Objective:Distribution and antibiotic resistance of pathogen isolated from children with intra-abdominal infection (IAI) associated sepsis in the intensive care unit (ICU) were analyzed to provide a reference for the empirical anti-infective treatment of IAI in children.Methods:We retrospectively analyzed the data of 116 children with culture-positive IAI-associated sepsis admitted to Children's Hospital of Zhejiang University School of Medicine from January 2019 to December 2021. Clinical isolation and drug resistance analysis were conducted based on different years of onset, locations of onset, and primary diseases.Results:A total of 186 strains of pathogens causing children with IAI-associated sepsis in ICU were collected. The distribution and antibiotic resistance of pathogen were as follows: the percentages of gram-positive bacteria, gram-negative bacteria, and fungi were 53.2%, 40.9%, and 5.9%, respectively; the top four strains were Enterococcus faecium, Escherichia coli, Klebsiella pneumoniae, and Enterococcus faecalis, accounting for 57.0% of all isolates; Enterococcus faecium(19.9%) and Enterococcus faecalis (10.2%) were the dominating gram-positive bacteria; Escherichia coli (13.4%) and Klebsiella pneumoniae (13.4%) were more common gram-negative bacteria; Fungi were dominated by Candida albicans (3.8%).Fifty-seven strains of gram-positive bacteria were detected in 61 children with infectious diseases, mainly Enterococcus faecium (28 strains). There were 53 gram-negative strains, mainly Klebsiella pneumoniae (21 strains). Thirty-two strains of gram-positive bacteria were detected in 40 children with digestive tract malformation, and Enterococcus faecalis (six strains) were the most common. There were 14 gram-negative strains, mainly Escherichia coli (six strains). In 13 children with malignant tumors of digestive system, nine strains of gram-positive bacteria were cultured, and Enterococcus faecium (four strains) was the most common. There were eight gram-negative strains, mainly Escherichia coli (four strains).In the 46 community-acquired IAI patients,30 gram-positive isolates were cultured,mainly including Enterococcus faecium (12 strains), Staphylococcus epidermidis (seven strains), and Viridans streptococci (six strains); Forty gram-negative isolates mainly contained Escherichia coli (16 strains), Klebsiella pneumoniae (14 strains), and Enterobacter cloacae (five strains). In the 70 hospital-associated IAI patients, 69 gram-positive isolates such as Enterococcus faecium (25 strains), Enterococcus faecalis (17 strains), Enterococcus gallinarum (eight strains), and Staphylococcus aureus (seven strains) were cultured;Tirty-six gram-negative isolates were dominated by Klebsiella pneumoniae (11 strains), Escherichia coli (nine strains), Pseudomonas aeruginosa (four strains), and Acinetobacter baumannii (four strains). The mixed infection rate of clinical pathogens was up to 46.6%, and the overall resistance rate was 43.4%, in which gram-negative bacteria had high sensitivity to piperacillin/tazobactam, cefoperazone/sulbactam, imipenem, and tigecycline.The detection rates of Klebsiella pneumoniae and Escherichia coli producing extended-spectrum β-lactamases were 36.0% and 24.6%, respectively, with 100% sensitivity to tigecycline. Gram-positive bacteria showed 100% sensitivity to vancomycin, linezolid, and tigecycline. Conclusion:Pathogen isolated from children with IAI-associated sepsis in ICU were dominated by Enterococcus faecium, Escherichia coli, Klebsiella pneumoniae, and Enterococcus faecalis,respectively. Before confirmation of pathogenic bacteria, antibacterial agents can be selected according to the infection type. It is important to note that a single broad-spectrum antibacterial agent or combination medication can be considered the initial empirical choice due to the large variety of pathogens, high rates of mixed infections, and high overall resistance.

Based on the traditional Chinese medicine （TCM）'s understanding of consumptive thirst disease and modern medicine's understanding of the etiology of diabetes mellitus and the evolution of the disease， this article discussed the rationality and clinical significance of using "sugar collateral disease" as the name of diabetes mellitus in TCM， to provide a reference for modernization and development of TCM diseases' names. It is argued that the clinical manifestations described in the TCM disease name of consumptive thirst disease are only at a certain stage of diabetes mellitus， and it is difficult to cover the clinical characteristics of modern diabetes mellitus comprehensively. In 2003， academician TONG Xiaolin proposed to use "sugar collateral disease" as the TCM disease name of diabetes mellitus， which on the one hand can reflect the essence of diabetes mellitus， and on the other hand can embody the disease location， disease mechanism and the evolution of the disease， highlight the harms of complications， and serve as a warning for the early diagnosis and treatment of the disease， which can help to enhance the level of diagnosis and treatment of diabetes mellitus in TCM.

