Objective To investigate the molecular epidemiology of CRAB isolated from children in wuhan. Methods Forty non-repetitive strains of CRAB were collected from hospitalized children of emergency department, neonatal medicine, cardiothoracic surgery, bone surgery, respiratory medicine and renal medicine in Wuhan children's hospital during December 2008 and May 2009. MIC values were PFGE; KPC, IMP, GIM, SPM, SIM, OXA-23, VIM genes and integrase gene were amplified by PCR and then sequenced to confirm the genotypes.; Plasmid conjugation experiment was used to study the transfer method of bacterial resistance and southern blot hybridization was used to target the resistance genes. Results Susceptible rates of 40 strains to gentamicin, tobramycin, amikacin, ciprofloxacin, levofloxacin, trimoxazole were 20%, 5%, 93%, 93%, 95%, and 23% respectively. Eleven types of clone were detected by PFGE,including 29 strains of type A clone, 2 strains of type B clone, and 1 strain for each type of C to K clone. Eleven isolates produced both IMP-4 and OXA-23 carbapemase. Twenty-six isolates only possessed OXA-23 carbapemase. Thirty-six strains carried class Ⅰ integron. The results of southern blot hybridization showed that Intl, IMP-4 and OXA-23 type were located on chromosome. Conclusions Type A clone of CRAB is the most common. OXA-23 and IMP-4 type are the major acquired carbapemases, especially the OXA-23 is the most common type. The horizontal transmission of OXA-23 and IMP-4 gene mediated by Int1 and the spread of type A resistant clone is the major way of the spread of carbapenem-resistant Acinetobacter baumannii in the region.

Objective To investigate the distribution of acquired carbapenemases in carbapenemresistant strains of Klebsiella pneumoniae, and explore its role in epidemiology of nosocomial infection. Methods From November 2008 to March 2009, twenty clinical isolates of carbapenem-resistant Klebsiella pneumoniae were collected from children hospitalized in Wuhan children's hospital. MICs of antibiotics were tested by DNA of Klebsiella pneumoniae. Modified Hodge test was used to screen strains producing carbapenemases,combined imipenem(IPM)-EDTA , meropenem(MEM)- EDTA and ceftazidime(CAZ) - EDTA double-disk synergy test (DDST) were used to detect metallo-β-lactamase-producing. PCR amplification of the carbapenemase and integrase genes, and sequencing were performed. Plasmid conjugation transfer experiments and Southern hybridization were applied to study the mode of drug resistance transmission. Results Four types of Klebsiella pneumoniae were detected by PFGE, type A consisted of 5 strains, including 3 strains of type Al and 2 strains of type A2), type B (2 strains), type C (12strains) and type D (1 strain). Type A and C were the main drug resistant clones. Eight strains of Klebsiella pneumoniae carried both KPC-2 and IMP-4 genes, 10 strains carried IMP-4 gene, 2 strains carried KPC-2 gene. None of NDM-1 ,GIM, SPM, SIM, OXA-23, and VIM carbapenemase genes was detected in 20 isolates. All of 20 isolates carried lntl which were found to be located on bacterial chromosome by Southern blot. Conclusions KPC-2and IMP-4 genes are the major carbapenemase genes in Klebsiella pneumoniae isolated in Wuhan.Transmission of drug resistance is mainly through vertical transmission of type C resistant clone and horizontal transmission of Intl on bacteria chromosome.

ObjectiveTo explore the relationship between the duration, MRI characters and prognosis in transient ischemic attack (TIA). Methods36 TIA cases were retrospectively analyzed according to the duration and Magnetic Resonance Imaging Diffusion Weighted Imaging(MRI-DWI). They were divided into two groups, Group A (13 cases) in which TIA continued within 1 h and Group B (23cases) in which TIA continued for 1～24 h. The patients were followed up 3 months and 12 months later. ResultsMRI abnormalities could be found with MRI-DWI in 2 cases in Group A, but 17 cases in group B(χ2=11.416,P=0.001). 1 case in Group A and 14 cases in Group B occurred cerebral infarction within a year(χ2=9.663,P=0.004). ConclusionThe longer TIA duration, the worse the prognosis.

Objective To analysis the risk factors and drug resistance of multidrug-resistant pseudomonas aeruginosa(MDRP) infection and to provide the basis for clinical anti-infective therapy .Methods Predisposing factors and drug resistance to clinical commonly used antibacterial drugs of MDRP which were separated from September 2010 to December 2011 were adopted for retro-spective analysis .Results A total of 235 hospital MDRP infection were collected ,97 multidrug resistant strains were concluded ,the separation rate was 41 .2% .The separation rate of ICU and neurosurgery were higher ,account for 35 .54% and 22 .31% respective-ly .The main resource of specimen is respiratory tract ,about 75 .21% .The resistance of MDRP was very serious .The resistant rate of Amikacin was the lowest ,account for 37 .11% ,followed by piperacillin/tazobactam ,ceftazidime ,account for 47 .4% and 48 .45%respectively .The resistant rate of other antimicrobial agents were greater than 50% .Advanced age ,serious underlying diseases ,long hospital stay ,long-term repeated application of broad-spectrum antimicrobial drugs ,admission to ICU ,invasive treatment operations were the risk factors for MDRP resistance .Conclusion The resistance is very serious ,in order to reduce the generation and spread of drug-resistant strains ,the hospital infection control ,drug resistance monitoring ,rational use of antimicrobial drugs and prevention of cross-infections should be strengthened .

