Objective To investigate the expressions of aminoglycoside modifying enzymes (AMEs)genes of extended-spectrum β-lactamase-producing Klebsiella pneumoniae (ESBL-KP) isolates in our hospital, with an attempt to provide evidence for rational clinical antibiotics use. Mothods A total of 42 strains of ESBL-KP were isolated from January 2007 to January 2008 in our hospital The expressions of 9 AMEs including aac (3)-Ⅰ , aac (3)-Ⅱ , aac (3)-l, aac (3)-Ⅳ, aac (6')- Ⅰ , aac (6')-Ⅰ, apb (3')-Ⅵ, ant (3")-Ⅰ, and ant (2") -Ⅰ were identified by polymerase chain reaction. Results The positive rates of aac (3) - Ⅱ, ant (3") - Ⅰ ,aac (6') - Ⅰ , apb (3') -Ⅵ, and aac (3) - Ⅰ were 85. 7%, 59. 5%, 21.4% , 9. 5%, and 7. 1% , respectively. All the other genotypes were negative. The positive rate of AMEs reached 90. 5% (38 of 42). Conclusions The expression rates of AMEs genes are high among ESBL-KP isolates in our hospital. The aminoglycoside resistance may be relevant with AMEs.

Intestinal ischemia is a severe and life-threatening acute abdomen. Although its incidence is low,early diagnosis remains relatively difficult. The efficiencies of conventional laboratory biochemical tests are low. In recent years, many new markers for the early diagnosis of intestinal ischemia have been developed. In this article,we summarize their diagnostic efficiencies and relevant factors.

Zinc-α2-glycoprotein (ZAG), a new adipokine, plays an important role in the development of cancer cachexia by decreasing lipid content in body via promoting lipid mobilization and utilization. The lipolytic effect of ZAG is achieved by increasing the activity of hormone sensitive lipase, activating β3 adrenergic receptors,and up-regulating cyclic adenosine monophosphate. In addition, ZAG increases adiponectin expression and decreases leptin expression in adipocytes and adipose tissue. The ZAG expression is regulated by glucocorticoid, peroxisome proliferator-activated receptor gamma agonist rosiglitazone, tumor necrosis factor-α and many other factors.ZAG can potentially be applied as a tumor marker, and may become a new target in the treatment of cancer cachexia.

Objective To explore the change of dietary intake and nutritional status before and after hematopoietic stem cell transplantation (HSCT) in pediatric patients to assess the importance of nutritional interventions.Methods In this observational cohort study,65 children undergoing HSCT between January 2012 and November 2012 in the Department of Hematology and Oncology,Shanghai Children's Medical Center were enrolled.The data collected before preconditioning were considered as the baseline data.We also collected data twice a week between preconditioning and 30 days after HSCT,and once a week from 30 days to 100 days after HSCT.Dietary analysis and urea nitrogen analysis were conducted in parallel.Results The baseline level of energy intake was (5 844.9 ±2 490.4) kJ/d,protein intake was (56.4 ±28.6) g/d,fat intake was (49.7 ±38.9) g/d,and carbohydrate intake was (190.9 ± 91.1) g/d.With the hematopoietic reconstruction,the oral nutrients intake significantly decreased compared with the baseline levels (all P =0.000).During the recovery period after HSCT,the energy intake showed no significant difference when compared with the baseline level in the 6th postoperative week,protein in the 13th week,carbohydrate in the 4th week,and fat in the 6th week.The urine nitrogen was (3.9 ± 2.4) g/d before HSCT,which increased to (16.7 ± 11.0) g/d after preconditioning (P=0.000).In the 1st postoperative week,the weight (P =0.000),triceps skin fold thickness (P =0.003),mid-upper arm circumference (P =0.000),serum albumin (P =0.000) and prealbumin (P =0.000) of the patients all significantly decreased compared with the baseline levels.In the 9th postoperative week,the fat-free body weight percentage (P =0.010),muscle percentage (P =0.001) and protein percentage (P =0.000) were significantly lower than the baseline levels,while the body fat percentage was higher than the baseline level (P =0.002).Conclusions Children undergoing HSCT exhibit a marked reduction in nutrient intakes at the early stage of HSCT,which may gradually return normal during the recovery period.This process may be slow,especially for the protein,and therefore may affect the serum protein level in these pediatric patients.Thus,more careful nutrition guidance is necessary during HSCT for pediatric patients,emphasizing oral nutrients intakes,and high protein dietary or formula may be helpful.

