Mycoplasma pneumoniae,Chlamydia pneumoniae and Legionella pneumophila are recognized as common and important pathogens in community-acquired respiratory tract infections(RTIs).Macrolides,tetracyclines and fluoroquinolones are the most commonly employed drugs in the treatment of these atypical pathogen infections.Macrolide-resistant M.pneumoniae strains have been reported in Japan,China,France and the United States since 2000.Advances in atypical pathogen infections,etiological resistance and antimicrobial treatment are reviewed in this article. Abstract:Summ ary:Mycoplasma pneum oniae,Chlamydia pneum oniaeandLegionella pneum ophilaare recogn ized as common and important pathogens in commun ity-acqu ired resp iratory tract infections(RTIs).M acrolides,tetracyc lines and fluoroqu ino-lones are the most common ly emp loyed drugs in the treatm ent of these atyp ical pathogen infections.M acrolide-resistantM.pneumon iae strains have been reported in Japan,Ch ina,France and the Un ited States since 2000.Advances in atyp ical pathogen infections,etiological resistance and antim icrob ial treatm ent are reviewed in th is artic le.

OBJECTIVE:To study the relevance between HLA-B27 gene and ankylosing spondylitis in Jiangxi province,and to discuss the diagnostic significance to ankylosing spondylitis.METHODS:A total of 1246 patients with suspected ankylosing spondylitis and related diseases were collected from the First Affiliated Hospital of Nanchang University from October 2007 to December 2008.Among all cases,323 were diagnosed as ankylosing spondylitis,and other 923 were rheumatoid arthdtis or related diseases.A total of 135 healthy subjects were collected as control group.Sequence-specific primer-polymerase chain method(PCR-SSP)was used to detect HLA-B27 gene in 1246patients and 135 healthy controls.The distribution of HLA-B27 gene,correlation between HLA-B27 gene and age,and relation between ankylosing spondylitis and HLA-B27 gene were studied.RESULTS:Total positive rate of HLA-B27 gene was 32.5%in 1246 patients with suspected ankylosing spondylitis.3.7%in 135healthy controls.and 91.6%in 323 patients with ankylosing spondylitis,respectively.The positive rate and incidence rates of male were significantly higher than female(P＜0.01)and mainly concentrated in the age of adolescence.The sensitivity of HLA-B27 genewas 91.64%and the specificity was 88.19%in patients with ankylosing spondylitis.CONCLUSION:HLA-B27 gene was highly correlated with ankylosing spondylitis in Jiangxi province,which was the same as other regions,suggesting that HLA-B27 gene is significance for diagnosis of ankylosing spondylitis in an eedy phase.

Objective To investigate the profile of antimicrobial susceptibility of the Mycoplasma pneumoniae (Mpn)strains isolated from pediatric patients with respiratory tract infection.Methods Antimicrobial susceptibility testing was conducted with a total of 112 Mpn clinical strains by broth microdilution method.Sequence analysis of full 23S rRNA genes was performed for all Mpn strains.Results One hundred and twelve Mpn strains were isolated from January 2009 to March 2011. Of these clinical isolates,98 (87.5%)were resistant to erythromycin and azithromycin.All macrolide-resistant Mpn strains harbored an A2063G or A2064G transition mutation in domain V of 23S rRNA genes.Mpn isolates were still very susceptible to the tetracyclines and fluoroquinolones tested.Conclusions The Mpn strains from pediatric patients are highly resistant to macrolides.The mechanism of macrolide resistance may be associated withthe transition mutation on 23S rRNA gene.

Objective To explore the diagnostic and differential diagnostic points of patients with rheumatoid arthritis (RA) complicated with fever.Methods Full clinical analysis was performed for a 62-year old patient with RA and fever.Results Hemophagocytes were found in bone marrows smear.Significantly increased ferritin level (74 299 ng/ml),decreased hemoglobin (67 g/L) and platelet (33×109/L),decreased fibrinogen,increased serum soluble CD25 (sCD25),positive cytomegalovirus (CMV) DNA,positive CMV-PP65 antigen,were found by laboratory examination.Decreased activity of NK cells was detected by flow cytometry.Positron emission computed tomography (PET-CT) revealed splenomegaly and pulmonary inflammations.The clinical conditions were recovered with the treatment of corticosteroid,VP16,cyclosporine,anti-CMV virus therapy.Ferritin level was significantly decreased and platelet was normal.The patient was diagnosed as hemophagocytic syndrome associated with CMV infection.Conclusion The possibility of hemophagocytic syndrome should be considered in RA patients presented with fever.