[Objective] To investigate the effects of preconditioning with low concentration of hydrogen peroxide (H2O2) on oxidative stress-induced BMSC apoptosis.[Methods] In vitro separation,purification,culture,and amplification of bone marrow mesenchymal stem cells were performed.BMSC were insulted with 0,50,100,200,300,400,500 μmol/L H2O2 and the effect of different consentration of H2O2 on BMSC was detected by Flow cytometry (FCM).And then cells were preconditioned with different consentraion of H2O2.(FCM) was used to determine the protective role of H2O2 preconditioning on BMSC apoptosis,BMSC chromatin distribution changes were observed by Hoechst33324;BMSC Caspase-3 and Bcl-2 gene changes were detected by RT-PCR.[Results] Analysis of BMSC apoptosis by flow cytometry showed that H2O2 induced BMSC apoptosis in a dose-dependent manner,and pretreatment of the cells with low concentration of H2O2 prevented subsequent stimulation with high H2O2.RT-PCR results showed that preconditioning with low concentration of H2O2 reduced the BMSC Caspase-3 gene expression but increased Bcl-2 gene expression.[Conclusion] Preconditioning with low concentration of H2O2 has an adaptive role in BMSC,and its mechanism may be related to inhibit abnormal gene expression of Caspase-3 and increase the gene expression of Bcl-2.

Objective:To investigate the effects of different local complications of acute pancreatitis (AP) on the microcirculation of multiple organs in the upper abdomen.Methods:A dynamic volume perfusion computed tomography (DVPCT) scan in the upper abdomen was prospectively conducted in 101 patients with AP and 24 patients with neither AP nor other obvious upper abnominal lesions diagnosed in People′s Hospital of Deyang City from April 1 to October 31, 2019, 86 patients with AP (AP group) and 21 controls (control group) were enrolled in the study. AP patients were divided into no local complications group (21 cases), acute peripancreatic fluid collection (APFC) group (19 cases), acute necrotic collection (ANC) group (27 cases), walled-off necrosis (WON) group (11 cases) and walled-off necrosis with infection (WONI) group (8 cases). The blood flow (BF) of pancreas, liver, spleen, two kidneys and adrenal glands was measured by deconvolution. The hepatic arterial perfusion (HAP), hepatic portal perfusion (HPP) and hepatic perfusion index (HPI) of each group were calculated by maximum slope. T test was used for statistical analysis. Results:The BF of pancreas, spleen and left adrenal gland of ANC group was (139.89±34.28), (141.42±47.85) and (107.87±26.41) mL·min -1·(100 g) -1, respectively, the BF of pancreas, spleen and left adrenal gland of WON group was (130.00±44.83), (106.12±38.16) and (98.38±41.39) mL·min -1·(100 g) -1 respectively, and the BF of pancreas, spleen and left adrenal gland of WONI group was (127.91±35.86), (102.09±23.73) and (105.66±27.01) mL·min -1·(100 g) -1, respectively, which were all lower than those of control group ((161.22±31.60), (174.00±62.73) and (134.53±36.36) mL·min -1·(100 g) -1), and the differences were statistically significant ( t=2.440, 2.043, 2.943; 2.296, 3.796, 2.548; 2.448, 4.479, 2.154; all P<0.05). The BF of left kidney cortex of WONI group was lower than that of control group ((247.44±39.32) mL·min -1·(100 g) -1 vs. (294.80±39.13) mL·min -1·(100 g) -1), and the difference were statistically significant ( t=2.910, P<0.05). The HAP of ANC group, WON group and WONI group was (18.63±9.54), (19.10±7.47) and (19.51±6.26) mL·min -1·(100 g) -1, respectively, and the HPI was (25.01±15.51)%, (45.98±31.42)% and (35.92±24.95)%, respectively, which were all higher than those of control group ((12.18±5.14) mL·min -1·(100 g) -1 and (13.44±6.49)%), and the differences were statistically significant ( t=2.997, 3.088, 3.235; 3.503, 3.397, 2.517; all P<0.05) . The HPP of ANC group, WON group and WONI group was (72.37±21.76), (48.83±35.10) and (57.55±29.45) mL·min -1·(100 g) -1, respectively, which were all lower than that of control group ((86.43±17.98) mL·min -1·(100 g) -1), and the differences were statistically significant ( t=2.391, 3.331 and 3.226, all P<0.05). The HAP and HPI of APFC group were both higher than those of control group ((18.67±10.24) mL·min -1·(100 g) -1 vs. 12.18±5.14) mL·min -1·(100 g) -1 and (23.75±20.41)% vs. (13.44±6.49)%), and the differences were statistically significant ( t=2.572 and 2.108, both P<0.05) . Conclusions:AP complicated with ANC, WON and WONI can reduce the BF of pancreas, spleen and left adrenal gland, and WONI can induce the decrease of BF of left kindney cortex. AP complicated with ANC, WON and WONI can increase HAP and HPI, but decrease HPP. Furthermore, AP complicated with APFC can increase HAP.

