Molecular epidemiology of clinical isolation of carbapenem-resistant Enterobacterales and application of carbapenemase inhibitor enhancement test / 中南大学学报(医学版)

OBJECTIVES@#The prevalence of carbapenem-resistant Enterobacterales (CRE) presents a significant challenge in clinical anti-infective treatment. This study aims to investigate drug resistance and the molecular epidemiological characteristics of CRE in our area. Additionally, we seek to evaluate practicality of utilizing carbapenemase inhibitor enhancement test in clinical laboratory.@*METHODS@#Non-repeated CREs isolated from clinical specimens at Xiangya Hospital, Central South University, were collected. Minimum inhibitory concentration (MIC) combined with Kirby-Bauer (KB) assay was used to detect the drug susceptibility of the strains, and 13 carbapenemase-producing genes were detected by PCR. The phenotype of 126 strains of carbapenemase-producing Enterobacterales identified by PCR was detected by the carbapenemase inhibitor enhancement test to understand the agreement between the method and the gold standard PCR results.@*RESULTS@#Among 704 CRE strains examined, we observed significant drug resistance in 501 strains dentified as carbapenemase-producing Enterobacterales (CPE). Klebsiella pneumoniae was the predominant CPE strain, followed by Enterobacter cloacae and Escherichia coli. A total of 9 carbapenemase types were detected, including Klebsiella pneumoniae carbapenemase (KPC), New Delhi metallo-β-lactamase (NDM), Verona integron- encoded metallo-β-lactamases (VIM), imipenemase (IMP), oxacillinase-48 (OXA-48), and rare imipenem-hydrolyzing β-lactamase (IMI), adelaide imipenemase (AIM), Bicêtre carbapenemase (BIC), and guiana extended-spectrum β-lactamase (GES). The detection rate of KPC serine carbapenemase was 61.7% (309/501). The carbapenemase inhibitor enhancement test exhibited a 100% consistency rate for the strains producing Class A serine carbapenemase and/or Class B metallo-β-lactamases.@*CONCLUSIONS@#CRE strains in Changsha, Hunan, China, are wide distribution and exhibit carbapenemase production. The main mechanism of carbapenem resistance in these bacterias is predominatly attributed to the production of KPC serine carbapenemase. The presence of GES and IMI genes carried by Enterobacterales has been detected for the first time in this region. The carbapenemase inhibitor enhancement test has been proven to be an accurate method for detecting CRE producing Class A serine carbapenemase and/or Class B metallo-β-lactamases. This method offers simpicity of operation and ease of results interpretation, making it weel-suited meeting the clinical microbiology laboratory's reguirements for the detection of serine carbapenemase and metallo-β-lactamases.

Application value of endoscopic Nd-Fe-B magnet ring tracer technique to laparoscopy for colorectal lesions (with video) / 中华消化内镜杂志

Objective:To explore the clinical application value of preoperative colonoscopic marking by Nd-Fe-B magnet ring to assist laparoscopy.Methods:A total of 51 patients with colorectal tumor who underwent radical laparoscopy from January 2020 to October 2021 at the Department of Gastrointestinal Surgery, Guizhou Provincial People's Hospital were recruited. The patients were marked by Nd-Fe-B magnet ring under endoscopy one day before the operation, another magnet ring was sent into the abdominal cavity during the radical laparoscopy through cannula. The two magnet rings were attracted and clung to each other to orient the lesions. The basic information of patients, location of preoperative marks under endoscopy and laparoscopy conditions were recorded.Results:All 51 Nd-Fe-B magnet rings were successfully located to the position of colorectal tumor and fixed. According to the location of the lesions, there were 15 cases of transverse colon, 12 cases of descending colon, 19 cases of sigmoid colon, and 5 cases of upper rectal segment. According to the lesion type, there were 21 cases of colon cancer, 25 cases of polyp carcinomatosis, and 5 cases of laterally spreading tumors with partial carcinomatosis. There were 5 cases with positive margins after endoscopic mucosal resection and 1 case with positive margin after endoscopic submucosal dissection. All lesions were accurately located during the operation. The marking time was 4.1±1.2 min (3-6 min) before the operation and the localization time was 1.5±1.1 min (0.9-5.3 min) during the operation. All magnet rings were removed from the body by laparoscope. The mean distances between the tumor and the cutting edge of the proximal and distal intestinal segments were 5.5 cm and 6.3 cm, respectively. No complications such as colon mucosal injury, bleeding, intestinal perforation or local inflammatory reactions occurred.Conclusion:Nd-Fe-B magnet ring tracer technique for laparoscopic orientation is simple, fast, accurate and safe with no need for additional equipment or apparatus, which is worthy of clinical application.

