Objective To analyze the resistance of Stenotrophomonas maltophilia to commonly used antibacterial drugs,and to investigate the existence status of 3 kinds of integron(Ⅰ,Ⅱand Ⅲ)and the carrying drug resistance gene cassettes so as to offer help for better preventing and controlling the infectious diseases caused by stenotrophomonas maltophilia in local place.Methods 51 strains of Stenotrophomonas maltophilia from clinical samples were collected and the minimum inhibitory concentration(MIC)of 17 kinds of antibacterial drugs to stenotrophomonas maltophilia was measured by the broth microdilution antifungal susceptibility test(Mi-AFST).3 kinds of integron(Ⅰ,Ⅱand Ⅲ)were amplified by PCR with primers designed according to registrated DNA se-quence in GenBank.The variable region products in the positive integron strains were amplified and performed the sequencing analy-sis.The homological comparison in the Genebank database was performed on the sequencing results for finding out what gene was included in variable domain of those integrons.Results (1)Among 51 strains of stenotrophomonas maltophilia,41 srains (80.39%) were collected from sputum samples,and the infected crowd was dominated by individuals aged over 60 years,38 strains accounted for 74.5%.In the department distribution,20 strains(39.22%)were collected from ICU,13 strains (25.49%)from the respiratory department and 6 strains(11 .76%)from the veteran cardres wards,which accounted for the larger proportion.(2)The drug suscep-tibility test demonstrated that stenotrophomonas maltophilia strains had the higher resistance to most of commonly used antibacteri-al drugs,some strains even showed the multi-drug resistance to over 9 kinds of antibacterial drugs.(3)The PCR gene amplification results showed that 7 strains (13.7%)were positive integronⅠ,while no strains containing integron Ⅱ or ⅢI were detected;the resistance genes carried in the variable region of integron I included the 5 kinds of aacA4,aadA1,catB8,dfrA17 and aphA15.Conclu-sion Stenotrophomonas maltophilias has relatively high resistance to majority of commonly used antibacterial drugs in clinic,and some strains show the muti-drug resitance.IntegronⅠis one of important factors for the multi-drug resistance of Stenotrophomonas maltophilias.

Objective To investigate positive picobirnaviruses(PVBs)infection and its association with unex-plained diarrhea in children. Methods From January to December 2015,the Clinical Microbiology Testing Center of Xuzhou Central Hospital as the sampling location,7 PVB reverse transcription - polymerase chain reaction(RT - PCR)- positive fecal samples with diarrhea were collected from children under 6 years old and 4 samples from healthy chil-dren were obtained and all the samples were analyzed by viral metagenomics to investigate the relationship between PVBs and diarrhea in children. Phylogenetic analysis of RdRp in the isolated PVB sequences was carried out to clarify the relationship between PVB classification and diarrhea. Results All the 7 diarrhea feces contained high titers of PVB sequences,while 3 of the controls were negative,and 1 with low titers of PVB. RdRp analysis was carried out on the iso-lated PVB sequences,which displayed that 7 RdRp sequences caming from 7 fecal samples separately,so named ChXz- 1 to ChXz - 7 respectively. Phylogenetic analysis based on the predicted amino acid sequences of RdRp from this study and whole RdRp sequences available in the GenBank database indicated that the 7 RdRp sequences belonged to 3 genogroups,in which ChXz - 1,ChXz - 2,ChXz - 3 belonging to genogroup Ⅰ,ChXz - 4,ChXz - 5,ChXz - 7 belong-ing to genogroup Ⅱ,and ChXz - 6 belonging to genogroup Ⅲ. Conclusions PVBs might be the cause of diarrhea in children in this study,and all the 3 different PVBs may lead to diarrhea.

Objective To study the injury risk and fatigue status of firefighters with different training postures under load-bearing conditions to reduce the occurrence of physical injuries and occupational diseases.Methods First,a questionnaire was administered to investigate the training injury conditions of firefighters in a fire-rescue brigade.Considering the exercise fatigue factor,which accounts for the highest proportion of injury causes,lower back analysis,static strength analysis,fatigue analysis,comfort analysis,and other human factor analysis tools in Jack software were used to analyze four common firefighter water-shooting training postures.Training postures while climbing a five-storey building with loads and a hooked ladder were also simulated.Results Injury caused by exercise fatigue accounted for 69.8%of injuries and was the most important injury-causing factor.The risk of knee and ankle joint injuries increased in all four water-shooting postures.The comfort levels of the four water-shooting postures from high to low were shoulder,standing,kneeling,and lying postures.For the entire dynamic training process,while climbing the five-storey building with loads and climbing the hooked ladder,firefighters did not have an increased risk of lower back injury but had an increased risk of ankle and knee joint injuries.Conclusions Some training postures are uncomfortable for firefighters,and they experience body discomfort during firefighting training with loads,thereby increasing injury risk.These results provide scientific references for the prevention and reduction of firefighter training injuries,and the formulation of reasonable training plans and targeted protective measures.

