OBJECTIVE To analyze the pathogens of severe pneumonia induced by different underlying diseases in(hospital) and to evaluate the difference of the pathogens to antimicrobial susceptibility test.METHODS The(bacteria) through sputum culture with VITEK-AMS,and the antimicrobial susceptibility against(bacteria) by K-B method were tested in hospital from 2002 to 2005.RESULTS There were 106 patients with 173 strains of isolated(pathogenic) bacteria,including Klebsiella pneumoniae(KPA) 20.9%,and Escherichia coli(ECO)(16.3%) from the aspiration severe pneumonia;Pseudomonas alcaligenes(PAL) 18.9%,P.aeruginosa(PAL)(16.2%) and Staphylococcus aureus(SAU) 16.2% from the obstructive severe pneumonia;KPN 22.6%,SAU(18.9%),and PAE 17.0% from the COPD complicated with severe pneumonia and PAE 25.0% and SAU 20% from the(hospital-)acquired pneumonia(HAP).CONCLUSIONS The constructed ratio of pathogens is different between(severe) pneumonia infected by different underlying diseases and community-acquired pneumonia without any(underlying) disease.The resistant pathogens are increasing significantly in cases with HAP.

Objective To detect the DMD gene mutation sites and the regions of breakpoints in Duchenne/Becker muscular dystrophy (DMD/BMD) patients in northern China. Methods Multiplex amplifiable probe hybridization (MLPA) was used to detect the mutation in 59 cases (51 cases with DMD and 8 with BMD) from northern China and dystrophin gene mutations in their parents. Results From northern China and dystrophin gene mutations 59 families found gene deletions in 33 cases of 59 DMD/BMD patients (55.9%), duplications in 6 cases (10. 2%) and point mutation in one case (1.7%). Intron 44 was most frequently affected (n = 13, 33.3%), followed by intron 50 (n = 11, 28.2%) and intron 45 (n=8, 20.5%). The novel mutations were identified, in two patients including two independent duplications carried by patient D1 149 and a point mutation [5208del(A)] carried by patient D1 65, which were not included in Leiden database. In addition, an exon 22 deletion was found in one patient, which was the first reported case in Chinese patients. Conclusions Deletions are mostly located in the hotspot between exon 45 and 50. Duplications mostly occurred in the 5' end of the gene. Intron 44 is the most frequently affected breakpoint in northern Chinese population.

OBJECTIVE:To study the effects of Clebopride(CBP)bioadhensive sustained-release tablets on experimental gas-tric ulcer and gastrointestinal motility disorder. METHODS:Gastric ulcer rat model was induced by ethanol and aspirin,and then divided into model group (normal saline),common tablet (CBP tablet 0.072 mg/kg) and sustained-release tablet high-dose and low-dose groups (CBP bioadhensive sustained-release tablet 0.072,0.036 mg/kg);normal rats were included in normal control group (normal saline);they were given relevant medicine intragastrically,twice a day for sustained-release tablet,three times a day for other. Ulcer area were observed 2 and 4 days after medication to calculate healing rate of ulcer(n=6). Gastrointestinal mo-tility disorder mice model was induced by atropine,and then divided into model group (normal saline),common tablet group (CBP tablet 0.1 mg/kg)and sustained-release tablet high-dose,medium-dose and low-dose groups(CBP bioadhensive sustained-re-lease tablet 0.1,0.05,0.025 mg/kg);normal mice were included in normal control group(normal saline);they were given rele-vant medicine intragastrically,once a day,for consecutive 3 days. The rate of gastric emptying and small intestinal propulsion were detected (n=6). RESULTS:Compared with normal control group,ulcer area of rats increased in model group;compared with model group,that of rats decreased in common tablet group and sustained-release tablet high-dose,low-dose groups,with statisti-cal significance (P<0.01);healing rates of gastric ulcer were 32.35%-48.24% 2 days after medication,and those were above 70% 4 days after medication. Compared with normal control group,the rate of gastric emptying and small intestinal propulsion in mice decreased in model group;compared with model group,those of mice increased in common tablet group and sustained-re-lease tablet high-dose,medium-dose,low-dose groups. The effects of sustained-release tablet high-dose and medium-dose groups were better than that of common tablet group;those difference had statistical significance (P<0.01 or P<0.05). CONCLU-SIONS:CBP bioadhensive sustained-release tablets have im-provement effects against gastric ulcer of rats and gastrointesti-nal motility disorder of mice.

