Objective To investigate the virulence and drug resistance characteristics of diarrheagenic Escherichia coli isolated from patients with infectious diarrhea in our hospital.Methods The preliminary identification of microbes was carried out by the VITEK-MS microbial mass spectrometry detection system and virulence genes were detected by the multiplex real-time PCR.Five types of diarrhea-genic Escherichia coli(DEC)clinically isolated from patients with infectious diarrhea in our hospital were identified.The drug resist-ance characteristics of DEC strains were detected by the microbroth dilution and E-test.The drug-resistant molecular characteristics were analyzed by the next-generation sequencing and bioinformatics.The Fisher exact probability method was used for statistical analy-sis.Results The detection rate of DEC in our hospital was 11.9%,with enteroaggregative E.coli(EAEC)accounting for 37.5%,a-typical enteropathogenic Escherichia coli(EPEC)accounting for 34.38%,enterotoxigenic E.coli(ETEC)accounting for 25.0%,and enteroinvasive E.coli(EIEC)accounting for 3.12%.None of enterohemorrhagic E.coli(EHEC)strain was detected.The resistance rates of 32 DEC strains to ampicillin,tetracycline,and trimethoprim/sulfamethoxazole were 53.12%,43.75%,and 37.5%,respec-tively.ESBLs(+)strains accounted for 18.75%,and the detection rate of multidrug-resistant strains was 83.83%,significantly higher than that of ESBLs(-)strains(P=0.042).A total of 25 ST genotypes were obtained from 32 DEC strains.The dominant genotypes were ST10(4 strains,12.5%),followed by ST28(2 strains,6.25%),ST31(2 strains,6.25%),ST3153(2 strains,6.25%),and the other 21 genotypes(1 strain,3.13%).One carbapenem resistant strain carrying the blaNDM-1 gene was detected in EAEC.Conclu-sion Four virulence genes such as aggR,pic,astA,and eae,are more common in the DEC of patients with infectious diarrhea in our hospital,with EAEC and EPEC as the main subtypes.The genotypes are highly polymorphic,and multidrug-resistant strains have been detected.

Objective:To investigate the safety and therapeutic effect of split liver transplantation (SLT) in clinical application.Methods:This is a retrospective case-series study. The clinical data of 203 consecutive SLT, 79 living donor liver transplantation (LDLT) and 1 298 whole liver transplantation (WLT) performed at the Third Affiliated Hospital of Sun Yat-sen University from July 2014 to July 2023 were retrospectively analyzed. Two hundred and three SLT liver grafts were obtained from 109 donors. One hundred and twenty-seven grafts were generated by in vitro splitting and 76 grafts were generated by in vivo splitting. There were 90 adult recipients and 113 pediatric recipients. According to time, SLT patients were divided into two groups: the early SLT group (40 cases, from July 2014 to December 2017) and the mature SLT technology group (163 cases, from January 2018 to July 2023). The survival of each group was analyzed and the main factors affecting the survival rate of SLT were analyzed. The Kaplan-Meier method and Log-rank test were used for survival analysis.Results:The cumulative survival rates at 1-, 3-, and 5-year were 74.58%, 71.47%, and 71.47% in the early SLT group, and 88.03%, 87.23%, and 87.23% in the mature SLT group, respectively. Survival rates in the mature SLT group were significantly higher than those in the early SLT group ( χ2=5.560, P=0.018). The cumulative survival rates at 1-, 3- and 5-year were 93.41%, 93.41%, 89.95% in the LDLT group and 87.38%, 81.98%, 77.04% in the WLT group, respectively. There was no significant difference among the mature SLT group, the LDLT group and the WLT group ( χ2=4.016, P=0.134). Abdominal hemorrhage, infection, primary liver graft nonfunction,and portal vein thrombosis were the main causes of early postoperative death. Conclusion:SLT can achieve results comparable to those of WLT and LDLT in mature technology liver transplant centers, but it needs to go through a certain time learning curve.

