Objective:To study the influence of different dietary patterns in hypertension, and to provide references for establishing a healthy dietary pattern, improving the abnormal blood pressure, preventing the early hypertension and controlling the high blood pressure.Methods:Random cluster sampling was adopted to analyze the dietary,examine the physical situations,and measure the blood pressures among 1 394 residents of Han nationality and Korean nationality aged from 40 to 80 years old from 8 villages in Jinlin Province from 2010 to 2011.Factor analysis was used to establish the dietary patterns and to analyze the effects of different dietary patterns on the prevalence of hypertension.Results:The prevalence of hypertension of middle aged and elderly people in the rural areas of Jilin Province was 35.3%.4 dietary patterns were obtained through factor analysis,including salted product dietary pattern,alcohol dietary pattern,condiments dietary pattern and high protein dietary pattern.By multivariate Logistic regression analysis and adjustment of the age,the gender,the nationality,the education and the career background, alcohol dietary pattern was positively correlated with the occurrence of the hypertension (OR=1.43,95%CI 1.07-1.90).Conclusion:Alcohol dietary pattern is closely related to the hypertension. Long-time large amount of alcohol is a risk cause for high blood pressure. Reducing alcohol consumption and developing healthy diet habits can help to prevent hypertension.

Objective:To explore a method of constructing universal 3-dimensional (3D)colorized digital dental model which can be displayed and edited in common 3 D software (such as Geomagic se-ries),in order to improve the visual effect of digital dental model in 3D software.Methods:The mor-phological data of teeth and gingivae were obtained by intra-oral scanning system (3Shape TRIOS),con-structing 3D digital dental models.The 3D digital dental models were exported as STL files.Meanwhile, referring to the accredited photography guide of American Academy of Cosmetic Dentistry (AACD),five selected digital photographs of patients’teeth and gingivae were taken by digital single lens reflex camera (DSLR) with the same exposure parameters (except occlusal views ) to capture the color data.In Geomagic Studio 201 3,after STL file of 3D digital dental model being imported,digital photographs were projected on 3D digital dental model with corresponding position and angle.The junctions of different photos were carefully trimmed to get continuous and natural color transitions.Then the 3 D colorized digital dental model was constructed,which was exported as OBJ file or WRP file which was a special file for software of Geomagic series.For the purpose of evaluating the visual effect of the 3 D colorized digital model,a rating scale on color simulation effect in views of patients’evaluation was used.Sixteen patients were recruited and their scores on colored and non-colored digital dental models were recorded.The data were analyzed using McNemar-Bowker test in SPSS 20.Results:Universal 3D colorized digital dental model with better color simulation was constructed based on intra-oral scanning and digital photography. For clinical application,the 3D colorized digital dental models,combined with 3D face images,were in-troduced into 3D smile design of aesthetic rehabilitation,which could improve the patients’cognition for the esthetic digital design and virtual prosthetic effect.Conclusion:Universal 3 D colorized digital dental model with better color simulation can be constructed assisted by 3 D dental scanning system and digital photography.In clinical practice,the communication between dentist and patients could be improved as-sisted by the better visual perception since the colorized 3 D digital dental models with better color simula-tion effect.

Objective To analyze the consistency of individual examination diagnosis with terminologies expressed in the conclusion report of physical examinations by the chief inspection physician. Methods Based on the clinical classifications used in the Guidelines on Prevention and Treatment of Blood Lipid Abnormality for Chinese Adults, and related terminology descriptions of Dyslipidemias that were actually used in four-item blood lipid examinations diagnosis, a lexicon database of Hyperlipidemias was constructed with 39 terms used in the four-item blood lipid examination diagnosis and chief physician conclusions. Totally 11953 electronic chief physician inspection reports from 8 health check-up institutions were included. We investigated the terms of lexicon database using word frequency analysis method, calculated the positive rate in the diagnosis of four single examinations of serum lipid and the positive rate in the chief physician's conclusion. Consistency of chief physician's conclusion with single examination diagnosis was analyzed by Kappa test. Results (1) Among the 39 terms of lexicon database, there are 18 nonstandard terms used in single examination diagnosis, accounted for 46％ of all terms; (2) In word frequency analysis, there are only 1％ of terms that corresponded to clinical classifications of Hyperlipidemias accurately;(3) The positive rate of Hyperlipidemias in serum lipid four single examinations diagnosis was 47％, the positive rate of physician diagnosis was 35％. The consistency analysis of chief physician conclusions with single examination diagnosis showed Kappa=0.71(P<0.01). Conclusions Although the final conclusion written by the chief physician was not using standard terms strictly, most of synonymous terminology expressed in the physician conclusion is normative, which enabled the construction of lexicon database and text mining. Whether the single examination diagnosis are consistent with physician conclusions can be an evaluation indicator to assess the quality of chief physician conclusions for physical examinations. Kappa>0.75 may be suggested as a favorable value.

