Abstract: Objective　To analyze the distribution and drug resistance evolution characteristics of pathogenic bacteria of bloodstream infection in nine tertiary hospitals in Yunnan Province from 2017 to 2021, so as to provide reliable basis for rational selection of antibiotics in clinic. Methods Using the drug sensitive paper method or instrument method, the bacteria identification and drug sensitivity test were carried out in nine tertiary hospitals in different regions according to the unified technical scheme. The results were judged according to the Clinical and Laboratory Standards Institute (CLSI) breakpoint standard in 2021, and use WHONET5.6 for data statistical analysis. Results A total of 12 003 strains of pathogenic bacteria were isolated from bloodstream infection samples in the past five years, including 7 442 strains of Gram-negative bacteria (62.0%) and 4562 strains of Gram-positive bacteria (38.0%), with an increasing trend in the number of isolated strains; of these, 163 strains (1.4%) were isolated from outpatients and 11 840 strains (98.6%) were isolated from inpatients. The top three gram-negative bacteria were Escherichia coli, Klebsiella pneumoniae and Acinetobacter baumannii, of which 309 strains (4.2%) were carbapenem-resistant Klebsiella pneumoniae (CR-KPN), 29 strains (0.4%) carbapenem-resistant Escherichia coli and 19 strains (0.3%) carbapenem-resistant Enterobacter cloacae, and the number of CR-KPN was on the rise year by year. The top three Gram-positive bacteria were coagulase-negative staphylococci, Staphylococcus aureus and Enterococcus faecium, of which methicillin-resistant Staphylococcus aureus (MRSA) was detected for 213 strains, accounting for 27.7%, and decreased from 40.0% in 2017 to 23.4% in 2021, showing a downward trend year by year. No vancomycin-resistant staphylococci and enterococci were found. Conclusions The detection and composition of bloodstream infection pathogenic bacteria in multicenter have not changed much in the past five years, but each hospital has its own characteristics. The number of carbapenem resistant Enterobacteriaceae increased year by year, which should be paid more attention.

To establish quality standards of Euonymus fortunei, and supply scientific evidence for the quality control of Euonymus fortunei. Empirical and microscopic identification methods were adopted to observe morphological and histological characters. The contents of water, total ash, acid-insoluble ash and alcohol-soluble extractive were analysed according to the methods of Chinese Pharmaco- poeia (2010). Dulcitol and reference herbs were used to identify materia medica of Euonymus fortunei by TLC method. The total flavonol glycosides contents were analysed by HPLC method, using quercetin and kaempferol as reference substances. Quercetin and kaempferol were separated on a C18 column (4.6 mm x 250 mm, 5 μm) with methanol-0.1% formic acid(51:49) as the mobile phase and detected at 366 nm. The flavonoid aglycones content was then multiplied by a conversion coefficient, and the result was the total flavonol glycosides content. The macroscopical identification, microscopic features and TLC methods were proper. The average contents of water, total ash, acid-insoluble ash, alcohol-soluble extractive and total flavonol glycosides were 8.76%, 6.48%, 0.31%, 17.48% and 0.211% , respectively. The quality standards established on the basis of the research results were suitable for the quality evaluation of Euonymus fortunei.
China ; Chromatography, High Pressure Liquid ; Chromatography, Thin Layer ; Drugs, Chinese Herbal ; chemistry ; standards ; Euonymus ; anatomy & histology ; chemistry ; Mass Spectrometry ; Quality Control

