Objective To determine the ESBLs of Klebsiella pneumoniae and ESBL typing by molecular genetic procedures. Methods MIC test and ESBLs confirmation test were taken by agar dilution method in 80 strains of Klebsiella pneumoniae isolated in Beijing area from July 1999 to December 1999. To the 20 ESBLs positive conjugates isoelectric focusing was given. And nucleotide sequencing was analysed to conjugate strain CK23. Results 28 (35%) of the 80 strains of Klebsiella pneumoniae produced ESBLs. In the 28 strains, 20 were successfully done with conjugation of resistant plasmid. Isoelectric focusing results revealed that 13 (65%) of the 20 strains produced an ESBLs protein with a pI of 8.8 with or without additional pI 7.6 and pI 5.4. These ? lactamases were all inhibited by clavulanite acid. The strains with pI=8.8 protein were highly resistant to cefotaxime and ceftriaxone but were susceptible or intermediate to ceftazidime. We picked CK23 strain out from 13 conjugates for gene cloning by the primers designed for bla CTX M and nucleotide sequencing. The results showed that the ESBLs gene in CK23 was CTX M, highly similar to CTX M 3 but had 3 amino acids, which were Glu39Gly, Leu122Pro, Asp278His. Conclusions 28 (35%) of the 80 strains of Klebsiella pneumoniae produced ESBLs. Resistant plasmid successfully conjugated in 20 of the 28 ESBLs producing strains. 13 of the 20 (65%) conjugates pruduced a pI =8.8 ESBLs,which was CTX M ESBLs,with only 3 amino acids different from CTX M 3. This paper indicated that a type of CTX M ESBLs existed in Klebsiella pneumoniae in Beijing, which specifically confers resistance to cefotaxime.

Objective To investigate the clinical significance and safety of liquid-based cytology (thinprep cytologic test, TCT ) in pregnant women and cytological characteristics of the smears during pregnancy. Methods TCT were performed in 1951 pregnant women (group A), 3752 gynecological out-patients(group B)and 5069 routine screening women (group C ). The age of the women was ranged from 20 to 39 years. The cytological preparations were analyzed using TCT method following the Bathesda system (TBS) standard. Results (1) The incidence of abnormal epithelial patterns in groups A, B and C was 23.58%(460/1951), 19.22%(721/3752) and 13.40%(679/5069) respectively (P0.05). Conclusions TCT smear screening is necessary, safe and acceptable for routine prenatal tests. There is no difference in the cervical squamous intraepithelial lesions between pregnant and non-pregnant women.

Objective To understand the soil heavy metal pollution along Diaojiang river and to search the way of using the polluted land in safety. Methods Twelve sampling sites were selected along the river sides, the soil, rice and corn samples were collected and the content of heavy metals was determined. Results The investigation revealed that the main pollutants in the soils were As, Pb, Cd, Zn, etc., the polluted area was coincided with the flooded area and the content of Cd, Pb in the rice and Pb, Cd and Zn in the corn planted in the polluted area was over the limits of national food hygiene standards. Conclusion This paper suggests food crops should be forbidden and mulberry be planted in the polluted area. The severely polluted area where the deposits of mine tailings are obvious should be changed to tailing ponds and the plant restoration and reconstruction should be conducted in these areas.

