Objective:To identify a suitable biomarker for early diagnosis and prognosis of Candida albicans pneumonia ( CAP) ,we investigated the expression of several biomarkers,such as soluble triggering receptor expressed on myeloid cells-1 ( sTREM-1),soluble hemoglobin-haptoglobin scavenger receptor (sCD163),C-reactive protein (CRP),and procalcitonin (PCT),in rabbits with CAP. Methods:A rabbit model was established after immunosuppression of 40 rabbits,randomly divided into 2 groups of 20 each. The experimental group received 1 ml injection of 5×107 cfu/ml C. albicans solution via percutaneous tracheal puncture,while the control group received normal saline. Rabbit blood samples were collected on days 2,3,4,5,6 and 9 post-inoculation and examined for levels of sTREM-1,sCD163,CRP,PCT,interleukin-6 (IL-6),IL-8,IL-10 and tumor necrosis factor-α (TNF-α). Other tests included routine blood examination,arterial blood gas test,chest thin-layer computed tomography on days 3 and 9 post-inoculation,lung tissue biopsy, and blood culture to confirm C. albicans infection. Results:The levels of sTREM-1,SCD163,PCT,and TNF-αwere higher in the exper-imental group as compared to control. Additionally,sTREM-1 and CRP indices showed an upward trend during 9 days of observation period in the experimental group,while others showed a short-term increase after inoculation and then declined gradually. Areas under the receiver operating characteristic curve for CAP diagnosis were calculated as 0. 882,0. 814,0. 685 and 0. 55 for sTREM-1,SCD163, PCT and CRP,respectively. Conclusion: The diagnostic value of biomarkers,sTREM-1 and SCD163,is superior to that of CRP and PCT in the diagnosis of CAP.

Objective To observe the prevalence of anionic trypsinogen (PRSS2) gene G191R mutation in patients with acute pancreatitis (AP) and chronic pancreatitis (CP),and to investigate the effect of PRSS2 gene G191R mutation on susceptibility to pancreatitis.Methods The blood samples of 82 patients with acute pancreatitis,73 patients with chronic pancreatitis and 138 healthy subjects were collected,and genomic DNA was extracted.Nest PCR were performed to amplify PRSS2 gene and restriction fragment length polymorphism (RFLP) was followed by using Hpy188Ⅲ to distinguish the G191R mutation.DNA sequencing analysis was performed to confirm the mutation status.Results The size of nest PCR products was 436 bp.RFLP2 produced 309 bp and 127 bp fragments,which were resulted from PRSS2 gene G191R mutation (GGA →AGA).DNA sequencing analysis of the PCR products further confirmed the PRSS2 gene G191R mutation.Five of eighty-two(6.1％) patients with acute pancreatitis had PRSS2 gene G191R mutation (OR=0.682,95％ CI 0.231 ～ 2.010); one of seventy-three (1.4％) patients with chronic pancreatitis had the mutation (OR =0.145,95％ CI 0.019 ～ 1.145),and the corresponding value in healthy group was 8.7％ (12/138).The G191R mutation rate in patients with chronic pancreatitis was significantly lower than that in healthy group (x2 =0.432,P =0.035),but the G191R mutation rates were not significantly different between AP group and healthy group (x2 =0.487,P =0.485).Conclusions PRSS2 gene G191R mutation facilitates the degradation of anionic trypsin,and may reduce the incidence of chronic pancreatitis.

