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By summarizing the biological formation and component function of Mycobacterium tuberculosis extracellular vesicles, this manuscript discusses the potential usage of Mycobacterium tuberculosis extracellular vesicles in diagnosis, prevention, and treatment of tuberculosis. It is concluded that both Mycobacterium tuberculosis membrane vesicles and exosomes secreted by the host contain the components of Mycobacterium tuberculosis to participate in immune regulation, and play different roles in the diagnosis, prevention, and treatment of tuberculosis. Mycobacterium tuberculosis extracellular vesicles contain abundant biomarkers and have natural immunogenicity, which are expected to become new targets for diagnosis, prevention, and treatment of tuberculosis.
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Objective To explore the value of cytokines,procalcitonin(PCT)and neutrophil-lymphocyte ratio(NLR)in the early diagnosis and prognosis evaluation in the patients with sepsis.Methods 98 patients with sepsis admitted to the First Affiliated Hospital of Air Force Medical University from January 2020 to January 2023 were selected as research objects,including 82 patients in the sepsis non-shock group and 16 patients in the sepsis shock group.According to the death within 28 days,the patients was divided into survival group(n=82)and death group(n=16).Meantime,95 cases of non-septic infection group were included as control.The expression of interleukin(IL)-1β,IL-2,IL-4,IL-5,IL-6,IL-8,IL-10,IL-12p70,IL-17,tumor necrosis factor(TNF)-α,interferon(IFN)-γ,IFN-α,PCT,and NLR were detected within 24h after admission,and their relationship with sepsis was analyzed by ROC curve.Results ①The IL-2,IL-4,IL-5,IL-6,IL-8,IL-10,IL-12p70,IL-17,TNF-α,IFN-α,NLR and PCT in patients with sepsis were significantly higher than those in healthy subjects(Z=0.43～30.54,all P＜0.05)except IL-1β,IFN-γ.Further analysis of ROC showed that IL-8,NLR,PCT and IL-17 had strong predictive ability,with area under curve(AUC)of 0.78(95%CI:0.71～0.84),0.81(95%CI:0.75～0.87),0.83(95%CI:0.78～0.88),0.86(95%CI:0.81～0.92),respectively.Combined detection of the four indicators can effectively improve the diagnostic efficiency of sepsis,with the AUC of 0.90(95%CI:0.85～0.93).② There were no significant differences in cytokines,PCT and NLR concentration between positive and negative blood culture groups(P＞0.05),suggesting that these indexes were not affected by blood culture detection results.③Among the patients in the shock group,IL-6[122.10(10.77～10 000.00)ng/L]was significantly higher than that in non-shock group[25.56(1.02～9 096.74)ng/L],the difference was statistically significant(Z=74.55,P=0.01),with the AUC of 0.73(95%CI:0.59～0.87).The levels of IL-10[10.69(1.12～1 338.00)ng/L],IL-2[12.52(0.86～280.42)ng/L]and IL-5[9.55(0.93～259.57)ng/L]in sepsis death group were higher than those[2.55(0.34～695.13)ng/L,4.46(0.13～625.43)ng/L,2.75(0.01～117.88)ng/L]in survival group,the differences were statistically significant(Z=3.64,6.37,4.74,all P＜0.05),and the AUC were 0.69(95%CI:0.53～0.85),0.71(95%CI:0.56～0.85)and 0.72(95%CI:0.58～0.87),respectively.Conclusion The combined detection of IL-8,NLR,PCT and IL-17 is helpful for the early diagnosis of sepsis.The increase of IL-6 level can effectively predict the occurrence of septic shock,and the high expression of IL-10,IL-2 and IL-5 has a good predictive value for the death of sepsis patients.
