Objective To investigate the drug resistance and risk factors of hospital-acquired pneumonia (HAP) induced by imipenem-resistant Acinetobacter baumannii.Methods Clinical data on 114 patients with Acinetobacter baumannii-related HAPs admitted in Wujiang First People' s Hospital in Suzhou during January 2013 and December 2014 were retrospectively analyzed.According to the results of drug sensitivity test,patients were divided into imipenem-resistant group and non imipenem-resistant group.Drug resistance to 20 commonly used antibiotics was observed in two groups,and multivariate Logistic regression analysis was performed to identify the risk factors of imipenem-resistant Acinetobacter baumannii infection.Results Among 114 strains ofAcinetobacter baumannii,66 strains (57.89％) were imipenem-resistant and 48 strains (42.11％) were non-imipenem-resistant.The resistance rates to β-lactams,quinolones and aminoglycosides were significantly higher in imipenem-resistant group than those in non-imipenem-resistant group (P ＜ 0.01),and no tigecycline-resistant strain was found in both groups.Univariate analysis showed that acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ) score ≥ 15,plasma level of albumin ≤ 25 g/L,intensive care unit (ICU) stay,indwelling gastric tube,deep venous catheterization,establishment of artificial airway,mechanical ventilation time ≥ 7 d,use of broad-spectrum antibiotics ≥ 14 d and combined use of antibiotics were risk factors of imipenem-resistant Acinetobacter baumannii related HAP (x2 =13.06,6.86,25.40,15.09,17.87,21.46,17.94,6.91 and 10.10,P ＜0.01).Multivariate Logistic regression analysis revealed that establishment of artificial airway [OR =72.014,95％ confidetial interval (CI):19.566-265.061,P ＜ 0.01],and use of broad-spectrum antibiotics ≥ 14 d (OR =3.892,95％ CI:1.092-13.879,P ＜ 0.05) were independent risk factors of imipenem-resistant Acinetobacter baumannii related HAP.Conclusion Imipenem-resistant Acinetobacter baumannii strains are highly resistant to most antibiotics.Strict control of invasive procedures and long-term combined use of antibiotics may reduce the occurrence of imipenem-resistant Acinetobacter baumannii related HAPs.

Adolescent ; Child ; Child, Preschool ; China ; epidemiology ; Female ; Humans ; Incidence ; Infant ; Male ; Respiratory Tract Infections ; epidemiology ; virology ; Virus Diseases ; epidemiology

Objective To investigate the epidemiological characteristics of children infected by mycoplasma pneumoniae(MP)over the last five years in Kunming region.Methods Indirect immunofluorescence assay was used to detect blood MP-IgM of hospitalized patients from January 2003 to December 2007 in order to determine the age and gender distribution characteristics of MP infection and to investigate the epidemiological features of the five years' results.Results Infection incidences by MP in Kunming region over the last five years were 20.9%,14.3%,17.5%,15.7%and 19.5%,respectively.Statistical significance was found among the groups mentioned above(P＜0.01).The MP infection incidences in different age groups were 10.7%(～1 year old),20.5%(～3 years' old),21.5%(～6 years' old)and 21.7%(～14 years' old).MP infection incidences showed age and gender characteristics(P＜0.01).Infants showed lower NIP infection incidence and infection incidence was higher in female.The epidemiological investigation indicated that MP infection incidences varied from year to year(P＜0.01).The infection incidences of 2003 and 2007 by MP were higher than those of the other years.There were epidemiological differences in infection incidences by NIP over last five years(summer,autumn and winter).The MP infection incidences showed seasonal differences(P＜0.01).Conclusion Mycoplasma pneumoniae was the main local causative agent responsible for respiratory tract infection in children aged under one years' old in Kunming region.Over the last five years,there were two outbreaks in the local area,but with no seasonal regularity of epidemiology.

