Objective To investigate the distribution and drug resistance of carbapenem-resistant Enterobacteriaceae ( CRE) isolated from children in China. Methods CRE strains were collected in 10 ter-tiary children's hospitals of China from January 1, 2016 to December 31, 2017. Antimicrobial susceptibility of the clinical strains was detected with disk diffusion method ( KB method) and automated method. The re-sults were analyzed according to the Clinical and Laboratory Standards Institute ( CLSI) Standards published in 2017. WHONET 5. 6 software was used to retrospectively analyze the distribution characteristics and drug resistance of these strains. Results A total of 3065 CRE clinical strains were isolated from children with an overall prevalence of 7. 7％ and among them, 13. 5％ were isolated in neonatal group and 5. 8％ in non-neo-natal group. The detection rate of CRE in 2017 was higher than that in 2016 (9. 7％ vs 5. 7％). Among the 3065 CRE strains, there were 1912 strains of Klebsiella pneumoniae (62. 0％), 667 strains of Escherichia coli (22. 0％), 206 strains of Enterobacter cloacae (7. 0％), 56 strains of Klebsiella aerogenes (1. 8％) and 47 strains of Serratia marcescens (1. 5％). Most of the strains were isolate in neonatology departments including neonatal intensive care units (NICU) and intensive care units (ICU), accounting for 44. 8％ and 19. 7％, respectively. Respiratory tract (61. 8％), urine (19. 4％) and blood (5. 7％) specimens were the main sources of CRE isolates. Results of antimicrobial susceptibility test showed that the CRE strains were highly resistant to carbapenem antibiotics such as imipenem, meropenem and ertapenem, as well as penicillins and most cephalosporins (79. 6％-100％), especially those isolated in the neonatal group (P<0. 05). Children had relatively low resistance rates to aminoglycosides such as amikacin (19. 7％) and fos-fomycin (11. 9％), fluoroquinolones such as levofloxacin (37. 7％) and ciprofloxacin (43. 3％), and tige-cycline (3. 8％). Currently, no polymyxin B-resistant strains were isolated. Conclusions The prevalence of common CRE strains in children in 2017 was higher than that in 2016, especially in newborns. Drug re-sistance in CRE strains isolated from neonates to common antibiotics was more severe, suggesting that great attention should be paid to it and timely measures should also be taken.

Objective To explore the value of diffusion kurtosis imaging (DKI) histogram analysis for differential diagnosis of prostate cancer and noncancerous foci and the correlation between histogram parameters and Gleason score. Methods Twenty?one patients were retrospectively enrolled in Beijing Hospital from May 2017 to May 2018. All subjects underwent Philips 3.0 T MR scanning. The pathologies were confirmed by in?bore MR?guided biopsy. Finally, 31 lesions were collected (two lesions each from 10 patients), including 15 prostate cancer and 16 noncancerous foci (benign prostatic hyperplasia and prostatitis). ROI was drawn manually by two experienced radiologists. All the lesions were measured mean apparent diffusion coefficient (Dapp), mean apparent kurtosis coefficient (Kapp) and their histogram parameters, the averages of two measurements were used to be calculated. The values of these parameters in cancer and noncancerous foci were compared using independent?samples t test. The Spearman test was used to evaluate the correlation of these parameters and Gleason scores of prostate cancer. Results Mean Dapp, 10th Dapp, 25th Dapp, 50th Dapp, 75th Dapp, 90th Dapp, minimum Dapp, maximum Dapp, mean Kapp, 50th Kapp, 75th Kapp, 90th Kapp, maximum Kapp between prostate cancer and noncancerous foci were statistically significant (P<0.05). 90th Kapp (r=0.630, P<0.05) and maximum Kapp (r=0.565, P<0.05) increased with the Gleason scores increasing. Conclusion Histogram analysis of DKI model is valuable for diagnosing and assessing aggressiveness of prostate cancer.

