Objective To analyze the genotypes and homology of MSP?1 and CSP gene of Plasmodium vivax in Shandong Province,so as to provide the evidence for case traceability. Methods A total of 12 blood samples were collected from P. vivax?infected cases in Shandong Province in 2011. Parasite genomic DNA was extracted. Primers were designed according to MSP?1 and CSP gene sequences of P. vivax. Then Nested PCR,enzyme digestion,sequencing and sequence alignment,and homolo?gous analysis were performed. Results The MSP?1 gene of all the 12 samples from P. vivax?infected cases were detected with a 470 bp PCR amplification band,and 350 bp and 120 bp enzyme digestion fragments,which were identified as type Sal?1. An analysis of phylogenetic tree of MSP?1 gene showed that the sequences of 9 indigenous case samples in Shandong Province were located in the same branch,one case sample infected from India was located in the same branch with India strains. All the 12 P. vivax?infected samples covered GDRA(D/A)GQPA sequences in CSP gene,which were identified as type PV?Ⅰ. Of the CSP gene among 12 P. vivax?infected samples,10 samples of indigenous case in Shandong Province and one sample of the case in?fected in Guangdong Province were detected with both 560-840 bp and 150-230 bp PCR amplification bands,which were iden?tified as temperate zone family strain of type PV?Ⅰ. However,one sample from the case infected in India was detected only with a 560-840 bp band,which was identified as tropical zone family strain of PV?Ⅰ. An analysis of phylogenetic tree of CSP gene showed that the sequences of 10 samples from the indigenous cases in Shandong Province and one sample from the case infected in Guangdong Province were located in the same branch,one sample from the case infected in India was located in the same branch with India and Indonesia strains. Conclusion Of all the indigenous isolates in Shandong Province,MSP?1 gene is geno?typed type Sal?1,CSP gene is genotyped temperate zone family strain of type PV?Ⅰ,with a high homology found among the in?digenous isolates.

Fournier gangrene is a relatively rare clinical critical disease, and its clinical symptoms are not specific and easily unrecognized by some clinicians. It has the features of acute onset, quick development, severe illness, and often accompanied by infection shock which is seriously life-threatening. It is difficult in treatment with high medical costs and long length of hospitalization, which increases pain for patients and relatives and brings heavy economic and psychological burden on patients, society, and medical workers. By reviewing the literature home and abroad and combined with clinical practice, I summarize the researches on concept, epidemiology, clinical manifestation, diagnosis and treatment of Fournier gangrene, in order to provide reference for vast number of clinical workers.

Objective To summarize and analyze the clinical first aid characteristics and etiology classi-fication of adult acute laryngeal obstruction so as to guide the targeted treatment in clinic.Methods The clini-cal data of the patients with the main symptoms such as suffocation and inspiratory dyspnea visiting in this hospital from January 2015 to December 2021 were collected.They conducted emergency tracheotomy for first aid,and their etiological distribution and characteristics were analyzed.Results A total of 94 patients with a-cute laryngeal obstruction and emergency tracheotomy caused by various causes were collected,73 males and 21 females,aged (65.44±12.23)years old.The proportions of disease causes from high to low were in turn 60 cases of tumor (63.83％),12 cases of bilateral vocal cord paralysis (12.77％),11 cases of inflammation (11.70％),5 cases of trauma (5.32％),2 cases of laryngeal edema (2.13％),2 cases of giant foreign matter (2.13％) and 2 cases of tube taking off after tracheotomy (2.13％).The age had the statistical difference a-mong different etiologies (F=4.463,P=0.001).The age in the patients with tumor,infection and bilateral vocal cord paralysis was greater than that of the other groups with statistical difference[(67.21±10.45)years old vs.(52.00±16.42)years old,t=2.993,P=0.012].The male patients with different severities of acute la-ryngeal obstruction were more than female patients,but the difference in the sex composition was not statisti-cally significant (P=0.469).Among the patients with emergency tracheotomy,there were 6 cases of compli-cating incision bleeding and 5 cases of subcutaneous emphysema;1 case of right pneumothorax complicating apposite side atelectasis,and all were improved by symptomatic treatment.Conclusion Acute laryngeal ob-struction in adults is critical.The common causes include tumor,bilateral vocal cord paralysis and inflamma-tion.The risk of emergency tracheotomy and complications occurrence risk are relatively high.

