Objective:To investigate the clinical characteristics and drug resistance of Klebsiella pneumoniae infections at different systems, providing laboratory reference for the rational use of antibiotics in clinical practice.Methods:The clinical characteristics and drug resistance of patients with Klebsiella pneumoniae infections in respiratory, urinary, hematologic, and other systems who received treatment in Wuzhou Red Cross Hospital from January 2015 to December 2021 were analyzed.Results:From 2015 to 2021, there were 3 496 cases of Klebsiella pneumoniae infections in the hospital, among which the respiratory system was most affected with 2 250 strains (64.34%). The sex ratio of patients with Klebsiella pneumoniae infections at different systems was statistically significant ( χ2 = 266.77, P < 0.001). The respiratory system and hematological system were more commonly infected by Klebsiella pneumoniae in men, while the urinary system was more commonly infected in women. The sex ratio of patients with Klebsiella pneumoniae infections at other systems were similar. The age distribution of patients with Klebsiella pneumoniae infections at different systems was significantly different ( χ2 = 176.54, P < 0.001). Klebsiella pneumoniae infections of the respiratory, urinary, and hematological systems were the most common in people aged > 60-80 years, while Klebsiella pneumoniae infections in other systems were mainly found in people aged > 18-60 years. There were significant differences in the distribution of departments among different Klebsiella pneumoniae infection systems ( χ2 = 1 415.30, P < 0.001). The ICU had the highest incidence of Klebsiella pneumoniae infections in the respiratory system, while the department of internal medicine had the highest incidence of Klebsiella pneumoniae infections in the urinary and hematological systems, and the department of surgery had the highest incidence of Klebsiella pneumoniae infections in other parts of the body. The resistance rate of Klebsiella pneumoniae to common antibiotics for the hematologic system was lower than that of the other three infection systems. For infections in the respiratory system, urinary system, and other body parts, the resistance rates of Klebsiella pneumoniae to amikacin, meropenem, imipenem, and piperacillin/tazobactam were all below 10%, while the resistance rate to tobramycin was below 20%, and the resistance rate to cephalosporins was around 30%. Conclusion:The proportion of Klebsiella pneumoniae infections in different body parts varies by gender, age, and department. For Klebsiella pneumoniae infections in the hematological system, the resistance rate to commonly used antibiotics is lower than that for infections in the other three systems. In contrast, Klebsiella pneumoniae infections in the respiratory system, urinary system, and other systems have a particularly high resistance rate to third- and fourth-generation cephalosporins but are still sensitive to piperacillin/tazobactam and carbapenem antibiotics.

Objective:To assess the role of Delta-RBC parameters in the automated hematocrit analyzer RET channel for the recognition of cold agglutinins (CA) and to explore the value of RET channel optical method parameters in correcting interference with CA.Methods:This is a retrospective study. The Cas group included 68 samples with Cas interference and the control group included 45 samples without CA interference. All specimens were collected from Zhongshan Hospital Fudan University Outpatient Department from January 2022 to January 2023. Specimens in both the CA and Control group were examined using the CBC+RET channel at room temperature. Recorded and calculated the Impedance method test parameters RBC-I, HGB, HCT-I, MCH-I, MCV-I, MCHC-I and the Optical method test parameters RBC-O, HCT-O, MCH-O, R-MFV, MCHC-O, Delta-RBC. Examined the specimens in the CA group using the CBC channel after prewarmed at 37 ℃ for 2 h, and Impedance method parameters RBC-I 37 ℃ 2 h, HGB 37 ℃ 2 h, HCT-I 37 ℃ 2 h, MCH-I 37 ℃ 2 h, MCV-I 37 ℃ 2 h, MCHC-I 37 ℃ 2 h were recorded. The ROC curves were used to analyze the discrimination efficacy of Delta-RBC in identifying CA interference, and the Bland-Altman method was used to analyze the consistency between the results of the optical method RBC parameters at room temperature and the results of the impedance method after prewarming. The correlation analysis was performed using Pearson and Spearman correlation analysis to analyze the results of the RBC parameters before and after prewarming in the CA group. Result:If Delta-RBC was used as diagnostic indicators for the identification of CA interference, the best cut-off value was 1.065, with AUCs of 0.998. In the CA group, the correlation coefficients between RBC-O, HCT-O, R-MFV, MCH-O, MCHC-O, and RBC-I 37 ℃ 2 h, HCT-I 37 ℃ 2 h, MCV-I 37 ℃ 2 h, MCH-I 37 ℃ 2 h, MCHC-I 37 ℃ 2 h were 0.985, 0.981, 0.729, 0.870, and 0.649, respectively. The percentages within the limits of agreement of the percentage differences between the results of the two methods were 95.6%, 92.6%, 95.6%, 94.1%, and 95.6%, respectively. Conclusions:The RBC parameter Delta-RBC from RET channel optical method can be used as an indicator to effectively assist in the clinical determination of the presence of CA. Reporting results using the optical method RBC parameters of the RET channel can correct the interference of CA without specimen pre-treatment and obtain more correct results of complete blood counts.

