Objective:To investigate the spectrum and antimicrobial resistance of major pathogens causing nosocomial infections in China during 2020-2021.Methods:A total of 1 311 non-duplicated nosocomial pathogens causing bloodstream infections (BSI, n=670), hospital-acquired pneumonia (HAP, n=394) and intra-abdominal infections (IAI, n=297) were collected from 10 teaching hospitals across China. The minimum inhibitory concentrations (MICs) of clinical common strains were determined using agar dilution or broth microdilution method. Interpretation of reults followed the CLSI M100-Ed33 criteria, with data analysis conducted using WHONET-5.6 software. The Chi-square test was used to compare rates. Results:The most prevalent pathogens causing BSI were Escherichia coli (21.2%, 142/670), Klebsiella pneumoniae (14.9%, 100/670) and Staphylococcus aureus (11.5%, 77/670); the most prevalent pathogens causing HAP were K. pneumoniae (27.7%, 109/394), Acinetobacter baumanii (22.1%, 87/394) and Pseudomonas aeruginosa (18.3%, 72/394). IN IAI, E. coli (24.3%, 60/247), Enterococcus faecium and K. pneumoniae (both 14.6%, 36/247) were dominated. All S. aureus strains were susceptible to tigecycline, linezolid, daptomycin and glycopeptides. Rates of methicillin-resistant S. aureus (MRSA) and coagulase-negative Staphylococcus (MRCNS) were 36.5% (42/115) and 74.5% (38/51), respectively. The rate of vancomycin-resistant E. faecium and E. faecalis was 3.3% (3/90) and 1.9% (1/53), respectively. The prevalence of extended-spectrum β-lactamase (ESBL) was 23.7% (58/245) in K. pneumonia and 60.5% (130/215) in E. coli.The rate of carbapenem-resistant K. pneumonia and E. coli was 29.8% (73/245) and 4.2% (9/215), respectively; the percentage of tigecycline-resistant K. pneumonia and E. coli was 1.6% (4/245) and 0, respectively; the rate of colistin-resistant K. pneumonia and E. coli was 1.6% (4/245) and 2.8% (6/215), respectively; the percentage of ceftazidime/avibactam-resistant K. pneumonia and E. coli was 2.0% (5/245) and 2.3% (5/215), respectively. The rate of carbapenem-resistant A. baumanii and P. aeruginosa was 76.7% (125/163) and 28.4% (33/116), respectively. A. baumanii showed low susceptibility to most antimicrobial agents except colistin (98.8%, 161/163) and tigecycline (89.6%, 146/163). Colistin, amikacin and ceftazidime/avibactam demonstrated high antibacterial activity against P. aeruginosa with susceptility rates of 99.1% (115/116), 94.0% (109/116) and 83.6% (97/116), respectively. Conclusions:The major pathogens of nosocomial infections were K. pneumonia, E. coli, A. baumanii, P. aeruginosa and S. aureus. Nosocomial Gram-negative pathogens exhibited high susceptibilities to tigecycline, colistin and ceftazidime/avibactam. Antimicrobial resistance in A. baumannii remains a significant challenge. The increasing prevalence of carbapenem-resistant Enterobacterales underscores the urgency of antibiotics rational applications and hospital infection controls.

Paroxysmal sympathetic hyperactivity (PSH) is a syndrome characterized by paroxysmal tachycardia, increased blood pressure, tachypnea, hyperthermia, profuse sweating, abnormal posture or dystonia. It occurs in diseases such as moderate to severe brain injury, cerebral hypoxia, hydrocephalus, brain tumor and encephalitis. At present, the etiology and pathogenesis are still unclear, and it is easy to be misdiagnosed as epilepsy clinically. This article reports a 43-year-old male patient with late-onset mitochondrial encephalomyopathy, lactic acidosis and stroke-like episodes (MELAS) confirmed by genetic testing. During hospitalization, he suddenly developed episodic involuntary limb movements, profuse sweating, tachycardia, and arterial hypertension. He was initially diagnosed with symptomatic epilepsy, but long-term electroencephalogram monitoring showed no synchronized discharge, and he was given antiepileptic drugs. The treatment was also ineffective. Brain magnetic resonance imaging revealed a new lesion in the left insular and insular operculum. Dexmedetomidine, baclofen, and gabapentin were given to suppress sympathetic nerve excitability. Drugs were effective, so the diagnosis was corrected to PSH. There is no report of MELAS complicated with PSH in the previous literature. It is speculated that it may be related to the low clinical cognition of PSH. In this case, new lesions in the insula and insular operculum appeared during the onset of PSH, suggesting that may be related to the pathogenesis of PSH.

