OBJECTIVE To investigate the disinfectant and antibiotic resistance genotypes in 60 strains of Escherichia coli isolated from urine.METHODS Sixty strains of E.coli isolated from inpatients′ urine were collected from Jan 2006 to Oct 2008.Antibiotic susceptibility tests for fifteen antibiotics were performed by Kirby-Bauer method.And three kinds of disinfectant and antibiotic resistance genes(qacE△1,tehA,merA)were analyzed by polymerase chain reaction(PCR) and DNA sequencing.RESULTS More than 70.0% of the sixty strains of E.coli were susceptible to imipenem,piperacillin/tazobactam,cefoxitin,amikacin and gentamicin,and less than 50.0% were susceptible to the other ten antibiotics.There were 42 strains with qacE△1 gene(70.0%),10 strains with merA gene(16.7%) and all strains with tehA gene.The sequence of the first strain was different from those reported in GenBank,so it was a new subtype.CONCLUSIONS There are 70% of E.coli strains isolated from urine samples with qacE△1 gene.And disinfectant resistance may be one of the main factors for hospital infection in the future.

Objective To investigate the nursing points of the mechanical ventilated patients after percutaneous endoscopic gatrostomy (PEG). Methods The nursing approaches of 28 mechanical ventilated patients after percutaneous endoscopic gatrostomy in our department was analyzed retrospectively. Results The nutritional status of the 28 patients was improved to different degree after enteral nutrition (EN) support by PEG. Thereby, the nutritional requirement of the mechanical ventilated patients was ensured effectively. Among these patients, 4 patients could take food by mouth after taking off ventilator and extubation and stoma tube was pulled out, 15 patients were discharged carrying with stoma tube and convalescent care was continued, 3 patients died of primary diseases. Conclusions The PEG is a simple,safe and cost-effective approach of nutritional support for EN of mechanical ventilated patients. The key point of insuring EN of severe patients is intensive nursing and to prevent and reduce the complication of PEG.

Objective To study the early clinical outcome of patients undergone minimally invasive direct coronary bypass(MIDCAB) surgery,and the mid-term patency of left internal mammary artery(LIMA)-left anterior descending(LAD) anastomosis.Methods From Jannuary 2007 to May 2014,47 cases underwent MIDCAB surgery in our department,with 35 males and 12 females,aged 48-76 years,with the average of (62.9 ± 8.1) years old.Types of LAD lesions were as followed:1 case was ostial total obstruction,28 severe stenosis at proximal segment,10 long and severe stenosis,3 calcified lesion with severe stenosis,5 myocardial bridge.All patients had symptomatic angina,typical myocardial ischemia could be detected by electrocardiogram for all patients with myocardial bridge.Comorbidities included:hypertension 38 cases,27 diabetes mellitus,3 COPD and 3 chronic kidney disease.Results All surgery went well without transfer to mid-sternotomy.LIMA harvest time was 38-53 minutes,mean LIMA flow rate was(22 ± 6) ml/min after anastomosis.Surgery duration was 117-143 minutes,blood loss was less than 100 ml for each operation.No blood transfusion was required.Tracheal intubation time was 4-16 hours,ICU stay time was 22-45 hours,hospital stay time was 6-10 days.There was no peri-operative death,either no myocardial infarction or cerebral vessel accident.During follow-up,all LIMA-LAD appeared to be patent by coronary CT angiography.Conclusion High patency rate of LIMA-LAD anastomosis could also be obtained during MIDCAB surgery.It was reserved as a safe and effective surgery for well-selected patients.

Objective To assess the antimicrobial actitivity of econazole nitrate in comparison with other six antibacterial drugs. Methods The minimal inhibitory concentrations (MICs) of econazole nitrate (Eco), neomycin (Neo), erythromycin (E), penicillin (P), cefotaxime sodium (Cef), ciprofloxacin (Cip) and amikacin (An) to 222 strains of Staphylococcus spp isolated from the lesions of patients with eczema and atopic dermatitis were determined by using the broth dilution method. Results MIC50 values of Eco were similar to Neo, Cip, An and Cef, and lower than those of P and E on methicillin-sensitive Staphylococcus aureus (MSSA); significantly lower than those of the other six antibacterial drugs on methicillin-resistant Staphylococcus aureus (MRSA); similar to An, Cip and P, and lower than those of Neo, Cef and E on methicillin-sensitive and coagulase-negative Staphylococcus (MSCNS); and similar to An, Cip P or Neo, and lower than Cef and E on methicillin-resistant and coagulase negative Staphylococus (MRCNS). Based on the NCCLS standards, the resistance rates of Cip, P and E were very high to either Staphylococcus areus or coagulase-negative Staphylococcus (CNS). The resistance rates of An and Cef of were lower to MSSA, but higher than 50% to MRSA. MIC90 value of Eco was similar to its MIC50, and lower than the MIC value reported in the literature. The MIC90 value of neomycin was muich higher than the MIC50 value of econazole. Conclusion Econazole nitrate has antibacterial activity to both Staphylococcus areus and CNS. MIC90 value of Eco is similar to its MIC50, and no resistance to Eco was found.

