Objective To investigate the clinical value of the bedside color Doppler in the assessment infants with periventricular-intraventricular hemorrhages (PIVH).Methods Sixty-eight cases of PIVH newborns and 156 healthy newborns were involved in the study,dynamic monitoring were undergone within a week after birth.The middle cerebral artery(MCA) hemodynamic parameters of velocity systolic (Vs),velocity diastolic(Vd) and resistance index (RI) were recorded,and the differences of the parameters were compared between different grades as well as those of the normal newborns at 1 d,4 d and 7 d after born.Results Total 68 PIVH infants were diagnosed by bedside color Doppler accurately.Prevalences of premature and low birth weight infants were higher than term infants and normal birth weight children,respectively (P ＜0.05).Vs and Vd of 4 groups of children with PIVH showed an increasing trend in a week after born.The differences of Vs between grade Ⅰ and normal newborns in 4 d and 7 d were not statistically significant (P＞ 0.05),the differences of the other three groups compared with normal newborn group in1 d,4 d and 7 d were statistically significant (P ＜0.05).Vd of grade Ⅱ newborns within 7 d were greater than those of other 4 groups (P ＜0.05),grade Ⅲ and grade Ⅳ within 7 d were less than healthy newborns (P ＜0.05).The difference of RI between all groups were not statistically significant (P ＞ 0.05).Conclusions The diagnostic accuracy rate of PIVH by bedside Doppler is high and the dynamic monitoring of neonatal hemodynamics could provide an important basis for assessing the occurrence and development of PIVH.

The family of Kazal-type serine protease inhibitor(SPINK)correlates with chronic pancreatitis,Netherton syndrome,esophageal carcinoma,and other humane diseases.The functions of SPINK1,SPINK5 and SPINK7 have been identified.However,other members remain to be explored.In this review,we summarized locations of SPINK genes,protein structures,functions of SPINK proteins,and the relationship between SPINK family and humane diseases.

Objective To investigate the correlation between vitamin D and systemic sclerosis(SSc).Methods The serum vita-min D2,vitamin D3 and total vitamin D levels were detected in 56 outpatients and inpatients with SSc(SSc group)and 60 individuals of healthy physical examination(control group)from January 2009 to December 2013.The detection results combined with the clini-cal data were statistically analyzed.Results 3 kinds of vitamin D levels in the SSc group were lower,than control group in which the total vitamin D and vitamin D3 levels were significantly lower than those in the control group(P <0.05).Conclusion Maintai-ning the higher concentration of serum vitamin D may have the preventive effect on progressive SSc.

Objective:To search for differences in early immune reconstitution after allogenic or autolo-gous hematopoietic stem cell transplantation (HSCT).Methods:The peripheral blood (PB)from 31 adult patients undergoing allogenic HSCT (allo-HSCT,1 5 patients)or autologous HSCT (auto-HSCT, 1 6 patients)for the treatment of hematological malignancies and from 20 related healthy controls (HC) from December 201 1 to August 201 4 was used to analyze the kinetic recovery of lymphocyte subsets by means of flow cytometry during 1 2 months after HSCT.The T cell receptor rearrangement excision circle (TREC)levels among CD3 + T cells were measured in the patients and HC to evaluate the thymic-dependent T cell reconstitution.Results:The allo-and auto-HSCT recipients did not differ significantly in CD4 + T cells,CD8 na?ve T cells,effecter memory T cells (TEM),CD4 central memory T cells (TCM),mid-activated T cells and dendritic cells (DC)during the follow-up (P >0.05).But they both differed significantly from HC (P <0.05).CD8 + T cells and NK cells reconstructed rapidly.There was no significant difference in the numbers of B cells between the allo-and auto-HSCT groups from M1 to M3 (P >0.05).B cells in both the groups were lower than those in HC (P <0.05).The recovery of B cells in auto-HSCT group was faster than in allo-HSCT group at M6 and M1 2 (P <0.05).The frequen-cies of CD4 na?ve T cells and later activated T cells in allo-HSCT group were significantly higher than in auto-HSCT group at M6 and M1 2 (P <0.05).The frequencies of CD8 TCM in auto-HSCT group were significantly higher than in allo-HSCT group at M6 and M1 2 (P <0.05).The TREC levels were signifi-cantly lower than in both the groups compared with the age-matched HC during the follow-up (P <0.05).No significant difference was observed between allo-HSCT and auto-HSCT groups (P >0.05). Conclusion:The differences of the nature and the speed of lymphocyte reconstitution observed between the two patents groups were minor.This leads us to conclude that in allografted patients,immune recons-titution and subpopulations of peripheral blood lymphocytes are probably not related to the allogenicity of the graft,but due to the impaired thymus functions and slow differentiation of T lymphocytes in thymus.