The immune checkpoint blockade therapy has profoundly revolutionized the field of cancer immunotherapy. However, despite great promise for a variety of cancers, the efficacy of immune checkpoint inhibitors is still low in colorectal cancer (CRC). This is mainly due to the immunosuppressive feature of the tumor microenvironment (TME). Emerging evidence reveals that certain chemotherapeutic drugs induce immunogenic cell death (ICD), demonstrating great potential for remodeling the immunosuppressive TME. In this study, the potential of ginsenoside Rg3 (Rg3) as an ICD inducer against CRC cells was confirmed using in vitro and in vivo experimental approaches. The ICD efficacy of Rg3 could be significantly enhanced by quercetin (QTN) that elicited reactive oxygen species (ROS). To ameliorate in vivo delivery barriers associated with chemotherapeutic drugs, a folate (FA)-targeted polyethylene glycol (PEG)-modified amphiphilic cyclodextrin nanoparticle (NP) was developed for co-encapsulation of Rg3 and QTN. The resultant nanoformulation (CD-PEG-FA.Rg3.QTN) significantly prolonged blood circulation and enhanced tumor targeting in an orthotopic CRC mouse model, resulting in the conversion of immunosuppressive TME. Furthermore, the CD-PEG-FA.Rg3.QTN achieved significantly longer survival of animals in combination with Anti-PD-L1. The study provides a promising strategy for the treatment of CRC.

Objective: To analyze the CT manifestations of the 2019 novel coronavirus pneumonia (NCP) combined with severe acute respiratory syndrome (SARS) and Middle East respiratory syndrome (MERS) literature review, and to summarize the characteristics of CT imaging, so as to improve the ability of rapid and accurate diagnosis. Methods: CT manifestations of two confirmed cases of NCP were reported, meanwhile the literatures on SARS and MERS imaging performance were reviewed and summarized. Results: The two cases of NCP were both in acute stage, the CT imaging showed multiple and scattered ground-glass opacity (GGO) in both lungs, which is similar to the CT performance of SARS and MERS in acute stage. Conclusions The CT features of 2019 novel coronavirus pneumonia are similar to SARS and MERS. It has certain characteristics and changes rapidly with the course of the disease. In the acute stage, GGO and paving stone sign were the main manifestations. In the acute phase, GGO and crazy paving are the main manifestations. In the progress stage, the interlobular septal thickening and consolidation appeared. During the absorption period, the lesions disappeared or fibrosis was left behind, with lung structure distortion and bronchiectasis. Lymphadenopathy and hydrothorax were rare.

