Objective To analyze the dynamic changes in serum adiponectin (APN) levels after acute myocardial infarction (AMI) and its relationship with heart failure (HF) and major adverse cardiovascular events (MACE). Methods A total of 124 AMI patients who underwent percutaneous coronary intervention (PCI) in our hospital from January 2021 to December 2023 were enrolled as AMI group. Additionally, 30 patients with non-AMI coronary artery disease and 30 healthy individuals were included in non-AMI coronary artery disease group and healthy group, respectively. General information such as age, gender, smoking, alcohol consumption, hypertension, diabetes, and blood lipids were recorded for all subjects. Serum APN levels were measured using the enzyme-linked immunosorbent assay (ELISA) method; plasma brain natriuretic peptide (BNP) levels were determined by immunofluorescence; and left ventricular ejection fraction (LVEF) was assessed using echocardiography. Changes in serum APN levels and its relationship with BNP, LVEF, and MACE were recorded during a one-year follow-up period. Results AMI patients had lower serum APN levels than those in the non-AMI coronary artery disease group and the healthy group, while levels of total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C); Lipoprotein-associated phospholipase A2 (Lp-PLA2), and the proportions of smokers and diabetics were higher(P < 0.05). A one-year follow-up of AMI patients revealed an upward trend in serum APN and BNP levels and a downward trend in LVEF levels at one week, one month, three months, six months, and one year postoperatively (P < 0.05). APN and BNP levels peaked one month after PCI, while LVEF reached its lowest level at the same time point. However, there were no statistically significant changes in these indicators in the subsequent 11 months (P>0.05). The incidence of MACE in AMI patients at one, three, six, and twelve months postoperatively was 2.8%, 3.2%, 4.6%, and 8.8%, respectively. Both preoperative and one-month postoperative serum APN levels had high predictive value for the occurrence of HF and MACE within one year in AMI patients, and the area under the curve for predicting HF and MACE one month postoperatively was larger than that preoperatively (P < 0.05). Conclusion Serum APN levels in AMI patients show an upward trend after PCI, peaking one month postoperatively. At this time point, serum APN levels have the highest predictive value for the occurrence of HF and MACE.

Objective:To analyze the molecular epidemiology, drug resistance and virulence of Haemophilus influenzae in children with ocular infection. Methods:Haemophilus influenzae isolates were obtained from ocular specimens of children. Antimicrobial susceptibility testing was conducted using the disk diffusion method and E-test. Whole-genome sequencing was performed to determine serotype, multilocus sequence typing, drug resistance genes, and virulence factors. Results:All 13 Haemophilus influenzae strains isolated from ocular infection specimens in children were identified as non-typeable Haemophilus influenzae. A total of 11 sequence types were identified through multilocus sequence typing, with ST2838 representing a novel sequence type. Haemophilus influenzae were 100.0% (13/13) sensitive to ceftriaxone, meropenem, and levofloxacin. The resistance rates to ampicillin, cefuroxime, ampicillin/sulbactam, amoxicillin/clavulanic acid, chloramphenicol, and trimethoprim-sulfamethoxazole were 84.6% (11/13), 46.2% (6/13), 38.5% (5/13), 15.4% (2/13), 15.4% (2/13), and 46.2% (6/13). The non-susceptible rate to azithromycin was found to be 46.2% (6/13). Whole-genome sequencing revealed the presence of resistance genes blaTEM-1B (84.6%, 11/13), tet( B) (15.4%, 2/13), catA2 (15.4%, 2/13), msr(D) (30.8%, 4/13), mef( A) (46.2%, 6/13). Additionally, 71 virulence genes were detected across the 13 strains, comprising 7 genes associated with adherence, 12 genes related to nutritional and metabolic functions, and 52 genes involved in immune modulation. Conclusions:Haemophilus influenzae in pediatric patients with ocular infections exhibits a high rate of resistance to ampicillin, predominantly mediated by the blaTEM-1B. Clinical laboratories should pay attention to the detection of Haemophilus influenzae in ocular specimens and maintain ongoing surveillance of antimicrobial resistance patterns and virulence factors.