Objective To evaluate the effect of two polymorphisms(rs761737 and rs2269058) of RNF8 and the interactions with cigarette smoking and alcohol consumption on sperm DNA fragment index (DFI)and primary male infertility .Methods Based on case-control design ,polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) technology was used to de-tect the genotype of rs761737 and rs2269058 in RNF8 between 332 primary male infertile patients (composed by 87 patients of azoospermia ,166 patients of oligoasthenozoospermia and 79 patients of normozoospermia ) and 329 controls ,and Sperm Chromatin Dispersion(SCD) assay was used to assess sperm DNA fragment index (DFI) .Results Genotype and allele frequencies distribution of rs761737 and rs2269058 between cases and controls had no statistically significant difference (P>0 .05) .Sperm DFI in infertile group (46 .2 ± 22 .3)% was significantly higher than that of control group (21 .4 ± 9 .2)% (P<0 .05) ,stratified analysis suggested that Sperm DFI in oligoasthenozoospermia group (50 .0 ± 22 .1)% was also significantly higher than that of normozoospermia group (38 .2 ± 20 .7)% .The statistic differences of Sperm DFI in individuals who carried different genotypes of rs 761737 and rs2269058 in oligoasthenozoospermia group and normozoospermia group had no statistically significant difference (P>0 .05) .There was an inter-action between RNF8 rs2269058 and Cigarettes smoking(P<0 .05 ,OR=2 .37 ,95% CI 1 .06-5 .27) .Conclusion Although RNF8 rs761737 and rs2269058 have no effects on primary male infertility and sperm DFI ,cigarettes smoking increase the risk of primary male infertility in individuals who carry RNF8 rs2269058 AC+AA genotype .Sperm DFI is an important test to assess sperm quali-ty ,it is vital to reveal the etiology of primary male infertility and provide therapy guidance to clinicians .

Objective To investigate the status quo of humanistic caring ability of undergraduate nursing students, and to analyze the influencing factors.Methods By convenient sampling method, 171 students majoring in Nursing, enrolled to School of Nursing, Shanxi University of Traditional Chinese Medicine in 2015, were selected and surveyed by Caring Ability Inventory (CAI) about their humanistic caring ability and influencing factors.Results In the scale CAI, total scores, scores of dimension courage, and scores of dimension patience of the nursing students were (185.29±23.32), (58.30±9.91), and (56.94±9.35), lower than the norm (208.58±23.32), (65.25±11.57) and (63.11±4.19) (t/Z=-12.907, -9.068, 2.229;P<0.001). Scores of students, who were the only child in their family, on the dimension courage and patience were (55.17±10.51) and [57(46,61)], lower than those who came from non-only-child family (59.16±9.59) and [59(55,63)], (t/Z=-2.166, -2.651;P<0.05).Conclusions Overall humanistic caring ability of nursing students in our country is relatively low. Educators should pay attention to related factors, formulate targeted training strategies, so as to strengthen education on humanistic caring of nursing students.

