Abstract： Objective　To investigate the epidemiological and molecular characteristics of carbapenem-resistant Klebsiella pneumoniae isolated from blood cultures of patients with bloodstream infections in Shanxi Bethune Hospital from January 2015 to January 2022. Methods　Klebsiella pneumoniae strains isolated from blood cultures of patients with bloodstream infections at Shanxi Bethune Hospital from January 2015 to January 2022 were collected for the study. Bacterial identification, drug sensitivity testing, and an improved carbapenem inactivation test were conducted to screen for carbapenem-resistant Klebsiella pneumoniae. Next-generation sequencing was performed on all strains, while whole genome sequencing was carried out on two strains that tested positive for the modified Hodge test indicating resistance to carbapenems. Results　A total of 431 strains of Klebsiella pneumoniae were isolated from blood cultures of patients with bloodstream infections at Shanxi Bethune Hospital between January 2015 to January 2022, among which 33 were carbapenem-resistant strains including 11 highly virulent ones and 2 of these exhibited positive for the modified Hodge test. All strains were resistant to both ertapenem and imipenem, with only one strain being intermediate-resistant to meropenem. Among the 33 resistant strains, KPC-2 was detected in 26 strains and NDM-1 in 4; three strains possessed dual carbapenemase types (KPC-2/NDM-9, KPC-2/OXA-1, NDM-1/OXA-1), while four did not show any detectable carbapenem-resistance genes. Evolutionary analysis following next-generation sequencing revealed that the main sequence types (ST) among these isolates were ST11, ST147, and ST412; and the predominant serotypes were KL64, KL47, and KL25. The plasmid conjugal transfer experiments were successful in 18 strains. The two high virulence strains identified in the modified Hodge test were found to carry virulence and resistance plasmids upon whole genome sequencing. Conclusions　The detection of carbapenem-resistant Klebsiella pneumoniae in patients with bloodstream infections has been increasing annually since 2015, with an outbreak occurring in 2021. The carbapenemase KPC-2 gene was the most prevalent, with the majority of strains being of the ST11/KL64 type. Strengthening screening and control measures for clinical drug-resistant strains is crucial for effective anti-infective treatment.

Aim To investigate the role of Wnt/β-cate-nin signaling pathway on the baicalin-induced osteo-genic differentiation in rat bone marrow derived mesen-chymal stem cells ( rBMSC ) . Methods rBMSC was isolated and cultured by adherence screening method. Alkaline phosphatase ( ALP) amount, CFU-FALP and mineralized nodules were compared between each ba-icalin group and vehicle control group at different time points. Real time q-PCR was employed to evaluate the mRNA level of Wnt signaling-related marker ( Wnt10a, GSK-3β,β-catenin and LEF1) after baica-lin treatment. Protein expression of β-catenin and Runx2 was measured by Western blot. Results Ba-icalin significantly increased ALP activities from day 3 to day 7 . The formation of CFU-FALP and mineralized nodules remarkably increased after rBMSC was treated with1, 10, 50 μmol · L-1 baicalin. mRNA levels of Wnt10a, β-catenin, GSK-3β, LEF1and osteocalcin were enhanced significantly in baicalin-treated group compared to control group. Protein expression of β-catenin and Runx2 was also elevated. Conclusion Baicalin ( 0. 1 to 50 μmol · L-1 ) promotes the osteo-genic differentiation and maturation of rBMSC, in which Wnt/β-catenin signaling pathway might be in-volved.