It is the current confusion encountered by integrated Chinese and Western medicine that how to find the breakthrough direction of integrating Chinese and Western medicine， from crossover to integration to innovation， and open up a new horizon of integrated Chinese and Western medicine. The progress of Chinese medicine lay in expanding the scope of diagnosis and treatment with the help of modern diagnostic and therapeutic equipments and developing “micro” identification， while the progress of Western medicine lay in looking at “macro” and developing systemic medicine and integrated medicine， both of which are in the direction of each other. The “state-target identification and treatment” may become an important way to build a modern diagnosis and treatment system of integrated Chinese and Western medicine， and the thinking mode of “from target to state” is a further refinement and development on the basis of the theoretical system of “state-target identification and treatment”， which provided a clearer solution for the current stage of the integrated Chinese and Western medicine model， and pointed out the important development direction for the future integrated Chinese and Western medicine. From the perspective of strategic level and diagnosis and treatment practice， it integrated the “target-state” thinking mode into the modern diagnosis and treatment model of the integrated Chinese and Western medicine， i.e.， “Western medicine as the basis and treating with Chinese medicine； Chinese medicine as the basis and treating with Western medicine”. On the one hand， Western medicine should strengthen the reference to the traditional theories and holism of Chinese medicine， and advocate a higher level of education on the integrated Chinese and Western medicine under the guidance of the traditional theories of Chinese medicine. On the other hand， the “from target to state” mode of thinking should be applied to guide the establishment of diagnostic and treatment strategies and clinical selection of medicines in clinical practice， so as to locate the target and adjust the body state in a gradual and orderly manner， and to provide practical methods for the modern clinical work of the integrated Chinese and Western medicines. Chinese and Western medicine systems can learn from each other， combine organically， give full play to their respective strengths， and form an internal law， so as to make breakthroughs and innovations in the integrated Chinese and Western medicine model.

Objective:To investigate the clinical characteristics, influencing factors and prevention and treatment measures of nosocomial infection in patients with acute myeloid leukemia (AML) (non-acute promyelocytic leukemia) after applying intermediate-high dose cytarabine (Ara-C) chemotherapy.Methods:The clinical data of 80 patients with AML treated with intermediate-high dose Ara-C in the Second Hospital of Shanxi Medical University from March 2013 to January 2020 were analyzed retrospectively. The clinical features of nosocomial infection were summarized and the influencing factors of infection were analyzed by using multivariate logistic regression.Results:A total of 80 patients received 198 times of chemotherapy, and the infection rate was 72.7% (144/198). Infection sites mainly included respiratory tract infection, pulmonary infection, gastrointestinal infection. A total of 45 strains of pathogenic bacterias were detected, among which Gram negative bacilli accounted for 55.6% (25/45), Gram positive cocci accounted for 24.4% (11/45), fungi accounted for 8.9% (4/45) and viruses accounted for 11.1% (5/45). There were no significant differences in infection rate, hospitalization time, neutrophils recovery time and hospitalization expenses between the sterile laminar flow ward and the general ward (all P > 0.05). Multivariate logistic regression analysis showed that infection during induction chemotherapy was independent risk factor of infection ( OR = 5.076, 95% CI 1.978-13.022, P =0.001), and antibiotic prevention was independent protective factor of nosocomial infection ( OR = 0.332, 95% CI 0.136-0.803, P = 0.014). Conclusions:The infection rate of AML patients receiving intermediate-high dose Ara-C chemotherapy is high. During the treatment, we should be alert to the infection during induction chemotherapy and use antibiotics to prevent it in time. For patients undergoing intermediate-high dose Ara-C chemotherapy, strengthening the environmental cleanliness of general wards may achieve the same preventive effect as that of sterile laminar flow wards.

