Objective To investigate the distribution and antimicrobial resistance profiles of clinically isolated Haemophilus influenzae and Moraxella catarrhalis in hospitals across China from 2015 to 2021,and provide evidence for rational use of antimicrobial agents.Methods Data of H.influenzae and M.catarrhalis strains isolated from 2015 to 2021 in CHINET program were collected for analysis,and antimicrobial susceptibility testing was performed by disc diffusion method or automated systems according to the uniform protocol of CHINET.The results were interpreted according to the CLSI breakpoints in 2022.Beta-lactamases was detected by using nitrocefin disk.Results From 2015 to 2021,a total of 43 642 strains of Haemophilus species were isolated,accounting for 2.91％of the total clinical isolates and 4.07％of Gram-negative bacteria in CHINET program.Among the 40 437 strains of H.influenzae,66.89％were isolated from children and 33.11％were isolated from adults.More than 90％of the H.influenzae strains were isolated from respiratory tract specimens.The prevalence of β-lactamase was 53.79％in H.influenzae strains.The H.influenzae strains isolated from children showed higher resistance rate than the strains isolated from adults.Overall,779 strains of H.influenzae did not produce β-lactamase but were resistant to ampicillin(BLNAR).Beta-lactamase-producing strains showed significantly higher resistance rates to these antimicrobial agents than the β-lactamase-nonproducing strains.Of the 16 191 M.catarrhalis strains,80.06％were isolated from children and 19.94％isolated from adults.M.catarrhalis strains were mostly susceptible to both amoxicillin-clavulanic acid and cefuroxime,evidenced by resistance rate lower than 2.0％.Conclusions The emergence of antibiotic-resistant H.influenzae due to β-lactamase production poses a challenge for clinical anti-infective treatment.Therefore,it is very important to implement antibiotic resistance surveillance for H.influenzae and guide rational antibiotic use.All local clinical microbiology laboratories should actively improve antibiotic susceptibility testing and strengthen antibiotic resistance surveillance for H.influenzae.

This research investigated the contamination level,distribution of drug-resistant strains,and molecular epidemiologi-cal characteristics of Campylobacter,and further explored transmission pathways and prevention strategies.Cecum,chicken carcass,chicken product,and environmental samples,as well as swabs from workers'hands,were collected from a slaughterhouse in a large broiler group in the Jiaodong area between August 2023 and July 2024.Quantitative contamination assessment of Campylobacter in chicken carcasses and chicken products was performed.After microbial mass spectrometry identification,the representative strains of different links were selected for drug resistance testing and whole genome sequencing(WGS).On the basis of the sequencing results,the resistance genes,virulence genes,multilocus sequence typing(MLST),and phylogenetic characteristics of representative strains were analyzed.Homology comparisons were performed between isolates and strains from patients with diarrhea in the NCBI database.A total of 297 Campylobacter strains were isolated from 806 samples,and the overall detection rate was 36.85%.The detection rate of Campylobacter was highest in the evisceration process(47.33%),followed by the cutting process(35.64%).Overall,the Campylo-bacter detection rate first increased,then decreased,and subsequently increased.Drug sensitivity testing revealed that 90 isolates were resistant to nalidixic acid and ciprofloxacin,and 94.97%of isolates were resistant to tetracycline.WGS showed that both Campylo-bacter jejuni(C.jejuni)and Campylobacter coli(C.coli)carried many drug resistance and virulence genes.ST-14176 of C.jejuni was isolated for the first time herein.The predominant ST-8261 strain of C.jejuni and ST-860,ST-829,and ST-1586 strains of C.coli are known to cause human diarrhea.LOS expression genes associated with Guillain-Barré syndrome(GBS)were detected in both C.jejuni isolates from the slaughter chain and patients with GBS.Some strains exhibited close genetic relatedness to human-derived Campylo-bacter strains from the NCBI database.The detection rate of Campylobacter in the slaughterhouse first increased,then decreased,and subsequently increased,and the quantitative contamination level of each link was similar to the detection rate.Quantitative analysis of chicken carcasses/products revealed that the average bacterial load was highest in eviscerated carcasses(102.80 cfu/g),and the high-est amount of Campylobacter in chicken products reached 451.80 cfu/g.Abundant drug resistance genes and virulence genes were iden-tified,and the drug resistance genes were highly correlated with the drug resistance rate.Therefore,surveillance intensity and control measures for Campylobacter in slaughter processes should be strengthened.