Objective To evaluate the predictive factors for failure of non-invasive positive pressure ventilation (NIPPV) in immunosuppressed patients with acute respiratory failure (ARF). Methods The clinical data of 118 immuno-deficient patients treated with NIPPV in the respiratory and intensive care unit (RICU) of the First Affiliated Hospital of Xinjiang Medical University from January 2012 to August 2017 were retrospectively analyzed. The patients were divided into a non-endotracheal intubation (ETI) group (n = 62) and ETI group (n = 56) according to whether ETI was performed during the hospitalization period or not. Each observed indicator was analyzed by univariate analysis, and factors leading to failure of NIPPV were further analyzed by Logistic regression. Receiver operating characteristic (ROC) curve was plotted to evaluate the predictive value of risk factors for failure of NIPPV in immunosuppressed patients with ARF. Results The non-intubation rate for NIPPV in immunosuppressed patients was 50.8% (60/118). Compared with the non-ETI group, the body temperature, pH value in the ETI group were significantly increased, the partial pressure of arterial carbon dioxide (PaCO2) was significantly decreased, the ratio of oxygenation index (PaO2/FiO2) < 100 mmHg (1 mmHg = 0.133 kPa), acute physiology and chronic health evaluation Ⅱ(APACHE Ⅱ) score ≥ 20, and the number of cases requiring catecholamine were significantly increased, the mortality was significantly increased. Multivariate Logistic regression analysis showed that the APACHE Ⅱ score ≥ 20 [odds ratio (OR) = 15.274, 95% confidence internal (95%CI) = 2.175-107.252, χ2= 7.516, 1 = 0.006], PaO2/FiO2< 100 mmHg (OR = 0.075, 95%CI = 0.014-0.408, χ2= 8.968, 1 = 0.003), and need for catecholamine (OR = 35.736, 95%CI = 6.974-183.124, χ2= 18.400, 1 < 0.001) were independent risk factors for failure of NIPPV. ROC curve analysis showed that the APACHE Ⅱ score ≥ 20 and PaO2/FiO2< 100 mmHg could predict failure of NIPPV, the area under ROC curve (AUC) of the APACHE Ⅱ score ≥ 20 was 0.787, the sensitivity was 83.93%, the specificity was 69.35%, the positive predict value (PPV) was 71.21%, the negative predict value (NPV) was 82.69%, the positive likelihood ratio (PLR) was 2.74, the negative likelihood ratio (NLR) was 0.23, and Youden index was 0.53; the AUC of PaO2/FiO2< 100 mmHg was 0.757, the sensitivity was 80.65%, the specificity was 66.07%, the PPV was 68.18%, the NPV was 78.85%, the PLR was 2.38, the NLR was 0.29, and Youden index was 0.47. Conclusions 50.8% of immunocompromised and ARF patients treated with NIPPV did not require ETI, which is independent of the etiology of ARF. APACHE Ⅱ score ≥ 20, PaO2/FiO2<100 mmHg, and the need for catecholamine are predictive factors for failure of NIPPV in immunocompromised patients.

Klebsiella pneumoniae(K.pneumoniae)is an important pathogen that can cause severe hospital-and community-acquired infections.To systematically investigate its methylation features,we determined the whole-genome sequences of 14 K.pneumoniae strains covering varying serotypes,multilocus sequence types,clonal groups,viscosity/virulence,and drug resistance.Their methy-lomes were further characterized using Pacific Biosciences single-molecule real-time and bisulfite technologies.We identified 15 methylation motifs[13 N6-methyladenine(6mA)and two 5-methylcytosine(5mC)motifs],among which eight were novel.Their corresponding DNA methyl-transferases were also validated.Additionally,we analyzed the genomic distribution of GATC and CCWGG methylation motifs shared by all strains,and identified differential distribution pat-terns of some hemi-/un-methylated GATC motifs,which tend to be located within intergenic regions(IGRs).Specifically,we characterized the in vivo methylation kinetics at single-base resolu-tion on a genome-wide scale by simulating the dynamic processes of replication-mediated passive demethylation and MTase-catalyzed re-methylation.The slow methylation of the GATC motifs in the replication origin(oriC)regions and IGRs implicates the epigenetic regulation of replication initiation and transcription.Our findings illustrate the first comprehensive dynamic methylome map of K.pneumoniae at single-base resolution,and provide a useful reference to better understand epigenetic regulation in this and other bacterial species.

【Objective】 To investigate the effects of 80 kVp combined with multi-model adaptive statistical iterative reconstruction algorithm （ASiR-V） on the image quality of CT angiography （CTA） of iliac artery in kidney transplantation candidates before operation. 【Methods】 Totally 50 kidney transplantation candidates underwent “one-stop” scanning combined CTA for coronary and iliac arteries were recruited consecutively. After the scanning， images were reconstructed with different ASiR-V levels on the iliac artery from 50% to 100% at a 10% interval， and 6 groups of images were obtained. We evaluated and compared all image qualities， DLP and CTDI in the patients’ examination were recorded， and the effective dose （ED） was calculated. 【Results】 All of the image quality objective scores of different ASiR-V levels on the iliac artery were above 3 points （3.32±0.24）， and the average CT value was （344.30±74.53）HU. The ED received by the patient throughout the examination was （2.71±0.42)mSv. The image noise decreased while SNR and CNR increased monotonically as the ASiR-V levels increased， among which 80% ASiR-V image quality score was the highest with 3.41±0.26. 【Conclusion】 For patients who need to have both coronary and iliac arteries evaluated before kidney transplantation operation， low tube voltage （80 kVp） combined with 80% ASiR-V can obtain high-quality iliac artery images under the premise of reducing the ED dose， which can provide practical basis for further reducing the dose in personalized scanning scheme for such patients. It has good feasibility and clinical application value.