Objective To understand the clinical distribution characteristics and drug-resistance genotypes of carbapenem-resistant Pseudomonas aeruginosa(CRPA)in a tertiary hospital in Shanghai,so as to guide the rational use of antibiotics,reduce bacterial resistance and control nosocomial infections.Methods A total of 94 consecutive and non-redundant CRPA strains isolated from clinical specimens were collected in The First Affiliated Hospital of Naval Medical University between Jan.1,and Dec.31,2019.The distribution of CRPA across departments and sample sources were analyzed.Antimicrobial susceptibility testing against 13 antibiotics was determined using the VITEK 2 Compact automated microbiology analyzer and the Kirby-Bauer disk diffusion method.Polymerase chain reaction(PCR)was employed to detect genes encoding extended-spectrum β-lactamase resistance gene,carbapenemase resistance gene,and porin resistance gene.Homology analysis of selected isolates was performed using kSNP3,a k-mer-based software,for single nucleotide polymorphism(SNP)analysis.An evolutionary tree was constructed to assess genetic relationships.Additionally,multilocus sequence typing(MLST)was performed using the Pseudomonas aeruginosa typing scheme from the PubMLST database.Results Among the 94 CRPA isolates,high resistance rates were observed for carbapenems,including imipenem(92.6%,87 strains)and meropenem(87.2%,82 strains).In contrast,low resistance rates were detected for aminoglycosides,such as amikacin(10.6%,10 strains),gentamicin(20.2%,19 strains),and tobramycin(20.2%,19 strains).The top 3 departments in terms of isolate distribution were the Emergency Intensive Care Unit(9.6%,9 strains),Department of Cerebrovascular Surgery(8.5%,8 strains),and Department of Respiratory Medicine(8.5%,8 strains).PCR analysis of 94 CRPA strains detected outer membrane protein D2(OprD2)gene deletion in 47(50.0%)strains,13(13.8%)strains were positive for blaKPC,4(4.3%)strains for blaVIM,2(2.1%)strains for blaIMP,1(1.1%)strain for blaNDM,12(12.8%)strains for blaTEM,4(4.3%)strains for blaPER,and 2(2.1%)strains for blaGES,while blaOXA-48,blaBIC,blaSIM,blaVEB,and blaSHV were not detected.MLST identified 36 different sequence types(STs),with ST463 and ST274 being the most common,and 2 new ST(ST4023 and ST4024)were identified for the first time.Conclusion CRPA strains carry multiple resistance genes and exhibit concurrent resistance to several commonly used clinical antibiotics.The resistance is primarily associated with the presence of blaKPC,blaVIM and blaTEM genes and the deletion of OprD2 gene.Clinical monitoring of CRPA should be strengthened,and rational use of antimicrobial agents is essential to control its spread within the hospital.

Objective:To investigate the efficacy and safety of hemodiafiltration (HDF) in treating CAR-T related grade 3-4 cytokine release syndrome after ineffective treatment with IL-6 receptor inhibitors.Methods:Between July 2015 and July 2021, retrospective analysis of hemodiafiltration for the treatment of 3 patients, including 2 cases of acute B-lymphoblastic leukemia and 1 case of diffuse large B-cell lymphoma, with grade 3-4 CRS after CAR-T cell therapy and ineffective treatment with IL-6 receptor inhibitor was carried out.Results:The patient's clinical symptoms, including body temperature, blood pressure, and blood oxygen, were relieved within 12 hours of all treatments, and the cytokines (IL-6, IL-10, TNF-α, INF-γ) and C-reactive protein (CRP) levels decreased significantly. No adverse side effects were observed during the follow-up period of 3 months.Conclusion:HDF can be a safe and feasible method to treat CAR-T related grade 3- 4 CRS after ineffective treatment with IL-6 receptor inhibitors.

