Objective:To evaluate the efficacy and safety of 532-nm picosecond laser in the treatment of early-stage facial seborrheic keratosis.Methods:A total of 95 patients with early-stage facial seborrheic keratosis were prospectively enrolled from the Department of Dermatology, General Hospital of Ningxia Medical University between December 2020 and September 2022. All the patients received a session of 532-nm picosecond laser treatment, and were followed up for 6 months. A 4-point scale was used to evaluate the overall improvement of skin lesions for assessing the clinical efficacy. A VISIA skin detector was used to quantitatively determine the characteristic counts, absolute scores, and percentiles of brown spots before and after treatment, and the paired sample t-test was used to compare the quantitative indicators of brown spots before and after treatment. The patients′ pain grades were evaluated, and adverse reactions were recorded. Results:All the 95 patients with early-stage facial seborrheic keratosis received a session of 532-nm picosecond laser treatment, and completed a 6-month follow-up. All the patients achieved over 25% regression of skin lesions in the treatment area, of whom 10 received mild improvement, 17 received favorable improvement, and 68 received marked improvement, with the response rate being 89.47% (85/95). The examination with the VISIA skin detector showed that the characteristic counts (195.19 ± 51.06) and absolute scores (28.80 ± 6.20 points) of brown spots significantly decreased, while the percentiles of brown spots (38.48% ± 10.80%) significantly increased at 6 months after treatment compared with the corresponding baseline indicators (211.48 ± 50.94, 35.16 ± 6.84 points, 30.61% ± 10.27%, t = 12.73, 16.90, -15.73, respectively, all P < 0.001). All the patients experienced varying degrees of pain during the treatment, with the pain scores being 2 - 6 (3.64 ± 1.67) points, but all of them could tolerate the pain and completed the treatment. Temporary postinflammatory hyperpigmentation and hypopigmentation occurred in 9 (9.47%) and 4 (4.21%) patients respectively, and the skin color restored to normal during the 6-month follow-up. Conclusion:The 532-nm picosecond laser was safe and effective for the treatment of early-stage facial seborrheic keratosis.

Objective:To improve the longevity genetic research study design by applying self-organizing maps to select a control group for longevity study.Methods:This study included the Han population aged 90 years and above or less than 80 years who have died (control group) from the natural population-based cohort formed by the fusion of the Chinese Chronic Diseases and Risk Factors Surveillance in 2013 and the China Death Surveillance System. The subjects who died of injury, infectious diseases, parasitic diseases, and malignant tumors were excluded. The self-organizing maps method, with multiple iterations and self-organizing clustering, was used to select similar factors among the population aged 90 years and above and the control group, including demographic characteristics, diseases, living habits, social behaviors, and mental and psychological factors. The study used PLINK 1.9 software to evaluate the quality of whole genome sequencing and to conduct logistic regression of single nucleotide polymorphisms (SNPs) and longevity on autosomes. Q-Q plots were used to visualize the P value associated with SNPs and longevity. Results:There were 1 019 samples selected from the baseline of 177 099 survey participants for genome sequencing, including 517 in the longevity group and 502 in the control group. The longevity and the control groups are generally similar in smoking, drinking, diet, sleep duration, blood lipid level, and self-assessment oral health status but differ significantly in socio-economic status, physical activity time, BMI, and self-assessment health status. The whole genome sequencing results were controlled, and 4 618 216 SNPs were involved in association analysis. The Q-Q plot of longevity-related SNPs analysis results showed that the enrichment of P value 1e-4 was significantly lower than the expected P value, and significant signals were also detected among P<1e-7 regions. Conclusions:The self-organizing maps can comprehensively consider the influence of socioeconomic and behavioral risk factors and select longevity control samples among samples with actual age and cause of death in a large-scale natural population cohort to improve the efficiency of longevity genome association analysis. This study provides a methodological reference for nested case-control study sample selection from the large-scale natural population cohort.

