Obstructive sleep apnea hypopnea syndrome (OSAHS) is a sleep breathing disorder caused by obstruction of the upper airway during sleep from various causes. At present, the diagnosis and treatment of OSAHS are insufficient. OSAHS causes cognitive decline due to excessive oxidative stress and inflammatory response caused by sleep breathing disorder, and its alteration of the brain gray matter area may be related to cognitive dysfunction. This review investigates the correlation between cognitive dysfunction and brain gray matter areas changes in OSAHS, and elucidates the underlying mechanisms, which provide a theoretical basis for early clinical diagnosis and treatment.

Tropheryma whipplei (TW) is an opportunistic pathogen that can cause Whipple′s disease (WD). Recently, the biomedical field is concerned about whether the bacteria cause pneumonia. When BALF was detected by PCR, the TW positive rate was about 6.1%. Etiology status is generally described as “associated” or “probable”. Immunocompromised status is the susceptible factor; Different species of the same genus have been reported. The current method may have missed detection. All relevant information needs further study. This article reviews the acute pneumonia caused by TW and the detection technology.

Presepsin(sCD14-ST), is an soluble leukocyte differentiation antigen 14 subtype. It is a glycoprotein fragment and a marker of acute phase reaction. For diagnosis of adult sepsis, bacteremia and bacterial DNAaemia, the area under of ROC is 0.88,0.78 and 0.79, respectively. The levels of Presepsin increase earlier than procalcitonin, and have better clinical value for early diagnosis of sepsis. It is significantly correlated with disease severity and can be used to predict prognosis. One study mentioned that in the absence of organ dysfunction, the value was 235.0 (172.0-340.3) pg/ml, and for one, two, three or more organ dysfunction, were 403.5 (275.8-587.3) pg / ml, 844.5 (559.8-1259.5) pg / ml, 1412.5 (893.0-2675.8) pg/ml (P<0.01), respectively. Another study mentioned that Presepsin is an independent risk factor for 30-day death of sepsis, and it is effective to evaluate poor prognosis with a threshold of >927.5 pg/ml. Presepsin also has clinical value for neonatal and child sepsis. The Greece meta-analysis showed that the AUC for neonatal sepsis diagnosis was 0.9751, which was higher and more sensitive than that of CRP and procalcitonin. Turkish study on children showed a significant increase in sCD14-ST in sepsis patients compared with healthy controls. Its AUC was 0.98, the best threshold was 990 pg/ml. The reference range of this value was been studied, showing that 75％ and 95％ percentiles of full-term infants are 791 and 1178 pg/ml. Adults do not exceed 200 pg/ml of all age groups. It is affected by renal function. Prospective trials are expected to further clarify its diagnostic value, more therapeutic research to elaborate its therapeutic value, and corresponding clinical practice guideline.

Time to positivity(TTP) is a new parameter in blood culture field.The article shows us the concepts of TTP,differential time to positivity (DTTP),and introduces their relation with bloodstream infection (BSI),catheter-related bloodstream infection (CRBSI).Besides,it stresses TTP' s clinical application,including determining the severity of disease;identifying the isolates whether pollution or not; identification of isolate strains ; detection of the drug resistance of isolates ; evaluating the effect of antibiotic ; helping to adjust the therapeutic drug; diagnosing or excluding CRBSI by means of DTTP;deciding whether the catheter is the source of infection in patients with candidemia; understanding the epidemiological distribution of strain.At the same time,the article also describes the shortcomings and domestic current status.

Objective To explore the clinical risk factors of ventilator-associated fungal pneumonia (VAFP) in emergency intensive care unit.Methods One hundred and ninety-seven consecutive patients with 121 males and 76 females,aged from 17 to 98 years met the criteria of ventilator-associated pneumonia in emergency intensive care unit admitted from July 2009 to June 2014,were retrospectively evaluated.Those with mechanical ventilation less than 48 hours or treatment discontinued were excluded.Patients were divided into VAFP group and ventilator-associated non-fungal pneumonia group according to the results of fungal culture and microscopy.Univariate analysis was used to find out preliminary risk factors for VAFP,and then the ultimate independent risk factors were determined with multivariate stepwise logistic regression analysis.Results The occurrence of VAFP was 32.0 ％ (63 cases) out of 197 patients with ventilatorassociated pneumonia.In those 63 patients,there were 71 species found from fungus culture.Candida albicans counted for 33 (46.5％),Candida glabrata for 11 (15.5％),other Candida Albicans for 26 (36.6％).The preliminary univariate analysis showed that 19 factors were statistically significant,while multivariate stepwise logistic regression analysis revealed that acute physiology and chronic health evaluation Ⅱ score≥ 22,radiotherapy or chemotherapy,mechanical ventilation ≥14.11 days,use of antibiotics ≥14 days,use of glucocorticoid and other immuno-suppressants were independent predictors of VAFP,and the adjusted odds ratios with 95％ confidential intervals were 4.133 (2.831-6.033),2.977 (1.942-4.564),2.305 (1.439-3.736),1.988 (1.441-2.741),1.528 (1.337-1.746),respectively.Conclusion Higher APACHE Ⅱ score,radiotherapy or chemotherapy,prolonged use of mechanical ventilation,prolonged use of antibiotics,use of glucocorticoid and immunosuppressants are independent risk factors of VAFP.The incidence rate of VAFP may be reduced by improving patients' overall clinical setting,shortening the duration of mechanical ventilation and employment of antibiotics,and more strict guidelines to the application of glucocorticoid and immunosuppressants.