Objective To develop a method for rapid detection of Mycoplasma pneumoniae and its macrolide resistance mutation. Methods The primers and cycling probe sets were designed to detect two single nucleotide mutation, A2063G and A2064G, in the 23s rRNA gene of Mycoplasma pneumoniae. By using recombinant plasmids containing 23s rRNA gene fragments, 102 Mycoplasma pneumoniae clinical isolates from 2005 to 2008, and 136 nasopharyngeal suction specimens from pediatric patients with low respiratory tract infections in Shanghai Children's Hospital from November to December in 2009 were investigated to determine the specificity and the sensitivity of the CycleavePCR method. PCR amplification and sequence analysis of 23S rRNA genes were performed for all Mycoplasma pneumoniae strains and Mycoplasma pneumoniae positive specimens to confirm the results of the CycleavePCR method. Results Of 102 clinical isolates, 83 was resistant to erythromycin and sequence results show that all macrolide-resistant Mycoplasma pneumoniae strains harbored an A2063G ( 82/83 ) or A2064G ( 1/83 ) transition mutation in 23S rRNA genes. Twelve was Mycoplasma pneumoniae detected positive by CycleavePCR in 136nasopharyngeal suction specimens. The CycleavePCR results were consistent with those of routine PCR and sequencing. There was no signal production from other bacterial species. Sensitivity and specificity were 100%. The detection limit of the CycleavePCR was 10 plasmid copies per reaction. Experiment can be done within 1.5 h. Conclusion A novel method is developed to detect erythromycin-resistant strains harboring A2063G and A2064G transition mutation in the 23s rRNA gene using CycleavePCR.

Objective Through the exploration of virtual simulation surgery to find a way to treat lumbar spinal metastases. Methods Based on 64 row spiral CT continuous 2-dimensional images of lumbar segments, normal lumbar vertebral, destruction of disease, abdominal aorta and kidneys were reconstructed by the Mimics software. 3D visualization structure was contemplated by anterior lesions clear, titanium mesh of bone cement support, and posterior pedicle screw fixation. Results The three-dimensional reconstruction distinctly displayed the structures of lumbar and its adjacent organs, and the entire virtual simulation surgery was intuitive. Conclusion The application of virtual simulation surgery ensures more accurate 3D model of lumbar establishment and its adjacent organs, and it provides an objective basis for in-dividualized treatment programs.

Objective To learn the current in vitro antimicrobial susceptibility of Mycoplasma pneu-moniae in Shanghai and to understand the mechanisms of resistance to macrolides. Methods M. pneumoniae was isolated from pediatric patients with low respiratory tract infections(RTI) using broth and PPLO agar medi-um. PCR amplification and sequence analysis of P1 adhesion gene were performed to identify all M. pneumoniae strains. Susceptibility testing was carried out for macrolides, tetracyclines and fluoroquinolones using broth mi-crodilution method with SP4 broth. PCR amplification and sequence analysis of 23S rRNA genes were performed for all M. pneumoniae strains. P1 gene PCR-RFLP typing was performed to subtype the M. pneumoniae strains. Results One hundred and two M. pneumoniae strains were isolated in Shanghai from Oct 2005 to Dec 2008. All M. pneumoniae isolates were susceptible to the tetracyclines and fluoroquinolones tested. Of 102 clinical isolates, 83(81.4%) was resistant to erytbromycin and all 83 erythromycin-resistant strains had MIC>128 mg/L. An increasing trend of resistance rates were showed: 16.7% (1/6) in 2005, 76.5% (13/17) in 2006, 100.0% (24/24) in 2007 and 81.8% (45/55) in 2008. All macrolide-resistant M. pneumoniae strains harbored an A2063G transition mutation in domain V of 23S rRNA genes. The P1 gene RFLP type 1 is predominant (85.3%, 87/102) in M. pneumoniae clinical isolates. Conclusion The macrolide resistance rate of M. pneu-moniae is very high in Shanghai. The mechanism of macrolide resistance is associated with transition mutation on the 23S rRNA gene.