Objective To assess the effect of alprostadil on accelerating early recovery of renal transplant patients with delayed graft function.Methods A randomized control clinical trial was designed in renal recipients with delayed graft function(DGF)who were administered with 50μg alprostadil each day after the operation.The effects of alprostadil were compared with the control group which included 14 recipients with DGF to determine the influences of alprostadil on urine,serum creatinine(SCr).Under Doppler ultrasound,the renal blood flow resistance-indexes(RI)were measured.The rates of acute renal graft rejection(AR)were also calculated in both groups,and the 1year patient/graft survival rates were compared between the two groups.Results Urine was significantly higher in alprostadil-treated group than in control group(P ＜ 0.05).On the contrary,SCr and RI were significantly lower in alprostadil-treated group than in control group(P ＜ 0.05).No significant differences were found between the two groups in AR rate(6.25％ vs 7.14％)and the 1-year patient/graft survival rates(P ＞ 0.05).Conclusion The application of alprostadil in renal recipients with DGF had beneficial effects on accelerating recovery of renal graft function.

Infectious disease is still one of the leading causes of death nowadays .More than half of pathogens causing infections are still unclear through conventional microbiological diagnostics in clinical laboratory.Recently, the metagenomic sequencing is being applied in the pathogenic diagnosis with full coverage, high efficiency and few bias.Though metagenomic sequencing has shown good performance in pathogenic diagnosis for respiratory tract infection , central nervous system infection and bloodstream infection, it still cannot replace the conventional microbiological tests ; however, this state-of-the-art tool should be considered as an effective supplement to pathogen diagnosis .This article reviews the current application of metagenomic sequencing in clinical scenarios and related pitfalls , with the aim of promoting better utilization of the tool.

Objective To investigate antimicrobial resistance among nosocomial gram-negative bacilli in 2006.Methods About 987 consecutive and non-repetitive gram-negative bacilli were isolated from 10 teaching hospitals from Sep.to Dec.in 2006 in China.All of these isolates were sent to the central laboratory for reidentification and susceptibility testing.The minimal inhibitory concentration(MICs)of meropenem and other antibacterial agents were determined by agar dilution method.Results The activity of antibacterial agents against Enterobacteriaceae was as fol lows in descending order of susceptible rate: meropenem(susceptible rate 99.8%),imipenem(99.5%),piperacillin/tazobactam(91.3%),amikacin (89.3%),cefepime(83.8%),cefoperazone/sulbactam(79.7%),ceftazidime(74.7%),cefotaxime (57.7%),ceftriaxone(56.6%),ciprofloxacin(53.6%).The prevalence of extended-spectrum β-Iactamases(ESBL)was 59.0% in Escherichia coli,33.0%in Klebsiella pneumoniae and 8.0%in Proteus mirabilis.The most active agents against E.coli and K.pneumoniae were meropenem,imipenem(99.2%. 100%),piperacillin/tazobactam(90.8%-97.0%),and amikacin(83.8%-92.4%).Cefepime Was more active against K.pneumoniae than E.coli(85.4% vs.65.2%).Against E.cloacae,E.aerogenes and Citrobacter freundii,the most active agents were as follows in desecnding order:meropenem,imipenem (99.2%-100%),amikacin(85.2%-92.6%),cefepime(81.5%-85.9%),piperacillin/tazobactam (73.4%-87.2%),cefoperazone/sutbactam(65.6%-77.7%),and ciprofloxacin(53.1%-72.3%).The most active agents against Pseudomonas aeruginosa were amikacin(83.5%),followed by meropenem (79.1%),piperacillin/tazobactam(74.1%),and imipenem(70.9%).The most susceptible agents against Acinetobacter baumannii were imipenem(79.1%),meropenem(73.4%) and cefoperazone/ sulbaetam(54.7%).Mutiresistant A.baumannii increased up to 53.0%.The most active agents against Burkholderia cepacia were meropenem(73.3%),eeflazidime(73.3%),and piperacillin/tazobactam (62.2%).Conclusions Carbapenems remained very high activity against Enterobacteriaceae.Increasing resistance to 10 antimicrobials agents tested from A.baumanni and P.aeruginosa brought great concern.

