To explore the role of P2X4 receptor in opioid-induced hyperalgesia (OIH).
 Methods: A total of 30 Sprague-Dawley (SD) male rats were randomly divided into 5 groups: a saline (N0) group, a remifentanil at 0.5 μg/(kg.min) (R1) group, a remifentanil at 1.0 μg/(kg.min) (R2) group, a remifentanil at 1.5 μg/(kg.min) (R3) group, and a remifentanil at 5.0 μg/(kg.min) (R4) group. The paw withdrawal mechanical threshold (PWMT) and paw withdrawal thermal latency (PWTL) were measured at follow time points to optimize the dosages: the day before treatment (T1), 30 min after tail intravenous catheterization (T2), and 30 min (T3), 1 h (T4), 2 h (T5), 24 h (T6) after withdrawal from remifentanil. Then, the rats were randomly divided into 2 groups: a saline group (N group), a remifentanil at 1.0 μg/(kg.min) group (R group). The PWMT and PWTL were measured at follow time points: T1, T2, and T4. The lumbar enlargement of spine was selected at 1 h after withdrawal from remifentanil, and the expression of P2X4 receptor mRNA and protein was examined in OIH. Additional male rats were selected and randomly divided into 2 groups: a plantar incision surgery followed by saline treatment group (I+N group), a plantar incision surgery followed by remifentanil treatment group (I+R group). The PWMT and PWTL were measured at follow time points: T1, T2, T3, T4, T5, T6, 48 h (T7) and 72 h (T8) after withdrawal from remifentanil. The lumbar enlargement of spine was selected at 1 h after withdrawal from remifentanil, the expression of P2X4 receptor mRNA and protein was examined by PCR and Western blotting, and the microglial activation in spine 1 h after withdrawal from remifentanil were assessed by immunofluorescence.
 Results: The pain thresholds including PWMT and PWTL in different groups were as follows: R4 group Animals ; Hyperalgesia ; Male ; Pain, Postoperative ; Rats ; Rats, Sprague-Dawley ; Receptors, Purinergic P2X4 ; Remifentanil ; Spinal Cord

Objective To explore the ultrasound-guided diffuse optical tomography (DOT) distribution difference and clinical characteristics of T 1-T3 breast carcinoma. Methods Four hundred and forty-seven breast cancer patients with 455 breast lesions were enrolled.The lesion maximal diameter and total hemoglobin concentration(THC) were obtained by ultrasound-guided DOT before breast surgery biopsy.The patients age,body mass index(BMI),and the distances from lesion to skin and nipple were measured,lymph node status were also assessed.According to the 7th Edition of the AJCC Cancer Staging, all tumors were divided into T1( ≤ 2 cm),T2(2 cm < lesion ≤ 5 cm),and T3( > 5 cm) three groups according to maximum diameter on ultrasound.Results Out of 455 breast cancer lesions,148 lesions were stage T1,251 lesions were stage T2,56 lesions were T3.The age,lesion size,lesion THC and the distances between lesions and nipples of breast cancer patients were found that there were significant differences among T1,T2 and T3(all P = 0.000). With T stages increasing,the age of breast cancers patients decreased,the distance between lesions and nipples decreased,the THC increased.THC of breast cancer T 2 [(221.0 ± 56.0)μmol/L] and T3[(233.1 ± 54.0)μmol/L] were significant higher than that of T1 [(181.6 ± 70.4)μmol/L](all P = 0.000).There were all no significant difference for BMI and the distancefrom lesion to skin among different stages T( P > 0.05).With T stages increasing,the ratio of lymph node metastasis increased(T1 26.4%,T2 49.8%,T3 55.4%; P =0.000).Conclusions With breast cancer T stages increasing,T HC increases,the age of the patients decreases,lymph node metastasis rate increases.

Objective To evaluate the commutability of 22 processed materials for serum alanine aminotransferase measurements which were performed in 11 routine assays without and 2 assays with pyridoxal-5′-phosphate.Methods 100 serum specimens were collected in Beijing Hospital,Zhao Yang Hospital and Tong Ren Hospital from May,2017 to August,2017.50 individual specimens together with fresh frozen human serum pools(HSPs), external quality assessment(EQA)materials, commercial calibrators and controls were measured by 11 routine assays without pyridoxal-5′-phosphate.Measurement results of the 50 individual samples were pairwise analyzed by Deming regression for slopes and intercepts, and 95%prediction interval(PI)were calculated to evaluate the commutability of processed materials.Another 50 individual specimens and 22 above-mentioned materials were analyzed by 2 assays with pyridoxal-5′-phosphate as the evaluated methods and internationally recognized reference method as the comparative method.The ordinary linear regression(OLR)and 95% PI were used to identify the commutability of 22 materials.Results The Deming slopes ranged from 0.879 to 1.064 and intercepts from -1.96 to 3.30;the OLR slopes were 0.905 and 0.955 while intercepts were -6.71 and 9.53.The HSPs were commutable for 51/57 and 56/57 assay pairs.The EQA materials, commercial calibrators and controls showed noncommutability from 8/57 to 47/57,38/57 and pairs after that, and from 13/57 to 43/57 assay pairs, respectively.Conclusion The lyophilized materials including EQA materials, commercial calibrators and controls demonstrated poor commutability in different degrees.