Objective To analyze the serum levels of medium-and long-chain free fatty acids (FFAs)in patients with hyperlipidemic non-alcoholic fatty liver disease (NAFLD) in order to shed some light on prevention and treatment of NAFLD.Methods The clinical data of 125 patients with high triglyceride (TG)levels who were treated in Hebei General Hospital from January 2011 to May 2011 were analyzed in this study.They were further divided into HF group (n =64) and H group (n =61) based on the presence of NAFLD or not.In addition,63 healthy individuals were recruited from the Central Hospital of Handan during the same period as the control group (N group).Serum medium-and long-chain FFAs were detected by gas chromatography.The body mass index (BMI),abdominal circumference,blood pressure,fasting blood glucose (FBG),and serum lipids including TG,total cholesterol (TC),high-density lipoprotein cholesterol (HDL-C),and low-density lipoprotein cholesterol (LDL-C) were measured.Results Compared with the N group,the H group had significantly higher BMI [(25.24 ± 1.41) kg/m2 vs.(24.32 ± 1.12) kg/m2,P =0.004],abdominal circumference [(84.72 ± 1.34) cm vs.(77.33 ±0.89) cm,P =0.010],and diastolic blood pressure [(77.35±1.21) mmHgvs.(75.21 ±1.61) mmHg,P=0.014]; also,the serum TG [(2.86±0.55) mmol/Lvs.(0.93±0.27) mmol/L,P=0.000] andTC levels [(4.56±0.66) mmol/Lvs.(4.36±0.47) mmol/L,P=0.000],serum myristic acid (C14∶0) [(0.49±0.04)％ vs.(0.36±0.01)％,P=0.011],palmitic acid (C16 ∶ 0) [(18.36 ± 0.47) ％ vs.(15.97 ± 0.30) ％,P =0.000],palmitoleic acid (C16∶ 1) [(1.00±0.12)％ vs.(0.58±0.02)％,P=0.001],and oleic acid (C18 ∶ 1) [(18.20±0.70) ％ vs.(12.23 ± 0.37) ％,P =0.000] all significantly increased,while stearic acid (C18 ∶ 0) [(7.52 ±0.22)％ vs.(8.15 ±0.28)％,P=0.012],eicosadienoic acid (C20 ∶ 2) [(0.61 ±0.07)％ vs.(1.03 ±0.17) ％,P =0.000],eicosatrienoic acid (C20 ∶ 3) [(1.77 ± 0.15) ％ vs.(2.49 ± 0.18) ％,P =0.002],and docosahexenoic acid (C22 ∶ 6) [(1.44 ± 0.08) ％ vs.(1.67 ± 0.09) ％,P =0.014] significantly decreased.Compared with the H group,the HF group had significantly higher weight [(85.76 ± 3.10) kg vs.(71.45 ±2.88) kg,P =0.003],abdominal circumference [(96.30 ±2.05) cm vs.(84.72 ± 1.34) cm,P=0.000],systolic blood pressure [(117.12 ±1.15) mmHg vs.(113.23 ±1.25) mmHg,P=0.009],and diastolic blood pressure [(79.54 ± 1.42) mmHg vs.(77.35 ± 1.21) mmHg,P =0.016],whereas the sreum FGB,TG,TC,HDL-C,and LDL-C showed no significant differentces; serum palmitic acid (C16 ∶ 0)[(19.54 ± 0.30) ％ vs.(18.36 ± 0.47) ％,P =0.000] also significantly increased.The serum level of eicosadienoic acid (C20 ∶ 2) in HF group was between that in N group and H group [(0.78 ± 0.09) ％ vs.(1.03 ±0.17)％,(0.78±0.09)％ vs.(0.61 ±0.07)％,both P=0.000].Conclusions The increased serum level of palmitic acid may be a risk factor for NAFLD.Reducing saturated fatty acids and increasing unsaturated acids in diets may be helpful for preventing NAFLD.

