Objective To investigate the antimicrobial activity of fosfomycin combined with other antibiotics against carbapenem-resistant enterobacteriaceae(CRE).Methods A total of 233 non-repititive CRE isolates were collected from January 2010 to December 2014 from 4 hospitals, including Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou Traditional Chinese Medicine Hospital, Zhejiang Provincial People's Hospital and Second Hospital of Jiaxing.Antimicrobial susceptibility of fosfomycin, imipenem, meropenem, cefepime, ceftazidime, ceftriaxone, cefperazone-sulbactam, piperacillin-tazobactam, ciprofloxacin, amikacin, tobramycin, polymyxin B and tigecycline were determined by agar dilution method.Synergistic effect between fosfomycin and other antibiotics, including meropenem, cefepime, ceftazidime, cefperazone-sulbactam, ciprofloxacin, amikacin, tobramycin and tigecycline against 30 CRE isolates was determined by chequerboard assay.Chi-Square test was used for statistical analysis, and the difference was statistical significant when P<0.05.Results An overall 45.1%(105/233) of 233 CRE isolates were resistant to fosfomycin.Among which, Klebsiella spp.possessed the highest resistance rate (61.9%,73/118), followed by Enterobacter spp.(50%,15/30), Serratia marcescens (25%,7/28), and Escherichia coli (8.2%,4/49).Fosfomycin in combination with tigecyclin showed best activity against CRE isolates with a synergy rate of 76.7%(23/30).Fosfomycin and aminoglycosides also presented good activity against CRE isolates with synergy rate of 53.3%(16/30) to 70.0%(21/30).Synergism was observed only in 30%(9/30) of CRE isolates for the combination of fosfomycin and ciprofloxacin.As for the combination of fosfomycin and β-lactam antibiotics, even less synergism was observed ( 0%-3.3%) ( 1/30 ).No antagonism was demonstrates among all of the combinations.Conclusions Fosfomycin demonstrates certain in vitro activity against CRE isolates.A combination of fosfomycin and tigecyclin or aminoglycosides shows good activity, which suggests a new strategy in the campaign against serious infections caused by CRE.

OBJECTIVETo study the salt stress tolerance of Hongxinju, Huangju and F1 seedlings from orthogonal and reciprocal cross under different salt treatments. Grope for transmissibility of salt tolerance between parents and F1 seedlings, and relativity between flavone, chlorogenic acid contents and salt tolerance.

METHODThe materials were put in 5 different concentrations of Hoagland nutrient solution (0, 40, 80, 120, 160 mmol x L(-1)) containing NaCl, keeping grads while raising the consistency of NaCl day by day. The injured leaf area per plant, proline, betaine, MDA, flavones and chlorogenic acid contents were measured and analyzed after treatment.

RESULTAs NaCl concentration was below 120 mmol x L(-1), the salt tolerance of Hongxinju was higher than that of Huangju, the salt tolerance of Hongxinju x Huangju higher than that of parents, the salt tolerance of Huangju x Hongxinju was at the level of parents. As NaCl concentration between 120 to 160 mmol x L(-1), the salt tolerance of Huangju was higher than that of Hongxinju, the salt tolerance of Huangju x Hongxinju higher than that of parents and the salt tolerance of Hongxinju x Huangju was at the level of parents.

CONCLUSIONSalt tolerance of F1 is more influenced by female parent, relativity showed between flavonoids, chlorogenic acid contents and salt tolerance.

