In recent years,the isolation rate of carbapenem-resistant Klebsiella pneunoniae(CRKP)in China has increased year by year.Due to its multidrug resistance and high mortality in patients,CRKP brings severe challen-ges to the clinical treatment.The major mechanism of drug resistance in CRKP is the production of carbapenemases,with Ambler A,B,and D being the common types while Ambler type C comparativly rare.Klebsiella pneumoniae carbapenemase(KPC)is the most common carbapenemase,which belongs to type A.KPC-producing Klebsiella pneumoniae(KPC-KP)widely spreads in the world,with very limited number of effective clinical drugs.In this re-view,advances in the treatment KPC-KP were summarized to provide reference for clinical treatment.

The latest epidemiological data suggests that the situation of adult diabetes in China is severe, and metabolic diseases have become significant chronic illnesses that have a serious impact on public health and social development. After more than six years of practice, the National Metabolic Management Center(MMC) has developed distinctive approaches to manage metabolic patients and has achieved a series of positive outcomes, continuously advancing the standardized diagnosis and treatment model. In order to further improve the efficiency, based on the first edition, the second edition guideline was composed by incorporating experience of the past six years in conjunction with the latest international and domestic guidelines.

OBJECTIVES: To study the clinical effect of full-dose prednisone for 4 or 6 weeks in the treatment of children with primary nephrotic syndrome and its effect on recurrence. METHODS: A prospective non-randomized controlled clinical trial was performed on 89 children who were hospitalized and diagnosed with incipient primary nephrotic syndrome from December 2017 to May 2019. The children were given prednisone of 2 mg/(kg·day) (maximum 60 mg) for 4 weeks (4-week group) or 6 weeks (6-week group), followed by 2 mg/(kg·day) (maximum 60 mg) every other day for 4 weeks and then a gradual reduction in dose until drug withdrawal. The children were regularly followed up for 1 year. The two groups were compared in terms of the indices including remission maintenance time and recurrence rate. A Cox regression analysis was used to assess the risk factors for recurrence. RESULTS: Within 3 months after prednisone treatment, the 4-week group had a significantly higher recurrence rate than the 6-week group (P<0.05). After 1-year of follow-up, there was no significant difference between the two groups in the recurrence rate, remission maintenance time, and recurrence frequency (P>0.05). The risk of recurrence increased in children with an onset age of ≥6 years or increased 24-hour urinary protein (P<0.05). CONCLUSIONS For the treatment of incipient primary nephrotic syndrome, full-dose prednisone regimen extended from 4 weeks to 6 weeks can reduce recurrence within 3 months. The children with an onset age of ≥6 years or a high level of urinary protein should be taken seriously in clinical practice, and full-dose prednisone treatment for 6 weeks is recommended to reduce the risk of recurrence.
Child ; Glucocorticoids ; Humans ; Nephrotic Syndrome ; Prednisone ; Prospective Studies ; Recurrence ; Risk Factors

Objective: To compare the differences between CAS risk model and CHA₂DS₂-VASc risk score in predicting all cause death, thromboembolic events, major bleeding events and composite endpoint in patients with nonvalvular atrial fibrillation. Methods: This is a retrospective cohort study. From the China Atrial Fibrillation Registry cohort study, the patients with atrial fibrillation who were>18 years old were randomly divided into CAS risk score group and CHA₂DS₂-VASc risk score group respectively. According to the anticoagulant status at baseline and follow-up, patients in the 2 groups who complied with the scoring specifications for anticoagulation were selected for inclusion in this study. Baseline information such as age and gender in the two groups were collected and compared. Follow-up was performed periodically to collect information on anticoagulant therapy and endpoints. The endpoints were all-cause death, thromboembolism events and major bleeding, the composite endpoint events were all-cause death and thromboembolism events. The incidence of endpoints in CAS group and CHA₂DS₂-VASc group was analyzed, and multivariate Cox proportional risk model was used to analyze whether the incidence of the endpoints was statistically different between the two groups. Results: A total of 5 206 patients with AF were enrolled, average aged (63.6±12.2) years, and 2092 (40.2%) women. There were 2 447 cases (47.0%) in CAS risk score group and 2 759 cases (53.0%) in CHA₂DS₂-VASc risk score group. In the clinical baseline data of the two groups, the proportion of left ventricular ejection fraction<55%, non-paroxysmal atrial fibrillation, oral warfarin and HAS BLED score in the CAS group were lower than those in the CHA₂DS₂-VASc group, while the proportion of previous diabetes history and history of antiplatelet drugs in the CAS group was higher than that in the CHA₂DS₂-VASc group, and there was no statistical difference in other baseline data. Patients were followed up for (82.8±40.8) months. In CAS risk score group, 225(9.2%) had all-cause death, 186 (7.6%) had thromboembolic events, 81(3.3%) had major bleeding, and 368 (15.0%) had composite endpoint. In CHA₂DS₂-VASc risk score group, 261(9.5%) had all-cause death 209(7.6%) had thromboembolic events, 112(4.1%) had major bleeding, and 424 (15.4%) had composite endpoint. There were no significant differences in the occurrence of all-cause death, thromboembolic events, major bleeding and composite endpoint between anticoagulation in CAS risk score group and anticoagulation in CHA₂DS₂-VASc risk score group (log-rank P =0.643, 0.904, 0.126, 0.599, respectively). Compared with CAS risk score, multivariable Cox proportional hazards regression models showed no significant differences for all-cause death, thromboembolic events, major bleeding and composite endpoint between the two groups with HR(95%CI) 0.95(0.80-1.14), 1.00(0.82-1.22), 0.83(0.62-1.10), 0.96(0.84-1.11), respectively. All P>0.05. Conclusions: There were no significant differences between CAS risk model and CHA₂DS₂-VASc risk score in predicting all-cause death, thromboembolic events, and major bleeding events in Chinese patients with non-valvular atrial fibrillation.
Adolescent ; Anticoagulants ; Atrial Fibrillation/drug therapy* ; Cohort Studies ; Female ; Hemorrhage/complications* ; Humans ; Male ; Retrospective Studies ; Risk Assessment ; Stroke/epidemiology* ; Stroke Volume ; Thromboembolism/etiology* ; Ventricular Function, Left

