Abstract: Objective　To analyze the distribution and drug resistance of pathogenic bacteria in blood culture specimens of patients with bloodstream infections before and after COVID-19 (2018-2019 and 2020-2021), and to provide scientific basis and reference for rational treatment and effective control of bloodstream infections in the post-epidemic period. Methods Blood culture specimens were collected from patients in Zhongnan Hospital of Wuhan University in the two years before and after the COVID-19 outbreak (2018-2021). The Automated Blood Culture Systems were used to perform blood culture on blood specimens sent for clinical inspection, and the Vitek MS automatic bacterial identification mass spectrometer was used for strain identification and the Vitek 2 automatic bacterial drug susceptibility analyzer was used for drug susceptibility testing and drug resistance analysis. Results　Blood culture specimens were performed on 28 736 patients with suspected bloodstream infection submitted for inspection from January 2018 to December 2019, and a total of 2 181 strains of pathogenic bacteria were detected after removing duplicate strains, with a positive rate of 7.69%, including 1 046 strains of Gram-negative bacteria, accounting for 47.96%. From January 2020 to December 2021, blood culture specimens from 26 083 patients with suspected bloodstream infection were submitted for inspection, and a total of 2 111 strains of pathogenic bacteria were detected after excluding duplicate strains, with a positive rate of 8.09%, including 1 000 strains of Gram-negative bacteria accounted for 47.37%. The drug resistance of Klebsiella pneumoniae was relatively serious, and the sensitivity rate to ertapenem, polymyxin B and tigecycline was more than 90%. The main non-fermentative bacteria Acinetobacter baumannii was more than 50% sensitive to piperacillin/tazobactam, amikacin and polymyxin B. The sensitivity rates of Pseudomonas aeruginosa to piperacillin/tazobactam, ceftazidime, cefepime, amikacin, gentamicin, tobramycin, ciprofloxacin, levofloxacin, piperacillin and meropenem were more than 50%. Conclusions　In the two years before and after COVID-19, there are many types of pathogenic bacteria in bloodstream infection, but the distribution do not differ significantly. The pathogens of bloodstream infection are mainly distributed in ICU, hepatobiliary research institute, and nephrology department. Among them, Gram-negative bacteria such as Escherichia coli, Klebsiella pneumoniae and Acinetobacter baumannii are the main ones, and different pathogens showed great differences in drug resistance.

Objective To estimate effects of AG490, a selective inhibitor of JAK2/STAT3 signaling pathway, on the biological behavior of human keloid?derived fibroblasts (HKFs), and to explore their possible mechanisms. Methods In vitro cultured human skin fibroblasts(HSFs)and HKFs were both divided into several groups to be treated with AG490 at different concentrations (12.5, 25, 50, 75, 100 μmol/L), with those receiving no treatment serving as the control group. Then, cell counting kit?8(CCK?8)assay was performed to evaluate cellular proliferative activity of HSFs and HKFs after 24?, 48?and 72?hour treatment, flow cytometry to estimate cell cycle distribution and apoptosis rate in HKFs after 24?hour treatment, reverse transcription(RT)?PCR to measure STAT3 and cyclin D1 mRNA expressions in treated HKFs as well as STAT3 mRNA expression in untreated HSFs and HKFs after 24?hour culture, and Western blot analysis to measure the protein expressions of STAT3 and p?STAT3 in HSFs and HKFs after 24?hour treatment. Results CCK?8 assay showed that the proliferation inhibition rates of both HSFs and HKFs gradually increased along with the increase in AG490 concentrations and treatment duration, and the inhibitory effects increased in both dose?and time?dependent manners(all P<0.05). Besides, when cells were treated with the same concentrations of AG490 for same durations, the proliferation of HKFs were inhibited to a greater extent than that of HSFs(all P<0.05). As flow cytometry revealed, along with the increase of AG490 concentrations, the proportion of HKFs in G1 phase and the apoptosis rate in HKFs both increased gradually(all P < 0.01), while the proportion of HKFs in G2 phase gradually decreased(all P < 0.01), and the proportion of HKFs in S phase remained insignificantly changed. RT?PCR showed that the mRNA expression of STAT3 was significantly higher in untreated HKFs than in untreated HSFs after 24?hour normal culture(P < 0.05). After 24?hour treatment with AG490, the mRNA expressions of STAT3 and cyclin D1 in HKFs gradually decreased with the increase of AG490 concentrations. Correlation analysis revealed that the mRNA expression of cyclin D1 was positively correlated with that of STAT3 in AG490?treated HKFs (r = 0.855, P < 0.01). Western blot analysis showed that the protein expressions of both STAT3 and p ? STAT3 gradually decreased in HKFs and HSFs along with the increase of AG490 concentrations(all P < 0.05), and were significantly lower in HKFs than in HSFs (both P < 0.05). Conclusion AG490 can effectively inhibit HKF proliferation by selectively blocking the JAK2/STAT3 signaling pathway.