Breeding ; China ; Chlorides ; metabolism ; Chrysanthemum ; genetics ; growth & development ; physiology ; Salt-Tolerance ; Seedlings ; genetics ; growth & development ; physiology

Objective To investigate the prevalence and drug resistance of clinical Klebsiella vari-icola ( K. variicola ) isolates and to illuminate the mechanism of drug resistance in carbapenem-resistant strains. Methods Clinical K. variicola isolates were identified with matrix-assisted laser desorption/ioniza-tion time-of-flight mass spectrometry ( MALDI-TOF MS ) . The antimicrobial susceptibility profile of these strains was determined using broth microdilution. Resistance genes carried by carbapenem-resistant K. vari-icola strains were detected by PCR with specific primers. Multilocus sequence typing ( MLST) was used for molecular typing. A pan-drug resistant strain which was isolated from cerebrospinal fluid sample was ana-lyzed with whole genome sequencing ( WGS) . Results Twenty-six isolates were identified as K. variicola by MALDI-TOF MS. Results of the antimicrobial susceptibility test showed that there were 15. 4％ (4/26) re-sistant to carbapenem and 11. 5％ (3/26) unsusceptible to tigecycline. These strains were highly suscepti-ble to amikacin and gentamicin, which accounted for 96. 2％ (25/26). As for the third-and fourth-genera-tion cephalosporins, the resistance rate was 23. 1％ (6/26). All of the four carbapenem-resistant isolates carried the resistance genes of blaIMP-4 , qnrA/B and blaTEM , and one of them was also positive for blaNDM-1 gene. The fosfomycin resistance gene, fosA, was detected in three of them. Molecular typing analysis indica-ted these isolates belonged to two sequence types ( ST) of ST357 ( three strains) and ST1737 ( one strain) . Two plasmids were obtained from the pan-drug resistant strain by WGS, including IncFⅡ/FIB( k) type plas-mid (160 kb) that was highly homologous to LMG 23571 plasmid (GenBank: CP013986. 1) and IncHⅠ1B/FIB type plasmid (260 kb) sharing high homology with pIMP4 LL34 (GenBank: CP025964. 1). Be-sides the resistance genes mentioned above, the two plasmids also carried a variety of other genes that media-ted the resistance to aminoglycosides (strB, strA, armA, aac3-Ⅱd, aadA2), macrolides (msrE, mphE), chloramphenicol (catA2), sulfonamides (sulⅠ) tigecycline (tetA variant) and trimethoprim (dfrA16). However, no virulence genes were detected. Conclusions In general, the resistance profile of K. variicola was similar to that of Klebsiella pneumoniae, but the differences were that carbapenem-resistant K. variicola strains mainly belonged to ST357 and the leading causes of resistance were carrying the genes encoding IMP-4 and NDM-1 metalβ-lactamases. WGC analysis revealed that the pan-drug resistant K. variicola strain carried multiple drug resistance genes without virulence determinants, which might be resulted from the evo-lution of drug resistance.

Objective To evaluate the clinical efficacy of antibiotic -impregnated shunt catheters in hydrocephalus shunt. Methods A retrospective analysis of clinical data from patients with hydrocephalus shunt surgery in our hospital during the period from May 2011 to August 2016. Based on the types of catheters, patients were divided into common conduit (not AISCs group) and antibiotics infiltrating pipe groups (AISCs group). All patients were followed up for 6 months after shunt surgery. The diversion and infection was recorded. Results The data of 193 patients with hydrocephalus shunt were analyzed, including 124 cases of non-AISCs group and 69 cases of AISCs group. Compared with non-AISCs group,the incidence of postoperative infection of AISCs was significantly decreased(P<0.05). There was no significant difference in the incidence of shunt and reoperation between the two groups (P>0.05). In addition, there was no significant difference in the rupture, displacement and exposure of the two groups (P>0.05).Conclusion ASICs can effectively reduce the incidence of hydrocephalus shunt infection.