Real-world study of the effectiveness of BBIBP-CorV (Sinopharm) COVID-19 vaccine in the Kingdom of Morocco

The Kingdom of Morocco approved BBIBP-CorV (Sinopharm) COVID-19 vaccine for emergency use on 22 January 2021 in a two-dose, three-to-four-week interval schedule. We conducted a case-control study to determine real-world BBIBP-CorV vaccine effectiveness (VE) against serious or critical hospitalization of individuals RT-PCR-positive for SARS-CoV-2 during the first five months of BBIBP-CorV use in Morocco. The study was conducted among adults 18-99 years old who were tested by RT-PCR for SARS-CoV-2 infection between 1 February and 30 June 2021. RT-PCR results were individually linked with outcomes from the COVID-19 severe or critical hospitalization dataset and with vaccination histories from the national vaccination registration system. Individuals with partial vaccination (<2 weeks after dose two) or in receipt of any other COVID-19 vaccine were excluded. Unadjusted and adjusted VE estimates against hospitalization for serious or critical illness were made by comparing two-dose vaccinated and unvaccinated individuals in logistic regression models, calculated as (1-odds ratio) * 100%. There were 348,190 individuals able to be matched across the three databases. Among these, 140,892 were fully vaccinated, 206,149 were unvaccinated, and 1,149 received homologous BBIBP-CorV booster doses. Unadjusted, full-series, unboosted BBIBP-CorV VE against hospitalization for serious or critical illness was 90.2% (95%CI: 87.8% - 92.0%). Full-series, unboosted VE, adjusted for age, sex, and calendar day of RT-PCR test, was 88.5% (95%CI: 85.8% - 90.7%). Calendar day- and sex-adjusted VE ranged from 93.9% to 100% for individuals <60 years, and was 53.3% for individuals 60 years and older. There were no serious or critical illnesses among BBIBP-CorV-boosted individuals. Effectiveness of Sinopharms BBIBP-CorV was consistent with phase III clinical trial results. Two doses of BBIBP-CorV was highly protective against COVID-19-associated serious or critical hospitalization in working-age adults under real-world conditions and moderately effective in older adults. Booster dose VE should be evaluated, as booster doses of BBIBP-CorV are recommended and are being used.

Retrospective single center study of inactivating coronavirus disease 2019 vaccine in liver transplantation recipients / 中华器官移植杂志

Objective:To explore the safety of inactivating coronavirus disease 2019(covid-19)vaccine in liver transplantation(LT)recipients.Methods:Retrospective analysis was performed for clinical data of 151 LT recipients from March 2003 to October 2019.They had stable conditions and completed the course of covid-19 vaccine.Frequencies of pain at injection site, fatigue, headache and pruritus after vaccination were recorded.The safety profiles were compared between recipients with and without local and general adverse reactions after vaccination.At the same time, recipients completing two doses of covid-19 vaccines were grouped.According to vaccine companies, they were classified into Sinovac Biotech Ltd and Beijing Biological.Based upon more than or less than 60 years, they were grouped into <60 years and ≥60 years.The safety profiles of inactivating COVID-19 vaccine were compared in subgroups.Results:Among 151 eligible LT recipients, 98 of them were in group of age <60 years and 53 in group of age >60 years.The median period between vaccination and LT was 8.44(4.37, 12.39)years and the median concentration of tacrolimus 2.5(1.8, 3.9)ng/L.Eighty-three cases completed two doses of Sinovac Biotech Ltd(Sinovac Biotech Ltd group)and 40 cases Beijing Biological(Beijing Biological group); 14 cases had combined course of Sinovac Biotech Ltd and Beijing Biological, four recipients were vaccinated with inactivated vaccine from other companies and ten recipients did not know their inactivated vaccine' companies.After immunization, 24/151(15.9%)recipients had a local and general adverse reaction.The prevalence of pain at injection site, fatigue, headache and pruritus was 9.9%( n=15), 5.2%( n=8), 1.3%( n=2)and 0.7%( n=1)respectively.No significant differences existed in age( P=0.602), gender( P=0.752), period after LT( P=0.890), trough concentration of tacrolimus( P=0.377)or versions of covid-19 vaccine( P=0.582)between 24 cases with general adverse reaction and 127 without.Local and general reactions occurred in 16/83(19.3%)in Sinovac group and 5/40(12.5%)in Beijing Biological.There was no significant inter-group difference( P=0.769). There were 98 cases(64.9%)in <60 years group, 17 cases(17.3%)had local and general reaction, 53 cases(35.1%)in ≥60 years group and 7 cases(13.2%)had a local and systemic reaction.There was no significant inter-group difference( P=0.507). Conclusions:Covid-19 vaccine is safe for long-term survival LT recipients with normal liver function.Few participants present with mild fatigue and pain at injection site.

