OBJECTIVE To get knowledge of the drugs resistance change of Pseudomonas aeruginosa in intensive care unit ICU, so as to offer the first-hand information to the clinical preventive and therapeutic countermeasures. METHODS Antimicrobial susceptibility tests of Staphylococcus aureus(SAU) were performed from 2001 to 2006. RESULTS The most frequent isolates were P. aeruginosa, Klebsiella pneumonia and Acinetobacter baumannii in 2001-2004. S. aureus were more than A. baumannii in 2006 and became the majore isolated bacteria in the sputum of the ICU patients. The incidence of drug resistance increased yearly(0, 25.0%, 29.4%, 74.4%, 87.7%, 92.7%, respectively) in S. aureus, and it was susceptibte to vancomycin. CONCLUSIONS It was showed that P. aeruginosa, K. pneumonia, A. baumannii and S. aureus were the major pathogens in the ICU, showing high drug resistance. Doctors should pay more attention to analyze the bacterial resistance profile in order to decrease the incidence of drug resistance and use the antibiotics properly.

ObjectiveTo investigate the impact of antimicrobial resistance on clinical outcomes and medical care costs among patients with imipenem-resistant Acinetobacter baumannii (IRAB) nosocomial infection.MethodsA retrospective matched case-control study was performed to compare the differences of clinical outcomes and medical care costs between patients with IRAB infection and patients with imipenem-susceptive Acinetobacter baumannii (ISAB) infection in a tertiary care university teaching hospital in China from January 2007 to June 2009.Cases were matched to controls with ratio of 1:1 on the basis of age,sex,severity of underlying diseases,source of infection,duration of hospitalization period and length of hospital stay before onset of infection.The measurement data between groups were compared by t test and rank test.The numeration data between groups were compared by x2 test. Multiple analysis was performed by Logistic regression.ResultsThe total mortality rate of IRAB infection patients was significantly higher than that of ISAB infection patients (39.1％ vs 20.3 ％ ; x2 =11.728,P＜0.01).Among 138 pairs of patients in IRAB group and ISAB group,there were 72 matched case-control pairs survived,which were significantly different in length of total hospital stay (28.5 days vs 23.0 days; x2 =2.886,P＜0.01) and intensive care unit (ICU) stay (14.5 days vs 0 day; x2 =4.844,P＜0.01).For all the 138 case-control pairs,everyday total hospitalization cost and everyday antibiotic therapy cost in IRAB cases were both higher than ISAB controls (RMB 3652 yuan vs RMB 2092 yuan; Z=3.792,P＜0.01 and RMB 555 yuan vs RMB 338 yuan; Z=4.209,P＜0.01).ConclusionIRAB infection can increase the mortality rate,lengthen hospital stay and elevate the medical costs notably.

Ex-vivo liver resection and liver autotransplantation offers a chance to cure extensive regional liver diseases which are otherwise deemed untreatable in selected cases. A 33-year-old male patient with advanced alveolar echinococcosis (AE) which invaded the right lobes and adjacent retrohepatic inferior vena cava, while the left lobes were free from lesion and had proliferated to over 1200 ml in size except for a 1 cm × 1 cm solid lesion in the segment Ⅳ. No extrahepatic metastases were found in this patient. A lesion with a size of 4300 ml and other small lesions in the right lobes were removed extracorporeally,and the retrohepatic vena cava was repaired, then the remaining AE-free left lobes (more than 700 ml in size) and the retrohepatic inferior vena cava were re-implanted in situ. A temporary end-to-end cavo-caval shunt with interposition of a blood vessel prosthesis and end-to-side portocaval shunt were established to keep the blood flow during the four-hour anhepatic phase. The patient was followed up for six months, and he had no signs of residual liver disease with good hepatic function.

[Summary] A total of 215 pregnant women at mid-gestation were enrolled, and their serum 25-hydroxyvitamin D levels were measured. Of them, 38 (17. 7%) were classified as cases with vitamin D sufficiency, 70 (32. 5%) as insufficiency, and 107 (49. 8%) as deficiency. Compared with the sufficient group, parathyroid hormone level increased and osteocalcin level decreased significantly in the deficient group. Therefore, vitamin D deficiency is highly prevalent among pregnant women and is associated with their potential disorder of bone turnover.