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Objective To analyze serum characteristics and determine the reference range for thyroid function among healthy 11～16 year-old teenagers in Xi'an in order to offer a theoretical basis for clinical diagnosis and therapy.Methods A sum of 1 378 healthy 11～16 year-old teenagers who met the inclusion criteria from the First Affiliated Hospital of the Air Force Medical University(Xijing Hospital)between January 2020 and December 2022 were selected as research subjects,including 628 males and 750 females.They were divided into three groups based on age:Group 1:11～＜13 year-olds(433 cases),Group 2:13～＜15 year-olds(425 cases),and Group 3:15～≤16 year-olds(520 cases).Differences in serum thyroid function indices among different genders and age groups were analyzed,the reference ranges for these indices were established,and 99 healthy 11-16 year-old teenagers who met the inclusion criteria were chosen for verification.Results There were no significant differences between different genders in thyroid stimulating hormone[TSH,2.56(1.80,3.63)μIU/ml vs 2.43(1.68,3.48)μIU/ml]and total thyroxine[TT4,97.84(85.34,111.00)nmol/L vs 98.20(87.16,111.23)nmol/L],the differences were statistically significant(Z=-1.881,-0.638,all P＞0.05).Meanwhile,the differences in free thyroxine[FT4,16.93(15.49,18.60)pmol/L vs 16.26(14.80,17.83)pmol/L],free triiodothyronine[FT3,6.21(5.66,6.80)pmol/L vs 5.59(4.98,6.19)pmol/L],and total triiodothyronine[TT3,2.24(1.96,2.55)nmol/L vs 2.04(1.78,2.34)nmol/L]between different genders were significant(Z=-5.368,-11.994,-6.417 all P＜0.01).The differences in thyroid function indices were significant among different age groups(Z=10.649～261.003,all P＜0.05).The reference ranges for thyroid function indices across different age groups and genders were established,in which thyroid function indicators were verified to be within the established reference range by 99 samples.Conclusion Teenage hormone secretion varies greatly,and the secretion of thyroid hormones is influenced by various factors.Thus,the diagnosis and treatment of teenage thyroid diseases cannot fully rely on the reference ranges provided by adults or manufacturers.This study established the reference range of the thyroid function indices of 11～16 year-old teenagers in Xi'an,offering clinical doctors'diagnosis and treatment data support.
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Objective:To evaluate the performance of the automated digital cell morphology instrument in detecting platelet (PLT) clumps.Methods:A total of 4271 blood samples whose PLT reached the reviewing rules of thrombocytopenia were selected from inpatients having blood analysis in Xijing Hospital from January 1 st to June 30 th, 2019, including 2 200 males and 2 071 females,with a median age of (35±7.03) years old. The smears for these cases were made, stained by Wright-Giemsa, and examined to capture PLT clumps by digital cell morphology system and manual microscope separately. The digital cell analysis system (hereinafter referred to as the instrument method) as an evaluation method and the microscope method as a reference method were used to calculate the positive rate of platelet clump detection and evaluate the comparison of two methods and bias assessments. The chi-square test was used to compare counting data rates. Results:Among 4, 271 samples reaching the reviewing rule of thrombocytopenia, 128 cases with platelet clumps were detected by manual microscope(initial) with a positive detection rate of 96.24%, and a total 133 of cases with PLT clumps were detected by microscope (initial+reconfirmation) with a positive detection rate of 100 %. Meanwhile, 129 cases with platelet clumps were detected by instrument method with a positive detection rate of 96.9%. There was no significant difference in terms of positive rate of PLT clumps detection between the instrumental method and the microscope method (initial) ( χ2 =0.115, P=0.73); the positive rate of clumps detection by the instrumental method was lower than microscope method (initial+reconfirmation), and the difference was statistically significant (χ 2 =4.061, P=0.04). For instrument method, the positive rate of PLT clumps detection by simultaneous observation of RBC analysis interface+PLT aggregation interface+WBC analysis interface was higher than only observation of PLT aggregation interface, and the difference was statistically significant (χ 2 =5.090, P=0.02). The average error of the deviation of PLT counting results before and after correction of the cases with PLT plumps missed by instrument method was significantly higher than microscope method (initial), and the difference was statistically significant (χ 2 =56.26, P<0.001). Conclusion:The automated digital cell morphology system has a good consistency with manual microscope(initial) in terms of the sensitivity of platelet clumps detection and can be used as a supplementary method for detecting platelet aggregation.
