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Antimicrobial susceptibility testing (AST) helps guide clinical rational selection of antibiotics, enabling patients to achieve better prognosis and reducing the development of drug resistance. However, traditional AST is time-consuming and labor-intensive, meaning that clinicians are not able to obtain susceptibility results in a timely manner, and have to rely on experience based on bacterial species and epidemiological data for empirical drug selection. This may be one of the reasons for the continuous increase in the number of drug-resistant strains. In recent years, researchers have focused on the development of rapid and simple AST assays and have made relevant research progress. This article reviews the new AST technologies based on matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI-TOF MS), microfluidic chip systems, nucleic acid detection methods, immunological detection, and flow cytometry, in the hope of providing reference for improving the efficiency of AST testing in clinical microbiology laboratories.

Collagen is one of the most abundant proteins in the body and is the main component of the extracellular matrix. Collagen regulates cellular behavior, and its dysregulation can cause a variety of diseases, including cancer. Collagen in tumors is mainly produced by fibroblasts and plays an important role in cancer progression and metastasis. Collagen can act as a prognostic predictor for cancer patients and may be an effective target for the treatment and prevention of tumor progression and metastasis. Anti-tumor drugs targeting collagen and its receptors may be developed in the future. This review focuses on the newly discovered role of collagen in cancer in recent years, specifically the role of collagen in tumor cell dormancy and immune evasion, and the participation of collagen in tumor cell metabolism.

Objective To evaluate the performance of a new fluorescence immunochromatographic assay for interleukin-6 (IL-6) detection. Methods A total of 104 serum samples from patients with suspected infections and normal population were collected at Peking Union Medical College Hospital in December, 2021. Assay A (Wanfu biofluorescence immunochromatography assay) and B (Siemens chemiluminescence assay) were used as references to evaluate the equivalence of the Innova assay for detecting serum IL-6. Meanwhile, 39 homologous paired plasma and serum were collected to evaluate the consistency of the Innova assay in detecting IL-6 content in different types of samples. Results In quantitative analysis, two samples were excluded because the content was above the limit of detection for method B. Compared with the assay A or B, the regression equations of the Innova assay were Y=-7.0950+1.1924X (R2=0.9448), Y=-2.6143+1.3072X (R2=0.9391), and the Pearson correlation coefficients were 0.9720 and 0.9691, respectively. With assay A or B as reference, the Innova assay showed the Bland-Altman bias values of -3.0 and 8.0, while the expected bias at the medical decision level (7 ng/L) was -1.44 ng/L (95% CI: -5.37 to 2.50), 1.97 ng/L (95% CI: -2.09 to 6.01), respectively, with 95% CI intervals all included permissible errors (±15%, -1.05 to 1.05 ng/L). The qualitative results showed the high total coincidence rate between the Innova assay and assay A (84.6%), and assay B (83.7%). In addition, the consistency of the Innova assay was good for 39 homologous pairs of plasma and serum samples (P < 0.0001). Only one data (2.6%, 1/39) was identified by Bland-Altman bias analysis to be outside the maximum allowable error range. Conclusions Compared with the two reference assays with the same or different principles used in clinical practice, the Innova assay for IL-6 detection has good consistency and correlation, and its test results are almost not affected by the type of serum/plasma samples. To a certain extent, the Innova assay meets the needs of rapid detection in clinical practice.

Objective To evaluate the clinical value of metagenomic next-generation sequencing (mNGS) technology in the central nervous system (CNS) infection. Methods Utilizing the Infectious Disease Metagenomic Testing Platform at Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, we conducted a retrospective analysis of clinical data, routine laboratory test results, and mNGS results of patients diagnosed with infectious CNS diseases from April to December 2022. The aim was to assess the diagnostic significance of mNGS technology in CNS infection. Results Among 39 patients clinically with CNS infection, suspected pathogenic microorganism-specific sequences were detected in 29 cases (74.4%). Among them, 11 cases (37.9%) were positive for bacteria, 13 cases (44.8%) for viruses, 3 cases (10.3%) for fungi, 1 case (3.5%) for both bacteria and viruses, and 1 case (3.5%) for both fungi and viruses, yielding a positivity rate of 74.4%. Ten cases reported negative results, resulting in a false-negative rate of 25.6%. The positivity rate of mNGS was significantly higher than that of conventional clinical pathogen detection methods (including cerebrospinal fluid smears, cultures, pathogen antigens, and nucleic acid polymerase chain reactions), with rates of 74.4% compared to 23.7%, respectively. Conclusions Compared to available conventional clinical pathogen detection methods, mNGS technology demonstrates a higher positivity rate in the diagnosis of infectious CNS diseases. This advancement could potentially contribute to the early diagnosis of CNS infection.

