Objective To analyze the bacterial distribution and antibiotic resistance of pathogenic bacteria in elderly patients with hospital-acquired pneumonia (HAP) so as to provide evidence for rational use of antibiotics. Methods The clinical data of 160 elderly patients with HAP in our hospital from June 2006 to September 2009 were analyzed retrospectively. And the pathogenic characteristics and antibiotic resistance were analyzed. Results A total of 180 pathogenic bacteria were separated: 108 Gram-negative bacteria (60.0%), 48 Gram-positive bacteria (26.7%) and 24 fungi (13.3%). In Gram-negative bacteria, Pseudomonas aeruginosa was the major pathogen (20.5%), and Staphylococcus aureus was the most prominent in Gram-positive bacteria (11.1%).The detection rate of fungi was increased in patients with long-term use of antibiotics and broadspectrum antibiotics. The Gram-negative bacilli was resistant to third-generation cephalosporin, and extended-spectrum β-lactamases (ESBLs) producing Escherichia coli and Klebsiella pneumonia were resistant to penicillin, penicillin + enzyme inhibitor, cephalosporin and monobactam antibiotics. The drug resistance of Pseudomonas aeruginosa was severe, but it was still sensitive to Ceftazidime. Gramnegative bacteria showed high sensitivities to Amikacin, Piperacillin + Tazobactam, Cefoperazone +Sulbactam, Imipenem and Meropenem. Methicillin-resistant Staphylococcus aureus (MRSA) occupied 92.6% of Staphylococcal aureus. The resistance rates of Gram-positive bacteria to Azithromycin,Ciprofloxacin, Oxacillin, Ampicillin + Sulbactam were all higher than 76%, but Gram-positive bacteria showed high sensitivities to Vancomycin, Linezolid and Teicoplanin. The staphylococcal strains that were resistant to Vancomycin, Linezolid and Teicoplanin were not found. Conclusions The major pathogen of HAP in elderly patients is Gram-negative bacilli. The detection rate of ESBLs producing Escherichia coil and Klebsiella pneumonia increases annually, and the drug resistances to the above bacteria is becoming more and more serious. But they are still highly sensitive to Amikacin,Piperacillin+ Tazobactam, Cefoperazone+ Sulbactam, Imipenem and Meropenem. The appropriate antibiotics for Gram-positive bacterial infections are Vancomycin, Linezolid and Teicoplanin.

Aim To investigate the role of TNF-αin propofol-induced neuronal apoptosis and long-term cog-nitive impairment in neonatal rats .Methods Seven-day-old SD rats were randomly divided into 3 groups:Control group ( n =12 ) , P ( single ) group ( n =6 ):propofol 50 mg · kg -1 was injected intraperitoneally (ip.)once;P(repeated) group(n=6):propofol 50 mg · kg -1 was injected ip.once daily, and for seven times. Hippocampal TNF-αlevel was measured 2 hours after propofol anesthesia , there were two time points(n=6) in Control group as control levels (post-natal day 7 for P ( single ) group and postnatal day 13 for P ( repeated ) group ) .In another experiment , 7-day-old rats were randomly divided into 5 groups:Con-trol group; P ( single ) group; P ( repeated ) group; P ( single ) +ETN group: ETN ( etanercept ) 0.4 mg · kg -1 was injected intracerebroventricularly 30 min be-fore propofol administration; P ( repeated ) +ETN group:ETN 0.4 mg· kg -1 was injected intracerebrov-entricularly 30 min before the 1st and 4th administration of propofol , which was injected ip .for seven times , once daily .Hippocampal neuronal apoptosis was detec-ted at postnatal day 7 [ P ( repeated ) and P ( repeated )+ETN groups not involved at this time point ] , 13, 21 and 35 , cognitive function was measured at postnatal day 36 to 41 using Morris water maze test .Results Propofol with different exposure times could increase hippocampal TNF-αlevels(P<0.05,P<0.01);in P ( single ) group, active caspase-3 positive neurons in hippocampal pyramidal cell layer were much greater than control level only at postnatal day 7 ( P<0.05 ) , there were no changes of escape latency or platform crossing times compared with control ( P>0.05 );in P ( repeated ) group, active caspase-3 positive neurons were more significantly increased at postnatal day 13, 21 and 35 than those in control group ( P<0.01 ) , es-cape latency was increased or platform crossing times were decreased more significantly than control in Morris water maze test ( P <0.01 ); after etanercept was ad-ministered intracerebroventricularly , there were no sig-nificant changes of active caspase-3 positive neurons , escape latency and platform crossing times after propo-fol anesthesia compared with control ( P>0.05 ) .Con-clusion TNF-αmediates hippocampal neuronal apop-tosis and long-term cognitive impairment induced by propofol in neonatal rats , and long-term cognitive im-pairment may be related with persistent neuronal apop-tosis.