Objective:To investigate the distribution and drug resistance of pathogens causing blood stream infection in patients with pancreatic neoplasms.Methods:Clinical data of patients with pancreatic neoplasms complicated with bloodstream infection with confirmed pathological evidence admitted in the First Affiliated Hospital of Naval Medical University from January 2016 to June 2019 were collected. Bacteria were isolated from blood culture, and microbial sensitivity tests were analyzed by minimum inhibitory concentration and Kirby-Bauer methods. The distribution and drug resistance of pathogens causing blood stream infection in patients with pancreatic neoplasms were analyzed.Results:There were 116 cases (8.5%) with bloodstream infection in 1 372 patients with pancreatic neoplasms. A total of 156 bacterial strains were isolated from blood culture, of which 127 strains (81.4%) were gram negative aerobic bacteria, mainly including Escherichia coli (42 strains), Klebsiella pneumoniae (34 strains), Pseudomonas aeruginosa (12 strains), and 25 strains (16.0%) were gram positive aerobic bacteria, mainly including Enterococcus faecium (11 strains), Enterococcus faecalis (3 strains), Streptococcus angina (3 strains). 4 strains (2.6%) were anaerobic bacteria. The results of antibiotic susceptibility showed that the resistance rate of Escherichia coli to ampicillin was 90.5%, and to cefoperazone-sulbactam was 2.4%. The resistance rate of Klebsiella pneumoniae to piperacillin was 20.6%, and to cefoperazone-sulbactam was 5.9%. The resistance rate of Pseudomonas aeruginosa to imipenem was 41.7%, and no resistant strain was found to cefoperazone-sulbactam. The resistance rate of Enterococcus and Streptococcus pharyngitis to erythromycin were 85.7% and 33.3%, and no strains were resistant to vancomycin.Conclusions:The rate of blood stream infection in patients with pancreatic neoplasms was relatively high. In clinical practice, the distribution of pathogenic bacteria should be understood, the drug resistance should be monitored and antibiotics should be reasonably used, in order to maximally prevent and interfere with the occurrence of blood stream infection.

Objective? To investigate the malnutrition status of cancer patients undergoing radiotherapy, and to provide research basis for later nutrition intervention. Methods? Using convenient sampling method, 380 patients with cancer treated by radiotherapy in Shanghai and Zhejiang provincial ClassⅢ Grade A hospitals from February to November 2018 were selected as the research subjects. The incidence of malnutrition, laboratory indicators on admission and discharge, and the incidence of significant weight loss during hospitalization were investigated. Malnutrition was assessed by Patient-Generated Subjective Global Assessment Scale (PG-SGA). Results? Among 380 cancer patients receiving radiotherapy, 48.9% (186/380) suffered from or suspected malnutrition at admission, of which 7.6% (29/380) suffered from severe malnutrition. At discharge, 64.2% (244/380) of radiotherapy patients developed or suspected malnutrition, of which 18.9% (72/380) suffered from severe malnutrition. In addition, 56.3% (214/380) patients lost weight during radiotherapy, and 12.4% (47/380) patients showed significant weight loss. Compared with that at admission, the levels of serum albumin and hemoglobin decreased significantly (P＜0.05). Conclusions The incidence of malnutrition is high in cancer patients during radiotherapy. Early nutritional assessment should be given at admission and early nutritional intervention should be given to malnutrition patients.

OBJECTIVETo observe the clinical effect of ear point embedding on plasma and effect site concentrations of propofol-remifentanil in elderly patients who underwent abdominal external hernia surgery at the time of consciousness and pain disappearing by target-controlled infusion (TCI) and bispectral index (BIS).