Objective The aim of this study was to evaluate the clinical and phychology profile after total cavopulmonary connection procedure and to identify the significant determinants of quality of life.Methods Data from 21 patients underwent total cavopulmonary connection procedure from January 2008 to December 2015 were retrospectively analyzed.Patients under went echocardiography aud cardiopulmonary exercise testing.Used ST-36 questionnaire to perceived health status.The NT-ProBNP levels was test.Results 21 patients aged between 19 to 36 years(mean 26.6 years) were enrolled.The mean follow-up time was(44.2 ± 29.9) months.The mean EF was (59.4 ± 6.2) ％,and the peak oxygen uptake was (19.9 ± 3.6) ml · kg-1 · min-1,perceut predict value was(52.5 ± 8.9) ％.SF-36 score was well.Independent risk for impaired exercise capacity was interval time from surgery.Conclusion The exercise capacity of total cavopulmonary connection patients was impaired.Identify more predict factors of the quality of these patients need further study.

The pediatric reference intervals in clinical laboratory play an important role in diagnosis of illness,therapeutic monitoring,prediction of prognosis and health evaluation.Compared with establishing reference interval for adults,there are more challenges to establish pediatric reference intervals.Therefore,the procedure and key technologies of direct method and indirect method are stated based on the characteristics of children population and pediatric,by which to define,transfer and validate pediatric reference intervals.This study will provide systematically methodological ideas for clinical laboratories to establish pediatric reference intervals.

Objective To investigate the myocardial protection of intraoperative continuous in-fusion of esmolol in elderly patients undergoing laparoscopic surgery.Methods Sixty patients,thirty-two males and twenty-eight females,aged 65-80 years,weighing 40-80 kg,ASA physical status Ⅰ orⅡ,undergoing selective general anesthesia laparoscopic resection of gastrointestinal cancer were ran-domly divided into 2 groups (n = 30 ):esmolol group (group E)and control group (group NS). Group E was administered esmolol 0.3 mg/kg 3 minutes before intubation,then with a continuously infusing rate of 50 μg · kg-1 · min-1 until extubation.Group NS was administered saline instead. MAP,HR,SpO 2 ,PET CO 2 ,BIS and RPP were recorded before intubation (T0 ),intubation (T1 ), pneumoperitoneum (T2 ),the end of surgery (T3 ),extubation (T4 )and 30 minutes after extubation (T5 ).The serum levels of cTnI,CK,CK-MB and LDH were measured before anesthesia and 6,30 hours after surgery.Adverse cardiovascular event happened during perioperation and 3 months follow-ing up was recorded.Results HR,MAP,RPP at T1 ,T2 ,T4 in group E were obviously lower com-pared with group NS (P <0.05).There were no significant differences in the serum levels of cTnI, CK,CK-MB and LDH between two groups at different time points.No major adverse cardiovascular event happened in two groups during perioperation and 3 months following up.Conclusion Intraoper-ative continuous infusion of esmolol 50 μg· kg-1 · min-1 can not significantly influence the serum level of myocardial injury marker in the elderly patients without myocardial damage undergoing lapa-roscopic resection of gastrointestinal cancer.Howerver,it can effectively reduce the cardiovascular re-sponse caused by stimulation,decrease myocardial oxygen consumption,protect myocardial.

