswestry Disability Index (ODI) were used to assess the improvement of the clinical symptoms before surgery, immediately after surgery, and 12 months after surgery, and the modified Macnab evaluation system was used to evaluate the clinical efficacy. RESULTS: The operative time was from 69 to 105 min with a mean of (88.29±9.85) min;and no intraoperative complications such as neurovascular injury or dural tear were occurredin all patients. One case in the transpedicular approach group was changed to general anesthesia and translaminar approach due to local anesthesia intolerance. All the patients were followed up from 13 to 34 months, with a mean of (13.71±3.56) months. VAS and ODI were significantly improved in two groups immediately after surgery and 12 months after surgery (P<0.05). According to modified Macnab criteria, 27 cases obtained excellent results, 11 good, 3 fair, and 1 poor. There were no postoperative complications such as lumbar fractures and postoperative infections in the follow-up patients. CONCLUSION: For migrated intervertebral disc herniation, the modified nucleus pulposus classification can be used to estimate the precise target before operation, and the reasonable bone tunnel approach can be selected to obtain good results.

Tumor- and Osteoblast-Derived Periostin in Prostate Cancer bone Metastases.

Exploring the biological function of periostin (POSTN) in prostate cancer (PCa) bone metastasis is of importance. It was observed that the expression of POSTN was high in PCa, especially highest in PCa metastasized to bone. In this study, we found that inhibiting POSTN in PCa cells could significantly alleviate PCa bone metastasis in vivo, suggesting POSTN is a promising therapeutic target. Since, due to the secreted expression of POSTN in osteoblasts and PCa, we hypothesized the positive feedback loop between osteoblasts and PCa mediated by POSTN in PCa bone metastasis. The in vitro experiments demonstrated that osteoblast-derived POSTN promoted PCa cell proliferation and invasion and PCa cell-derived POSTN promotes proliferation of osteoblasts. Furthermore, we found that POSTN regulated PCa and osteoblast function through integrin receptors. Finally, 18F-Alfatide II was used as the molecule probe of integrin αvß3 in PET-CT, revealing high intake in metastatic lesions. Our findings together indicate that targeting POSTN in PCa cells as well as in the osteoblastic may be an effective treatment for PCa bone metastasis.

Adrenal diffuse large B-cell lymphoma with high PD-L1 expression: Two case reports and literature review.

BACKGROUND: Primary adrenal lymphoma (PAL) is an infrequent malignant disease and there is no consensus classification or specialized treatment for it. However, PAL has been observed to have worse prognosis compared with other extrarenal malignant lymphomas and diffuse large B-cell lymphoma presents as the most common subtype of PAL. METHODS: The current study reported two cases of adrenal diffuse large B-cell lymphoma with high PD-L1 expression and discussed the clinical significance of PD-L1 through literature review. KEY RESULTS: The PD-L1 expression rate of the two cases was 90% and 80%, respectively, which was significantly higher than those reported in the literature. CONCLUSION: PAL is a type of non-Hodgkin's lymphoma with low incidence and poor prognosis, and it is necessary to further explore the early use of immunological checkpoint inhibitors for patients with higher expression of PD-L1 and with rituximab-resistance.

Immunoregulatory effect of human ß-defensin 1 on neonatal cord blood monocyte-derived dendritic cells and T cells.

The relationship between breastfeeding and infant health has been well elucidated in past decades. Our previous study has shown that human ß-defensin 1 (hBD-1) in human breast milk plays a protective role in reducing the incidence of upper respiratory infection in infants younger than 6 months. In the present study, we aim to reveal the mechanism underlying the protective role of hBD-1 by focusing on its immunoregulatory function in neonates. Cord blood (CB) from newborns' umbilical cords, which can simulate many of the neonatal symptoms, was used to study the immunomodulatory role of hBD-1 in neonates in vitro. Our results showed that hBD-1 promotes the GM-CSF- and IL-4-driven differentiation of neonatal umbilical CB monocytes to immature dendritic cells (DCs) and the final maturation of CB monocyte-derived DCs (moDCs) induced by LPS but not inflammatory cytokine production. In addition, hBD-1 inhibits apoptosis in neonatal moDCs through CCR6, which might be a possible mechanism of the hBD-1-induced phenotypes in moDCs. Furthermore, we found that hBD-1 promotes the proliferation and activation, but not the maturation, of neonatal CB CD4 + T cells. These results extend the immunoregulatory effects of hBD-1 and provide a potential mechanism for the protective role of hBD-1 in early infants, which will inform the development of infant nutrition, novel vaccines and anti-infective strategies in the future.

[Treatment of thoracolumbar burst fractures with intelligent inflated reduction combined with percutaneous pedicle screw fixation].