[Objective] To summarize image manifestations in intestinal tuberculosis (ITB) examined by multi-slice computed tomography enteroclysis (MSCT) and evaluate the diagnostic value of MSCTE in ITB,[Methods] The imaging findings were retrospectively analyzed in 15 cases of ITB that were confirmed by endoscopy or postoperative pathologic examination,including the location,number,shape,edge,surrounding tissue alterations of ITB and other associated changes in the peritoneum,mesentery and solid abdominal organs,and compared with endoscopy and pathology.[Results] In 15 patients,ileocecum was involved in 13 cases (87％),4 cases (27％) showed multi-segmental symmetric intestinal mural thickening,9 patients (60％) showed solid masses,1 case (7％) showed multi-segmental symmetric intestinal mural thickening and solid masses,1 case (7％) showed homogenous enhanced masses and perforation,12 cases (86％) showed enlarged lymph nodes (LNs) with rim enhancement,and 2 cases (13％) showed the comb sign of enhanced mesenteric vessels.Based on enhancement pattern of MSCTE,ITB was divided into three types:homogenous enhancement type (n=5);target sign type (n=2);caseous necrosis type (n=2).[Conclusion] The imaging features of ITB are diverse.MSCTE can clearly display the shape of intestinal mucosa,the alterations of intestinal wall and the relationship between lesion and adjacent tissues,which provides valuable information for the clinic diagnosis of ITB.

We analyzed genetic evolution characteristics of avian influenza A (H7N9) virus isolated in Zhaoqing,China,2014-2016.Nucleic acid were extracted and sequenced from 17 samples of H7N9 positive cases in Zhaoqing.Genetic characteristics of homology and important amino acid sites were analyzed by using BioEdit5.0 and MEGA6.0.The evolutionary trees were constructed by Neighbor-Joining and the referenced sequences were downloaded from GenBank,Eight nucleic acid fragments from 7 strains of H7N9 viruses were successfully generated.The highest homology was found in HA gene with A/chicken/Dongguan/695/2014(H7N9),and NA gene with A/chicken/Dongguan/1075/2014(H7N9).The internal genes were high homology with avian H7N9 and H9N2 virus from Dongguan and Shenzhen in Guangdong,China.The HA and NA genes were directly evolved in the Pearl River Delta evolution branch with the H7N9 sequences from the cities of Dongguan,Guangzhou and Shenzhen,while the sequences from the provinces of Anhui,Zhejiang,and Jiangsu were in the Yangtze River Delta evolution branch.There were 2 alkaline amino acids in cleavage site of HA,2 mutations (G186V and Q226L) in the crucial sites related with the receptor of HA protein,1 mutation (E627K) in PB2 protein,and 1 drug resistance mutation (S31N) in M2 protein.And no evidence of neuraminidase resistance in NA protein was found.In conclusion,the H7N9 virus for human infection in Zhaoqing may originate from avian H7N9 and H9N2 viruses,which circulated in the Pearl River Delta region of Guangdong from 2013 to 2014.The mutations of G186V,Q226L and E627 K might be related with high susceptibility to human beings.