Objective To identify the risk factors of adverse pregnancy outcomes in expectant management of pregnant women with early onset severe pre-eclampsia (EOSP). Methods Totally, 136 gravidas, who were diagnosed as ESOP and received expectant management from January 2007 to June 2008 in Beijing Obstetrics and Gynecology Hospital, were selected and divided into two groups; the favorable pregnancy outcome group (control, n=101)and the adverse pregnancy outcome group (n=35).The general clinical information, pregnancy outcomes, routine urine test, hemodynamic data, routine blood test, liver and renal function test on admission were collected and the risk factors for adverse outcomes were retrospectively analyzed.Results (1)General clinical information; more women complained of preeclamptic symptoms on admission in the adverse outcome group than in the control group (35.6% vs.57.1 %,P< 0.05).No significant differences was found between the two groups in the maternal age, times of previous pregnancies, prevalence of concurrent complications, pre-pregnant body mass index (BMI),proportion of women who had regular antenatal checks(P > 0.05).(2) Pregnant outcomes; the average duration of expectant management in the control group were similar to the adverse outcomes group [(6.5 ± 8.2) days vs.(6.8 ±10.0) days, P > 0.05].The main complications in the adverse outcome group included placental abruption (n=13), heart failure and pulmonary edema (n=10),hemolysis, elevated liver enzymes and low platelet syndrome (HELIP syndrome, n=5),and no eclampsia was reported.However, none of these complications was reported from the control group.(3)Blood pressure and proteinuria; the gestation ages at the onset of EOSP and at delivery in the control group were earlier than those of the adverse outcome group [(31.3 ± 3.4) weeks vs.(33.0 ± 4.9) weeks, (32.1 ± 3.0) weeks vs.(34.0 ± 3.6) weeks, P< 0.05],the systolic blood pressure and urinary protein and the proportion of women with urinary protein of (+ + +)were also much higher in the adverse outcome group (all P<0.05).(4) Hemodynamics and routine blood tests; the blood viscosity in the control group was obviously lower than that of the adverse outcome group (P< 0.05 ).But there was no significant difference in the cardiac output, cardiac index, peripheral resistance and vascular compliance between the two groups (P >0.05).The adverse outcome group showed lower platelet(PLT) level and higher red blood cell(RBC) count and hematocrit compared with those of the control(all P<0.01).(5)Liver and renal function; the alanine aminotransferase (ALT), aspartate aminotransferase (AST), lactate dehydrogenase (LDH),blood urea nitrogen(BUN) in the adverse outcome group were significantly higher than those of the control group (all P<0.05), but the plasma level of total protein (TP),albumin (Alb), uric acid (UA) and creatinine (Cr) were similar between the two groups(P>0.05).(6) Risk factor analysis: RBC count (OR =3.68, 95% CI: 1.90-7.13 ),PLT count (OR=0.99,95% CI:0.98-1.00) and the gestations at delivery (OR=0.87, 95% CI: 0.80-0.94) were the risk factors of adverse pregnancy outcomes during the expectant management of EOSP.Conclusion Elevated RBC count, reduced PLT count and earlier delivery weeks are the risk factors of adverse pregnancy outcomes during the expectant management of EOSP.

Objective To investigate the risk factors associated with abnormal cervical cytology findings in pregnant women. Methods From Sep. 2007 to Sep. 2008, 12 112 pregnant women who underwent their antenatal examinations at 12-36 gostational weeks in Beijing Obsteties and Gynecology Hospital were enrolled in this study. They were all excluded from the following pathologic obstetrics factors including threatened abortion, premature rupture of membranes or placental previa Thinprep cytology test (TCT) were given at their first examination, meanwhile, a personal clinic file was established to record her occupation, education, address, family income, nationality, age of first intercourse, number of sex partners, contraception, marriage and pregnancy, current gynecologic diseases, family history of gynecologic tumors, history of gynecologic diseases and smoking and result of pelvic examination. Those risk factors leading to abnormal cervical cytology were analyzed. Results The complete clinical data were collected from 11 906 cases(98.30%, 11 906/12 112). It was found that 10 354 women were shown with normal TCT result, however, 1134 women (9.52%, 1134/11 906) with atypical squamaous cells of undetermined significance(ASCUS), 112 women (0.94%, 112/11 906) with atypical glandular cells of undetermined significance(AGUS), 229 women (1.92%, 229/11 906) with low grade squamaous intraepithelial(LSIL),74 women (0.62%, 74/11906) with high grade squamaous intraepithelial(HSIL). Multiple factorial non-conditioned logistic regression analysis showed that age of first sexual intercourse (OR_(ASCUS)=2.90, OR_(AGUS)=7. 32), number of sex partners (OR_(AGUS)=1.49, OR_(AGUS)=2. 02), number of abortion (OR_(ASCUS)=1.68,OR_(AGUS)=3.50) were correlated with ASCUS and AGUS. In LSIL group and HSIL group, age of first sexual intercourse (OR_(LSIL)=6. 34, OR_(HSIL)=9.26), number of sex partners (OR_(LSIL)=1.69, OR_(HSIL)=1.6.5),number of abortion (OR_(LSIL)=1.53, OR_(HSIL)=5. 33), smoking (OR_(LSIL)=1.84, OR_(HSIL)=1.77) were remarkable variables. The infection of human papilloma virus (HPV) and trichomonas vaginitis were correlated with abnormal cervical cytology(including ASCUS, AGUS, LSIL and HSIL) significantly (P< 0.01). Columnar epithelium dystopia were also significantly correlated with abnormal cervical cytology (χ~2=43. 269, P=0. 000). However, abnormal cervical cytology was uncorrelated with degrees of Columnar epithelium dystopia. Conclusions The risk factors associated with abnormal cervical cytology in pregnant women were the same with those of non-pregnant women.