Objective Toinvestigateantimicrobialresistanceamonggram-positivecocciinChinain 2013.Methods Retrospectivestudy.FromJune2013toDecember2013,1663consecutiveandnon-repetitive gram-positive cocci were collected from 15 teaching hospitals. The minimal inhibitory concentration ( MIC) of antibacterial agents was determined by agar dilution method. A retrospective study was conducted on rates of resistance to antimicrobial agents. The prevalence of penicillin-resistant Streptococcus pneumoniae ( PRSP) between children and adult patients and the prevalence of methicillin-resistant Staphylococcus aureus (MRSA) between elder group and younger adult patients were compared using chi-square test. Results The prevalence of PRSP in children below 3 years old ( 72. 9%, 51/70 ) was higher than adult patients (55. 2%, 106/192) (χ2 =6. 653,P<0. 05). About 94. 9%(261/275) and (92. 7%,255/275) of S. pneumonia were resistant to erythromycin and clindamycin. All S. pneumoniae strains were susceptible to teicoplanin, vancomycin, linezolid, tigecycline and daptomycin. Penicillin still showed very high activity against Streptococcus spp. β-Hemolytic group. More than 60% of Streptococcus spp.β-Hemolytic group were resistant to erythromycin, clindamycin and tetracyclines. The prevalence of MRSA and methicillin-resistant coagulase-negative Staphylococci(MRCoNS) was 39. 7%(229/576) and 80. 6%(224/278), respectively. The MRSA prevalence ranged from 24. 2% to 70. 0% in different regions. About 52. 6%( 100/190 ) of Staphylococcus aureus from respiratory tract specimens, 38. 5%(40/104)of Staphylococcus aureus from blood samples, and 29. 7%(58/195) of Staphylococcus aureus from wound and pus were resistant to methicillin. The prevalence of MRSA in elder group ( 48. 6%, 84/173 ) was higher than that in younger adult patients (35. 7%, 144/403)(χ2 =8. 322,P <0. 05). The susceptibility rates of MRSA to chloramphenicol and trimethoprim/sulfamethoxazole were 86. 4% ( 244/228 ) and 94. 7% ( 237/228 ) , respectively. Susceptibility rates to gentamycin, erythromycin, clindamycin, tetracyclines, rifampicin and quinolones were ranged from 15. 8% to 59. 6%. All Staphylococci isolates were susceptible to teicoplanin, vancomycin, linezolid, daptomycin and tigecycline. All Enterococcus isolates were susceptible to daptomycin and tigecycline. All E. faecalis ( 158/158 ) and 96. 4% ( 133/138 ) of E. faecium were susceptible to teicoplanin. About 98. 0% ( 150/153 ) of E. faecalis and 97. 1% ( 145/138 ) of E. faecium were susceptible to linezoild. About 45. 8% (70/153) of E. faecalis and 60. 9% (84/138) of E. faecium were resistant to gentamycin with a high concentration. The susceptibility of E. faecalis to all the antibiotics tested exceptchloramphenicolandtetracyclinewashigherthanthatofE.faecium.Conclusions Basedon different age groups and regions, the resistance rates of Gram-positive cocci are different. Teicoplanin, vancomycin, tigecycline, daptomycin, linezolid and tedizolid showed very high activity against Gram-positive cocci. (Chin J Lab Med,2015,38:373-381)

