The detection rate of carbapenem-resistant Enterobacter cloacae(CRECL)in clinical practice has risen steadily in recent years,and it has become one of the main pathogens of hospital-acquired infections.CRECL resistance is primarily driven by carbapenemase-encoding genes(CEG),which can spread through multiple mechanisms under the selective pressure of antibiotics and other environmental factors.This gene transfer significantly hampers antimicrobial treatment and infection control efforts.This review outlines the current understanding of CEG distribution in CRECL,key transmission pathways,and their public health im-plications.The findings aim to support the development of effective strategies for the prevention and manage-ment of CRECL infections.

Chlamydia trachomatis (CT) infection is the most prevalent sexually transmitted bacterial disease worldwide. However, unlike that in female infertility, the role of CT infection in male infertility remains controversial. The objective of this retrospective study was to explore the impacts of CT infection in the genital tract on sperm quality, sperm acrosin activity, antisperm antibody levels, and inflammation in a large cohort of infertile males in China. A total of 7154 semen samples were collected from infertile male subjects, 416 of whom were CT positive (CT+ group) and 6738 of whom were CT negative (CT- group), in our hospital between January 2016 and December 2018. Routine semen parameters (semen volume, pH, sperm concentration, viability, motility, morphology, etc.), granulocyte elastase levels, antisperm antibody levels, and sperm acrosin activity were compared between the CT+ and CT- groups. Our results showed that CT infection was significantly correlated with an abnormally low semen volume, as well as an increased white blood cell count and granulocyte elastase level (all P < 0.05) in the semen of infertile males; other routine semen parameters were not negatively impacted. The antisperm antibody level and sperm acrosin activity were not affected by CT infection. These findings suggested that CT infection might contribute to inflammation and hypospermia but does not impair sperm viability, motility morphology, and acrosin activity or generate antisperm antibodies in the infertile males of China.
Chlamydia trachomatis ; Female ; Genitalia ; Humans ; Infertility, Male/epidemiology* ; Inflammation/epidemiology* ; Male ; Retrospective Studies ; Semen ; Spermatozoa

Objective:To observe the changes of abdominal aortic calcification and biochemical indicators after parathyroidectomy (PTX) in the maintenance hemodialysis (MHD) patients with secondary hyperparathyroidism (SHPT).Methods:The MHD patients with SHPT who were followed up for 2 years were analyzed retrospectively and divided into PTX surgery group ( n=26) and non-surgery group ( n=18) according to whether they underwent PTX, and then the abdominal aortic calcification score (AACS), intact parathyroid hormone (iPTH), blood calcium and phosphorus after 2 years were observed in the two groups. The PTX surgery group was divided into advanced group and non-advanced group according to whether abdominal aortic calcification had progressed or not 2 years after the operation. Indicators such as age, dialysis age, iPTH, blood calcium, blood phosphorus, calcium and phosphorus product were compared between the two groups to analyze the possible factors related to the development of abdominal aortic calcification. Results:A total of 44 patients meeting the inclusion criteria were included, with 26 in the PTX surgery group and 18 in the non-surgery group. The baseline data of the PTX surgery group and the non-surgery group showed statistical difference in the age of dialysis ( P<0.05), but no statistical differences in gender, age and history of hypertension. Compared with preoperative indicators, postoperative iPTH, blood calcium and phosphorus significantly reduced (all P<0.05), and there was no significant difference in AACS. There were 8 cases (30.77%) of accelerating progress of calcification, 8 cases (30.77%) of improvement in calcification, 10 cases (38.46%) of calcification stability. After 2 years, iPTH value of non-advanced group was significantly lower than advanced group [(20.62±6.44) ng/L vs (132.72±76.83) ng/L], while the preoperative AACS progress was higher in non-advanced group [(13.11±2.71) vs (2.00±1.41)] (all P<0.05). In non-surgery group, AACS was significantly higher after 2 years [(10.44±1.65) vs (8.05±1.26)], blood phosphorus and the product of blood calcium and phosphorus significantly decreased (all P<0.05) , and the levels of iPTH and blood calcium did not significantly change. Pearson correlation analysis showed that the decreased value between preoperative AACS and 2-year postoperative AACS was positively correlated with the decreased value of iPTH ( r=0.534, P=0.012), blood calcium ( r=0.643, P=0.004), blood phosphorus ( r=0.897, P<0.001) and calcium-phosphorus product ( r=0.568, P=0.021) , and negatively correlated with preoperative AACS ( r=-0.647, P=0.014). Conclusions:Small sample data shows that PTX can correct parathyroid hormone, calcium and phosphorus for long term, and prevent abdominal aortic calcification progression, even reverse vascular calcification. Whether abdominal aortic calcification improves or not may be associated with the decrease of iPTH, calcium, phosphorus and the product of blood calcium and phosphorus.