Objective: To investigate the factors related to severe acute pancreatitis (SAP) with intestine functional disturbance (IFD) and to establish the multiple predictor models of SAP with IFD. Methods: Clinical data of consecutive SAP patients admitted to department of gastroenterology of Beijing Shijitan Hospital, Capital Medical University from January 2015 to March 2019 were retrospectively collected and analyzed. According to the occurrence of IFD at 48 hours after onset, the patients were divided into IFD group and control group. The clinical indicators within 4 hours after admission were compared between the two groups, and the independent predictive factors for SAP with IFD were screened by single factor analysis and multiple classified Logistic regression analysis. The unweighted predictive score (unwScore) and weighted predictive score (wScore) models were constructed by combining the independent predictors. The receiver operating characteristic (ROC) curves of SAP patients with IFD were plotted by independent predictive factors and predictive models, and the clinical predictive effect of each independent predictive index and predictive models were analyzed. Results: A total of 149 patients with SAP were enrolled, including 87 males and 62 females, with age of (52.8±18.1) years old. There were 45 patients in IFD group and 104 patients in control group.Univariate analysis and multiple classified Logistic regression analysis showed that high sensitive C-reactive protein (hs-CRP), blood urea nitrogen (BUN), serum creatinine (SCr), serum calcium (Ca), procalcitonin (PCT) and neutrophil-lymphocyte ratio (NLR) were independent predictive factors of SAP with IFD. The ROC curve was used to calculate the cut-off value of the above indexes to predict IFD, and unwScore model was established. The cut-off score of IFD prediction by the unwScore model was 3 points, and the probability of IFD increased with the increase of the score. The area under ROC curve (AUC) of unwScore was 0.944, the sensitivity was 95.6%, the specificity was 94.2%, the positive predictive value (PPV) was 87.8%, and the negative predictive value (NPV) was 98.0%. The binary Logistic regression analysis of hs-CRP, BUN, Ca, SCr, PCT and NLR were carried out, and wScore model was established. The AUC of wScore was 0.959, the sensitivity was 95.9%, the specificity was 96.2%, the PPV was 91.5%, and the NPV was 98.1%; predictive value was superior to each independent index and unwScore model. Conclusions hs-CRP, BUN, SCr, Ca, PCT and NLR were independent predictive factors of SAP with IFD. The multiple predictor models of SAP with IFD have a good predictive efficiency which may provide valuable clinical reference for prediction and treatment.

Objective: To explore the value of diffusion kurtosis imaging (DKI) histogram analysis for differential diagnosis of prostate cancer and noncancerous foci and the correlation between histogram parameters and Gleason score. Methods: Twenty-one patients were retrospectively enrolled in Beijing Hospital from May 2017 to May 2018. All subjects underwent Philips 3.0 T MR scanning. The pathologies were confirmed by in-bore MR-guided biopsy. Finally, 31 lesions were collected (two lesions each from 10 patients), including 15 prostate cancer and 16 noncancerous foci (benign prostatic hyperplasia and prostatitis). ROI was drawn manually by two experienced radiologists. All the lesions were measured mean apparent diffusion coefficient (D_app), mean apparent kurtosis coefficient (K_app) and their histogram parameters, the averages of two measurements were used to be calculated. The values of these parameters in cancer and noncancerous foci were compared using independent-samples t test. The Spearman test was used to evaluate the correlation of these parameters and Gleason scores of prostate cancer. Results: Mean D_app, 10th D_app, 25th D_app, 50th D_app, 75th D_app, 90th D_app, minimum D_app, maximum D_app, mean K_app, 50th K_app, 75th K_app, 90th K_app, maximum K_app between prostate cancer and noncancerous foci were statistically significant (P<0.05). 90th K_app (r=0.630, P<0.05) and maximum K_app (r=0.565, P<0.05) increased with the Gleason scores increasing. Conclusion Histogram analysis of DKI model is valuable for diagnosing and assessing aggressiveness of prostate cancer.

Objective: To explore the effect of exercise intervention based on the self-efficacy theory on quality of life, physical function, fatigue and pain in patients with rheumatoid arthritis. Methods: The convenience sampling method was used to select 64 rheumatoid arthritis patients who visited the department of rheumatology of Tianjin Medical University General Hospital from December 2017 to August 2018. Thirty-two rheumatoid arthritis patients were divided into the intervention group and other 32 rheumatoid arthritis patients were divided into the control group according to the visiting time. Patients in the control group received the conventional nursing care, and patients in the intervention group received the conventional nursing care and exercise intervention based on the self-efficacy theory. The 36-Item Short Form Health Survey (SF-36), Health Assessment Questionnaire (HAQ), Fatigue Severity Scale (FSS), Visual Analog Scale (VAS) were assessed three months after the intervention. Results: After the intervention, the scores of the SF-36 in the intervention group and the control group were (68.04±12.27) and (54.32±21.66) points, respectively. The difference between the two groups was statistically significant (t=-3.119, P<0.05). After the intervention, the scores of the HAQ, FSS and VAS were (0.60±0.57), (3.68±1.75) and (4.08±2.17) points, respectively in the intervention group and (1.00±0.78), (4.65±2.07) and (5.44±2.75) points in the control group. The difference between the two groups was statistically significant (t=2.329, Z=-2.024, Z=-2.058, P<0.05). Conclusions The exercise intervention based on the self- efficacy theory can improve the quality of life, physical function, fatigue and pain in patients with rheumatoid arthritis, which is worthy of further promotion in clinical practice.

