Objective To investigate the efficacies of laparoscopic Roux-en-Y gastric bypass (LRYGB) surgery in the treatment of patients with different body mass indexes (BMI) and type 2 diabetes mellitus.Methods The clinical data of 40 patients with type 2 diabetes mellitus who underwent LRYGB surgery at the Shengjing Hospital of China Medical University from January 2013 to December 2013 were retrospectively analyzed.According to different BMI,8 patients with BMI ＜ 27.5 kg/m2 were allocated into group 1,14 patients with BMI≥27.5 kg/m2 and ＜32.5 kg/m2 in group 2 and 18 patients with BMI≥32.5 kg/m2 in group 3.Forty patients were followed up via telephone interview and food habits questionnaire by weight loss file managers of Shengjing Hospital and the fourth Affiliated Hospital of China Medical University.All the patients received the reexamination of blood test and data collection at postoperative year 1.The preoperative and postoperative 1-year fasting plasma glucose,glycosylated hemoglobin (HbA1 c),BMI and C-peptide were collected and detected.The fasting plasma glucose ＜ 7.00 mmol/L and HbA1 c ＜ 7.00％ were used as a standard of complete remission.Count data and comparison of rates were analyzed using the chi-square test.Measurement data with normal distribution were presented as x ± s and analyzed by the t test.Skew distribution data were described as M (range) and analyzed by the Wilcoxon rank sum test.Repeated measurement data were analyzed by the repeated measures ANOVA.Results Forty patients received successful LRYGB surgery without perioperative complications,and were followed up for 1 year at the Shengjing Hospital (23 patients),the fourth Affiliated Hospital (8 patients) and other hospitals (9 patients).Of the 40 patients,85.0％ (34/40) of patients had no postoperative long-term obvious malnutrition,anastomotic stenosis,ion disorders and digestive tract dynamic obstacles,15.0％ (6/40) of patients were not adapted to the change of life habits such as frequent nausea and vomiting.Five patients with different degrees of frequent vomiting,abdominal pain and night heartburn within postoperative 1 month had the remission of synptoms after symptomatic treatment.One patient in group 2 had a symptom of hypertonic coma due to intake of oral high-sugar drinks at postoperative 1 week and then was cured by hospitalization.The fasting plasma glucose,HbA1c and BMI in group 1 from preoperation to postoperation were decreased from 11.07 mmol/L (range,6.00-17.00 mmol/L) to 7.18 mmol/L (range,6.00-15.00 mmol/L),from 8.85％ (range,6.00％-11.00％) to 6.35％ (range,6.00％-9.00％) and from 26.0 kg/m2 (range,22.0-27.0 kg/m2) to 22.2 kg/m2 (range,20.0-25.0 kg/m2),with significant differences (F =2.413,3.256,6.750,P ＜ 0.05).C-peptide from preoperation to postoperation was decreased from 1.20 nmol/L (range,1.00-3.00 nmol/L) to 1.07 nmol/L (range,1.00-2.00 nmol/L),with no significant difference (F =1.678,P ＞ 0.05).The remission rate of diabetes in group 1 was 3/8.The fasting plasma glucose and HbA1c in group 2 from preoperation to postoperation were decreased respectively from 10.73 mmol/L (range,7.00-19.00 mmol/L) to 5.89 mmol/L (range,5.00-9.00 mmol/L) and from 8.00％ (range,6.00％-15.00％) to 5.85％ (range,5.00％-8.00％).The BMI from preoperation to postoperation was decreased from 31.0 kg/m2 (range,29.0-32.0 kg/m2) to 25.5 kg/m2 (range,21.0-29.0 