Impact of intraoperative ligation of splenic artery on prognosis of liver transplantation on patients with severe hypersplenism / 中华肝胆外科杂志

Objective:To study the impact of simultaneous ligation of splenic artery on prognosis of patients with severe hypersplenism in liver transplantation.Methods:A retrospective analysis was performed on the clinical data of 206 patients who underwent liver transplantation in the Fifth Medical Center of PLA General Hospital from December 2016 to February 2019. There were 180 males and 26 females, aged (51.0±9.0) years old. Fifty-one patients underwent splenic artery ligation during liver transplantation and they were enrolled into the observation group, and 155 patients without splenic artery ligation were enrolled into the control group. The changes in white blood cells (WBC), platelets, alanine aminotransferase, total bilirubin and serum creatinine as well as the incidence of postoperative complications were compared between the two groups.Results:The platelet count of the observation group was significantly lower than those of the control group before operation and on days 1, 3, 7, 30 and 90 after operation, (all P<0.05). The WBC counts in the observation group were significantly lower than those in the control group before operation and on days 1 and 3 after operation (all P<0.05). However, there were no significant differences in the WBC counts between the two groups on days 5, 7, 30 and 90 after operation (all P>0.05). There were also no significant differences in alanine aminotransferase and total bilirubin indexes between the two groups after surgery (all P>0.05), but the serum creatinine levels in the observation group were significantly lower than those in the control group on days 3, 5, 7 and 30 after surgery (all P<0.05). There were no significant differences in the rates of infection, severe acute rejection, biliary tract complications, arterial/portal thrombosis and mental complications between the two groups (all P>0.05). The rate of renal replacement therapy for acute kidney injury in the observation group (9.8%, 5/55) was significantly higher than that in the control group (1.3%, 2/155) ( P<0.05). Conclusion:Ligation of splenic artery during liver transplantation was safe and it had a significant advantage in the early postoperative recovery of WBC count and creatinine without increasing the incidence of complications in patients with severe hypersplenism.

Rapid detection of the metformin illegally added of in TCM and health food by TLC-IR.

Based on TLC-IR, the study established an effective method for rapid detection of metformin illegally added in hypoglycemic traditional Chinese medicine and health food products. 12 batches of hypoglycemic traditional Chinese medicine and health products were purchased in the pharmacy, which were produced by different manufacturers. TLC was used to separate metformin and phenformin for preliminary identification from. IR was applied to further identification and HPLC method was used to verify the experimental results of TLC-IR. TLC developing solvents was petroleum ether-methanol-glacial acetic acid (5:12:0.5) and the stationary phase was silica gel prefabricated GF254 plate. IR used KBr pellet pressing method with a resolution of 4cm-1 and scanned 64 times. The column for HPLC analysis was SinoChrom ODS-BP 5 µm (4.6mm *250mm) and the injection volume was 20µL. The detection wavelength was 234nm. The flow rate was 1ml•min-1. Metformin and phenformin were significantly separated under the TLC condition. Joint identification by TLC-IR, none of metformin and phenformin were identified in the hypoglycemic traditional Chinese medicine. Phenformin was detected in two kinds of health products while metformin was identified in one kind of health food. The result of HPLC was consist with TLC-IR. The established TLC-IR method was simple, rapid and selective, which was suit to apply in the identification of metformin illegally added in hypoglycemic traditional Chinese medicine and health food products.

Analysis on dynamic change of cytokines in patients with occupational trichloroethylene-induced medicamentosa-like dermatitis / 中国职业医学

OBJECTIVE: To analysis the dynamic change of cytokines in patients with occupational trichloroethylene-induced medicamentosa-like dermatitis(OMDT) at the initial stage of treatment. METHODS: Twenty-two cases of early onset OMDT with no glucocorticoid treatment history were selected as the research subjects by judgment sampling method. Blood samples were collected on the 1 st, 2 nd, 3 rd, 4 th and 5 th weeks after admission and on the day of hospital discharge. The levels of tumor necrosis factor-α(TNF-α), interferon-γ(IFN-γ), interleukin(IL)-5, IL-6 and IL-10 in plasma samples were measured by the enzyme linked immunosorbent assay. RESULTS: The five cytokines in patients with exfoliative dermatitis showed an increasing trend at the initial stage of treatment. Among them, the levels of TNF-α, IL-5 and IL-10 reached a peak and then dropped rapidly to form a plateau, and the levels of IFN-γ and IL-6 were slightly increased and the duration of increase was shorter than that of other cytokines. The levels of TNF-α, IFN-γ, IL-5 and IL-6 in patients with erythema multiforme remained within the detection limits in the detection process. Only a few patients showed a short-term increase, the IL-10 level showed a slight increase at the initial stage and then decreased to the plateau stage. The levels of TNF-α, IFN-γ and IL-6 in patients with bullous epidermal necrolysis increased rapidly at the initial detection stage for a short period of time, and then decreased sharply. The level of IL-5 remained at the detection limit, and the IL-10 level showed alternative rising and falling pattern. Part of the dynamic change of cytokines in patients with exfoliative dermatitis and bullous epidermal necrolysis was similar. CONCLUSION: The levels of TNF-α, IFN-γ, IL-5, IL-6, and IL-10 in OMDT patients changed with the progression of the disease at the early treatment stage, and the degree of change was related to the type of rash. Among them, the levels of TNF-α and IL-10 showed dynamic changes due to the progression of the disease, which could be considered as effect biomarkers to evaluate the severity and progression of the disease, and provide a reference for the rational treatment of patients.