Objective To study the clinical efficacy of respiratory allergic diseases in children treated by nasal atomization of budesonide combined with 3% hypertonic saline. Methods Children diagnosed as upper air-way cough syndrome or mild to moderate asthma without being controlled by anti-asthma treatment were included in the study.They contracted with complications of nasal congestion and/or running noseand other symptoms,and na-sal CT confirmed the nasal lesions.Thirty children undergoing conventional treatment(conventional drug therapy+keeping away from allergen)were defined as the control group. 89 children treated with nasal spray therapy(con-ventional drug therapy + keeping away from allergen + nasal spray treatment)were defined as the therapy group. The treatment group was subdivided into IgE-mediated group and non-IgE-mediated group according to IgE level. The treatment course was 7 days.The clinical symptoms score,nasal symptom visual scale(VAS),peak expirato-ry flow(PEF)index were observed and analyzed. Results The clinical symptom score and nasal VAS showed a decreasing trend and the percentage of PEF showed an increasing trend in the two groups within 1 week after treat-ment.The clinical symptom score and nasal VAS score of the treatment group were significantly lower than those of the control group,while the PEF%value was significantly higher.The difference in treatment method was interact-ed with the treatment time(P<0.05).The percentage of PEF in the non-IgE-mediated group was significantly high-er than that of IgE-mediated group 1 week after treatment(P < 0.05). Conclusion The nasal atomization of budesonide combined with hypertonic saline in the treatment of children with respiratory allergic diseases is effec-tive and of a good clinical value.

Objective: To examine endoscopic features of early colorectal carcinomas smaller than 2 cm. Methods: A total of 191 pa-tients (201 early colorectal carcinomas) who were definitely diagnosed with early colorectal cancer smaller than 2 cm between Janu-ary 2014 and December 2017 in Beijing Shijitan Hospital, Capital Medical University were enrolled. The patients'clinical characteris-tics, endoscopic and pathological data were retrospectively analyzed. Results: There were more male patients than female patients (1.81:1) in the study population; distribution of lesions was higher in the left colon than in the right colon (141/201). Group 1 had a higher number of IIa lesions (20/67, P=0.037) and a lower number of Ip lesions than Group 2 (52/134, P<0.01). Conclusions: There are special characteristics in distribution and endoscopic manifestations of early colorectal carcinoma. Lesion size was less than 1 cm in 67 (191 cases of early colorectal cancer) early colorectal carcinoma cases; however, a high-risk adenoma is defined as a lesion larger than 1 cm in size. Therefore, regardless of lesion size, if fractionation, echinodermata, congestion, erosion, expansion, and depression are observed, the lesion should be assessed in detail for the sake of carcinogenesis.

Objective RNPC1 may act as an oncogene or suppressor gene in human tumors and its role in human renal cell carcinoma (RCC) remains unclear.The objective of this study was to investigate the role of RNPC1 in the development of RCC.Methods Over-expression of RNPC1 gene group (RNPC1 group) and short hairpin RNA interfering RNPC1 gene expression (shRNPC1 group) were respectively built in RCC CAKI-1 and CAKI-2.The blank control group (NC group) and negative control group (SCR group) were built as well.The qRT-PCR and western blot (WB) were used to detect the expression levels of RNPC1 mRNA and RNPC1 protein in RCC cells.Lentivirus infection was applied to establish stable expressed RCC cell lines of RNPC1 over-expression and interference.Detection was made on mRNA and protein expression levels in RNPC1 stable RCC cell lines.The effects of RNPC1 on cell proliferation, colony formation assay, migration, and invasion were detected by CCK-8 cell differentiation test, clone test, scratch test, and migration and invasion test.WB was applied to detect the change of protein expression in the EMT path of RNPC1 stable RCC cell lines and explore the molecular mechanism of RNPC1 effect on the biological function of RCC cells.Results The expression levels of RNPC1 mRNA and protein were found lower in shRNPC1 group than those in SCR group, while the expression levels of RNPC1 mRNA and protein in SCR group were higher than those NC group (P<0.05).The capability of proliferation in shRNPC1 group was stronger than that in SCR group, while the capability of proliferation in shRNPC1 group was weaker than that in NC group (P<0.05).The capabilities of cell migration and invasion were stronger in shRNPC1 group than those in SCR group, while the capabilities of cell migration and invasion in RNPC1 group were weaker than those in NC group (P<0.05).RNPC1 could inhibit the proliferation capability of RCC cells and might up-regulate the protein expression of E-cadherin and down-regulate the protein expression of β-catenin and vimentin, thus inhibiting EMT path and the capabilities of migration and invasion off RCC cells (P<0.05).Conclusion RNPC1 acts as a tumor suppressor in RCC and has the potential for the prediction of RCC prognosis.