Objective:To investigate the specific chest computed tomography(CT) features of corona virus disease 2019 (COVID-19) and to evaluate its clinical diagnostic value.Methods:The clinical data of 35 cases with suspected COVID-19 from Shanghai Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine and Shanghai East Hospital Affiliated to Tongji University from January 1 to February 14, 2020 were retrospectively analyzed. A total of 17 cases with positive results of two times of real time polymerase chain reaction (RT-PCR) for 2019 novel coronavirus (2019-nCoV) were evaluated as the case group, and the remaining 18 cases with negative results of two times of RT-PCR for 2019-nCoV were evaluated as the control group. The features of chest CT images of 35 cases were obtained. The frequencies of four CT imaging indicators including ground glass opacities (GGO), crazy paving, heterogeneous consolidation and mutiple subpleural lesions were analyzed. The sensitivity, specificity, positive predictive values (PPV) and negative predictive value (NPV) for COVID-19 were calculated.Results:In the case group, there were 11 cases with GGO, seven cases with crazy paving, six cases with heterogeneous consolidation, and 16 cases with mutiple subpleural lesions, while in the control group, there were seven cases with GGO, one case with crazy paving, six cases with heterogeneous consolidation, and five cases with mutiple subpleural lesions. When multiple subpleural lesions or any two of the CT imaging indicators were used as the characteristic indicators, the diagnosis efficiencies were better, with the sensitivity, specificity, PPV, NPV and Youden index of 94.12%, 72.22%, 76.19%, 98.86% and 0.66, respectively, and 88.24%, 77.78%, 78.95%, 87.50% and 0.66, respectively.Conclusions:Chest CT indictors are of high clinical diagnostic value for COVID-19. Any two of the four CT indicators (GGO, crazy paving, heterogeneous consolidation and mutiple subpleural lesions) or the single characteristics (mutiple subpleural lesions) are of high diagnostic efficacy.

Objective To firstly report the clinical features,diagnosis and treatment response of patients with anti-γ-aminobutyric acid type A receptor (GABAAR) encephalitis in China,thus raising neurologists' awareness of this emerging type of autoimmune encephalitis.Methods Specific anti-GABAAR autoantibodies in the serum and cerebrospinal fluid (CSF) of patients with suspected autoimmune encephalitis but negative for commercial available antibody tests were detected by live cell-based assay (CBA).The clinical features,laboratory examinations and treatment of two cases of autoimmune encephalitis with anti-GABAAR autoantibodies were analyzed,who admitted to Huashan Hospital,Fudan University between 2013 and 2014.Results By using live CBA,serum and CSF of the two patients diagnosed with possible autoimmune encephalitis both contained autoantibodies targeted to the GABAAR.These two patients had onset symptom of seizure or refractory seizures.Memory impairment,psychiatric symptoms and decreased consciousness were also presented.One patient was combined with mass in anterior superior mediastinum.Both patients had multifocal cortical and subcortical T2 /fluid attenuated inversion recovery-weighted images hyperintensity signal on brain magnetic resonance imaging.The two patients had poor response to antiepileptic drugs,but showed noticeable recovery with sufficient immunotherapeutic treatments.Conclusions Anti-GABAAR encephalitis is characterized by prominent epilepsy and multifocal abnormalities on brain magnetic resonance imaging.Autoantibodies specifically against GABAAR could be detected by CBA in this group of patients.Early diagnosis and immunotherapy are critical to improve clinical symptoms and outcomes of the disease.

Objective To investigate the application value of MRI in the diagnosing and assessing the severity of acute pancreatitis (AP).Methods 78 cases suspected with AP in our hospital underwent MRI.According to the golden standard of combination with the observation of the patients during hospitalization and the surgical pathological results,the sensitivity,accuracy and specificity of MRI in diagnosing AP were calculated.MRI Balthazar scoring system was used to evaluate the severity grade of AP.The results were compared with Ranson evaluation criterion usually used in clinic to evaluate the severity of AP.Results A total of 64 patients were final diagnosed by means of clinic and pathology.The sensitivity,accuracy and specificity of the MRI were 95.31％(61/64),93.59 ％ (73/78) and 85.71％(12/14),respectively.With the clinical and pathological diagnosis,the patient with mild AP were 45 cases,and the severe AP were 19 cases.The accuracy of MRI Balthazar severity grading was 95.31％ (61/64),which was significantly higher than that of Ranson evaluation accuracy 82.81 ％(53/64),with P =0.023.Conclusion MRI is an effective method for clinical diagnosis of AP,and it is superior to Ranson evaluation criterion for assessment of the severity,of which has a significant role in guiding clinical diagnosis and treatment.