Objective:To monitor the susceptibility of common used antimicrobial agents against nosocomial Gram-negative bacilli in 2018 across China.Methods:Prospective collection of Gram-negative bacilli from 13 teaching hospitals nationwide from January to December 2018. The minimal inhibitory concentration (MICs) of antibiotics such as meropenem was determined by agar dilution methods and broth microdilution methods. Interpretation of results using the Clinical and Laboratory Standards Institute(CLSI) 2019 M100S (29th Edition) standard. Data were analyzed by using WHONET-5.6 software.Results:A total of 1 214 non-repetitive Gram-negative bacilli were collected, accounting for 96.7% (1 174/1 214) of blood and sterile body fluid samples. The activity of antimicrobial agents against 871 strains of Enterobacteriaceae was as follows in descending order of susceptible rate: amikacin (93.2%, 812/871), meropenem (92.0%, 801/871), ertapenem (88.9%, 774/871), imipenem (88.4%, 770/871), piperacillin-tazobactam (84.0%, 732/871), cefoperazone-sulbactam (83.1%, 724/871), cefepime (71.4%, 622/871), minocyline (68.9%, 600/871), ceftazidime (66.9%, 583/871), levofloxacin (54.4%, 474/871).The resistance rates of Escherichia coli to the third generation cephalosporins were 61.5% (155/252) (ceftriaxone) and 60.7% (153/252) (cefotaxime), respectively. The resistance rates of Klebsiella pneumoniae to the third generation cephalosporins were 56.6% (126/222) (ceftriaxone) and 57.9% (129/222) (cefotaxime), respectively. The incidence of extended-spectrum β lactamase (ESBLs) positive E. coli and K. pneumoniae was 50.2% (127/252) and 18.2% (40/222), respectively. Over 95% of all the ESBLs positive strains were susceptible to imipenem and meropenem. The incidence of carbapenem-resistant Escherichia coli and Klebsiella pneumoniae was 2.8% (7/252) and 20.4% (45/222), respectively. For Enterobacter cloacae, Klebsiella aerogenes, Citrobacter freundii, the most susceptible agent were tigecycline (96.3%-100%), followed by amikacin (94.9%-97.1%), meropenem (89.8%-96.6%)and imipenem (89.8%-94.9%).The susceptibility of Proteus mirabilis, Morganella morganii and Serratia marcescens to meropenem and amikacin was over 90%.A total of 67 strains of carbapenems resistant enterobacteriaceae(CRE) were detected. Modified carbapenem inactivation method showed, 45 strains were serine carbapenemase and 20 were metalloenzymes. The susceptibility of Pseudomonas aeruginosa to meropenem and imipenem were 73.2% (112/153) and 66.0% (101/153), respectively. Acinobacter baumannii has the highest sensitivity to colistin (100%, 163/163), followed by tigecycline (87.1%, 142/163).Compared with other sources of infection, specimens of bloodstream infections were less resistant to Klebsiella pneumoniae (17.6%, 27/153 vs 21.7%, 15/69) and Acinetobacter baumannii (68.3%, 71/104 vs 71.2%, 42/59). Escherichia coli (2.5%,4/198 vs 0%,0/54) and Pseudomonas aeruginosa (37%, 33/89 vs 18.8%, 12/64) have a high proportion of carbapenem resistance. Conclusions:Carbapenems still maintain high antibacterial activity against Enterobacteriaceae bacteria, especially strains producing only ESBLs. Carbapenem-resistant Klebsiella pneumoniae should be given sufficient attention. Carbapenemase is the most important drug resistance mechanism of carbapenem-resistant Enterobacteriaceae in China.

Two skeletally undescribed polyketide-indole hybrids (PIHs), named indolchromins A and B, were generated from indole-3-carbinol (I3C) in the fungal culture (). The indolchromin structures were elucidated mainly by their 1D and 2D NMR spectra with the former confirmed by the single-crystal X-ray crystallographic analysis. Each indolchromin alkaloid was chirally separated into four isomers, whose absolute configurations were assigned by comparing the recorded circular dichroism (CD) spectra with the electronic CD (ECD) curves computed for all optional stereoisomers. Furthermore, the indolchromin construction pathways in fungal culture were clarified through enzyme inhibition, precursor feeding experiment, and energy calculation. The cascade reactions, including decarboxylative Claisen condensation catalyzed by 8-amino-7-oxononanoate synthase (AONS), C()-H activation, double bond migration, and Michael addition, all undergone compatibly during the fungal cultivation. In an MIC range of 1.3-8.6 μmol/L, (2,4)- and (2,4)-indolchromin A and (2,4)-indolchromin B are inhibitory against , , sp., , and . (2,4)-Indolchromin A and (2,4)-indolchromin B were cytotoxic against the human breast cancer cell line MDA-MB-231 with IC values of 27.9 and 131.2 nmol/L, respectively, with the former additionally active against another human breast cancer cell line MCF-7 (IC 94.4 nmol/L).