METHODSFifty patients who underwent elective abdominal hernia surgery were randomly assigned into an observation group and a control group, 25 cases in each one. In the observation group, 30 minutes before anesthesia induction, Fugugou (Extra), Gan (CO), Pizhixia (AT), and Shenmen (TF) were embedded by auricular needles until the end of surgery, 10 times of counter press each point. In the control group, the same amount of auricular tape was applied until the end of surgery at the same points without stimulation 30 minutes before anesthesia induction. Patients in the two groups were given total intravenous anesthesia, and BIS was monitored by BIS anesthesia depth monitor. Propofol was infused by TCI at a beginning concentration of 1.5μg/L and increased by 0.3μg/L every 30s until the patients lost their consciousness. After that, remifentanil was infused by TCI at a beginning concentration of 2.0μg/L and increased by 0.3μg/L every 30s until the patients had no body reaction to pain stimulation (orbital reflex). Indices were recorded, including mean arterial pressure (MAP), heart rate (HR) and the BIS values, at the time of T(entering into the operation room), T(losing consciousness) and T(pain relief), the plasma and effect site concentrations of propofol at T, the plasma and effect site concentrations of remifentanil at T. After surgery we recorded the total amounts of propofol and remifentanil, surgery time and anesthesia time.

RESULTSAt Tand T, MAP and HR of the observation group were higher than those of the control group (<0.05,<0.01). At T, the plasma and effect site concentrations of propofol in the observation group were significantly lower than those in the control group (<0.05,<0.01). At T, the plasma and effect site concentrations of remifentanil in the observation group were significantly lower than those in the control group (<0.05,<0.01). There was no significant difference in BIS values at Tand Tbetween the two groups (both>0.05). There was no significant difference in operation time and anesthesia time between the two groups (both>0.05). The total amount of remifentanil in the observation group was significantly lower than that in the control group (<0.01). There was no significant difference in the total amount of propofol between the two groups (>0.05).

CONCLUSIONSEar points embedding combined with propofol-remifentanil TCI could reduce the plasma and effect site concentrations of propofol and remifentanil and the total amount of remifentanil in elderly patients with extra-abdominal hernia surgery, and had the effect of assisting sedation and analgesia.

Objective To investigate the traditional Chinese medicine(TCM) syndromes distribution rule of nonalcoholic fatty liver disease(NAFLD) and its correlation with related clinical indexes.Methods The general condition,TCM four diagnostic methods,biochemical and CT results in 1950 cases of NAFLD in Chongqing City were investigated for analyzing the TCM syndromes distribution rule and its correlation with biochemistry and CT.Results In 1950 cases,the accumulation and binding of damp-heat,congestion of dampness turbidity,stagnation of liver-QI with spleen deficiency,intermin-gled phlegm and blood stasis and yin deficiency of both liver and kidney accounted for 36.62 ％,27.69 ％,19.38 ％,10.10 ％ and 6.21 ％ respectively;there was statistically significant difference in age among different TCM syndromes(P＜0.05);the vin deficiency syndrome of both liver and kidney and intermin-gled phlegm and blood stasis in severe fatty liver were maximal;glutamic-pyruvic transaminase(ALT) and glutamic-oxalacetic transaminase(AST) level was higher in the accumulation and binding of damp-heat;the level of fasting plasma gluco se(FBG) was higher in the yin deficiency syndrome of both liver and kidney;the total cholesterol(TC),triglyceride(TG) and FBG levels were lower in the stagnation of liver-QI with spleen deficiency,the differences were statistically significant(P＜0.05).Conclusion In NAFLD patients,the accumulation and binding of damp-heat distribution is maximal,the proportion of severe fatty liver with vin deficiency syndrome of both liver and kidney is higher.Different dialectical types may play an important role in the clinical indexes and disease development.

