OBJECTIVE To investigate the prevalence of extended-spectrum ?-lactamases(ESBLs) and the resistance in Escherichia coli isolates from biliary tract and abdominal cavity.METHODS ESBLs-producers were detected by CLSI Phenotypic Confirmatory Test and susceptibilities were tested by agar dilution method.RESULTS 50.1% Of isolates were ESBLs producers in those isolates.ESBLs producers were highly resistant to ampicillin,cefazolin,cefuroxime,fluoroquinolones,and cefotaxime.The resistant rate to ceftazidime,cefepime,cefoperazone-sulbactam,amikacin,and cefmetazole was less than 40%.None was resistant to meropenem in ESBLs producers.In non-ESBLs producers the resistant rate to ampicillin,cefazolin,cefuroxime,fluoroquinolones was more than 40% and most were susceptible to other antimicrobial agents.The resistant rate to ampicillin,cefazolin,cefuroxime,and ciprofloxacin was significantly higher in ESBLs producers than non-ESBLs producers.CONCLUSIONS With resistance to most of antimicrobial agents,ESBLs-producers were highly prevalent in E.coli isolates from biliary tract and abdominal cavity,so more attention should be paid to survey and detect those strains.

Aim To obtain the encoding gene sequences of TEM-type ?-lactamases produced by 4-strain Klebsiella pneumoniae in Zhejian g Province, identify their genotypes and study some properties of these TEM-typ e ?-lactamases.Methods The encoding genes of TEM-type ?-la ctamases produced by 4 isolates were amplified by PCR. The purified PCR products were ligated with pGEM-T easy vectors, expressed in E. coli DH 5?, and sequenced by Sanger's dideoxy chain termin ation composition method. Compared with anino acid sequences in the GenBank,TEM -types of the ?-lactamases was determined. The genes of TEM ?-lactamases were ligated with pET-28 c vector to express recombinant proteins in E. coli DH 5?. Plasmids were extracted from the p ronucleus expression strains and PCR was performed to determine whether the pron ucleus expression was successful or not. Their phenotypes were determined by ESB Ls phenotype affirmative test. The isoelectric points (pIs) of the recombinant p roteins were determined by isoelectric focus. Conjugation test was performed to determine whether their genes existed in plasmid or chromosome. Results The encoding genes of ?-lactamases were determined as TEM by PCR. It s PCR product had 1 009 nucleotides. The pI of the novel TEM ?-lactamase was 5.4. The enzyme was determined as non-ESBLs by ESBLs phenotype affirmative tes t.Transconjugants were successfully selected from the paternal producers in conj ugation tests. The TEM-type ?-lactamase produced by 4 strains was determined as TEM-105(AF516720) by GenBank. Conclusion The ?-lactamase produced by 4-strain K. pneumoniae from 4 patients in Zhejiang Province was TEM-105. It was the first report of TEM-105 type ?-lactamase produced by 4-st ain K. pneumoniae from China in the world.

Pregnant women with subacute thyroiditis (SAT) are rare.One case was reported and the clinical features and management principles of SAT during pregnancy were reviewed.In pregnant women with SAT,the illness is usually not serious.If subclinical or clinical hypothyroidism develops,L-T4 must be given and thyroid function be monitored routinely,and the medication be adjusted carefully to ensure the maternal-fetal safety.

Objective To investigate the related clinical factors and homology of strains in Stenotrophomonas maltophilia (S. Maltophilia) infections in 15 patients with liver transplantation. Methods Fifteen patients with S. Maltophilia infection from September to December 2006 were enrolled and their clinical data were collected. Minimal inhibitory concentrations (MICs) of 10 antimierobial agents against S. Maltophilia were determined by Etest strips. Antibiogram was carried out by resistance analysis assembly with WHONET 5 software. The genomic DNA of all the isolates was digested with Xbal and subjected to pulse-field gel electrophoresis (PFGE). Results All patients received mechanical ventilation during the treatment and had a history of long-term use of extended-spectrum β-lactamases and quinolones. MICs of 10 antimicrobial agents indicated that S. Maltophilia were susceptible to several antimicrobial agents including compound sulfamethoxazole and ciprofloxacin, but the best active agent against these resistant isolates was minocycline in vitro. The results of all 15 S. Maltophilia antibiograms were accordance with PFGE patterns. All 15 S. Maltophilia isolates were classified as 2 PFGE patterns: 9 for pattern A and 6 for pattern B. Conclusion Mechanical ventilation might be associated with the S. Maltophilia septicemia in patients with liver transplantation.