Objective:To explore the effect of moderate-intensity swimming exercise on liver glucose and lipid metabolism disorder in type 2 diabetic rats and possible mechanism. Method:Eight-week-old male SD rats were randomly selected as a blank control group(negative control group,NC group)and fed with normal food,while the rest were fed with high-fat and high-sugar adaptively for one week.Streptozotocin(Streptozotocin,STZ,30mg/kg)was injected intraperitoneally to produce the T2DM rat model.Sixteen rats were randomly selected as type 2 diabetes model group(diabetic model group,DC group)and type 2 diabetes aerobic exercise group(diabetic swimming group,DS group),with eight rats in each group.Aerobic exercise was intervened by non-weight-bearing swimming.After 3 days of adaptive train-ing,the exercise time was 15min/day,and gradually increased to 60min/day,5 days/week,for a total of 8 weeks of training.During the experiment,the body weight,blood sugar,and liver index of rats in each group were detected;ELISA was used to detect the serum insulin(insulin),tumor necrosis factor-α(TNF-α),interleukin-6(IL-6),interleukin-1β(IL-1β),serum total cholesterol(TC),triglyceride(TG),low-density lipo-protein cholesterol(LDL-C),HDL Lipoprotein cholesterol(HDL-C)and serum alanine aminotransferase(ALT)and aspartate aminotransferase(AST)levels;the expression changes of peroxisome proliferator-activat-ed receptor γ(PPARγ),nuclear factor-κB(NF-κB)and adiponectin(ADPN)in liver tissue were detected. Result:After 8 weeks of aerobic exercise intervention,compared with the DC group,the rats in the DS group had significantly increased body weight,signifiicantly decreased blood sugar(P＜0.01),and significantly increased serum insulin and HDL-C levels(P＜0.01).The serum TNF-α,IL-6,IL-1β and TC,TG,LDL-C,ALT,AST levels were significantly decreased(P＜0.05 or P＜0.01).The liver index and oil red O staining pos-itive area decreased significantly(P＜0.01).The positive area of liver glycogen staining increased significantly(P＜0.01),with neatly arranged liver tissue cells and alleviated fat vacuoles,lipid droplets and inflammatory cell infiltration.The protein and mRNA expression levels of PPARγ,GLUT4 and ADPN in the liver were sig-nificantly increased(P＜0.05 or P＜0.01),and the levels of PPARγ and ADPN immunofluorescence positive cells were significantly increased(P＜0.01).The levels of mRNA and immunofluorescence positive cells of NF-κB were significantly decreased(P＜0.05 or P＜0.01).The mRNA level of ADIPOR2 was also significantly in-creased(P＜0.05),and the protein levels of NF-κB and IL-6 were significantly decreased(P＜0.01). Conclusion:8-week moderate-intensity swimming exercise can improve the disturbance of glucose and lipid me-tabolism by regulating the inflammatory response in the liver of T2DM rats,and the mechanism may be relat-ed to the PPARγ/NF-κB/ADPN pathway.

OBJECTIVETo evaluate the efficacy of periodic fecal microbiota transplantation (FMT) for refractory constipation.

METHODSClinical data of 49 patients with refractory constipation undergoing FMT through standard transplantation path of nasojejunal tube between April 2015 and April 2016 in Intestinal Microenvironment Treatment Centre of Nanjing General Hospital were analyzed retrospectively. Of 49 patients, 25 received single FMT for only 6 days (single group), and 24 received periodic FMT with another 6 days FMT 1 month after the first 6 days FMT (periodic group). The follow up was at 12 weeks after treatment. Autonomous defecation frequency, Wexner constipation score, gastrointestinal quality of life index and related adverse reaction were evaluated and compared at 4-, 8- and 12-week after treatment. Statistical analysis was performed on the difference after treatment at each time point, and the greater difference indicated the better improvement.

