Objective To analyze the distribution of pathogens isolated from medistream urine specimens of patients with urinary infection and their antibacterial susceptibility ,so as to provide references for rational use of antibacterial agents .Methods A total of 853 medistream urine specimens collected from January to December 2014 in this hospital were cultured ,bacterial identification and antimicrobial susceptibility testing were carried in the isolates .Results Pathogens were isolated from 245 medistream urine specimens ,and the positive rate was 28 .7% .A total of 269 strains were isolated and most were gram‐negative bacteria(accounted for 60 .2% ) ,followed with gram‐positive bacteria(accounted for 33 .8 % ) and fungi(accounted for 5 .9% ) .A total of 48 strains of extended‐spectrumβ‐lactamases(ESBLs)producing Escherichia coli and 3 strains of ESBLs producing Klebsiella pneumoniae were i‐solated .The detection rate of methicillin resistant Staphylococcus epidermidis (MRSE) and methicillin resistant Staphylococcus au‐reus(MRSA) was 17 .6% and 35 .8% ,respectively .Conclusion Clinical physicians should scientifically and rationally select anti‐bacterial drugs according to drug‐sensitivity results and avoid blindly empirical use of antibacterial agents ,in order to reducing and controlling the emergence and prevalence of ESBLs producing strains and other drug‐resistant bacteria .

Objective To explore the sensitivity and specificity of anti‐cyclic citrullinated peptide antibody (anti‐CCP antibody) and anti‐keratin antibody (anti‐AKA antibody) detection for diagnosing rheumatoid arthritis (RA) and the application value of their combination detection in the diagnosis and treatment of RA .Methods The chemiluminescent microparticle immunoassay and indi‐rect immunofluorescence analysis were adopted to detect anti‐CCP antibody and anti‐AKA antibody in 80 cases of RA ,40 cases of other auto‐immune diseases(AID) and 30 people undergoing the physical examination .Results The positive rates of anti‐CCP anti‐body and anti‐AKA antibody in the RA group were significantly higher than those in the non‐RA group and control group ,the differences were statistically significant (P< 0 .05) .The sensitivity of single anti‐CCP antibody detection in the RA group was 73 .8% ,which was higher than 41 .3% of anti‐AKA antibody ,while the specificity of single anti‐CCP antibody detection was 86 .2% ,which was lower than 95 .7% of anti‐AKA antibody detection .In their combined detection ,the sensitivity and specificity were increased .Conclusion The anti‐CCP antibody detection has higher sensitivity and specificity for diagnosing RA .Its combined detection with anti‐AKA antibody can avoid the missed diagnosis of atypical clinical early stage RA ,which has a higher clinical value in the diagnosis and prognosis of RA .

Objective To analyze and compare the clinical characteristics of primary sclerosing cholangitis (PSC) with IgG4-related sclerosing cholangitis (IgG4-SC).Methods The clinical data of 32 PSC patients and 72 IgG4-SC patients who were hospitalized in Peking Union Medical College Hospital (PUMCH) from January 2004 to December 2014 were retrospectively analyzed.Results Of the 32 PSC patients,there were 16 male and 16 female.Of the 72 IgG4-SC patients,there were 61 male and 11 female,(ratio =5.5∶ 1).The average ages were 44.9 (11 ～ 77) and 59.8 (28 ～ 83) years,respectively (P ＜0.05).The most common symptoms of PSC and IgG4-SC were abdominal pain and jaundice,and the incidences of abdominal pain and jaundice were 50.0％ and 68.1％,78.1％ and 81.9％,respectively.The serum IgG4 level of the IgG4-SC patients was significantly higher than the PSC patients (P ＜ 0.05).The total protein in serum of the IgG4-SC patients was higher than the PSC patients (P ＜ 0.05).The rate of bile duct wall thickening as detected on endoscopic ultrasonography (EUS) was higher than by abdominal ultrasound and abdominal CT,which were 91.2％,11.5％ and 33.3％,respectively (P ＜0.05).12 PSC patients were followed up for over 2 years,including 2 patients who underwent liver transplantation after failure of conservative treatment,5 patients who died from hepatic failure and infection,and 3 with stable condition.43 IgG4-SC patients were followed up for over 2 years,including 16 patients with relapse.The recurrence rate was 37.2％ (16/43).The more the extrabiliary organs or bile duct segments were involved,the higher was the recurrence rate.Conclusions Both PSC and IgG4-SC are cholestatic diseases,and they have many similarities in clinical and imaging manifestations.However,they still have unique features.IgG4-SC is sensitive to glucocorticoids therapy and has good prognosis.Thus,it is important to differentiate PSC from IgG4-SC.