Objective To explore the effects of renal artery calcification on the renal function in type 2 diabetic ne-phropathy rats .Methods Rats were randomly divided into control group ( CON group ) , diabetic nephropathy group ( DN group) and DN with vascular calcification group ( DN+VC group) .Rats of group DN and DN +VC were fed with high sugar and fat diet and injected with streptozotocin (STZ)into abdominal cavity to induce type 2 diabetes. After diabetic models were made , rats of group DN+VC were treated by vitamin D 3 plus nicotine .The rats were sacrificed at 8 , 12 and16 week respectively and the pathologic change to the renal artery were microscoped by von Kossa staining .The calcium content were detected by calcium assay kit and double immunofluorescence staining and real-time polymerase chain reaction ( RT-qPCR) were applied to detect the protein and gene expression levels of BMP2 in the renal artery.Measure the levels of blood urea nitrogen (BUN),serum creatinine (Scr),cystatin C (Cys C) and 24 hour urinary protein (24-h UA)respectively at the 8th,12th and 16th weeks.Histopathology of kidney was assessed by hematoxylin/eosin staining .Results The deposition of black granules , the calcium content and the protein and gene expression levels of BMP 2 in DN group were significantly higher than those in group CON and lower than DN+VC group at each time points(P<0.05).The BUN, Scr, Cys C and 24-h UA in group DN and group DN+VC were gradually increased in 8th,12th and 16th weeks, and were higher than those in group CON( P<0.05 ) .Compared with the DN group , only the level of Cys C at each time point and the level of 24-h UA in 16th week in DN+VC group were significantly higher ( P<0.05 ) .The pathological damages of the kidney in group DN showed a continual worsening trend and the pathological changes of the kidney in group DN +VC were more serious than group DN .Calcium content was positively correlated with the increased serum BUN , Scr, Cys C, 24-h UA and BMP2 mRNA ( all P<0.01 ) .Conclusions The occurrence and severity of renal artery calcification may participate in and promote the progression of DN .

Objective The changing patterns of pathogenic isolates and antibiotic susceptibility in Chongqing's neonates between 2010 and 2015 were investigated for the purpose to provide evidence for rational use of antibiotics and control of nosocomial infections.Methods The distribution of pathogenic bacteria and antibiotic susceptibility were analyzed.Identification and antibiotic susceptibility testing were carried out using BD Phoenix 100 automated system and the conventional Kirby-Bauer method.The results were interpreted in accordance with the breakpoints of the Clinical and Laboratory Standards Institute.Results A total of 10 569 pathogenic bacterial strains were isolated during the period,most of which were gram-negative bacteria (80.8 ％,8 540/10 569),primarily Klebsiella pneumoniae (29.3 ％),followed by Escherichia coli (16.7 ％),Acinetobacter baumanmii (9.9 ％),Enterobacter cloacae (8.6 ％) and Pseudornonas aeruginosa (3.3 ％).Gram-positive strains accounted for 14.1％ (1 490/10 569),mainly Staphylococcus aureus (7.8％),Staphylococcus epidermidis (2.2 ％),and Staphylococcus haemolyticus (1.8 ％).Imipenem and meropenem showed high activity against Enterobacteriaceae (＜ 10％ resistant),followed by P.aeruginosa (＞ 10 ％ resistant),and A.baumannii (＞20％ resistant).The prevalence of carbapenem-resistant strains was 8,4 ％ in K.pneumoniae and 2.9 ％ in E.coli isolates,No gram-positive isolates were resistant to vancomycin,teicoplanin or linezolid.Conclusions K.pneumoniae was the most frequently isolated pathogen in the neonates treated in Children's Hospital of Chongqing Medical University.The prevalence of A.baumannii isolates is increasing.Carbapenem-resistant Enterobacteriaceae strains are emerging.