Objective:To strengthen the integration and sharing of medical data resources, provide high-quality and usable data for clinical researchers, and promote the medical data use in clinical research.Methods:According to the development and application goals of the medical big data platform, data from different major clinical information systems in our hospital are integrated and then cleaned, processed and analyzed, and finally aggregated into a unified platform and turned to valuable and usable data resources.Results:A medical big data platform for clinical research in our hospital has been developed. It has stored over 13.42 million patients′ clinical data of more than 50 million visits since 2004 in our hospital; an analysis-oriented common data model (CDM) for clinical research has been designed; clinical researchers can query and extract clinical data according to CDM; the standard clinical research data service mechanisms have been established.Conclusions:The medical big data platform in our hospital helps to provide usable data of good quality for high-level scientific research based on medical big data, and improve the efficiency and quality of clinical research; at the same time, it also provides a efficient way to manage and control clinical research data use while ensuring data security and regulatory compliance.

Objective: To translate the English version of the Pressure Ulcer Risk Primary or Secondary Evaluation Tool (PURPOSE T) into Chinese and evaluate its reliability and validity. Methods: Firstly, PURPOSE T was translated and revised, cross-cultural debugging, and then 213 inpatients from Jiangsu University Affiliated Hospital from November 2017 to May 2018 were selected for investigation. Choosing the total item content validity index (S-CVI/Ave) and the content validity of the item level content validity index (I-CVI) to evaluate content validity, using the Chinese version of the Braden scale as the criterion to measure the validity-related validity of the Chinese version of PURPOSE T. The internal consistency reliability Cronbach α coefficient, the assessor reliability, and the test-retest reliability measure the reliability. Results: The Chinese version of PURPOSET S-CVI was 0.967; I-CVI was 0.6-1.0, The coefficients between PURPOSET and Braden scale in mobility, activity ability, perception status, nutritional status and humidity were 0.600, 0.661, 0.699, 0.519, and 0.783. The PURPOSET and Braden scales had a correlation coefficient of 0.407 in predicting the risk of pressure injury. The Cronbach α=0.859 of the evaluation tool, the assessor reliability were 0.87 and the correlation coefficient of the 2 measurements of the test-retest reliability were 0.91. Conclusions The Chinese version of PURPOSET has good reliability and validity and can be used as a risk assessment tool for pressure injury in hospitalized patients in China.

Human exhaled gases contain thousands of trace amounts of trace volatile organic compounds (VOCs), some of which are endogenous substance and can be detected as potential biomarkers for disease. Acetone, the second highest VOCs in human exhaled gases, has been widely used in non-invasive diagnosis and monitoring of diabetes. At present, more than 30 independent studies have been undertaken on the range of breath acetone concentration and its influencing factors, and the quantitative relationship between blood glucose and glycosylated hemoglobin in diabetic patients. However, there are still many challenges in the application of breath acetone as a clinical regulatory parameter for diabetes. In this paper, the research status and progress in the breath acetone and analysis method were reviewed, and the existing problems in diabetes diagnosis and monitoring were discussed. Besides, the future development prospects were analyzed with the present technical level.