Bacterial vaginosis (BV), an imbalance of normal vaginal microecology, is manifested as a mixed infection. It is characterized by a decrease of normal hydrogen peroxide-producing lactobacillus and an overgrowth of anaerobic bacteria (mobiluncus, prevotella) and facultative bacteria (gardnerella vaginalis, atopo vaginalis). BV is a risk factor for pelvic inflammatory disease, infertility, sexually transmitted pathogens (human papillomavirus, human immunodeficiency virus, neisseria gonorrhoeae, chlamydia trachomatis, etc.) infection. In addition, BV during pregnancy can lead to adverse obstetrical outcomes, including early miscarriage, premature delivery, postpartum endometritis, and low birth weight. The pathogens causing BV are diverse and have a high recurrence rate after treatment. About 10% to 50% of BV patients have no clinical symptoms and are easy to miss diagnosis. Rapid and accurate laboratory detection can provide timely diagnosis and treatment for BV patients and avoid adverse outcomes. Therefore, this paper reviews the research progress of diagnostic criteria, vaginal microecological evaluation and novel detection methods for BV, in order to provide reference for clinical diagnosis and treatment of BV.

Objective To evaluate the in vitro antimicrobial activities of 16 common agents against Staphylococcus aureus, Enterococcus faecium and Enterococcus faecalis to provide data for the rational clinical use of drugs. Methods From 1st January to 31st December in 2019, Staphylococcus aureus, Enterococcus faecium and Enterococcus faecalis were collected from 24 hospitals in 18 provinces in China. Antimicrobial susceptibility testing was conducted by automated instrumentation method, and WHONET 5.6 software was used to calculate the drug sensitivity results of the strains to 16 antibacterial drugs including vancomycin, norvancomycin, fusidic acid and linezolid. Results A total of 255 strains of Staphylococcus aureus, 117 strains of Enterococcus faecalis and 114 strains of Enterococcus faecium were collected. Blood was the most common specimen type (22.2%, 108/486), followed by urine (18.9%, 82/486). According to the drug sensitivity results, vancomycin, norvancomycin, linezolid and teicoplanin maintained high activity to all strains. All Staphylococcus aureus and Enterococcus faecalis were sensitive to vancomycin and teicoplanin, while the resistance rates of vancomycin and teicoplanin against Enterococcus faecium were 4.4% and 2.6%, respectively. The resistance rates of linezolid against Staphylococcus aureus, Eenterococcus faecium and Eenterococcus fascalis were 0, 0 and 4.3%, respectively. Norvancomycin and vancomycin showed similar antibacterial activity against Staphylococcus aureus, Enterococcus faecium, and Enterococcus faecalis, with 50% minimum inhibitory concentration (MIC50) of 1 mg/L, and MIC90 of 2 mg/L. The isolation rate of methicillin-resistant Staphylococcus aureas(MRSA) was 35.7%, with 13.2% resistance to fusidic acid and 3.0% in methicillin-susceptible Staphylococcus aureas. Conclusions The activity of the 16 antimicro-bial drugs against Staphylococcus aureus, Enterococcus faecium and Enterococcus faecalis varied considerably. The data will provide reference for the rational use of antimicrobial drugs.

Objective To study the epidemiology of mold infections in China. Methods Based on the surveillance data of 19 hospitals participating in the China Hospital Invasive Fungal Surveillance Net from Jan 2019 to Jun 2022, the general information of patients and the epidemiological characteristics such as the proportion of different strains and clinical infection were analyzed by WHONET software. Results A total of 16 285 mold infection cases were included in the analysis, of which 49.3% were patients aged 61 and over, with the median age of 60 years old. The proportion of males was significantly higher than that of females (62.1% vs. 37.9%). The patients were mainly from the internal medicine, ICU and surgical wards. Most strains were isolated from lower respiratory tract, accounting for 81.7%, followed by pus and secretions (7.8%). In terms of species distribution, Aspergillus spp. accounted for the highest proportion (84.8%), with Penicillium spp., Fusarium spp., order Mucorales and Sedosporium spp. accounting for 5.1%, 3.0%, 1.3% and 0.4%, respectively. For species distribution among different mold infection, 88.7% of lower respiratory tract mold infections were caused by Aspergillus spp., and Aspergillus fumigatus(47.8%) was the most common species. Otomycosis was mainly caused by Aspergillus spp.(98.7%), of which Aspergillus terreus accounted for 39.7%, and ophthalmomycosis was mainly caused by Fusarium spp.(54.6%). Conclusions By the retrospective analysis of mold isolation from multicenter in China, we found that Aspergillus fumigatus, Aspergillus terreus, and Fusarium spp. were the most common species causing pneumonomycosis, otomycosis, and ophthalmomycosis, respectively. Therefore, it is necessary to pay attention to the differences in species distribution among different mold infections in clinical empirical treatment of fungal infections.