Objective To deepen the understanding of chronic eosinophilic leukemia (CEL).Methods The course of diagnosis and treatment in a case of FIP1L1/PDGFRα fusion gene negative CEL was reported. Flow cytometry was used to analyze the immunophenotype of the cells in peripheral blood and pleural fluid. Karyotype was analyzed with G-banding. The expression of FIP1L1/PDGFRα fusion gene was detected by RT-PCR technique. Routine pathological examination of the tissues from bone marrow, lung and spleen were performed. Result A sixteen-year-old girl had severe anemia, fever, splenomegaly,thrombocytopenia and dominant hypereosinophilia lasting for 22 months. Trephine biopsy showed a hypercellular marrow with eosinophilic proliferation and moderate reticular fibrosis. Eosinophilic infiltration was found in lung and spleen and embolism was also found in spleen. She had a clonal chromosomal abnormality t(5;12)(q31;p13). The expression of FIP1L1/PDGFRα was negative. An abnormal clone of T cells expressing CD3-,CD4-,CD8- was found in peripheral blood and pleural fluid, in which the cional T cell accounted for 5.43% and 1.66% of the total lymphocytes respectively. The patient was refractory to treatment with hydroxyurea, prednisone and interferon alpha. She had poor response to a combination of therapy with low dose cytosine arabinoside, mitoxantrone, vincristine, cyclophosphamide, methotrexate and prednisone. She did not respond to imatinib and died of multiple organ failure. Conclusion The present case fulfilled the WHO diagnostic criteria of FIP1L1/PDGFRα(-) CEL which did not respond to routine treatment and imatinib. Allogenic stem cell transplantation should be considered as early as possible in this case. It is noteworthy that clonal CD3-,CD4-,CD8- T-cell abnormality is related to the pathogenesis of CEL.

Objective To understand the current situation of occupational exposure and occupational safety attitudes among nursing students in Kunming Medical University, and to find effective interventions to improve nurses' occupational safety,and to reduce occupational exposure.Methods 854 students in Kunming Medical University were investigated by a questionnaire survey, including Demographic characteristics, Occupational exposure conditions, Occupational safety attitude and Gathers, quit intention . The correlations between occupational safety attitudes and occupational exposure were analyzed with Simple Linear Correlation.Results There were 94.30%female respondents,and only 5.70%male respondents.The average age of respondents was 22.52±2.90 years. The Simple Linear Correlation analysis showed that correlation between Negative attitude and occupational exposure was positive correlated, the occupational exposure and Support from managers, and Optimistic were negative correlation ( <0.05) .Conclusions Occupational safety and attitude are related to occupational exposure. Nursing students should apply standardized operation to improve the professional quality and ability. Schools should strengthen the education of occupational protection for nursing students. Hospital management should regularly organize nurses to study occupational exposure protection knowledge,give full affirmation of the nurse's achievements in the work, and offer certain reward appropriately.

Objective To investigate early Epstein-Barr virus (EBV) reactivation and the outcome of preemptive therapy after allogeneic hematopoietic stem cell transplantation (allo-HSCT). Methods From January 2007 to January 2009, totally 277 patients after allo-HSCT were studied (haploidentical 116,unrelated 75, matched sibling 86). Conditioning regimens were mainly busulfan (BU) + cyclophosphamide ( CY)/fludarabine(Flu) or total body irradiation (TBI) + CY/Flu. Antihuman thymocyte globulin (ATG)was added in haploidentical and unrelated transplants. Plasma EBV DNA was monitored once to twice weekly in the first 3 months after allo-HSCT with real time quantitative polymerase chain reaction (RQ-PCR). EBV viremia was diagnosed when EBV DNA was more than 5 × 102 copies/ml but without symptoms. Acyclovir (10 mg/kg, intravenous drip, 8 h) was used for preemptive therapy and immnuo-suppressants were decreased if possible. Results Totally 33 patients ( 11.9% ) developed EBV viremia with a median time at day 44 (day 19 to day 84). The incidences of EBV viremia in the transplants from matched sibling,haploidentical, unrelated donors were 0, 15.5%, 20. 0%, respectively. There was no significant difference between haploidentical and unrelated transplants ( P = 0. 09 ), but much less EBV viremia was seen in matched sibling transplant ( P = 0. 001 ). Twenty of 33 patients ( 60. 6% ) had complete response to preemptive therapy. The median time to reach EBV DNA negative in plasma was 11 (4-56) d. The median duration of preemptive therapy was 21 (14-60) d. Both univariate and multivariate analysis indicated that haploidentical and unrelated transplants, acute graft versus host disease (GVHD) were the risk factors for EBV viremia. Two-year overall survival in the patients with EBV viremia was significantly lower than that without EBV viremia (54. 2% vs 72. 1%, P = 0. 006 ). Conclusions Our large clinical study has demonstrated that preemptive therapy with acyclovir that is guided by EBV viremia is effective in majority of the patients with high-risk for EBV reactivation after allo-HSCT, which may further decrease the risk for developing life-threatening EBV disease or post-transplantation lymphoproliferative disorder. Haploidentical and unrelated transplants, acute GVHD are the risk factors for EBV viremia which has negative impact on survival.