Objective To evaluate the influences of susceptibility interpretation of Escherichia coli,Klebsiella pneumonia and Proteus mirabilis in China mainland according to the old and new ceftazidime,cefotaxime and ceftriaxone breakpoints in CLSI M100-S20 and CLSI M100-S19. Methods First, We analyzed the antibacterial susceptibility results of the three bacteria by agar dilution method in the SEANIR surveillance item, which were collected from 15 national hospitals between the year of 2005 and 2007 and excluded the AmpC enzyme positive isolates according to the PGR-DNA sequencing method and/or the antibacterial susceptibility phenotype. ESBL phenotype was confirmed by the CLSI phenotypic confirmatory test. Antibacterial susceptibility of the total 2733 Escherichia coli, Klebsiella pneumonia, Proteus mirabilis isolates was retrospectively analyzed by WHONET 5. 4 software according to the breakpoints of the CLSI M100-S19 (S19) and CLSI M100-S20 (S20). Second, 207 isolates of Peking Union Medical College Hospital with the results of both agar dilution method and disk diffusion method were performed by recurrent analysis. Then we observed the inter-method agreement through the scatter diagram according to the breakpoints of S19 and S20. Results First, as to the ESBL positive Escherichia coli, Klebsiella pneumonia and Proteus mirabili.s, the resistant rate of cefotaxime increased from 65.2% , 55.5%, 14. 6% under S19 (64 μg/ml) to 99. 7%, 96. 2% , 93. 8% under S20 (4 μg/ml). The susceptibility rates decreased from 6. 0%, 11.5%, 33.3% under S19 (8 μg/ml) to 0%, 0. 2%, 0% under S20 ( 1 μg/ml). Ceftriaxone had the same trend as cefotaxime. Though ceftazidime was more active than cefotaxime and ceftriaxone, as to the ESBL positive Escherichia coli and Klebsiella pneumonia, the resistant rates slightly increased from 30. 3%,43. 2% under S19 (32 μg/ml) to42.0%, 56. 0% under S20 (16 μg/ml). The susceptibility rates slightly decreased from 58. 1%, 44. 1% under S19 (8 μg/ml) to 44. 7%, 28.0% under S20 (4 μg/ml). Second,as to the ESBL negative Escherichia coli, Klebsiella pneumonia and Proteus mirabilis, all the susceptibility rates of ceftazidime, cefotaxime and ceftriaxone were between 99. 2%-100. 0%, the resistant rate were between 0%-0. 4%. Third, the S20 MIC breakpoints had a good correspondence with the ESBL phenotype.Fourth, according to the recurrent analysis of MIC testing and disk dilution method, r value was 0. 67,0. 79, 0. 77 for ceftazidime, cefotaxime and ceftriaxone, respectively, and all P value were under 0. 01. The intermethod rates of S19 and S20 were both acceptable. Conclusions If the cefotaxime and ceftriaxone S20 new breakpoints were used, the concordance of antibacterial susceptibility results and ESBL phenotype would increase greatly. The clinician could select proper antibiotics according to the antibacterial susceptibility results and clinical symptoms. It is no longer necessary to edit results for cephalosporins, aztreonam, or penicillins from susceptible to resistant. However, until laboratories implement the new interpretive criteria,ESBL testing should be performed as described in Supplemental Table 2A-S1. The relationship between the new breakpoints of ceftazidime and clinical outcomes need to be further evaluated.