Since the outbreak of COVID-19, SARS-CoV-2 has continued to evolve. As the fifth variants of concern (VOCs) announced by the World Health Organization, Omicron has significantly changed from previous VOCs in terms of genome, biological and epidemiological characteristics. Although the severe illness and mortality caused by Omicron infection are significantly lower than those caused by the previous VOCs, Omicron's strong transmission ability has continued to break through the epidemic prevention barrier and human immunity barrier established by prior infections and vaccines. Omicron has opened a new chapter in the COVID-19 pandemic. In this paper, we review the changes in genome and biological characteristics of Omicron and its subspecies as well as the differences in epidemiological characteristics between Omicron and influenza viruses in order to provide scientific basis for the optimization of epidemic prevention and control.

Objective To explore the operation status and effect of the neonatal deafness gene screeningin Beijing Union Medical College Hospital for the past 10 years and analyze the follow-up, genetic consultation and intervention to improve the quality of neonatal deafness gene screening. Methods From April 2012 to March 2022, the screening data of newborns with deafness genetic screening by microarray microarray in Peking Union Medical College Hospital, and the data from the genetic counseling clinic of Peking Union Medical College Hospital were retrospectively collected. The mutation loci, mutation types, genetic clinic visits and follow-up interventions of newborns who did not pass the deafness genetic screening were analyzed. Results Among 165 813 newborns, 8019 samples 'failed' in the screening, accounting for 4.84%. Of the 'failed' samples, 4173 cases carried GJB2 gene mutation, with a carrying rate of 2.52%; 3016 cases carried SLC26A4 gene mutation, with a carrying rate of 1.82%;570 cases carried GJB3 gene mutation, with a carrying rate of 0.34%; 405 cases carried homogeneous or heterogeneous mutation in 12S rRNA, with a carrying rate of 0.24%. During the screening, multiple mutation carriers were identified in 126 cases, all of whom had normal hearing at follow-up and were not given special intervention; 44 cases of deafness causing genotypes (except those at risk of drug-induced hearing loss), all of whom were given different interventions according to the degree of hearing loss; the presence of drug-sensitive deafness genotype was found in 405 cases, all of which were warned by drug warning cards for newborns and their maternal family members about drug use. The overall lost follow-up rate was 0.12%(204/165 813), and the overall genetic counselling rate of newborns who failed the screening was 46.10%(3697/8019). Among them, the lost rate of the first stage (from April 2012 to March 2013), the second stage (from April 2013 to December 2017) and the third stage (from January 2018 to March 2022) were 0.63%(72/11 489), 0.10%(80/81 663) and 0.07%(52/72 661), respectively. The visiting rate of genetic clinic was 38.05%(207/544), 39.44% (1496/3793) and 54.16%(1994/3682), respectively. The Cochran-Armitage trend test showed that the lost rate progressively lowered and the visiting rate gradually increased in the 3 stages (all P < 0.001). Conclusion In the past 10 years, a thorough screening, follow-up, consultation and intervention platform has been established, which can help us in the early warning, early diagnosis and early intervention of families and individuals at risk of hearing impairment.

Objective·To investigate the efficacy and safety of weekly paclitaxel in combination with cisplatin (DP) as first-line regimen compared with other treatment of physician's choices (TPC) for metastatic breast cancer (MBC). Methods·The clinical data of 117 MBC patients who were hospitalized in the Department of Oncology, Renji Hospital, Shanghai Jiao Tong University School of Medicine from July 2008 to June 2021 were retrospectively analyzed. Fifty-five patients were divided into DP group and 62 patients were divided into TPC group, according to whether the DP regimen was used as first-line chemotherapy. The DP group received paclitaxel 80 mg/m2 combined with cisplatin 25 mg/m2, administered on the 1st, 8th and 15th day, respectively, every 28 d as a cycle, a total of 6 cycles of treatment. TPC group received other first-linechemotherapy regimens, including single or combined regimens of capecitabine, gemcitabine, docetaxel and other regimens.Clinicopathologic characteristics including age, menopausal status, pathological results and molecular subtypes were collected and analyzed. Objective response rate (ORR) and clinical benefit rate (CBR) were used to evaluate the efficacy of different regimens based on Response Evaluation Criteria in Solid Tumors (RECIST) version 1.1. The adverse effects (AEs) were assessed in accordance with National Cancer Institute's criteria for common adverse effect 5.0 (NCI CTC 5.0), and NCI III/IV AEs were analyzed as severe AEs. The numbers and sites of MBC relapses were analyzed as progression pattern. The differences of clinicopathologic characteristics, efficacy and severe AEs between the two groups were compared by χ2 test. Kaplan-Meier survival analysis was used to compare the difference of first-line progression free survival (PFS1) between the two groups, and the factors with probable influence on PFS1, including clinicopathologic characteristics, treatments and other factors were analyzed. The univariate Cox regression analysis was further applied to analysis of the possible influencing factors screened above. Results·Except the progesterone receptor (PR) expression (P=0.048), there was no significant difference in clinicopathologic characteristics between the two groups (P>0.05). The ORR (47.3% vs 22.6%, P=0.009) and CBR (78.2% vs 41.9%, P=0.002) in the DP group were significantly higher than those in the TPC group. The median PFS1 was 12.0 months (95%CI 10.0-15.0 months) in the DP group, while the median PFS1 was 6.0 months (95%CI 5.0-9.0 month) in the TPC group, demonstrating significant difference (Log-rank P=0.000). Only the factor "receiving DP regimen as first-line chemotherapy" was recognized as a protective factor for MBC progression by univariate Cox analysis (P=0.000, HR=0.419, 95%CI 0.271-0.649). There was no significant difference (P>0.05) in the progression pattern between the two groups except for fewer bone metastasis (P=0.006). The AEs of the two groups were tolerable, and there was no significant difference in the proportion of severe AEs between the two groups (P>0.05). Conclusion·The first-line DP regimen demonstrates better efficacy and prolonged PFS1 than TPC regimens. It could be an effective selection and should be considered for MBC according to the clinical situations. [ABSTRACT FROM AUTHOR]