Objective To determine the structures of resistance transposons and muhilocus sequencing typing(MLST)in the vancomycin resistant enterococcus(VRE).Methods Twenty-one VRE strains were isolated from five hospitals in Hangzhou.The resistance to antimicrobial agents was determined by Etest.Polymerase chain reaction(PCR),conjugation,plasmid extract,transposon structures,pulse field gel electrophoresis(PFGE),muhilocus sequencing typing(MLST),and multiple-locus variable-number tandem repeat analysis(MLVA)were carried out.Results All of the 21 VRE strains harbored the vanA gene.These strains were divided into 10 PFGE types,7 sequence types(STs)and 5 MLVA types.All of these VRE strains were susceptible to linezolid and tigecycline.The vanA genes in two VRE strains were located in transposon Tnl546,and those in the other 19 VRE strains were located in transpeson Tnl546- like,with ISl485 inserted in vanXY.Vancomycin resistance of 1 8 VRE isolates was transferred by filter mating. All of these conjugants had a plasmid containing a molecular size of about 54 000 bo.Conclusions These 21 VRE strains were all caused by the vanA gene and divided into 7 MIST types.A novel trasnposon was detected.Most of these VRE isolates belonged to the clonal complex(CC17)by MIST,which was the hospital-adapted and pandemic VRE clonal complex.

OBJECTIVE To identify the antibiotic resistance,homology and the carbapenemases determinants of imipenem-resistant strains of Acinetobacter baumannii isolated from elderly in the Zhejiang Hospital.METHODS All 142 strains of A.baumannii were isolated from Zhejiang Hospital through Jan 2005 to Jan 2007.K-B method was used to screen imipenem-resistant strains.The MICs of imipenem-resistant strains to 14 antimicrobial agents were determined by agar dilution method.The homology of these isolates was analyzed by pulse-field gel electrophoresis(PFGE).The coding genes of carbapenamases and the gene environments were investigated by PCR,clone,and sequencing.RESULTS Ninety-seven strains of imipenem-resistant A.baumannii were isolated from 142 strains.All of the strains of carbapenem resistant A.baumannii belonged to 4 epidemic PFGE-clones.Ninety carbapenem resistant strains contained OXA-23-like carbapenemase gene and 91 isolates were positive for OXA-51-like gene. OXA-23-like gene of 86 strains was just on the down-stream of insert sequence ISAba1.OXA-51-like gene of 6 strains had an ISAba1 sequence just on the up-stream.CONCLUSIONS All imipenem-resistant strains of A.baumannii are pan-resistant isolates.Clone dissemination is the most important style of strains spread.No OXA-24-like,OXA-58like,IMP-like,and VIM-like gene are detected.OXA-23-like and OXA-51-like gene are the most popular carbapenemases coding genes of these strains in the Zhejiang Hospital.ISAba1 has close relationship with OXA type carbapenemases genes in Zhejiang Hospital.

Objective To compare zinc-finger BED domain-containing 3 ( ZBED3 ) expression in various tissues of C57BL/6J mice and the effects of liraglutide, glucose, and insulin on the levels of ZBED3 protein expression in C57BL/6J mice and db/db mice. Methods The mRNA level of ZBED3 in various tissues of C57BL/6J mice was measured by realtime PCR. The protein level of ZBED3 was measured by using western blot. Results ZBED3 mRNA levels were detected in muscle, spleen, kidney, brain, heart, lung, and liver of C57BL/6J mice, yielding the highest expression in muscle. Additionally, The liver ZBED3 levels were higher in db/db mice compared with C57BL/6J mice (P<0. 01). Furthermore, the protein expression of ZBED3 was significantly increased in liver tissues of db/db mice treated with high concentrations of liraglutide, glucose or insulin(P<0. 05), however, the expression of ZBED3 only responded to high concentration of glucose in liver tissues of C57BL/6J mice. Conclusion ZBED3 may act as a novel factor in regulating glucose metabolism. The expression of ZBED3 can be regulated by liraglutide, glucose, and insulin. Thus, ZBED3 may play an important role in conditioning of hyperglycemia.

ObjectiveTo discuss the incidence,treatment and effect of cryptogenic hemoptysis (CH).MethodsPatients with CH were selected from 231 patients with hemoptysis according to clinical evaluation,chest radiography,fiberoptic bronchoscopy and CT scan,and the clinical data and treatment methods were retrospectively analyzed.ResultsFifty-three of 231 patients referred for CH,the incidence of CH was 22.94 ％ (53/231),of which 45 (45/53,84.91％ ) received internal conservative treatment and 8 (8/53,15.09％) received bronchial artery embolization (BAE).High resolution CT (HRCT) showed ground-glass opacities in 20 CH patients after hemoptysis.Bronchial arteriography showed abnormalities,including arterial enlargement and localized hypervascularity in 8 patients and systemic to pulmonary shunting in 3 patients.No recurrence of hemoptysis was observed during 1 to 8-year follow-up.ConclusionBleeding can be controlled in most of CH patients by internal conservative treatment,only a few patients with massive hemoptysis need BAE,and both treatments have good short and long term results.