Objective To explore the characteristics of nosocomial infection and its related factors among those very low birth weight infant(VLBWI)for coming up with appropriate preventive measures.Methods Fifty-eight infants with birth weight of 1500 g or below in the hospital from January to June in 2012 were studied actively and retrospectively about their nosocomial infection and related risk factors.Results Thirty-five cases of nosocomial infection occurred among the 58 infants with a prevalence of 60.34%. The mainly pathogenic bacteria was Gram-positive bacteria(88.47%)and mostly,infections presented with lung infections(82.90%) within 21 days after birth.The risk factors included mechanical ventilation,PICC,Apga score<7,fluconazole administration and premature rupture of membranes of VLBWI.Conclusion VLBWI are prone to nosocomial infections,mostly lung infection on day 21 after birth.Management should be strengthened within 3 weeks after birth of VLBWI to minimize infections.Reduction of invasive procedures on children and antibiotic use is particularly important.On the other hand,strengthening the health care in the perinatal period and reducing the incidence of preterm birth cannot be ignored.

Objective To explore the association between maternal age and perinatal outcomes.Methods Totally,3 151 women with advanced maternal age and 6 098 women younger than 35 years old who delivered in Beijing Obstetrics and Gynecology Hospital in 2016 were recruited.Their clinic characteristics and perinatal outcomes were collected to divide into 3 groups based on delivery age,Group 1 (aged 35-39 years,2 683 cases),Group 2 (aged ≥40 years,366 cases) and the control group (aged＜35 years,6 098 cases).The association between maternal age and adverse perinatal outcomes were analyzed,including hypertensive disorder complicating pregnancy,gestational diabetes mellitus (GDM),preterm birth and postpartum hemorrhage.Results The rate of cesarean section history (27.39％,33.61％,5.53％) or previous myomectomy history (2.80％,5.46％,0.72％) were compared between the advanced maternal age groups and the control group,and the differences were statistically significant (P＜0.05).The percentage of prepregnancy overweight and obesity (29.67％,27.05％,18.47％),complicated with myoma (14.83％,19.95％,5.64％) were compared among the three groups,and the differences were statistically significant (P＜ 0.05).The percentage of pregnancy through assisted reproductive technology (9.84％,15.03％,3.12％) also had statistically significant differences (P＜0.05).The incidence of fetal chromosomal abnormalities (1.23％,3.01％,0.36％) and fetal malformations (1.94％,4.37％,0.48％) increased with the maternal age,with statistically significant differences (P＜0.01).The mobidity of hypertensive disorders (9.84％,13.11％,9.23％),pregestational diabetes mellitus (1.83％,2.19％,0.72％),gestational diabetes mellitus (22.70％,28.42％,14.87％),premature rupture of membranes (25.57％,19.40％,31.42％),placenta previa (2.05％,2.46％,0.92％),preterm birth(8.35％,11.20％,5.51％),postpartum hemorrhage (25.11％,18.31％,20.27％)and forceps delivery (5.42％,2.33％,5.71％) were compared,and the differences were statistically significant (P＜0.05).The cesarean section rate in primipara (45.42％,75.74％,21.33％) and multipara (51.46％,61.54％,30.95％) had statistically significant difference (P＜0.05).The proportion of macrosomia (10.80％,8.85％,7.96％) and neonates transferred into neonatal ICU (9.63％,11.48％,5.21％) in term neonates had statistically significant difference (P＜0.05).Conclusions Women with advanced maternal age increase after new family planning policy put into effect,so do the risk of adverse perinatal outcomes.Attention and interventions should be made to cope with the occurrence of adverse perinatal outcomes.

Objective To study the epidemiological features of Cryptococcus neoformans and Cryptococcus gattii isolated from clinical samples in Shenzhen and to elucidate the distribution of species,varieties,genotypes and mating types within the strains tested.Methods The strains involved in this study were 55 cryptococcal strains isolated from our clinical samples.The canavanine-glycine bromthymolblue (CGB) culture was performed to distinguish Cryptococcus neoformans from Cryptococcus gattii.The genotype was characterized by polymerase chain reaction (PCR) fingerprinting with primer M13.The Cryptococcus gattii species and varieties of grubii and neoformans together with two opposite mating type α and a were identified by PCR with variety-specific and mating type-specific primers.The GEF1-restriction fragment length polymorphism analysis was conducted to simultaneously determine the genotype and mating types of strains tested.The sequence type of IGS1 region was analyzed for the VG Ⅱ genotype.Results Of the 55 tested cryptococcal strains,52 were Cryptococcus neoformans,all of which were var.grubii,genotype VN Ⅰ and mating type α.The remaining 3 strains were Cryptococcus gattii,among which,one was genotype VG Ⅰ and mating type α,and two were genotype VG Ⅱ and mating type α.The two VGⅡ genotype strains belonged to the sequence type Ⅱ.Conclusions The strains belonging to the Cryptococcus neoformans var.grubii,genotype VN Ⅰ and mating type α predominate in causative pathogens of cryptococcosis in Shenzhen.Cryptococcus gattii accounts for minority of the cryptococcal isolates,and the highly pathogenic VG Ⅱ genotypes in foreign countries are also characterized.The sequence types of IGS1 region of the two VG Ⅱ strains are in accord with VG Ⅱb sub-genotype.

