Objective To evaluate the reliability of Vitek 2 AST-N335 card for determining the susceptibility of Acinetobacter bauman-nii(AB)to cefoperazone/sulbactam.Methods A total of 318 non-repeated clinical isolates of AB collected in 2023 were tested for antimicrobial susceptibility to cefoperazone/sulbactam using broth microdilution(BMD),the AST-N335 card,and the Kirby-Bauer(K-B)disk diffusion method.Using BMD as the reference method,the reliability of AST-N335 card was assessed,and the accuracy of K-B disk diffusion method as the confirmatory test was validated.Results Compared with BMD,the susceptibility testing of 318 AB strains to cefoperazone/sulbactam using the AST-N335 card showed categorical agreement(CA)of 87.8％(279/318),very major er-ror(VME)of 6.0％(19/318),major error(ME)of 0％(0/318),and minor error(mE)of 1.9％(6/318),which fall outside of the acceptable error range.In contrast,the K-B method achieved CA of 99.4％(316/318),VME of 0％,ME of 0.3％(1/318),and mE of 0.3％(1/318),all within acceptable limits.Of these,the errors with AST-N335 card occurred within the minimum inhibitory concentration(MIC)range of 8-32 μg/mL.Using BMD as the reference method,further analysis was performed on the 171 AB strains with AST-N335 card MIC values of 8-32 μg/mL for cefoperazone/sulbactam.It was revealed that at MIC of 32 μg/mL,the CA was 0％;at MIC of 16 μg/mL,CA was 5.3％(1/19)and VME rate was 84.2％(16/19),both of which substantially exceeded accepta-ble error ranges.At MIC of 8 μg/mL,the CA was 94.9％(131/138)and VME was 2.2％(3/138),both approaching the acceptable ranges.Conclusion The results obtained with Vitek 2 AST-N335 card in determining for cefoperazone/sulbactam are unreliable when the MIC values fall within the range of 8-32 μg/mL,which leads to an underestimation of the resistance rate to cefoperazone/sulbac-tam.This issue requires urgent attention in both laboratories and clinical practice.The K-B disk diffusion method could serve as a sup-plementary verification approach in routine laboratories.

Objective To evaluate the reliability of Vitek 2 AST-N335 card for determining the susceptibility of Acinetobacter bauman-nii(AB)to cefoperazone/sulbactam.Methods A total of 318 non-repeated clinical isolates of AB collected in 2023 were tested for antimicrobial susceptibility to cefoperazone/sulbactam using broth microdilution(BMD),the AST-N335 card,and the Kirby-Bauer(K-B)disk diffusion method.Using BMD as the reference method,the reliability of AST-N335 card was assessed,and the accuracy of K-B disk diffusion method as the confirmatory test was validated.Results Compared with BMD,the susceptibility testing of 318 AB strains to cefoperazone/sulbactam using the AST-N335 card showed categorical agreement(CA)of 87.8％(279/318),very major er-ror(VME)of 6.0％(19/318),major error(ME)of 0％(0/318),and minor error(mE)of 1.9％(6/318),which fall outside of the acceptable error range.In contrast,the K-B method achieved CA of 99.4％(316/318),VME of 0％,ME of 0.3％(1/318),and mE of 0.3％(1/318),all within acceptable limits.Of these,the errors with AST-N335 card occurred within the minimum inhibitory concentration(MIC)range of 8-32 μg/mL.Using BMD as the reference method,further analysis was performed on the 171 AB strains with AST-N335 card MIC values of 8-32 μg/mL for cefoperazone/sulbactam.It was revealed that at MIC of 32 μg/mL,the CA was 0％;at MIC of 16 μg/mL,CA was 5.3％(1/19)and VME rate was 84.2％(16/19),both of which substantially exceeded accepta-ble error ranges.At MIC of 8 μg/mL,the CA was 94.9％(131/138)and VME was 2.2％(3/138),both approaching the acceptable ranges.Conclusion The results obtained with Vitek 2 AST-N335 card in determining for cefoperazone/sulbactam are unreliable when the MIC values fall within the range of 8-32 μg/mL,which leads to an underestimation of the resistance rate to cefoperazone/sulbac-tam.This issue requires urgent attention in both laboratories and clinical practice.The K-B disk diffusion method could serve as a sup-plementary verification approach in routine laboratories.