OBJECTIVE: To evaluate the clinical outcome of intelligent inflated reduction combined with percutaneous pedicle screw fixation in treating thoracolumbar burst fractures. METHODS: The clinical data of 22 patients with thoracolumbar burst fractures of single segment treated from January 2013 to December 2015 were retrospectively analyzed. There were 12 males and 10 females, aged from 32 to 56 years old with an average of (42.4±8.6) years. Self-made intelligent pneumatic reset instrument was applied to 22 cases under anaesthesia reduction, and then percutaneous pedicle screw fixation was performed. Clinical features were observed and the clinical effects were evaluated by VAS, ODI, kyphotic angle (Cobb angle) and the injured vertebral anterior border height before and after operation. RESULTS: All the patients were followed up from 1 to 2.5 years with an average of 18 months. All fractures obtained bone healing, no complications such as loosening, displacement, breakage of pedicle screw and kyphosis were found. Preoperative, 1 week postoperative, and final follow-up, VAS scores of lumbar pain were 7.82±0.85, 3.09±0.92, 1.05±0.72;ODI scores were 84.2±11.2, 46.3±9.0, 12.2±4.3;Cobb angle were (16.3±5.4)°, (3.7±2.2)°, ( 5.5±2.6)°; the injured vertebral anterior border heights were (59.5±7.8)%, (86.9±6.0)%, (83.5±5.5)%, respectively. There was significant differences in VAS, ODI scores between any two times(P<0.05). At 1 week postoperative and final follow-up, Cobb angle, injuried vertebral anterior border height were obviously improved (P<0.05), and there was no significant difference between postoperative 1 week and final follow-up (P>0.05). CONCLUSIONS: It is safe and feasible surgical technique that intelligent inflated reduction combined with percutaneous pedicle screw fixation for thoracolumbar burst fractures. It has advantage of little trauma, reliable fixation, and less complication, etc. Therefore, it is a better choice for single-segment thoracolumbar burst fractures.

Percutaneous endoscopic lumbar discectomy for high-grade down-migrated disc using a trans-facet process and pedicle-complex approach: a technical case series.

PURPOSE: The use of conventional percutaneous endoscopic lumbar discectomy (PELD) for high-grade down-migrated lumbar disc herniation medial to the pedicle via the transforaminal route can result in less favorable outcomes. We report a new PELD technique for the treatment of high-grade down-migrated lumbar disc herniation via a facet process and pedicle-complex approach. METHODS: Three patients with high-grade down-migrated L3-4 and L4-5 disc herniation presented to our hospital. Each underwent PELD via a facet process and pedicle complex approach to remove the herniated fragment and achieve complete decompression of the nerve root. RESULTS: Patients' symptoms were relieved. Postoperative magnetic resonance imaging showed root decompression. Follow-up 12-month computed tomography revealed no pedicle or facet fracture and healing of the pedicle complex and facet process bone tunnel. CONCLUSION: PELD via a facet process and pedicle-complex approach may be an option for high-grade, down-migrated lumbar disc herniation with completely sequestrated nucleus pulposus.

[Effects of Ligustrazine on Serum S100ß Protein and Neuron-Specific Enolase in Elderly Patients Undergoing Orthopedics Operations].

OBJECTIVE: To observe effects of Ligustrazine on serum S100p protein and neuron-specific enolase (NSE) in elderly patients undergoing orthopedics operations. METHODS: Totally 60 patients undergoing selective total hip replacement, 65-80 years old, who were in line with American Society of Anesthesiologists (ASA) grade I or II, were randomly assigned to the Ligustrazine group (Group L) and the normal saline control group (Group S). The right internal jugular vein catheters were placedcephalad and ensured theirs tips in jugular venous bulbs after anesthesia induction and tracheal intubation. Patients in Group L received 2 mg/kg Ligustrazine Injection (40 drops within one minute) and those inGroup S received equal volume of normal saline via central veins before operations. Other medicines were the same for all patients during and after operation. Five millimeter blood sample was collected frominternal jugular venous bulbs before operation (T0), 24 h (T1), 72 h (T2), 168 h (7th day, T3) after operation. Serum was collected after centrifuge. S100ß protein and NSE concentration were analyzed usingELISA. Mini-mental state examinations (MMSE) were scored by the same doctor at T0, T1, T2, and T3,respectively. RESULTS: There was no statistical difference in MMSE scores, serum S1000 protein, or NSE at TO (P > 0.05). Compared with TO, S100 P protein and NSE concentration increased and MMSE scores decreased at T1, T2, and T3 in the two groups. All indices except S100P protein and NSE at T3 were statistically different between Group L and Group S (P < 0.05). CONCLUSION: Serum S100P protein and NSE could be changed by pre-operation injecting Ligustrazine at certain dose in elderly patients undergoing orthopedics operations.