Objective To investigate the distribution and antimicrobial susceptibility of the bacteria isolated from bloodstream infections during 2013-2014 in Changhai Hospital for rational use of antibacterial agents.Methods The bacterial strains from blood samples were collected during the period from January 2013 through December 2014,and subjected to antimicrobial susceptibility testing by using automated system or Kirby-Bauer method.The results were interpreted according to CLSI M100-S24 breakpoints or FDA breakpoints.The data were analyzed by WHONET 5.6 software.Results A total of 1 048 nonduplicate isolates were collected,of which Escherichia coli,coagulase-negative Staphylococcus (CNS) and Klebsiella pneumoniae accounted for 29.5％,15.8％ and 13.8％,respectively.Gastroenterology,Hematology,General surgery,Urology and Department of Infectious Diseases are the top 5 departments according to their total number of bacterial isolates.The results of antimicrobial susceptibility testing showed that ESBLs-producing E.coli and K.pneumoniae accounted for 63.8％ and 38.6％,respectively.The prevalence of methicillinresistant CNS (MRCNS) was 77.6％.The E.coli strains isolated from Urology showed higher resistance rates to cephalosporins than the total E.coli strains,while the E.coli strains isolated from Gastroenterology showed higher resistance rates to betalactarn/beta-lactamase inhibitor combinations and carbapenems than the total E.coli strains.Higher prevalence of MRCNS was found in departments of Hematology,Urology and Neurosurgery.All the CNS strains isolated from Neurosurgery were resistant to methicillin.The K.pneumoniae strains isolated from Bum ICU had higher resistance rates to all the antibacterial agents tested than the total K.pneumoniae strains,while the K.pneumoniae strains isolated from Gastroenterology showed higher resistance rates to carbapenems and tigecycline than the total K.pneumoniae strains.Conclusions The pathogenic bacteria isolated from bloodstream infections vary with departments in terms of species distribution and antimicrobial susceptibility profile.It is necessary to strengthen the surveillance of antimicrobial resistance in hospital for rational use of antibiotics.

Background and purpose:Risk of invasive cervical carcinoma (ICC) and its precancerous lesions following high risk human papillomavirus (hrHPV) infection may vary according to HPV types and geographic regions. Analyzing HPV-type distribution in cervical samples from local women aged 30 years and older, this study aimed to identify HPV types with higher risk of developing CIN2+, and to compare diagnostic performance for CIN2+using these types and type combinations. Methods:Cervical samples with histology follow-up from patients of a tertiary cancer center in Shanghai were collected for HPV genotyping by PCR-RDB. The risk associations of HPV types with CIN2+were estimated by logistic regression analysis, and ROC curves were plotted for diagnostic performance evaluation. Results:A total number of 413 specimens were obtained, including 38 CIN1, 184 CIN2/3, 126 ICC patients and 65 negative control people. The 4 most common HPV types in CIN2+were HPV16, 58, 33 and 18, in descending order. And only HPV16 (P<0.000 1), 58 (P=0.002), 33 (P=0.015) were signiifcantly associated with CIN2+lesions. Besides, the area under the ROC curve of the HPV16/18/33/58 test scored statistically higher than the HPV16/18 test did (P=0.006 6). Conclusion:A combined test of HPV16/18/33/58 may offer better performance for detecting CIN2+lesions in our geographic region.