Objective To analyze the correlation between the lung allocation score (LAS) and the risk of early death and complications in patients with idiopathic pulmonary fibrosis (IPF) after lung transplantation. Methods Clinical data of 275 patients with IPF were retrospectively analyzed. The correlation between LAS and the risk of early death in IPF patients after lung transplantation and the correlation between LAS and complications at postoperative 1 year was assessed by univariate and multivariate Cox regression analyses. Results Among 275 recipients, 62, 83, 95 and 108 cases died within postoperative 30, 90, 180 and 365 d, respectively. LAS was correlated with 30-, 90-, 180- and 365-d fatality of IPF patients (all P<0.05), whereas it was not correlated with the incidence of primary graft dysfunction (PGD) and acute kidney injury (AKI) at 365 d after lung transplantation (both P>0.05). Conclusions LAS is correlated with the risk of early death of IPF patients after lung transplantation. While, it is not correlated the incidence of PGD and AKI early after lung transplantation. Special attention should be paid to the effect of comprehensive factors upon PGD and AKI.

Tyrosine kinase inhibitor (TKI) have been proved to be effective in the treatment of advanced non-small cell lung cancer (NSCLC) patients with epidermal growth factor receptor (EGFR) sensitive mutation, which is superior to chemotherapy. However, there are still some patients with sensitive mutations have primary drug resistance. It may be related to the coexistence of susceptible and resistant mutations of EGFR gene, downstream mutations of EGFR pathway, MET amplification and BIM deletion polymorphism. We present 2 cases of primary drug resistance and analyze the reasons.
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Carcinoma, Non-Small-Cell Lung ; diagnostic imaging ; drug therapy ; genetics ; Disease Progression ; Drug Resistance, Neoplasm ; drug effects ; genetics ; ErbB Receptors ; antagonists & inhibitors ; genetics ; Fatal Outcome ; Humans ; Lung Neoplasms ; diagnostic imaging ; drug therapy ; genetics ; Male ; Middle Aged ; Mutation ; Protein Kinase Inhibitors ; therapeutic use ; Treatment Outcome

Objective To compare the adverse reactions of intranasal and intravenous dexmedetomidine on tracheal extubation during wake up of general anesthesia.Methods One hundred and twenty patients who ASA Ⅰ or Ⅱ grade were divided into four groups (each 30 patients) by random digits table method.The patients in intravenous group were given 0.5 μ g/kg intravenous dexmedetomidine (diluted to 10 ml by 0.9％ sodium chloride,intravenous injection slowly,≥30 s).The patients in intranasal group 1 were given 0.5 μg/kg intranasal dexmedetomidine.The patients in intranasal group 2 were given 0.8 μg/kg intranasal dexmedetomidine.The patients in control group were given intravenous 0.9％ sodium chloride.The systolic blood pressure(SBP),mean arterial blood pressure (MAP),heart rate were compared among groups.Eyes open time and extubation time,the rate of cough and the degree during extubation were compared too.Results The SBP,MAP,heart rate in intravenous group,intranasal group 1 were significantly higher than those in basal state (P ＜ 0.05).The SBP,MAP,heart rate at different time in intranasal group 2 had no significant difference (P ＞ 0.05).The SBP,MAP,heart rate before extubation and after extubation for 3 min in control group were significantly higher than those in intravenous group,intranasal group 1 and intranasal group 2 (P ＜ 0.05).Eyes open time and extubation time among four groups had no significant difference(P ＞0.05).The rate of cough,restlessness and 3 scores of degree before extubation in intravenous group,intranasal group 1 and intranasal group 2 were significandy lower than those in control group [43％ (13/30),50％(15/30),47％(14/30) vs.70％ (21/30); 17％(5/30),23％(7/30),20％(6/30) vs.43％(13/30);53％ (16/30),60％ (18/30),50％ (15/30) vs.80％ (24/30)] (P ＜ 0.05).Conclusions Either intravenous or intranasal dexmedetomidine can effectively prevent the stress reaction during extubation,decrease the degree of restlessness and cough.Intranasal dexmedetomidine(0.8 μ g/kg) is more effective and safe.

