Objective To investigate the distribution and antimicrobial resistance of pathogens from lower respira-tory tract in patients in intensive care unit (ICU),so as to provide reference for clinical treatment.Methods Distri-bution and antimicrobial susceptibility of pathogens isolated from ICU patients’sputum obtained through fiberbron-choscope between 2011 and 2014 were analyzed retrospectively.Results A total of 3 454 pathogenic strains were isolated between January 1 ,2011 and December 31 ,2014,the percentage of gram-negative bacteria,gram-positive bacteria,and fungi were 84.11 %,14.50%,and 1 .39% respectively.The detection rates of extended-spectrum β-lactamase-producing Escherichia coli and Klebsiella spp .in 2011 -2014 were 38.46% -73.33% and 26.95% -37.06% respectively. Enterobacteriaceae strains had low resistance rates to imipenem and meropenem (<20.00%);resistance of Acinetobacter baumannii was higher than Pseudomonas aeruginosa ,both had low resistance rates to amikacin(3.32%-37.16%);vancomycin-and linezolid-resistant strains were not found among Staphylo-coccus .In 2011 - 2014,detection rates of methicillin-resistant Staphylococcus aureus (MRSA)were 42.86% -61 .22%,methicillin-resistant coagulase-negative staphylococcus (MRCNS)were 86.96% - 91 .67%;resistance rates of Enterococcus faecium was higher than Enterococcus faecalis ,vancomycin-resistant strains were not found among Enterococcus faecalis and Enterococcus faecium ;the major fungus was Candida albicans .Conclusion Anti-microbial resistance of pathogens isolated from lower respiratory tract is getting more serious,clinicians should pay attention to non-antimicrobial infection control strategies in addition to rational use of antimicrobial agents.

Objective To investigate the application effect of nasojejunal feeding tube nutrition in patients with severe traumatic brain injury. Methods The clinical data of 54 patients with severe traumatic brain injury admitted to the Department of Surgical Critical Care Medicine,the Third Affiliated Hospital,Sun Yatsen University between June 2012 and December 2014 were analyzed retrospectively. They were divided into either a nasojejunal feeding tube nutrition support group (nasojejunal group,n = 26)or an asogastric feeding tube nutrition support group (asogastric group,n = 28)according to the different ways of enteral nutrition. All patients began to receive nasal feeding whole protein preparations (enteral nutritional emulsion,TPF-D)from the second day after admission to intensive care unit (ICU). The time to reach the enteral nutrition support target,the time of parenteral nutritional support,nutritional index (albumin and hemoglobin),the time admission to ICU,and the incidences of infection and gastrointestinal complications in both groups were observed. Results (1)According to the body weight to calculate calorie demand, the nasojejunal group reaching the time of enteral nutrition support target was faster than that of the asogastric group (3. 0 ± 0. 8 d vs. 7. 7 ± 2. 5 d). There was significant difference between the 2 groups (P < 0. 01). The time of the combined parenteral nutrition support in the nasojejunal group was reduced significantly compared with the asogastric group (2. 0 ±0. 8 d vs. 6. 7 ±2. 5 d). There was significant difference between the 2 groups (P <0. 01). (2)At day 30after treatment,the levels of total serum protein and hemoglobin in the nasojejunal group were higher than those of the asogastric group (64 ± 6 g/ L vs. 61 ± 6 g/ L and 120 ± 17 g/ L vs. 106 ± 16 g/ L,respectively. There were significant differences (P < 0. 05). (3)The mean length of stay in the ICU was obviously shorter in nasojejunal group compared with the asogastric group (11 ± 5 d vs. 14 ± 6 d). There was significant difference between the 2 groups (P < 0. 05). (4)There were no significant differences in complications of the patients,such as the incidences of pulmonary infection,hyperglycemia,and diarrhea between the 2 groups (P > 0. 05). Conclusion Nasojejunal feeding tube nutrition support may be faster to achieve the target of enteral nutrition supports and shorten the time in ICU.