Objective To investigate the distribution and antimicrobial resistance profiles of clinically isolated Haemophilus influenzae and Moraxella catarrhalis in hospitals across China from 2015 to 2021,and provide evidence for rational use of antimicrobial agents.Methods Data of H.influenzae and M.catarrhalis strains isolated from 2015 to 2021 in CHINET program were collected for analysis,and antimicrobial susceptibility testing was performed by disc diffusion method or automated systems according to the uniform protocol of CHINET.The results were interpreted according to the CLSI breakpoints in 2022.Beta-lactamases was detected by using nitrocefin disk.Results From 2015 to 2021,a total of 43 642 strains of Haemophilus species were isolated,accounting for 2.91％of the total clinical isolates and 4.07％of Gram-negative bacteria in CHINET program.Among the 40 437 strains of H.influenzae,66.89％were isolated from children and 33.11％were isolated from adults.More than 90％of the H.influenzae strains were isolated from respiratory tract specimens.The prevalence of β-lactamase was 53.79％in H.influenzae strains.The H.influenzae strains isolated from children showed higher resistance rate than the strains isolated from adults.Overall,779 strains of H.influenzae did not produce β-lactamase but were resistant to ampicillin(BLNAR).Beta-lactamase-producing strains showed significantly higher resistance rates to these antimicrobial agents than the β-lactamase-nonproducing strains.Of the 16 191 M.catarrhalis strains,80.06％were isolated from children and 19.94％isolated from adults.M.catarrhalis strains were mostly susceptible to both amoxicillin-clavulanic acid and cefuroxime,evidenced by resistance rate lower than 2.0％.Conclusions The emergence of antibiotic-resistant H.influenzae due to β-lactamase production poses a challenge for clinical anti-infective treatment.Therefore,it is very important to implement antibiotic resistance surveillance for H.influenzae and guide rational antibiotic use.All local clinical microbiology laboratories should actively improve antibiotic susceptibility testing and strengthen antibiotic resistance surveillance for H.influenzae.

This research investigated the contamination level,distribution of drug-resistant strains,and molecular epidemiologi-cal characteristics of Campylobacter,and further explored transmission pathways and prevention strategies.Cecum,chicken carcass,chicken product,and environmental samples,as well as swabs from workers'hands,were collected from a slaughterhouse in a large broiler group in the Jiaodong area between August 2023 and July 2024.Quantitative contamination assessment of Campylobacter in chicken carcasses and chicken products was performed.After microbial mass spectrometry identification,the representative strains of different links were selected for drug resistance testing and whole genome sequencing(WGS).On the basis of the sequencing results,the resistance genes,virulence genes,multilocus sequence typing(MLST),and phylogenetic characteristics of representative strains were analyzed.Homology comparisons were performed between isolates and strains from patients with diarrhea in the NCBI database.A total of 297 Campylobacter strains were isolated from 806 samples,and the overall detection rate was 36.85%.The detection rate of Campylobacter was highest in the evisceration process(47.33%),followed by the cutting process(35.64%).Overall,the Campylo-bacter detection rate first increased,then decreased,and subsequently increased.Drug sensitivity testing revealed that 90 isolates were resistant to nalidixic acid and ciprofloxacin,and 94.97%of isolates were resistant to tetracycline.WGS showed that both Campylo-bacter jejuni(C.jejuni)and Campylobacter coli(C.coli)carried many drug resistance and virulence genes.ST-14176 of C.jejuni was isolated for the first time herein.The predominant ST-8261 strain of C.jejuni and ST-860,ST-829,and ST-1586 strains of C.coli are known to cause human diarrhea.LOS expression genes associated with Guillain-Barré syndrome(GBS)were detected in both C.jejuni isolates from the slaughter chain and patients with GBS.Some strains exhibited close genetic relatedness to human-derived Campylo-bacter strains from the NCBI database.The detection rate of Campylobacter in the slaughterhouse first increased,then decreased,and subsequently increased,and the quantitative contamination level of each link was similar to the detection rate.Quantitative analysis of chicken carcasses/products revealed that the average bacterial load was highest in eviscerated carcasses(102.80 cfu/g),and the high-est amount of Campylobacter in chicken products reached 451.80 cfu/g.Abundant drug resistance genes and virulence genes were iden-tified,and the drug resistance genes were highly correlated with the drug resistance rate.Therefore,surveillance intensity and control measures for Campylobacter in slaughter processes should be strengthened.