Objective:To assess the effect of patient-controlled intravenous analgesia (PCIA) with different postoperative analgesics on prognosis after colorectal surgery. Methods:A total of 460 colorectal cancer patients (TNMⅠ-Ⅱ) who underwent elective surgery within January 2010 to December 2012 in Chongqing Cancer Hospital were randomly divided into five groups for PCIA with sufentanil, dezocine, butorphanol, morphine, and tramadol. We evaluated the analgesic efficacy, detected NK cell activity and Th1/Th2 ratio from peripheral blood, and observed short-term complications and long-term cancer recurrence and metastasis. Healthy volunteers served as the control group. Results:The morphine group displayed a VAS score of less than 3 in the rest state and showed the longest hospital stay and the highest incidence of pruritus (P<0.05). The incidence of postoperative nausea and vomiting was the highest in the tramadol group (P<0.05). NK cel activity and Th1/Th2 ratio decreased in al experimental groups after surgery. NK activity and Th1/Th2 ratio returned to the control level 7 days after surgery in the tramadol and sulfentanil groups and 14 days after surgery in the dezocine and butorphanol groups (P>0.05), whereas those in the morphine group remained low (P<0.05). The incidences of cancer recurrence and metastasis were ranked as follows:morphine>butorphnol>dezocine>sufentanil>tramadol. Conclusion:Tramadol and sufentanil used in PCIA after colorectal surgery could facilitate the recovery of immune function and reduced the incidence of recurrence and metastasis.

Objective To investigate the protective effect of agmatine (AGM) against peritoneal inflammatory response and neutrophil (PMN) infiltration induced by zymosan (ZYM) in mice. Methods Thirty-six adult male C57BL/6 mice were randomly divided into sham group, model group, and AGM treatment group. Peritonitis model was reproduced by intra-peritoneal injection of 1 mg/mL ZYM (0.5 mL), while equivalent phosphate buffer saline (PBS) was given to sham group. 200 mg/kg AGM was injected into peritoneal cavity after ZYM challenge in AGM treatment group. Six mice in each group were sacrificed at 2 hours and 6 hours, respectively, after reproduction of the model. Blood sample and peritoneal lavage fluid (PLF) were collected. The levels of keratinocyte-derived chemokine (KC), macrophage inflammatory protein 2 (MIP-2), tumor necrosis factor-α (TNF-α), interleukins-6 (IL-6) in serum and PLF were determined by enzyme linked immunosorbent assay (ELISA). The number of leukocytes and PMN in PLF were determined by hemocytometer and flow cytometry, respectively. Results Compared with sham group, all serum and PLF levels of KC, MIP-2, TNF-α and IL-6 were greatly elevated at 2 hours after ZYM injection in model group, while AGM treatment could dramatically reduce the levels of the above-mentioned cytokines in serum and PLF as compared with those of the model group [serum KC (ng/L): 990.7±137.9 vs. 2 053.2±262.7, MIP-2 (ng/L): 642.2±124.4 vs. 1 369.7±146.5, TNF-α (ng/L): 608.6±38.1 vs. 1 044.7±101.0, IL-6 (ng/L): 1 058.2±129.1 vs. 1 443.3±190.1; PLF KC (ng/L): 7 462.3±839.6 vs. 12 723.5±1 515.7, MIP-2 (ng/L): 1 570.8±193.4 vs. 3 471.4±384.7, TNF-α (ng/L): 1 115.8±156.7 vs. 1 499.2±231.2, IL-6 (ng/L): 2 646.5±223.2 vs. 3 126.7±291.4; all P < 0.05]. The expressions of KC, MIP-2 and TNF-α at 6 hours were significantly lower than those at 2 hours in model group and AGM treatment group, but IL-6 levels were further increased. The levels of KC and MIP-2 in serum and PLF at 6 hours were decreased to the levels of sham group. At 6 hours after the reproduction of the model, the number of total inflammatory cells and PMN of PLF in the model group was significantly higher than those of the sham group. In contrast, AGM notably lowered the number of inflammatory cells and PMN in peritoneal fluid after ZYM attack [total inflammatory cells (×109/L): 14.7±1.1 vs. 2.0±0.4, 10.1±1.2 vs. 14.7±1.1; PMN (×109/L): 11.37±1.22 vs. 0.18±0.05, 7.69±0.57 vs. 11.37±1.22, all P < 0.05]. Conclusion AGM can effectively alleviate acute peritoneal inflammatory injury induced by ZYM, mainly through reducing the secretion of inflammatory mediators and chemokines, and inhibiting the infiltration of leukocytes and neutrophils.