Based on the hourly heavy precipitation data from 74 national meteorological observation stations during the rainy seasons (May to September) from 1983 to 2017 in Hubei Province, the heavy precipitation events were classified into long and short duration heavy precipitation events according to their temporal and spatial characteristics. The methods of ordinary least squares (OLS) and geographically weighted regression (GWR) were used to quantitatively explore the relationship between heavy rainfall frequency and terrain factor. The results showed that the annual frequency of short duration heavy precipitation in extended rainy seasons in Hubei Province had obvious periodic variation, and there was one main oscillation mode in interdecadal variation (≥10 a), and two main oscillation modes in the variation of periods with a timescale shorter than interdecadal (<10 a). The ten-day frequency of long- duration heavy precipitation reached its peak in Meiyu periods, and decreased in midsummer periods, while the frequency of short duration heavy rainfall jumped in the middle of July after the end of Meiyu periods. The diurnal variation curves of long and short duration heavy rainfall were both single peak structures. The high-frequency stations of long and short-duration heavy precipitation in Hubei Province mostly appeared under specific terrain conditions where there were quasi-constant mesoscale convergence lines or vortices on the ground. Compared with the traditional OLS method, GWR significantly improved the fitting effect of heavy rainfall frequency, altitude and slope. Combined with the analysis of the significance of the fitting coefficients, GWR was not suitable for the mountainous areas with small samples and sparse sites in western Hubei Province, and more suitable for the central and eastern parts of Hubei Province which is home to medium and small-scale topography. In the geographically weighted regression model, the positive correlation between the altitude and the frequency of long-duration heavy precipitation was the largest on the west side of the eastern foot of Dabie Mountain, and the negative correlation was the largest on the south side of the western foothill of Dabie Mountain, while it was the opposite with slopes. Altitude and slope had a positive effect on the frequency of short-duration heavy precipitation. The greatest impact was on the west side of the eastern foot of the Dabie Mountains and the low-lying urban belt along the mainstream of the Yangtze River in the Wuhan-Huangshi region. They were -0.20 times/m and 6.43 times/degree respectively at the Wuhan station where the influence of terrain slope was much higher than altitude. [ABSTRACT FROM AUTHOR]

Objective: To study the distribution and drug resistance characteristics of pathogenic bacteria in the elderly population of China by collecting and analyzing the standardized case data on the pathogens of infections in elderly patients, and to facilitate the establishment of a standardized layered surveillance system for pathogenic bacteria in China., Methods: We collected the case data of elderly patients (≥65 years old) from 62 sentinel hospitals across the country in 2021. Then, we statistically analyzed the data by patient age, their geographical region, the distribution of pathogenic bacteria, and the drug resistance characteristics of main pathogens., Results: A total of 3468 cases from across the country were included in the study. The top three sources of patients were the intensive care unit (13.2%), the department of respiratory medicine (11.2%), and the department of general surgery (8.4%). The top three types of specimens were urine (25.5%), sputum (20.6%), and blood (18.7%). A total of 3468 strains of pathogens were isolated, among which, 78.9% were gram-negative bacteria and 21.1% were gram-positive bacteria. The top five types of bacteria were Escherichia coli (20.9%), Klebsiella pneumoniae (18.3%), Pseudomonas aeruginosa (11.2%), Staphylococcus aureus (9.0%), and Acinetobacter baumannii (7.0%). The isolation rates of common important drug-resistant bacteria were 38.0% for methicillin-resistant Staphylococcus aureus (MRSA), 68.7% for carbapenem-resistant Acinetobacter baumannii (CRAB), and 38.2% for carbapenem-resistant Pseudomonas aeruginosa (CRPA), 20.1% for carbapenem-resistant Klebsiella pneumoniae (CRKP), 5.2% for carbapenem-resistant Escherichia coli (CRECO), and 2.1% for vancomycin-resistant Enterococcus (VRE). There were differences in the isolation rates of CRAB and CRKP in clinical care in the elderly population in seven geographical regions of China ( P <0.05). Klebsiella pneumoniae is the most important pathogen in the elderly population ≥85 years old, and the isolation rates of CRKP showed significant differences in different age groups ( P <0.05)., Conclusion: There are significant differences in the drug resistance of pathogenic bacteria in the elderly populations of different regions and age groups in China. Therefore, monitoring the distribution and drug resistance of pathogenic bacteria in the elderly population and formulating targeted treatment plans according to the characteristics of the specific regions and age groups are of great significance to the improvement in the treatment outcomes and prognosis of the elderly population., Competing Interests: 利益冲突　所有作者均声明不存在利益冲突, (© 2024《四川大学学报（医学版）》编辑部 版权所有Copyright ©2024 Editorial Office of Journal of Sichuan University (Medical Sciences).)

