Matrix assisted laser desorption ionization time of flight mass spectrometry (MALDI-TOF MS) is an emerging tool for detecting microorganisms. It can be used not only for rapid identification of microorganisms, but also for the research of resistance mechanisms. Producing β-lactamase is the main mechanism for resistance of β-lactam antibiotics in Gram-negative bacilli. Currently using MALDI-TOF MS for rapid detection of bacterialβ-lactamase has been widely reported, including detection of β-lactam hydrolysis activity of β-lactamase, direct detection of β-lactamase molecule, peptide and relevant proteins, and detection of the single nucleotide polymorphisms (SNPs) of β-lactamase gene. This paper reviews current application of MALDI-TOF MS to the detection of β-lactamase based on the latest research findings.

Osteoarthritis is a common articular cartilage degenerative disease and the main cause is mechanical instability. The mechanical instability can reduce the number of chondrocytes and destroy extracellular matrix through direct injury, inducing cell apoptosis, and stimulating the production of inflammatory factors, leading to decrease of matrix typeⅡ collagen and proteoglycan and degeneration of cartilage. Long-term cartilage degeneration can result in osteoarthritis. Therefore, understanding how mechanical instability leads to the incidence of osteoarthritis can better improve the course of osteoarthritis from the perspective of mechanics.

Objective·To investigate the reference range for serum 25-hydroxyvitamin D in pregnant women in Shanghai. Methods·A total of 4969 healthy pregnant women in second trimester were enrolled, in whom there were 554 women aged over or equal to 35 years old and 4415 women aged under 35 years old. Meanwhile, 1048 non-pregnant women in child-bearing period were enrolled. The new born children had no complications of vitamin D deficiency such as rickets. The levels of 25-hydroxyvitamin D of all participants were detected by ELISA. The reference interval was defined as the central 95% range between the 2.5th and the 97.5th percentiles. Results·The 95% reference range for 25-hydroxyvitamin D levels showed a positive skewness distribution in second trimester pregnant women. The median of 25-hydroxyvitamin D levels was 36.8 nmol/L. The maximum was 108.6 nmol/L whereas the minimum was 11.8 nmol/L. The 95% reference range for 25-hydroxyvitamin D levels was from 15.9 nmol/L to 70.3 nmol/L. The median 25-hydroxyvitamin D was 36.6 nmol/L in women less than 35 years old, and 35.5 nmol/L in women aged over or equal to 35 years old. A significant difference was found between women aged under 35 years old and women aged over or equal to 35 years old (Z=-2.75, P<0.05). The median, maximum and minimum of 25-hydroxyvitamin D in non-pregnant women was 38.5 nmol/L, 110.5 nmol/L, 12.1 nmol/L, respectively, which were all higher than those in pregnant women (P<0.05). Conclusion·There was a lack of vitamin D in pregnant women in Shanghai, especially in pregnant women aged over or equal to 35 years old, despite the multivitamin supplements. However, no complications of vitamin D deficiency such as rickets were found in new born children. To determine the reference range of vitamin D in Shanghai is helpful for pregnancy women in taking vitamin supplement, especially important in preventing maternal and fetal complications caused by vitamin D deficiency.

Objective·To discusses the high risk factors and therapy strategies for ovarian hyperstimulation syndrome (OHSS). Methods·Seventy-seven cases with moderate and severe OHSS were collected to be retrospectively analyzed in Shanghai Ninth People's Hospital affiliated to Shanghai Jiao Tong University School of Medicine from January 2010 to December 2016. Results·Compared with non-pregnant patients, pregnant patients were more likely to have severe OHSS (P<0.05). Embryo transfer patients who underwent ovulation induction and oocyte retrieval became severe OHSS much more easily and had a much longer hospital stay than oocyte retrieval patients (P<0.05). Pumping ascites and pleural effusion or not has no effect on the length of hospital stay and the usage of low molecular dextran for patients with severe OHSS. Conclusion·The risk of OHSS should be evaluated to determine whether or not to carry out a fresh embryo transfer in patients who underwent ovulation induction and oocyte retrieval. For OHSS patients who have undergone embryo transfer or pregnancy, more attention should be paid to the progress of the disease, and individualized treatment is required.

