Objective To investigate the molecular epidemiology and risk factors of the expression of the efflux pumps of multidrug resistant Pseudomonas aeruginosa (Pa). Method From April 2014 to October 2014 , clinical features of 100 patients infected with multidrug resistant Pa were retrospectivly analyzed . Results MexAB-OprM was expressed in all multidrug resistant Pa strains (100%). The expression rates of MexEF-OprN and MexCD-OprJin the multidrug resistant Pa strains were 50% and 36%, respectively. The risk factor of the three efflux pumps expression was analyzed and the results were as follows: the use of carbapenems and glycopeptides antibiotics was the risk factor of MexAB-OprM overexpression which was induced. The use of macrolide and carbapenems antibiotics was the risk factor of the induced MexEF-OprN and MexCD-OprJ expression. Invasive procedures, low WBC, anaemia, chronic fundamental disease and hospitalized in ICU ward were the common risk factors of communicable expression or overexpression of the three efflux pumps. Invasive procedures, low WBC, anaemia, chronic fundamental disease and hospitalized in ICU ward were commonly independent risk factors of expression of the three efflux pumps. Conclusion The normalized use of carbapenems and glycopeptides antibiotics , the reduction of unnecessary invasive procedures , the severely grasped standard of hospitalized in ICU ward , curing the fundamental diseases and improving the immunonity played important roles in the prevention of the expression or overexpression of the efflux pumps of multidrug resistant Pa.

Objective To study the promotive effect of chitosan liquid on wound healing.Methods Wound model was established on the back of 60 rats,which were classified into 3 groups to be treated with topical chitosan liquid (group A),basic fibroblast growth factor (group B),and sodium chloride physiological solution (group C),respectively.The time required for the healing of wound was recorded.Regenerated tissues were resected from the rats on day 3,7 and 14 after the establishment of wound model,and observed with light microscopy.Results The time required for the healing of wound was 17.3 ± 1.35 days in group A,18.2 ± 1.15 days in group B,and 24.0 ± 1.37 days in group C.For the time required for the healing of wound,no significant difference was observed between the group A and B (P ＞ 0.05),but group C significantly differed from group A and B (both P ＜ 0.05).Chitosan liquid accelerated the generation of capillary sprouts and vascular endothelial cells at the early stage of wound healing,promoted the production of fibroblasts and collagen fibers at the middle stage,and improved the organization of collagen fibers at the late stage.Conclusion Chitosan liquid exerts a promising promotive effect on wound healing.

Objective:To evaluate the prognostic value of plasma microRNA-30b-5p (miR-30b-5p) combined with extravascular lung water index (EVLWI) in patients with acute respiratory distress syndrome (ARDS).Methods:120 ARDS patients admitted to Danzhou People's Hospital from January 2016 to June 2019 were enrolled. The gender, age, body mass index (BMI), underlying diseases, etiology and baseline values of heart rate (HR), respiratory rate (RR), oxygenation index (OI), arterial partial pressure of carbon dioxide (PaCO 2) and acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ) score were collected. According to the survival outcome during hospitalization, the patients were divided into survival group and death group. According to OI, the patients were divided into mild-moderate group (OI > 100 mmHg, 1 mmHg = 0.133 kPa) and severe group (OI ≤ 100 mmHg). The expression of plasma miR-30b-5p was detected by real-time fluorescence quantitative reverse transcription-polymerase chain reaction (RT-PCR), and EVLWI was measured. The receiver operating characteristic (ROC) curve was drawn to analyze the value of plasma miR-30b-5p and EVLWI in predicting the death of patients with ARDS. Pearson correlation method was used to analyze the correlation between miR-30b-5p and EVLWI in ARDS patients with different prognosis during hospitalization. Results:120 patients with ARDS were enrolled in the analysis, with 42 patients in the death group, and 78 in the survival group; with 67 patients in the mild-moderate group, and 53 in the severe group. APACHE Ⅱ score in the death group was higher than that in the survival group, but there was no significant difference in gender, age, BMI, underlying diseases, etiology or baseline values of HR, RR, OI, or PaCO 2 between the two groups. The expression of plasma miR-30b-5p and EVLWI level in the death group were significantly higher than those in the survival group [miR-30b-5p (2 -ΔΔCt): 2.28±0.74 vs. 0.52±0.06, EVLWI (mL/kg): 15.38±4.60 vs. 10.24±2.15, both P < 0.01]. The expression of plasma miR-30b-5p, EVLWI and mortality during hospitalization in the severe group were significantly higher than those in the mild-moderate group [miR-30b-5p (2 -ΔΔCt): 2.05±0.65 vs. 0.93±0.17, EVLWI (mL/kg): 14.65±4.20 vs. 11.36±2.28, mortality during hospitalization: 58.5% (31/53) vs. 16.4% (11/67), all P < 0.01]. ROC curve analysis showed that the best cut-off value of plasma miR-30b-5p and EVLWI in predicting the death during hospitalization of ARDS patients were 1.62 and 13.28 mL/kg, respectively. Moreover, the area under ROC curve (AUC) of the combination of two parameters was significantly higher than that of the two alone (0.897 vs. 0.827, 0.785), with high sensitivity and specificity, 90.5% and 84.2%, respectively. Pearson correlation analysis showed that plasma miR-30b-5p in dead ARDS patients was significantly positively correlated with EVLWI ( r = 0.768, P < 0.01), but the correlation was not found in surviving patients ( r = 0.118, P > 0.05). Conclusion:The expression of plasma miR-30b-5p and EVLWI are related to the severity and prognosis of patients with ARDS, and the combination of the two has certain evaluation value for the prognosis of ARDS patients.