RESULTSThere were no statistically significant differences in general characteristics between the two groups (all P<0.05). Before treatment, Wexner constipation score was 17.32±2.66 and 16.25±2.47, gastrointestinal quality of life index was 81.84±8.73 and 83.25±7.87, autonomous defecation frequency was (1.64±0.57) time/week and (1.42±0.65) time/week in single group and periodic group respectively, whose differences were not significant (all P>0.05). Compared with before FMT treatment, the autonomous defecation frequency, Wexner constipation score, gastrointestinal quality of life index were obviously improved at the 4-, 8-, 12-week (all P=0.000). At the 4-week after FMT treatment, the improvement degree of autonomous defecation frequency, Wexner constipation score, gastrointestinal quality of life index was compared between two groups, and no statistically significant differences were found (all P>0.05). While at 8-week and 12-week after FMT treatment, as compared to single group, periodic group had greater Wexner constipation score (at 8-week: 7.29±2.05 vs. 5.96±2.30, t=2.135, P=0.038; at 12-week: 7.21±1.98 vs. 5.80±2.43, t=2.218, P=0.031), greater gastrointestinal quality of life index (at 8-week: 25.71±8.91 vs. 20.20±8.53, t=2.211, P=0.032; at 12-week: 24.16±8.99 vs. 18.92±8.28, t=2.127, P=0.039) and better autonomous defecation frequency [at 8-week: (2.42±0.93) time/week vs. (1.72±0.61) time/week, t=3.110, P=0.003; at 12-week: (1.37±0.88) time/week vs. (0.84±0.62) time/week, t=2.454, P=0.018].

CONCLUSIONPeriodic FMT has better efficacy than single FMT in the treatment of refractory constipation.

OBJECTIVETo evaluate the efficacy and safety of fecal microbiota transplantation (FMT) for gastrointestinal disorders.

METHODSRetrospective analysis of the clinical data of 406 patients who underwent FMT from May 2014 to April 2016 in the Intestinal Microenvironment Treatment Centre of Nanjing General Hospital was performed, including patients with constipation(276 cases), recurrent Clostridium Difficile infection (RCDI, 61 cases), ulcerative colitis(44 cases), irritable bowel syndrome (15 cases) and Crohn's disease(10 cases). Donors were completely unrelated, 18- to 50-year-old non-pregnant healthy adult, with healthy lifestyle and habits, without taking antibiotics, probiotics and other probiotics history within 3 months. There were three routes of FMT administration: patients received 6 days of frozen FMT by nasointestinal tube placed in the proximal jejunum under gastroscope (319 cases); patients received capsules FMT per day for 6 consecutive days (46 cases) or once 600 ml of treated fecal liquid infusion into colon and terminal ileum by colonoscopy(41 cases).

RESULTSClinical cure rate and improvement rate of different diseases receiving FMT were respectively as follows: RCDI was 85.2% (52/61) and 95.1%(58/61); constipation was 40.2%(111/276) and 67.4%(186/276); ulcerative colitis was 34.1%(15/44) and 68.2% (30/44); irritable bowel syndrome was 46.7% (7/15) and 73.3% (11/15) and Crohn disease was 30.0%(3/10) and 60.0%(6/10). RCDI had the best efficacy among these diseases(P<0.01). There was no significant difference between the three routes of FMT administration(P=0.829). The clinical cure rate and improvement rate of different routes were 43.3%(138/319) and 58.6% (187/319) respectively in nasogastric transplantation group, 41.5%(17/41) and 61.0%(25/41) in colonoscopy group, 37.0%(17/46) and 63.0% (29/46) in the capsule transplantation group. There was no serious adverse event during the follow-up. The most common side effects were respiratory discomfort (27.3%, 87/319) and increased venting (51.7%, 165/319) in nasogastric transplantation group. Diarrhea was the most common complication in colonoscopy group (36.6%, 15/41). The main symptoms were increased venting (50.0%, 23/46) and nausea(34.8%, 16/46) in oral capsule group. Side effect symptoms disappeared after the withdraw of nasogastric tube, or at the end of treatment, or during hospitalization for 1-3 days.

CONCLUSIONSFMT is effective for many gastrointestinal disorders. No significant adverse event is found, while the associated mechanism should be further explored.