Objective·To investigate the correlation between the serum haptoglobin (Hp) level and the metabolic parameters in patients with polycystic ovarian syndrome (PCOS), and explore the distribution of Hp genotype and allele frequency in PCOS patients and their correlations with PCOS. Methods·A total of 106 patients with PCOS and 86 cases of patients with non-hyperandrogenic and regular menstruation (control group) were enrolled. Serum Hp level was measured by enzyme-linked immunosorbent assay (ELISA); Hp genotype and allele frequency were determined by polymerase chain reaction (PCR), respectively. Results·The serum Hp level in PCOS group was significant higher than that in the control group (P=0.000). Correlation analysis reveals that serum Hp level was positively related to body mass index (BMI) (P=0.000) and homeostatic model assessment insulin resistance (HOMA-IR) (P=0.000). Compared with control group, proportion of Hp2-2 genotype (Hp2/Hp2) increased significantly in PCOS group (P=0.006), and the frequency of Hp2 allele was also higher (P=0.002). Conclusion·Serum Hp level was positively related to BMI and HOMA-IR, which maybe associated with the occurrence and development of obesity and insulin resistance. Patients with Hp2-2 genotype might have genetic predisposition to PCOS, and high frequency Hp2 allele was found in them.

Objective·To observe changes of exhaled nitric oxide (FeNO) level in patients with chronic obstructive pulmonary disease (COPD) before and after inhaled corticosteroid (ICS) therapy and to explore the correlation of FeNO level with inflammation and pulmonary function indexes. Methods·Seventy COPD patients at stable stage who underwent ICS therapy (the COPD group) were enrolled. Levels of peripheral blood eosinophil (Eos) and neutrophil (N), FeNO, PEF, FEV1 and FEV1/pred before and after treatment were measured. Fifty healthy volunteers who received physical examination at the same time served as controls (the control group). The relationship between these indexes and clinical efficacy and the correlation between FeNO level and inflammation or pulmonary function indexes were analyzed. Results·The COPD group had significantly higher FeNO, Eos, and N levels before treatment, significantly lower PEF, FEV1 and FEV1/pred after treatment (P<0.05), and remarkably better indexes after treatment (P<0.05) compared with the control group. Indexes of the effective group and the improved group were significantly better than that of the ineffective group after treatment. Results of correlation analysis showed that before treatment, the FeNO level was positively correlated with peripheral blood Eos and N levels (P<0.05) and negatively correlated with PEF, FEV1 and FEV1/pred (P<0.05). After treatment, the FeNO level was positively correlated with peripheral blood Eos and N levels (P<0.05) and the correlation of the FeNO level with PEF, FEV1 and FEV1/pred was not statistically significant (P>0.05). Conclusion·The FeNO level increased significantly in patients with COPD at stable stage and is a sensitive index of airway inflammation. Combined with lung function test, it's useful for evaluating the efficacy of ICS and guiding treatment.

Objective·To study the hemodynamic parameters of uterine at midluteal phase in patients with early recurrent spontaneous abortion (ERSA) and the effect of aspirin on them. Methods·Transvaginal color Doppler ultrasonography was used to measure the parameters of uterine blood flow and the endometrial thickness at midluteal phase of 271 women with ERSA (ERSA group) and 66 women without a history of recurrent spontaneous abortion (control group). Then ERSA group were administered with aspirin 50 mg/d orally for 2 months and other individualized treatment, and the effect of aspirin on parameters of uterine blood flow and the early pregnancy outcome of them were observed. Results·At midluteal phase, the endometrium was significantly thinner in ERSA group than that in control group. Pulsatility index (PI) of endometrial blood flow and mean PI (mPI), mean resistance index (mRI), and mean systolic/diastolic ratio value (mS/D) of uterine arteries were statistically significantly higher in ERSA group in comparison to control group (P<0.05). Following aspirin treatment, resistance to uterine blood flow reduced significantly in ERSA group (P=0.000), and the endometrial thickness increased in the patients with endometrial thickness less than 7 mm (P=0.000). Only 163 ERSA patients were re-examined by transvaginal color Doppler ultrasonography after aspirin treatment, among whom 136 women was pregnant after individualized treatment. Among these pregnant patients, 97 cases were pregnant for more than or equal to 12 weeks, while 10 cases aborted during the first 12 weeks, and the early pregnancy outcomes of the other 29 cases were still unclear. Conclusion·In comparison with normal fertile women, ERSA patients have significantly higher resistance to uterine blood flow and thinner endometrium. Aspirin can improve uterine blood perfusion, which improves early pregnancy outcome.