Objective To analyze the distribution and antibiotic resistance of bacterial pathogens in blood culture in the Department of Hematology of the First Affiliated Hospital of Nanjing Medical Universi-ty from 2013 to 2017. Methods BACTEC FX automatic blood culture instrument was used for blood cul-ture. VITEK-2 Compact automatic microbial identification and drug susceptibility system was used for bacte-rial identification, drug sensitivity testing and fungal identification. K-B and ATB FUNGUS 3 methods were used for Streptococcus and fungi susceptibility testing, respectively. WHONET5. 6 software was used for sta-tistical analysis. Results The positive results of blood culture accounted for 7. 6% during 2013 to 2017 and the top five isolated pathogenic bacteria were Escherichia coli (20. 9% ), Klebsiella pneumoniae (18. 0% ), coagulase negative Staphylococcus (12. 4% ), Pseudomonas aeruginosa (11. 5% ) and Enterobacter cloacae (3. 6% ). Carbapenems (94. 4% ) were the most active antibiotics against Enterobacteriaceae. Pseudo-monas aeruginosa strains were sensitive to all antibacterial dugs except aztreonam. Acinetobacter baumannii strains had a lower sensitivity to almost all antibacterial dugs. Vancomycin, linezolid and teicoplanin were active antimicrobial agents against gram-positive cocci. Conclusion Patients with hematological diseases are more susceptible to nosocomial infection, which should be paid more attention to in clinical and laborato-ry practice. Rational antimicrobial therapy is an effective way for control of antimicrobial resistance.

Objective To investigate antimicrobial resistance among nosocomial gram-negative bacilli in 2016 across China.Methods About 1 394 consecutive and non-repetitive gram-negative bacilli were isolated from 14 teaching hospitals from March to August in 2016 across 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.The data were analyzed by using WHONET-5.6 software.Results The activity of antimicrobial agents against Enterobacteriaceae was as follows in descending order of susceptible rate: meropenem (95.2%,891/936), amikacin (94.6%,885/936), ertapenem (92.1%,862/936), piperacillin/tazobactam (88.1%,825/936), imipenem (88.0%,823/936), cefoperazone-sulbactam (83.1%,778/936), cefepime (72.2%,676/936), cefiazidime (72.2%,676/936), levofloxacin(68.8%,644/936), ciprofloxacin (63.2%,592/936), minocyline (62.9%,589/936), cefiriaxone (54.9%,514/936), cefotaxime (54.0%,505/936), cefoxitin (44.3%,415/936).The sensitivities of E.coli to carbapenems, amikacin, piperacillin-tazobactam, polymyxin B and cefoperazone-sulbactam were over 80%.The more sensitive antibiotic to Klebsiella pneumoniae was polymyxin B (99.0%), followed by amikacin (84.9%), meropenem (84.4%) and imipenem (82.0%).The prevalence of extended-spectrum β-lactamase was 62.8%(137/218)in Escherichia coli and 28.3%(58/205)in Klebsiella pneumonia.The activity of antimicrobial agents against E.cloacae, E.aerogenes and Citrobacter freundii was as follows in descending order of susceptible rate: meropenem (97.0%-98.5%), amikacin (95.8%-98.3%), imipenem (94.5%-97.5%), polymyxin B (96.4%-100%), cefoperazone-sulbactam (76.5%-90.0%), ertapenem (73.3%-90.1%), piperacillin/tazobactam (82.4%-88.3%).The most active agents against Pseudomonas aeruginosa were polymyxinB (100%), followed by amikacin (89.3%) and ciprofloxacin (82.4%).The most active agents against Acinetobacter baumannii were polymyxinB (100%).The sensitivities of Acinetobacter baumannii to meropenem, imipenem, minocycline and cefoperazone-sulbactam were 20.3%(39/202), 19.3%(41/202), 66.3%(134/202) and 24.8%(50/202), respectively.Conclusions Carbapenems remain high sensitive against Enterobacteriaceae.Controlling carbapenem resistant Klebsiella pneumoniae is urgent.Drug antimicrobial resistance in A.baumanni is a still serious problem.