OBJECTIVE To investigate in vitro activities of 12 antimicrobial agents including cefmetazole against extended-spectrum beta-lactamases-producing Escherichia coli(528 strains),Klebsiella pneumoniae(311 strains) and Proteus mirabilis(15 strains).METHODS They all collected from 15 teaching hospitals in China during 2005 and 2006 and included in the study.The levels of minimal inhibitory concentration(MIC) of 12 antimicrobial agents were determined by agar dilution method.WHONET 5.4 Software was used to analyze the data.RESULTS Against ESBLs-producing E.coli and ESBLs-producing K.pneumoniae,carbapenems were the most active antimicrobial agents(all 100.0% susceptible),followed by cephamycins(80.1-97.3%).Piperacillin/tazobactam(78.5-95.1%)showed a higher activity than cefoperazone/sulbactam(44.1-56.2%).The susceptible rate to ceftazidime against ESBLs-producing E.coli was remarkably higher than the other three cephalosporins,however the differences did not happen to ESBL-producing K.pneumoniae obviously.The susceptible rate to cefuroxime was below 1.6%.ESBLs-producing K.pneumoniae showed high sensitivity to carbapenems,cephamycins and ?-lactam/lactamase inhibitor combinations(all 100% susceptible),however the susceptible rates to cephalosporins were relatively lower.CONCLUSIONS Carbapenems and cephamycins remain the relatively high activity against ESBLs-producing Enterobacteriaceae.

We report a case of fetal cerebellar vermis dysplasia diagnosed prenatally by ultrasonography. Ultrasonography of the 27-year-old woman at 20 +6 gestational weeks revealed partial separation of the cerebellar vermis (Dandy-Walker variants), unclosable upper and lower lips, and polydactyly, based on which a preliminary diagnosis of multiple fetal malformations was made. Karyotype and chromosomal microarray (CMA) analysis of the amniotic fluid showed no abnormality. After genetic counseling, amniocentesis was performed again for a whole-exome sequencing test. The results suggested that there are compound heterozygous variations of c.3435G>A(P.W1145X) and c.2941C>G(p. p981A) in the exon 19 and exon 17 of the CPLANE1 gene, which were both de novo mutations and inherited from the father and mother, respectively. The fetus was diagnosed as Joubert syndrome. Given the facial and limb deformities and a significant risk of neurological abnormalities of the fetus, the patient and her family decided to terminate the pregnancy.

OBJECTIVE To investigate the antimicrobial resistance of hospital-and community-acquired pathogens collected from 10 teaching hospitals located at different areas in China in 2006.METHODS According to the study protocol,the strains of Streptococcus pneumoniae,meticillin-susceptible Staphylococcus aureus(MSSA),Escherichia coli and Klebsiella pneumoniae were collected and sent to the central lab for reidentification and susceptibility testing.The minimal inhibitory concentrations(MICs) of antimicrobial agents against Str.pneumoniae were determined by Etest method and MICs of antimicrobial agents against S.aureus,E.coli and K.pneumoniae strains were determined by agar dilution method.WHONET5.4 software was used to analyze the data.RESULTS Among 353 Str.pneumoniae strains,74.2% were penicillin-susceptible(PSSP),9.6% were penicillin-intermediate(PISP) and 16.2% were penicillin-resistant(PRSP).Strains from different hospitals showed different sensitivity to penicillin.Among ?-lactam antibiotics,cefuroxime showed the lowest susceptibility rate of 0%(for PRSP) to 76.7%(for PSSP).The susceptibility rate to ceftriaxone and amoxicillin-clavulanic acid was 98.1% and 98.9% in PSSP group,61.8% and 64.7% in PISP group,and 15.8% and 10.5% in PRSP group.The ESBLs rate was 56.2% among 267 Escherichia strains and 42.7% among 206 K.pneumoniae strains.For ESBLs-producing strains,the susceptibility rates to cefotaxime and ceftriaxone were low and the rate to ceftazidime was relatively high among ?-lactam antibiotics.73.4% MSSA strains produced ?-lactamase.?-Lactam antibiotics tested showed high susceptibility against MSSA strains.The susceptibility rate was 98.9-100%.The susceptibility rate to ciprofloxacin and levofloxacin was 80.8% and 88.1%,separately.CONCLUSIONS Fluoroquinolones show high susceptibility against Str.pneumoniae.Ceftriaxone and amoxicillin-clavulanic acid have relatively high susceptibility among ?-lactams.For MSSA and non-ESBLs-producing E.coli and K.pneumoniae strains,?-lactams show high susceptibility.For ESBLs-producing E.coli and K.pneumoniae strains,the susceptibility rates to cefotaxime and ceftriaxone are low and that to ceftazidime,cefepime and cefoperazone-sulbactam are relatively high.