[Objective] To investigate the mesenchymal stem cells (MSC) in treating acute lung injury (ALI) via ALI mouse model.[Methods] By monoclonal antibody Anti-GD2 of specific antigen ganglioside (GD2) only expressed on MSC as a carrier,new fluorescent molecule probe were synthesized through covalently coupling Anti-GD2 and fluorescent group CyDye mono-reactive NHS Esters (Cy7).Synthetic Anti-GD2-Cy7 and MSC were labeled by the specific binding of antigen and antibody in vitro.Total 84 balb/c male mice were selected and randomly selected 48 mice were divided into three groups:sham group (n =16),MSC+ ALI group (n =16),NS + ALI group (n =16).The lung histopathology and scores,lung W/D ratio and permeability of lung microvasculature were examined at 24 h,48 h after ALI mouse model.Other 36 mice were randomly divided into three groups:normal group (n =12),sham group(n =12),MSC +ALI group(n =12).Labeled MSC-GD2-Cy7 were transplanted into MSC+ALI group and sham group mice via tail vein injection.At 30 min,1 d,3 d,and 7 d post-MSC-GD2-Cy7 injection,the mice were sacrificed after anesthesia and then the lung was removed.Excised lung was detected on small animal fluorescent imager.[Results] Contrast to NS+ ALI group,the lung histopathology and scores,lung W/D ratio and permeability of lung microvasculature of MSC +ALI group were more greatly improved at both 24 h and 48 h.Fluorescent results showed that the signal intensity in thc lung of MSC +ALI group was significantly higher than that of sham group at each time point [(3.37 ± 0.02)× 10-4 vs (2.05 ± 0.04) × 10-4 scaled counts/s;(35.54 ± 0.47)× 10-4 vs (25.29 ± 1.48) × 10-4 scaled counts/s;(11.17 ± 0.75)×10-4 vs (6.09 ± 0.62)× 10-4 scaled counts/s;(3.10 ± 0.14) vs (0.00 ± 0.00)× 10-4 scaled counts/s;all P ＜ 0.05].[Conclusion] Our study showed that a proportion of cells migrated into normal and injured lungs 30 min after cell transplantation,and the cells started to recruit and largely gather in injured lungs at day 1 and persisted to day 7,these results suggest that MSC possess the ability to home into injured tissues.

Objective To investigate the feasibility of buccal mucosa swab method to isolate genomic DNA for au-tism spectrum disorders (ASD)-related genetic screening. Methods Buccal mucosa swabs and blood were collected from 41 children with ASD. Genomic DNA was extracted from either blood by using a commercial genomic DNA kit or buccal mucosa swab by using phenol-chloroform-isoamyl alcohol method. The concentration, total quality and purity of genomic DNA were compared between these two methods. Genotyping of the ASD-related methylenetetra-hydrofolate reductase (MTHFR) gene C677T locus was analyzed using PCR-restriction enzymatic digestion and sanger sequencing was per-formed for validation. Results The total quality [(5.87±2.58)μg vs. (2.00±0.92)μg] and concentration [(143.25±72.78) mg/L vs. (66.68±24.43) mg/L] of genomic DNA extracted from buccal mucosa swab were higher than that form blood (P<0.05), while the purity was not significantly different between these two methods (P>0.05). Genotyping analysis of MTHFR was also consistent between these two methods. Conclusion Buccal mucosa swab is a simple, non-invasive and reliable meth-od to obtain genomic DNA, which can partially replace blood for analysis of ASD-related gene polymorphisms.

Objective To investigate the predictive value of plasma copeptin level for the outcomes in patients with acute ischemic stroke. Methods Consecutive patients with acute ischemic stroke were enroled in the study. Enzyme-linked immunosorbent assay was used to detect the plasma copeptin level. The National Institutes of Health Stroke Scale (NIHSS) was used to evaluate baseline stroke severity. The outcome was evaluated at 90 days with the modified Rankin Scale (mRS), and the good outcome was defined as mRS 0 - 2. Results A total of 160 patients with acute ischemic stroke were enroled, 121 had good outcome and 39 had poor outcome. The age (71. 87 ± 6. 11 years vs. 66. 19 ± 9. 39 years; t =- 3. 540, P = 0. 001), serum levels of C-reactive protein (6. 84 ± 2. 80 mmol/L vs. 5. 84 ± 2. 89 mmol/L;t = - 2. 459, P = 0. 023) and copeptin (143. 12 ± 34. 02 pmol/L vs. 50. 78 ± 18. 62 pmol/L; t = 21. 564, P <0. 001), NIHSS score (12. 00 ± 4. 00 vs. 6. 00 ± 3. 00; t = - 7. 861, P < 0. 001), as wel as proportions of patients with hypertension (79. 5% vs. 60. 3% ; χ2 = 4. 758, P = 0. 029), atrial fibrilation (20. 51% vs. 7. 44% ; χ2 = 4. 022, P = 0. 045), and large artery atherosclerotic stroke (43. 59% vs. 22. 31% ; χ2 = 6. 696, P = 0. 010) in the poor outcome group were significantly higher than those in the good outcome group, but diastolic blood pressure was significantly lower (89 ± 12 mmHg vs. 95 ± 9 mmHg, 1 mmHg = 0. 133 kPa;t = 3. 323, P = 0. 001). Multivariate logistic regression analysis showed that the plasma copeptin level (odds ratio 2. 332, 95% confidence interval 1. 725 - 3. 153; P < 0. 001) was an independent risk factor for the poor outcome in patients with acute ischemic stroke. Person correlation analysis showed that the plasma copeptin level and baseline NIHSS score showed a significant positive correlation (r = 0. 895, P < 0. 001). Receiver operating characteristic (ROC) analysis showed that plasma copeptin level has a significant predictive value for the poor outcome at day 90 after acute ischemic stroke (area under the ROC curve = 0. 740, 95%confidence interval 0. 623 - 0. 783; P < 0. 01). When plasma copeptin level > 104. 3 pmol/L was used as the cutoff value, the sensitivity and specificity for predicting the poor outcomes at day 90 after onset were 86. 8% and 40. 2% , respectively. Conclusions The plasma copeptin level may be a good predictor for neurological outcome at day 90 after onset in patients with acute ischemic stroke.