Objective To investigate the relationship between iodine nutritional status and thyroid hormone levels,and to provide a guideline for monitoring iodine nutrition and thyroid function.Methods A crosssectional survey was performed by randomly selecting 341 samples (health pregnant women with a first child) from the Second People's Hospital of Guiyang,Bihai Community Medical Center and Jinhuayuan Community Center from October 2015 to September 2016.Levels of serum hormones and antibodies relative to throid of pregnant women in Guanshan Lake District of Guiyang at different pregnant times,which included throid stimulating hormone (TSH),free three triiodothyronine (FT3),free thyroxine (FT4),thyroid peroxidase antibody (TPOAb),and thyroglobulin antibody (TgAb),were measured by the electrochemical luminescence method,and urinary iodine levels were measured by heat digestion.Results The median urinary iodine of pregnant women at early,middle and late stages (T1,T2 and T3 stages) were 191.8,198.9 and 214.5 μg/L,respectively.FT3 increased first and then decreased during pregnancy.Levels of FT3 in the T2 stage were significandy higher than those in T1 and T3 stages (FT3 medians at the three stages were 4.49,4.83 and 4.57 pmol/L),and the differences were statistically significant (P ＜ 0.05).FT4 levels decreased during pregnancy (FT4 medians at the three stages were 16.32,14.65 and 13.22 pmol/L),and the differences among the three groups were statistically significant (H =67.517,P ＜ 0.01).Statistically significant differences were not found in the TSH levels among the three groups ~SH medians at the three stages were 2.05,2.01 and 2.39 mU/L,H =1.297,P ＞ 0.05).The medians of TPOAb and TgAb during T2 stage (9.60 and 19.02 U/ml) were significantly lower than those of other groups (18.92 and 24.75 U/ml at stage T1,and 13.46 and 22.06 U/ml at stage T3),and the differences were statistically significant (P ＜ 0.05).TSH levels were consistent with urinary iodine levels.TSH levels in the excessive iodine group (urine iodine:250 ～ 499 μg/L,2.54 mU/L) were significantly higher than those in the adequate iodine group (urine iodine:150 ～ 249 μg/L,1.97 mU/L) and deficient iodine group (urine iodine:＜ 150 μg/L,1.91 mU/L),and the differences were statistically significant (P ＜ 0.05).No correlations were found between levels of FT3,FT4,TPOAb,TgAb and levels of the urinary iodine.There was a significant positive correlation between urinary iodine levels and TSH levels (rs =0.180,P ＜ 0.01).The incidence of abnormal thyroid function in pregnant women was 29.33％ (100/341),which was composed of clinical hypothyroidism (accounting for 0.88％,3/341),subclinical hypothyroidism (accounting for 25.51％,87/341),low T4 level (accounting for 1.76％,6/341),clinical hyperthyroidism (accounting for 0.59％,2/341),subclinical hyperthyroidism (accounting for 0.59％,2/341),and TPOAb positive and TgAb positive (accounting for 12.61％,43/341).These abnormalities occurred mainly in the T1 and T3 stages.The prevalence of subclinical hypothyroidism increased with increasing of urinary iodine level,and the difference was statistically significant (x2 =11.269,P ＜ 0.05).Conclusion There is a positive correlation between pregnancy iodine nutritional status and its TSH level,so it is important to monitor the level of urinary iodine during pregnancy and to screen the thyroid function and antibodies in the early and middle time of pregnancy.

Objective To investigate the changes of serum thyroid peroxidase(TPOAb)and thyroglobulin antibody(TGAb)and their relationship with thyroid function in pregnant women during different gestation period Methods Totally 341 cases of primiparae were selected from October 2015 to September 2016 and levels of se-rum thyrotropin(TSH),free triiodothyronine(FT3),free thyroxine(FT4),thyroid peroxidase antibody(TPOAb) and thyroglobulin antibody(TgAb)were measured by electrochemiluminescence. Results The prevalence of thy-roid dysfunction and positive serum thyroid autoantibodies were 13.2%and 12.61%respectively,which mainly oc-curred in early and middle pregnancy. Thyroid dysfunction in subjects included hypothyroidism(0.59%),subclini-cal hypothyroidism(7.92%),low T4 hyperlipidemia(3.23%),hyperthyroidism(0.88%)and subclinical hyper-thyroidism(0.59%). The positive rate of TPOAb was significantly higher than that of TgAb(10.85% vs. 4.99%, P<0.01). The positive rate of TPOAb in women with thyroid disfunction was significantly higher than that in those with normal thyroid function(44.44%vs. 5.74%,P<0.01). TSH level of TPOAb positive subjects was higher than that of TPOAb negative ones(P<0.05,P<0.01);TSH level of TPOAb positive subjects with thyroid dysfunction were significantly higher than those of TPOAb negative subjects and TPOAb positive pregnant women but with nor-mal thyroid function(P < 0.01). The hypothyroidism prevalence rate of TPOAb positive subjects was significantly higher than that of TPOAb negative subjects in early and middle stage of pregnancy (P < 0.01). The prevalence rates of subclinical hypothyroidism ,low T4 hyperlipidemia and clinical hypothyroidism were significantly higher in TPOAb positive pregnant women(29.17%,20.83% and 8.33%)than those in TPOAb negative pregnant women (P < 0.01). Conclusions Thyroid dysfunction is closely related to positive status of TPOAb and TgAb in pregnancy,which could influence the outcome of pregnancy and the development of offspring. Since levels of TSH, FT3 and FT4 could not fully reveal thyroid function ,it is necessary to monitor the status of TPOAb and TgAb as early as possible for the early diagnosis and treatment of thyroid disease in pregnancy.