Observation of pathological changes in rat silicosis model at different time points / 中国职业医学

OBJECTIVE: To observe the pathological changes of rat silicosis model at different time points. METHODS: The specific pathogen free SD rats were randomly divided into control group and 7, 15, 21, 30, 45, 60, 75 and 90 day model groups based on their body weight, with 5 rats in each group. Non-exposed endotracheal intubation was performed. Silicosis rat model was established by intratracheal instillation of 250 g/L silica suspension in each rat, and 0.9% sodium chloride solution was perfused into the trachea of rats in the control group. The rats in the control group were sacrificed on the 90 th day after exposure, and the model rats in the other 8 groups were sacrificed on the 7 th, 15 th, 21 st, 30 th, 45 th, 60 th, 75 th and 90 th days after the end of exposure. The gross appearance of the lung tissue of rats was observed. The rat lung tissues were stained with hematoxylin-eosin and Masson staining to observe the pathological changes, and Ashcroft score was evaluated. RESULTS: The gross observation showed that the lungs of rats in the model groups had varying degree of gray changes, hardened texture, and spots and nodules on the surface of the lobes. These changes were aggravated with the increase of time after dust exposure. The results of histopathological examination of the lungs showed that the rats developed acute alveolar inflammation, and a large number of macrophages and neutrophils were seen in the lung tissues in the 7 th and 15 th day model groups. Cellular nodules appeared in the lung tissue, and fibrosis appeared in the center of the nodule in the rats of 21 st, 30 th, and the 45 th day model groups; the silicosis nodules appeared in the lung tissues of rats in the 60 th, 75 th, and 90 th day model groups, and the small nodules gradually merged into larger ones. Simultaneously, with the increase of time after dust exposure, the lung tissue of rats gradually showed severe pulmonary fibrosis. The lung organ coefficient and Aschcroft score of rats increased with the increase of time after dust exposure(P<0.01). CONCLUSION: The rat lung changes after dust exposure. Acute alveolar inflammation occurs on the 7 th to 15 th day after dust exposure; cellular nodules develop on the 21 st to 45 th day after dust exposure; silicosis nodules develop on the 60 th to 90 th day after dust exposure. The severity of lung fibrosis after dust exposure showed a time-effect relationship in rats.

Correlation between cytokine levels and liver function damage in patients with occupational medicamentosa-like dermatitis due to trichloroethylene / 中国职业医学

OBJECTIVE: To investigate the correlation between plasma cytokine levels and liver functions in patients with occupational medicamentosa-like dermatitis due to trichloroethylene(OMDT). METHODS: A total of 22 OMDT patients were selected as research subjects using judgment sampling method. Blood samples were collected from patients on the 1 st, 2 nd, 3 rd, 4 th, and 5 th week of admission and the day of hospital discharge. The automatic biochemical instrument was used for detecting the index of serum liver function. The levels of cytokines including tumor necrosis factor-α(TNF-α), interferon-γ(IFN-γ), interleukin(IL)-5, IL-6, and IL-10 in plasma were measured by enzyme-linked immunosorbent assay. The Spearman correlation analysis was performed to analyze the correlation between cytokines and liver function in 15 patients with exfoliative dermatitis. RESULTS: The levels of alanine aminotransferase(ALT), aspartate aminotransferase(AST), total bilirubin(TBIL), direct bilirubin(DBIL), glutamyl transpeptidase(GGT), and total bile acid(TBA) of OMDT patients on the 1 st week of admission increased(P<0.05), while total protein(TP) and albumin(ALB) decreased(P<0.05) compared with the results at discharge(a stage of recovery). The correlation analysis results of patients with exfoliative dermatitis showed that: the levels of TNF-α, IFN-γ and IL-6 were negatively correlated with the levels of TP and ALB respectively(P<0.05), the level of IL-5 was negatively correlated with TBIL(P<0.05), and the level of IL-10 was negatively correlated with ALB(P<0.05) in the 1 st week. The level of IL-6 was positively correlated with ALT(P<0.05) in the 2 nd week. The level of TNF-α was positively correlated with TBIL(P<0.05), the level of IL-10 was positively correlated with AST(P<0.05) in the 3 rd week. The levels of TNF-α and IL-10 were positively correlated with AST and ALT respectively(P<0.05), the level of IFN-γ was positively correlated with AST(P<0.05) in the 4 th week. The levels of IL-6 and IL-10 were positively correlated with ALT and GGT(P<0.05), and the levels of TNF-α and IFN-γ were positively correlated with AST(P<0.05) in the 5 th week. The level of TNF-α was negatively correlated with DBIL(P<0.05) and was positively correlated with TBA(P<0.05) at discharge.CONCLUSION:s Patients with OMDT are frequently accompanied with severe liver function damage at the early stage. The level of plasma cytokines(TNF-α, IFN-γ, IL-6 and IL-10) might correlate with the severity of liver dysfunction.

