OBJECTIVE To investigate the genotype distribution in extended-spectrum ?-lactamases-producing Escherichia coli in our hospital.METHODS Clinical strains of E.coli confirmed to produce ESBLs were collected from our hospital.ESBLs genotype was analyzed by plasmid conjugation,PCR and nucleotide sequencing analysis.RESULTS The susceptiblility rate of ESBLs-producing strains were 100% to imipenem,75.4% to piperacillin/tazobactam.A total of 4 genotypes were identified in the 28 ESBLs-producing strains.CTX-M type was identified in 92.9% of the strains,including CTX-M-14,CTX-M-24 and CTX-M-3.SHV Type was identified in 7.1% of the strains,including SHV-12.CONCLUSIONS ESBLs producers are common in E.coli isolated from our hospital.Most of them are multidrug resistant and CTX-M is the main genotype of ESBLs.Other genotypes of ESBLs are not found.

Objective:To study the expression and clinical relevance of IRAK-M in monocytes in patients with systemic lupus erythematosus. Methods: Real-time quantitative PCR was performed for IRAK-M mRNA measurement and enzyme-linked immunosorbent assay was used for anti-double-stranded DNA antibody ( dsDNA ) and anti-single-stranded DNA antibody ( ssDNA ) . Dynamic scattering turbidimetric immunoassay was applied for complement 3(C3),complement 4(C4) and C-reactive protein(CRP), while Westergren method for erythrocyte sedimentation rate (ESR). Correlation analysis of IRAK-M with SLEDAI,dsDNA,ssDNA,C3, C4,CRP and ESR was computed by Pearson or Spearman. Results:①The result showed that the mRNA expression of IRAK-M in SLE patients was significantly lower than healthy controls (P<0. 05);and the mRNA expression of IRAK-M in active group was significantly lower than stable group ( P<0. 05 ) . ②The levels of dsDNA, ssDNA, CRP and ESR in SLE patients were significantly higher than healthy controls( P<0. 05 );and the levels of C3 and C4 in SLE patients were significantly lower than healthy controls ( P<0. 05 ) . Meanwhile,the levels of dsDNA,ssDNA,CRP and ESR in active group were significantly higher than stable group (P<0. 05),and the levels of C3 and C4 in active group were significantly lower than stable group (P<0. 05).③Correlation analysis showed that the mRNA expression of IRAK-M had a positive correlation with C3 (P<0. 05),and had a negative correlation with SLEDAI,dsDNA,CRP and ESR (P<0. 05),but had no correlation with ssDNA and C4(P>0. 05). Conclusion: This study indicated that IRAK-M play certain significant roles in the pathogenesis of SLE. We can monitor SLE disease activity and prognosis by quantitative detection of mRNA expression of IRAK-M. Meanwhile,it is very necessary to routinely test and regularly monitor the levels of dsDNA,ssDNA,C3,C4,CRP and ESR in SLE.

Objective:To investigate the diagnostic values of anti-cyclic citrullinated peptides antibody ( anti-CCP ) and rheumatoid factor( RF) in rheumatoid arthritis( RA) ,and analyse the clinical relevance of prognosis,drug reaction and bone destruction between anti-CCP and RA.Methods: Serum anti-CCP was detected by enzyme-linked immunosorbent assay ( ELISA ) , and RF was detected by immune rate nephelometry.Results:The sensitivity and specificity of anti-CCP in RA were 83.0%and 96.7%,while the sensitivity and specificity of RF in RA were 76.0%and 70.0%.When joint detect anti-CCP and RF,with anti-CCP or RF positive as a positive determination,with anti-CCP and RF negative as a negative judgment,the combined sensitivity was 87.0%,higher than that of detection alone.The combined specificity was 98.3%, higher than that of single detection.There were big different concentrations of anti-CCP among RA patients before treatment, three months after treatment and six months after treatment.There were significant differences between bone erosion and non-bone erosion in RA patients.And the more serious joint damage,the higher the concentrations of anti-CCP.As for treatment,anti-CCP concentrations declined.Conclusion:Combined detection of anti-CCP and RF can significantly improve the diagnosis and differential diagnosis of RA.The concentration of anti-CCP can change with effective treatment,then dynamic monitoring can be used as study drug efficacy.At the same time,the level of anti-CCP in patients with RA can reflect the degree of bone erosion,and serious bone destruction who was poor treatment effect.

OBJECTIVE： To analyze the pathogenic characteristics and clinical features of patients with bloodstream infection in the First Affiliated Hospital of Baotou Medical College so as to provide reference for anti-infective treatment. METHODS： The positive rate of 6 052 blood culture specimens in our hospital collected during Jan 1st， 2016-Dec. 31st， 2018 were counted by retrospective study. WHONET 5.6 software was used to analyze clinical department， the distribution and drug resistance of pathogenic bacteria. The clinical data of 447 inpatients with bloodstream infection were collected in respect of gender， age， underlying disease， invasive operation， length of stay and prognosis （cured， uncured， dead）. The patients were divided into two groups according to community acquired blood flow infection （CABSI） and hospital acquired blood flow infection （HABSI）. The differences of the above clinical data between the two groups were analyzed by χ2 test. RESULTS： Total positive rate of     6 052 blood culture samples were 10.3％ （623/6 052）. The blood culture pathogens mainly came from infectious disease department （12.0％， 76/623）， nephrology department （11.4％， 71/623）， hematology department （10.8％， 67/623）， surgery department （10.1％， 63/623）. Of 623 strains of pathogens， Gram- negative bacteria accounted for 49.3％， Gram-positive bacteria accounted for 49.3％， and fungi accounted for 1.4％. The top six pathogens were Coagulase-negative Staphylococcus （36.5％）， E. coli （26.6％）， K. pneumoniae （13.0％）， S. aureus （5.8％）， Enterococcus （5.8％） and P. aeruginosa （2.9％）. The detection rate of MRCNS was 75.3％ in Coagulase-negative Staphylococcus （171/227） and that of MRSA was 25.0％ in S. aureus （9/36）， respectively. The sensitivity rate of Staphylococcus to rifampicin was higher than 90.0％， and the drug resistance rates of Enterococcus to penicillin G， ampicillin， high concentration of gentamicin， ciprofloxacin， levoflox acin and erythromycin were higher than or equal to 50.0％. No vancomycin-resistant gram positive bacteria were found. The prevalence of ESBLs-producing strains was 49.4％ in E. coli （82/166） and 8.6％ in K. pneumoniae （7/81）. The sensitivity of E. coli to carbapenems was higher than 98.5％. The sensitivity rate of K. pneumoniae to carbapenems was 100％. The sensitivity rate of P. aeruginosa to carbapenems was higher than 90.0％. Among 447 hospitalized BSI patients， CABSI accounted for 49.2％ and HABSI accounted for 50.8％. Distribution of underlying diseases （including diabetes mellitus， malignant tumor， hematological disease， urinary tract infection， liver disease， bitiary tract disease）， invasive operation， the proportion of patients with length of hospital stay＞2 weeks and death proportion were higher in HABSI group than CABSI group （P＜0.05）. CONCLUSIONS： The blood culture pathogens mainly came from infectious diseases department in our hospital. The most common pathogens were Coagulase negative Staphyococcus and E. coli. HABSI occurs more readily in immunocompromised patients and has a poor prognosis. Clinicians should reduce the use of invasive procedures and use appropriate antimicrobial agents for anti-infective treatment.