Objective To investigate the genotype of carbapenem-resistant Acinetobacter baumannii(CRAB) acquired from intensive care units (ICUs) environment in Shanghai hospitals and to evaluate the gene homology of CRAB isolated from patients and environment in ICUs in Shanghai hospital.Methods Sixty-one CRAB isolated from ICUs environment in Shanghai hospitals and 14 strains isolated from ICUs patients in S hospital were typed by REP-PCR based DiversiLab system.Results There were 7 types of the CRAB isolated from ICUs environment in Shanghai hospitals.Type G1 was the dominant type,accounting for 75.4％ of all CRAB,mainly in 13 hospitals in Shanghai.The percentage of the 7 types CRAB strains were 75.4％,13.1％,3.3％,1.6％,1.6％,3.3％ and 1.6％,respectively.Except for 1 strain of type G6 isolated in D hospital,type G1 CRAB was identified in every hospital which was isolated CRAB.There were 25 strains isolated from patients and environment in S hospital ICUs,which were divided into 4 types.Type G1 was the dominant type mainly distributed in SICU and CICU,including 9 from patients and 8 from environment.The distribution diagram of environmental and patients' strains indicated that the patients in adjacent bed isolated G1 CRAB in SICU and a patient in CICU and its surrounding environment both isolated G1 CRAB.Conclusion Type G1 is the dominant type in ICUs environment in Shanghai hospitals.There are inter-hospital transmission of CRAB in ICUs environment and highly homology of CRAB isolated from patients and environment in ICUs in Shanghai hospitals.Active surveillance of infection and colonization by CRAB,together with implementation of enhanced control strategies should be taken to eradicate CRAB in ICU environment.

BACKGROUND: Ventilation dysfunction caused by bronchomalacia induced bronchostenosis following high-risk heart transplantation is an acute clinical disease, which seriously impairs the function of transplant heart. The case of emergency bronchial stent placement following heart transplantation with high-risk multi-complication has not been reported yet.OBJECTIVE: To investigate the curative effect of emergency stent placement for worse left main bronchial malacia, stenosis and collapse following orthotopic heart allotransplantation.DESIGN: A case analysis.SETTINGS: National Ministry of Health Transplantation Engineering and Technical Research Center, the Third Xiangya Hospital, Central South University; Department of Cardiosurgery, Zhongshan Hospital affiliated to Xiamen University.PARTICIPANTS: An 18-year-old female patient with dilated cardiomyopathy accompanied by moderate to severe pulmonary artery hypertension, who sequentially carried out orthotopic heart allotransplantation, was selected from the Department of Cardiosurgery, Zhongshan Hospital affiliated to Xiamen University in April, 2004. She had suffered from dilated cardiomyopathy for 15 years, and the mean pulmonary artery pressure (MPAP) was 50-51 mm Hg, she was also accompanied by left main bronchial malacia, stenosis and collapse, mixed (mainly central-) sleep apnea syndrome, left inferior pulmonary sequestration, right emphysema, and rheumatoid arthritis for half a year.METHODS: After heart transplantation, bronchus inflammation, congested edema aggravated the severity of bronchial malacia, stenosis and collapse, tenosis reduced to 4/5, and led to obstructive type of ventilation, and the patient was also accompanied by supraventricular tachycardia, ventricular extrasystole, and hypofunction of transplant cardiac systolic function (peak E＜peak A, ejection fraction reduced to 40%, inharmonious motion of ventricular wall). Attempted with inotropic agents and ventilator/support were not relieved, which resulted in the aggravation of illness. In order to improve the post-transplant cardiac function, to relieve bronchial collapse and stenosis, and correct the obstructive type of ventilation, an emergency bronchial stent placement surgery was carried out on the sixth day after heart transplantation. Under monitoring of electrocardiogram (EGG) and percutaneaous oxygen saturation (SpO2), patient was awake and in supine to relieve left main bronchial stenosis with a nickel-titanium shape memory alloy stent (Diameter: 12 mm; length: 20 mm) by D20 fiberoptic bronchoscope. Fibrobronchoscopy was used to observe the proximal end of bronchostenosis and set the proximate location mark by using video fluoroscopy; the patency of distal end was explored by stricture, and set the distal location mark; guidewire was inserted into working path of bronchofibroscope and led through the stricture; then loaded the Ni-Ti stent on a special placement apparatus, and led in bronchial stent implantation apparatus along guidewire. When targeting well, the stent was slowly released and adjusted properly. When it was completely released, the stent implantation apparatus was drawn out. Bronchofibroscope was performed postoperatively to observe the adherence of stent; immediately photographed to observe its unfolding. Synchronized intermittent mandatory ventilation (SIMV) was given postoperatively as supportive treatment.MAIN OUTCOME MEASURES: Ameliorations of the cardiac and pulmonary functions of the patient.RESULTS: ①Carbon dioxide retention and hypercapnia were remarkably improved as compared with those preoperatively; hypertensive pulmonary vascular disease was alleviated gradually, and MPAP reduced to 30 mm Hg. One week later, re-examination of bronchofibroscopy was carried out, and the results showed that bronchi of left upper lobe, lingual lobe as well as left lower lobe could be seen distinctly, mucous membrane had slightly congested edema, and lumens were unobstructed.②Supraventricular tachycardia and premature ventricualr contraction disappeared, and the transplant cardiac function recovered well (peak E ＞ peak A, ejection fraction 70%, FS41%), and the heart rate fluctuated at 100-110 beats per minute. ③The chest-radiography and CT postoperatively indicated the relief of left main bronchial stenosis. When the ventilation function of the patient was improved, the parameters of breathing machine were reduced gradually, and replaced by low-flow oxygen. There was no recurrence of obstructive ventilatory disorder. The sleep apnea syndrome of the patient was moderated.CONCLUSION: Emergency treatment with stent placement for bronchial malacia, stenosis and collapse occurring after orthotopic heart allotransplantation cAN improve ventilation dysfunction caused by bronchial malacia and stenosis,and increase the survival rate of heart transplantation.