Objective:To analyze the molecular epidemiology, drug resistance and virulence of Haemophilus influenzae in children with ocular infection. Methods:Haemophilus influenzae isolates were obtained from ocular specimens of children. Antimicrobial susceptibility testing was conducted using the disk diffusion method and E-test. Whole-genome sequencing was performed to determine serotype, multilocus sequence typing, drug resistance genes, and virulence factors. Results:All 13 Haemophilus influenzae strains isolated from ocular infection specimens in children were identified as non-typeable Haemophilus influenzae. A total of 11 sequence types were identified through multilocus sequence typing, with ST2838 representing a novel sequence type. Haemophilus influenzae were 100.0% (13/13) sensitive to ceftriaxone, meropenem, and levofloxacin. The resistance rates to ampicillin, cefuroxime, ampicillin/sulbactam, amoxicillin/clavulanic acid, chloramphenicol, and trimethoprim-sulfamethoxazole were 84.6% (11/13), 46.2% (6/13), 38.5% (5/13), 15.4% (2/13), 15.4% (2/13), and 46.2% (6/13). The non-susceptible rate to azithromycin was found to be 46.2% (6/13). Whole-genome sequencing revealed the presence of resistance genes blaTEM-1B (84.6%, 11/13), tet( B) (15.4%, 2/13), catA2 (15.4%, 2/13), msr(D) (30.8%, 4/13), mef( A) (46.2%, 6/13). Additionally, 71 virulence genes were detected across the 13 strains, comprising 7 genes associated with adherence, 12 genes related to nutritional and metabolic functions, and 52 genes involved in immune modulation. Conclusions:Haemophilus influenzae in pediatric patients with ocular infections exhibits a high rate of resistance to ampicillin, predominantly mediated by the blaTEM-1B. Clinical laboratories should pay attention to the detection of Haemophilus influenzae in ocular specimens and maintain ongoing surveillance of antimicrobial resistance patterns and virulence factors.

Objective:To screen and analyze the hub genes/gene panel for pediatric sepsis by bioinformatics methods.Methods:The pediatric sepsis chip datasets GSE66099 uploaded on Feb 19, 2015 and GSE145227 uploaded on Feb 13, 2020 were obtained from the gene expression omnibus (GEO) database and used to screen out the differentially expressed mRNA (DEmRNA) by the limma package. The Gene ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) enrichment analyses were applied and performed for the functional and pathway enrichment analysis subsequently. The online database STRING and Cytoscape software were used to construct a protein interaction network (PPI) for DEmRNA and screen the hub gene. R package was used to analyze the expression and diagnostic significance of hub genes.Results:In this study, 160 total DEmRNA including 126 up-regulated mRNA and 34 down-regulated mRNA were obtained. By GO functional enrichment analysis, the results showed that DEmRNA were mainly enriched and focused on these areas: neutrophil activation, neutrophil degranulation, T cell activation and regulation of lymphocyte activation. KEGG enrichment pathway analysis showed that DEmRNA was mainly involved in signaling pathways including natural killer cell-mediated cytotoxicity and neutrophil extracellular trap formation. Ten DEGs (ARG1, RETN, MMP9, C3AR1, LCN2, FPR2, CCL5, CEACAM8, ELANE and DEFA4) as hub genes were screened by STRING and Cytoscape. A gene panel with 10 members had significant differences and the area under the ROC curve of each hub gene was greater than 0.7.Conclusion:By bioinformatics analysis, we find 10 genes that play an important role in the progression of pediatric sepsis, and provide a new theoretical basis for the diagnosis, prognostic markers and potential therapeutic targets of pediatric sepsis.

Objective To analyze the efficacy of drug-coated balloon in the treatment of hetero-geneous in-stent restenosis.Methods A total of 118 patients who received treatment and diagnosed with heterogeneous in-stent restenosis were selected as study objects,and were divided into two groups using a random table method.The experimental group(n=59)received drug-coated balloon thera-py,and the control group(n=59)received drug-eluting stent therapy.The therapeutic effects of the two different treatment methods on heterogeneous in-stent restenosis were compared.Results There was no significant difference in the incidence of in-stent restenosis in the right coronary artery,cir-cumflex artery,and anterior descending artery between the two groups(P＞0.05).There was no sig-nificant difference between the two groups in the preoperative reference vessel diameter,lesion length,lumen stenosis degree,and localized restenosis(P＞0.05).The postoperative residual ste-nosis rate in the experimental group was significantly higher than that in the control group(P＜0.05).There was no significant difference between the two groups in the preoperative lumen area,neointimal load,stent inner area,neointimal area,incidence of neoatherosclerosis and thrombus(P＞0.05).Operative lumen area of the experimental group was smaller than that of the control group(P＜0.05).No target vessel reconstruction,stent thrombosis,nonfatal myocardial infarction,or cardiac death occurred in two groups during 12 months of follow-up.Conclusion Drug-coated balloons are effective and safe in the treatment of heterogeneous in-stent restenosis,and can obtain similar effects to drug-eluting stents.