Objective To analyze the dynamic changes and the influencing factors of T lymphocyte subsets in recipients with stable graft status within 1 year after lung transplantation. Methods Clinical data of 41 recipients with stable graft status after allogeneic lung transplantation were analyzed. The absolute value and ratio of T lymphocyte subsets in peripheral blood from recipients were measured by flow cytometry before operation, 2 weeks and each month (within 1 year) after operation, respectively. The effects of age, gender, body mass index (BMI), surgical method, incidence of primary graft dysfunction (PGD) after operation, and primary disease upon the absolute values of T lymphocytes were evaluated. Results Within 1 year after lung transplantation, the absolute values of CD3⁺, CD3⁺CD4⁺, CD3⁺CD8⁺T lymphocytes and CD4⁺/CD8⁺ ratio were changed over time (all P < 0.001). Compared with preoperative values, there was no statistical significance in the absolute values of CD3⁺ and CD3⁺CD4⁺T lymphocytes at 12 months after operation (P=0.659, 0.109), whereas the absolute value of CD3⁺CD8⁺T lymphocytes was increased (P=0.02) and the CD4⁺/CD8⁺ ratio was decreased (P < 0.001). Age, gender, BMI, surgical method and incidence of PGD after operation exerted no significant effect on the dynamic changes of absolute values of CD3⁺CD4⁺ and CD3⁺CD8⁺T lymphocytes (all P > 0.05). Primary disease before lung transplantation exerted no effect on the changes of CD3⁺CD4⁺T lymphocytes, whereas the postoperative absolute value of CD3⁺CD8⁺T lymphocytes was higher in recipients with infectious lung diseases (P < 0.05). Conclusions The absolute values of CD3⁺, CD3⁺CD4⁺, CD3⁺CD8⁺T lymphocytes in recipients with stable graft status after lung transplantation are relatively low in the early stage after lung transplantation, then gradually restore, and stabilize at 6 months after operation. Dynamic changes are not associated with age, gender, BMI, surgical method and incidence of PGD after operation of recipients.

Objective To analyze the risk factors and clinical prognosis of acute kidney injury (AKI) early after lung transplantation. Methods Clinical data of 155 recipients undergoing lung transplantation or combined heart-lung transplantation were retrospectively analyzed, and they were divided into the AKI group (n=104) and non-AKI group (n=51) according to the 2012 Kidney Disease: Improving Global Outcomes Clinical Practice Guideline. The incidence of AKI early after lung transplantation was summarized. The main indexes of recipients were collected. The risk factors of the occurrence of AKI early after lung transplantation were subjected to univariate and multivariate analysis. The clinical prognosis of lung transplant recipients was evaluated and the survival curve was delineated. Results The incidence of AKI early after lung transplantation was 67.1%(104/155), including 47 recipients with stage 1 AKI, 34 recipients with stage2 AKI and 23 recipients with stage 3 AKI, respectively. Sixteen recipients required continuous renal replacement therapy (CRRT) early after lung transplantation. Preoperative complication with diabetes mellitus, preoperative complication with pulmonary hypertension, intraoperative mean arterial pressure (MAP) < 60 mmHg, intraoperative massive blood transfusion, and treatment with excessive therapeutic concentration of tacrolimus (Tac) within postoperative 1 week were the independent risk factors for the occurrence of AKI early after lung transplantation. Up to the end of follow-up, 66 recipients (42.6%) died, including 50 recipients in the AKI group and 16 recipients in the non-AKI group. The cumulative survival rate in the AKI group was significantly lower than that in the non-AKI group (40% vs. 66%, P < 0.05). With the increase of AKI severity, the cumulative survival rate of lung transplant recipients was decreased. Conclusions AKI develops early after lung transplantation with high incidence and poor clinical prognosis. Preoperative complication with diabetes mellitus and pulmonary hypertension, intraoperative MAP < 60 mmHg and massive blood transfusion, and treatment with excessive therapeutic concentration of Tac within postoperative 1 week are the independent risk factors for the occurrence of AKI early after lung transplantation.