OBJECTIVE:To observe the clinical efficacy and safety of edaravone combined with early rehabilitation in the treat-ment of cerebral hemorrhage,and to provide clinical evidence for rehabilitation management and drug treatment of cerebral hemor-rhage patients. METHODS:168 patients with cerebral hemorrhage,collected from neurology department of our hospital during Jan. 2012 to Dec. 2014,were randomly divided into observation group and control group with 84 cases in each group. Both groups re-ceived routine treatment;observation group was additionally given edaravone intravenously on the basis of routine treatment,and be-gan to receive standardized rehabilitation treatment within 48 hours after the onset of symptom;control group began to receive stan-dardized rehabilitation treatment 2 weeks after the onset of symptom. NIHSS and MMSE score of 2 groups were conducted before re-habilitation treatment,and after 4 and 12 weeks of treatment. RESULTS:There was no statistically significant difference in lesion site and clinical manifestations between 2 groups on admission(P>0.05);both NIHSS and MMSE score of observation group were better than those of control group after 4 and 12 weeks of treatment,there was statistical significance(P<0.05). CONCLUSIONS:Edaravone associated with early rehabilitation can obviously improve the prognosis of patients with cerebral hemorrhage.

Objective To explore the effect of the joint edaravone in early rehabilitation on the prognosis of patients with ischemic stroke.Methods The general branch of Kailuan group of patients with ischemic stroke who were conformed to the 1995 national conference on the 4th cerebrovascular diagnostic criteria with head CT or MRI imaging diagnosis,were collected from January 2012 to December 2014.A total of 324 cases were the first onset,who had been treated with conventional drugs,and were randomly divided into the observation group(edaravone associated with early rehabilitation)and the control group(early rehabilitation)with 162 cases in each group.Patients of the observation group were given venous application of edaravone and received the standardized rehabilitation treatment within 48 hours.The control group were given standard rebabilitation therapy at 2 weeks after attacked.NIHSS and MMSE scores of the two groups of patients were evaluated at the beginning of the rehabilitation course,4 weeks and 12 weeks of the treatments.Results There were no statistically significant difference and the clinial manifestations of the lesion site between the two groups of patients on admission.At the beginning of the rehabilitation,the NIHSS and MMSE score of control group were statistically significant different from that of observation group [NIHSS:(14.8 ±5.3)vs.(16.1 ±5.1),PNIHSS =0.049;MMSE:(15.9 ±6.3)vs.(14.2 ±6.2),PMMSE =0.041].The sec-ond and third evaluation were respectively conducted at 4 weeks[NIHSS:(10.1 ±6.3)vs.(8.2 ±5.7),MMSE:(17.7 ±5.5)vs.(20.9 ±5.9)]and 12 weeks[NIHSS:(6.6 ±4.9)vs.(4.7 ±3.6),MMSE:(21.0 ±4.8)vs. (24.6 ±4.9)].The results of the observation group were significantly better than the control group(P4W NIHSS =0.036,P4W MMSE =0.035;P12W NIHSS =0.006,P12W MMSE =0.003),and the differences were statistically significant. Conclusion Edaravone associated with early rehabilitation can obviously improve the prognosis of patients with ischemic stroke.

Objective To study the possibility of direct identification of pathogens from positive blood cul-tures by methods of separation gel tube -centrifugation.Methods 216 cases of positive blood culture were collected from 2015.7 to 2015.12.The bacterias were purified from blood culture bottle by separation gel tube.After washing 2 times,identified by MALDI -TOF MS.At the same time,traditional culture,smears and identification were done. Compared the results of identification by two methods.Results 216 cases of positive blood culture were single bacte-rial infection.By Gram stain,89 strains were Gram positive,119 strains were Gram negative and 8 strains were fungal spores.190 cases of positive blood culture were identified by MALDI -TOF MS,it concluded 67 Gram positive strains,111 Gram negative strains,4 anaerobe strains and 8 fungus.Compared with traditional culture,the coincidence rate reached up to 87.9%,Gram positive strains 78.8%,Gram negative strains 93.2%,anaerobe strains 100.0%and fungus 100.0%.Conclusion It takes less than 30 minutes purified from blood culture bottle by separation gel tube.And the time of identification is shorter than traditional culture.This method is good for clinical diagnosis and treatment.