Objective To investigate the pathogen distribution and susceptibility profile of fungal isolates from bloodstream infections,and valuate the clinical utility of G test in diagnosis of fungal infections for the purpose to improve antifungal therapy.Methods A retrospective analysis was carried out to analyze the fungal pathogens isolated from bloodstream infections in the First Affiliated Hospital of Nanjing Medical University during the period from January 2013 through December 2015 and their antimicrobial susceptibility.Results A total of 114 fungal strains were isolated from bloodstream infections during the 3-year period,most of which were Candida (99/114,86.8％),especially Candida albicans (30.7％).About 41.2％ (47/114) of the fungal strains were isolated from Department of Thoracic Surgery (10,5 and 4 strains in 2013,2014 and 2015),Hematology (11 strains in 2014),and ICU (7 strains in 2014).Antimicrobial susceptibility testing showed that all the fungal strains (100％) were susceptible to amphotericin B,but 83.5％ susceptible to itraconazole (the lowest).G test was positive before the result of blood culture in 13 of the 54 patients who received G test.Conclusions Candida was the most common fungus in fungal bloodstream infection.Amphotericin B is the most active antifungal agent in vitro.Blood culture combined with serological test can provide clinicians an earlier and reliable diagnosis.

Purpose To investigate the expression of mismatch repair proteins MLH1,MSH2,MSH6 and PMS2 and their clinical significance in colorectal cancer.Methods Immunohistochemical analysis was used to detect MLH1,MSH2,MSH6 and PMS2 protein expression in formalin-fixed paraffin-embedded tissues from 102 colorectal cancer patients,and microsatellite instability (MSI) was tested in 20 cases.The relationship between MMR protein expression and clinical pathological features was also analyzed.Results 15 cases (14.7％) had MMR protein loss.The loss rate of MLH1,MSH2,MSH6 and PMS2 protein was 12.7％ (13/102),3.9％ (4/102),4.9％ (5/102) and 10.8％ (11/102),respectively.MLH1,MSH2,MSH6 and PMS2 protein losses were not related with gender,age,tumor size,depth of invasion and lymph node metastasis (P ＞ 0.05).MLH1 and PMS2 protein losses were related to histological differentiation (P ＜0.05).MSI was detected in 10 Lynch syndrome candidates.2 cases (2.0％)of high-frequency microsatellite instability (MSI-H) were identified,and the remaining 8 cases were MSS.However,10 cases without MMR expression abnormality all showed MSI-L/MSS.Conclusion Immunohistochemical detection of MLH1,MSH2,MSH6 and PMS2 can be used as primary screening for Lynch syndrome and its combination with MSI test can effectively increase the diagnostic rate in Lynch syndrome.

Objective To study the anatomy basis and biomechanical stability of euthyphoria reduction and percutaneous cannulated screw fixation for sacroiliac dislocation,and to evaluate the primary clinical efficacy of this method.Methods The distances from the anterior branches of the nerve roots at L4,and L5 and obturator nerve on the superior border of sacral ala to the sacroiliac joint were measured on 12 adult cadavers (24 sides) fixed and preserved by formalin.Models of sacroiliac dislocation were made on six pelvic specimens of fresh cadavers.A comparison of stability was made on the six models between the fixation studied here and the traditional fixations by posterior percutaneous sacroiliac screws and by anterior sacroiliac joint plates.At the same time,17 patients with type C Tile fracture were treated with our method.The clinical efficacy was analyzed for the 17 patients.Results The distances from the anterior branches of the nerve roots at L4,and L5 and obturator nerve on the superior border of sacral ala to the sacroiliac joint were 20.24?1.20mm,23.80?1.43mm,and 16.26?2.07 mm respectively. There was no statistically significant difference in stability between our method and the traditional fixation by posterior percutaneous sacroiliac screws,though ours seemed better.Follow-ups for the 17 cases averaged 2.2 years,re- vealing fine functional recovery in all according to Matta scoring.Conclusions Euthyphoria reduction and per- cutaneous cannulated screw fixation can lead to sufficient biomechanical stability for the sacroiliac joint and effec- tively avoid nervous injuries.In addition,our method is simple and clinically effective,It is recommendable for small and middle-sized hospitals.