Objective To explore the effects of family-centered care based on Timing It Right on patient com-pliance,quality of life and readmission rate in patients with acute myocardial infarction. Methods To tally 100 cases were selected and randomly divided into two groups by random number table,with 50 cases in the interven-tion group and 50 cases in the control group. The intervention group received routine care and follow-up and fami-ly-centered care intervention based on Timing It Right;the control group received routine care and follow-up. Pa-tient compliance,quality of life and readmission rate were compared between two groups at discharge,3 months and 6 months after discharge. Results Patient compliance in the intervention group was better than that in the control group (P<0.05) 3 months after discharge except blood glucose,blood pressure,blood lipid and alcohol (P>0.05);6 months after discharge,patient compliance in the intervention group was better except alcohol(P>0.05);physical activity,safety and diet in the intervention group were better than those in the control group when discharged (P<0.001);3 months after discharge,there were no significant differences in physical activity and dependence between two groups(P>0.05);6 months after discharge,all domains in the intervention group were significantly better than those in the control group(P<0.001);when the research was finished,readmission rate in the intervention group was signif-icantly lower than that in the control group (P<0.05). Conclusion The family-centered care intervention based on Timing It Right can effectively improve patient compliance,quality of life and decrease readmission rate for patients with acute myocardial infarction.

Adolescent ; Cardiomyopathies ; diagnosis ; etiology ; physiopathology ; Diagnosis, Differential ; Electrocardiography ; Female ; Humans ; Tachycardia, Ectopic Atrial ; complications

Background:Chronic kidney disease (CKD) is an independent risk factor for cardiovascular disease (CVD).However,the association between CKD and CVD risk in patients with type 2 diabetes mellitus (T2DM) in China has not yet been well investigated.This study aimed to determine the association of CKD with the risks of coronary heart disease (CHD) and stroke in a Chinese population with T2DM.Methods:A total of 1401 inpatients with T2DM at the Second Affiliated Hospital of Zhejiang University School of Medicine between April 2008 and November 2013 were included in this study.The CKD-Epidemiology Collaboration equation for Asians was used to classify CKD.The UK Prospective Diabetes Study risk engine was used to estimate the risks of CHD and stroke.Results:CHD risk was significantly increased with CKD stage (20.1％,24.8％,and 34.3％ in T2DM patients with no CKD,CKD Stage 1-2,and Stage 3-5,respectively;P ＜ 0.001 for all).The stroke risk was also increased with CKD stage (8.6％,12.7％,and 25.4％ in T2DM patients with no CKD,CKD Stage 1-2,and Stage 3-5,respectively;P ＜ 0.001 for all).Compared with no-CKD group,the odds ratios (ORs) for high CHD risk were 1.7 (P ＜ 0.001) in the CKD Stage 1-2 group and 3.5 (P ＜ 0.001) in the CKD Stage 3-5 group.The corresponding ORs for high stroke risk were 1.9 (P ＜ 0.001) and 8.2 (P ＜ 0.001),respectively.Conclusion:In patients with T2DM,advanced CKD stage was associated with the increased risks of CHD and stroke.

INTRODUCTIONCirculating insulin concentrations provide important information for the evaluation of insulin secretion and insulin resistance. Reference intervals are the most widely applied tool for the interpretation of clinical laboratory results. We carried out an analysis of the data available from the Fangchenggang Area Male Health and Examination Survey in order to derive a reference interval for fasting insulin specific to the Chinese population.

METHODSA total of 1,434 fasting serum insulin results were obtained from healthy nondiabetic adult men aged 20-69 years, after taking into consideration the inclusion and exclusion criteria. Serum insulin was measured using electrochemiluminescence immunoassays. Nonparametric statistical methods were used to calculate and analyse the data.

RESULTSThe reference interval for fasting serum insulin for Chinese adults was in the range 1.57-16.32 μU/mL (median 5.79 μU/mL). Significant correlations were found between fasting serum insulin and glucose and diastolic blood pressure (p < 0.001). Statistically significant differences were observed in insulin concentration with respect to age and body mass index (BMI; p < 0.001). Younger people had a higher fasting serum insulin concentration. Increased fasting serum insulin was also found to be associated with BMI.

CONCLUSIONWe established a reference interval for fasting serum insulin in healthy nondiabetic adult Chinese men that is lower than what was previously suggested. BMI and age (but not smoking, alcohol consumption or physical activity) were found to be important factors associated with fasting serum insulin. Our results will help improve the diagnostic interpretation of investigations for metabolic and cardiovascular disorders in a Chinese population.