Objective To analyze the efficacy of drug-coated balloon in the treatment of hetero-geneous in-stent restenosis.Methods A total of 118 patients who received treatment and diagnosed with heterogeneous in-stent restenosis were selected as study objects,and were divided into two groups using a random table method.The experimental group(n=59)received drug-coated balloon thera-py,and the control group(n=59)received drug-eluting stent therapy.The therapeutic effects of the two different treatment methods on heterogeneous in-stent restenosis were compared.Results There was no significant difference in the incidence of in-stent restenosis in the right coronary artery,cir-cumflex artery,and anterior descending artery between the two groups(P＞0.05).There was no sig-nificant difference between the two groups in the preoperative reference vessel diameter,lesion length,lumen stenosis degree,and localized restenosis(P＞0.05).The postoperative residual ste-nosis rate in the experimental group was significantly higher than that in the control group(P＜0.05).There was no significant difference between the two groups in the preoperative lumen area,neointimal load,stent inner area,neointimal area,incidence of neoatherosclerosis and thrombus(P＞0.05).Operative lumen area of the experimental group was smaller than that of the control group(P＜0.05).No target vessel reconstruction,stent thrombosis,nonfatal myocardial infarction,or cardiac death occurred in two groups during 12 months of follow-up.Conclusion Drug-coated balloons are effective and safe in the treatment of heterogeneous in-stent restenosis,and can obtain similar effects to drug-eluting stents.

Objective To investigate the correlations between lipoprotein associated phospholipase A2(Lp-PLA2),platelet aggregation rate(PAG),the ratio of mean platelet volume to platelet count(MPV/PLT)and major adverse cardiovascular events(MACE)in elderly patients with coronary heart disease(CHD).Methods The clinical data of 162 elderly patients with CHD admitted to Jianhu Hospital affiliated to Nantong University from August 2020 to September 2021 were collected retrospectively.All the patients were treated with aspirin orally and followed up for 1 year.The development of MACE within 1 year was recorded.MACE occurred in 30 patients(development group)and the other 132 patients without MACE were assigned to non-development group.Serum Lp-PLA2,PAG,and MPV/PLT were compared between the 2 groups at admission.Logistic regression was used to analyze the relationship between these parameters and MACE in elderly CHD patients.Receiver operating character(ROC)curve was used to evaluate the value of serum Lp-PLA2,PAG,MPV/PLT alone and jointly at admission in predicting MACE within 1 year.Results The proportions of patients with age≥75 years and hypertension in the development group were significantly higher than those in the non-development group(P<0.05).Serum Lp-PLA2,PAG,MPV/PLT in the development group were also significantly higher than those in the non-development group(P<0.05).Binary logistic regression analysis showed that hypertension,Lp-PLA2,PAG,and MPV/PLT were influence factors of MACE in elderly CHD patients(P<0.05).ROC curve results showed that the area under curve(AUC)values of Lp-PLA2,PAG,MPV/PLT alone or jointly were 0.832,0.817,0.841 and 0.939 in predicting MACE in elderly CHD patients.Conclusion Overexpression of Lp-PLA2,PAG and MPV/PLT are closely related to the development of MACE in elderly CHD patients.During hospitalization,the risk of MACE can be assessed by detecting Lp-PLA2,PAG,and MPV/PLT,and timely clinical intervention can be carried out.

Objective:To analyze the anti-drug resistance, molecular epidemiology and virulence gene distribution of non-A-F group serotype isolates of Salmonella enterica enteric subspecis, so as to provide epidemiological basis for clinical diagnosis and treatment.Methods:Serotyping, antimicrobial susceptibility test and whole genome sequencing were performed on 11 isolates of non-A-F group serotype isolates of Salmonella enterica enteric subspecies that were isolated from The Children′s Hospital, Zhejiang University School of Medicine between 2017 and 2020. The serotype, multilocus sequence typing and virulence gene of the whole genome sequencing results were analyzed. Results:In our hospital, the detection rate of non-A-F group serotype isolates of Salmonella enterica enteric subspecies was low (1.13%). Among the 11 strains, there were 3 strains belong to Jangwani serotype, 2 strains of Hvittingfoss serotype, and Wandsworth, Pomona, Kedougou, Urbana, Poona and Kumasi serotypes have 1 strain each. Except for the two multi-drug resistant strains, the other strains were sensitive to most antibiotics, and the MICs were at low levels. A total of 9 ST types were detected in the 11 strains, the 3 Jangwani serotype strains were ST3918, and the other isolates were of different ST types. The phylogenetic tree shown that the three strains of Jangwani serotype were closely related. A total of 103 virulence genes were detected in the 11 strains, including 78 genes related to secretion system, 21 genes related to adherence, 2 genes related to magnesium uptake, 1 gene related to resistance to antimicrobial peptides and 1 gene related to typhoid toxin. Conclusions:The detection rate of the non-A-F group serotype isolates of Salmonella enterica enteric subspecies was low, and the sensitivity of the isolates to common antibiotics was high. The ST types and genetic relationship showed diversity. Clinical laboratory should pay attention to the detection of the non-A-F group serotype isolates of Salmonella enterica enteric subspecies, and the changes in drug resistance and virulence genes of the isolates should be closely monitored.