Objective To observe the change characteristics of serum prealbumin and cholinesterase in the liver cirrhosis pa-tients ,and to discusses the determination of these two indicators in diagnosis ,treatment and prognosis of clinical significance in pa-tients with liver cirrhosis .Methods A total of 45 liver cirrhosis patients diagnosis in our hospital from July to December 2013 were recruited into study group ,at the same time 98 healthy people were recruited into control group .The Hitachi 7170 automatic bio-chemical analyzer was used to detected serum prealbumin and cholinesterase ,the former was detected by immunoturbidimetry meth-od ,the latter was detected by butyryl glucosinolates choline bottom method .The levels and abnormal rates of the two indicators be-fore and after treatment in the study group were compared with those of the control group .Results The serum prealbumin and cho-linesterase at different stage in the study group were significant lower than those of the control group(P<0 .05) .The abnormal rate of serum prealbumin after treatment was significant different with those among and before treatment in patients with cirrhosis (χ2 =10 .08 ,P<0 .05) ,but there were no significant difference on cholinesterase(P>0 .05) .Conclusion The serum prealbumin is a sensitive indicator of liver cell damage ,its change could reflect the condition of treatment and development status ,which has im-portant clinical significance on judging the prognosis of patients with liver cirrhosis .

AIM: To study the application of macular ganglion cell complex (mGCC) and peripapillary retinal nerve fiber layer thickness (pRNFL) measured by optical coherence tomography (OCT) in the early diagnosis of glaucoma.METHODS: Case-control study.Eighty-six subjects, including 30 eyes in normal subjects, 27 eyes in suspected primary open angle glaucoma, 29 eyes in primary open angle glaucoma were enrolled in this study.The thickness of mGCC and pRNFL were measured by OCT.The area under the receiver operating characteristic(AROC) curve at fixed specificities were calculated for each parameter.RESULTS: There were significant differences in mean pRNFL thickness, superior pRNFL thickness and inferior pRNFL thickness between normal group, suspected glaucoma group and early glaucoma group (P=0.001, 0.004, 0.011).The mean mGCC thickness, the thickness of the top mGCC, the thickness of the lower mGCC were statistically significant (P=0.008, 0.002, 0.003);the difference of general loss of volume (GLV) and focal loss of volume (FLV) between the three groups was statistically significant (P=0.002).Compared with the normal group, all the pRNFL and the mGCC parameters were higher in the suspected glaucoma group, and the FLV had the highest AROC (0.801), all the remaining AROC was >0.700 except above Prnlf (0.688).Compared with the normal group and the early glaucoma group, all the pRNFL and the mGCC had higher AROC, average mGCC was hightest(0.804), all parameters AROC were >0.700 except mean pRNFL (0.683).In suspected glaucoma group, 58% patients had abnormal mGCC thickness and 23% had abnormal pRNFL thickness;in early glaucoma group, 98%patients had abnormal mGCC thickness and 90% had abnormal pRNFL thickness;in normal group, 93%patients had abnormal mGCC thickness and 93%had abnormal pRNFL thickness, the correlation between the three groups was statistically significant (x2=12.11, P<0.05).CONCLUSION: OCT measurement of mGCC thickness and pRNFL thickness in early glaucoma have good diagnostic ability;mGCC thickness measurement can be used as an effective method for early diagnosis of glaucoma.

Objective To compare the effect of traditional open surgery and laparoscopic repair of gastric perforation on postoperative pulmonary function.Methods Fifty patients were divided into two groups according to therapeutic method.Group A underwent traditional open gastric perforation repair(n=25).Group B underwent laparoscopic repair of gastric perforation(n=25).The pulmonary functions were examined at 1 day,3 days and 7 days postoperatively.Results All patients had different degrees of postoperative pulmonary function decline.After operation,the forced vital capacity(FVC)and forced expiratory volume in 1 second(FEV1)and vital capacity(VC)in group A were significantly lower than those in preoperation(P<0.05).The patients in laparoscopic operation group decreased significantly only on the first day postoperative.The postoperative pulmonary function of patients undergoing open surgery was significantly lower than that of patients undergoing laparoscopic surgery(P<0.05).Conclusion Laparoscopic repair of gastric perforation has less damage to the lung function than traditional open gastric perforation repair.Laparoscopic surgery plays an important role in the recovery of postoperative pulmonary function.