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OBJECTIVE@#To analyze the clinical phenotypes and genetic variants of a Chinese pedigree affected with Hereditary coagulation factor Ⅻ (FⅫ) deficiency.@*METHODS@#A pedigree presented at the First Affiliated Hospital of Air Force Medical University on December 24,2021 was selected as the study subject. Activated partial thromboplastin time (APTT) and coagulation factor Ⅻ activity (FⅫ:C) were determine by a clotting method, and FⅫ antigen was detected with an ELISA assay. Following the extraction of genomic DNA, all exons and flanking regions of the F12 gene were subjected to Sanger sequencing. Clustalx-2.1-win, PROVEAN and Swiss-PDB Viewer software was used to analyze the conservation of amino acids at the variant sites, impact of of the variants on the amino acid substitutions and the protein structure.@*RESULTS@#The APTT of the proband has prolonged to 70.2 s. Her FⅫ:C and FⅫ:Ag have decreased to 12% and 13%, respectively. DNA sequencing revealed that the proband has harbored c.346G>A (p.Gly97Ser) and c.1583C>A (p.Ser509Tyr) heterozygous compound missense variants in exons 5 and 13 of the F12 gene, respectively. Her father and sister were heterozygous carriers for the c.346G>A (p.Gly97Ser) variant, whilst her mother and brother were heterozygous for the c.1583C>A (p.Ser509Tyr) variant.@*CONCLUSION@#The c.346G>A (p.Gly97Ser) and c.1583C>A (p.Ser509Tyr) compound heterozygous variants of the F12 gene probably underlay the pathogenesis of hereditary coagulation FⅫ deficiency in this pedigree.
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Humanos , Masculino , Femenino , Linaje , Factor XII/genética , Mutación , Pueblos del Este de Asia , Heterocigoto , Madres , Deficiencia del Factor XII/genéticaRESUMEN
Objective To evaluate the clinical application value of transcatheter arterial methylene blue angiography in the localization of lower gastrointestinal arterial bleeding.Methods Ten patients with lower gastrointestinal arterial bleeding received interventional celiac artery angiography.After the bleeding responsible arteries were identified,a microcatheter was super-selectively placed in the bleeding responsible artery.During surgical procedure,the methylene blue solution was injected through the microcatheter to display the bleeding segment of the intestinal tract,providing precise localization of the bleeding intestinal segment for surgical resection.Results Transcatheter arterial methylene blue angiography could clearly display the bleeding segment of the intestinal tract.The bleeding segments of the intestinal tract in the 10 patients were quickly and accurately removed.After surgery,the gastrointestinal bleeding stopped,and no surgery-related complications occurred.Conclusion Transcatheter arterial methylene blue angiography can accurately detect the arterial bleeding segment of the lower gastrointestinal tract,which provides precise localization for quickly removing the bleeding segment of intestinal tract,therefor,this technique is worthy of widespread clinical application.(J Intervent Radiol,2023,32:1230-1232)
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Objective:To investigate the application effect of case-based learning (CBL) combined with flipped classroom in the teaching of experimental diagnostics in the integrated course of Diagnosis and Treatment Fundamentals. Methods:The cluster random sampling method was used to select the class of 2019 in the eight-year program and the class of 2020 in the five-year program, with the major of stomatology in Air Force Medical University. The 24 students in the observation group received CBL combined flipped classroom, and the 37 students in the control group received traditional teaching. The two groups were compared in terms of theoretical assessment score, classroom assessment score, comprehensive ability, self-learning ability, and degree of satisfaction with teaching. SPSS 22.0 was used for the t-test. Results:The observation group had a significantly higher theoretical assessment score than the control group [(74.88±3.46) vs. (71.89±4.45), P<0.05]. The observation group had significantly better scores of practical skill assessment than the control group ( P<0.05). Compared with the control group, the observation group had significantly better scores of comprehensive ability and self-learning ability ( P<0.05). The observation group had significantly better scores of satisfaction with teaching than the control group ( P<0.05). Conclusion:The application of CBL combined with flipped classroom in the teaching of experimental diagnostics in the integrated course of Diagnosis and Treatment Fundamentals can improve theoretical knowledge, practical skills, comprehensive quality, and satisfaction with teaching among students, and therefore, it holds promise for application in teaching.
