Objective:To investigate the clinical characteristics, diagnosis and treatment of chronic natural killer cell lymphoproliferative disease (CLPD-NK) associated peripheral neuropathy.Methods:The clinical data of 1 case of CLPD-NK associated peripheral neuropathy who was hospitalized in Beijing Chaoyang Hospital on March 17, 2022 were reported. The clinical characteristics, laboratory examinations, nerve biopsy, treatment and prognosis of CLPD-NK associated peripheral neuropathy were summarized in combination with domestic and foreign literature reports.Results:This patient was a 62-year-old woman with progressive weakness and numbness of limbs. Nerve conduction test revealed peripheral nerves injures of limbs. No abnormality was found in a routine biochemistry test of cerebrospinal fluid. Lymphocyte infiltration was found in the nerve bundle of sural nerve with CD56(+), TIA-1(+). After prednisone combined with cyclophosphamide treatment, her weakness and numbness of limbs were relieved, and the white blood cells count decreased. A total of 10 cases of CLPD-NK associated peripheral neuropathy were summarized, including 5 males and 5 females. The median onset age was 64 years. The peripheral blood white cells count was 5.50×10 9/L-24.66×10 9/L, the lymphocytes count was 1.54×10 9/L-32.00×10 9/L, and cerebrospinal fluid protein increased in 3 cases. Biopsy of sural nerve showed NK cell infiltration in all patients. Immunosuppression was the main treatment, and most patients had a good prognosis. Conclusions:CLPD-NK associated peripheral neuropathy is rare. Peripheral nerve biopsy is the important diagnostic method. Corticosteroids and immunosuppressants are effective for this disease.

Objective To understand the frequency distribution of CYP2C9 and VKORC1 gene single nucleotide polymor-phisms in Yunnan Han population.Methods CYP2C9(430C> T,1075A>C and 1080C> G)locus and VKORC1(-1639G> A and 1173C> T)locus gene polymorphisms in 202 samples were detected by adopting electrochemical gene sensor method,and the allele frequencies and genotype frequencies were performed the statistics and the gene polymorphism in relevant populations was an-alyzed.Results Among 202 samples,202 cases(100.0%)were genotype C/C at CYP2C9 * 2 locus,C allele frequency was 100.0%;185 cases(91.6%)were genotype A/A at CYP2C9*3 locus,15 cases(7.4%)were A/C genotype,2 cases(1.0%)were C/C genotype,A allele frequency was 95.3%,C allele frequency was 4.7%;CYP2C9*5 locus genotype C/C was in 202 cases (100.0%),C allele frequency was 100%;VKORC1 -1639G > A locus genotype A/A was in 145 cases(71.8%),57 cases (28.2%)were G/A genotype,A allele frequency was 85.9%,G was 14.1%;1173C> T locus genotype T/T was in 145 cases (71.8%),C/T gene type in 57 cases(28.2%),T allele frequency was 85.9%,and C was 14.1%.Conclusion The distribution of CYP2C9 gene in Yunnan Han population is similar to that in other regions of our country.The VKORC1 gene is different from the foreign population,Chinese Han nationality and partial minority nationalities.