Objective To investigate the clinical efficacy of renal transplantation from donors of donation after brain and cardiac death(DBCD) complicated with acute kidney injury (AKI),and summarize the clinical experience of evaluation and application.Methods The clinical data of the 45 DBCD donors and 80 recipients in the First People's Hospital of Foshan from September 2011 to September 2015 were retrospectively analyzed.DBCD donors were classified into the AKI group (n=26) and non-AKI group (n=19) according to the serum creatinine level and urine output when the donors were admitted to the intensive care unit (ICU) in this hospital.A total of 80 recipients were divided into the AKI group (n=46) and non-AKI group (n=34) correspondingly.The condition of the donors before organ procurement between the two groups was compared,and the incidence of various complications,the 1 years survival rates of recipients and graft after renal transplantation were compared between the two groups.Results Among 45 donors,26 cases(57.8％) suffered from AKI.The serum creatinine of donors was significantly higher in the AKI group than that in the non-AKI group (P ＜ 0.01).The incidence of delayed graft function (DGF) in AKI group and non-AKI group was 21.7％ and 8.8％ respectively (P ＞ 0.05).After 1 years,the serum creatinine of the recipients in AKI group was significantly higher than that in non-AKI group [(134.9±63.4) μmol/L vs (106.6±28.2) μmol/L,P＜ 0.05],but the survival rates of recipients and grafts did no differ between the two groups (both P ＞ 0.05).Conclusions The donors combined with AKI do nothave a worse effect on the incidence of DGF,the 1-year survival rates of recipients and grafts after transplantation.So,the donors with AKI for transplantation can widen the origin of kidney grafts.

Objective: To investigate the clinical efficacy of daytime continuous blood purification (DCRRT) combined with plasma exchange in the treatment of severe acute pancreatitis. Methods: The clinical data of 49 patients with non-biliary severe acute pancreatitis admitted to the First People's Foshan Hospital from January 2012 to January 2019 were analysed respectively. The enrollees were randomized into DCRRT combined with plasma exchange (combination therapy) group and DCRR only (DCRR) group using a random number table method. All patients received DCRRT therapy [8 hours continuous venous-venous blood purification/day (CVVH/d)] immediately after the diagnosis of non-biliary severe acute pancreatitis was established. The combination group received at least one plasma exchange during the course of treatment. The differences of laboratory examination and prognosis between the two groups before and after treatment were compared. Results: A total of49 patients were enrolled, including 29 males and 20 females, with age of (46.40±17.81) years. There were 24 patients in the combination therapy group and 25 patients in DCRR group. There were no significant differences in the age, gender, body mass index (BMI), and pre-treatment laboratory findings between the two groups. After treatment, the blood glucose, hypersensitive C-reactive protein (hs-CRP), procalcitonin (PCT-u), amylase, lipase, triglyceride, cholesterol, serum creatinine were lower than those before treatment (all P<0.05). The blood hs-CPR, PCT-u, lipase and triglyceride in the combination therapy group were significantly lower than those in the DCRR group (all P<0.05). The acute physiology and chronic health scores (APACHEⅡ) of the two groups were lower than those before treatment, and the combination therapy group was more significant than DCRR group (all P<0.05). There were 5 deaths (20.83%) in the combination therapy group and 7 deaths (28.00%) in DCRR group. There was no significant difference in mortality between the two groups. There was no significant difference in the start time and duration of DCRRT between the two groups. Conclusions DCRRT or combined plasma exchange therapy can effectively treat non-biliary severe acute pancreatitis. DCRRT combines with plasma exchange therapy can more effectively remove inflammatory factors and reduce APACHEⅡ score.