ObjectiveTo analyze the seroepidemiologic of Mycoplasma pneumoniae infection and evaluate antibiotics medication of some positive patients by follow-up. Methods Serodia-MycolⅡ particle agglutination assay was used to detect serum antibodies against Mycoplasma pneumoniae in 3 134 clinically suspected infections. Mycoplasma pneumoniae infection was determined and seroepidemiologic was analyzed by results of the test, including positive antibody rates in whole subjects, in male or female groups, in different seasons or age groups as well as in different sources. Evaluate antibiotics medication of some positive patients by follow-up. The average days of medication were counted, different antibiotics medication and medication effect were analyzed. Results In 3 134 serum samples from clinically suspected Mycoplasma pneumoniae infections, 350 ( 11.2％ ) were tested with positive antibodies. The positive antibody rate in female patients was 12. 3％ ( 198/1 604), which was higher than 9. 9％ ( 152/1 530) in males (X2 =4. 58,P ＜0. 05). The peak season was found in the fourth quarter (October-December) with 13.2％ of positive antibody and the highest positive rate (32. 8％, 45/137 ) was found in school aged (5 -9 years old )children. Samples from pediatrics clinic and ward were tested to have highest positive rates ( 27. 9％ and 26. 5％, respectively ), comparing that from other sources. Infection due to Mycoplasma pneumoniae was identified in 28％ (7/25) of community-acquired pneumonia (CAP) patients, which is higher than other diseases. Based on the follow-up of 91 antibody positive patients, between 5 to 120 days ( mean 24. 2 days )were counted from appearance of clinical symptoms to clinic visiting/testing. 71 of 91 (78. 0％ ) patients was medicated with macrolide antibiotics, 4 (4. 4％ ) with quinolones, 4 (4. 4％ ) with cephalosporin, and the rest 12 ( 13.2％ ) patients were medicated with other antibiotics or only symptomatic treatment. The average period of antibiotics medication was between 3 to 21 days (mean 8. 2 days). Medication effect results by follow-up were cure in 35 ( 38. 5％ ), improvement in 50 (54. 9％ ), and poor responses in 6 (6. 6％ ).ConclusionsMycoplasma pneumoniae positive rate in female patients was higher than in males, and peak rate was found in the fourth quarter and in school aged children. Samples from pediatrics clinic and ward were tested to have highest positive rates. Physicians could choose first line antibiotics according to laboratory test results of Mycoplasma pneumoniae, and gain good effect.

Objective To investigate the features and risk factors associated with lymph node metastasis in colorectal neuroendocrine neoplasm.Methods Clinical and pathological data of 63 patients with colorectal neuroendocrine neoplasm treated in Yinzhou People's Hospital between June 1997 to December 2012,were analyzed retrospectively.Comparisons of categorical data and univariate analysis of risk factors of lymph node metastasis were conducted by x2 test,multivariate analysis was conducted by Logistic regression analysis.Results Of the 63 patients the rate of regional lymph node metastasis was 30％ (19/63) with 58％ limited to para-intestinal lymph nodes in 11 cases,26％ limited to mesenteric lymph nodes in 5 cases,and 16％ limited to mesenteric root central lymph nodes in 3 cases.No metastasis exceeding central lymph nodes was observed.According to univariate analysis,tumor size,depth of invasion,ulceration in mucous membrane,invasion of lymphatic vessel and pathological grading suggested by WHO were related to regional lymph node metastasis (P ＜ 0.01).Multivariate regression analysis revealed that tumor size,invasion of lymphatic vessel and pathological grading were independent risk factors for lymph node metastasis in colorectal neuroendocrine neoplasm (P ＜ 0.05).Conclusions Colorectal neuroendocrine neoplasm with larger tumor size,invasion of lymphatic vessel or higher grade (G2,G3) has high risk of regional lymph node metastasis.

Objective To investigate the effects of melatonin on choline acetyltransferase (ChAT) in the hippocampus of rats after isoflurane anesthesia.Methods Sixty male SD rats weighing 390-440 g were randomized into five groups (n =12 each):control group (group C),1％ isoflurane group (group Ⅰ),1％ isoflurane + melatonin group (group IM),2％ isoflurane group (group J) and 2％ isoflurane + melatonin group (group JM).Rats in groups IM and JM received intraperitoneal injection of melatonin (10 mg/kg) for 7 days,and rats in other groups received normal saline.On the 7th day of injection,rats in groups Ⅰ and IM inhaled 1％ isoflurane for 4 hours,and rats in groups J and JM inhaled 2％ isoflurane for 4 hours.One day after anesthesia,all the rats began Morris water maze to assess the learning and memory ability,which was made for continuous 5 days.At the end of probe test,6 rats in each group were randomly selected,blood samples were collected to detect plasma melatonin level,and the hippocampi were removed to evaluate the expression and activity of ChAT.The other rats were sacrificed to perform immunofluorescence to detect ChAT in hippocampal CA1 region and dentate gyrus.Results The plasma melatonin level,and the expression and activity of ChAT were significantly lower in group Ⅰ than in group C (P ＜ 0.01).The escape latency was significantly longer,the probe time was significantly shorter,and the plasma melatonin level and the expression and activity of ChAT were significantly lower in group J than in group C (P ＜ 0.05 or 0.01).The escape latency was significantly shorter,the probe time was significantly longer,and the plasma melatonin level and the expression and activity of ChAT were significantly higher in group IM than in group Ⅰ (P ＜ 0.05 or 0.01).The escape latency was significantly shorter,and the plasma melatonin level and the ChAT activity were significantly higher in group JM than in group J (P＜ 0.05 or 0.01).Conclusion Melatonin can attenuate isoflurane-induced ChAT inhibition and thus improve the cognitive function of rats after isoflurane anesthesia.