OBJECTIVE: To perform prenatal diagnosis, pedigree analysis, and genetic counseling of a pregnant woman who gave birth to a child with Kleefstra syndrome. METHODS: Karyotype analysis, chromosomal microarray analysis (CMA), multiplex ligation-dependent probe amplification (MLPA) and fluorescence in situ hybridization (FISH) were used of peripheral blood and amniotic fluid to find causes. Recurrence risk assessment was performed later. RESULTS: The amniotic fluid sample showed a 9q34.3 microduplication of arr (hg19) 9q34.3 (140 168 806-141 020 389)× 3, which overlapped the 9q34.3 microdeletion region of proband. The pregnant woman was detected with a balanced translocation of ish, t(9;17)(9q34.3; qter) (9p+; 17p+,9q+, 17q+). No other abnormal results were found in the family. CONCLUSION Offspring who share the same chromosome segment deletion or duplication are always from parent who carries balanced chromosomal structural aberration.
Chromosome Aberrations ; Chromosome Deletion ; Chromosomes, Human, Pair 9/genetics* ; Female ; Genetic Testing ; Humans ; In Situ Hybridization, Fluorescence ; Pregnancy

Objective To investigate the correlation between red blood cell distribution width (RDW) and urinary protein /cre-atinine ratio(TPCR) in elderly patients with essential hypertension .Methods TPCR ,Cr ,CysC ,eGFR ,TG ,TC ,LDL-C ,ApoA1 , ApoB and blood routine were detected in 801 elderly patients with essential hypertension and 98 healthy people .The differences of these indexes were compared between the two groups and the difference of RDW was compared among different grades of hyperten-sion .The hypertension patients were divided into two groups by TPCR<200 mg/g Cr or ≥200 mg/gCr ,the levels of RDW were compared between the two groups and the correlation between TPCR with RDW was analyzed .Results The age ,gender ,Cr and HB had no statistical differences between the hypertension group and control group (P>0 .05);TPCR ,TG ,TC ,LDL-C ,ApoB and RDW levels in the hypertension group were increased ,the ApoA1 ,CysC and eGFR levels were decreased ,the differences were sta-tistically significant (P<0 .05);the RDW level in the hypertension group was significantly higher than that in the control group ,the difference was statistically significant(P<0 .05);the RDW level was increased with the increase of blood pressure level ,the differ-ence was statistically significant(P<0 .05);the Pearson correlation analysis showed that RDW was positively correlated with TPCR (P<0 .05) .Conclusion The RDW level is elevated in the essential hypertension group ,and correlated with the level of TPCR .

Objective Henoch-Sch?nlein purpura(HSP)is a common multisystemic vasculitis in children ,but the exact pathogenesis remains unknown. Pentraxin 3(PTX3),a new kind of inflammatory cytokines,has a strong inflammatory effect,and is involved in occurrence and develop-ment of a variety of autoimmune diseases. The objective of this study is to evaluate the expression of PTX3,interleukin-8(IL-8),tumor necrosis fac-tor-α(TNF-α)and high sensitivity C-reactive protein(hs-CRP)in children with HSP,and explore the clinical significance of PTX3 in HSP devel-opment. Methods Thirty-six children(HSP group)and 17 healthy children(control group)were enrolled in the study. Serum levels of PTX3,IL-8 and TNF-α were detected by enzyme-linked immunosorbent assay. Serum hs-CRP levels were measured by automatic biochemical analyzer. Re-sults The serum levels of PTX3,IL-8,TNF-α,and hs-CRP were up-regulated in HSP group compared with the control group(P<0.05). The levels of PTX3,IL-8,TNF-α,and hs-CRP in patients with joint symptoms,or/and gastrointestinal symptoms,or/and kidney injury were significant-ly higher than those patients without joint symptoms,or/and gastrointestinal symptoms,or/and kidney injury(P<0.05). The expression of PTX3 was positively correlated with the expression of IL-8 and TNF-α(r=0.514,0.833,all P<0.05),but there was no correlation between PTX3 and hs-CRP(r=0.292,P>0.05). The expression of PTX3,IL-8,TNF-α and hs-CRP in HSP patients had no gender difference(all P>0.05). Con-clusion The high expression of PTX3 is related to the degree of inflammation in children with HSP. The up-regulated expression of PTX3 may play an important role in pathogenesis of HSP in children.