Adult ; Clostridium Infections ; drug therapy ; Clostridium difficile ; drug effects ; Colitis, Ulcerative ; drug therapy ; Colonoscopy ; adverse effects ; methods ; Constipation ; drug therapy ; Crohn Disease ; drug therapy ; Diarrhea ; chemically induced ; Fecal Microbiota Transplantation ; methods ; statistics & numerical data ; Female ; Flatulence ; chemically induced ; Gastrointestinal Diseases ; drug therapy ; Gastroscopy ; methods ; Humans ; Intubation, Gastrointestinal ; adverse effects ; methods ; Irritable Bowel Syndrome ; drug therapy ; Male ; Middle Aged ; Nausea ; chemically induced ; Retrospective Studies ; Treatment Outcome

Objective:To explore the role of parental origin verification in chromosomal microarray analysis (CMA) on the determination of the clinical significance of copy number variations (CNVs).Methods:This retrospective study collected clinical information from 73 core families who underwent prenatal diagnosis at Peking University First Hospital from November 2017 to December 2019. Indications for prenatal diagnosis included ultrasound abnormality in 54 cases (including 12 with thickened nuchal translucency (≥2.5 mm), four with fetal growth restriction, seven with abnormal pregnancy history, and 31 with isolated ultrasound abnormality), NIPT indicated high-risk in four cases, advanced age in nine cases, abnormal pregnancy history alone in three cases, intrauterine death in two cases and one with maternal mental retardation. Genomic DNA of amniotic fluid sample, chorionic villi, cord blood, fetal tissues, and fetal heart blood were extracted using genomic DNA extraction kit. The CNVs of prenatal samples in 73 subjects were analyzed using array-based comparative genomic hybridization (array-CGH) analysis and single nucleotide polymorphism array (SNP-array). Peripheral blood DNA of the couples, and relevant families if necessary, were collected and analyzed in the same way. The results of parental origin detection in CMA were summarized.Results:A total of 76 CNVs were detected in these 73 samples, out of which nine were pathogenic and parental origin detection revealed that six were de novo, two were maternally, and one was paternally inherited; six CNVs were likely pathogenic, including three de novo, two maternally inherited and one paternally inherited; 20 CNVs were variants of uncertain significance, including five paternally inherited, three maternally inherited and 12 de novo; 41 CNVs were likely benign, among which 38 were inherited from parents with normal phenotype. Conclusions:Parental origin verification plays an important role in explaining the clinical significance of detected fetal CNVs and thereby can help to analyze its clinical effect and reproductive risk.