Adolescent ; Adult ; Aged ; Aged, 80 and over ; Body Mass Index ; China ; Fasting ; blood ; Humans ; Insulin ; blood ; Insulin Resistance ; physiology ; Male ; Middle Aged ; Nomograms ; Reference Values ; Retrospective Studies ; Young Adult

AIM:Increasing evidence indicates that inflammation contributes to the initiation and perpetuation of atrial fibrillation ( AF) .Al-though tumor necrosis factor ( TNF)-αlevels are increased in patients with AF , the role of TNF-αin the pathogenesis of AF remains unclear.Recent research has revealed that T-type Ca2+currents ( ICa,T ) play an important role in the pathogenesis of AF .METH-ODS:In this study , we used the whole-cell voltage-clamp technique and biochemical assays to explore the role of TNF-αin the regula-tion of ICa,T in atrial myocytes.RESULTS:We found that compared with sinus rhythm (SR) controls, T-type calcium channel (TCC) subunit mRNA levels were decreased , while TNF-αexpression levels were increased , in human atrial tissue from patients with AF .In murine atrial myocyte HL-1 cells, after cultured for 24 h, 12.5, 25 and 50 μg/L TNF-αsignificantly reduced the protein expression levels of the TCC α1G subunit in a concentration-dependent manner .The peak current was reduced by the application of 12.5 or 25μg/L TNF-αin a concentration-dependent manner [from ( -15.08 ±1.11) pA/pF in controls to ( -11.89 ±0.83) pA/pF and (-8.54 ±1.55) pA/pF in 12.5 and 25 μg/L TNF-αgroups, respectively].TNF-αapplication also inhibited voltage-dependent inactivation of ICa,T shifted the inactivation curve to the left .CONCLUSION:These results suggest that TNF-αis involved in the path-ogenesis of AF, probably via decreasing ICa,T function in atrium-derived myocytes through impaired channel function and down -regula-tion of channel protein expression .This pathway thus represents a potential pathogenic mechanism in AF .

Human Zona Pellucida(ZP), which is a complex matrix surrounding oocytes,is comprised of three immunologically distinct glycoproteins(hZP1, hZP2 and hZP3). Because hZP3 possesses the sperm receptor activity and the acrosome-inducing activity, it has long been used as a candidate antigen to develop an immunocontraceptive vaccine. However, a large amount of native hZP3 protein is unavailable. It is an effective way to express hZP3 protein directly in vitro. Nevertheless, it had been reported that the rhZP3 protein produced in Pichia pastoris was not secreted but accumulated in the cells and could only be purified after being solubilized by strong denaturants. More unfortunately, after purification the final product required 6mol/L urea to maintain solubility. An improved project was advanced with the aim to express secreted and soluble rhZP3 protein in yeast. In this study, the fragment of hZP3 cDNA coding for aa 23 - 408, which the N-terminal leader was removed and most of the C-terminal transmembrane-like domain was reserved, was amplified by two PCR primers including EcoR I and Not I sites respectively and a His6 codon cassette was added to 5'-terminal. The hZP3 insert was incorporated into expression vector pPIC9K. The resulting recombinant yeast expression vector was designated pPIC9K-rhZP3. Linearized pPIC9K-rhZP3 was transformed into Pichia pastoris. After G418 selection, the recombinant Pichia pastoris strains were identified by PCR and the rhZP3 was expressed following the manufacturer' s protocol. Following induction with methanol, the rhZP3 protein was secreted and dissolved into the culture supernatant. SDS-PAGE and Western blot analyses showed that the apparent molecular weight of the expressed rhPZ3 proteins in yeast was smaller and a little size heterogeneity than native ones; after purified with Ni-chelating affinity chromatography, the final product's apparent molecular weight was about 32 - 34KD and their yield more than 20mg/L. We supposed that the C-terminal transmembrane-like domain be useful for secretion of rhZP3 into the culture supernatant and the expressed rhZP3 protein be incompletely digested by proteinases of Pichia into shorter fragments which all were glycosylated inhomogeneously. Fortunately, the fragments of rhZP3 protein can be recognized in Western blot by the polyclonal antibodies to porcine ZP3 which has showed a cross-reactivity with human ZP in vitro. It will be expected that the rhZP3 protein expressed in Pichia pastoris not only has immunogencity, say, it can rise antibodies in vivo to prevent spermatozoa-ovum binding, but also does not contain ovarian factors that might be the cause of undesired side effects, e.g. ovaritis and can be used as a safe immunogen in human antifertility vaccine research.
Blotting, Western ; Chromatography, Affinity ; Egg Proteins ; genetics ; metabolism ; Electrophoresis, Polyacrylamide Gel ; Genetic Vectors ; genetics ; Humans ; Membrane Glycoproteins ; genetics ; metabolism ; Pichia ; genetics ; metabolism ; Polymerase Chain Reaction ; Receptors, Cell Surface ; genetics ; metabolism ; Recombinant Proteins ; genetics ; isolation & purification ; metabolism ; Zona Pellucida Glycoproteins