OBJECTIVETo investigate cellular immune function and its clinical significance in patients with multiple myeloma (MM).

METHODS45 MM patients were divided into three groups:newly diagnosed (n=18), stable stage (n=17) and relapsed/refractory (n=10). The frequencies of T cell subtypes, natural killer (NK) cells, dendritic cells (DC), helper T cells (including Th1 and Th2), regulatory T cells(Treg) and Th17 cells in peripheral blood were detected by flow cytometry. Serum concentrations of β2 microglobulin (β2-MG), lactate dehydrogenase (LDH) and hemoglobin (Hb) were also detected, respectively.

RESULTSCompared with controls and stable stage group, the ratios of CD4+/CD8+, DC1/DC2, and Th1/Th2, the numbers of Treg and NK cells were significantly lower in newly diagnosed group. However, the ratio of IL-17A/Treg was significantly higher in newly diagnosed group (P<0.05). Compared with stable stage group, the ratios of CD4+/CD8+, DC1/DC2 and Th1/Th2 were significantly lower, and the ratio of IL-17A/Treg was significantly higher in relapsed/refractory group (P<0.05). In higher ISS stages, the ratios of CD4+/CD8+ and Th1/Th2 were significantly lower and the ratio of IL-17A/Treg was significantly higher (P<0.05). There were negative correlations between the ratios of CD4+/CD8+, DC1/DC2, Th1/Th2 and the levels of β2-MG and LDH, respectively (P<0.05). The ratio of IL-17A/Treg was positively correlated with the levels of β2-MG and LDH (P<0.05). They were no correlated with the level of Hb (P>0.05).

CONCLUSIONThe abnormal ratios of CD4+/CD8+, DC1/DC2, Th1/Th2 and IL-17A/Treg were closely related with disease condition stages, treatment outcomes, progression and prognosis in MM patients.