Objective To analyze the etiological factor and genetic feature of a familial hemophagocytic lymphohistiocytosis patient with PRF1 mutation (FHL2) with human herpesvirus 7 (HHV7)infection and its family constellation. Methods Clinical characteristics, laboratory examinations of a FHL2 case with HHV7 infection were reported. HHV1-HHV8 virus DNA was screened by PCR; NK cell function was analyzed by flow cytometry; PRF1 gene mutations were analyzed by PCR and direct sequencing, structure of mutant PRF1 proteins were analyzed using ExPasy and I-TASSER server and genetics pedigree were analyzed. Results The patient's HHV7 viral was detected positive with DNA copy number of 350/106 peripheral nucleated cells. Flow cytometry analysis showed decrease both in proportion of perforin positive NK cells and perforin protein expression. Genetic testing showed PRF1 biallelic heterozygote mutations (c. 503G ＞ A/p. S168N and c. 1177T ＞ C/p. C393R) and pedigree analysis showed they were inherited. The patient was then treated with antivirus therapy, dexamethasone and VP16 therapy, but only achieved partial response. The patient was then followed by human leukocyte antigen 10/10 allele identical nonconsanguinity allogeneic hematopoietic stem cell transplantations (allo-HSCT) and soon the successful implantation of donor hematopoietic cells and persistent recovery was achieved. The patient was now surviving without recurrence for 9 months after allo-HSCT. Conclusions FHL is prone to be misdiagnosed as lymphoma. Genetic analysis of related gene mutation and herpes simplex virus detection will help in early and accurate diagnosis. Allo-HSCT is a fundamental treatment of FHL.

Objective To analyze the clinical distribution ,drug resistance and genotyping of bloodstream infection Staphylococ-cus aureus in our hospital .Methods Bacteria identification and drug sensitivity test were performed in 102 strains of Staphylococ-cus aureus isolated by automatic bacteria identification system in our hospital during January 2010 to January 2017 ,and the geno-types were determined by polymerase chain reaction (PCR) .Results Staphylococcus aureus bloodstream infection was the most common in people aged 70- <80 years old (29 .41% ) ,followed by the age of 50- <60 years old (15 .69% ) .The disease was the most common in the intensive care unit (ICU) (29 .41% ) ,followed by hemodialysis room (21 .57% ) .The drug resistance rate to penicillin was the highest (94 .12% ) ,followed by clindamycin (66 .67% ) ,and it was sensitive to vancomycin ,tigecycline ,teicoplanin and linezolid (100 .00% ) .The drug resistance rates of Methicillin-resistant Staphylococcus aureus (MRSA) to penicillin ,clindamy-cin ,erythromycin ,gentamicin ,levofloxacin ,tetracycline ,rifampicin ,ciprofloxacin and ampicillin/sulbactam were significantly higher than those of Methicillin-sensitive Staphylococcus aureus (MSSA) (P<0 .05) .The erm gene carrying rate was 100 .00% .Among MRSA ,there were 12 strains carrying ermA gene and 28 strains carrying ermA+ermC gene .Among MSSA ,there were 38 strains carrying ermB gene and 24 strains carrying ermC gene .The ermC gene accounted for 77 .27% in induced drug-resistant strains .Con-clusion Staphylococcus aureus bloodstream infection is more common in the elderly ,especially in the advanced age ,and it is more common in ICU .The detection rate of MRSA is relatively higher ,and the erm gene carrying rate of Staphylococcus aureus is high . ermA gene is common in MRSA while ermB gene is common in MSSA .MRSA is resistant to several antibiotics .It is recommended to choose vancomycin and tigecycline for antibiotic treatment .