Objective To study the concentration distribution of acetone in fasting exhaled breath in diabetic patients and healthy subjects,to explore the effect of individual indexes on the concentration of acetone in fasting exhaled breath,and to study the role of individual indexes of fasting exhaled breath acetone in diabetes screening.Methods The acetone concentration measurements of fasting exhaled breath were performed on 265 healthy subjects,39 patients with type 1 diabetes (T1D),and 300 patients with type 2 diabetes (T2D) using real-time online respiratory acetone analyzer based on cavity ring-down spectroscopy (CRDS).SPSS 19.0 software was used to eliminate outliers,and relevant statistical analysis was carried out with the corresponding gender,age,height,body mass,body mass index (BMI) and blood glucose concentration (BGL).The receiver operating characteristic (ROC) curve was used to evaluate the diagnostic value of fasting breath acetone concentration for diabetes diagnosing.Results The mean fasting breath acetone concentration in T1D patients was (2.24±1.43)×10-6 was significantly higher than (1.43±0.55)×10-6 in healthy subjects and (1.41±0.73)×10-6 in T2D patients,and the differences were statistically significant (all P＜0.05).The average fasting breath acetone concentration in male diabetic patients was higher than that in female patients.The mean fasting breath acetone concentration was positively correlated with age (R=0.31,P＜0.01) in healthy subjects,was positively correlated with BMI (R=0.33,P＜0.05) in T1D patients,and was positively correlated with height (R=0.18,P＜0.01) in T2D patients.The area under the ROC curve for the diagnosis of T1D by fasting breath acetone concentration was 0.853 with a sensitivity of 71.9％ and specificity of 87.4％ (P＜0.01),and for the diagnosis of T2D was 0.528 with a sensitivity of 54.1％ and specificity of 55.0％ (P＞0.05).Conclusions The detection of fasting breath acetone concentration is meaningful for T1D diagnosing,but has a low accuracy for T2D diagnosing (no statistically significant).

Objective To study the correlation between apolipoprotein E (APOE) genetic polymorphisms and sepsis in Chinese children.Methods The inpatients suffered with sepsis were enrolled as septic group and the healthy children from child health division were enrolled as control group.The study of APOE genotypes were carried out by polymerase chain reactions followed a high-resolution melting curve analysis.SPSS 16.0 statistical software was used for data analysis.Mann-Whitney U test was used to compare the age between the groups.Hardy-Weinberg equilibrium was tested using the Pearson x2-test.The x2-test was used to compare gender and the genotype distribution between the groups.The odd ratio (OR) was calculated together with its 95％ confidence interval (CI).Potential confounding effects of variables were corrected using a multivariate unconditional logistic regression model.All statistical tests were two-sided and P ＜ 0.05 indicates statistically significance.Results Among a total of 285 children collected from March 2011 to June 2012,there were 88 patients with sepsis and 197 healthy children.In the septic group,15 septic patients were complicated with central nervous system infection.Four apolipoprotein E genotypes were identified to be ε3/ε3,ε2/ε3,ε3/ε4,and ε2/ε4.The percentage of each genotype found in patients of the septic group and the control group was 64.4％ vs.73.1％ (ε3/ε3);16.8％ vs.10.7％ (ε2/ε3);18.8％ vs.14.7％ (ε3/ε4);0％ vs.1.5％ (ε2/ε4),respectively.The number of patients with the genotype ε3/ε3 among septic patients was significantly lower than that among the control individuals (P =0.047,1-β =0.334,OR =0.585,adjusted OR =0.559).The number of patients with the genotype ε3/ε3 among the septic patients with central nervous system infection was 33.3％,which was also significantly lower than that among the septic patients without CNS infection (67.1％).(P =0.014,1-β5 =0.685,OR =0.245,adjusted OR =0.275).Conclusions Apolipoprotein E genetic polymorphisms were associated with the occurrence of sepsis and central nervous system complications in children.The susceptibility of children with genotype ε3/ε3 to sepsis and central nerve system infection complications is significantly lower than that of children with other genotypes.