Objective To investigate antimicrobial resistance among gram-positive cocci in 14 teaching hospitals in China in 2011.Methods From June 2011 to December 2011,1498 consecutive and non-repetitive gram-positive cocci were collected from 14 teaching hospitals.The minimal inhibitory concentration (MIC) of antibacterial agents was determined by agar dilution method.A retrospective study was conducted on rates of resistance to antimicrobial agents.Data was compared using chi-square test.Results The prevalence of methicillin-resistant Staphylococcus aureus (MRSA) and methicillinresistant coagulase-negative Staphylococci (MRCoNS) was 43.7％ (222/508),and 85.6％ (214/250),respectively.The MRSA prevalence ranged from 20.0％ to 63.5％ in different regions.About 58.2％ (82/141) of Staphylococcus aureus from respiratory tract specimens,44.8％ (48/107) of Staphylococcus aureus from blood samples,and 23.8％ (31/130) of Staphylococcus aureus from pus and wound were resistant to methicillin.The susceptible rates of MRSA to chloramphenicol and sulfamethoxazole-trimethoprim SXT were 94.1％ (209/222) and 83.3％ (185/222),respectively.Susceptibility to gentamycin,erythromycin,clindamycin,tetracyclines,rifampicin and quinolones were from 11.3％ to 52.3％.All Staphylococci isolates were susceptible to vancomycin,teicoplanin,linezolid and daptomycin.Five vancomycin-resistant enterococcus (VRE) strains were found in this study.All enterococcus isolates were susceptible to daptomycin(268/268),and 98.3％ (118/120) of E.faecalis and 99.3％ (147/148) of E.faecium were susceptible to linezoild.About 45.9％ (68/148) of E.faecalis and 67.5％ (81/120) of E.faecium were resistant to high concentration gentamycin.The susceptibility of E.faecalis to all the antibiotics except for chloramphenicol and tetracycline was higher than that of E.faecium.The prevalence of penicillinnonsusceptible Streptococcus pneumoniae (PNSSP) was 15.5％ (37/239).The prevalence of PNSSP in children below 3 years-old was 25％ (13/52),and the prevalence of PNSSP from other patients was 13％(24/187).About 91.6％ (219/239),88.7％ (212/239) and 88.3％ (211/239) of S.pneumonia was resistant to erythromycin,clindamycin and tetracyclines.All S.pneumoniae strains were susceptible to teicoplanin,vancomycin,linezolid,tigecycline and daptomycin.Penicillin still showed high activity against Streptococcus spp.β-hemolytic group.More than 60％ of Streptococcus.spp.β-hemolytic group are resistant to erythromycin,clindamycin and tetracyclines.Conclusions Based on regions,the resistance rates of Gram-positive cocci are different,of which,the increasing tendency should be taken seriously.Teicoplanin,vancomycin,linezolid,tigecycline and daptomycin show very high activity against Gram-positive cocci.

Objective To investigate antimicrobial resistance among gram-negative bacilli in China in 2010.Methods A total of 1 259 consecutive and non-repetitive gram-negative bacilli were isolated from 13 teaching hospitals from September to December in 2010 in China.All of these isolates were sent to the central laboratory for re-identification and susceptibility testing.The MIC of meropenem and other antibacterial agents were determined by agar dilution method.Interpretive results was determined by CLSI M100-S21.Results The activity of 14 antibacterial agents against 845 Enterobacteriaceae isolates was as follows in order:meropenem ( 98.1％,829 ),amikacin ( 94.0％,794 ),imipeuem ( 90.0％,761 ),piperacillin/tazobactam ( 87.5％,739 ),cefepime ( 83.0％,701 ),ertapenem ( 82.4％,696 ),cefoperazone/sulbactam ( 80.3％,678 ),colistin (75.4％,637),ceftazidime (70.0％,591 ),ciprofloxacin (59.1％,499 ),cefoxitin ( 54.8％,463 ),ceftriaxone ( 53.5％,452 ),cefotaxime ( 52.3％,442 ) and minocycline(51.5％,435).The prevalence of ESBL was 61.3％ (106/173) in Escherichia coli,which was much higher than 41.2％ (70/170) in Klebsiella pneumoniae.The susceptibility rate of Klebsiella pneumoniae against meropenem,imipenem,amikacin and colistin were more than 90％,but were highly resistant to ceftriaxone and cefotaxime.Over 80％ of Enterobacter cloacae,Enterobacter aerogenes,Citrobacter freundii,were susceptible to meropenem,amikacin,cefepine,cefoperazone/sulbactam,imipenem,piperacillin/ tazobactam,and ertapenem.The most active antibiotics against Pseudomonas aeruginosa were Colistin (98.4％,182),Amikacin ( 85.9％,159 ),Piperacillin/Tazobactam ( 80％,148 ),Ceftazidime ( 79.5％,147),Meropenem (74.1％,137),Ciprofloxacin (74.1％,137),Cefepime (73.5％,136),Imipenem (71.9％,132) and Cefoperazone/Sulbactam (70.8％,131 ).Less than 37％ of Acinetobacter baumannii isolates were resistant to carbapenems.The susceptible rate to Minocycline was 47.8％.Colistin kept good activity against Acinetobacter baumannii (susceptible rate,97.8％,n =176),The prevalence of Pan-drug resistant P.aeruginosa and A.baumannii was 18.9％ (n =35),and 61.8％ (n =108),respectively.Conclusions Carbapenems remained very high activity against Enterobacteriaceae.Increasing resistance to the antimicrobials agents test among A.baumanni and P.aeruginosa,especially carbapenems among A.baumanni brought great concern.