Sub-acute toxicity of 1-bromopropane oral exposure in rats / 中国职业医学

OBJECTIVE: To observe the sub-acute toxicity of 1-bromopropane(1-BP) oral exposure for 28 days in SD rats. METHODS: Specific pathogen free adult female SD rats were randomly assigned to the control and exposed group, 8 rats in each group. The 1-BP was suspended in corn oil and administered by gavages in a dose of 800 mg/kg body weight to rats in the exposed group, once a day, 5 days per week for 4 weeks. The rats in the control group were given equal volume of corn oil. After the last exposure, blood and urine of rats were collected for 1-BP level detection and hematological examination. Brain, heart, lung, liver, kidney and spleen of rats were collected for gross pathological examination and histopathological examination. RESULTS: The rats of exposed group showed unstable standing, weakness of hind limbs, limping and lying down from the 3 rd week of exposure. From the 1 st to 4 th week of exposure, mean body weight of rats in the exposed group were significantly lower than those of the control group(P<0.05). In the exposed group, the level of 1-BP in urine was higher than that in blood(P<0.05), and that there was positive correlation between them(Spearman correlation coefficient=0.954, P<0.01). In the control group, 1-BP was not detected. The absolute weights of brain and lung tissue in the exposure group decreased(P<0.05), meanwhile the organ coefficients of heart, liver, spleen and kidney were significantly increased compared with the control group(P<0.05). The number of red blood cells, hemoglobin concentration, hematocrit, the mean hemoglobin concentration, the total serum cholesterol and triglycerides were decreased(P<0.05). No pathological change related to 1-BP exposure was observed in the main organs of the rats in the exposed group. CONCLUSION: The sub-acute oral toxicity of 1-BP is mainly neurotoxicity and hematotoxicity. The 1-BP level in urine may reflect its exposure.

Hyperbaric oxygen inhalation downregulates the expression of BCL2-associated protein X and upregulates the expression of the B lymphoblastoma-2 gene after cerebral hemorrhage / 中华物理医学与康复杂志

Objective:To explore any effect of inhaling hyperbaric oxygen on edema resulting from cerebral hemorrhage.Methods:Cerebral hemorrhage was modeled using collagenase in 125 Wistar rats, with 5 others used as controls. The injured rats were randomly divided into a second control group without any hyperbaric oxygen intervention, and groups which inhaled hyperbaric oxygen for 40 min, 60 min, 80 min or 100 min. There were 25 rats in each group. The inhalation began 6 hours after the modeling and was administered once a day. On the 2nd, 4th, 6th, 8th and 16th day of the treatment, 5 rats from each group were sacrificed and the expression of the B lymphoblastoma-2 gene (Bcl-2) and BCL2-associated protein X (Bax) in the brain tissue around the hematoma was detected using immunohistochemical methods.Results:The average Bax expression in all of the HBO groups was significantly lower than in the second control group at each time point, but with significant differences between the HBO 60 min and HBO 40 min groups, as well as between the HBO 80 min and HBO 100 min groups. By the 4th day the average Bcl-2 expression in the HBO 40 min group was significantly different from that in the HBO 80 min group, and the same was true of the HBO 60 min and HBO 100 min groups.Conclusions:One of the mechanisms by which HBO treats intracerebral hemorrhage may be related to down-regulating the expression of Bax and increasing the expression of Bcl-2. The best everyday treatment duration is 80 min.