OBJECTIVE: To detect the expression of JAK2/STAT3 mRNA in peripheral blood T cells from the patients with chronic idiopathic thrombocytopenic purpura（CITP）, and to explore the relationship between JAK2/STAT3 mRNA and CITP. METHODS: CITP group and healthy control group were set in this study, The JAK2/STAT3 mRNA expression level in peropheral blood T cells of 2 groups was detected with the RT-PCR and agarose gel electrophoresis. RESULTS: JAK2 mRNA expression level in CITP group was significantly higher than that in control group（P<0.01）, the STAT3 mRNA expression level in CITP group was also higher than control group（P<0.01）, The JAK2/STAT3 mRNA expression level of CITP patiants increased obviously compared with control group. CONCLUSION The expression level of JAK2/STAT3 mRNA increases signficanlty in chronic ITP patients, which involves in pathogenesis of CITP.
Chronic Disease ; Humans ; Janus Kinase 2 ; genetics ; Purpura, Thrombocytopenic, Idiopathic ; RNA, Messenger ; STAT3 Transcription Factor ; genetics ; T-Lymphocytes

Objective To evaluate the effect of local treatment for the prognosis of hormonesensitive metastatic prostate cancer.Methods A systematic review of the literature about local treatment for the prognosis of hormone-sensitive metastatic prostate cancer was performed,searching Medline,Embase,Cochrane Library,CBM,CNKI,VIP and Wan Fang database from January 2001 to October 2016.Two authors reviewed the records to identify comparative studies.A meta-analysis was conducted using Review Manager 5.0.Results Five studies were enrolled,including 29 354 patients.Meta-analysis showed that,compared with no local treatment,local treatment had a significant beneficial effect in 5-year overall survival rate (OR =0.18,95 ％ CI 0.15-0.22,P ＜ 0.01),5-year disease specific survival rate (OR =0.39,95 ％ CI 0.31-0.49,P＜0.01) as well as 3-year overall survival rate (OR =0.47,95％ CI 0.35-0.62,P＜0.01).Sub-group analysis showed that,compared with no local treatment,prostatectomy had a significant beneficial effect in 5-year overall survival rate (OR =0.17,95 ％ CI 0.12-0.25,P ＜ 0.01),5-year disease specific survival rate (OR =0.30,95％ CI 0.22-0.40,P ＜0.01) as well as 3-year overall survival rate (OR=0.25,95％CI 0.19-0.32,P ＜0.01),and external beam radiation therapy only had a significant beneficial effect in 3-year overall survival rate (OR =0.54,95％ CI 0.42-0.69,P ＜ 0.01).Conclusions Prostatectomy and external beam radiation therapy may have a survival benefit for hormone-sensitive metastatic prostate cancer.Prospective randomized controlled studies are necessary because of the limits of current studies.