Immune checkpoint inhibitors (ICIs) have been widely used in management of malignant tumor. Programmed death ligand 1 (PD-1)/programmed death ligand 1 (PD-L1) inhibitors have been introduced to treat non-small cell lung cancer (NSCLC) in recent years. Currently, PD-1/PD-L1 inhibitors are considered to have minor side effects and do not independently increase the risk of infection. However, they may cause immune-related adverse events (irAEs) that can require immunosuppressive therapy with corticosteroids and/or immunosuppressants, leading to opportunistic infections. Furthermore, there were reports about reactivation of chronic/latent infections without irAEs. Thus, immune checkpoint inhibitor related infections have drawn more and more attention in the world. In this paper, we described the potential mechanism, available clinical data and recommendation of diagnosis and management for PD-1/PD-L1 inhibitor related infections.

Objective: To better understand the clinical characteristics and predisposing factors in non-pregnant patients with Listeria monocytogenes (Listeria) sepsis., Methods: Clinical data were collected at Peking Union Medical College Hospital between January 2002 and December 2014. A case with non-pregnant Listeria sepsis is defined as a non-pregnant person with clinically compatible illness and from whom Listeria was isolated from his/her blood culture. We define an underlying condition if a patient has been diagnosed of and/or has been treated for a concurrent baseline disease within 1 month prior to the onset of Listeria sepsis., Results: A total of 35 patients were enrolled. The age of all patients was (49.1 ± 17.0) years. The male to female ratio was 2: 3. Most patients were combined with at least 1 underlying condition (33, 94.3%), including 42.9% patients with an autoimmune disease, 34.3% with malignancies. The majority (91.4%) represented an acute onset (<1 week) with median time of 3 days. Clinical manifestations included fever (34/35, 97.1%), central nervous system (CNS) symptoms (17/35, 48.6%), gastrointestinal tract symptoms (13/35, 37.1%). Fourteen patients had undergone lumber puncture and cerebral spinal fluid (CSF) tests, which revealed abnormalities comparable of Listeria meningitis. Listeria was isolated from CSF in 11 of 14 patients (78.6%). There were 34 patients receiving empiric antibiotics including 54.3% cephalosporins which are resistant to Listeria. Twenty five (71.4%) patients were switched to the target antimicrobials according to positive blood culture. Of the 35 patients with Listeria sepsis, 21 (60.0%) recovered or were cured, however the rest (40.0%) had dismal outcome. Six patients died in hospital, 8 critical patients were discharged and died after transferring to local hospitals., Conclusions: Listeria sepsis is commonly associated with non-pregnant patients with compromised immune function. Clinical presentations include acute fever, CNS symptoms and gastrointestinal symptoms etc. Empiric antibiotics covering Listeria should be considered when sepsis is suspected among susceptible hosts.