Role of α7nAChR in postoperative cognitive dysfunction in aged rats with tibial fracture / 中华麻醉学杂志

Objective To evaluate the role of α7 nicotinic acetylcholine receptor (α7nAChR) in postoperative cognitive dysfunction in aged rats with tibial fracture. Methods One hundred and fifty clean-grade healthy male Sprague-Dawley rats, aged 18-22 months, weighing 440-580 g, were divided into 5 groups ( n=30 each ) using a random number table method: control group ( group C ) , sham operation group ( group S) , tibial fracture group ( group T) , normal saline group ( group N) and α7nAChR agonist PUN282987 group (group P). Group C received no treatment. Ten percent chloral hydrate 0. 4 ml/100 g was injected intraperitoneally in group S. Group T underwent tibial fracture. PUN2829872. 4 mg/kg was in-traperitoneally injected at 5 min before tibial fracture in group P . The equal volume of normal saline was giv-en at 5 min before tibial fracture in group N. Morris water maze test was performed at day 7 after surgery. At days 1, 3 and 7 after surgery, the pathological changes of the hippocampal CA3 region were observed by haematoxylin and eosin staining, and the expression of α7nAChR, choline acetyltransferase ( ChAT ) , tumor necrosis factor-α( TNF-α) and interleukin-1β( IL-1β) in the hippocampal CA3 region was measured by Western blot. Results Compared with group C, the postoperative escape latency and swimming dis-tance were significantly prolonged, and the expression of α7nAChR, ChAT, TNF-α and IL-1β was up-regulated at each time point after operation in T, N and P groups ( P＜0. 05) , and no significant change was found in the parameters mentioned above in group S ( P＞0. 05) . Compared with group T, the postoper-ative escape latency and swimming distance were significantly shortened, and the expression of α7nAChR and ChAT was up-regulated and the expression of TNF-α and IL-1β was down-regulated at each time point after operation in group P ( P＜0. 05) , no significant change was found in the parameters mentioned above in group N ( P＞0. 05) , and the pathological changes of the hippocampal CA3 region were significantly at-tenuated in group P. Conclusion α7nAChR antagonism is involved in the development of postoperative cognitive dysfunction in aged rats with tibial fracture.

Value of 18F-FDG PET-CT in the diagnosis, staging and treatment decision of lymphoma / 白血病·淋巴瘤

Objective To investigate the clinical value of 18F-FDG PET-CT in the diagnosis, clinical staging and treatment guide of malignant lymphoma. Methods A total of 136 lymphoma patients confirmed by pathological diagnosis who received 18F-FDG PET-CT and contrast enhanced CT (CECT) examination in Gansu Provincial Hospital from January 2011 to December 2016 were collected. The sensitivity, specificity, accuracy, positive predictive values (PPV) and negative predictive values (NPV) of 18F-FDG PET-CT and CECT were evaluated, respectively. The effects of 18F-FDG PET-CT on diagnosis, clinical staging and treatment regimens of lymphoma were analyzed. Results The sensitivity, specificity, accuracy, PPV and NPV of 18F-FDG PET-CT in the diagnosis of lymphoma for all 136 patients was 98.2%, 82.1%, 94.9%, 95.5% and 92.0%, respectively. CECT was 80.6%, 67.9%, 77.9%, 90.6% and 47.5%, respectively. The difference in sensitivity and specificity between 18F-FDG PET-CT and CECT was statistically significant (χ2＝ 16.0, P<0.01). The accuracy of 18F-FDG PET-CT was higher than that of CECT. Compared with CECT, 26 (20.6%) patients with image of 18F-FDG PET-CT showed the increase of the clinical staging, 4 (2.9%) patients showed the decrease of the clinical staging, and 16 (11.8%) patients changed the treatment regimen after the stage alteration. Conclusion 18F-FDG PET-CT is superior to CECT in the diagnosis, clinical staging and treatment guide of lymphoma, which shows the promising prospect in the diagnosis and treatment of lymphoma.

Mesenchymal stem cells and immune disorders: from basic science to clinical transition / 医学前沿

As a promising candidate seed cell type in regenerative medicine, mesenchymal stem cells (MSCs) have attracted considerable attention. The unique capacity of MSCs to exert a regulatory effect on immunity in an autologous/allergenic manner makes them an attractive therapeutic cell type for immune disorders. In this review, we discussed the current knowledge of and advances in MSCs, including its basic biological properties, i.e., multilineage differentiation, secretome, and immunomodulation. Specifically, on the basis of our previous work, we proposed three new concepts of MSCs, i.e., "subtotipotent stem cell" hypothesis, MSC system, and "Yin and Yang" balance of MSC regulation, which may bring new insights into our understanding of MSCs. Furthermore, we analyzed data from the Clinical Trials database ( http://clinicaltrials.gov ) on registered clinical trials using MSCs to treat a variety of immune diseases, such as graft-versus-host disease, systemic lupus erythematosus, and multiple sclerosis. In addition, we highlighted MSC clinical trials in China and discussed the challenges and future directions in the field of MSC clinical application.