Objective To evaluate antimicrobial resistance and antimicrobial resistance mechanisms of Enterococcus faecalis (E.faecalis)to linezolid (LNZ),and provide basis for clinical rational drug use.Methods Twelve E.faecalis strains isolated from sputum of patients who received LNZ therapy in a hospital between January 2012 and January 2013 were collected.The minimum inhibitory concentrations (MICs)of antimicrobial agents were de-termined by agar dilution method,23S rRNA V region gene of E.faecalis was amplified by polymerase chain reac-tion,the amplified products were sequenced.Results Of 1 2 isolates,2 were intermediate strains and 1 0 sensitive strains.The G2576U mutation was detected in 2 intermediate strains,1 of which was also detected G2424U muta-tion;the variations were not detected in 10 sensitive strains.C2424U and G2576U mutation existed in R1 and R4 region respectively.Conclusion 23S rRNA V region gene mutations are found in the intermediate strains of E.faecalis.Change in MIC values of linezolid should be paid close attention in clinical use.

OBJECTIVE:To observe the activity of Pyrazinamide gel against Mycob ac terium tuberculosis in vitro and its security in bronchial interventional therap y METHODS:The MIC and MBC of Pyrazinamide and Pyrazinamide gel were measured b y handwork method and instrument method and secuity of Pyrazinamide gel was asse ssed by bronchial interventional therapy in rabbits RESULTS:The MICs of pyrazi namide gel to M tuberculosis H37 RV,M bovis and M phlei were 1mg/L,1mg/L,1 0mg/L,the MBCs of Pyrazinamide gel to M tuberculosis H37RV,M bovis and M ph lei were 10mg/L,10mg/L,40mg/L respectively;the MIC and MBC of Pyrazinamide gel and those of Pyrazinamide had no significant differences;the animal security ex periment was negative CONCLUSION:These results suggest that Pyrazinamide gel a nd Pyrazinamide have the same efficacy against M tuberculosis,because carbomer dose not affect the activity of Pyrazinamide against M tuberculosis;Pyrazinami de gel which contains carbomer is safe in bronchial interventional therapy

OBJECTIVE To analyze the research status and hotspots of wine processing of Chinese medicine， and to provide reference for its related research. METHODS Related literature about wine processing research in Chinese medicine was retrieved from CNKI and Web of Science （WOS）. VOSviewer 1.6.18 and CiteSpace 6.1.1R2 software were used to visualize the core authors， research institutions， keywords， and other contents. RESULTS A total of 962 Chinese literature and 57 English literature were included in the study. In total， the trend in the amount of Chinese and English literature was on the rise during 2000-2022. The analysis of the authors showed that ZHANG Xuelan and CAI Baochang had the most publications in Chinese and English literature. Research institutions were mainly Chinese medicine universities， and Chengdu University of Chinese Medicine and Nanjing University of Chinese Medicine were the research institutions with the largest number of Chinese and English literature published. The analysis of keywords in Chinese and English literature showed that the wine-processing research of Chinese medicine mainly focused on wine-processed varieties， chemical constituents， wine-processed process， and quality standards. Response surface method， chroma value， metabolomics， and action mechanism had become current research hotspots. CONCLUSIONS The related research of wine processing for Chinese medicine is still in the development period. In the future， the response surface method to optimize the wine-processed process and the combination of metabolomics with related technologies of other omics to reveal the pharmacodynamic mechanism of wine processing for Chinese medicine is still the future development trend. In the future， cooperation between institutions should be further strengthened， and research on the use of excipients and alcohol should be strengthened. Modern analytical methods should be utilized to enhance the efficiency of wine processing for Chinese medicine， thereby promoting the modernization and internationalization of wine processing for Chinese medicine.