OBJECTIVETo conduct a survey on the prevalence of active pulmonary tuberculosis among 65 year olds or above. Study subjects would include those with characteristics of TB suspicious symptoms, diabetes and close contacts.

METHODSPurpose-sampling method was applied to choose 3 counties in Shandong province as the study sites, relying on the local basic public health service, for those elderly under 65 years old or above. The study team would introduce the process and contents of this study to the subjects followed by chest X-ray and sputum smears on those registered tuberculosis suspects, patients with diabetes, TB close contacts in the past 2 years, from January to September, 2013.

RESULTS82 active pulmonary TB cases were identified among 9 041 cases who received the examination, with a crude prevalence rate as 9.1‰. From patients having both suspicious TB and diabetic symptoms, patients with diabetes or having suspicious symptoms of TB, the prevalence rates of active TB were 115‰, 3.4‰, 0.9‰ respectively. No active pulmonary TB case was found in the TB close contacts, patients with diabetes, or those people with suspicious TB symptoms. TB prevalence rates among all the above mentioned groups were significantly different (χ(2) = 697.478, P = 0.000). Prevalence rate of active pulmonary TB with diabetes was 18 times (RR = 17.951) higher than those non-diabetic patients, and 2 times higher than those with suspicious symptoms (RR = 3.860). Results from single factor analysis showed that diabetes were closely related to the prevalence of pulmonary tuberculosis(χ(2) = 46.637, P = 0.000), the longer duration of diabetes and the higher risk of tuberculosis(RR > 1).

CONCLUSIONOur data showed that active pulmonary TB prevalence was high in elderly diabetes patients which suggesting that 'Key crowd screening program' should be introduced into case-finding strategy on TB, with special focus on TB patients with diabetes or those people having suspicious symptoms of TB.

Aged ; Aged, 80 and over ; China ; epidemiology ; Cross-Sectional Studies ; Female ; Humans ; Male ; Prevalence ; Tuberculosis ; epidemiology

Objective To conduct a survey on the prevalence of active pulmonary tuberculosis among 65 year olds or above. Study subjects would include those with characteristics of TB suspicious symptoms,diabetes and close contacts. Methods Purpose-sampling method was applied to choose 3 counties in Shandong province as the study sites,relying on the local basic public health service,for those elderly under 65 years old or above. The study team would introduce the process and contents of this study to the subjects followed by chest X-ray and sputum smears on those registered tuberculosis suspects,patients with diabetes,TB close contacts in the past 2 years,from January to September,2013. Results 82 active pulmonary TB cases were identified among 9 041 cases who received the examination,with a crude prevalence rate as 9.1‰. From patients having both suspicious TB and diabetic symptoms,patients with diabetes or having suspicious symptoms of TB,the prevalence rates of active TB were 115‰,3.4‰,0.9‰respectively. No active pulmonary TB case was found in the TB close contacts,patients with diabetes,or those people with suspicious TB symptoms. TB prevalence rates among all the above mentioned groups were significantly different(χ2=697.478, P=0.000). Prevalence rate of active pulmonary TB with diabetes was 18 times(RR=17.951)higher than those non-diabetic patients,and 2 times higher than those with suspicious symptoms (RR=3.860). Results from single factor analysis showed that diabetes were closely related to the prevalence of pulmonary tuberculosis(χ2=46.637,P=0.000),the longer duration of diabetes and the higher risk of tuberculosis (RR>1). Conclusion Our data showed that active pulmonary TB prevalence was high in elderly diabetes patients which suggesting that‘Key crowd screening program’should be introduced into case-finding strategy on TB,with special focus on TB patients with diabetes or those people having suspicious symptoms of TB.

OBJECTIVETo study the basic pathogenesis of "asthenia of healthy energy and blood stasis" in liver cirrhosis studied by Chinese syndromes and serum proteomics.