Effects of 1,2-dichloroethane subacute exposure on depressive behavior and monoamine neurotransmitter level in rats / 中国职业医学

OBJECTIVE: To investigate the effects of 1,2-dichloroethane(1,2-DCE) subacute exposure on depression in rats as well as the relevant mechanism of monoamine neurotransmitters. METHODS: The specific pathogen free male SD rats were randomly divided into control group, low-, medium-, and high-dose groups, with 10 rats in each group. The rats in these 4 groups were intra-gastrically administered with 1,2-DCE(diluted in corn oil) at the dose of 0, 20, 40, 80 mg/kg body weight, every other day for 14 times. After exposure, the behavior change of rats was observed by open-field test, sucrose preference test and forced swim test. The levels of the monoamine neurotransmitters including 5-hydroxytryptamine(5-HT), noradrenaline(NA) and dopamine(DA) in prefrontal cortex, hippocampus, and striatum of rats were analyzed by high performance liquid chromatography-electrochemical detection method. RESULTS: The number of rearing, time and distance of central area, sucrose preference index of mice in medium and high dose groups were decreased(P<0.05), while immobility time of forced swim test was increased(P<0.05) when compared with the mice in control group. The levels of 5-HT, NA and DA in prefrontal cortex, hippocampus, and striatum decreased with the increase of 1,2-DCE exposure(P<0.05), showing a dose-effect relationship. The levels of 5-HT, NA and DA in prefrontal cortex, hippocampus, and striatum in the high-dose group were lower than that of control group(P<0.05). CONCLUSION: The subacute exposure of 1,2-DCE can induce depression-like behavior in rats. The mechanism might be related to the reduction of monoamine neurotransmitters in striatum, hippocampus and prefrontal cortex.

Expression and significance of NAD (P) H: quinone oxidoreductase 1 and heme oxygen-ase-1 proteins in T-cell lymphoma / 中国肿瘤临床

Objective: To investigate the expression of NAD (P) H: quinone oxidoreductase 1 (NQO1) and heme oxygenase-1 (HO-1) in T-cell lymphoma (TCL), and investigate the correlation between these two indicators and other clinicopathological parameters in TCL. Methods: Clinical data of 61 patients with TCL who were initially diagnosed in Gansu Provincial Hospital were analyzed retrospectively. Immunohistochemical examination was performed to detect NQO1 and HO-1 expression levels in 61 TCL tissues (TCL group) and 20 lymph node reactive hyperplasia tissues (control group). Results: Positive expression rates of NQO1 and HO-1 were significantly higher in TCL tissues than in lymph node reactive hyperplasia tissues (P<0.05). NQO1 expression was closely related with Ann-Arbor clinical stage and B symptoms (P<0.05); HO-1 expression was correlated with clinical stage, bone marrow invasion, and B symptoms (P<0.05). NQO1 and HO-1 expression levels were not related to age, sex, lactate dehydrogenase level, and pathological type (P>0.05); there was a correlation between NQO1 and HO-1 expression (r=0.264; P=0.040). Conclusions: NQO1 and HO-1 are highly expressed in TCL and may interact and contribute to the occurrence and development of TCL.

Bloodstream infections with O16-ST131 and O25b-ST131: molecular epidemiology, phylogenetic analysis and antimicrobial resistance / 南方医科大学学报

OBJECTIVE@#To investigate the phylogenetics and prevalence of bloodstream infections with ST131, the antimicrobial resistance profiles of the pathogens, and the clinical features.@*METHODS@#Non-duplicate isolates were collected from 144 patients with bloodstream infections in our hospital between January and December, 2016.The phylogenetic groups of the isolates were analyzed using multiplex PCR, and O serotyping of ST131 strains was performed by allele-specific PCR.The clinical characteristics of the 144 patients were analyzed to define the differences in the clinical features between patients with ST131 infection and those with non-ST131 infection.Antibiotic susceptibility of the isolates was determined using the Vitek 2 compact system.@*RESULTS@#The phylogenetic group analysis showed a domination by group B2 (41.0%[59/144]), followed by group F, group B1 and group E, which accounted for 16.7%(24/144), 13.9%(20/144), and 13.2% (19/144), respectively.Nine strains (6.3%) of were identified to be ST131 strains, among which 8 were O25b-B2-ST131 strains and 1 was O16-B2-ST131 strain.Of the 9 cases of ST131 infection, 7(77.8%) were found to occur in a nosocomial setting.The demographic characteristics and clinical features of the ST131-infected patients were similar to those of non-ST131-infected patients.ST131 strains were sensitive to piperacillin/tazobactam, imipenem, ertapenem, and amikacin, but showed high resistance rates to cefazolin, ceftriaxone, ciprofloxacin, levofloxacin, gentamicin, and trimethoprim/ sulfamethoxazole (all over 50%).The positivity rate of ESBLs in the ST131 strains was 77.8%, and the multidrug resistance rate reached 88.9%, which was higher than that of non-ST131 isolates, but the difference was not statistically significant.@*CONCLUSIONS@#The most common phylogenetic groups of isolates from patients with bloodstream infections are group B2 and F, and the positivity rate of ST131 is low.We for the first time detected O16-ST131 in patients with blood-borne infections in China.The clinical features of ST131-infected patients are similar to those of non-ST131-infected patients.The positivity rate of ESBLs and the multidrug resistance rate are high in ST131 strains, which may raise concerns in the future.

