Objective: To analyze the distribution and drug resistance characteristics of clinical separation germ in a hospital from 2013 to 2015 to provide reference and basis for the prevention and control of nosocomial infection and rational use of antibiotics.Methods: The microbial susceptibility of isolated strains was detected using the conventional methods, and the drug sensitivity was analyzed by BioMerieux ATB 1.22.The drug sensitivity was determined according to CLSI 2014 criteria.Results: A total of 18 421 specimens were isolated during 2013 and 2015, and a total of 3 744 strains were isolated with the total positive rate of 20.32%.The separation and identification of pathogenic bacteria at the top 5 were Escherichia coli (967 strains, 44.34%), Bauman Acinetobacter (323 strains, 14.81%), Klebsiella pneumoniae (312 strains, 14.31%), Staphylococcus aureus (297 strains 13.62%) and Pseudomonas aeruginosa (282 strains, 12.92%).Besides the natural resistance of Klebsiella pneumoniae to amoxicillin, the resistance rate of Escherichia coli to piperacillin was over 75%, while the sensitivity rate of Klebsiella pneumoniae to piperacillin and tazobactam was more than 90%.The sensitivity of Acinetobacter baumannii and Pseudomonas aeruginosa to clinical antibiotics was basically below 40%, and the overall resistance level was higher than that of Bauman.MRSA was sensitive to nitrofurantoin, minocycline, quinupristin-Dafoe and leptin glycopeptide antibiotics (such as teicoplanin and vancomycin).Conclusion: The hospital should strengthen the monitoring of bacterial resistance and track the results in a timely manner so as to provide reference for the rational drug use in clinical practice.

Objective To explore the expression of papillary thyroid carcinoma (PTC)-specific microRNAs in order to improve early diagnosis of PTC's and determine the invasiveness of PTC.Methods Thyroid samples from 51 cases were analyzed to investigate microRNA expression differences between benign and malignant thyroid nodules by using miRNA chip technique.The differences in the expression of microRNAs were validated by qRT-PCR,and their correlation with clinical and pathological features of PTC was analyzed.Results (1) qRT-PCR analysis showed that miR-30a-3p (U =60,P =0.003),miR-146b-5p(U =40,P =0.001) and miR-199b-5p (U =69,P =0.007) significantly different between benign and malignant tissues.(2) Expression of miR-199b-5p was significantly higher in PTC patients with margin invasion and of ipsilateral neck lymph node metastasis(P =0.010).Conclusions miR-199b-5p,miR-30a-3p and miR-146b-5p may be used to differentiate benign and malignant thyroid nodules; miR-199b-5p can help assess the invasiveness of PTC.

Objective To assess the value of computed tomgraphy (CT)in differential diagnosis between medullar thyroid carcinoma (MTC)and papillary thyroid carcinoma (PTC).Methods CT findings of 20 lesions in 16 MTC patients and 35 lesions in 35 PTC patients were retrospectively analyzed.All patients were confirmed by pathology exam.We investigated the shape,location,bitten cookie sign,calification and lymph node metastasis between the two groups of patients to summarize the sensitivity and specificity of regular shape for MTC or lesions located in lower thyroid lobe,bitten cookie sign,lymph node metastasis for PTC.Results Regular shape was more common in MTC patients than in PTC patients (X2=5.815,P=0.016),with sensitivity and specificity of 55％ and 77.1％ respectively.Lesions were located at lower thyroid(X2=10.732,P=0.001),bitten cookie sign(X2=18.832,P=0.000)and lymph node metastasis (X2=4.377,P=0.036)was significantly more common in PTC patients than in MTC patients,with sensitivity and specificity of 40％ (14/35)and 100％ (16/16),80％ (28/35)and 80％ (16/20),and 68.6％(24/35)and 62.5％(10/16)respectively.Calcification was not significantly different between MTC and PTC patients (X2=0.550,P=0.458).Conclusions CT plays an important role in differential diagnosis between MTC and PTC.Regular shape is helpful for the diagnosis of MTC.Leisions located at lower thyroid,with bitten cookie sign and lymph node metastasis are conductive to the diagnosis of PTC.