Objective: To investigate the drug-resistance rate of community-acquired respiratory tract pathogens isolated from class B hospitals in China during 2013 and 2014., Methods: A total of 860 strains (S.pneumoniae 299, K. pneumoniae 221, H. influenzae 185, S. aureus 116, and M. catarrhalis 39) of non-duplicated community-acquired respiratory tract pathogens were isolated from 10 class B hospitals in 9 cities. The minimal inhibitory concentration (MIC) of antibacterial agents was determined by the broth microdilution method. The sensitive rates and MIC range of the antibiotics were analyzed by the WHONET-5.6 software., Results: Only 19.7%(59/299) S. pneumoniae was sensitive to oral penicillin. The sensitive rates of S. pneumoniae to second-generation cephalosporins(cefuroxime and cefaclor), amoxicillin with clavulanic acid, ceftriaxone, and macrolides (erythromycin, azithromycin and clarithromycin) were 25.6% (77/299), 33.4% (100/299), 63.5% (190/299), and 4.4% (13/299), respectively. About 93.5% (280/299)and 98.0% (293/299)of S. pneumoniae isolates were sensitive to levofloxacin and moxifloxacin.All of the K. pneumoniae isolates were sensitive to ertapenem and imipenem. The sensitive rates of K. pneumoniae to ceftriaxone, cefotaxime, ceftazidime, cefepime, and cefoxitin were about 85.0%, 93.2% (206/221), and 90.3% (200/221)of K. pneumoniae isolates were sensitive to levofloxacin and moxifloxacin.The mean prevalence of ESBL-producing K. pneumoniae was 8.1% (18/221). No S. aureus isolates resistant to vancomycin were detected in this study.The sensitive rates of S. aureus to levofloxacin, moxifloxacin, trimethoprim/sulfamethoxazole, and rifampin were 83.5% (97/116), 82.8% (96/116), 89.6% (104/116) and 83.5% (97/116), respectively. 37.4% (43/116) and 34.8% (40/116)of S. aureus isolates were sensitive to erythromycin and chloramphenicol.All of the H. influenzae and M. catarrhalis isolates were sensitive to amoxicillin with clavulanic acid, ceftriaxone, levofloxacin and moxifloxacin. The sensitive rates of H. influenza and M. catarrhalis to ampicillin, cefuroxime, cefaclor, erythromycin, azithromycin, and clarithromycin were from 80% to 100%., Conclusions: Penicillins, second-generation cephalosporins (cefuroxime and cefaclor) and amoxicillin with clavulanic acid showed low antimicrobial activity to S. pneumoniae, but a higher sensitive rate to ceftriaxone. The macrolides exhibited a high activity against H. influenza and M. catarrhalis, but low antimicrobial activity against S. pneumoniae and S. aureus. The antimicrobial activity of fluoroquinolones such as levofloxacin and moxifloxacin against most of the respiratory pathogens was high.

Objective: To verify the feasibility of human papilloma virus(HPV) subtypes detection by AUTRAX automatic nucleic acid extraction workstation., Methods: A total of 183 HPV test samples (2 562 types) were collected during August 2014 in Peking Union Medical College Hospital. Nucleic acid determination kit of high-risk HPV types (16, 18, 35, 39, 58, 31, 33, 68, 56, 45, 59, 51, 52) and 6 , 11 type (real-time PCR) were applied for detection. Each sample was divided into two parts. One part was treated with manual extraction, which entailed manually preparing PCR reaction system and added the sample to the PCR plate. Another was treated with the AUTRAX automatic nucleic acid extraction workstation, which automatically prepared the reaction system and added to the PCR board. These two parts proceeded to the real-time PCR detection. The result of manual extraction was set as the golden standard and the Kappa consistency analysis was conducted. Meanwhile, precision and pollution prevention of the AUTRAX were verified., Results: The sensitivity of AUTRAX automatic nucleic acids extraction workstation was 97.12% (101/104). The specificity was 99.51% (2 446/2 458). The accuracy was 99.42% (2 547/2 562). The result of Kappa consistency analysis showed that the two parts were the same (Kappa=0.926). Coefficient of variation (CV) of each HPV types was less than 5%.No pollution phenomenon was found., Conclusion: AUTRAX automatic nucleic acids extraction workstation can be used for the HPV subtypes detection in clinical settings.

Objective: To investigate cytokine level in bronchoalveolar lavage fluid (BALF) in children with refractory Mycoplasma pneumoniae pneumonia (RMPP) and the effects of methylprednisolone on RMPP., Method: Sixty cases with RMPP and 20 cases with bronchial foreign body with no respiratory tract infection as control group hospitalized in Department of Pulmonary Diseases, the Children's Hospital Affiliated to Medical School of Zhejiang University from February 2012 to February 2013 were enrolled. The RMPP patients were divided into two groups randomly (30 cases in each). Steroid group were given methylprednisolone 2 mg/(kg·d) intravenously for 3 days, and the cases in non steroid group were not given steroid therapy. Patients whose fever relieved after steroid treatment were classified as defervesced group while the others were classified as non defervesced group. Each patient was examined with fiberoptic bronchoscopy and bronchoalveolar lavage 3 days after admission and cytokine level in BALF of each patient was detected., Result: (1) In steroid group, the proportion of patients whose fever disappeared within 3 days after steroid therapy was 9/30 cases (30%), and in non steroid group no one responded within 3 days after medication, showing statistically significant difference (χ² = 14.073, P=0.002), at the same time, the duration of cough in steroid group was significantly shorter than that in non steroid group (5.1 d vs. 7.0 d, t=-2.276, P=0.027). The total fever time of steroid group was 4.7 days, which as compaired with non steroid group (6.7 days) was shorter, but the difference was not significant (t=-1.351, P=0.134). (2) IL-1 β, IL-4, IL-6, IL-8, IL-10, IFN-γ in BALF of steroid group and non steroid group were both significantly higher than that of control group. But the same comparison between steroid group and non steroid group showed no significant difference. (3) In steroid group, IL-2 and IL-8 in BALF of patient whose fever disappeared after steroid therapy were both significantly lower than that of patients who still had fever (t=2.771, 2.054, P=0.010, 0.049) , but no significant difference was found between the two groups in BALF IL-1 β, IL-4, IL-6, IL-10, IFN-γ levels (P>0.05)., Conclusion: (1) Three days of 2 mg/(kg·d) methylprednisolone therapy had the antipyretic effect in children with RMPP, and could shorten the length of cough. (2) Incresed BALF IL-1 β, IL-4, IL-6, IL-8, IL-10, IFN-γ levels were observed in RMPP and high level of BALF IL-2 and IL-8 might have some relevance with persistent fever of RMPP in children.