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Objective:To investigate the genetic etiology of a Marfan syndrome pedigree, and the impact of c.4336G>A variant on the splicing process of FBN1 gene.Methods:The proband was admitted to the Department of Cardiovascular Surgery of Xijing Hospital due to thoracic aortic aneurysm and dissection in August 2019. Multiplex PCR and next generation sequencing technology were used to detect 15 genes associated with hereditary aortic diseases in the proband. Then the pathogenic sites were further verified by Sanger sequencing, and above examinations were also performed among the family members of the proband. The effect of the mutation on mRNA splicing was predicted by splicing prediction software. RNAs from peripheral blood cells of the proband and the healthy person were extracted, and the effect of the mutation on mRNA splicing was verified by reverse transcription PCR and Sanger sequencing. The pathogenicity was analyzed by the recommendations from the American College of Medical Genetics (ACMG).Results:The gene panel detected a missense mutation of FBN1 gene (c.4336G>A) in the proband. Sanger sequencing results were consistent with that of panel. Sanger sequencing results showed that 4 family members were carriers of the same variant, and 3 out of the 4 family members presented signs of thoracic aortic aneurysm and dissection. The dbscSNV_ada_score and dbscSNV_rf_score software predicted that this mutation would lead to the occurrence of abnormal splicing of mRNA. The skipping of exon 35 was verified in the subsequent examinations by reverse transcription PCR and Sanger sequencing. The variant was classified as"pathogenic"according to ACMG guideline.Conclusion:FBN1 c.4336G>A mutation can cause the skipping of exon 35, and this might be the genetic mechanistic of severe cardiovascular abnormalities observed in this Marfan syndrome pedigree.
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As a new type of intercellular signaling rector, extracellular vesicles (EV) are involved in almost the whole process of tumorigenesis, progression, metastasis, and drug resistance. Therefore, EV have become the ideal biomarker candidates and research hotspots for cancer diagnosis and treatment. However, EV tumor biomarker research mainly focused on RNA and protein, and a small part of the research focused on lipids at the early stage. EV DNA has received little attention and its diagnostic value has gradually been recognized in recent years. Study on the biological characteristics and function of EV DNA may highlight its potential in tumor diagnosis.
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Objective:A multi-center and large sample volume study was conducted on the verification and improvement of the early established criteria for intelligent routine urinalysis validation (including the microscopic review rules and manual validation rules, referred to as intelligent criteria for short), in order to improve the clinical application of this intelligent criteria.Methods:A total of 31 456 urine specimens were collected from the inpatients and outpatients in six hospitals in China, from March to September 2019. Firstly, 3105 specimens were analyzed for preliminary verification and improvement of the intelligent criteria based on the results of the microscopic examination and manual validation. Secondly, 28 351 specimens were used to verify the clinical application of the improved intelligent criteria. All samples were manually validated as reference.Results:The approval inconsistency rate of the manual validation rules in the original intelligent criteria was 8.59% (202/2 352), and the interception inconsistency rate was 8.84% (208/2 352). The false negative rate and the microscopic review rate of the microscopic review rules were similar to the previous results. Based on an in-depth analysis of big data and the discussions by senior technicians from eight hospitals, one microscopic review rules and four manual validation rules were added, meanwhile two manual validation rule was deleted. The manual validation standards were unified. Finally, the intelligent criteria was improved. Based on the improved intelligent criteria, for microscopic review rules, the false positive rate, false negative rate (misdiagnosis rate), and microscopic review rate did not change significantly, which were 14.72% (457/3 105), 4.06% (126/3 105), and 24.73% (768/3 105), respectively. The approval inconsistency rate and the interception inconsistency rate of manual validation rules were both reduced to 0; the total manual validation rate of the intelligent criteria was 50.89% (1 580/3 105), and the auto-validation rate was 49.11% (1 525/3 105). The large sample volume verification results were consistent with the preliminary verification results of the improved intelligent criteria.Conclusion:This multi-center and large sample volume study had shown that the improved intelligent criteria had better clinical performance.