Objective To investigate the changes of T lymphocyte immune balance in the patients with COPD.Methods Forty-eightpatients with AECOPD from January 2015 to December 2016 in this hospital were selected as study group and 30 healthy subjects as control.T cells and cytokines in peripheral blood were detected by flow cytometry and ELISA,respectively.The levels of them were compared between the two groups.The correlations of them and principal components were analyzed among the two groups.Results (1) CD8+T cells in the study group decreased [23.8％(17.5％,30.1％) vs.28.2％(23.8％,31.5％),P＜0.05],TregandTh17increased[8.5％(8.3％,9.0％) vs.5.6％(4.9％,6.1％),P＜0.01;2.9％(2.8％,3.0％) vs.1.2％(1.2％,1.4％),P＜0.01],respectively.(2)In the study group,IL-12 [54.97 pg/mL(31.20,161.59) pg/mL],IL-22 [17.70 pg/mL(15.60,35.99) pg/mL],IL-23[120.28 pg/mL(82.97,169.27) pg/mL],IL-23R [0.15 pg/mL(0.15,0.71)pg/mL]and TNF-α[1 000 pg/mL(1 000,1 000)pg/mL] were higher than that of the control group[31.20 pg/mL(31.20,56.23)pg/mL,15.60 pg/mL(15.60,15.60)pg/mL,78.10 pg/mL(78.10,99.08)pg/mL,0.15 pg/mL(0.15,0.15)pg/mL,722.16 pg/mL(494.25,941.44)pg/mL,P＜0.05].(3)Correlation analysis showed that there was a negative correlation between Th17 and Treg (r=-0.883,P＜0.01) in the study group (r=-0.883,P＜0.01),and IL-22 was positively correlated with IL-23 (r=0.340,P＜0.05).In the control group,there was a negative correlation between CD4+T cells and CD8+ T cells,Th17 and CD3+ T cells,Th17 and CD8+T cells (r was-0.578,-0.393 and-0.569,respectively,P＜0.05),and a positive correlation between Th17 and Treg,IL-23 and CD4+T cells,TNF-α and DNT(r=0.403,0.440 and 0.392,respectively.(4) There were 5 main components among each group,but the variable factors differed in the study group from the controls,as that:Th17/Treg,Th17,Treg vs.CD4+ T/CD8+ T cells,CD4+ T cells,CD8+ T cells and CD4+T/CD8+T cells,CD8+ T cells vs.Th17/Treg,Treg and CD4+ T cells,CD3+ T cells vs.IL-12,IL-23R andIL-12,IL-23R vs.CD3+ T cells and IL-23,IL-22 vs.TNF-α,DNT.Conclusion The increasing immune function of Th17 cells with IL-22 and IL-23 may be involved in the pathological mechanism of COPD,which accompanied with the weakened toxicity of CD8+T cells and regulation of DNT.

Objective For the second children diagnosed as ABO hemolytic disease of the newborn(ABO-HDN),we made a comprehensive analysis of the related indicators of prenatal and postpartum,so as to achieve early prevention,early diagnosis and early treatment.Methods Prenatal microcolumn gel assay was used to detect the father and mother's blood type and mother's irregular antibody,mother serum IgG anti A(B)anti-body titer.Microcolumn gel assay was used to detect hemolysis three tests after the production of pregnant women.The results were divided into five groups according to the results of hemolysis three tests:group A[di-rect antiglobulin test(+),free antibodies test(+)and antibody releasing test(+)],group B[direct antiglobu-lin test(-),free antibodies test(+)and antibody releasing test(+)],group C[direct antiglobulin test(+), free antibodies test(-)and antibody releasing test(+)],group D[direct antiglobulin test(-),free antibod-ies test(-)and antibody releasing test(+)]and group E[direct antiglobulin test(+),free antibodies test (-)and antibody releasing test(-)].Total bilirubin,unbound bilirubin,hemoglobin,reticulocyte percentage and lactate dehydrogenase were detected by automatic analyzer.Results ABO-HDN children hemolysis three tests,in the 5 groups,the higher the titer of the mother's IgG anti A(B)antibody,the more serious the child' s condition was,the difference was statistically significant(P<0.05).Reticulocyte percentage and lactate de-hydrogenase in the five groups,the difference was statistically significant(P<0.05).Conclusion A combina-tion of antenatal and postnatal multiple laboratory test parameters is more accurate in predicting the second child ABO-HDN.At the same time,it helps to master the state of the disease and reduce the occurrence of complications and sequelae.

Objective To analyze the rate of blood culture contamination,pollution path,the proportion of contaminated bacteria of First People′s Hospital of Kunming city from 2013 to 2015,and provide a basis for effective prevention and control of pollution.Methods A total of 34 713 cases of blood culture samples from 2013 to 2015,were retrospectively analyzed.Results A total of 2860 culture positive samples from 34 713 cases were found,from which 361 cases were polluted(1.04%).According to the classification of the year,the lowest rate of blood culture contamination was 2015 According to the classification in the quarter,there was no significant difference between the 4 seasons;According to the classification of internal and surgical systems,,the pollution rate of internal medicine system was 1.06%,while the surgical system was 0.96%.According to the classification of departments:the hemodialysis center has the highest pollution rate(2.71%),followed by ICU (2.23%).Galactophore Department has the highest pollution rate (2.30%) in the surgical system and followed by orthopedics(1.92%).According to the statistics of contaminated bacteria,Staphylococcus aureus was the highest,accounting for 32.41%,followed by Staphylococcus epidermidis,accounting for 31.30%.Conclusion Hospital has a high blood culture contamination rateand diversification pollution waywhich can not be ignored.The pollution of bacteria in the blood culture mainly for bottle of single positive coagulase negative Staphylococcus.