Objective: To construct a novel tissue engineering complex, BMSCs sheet-RADA16 scaffold, by combining cell sheet and self-assembled peptides.. Methods: The self-assembled peptide RADA16 scaffold was wrapped with the BMSCs cell sheet. The morphology of the cells and the complex were observed by SEM and confocal laser microscopy, and the proliferation of cells was assessed by CCK-8. The osteogenic differentiation of BMSCs was examined by detection of related gene expression with RT-PCR. Results: Compared with the BMSCs cell sheet, the numbers of cells on RADA16 scaffold growth rapidly at 3 rd-8 th day, and BMSCs were more on the scaffold than those on the cell sheet (P＜0. 05) . RT-PCR results showed that the expression level of osteogenesis-related genes was higher in the complex (P＜0. 05) . Conclusion: BMSCs Sheet-RADA16 Scaffold may promote proliferation and osteogenic differentiation of BMSCs.

Objective:To explore the precision treatment effect of multidrug-resistant pulmonary tuberculosis (MDR-PTB) based on the proportion method for drug susceptibility test, and to provide a scientific basis for formulating MDR-PTB treatment plan.Methods:One hundred and eighty patients with MDR-PTB treated in Shenzhen Center for Chronic Disease Control from January 5, 2016 to April 30, 2018 were enrolled. The initial treatment plan after diagnosis was six months of amikacin (AM), pyrazinamide (Z), levofloxacin (LFX), ethambutol (E), prothionamide (PTO) and 18 months of Z, LFX, E, PTO. According to whether proportion method for drug susceptibility test for 10 commonly used drugs was implemented, patients were divided into precision treatment group and empirical treatment group. In the precision treatment group, the treatment plans were adjusted according to the results of the drug susceptibility test. The treatment plans and disease outcomes of the two groups of patients were retrospectively analyzed. Chi-square test was used for statistical analysis.Results:Among the 180 patients, there were 113 patients in the precision treatment group and 67 patients in the empirical treatment group. The drug resistance rates of the precision treatment group from low to high were: capromycin (CM) (0, 0/113), AM (2.65%, 3/113) and kanamycin (KM) (2.65%, 3/113), para-aminosalicylic acid (PAS) (7.96%, 9/113), PTO (11.50%, 13/113), ofloxacin (OFX)(38.05%, 43/113), E (39.82%, 45/113), and streptomycin(S) (76.99%, 87/113). In the precision treatment group, the drugs were adjusted for 104 person-times according to the proportion method for drug susceptibility test during the treatment, from low to high: AM (3 person-times), PTO (13 person-times), LFX (43 person-times) and E (45 person-times). The treatment success rate of the precision treatment group was 78.8%(89/113), which was higher than that of the experience treatment group (52.2%(35/67)), the difference was statistically significant ( χ2=13.805, P=0.000 2). In the precision treatment group and empirical treatment group, there were no statistically significant differences of alanine aminotransferase elevated (32.3%(31/96) vs 34.0%(18/53)), serum creatinine elevated (4.2%(4/96) vs 5.7%(3/53)), and white blood cell count decreased (24.0%(23/96) vs 22.6%(12/53)) (all P>0.05). Conclusion:The traditional treatment plan based on the proportion method for drug susceptibility test has a high success rate in the treatment of MDR-PTB, which is still a worthy choice.