Objective To discuss the effect of atorvastatin to prevent the arterial restenosis after intracavitary therapy of patients with lower atherosclerotic occlusive (LASO).Methods One hundred and ten patients with LASO were randomly divided into the control group (n =55) and research group (n =55).All patients were given intraeavitary therapy (including balloon dilation, stent implantation and endarterectomy, stentimplantation and thromboetomy).The patients of the control group were given conventional anticoagulant therapy while the observation group were given atorvastatin 20 mg/d based same treatment of the control group for 6 months.The blood lipid, C-reactive protein (CRP), intima-media thickness (IMT) and the patency rate of lower limb artery of two group were observed and recorded before treatment and at 1 day,1 month,3 months and 6 months after treatment.Results The total cholesterol (preoperation, 1 month, 3 months and 6 months after operation were (4.90± 1.02) mmol/L, (4.07 ± 0.76) mmol/L, (3.82 ± 0.53) mmol/L and (3.64 ± 0.35) mmol/L respectively), CRP (preoperation, 1 month, 3 months and 6 months after operation were (31.60 ± 13.32) mg/L, (19.24±9.45) mg/L, (9.84 ± 6.43) mg/L and (6.34 ± 3.82) mg/L respectively) and IMT (preoperation, 1 month, 3 months and 6 months after operation were (1.08±0.25) mm, (1.02±0.27) mm, (0.92±0.22) mm and (0.81±0.16) mm respectively) of research group showed a downward trend,while the control group had no significant change, there were statistically significant differences among the research group (P＜0.05).Total cholesterol, IMT and CRP were significantly different among the patients of the research group at different time points (P ＜ 0.05), while there was no statistically significant difference in different times of patient(P＞0.05).There were no statistical significant about the patency rate at 1 day, 1 month,and 3 months after treatment between the two groups(P＞0.05),while the patency rate of research group at 6 months after treatment was obviously higher than that of control group (94.5％ (52/55) vs.74.5％ (41/55);x2 =7.637, P ＜0.05).Conclusion Atorvastatin can effectively reduce the blood lipid and CRP of patients with lower atherosclerotic occlusive and increase the patency rate,it is worth popularization and application.

Objective:To study the function and possible mechanism of Fufang-Zhongjiefeng aerosol in the treatment of chronic pharyngitis. Method:Sixty SD rats were randomly divided into normal group, model group, low-, medium-, and high-dose Fufang-Zhongjiefeng aerosol group, and positive drug group, with 10 rats in each group. Except the normal group, the pharynx of other groups were injected with group A beta-hemolytic streptococcus (GAS) to establish chronic pharyngitis rat model. After the modeling, the low-, medium-, and high-dose Fufang-Zhongjiefeng aerosol groups were sonicated with 20 ml of 0.9% normal saline to dissolve the Fufang-Zhongjiefeng aerosol 2.33, 4.66, 9.32 g/kg, respectively. The normal group and the model group were given the same volume of normal saline, and the positive drug group was intraperitoneally injected with ampicillin sodium 0.93 g/kg once a day for 14 days. The pathological changes of pharyngeal mucosa were detected by hematoxylin and eosin (HE) staining. The levels of tumor necrosis factor-α (TNF-α), interleukin-1β (IL-1β) and nterleukin-6 (IL-6) in serum were detected by Enzyme-linked Immunosorbent Assay (ELISA). The expression levels of toll-like receptor 4 (TLR4), myeloid differentiation factor 88 (MyD88) and nuclear factor kappa B (NF-κB) p65 protein in pharyngeal mucosa were detected by immunohistochemistry. The expression levels of TLR4, MyD88 and NF-κB p65 mRNA in pharyngeal mucosa were detected by quantitative real-time reverse transcription-polymerase chain reaction (RT-qPCR). Results:Compared with the model group, the serum TNF-α, IL-1β and IL-6 levels of rats in the Fufang-Zhongjiefeng aerosol low-, medium-, high-dose group and the positive drug group were significantly reduced ( P<0.05). The expression of TLR-4, MyD88 and NF-κB p65 protein in the pharyngeal mucosal tissue of rats in the low-, medium-, high-dose Fufang-Zhongjiefeng aerosol group and the positive drug group were significantly reduced ( P<0.05). The expressions of TLR-4 mRNA (1.17 ± 0.41, 2.44 ± 1.06, 1.25 ± 0.34 vs. 3.87 ± 1.43), MyD88 mRNA (1.15 ± 0.53, 1.75 ± 0.36, 1.09 ± 0.14 vs. 2.44 ± 0.19), and NF-κB p65 mRNA (1.97 ± 0.51, 2.64 ± 0.26, 2.31 ± 0.44 vs. 5.08 ± 0.34) in the pharyngeal mucosa tissue of rats in the medium-, high-dose group and the positive drug group were significantly reduced ( P<0.05). Conclusion:Fufang-Zhongjiefeng aerosol can effectively treat chronic pharyngitis, which could inhibit the expression of TLR-4, MyD88, and NF-κB to reduce the expression of inflammatory factors so as to play the rold of anti-inflammatory effect.