Objective:To establish a method to detect IDH2 gene mutations in the cell-free DNA (cfDNA) sample of angioimmunoblastic T-cell lymphoma (AITL) based on the digital droplet PCR (ddPCR) method. The performance of this method was evaluated.Methods:Specific primers and probes were designed for IDH2 p. R172K, IDH2 p. R172M, and IDH2 p. R172W mutations, and primer combinations were optimized to establish the optimal ddPCR reaction system. In addition, the accuracy, precision, specificity, and detection limit of the method were evaluated using clinical cfDNA samples obtained from 40 patients with AITL at the First Affiliated Hospital of Nanjing Medical University.Results:The IDH2 R172K/M/W F2/R2 primer combination was selected to establish the ddPCR detection method for IDH2 R172K/M/W mutations. Specific standard samples showed no false-positive results. The accuracy test revealed that the relative deviation of the standard sample measurements was within ±10%. The detection limit test indicated that the method could detect 1 ng/μl with a 0.2% mutation rate for IDH2 R172K/M/W mutations. The precision measurements (inter-experimenter, inter-run, and inter-laboratory) all had a coefficient of variation of <5%. ddPCR was applied to 40 clinical samples with IDH2 R172K/M/W mutations, and the results were fully consistent with gene sequencing.Conclusion:ddPCR can detect IDH2 gene mutations in cfDNA from AITL with high sensitivity, specificity, and absolute quantification. This method offers a simple, rapid, and reliable approach for diagnosing and monitoring.

Objective To investigate the effects of electroacupuncture for the restoration of muscle regeneration and the secretion of exosomes around acupoints in a model of erector spinae muscle injury.Methods Forty SPF-grade male SD rats were randomly divided into blank group,model group,electroacupuncture group,and electroacupuncture+exosome inhibitor group,with 10 rats per group.Except for the blank group,the erector spinae muscle injury models were established in other groups by intramuscular injection of 0.5%bupivacaine.The blank control group received no treatment,whereas the rats in the electroacupuncture and electroacupuncture+exosome inhibitor groups were treated with electroacupuncture at"Weizhong"(BL40)and"Shenshu"(BL23)acupoints,respectively,stimulation was applied daily for 7 consecutive days,with each session lasting 20 minutes.The parameters used were a sparse-dense wave waveform,a frequency of 2/10 Hz,and a current intensity of 1 mA.The exosome inhibitor GW4869(3 g/L,50 μL per acupoint)was injected 1 h before each electroacupuncture in the electroacupuncture+exosome inhibitor group.After intervention,the erector spinae muscles were collected and observed by HE and Masson staining for morphological changes.The expression of paired box gene 7(Pax7)and recombinant myogenic differentiation(MyoD)was detected by immunohistochemistry,while the expression of myogenin(MyoG)and myosin heavy chain(MyHC)proteins was detected by western blotting.The serum exosomes of rats in each group were extracted and identified by transmission electron microscopy and nanoparticle tracking analysis,and the expression of Alix,differentiation cluster 63(CD63),and tumor susceptibility gene 101(TSG101)proteins were detected by Western blotting.Results Compared with the blank group,the model group,the electroacupuncture group,and the electroacupuncture+exosome inhibitor group exhibited spinae muscle fiber fragmentation,degeneration,necrosis,and inflammatory cell infiltration in HE staining.The result of Masson staining showed that collagen fiber hyperplasia was increased.The model group showed increased expression of MyoD,Pax7,MyoG,MyHC,and CD63,while TSG101 expression was downregulated(P<0.05).In the electroacupuncture group,the expression of MyoD,Pax7,Alix,and TSG101 was elevated(P<0.05),and the expression of MyHC and CD63 was decreased(P<0.05).The electroacupuncture+exosome inhibitor group displayed increased expression of MyHC,Alix,and TSG101(P<0.05),and the expression of CD63 was decreased(P<0.05).Compared with the model group,the electroacupuncture group and the electroacupuncture+exosome inhibitor group showed reduced muscle fiber degeneration,necrotic areas,and inflammatory cell infiltration as observed in HE staining,along with decreased collagen fiber hyperplasia in Masson staining.Specifically,the electroacupuncture group demonstrated increased expression of MyoD,Pax7,MyoG,Alix,and TSG101(P<0.05),and the expression of CD63 was decreased(P<0.05).The electroacupuncture+exosome inhibitor group displayed downregulated expression of Pax7,MyoG,MyHC,and CD63(P<0.05),and the expression of Alix and TSG101 was regulated(P<0.05).Compared with the electroacupuncture+exosome inhibitor group,the electroacupuncture group exhibited less muscle fiber degeneration and necrosis,reduced inflammatory cell infiltration in HE staining,and decreased stained collagen fibers in Masson staining.The electroacupuncture group showed increased expression of MyoD,Pax7,MyoG,MyHC,Alix,and CD63(P<0.05).Conclusion Electroacupuncture can up-regulate the expression of Pax7 and MyoD,and promote the regeneration of erector spinae muscles,which may be related to stimulating the secretion of exosomes around the acupoint.Exosomes may be an important mediator for the efficacy of acupuncture.

