Objective To analyze clinical distribution and drug resistance of extended-spectrum β-lactamase(ESBLs)-producing and non ESBLs-producing Escherichia coli(E.coli) isolated from 2014 to 2015.Methods Collected 4 721 clinical specimens from January 2014 to December 2015,separated and identified by using VITEK 2-Compact automatic microorganism identification and sensitivity analysis system of Biomerieux,France.Results A total of 1 181 E.coli were isolated from 4 721 clinical specimens,the isolation rate was 25.02%,and the isolation rates of 2014 and 2015 were 17.38% and 19.24% respectively.Meanwhile,the isolation rates of ESBLs-producing E.coli from 2014 and 2015 were 44.46% and 51.71%,increased 7.25%.For the ESBLs-producing E.coli,the main specimens from urine,sputum,blood,appendix content,pus and secreta,and general surgery department,pneumology department,urology,Neurosurgery departments were the main infection departments.For the non ESBLs-producing E.coli,the main specimens from urine,blood,sputum,appendix content,pus and secreta.The drug resistance of E.coli to antibiotics showed increasingly upward trend from 2014 to 2015.However,it showed high sensitive to amikacin,imipenem and meropenem.Conclusion As the isolation rate of E.coli increased in 2015,so does the drug resistance,and it is need combine with the actual situation of medication to regulate the usage of antibiotics.

With the emerging of aging society and advances of information sciences, telemedicine has gradually become a new medical model.Telemedicine can be used in health monitoring, disease diagnosis, counseling, education, chronic disease management and long-term care in elderly population;particularly in management of chronic heart failure, diabetes and other chronic diseases, as well as in referral and continuous medical care.To promote telemedicine in the elderly population can break the physical limitations of different health care settings, so that geriatrician and the allied team members are enable to maximize their values in providing corresponding health services.This article reviews the progress of telemedicine in foreign countries, which would be of reference value for development of telemedicine for elderly people in China.

Objective To investigate the differences of four equations to estimate glomerular filtration rate (GFR) and their impacts on chronic kidney disease (CKD) prevalence in communitydwelling elderly people in Beijing.Methods A total of 489 participants aged above 70 years were enrolled.The GFR was estimated using the Cockcroft Gault (CG) equation,Chronic Kidney DiseaseEpidemiology Collaboration (CKD-EPI) equation,Modification of Diet in Renal Disease (MDRD) equation and Berlin Initiative Study (BIS) equation respectively.The internal-consistency check was made on the four equations for the GFR (ml min 1 1.73m 2) estimates.Results The mean age of participants was (81.8±7.6) years.The mean GFR estimated using the CG,CKD-EPI,MDRD and BIS equation was 58.4± 17.2,71.9± 15.3,76.7± 19.1 and 62.7± 12.7,respectively.And the prevalence of CKD was 56.2％,22.7％,17.8％ and 41.7％,respectively.The greatest differences of equations to estimate GFR were seen in elderly people aged 90 and above,and those with body mass index＜ 20.0 kg/m2 or serum creatinine concentration＜ 88.4 μmol/L.Conclusions The GFR estimated using different equations has a large difference which has a significant effect on CKD classification in elderly people.The equation to estimate GFR for the elderly is urgently needed.Until then,the eGFR and CKD classification estimated using different equations should be regarded with caution.