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Objective To compare the efficacy of femoral triangle versus adductor canal approach to saphenous nerve block for postoperative analgesia in the patients undergoing knee arthroplasty.Methods Sixty American Society of Anesthesiologists physical status Ⅰ or Ⅱ patients of both sexes,aged 53-68yr,scheduled for elective total knee arthroplasty under general anesthesia,were assigned into 2 groups (n=30 each) using a random number table method:femoral triangle approach to saphenous nerve block group (group F) and adductor canal approach to saphenous nerve block group (group A).Femoral triangle and adductor canal approach to saphenous nerve block was performed by injecting 0.5％ ropivacaine 20 ml in group F and group A,respectively.Patient-controlled saphenous nerve block analgesia was used in two groups,and the analgesic pump solution contained 1％ ropivacaine 400 mg diluted to 160 ml in 0.9％ sodium chloride injection.The analgesic pump was set up with a 5 ml bolus dose,a 30-main lockout interval and background infusion at a rate of 5 ml/h,and analgesia lasted until 72 h after operation.When visual analog scale score ＞ 4 and pain was not relived after 30-min pressing by patients,pethidine hydrochloride 100 mg was intramuscularly injected as rescue analgesic.The muscle strength of quadriceps femoris was assessed by manual muscle test at 4,8,24,48 and 72 h after operation.The patient's satisfaction score was assessed and recorded at 72 h after operation.Rescue analgesia and development of adverse reactions (local anesthetic intoxication,itching,dizziness,urinary retention,nausea and vomiting) were recorded within 72 h after operation.Results Compared with group F,the muscle strength of quadriceps femoris was significantly increased at 4,8 and 24 h after operation,the rate of postoperative rescue analgesia was decreased (P＜0.05),and no significant change was found in patient's satisfaction score or incidence of adverse reactions in group A (P＞0.05).Conclusion Adductor canal approach to saphenous nerve block provides better efficacy for postoperative analgesia than femoral triangle approach to saphenous nerve block in the patients undergoing knee arthroplasty.
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Objective@#To compare the efficacy of femoral triangle versus adductor canal approach to saphenous nerve block for postoperative analgesia in the patients undergoing knee arthroplasty.@*Methods@#Sixty American Society of Anesthesiologists physical status Ⅰ or Ⅱ patients of both sexes, aged 53-68 yr, scheduled for elective total knee arthroplasty under general anesthesia, were assigned into 2 groups (n=30 each) using a random number table method: femoral triangle approach to saphenous nerve block group (group F) and adductor canal approach to saphenous nerve block group (group A). Femoral triangle and adductor canal approach to saphenous nerve block was performed by injecting 0.5% ropivacaine 20 ml in group F and group A, respectively.Patient-controlled saphenous nerve block analgesia was used in two groups, and the analgesic pump solution contained 1% ropivacaine 400 mg diluted to 160 ml in 0.9% sodium chloride injection.The analgesic pump was set up with a 5 ml bolus dose, a 30-min lockout interval and background infusion at a rate of 5 ml/h, and analgesia lasted until 72 h after operation.When visual analog scale score > 4 and pain was not relived after 30-min pressing by patients, pethidine hydrochloride 100 mg was intramuscularly injected as rescue analgesic.The muscle strength of quadriceps femoris was assessed by manual muscle test at 4, 8, 24, 48 and 72 h after operation.The patient′s satisfaction score was assessed and recorded at 72 h after operation.Rescue analgesia and development of adverse reactions (local anesthetic intoxication, itching, dizziness, urinary retention, nausea and vomiting) were recorded within 72 h after operation.@*Results@#Compared with group F, the muscle strength of quadriceps femoris was significantly increased at 4, 8 and 24 h after operation, the rate of postoperative rescue analgesia was decreased (P<0.05), and no significant change was found in patient′s satisfaction score or incidence of adverse reactions in group A (P>0.05).@*Conclusion@#Adductor canal approach to saphenous nerve block provides better efficacy for postoperative analgesia than femoral triangle approach to saphenous nerve block in the patients undergoing knee arthroplasty.