Objective To compare the influence of hemodialysis (HD) and peritoneal dialysis (PD) on early outcome of patients underwent kidney transplantation from donation after cardiac death (DCD).Methods Patients admitted in the First People's Hospital of Foshan with DCD kidney transplant from January 1st,2011 to June 30th,2016 were analyzed retrospectively.Recipients were grouped into HD group (n=61) and PD group (n=28) according to their pre-transplant dialysis modality.Their short-term outcomes after DCD kidney transplant were compared,including recovery of renal function,short-term complications and laboratory data.Results Patients had longer dialysis duration and lower hemoglobin,serum albumin and phosphorus in PD group than those in HD group (all P ＜ 0.05),but no significant difference shown in age,gender,body mass index,primary disease,blood pressure,and hepatitis B infection (all P ＞ 0.05).HD patients with 6.00(4.00,11.00) d recovery time of renal function,18.00(17.00,21.50) d hospital time,had 24.59％ the delayed graft function (DGF),3.28％ acute rejection and 16.39％ infection during hospitalization.While for PD patients the recovery time of renal function was 4.00(3.75,7.00) d;hospital time was 19.00(15.00,21.75) d;the incidence rate of DGF was 14.29％;acute rejection was 3.57％;and infection during hospitalization reached 17.86％.Above indexes were not significantly different between HD and PD groups (all P ＞0.05).Repeated measure ments showed that,compared with those before transplant surgery,after 1 month,3 months and 6 months HD and PD groups had decreased creatinine and phosphorus,and increased hemoglobinserum albumin and calcium;Serum albumin and calcium were different between the two groups (P ＜ 0.001,P=0.040),whereas creatinine,hemoglobin and phosphorus did not show difference (all P ＜ 0.05).After transplantation the trends of creatinine,hemoglobin,calcium and phosphorus were not different between the two groups (P values were 0.295,0.310,0.501 and 0.063,respectively).Conclusions No significant difference of the recovery regarding renal function,anemia,nutrition status and mineral metabolites was found between pre-transplant HD and PD modality in patients who underwent DCD kidney transplantations.

Objective To assess the medium and long term efficacy of hemodialysis combined with hemo-perfusion on the endothelial function in patients with maintance hemodialysis(MHD). Methods 60 stable MHD patients were enrolled in the research and randomly divided into 2 group. The observation group received hemodialy-is combined blood perfusion,and the control group received pure hemodialysis therapy. Blood was collected before and after treatment for 6 months for detection of serum C-reactive protein (CRP),hemoglobin (HB),albumin (ALB),advanced glycation end products(AGEs),homocysteine(Hcy)and intercellular cell adhesion molecule (ICAM). Results Plasma hs-CRP,AGEs,Hcy and ICAM decreased gradually after the treatment for 6 months. Compared with the indexes before treatment ,serum HGB and ALB increased significantly after the treatment for 6 months(P < 0.05). Conclusions Hemodialysis combined with hemoperfusion with an appropriate frequency and in a medium or long period is a safe ,convenient,and effective approach for MHD patients to pretect the endotheli-al function.