OBJECTIVETo confirm a new allele HLA-B*13:01:06 and analyze its nucleotide sequence.

METHODSGenomic DNA was extracted using a Qiagen DNA extraction kit. Nucleotide sequences of HLA-A, HLA-B, HLA-C and HLA-DRB1 were analyzed by polymerase chain reaction-sequence based typing (PCR-SBT). HLA high-resolution results were assigned, and the nucleotide sequences of HLA-B locus was compared with that of HLA-B*13:01:01.

RESULTSThe nucleotide sequence of the new allele shows a strong similarity to that of HLA-B*13:01:01. One nucleotide in exon 2 has changed from G to A at position 219 (codon 49 GCG>GCA), which however did not result in amino acid change.

CONCLUSIONThe novel allele verified by sequencing has been submitted to GenBank and officially named as HLA-B*13:01:06 by the World Health Organization HLA Nomenclature Committee.

Alleles ; Amino Acid Sequence ; Base Sequence ; Exons ; HLA-B Antigens ; genetics ; Humans ; Male ; Middle Aged ; Molecular Sequence Data ; Sequence Analysis, DNA

Standardized reporting is a crucial factor affecting the use of patient guidelines （PGs）， particularly in the reporting and presentation of recommendations. This paper introduced the current status of PG reporting， including the research on PG content and presentation formats， and provided comprehensive recommendations for PG reporting from aspects such as overall framework， recommendations， presentation format， and readability. First， the presentation of PG recommendations should include clearly defined clinical questions， recommendations and their rationale， and guidance on how patients should implement the interventions； for specific content in the PG， such as level of evidence， level of recommendation， it is recommended to explain in text the reasons for giving different levels of recommendation， i.e.， to present the logic behind giving the level of recommendation to the patient； additional information needed in the recommendation framework should be supplemented by tracing references or authoritative textbooks and literature that support the recommendations. Subsequently， the PG text should be written based on the Reporting Checklist for Public Versions of Guidelines （RIGHT-PVG） reporting framework. Finally， to enhance readability and comprehension， it is recommended to refer to the Patient Education Materials Assessment Tool （PEMAT） for translating PG content. To enhance the readability of PGs， it is suggested to present the PG content in a persona-lized and layered manner.

Since the concept of patient versions of guidelines （PVGs） was introduced into China， several PVGs have been published in China， but we found that there is a big difference between the concept of PVG at home and abroad， and the reason for this difference has not been reasonably explained， which has led to ambiguity and even misapplication of the PVG concept by guideline developers. By analyzing the background and purpose of PVGs， and the understanding of the PVG concept by domestic scholars， we proposed the term patient guidelines （PGs）. This refers to guidelines developed under the principles of evidence-based medicine， centered on health issues that concern patients， and based on the best available evidence， intended for patient use. Except for the general attribute of providing information or education， which is typical of common health education materials， PGs also provide recommendations and assist in decision-making， so PGs include both the patient versions of guidelines （PVG） as defined by the Guidelines International Network （GIN） and "patient-directed guidelines"， i.e. clinical practice guidelines resulting from the adaptation or reformulation of recommendations through clinical practice guidelines.

At present， the process and methodology of patient guidelines （PGs） development varies greatly and lacks systematic and standardised guidance. In addition to the interviews with PG developers， we have sorted out the relevant methodology for the adaptation and development of existing clinical practice guideline recommendations and facilitated expert deliberations to achieve a consensus， so as to finally put forward a proposal for guidance on the process and methodology for the development of PGs. The development of PGs can be divided into the preparation stage， the construction stage， and the completion stage in general， but the specific steps vary according to the different modes of development of PGs. The development process of Model 1 is basically the same as the patient version of the guideline development process provided by the International Guidelines Network， i.e.， team formation， screening of recommendations， guideline drafing， user testing and feedback， approval and dissemination. The developer should also first determine the need for and scope of translating the clinical practice guideline into a patient version during the preparation phase. Model 2 adds user experience and feedback to the conventional clinical practice guideline development process （forming a team， determining the scope of the PG， searching， evaluating and integrating evidence， forming recommendations， writing the guideline， and expert review）. Based on the different models， we sort out the process and methods of PG development and introduce the specific methods of PG development， including how to identify the clinical problem and how to form recommendations based on the existing clinical practice guidelines， with a view to providing reference for guideline developers and related researchers.