Objective To analyze the resistance proifle of bacterial strains isolated from geriatric patients in 17 hospitals across China from 2005 to 2014.Methods A total of 17 representative general hospitals were involved in this program. Bacterial susceptibility testing was carried out by means of a uniifed protocol using Kirby-Bauer method and MIC determination. The results were analyzed according to CLSI 2014 breakpoints.Results The proportion of the strains isolated from geriatric patients among all the clinical isolates increased with time from 30.0% in 2005 to 32.7% in 2014. A total of 159 888 clinical isolates were collected from geriatric patient during the period from 2005 to 2014, about 33.1% of the whole patient population. Gram negative organisms and gram positive cocci accounted for 77.1% (123 229/159 888) and 22.9% (36 659/159 888), respectively. Majority (92.8%, 148 376/159 888) of the isolates were from inpatients and more than half (55.2%, 88 201/159 888) of the isolates were from sputum or other respiratory tract specimens. Methicillin-resistant strains inS. aureus (MRSA) and coagulase negativeStaphylococcus (MRCNS) accounted for an average of 67.1% and 75.9%, respectively. The resistance rates of methicillin-resistant strains to β-lactams and other antimicrobial agents were much higher than those of methicillin-susceptible strains. No staphylococcal strains were found resistant to vancomycin, teicoplanin or linezolid. Some strains ofE. faecalis (0.4%) andE. faecium (4.6%) were resistant to vancomycin, which was higher than average national level (0.3%, 3.2%). Vancomycin-resistant strains ofE. faecalisandE. faecium were mainly VanA type and VanB type based on their phenotype. The prevalence of penicillin-susceptibleS. pneumoniae strains was 78.2%, slightly lower than the 95.0% in Chinese adults in year 2014. The prevalence of ESBLs-producing strains was 67.5% inE. coli, 40.4% inKlebsiella (K. pneumoniae andK. oxytoca) and 34.3% inProteus mirabilis isolates on average. The strains ofEnterobacteriaceae were still highly susceptible to carbapenems (<10% resistant), followed by amikacin and the beta-lactam and beta-lactamase inhibitor combinations. Overall, 35.9% and 33.0% of theP. aeruginosa strains were resistant to imipenem and meropenem. More than 50% of theA. baumannii strains were resistant to imipenem and meropenem. The prevalence of extensively drug-resistant (XDR)P. aeruginosa (4.0%-1.8%) was higher than the average national level (2.1%-1.6%). The prevalence of XDR A. baumannii (19.2%-15.5%) and XDREnterobacteriaceae (0.1%-1.0%) was lower than the average national level (21.4%-19.7% and 0.3%-3.2%).Conclusions The proportion of clinical isolates from geriatric patients is different from average national level at the same period. The isolates from geriatric patients are more likely from inpatients, respiratory tract specimens and more likely non-fermentative gram-negative bacilli compared to average national level. The proportion of fastidious bacteria andEnterobacteriaceae species is generally lower than average national level. MRSA, VRE, ESBLs-producing strains and XDRP. aeruginosa are more prevalent in geriatric patients than in general Chinese patient population. This study suggests that surveillance of antimicrobial resistance for the clinical isolates from geriatric patients is very important for rational antimicrobial therapy.

Objective To investigate the distribution and changing resistance proifle ofSalmonella isolates in hospitals across China during the period from January 2005 to December 2014.Methods Seventeen general hospitals and two children’s hospitals were involved in this program. Antimicrobial susceptibility testing was carried out by means of a unified protocol using Kirby-Bauer method or MIC determination. The results were analyzed according to CLSI 2014 breakpoints.Results The proportion ofSalmonella isolates increased with time from 0.2% in 2005 to 0.7% in 2014. A total of 3 478Salmonella strains were collected from 19 hospitals. The proportion ofSalmonella typhimurium andSalmonella enteritidis was 27.4% and 24.4%, respectively. During the 10-year period, theSalmonella strains showed highest resistance rate to ampicillin (33.3%-64.8%), but low resistance to cefoperazone-sulbactam (0-5.3%) and ciprofloxacin (2.4%-14.3%).S. typhimurium showed higher resistance rate thanS. typhi,S. paratyphi andS. enteritidis. About 76.8% and 50.5% ofS. typhimurium were resistant to ampicillin and trimethoprim-sulfamethoxazole. The average prevalence of multi-drug resistantSalmonellawas 3.9% in the ten-year period, the highest (7.5%) was in 2005, the lowest (1.5%) in 2013.Conclusions During the period from 2004 to 2015, majority of theSalmonella isolates in hospitals across China wasS. typhimurium andS. enteritidis. Ampicillin and trimethoprim-sulfamethoxazole are no longer appropriate for empirical treatment ofS. typhimurium infection due to high resistance rate.Salmonella isolates are relatively more susceptible to third-generation cephalosporins and quinolones. Ongoing monitoring is necessary to identify multi-drug resistant strains ofSalmonella.