Objective To investigate the short?term complications and cosmetic outcomes of radiotherapy in breast conserving surgery for early?stage breast cancer. Methods A retrospective analysis was performed on clinical data from 30 patients with early?stage breast cancer from 2013 to 2015. All patients underwent breast conserving surgery combined with intraoperative low?energy X?ray radiotherapy. The prescribed dose was 20 Gy at the surface of the applicator. Local complications, radiation injury, and cosmetic outcomes were observed after surgery. Results No grade 3?4 adverse reactions were found in patients. In terms of short?term complications, four patients (13%) had seroma, two of whom needed suction treatment;three patients ( 10%) had grade 1?2 skin erythema. Half of the patients had excellent cosmetic outcomes. None of the patients had local recurrence or distant metastasis. Conclusions Intraoperative low?energy X?ray radiotherapy is safe and feasible in breast conserving surgery for breast cancer. It can be considered as an optional approach for tumor bed boost in some patients with early?stage low?risk breast cancer.

Objective To study the effects of TGFβ-activated kinase-1 (TAK1)mediated cell autophagy after global cerebral ischemia-reperfusion (IR ) in rats.Methods Seventy-two male Kunming rats were randomly divided into six groups:control group (group C),sham operation group (group S),ischemia-reperfusion group (group IR),TAK1 shRNA lentivirus group (group T),nega-tive lentivirus group (group Y)and normal saline group (group NS)(n = 12 each).The rats in groups T,Y and NS received cerebral ventricles injection of TAK1 shRNA lentivirus,negative lenti-virus and normal saline 10 μl two weeks before preparing animal model.Using thread embolism of the right middle cerebral artery occlusion (MCAO)to cause focal ischemia for 2 h and released for 24 h for reperfusion in groups IR,T,Y and NS.The common carotid arteries were separated but not liga-ted in group S,the rest of the procedure as the same as group IR.The rats of each group were evalua-ted by neurological severity scores (NSS)24 h after reperfusion,the cerebral infarct volume was measured with the method of TTC and the expression of TAK1,LC3Ⅱ/LC3Ⅰ,Beclin1 and p62 pro-tein in rat hippocampus were determined by using Western blot.Results The infarct volume and NSS in groups IR,T,Y and NS were significantly higher than those in group C (P <0.05).The infarct volume and NSS in group T were significantly lower than those in group IR (P <0.05).TAK1 pro-tein of hippocampus in groups IR,Y and NS was significantly higher than that in group C (P <0.05).TAK1 protein of hippocampus in group T were significantly lower than that in group IR (P <0.05).LC3Ⅱ/LC3 Ⅰand Beclin1 protein of hippocampus in groups IR,T,Y and NS were signifi-cantly higher than those in group C,and the p62 protein of hippocampus in groups IR,T,Y and NS was significantly lower than that in group C (P <0.05).The LC3 Ⅱ/LC3 Ⅰand Beclin1 in group T were significantly lower than those in group IR,and the p62 protein of hippocampus in group T was significantly higher than that in group C (P < 0.05 ).Conclusion TAK1 mediated cell autophagy takes part in the mechanism of brain ischemia-reperfusion injury in rats.

OBJECTIVE:To determine serum concentrations of western medicines in patients treated with "traditional Chinese antiepileptic medicine" alone and to evaluate the curative effects.METHODS:A total of 60 epileptic patients who visited our hospital between Feb.1997 and June 2006 were subjected to plasma drug level monitoring and during which the patients were treated with "traditional Chinese antiepileptic drugs" alone.Plasma concentrations of 4 kinds of western medicin-es were determined by FPIA.RESULTS:Of the 60 cases,valproic acid,carbamazepine,phenytoin and phenobarbitone were detected in 18,40,41,and 47 cases/times,respectively.On average,more than two kinds of western medicines were detected in every patient,and the blood concentrations were mostly beyond effective plasma drug concentration.The total curative effects were unsatisfactory.CONCLUSION:The fact that western medicine ingredients detected in these traditional Chinese antiepileptic medicines is inconformity with medication principle of epilepsy.Traditional Chinese antiepileptic medicines should be used with caution in the clinic in the treatment of epileptic patients.