Objective:To explore the clinical characteristics of children with Streptococcus pneumoniae cellulitis. Methods:The bacterial culture information management system in 18 children′s hospitals from January 2012 to December 2017 were reviewed.Among 1 138 children diagnosed with invasive pneumococcal disease(IPD), 7 cases were hospitalized with cellulitis.Clinical information was collected and analyzed.Results:Seven cases of Streptococcus pneumoniae cellulitis accounted for 0.6%(7/1 138 cases) of 1 138 IPD cases in 18 hospitals.There were 5 males and 2 females.The onset age was from 1 month to 6 years old, and the median age was 2 years old.There were 4 cases in rural areas and 3 cases in urban areas.Langerhans cell histiocytosis (LCH) was found in 1 case.Clinical manifestations: fever, local swelling and pain with infection.The focus of cellulitis: orbital cellulitis in 2 cases, buccal infection in 2 cases, upper extremity, head and buttock infection in 1 case, respectively.At the beginning of the disease: 2 cases of orbital cellulitis were accompanied by nasosinusitis and suppurative otitis media, 1 case was treated with acute periapical inflammation, 1 case was 10 months after chemotherapy.Type of infection: 6 cases were complicated with bloodstream infection, 2 cases with bacterial meningitis and 1 case with pneumonia.Other culture results: 6 cases of Streptococcus pneumoniae were cultured in peripheral blood, 2 cases were positive in local pus culture.Drug sensitivity test: 6 cases were sensitive to Penicillin and Cephalosporin (Cefotaxime/Ceftriaxone), 1 case was resistant.Treatment: 3 patients were treated with Cephalosporins alone, 2 cases with Cephalosporins and Penicillins, 2 cases with Vancomycin and Meropenem for meningitis, 3 cases with local abscess by incision and drainage, 2 cases with meningitis in Intensive Care Unit, and 1 case with endotracheal intubation and ventilator assisted ventilation.The average length of stay was 14.3 days(5-41 days). Discharge outcome: 6 cases improved and 1 case died. Conclusions:Cellulitis is a rare type of infection in children with IPD.It is mainly found in the head, face and around the orbit.It may be accompanied by bloodstream infection or bacterial meningitis.Most of them have a good prognosis.

Objective: To explore the clinical features, the serotype distribution and drug resistance of the isolates in patient with invasive pneumococcal disease (IPD). Methods: By retrieving the laboratory information system in 18 children′s hospitals from 2012 to 2017, the children with IPD were enrolled. Streptococcus pneumoniae (Spn) must be isolated from the sterile sites (blood, cerebrospinal fluid, hydrothorax and joint effusion etc.). The clinical characteristics, serotype, drug resistance, treatment and prognosis were reviewed and analyzed. According to the telephone follow up results, the patients were divided into death group and recovered group. The index as an independent risk factor of mortality was demonstrated by multivariate logistic regression analysis. Results: There were 1 138 children with IPD, including 684 male and 454 female. The proportion of male to female was 1.5∶1. The age ranged from one day to 16 years. The median age was 1 year 3 month. The majority was under 5 years of age (89.3%, n= 1 016), especially under 2 years of age (61.9%, n=704). In all cases, 88.2% (n=1 004) were community acquired infection. The infections included meningitis (n=446, 39.2%), pneumonia with bacteremia (n=339, 29.8%), and bacteremia without focus (n=232, 20.4%). Underlying diseases were found in 242 cases (21.3%). Co-infections were determined in 62 cases (5.4%) with mycoplasma, 27 cases (2.4%) with adenovirus and 34 cases with influenza virus (3.0%). The penicillin insensitivity (PNSP) rates in meningitis and non-meningitis isolates were 69.5% (276/397) and 35.9% (221/615), respectively. There were 81 strains serotyped, in which 93.8% (76/81) were covered by 13-valent protein-polysaccharide conjugate vaccine (PCV13). In the 965 patients who were followed up by phone call, 156 cases (16.2%) were confirmed dead. The independent risk factors for the death were under 2 years of age (OR=2.143, 95%CI 1.284-3.577, P=0.004), meningitis (OR=3.066, 95%CI 1.852-5.074, P<0.01), underlying disease (OR=4.801, 95%CI 2.953-7.804, P<0.01), septic shock(OR=3.542, 95%CI 1.829-6.859, P<0.01), disseminated intravascular coagulation (DIC) (OR=4.150, 95%CI 1.468-11.733, P=0.007), multiple organ failure (OR=12.693, 95%CI 6.623-24.325, P<0.01) and complications of central nervous system (OR=1.975, 95%CI 1.144-3.410, P=0.015). Conclusions Most children with IPD were under 5 years of age, having underlying diseases and acquired the infection in community. The independent risk factors for death were under two years old, meningitis, underlying diseases and multiple organ failure. The problem of drug resistance was severe. The universal immunization of PCV13 would be effective to prevent IPD in Chinese children.