[Roles of folate metabolism in prostate cancer].

Epidemiological surveys show that folic acid can prevent prostate cancer, but fortified folic acid may increase the risk of the malignancy. The physician data queries from the National Cancer Institute of the USA describe folate as protective against prostate cancer, whereas its synthetic analog, folic acid, is considered to increase prostate cancer risk when taken at levels easily achievable by eating fortified food or taking over-the-counter supplements. We review the current literature to examine the effects of folate and folic acid on prostate cancer, help interpret previous epidemiologic data, and provide a clarification regarding the apparently opposing roles of folate for patients with prostate cancer. A literature search was conducted in Medline to identify studies investigating the effect of nutrition and specifically folate and folic acid on prostate carcinogenesis and progression. In addition, the National Health and Nutrition Examination Survey database was analyzed for the trends in serum folate levels before and after mandatory fortification. Folate likely plays a dual role in prostate carcinogenesis. There remains some conflicting epidemiologic evidence regarding folate and prostate cancer risk. However, there is growing experimental evidence that higher circulating folate levels can contribute to prostate cancer progression. Further research is needed to clarify these complex relationships.

Procalcitonin is a marker of gram-negative bacteremia in patients with sepsis.

BACKGROUND: Prediction of the species of pathogen among patients with sepsis within hours would be helpful in accelerating proper treatment. As a potential method of shortening the time to identification, this study considered the usefulness of measuring procalcitonin (PCT) to predict blood culture (BC) results. METHODS: The authors retrospectively analyzed the data of patients with a diagnosis of sepsis in their hospital from December 2012 to December 2013. The authors analyzed all diagnostic episodes consisting of BC and PCT concentration. The diagnostic performance of PCT to predict gram-negative bacteremia was tested using a receiver operative characteristic curve. Logistic regression was constructed using the presence of gram-negative bacteria as the dependent variable. RESULTS: A total of 262 diagnostic episodes met the inclusion criteria. According to BC classifications, a significantly higher value of PCT was observed in bloodstream infections caused by gram-negative bacteria (26.7 ng/mL, 0.09-188.3) than that in bloodstream infections caused by gram-positive bacteria (0.84 ng/mL, 0.05-18.79) or Candida spp. (1.12 ng/mL, 0.07-49.68). A cutoff value of ≥ 3.39 ng/mL for PCT showed a sensitivity of 80%, a specificity of 71%, a positive predictive value of 35%, a negative predictive value of 91% and an area under the curve of 0.73 for gram-negative bacteremia identification by BC. Among the 122 diagnostic episodes with positive BC results, a cutoff value of ≥ 6.47 ng/mL for PCT yielded a sensitivity of 74%, a specificity of 81%, a positive predictive value of 82%, a negative predictive value of 75% and an area under the curve of 0.81 for gram-negative bacteremia identification. CONCLUSIONS: PCT may represent a useful tool for differentiating gram-positive from gram-negative bloodstream infection with a significantly higher PCT level indicating gram-negative bacteremia.

Translaminar Screw Fixation in the Upper Thoracic Spine: Computed Tomography-Based Quantitative Laminar Analysis and Feasibility Study of Translaminar Virtual Screw Placement.

Translaminar screws (TLS) offer an alternative to pedicle screw fixation in the upper thoracic spine. Although some studies have described the anatomy of the laminae at the upper thoracic spine, computed tomography (CT) imaging is the modality of choice for presurgical planning. The characteristics of upper thoracic lamina in healthy Han adults have not been ascertained for the safe placement of TLSs. To determine the measurements (the diameter, maximal screw length, and optimal screw trajectory) required for safe TLSs placement in the T1-3 by CT scan evaluation, forty patients (20 men, 20 women), age (48.2 ± 13.9) years (range 19-78 years), were involved in the study from December 2008 to June 2012. Patients received a standardized axial bone-window CT imaging at T1-3, and had no evidence of spinal trauma, bone defect, or deformity. For each lamina, the height, thickness (outer cortical and inner cancellous), maximal screw length, and the crossing angle of the lamina were measured using Syngo 3D software and statistically analyzed. There were no significant differences between the left and right sides for each of the measurements (P > 0.05), but significant differences were determined between males and females for some measurements. The thickness of the laminar outer cortical diameter for the axial reconstruction was higher than that for the sagittal reconstruction (P < 0.01). The T1 lamina was estimated to accommodate, on average, a 4.2-mm longer screw than the T2 lamina, and a 5.7-mm longer screw than the T3 lamina. Most laminae could accept a 4.0-mm screw with a 1.0-mm clearance. Thus, it is more reasonable and accurate to select screw sizes according to the measurement of laminar thickness in the parasagittal reconstruction of the CT scan. T1 crossing laminar screws were successfully placed, without impingement to the spinal canal. Based on the CT evaluation, there are no anatomical limitations to the placement of TLSs at T1-3 in Chinese patients. Gender differences were noted in the superior thoracic vertebrae for dimensions of the laminae, which must be considered when placing TLSs at these levels. The TLSs add to the surgeon's armamentarium for instrumented fixation of the upper thoracic vertebrae.