Objective To investigate the effects of electroacupuncture for the restoration of muscle regeneration and the secretion of exosomes around acupoints in a model of erector spinae muscle injury.Methods Forty SPF-grade male SD rats were randomly divided into blank group,model group,electroacupuncture group,and electroacupuncture+exosome inhibitor group,with 10 rats per group.Except for the blank group,the erector spinae muscle injury models were established in other groups by intramuscular injection of 0.5%bupivacaine.The blank control group received no treatment,whereas the rats in the electroacupuncture and electroacupuncture+exosome inhibitor groups were treated with electroacupuncture at"Weizhong"(BL40)and"Shenshu"(BL23)acupoints,respectively,stimulation was applied daily for 7 consecutive days,with each session lasting 20 minutes.The parameters used were a sparse-dense wave waveform,a frequency of 2/10 Hz,and a current intensity of 1 mA.The exosome inhibitor GW4869(3 g/L,50 μL per acupoint)was injected 1 h before each electroacupuncture in the electroacupuncture+exosome inhibitor group.After intervention,the erector spinae muscles were collected and observed by HE and Masson staining for morphological changes.The expression of paired box gene 7(Pax7)and recombinant myogenic differentiation(MyoD)was detected by immunohistochemistry,while the expression of myogenin(MyoG)and myosin heavy chain(MyHC)proteins was detected by western blotting.The serum exosomes of rats in each group were extracted and identified by transmission electron microscopy and nanoparticle tracking analysis,and the expression of Alix,differentiation cluster 63(CD63),and tumor susceptibility gene 101(TSG101)proteins were detected by Western blotting.Results Compared with the blank group,the model group,the electroacupuncture group,and the electroacupuncture+exosome inhibitor group exhibited spinae muscle fiber fragmentation,degeneration,necrosis,and inflammatory cell infiltration in HE staining.The result of Masson staining showed that collagen fiber hyperplasia was increased.The model group showed increased expression of MyoD,Pax7,MyoG,MyHC,and CD63,while TSG101 expression was downregulated(P<0.05).In the electroacupuncture group,the expression of MyoD,Pax7,Alix,and TSG101 was elevated(P<0.05),and the expression of MyHC and CD63 was decreased(P<0.05).The electroacupuncture+exosome inhibitor group displayed increased expression of MyHC,Alix,and TSG101(P<0.05),and the expression of CD63 was decreased(P<0.05).Compared with the model group,the electroacupuncture group and the electroacupuncture+exosome inhibitor group showed reduced muscle fiber degeneration,necrotic areas,and inflammatory cell infiltration as observed in HE staining,along with decreased collagen fiber hyperplasia in Masson staining.Specifically,the electroacupuncture group demonstrated increased expression of MyoD,Pax7,MyoG,Alix,and TSG101(P<0.05),and the expression of CD63 was decreased(P<0.05).The electroacupuncture+exosome inhibitor group displayed downregulated expression of Pax7,MyoG,MyHC,and CD63(P<0.05),and the expression of Alix and TSG101 was regulated(P<0.05).Compared with the electroacupuncture+exosome inhibitor group,the electroacupuncture group exhibited less muscle fiber degeneration and necrosis,reduced inflammatory cell infiltration in HE staining,and decreased stained collagen fibers in Masson staining.The electroacupuncture group showed increased expression of MyoD,Pax7,MyoG,MyHC,Alix,and CD63(P<0.05).Conclusion Electroacupuncture can up-regulate the expression of Pax7 and MyoD,and promote the regeneration of erector spinae muscles,which may be related to stimulating the secretion of exosomes around the acupoint.Exosomes may be an important mediator for the efficacy of acupuncture.