To provide a theoretical basis for controlling the spread of rust disease, cultivating disease-resistant varieties and reducing yield losses, we investigated the transcriptome differences between Gymnosporangium yamadae and Gymnosporangium asiaticum at the haustorial stage and revealed a specialized selection mechanism for Gymnosporangium species to infect host plants. We sequenced the transcriptomes of the haustoria in rust-infected leaves when basidiospores of G. yamadae and G. asiaticum infected their hosts, and obtained 21 213 and 13 015 unigenes, respectively. Real-time fluorescence quantitative PCR validation of five genes selected from G. yamadae and G. asiaticum, respectively, showed that their expression profiles were generally consistent with the results of transcriptome analysis, demonstrating the reliability of the transcriptome data. We used seven databases such as Nr, GO, KEGG, and KOG to perform gene function annotation and enrichment analysis, and found that the genes from both rusts were mainly enriched in cellular processes, translation, and metabolism-related pathways. Moreover, we used SignalP, TMHMM online website and other software such as dbCAN, BLSAT, HMMER to show that there were 343 (2.51%) and 175 (2.79%) candidate effector proteins containing 14 and 5 proteases and 10 and 3 lipases in the haustoria of G. yamadae and G. asiaticum, respectively. Furthermore, we used OrthoFinder, BLAST and KaKs Calculator software to analyze the evolutionary relationship of the two fungi. Among one-to-one homologous genes, gene pairs with > 82% alignment were considered to be under conservative selection, and 12.37% under positive selection. Five effectors of G. asiaticum were under positive selection, and one of which was a lipase. No significant differences were found in the enrichment of expressed genes between G. yamadae and G. asiaticum, indicating the biological processes involved in haustoria were relatively conserved, despite the typical host selectivity between species. The low protein similarity between the two species suggested that they were under greater host selective pressure and there was significant evolutionary divergence, which might be related to the host-specific selection mechanism. In the haustorial, the main purpose of the effectors might be to regulate physiological processes in the plants rather than attacking the host directly, and G. yamadae and G. asiaticum might use plant lipids as energy sources.
Transcriptome ; Reproducibility of Results ; Plant Diseases/microbiology* ; Gene Expression Profiling/methods*

【Objective】 To study the safety, effectiveness and nursing of blood/fluid warmer during the process of plateletpheresis in winter. 【Methods】 The blood re-transfusion speed during plateletpheresis in winter and the time of blood passing through the blood return pipeline was counted. The vitro blood was heated with a blood/fluid warmer under different temperature settings, and the rising speed of blood temperature was recorded. The blood samples were tested for blood routine examination, free Hb and erythrocyte morphology at 0, 15 and 30 minutes. In the process of plateletpheresis in winter, the blood donors′ ear temperature and the skin temperature near the reinfusion needle in the observation group and the controls were measured, and the blood donors were observed for shivering, arm chills, pain or other discomfort. After the blood donation, the thermal comfort was evaluated. 【Results】 There was no difference in the results of routine blood test and plasma free Hb test of vitro blood after warming at 41℃, 42℃ and 43℃ for 0, 15 and 30 minutes (P>0.05), and no change in erythrocyte morphology was found. The skin temperature near the reinfusion needle (before vs. after the start of phlebotomy) was statistically different by applying blood/fluid warmer or not(P<0.05), and no difference in the temperature between the start and end of phlebotomy was observed in the observation group(P>0.05). The vitro blood heating experiment showed that when the room temperature was within 22~24℃, the blood retransfusion speed was (100-120) mL/min; after the application of blood/fluid warmer, the temperature of reinfusion blood could be raised from 27℃ to 33~37℃. The proportion of feeling comfortable and very comfortable and the score of thermal comfort in the blood donors who used the warmer were higher than those in the controls (P<0.05). When the temperature of the warmer was set above 38℃, the average score of thermal comfort of blood donors was above 8. 【Conclusion】 It is safe to apply the blood/fluid warmer during the plateletsapheresis in winter, which can significantly improve the comfort of blood donors and reflect the humanized service of blood stations, and is worth popularizing.