[The anatomical feasibility analysis of posterior laminar screw fixation techniques in upper thoracic vertebrae].

OBJECTIVE: To investigate the anatomical feasibility and the technique of T(1)-T(3) crossing laminar screws fixation in the adult population. METHODS: There were 33 dry upper thoracic vertebras specimen which included respectively T(1), T(2), T(3) were studied. Spinous process height (Hs), bilateral laminar height (H), length of superior laminar screws (Ls), length of inferior laminar screws (Li), bilateral thickness of laminar (TL) and crossing angle the laminar (A) were measured. On the basis of modified Kretze's technique, T(1) crossing laminar screws implantation was performed under visual control. The crossing laminar screws position were evaluated by X-ray and visualizing. RESULTS: The mean Hs of T(1) was the highest which was (15.7 ± 1.6) mm; the mean H of T(3) was the highest which was (18.7 ± 1.1) mm; the TL and A of T(1) were (6.3 ± 0.9) mm and 101.8° ± 4.5°, that of T(2) were (6.9 ± 1.0) mm and 101.9° ± 4.3°, that of T(3) were (6.5 ± 0.9) mm and 102.9° ± 4.4°, respectively. There were no significant differences between the values of the H and TL on left and right sides (P > 0.05). The Ls of T(1), T(2), T(3) were shorter than Li of that [(31.7 ± 2.4) mm vs. (37.3 ± 2.3) mm, (25.8 ± 2.2) mm vs. (32.3 ± 2.7) mm, (25.3 ± 2.7) mm vs. (31.2 ± 2.9) mm, respectively]. There was significant statistically difference between the values of the Ls and Li on the same vertebra (P < 0.05). The mean TL of T(2) was the thickest, which was significant statistically thicker than that of T(1) (t = 8.876, P < 0.01), which was not significant statistically thicker than that of T(3) (t = 1.919, P > 0.05). The T(1) crossing laminar screws were successfully placed, without impingement of the spinal canal. CONCLUSIONS: It is feasible to place T(1), T(2), T(3) crossing laminar screws in most people. This study provides anatomic guidelines to allow for accurate screw selection and insertion.

Outbreak of Klebsiella pneumoniae carbapenemase 2-producing K. pneumoniae with high qnr prevalence in a Chinese hospital.

Forty carbapenem-resistant Klebsiella pneumoniae isolates were recovered from 28 patients from various sites in an intensive care unit in Zhejiang Provincial People's Hospital, China, over a 6 month period. PFGE analysis indicated that the 40 strains were all closely related. The MICs of carbapenems varied from 16 to >256 µg ml⁻¹. Conjugation studies with Escherichia coli resulted in the transfer of reduced carbapenem susceptibility from the original isolates. All K. pneumoniae and E. coli transconjugants produced K. pneumoniae carbapenemase 2 (KPC-2), and most of them produced TEM, SHV and CTX-M. Additionally, 27 isolates and 27 E. coli transconjugants carried the qnr gene (25 were qnrB2 and 2 were qnrS1). K. pneumoniae harboured several plasmids, and bla(KPC-2) was located on a 55 kb plasmid. SDS-PAGE and ompK35/36 gene sequence analysis of OMPs suggested that porins in K. pneumoniae are expressed normally. The MICs of the carbapenems did not change in the presence of CCCP. Thus, production of KPC-2 appears to play an important role in resistance to carbapenems, although other mechanisms may be involved. The bla(KPC-2) gene is associated with several antibiotic-resistance genes, such as bla(TEM), bla(SHV), bla(CTX-M) and qnr.

[Evaluation of two methods for counting residual white blood cells in thrombocytaphoresis concentrates].

To evaluate flow-cytometry and Nageotte method for counting residual WBC in thrombocytaphoresis concentrates, their accuracies were determined by dilution studies separately; the repeatability was determined by measuring the interassay coefficient of variation for 14 replicates of a sample with known leukocyte concentration. 102 samples of leukocyte-depleted thrombocytaphoresis concentrates were detected by the above mentioned two methods, and the results were compared each other. The results showed that no difference was observed between two methods over a range of leukocyte concentrations from 0.8 to 10 WBC/microl (P > 0.05). In conclusion, flow-cytometry and Nageotte methods can be used for quality control of WBC-reduced blood components.