Acute cellular rejection (ACR) is a common complication after lung transplantation, which is mainly caused by the immune response of T lymphocytes recognizing the major histocompatibility complex on the cellular surface of grafts. It is currently considered as the main pattern of acute rejection. ACR is not only a direct cause of death of recipients, but also a high-risk factor for chronic rejection after lung transplantation. Nevertheless, it is a challenging task to deliver the diagnosis and treatment of ACR following lung transplantation. In this article, new progresses on the risk factors, pathogenesis, diagnosis and treatment of ACR in lung transplant recipients were summarized, aiming to improve the diagnostic and treatment efficiency of ACR and prolong the survival of recipients.

Guideline or consensus for the vaccination of children with special conditions like immunocompromised children may be more suitable for pediatricians.However, the vaccination of children in China is mainly performed by general practitioners or child health care practitioners in community health service centers.They need to master the screening knowledge of contraindications and precautions for the vaccination of children, and make the decision to referral to specialists.Based on the technical guidelines for Immunization of National Health Commission of the People′s Republic of China, Best Practices Guidance of the Advisory Committee on Immunization Practices and contraindications and precautions proposed by the Immunization Action Coalition, 20 suggestions for primary screening of children with vaccination contraindications and referral recommendations for primary care providers were developed by experts from the Integration of Medicine and Prevention in Children of Health Commission of Shenzhen Municipality.

Objective To summarize the experience of selection and maintainence for the lungs from donation. Methods From January 2015 to June 2016, 62 cases had been evaluated by Department of Thoracic Surgery, First Affiliated Hospital of Guangzhou Medical University? All the clinic data had been collected to evaluate the donor lungs, including the basic information, physical examination, results of radiology and laboratory, the bronchoscope, etc? All the satisfactory donors had been harvested and transplanted to the receipient and then follow up? Results Forty cases of donor lung had been harvested from 62 cases? There were 31 male and 9 female cases with average age of 28?7 years? There were 34 cases form donation after brain death and 6 cases from donation after circulatory death? In addition, 8 cases which were considered to be the marginal donors became satisfied after the donor maintanence? The microbe in all 40 cases had been detected and the bacterial infection rate was 82?5% ( 33/40)? The microbe below could be detected in the bronchial stump or lung tissue, including Klebsiella Pneumonia, Baumanii, Staphylococcus Aureus, Enterococcus Faecium, etc? In the end, 22 bilateral lung transplantations, 17 single lung transplantations, 1 heart?lung transplantation had been implemented successfully and the survival rate in the perioperative period was 90?0%? Conclusions The utilization ratio of donation can be increased and the waste of medical resource in unacceptable donor can be reduced by the sufficient donor selection and maintanence? The participation of multi?department is needed in the process of donor selection and maintanence.

Objective To summarize the experience of selection and maintainence for the lungs from donation. Methods From January 2015 to June 2016, 62 cases had been evaluated by Department of Thoracic Surgery, First Affiliated Hospital of Guangzhou Medical University? All the clinic data had been collected to evaluate the donor lungs, including the basic information, physical examination, results of radiology and laboratory, the bronchoscope, etc? All the satisfactory donors had been harvested and transplanted to the receipient and then follow up? Results Forty cases of donor lung had been harvested from 62 cases? There were 31 male and 9 female cases with average age of 28?7 years? There were 34 cases form donation after brain death and 6 cases from donation after circulatory death? In addition, 8 cases which were considered to be the marginal donors became satisfied after the donor maintanence? The microbe in all 40 cases had been detected and the bacterial infection rate was 82?5% ( 33/40)? The microbe below could be detected in the bronchial stump or lung tissue, including Klebsiella Pneumonia, Baumanii, Staphylococcus Aureus, Enterococcus Faecium, etc? In the end, 22 bilateral lung transplantations, 17 single lung transplantations, 1 heart?lung transplantation had been implemented successfully and the survival rate in the perioperative period was 90?0%? Conclusions The utilization ratio of donation can be increased and the waste of medical resource in unacceptable donor can be reduced by the sufficient donor selection and maintanence? The participation of multi?department is needed in the process of donor selection and maintanence.