Objective To study the activation of Janus protein tyrosine kinase (JAK)/signal transducer and activator of transcription 1 (STAT1) signaling pathway and its inhibitor-signal transducer and activator of transcription-1(SOCS-1) in patients with systemic lupus erythematosus. Methods A total of 45 patients with active systemic lupus erythematosus (SLE) and 30 healthy controls were randomly selected. Western blot was performed to measure the expression of Stat1 protein and phospho-Stat1 protein (an activated form of Stat1 protein) in the monocytes after stimulation with recombinant high mobility group box1 (rHMGB1) at various time points. Expression of Stat1 protein in the skin or lesional skin was also detected. Phasic expressions of SOCS-1 mRNA in the monocytes after rHMGB1 stimulation were detected by real-time reverse transcription-polymerase chain reaction. SOCS-1 gene expression in the skin or lesional skin was also detected. Results The expression level of Stat1 proteins in the monocytes from patients with SLE was higher than that from healthy controls (t=9.16,P＜0.01) and positively correlated with SLE disease activity index (SLEDAI) (r=0.59,P＜0.01). Expression of phospho-Stat1 in the monocytes from SLE patients was time-dependently upregulated after stimulation with rHMGB1 at various time points, while expression of SOCS-1 mRNA remained unchanged(all P＞0.05). Expressions of phospho-Stat1 protein and SOCS-1 mRNA in the monocytes from healthy controls were increased transiently after stimulation with rHMGB1(all P＜0.05). Both expressions of phospho-Stat1 protein and SOCS-1 gene in the lesional skin from patients with SLE were upregulated compared with those in normal skin from healthy controls (all P＜0.01). Conclusion There are hyperactivation of JAK-STAT1 signaling pathway and negative feedback down-regulation of SOCS-1 in patients with systemic lupus erythematosus. HMGB-1 may be partly involved in the pathogenesis of SLE by the abnormal mediating function of JAK-STAT1 signal transduction pathway.

Objective To study the effects of COX-2 selective inhibitor celecoxib on the apoptosis of acute promyelocytic leuke-mia NB4 cell line,and to investigate its apoptosis mechanisms.Methods The expression of COX-2 mRNA in different cell lines was detected by reverse transcript polymerase chain reaction(RT-PCR).After treatment of NB4 with different doses of celecoxib,the in-hibition of NB4 growth was assayed by MTT,and the DNA fragmentation was examined by the DNA ladder test.The level of Bcl-2 protein expression was assayed by the flow cytometry.Results As compared with the no-medication treatment group,the DNA ladder fragments became more and more obvious after the treatment by different doses of celecoxib.The expression rates of Bcl-2 protein in the different doses of celecoxib groups (25,50,100 μmol/L)were (71.69 ±1.65 )%,(34.51 ±2.53)% and (29.28 ± 2.38)% respectively,compared with the Bcl-2 protein expression rate (85.34±2.89%)in the blank control group,the expression rate of Bcl-2 protein in different doses of celecoxib groups(50,100 μmol/L )was significantly decreased(P <0.05 ).Conclusion Celecoxib as COX-2 selective inhibitor could evidently induce the apoptosis of NB4 cells by down-regulating the expression of Bcl-2 protein in NB4 cells.

Objective To retrospectively analyse pathogenic bacteria isolated from inpatients with lupus erythematosus (SLE) and lupus nephritis (SLE‐LN ) ,and provide references for diagnosis and treatment for these patients with infection . Methods A total of 380 inpatients diagnosed with SLE/SLE‐LN in our hospital from 2010 to 2014 were enrolled in this study ,in‐cluding 96 cases of patients with SLE‐LN .Bacterial inoculation ,culture ,isolation ,identification and drug sensitivity test were carried out .Statistical analysis and susceptibility analysis was performed by using the SPSS 19 .0 and WHONET5 .6 software .Results For patients with SLE and SLE‐LN ,urinary tract infection accounted for 25 .0% and 27 .1% ,hematogenous infection accounted for 8 .1% and 10 .4% ,skin tissue infection accounted for 12 .0% and 8 .3% ,respectively .The most common gram negative bacteria was Escherichia coli ,which accounted for 25 .53% and 30 .21% in patients with SLE and patients with SLE‐LN ,respectively .Followed by Bauman Acinetobacter ,which accounted for 13 .42% and 14 .54% in patients with SLE and patients with SLE‐LN ,respectively . The most common gram positive bacteria was Staphylococcus aureus ,which accounted for 11 .58% and 11 .46% in patients with SLE and patients with SLE‐LN ,respectively .Strains of Escherichia coli were isolated from urine specimens of 69 .79% of patients with SLE and 66 .67% patients with SLE‐LN ,the percentages were significantly higher than that of the conventional urine culture (45% ,P< 0 .01) .The resistance rate of Escherichia coli strains isolated from patients with SLE to quinolones was higher than 66 .00% ,the resistance rate to ampicillin was 89 .69% ,and the resistance rate to piperacillin/tazobactam was low (3 .09% ) .The iso‐lation rates of ESBLs‐producing Escherichia coli strains and ESBLs‐producing Klebsiella pneumoniae strains in patients with SLE‐LN were higher than those in patients with SLE .Conclusion The patients with SLE have a higher risk for infection .The beta‐lac‐tams could be used for the treatment of Escherichia coli urinary tract infection in patients with SLE .