Objective To investigate the pathogen distribution and susceptibility profile of fungal isolates from bloodstream infections,and valuate the clinical utility of G test in diagnosis of fungal infections for the purpose to improve antifungal therapy.Methods A retrospective analysis was carried out to analyze the fungal pathogens isolated from bloodstream infections in the First Affiliated Hospital of Nanjing Medical University during the period from January 2013 through December 2015 and their antimicrobial susceptibility.Results A total of 114 fungal strains were isolated from bloodstream infections during the 3-year period,most of which were Candida (99/114,86.8％),especially Candida albicans (30.7％).About 41.2％ (47/114) of the fungal strains were isolated from Department of Thoracic Surgery (10,5 and 4 strains in 2013,2014 and 2015),Hematology (11 strains in 2014),and ICU (7 strains in 2014).Antimicrobial susceptibility testing showed that all the fungal strains (100％) were susceptible to amphotericin B,but 83.5％ susceptible to itraconazole (the lowest).G test was positive before the result of blood culture in 13 of the 54 patients who received G test.Conclusions Candida was the most common fungus in fungal bloodstream infection.Amphotericin B is the most active antifungal agent in vitro.Blood culture combined with serological test can provide clinicians an earlier and reliable diagnosis.

Objective To observe the formation of Staphylococcus aureus biofilm and the inhibitory and dispersive effects of betaine on the biofilm.Methods The inhibitory and dispersive effects of 0.1％ betaine on the biofilm from 20 strains of Staphylococcus aureus were examined by crystal violet assay.Results All the 20 strains of Staphylococcus aureus formed biofilm.The biofilm of methicillinsensitive Staphylococcus aureus (MSSA) was formed in 24 hours with peak value of absorbance (A590 nm) (1.99 ± 0.53).The biofilm of methicillin-resistant Staphylococcus atureus(MRSA) was formed in 48 hours with peak value of absorbance(A590 nm) (1.13 ±0.47).After adding betaine,the absorbance(A590 nm) of MSSA biofilm fell down to(1.74 ± 0.61) in 24 hours,while the absorbance(A590 nm) of MRSA biofilm fell down to(0.40 ± 0.12) in 48 hours,which was significantly reduced compared with the controls (t =2.43,5.84,P ＜ 0.05 respectively).When adding betaine after the biofilm formed,the absorbancies (A590 nm) of both MSSA and MRSA showed no significant difference compared with the controls (P ＞ 0.05).Conclusion Betaine could inhibit biofilm formation of Staphylococcus aureus at concentration of 0.1％,but it could not disperse the mature biofilm of Staphylococcus aureus.

Objective To investigate the distribution and antimicrobial resistance profile of clinical gram-negative bacterial isolates in the First Afifliated Hospital of Nanjing Medical University during 2014.Methods Bacteria identiifcation was performed by API system or the VITEK-2 Compact automatic identiifcation system. Disk diffusion susceptibility testing or VITEK-2 Compact automatic identification system was used to determine the susceptibility to antimicrobial agents. All data were analyzed using WHONET 5.6 software.Results Among the total 7 931 clinical isolates in 2014, gram-negative bacteria accounted for 64.2% (5 088/7 931). The top three pathogens wereE. coli,A. baumannii andK. pneumoniae. Notably, during the year 2014, 195 strains of carbapenem-resistantEnterobacteriaceaewere isolated, about 6.9% of all theEnterobacteriaceae isolates. Meanwhile, 613 (66.5%) strains of multiple drug resistantA. baumannii and 197 (28.7%) strains of multiple drug resistantP. aeruginosa were isolated.Conclusion During the year 2014, the resistance of the gram-negative bacteria in this hospital is mainly characterized by carbapenem-resistantEnterobacteriaceae, multiple drug resistant A. baumanniiand multiple drug resistantP. aeruginosa. Surveillance of antimicrobial resistance is beneifcial for rational use of antibiotics.