Objective To explore the types and drug resistance of pathogens in patients with type Ⅰ incision surgical site infection in orthopedics department.Methods Patients with type Ⅰ incision surgical site infection in orthopedics department at Peking University Third Hospital from January 2005 to December 2013 were retrospectively collected.Clinical characteristics of patients,distribution and drug resistance of pathogens were analyzed.Results A total of 58.2 thousands patients with type Ⅰ incision surgical site were hospitalized from January 2005 to December 2013 in orthopedics department,and among them 442 patients had infection in the type Ⅰ incision surgical site.The infection rate was 0.8％.Infection was mainly observed in elderly patients.The most common diseases were lumbar canal stenosis (21.7％),cervical spondylosis (20.6％) and lumbar intervertebral disc herniation (14.0％).A total of 453 pathogenic strains were detected,of which 52.9％ were gram-positive bacteria,45.5％ were gramnegative bacteria and 1.6 ％ were fungi.The common pathogens were Staphylococcus aureus (25.2 ％),Staphylococcus epidermidis (14.1 ％),Escherichia coli (11.5 ％),Enterobacter cloacae (7.3 ％),Pseudomonas aeruginosa (6.2 ％) and Acinetobacter baumannii (6.0 ％).The percentage of Meticillinresistant Staphylococcus aureus (MRSA) was 23.7％ and the percentage of Meticillin-resistant Staphylococcus epidermidis (MRSE) was 43.8％.Vancomycin or linezolid-resistant Staphylococcus aureus or Staphylococcus epidermidis were not detected.Proportion of extended-spectrum beta-lactamases (ESBL) producing strains in Escherichia coli was 53.8％,and proportion of ESBL-producing strains in Klebesiella pneumonia was 50.0％.The resistance rates to impenem and meropenem of the three different species in Enterobacteriaceae,including Escherichia coli,Enterobacter cloacae and Klebsiella pneumonia,were 0.Resistance rates of Pseudomonas aeruginosa to cefoperazone-sulbactam,piperacillin-tazobactam were less than 10 ％.Resistance rate of Acinetobacter baumannii to minocyline was 11.1％ and resistance rates of it to other drugs were more than 20％.Conclusions The rate of type Ⅰ incision surgical site infection in orthopedics department is low.Gram-positive and gram-negative bacteria each account for half of the pathogens.The proportion of resistant pathogens is high and empirical treatment is needed to cover these pathogens.

Objective:To establish the control charts for early warning of diarrhea based on the syn-dromic surveillance data from enteric clinic in Beijing .Methods:The outpatient data from enteric clinic of a Grade Three General hospital in Haidian district , Beijing from April 1 to Oct.31, 2009 and from May 1 to Nov.10, 2010 were collected, according to the moving average method , the baseline calcula-ted, the value of probability αand μα, the early warning value based on the formula “w=Xj +μαSj”calculated and the early warning control charts drew at last .Results:According to the harmfulness , the severity and controllability of diarrheal diseases , the value of probability αwas determined as 0.01, thenμα( unilateral) as 2, based on the early warning value , the control charts of diarrheal diseases , bacillary dysentery and other infectious diarrhea were established .Conclusion:The enteric clinic requires to fur-ther collect baseline data to evaluate and continuously adjust the established control charts for the best early warning model in accordance with the enteric clinic .

Clinical microbiology should participate the infectious diseases consult.There is no guideline about this topic in the professional field so far.The professional recommendations are given to the different items including definition,professional,prerequisite,pre-consult phase,consult phase,post-consult phase,and etc.It is hoped that our recommendations are conducive to the consult task and can promote the development of clinical microbiology and infectious diseases.