Objective: To investigate the association between ABCC2 gene polymorphisms and cyclosporine-induced liver injury in re-nal transplant recipients. Methods: The renal transplant recipients were divided into the liver injury group and the control group. Five single nucleotide polymorphisms ( rs4919395, rs2804398, rs4148394, rs4148397 and rs3740065) of ABCC2 were detected by high-throughput technique. The genotypes and haplotypes were analyzed between the groups. Results: There were 35 patients and 182 patients respectively in the liver injury group and the control group. No significant differences in alleles and genotypes were found between the groups (P>0. 05), and the SNP haplotypes showed no significant difference between the groups (P>0. 05). Conclusion: There is no association of ABCC2 polymorphisms (rs4919395, rs2804398, rs4148394, rs4148397 and rs3740065) with the liver injury induced by cy-closporine.

Objective: To explore the menopausal symptoms and quality of life of hormone receptor positive (HR+ ) breast cancer patients at different endocrine therapy time. Methods: The HR+ breast cancer patients who were pathologically confirmed from 2011 to 2017 in the Sichuan Cancer Hospital were divided into three groups according to endocrine therapy time (<12 months, 12~36 months, >36 months) and analyzed by a cross-sectional study. The Menopausal symptoms and quality of life of these patients were measured using the modified Kupperman scale and the functional assessment of cancer therapy-breast cancer (FACT-B) scale. The differences of menopausal symptoms among different time groups and drug groups were analyzed by Chi-square test. The differences of quality of life and the effects of menopausal symptoms on quality of life were tested by covariance and multiple linear regression analyses. Results: The average score of menopausal symptom of 167 patients was 14.5±7.6 and the prevalence rate was 87.4% (146/167). Among all of the menopausal symptoms, the prevalence rate of insomnia was the highest (73.7%, 123/167). Besides insomnia and excitement, hot flashes was more prevalent in selective estrogen receptor modulator (SERM) users (64.8%, 79/122) , while osteoarthritis was more prevalent in aromatase inhibitor (AI) users (62.2%, 28/45). The total score of FACT-B of Patients was 104.5±15.5, and the compliance rate was up to 89.8% (150/167). However, the condition of each dimension was different, the compliance rates of social/ family and functional dimension were lowest, which were 73.0% (122/167) and 50.9% (85/167), respectively. The menopausal symptoms of patients at different time groups were 15.0±1.3, 14.0±6.9, 14.5±7.4, respectively, and the total score of FACT-B of patients at different time groups were 102.7±17.8, 105.0±12.9, 105.6±16.7, respectively, without significant differences (both P>0.05). Multiple linear regression analysis showed that menopausal symptoms impaired the quality of life of SERM users during the endocrine therapeutic period. The standardized regression coefficients of three time groups were -0.67, -0.30, -0.50, respectively, with the lowest effect on 12~36 months group. Conclusion HR+ breast cancer patients will have a poor function recovery and social/ family return, who need more attention. Menopausal symptoms are common problems during endocrine therapy, and active measures should be taken to improve patients′ quality of life.

BACKGROUND: The fetal growth charts in widest use in China were published by Hadlock >35 years ago and were established on data from several hundred of American pregnant women. After that, >100 fetal growth charts were published around the world. We attempted to assess the impact of applying the long-standing Hadlock charts and other charts in a Chinese population and to compare their ability to predict newborn small for gestational age (SGA). METHODS: For this retrospective observational study, we reviewed all pregnant women ( n  = 106,455) who booked prenatal care with ultrasound measurements for fetal biometry at the Shenzhen Maternity and Child Healthcare Hospital between 2012 and 2019. A fractional polynomial regression model was applied to generate Shenzhen fetal growth chart ranges for head circumference (HC), biparietal diameter (BPD), abdominal circumference (AC), and femur length (FL). The differences between Shenzhen charts and published charts were quantified by calculating the Z -score. The impact of applying these published charts was quantified by calculating the proportions of fetuses with biometric measurements below the 3rd centile of these charts. The sensitivity and area under the receiver operating characteristic curves of published charts to predict neonatal SGA (birthweight <10th centile) were assessed. RESULTS: Following selection, 169,980 scans of fetal biometry contributed by 41,032 pregnancies with reliable gestational age were analyzed. When using Hadlock references (<3rd centile), the proportions of small heads and short femurs were as high as 8.9% and 6.6% in late gestation, respectively. The INTERGROWTH-21st standards matched those of our observed curves better than other charts, in particular for fat-free biometry (HC and FL). When using AC<10th centile, all of these references were poor at predicting neonatal SGA. CONCLUSIONS Applying long-standing Hadlock references could misclassify a large proportion of fetuses as SGA. INTERGROWTH-21st standard appears to be a safe option in China. For fat-based biometry, AC, a reference based on the Chinese population is needed. In addition, when applying published charts, particular care should be taken due to the discrepancy of measurement methods.
Infant, Newborn ; Child ; Female ; Pregnancy ; Humans ; Growth Charts ; Prenatal Care ; Ultrasonography, Prenatal/methods* ; Fetal Development ; Fetal Growth Retardation ; Gestational Age ; Fetus ; China ; Infant, Newborn, Diseases ; Observational Studies as Topic