Objective To explore the factors related to the tolerance to enteral nutrition (EN) in gastric carcinoma patients undergoing surgical treatment and the implementation strategy of EN.Methods Fifty-four patients with gastric carcinoma undergoing surgery from November 2011 to September 2012 in the Affiliated Hospital of Medical College of Qingdao University were enrolled.EN were applied with sequential and gradual strategies.The tolerance status to EN was recorded.Factors related to the patient tolerance to EN were analyzed using single-factor and multiple-factor Logistic regression analysis.The incidences of gastrointestinal symptoms during EN application were recorded.Results Among the 54 patients,49 (90.74％) patients could tolerate EN.Single-factor analysis and multiple-factor Logistic regression analysis both showed that tumor staging (single-factor analysis:x2 =7.287,P =0.007 ; multiple-factor analysis:t =2.559,P =0.014) and surgical approach (singlefactor analysis:x2 =7.825,P =0.005 ; multiple-factor analysis:t =2.254,P =0.043) were major factors affecting patient tolerance to EN.Among the patients tolerant to EN,abdominal distension (19/49,38.8％) was the major gastrointestinal symptom of EN.Conclusion The sequential and gradual EN application strategy is suitable for the patients with gastric cancinoma after surgery,and can be widely used in clinical practice.

Objective To evaluate the effects of perioperative probiotics administration on patients with colorectal cancer and to explore its possible mechanism.Methods Seventy patients with colorectal cancer who were scheduled to undergo radical colorectomy at Shanghai Sixth People's Hospital between May 2011 and July 2011 were randomly divided with random number table into the control group (n =35) and the treatment group (n =35).The two groups in 5 days preoperatively and 7 days postoperatively were given daily doses of probiotics preparation consisting of two combined live bacteria and placebo,respectively.The structure of intestinal epithelial tight junction was observed by electron microscopy in colorectal tissue specimens collected during the operation.The expression of tight junctional protein was detected using Western blot and real-time RT-PCR technology.Intestinal epithelial permeability was evaluated by Ussing Chamber system.Stool samples and blood samples were collected on the 7th day after operation.The diversity of faecal flora was analyzed by terminal restriction fragment length polymorphism (T-RFLP) technique,and the quantitative detection of specific bacteria was conducted by bacterial culture.Clinical parameters including the first exhaust and defecate time,distension and diarrhea incidence,systemic inflammatory response,and postoperative infective complications were recorded.Results Compared with the control group,the treatment group showed better intestinal epithelial tight junction ultrastructure.The expression of tight junction proteins occludin,claudin-1,and ZO-1 (protein:all P ＜ 0.001 ; mRNA:P =0.005,0.001,0.006) and the transepithelial electrical resistance [(28.3 ±5.2) Ω · cm2 vs.(22.1 ± 4.7) Ω · cm2,P =0.002] were significantly increased,the large molecule permeability [(0.91 ± 0.17) ％ vs.(1.65 ± 0.33) ％,P ＜ 0.001] reduced,the diversity of intestinal flora (P=0.006) increased,the growth of intestinal Bifidobacteria [(143.4 ±35.9) vs.(100.0 ±0.0),P=0.002] and Lactobacilli [(111.3 ± 52.9) vs.(100.0 ± 0.0),P ＜ 0.001] promoted,and the growth of Clostridium perfringens [(66.2 ±23.7) vs.(100.0 ±0.0),P ＜0.001] inhibited in the treatment group.The treatment group also showed shorter postoperative exhaust [(2.5 ± 1.7) d vs.(4.5 ±2.0) d,P ＜0.001] and defecate time [(5.0 ± 1.3) d vs.(6.3 ± 1.1) d,P =0.002],lower incidence of diarrhea (20％ vs.40％,P =0.005) and abdominal distension (35 ％ vs.60％,P =0.021).Conclusion Probiotics used perioperatively in patients with colorectal cancer can effectively enhance the intestinal epithelia barrier function,maintain the homeostasis of gut flora,shorten the postoperative first exhaust and defecate time,reduce the incidence of diarrhea and abdominal distension,and promote the recovery of intestinal function.