Objective Early clinical symptoms of esophageal cancer are often not obvious , so a deeper insight into tumor markers is very important for the early diagnosis of esophageal cancer .This study was to investigate the expressions of Rock 2 and Wnt11 in the specific esophageal cancer cell lines Eca-109 and HEEC and the relationship of the signal transduction pathway of proteins with the development of esophageal cancer . Methods Esophageal cancer cell lines Eca-109 and HEEC were cultured and the expression levels of Rock2 and Wnt11 in the cell lines were determined by real-time quantitative PCR and Western blot . Results The mRNA expressions of Rock2 and Wnt11 were significantly increased in the Eca-109 as compared with those in the HEEC cell line (4.955± 0.539 vs 1.000±0.000, P<0.01;2.925±0.230 vs 1.000±0.000, P<0.01), and so were the protein expressions of Rock 2 and Wnt11 (955.000±21.628 vs 778.844±102.193, P<0.05;2175.316±145.623 vs 1312.233±50.734, P<0.05). Conclusion The up-regula-ted expressions of Rock 2 and Wint11 may be the markers of the metastasis of esophageal squamous cancer .

Objective To establish HPLC fingerprints for the identification of Ilicis Rotundae Cortex (Jiubiying), dried bark of Ilex rotunda Thunb., and its adulterant, dried bark of Ilex godajam (Colebr.) Wall.. Methods Some samples named Jiubiying were collected from some medicine markets and drugstores. The HPLC fingerprints were obtained to detect Jiubiying and Ilex godajam. The software Similarity Evaluation System of Chromatographic Fingerprints of Traditional Chinese Medicine (2004A edition) was used to evaluate fingerprints. Results The fingerprints of Jiubiying and Ilex godajam were established. Methodological study met the technical requirements of fingerprints. There were 31 and 28 common peaks in Jiubiying and Ilex godajam, respectively. Jiubiying and Ilex godajam could be classified into two clusters by principal component analysis and hierarchical clustering analysis. Conclusion Jiubiying and Ilex godajam can be identified by HPLC fingerprints. This method can provide an effective method for quality evaluation of Jiubiying.

Objective:To determine the value of 18F-fluorodeoxyglucose positron emission tomography (18F-FDG PET) scans in identify-ing the residual retroperitoneal tumor after chemotherapy of testis germ cell tumors. Methods:Sixteen testis germ cell tumor patients with metastasis of retroperitoneal lymph nodes who were treated in our hospital from February 2014 to December 2016 were select-ed for the study from February 2014 to December 2016. After 4-6 cycles of chemotherapy, their CT scans showed residual masses with diameters greater than 2 cm. The retroperitoneal lymph nodes were dissected after the 18F-FDG PET exam. The post-surgery pathology results were compared with the results of the 18F-FDG PET exam. Results:Residual tumors were found in 5 of 10 patients with 18F-FDG PET positive. Residual tumor was absent in 4 of 6 patients with 18F-FDG PET negative, while residual mature teratoma tumors were found in two patients. The accuracy rate, sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of the 18F-FDG PET exam were 56.25%(9/16), 71.42%(5/7), 44.44%(4/9), 50.00%(5/10), and 66.67%(4/6), respectively. Conclusion: 18F-FDG PET is highly sensitive. However, many factors influence the result of 18F-FDG PET. Mature teratoma leads to a false negative re-sult, whereas massive tissue inflammation leads to a false positive result. Therefore, more clinical examinations should be made.

Objective To investigate the clinical features and surgical treatment of cerebral amyloid angiopathy hemorrhage (CAAH) caused by cerebral vascular amyloidosis.Methods The clinical data,radiological diagnoses,pathology results and treatment efficacies of 76 patients with CAAH,admitted to and performed surgery in our hospital from August 2010 to September 2015,were retrospectively analyzed.Results The first preoperative CT indicated that prompt hematomas were located in the cerebral hemisphere brain cortex,forming lobulated or irregular shape;2 or more lesions of recurrent hemorrhage were noted in 14 (18.4％);34 (44.7％) were with subarachnoid hemorrhage,16 (21.1％) were with intraventricular hemorrhage.Histopathological examination supported the diagnosis.Sixteen patients (21.1％) underwent second operation during hospitalization due to large amount of bleeding.During hospitalization,18 (23.7％) died,and 20 (26.3％) had long-term coma.During the follow-up period,23 patients (30.3％) had recurrent intracranial hemorrhage,of which,6 patients (7.9％) underwent surgical treatment,and 17 patients (22.4％) died.Conclusion The bleeding sites of CAAH mainly locate in the lobes of the brain surface,with lobulated or irregular shape,which is easily complicated with subarachnoid hemorrhage or intraventricular hemorrhage,with multiple features;diagnostic rate of CAAH can be improved by pathological examination of brain tissues and blood vessels;CAAH after surgery has high relapse rate and poor surgical results.