Background: Insulin resistance (IR) is the key pathological basis of many metabolic disorders. Lack of asialoglycoprotein receptor 1 (ASGR1) decreased the serum lipid levels and reduced the risk of coronary artery disease. However, whether ASGR1 also participates in the regulatory network of insulin sensitivity and glucose metabolism remains unknown. Methods: The constructed ASGR1 knockout mice and ASGR1-/- HepG2 cell lines were used to establish the animal model of metabolic syndrome and the IR cell model by high-fat diet (HFD) or drug induction, respectively. Then we evaluated the glucose metabolism and insulin signaling in vivo and in vitro. Results: ASGR1 deficiency ameliorated systemic IR in mice fed with HFD, evidenced by improved insulin intolerance, serum insulin, and homeostasis model assessment of IR index, mainly contributed from increased insulin signaling in the liver, but not in muscle or adipose tissues. Meanwhile, the insulin signal transduction was significantly enhanced in ASGR1-/- HepG2 cells. By transcriptome analyses and comparison, those differentially expressed genes between ASGR1 null and wild type were enriched in the insulin signal pathway, particularly in phosphoinositide 3-kinase-AKT signaling. Notably, ASGR1 deficiency significantly reduced hepatic gluconeogenesis and glycogenolysis. Conclusion The ASGR1 deficiency was consequentially linked with improved hepatic insulin sensitivity under metabolic stress, hepatic IR was the core factor of systemic IR, and overcoming hepatic IR significantly relieved the systemic IR. It suggests that ASGR1 is a potential intervention target for improving systemic IR in metabolic disorders.

【Objective】 To analyze the composition of urinary calculi in Longnan, Gansu province, and the relationship between the composition and clinical characteristics of patients, so as to provide reference for the prevention and treatment of this disease. 【Methods】 The composition of 500 cases of urinary calculi hospitalized in our department during Apr. 2021 and Feb.2023 were analyzed using the infrared spectrum stone composition analyzer. The clinical characteristics of the patients were evaluated and analyzed. 【Results】 The male-to-female ration of patients was 2.70∶1. Most patients aged 21 to 60 years (437, 87.4%). Most cases were ureteral calculi (72.8%), followed by renal calculi (22.2%), and bladder calculi (5.0%). There were 166 cases of calcium oxalate calculi, 293 cases of calcium oxalate + carbonated apatite calculi, 24 cases of calcium oxalate + carbonated apatite + hydroxyl apatite calculi, 4 cases of calcium oxalate + calcium bicarbonate calculi, 7 cases of urate calculi, 6 cases of carbonated apatite + struvite calculi. Oxalate calculi were the most common in all age groups, and urate calculi were the most common in the 21 to 40 age group. Calcium oxalate calculi were most common in the ureter (127, 76.5%), significantly higher than in other sites (χ²=3.222, P=0.020). Calcium oxalate + calcium hydrogen phosphate calculi was the least common in the bladder, significantly different from the other parts (χ²=2.092, P=0.037). Magnesium ammonium phosphate hexahydrate and/or calcium carbonate or calcium oxalate calculi were the most common in the kidney (50.0%), significantly different from the other parts (χ²=9.448, P=0.007). 【Conclusion】 In Longnan area, the incidence of urinary calculi is significantly higher in male than in female. Ureteral calculi are mainly composed of calcium oxalate + carbonated apatite and calcium oxalate. According to different risk factors, individual prevention programs should be developed.