ObjectiveTo analyze the characterstics of phenotype and genotype of multidrug resistant tuberculosis (MDR-TB) and extensively drug resistant tuberculosis (XDR-TB) by molecular line probe assay and liquid culture with MGIT960.MethodsGenoType MTBDR Kits were used for identifying the types of the first-line and second-line antituberculosis drug resistant genes partly and BD MGIT960 was used for detecting the chug susceptibility.Results( 1 ) Out of 94 MDR-TB strains,the rate of drug resistant to EMB,AMK,OFX and MFX by BD MGIT960 assay were 36.2%,17.0%,54.3% and 55.3%,respectively.Among these isolates,13 were extensively drug resistant tuberculosis (XDR-TB).(2) Compared with MGIT960,the concordance rate of GenoType MTBDRplus was 86.2% and 95.7% respectively.Taking MGIT960 results as reference,the sensitivity of GenoType MTBDRsl detecting the susceptibility of EMB,AMK,OFX and MFX to 94 isolates were 47.1%,81.3%,94.1%,94.2%,respectively.The specificity were 75.0%,98.7%,90.7%,92.9%,respectively.(3) Among the rpoB mutation categories,S531L accounts for most.MTB resistant to IFN caused by the mutation of katG chiefly and the S315T1 was in the majority.The gyrA mutation sites located at the ninety-fourth codon most.Out of 94 strains,23 were mixed with 2 kindsof Mycobacterium tuberculosis at least and 7 were undetectable mutations.Conclusion Among the M/XDR-TB,the strains resistant to INH,RFP,AMK,OFX and MFX were caused most by the mutation of katG,rpoB,rrs and gyrA,respectively.The relationship between EMB and embB was not so clear relatively.As a fast detecting drug susceptibility test kit,GenoType MTBDR possess good sensitivity and specificity.So,it could be as an assistant method to guide the therapy on clinic.

Objective: To understand the similarities and differences in different dosage forms of tuberculin test for college students having close contact with tuberculosis in Nanning colleges and universities in order to provide reference for the prevention and control of tuberculosis. Methods: A total of 7 771 students were screened for symptoms and tuberculin skin test(TST)、X radiographs from 2018 to 2019 in Nanning.The used doses of Purified Protein Derivative of Tuberculin (TB-PPD) in 2018 and 2019 were 2 IU and 5 IU respectively. Results: A total of 916 positive cases were detected in 2 years, with the total positive rate of 11.79%. Total strong positive number was 184 and the strong positive rate was 2.37%. The number of tuberculosis patients was 17. Positive rate of the students from grade one to grade four was 13.88%, 8.57%, 10.59%, 10.29%, respectively. The difference was statistically significant(χ 2=46.30，P＜0.01). The positive rates of male and female in the past two years were 13.24%(500/3 777) and 10.42%(416/3 994), respectively (χ 2=17.84, P<0.01)，and there was no significant difference in the diagnosis of pulmonary tuberculosis among TST positive patients (χ 2=0.29,P=0.59). The positive and strong positive rates of 2 IU dose and 5 IU dose were 7.57%, 15.04%, respectively, the difference in dosage forms were statistically significant (χ 2=114.41,P<0.01). The tuberculosis case detection rate (CDR) of moderate & above positive subjects of 2 IU and 5 IU dose was 6.92% and 2.07%, respectively, the difference was statistically significant(χ 2=6.60，P=0.02). Conclusion More positive tuberculosis cases (including moderate & strong positive) can be detected by using 5 IU dose, though it is may not have advantage over discovering tuberculosis patients comparing to 2 IU dose. However, it is more critical to minimize the following cases and control the outbreak in university.