Objective:To investigate the role of type Ⅵ secretion system (T6SS) in the pathogenicity and antibiotic resistance of Acinetobacter baumanii. Methods:From January 1 to December 31, 2016, a total of 45 Acinetobacter baumanii isolates were collected from patients with bloodstream infection in the First Affiliated Hospital of Wenzhou Medical University. The susceptibilities to commonly used antimicrobial agents were determined by VITEK 2 Compact automatic microbiology analyzer. Detection of T6SS characteristic gene hemolysin coregulated protein ( hcp) was achieved by polymerase chain reaction. Biofilm formations, serum resistances and competition tests of T6SS-positive/negative Acinetobacter baumanii were performed in vitro. The clinical data of patients with bloodstream infection were collected and analyzed. Chi-square test, t test and Kruskal-Wallis test were conducted for statistical analysis. Results:The positive rate of T6SS in 45 Acinetobacter baumanii isolates was 53.3% (24/45). The resistance rates of T6SS-positive Acinetobacter baumanii to ceftazidime, ciprofloxdcin, gentamicin, imipenem, levofloxacin, piperacillin/tazobactam, tobramycin and cefepime (95.8%, 95.8%, 66.7%, 95.8%, 79.2%, 95.8%, 79.2%, 91.7%)were all higher than that of T6SS-negative Acinetobacter baumanii (28.6%, 28.6%, 28.6%, 28.6%, 9.5%, 23.8%, 23.8%, 28.6%), and the differences were all statistically significant ( χ2=22.12, 22.12, 6.51, 22.12, 21.83, 24.72, 13.79, 18.97, respectively, all P<0.05). The biofilm formation ability, serum resistance and competitive ability of T6SS-positive Acinetobacter baumanii were stronger than those of T6SS-negative Acinetobacter baumanii, and the differences were all statistically significant ( t=4.99, Z=-2.61 and -2.27, respectively, all P<0.05). The positive rate of T6SS isolated from intensive care unit (ICU) ward (80.0%, 16/20) was significantly higher than that from non-ICU ward (32.0%, 8/25; χ2=10.29, P<0.05). But T6SS had no effect on the prognosis of patients ( χ2=1.74, P=0.188). Conclusions:T6SS of Acinetobacter baumanii is associated with high pathogenicity, and the high drug resistance rate makes treatment extremely difficult. Physicians need to pay much attention, especially to the patients from ICU wards.

Objective: To investigate the distribution and expression of T3SS virulence genes in clinically isolated Pseudomonas aeruginosa (P. aeruginosa) strains and its correlation with drug resistance. Methods: A total of 68 P. aeruginosa isolates were collected from the First Affiliated Hospital of Wenzhou Medical University in 2015. The antimicrobial susceptibility was detected by the agar dilution method. The distribution of virulence genes such as exoU, exoS, exoT and exoY from different isolates was detected by PCR. The expression levels of transcriptional regulator genes (ptrA and exsA) and effector-related genes (exoT and exoS) in some isolates were determined by real-time fluorescence quantitative PCR, and the Pearson correlation analysis was used to analyze the results. Results: The detection rates of exoT and exoY in 68 P. aeruginosa isolates were higher, accounting for 79.4% and 75.0%, respectively. The detection rate of exoT in wound-sourced isolates was significantly higher than that in sputum (97.0% vs 61.8%, P＜0.01). In addition, the genotype of exoU - /exoS + was the most common, accounting for 51.5% (35/68). The resistance rates of sputum-sourced isolates to imipenem and meropenem were significantly higher than that of wound-sourced isolates (47.1% vs 8.8%, 47.1% vs 14.7%, P＜0.01). The resistance rates of isolates carrying exoU gene to carbapenems, aminoglycosides and fluoroquinolones were higher than those of isolates carrying exoS, exoT or exoY genes. Pearson correlation analysis showed that the expression level of ptrA gene was negatively correlated with those of exoT, exoS and exsA genes (P＜0.05). Conclusion The P. aeruginosa isolates from our hospital carrying T3SS virulence genes exoT and exoY are common, and the virulence genes are related to the drug resistance of P. aeruginosa. In addition, ptrA may be a potential negative regulatory gene for the expression of T3SS virulence genes.