Objective To compare 6 sub-function scale differences of frontal lobe function rating scale or a Frontal Assessment Battery(FAB)among patients with two subtypes of vascular cognitive impairment(VCI) to provide clues for the distinctive intervention and disease prevention and control of patients with two subtypes.Methods Totally 220 non-dementia vascular cognitive impairment (NDVCI)patients and 68 patients with vascular dementia(VaD)with final diagnosis were selected.The overall function and six sub-function scores were tested by FAB.Analyzing the score difference and probing a progress tendency from NDVCI to VaD were performed.Results The scores of frontal lobe function rating scale were higher in NDVCI(14.0 ± 2.8)than in VaD (9.5±2.0) patients with significant difference(t =29.92,P =0.00).The scales of frontal lobe function rating score of conceptualization ability (t =6.24,P =0.00),intelligence flexibility (t =7.00,P =0.00),antiinterference ability(t =7.21,P =0.00) and attention suppression(t =5.32,P =0.00) were lower in VaD group than in NDVCI group.The conceptualization weight capacity was significantly lower in VaD group than in NDVCI group(0.04 versus 0.32).Conclusions During a transitive process from NDVCI to VaD,it is important to focus on the mutation and deterioration of conceptualization capacity.

AIM:To investigate the relationship between polyamine metabolism and hypoxia /ischemia ( H/I)-induced cell apoptosis and to determine the mechanisms by which exogenous spermine protects cell apoptosis against AMI in rats .METHOD:The left anterior de-scending coronary artery ( LAD) of the Wistar rats were ligated , and neonatal rat cardiomyocytes were placed under hypoxic conditions for 24 h to establish the model of AMI (or H/I).Exogenous spermine was administered by intraperitoneal injection (2.5 mg/kg daily for 7 days) in vitro and subjected to the cell medium at 5μmol/L as a pre-treatment therapy.RESULTS:AMI (or H/I) induced an increase in polyamine catabolized enzyme SSAT and a decrease in polyamine biosynthesis enzyme ODC , which result in endogenous spermine and spermidine decrease and putrescine increase .At the same time, AMI ( or H/I) lowered cardiac function , increased cTnI and CK-MB concentrations , aggravated myocardial infarct size , cardiomyocyte damage and apoptosis , raised ROS generation , increased the expression of cleaved caspase-3, cleaved caspase-9 and endoplasmic reticulum stress (ERS)-related proteins, promoted the release of cytochrome C and mPTP opening , down-regulated Bcl-2 expression and the phosphorylation of ERK 1/2, PI3K, Akt and GSK-3β, and activated PERK and eIF 2αphosphorylation .Spermine pre-treatment reversed the above-motioned changes .CONCLUSION:AMI ( or H/I ) could induce cardiomyocyte apoptosis and polyamine metabolism disorder .Exogenous spermine attenuates cardiac injury through scavenging the ROS and inhibiting mPTP opening and ERS injury .These findings provide a novel target for the prevention of apoptosis in the setting of AMI .

A novel near-infrared (NIR) diffuse correlation spectroscopy (DCS) has recently been developed for noninvasive monitoring of tumor blood flow during photodynamic therapy (PDT).DCS offers several attractive new features for tumor blood flow measurement such as noninvasiveness,portability,low cost,high temporal resolution and relatively large penetration depth.DCS technology has been utilized for continuous measurement of tumor blood flow before,during and after PDT in both animals and humans.The ultimate goal is to predict treatment outcomes from the measured tumor hemodynamic responses to PDT.