MSCT manifestations of hepatic fat-poor perivascular epithelioid cell tumor / 实用放射学杂志

Objective To investigate the MSCT manifestations of hepatic fat-poor perivascular epithelioid cell tumor (PEComa). Methods CT and pathological findings of 8 patients with hepatic fat-poor PEComa confirmed by surgery were assessed retrospectively.Results 8 cases had solitary lesion,all lesions with round or round-like shape.The largest diameter ranged 20-110 mm.The fat density was not measured by CT scan.6 lesions composed of solid component,and solid part showed obviously enhancement on arterial phase.On portal venous phase and parenchymal phase,the tumors showed equal or low or slightly high density.2 lesions showed cystic necrosis,peripheral enhancement on arterial phase,1 lesion showed continuous enhancement and the enhancement degree increased,and another lesion showed reduced enhancement.All lesions had tortuous vascular in the center of lesions or at the peripheral.Immunohistochemistry examinations showed that HMB45,Melan-A and SMA were positive in all cases,CD31,CD34 and S-100 expressed positive in partial cases. Conclusion The CT findings of hepatic fat-poor PEComa are lack of specificity.When the enhancement and clearance pattern of liver mass is similar to hepatocellular carcinoma or adenoma,the clinical history does not support the diagnosis,may consider the possibility of PEComa when tortuous vascular in the center of lesions or at the peripheral on arterial phase.

The clinical curative effect of transcranial direct current stimulation on patients with disorders of consciousness / 中华物理医学与康复杂志

Objective To assess the clinical efficacy of transcranial direct current stimulation (tDCS) in improving consciousness in patients with severe disorders of consciousness.Methods Thirty-eight patients with disorders of consciousness were divided into an observation group and a control group according to a random number table,each of 19.Both groups received conventional rehabilitation therapy,while the observation group was additionally provided with tDCS at the intensity of 2 mA for 20 minutes per day,6 days per week,for 20 times,with the anodal electrode (isotonic saline gelatin sponge,7 cm×5 cm) placed over the left dorsolateral prefrontal cortex and the cathodal stimulation over the right eye socket or right shoulder.The patients were evaluated with brainstem auditory evoked potential (BAEP),upper limb somatosensory evoked potential (USEP),electroencephalogram (EEG) and Glasgow coma scale (GCS) and persistent vegetative state (PVS) scores before and after the treatment.Results There were no significant differences between the two groups with regard to BAEP,USEP,EEG,GCS and PVS scores (P＞0.05).After the treatment,significant improvement was observed in all the measurements,with those of the observation group superior to the control group (P＜0.05).In the evaluation of clinical efficacy,the total effective rate and the significant effective rate of the observation group was 89.47％ and 78.95％,respectively,significantly higher than those of the control group (84.21％ and 42.11％) (P＜0.05).Conclusions Conventional rehabilita tion treatment can improve the BAEP,USEP,EEG,GCS and PVS scores of patients with severe disorders of con sciousness,and the addition of tDCS on the basis of conventional rehabilitation treatment is more effective.

Effects of 1-bromopropane on brain ultrastructure in male rats / 中国职业医学

OBJECTIVE: To explore the effects of sub-acute inhalation of 1-bromopropane( 1-BP) on the ultrastructure of cerebral cortex,hippocampus,cerebellum,and brainstem in male rats. METHODS: Specific pathogen free healthy male Wistar rats were randomly divided into control group and exposure group with 6 rats in each group. The rats of exposure group received 1-BP vapor at a concentration of 5 000 mg/m3. The rats in the control group were given fresh air in a dynamic inhalation chamber system for 4 weeks(6 hours/day,5 days/week). After the end of the exposure,the cerebral cortex,hippocampus,cerebellum and brainstem of rats were collected and the ultrastructural changes were observed under transmission electron microscope( TEM). RESULTS: After 3 weeks of exposure to 1-BP,the rats in the exposure group began to have unresponsiveness and decreased muscle strength in hind limbs. The body weight of exposure group was lower than that of control group from the 1 st to the 4 th week( P < 0. 05). TEM results showed destroyed structure of the myelin sheath in the region of cerebral cortex, hippocampus, cerebellum and brainstem, and irregular nucleus, vacuolar degeneration,increased lysosome of endoplasmic reticulum,mitochondrion swelling of neuron cells,karyopyknosis of astrocytes and vacuolation in the neurite of astrocytes located in the blood brain barrier( BBB). CONCLUSION: 1-BP sub-acute inhalation exposure could damage the myelin,neuron,astrocyte and BBB in male rats. The demyelination of nerve fiber and decreased permeability of BBB was particularly noticeable.