Objective To further investigate inhibitory mechanism(s) of resveratrol on varicellazoster virus (VZV) in vitro with our previously generated reporter cell line MV9G.Methods Cell-free VZVs were directly inoculated onto MV9G cells (CFVs direct-infection) or cell-associated VZVs wereco-cultured with MV9G cells (CAVs co-culture) to activate expression of reporter gene firefly luciferase in MV9G cells.Resveratrol was added before or after virus infection,roles of resveratrolon direct inactivation,on viral attachment to and penetration into MV9G cells,on intracellular viral replication and its IC50,inhibitorytime points and reversibility were assayed by comparing the luciferase activities reduction by resveratrol.Thereductions of VZV IE62 mRNA copies and IE62-antibody positive cells by resveratrol were further assayed.Results ATPs contents of MV9G cells in the presence of resveratrol over 30.0 μg/ml were concentrationdependently reduced,the CD50 of which was around 60.3 μg/ml.CFVs were premixed with 25.0 μg/ml resveratrol andincubated at 37℃ waterbath for two hours and then directly inoculated onto MV9G cells,luciferases activated by resveratrol-treated CFVs were reduced to around half of the untreated controls.MV9G cells were pre-incubated with resveratrol at 37℃ for 2 h and then directly infected with CFVs at 37℃ for another 2 h,the CFVs-activated luciferase was concentration-dependently reduced,but no big change was observed in those pre-incubated at 4℃.MV9G cells were co-cultured with CAVs in the presence of resvertrolfor 72 h,the CAVs-activated luciferases were markedly reduced in a concentration-dependent manner,the IC50 of which was around 8.7 μgml.Resveratrol was added in CAVs co-culture at 1,3,6,9,12,24,30,and 36 h post infection,the CAVs-activated luciferase in those resveratrol was added at 3,6,9,12,and 24 h post infection were significantly higher than those of controls.Resveratrol was withdrawn from CAVs coculture media,the CAVs-activated luciferases after withdrawal were significantly higher than those before,especially in those withdrswn at 24 and 72 h post infection.The IE62 mRNA levels shown by cDNA copiesdetected with SYBR Green RT-PCR and IE62 positive cells shown by monoclonal anti-IE62 antibody of thevirus-infected cells treated with resveratrol were significantly reduced with increase of incubation time withresveratrol.Conclusion Resveratrol was cytotoxic to MV9G cells,and the maximum resistant concentrationon MV9G cells was around 30.0 μg/ml,the CD50 of which was around 60.3 μg/ml.Non-cytotoxic resveratrol partly inactivated CFVs,inhibited viral penetration into rather than attachment to MV9G cells.Resveratrol inhibited CAVs' intmcellular replication strongly but reversibly in a concentration-dependent manner,the IC50 of which was around 8.7 μ/ml.The inhibition of resveratrol on VZV in vitro might be through suppression of IE62 gene transcription and expression in the early stage of infection.

This paper retrospectively analyzed the clinical manifestation,diagnostic method,as well as the clinical treatment of 8 cases,who suffered complicated tuberculosis infection following renal transplantation.Of the 8 cases,2 cases showed blood Tb-Ab positive,1 case was positive to antiacid bacillus of sputum,the rest cases with negative TBAb.3 patients with 2 showed organs infection,6 patients passed the tissue biopsy diagnose,body temperature of 6 cases fall to normal after 3-7 days of antituberculotic treatment,mild liver dysfunction appeared in 2 patients,hyperuricemia occurred in 7 patients,in addition,1 patient developed reject reaction.Among all the cases,7 cases healed,1 died of pulmonary fungal infection.The result showed that minimal invasive tissue biopsy offers reliable basis for early diagnosis and treatment of disease.

OBJECTIVE: To study the effect of continuous renal replacement therapy on acute renal failure and multiple organ dysfunction syndrome following simultaneous pancreas-kidney transplantation. METHODS: A patient was complicated with acute renal failure, severe acute pancreatitis, lung infection, bleeding in anastomosisbetween duodenum and jejunum, and peritonitis following simultaneous pancreas-kidney transplantation. He was treated with immunosuppressor, antibiotics, amylopsin inhibitor, haemostatic and alimentation; at the same time, he was treated with continuous renal replacement therapy for 22 days. The Baxter system was used for continuous venovenous hemofiltration. RESULTS: The vital signs and hemodynamic indicators were stable during continuous renal replacement therapy. Pulmonary edema was well controlled, and acid-base equilibrium of water electrolyte was maintained. The function of vital organs was stableand graft function was normal following continuous renal replacement therapy for 22 days. He was completely cured and out of hospital on day 40. CONCLUSION: Continuous renal replacement therapy plays an important role in treating acute renal failure and multiple organ dysfunction syndrome following simultaneous pancreas-kidney transplantation. Thus, it is a well kidney support for ultaneous pancreas-kidney transplantation.