Objective To investigate the expression and significance of ADAMDEC1 in glioma.Methods We prospectively observed the expression of ADAMDEC1 in 77 glioma patients,of which 28 cases were grade Ⅳ glioma,26 were grade Ⅲ glioma (high-grade glioma);of which 23 cases were Grade Ⅱ glioma,5 were grade Ⅰ glioma (low-grade glioma).For 10 cases in the control group,brain tissue samples were collected from internal decompression patients with heavy traumatic brain injury.The expression of ADAMDEC1 in glioma tissue was detected immunohistochemistry,RT-PCR,and Western blot.With follow-up survey we explored the relationship between the survival time and the expression of ADAMDEC1 in the patients with high-grade gliomas and low-grade gliomas.Results Compared with the low-grade glioma group and the control group,qPCR,immunohistochemistry and Western blotting all showed that the protein and mRNA levels of ADAMDEC1 in high-grade glioma group were significantly increased,while ADAMDEC1 was expressed little in low-grade glioma group and not expressed in control group (P ＜ 0.05).The survey results showed that the survival time of high-grade glioma patients was significantly shorter than low-grade glioma patients;however,the expression level of ADAMDEC1 in the highgrade glioma tissue was significantly higher than in low-grade glioma tissue (x2=5.031,P＜0.05).Conclusion The expression of ADAMDEC1 is closely related to the malignant degree of glioma cells and the prognosis of glioma patients.Therefore,ADAMDEC1 can be used as an index to evaluate the malignance degree of glioma and the prognosis of glioma.

Objective:To investigate the effect of smoking on surgical site infection (SSI) after spinal surgery, and to provide evidence-based information for preventing the occurrence of SSI after spinal surgery.Methods:Literature searches were independently conducted in PubMed, EMBASE, CNKI, Wanfang and other databases from January 2000 to June 2020 by two researchers. Stata13.0 software was used to analyze the included literatures. Statistical analysis and subgroup analysis were preformed based on different population, research types, and adjustments.Results:44 literatures were finally included, involving 79 601 samples including 3 016 cases in the infected group. Compared with non-smokers, the combined odds ratio ( OR) of SSI in smokers after spinal surgery was 1.45 (95% CI: 1.25~1.68). The results of subgroup analysis showed that the risk of SSI in the yellow population and smokers after spinal surgery was 1.69 times that of the control group (95% CI: 1.35~2.12), and no such association was found in the white population. Smokers in the case-control studies and cohort studies had a higher risk of SSI after spinal surgery than that of the control group. Regardless of whether the effect size was adjusted, smokers had a higher risk of SSI after spinal surgery than that of the control group. Conclusions:This study has the advantages of using the latest data, including more literature, and analyzing ethnicity for the first time. The results show that smokers have a higher risk of SSI after spinal surgery. Clinically, patients should be encouraged to quit smoking to reduce the risk of SSI after spinal surgery. However, when to quit smoking to achieve the maximum benefit still needs further research.

To investigate the antitumor activity induced by Ganoderma lucidum spore oil on different tumor cells. Human hepatoma cells(HepG2), human non-small cells lung cancer cells(A549)and human colon cancer cells(HCT116)were selected and tested. Cell viability was determined by MTT assay. Western blot analysis was performed to measure the expression of NF-κB and Caspase-3 activity in order to elucidate the mechanism of apoptotic activity caused by Ganoderma lucidum spore oil and to screen out the most sensitive cancer cell lines to Ganoderma lucidum spore oil. MTT assay demonstrated that Ganoderma lucidum spore oil had a strong inhibitory effect on the growth of three cancer cell lines. Among these cells, A549 cells were most sensitive to Ganoderma lucidum spore oil, followed by HepG2 cells and then by HCT116 cells. The results of Western blot showed that Ganoderma lucidum spore oil could promote the activation of NF-κB pathway, and that the activation of NF-κB signaling pathway in cancer cells treated by Ganoderma lucidum spore oil was stronger in A549 cells, HepG2 cells, HCT116 cells respectively. The detection of Caspase-3 activity showed that ganoderma spore oil could activate Caspase-3 dependent apoptosis pathways, which was more important in A549 cells, HepG2 cells and HCT116 cells. This study found that Ganoderma lucidum spore oil had inhibitory effects on A549, HepG2 and HCT116 cells growth and that its antitumor activity was in time-dose dependence. The mechanism may be related to the activation of NF-κB pathway and the Caspase-3 apoptotic pathway, which could accelerate apoptosis and necrosis of tumor cells. Among the three kinds of cancer cells, A549 cells was most sensitive to Ganoderma lucidum spore oil, followed by the HepG2 cells, and then by HCT116 cells.