Objective:To investigate the clinical characteristics and prognosis of acute myeloid leukemia (AML) patients with positive TLS-ERG fusion gene.Methods:The clinical data of 9 AML patients with positive TLS-ERG fusion gene in the First Hospital of Jilin University from June 2013 to August 2020 were retrospectively analyzed, and the relevant literature was reviewed.Results:Among 9 patients with positive TLS-ERG fusion gene, there were 5 males and 4 females, with a median age of 16 years old (6-40 years old). Five patients received chemotherapy alone, 3 patients received allogeneic hematopoietic stem cell transplantation (allo-HSCT), and 1 patient did not receive systematic treatment. Among 8 patients with systematic treatment, 1 patient had complete remission after the first induction chemotherapy and 5 patients had complete remission after induction therapy. The median overall survival time of 5 patients with chemotherapy alone was 1.5 months (1-11 months), of which 3 patients did not respond to the first course of treatment and died of infection, and 2 patients died after relapse. The median overall survival time of 3 patients with allo-HSCT was 16 months (13-17 months), of which 2 patients died after relapse and 1 patient had sustained molecular complete remission by the end of follow-up.Conclusions:AML with positive TLS-ERG fusion gene has low incidence rate and poor induction efficacy. Hematopoietic stem cell transplantation may partially improve the survival prognosis of patients, but it cannot overcome the adverse effect of positive TLS-ERG fusion gene on prognosis.

Background: The terminology of nonalcoholic fatty liver disease (NAFLD) was changed to metabolic dysfunction ⁃ associated fatty liver disease (MAFLD) in 2020. NAFLD has been confirmed to be a risk factor for colorectal neoplasms, but the association between MAFLD and colorectal neoplasms is conflicting. Aims: To investigate the correlation of MAFLD with colorectal adenoma and early colorectal cancer. Methods: The clinical information of 701 patients who met the criteria and were admitted to Renmin Hospital of Wuhan University from January 2021 to August 2021 was collected retrospectively. Among them, 274 colorectal adenoma patients with low ⁃ grade intraepithelial neoplasia or without intraepithelial neoplasia were classified as adenoma group, 21 patients with high ⁃ grade intraepithelial neoplasia, intramucosal carcinoma, and submucosal carcinoma were classified as early cancer group, and 406 patients with normal colonoscopy or non⁃adenomatous polyps were served as control group. The general information and prevalence of MAFLD between these groups were compared. Furthermore, the correlation of MAFLD with colorectal adenoma and early colorectal cancer, and the gender difference of these correlations were analyzed by Logistic regression models. Subgroup analysis was performed based on the clinicopathological characteristics of colorectal adenoma. Results: When adjusting the confounding variables including gender, age, smoking, alcohol drinking, diabetes, hypertension, and serum creatinine, MAFLD was significantly associated with the prevalence of colorectal adenoma (OR=1.83, 95% CI: 1.04 ⁃ 3.22, P=0.037) and early colorectal cancer (OR=3.91, 95% CI: 1.14⁃13.42, P=0.031). When stratified as gender, the significant association remained in females (OR=4.04, 95% CI: 1.56 ⁃ 10.47, P=0.004), but not in males. In addition, no correlation was found between MAFLD and the location, size, number, and advanced histology of colorectal adenoma (all P>0.05). Conclusions: MAFLD is an independent risk factor for colorectal adenoma and early colorectal cancer. MAFLD is specifically associated with increased risk of colorectal adenoma in females but not in males.

In prospective cohort study, multi follow up is often necessary for study subjects, and the observed values are correlated with each other, usually resulting in time-dependent confounding. In this case, the data generally do not meet the application conditions of traditional multivariate regression analysis. Sequential conditional mean model (SCMM) is a new approach that can deal with time-dependent confounding. This paper mainly summarizes the basic theory, steps and characteristics of SCMM.