Objective:To report four male COL4A5 mutation mosaicism patients with X-linked Alport syndrome, and to provide evidence for diagnosis, genetic counseling, and reproduction in the respective families and improve our knowledge of mosaicism in Alport syndrome. Methods:Suspected male mosaic patients for COL4A5 who met the following criteria: clinical diagnosis of Alport syndrome, harbored COL4A5 mutations detected using next generation sequencing or Sanger sequencing, heterozygosity for the mutant and normal COL4A5 alleles in the DNA demonstrated by Sanger sequencing, registered in the on-line registry of hereditary kidney diseases, and admitted to Peking University First Hospital during the period of April 2018 to April 2019 were enrolled. Clinical data and karyotypes were retrospectively analyzed. Genetic DNA isolated from multiple tissues was analyzed for COL4A5 gene mutations by using PCR and Sanger sequencing. Related literatures published in PubMed, CNKI and Wanfang databases were reviewed. Results:Four COL4A5 somatic and germline mosaic male patients with Alport syndrome were included in the study. Patient 1 was characterized by hematuria and proteinuria. His karyotype of peripheral blood was normal. COL4A5 c.3455-1G>A mosaicism was detected in multiple tissues (peripheral blood, saliva and urine). Patient 2 presented with hematuria and microalbuminuria. His karyotype of peripheral blood was normal. COL4A5 c.4994+1G>A mosaicism was detected in multiple tissues (peripheral blood, saliva and skin fibroblasts). Patients 3 showed hematuria without proteinuria. COL4A5 c.3535G>A mosaicism was found in genomic DNA of peripheral blood and hair. Laboratory and physical examinations of patient 4 showed hematuria and normal renal function, without proteinuria, megasoma or small testes. COL4A5 c.3106G>A mosaicism was detected in genomic DNA of skin fibroblasts. Although without karyotype analysis due to unavailable specimens, 47,XXY or 46,XY/47,XXY mosaicism was not considered according to the reproductive history and lack of clinical manifestations of megasoma and small testes in patients 3 and 4. Renal disease in 8 published male cases with mosaicism for COL4A5 was affected by mutant allelic fractions and genotype. Conclusions:Compared with hemizygous males with X-linked Alport syndrome, the renal phenotype of mosaic males was milder, and associated with mutant allelic fractions and mutation type.

BACKGROUND: Insufficient angiogenesis and the lack of skin appendages are critical challenges in cutaneous wound healing. Stem cell-fabricated cell sheets have become a promising strategy, but cell sheets constructed by a single cell type are inadequate to provide a comprehensive proregenerative microenvironment for wound tissue. METHODS: Based on the communication between cells, in this study, bone marrow mesenchymal stem cells (BMSCs) and hair follicle stem cells (HFSCs) were cocultured to fabricate a composite cell sheet (H/M–CS) for the treatment of fullthickness skin wounds in mice. RESULTS: Experiments confirmed that there is cell–cell communication between BMSCs and HFSCs, which enhances the cell proliferation and migration abilities of both cell types. Cell–cell talk also upregulates the gene expression of proangiogenic-related cytokines in BMSCs and pro-hair follicle-related cytokines in HFSCs, as well as causing changes in the properties of secreted extracellular matrix components. CONCLUSIONS Therefore, the composite cell sheet is more conducive for cutaneous wound healing and promoting the regeneration of blood vessels and hair follicles.

Objective : To investigate the prevalence and distribution of skeletal malocclusion and axial inclination of the maxillary central incisors in short root anomaly (SRA) patients in Kunming city, to provide some reference and guidance for SRA patients′ clinical diagnosis and treatment and prevention in SRA patients. Methods: A total of 1 000 cases were randomly selected from the CBCT database of patients admitted to the author′s hospital from January 2011 to July 2019, and a retrospective analysis was performed. A total of 27 patients with SRA were diagnosed (SRA group).The control group, consisted of 100 randomly selected patients from non-SRA patients. According to the clinical data and cephalometric data, skeletal malocclusion was divided into three subgroups: Class I skeletal malocclusion, Class II skeletal malocclusion and Class Ⅲ skeletal malocclusion. Additionally, the axial inclination of the central incisors was divided into three subgroups: the lingual inclination group, labial inclination group and normal inclination group. The two groups each according to sex, skeletal malocclusion and types of axial inclination of the maxillary central incisors were discussed. Results : The prevalence rate of SRA in the selected population was 2.7%, and the prevalence of SRA in females was 3.67% (21/572) , which was higher than that in males by 1.4% (6/428), and was significantly different between sexes (χ2=4.562, P=0.033). There was a significant difference between SRA patients and control group in terms of skeletal malocclusion (χ2=8.710, P=0.013). Class Ⅲ skeletal malocclusion was the main type of skeletal malocclusion in SRA. There was a significant difference between SRA patients and control group in terms of the axial inclination of the maxillary central incisors (χ2=16.75,P<0.001). Lingual inclination of the maxillary central incisors was the main type of axial inclination of the maxillary central incisors in SRA. Conclusion There is a certain correlation between class Ⅲ skeletal malocclusion and lingual inclination of the maxillary central incisors and SRA, and the root-crown ratio and root shape of these patients should be evaluated before orthodontics are implemented.