Objective To investigate the antimicrobial resistance mechanisms and genetic homogeny of Salmonella from community acquired infections in Shenzhen,China.Methods Ninety-three of Salmonella were isolated from 2002 to 2007 at Shenzhen People's Hospital,China.PCR and DNA sequencing were used to investigate the mutation in QRDR of the gyrA,gyrB,parC and parE.Plasmid mediated quinolone resistance genes including qnr and aac(6')-Ib-cr,β-lactamase genes including blaTEM,blaSHV,blaOXA, blaCTX-M, and class 1 integron were detected. All isolates were typed by PFGE. Results S. enterica typhi and S. enterica paratyphi A were susceptible to ampicillin, chloramphenicol, trimethoprim/sulfamethoxazole, ceftriaxone and ciprofloxacin, with the susceptible rate of 96%-100%. Fifty-two percent (13/25) of S. enterica typhi and 95% (61/64) of S. enterica paratyphi A were resistant to nalidixic acid. Twenty-four percent (6/25) of nalidixic acid-resistant S. enterica typhi and 94% (60/64) of nalidixic acid-resistant S. enterica paratyphi A showed decreased susceptibility to ciprofloxacin (MIC of 0. 125-1 μg/ml).All nalidixic acid-resistant (susceptible to ciprofloxacin ) Salmonella (NARS) isolates had a single substitution in the QRDR of GyrA, and 91% (68/75) of these isolates carried the substitution Ser83Phe in GyrA. Two mutations in the QRDR of GyrA were detected in both of two ciprnfloxacin-resistant Salmonella,with the additional one mutation in the QRDR of parC. Plasmid mediated quinolone resistance genes including qnr and aac(6')-lb-cr were not detected in any isolate. The blaCTX-M-14 gene was detected in a ceftriaxoneresistant isolate of S. enterica paratyphi A, with ISEcpl located on the upstream of it. Three muhidrugresistant strains of Salmonella all carried one 1 900 bp classⅠ integron gene cassette dhfrⅫ-orfF-aadA2,with the additional one β-lactamase gene of blaTEM-1, or blaOXA-30. Twenty-two distinct PFGE patterns were observed among twenty-five S. enterica typhi. The PFGE patterns of sixty-four S. enterica paratyphi A showed limited genetic diversity (average similarity of 91% ). Ninety investigated inpatients were infected in the community. Six patients infected by S. enterica paratyphi A had a travel history before infection. Conclusions Nalidixic acid-resistant S. enterica typhi and S. enterica paratyphi A are highly prevalent in Shenzhen,China. The mutation in the QRDR of GyrA is the prevalent mechanism responsible for the resistance to nalidixic acid in Slmonella. The great genetic similarity among S. enterica paratyphi A isolates indicates endemic disease from the presence of a single clone over 6-year period.

OBJECTIVE To investigate the prevalence of multidrug resistance(MDR) mechanisms of Staphylococcus haemolyticus against oxacillin,gentamycin and erythromycin.METHODS Agar dilution method was performed to detect the minimal inhibition concentration(MIC) of 3 antimicrobial agents against 63 strains of S.haemolyticus,and the resistance genes of mecA,aac(6′)+aph(2″),ermA,ermB,ermC and msrA/msrB were investigated by PCR in all clinical isolates.RESULTS mecA Gene was detected in 62 isolates of meticillin-resistant S.haemolyticus(MRSH),and aac(6′)+aph(2″) gene was found in 50 isolates resistant to gentamicin,and the most prevalence erythromycin resistance gene in S.haemolyticus was msrA/msrB(58.7%),followed by ermC(31.7%).Among the 43 MDR strains,the more commonly encountered three genes were mecA,aac(6′)+aph(2″) and msrA/msrB(58.1%)or ermC(20.9%),and 8 isolates(18.6%) were found harboring four genes of mecA,aac(6′)+aph(2″),ermC and msrA/msrB.CONCLUSIONS The mecA,aac(6′)+aph(2″),msrA/msrB and ermC genes are main resistance mechanisms against oxacillin,gentamicin and erythromycin in mutidrug resistant S.haemolyticus.