Objective: To investigate the serotypes and drug resistance of non-typhoidal Salmonella in Zhengzhou City, so as to provide insights into prevention and control of non-typhoidal Salmonella infections. Methods: Salmonella isolates were collected from diarrheal patients in Zhengzhou municipal sentinel hospitals from 2017 to 2021. Salmonella serotypes were identified using slide agglutination test and soft agar colony formation assay, and antimicrobial susceptibility test was performed using the broth micro-dilution method. Results: Five serogroups and 37 serotypes were identified among 446 non-typhoidal Salmonella isolates, with S. enteritidis (210 isolates, 47.09%) and S. typhimurium (133 isolates, 29.82%) as dominant serotypes. Non-typhoidal Salmonella showed high resistance to ampicillin (79.60%), ampicillin/sulbactam (58.74%), naphthyric acid (56.05%), tetracycline (54.26%) and doxycycline (54.04%), respectively. There were 290 multidrug-resistant Salmonella isolates (65.02%), and the multidrug resistance rates were 70.48% for S. enteritidis and 67.67% for S. typhimurium, respectively. Conclusions Multiple serotypes of non-typhoidal Salmonella were identified in Zhengzhou City from 2017 to 2021, with S. enteritidis and S. typhimurium as dominant serotypes. Widespread drug resistance and multidrug resistance was seen in non-typhoidal Salmonella.

Objective: To analyze the pathogenic spectrum of infectious diarrhea among children in Zhengzhou City in 2020, so as to provide insights into the management of childhood infectious diarrhea. Methods: A total of 230 stool samples were collected from children with diarrhea in the Diarrhea Clinic of Zhengzhou Municipal Children's Hospital in 2020. Diarrheagenic Escherichia coli, Salmonella, Shigella, Vibrio parahaemolyticus, Campylobacter and Aeromonas were isolated. Salmonella was typed using pulsed-field gel electrophoresis ( PFGE ) and antimicrobial resistance was tested in Salmonella. The main types and drug resistance of pathogens were descriptively analyzed. Results: The 230 children with diarrhea included 152 males and 78 females, with a male to female ratio of 1.95∶1. There were 173 cases at ages of 3 years and below ( 75.22% ), and 82 cases seen between June and August ( 35.65% ). A total of 71 pathogenic bacteria strains were isolated, with a detection rate of 30.87%. Salmonella was the most frequently isolated pathogen ( 35 strains, 15.22% prevalence ), following by diarrheagenic E. coli ( 20 strains, 8.70% ). Eleven serotypes of Salmonella were identified, which mainly included S. enteritidis and S. typhimurium. PFGE typing revealed 25 band patterns of Salmonella, with a similarity ranging from 11.85% to 100%. Salmonella were sensitive to imipenem, meropenem, polymyxin B and amikacin and highly resistant to streptomycin ( 85.71% ), ampicillin ( 80.00% ) and sulfaisoxazole ( 80.00% ). A 82.86% proportion of multi-drug resistance was detected in the 29 Salmonella strains. Conclusions A wide range of pathogenic bacteria were detected from the childhood infectious diarrhea in Zhengzhou City in 2020, which mainly included Salmonella and diarrheagenic E. coli. A high polymorphism level was seen in PFGE fingerprints of Salmonella, which presented high-level resistance to antimicrobial agents.