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Objective To compare the sensitivity of four kinds of drug susceptibility test method in detecting sensitivity of tigecycline against Acinetobacter baumannii.Methods The susceptibility of 72 clinically isolated strains of carbapenemase-resistant Acinetobacter baumannii(CRAB) to tigecycline in vitro was detected with disk diffusion method,VITEK 2 Compact system,E-test and MIC test strip(MTS) test strip respectively,according to FDA standards,and the differences of four kinds of drug susceptibility test methods were compared.Results The susceptibility rates of 72 strains of CRAB to tigecycline by disk diffusion method,VITEK 2 Compact system,E-test and MIC test strip were 50.00%,69.44%,36.11% and 98.61% respectively,the intermediate rates were 48.61%,29.17%,26.39% and 1.39% respectively,the resistant rates were 1.39%,1.39%,37.50% and 0.00% respectively.Compared with MTS,the classification consistency rates of E-test,disk diffusion method and VITEK 2 Compact system were 36.11%,51.39% and 70.83% respectively.Conclusion There is difference among four kinds of method for conducting the drug susceptibility testing of tigecycline against CRAB,the consistency of disk diffusion method,VITEK 2 Compact system and E-test is lower.Detecting mediation or drug resistant strains of CRAB by disk diffusion method,VITEK 2 Compact system and E-test needs to be verified by MTS or Broth dilution method.
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Objective To study the characteristics of antimicrobial resistance and molecular epidemiology of Staphylococcus aureus (S .aureus)in the intensive care units(ICUs)of a hospital.Methods Clinical isolates of S .aureus collected from ICUs between January and December 2014 were identified and performed antimicrobial susceptibility testing,then typed by staphylococcal protein A (spa)typing and multilocus sequence typing (MLST) methods.Results Of 160 isolates of S .aureus ,120 (75.00%)were methicillin-resistant S .aureus (MRSA). Resistance rates of MRSA to erythromycin,clindamycin,and levofloxacin were all > 80%;methicillin-sensitive S .aureus (MSSA)were sensitive to cefazolin,resistance rates to erythromycin,clindamycin,and levofloxacin were 62.50%,35.00%,and 10.00% respectively.spa typing and MLST results showed that the main types of 120 isolates of MRSA were ST239-t030,ST239-t037,and ST5-t2460,the major epidemic strains were ST239-t030 (n=105,87.50%),and were isolated from 8 ICUs;MSSA had more types,ST59-t437 were detected only from depart-ment of neurology(n =8)and department of digestive diseases(n =2),ST6-t701 ,ST398-t3625,ST398-t1793,and ST121-t2092 were isolated from departments of neurology(n=7),anesthesiology(n=5),neurosurgery(n=4),and cardiac surgery(n=4)respectively.Conclusion Isolation rate of MRSA in ICUs in this hospital is high,ST239-t030 is the main type,which prevailed in hospital;different types of MSSA have epidemic trends in various departments.