Objective:To report the results of national surveillance on the distribution and antimicrobial resistance profile of clinical Gram-negative bacteria isolates from bloodstream infections in China in 2022.Methods:The clinical isolates of Gram-negative bacteria from blood cultures in member hospitals of national bloodstream infection Bacterial Resistant Investigation Collaborative System（BRICS）were collected during January 2022 to December 2022. Antibiotic susceptibility tests were conducted by agar dilution or broth dilution methods recommended by Clinical and Laboratory Standards Institute（CLSI）. WHONET 5.6 and SPSS 25.0 software were used to analyze the data.Results:During the study period，9 035 strains of Gram-negative bacteria were collected from 51 hospitals，of which 7 895（87.4%）were Enterobacteriaceae and 1 140（12.6%）were non-fermenting bacteria. The top 5 bacterial species were Escherichia coli（ n=4 510，49.9%）， Klebsiella pneumoniae（ n=2 340，25.9%）， Pseudomonas aeruginosa（ n=534，5.9%）， Acinetobacter baumannii complex（ n=405，4.5%）and Enterobacter cloacae（ n=327，3.6%）. The ESBLs-producing rates in Escherichia coli， Klebsiella pneumoniae and Proteus spp. were 47.1%（2 095/4 452），21.0%（427/2 033）and 41.1%（58/141），respectively. The prevalence of carbapenem-resistant Escherichia coli（CREC）and carbapenem-resistant Klebsiella pneumoniae（CRKP）were 1.3%（58/4 510）and 13.1%（307/2 340）；62.1%（36/58）and 9.8%（30/307）of CREC and CRKP were resistant to ceftazidime/avibactam combination，respectively. The prevalence of carbapenem-resistant Acinetobacter baumannii（CRAB）complex was 59.5%（241/405），while less than 5% of Acinetobacter baumannii complex was resistant to tigecycline and polymyxin B. The prevalence of carbapenem-resistant Pseudomonas aeruginosa（CRPA）was 18.4%（98/534）. There were differences in the composition ratio of Gram-negative bacteria in bloodstream infections and the prevalence of main Gram-negative bacteria resistance among different regions，with statistically significant differences in the prevalence of CRKP and CRPA（ χ2=20.489 and 20.252， P<0.001）. The prevalence of CREC，CRKP，CRPA，CRAB，ESBLs-producing Escherichia coli and Klebsiella pneumoniae were higher in provinicial hospitals than those in municipal hospitals（ χ2=11.953，81.183，10.404，5.915，12.415 and 6.459， P<0.01 or <0.05），while the prevalence of CRPA was higher in economically developed regions（per capita GDP ≥ 92 059 Yuan）than that in economically less-developed regions（per capita GDP <92 059 Yuan）（ χ2=6.240， P=0.012）. Conclusions:The proportion of Gram-negative bacteria in bloodstream infections shows an increasing trend，and Escherichia coli is ranked in the top，while the trend of CRKP decreases continuously with time. Decreasing trends are noted in ESBLs-producing Escherichia coli and Klebsiella pneumoniae. Low prevalence of carbapenem resistance in Escherichia coli and high prevalence in CRAB complex have been observed. The composition ratio and antibacterial spectrum of bloodstream infections in different regions of China are slightly different，and the proportion of main drug resistant bacteria in provincial hospitals is higher than those in municipal hospitals.

Objective:To investigate the distribution and antimicrobial resistance profile of clinical bacteria isolated from blood culture in China.Methods:The clinical bacterial strains isolated from blood culture from member hospitals of Blood Bacterial Resistant Investigation Collaborative System (BRICS) were collected during January 2018 to December 2019. Antibiotic susceptibility tests were conducted with agar dilution or broth dilution methods recommended by US Clinical and Laboratory Standards Institute (CLSI). WHONET 5.6 was used to analyze data.Results:During the study period, 14 778 bacterial strains were collected from 50 hospitals, of which 4 117 (27.9%) were Gram-positive bacteria and 10 661(72.1%) were Gram-negative bacteria. The top 10 bacterial species were Escherichia coli (37.2%), Klebsiella pneumoniae (17.0%), Staphylococcus aureus (9.7%), coagulase-negative Staphylococci (8.7%), Pseudomonas aeruginosa (3.7%), Enterococcus faecium (3.4%), Acinetobacter baumannii(3.4%), Enterobacter cloacae (2.9%), Streptococci(2.8%) and Enterococcus faecalis (2.3%). The the prevalence of methicillin-resistant S. aureus (MRSA) and methicillin-resistant coagulase-negative Staphylococcus were 27.4% (394/1 438) and 70.4% (905/1 285), respectively. No glycopeptide-resistant Staphylococcus was detected. More than 95% of S. aureus were sensitive to amikacin, rifampicin and SMZco. The resistance rate of E. faecium to vancomycin was 0.4% (2/504), and no vancomycin-resistant E. faecalis was detected. The ESBLs-producing rates in no carbapenem-resistance E. coli, carbapenem sensitive K. pneumoniae and Proteus were 50.4% (2 731/5 415), 24.6% (493/2001) and 35.2% (31/88), respectively. The prevalence of carbapenem-resistance in E. coli and K. pneumoniae were 1.5% (85/5 500), 20.6% (518/2 519), respectively. 8.3% (27/325) of carbapenem-resistance K. pneumoniae was resistant to ceftazidime/avibactam combination. The resistance rates of A. baumannii to polymyxin and tigecycline were 2.8% (14/501) and 3.4% (17/501) respectively, and that of P. aeruginosa to carbapenem were 18.9% (103/546). Conclusions:The surveillance results from 2018 to 2019 showed that the main pathogens of bloodstream infection in China were gram-negative bacteria, while E. coli was the most common pathogen, and ESBLs-producing strains were in majority; the MRSA incidence is getting lower in China; carbapenem-resistant E. coli keeps at a low level, while carbapenem-resistant K. pneumoniae is on the rise obviously.