kg/m2),with significant differences in the above 3 indexes (F =5.449,4.008,-3.296,P ＜ 0.05).C-peptide from preoperation to postoperation was decreased from 1.53 nmol/L (range,1.00-5.00 nmol/L) to 1.52 nmol/L (range,1.00-6.00 nmol/L),with no significant difference (F =-0.251,P ＞ 0.05).The remission rate of diabetes in group 2 was 10/14.The fasting plasma glucose,HbA1c and BMI in group 3 from preoperation to postoperation were decreased from 9.44 mmol/L (range,5.00-16.00 mmol/L) to 6.65 mmol/L (range,4.00-15.00 mmol/L),from 7.90％ (range,6.00％-11.00％) to 6.45％ (range,5.00％-9.00％) and from 36.9 kg/m2 (range,33.0-47.0 kg/m2) to 27.7 kg/m2 (range,23.0-34.0 kg/m2),with significant differences (F =-3.027,-3.410,-3.724,P ＜ 0.05).C-peptide from preoperation to postoperation was decreased from 2.91 nmol/L (range,0.00-9.00 nmol/L) to 2.13 nmol/L (range,0.00-6.00 nmol/L),with no significant difference (F =-3.724,P ＞ 0.05).The remission rate of diabetes in group 3 was 14/18.There was no significant difference in the remission rate of diabetes of 3 groups (x2 =4.460,P ＞ 0.05).There were significant differences in the changing trends of fasting plasma glucose and BMI among the 3 groups (F =3.200,22.500,P ＜ 0.05).There were no significant differences in the changing trends of HbA1c and C-peptide among the 3 groups (F =0.720,1.640,P ＞ 0.05).Conclusion LRYGB surgery is feasible for the treatment of type 2 diabetes mellitus with effectively decreasing fasting glucose,and should be performed on patients with BMI ≥ 27.5 kg/m2 instead of patients with BMI ＜ 27.5 kg/m2 according to a correlation of blood glucose control and preoperative BMI.

Objective To study the expression of the apoptosis inhibitor Livin gene and its relationship with the expression of Bcl-2,p53 proteins in pancreatic carcinoma.Methods The expression of LivinmRNA was investigated by reverse transcriptase polymerase chain reaction(RT-PCR) in pancreatic carcinoma tissue of 52 cases and normal pancreatic tissue of 12 cases.The expression of Bcl-2 and p53 was detected by immunohistochemical assay.Results The expression rate of Livin gene in pancreatic carcinoma tissue was 71.2%,which was obviously higher than that in normal pancreatic tissue(P

Objective To investigate the effects of three laparoscopic bariatric operations on relieving type 2 diabetes in morbid obese patients. Methods From 2005 to 2009, 15 morbid obese patients with type 2 diabetes received bariatric operations in Shengjing Hospital including lapband operation (7 cases) , sleeve gastrectomy (7 cases) and gastric bypass(4 cases). All patients were followed up for more than 1 year. Results All patients recovered without major complications. Body weight decreased and BMI was respectively (27. 6 ± 2. 0) kg/m2, ( 26. 9 ± 1. 4) kg/m2 and (27. 5 ± 3. 0) kg/m21 year after operation. The excess BMI loss in three groups were (76. 4% ± 6. 8% ) , (83. 7% ± 4. 6% ), (85. 7% ±9. 5% ) 1 year after operation. On the other side, the fasting glucose levels and glycohemoglobin in gastric bypass group were much lower than that in other two groups. Conclusion All these operations were effective in controling the weights and fasting glucose levels, while the gastric bypass method is better than other two methods in weight and serum glucose control. Sleeve gastrectomy was better in weight and glucose control than lap band operation.