Objective: To investigate the current situation of antimicrobial resistance of nosocomial gram-negative bacilli in 2014 in China., Methods: About 1 430 consecutive and non-repetitive strains of gram-negative bacilli were isolated from 15 teaching hospitals from March to August in 2014. All of these isolates were sent to the central laboratory for reidentification and susceptibility testing. The minimal inhibitory concentration (MIC) of meropenem and other antibacterial agents were determined by agar dilution method. The data were analyzed by using WHONET-5.6 software., Results: The activity of antimicrobial agents against Enterobacteriaceae was listed as followings in descending order of susceptibility: meropenem (94.7%, 913/964), amikacin (94.4%, 910/964), imipenem (88.5%, 853/964), ertapenem (87.8%, 847/964), piperacillin-tazobactam (87.2%, 841/964), cefoperazone-sulbactam (86.7%, 836/964), polymyxin B (77%, 742/964), cefepime (74.5%, 718/964), cefiazidime (71.8%, 692/964), levofloxacin (71.1%, 685/964), ciprofloxacin (67.7%, 653/964), minocyline (64.2%, 619/964), ceftriaxone (56.8%, 548/964), cefotaxime (55.8%, 538/964), cefoxitin (45.5%, 439/964). The prevalence of extended-spectrum beta-lactamases (ESBLs) was 57.6% (114/198) in E. coli and 24.6% (49/199) in Klebsiella pneumonia. The sensitivity of E. coli to carbapenems, amikacin, piperacillin-tazobactam, polymyxin B and cefoperazone-sulbactam was all over 80%. However, over 60% E. coli strains were resistant to ciprofloxacin, levofloxacin, ceftriaxone and cefotaxime. Polymyxin B was the most susceptible antibiotic to Klebsiella pneumoniae (99.5% sensitive), followed by amikacin (89.9%), meropenem (86.4%), imipenem (86.4%) and piperacillin-tazobactam (81.9%), while ceftriaxone (60.8%) and cefotaxime (59.8%) were less sensitive. The activity of antimicrobial agents against E. cloacae, E. aerogenes and Citrobacter freundii was listed as followings in descending order of susceptibility: meropenem (96.1%-97.4%), imipenem (95.1%-97.1%), polymyxin B (92.6%-99.0%), cefoperazone/sulbactam (87.3%-92.6%), ertapenem (85.6%-93.3%), piperacillin-tazobactam (65.0%-89.8%). The susceptibility rates of meropenem, cefoperazone-sulbactam, piperacillin-tazobactam, cefepime to Proteus mirabilis, Proteus vulgaris and Morganella morganii were all more than 90.0%. The most active agents against Pseudomonas aeruginosa were polymyxin B (99.5%), followed by amikacin (92.0%) and ciprofloxacin (82.1%). A. baumanni was most susceptible to polymyxin B (99.0%), while resistant to imipenem, meropenem and cefoperazone-sulbactam (29.2%, 28.2% and 29.7% respectively), mediate to minocycline (67.0%). Based on the new breakpoints for cefepime to Enterobacteriaceae, the drug susceptible rates decreased 25.8% to E. coli and 14.7% to E. cloacae., Conclusions: Carbapenems remain high susceptibility against Enterobacteriaceae, however carbapenem-resistant Enterobacteriaceae (CREs) have emerged. The sensitivity of Enterobacteriaceae against cefepime has been decreased according to the new breakpoint. Multi-drug resistant A. baumanni should be monitored persistently.

Objective: To analyze the testing results of hospitalized patients with suspected viral pneumonia using xTAG Respiratory Virus Panel Array (xTAG RVP)., Methods: 133 hospitalized patients with suspected viral pneumonia from Peking Union Medical College Hospital from January 2013 to December 2014 were divided into two groups, including 42 young and middle-aged patients (17-49 years old) and 91 middle and old-aged patients (50-88 years old). The nucleic acids of sputum or bronchoalveolar lavage fluid (BALF) samples from the two group patients were screened by xTAG RVP and the results were analyzed., Results: Viruses can be detected from 50 out of all 133 samples, and the positive rate was 37.6%. Among the viral positive samples, the proportion of mixed infections was 12.0%. The detection rates of Influenza A virus (FluA) and Rhinovirus (RV) were higher than others (45.0% and 16.7%). The infection rate of young and middle-aged patients was significantly higher than that of the middle and old-aged patients (73.8% vs 31.9%, P<0.001). The viral detection rates of samples from spring, summer, autumn and winter were 25.0%, 6.7%, 20.0% and 38.3%, respectively. The positive rate difference among four seasons was not significant (P=0.257)., Conclusion: FluA and RV are dominant respiratory viruses in hospitalized patients with suspected viral pneumonia, and the infection rate of the young and middle-aged patients is higher than the middle and old-aged patients.

