Bacterial extracellular metalloproteases ( BEMPs) are a large group of metal ion-contai-ning proteases. All BEMPs identified so far are endopeptidase or endoprotease. BEMPs can be classified into nine metalloprotease families based on the sequences and structures of enzymatic molecules. Double-valence zinc ion ( Zn2+) is necessarily required by catalytic centers of most BEMPs. The main function of BEMPs in non-pathogenic heterotrophic bacteria is to hydrolyze environmental proteins and polypeptides to provide vari-ous amino acids as nutrients. However, BEMPs of pathogenic bacteria, serving as important virulence fac-tors, help the pathogens invade into hosts and spread in hosts. In recent years, the roles and mechanism of BEMPs in bacterial pathogenesis have attracted great attention. Here, we make a brief review about the structures and types as well as the functions and pathogenic roles of BEMPs.

Objective To observe the function improvement of deep venous valve after superficial vein surgery of lower extremity by ultrasound.Methods Sixty patients(70 lower limbs)with primary deep venous insufficiency were enrolled tO accept surgical management of vein systems.All Datients were detected with color Doppler ultrasonography,their deep venous hemodynamics indices were measured and recorded before operation and 6 months after operation. Results The total improvement rate of the deep venous hemodynamics after superficial vein surgery was 65.7%.The valve function of suPerficial femoral vein and popliteal vein were improved after operation,and there was no significant difference between the two veins in effectiveness.The improvement for deep venous reflux had no significant difference between two surgical methods. Conclusions The superficial vein surgery of lower extremity can improve deep vein valve function in some extent.

Objective To analyze Candida species causing vulvovaginal candidiasis in Qingdao and surrounding areas.Methods Vaginal discharge specimens were collected from 362 patients with suspected vulvovaginal candidiasis in the Affiliated Hospital of Qingdao University Medical College from May 2011 to November 2011,and subjected to routine fungal culture.The Candida isolates were identified by using Sabouraud dextrose agar,CHROMagar medium,germ tube test with serum,and API 20C AUX Clinical Yeast System.Results Totally,313 (86.46％) Candida strains were isolated from the specimens of 362 patients.Of these Candida strains,275 were identified as Candida albicans,38 as non-albicans Candida species,including 13 Candida glabrata strains,8 Candida parapsilosis strains,7 Candida tropicalis strains,5 Candida krusei strains,1 Candida lusitaniae strain,1 Candida dubliniensis strain,1 Rhodotorula mucilaginosa strain,1 Pichia ohmeri strain and 1 Trichosporon mucoides strain.Conclusions As far as vulvovaginal candidiasis is concerned,Candida albicans is still the most prevalent pathogen,and Candida glabrata appears to be the predominant species in pathogenic non-albicans Candida species.

Objective To investigate the relationship between the cystic fluid characteristics of symptomatic sacral canal cyst and the interventional therapeutic prognosis.Methods A total of 114 patients with symptomatic sacral canal cyst were enrolled in this study.Clinically,all patients complained of discomfort at lumbosacral area.Among the 114 patients,86 were primary sacral canal cyst and 28 were recurrent sacral canal cyst.Under DSA guidance,percutaneous puncturing of the cyst was performed,2-5 ml cerebrospinal fluid (CSF) was aspirated and sent for laboratory tests.Then a small amount of nonionic contrast agent was injected into the cyst to determine whether the cyst was communicated with the subarachnoid space or not.Finally,double-needle method was used to aspirate the cyst fluid.Results Radiography showed that communication between the cyst and subarachnoid space was detected in 66 patients (group A),while no communication between the cyst and subarachnoid space was observed in 48 patients (group B).In patients with primary symptomatic sacral canal cyst,the differences in the sugar and chloride levels of CSF between group A and group B were statistically significant.In patients with recurrent symptomatic sacral canal cyst,the differences in the sugar,protein and chloride levels of CSF between group A and group B were also statistically significant.Statistically significant correlation existed between the single or multiple CSF changes and the interventional therapeutic prognosis.Conclusion Sacral canal cysts can be classified into two types:cyst-subarachnoid space communicating type and cyst-subarachnoid space non-communicating type.The characteristics of CSF in patients with primary symptomatic sacral canal cyst are different from those in patients with recurrent symptomatic sacral canal cyst.Multiple CSF changes,the increased sugar level and decreased chloride level in CSF are well correlated with the interventional therapeutic prognosis.