Objective To investigate the distribution and antibiotic resistance of clinical Pseudomonas aeruginosa in Yunnan provincal of China in 2014.Methods Pseudomonas aeruginosa were collected from 28 hospitals in Yunnan surveillance of China.All hospitals were carried with the unified solution for bacteria culture,isolation,identification and antibiotic sensitivity tests according to CLSI M100-S24.The data of 2 873 strains pseudomonas aeruginosa were analyzed by WHONET5.6 software.Results 2 873 clinical strains of non-repetitive Pseudomonas aeruginosa isolates,90.36%were isolated from hospitalized patients and 60.32% from sputum,8.42% from urine,8.11% from secretion,4.70% from abscess,2.92% from blood,etc.The sensitive rates of common antimicrobial agents of Pseudomonas aeruginosa in top five were turn amikacin (88.7%),piperacillin/he azole temple (85.0%),tobramycin (83.1%),piperacillin (80.3%) and cefepime (80.1%).59.0% of the Pseudomonas aeruginosa strains were resistant to Aztreonam.20.9%-29.7% of the Pseudomonas aeruginosa strains were resistant to Imipenem,Ceftazidime,Meropenem,Ciprofloxacin and Levofloxacin.The Pseudomonas aeruginosa isolates showed the lowest resistance rate (10.3%-19.9%) to Piperacillin,Gentamicin,Cefepime,Tobramycin,Piperacillin/Tazobactam and Amikacin.Conclusion The antimicrobial susceptibility pattern varies widly with Pseudomonas aeruginosa isolated in Yunnan of China in 2014.Antimicrobial resistance sur-Monitoring the antibiotic resistant trend of Pseudomonas aeruginosa and implementing the nosocomial infection control policy become more important in hospital management setting.

Objective To evaluate the effect of dexmedetomidine administered locally on the median effective concentration ( EC50 ) of ropivacaine for paravertebral nerve block ( PVNB) . Methods Forty?eight ASA physical status Ⅰ or Ⅱ female patients, aged 20-64 yr, with body mass index<24 kg∕m2 , scheduled for elective unilateral segmental mastectomy under PVNB, were randomly divided into 2 groups ( n=24 each) using a random number table: ropivacaine group ( group R) and ropivacaine mixed with dexmedetomidine group ( group RD) . PVNB was performed at T4 on the operated side guided by ultrasound and nerve stimulator. Ropivacaine 20 ml and a mixture of ropivacaine and 20 μg dexmedetomidine 20 ml were injected locally in group R and group RD, respectively. The concentration of ropivacaine was determined by up?and?down sequential allocation. The initial ropivacaine concentration was set at 0. 35%, and the ratio between the two successive concentrations was 1. 2. The EC50 and 95%confidence interval of ropivacaine were calculated using Dixon?Massey method. Results The EC50 ( 95%confidence interval) of ropivacaine was 0.27% (0.23%-0.30%) and 0.22% (0.18%-0.25%) in group R and group RD, respectively. Compared with group R, the EC50 of ropivacaine was significantly decreased by 19% in group RD. Conclusion Small dose of dexmedetomidine administered locally can significantly enhance the efficacy of PVNB with ropivacaine.