Objective:To systematically evaluate the efficacy and safety of controlled low central venous pressure (CLCVP) applied in patients undergoing hepatectomy.Methods:PubMed, Web of Science, Cochrane Library, CNKI, Wanfang, and VIP databases were searched from inception to October 1, 2022 for randomized controlled trials (RCTs) involving CLCVP in hepatectomy.All RCTs enrolled included CLCVP group and conventional operation group.The major evaluation indicators were intraoperative blood loss, operation duration and intraoperative blood transfusion.The secondary evaluation indicators were intraoperative monitoring indicators, postoperative liver and renal function, and complications at 1 day after operation.Meta-analysis was performed using the RevMan 5.3 software.Results:A total of 25 RCTs involving 1 816 patients were finally included.Compared with conventional operation group, the intraoperative blood loss was significantly reduced, the operation time was shorten, the rate of intraoperative blood transfusion was decreased, the amount of blood transfused was decreased ( P<0.01), and no significant change was found in intraoperative hemodynamic parameters and parameters of liver and renal function at 1 day after operation, and incidence of gas embolism, pleural effusion and bile leakage in CLCVP group ( P>0.05). Conclusions:CLCVP is safe and effective during hepatectomy.

Objective:To investigate the prognostic value of Onodera's prognostic nutrition index (PNI) before treatment in patients with cervical and upper thoracic esophageal squamous cell carcinoma (CUTESCC) undergoing definitive chemoradiotherapy (dCRT) and its predictive value in the occurrence of ≥ grade 2 radiation esophagitis (RE).Methods:The data of 163 CUTESCC patients eligible for inclusion criteria admitted to the Fourth Hospital of Hebei Medical University from January 2012 to December 2017 were retrospectively analyzed. The receiver operating characteristic (ROC) curve was used to calculate the best cut-off value of PNI for predicting the prognosis of patients. The prognosis of patients was analyzed by univariate and Cox multivariate analyses. Logistics binary regression model was adopted to analyze the risk factors of ≥ grade 2 RE in univariate and multivariate analyses. The significant factors in logistic multivariate analysis were used to construct nomogram for predicting ≥ grade 2 RE.Results:The optimal cut-off value of PNI was 48.57 [area under the curve (AUC): 0.653, P<0.001]. The median overall survival (OS) and progression-free survival (PFS) were 26.1 and 19.4 months, respectively. The OS ( χ2=6.900, P=0.009) and PFS ( χ2=9.902, P=0.003) of patients in the PNI ≥ 48.57 group ( n=47) were significantly better than those in the PNI < 48.57 group ( n=116). Cox multivariate analysis showed that cTNM stage and PNI were the independent predictors of OS ( HR=1.513, 95% CI: 1.193-1.920, P=0.001; HR=1.807, 95% CI: 1.164-2.807, P=0.008) and PFS ( HR=1.595, 95% CI: 1.247-2.039, P<0.001; HR=2.260, 95% CI: 1.439-3.550, P<0.001). Short-term efficacy was another independent index affecting PFS ( HR=2.072, 95% CI: 1.072-4.003, P=0.030). Logistic multivariate analysis showed that the maximum transverse diameter of the lesion ( OR=3.026, 95% CI: 1.266-7.229, P=0.013), gross tumor volume (GTV) ( OR=3.456, 95% CI: 1.373-8.699, P=0.008), prescription dose ( OR=3.124, 95% CI: 1.346-7.246, P=0.009) and PNI ( OR=2.072, 95% CI: 1.072-4.003, P=0.030) were the independent factors affecting the occurrence of ≥ grade 2 RE. These four indicators were included in the nomogram model, and ROC curve analysis showed that the model could properly predict the occurrence of ≥ grade 2 RE (AUC=0.686, 95% CI: 0.585-0.787). The calibration curve indicated that the actually observed values were in good agreement with the predicted RE. Decision curve analysis (DCA) demonstrated satisfactory nomogram positive net returns in most threshold probabilities. Conclusions:PNI before treatment is an independent prognostic factor for patients with CUTESCC who received definitive chemoradiotherapy. The maximum transverse diameter of the lesion, GTV, prescription dose and PNI are the risk factors for ≥ grade 2 RE in this cohort. Establishing a prediction model including these factors has greater predictive value.