Objective To express virus-like particles(VLP) of enterovirus 71 (EV71) in Han-senula polymorpha.Methods The coding sequences of P1 and 3CD genes of EV71 were optimized accord-ing to codon usage bias of Hansenula polymorpha for achieving high expression , and then cloned into the ex-pression vector PMV of Hansenula polymorpha .The recombinant expression vector PMV-P1-3CD was trans-formed into Hansenula polymorpha AU 0501 .The transformants were stably cultured in selective medium (Yeast Nitrogen Base) and screened for strains with positive P1 and 3CD genes by PCR.Then an induced cultivation on the recombinant strains were performed in a medium supplemented with methanol to a final concentration of 1.0%and the expressed products were analyzed by SDS-PAGE and Western blot assays to select high expression strains .The high expression strains were cultured in 30 L fermentor and its fermenta-tion products were analyzed by electronic microscope after purification .Results EV71 recombinant expres-sion strains were successfully constructed .The results of SDS-PAGE showed that the expressed products had obvious VP3, VP1, VP0 protein bands with molecular weights of 26×103, 33×103 and 35×103, respective-ly, which were consistent with the expected molecular weight of the fusion proteins .Western blot demonstra-ted that the expressed products could be specifically recognized by the polyclonal antibody against EV 71-VP1 at 33 ×10 3 , indicating its high immunoreactivity .ELISA confirmed that the expression level of EV 71 fermen-tation products was reached to 200 mg/L.Electronic microscope analysis showed that the VLP of recombi-nant EV71 were 24-30 nm in diameter with normal structure .Conclusion The virus-like particles of human enterovirus 71 are successfully expressed in Hansenula polymorpha , which provides a foundation for the fur-ther development of EV 71 VLP vaccine .

Objective To evaluate the effect of remifentanil on mean arterial pressure (MAP), heart rate (HR) and QTc interval during tracheal intubation of general anesthesia patients. Methods Seventy-five ASA Ⅰ -Ⅱ grade patients were selected and allocated to receive either saline (group C), remifentanil 0.50 μg/kg (group R1) or remifentanil 0.75 μg/kg(group R2) by random digits table with 25 cases in each, they were administrated as a bolus intravenous, followed by a continuous infusion at 0.10 μg/ (kg·min), 1 min before laryngoscopy. All patients received fentanyl 3 μg/kg,propofol 1.0 - 1.5 mg/kg and vecuronium 0.1 mg/kg. The ECG.MAP and HR were recorded prior to induction of anesthesia (T0), 2 min following the start of drug intravenous of fentanyl and propofol with vecuronium (T1), 1 min following remifentanil or saline (T2), before laryngoscopy(T3), 30 s (T4), 2 min (T5) and 4 min (T6) after intubation. Results The QTc interval was significantly prolonged immediately following intubation in group C and group R1, but it remained stable in group R2, compared with the QTc interval just before laryngoscopy. In group R2, QTc interval was significantly shorter at T4-T6 compared to group C(P＜ 0.05 or ＜ 0.01). QTc interval significantly increased from baseline at T4 in group R1 and T4-T6 in group C (P＜ 0.05 or ＜ 0.01). The number of patients with QTc interval ＞ 440 ms were significantly greater immediately following tracheal intubation in group C than that in group R2 [44% (11/25) vs. 12% (3/25)] (P ＜ 0.05). Conclusions QTc interval increases following tracheal intubation during induction of anesthesia using fentanyl and propofol. Intravenous of remifentanil attenuates the QTc interval prolongation associated with tracheal intubation. In addition, remifentanil decreases the hemodynamic responses to tracheal intubation.