Objective:To report the results of national surveillance on the distribution and antimicrobial resistance profile of clinical bacterial isolates from bloodstream infections in China in 2021.Methods:The clinical bacterial strains isolated from blood culture from member hospitals of Blood Bacterial Resistant Investigation Collaborative System (BRICS) were collected during January 2021 to December 2021. Antibiotic susceptibility tests were conducted by agar dilution or broth dilution methods recommended by Clinical Laboratory Standards Institute (CLSI). WHONET 5.6 was used to analyze data.Results:During the study period, 11 013 bacterial strains were collected from 51 hospitals, of which 2 782 (25.3%) were Gram-positive bacteria and 8 231 (74.7%) were Gram-negative bacteria. The top 10 bacterial species were Escherichia coli (37.6%), Klebsiella pneumoniae (18.9%), Staphylococcus aureus (9.8%), coagulase-negative Staphylococci (6.3%), Pseudomonas aeruginosa (3.6%), Enterococcus faecium (3.6%), Acinetobacter baumannii (2.8%), Enterococcus faecalis (2.7%), Enterobacter cloacae (2.5%) and Klebsiella spp (2.1%). The prevalence of methicillin-resistant Staphylococcus aureus (MRSA) and methicillin-resistant coagulase-negative Staphylococcus aureus were 25.3% and 76.8%, respectively. No glycopeptide- and daptomycin-resistant Staphylococci was detected; more than 95.0% of Staphylococcus aureus were sensitive to ceftobiprole. No vancomycin-resistant Enterococci strains were detected. The rates of extended spectrum B-lactamase (ESBL)-producing isolated in Escherichia coli, Klebsiella pneumoniae and Proteus mirabilis were 49.6%, 25.5% and 39.0%, respectively. The prevalence rates of carbapenem-resistance in Escherichia coli and Klebsiella pneumoniae were 2.2% and 15.8%, respectively; 7.9% of carbapenem-resistant Klebsiella pneumoniae was resistant to ceftazidime/avibactam combination. Ceftobiprole demonstrated excellent activity against non-ESBL-producing Escherichia coli and Klebsiella pneumoniae. Aztreonam/avibactam was highly active against carbapenem-resistant Escherichia coli and Klebsiella pneumoniae. The prevalence rate of carbapenem-resistance in Acinetobacter baumannii was 60.0%, while polymyxin and tigecycline showed good activity against Acinetobacter baumannii (5.5% and 4.5%). The prevalence of carbapenem-resistance in Pseudomonas aeruginosa was 18.9%. Conclusions:The BRICS surveillance results in 2021 shows that the main pathogens of blood stream infection in China are gram-negative bacteria, in which Escherichia coli is the most common. The MRSA incidence shows a further decreasing trend in China and the overall prevalence of vancomycin-resistant Enterococci is low. The prevalence of Carbapenem-resistant Klebsiella pneumoniae is still on a high level, but the trend is downwards.

Objective:To investigate the bacterial composition and antimicrobial resistance profile of clinical isolates from bloodstream infections in China.Methods:The clinical bacterial strains isolated from blood culture were collected during January 2020 to December 2020 in member hospitals of Blood Bacterial Resistant Investigation Collaborative System (BRICS). Antibiotic susceptibility tests were conducted by agar dilution or broth dilution methods recommended by Clinical Laboratory Standards Institute(CLSI, USA). WHONET 5.6 was used to analyze data.Results:During the study period, 10 043 bacterial strains were collected from 54 hospitals, of which 2 664 (26.5%) were Gram-positive bacteria and 7 379 (73.5%) were Gram-negative bacteria. The top 10 bacterial species were Escherichia coli (38.6%), Klebsiella pneumoniae (18.4%), Staphylococcus aureus (9.9%), coagulase-negative Staphylococci (7.5%), Pseudomonas aeruginosa (3.9%), Enterococcus faecium (3.3%), Enterobacter cloacae (2.8%), Enterococcus faecalis (2.6%), Acinetobacter baumannii (2.4%) and Klebsiella spp (1.8%). The prevalence of methicillin-resistant Staphylococcus aureus (MRSA) and methicillin-resistant coagulase-negative Staphylococcus aureus were 27.6% and 74.4%, respectively. No glycopeptide- and daptomycin-resistant Staphylococci were detected. More than 95% of Staphylococcus aureus were sensitive to rifampicin and SMZco. No vancomycin-resistant Enterococci strains were detected. Extended spectrum β-lactamase (ESBL) producing Escherichia coli, Klebsiella pneumoniae and Proteus mirabilis were 48.4%, 23.6% and 36.1%, respectively. The prevalence rates of carbapenem-resistance in Escherichia coli and Klebsiella pneumoniae were 2.3% and 16.1%, respectively; 9.6% of carbapenem-resistant Klebsiella pneumoniae strains were resistant to ceftazidime/avibactam combination. The prevalence rate of carbapenem-resistance in Acinetobacter baumannii was 60.0%, while polymyxin and tigecycline showed good activity against Acinetobacter baumannii. The prevalence rate of carbapenem-resistance of Pseudomonas aeruginosa was 23.2%. Conclusions:The surveillance results in 2020 showed that the main pathogens of bloodstream infection in China were gram-negative bacteria, while Escherichia coli was the most common pathogen, and ESBL-producing strains declined while carbapenem-resistant Klebsiella pneumoniae kept on high level. The proportion and the prevalence of carbapenem-resistant Pseudomonas aeruginosa were on the rise slowly. On the other side, the MRSA incidence got lower in China, while the overall prevalence of vancomycin-resistant Enterococci was low.