Objective To evaluate the value of immunophenotype in diagnosis of myelodysplastic syndrome (MDS).Methods The immunophenotype of bone marrow cells in 27 patients with MDS were detected by monoclonal antibody by flow cytometry.Results As the progression of the disease,CD34 positive cells gradually increased:refractory anemia/ring sideroblasts refractory anemia (RA/ AS) 7.43 %,refractory anemia with excess of blasts (RAEB) 36.81%,refractory anemia with excess of blasts transformed (RAEB-T)56.45 %,and the differences were statistically significant (P ＜0.05); the expressions of CD33+,CD13 and HLA-DR increased gradually,the expressions of CD14 and CD15 antigens gradually decreased,the difference of three groups was statistically significant (P ＜0.05),the differences between RA/RAS and RAEB-T,RAEB and RAEB-T were statistically significant (P ＜0.05); the expression of CD19 and CD10 decreased and the expression of CD7 increased (RA/RAS 2.63 %,RAEB 10.79 % and RAEB-T 11.00 %) with the progression of the disease,the difference of three groups was statistically significant (F =10.439,P ＜0.05),the differences between RA/RAS and RAEB,RA/RAS and RAEB-T were statistically significant (P ＜0.05).Conclusion The detection of immunophenotype of bone marrow cella in patients with MDS contributes to the diagnosis,classification and prognosis of MDS.

Objective To study the reconstitution of nature kill cell early after non-myeloablative allogeneic stem cell transplantation (NAST). Methods Cell phenotypes and in vitro immune functions were analyzed by direct immune fluorescence with FCM, T-cell activation test and MTT assay, respectively. Results The percentages of CD+3, CD+4 cells were low, (2.03±15.60) % and (22.69±12.29)%, respectively, while CD+8 lymphocytes were normal or high [(29.26±8.99)%] 1 month after NAST. Proliferative response to a T lymphocyte activator (PHA) was blunted, 94.60±44.87. The percentage of NK cells was within normal limits or high (n=7) in allotransplanted patients. It is (18.77±9.11) %. The percentage of CD+56 NK cells expressing IL-2R (CD25) was high and values obtained from transplanted patients were significantly different from control values . They are (3.71±2.23) % (t = 2.116, P = 0.044). NK cell activity in part of patients was higher than that observed in control cells (25.30±12.39) % vs (16.60±3.53) % (t = 2.135, P= 0.047). Conclusion NK cell has recovered early after transplantation and may be particularly relevant as a first line of defence in immunosurveillance against neoplastic cells or microbial infections, until a full reconstitution of T cellmediated immune response can be achieved.

Objective To explore the effect of costimulatory moleculars expressed peripheral CD4+ T lymphocyts on graft-versus-host disease(GVHD) after allogeneic hematopoietic stem cell transplantation (alloHSCT). Methods 21 patients who suffered of hematology diseases or malignant solid tumors were underwent allo-HSCT and 10 normal individuals were enrolled in the study. The levels of CD28, CD80 and CD152expressions on peripheral CD4+ T lymphocytes were detected by FCM in different time(before allo-HSCT, 7 day,14 day, 21 day, 30 day after allo-HSCT, thetime of GVHD and the time after GVHD treated). STR-PCR was used to detect micro-satellites chimeras forming. Results All 21 patients achieved engraftment. By STR-PCR assay, 12 cases formed complete chimeras (CC) and 9 cases formed mixed chimeras (MC). A multivariate COX survival function modle analysis showed: CD4 CD152 was independent prognostic factors for GVHD (x2=13.128,P ＜0.0001). Patients with GVHD demonstrated higher CD4+ CD28+, CD4+ CD80+ and CD4+ CD152+ T cell levels than those without GVHD (P ＜0.01); patients with aGVHD demonstrated higher than those with cGVHD (P ＜0.05)and without GVHD (P ＜0.05); Patients with GVHD demonstrated lower CD4+ CD152+ T cell level than those without GVHD (P ＜0.01); the same result occured between aGVHD and cGVHD and without GVHD.Conclusion The incidence of GVHD between NST and traditional HSCT have no difference. B7-CD28/CD152 costimulatory pathway plays a critical role in the development of GVHD.