Objective To explore the diagnostic value of thin image and multiplanar reconstruction (MPR) for preoperative T staging on different regions and various pathological staging of colorectal cancer. Methods A total of 163 colorectal cancer patients underwent 64-slice CT examination, then cross section image with thickness of 5 mm (5 mm interval) and 0.5 mm (0.4 mm interval) were reconstructed. The lesions were evaluated and T staged with 5 mm, 0.5 mm and MPR image, respectively. Patients were divided according to the region of lesions: groupⅠ: the anterior wall of lower rectal or near dentate line; groupⅡ: the posterior or lateral wall of lower rectal; group Ⅲ: upper middle rectal or clone. Patients in group Ⅲ were divided into 4 subgroups according to postoperative pathological staging: group A: Tis and T1; group B: T2 (B1: T2a; B2: T2b); group C: T3; group D: T4. The accurate diagnostic rates of different regions, different imaging techniques and different pathological staging were analyzed compared with postoperative pathological results. Results CT accurate T staging diagnostic rate for group Ⅰ, Ⅱ, Ⅲ was 44.44%, 61.54% and 66.67% respectively with 5 mm; 51.85%, 61.54% and 69.92% respectively with 0.5 mm; 51.85%, 76.92% and 78.86% with MPR. There was significant difference of CT accurate diagnostic rates only between group Ⅰ and group Ⅲ (5 mm P=0.031, MPR P=0.004). MRP was better then 5 mm and 0.5 mm only in group Ⅲ (P=0.008, P=0.019). The sensibility of diagnostic T staging of A, B, C and D subgroup in group Ⅲ was as follows: 53.85%, 30.00%(B1: 57.14%, B2: 6.25%), 84.00% and 60.00% with 5 mm; 76.92%, 33.33%(B1: 76.92%, B2: 18.75%),84.00% and 60.00% with 0.5 mm; 92.31%, 53.33%(B1: 78.57%, B2: 31.25%), 86.67% and 80.00% with MPR. CT accurate T staging diagnostic rate of subgroup B2 was significantly lower than those of other groups, and most of the errors were over valuated. Conclusion CT has good sensitivity, specificity and accuracy for diagnostic T staging for early colorectal cancer. MPR can raise the accurate diagnostic rate of upper middle rectal and colon tumor. CT diagnostic value for T staging of lesions at the anterior wall of lower rectal or near dentate line tumor is limited, and the primary cause is over diagnosis of T2b lesions.

Objective To assess the value of rigid wall and outer coarse signs in 64-slice CT for pre-operation stages of colorectal carcinoma. Methods One hundred and twenty-three colorectal carcinoma patients underwent 64-slice CT;then rigid wall and out coarse signs were evaluated respectively. The tumors were grouped according to the postoperative pathologic infiltrative depth. Two signs of the neighboring infiltrative depth groups were compared and analyzed, so as the relativity between two signs and tumor infiltrative depth. Results Among all 123 patients, 7 were Tis, 6 were T1, 14 were T2a, 16 were T2b, 75 were T3 (including 22 infiltrate to chorion and 53 infiltrate through chorion) and 5 were T4. According to the pathologic infiltrative depth, the patients were grouped into GroupⅠ: Tis+T1;GroupⅡ: T2a;Group Ⅲ: T2b;Group Ⅳ: T3a;Group Ⅴ: T3b+T4. Significant difference of the incidence of rigid wall was found between GroupⅠand Ⅱ (P=0.013), while of outer coarse between Group Ⅱ and Ⅲ (P=0.004). Coefficient correlation of rigid wall, outer coarse and the infiltrative depth of the tumor were detected (r=0.673, r=0.528, respectively, both P＜0.001), also between the two signs (r=0.725, P＜0.001). To predict the tumor of and above T1 with rigid wall and tumor of and above T3a with outer coarse, the sensitivity, specificity and accuracy was 92.30% and 79.31%, 89.09% and 69.44%, 89.43% and 76.42%, respectively. Conclusion The sign of rigid wall is valuable to distinguish the pathological changes in the tumor of and above T1, while outer coarse is better to distinguish the pathological changes of and above T2a, but not good at distinguishing tumors of T2b and T3 or above. Rigid wall and outer coarse are both in positive correlation with the infiltrative depth of the tumor, and each has different values. Combination of the two signs may be helpful to raise the accuracy for pre-operation staging of colorectal carcinoma.