Objective:To investigate the safety and therapeutic effect of split liver transplantation (SLT) in clinical application.Methods:This is a retrospective case-series study. The clinical data of 203 consecutive SLT, 79 living donor liver transplantation (LDLT) and 1 298 whole liver transplantation (WLT) performed at the Third Affiliated Hospital of Sun Yat-sen University from July 2014 to July 2023 were retrospectively analyzed. Two hundred and three SLT liver grafts were obtained from 109 donors. One hundred and twenty-seven grafts were generated by in vitro splitting and 76 grafts were generated by in vivo splitting. There were 90 adult recipients and 113 pediatric recipients. According to time, SLT patients were divided into two groups: the early SLT group (40 cases, from July 2014 to December 2017) and the mature SLT technology group (163 cases, from January 2018 to July 2023). The survival of each group was analyzed and the main factors affecting the survival rate of SLT were analyzed. The Kaplan-Meier method and Log-rank test were used for survival analysis.Results:The cumulative survival rates at 1-, 3-, and 5-year were 74.58%, 71.47%, and 71.47% in the early SLT group, and 88.03%, 87.23%, and 87.23% in the mature SLT group, respectively. Survival rates in the mature SLT group were significantly higher than those in the early SLT group ( χ2=5.560, P=0.018). The cumulative survival rates at 1-, 3- and 5-year were 93.41%, 93.41%, 89.95% in the LDLT group and 87.38%, 81.98%, 77.04% in the WLT group, respectively. There was no significant difference among the mature SLT group, the LDLT group and the WLT group ( χ2=4.016, P=0.134). Abdominal hemorrhage, infection, primary liver graft nonfunction,and portal vein thrombosis were the main causes of early postoperative death. Conclusion:SLT can achieve results comparable to those of WLT and LDLT in mature technology liver transplant centers, but it needs to go through a certain time learning curve.

Objective To investigate the diagnostic value of B7-H3 and carcinoembryonic antigen (CEA) on diagnosis of malignant pleural effusion (MPE).Methods We collected and analysed the expression of B7-H3 and CEA in 40 MPE cases and 22 cases of benign pleural effusion (BPE) using enzyme-linked immunosorbent assay (ELISA).Receiver operator characteristic curves (ROC) were drawn according to the expression of B7-H3 and CEA, calculated diagnosis sensitivity, specificity and the area under curve (AUC).Results The diagnosis sensitivity of B7-H3 was 62.5％, specificity 81.0％, with the AUC of 0.777;similarly, The diagnosis sensitivity of CEA was 72.5％, specificity 81.0％, with the AUC of 0.850.Higher AUC of 0.910 was gained in combination ROC, with sensitivity and specificity of 72.5％, 81.0％, respectively.Conclusion B7-H3 and CEA could be available diagnosing markers for MPE.Combined applications of B7-H3 and CEA have higher AUC.They may be widely applied in future clinical practice.

Objective To establish a serological detection method for EA-D-IgA antibody,and to evaluate its diagnostic efficacy for nasopharyngeal carcinoma in different clinical stage.Methods EA-D-IgA antibody serological detection method was established by using the polypropylene microplate with eukaryotic expression product of BMRF1 whole gene fragment of EB virus.Fifteen early stage (stage Ⅰ and Ⅱ) and 48 advanced (stage Ⅲ and Ⅳ) patients with nasopharyngeal carcinoma in Shanxi Provincial Cancer Hospital and Shanxi Dayi Hospital from April 2012 to August 2017,and serum samples from 40 patients with rhinitis who were treated at Shanxi Dayi Hospital from October 2016 to October 2017 were examined respectively by using the constructed EA-D-IgA antibody detection method.The positive detection rate of EA-D-IgA antibodies in different groups was calculated.When the patients with rhinitis were used as the differential control,the diagnostic efficacy of this index for different stages of nasopharyngeal carcinoma was evaluated.Results EA-D-IgA antibody serological method was successfully established.The positive detection rate of EA-D-IgA antibody in early nasopharyngeal carcinoma,advanced nasopharyngeal carcinoma and rhinitis control was 60.0 ％ (10/15),68.3 ％ (33/48) and 5.0 ％ (2/40) respectively.The differences between early stage nasopharyngeal carcinoma and the rhinitis control,advanced nasopharyngeal carcinoma and the rhinitis control were statistically significant (x2 =20.625,P =0.000;x2 =37.017,P =0.000).The difference between early nasopharyngeal carcinoma and advanced nasopharyngeal carcinoma was not statistically significant (x2 =0.394,P =0.530).When compared with the patients with rhinitis,the diagnostic sensitivity,specificity,positive predictive value,negative predictive value was 60.0 ％ and 68.3 ％,95.0 ％ and 95.0 ％,81.8 ％ and 94.3 ％,86.4 ％ and 71.7 ％ respectively in early nasopharyngeal carcinoma and advanced nasopharyngeal carcinoma.Conclusion The method constructed in this study effectively improves the efficacy of EA-D-IgA antibody detection in serological diagnosis of nasopharyngeal carcinoma,which can be used as an adjunct for early diagnosis of nasopharyngeal carcinoma,yet not as a reference for clinical staging.