Objective·To investigate the incidence, risk factors and treatment of the catheter-related thrombosis (CRT) in breast cancer patients after implantation of totally implantable venous access port (TIVAP) in chemotherapy. Methods·A total of 190 cases after implantation of TIVAP were investigated. Color Doppler ultrasound was used to monitor the neck blood vessels to find whether there was CRT before chemotherapy and before taking out the port. The incidence of CRT, occurrence time, risk factors and treatment efficacy were observed. Results·There were 112 (58.9%) cases with CRT and 108 (56.8%) patients with asymptomatic thrombosis, and only 4 cases had symptomatic thrombosis, the incidence of which was 2.1%. Most thrombosis developed on the 21th day after catheterization, and the patients over the age of 60, with clinical stage Ⅲ - Ⅳ and chemotherapy regimens TEC (docetaxel combined pirubicin and cyclophosphamide) were the risk factors for thrombosis. All the patients with asymptomatic thrombosis accepted anticoagulant treatment with low molecular heparin, earthworms enzyme or aspirin, respectively, but there was no significant difference in efficacy in the three groups (P=0.743). Conclusion·Port catheter related symptomatic thrombosis incidence is low but the incidence of symptomatic thrombosis is high in the breast cancer patients after chemotherapy. Age, tumor stage and TEC chemotherapy regimens are the risk factors for catheter-related thrombosis.

Objective·To investigate the effect of early neurodynamic mobilization on the recurrence of sciatica after the minimally invasive surgery-transforaminal lumbar interbody fusion (MIS-TLIF). Methods·Fifty-four patients who underwent MIS-TLIF were divided into treatment group (n=28) and control group (n=26). The control group received conventional rehabilitation treatment, while the treatment group received neurodynamic mobilization every day after the first post-operative day. The score of visual analogue scale (VAS) and Japanese Orthopaedic Association (JOA) score were evaluated before and after the treatment. Results·There was no significant difference in the score of VAS or JOA between two groups before the treatment or three months after surgery (P>0.05). The score of VAS was significantly lower (P<0.05), and the JOA score was significantly higher (P<0.05) in the treatment group than in the control group four days after surgery. Conclusion·The early neurodynamic mobilization is effective to decrease the recurrence rate of sciatica in patients underwent MIS-TLIF.

Objective·To explore the effect of intracardiac shunts direction on preoperative cerebral tissue oxygenation in children with congenital heart disease. Methods·Sixty children aged from 4 to 24 months diagnosed with ventricular septal defect (VSD group), tetralogy of Fallot (TOF group) and indirect inguinal hernia (control group) undergoing elective surgeries were recruited, with 20 cases in each group. The NIRS cerebral oximeter was used to monitor TOI of patients. Two sensors were placed on the subject's forehead bilaterally for continuous monitoring of cerebral oximetry. Pulse oxygen saturation (SpO2), noninvasive blood pressure, heart rate were also measured and recorded. TOI and fractional tissue oxygen extraction (FTOE) were compared among the three groups and multiple linear regression analysis was used to evaluate the relationship between TOI and these parameters. Results·There was no significant difference in TOI between VSD group and control group (P>0.05). Both sides of TOI in TOF group were significantly lower than those in other two groups (P=0.000) and FTOE in TOF group were significantly higher than those in VSD group (P=0.005). Multiple linear regression analysis showed that only SpO2 was related to TOI in children with congenital heart disease (r=0.560, P=0.000). Conclusion·Different intracardiac shunts direction can affect cerebral tissue oxygenation through affecting systemic oxygen supply. Children with right-to-left shunt physiology have lower TOI and higher FTOE due to low systemic oxygenation.