Objective To prospectively investigate the value of urinary neutrophil gelatinase-associated lipocalin (NGAL) in the diagnosis of acute kidney injury (AKI) following adult cardiac surgery. Methods Twenty-nine hospitalization patients undergone cardiac surgery were enrolled in the study. Serial blood and urinary samples were collected immediately before incision and at various time intervals after surgery. The primary outcome measure was acute kidney injury, defined as a 50% increase in the level of serum creatinine (Scr) from baseline. Results Fourteen of 29 developed acute kidney injury. The diagnosis time point with Ser was at 24 (10, 48) h after cardiac surgery. By contrast, the concentration of urinary NGAL rose from a median of 3.42(1.60, 9.92) μg/L at baseline to 20.51(13.42, 50.02) μg/L at admission to ICU (P=0.006),and the median concentration of urinary NGAL in patients who developed AKI was significantly higher at admission to ICU compared with patients who did not develop AKI [20.51 (13.42, 50.02) μg/L vs 2.91 (0.72,8.61) μg/L, P=0.002]. As to urinary NGAL at admission to ICU, the area under the receiver-operating characteristic (ROC) curve was 0.824, the sensitivity was 85.7% and the specificity was 80.0% with a cutoff value of 10.95 μg/L. Significant correlation was found between urinary NGAL at admission and the levd of Scr at 24 h in ICU (r=0.545, P=0.002), as well as estimated GFR (r=-0.546,P=0.002). Conclusion Urinary NGAL concentration is significantly higher in patients developing postoperative AKI at the early time of admission to ICU, which may be a useful early biomarker of AKI after adult cardiac surgery.

Objective To understand the prevalence,drug resistance and clinical features of children with acute lower respiratory tract infection(ALRI) caused by escherichia coli.Methods From Oct. 2005 to Oct. 2006,659 patients with ALRI who were admitted to hospital were chosen and their nasopharyngeal secretions were obtained and cultured.K-B disc diffusion for antibiotic susceptibility were performed for these clinical isolates.Results Among 659 patients,118 cases were isolated escherichia coli,the rate was 17.99% which had 90 boys and 28 girls.Eighty-seven of 118 E.coli strains were with extended-spectrum ?-lactamase(ESBLs),the rate was 73.73%.All of strains were sensitive to imipenem.For ESBLs-producing strains,the ratio of resistance tocefotaxime,ceftriaxone,cefuroxime,ampicillin,piperacillin were 78.81%,73.73%,73.73%,76.27%,78.81%,respectively.Conclusions The positive rate of ESBLs producing E coli in Kunming area is high and drug resistance is severe gradually.Imipenem can be the first selection for treatment on these infections.

The changes of interstitial cells of Cajal(ICC)distribution and connexin 43(Cx43)expression in gastric muscle layers were assayed in gastroparesis models of streptozotocin-induced diabetic rats.The results showed that gastric emptying was significantly delayed,the contraction frequency and amplitude of gastric muscle segments were greatly decreased,Cx43 gray values were significantly increased and Cx43 distributed homogeneously with ICC immunopositivity in the model rats.These changes appear to be related to the pathogenesis of diabetic gastroparesis.

Objective To determine the pathogenic bacteria distribution and drug resistance in children with sepsis. Methods From 2002 to 2011, a ten consecutive years of monitoring of pathogenic bacteria distribution, drug resistance in pediatric patients with sepsis were conducted. Results From 2002 to 2011, 2 493 strains of pathogenic bacteria were detected in 68 419 specimens of blood culture. The positive rate was 3.64%. Among them, 1 913 strains (76.73%) were the gram-positive bacteria (G+bacteria), 562 strains (22.54%) were gram-negative bacteria (G-bacteria) and 18 strains (0.72%) were fungi. From 2002 to 2006, 959 strains (4.73%) of pathogenic bacteria were detected in 20 287 specimens of blood culture. Among them, the G+bacteria was 731 strains (76.23%), G-bacteria was 228 strains (23.77%). From 2007 to 2011, 1 534 strains (4.73%) of pathogenic bacteria were detected in 48 132 specimens of blood culture, G+ bacteria was 1 182 strains (77.05%), G-bacteria was 334 strains (21.77%), fungi was 18 strains (1.17%). The positive rate of blood culture, the pathogenic bacteria distributions of G+, G-, and fungi were signiifcantly different between the ifrst and the second 5 years (P<0.01). The positive rate of G+bacteria tended to increase and the positive rate of G-bacteria tended to decrease. Com-paring between the ifrst and second 5 years, the positive rate of coagulase-negative staphylococci, Klebsiella, Alcaligenes, fungi tended to increas, and the positive rate of Staphylococcus aureus, Enterococcus, Pseudomonas, Salmonella tended to decrease. The distribution of pathogens in different age groups of children with sepsis also were signiifcantly difference (P<0.001). Over the 10 years, G+positive bacteria were highly resistant to penicillin and erythromycin, but not resistant to Vancomycin. ESBLs positive E. coli strains and Klebsiella Trevisan became highly resistant to antibiotics. Salmonella was sensitive to commonly used antibiotics. Conclusions Coagulase negative staphylococcus was the most common pathogenic bacteria in children with sepsis in the last 10 years, multiple pathogenic bacteria also show a growing trend in drug resis-tance.