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Objective To evaluate the diagnostic performance of Xpert MTB/RIF for the diagnosis of tuberculous meningitis (TBM).Methods This was a prospective, single center clinical trial.A total of 116 consecutive patients with suspected meningitis who were admitted to Xijing Hospital from October 2013 to June 2015 were recruited.Mycobacterium tuberculosis ( MTB) and rifampicin ( RIF) resistance mutations in 1 ml cerebrospinal fluid ( CSF) were detected with Xpert MTB/RIF and the remaining sample was tested by Ziehl-Neelsen staining , MGIT960 liquid culture and other laboratory tests .And the enrolled patients were grouped according to the 2010 South African expert consensus .The diagnostic performance of Xpert MTB/RIF was evaluated by comparing against clinical score >5 points and MGIT960 liquid culture as reference standards respectively .The comparison was performed using a χ2 test or Fisher′s exact test for categorical variables and a nonparametric rank sum test for continuous variables .Results Among the enrolled 116 subjects, 23 subjects were diagnosed as definite-TBM by MGIT960 liquid culture, 16 subjects were classified as probable TBM , 27 subjects were classified as possible TBM , and 50 subjects were classified as non-TBM.When clinical score >5 points was used as a reference standard , the sensitivity of Xpert MTB/RIF (39.4%) was comparable with that of MGIT960 liquid culture (34.8%) (χ2 =0.292, P=0.589), and significantly better than that of Ziehl-Neelsen staining (9.9%) (χ2 =16.500, 12.771, P<0.001). No significant differences were found among the specificities of Xpert MTB /RIF, MGIT960 liquid culture and Ziehl-Neelsen staining ( 98.0%, 100.0% vs 98.0%, χ2 =1.014, P=0.602 ) .When tested against MGIT960 liquid culture as a reference standard , the sensitivity of Xpert MTB/RIF was 91.3%. Conclusions Xpert MTB/RIF is a rapid and specific method to detect MTB and RIF resistance in CSF .It exhibits a good rule in value for the diagnosis of TBM and a comparable sensitivity with MGIT 960 liquid culture, thus it can be used as the initial method for the diagnosis of tuberculous meningitis .
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Objective To investigate the distribution and antimicrobial resistance of multidrug‐resistant organisms(MDROs) . Methods The distribution and antimicrobial resistance of MDROs ,isolated from 2010 to 2014 ,were retrospectively analyzed . MDROs were identified according to international consensus .The WHONET5 .6 software was used to analyze data .Results A to‐tal of 5 709 strains of MDROs were isolated in five years ,in which 2 441 strains were Staphylococcus(42 .76% ) ,2 091 strains were non‐fermentive bacterial(36 .63% ) ,737 strains were Enterococcus(12 .90% ) ,440 strains were Enterobacter(7 .71% ) .Of the 5 709 MDROs isolates ,55 .04% were isolated from respiratory tract specimens .The resistant rate of multidrug‐resistant E .coli and K . pneumoniae against cefoperazone/sulbactam ,imipenem and meropenem was less than 30% .The resistance of multidrug‐resistant A . baumanii was higher than 90% ,except to minocycline and cefoperazone/sulbactam ,20 .2% and 50 .6% respectively .The resistant rate of multidrug‐resistant P .aeruginosa was 71 .4% -97 .0% against other antimicrobial agents ,except to polymyxin B .The resist‐ance of multidrug‐resistant E .faecium against the antimicrobials was higher than 90% ,except 13 .8% to minocycline and less than 3% to linezolid ,teicoplanin and vancomycin .Meanwhile ,1 linezolid resistant strain was identified in 1 914 methicillin resistant S .au‐reus(MRSA) strains and all MRSA strains were susceptible to vancomycin and teicoplanin .Conclusion MDROs could be predomi‐nated by A .bauman and MRSA in this hospital .Monitoring and control measures to healthcare‐associated infections should be in‐tensified to prevent the spread of MDROs .