Objective To evaluate a therapeutic strategy using aromatase inhibitors and TAM in postmenopausal Luminal B breast cancer patients. Methods The clinical data of 733 primary breast cancer cases receiving postoperative endocrine thempy from July 2002 to Mar 2005 in Tianjin Cancer Hospital were retrospectively analyzed.Diagnosis was confirmed by pathology in all the cases.All patients were post-menopausal and ER-positive.501 patients were given tamoxifen(TAM 2.5 mg qd,po),232 patients were given aromatase inhibitors(Letrozole 10 mg bid,po).The follow-up time ranged from 36 to 90 months.Median follow-up time was 46 months.Results The disease-free-survival(DFS)rate of Luminal B breast cancer patients in aromatase inhibitors(AIS)group was higherthan that in TAM group(90.6% vs.88.6%,P=0.038).In TAM group,subgroup analysis showed 3-year DFS of node-positive with HER2(+)is lower than that of node-positive with Her-2-negative(88.2% vs.90.4%,P=0.037);3-year DFS of ER+/PR+ group in HER2(+) patients was higher than that of ER+/PR-group(90.8% vs.89.5%.P=0.032).In AIs group,in spite of the axillary lymph node status,there was no significant difference of 3-year DFS between HER2(+)patients and HER2(-)ones(P>0.05).3-year DFS of ER+/PR+with HER2(+) patients was higher than that of ER+/PR-ones with HER2(+)(91.9% vs.90.5%,P=0.029).Hot flush,vaginal bleeding and thromboembolics in AIS group is less frequent,but muscle pain and bone fracture is more common than that in TAM group(P<0.05).Conclusion Compared to TAM, AIs is more effective and safer with postmenopausal Luminal B patients,and the effect is independent on node stams.

OBJECTIVETo investigate the expression of full-length spleen tyrosine kinase [SYK (L)] mRNA and protein in human oral squamous cell carcinoma (OSCC) as well as its possible effects on the invasion and metastasis of OSCC.

METHODSThe expression of SYK (L) was detected in 27 cases of OSCC tissues and its matched adjacent non-cancerous tissues by real-time quantitative polymerase chain reaction (RT-qPCR), Western blot, and immunohistochemistry. Fourteen cases of normal oral gingival tissues were also analyzed as a normal control.

RESULTSReduced mRNA and protein expression of SYK (L) in OSCC tissues was observed compared with that in normal oral gingival tissues (P<0.01) and adjacent non-cancerous tissues (P<0.05). SYK(L) expression was significantly associated with lymph-node metastasis (P<0.05).

CONCLUSIONSYK(L) is a candidate tumor suppressor for OSCC tissues, and has an inhibitive effect on the initiation, proliferation, and lymph-node metastasis of human OSCC.

Blotting, Western ; Carcinoma, Squamous Cell ; metabolism ; Humans ; Immunohistochemistry ; Lymphatic Metastasis ; Mouth Neoplasms ; metabolism ; RNA, Messenger ; Syk Kinase ; metabolism

Objective: To examine the efficacy and safety of pemetrexed plus apatinib for the treatment of advanced non-squamous non-small cell lung cancer (NSCLC) in elderly patients. Methods: Between January 2016 and June 2017, 38 elderly patients with ad-vanced non-squamous NSCLC from Qingdao Municipal Hospital were examined. All patients received first-or second-line therapy. The inclusion criteria were an age of≥65 years, physical status score of 0-2, and expected survival time of>3 months. Eighteen patients were assigned to the test group, and the remaining 20 patients were assigned to the control group. The patients in the test group were treated with pemetrexed plus apatinib, pemetrexed 500 mg/m2 on day 1 and apatinib 250 mg/d on days 1-21. The control group re-ceived pemetrexed in a 21-day cycle until the disease progressed or intolerable adverse reactions developed. The study was reviewed and approved by the medical ethics committee of Qingdao Municipal Hospital. Results: The disease control rates in the test and con-trol groups were 72.2% and 35%, respectively, with a statistically significant difference (χ2=5.265, P=0.022). The median progression-free survival time (PFS) in the test and control groups were 5.7 months [95% confidence interval (CI): 2.8-8.6] and 3.1 months (95% CI:2.7-3.5), with a statistically significant difference (χ2=4.01, P=0.045). The difference in the incidence of hand-foot syndrome and hyper-tension between the two groups was statistically significant (P=0.007 and P=0.016, respectively), with side effects of 1 or 2 degree in most cases, which was acceptable. Conclusions: Pemetrexed plus apatinib has a definite curative effect on advanced NSCLC, with con-trollable adverse reactions.