Objective To investigate the relationship of the nutritional status with liver function and clinical outcomes of liver cancer patients treated with surgery.Methods Altogether 112 hospitalized patients undergoing surgical treatments for liver cancer were enrolled from October 2011 to October 2013.Their general clinical data were collected,including creatinine-height index (CHI),arm circumference,grip strenghth,albumin,prealbumin,and transferrin.The nutritional status was assessed using Patient-Generated Subjective Global Assessment (PG-SGA).The liver function was assessed with Child-Pugh classification.Postoperative infectious complications and the hospital stays were recorded to assess the clinical outcomes.The correlation between nutritional status and liver function,and that between nutritional status and clinical outcomes were analyzed.Results Among the 112 patients,70 (62.5％) were in normal nutritional status,34 (30.4％) were with moderate malnutrition,and 8 (7.1％) were with severe malnutrition according to PG-SGA scores.PG-SGA assessment showed strong consistence with CHI nutritional assessment (κ =0.760,P =0.000),and moderate consistence with arm circumference assessment (κ =0.564,P =0.000),and grip strength assessment (κ =0.523,P =0.000).The live function classified by Child-Pugh was found highly correlated with PG-SGA assessment (rs =0.829,P =0.000).Postoperative infectious complications and hospital stays were both positively correlated with PG-SGA assessment (r =0.349,P =0.000 ; r =0.624,P =0.000).Conclusions PD-SGA combining with CHI can be used for the nutritional status assessment of liver cancer patients undergoing surgical treatments.The nutritional status of the patients has positive correlation with live function,infectious complications,and postoperative hospital stays.

Objective To establish a rapid real-time quantitative polymerase chain reaction (RQ-PCR)assay in quantifying and detecting Staphylococcus aureus DNA from human venous blood samples,so as to quantificationally evaluate the systemic infection caused or deteriorated by intestinal bacteria translocation.Methods Totally 26 clinical blood samples and 15 simulation blood samples were detected.The primers and TaqMan probe were designed targeting the highly conserved house-keeping femA gene of Staphylococcus aureus,and a 20 μl RQ-PCR amplification reaction system was established.The standard curve was built based on the recombinant plasmid DNA containing the amplicon of the target gene,and genomic DNA was extracted using QIAamp DNA Blood Mini Kit.Results The specificity of primers and probe was excellent,the detecting limit was 100 copies/μl (103 CFU/ml),the sensitivity was 99.7％,and the specificity was 94.6％.The correlation coefficient of the standard curve was between 0.9918 and 0.9997.For samples with different Staphylococcus anreus concentrations,the average accuracy of the RQ-PCR assay was (96.25 ± 2.26) ％ ; the intra-and interassay coefficients of variation were (8.06 ±0.07)％ and (10.01 ±4.40)％,respectively.The average recovery rate of Staphylococcus aureus DNA in blood samples was (111.72 ± 20.72) ％.In clinical blood samples,the positive rate of Staphylococcus aureus DNA was 15.4％ (4/26),while the blood culture of these samples all produced negative result for Staphylococcus aureus.Conclusion RQ-PCR assays is a rapid,sensitive,and specific method with good repetitiveness and can be used in the quantitative detection of Staphylococcus aureus in whole blood samples.

Malnutrition is common in critically ill children.Nutrition prescription is hampered by various factors,and the nutritional status of these children often deteriorates during hospitalization.Nutrition therapy for critically ill children must be based on proper nutrition screening and nutritional assessment.Adopting dynamic nutritional assessment is an effective method to monitor patients under nutrition therapy and inform the prescription and administration of nutrition therapy.This article reviews the recent advances in nutrition screening and nutritional assessment in critically ill children.