Objective: To summarize the clinical characteristics and outcome of maternal listeriosis so as to improve the understanding of disease and the level of diagnosis and treatment., Methods: Retrospectively, 16 cases of maternal listeriosis, who were treated at Peking Union Medical College Hospital between March 2007 and December 2014 were reviewed. Maternal listeriosis is defined when a pregnant woman presents with symptoms as listeriosis, meanwhile Listeria monocytogenes is isolated from sterile tissue or peripheral blood, or from a non-sterile site (uterus swab) or pathological evidence of chorioamnionitis. The neonatal listeriosis is diagnosed as acute listeria sepsis., Results: The mean age of these 16 patients was (30.0 ± 3.9) years old. There were 1, 8, 7 patients with listeriosis diagnosed in the first, second and third trimester of pregnancy, respectively. All had an acute onset of illness (≤ 2 weeks), the median time from onset to presentation was 2.5 days. Clinical manifestations included fever (93.8%, 15/16), leukocytosis (78.6%, 11/14), chorioamnionitis (77.8%, 7/9), gastrointestinal symptoms (37.5%, 6/16) and fetal movement decrease (31.3%, 5/16). Listeria monocytogenes were isolated from blood (6 cases), uterus swab (6 cases), blood plus uterus swab (1 case), and neonates (3 cases). All maternal cases recovered well after the termination of pregnancy, even none of them had received empiric antibiotics sensitive to listeria. A very high proportion of adverse pregnancy outcomes occurred (15/16, 93.8%). There were 8 fetal losses. Seven neonates were complicated with listeria sepsis and treated successfully., Conclusions: The patients with maternal listeriosis commonly presented with acute fever and an extremely high incidence of adverse pregnancy outcomes, however empiric antibiotics can hardly cover this pathogenic bacterium. So both pregnant women and clinicians should maintain a high level of vigilance against listeriosis and pay more attention to dietetic hygiene.

Objective: To investigate the optimal conditions of tri-expression of CYP3A4, POR and cyt b5 in Sf 9 cells., Methods: The Sf 9 cells expressing CYP3A4, POR and cyt b5 were cultured in shaker flasks. The optimized conditions, including the temperature and rotation speed, the culture volume, the amount of surfactant and the culture time were studied. The expressed products in microsomes were used to metabolize the testosterone and their metabolic activity was determined., Results: When the temperature and rotation speed of the shaker were 27 degree and 90 r/min, the cell density and culture volume were 5X105 cells/ml and 80-120 ml per 250 ml shaker flasks, respectively. When Pluronic F-68 was 0.1% and the culture time was 72 h, the condition was most suitable for culture of Sf 9 cells and expression of targeted proteins. When the ratio of the volume of three added viruses was 1:1:1, the expression condition was optimal, under which the Km, Vmax, and CLint for testosterone metabolism were 119.6 μmol/L,0.52 μmol/(min*g protein) and 4.34 ml/(min*g protein), respectively., Conclusion: The conditions of tri-expressing of CYP3A4, POR and cyt b5 have been optimized in the study and the product CYP3A4 is obtained with higher metabolic activity.

To determine the correlations between atopy and airway hyperresponsiveness(AHR), 3000 nuclear families were selected by indicator case of asthma. All of questionaire, methacholine challenge test(5 g/L) and skin test(with 12 allergens) were conducted among all relatives in those nuclear families. The data were analysed through the EP15.01 and SAS6.12 and the odds ratio(OR) was obtained. The results of the skin prick tests on 12,516 relatives of the asthma nuclear families declared that the percentages of the positive erythema and rash were 12.5% and 51.3%, respectively. Furthermore, the positive rate of male was higher than that of female(P < 0.01). At the meantime, the positive rate under age of 35 was higher than that of people with the age over 35(P < 0.01). The prevalence of AHR was 11.9% among all relatives, in which the positive erythema and rash were 15.5% and 12.7%, respectively. Both the positive erythema and rash increased the risk of AHR, and their odds ratio are 1.17 and 1.14(P < 0.01), respectively, and the risk of AHR was greater with the increasing of kind of allergens causing the positive erythema or rash. The AHR was related with positive skin prick.

Yield and quality of Flos Lonicerae varied in different phenological phase. Yield in the first flowering season was the highest. Yield in the last three flowering season decreased one by one. The dry weight of one thousand flower buds and chlorogenic acid content in the first flowering season were the highest during a year, then was the fourth, the second and the third were both the lower. The difference of above was related to such biologic factors as days of flower bud differentiation, types of flower branch, leaf area, chlorophyll content, and also to such climatic factors as air temperature, hours of sunshine and precipitation.