Objective:To explore the construction method of a resistant multiple myeloma(MM)patient-derived xenotransplantation(PDX)model.Methods:1.0 × 107 MM patient-derived mononuclear cells(MNCs),2.0 × 106 MM.1S cells and 2.0 × 106 NCI-H929 cells were respectively subcutaneously inoculated into NOD.CB17-Prkdcscid Il2rgtml/Bcgen(B-NDG)mice with a volume of 100 p1 per mouse to establish mouse model.The morphologic,phenotypic,proliferative and genetic characteristics of PDX tumor were studied by hematoxylin-eosin staining,immunohistochemical staining(IHC),cell cycle analysis,flow cytometry and fluorescence in situ hybridization(FISH).The sensitivity of PDX tumor to bortezomib and anlotinib monotherapy or in combination was investigated through cell proliferation,apoptosis and in vitro and in vivo experiments.The effects of anlotinib therapy on tumor blood vessel and cell apoptosis were analyzed by IHC,TUNEL staining and confocal fluorescence microscope.Results:MM PDX model was successfully established by subcutaneously inoculating primary MNCs.The morphologic features of tumor cells from MM PDX model were similar to those of mature plasma cells.MM PDX tumor cells positively expressed CD138 and CD38,which presented 1q21 amplification,deletion of Rb1 and IgH rearrangement,and had a lower proliferative activity than MM cell lines.In vitro,PDX,MM.1S and NCI-H929 cells were treated by bortezomib and anlotinib for 24 hours,respectively.Cell viability assay showed that the IC50 value of bortezomib were 5 716.486,1.025 and 2.775 nmol/L,and IC50 value of anlotinib were 5 5107.337,0.706 and 5.13 μmol/L,respectively.Anlotinib treatment increased the apoptosis of MM.1S cells(P＜0.01),but did not affect PDX tumor cells(P＞0.05).In vivo,there was no significant difference in PDX tumor growth between bortezomib monotherapy group and control group(P＞0.05),while both anlotinib monotherapy and anlotinib combined with bortezomib effectively inhibited PDX tumor growth(both P＜0.05).The vascular perfusion and vascular density of PDX tumor were decreased in anlotinib treatment group(both P＜0.01).The apoptotic cells in anlotinib treatment group were increased compared with those in control group(P＜0.05).Conclusion:Bortezomib-resistant MM PDX model can be successfully established by subcutaneous inoculation of MNCs from MM patients in B-NDG mice.This PDX model,which retains the basic biological characteristics of MM cells,can be used to study the novel therapies.

Objective:To establish a method to detect IDH2 gene mutations in the cell-free DNA (cfDNA) sample of angioimmunoblastic T-cell lymphoma (AITL) based on the digital droplet PCR (ddPCR) method. The performance of this method was evaluated.Methods:Specific primers and probes were designed for IDH2 p. R172K, IDH2 p. R172M, and IDH2 p. R172W mutations, and primer combinations were optimized to establish the optimal ddPCR reaction system. In addition, the accuracy, precision, specificity, and detection limit of the method were evaluated using clinical cfDNA samples obtained from 40 patients with AITL at the First Affiliated Hospital of Nanjing Medical University.Results:The IDH2 R172K/M/W F2/R2 primer combination was selected to establish the ddPCR detection method for IDH2 R172K/M/W mutations. Specific standard samples showed no false-positive results. The accuracy test revealed that the relative deviation of the standard sample measurements was within ±10%. The detection limit test indicated that the method could detect 1 ng/μl with a 0.2% mutation rate for IDH2 R172K/M/W mutations. The precision measurements (inter-experimenter, inter-run, and inter-laboratory) all had a coefficient of variation of <5%. ddPCR was applied to 40 clinical samples with IDH2 R172K/M/W mutations, and the results were fully consistent with gene sequencing.Conclusion:ddPCR can detect IDH2 gene mutations in cfDNA from AITL with high sensitivity, specificity, and absolute quantification. This method offers a simple, rapid, and reliable approach for diagnosing and monitoring.

177Lu-prostate specific membrane antigen(PSMA)radio-ligand therapy has been approved abroad for advanced prostate cancer and has been in several clinical trials in China.Based on domestic clinical practice and experimental data and referred to international experience and viewpoints,the expert group forms a consensus on the clinical application of 177Lu-PSMA radio-ligand therapy in prostate cancer to guide clinical practice.