Since human society entered the 21st century, the rapid development of medical technology also gave birth to a series of negative effects:medical service technology first, trust crisis of the doctor-patient relation-ship, and medical industry money worship. Especially in recent years, due to the lack of humanistic spirit in medi-cal institutions, the doctor -patient relationship is of the worst state in the history. Therefore, it is urgent to strengthen the medical humanities education in the construction of hospital culture. Aiming at the problems existing in the current medical industry, this paper expounds the importance of strengthening the humanistic education in the construction of hospital culture.

Objective To observe the epidemiology characterization of Borna disease virus (BDV) in animal brain in Ili, Xinjiang, and to find out the potential infection of the Borna disease virus to prevent its outbreak. Methods The BDV p24 gene of animal brain tissues in Ili including 200 horses, 75 donkeys and 100 shepherd dogs was detected by fluorescence quantitative nest reverse transcriptase polymer-ase chain reaction(FQ-nRT-PCR). GFP-p24,pMD-19 plasmid contamination was excluded from positive products. Clone sequencing was used to analyze the homology of gene and amino acid sequence. Results BDV p24 gent was found in 3 Ili horses, 4 Ili donkeys and 9 shepherd dogs, and the positive ratio is 1.5%, 5.3% and 9.0%, respectively. The GFP-p24,pMD-19 were not found in BDV p40 gene and plasmid stand-ard. The sequence of BDV p24 amplification production was totally the same as He/80 virus strain. Conclu-sion Natural infection of BDV may exist in the animals(horses, donkeys and dogs)in Ili, and the epidem-ic strain of BDV in this area was homological as He/80 virus strain.

Objective To understand and determine the biological activity and pathogenicity of metalloendopeptidases encoded by LA2582 and LA2901 genes of Leptospira interrogans(L.interrogans) sero-group Icterohaemorrhagiaeserovar Lai strain Lai. Methods Structures and functions of LA2582 and LA2901 genes were analyzed by using bioinformatic software. Prokaryotic expression systems for expressing the extra-cellular regions of LA2582 and LA2901 genes were generated. The target recombinant expression products, rLA2582 and rLA2901,were extracted by Ni-NTA affinity chromatography. The Azo-casein-hydrolyzingactiv-ity of rLA2582 and rLA2901 was detected by spectrophotometry. Activities of rLA2582 and rLA2901 in the hydrolysis of Dabsyl-Leu-Gly-Gly-Gly-Ala-Edans, a fluorescence-labeling pentapeptide substrate, were de-tected by fluorospectrophotometry,and then the Km and Kcat values were determined. SDS-PAGE and spec-trophotometry were performed to detect the activities of rLA2582 and rLA2901 in hydrolyzing extracellular matrix molecules such as collagen type-Ⅰ (COL1), fibronectin (FN) and Congo red-labeling elastin (ELN). Real-time fluorescent quantitative RT-PCR(qRT-PCR) and Western blot were respectively used to measure the expression of LA2582 and LA2901 genes at mRNA and protein levels after infecting human um-bilical vein endothelial cells(HUVEC) with L. interrogans strain Lai. Results The gene products of LA2582 and LA2901 genes were identified as the signal peptide and matrix metalloproteinase motif HXH-containing Zn2+-dependent Gly-Gly metalloendopeptidases belonging to the M23 superfamily. rLA2582 and rLA2901 did not hydrolyze Azo-casein (Km=126.54 μmol/L, Kcat=4.67/s), but could hydrolyze the pentapeptide substrate (Km=190. 25 μmol/L, Kcat 4. 86/s). rLA2582 and rLA2901 could hydrolyze COL1, FN and ELN. Expression of LA2582 and LA2901 genes at both mRNA and protein levels was signifi-cantly increased after infection of HUVEC with L.interrogans strain Lai(P<0.05). Conclusion The prod-ucts of LA2582 and LA2901 genes of L.interrogans strain Lai are Zn2+-dependent M23 metalloendopeptidas-es, which can hydrolyze multiple ECM molecules and are closely associated with the leptospiral invasiveness.