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Objective To understand the clindamycin resistance gene and molecular epidemic of Staphylococcus aureus in the pa‐tients with bloodstream infection in our hospital during 2014 .Methods The clinical isolates of Staphylococcus aureus in clinical bloodstream infection were collected during 2014 .The phenotype of erythromycin to clindamycin induced resistance was assessed by D test .The erm gene was detected by PCR .The different erm types of the molecular epidemiology of Staphylococcus aureus were studied by spa and MLST typing .Results In 33 strains of Staphylococcus aureus ,the isolation rate of MRSA strains were 78 .79% ,moreover all of MRSA strains carried ermA gene .In 7 strains of methicillin sensitive Staphylococcus aureus(MSSA) ,4 strains respectively carried ermB or ermC gene .The results of MLST and spa results showed that the main type of MRSA in our hospital was ST239‐t030 .But MSSA had more types ,such as ST59‐t437 ,ST398‐t3625 and so on .Conclusion MRSA has higher i‐solation rate in our hospital ,which is dominated by ST239‐t030 type .For the detection of gene erm ,ermA (86 .67% ) is the main type .The strains are obviously resistant to antibacterial drugs .The laboratory should strengthen the detection of clindamycin in‐duced resistance for guiding the clinical rational use of antibacterial drugs .
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GeneXpert is an advanced molecular biological detection system developed in recent years, it integrates and automates the sample preparation , nucleic acid purification, gene amplification, results report of the fluorescent quantitative PCR process.As, an accurate, rapid, biosafe technology , GeneXpert has become one of the novel molecular POCT detection technology platforms for diagnosis of infectious pathogens and especially declared it a major milestone for global TB diagnosis .This paper introduces the detection principle , clinical application in the detection of infectious pathogens , limitation and prospect of GeneXpert.
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Objective To express recombinant HBHAΔC and HBHAΔN protein,and compare the HBHA series protein activity with each other.It will be provide a experimental basis for the research on clinical diagnostic of HBHA.Methods The HBHAΔC and HBHAΔN gene fragments were cloned and expressed by transforming E.coli BL-21.Test the protein heparin binding ability by CL-6B column.And then added protein to the BCG 7H9 culture medium,to observe the induced BCG aggregation.Results nHB-HA,rHBHA and HBHAΔN protein have heparin binding ability.Meanwhile nHBHA,rHBHA and HBHA Δ C protein have in-duced BCG aggregation effect.Conclusion The HBHAΔC and HBHAΔN protein were successfully obtained.It was proved that the HBHA C-terminal could be combined with heparin and the N-terminal involved could induce the aggregation of BCG.This results provide a basis for further study on molecular mechanism of TB infection and clinical application.
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ObjectiveTo screen out the two-component system associated with drug resistance of Mycobacterium tuberculosis by detecting the differential expression of two-component system regulator genes between multidrug resistant Mycobacterium tuberculosis strains and drug sensitive strains. MethodsTotal RNA of MTB was extracted from cultured MTB during the logarithmic phase in the 7H9 brook medium, and then its purity was identified. Reverse transcription was further completed. The expressing levels of TCS response regulators were quantified using SYBR Green I qRT-PCR, which aimed at finding the differential expressions between multidrug resistant strains and sensitive strains. Finally, all of differentially expressed TCS were screened out under the stress of INH, SM and LFA. Results Compared with sensitive strains,multidrug resistant strains of Rv0491, Rv3133c, Rv3143 and Rv3246c were up-regulated 1. 03, 7.11,3.48and 1.37 folds, respectively (t/t' =5. 623, -4. 196, -3. 559 and -3. 016, respectively, P ＜0. 01 ). The expressing level of other regulators had no statistical significance between muhidrug resistant strains and drug sensitive strains. Under the antibiotic pressure, the expression of Rv1027c, Rv3246c and Rv3143 showed significant changes compared with no antibiotic group. ConclusionRv3246c and Rv3143 may be associated with MTB drug resistance and the differentially expressed genes in multi-drug resistant strains may be used as potential drug targets against drug resistant tuberculosis.