MiRNAs represent a class of short endogenous non-coding RNAs regulating gene expression at mRNA post-transcriptional level in many biological processes,including differentiation,proliferation,development and apoptosis.The deregulation of miRNA expression is believed to be an important regulator of tumor development.Increasing evidence has revealed the abnormal expression of miRNA in papillary thyroid carcinoma,indicating the important role in PTC invasion mechanism,clinical diagnostic value,efficacy evaluation,recurrence monitoring and prognosis judgement.

Preoperative serum specimens were collected from 249 endometrial cancers and 99 uterine leiomyomas and their concentrations of human epididymis protein 4 (HE4),CA 125 and CA 19-9 were detected.The indices of diagnostic evaluation were calculated.Preoperative serum concentrations of HE4,CA125 and CA19-9 in endometrial carcinoma group were significantly higher than those of control group.The areas under curve of HE4,CA125 and CA19-9 were 0.736,0.615 and 0.661 respectively and that of combiued markers was 0.774.At a 90％ specificity,the sensitivities for HE4,CA125,CA19-9 were 55.0％,26.9％ and 30.1％ while that of combined markers was 56.2％.HE4 is an ideal tumor marker for endometrial cancer and combined detection improves diagnostic rate.

Objective To investigate the expression of miR-199b-5p in papillary thyroid carcinoma ( PTC) and its relationship with clinical features .Methods Total RNA was extracted from 36 cases of PTC and the adjacent normal thyroid tissues by reverse transcription quantitative real-time polymerase chain reaction ( qRT-PCR)method to detect the expression of miR-199b-5p, and to analyze its relationship with clinical features such as the capsule invasion and lymph node metastasis .Results miR-199b-5p expression in PTC was related to lymph node status(χ2 =9.20, P=0.01), capsule invasion(U=36.00, P=0.047), but had no correlation with other clinical characteristics such as age , sex, tumor size, the number of tumor foci ( U =151.00, 87.00, 64.00, 87.00 respectively, P>0.05).ROC curve analysis showed that the specificity and sensitivity of miR-199b-5p in diagnosis of PTC were 82.1% and 72.7% respectively.Conclusion The abnormal expression of miR-199b-5p may be related to the occurrence , development and invasion of PTC .

Objective:To investigate the clinical application value of serum carcinoembryonic antigen (CEA) level in predicting lymph node metastasis of resectable medullary thyroid carcinoma (MTC) .Methods:140 patients of resectable MTC from Zhejiang Cancer Hospital and Hangzhou First People’s Hospital from Jan. 2009 to Feb. 2019 were included. The relationship of serum CEA and lymphatic metastasis was retrospectively analyzed in 140 patients of resectable MTC, and the clinical significance of serum CEA for predicting total lymph node, central lymph node, lateral lymph node and upper mediastinal lymph node metastasis was also evaluated.Results:The positive rate of serum CEA in resectable MTC was 77.14%. The expression level of serum CEA in resectable MTC with lymph node metastasis was significantly higher than those without lymph node metastasis ( P<0.001) . Spearman correlation analysis further indicated that the level of serum CEA expression was positively correlated with the number of lymph node metastases of resectable MTC patients ( P<0.001) . The area under curve of predicting lymphatic metastasis of total lymph node, central lymph node, lateral lymph node and upper mediastinum was 0.773, 0.768, 0.827 and 0.847. When the cut-off value of serum CEA was 6.58, 11.43, 15.74 and 30.45 ng/ml, respectively, the sensitivity of serum CEA to predict total, central, lateral neck and upper mediastinal lymph node metastasis was 88.46%, 81.43%, 85.00%, 95.00%, and the specificity was 56.45%, 60.00%, 71.25%, and 69.17%, respectively. Conclusion:Serum CEA has a high positive expression rate in resectable MTC, and its expression level has important clinical significance in evaluation of lymphatic metastasis.