Objective To evaluate the efficacy and safety of fecal microbiota transplantation (FMT) for intestinal disorders. Methods A retrospectively descriptive cohort study was carried out. Clinical data of 2010 patients who underwent FMT and received follow?up for more than 3 months from May 2014 to November 2018 were collected, including 1,206 cases from Tongji University Shanghai Tenth People′s Hospital and 804 cases from Nanjing Eastern Military General Hospital. Of the 2,010 patients, 797 were male and 1,213 were female, with a mean age of (49.4±16.5) years old. Inclusion criteria were those with indications for FMT and voluntary treatment of FMT. Pregnant or lactating women, patients with end?stage disease, cases who were participating or participated in other clinical trials within 3 months, and patients with previous bowel history of pathogen infection, oral antibiotics or proton pump inhibitors (PPI) for the recent2 weeks, and those at immunosuppressive state were excluded. Informed consent was obtained from the enrolled patients and their families. There were 1, 356 cases of constipation, 175 cases of inflammatory bowel disease, 148 cases of chronic diarrhea, 127 cases of radiation enteritis, 119 cases of irritable bowel syndrome, and 85 cases of autism (complicating with intestinal disorders). FMT donor requirements: (1) 18 to 30 years old non?relatives, non?pregnant healthy adults with healthy lifestyle and good eating habits as volunteers to participate in fecal donation; (2) no administration of antibiotics within 3 months; (3) no chronic diseases such as constipation, irritable bowel syndrome, inflammatory bowel disease, etc., no autoimmune disease, not in immunosuppressive state, no history of malignant disease; (4) negative pathogen examination of infectious diseases (hepatitis B virus, hepatitis C virus, syphilis, HIV, etc.); (5) negative fecal examination (C. difficile, dysentery bacillus, Shigella, Campylobacter, parasites, etc.). The donor requirements after enrollment: (1) physical examination was reviewed once every two months, and the result still met the above requirements; (2) 16S rRNA sequencing was performed for every fecal donation in order to ensure that the composition and diversity of the fecal flora was stable and reliable. The preparation of the stool suspension referred to the Amsterdam criteria and the preparation process was less than 1 hour. The preparation of the FMT capsule was processed by pre?freezing the stool suspension after the preparation of the above suspension, and the frozen sample was transferred into a freeze dryer for freezing. The dried and lyophilized powder was encapsulated in capsules, and the capsule shell was made of acid?resistant hypromellose capsule (No.0) and pediatric?specific capsule (No.3), sealed and packaged in a-20℃refrigerator. Three ways of accepting FMT treatment pathways included 6?day transplantation after the placement of the nasointestinal tube, 6?day oral FMT capsule transplantation and one?time transplantation through colonoscopy. Intestinal preparation (nasointestinal tube feeding of polyethylene glycol until watery stool) was carried out before transplantation. Other treatments were stopped during treatment and follow?up, and any medication was not recommended when necessary. Results Of the 2010 patients, 1, 497 cases received nasointestinal tube transplantation (nasointestinal tube group), 452 cases oral capsule transplantation (oral capsule group) and 61 cases colonoscopy (colonoscopy group). At 3 time points of 3, 12, and 36 months after FMT, the clinical cure rates and the clinical improvement rates were 41.3% (560/1 356), 35.2% (320/909), 31.4% (69/220), and 29.0% (393/1 356), 27.8% (253/909), 29.1% (64/220), respectively in constipation patients; 33.1% (58/175), 29.9% (35/117), 24.5% (12/49), and 31.4% (55/175), 27.4% (32/117), 57.1% (28/49), respectively in inflammatory bowel disease patients;87.8% (130/148), 81.8% (81/99), 78.3% (36/46), and 8.1% (12/148), 7.1% (7/99), 4.3% (2/46), respectively in chronic diarrhea patients; 61.4% (78/127), 56.5% (48/85), 47.6% (20/42), and 21.2% (27/127), 15.3% (13/85), 14.3% (6/42), respectively in radiation enteritis patients; 53.8% (64/119), 45.0% (36/80), 6/15, and 21.0% (25/119), 26.2% (21/80), 4/15, respectively in irritable bowel syndrome patients;23.5% (20/85), 22.8% (13/57), 20.0%(5/25), and 55.3% (47/85), 49.1% (28/57), 40.0% (10/25), respectively in autism patients. Meanwhile the clinical cure rates and the clinical improvement rates at 3, 12, and 36 months were 47.7% (714/1 497), 42.8% (425/994), 39.1% (128/327), and 29.1% (436/1 497), 27.0% (268/994), 28.1% (92/327), respectively in the nasointestinal tube group; 38.7% (175/452), 30.2% (91/301), 33.3% (16/48), and 24.3% (110/452), 26.2% (79/301), 25.0% (12/48), respectively in the oral capsule group; 34.4% (21/61), 32.7% (17/52), 18.2% (4/22), and 21.3% (13/61), 13.5% (7/52), 45.5% (10/22), respectively in colonoscopy group. No serious adverse events occurred during treatment and follow?up period. The adverse event of nasointestinal tube group presented higher ratio of discomfort in respiratorytract accounting for 13.1% (196/1497); the oral capsule group had a higher proportion of nausea and vomiting when swallowing capsules accounting for 7.1% (32/452); the colonoscopy group was mainly diarrhea, accounting for 37.7% (23/61). The above symptoms disappeared after the nasointestinal tube was removed, or after treatment ended, or within 1 to 3 days after hospitalization. Conclusion FMT is a safe and effective method for the treatment of intestinal dysfunction.