Objective To discuss the practice effect about the waiting area in the hospital building of the daping hosptial ,the third military medical university to be reformed into digital subtraction angiography (DSA) composite operating room .Methods We reasonably choiced the form of purify conditioning ,medical C arm ,smallpox air supply ,and the efficient screening device layout at the end of smallpox air supply .Results The main parameters of the measured results met the national standards of indexes .The fan frequency was 48 Hz running at hundred grade ,and its operation energy consumption was about 25 kw/h ;the fan frequency was 35 Hz running at ten thousand grade ,and its operation energy consumption was about 12 kw/h;the conversion time was very short between hundred grade and ten thousand grade running ,about 10 minutes .Conclusion On the condition that the building environ-ment is not fit to install hanging medical C arm ,we can thorough choose floor type C arm ,adopt “leakage resistance type clean air supply smallpox” ,reasonably modify the form of purify air conditioning to design or modify a hundred grade operating room meet-ing requirement .

OBJECTIVETo study the effects of Zhuhong ointment on accumulation in the body of mercury and the pathological morphology changes of kidney, via the measurement of related indicators of the skin-impaired model rat.

METHODEighty-eight SD rats were randomly divided into the impairment control group, and high-, middle-, low-dose Zhuhong ointment groups. Each group was treated by corresponding methods for 4 weeks, and recovering for 4 weeks. Urinary potein (PRO), pH, Beta N-acetyl aminoglycosidase enzymes (NAG) and beta2-microglobulin (beta2-MG) contents in urine were taken as monitoring indexes, blood urea nitrogen (BUN) and serum creatinine (SCr) in blood and the levels of mercury in urine, blood and kidney were tested, and the pathological morphology changes of kidney were observed.

RESULTAfter treatment for 4 weeks, compared with impairment control group, the levels of mercury in urine, blood and kidney in every dose group increased significantly (P < 0.01). And the relation exists between toxicity and dose on Zhuhong ointment. After recovery for 4 weeks, the levels of mercury in urine and blood in every dose group restore normal, while the level of mercury in kidney in high- dose group still increased (P < 0.01). The level of NAG increased only in high-dose group. There was no significant difference in NAG contents between Zhuhong ointment groups and the impairment control group (P < 0.05).

CONCLUSIONExcess using Zhuhong ointment repeatedly may lead to accumulation of mercury and pathological morphology changes of kidney. So the levels of mercury in the body and related indicators of renal functions should be tested in clinical when long-term using Zhuhong ointment.

Acetylglucosaminidase ; drug effects ; urine ; Animals ; Blood Urea Nitrogen ; Creatinine ; blood ; Disease Models, Animal ; Drugs, Chinese Herbal ; pharmacology ; toxicity ; Female ; Hydrogen-Ion Concentration ; drug effects ; Kidney ; drug effects ; enzymology ; metabolism ; pathology ; Male ; Mercury ; blood ; metabolism ; urine ; Ointments ; Random Allocation ; Rats ; Rats, Sprague-Dawley ; Retinol-Binding Proteins ; drug effects ; urine ; Skin ; drug effects ; injuries ; Time Factors ; beta 2-Microglobulin ; urine

OBJECTIVETo study the effect of repeated administration of Zhuhong ointment on renal antioxidant capability of ulcerous skin in rats, in order to further discuss the mechanism of mercury contained in Zhuhong ointment on the antioxidant capability of kidney in skin ulcer rats.

METHODEighty SD rats were randomly divided into eight groups: Zhuhong ointment A, B, C, D, E (1.219, 0.609, 0.305, 0.152, 0.76 g x kg(-1)) groups, the vaseline group, the ulcer model group and the impairment control group. The levels of NAG and RBP of toxicity for early kidney tubular injury and T-AOC, SOD, GSH-PX and GSH in kidney were determined after consecutive administration for 14 days.

RESULTCompared with ulcer model group, the levels of RBP in groups A, B, C and D increased, while the levels of NAG increased only in the group A. The level of T-AOC increased in groups A, B and C. The level of T-SOD increased in the group E, while it dropped down greatly in the group A. The level of GSH-PX increased in groups A, B and C. The content of GSH increased in every dose groups.

CONCLUSIONAntioxidant capacity in rats can be increased in a reasonable dose of Zhuhong ointment, but some antioxidant activity can be notably inhibited by with the increase of dose.