OBJECTIVE:To provide reference and basis for strengthening the drug quality supervision of medical institutions.METHODS:The problems about the drug quality supervision of the medical institutions were analyzed from the angle of legislation.Countermeasures for strengthening drug quality supervision of medical institutions in China as well as legislative suggestions on improving drug quality supervision of medical institutions in China were put forward.RESULTS & CONCLUSIONS:At present,the existing problems about drug quality supervision in medical institutions include that pharmacy setting lack mandatory standards;routine drug quality supervision is mainly the formal regulation;the punishment of drug related illegal behavior in medical institutions is too light,etc.To strengthen drug quality supervision of medical institutions in China,it is suggested that the government should establish the mandatory standards for medical institution pharmacy setting,add administrative inspections,and formulate Good Using Practice applicable to the whole country.When perfecting the law of drug quality supervision in medical institutions in China,relevant provisions may be added in The Drug Administration Law of the PRC,Regulations for the Implementation of Drug Administration Law,and the subordinate laws and regulations of Management Regulation of Medical Institutions so as to strengthen drug quality supervision of medical institutions.

Objective To compare the efficacy and safety of β - lactams alone and the combination of β - lactams with macrolides in the treatment of community-acquired pneumonia(CAP) in children. Methods PubMed, CNKI and VIP databases were searched by computer. RCT on children with CAP treated by β-lactams and macrolides were collected. The retrieval time was from the establishment of the database to July 2020. Literatures were selected and data was extracted according to inclusion and exclusion criteria. The risk of bias was evaluated, RevMan 5.3 software was used for Meta-analysis. Results Thirteen articles with 1788 patients were included in the study. The results showed that the clinical efficacy of the combination therapy in the experimental group was better than that in the control group [RR = 1.11, CI = 1.07–1.15, P < 0.000 01]. The time for fever returning to normal was shorter in the experimental group than that in the control group [MD = −1.31, CI =−1.58– −1.05, P < 0.000 01]. The disappearance time of pulmonary rales was shorter in the experimental group than that in the control group [MD = −1.75, CI = −2.13– −1.37, P < 0.000 01], There was no statistically significant difference in adverse reactions between the two groups (P > 0.05). Conclusion The combination therapy of β - lactams and macrolides is better than β-lactams alone in children with CAP with no significant difference in adverse reactions. Limited by the quantity and quality of the included studies, the conclusions from this study need to be further verified by large samples of high-quality RCT.

Objective To investigate the distribution and resistance profile of bacterial isolates in Shanghai Children's Hospital. Methods Antimicrobial susceptibility of all isolates was determined by Kirby-Bauer disk diffusion method according to 2016 CLSI standard. The data were analyzed by WHONET 5.6 software. Results A total of 23 259 non-duplicate strains were isolated from 2011 to 2016, including 10 885(46.8％)gram-postive cocci and 12 374(53.2％)gram-negative bacilli. The average prevalence of methicillin-resistant S. aureus(MRSA)and coagulase-negative Staphylococcus(MRCNS)was 35.8％ and 82.2％, respectively. The prevalence of MRSA rose from 27.4％ in 2011 to 42.9％ in 2016. The resistance rate of MRSA and MRCNS strains were significantly higher than methicillin sensitive strains. The resistance rate of Enterococcus faecium strains was significant higher than Enterococcus faecalis. The prevalence of non-susceptible Streptococcus pneumoniae was 31.2％(908). No gram-positive strain was resistant to vancomycin or linezolid. The prevalence of carbapenem resistance increased in gram-negative strains. The resistance rate of Klebsiella pneumoniae to imipenem and meropenem rose from 3.1％ and 4.8 ％ in 2011 to 28.7％ and 37.4％ in 2016, respectively.The rate of Pseudomonas aeruginosa resistance to imipenem and meropenem rose from 13.8％ and 16.5％ in 2011 to 18.8％ and 19.4％ in 2016, respectively, while Acinetobacter baumannii showed resistance rate of 38.3％ and 39.9 ％ in 2011 to 68.4％ and 69.7％ in 2016. Conclusions Increasing prevalence of MRSA, carbapenem-resistant K. pneumoniae, extensively drug-resistant A.baumannii has become a concern in clinical practice. Therefore, antimicrobial resistance surveillance should be highly strengthened in children's hospital.