Objective To investigate and compare the features of the HIV-1-specific CTL responses among three HIV-infected groups with varied infection history. Methods Three HIV-infeeted groups were enrolled in this study, including two groups infected by blood transmission (one group has been infected for more than 10 years and the other for 1-2 years) and one group of the man who have sex with man. The HIV-1-specific CTL responses were quantified by an IFN-γ based ELISPot assay with a peptide matrix system containing overlapping peptides spanning the entire HIV-1 Clade B genomic consensus sequences. Results The responding rate of CTL responses against all 17 peptide pools among the group that infected 1-2 years,the group infected more than 10 years and the group of MSM were 40% ,65% ,23%. One way ANOVO analysis showed that the responding rate of CTL responses against all 17 peptide pools were statistical significant among the three groups (F=19.96, P＜0.01);the magnitude of CTL responses of the three groups were 0-5 835 SFCs/106 PBMC, 0-7 225 SFCs/106PBMC, 0-9 740SFCs/106pBMC, Kruskal-Wallis test showed that the magnitude of CTL responses were statistical significant among the three groups( H = 101.90 , P ＜0.01);the breadth of CTL were 7 ( 2-11 ), 11(9-14) and 4 (2-6) respectively and Kruskal- Wallis test showed that the breadth of CTL had no statistical significant among the three groups( H = 34. 75 ,P ＜0. 01 ). The sequence of responding rate, magnitude and breadth of CTL from high to low was the group that had been infected for more than 10 years, the group infected 1-2 years and the sex transmission group. The common characteristics of the CTL response among the three groups were that the responding rate and the magnitude of the peptide Nef and Gag was higher than other peptide's. The magnitude of CTL responses among three different CD4count groups (CD4 ＜ 200/μl, CD4 200-500/μl, CD4 ≥500/μl,) was 0-18 475 SFCs/106pBMC, 350-34 095 SFCs/106pBMC, 490-21 550 SFCs/106 PBMC and had no statistic difference among the three different CD4 groups(H=2.93, P=0.23) while the breadth of CTL was 3(0-8), 10(2-17), 10 (1-17)respoctively and the breadth of CTL was lower in the group of CD4 count less than 200/μl than the other two groups( H = 14. 72, P ＜ 0. 01 ). The magnitude of CTL responses among three different viral load (VL)groups (VL＜ LDL, LDL ＜ VL ＜ 1 × 104 copys/ml, VL≥1 ×104 copys/ml) was 490-18 475 SFCs/106pBMC, 0-24 115 SFCs/106pBMC, 770-34 095 SFCs/106 pBMC and had no statistic difference among the three different viral load groups ( H = 0.79, P=0.67) and the breadth of the three different viral load groups CTL was 8( 1-17), 11 (0-17), 8 (1-16) and Kruskal-Wallis test showed that there was no statistic difference among the three different viral load groups (H =5.27, P =0. 07). Conclusions All groups predominantly develope T cell immune responses against Nef and Gag proteins. With the elapse of HIV infection, the CTL responses are increased in both magnitude and responding rate. This information is important for vaccine development.

OBJECTIVETo study the long-term curative effects of suture plus proximal gastric vagotomy (PGV) and suture plus triad-therapy (omeprazole, amoxycillin and flagyl taken orally) for the treatment of duodenal ulcer with acute perforation.

METHODSThree hundred and twenty-nine patients with duodenal ulcer and acute perforation were treated with 2 different methods, respectively. Method A was suture plus PGV (group A, 153 cases), and method B was suture plus triad-therapy (group B, 176 cases). Follow-up was made by means of correspondence, outpatient reexamination and cooperation with local hospitals in 5 to 8 years after operation. The contents of follow-up included symptom acquisition (such as upper abdominal pain or distention, pyrosis, belch, acid regurgitation, vomiting, diarrhea and conditions of living or working), gastroscopy and Helicobacter pylori (HP) detection. The curative effects were evaluated by the Visick scale.

RESULTSThree hundred and one patients were followed up (group A 142 and group B 159). According to the Visick scale, 97 (68.3%), 19 (13.4%), 13 (9.15%) and 13 (9.15%) patients in group A, and 31 (19.5%), 28 (17.6%), 24 (15.1%) and 76 (47.8%) in group B were classified as Visick I, II, III and IV respectively (Z = -9.818, P < 0.01). As for HP detection, there were 130 (91.5%) patients in group A and 94 (59.1%) in group B (chi(2) = 41.438, P < 0.01).

CONCLUSIONSThe long-term curative effects of suture plus PGV were superior to those of suture plus triad-therapy for duodenal ulcer with acute perforation although HP positive rate was higher in group A than in group B. HP infection is one of the etiological factors of duodenal ulcer. The increased excitability of the vagus nerve remains to play an important role in duodenal ulcer.

Acute Disease ; Adolescent ; Adult ; Aged ; Amoxicillin ; administration & dosage ; Drug Therapy, Combination ; Duodenal Ulcer ; drug therapy ; etiology ; surgery ; Female ; Follow-Up Studies ; Humans ; Male ; Metronidazole ; administration & dosage ; Middle Aged ; Omeprazole ; administration & dosage ; Peptic Ulcer Perforation ; drug therapy ; surgery ; Suture Techniques ; Vagotomy, Proximal Gastric ; methods