BACKGROUNDTriple-phase enhancement of multi-slice computed tomography (MSCT) has markedly improved the diagnostic accuracy of hepatocellular carcinoma (HCC), and MSCT angiography (MSCTA) has been proved useful in detecting vascular anatomy noninvasively. This study aimed to explore the value of MSCTA by triple-phase enhancement in preoperative evaluation of HCC.

METHODSFifty-six consecutive cases of primary HCC scheduled for resection were studied with MSCTA by triple-phase enhancement. The raw data images were processed on a workstation for multiplanar reconstruction (MPR) and three-dimensional (3D) reconstruction. The findings after processing of the data were compared with those after surgery or intraoperative sonography.

RESULTSThe false positive rate of MSCTA by triple-phase enhancement was 10.1% and its false negative rate was 4.3% in detecting HCC. No significant difference was observed in MSCTA and surgery or intraoperative sonography in detecting vascular anatomy anomalies and pathologic variations, whereas significant difference was found in detecting bile duct invasion with MSCT compared to intraoperative sonography.

CONCLUSIONSMSCTA by triple-phase enhancement not only improves the detection of HCC, but also provides valuable preoperative information about hepatic vascular architecture and parenchyma. MSCTA by triple-phase enhancement is worthy of application as a non-invasive method in preoperative evaluation of HCC.

Adult ; Angiography ; Carcinoma, Hepatocellular ; diagnostic imaging ; pathology ; surgery ; Female ; Hepatic Artery ; diagnostic imaging ; Hepatic Veins ; diagnostic imaging ; Humans ; Liver Neoplasms ; diagnostic imaging ; pathology ; surgery ; Male ; Middle Aged ; Portal Vein ; diagnostic imaging ; Radiographic Image Enhancement ; Tomography, X-Ray Computed

The purpose of this study was to explore the effect of amifostine in treating aged patients with idiopathic thrombocytopenic purpura (ITP). Three aged ITP patients (one aged 88, one aged 75, another aged 65) were treated with amifostine over a period of 4 weeks for each. The results showed that the early positive responses were observed in all 3 aged patients after treatment with amifostine 5 x 400 mg per week for 4 weeks, the recovery of platelet counts to normal level were found in 2 cases after 1 week and in 1 case after 2 weeks. Following 4 months after stop of treatment with amifostine, the normal platelet counts still remains in all patients, no more blood transfusions, hormonal preparation and gamma-globulin were given. Amifostine has never been reported elewhere as to treat of aged ITP. In conclusion, amifostine has a good early therapeutic effect on aged ITP patients, but its clinical outcome of long-term still needs further evaluation.
Aged ; Aged, 80 and over ; Amifostine ; therapeutic use ; Drug Administration Schedule ; Humans ; Male ; Platelet Count ; Purpura, Thrombocytopenic, Idiopathic ; drug therapy ; Treatment Outcome