Objective To investigate distribution and antimicrobial resistance among nosocomial pathogens from 13 teaching hospitals in China in 2009. Methods Non-repetitive pathogens from nosocomial BSI, HAP and IAI were collected and sent to the central lab for MIC determination by agar dilution method.WHONET5.6 software was used to analyze the data. Results A total of 2 502 clinical isolates were collected. The top three pathogens of BSI were Escherichia coli [27. 1% (285/1 052 )] , coagulase-negutive staphylococcus [12. 6% ( 133/1 052)] and Klebsiella pneumoniae [10. 8% ( 114/1 052)]. The top three pathogens of HAP were Acinetobacter baumannii [28. 8% (226/785)], Pseudomonas aeruginosa [16. 1% (126/785)] and Klebsiella pneumoniae [14.6% (115/785 )] . The top three pathogens of IAI were Escherichia coli[31.0% ( 206/665 )], Klebsiella pneumonia [11.3% ( 75/665 )] and Enterococcus faecium [10. 8% (72/665)]. Against Escherichia coil and Klebsiella spp. , the antimicrobial agents with higher than 80% susceptibility rate included imipenem and meropenem (98. 1%-100% ), tigecycline (95.3%-100% ), piperacillin-tazobactam ( 88.6% -97. 1% ) and amikacin ( 88. 3% -92. 5% ). Against Enterobacter spp. , Citrobacter spp. and Serratia spp. , the susceptibility rates of tigecycline were 93.5% -100% whereas the value of imipenem and meropenem were 92.9% -100%. Other antimicrobial agents with high activity included amikacin ( 85.2% -96. 7% ), pipcracillin-tazobactam ( 82.4% -96.4% ), cefepime ( 79. 6% -96. 7% ) and cefoperazonc-sulbactam (78. 7%-90. 0% ). Polymyxin B showed the highest susceptibility rateagainst Pseudomonas aeruginosa ( 100% ), followed by amikacin ( 81.9% ) and piperacillin-tazobactam (80.1% ). Polymyxin B also showed the highest susceptibility rate against Acinetobacter baumannii (98. 8% ), followed by tigecycline (90. 1% ) and minocycline (72. 0% ). The incidence of carbapenemresistant Acinetobacter baumannii was 60. 1%. The MRSA rate was 60. 2% and the MRSCoN rate was 84. 2%. All Staphylococcus strains were susceptible to tigecycline, vancomycin, teicoplanin and linezolid except for one isolate of Staphylococcus haemolysis with intermediate to teicoplanin. Two Enterococcus faecalis isolates which were intermediate to linezolid and one Enterococcus faecium isolate which was resistant to vancomycin and teicoplanin was found in this surveillance, while the MICs of tigecycline against these three isolates were 0. 032-0. 064 μg/ml. Conclusions Tigecycline, carbapenems, piperacillin-tazobactam,amikacin and cefepime remain relatively high activity against nosocomial Enterobacteriaceae. Pseudomonas aeruginosa exhibite high susceptibility to polymyxin B, while Acinetobacter baumanni shows high susceptibility to polymyxin B and tigecycline. Tigecycline, vancomycin, teicoplanin and linezolid remain high activity against nosocomial gram-positive cocci.

Objective To investigate the characteristic of intravascular catheter-related infections (CRI) in Peking University Third Hospital in 2009. Methods The clinical and microbiological features of CRI were analyzed retrospectively. Results Two hundred and nineteen catheters were examined. Twenty-nine CRI cases were confirmed with colonization, 7 were insertion site infection and 6 were catheter-related bloodstream infections (CRBSI) by quantitative catheter culture method, but no CRBSI was diagnosed by differential time to positivity (DTTP) method. The incidence rates of CRBSI in intensive care units (ICU) were 0. 99- 3.03 per 1000 catheter-days.Among the colonized strains, 51.72 % were Gram-positive cocci, 20.69 % were non-fermenting bacilli (NFB), 13. 79% were Enterobacteriaceae and 10. 34% were Candida. One neonatal CRBSI was caused by Leuconostoc mesenteroides. Most of bacterial isolates were drug resistant. Seventy-seven percent of adult patients were older than 60 years and most of them had chronic underlying diseases.All of the 9 neonate patients were preterm neonate and 7 of them were extremely low birth weight infants. Conclusion There is a certain amount of CRI occurred in Peking University Third Hospital in 2009 and the intravascular catheter management should be enhanced.