Objective:To report the results of national surveillance on the distribution and antimicrobial resistance profile of clinical Gram-negative bacteria isolates from bloodstream infections in China in 2022.Methods:The clinical isolates of Gram-negative bacteria from blood cultures in member hospitals of national bloodstream infection Bacterial Resistant Investigation Collaborative System（BRICS）were collected during January 2022 to December 2022. Antibiotic susceptibility tests were conducted by agar dilution or broth dilution methods recommended by Clinical and Laboratory Standards Institute（CLSI）. WHONET 5.6 and SPSS 25.0 software were used to analyze the data.Results:During the study period，9 035 strains of Gram-negative bacteria were collected from 51 hospitals，of which 7 895（87.4%）were Enterobacteriaceae and 1 140（12.6%）were non-fermenting bacteria. The top 5 bacterial species were Escherichia coli（ n=4 510，49.9%）， Klebsiella pneumoniae（ n=2 340，25.9%）， Pseudomonas aeruginosa（ n=534，5.9%）， Acinetobacter baumannii complex（ n=405，4.5%）and Enterobacter cloacae（ n=327，3.6%）. The ESBLs-producing rates in Escherichia coli， Klebsiella pneumoniae and Proteus spp. were 47.1%（2 095/4 452），21.0%（427/2 033）and 41.1%（58/141），respectively. The prevalence of carbapenem-resistant Escherichia coli（CREC）and carbapenem-resistant Klebsiella pneumoniae（CRKP）were 1.3%（58/4 510）and 13.1%（307/2 340）；62.1%（36/58）and 9.8%（30/307）of CREC and CRKP were resistant to ceftazidime/avibactam combination，respectively. The prevalence of carbapenem-resistant Acinetobacter baumannii（CRAB）complex was 59.5%（241/405），while less than 5% of Acinetobacter baumannii complex was resistant to tigecycline and polymyxin B. The prevalence of carbapenem-resistant Pseudomonas aeruginosa（CRPA）was 18.4%（98/534）. There were differences in the composition ratio of Gram-negative bacteria in bloodstream infections and the prevalence of main Gram-negative bacteria resistance among different regions，with statistically significant differences in the prevalence of CRKP and CRPA（ χ2=20.489 and 20.252， P<0.001）. The prevalence of CREC，CRKP，CRPA，CRAB，ESBLs-producing Escherichia coli and Klebsiella pneumoniae were higher in provinicial hospitals than those in municipal hospitals（ χ2=11.953，81.183，10.404，5.915，12.415 and 6.459， P<0.01 or <0.05），while the prevalence of CRPA was higher in economically developed regions（per capita GDP ≥ 92 059 Yuan）than that in economically less-developed regions（per capita GDP <92 059 Yuan）（ χ2=6.240， P=0.012）. Conclusions:The proportion of Gram-negative bacteria in bloodstream infections shows an increasing trend，and Escherichia coli is ranked in the top，while the trend of CRKP decreases continuously with time. Decreasing trends are noted in ESBLs-producing Escherichia coli and Klebsiella pneumoniae. Low prevalence of carbapenem resistance in Escherichia coli and high prevalence in CRAB complex have been observed. The composition ratio and antibacterial spectrum of bloodstream infections in different regions of China are slightly different，and the proportion of main drug resistant bacteria in provincial hospitals is higher than those in municipal hospitals.