Objective To study the rate of kidney function decline and the influencing factors in the aged population. Methods This was a prospective population-based study of 468 participants aged 65 years and older. All participants’ general health information and serum creatinine levels were collected as the baseline. After a 3-year follow-up ,the serum creatinine level of each participant was measured again.Kidney function was assessed with estimated glomerular filtration rate (eGFR) calculated using the Chronic Kidney Disease-Epidemiology Collaboration ( CKD-EPI ) equation. Outcomes of interest were mean eGFR decline and rapid decline in eGFR (annual eGFR loss≥3 ml·min－1·1.73 m －2).Risk factors were analyzed with Logistic regression. Results At baseline ,the mean age of participants was(78.4 ± 8.7)years and the mean eGFR was(74.8 ± 14.5)ml ·min－1·1.73 m －2.Annual eGFR decline was 1.5 ml·min－1·1.73 m －2,with rapid declines in 149 (32%) participants and stable kidney function in 319 (68%) individuals. The rate of kidney function loss slowed down as the age increased.Baseline eGFR was an independent predictor for rapid kidney function decline. The incidence of rapid kidney function decline in individuals with eGFR ≥ 60 ml· min－1·1.73 m －2was 2.40 times (95% CI :1.16-4.98) higher than that of participants with eGFR＜60 ml·min－1·1.73 m －2after adjustment for confounders. Conclusions Kidney function changes in the community-dwelling elderly in China are heterogeneous. Most elderly individuals do not show appreciable kidney function decline over a 3-year period.

Objective: To investigate the clinical efficacy and safety of lenalidomide (Revlimid, R) -based chemotherapy in the treatment of relapsed/refractory multiple myeloma (MM) patients. Methods: 57 consecutively relapsed/refractory MM patients were retrospectively analyzed from June 2013 to February 2016. All the patients received lenalidomide-based chemotherapy. Results: ① 60.4% patients had international staging system (ISS) stage Ⅲ, 37.9% patients had revised international staging system (R-ISS) stage Ⅲ, and 53.3% patients harbored at least one of the high-risk cytogenetic abnormalities[del (17p) and/or t (4;14) and/or t (14;16) ]. ②The patients received median 6 cycles of R (range: 1-32). The overall response rate (ORR) was 58.9% (33/56) , among which 8.9% was complete response (CR) , 19.8% was very good partial response (VGPR) , and 30.4% was partial response (PR). In addition, 10.7% patients attained minor response (MR). Total clinical benefit was 69.6%. Patients with more than 1 line of prior therapy, or previously thalidomide-resistance, or R-ISS stage Ⅲ disease showed significantly lower ORR. ③With a median follow-up of 27 months, the median progression free survival (PFS) , the median interval to PR, the median duration of response (DOR) , and the median overall survival (OS) was 8 months, 2 months, 8 months, and 19 months, respectively. Univariate prognostic analysis showed that abnormal karyotype, R-ISS stage Ⅲ and response inferior to PR were negative prognostic factors for PFS and OS. While the multivariate prognostic analysis showed that abnormal karyotype and R-ISS stage Ⅲ were independent prognostic factors. ④In the safety aspect, the most common grade 3-4 non-hematology adverse events (AEs) were infection (17.5%) , rash (1.8%) and thromboembolism (1.8%) , and the most common grade 3-4 hematology AEs were neutropenia (7.0%) and thrombocytopenia (3.5%). Totally 3 patients (5.3%) discontinued R because of AEs, and 2 cases (3.5%) of secondary primary malignancies were observed. Conclusion The R-based treatment is effective and safe in the treatment of relapsed/refractory MM patients in China. Abnormal karyotype and R-ISS stage Ⅲ were independent negative prognosis factors in this cohort.