To explore novel antifatigue agents targeting with AMPA receptor, 10 compounds were synthesized and their structures were confirmed by 1H NMR, ESI-MS and elemental analysis. 1-BCP was treated as the leading compound. The antifatigue activities were evaluated by weight-loaded forced swimming test, and the AMPA receptor binding affinities were tested with radioligand receptor binding assays. The results unveiled that 5b appeared to possess potent antifatigue activities and high affinity with AMPA receptor, which deserved further studies.

Objective To investigate the curative effect and safety of transcatheter arterial chemoembo -lization (TACE) containing raltitrexed scheme for primary hepatocellular carcinoma (PHCC).Methods From May 2013 to June 2014,a total of 90 patients with inoperable PHCC were treated with TACE containing raltitrexed scheme.The short-term effect,long-term effect and adverse reactions were analyzed.Results Of the 90 patients,complete response was obtained in 23,partial response in 36,stable disease in 24 and progressive disease in 7,the effective rate was 65.6％.The one-year survival rate was 72.2％,the median survival time was 15.9 months,and the progression free survival was 9.1 months.Single factor analysis showed that the statistically significant differences in survival rate existed among the patients with different BCLC staging,combination therapy,lipiodol deposit pattern and vascular tumor thrombus (P＜0.05).Multivariate analysis of Cox model indicated that BCLC staging (x2=9.83,P=0.002) and combined therapy (x2=6.40,P=0.011) were independent prognostic factors.The main adverse reactions were fever,pain,vomiting and bone marrow suppression.Grade Ⅲ-Ⅳ adverse reactions were rare and no treatment-related death occurred.Conclusion For the treatment of inoperable PHCC,TACE containing raltitrexed scheme is effective and safe,and this therapy can be well tolerated by patients.

With increasing use of carbapenem antibiotics , carbapenems-resistant gram-negative bacteria are spreading, and carbapenemase-producing is the main mechanism of carbapenems resistance . Rapid and accurate identification of carbapenemase and its type is of great importance to timely and effective treatment and control of infections .Chromogenic /Fluorogenic culture media, modified Hodge test and double disk synergy test are traditional methods for carbapenemase detection , but all are time-consuming. Biochemical method is more time efficient and with high sensitivity and specificity , but cannot be used to identify subtypes.Now matrix-assisted laser desorption ionization -time-of-flight mass spectrometry (MALDI-TOF MS) has been successfully applied in the identification of species , subtypes and detection of drug -resistant genes.And among various carbapenemase gene detection techniques , next generation sequencing (NGS) can also be used for the detection of integrons , transposons and plasmids, which is important in both epidemiology and resistant mechanism studies .This article reviews the advantages and disadvantages of various methods for phenotype and gene detection of carbapenemase .

Objective: To investigate the relationship between long-, short-term systolic blood pressure variability (SBPV) and renal damage in elder population. Methods: Our research was conducted in the 3rd physical examination of healthy population from Kailuan group by cohort study. Cluster sampling was used by 25% ratio in subjects≥60 years of age to monitor their 24-hour ambulatory blood pressure and finally, 2464/3064 participants with inclusion criteria were recruited. SBPV indexes as standard deviation of systolic blood pressure (SSD), variability independent of the mean (VIM), maximum-minimum difference (MMD) and average real variability (ARV) were examined; renal damage indexes as estimated glomerular filtration rate (eGFR) and microalbuminuria (ALBU) were detected. Relationships between different long-term, short-term SBPV indexes and eGFR, ALBU were studied by multi-liner regression analysis. Results:①The mean age of 2464 participants was (67.41 ± 6.05) years including 1667 (67.7%) male and 797 (32.3%) female.②Multi-liner regression analysis indicated that different long-term SBPV indexes were not related to eGFR and ALBU; 24h SBPV in all 4 indexes and day-time SSD, MMD, ARV were negatively related to eGFR; 24h ARV and day-time MMD, ARV were positively related to ALBU; night-time SBPV indexes were not related to eGFR and ALBU.Conclusion: Different short-term SBPV indexes were, at certain point related to eGFR and ALBU