METHODSThe information of four methods of examinations and serum samples were collected from 44 cases of male cirrhotic patients and 17 cases of healthy male volunteers. The different syndrome groups were summarized according to syndrome differentiation and frequency analysis using the patient's information of four methods of examinations. The serum proteins were isolated by magnetic beads and detected by matrix-assisted laser desorption ionization time of flight mass spectrometry (MALDI-TOF-MS). The proteins expressed differently between cirrhotic patients of different syndrome types and healthy volunteers were analyzed by statistical analysis software (product of Bruker Corporation ClinProTools 2.1 software). The diagnosis model was established by QC algorithm.

RESULTSThe liver cirrhosis syndrome with the appearance frequency of more than 30% was sequenced from high to low as fatigue, listlessness, spider telangiectasia, liver palms, anorexia, bleeding from the nose, the gum or the subcutaneous tissue, the abdominal distention, shortness of breath while moving, dim facial complexion, pricking pain of the flank, weak waist and knees, dull pain in the flank, burning sensation of five centers, or low fever, hectic fever, and night sweat. The cases belonging to Child-Pugh A in the seventeen patients of the Pi-qi asthenia syndrome group accounted for 64.7%. The cases belonging to Child-Pugh C in the twelve patients of the Gan-Shen yin deficiency syndrome group accounted for 66.7%. The cases belonging to Child-Pugh A were similar to the cases belonging to Child-Pugh C in the fifteen patients of the blood stasis syndrome group, being more than 40%. Such syndromes as spider telangiectasia, liver palms, shortness of breath while moving, burning sensation of five centers, or low fever, hectic fever, and night sweat, varicose vein of the abdominal wall, and edema of lower extremities appeared more frequently in Child-Pugh C than in Child-Pugh A (all P < 0.05). The characteristic protein expression peak with mass-to-charge ratio of 4642.81, 4963.91, 5247.8, 5805.95, 6305.27, and 12447.7 in the Pi-qi asthenia syndrome diagnosis model were chosen. The former five peaks could be found in Child-Pugh A and Child-Pugh C. The protein expression peak with mass-to-charge ratio of 9 290. 3 was the characteristic protein expression peak in the Gan-Shen yin deficiency syndrome diagnosis model. The protein expression peak with mass-to-charge ratio of 9290.06 and 7 768. 29 were down-regulated in the Gan-Shen yin deficiency syndrome group compared with the other two syndromes groups. The protein expression peaks 9290.3 and 7768.29 were included in the diagnosis model of hepatitis B cirrhosis. They did not appear in Child-Pugh A, while they were gradually down-regulated in Child-Pugh B and Child-Pugh C. Of the other seventeen protein expression peaks in patients of the Gan-Shen yin deficiency syndrome, eight expressed in Child-Pugh A. The protein expression peaks 4964.55 and 5806.83 that expressed both in Child-Pugh A and Child-Pugh C constituted the characteristic protein peaks of the hepatitis B cirrhosis blood stasis diagnosis model. The diagnosis model of the Pi-qi asthenia syndrome was established with the sensitivity of 100% and the specificity of 82.35%. The diagnosis model of the Gan-Shen yin deficiency syndrome was established with the sensitivity of 100% and the specificity of 94.12%. The diagnosis model of the blood stasis syndrome was established with the sensitivity of 100% and the specificity of 100%.

CONCLUSIONSAsthenia of healthy energy and blood stasis was the basic pathogenesis during the whole process of liver cirrhosis. Asthenia of healthy energy covers Pi-qi asthenia and Gan-Shen yin deficiency. Gan-Shen yin deficiency was obvious in the compensation stage of liver cirrhosis, but it has manifested in this stage. So early treatment was necessary.

Adult ; Aged ; Blood Proteins ; metabolism ; Case-Control Studies ; Humans ; Liver Cirrhosis ; blood ; diagnosis ; Male ; Medicine, Chinese Traditional ; Middle Aged ; Proteomics ; Serum ; metabolism ; Yang Deficiency ; blood ; diagnosis ; Yin Deficiency ; blood ; diagnosis