Objective To evaluate the effect of oxytocin on Tp-e and QTc interval during caesarean section under spinal anesthesia in healthy puerperas. Methods Forty ASA Ⅰ puerperas were selected and allocated to receive oxytocin intravenous bolus group (group-IB) or oxytocin continuous infusion group (group-CI) with 20 puerperas in each by random digits table. An intravenous bolus of 5% glucose 5 ml and 5 U oxytocin was administered after delivery a 55-60 s period. A continuous infusion of 5% glucose 5 ml and 5U oxytocin was administered after delivery a 10 min period. Measured the QTc interval,Tp-e interval,mean arterial pressure (MAP) and beart rate ( HR ) pre-operatively, then 1,3 and 5 ain after spinal anesthesia, and at least 1,3,5 and 10 min after oxytocin injection. Results In group-IB:HR was fast 1 min after oxytocin injection compared with pre-operatively [(89 ± 13) beats/min vs. (73 ± 12) beats/min] ,MAP was decreased [(69 ± 12 ) mm Hg ( 1 mm Hg= 0. 133 kPa ) vs. ( 82 ± 13 ) mm Hg] and QTc interval was prolonged [(426 ±21 ) ms vs. (405 ± 18 ) ms] (P ＜ 0.01 ); but Tp-e interval was prolonged 1,3,5 min after oxytocin injection compared with pre-operatively (P ＜ 0.01 or ＜ 0.05 ). Conclusions Single large dose of oxytocin intravenous bolus (5 U) can prolong QTc interval and Tp-e interval in healthy puerperas, and Tp-e interval can exact predict the occurrence of ventricular arrhythmias. The risk-benefit balance of oxytocin bolus during caesarean delivery should be discussed with women with a history of long QT syndrome.

Objective To evaluate the effectiveness of epidural saline washout on regression of sensory and motor block after epidural anesthesia in elderly patients.Methods A total of 70 males with ASA Ⅰ or Ⅱ who were subjected lumbar epidural anesthesia with 10 ml of 1.73% bicarbonate-lidocaine and fentanyl 50 μg (1 ml).At the end of transurethral surgery,the washout group (35 cases) received an epidural bolus of 20 ml saline while the control group(35 cases) did not,extracted the epidural catheter after 10 minutes.Results Mean times of 3-dermatomal sensory regression for pinpric, 1-grade of motor block, and the rate of 1 h motor block were significantly shorter in the washout group than those in the control group [(24.6 ± 15.9) min vs(32.8 ± 16.7) min, (32.7 ± 13.4) min vs(47.9 ± 22.6) min,5 cases (14.3%) vs 14 cases (40.0%)](P < 0.05 or < 0.01 ).There was no difference in pain-killer utilization, postoperative pain scores no more than 3 scores and side effects between the two groups (P > 0.05).Conclusion It suggests that epidural washout facihtates regression of both sensory and motor block following epidural anesthesia without reducing the postoperative analgesic benefit.

Objective To investigate the autophagy and the expression of its related genes in the peripheral blood mononuclear cells (PBMCs) of active systemic lupus erythematosus (SLE) patients.Methods Patients with newly onset or recently-diagnosed SLE (n=20) were enrolled.RA patients (n=10) and healthy blood donors (n=10) were used as controls.PBMCs from all subjects were immediately isolated by Ficoll-Hypaque density gradient centrifugation.And then monocytes were removed by wall sticking method.The morphology was observed using transmission electron microscopy (TEM).Messenger RNA (mRNA) expression of Beclin 1 and microtubule-associated protein 1-light chain 3 (MAPLC3) were determined by reverse transcription polymerase chain reaction (RT-PCR) and real-time quantitative RT-PCR respectively.Results TEM showed autophagic phenomenon in PBMCs from active SLE.On the mRNA level,expression of Beclin 1 and LC3 was significantly increased in fresh isolated SLE cells as compared with RA or healthy donor's PBMCs.Conclusion Based on these results,we can conclude that autophagy occurs in active SLE and the expression of its related genes is significantly higher in active SLE than in RA or normal controls.The enhanced autophagy may indicate its role in the pathogenesis of SLE.