Acetylglucosaminidase ; drug effects ; urine ; Animals ; Antioxidants ; analysis ; metabolism ; Disease Models, Animal ; Dose-Response Relationship, Drug ; Drugs, Chinese Herbal ; administration & dosage ; pharmacology ; toxicity ; Glutathione ; drug effects ; metabolism ; Glutathione Peroxidase ; drug effects ; metabolism ; Kidney Tubules ; drug effects ; injuries ; metabolism ; Male ; Mercury ; metabolism ; Ointments ; Random Allocation ; Rats ; Rats, Sprague-Dawley ; Retinol-Binding Proteins ; drug effects ; urine ; Skin Ulcer ; metabolism ; microbiology ; Specific Pathogen-Free Organisms ; Staphylococcal Skin Infections ; metabolism ; Superoxide Dismutase ; drug effects ; metabolism ; Time Factors

ObjectiveTo assess the impact of set-up correction on dosimetry using non-daily kilovolt cone-beam computed tomography (KVCBCT) for nasopharyngeal cancer patients treated with intensitymodulated radiotherapy (IMRT). MethodsThe mean shift values from 14 nasopharyngeal cancer patients received KVCBCT scans during the first 5 treatment fractions were calculated as prediction of systemic set-up errors and used for off-line correction at 1.5 mm threshold level. Presumed that the systemic errors can be corrected by moving couch without residual errors, the pre-correction set-up errors in the remaining fractions were the sum of actual set-up errors and predicted errors. The dosimetric effects of non-daily protocol were simulated in the planning system and analyzed with physical dose parameters in 14 IMRT plans. ResultsIn 10 patients with predicted systemic errors ＞ 1.5 mm, target dose was reduced significantly. The mean reduction of GTV-D98 ( dose received by 98％ of the volume of GTV ), CTVnx-D95 ( dose received by 95％ of the volume of CTVnx ), CTV1 -D98 ( dose received by 98％ of the volume CTV1 ) were 3. 8 Gy ( Z =- 2. 81,P =0. 005 ) ,4. 8 Gy ( Z =- 1.96, P =0. 050 ), 1.0 Gy ( Z =- 2. 82, P =0. 005 ), respectively. The effect on dose to CTV2 was much less. After correction, mean 3D vector positioning errors was reduced from 3. 6mm to 2. 3 mm (t =2.00,P =0. 000). After correction, the dose led to increase in GTV-D98, CTVns-D95,CTV1-D95 was 3.8 Gy (t=-2. 70,P=0.007),5.0 Gy (t =-2. 15,P=0.030),0.9 Gy (Z=-2.80,P=0. 005 ) respectively, and reduced the dose deviation greater than 3％ or 5％ for organs at risk.Conclusion Non-daily KVCBCT correction reduced dosimetric effect of set-up errors in IMRT for nasopharyngeal cancer patients.

Objective To analyze the dose distributions of changing target volumes during intensity modulated radiotherapy (IMRT) for nasopharyngeal carcinoma (NPC). Methods Twenty-one NPC patients received definitive IMRT. A total of 126 computed tomography (CT) planning images were acquired, including the first CT scan for the primary plan and a series of scans taken weekly from the start of treatment to the fifth week. The images were registered to the planning images. Target volumes (GTV_(nx), CTV_1 ,CTV_2 ,PTV, and PTV_2) and normal structures (the parotid, brain stem and spinal cord) were re-contoured on the fusion CT images. Results The D_(mean) D_(95), D_(90), D_(10), D_5 and V_(100) of GTV_(nx) were 15.44 -15.60 Gy (F=0.07,P=0.996),14.66 -14.92 Gy (F=0. 11,P=0.990),14.81 -15.06 Gy (F= 0. 12,P=0.988),15.88 -16.29 Gy (F =0.28,P=0.924),16.00 -16.38 Gy (F=0.25,P =0. 940) and 98. 1% -99. 5 % (F = 0. 08, P = 0. 995), CTV_1 with 14. 75 -14. 98 Gy (F = 0. 07,P = 0. 997), 13.39 -13.73 Gy (F=0.20,P=0.964),13.74 -13.96 Gy (F=0.08,P=0.995), 15.65 -15.90 Gy (F= 0.09,P=0.994),15.91 -16.05 Gy (F=0. 10,P=0.992), 98.2% -99.5% (F=0.02,P= 1.000), and CTV_2 with 13.34 -13.64 Gy (F=0. 18,P=0.970),12.71 -13. 18 Gy (F=0.32,P=0.898), 12.89 -13.28Gy(F=0.23,P=0. 949) ,13.79 -14.03Gy(F=0. 12,P=0. 987) ,13.92 -14. 16 Gy (F=0. 12,P=0.987), 94.4% -99.6% (F=0.25,P=0.937), respectively. Conclusions No significantly different dose distributions exists with the changes of the target volumes, even on the largest variations of external contours. The primary plan could ensure adequate doses to the changing target volumes. The replanning is unnecessary in terms of the change of target volumes during radiotherapy.