Objective To evaluate the comparability of the detection results of different blood cells analysis systems in same hos-pital.Methods Referring to the Guideline for Comparability Verification of Quantitative Test Results in Medical Institutions,the comparability validation protocol was established.The EDTA-K2 anticoagulation fresh whole blood samples with proper concentra-tion were detected for 5 parameters of HGB,RBC,HCT,PLT and WBC by 4 systems (Sysmex XT-1800i,Sysmex XT-2000,Sys-mex XT-4000i and Mindray BC-5800).The range was calculated and the detection results consistency analysis was performed.Re-sults The acceptable standard of critical differentials was intended to be HGB3.5%,RBC3%,HCT3%,PLT12.5% and WBC 7.5%.The replication detection was at least 2 times and up to 5 times.The ranges of 3 concentrations after replication detection and sample comparison were 2.87%-6.29%,1.57%-2.99%,1.95%-4.77%,12.81%-25.74% and 6.72%-11.13% respective-ly.The ranges of RBC detection results in 4 systems were smaller than the critical differentials,the validation was passed.The ran-ges of HGB,HCT,PLT and WBC detection results in 4 systems all had the condition of more than the critical differentials,the vali-dation did not passed.After removing the test system with obvious bias,the validation of the detection results by other test systems was passed.Conclusion The RBC detection results by 4 systems have the comparability;the HGB,HCT and PLT detection results by Sysmex XT-1800i,Sysmex XT-2000i and Sysmex XT-4000i have the comparability;the WBC detection results by Sysmex XT-1800i,Sysmex XT-2000i and Mindray BC-5800 have the comparability.

Objective To learn the species distribution characteristics and proportion occurrence of methicillin-resistant strains about Staphylococcus detected in the First People′s Hospital of Kunming.Methods The species distribution characteristics and proportion occurrence of methicillin-resistant strains were analyzed retrospectively from January 2005 to December 2013.Results A total of 3 561 Staphylococcus strains were detected in 9 years,included 21 species and subspecies,and another 12 strains were not i-dentified to species.2005-2013 species composition showed an increasing trend,there were five kinds of Staphylococcus in 2005, until 2013 reach to 13 kinds.Each year the main bacterial were Staphylococcus aureus,Staphylococcus epidermidis,Staphylococcus haemolyticus and staphylococcal hominis.Methicillin resistant Staphylococcus aureus incidence decreased significantly since 201 1, decrease from 76.3% in 2010 to 25.6% in 2013.Staphylococcus epidermidis,Staphylococcus haemolyticus,Staphylococcal hominis and coagulase-negative Staphylococci resistant to high incidence of methicillin-resistant strains of the average,remained stable at a-round 70.0%.Conclusion The distribution characteristic of Staphylococcus in this hospital was increasingly complex year by year, the opportunity of infection caused by Staphylococcus was also increased,the detection rate of methicillin-resistant strains was high, it should be noted to use clinical drug rationally.

Objective To analyze the detected pathogens composition in positive blood culture samples and drug resistance in our hospital from January 2005 to December 2012 in order to accumulate the data information of pathogenic bacteria distribution and drug resistance in bacteremia .Methods The BD9240 and BacT /Alert3D 240 blood culture systems were used to perform the blood culture .The identification of isolated bacteria and the drug susceptibility test were conducted by using Microscan walkaway 40 sys‐tem and the Vitec2 compact system .The Data were analyzed by adopting the Whonet5 .6 software .Results In 1 829 positive bacte‐rial strains by blood culture ,986 strains were Gram negative bacilli ,accounting for 53 .9% ;721 strains were Gram positive coccus , accounting for 39 .4% ;104 strains were fungi ,accounting for 5 .68% .The resistant rate of staphylococcus to vancomycin ,linezolid and teicoplanin was 0% ,which to amoxycillin/clavulanic acid ,rifampicin ,amikacin ,sulfamethoxazole compound and chloramphenicol was lower than 40% .The sensitive of enterococcus to linezolid and teicoplanin was 100% ,but enterococcus faecium was resistant to vancomycin(2 .6% ) .The penicillin resistant rate of Streptococcus was 21 .7% .The resistant rates of E .coli and K lebsiella pneumo‐nia were 0% to imipenem and meropenem ,and less than 22% to amikacin ,piperacillin/tazobactam and cefoxitin .The resistant rates of salmonella to CLSI recommended five kinds of detection drug were less than 6 .5% .The resistant rates of pseudomonas aerugino‐sa were more than 25% to imipenem and more than 25% to meropenem .Conclusion The pathogens spectrum detected by blood culture is widespread .The resistance rates of different bacteria vary widely .