Objective To investigate the distribution and antibiotic resistance proifle of clinicalEnterobacter isolates using the data from CHINET during the period from 2005 through 2014.Methods A total of 20 558 clinical strains ofEnterobacter spp. were collected from 2005 to 2014 in CHINET Antimicrobial Resistance Surveillance Program. Antimicrobial susceptibility testing was performed with Kirby-Bauer or minimum inhibitory concentration method. The results were analyzed according to CLSI 2014 breakpoints.ResultsEnterobacter cloacae andEnterobacter aerogenes accounted for 71.1% (14 617/20558) and 20.1% (4 129/20 558) of all theEnterobacterisolates, respectively. The proportion ofEnterobacter spp. increased with time from 3.5% in 2005 to 4.3% in 2014. The main source of the isolates was respiratory tract, accounting for 55.2% (11 358/20 558). More than 90% of theEnterobacterisolates were resistant to cefazolin and cefoxitin, but less than 30% of the strains were resistant to cefepime, piperacillin-tazobactam, cefoperazone-sulbactam, amikacin, gentamicin, ciprolfoxacin, meropenem, imipenem and ertapenem. TheEnterobacterisolates showed a trend of declining resistance to most antibiotics except ertapenem and meropenem. The resistance proifle ofEnterobacterisolates varied with departments where they were isolated. The strains from ICU and Department of Surgery were relatively more resistant to antibiotics. The prevalence of multi-drug resistant (MDR) strains was decreasing, but the prevalence of carbapenem-resistantEnterobacter (CRE, resistant to any of imipenem, meropenem or ertapenem) was increasing. The MDR and CRE strains were primarily isolated from ICU and Department of Surgery. At least 30% of the MDREnterobacter strains were resistant to any of the antimicrobial agents tested except meropenem, imipenem and ertapenem and at least 35% of the CRE strains were resistant to any of the antimicrobial agents tested except amikacin and ciprolfoxacin.Conclusions TheEnterobacter isolates in CHINET Antimicrobial Resistance Surveillance Program showed decreasing resistance to most of the antimicrobial agents tested since 2011, but the prevalence of CRE strains increased progressively. Effective measures should be carried out to prevent the spread of CRE strains in hospitals.

Objective To evaluate the changing pattern of antibiotic resistance inKlebsiella strains isolated from the patients in 19 hospitals across China based on the data from CHINET Antimicrobial Resistance Surveillance Program during the period from 2005 through 2014.Methods Kirby-Bauer disk diffusion and automated susceptibility testing methods were used to test the susceptibility ofKlebsiella isolates to the commonly used antibiotics. The results were interpreted according to the criteria of the Clinical and Laboratory Standards Institute (CLSI) Performance Standards for Antimicrobial Susceptibility Testing (CLSI-2014).Results A total of 61 406Klebsiella strains were identified between 2005 and 2014, includingK. pneumoniae (56 281 strains), K. oxytoca(4 779),Klebsiella pneumoniae subsp.Ozaenae (300) and otherKlebsiella species (46). Most (89.0%, 54 664/61 406) of theKlebsiella strains were isolated from inpatients, and 60.0% (36 835/61 406) were from respiratory tract speciems. About 16.7% (10 248/61 406) of the strains were isolated from pediatric patients aged 0-17 years and 83.3% (51 158/61 406) from adult patients. The prevalence ofKlebsiella spp. increased with time from 10.1% in 2005 to 14.3% in 2014. Based on the surveillance data during the 10-year period, we found a marked increase of resistance to imipenem (2.9% to 10.5%) and meropenem (2.8% to 13.4%) inKlebsiella spp. The prevalence of ESBLs-producing isolates inK. pneumoniae andK. oxytoca decreased from 39.0% in 2005 to 30.1% in 2014. The resistance to amikacin, ceftazidime, ciprolfoxacin, pipracillin-tazobactam and cefoperazone-sulbactam was on decline. The resistance rate to cefotaxime remained high about 49.5%. Carbapenem resistantance was identiifed in 5 796 (9.4%) of the isolates, including 5 492 strains ofK. pneumoniae and 280 strains ofK. oxytoca. Overall, 4 740 (7.8%) strains were identiifed as extensively-drug resistant (XDR), including 4 520 strains ofK. pneumoniae and 202 strains ofK. oxytoca. The carbapenem-resistant strains showed high (>60%) resistance rate to majority of the antimicrobial agents tested, but relatively low resistance to tigecycline (16.8%), amikacin (54.4%), and trimethoprim-sulfamethoxazole (55.5%).Conclusions During the 10-year period from 2005 through 2014, carbapenem resistance amongKlebsiella isolates has increased dramatically in the hospitals across China. The level of resistance to other antibiotics remains stable.