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肾动脉的变异较多，其中副肾动脉是肾脏供血动脉中最为常见的解剖变异。肾血管发育是一个复杂的过程，副肾动脉多被认为是一种退化结构，与胚胎发育相关。副肾动脉在临床工作中很常见，正确认识和准确评估副肾动脉不仅对于诸多外科手术具有重要指导意义，而且对于很多内科疾病也具有重要参考意义。.

目的 了解血液科碳青霉烯耐药革兰阴性菌（CRO）感染的分布及耐药情况，分析影响CRO感染患者预后的危险因素，为临床CRO感染患者的治疗和预后判断提供依据。 方法 回顾性分析2018年1月至2020年6月血液科确诊的CRO感染患者181例，收集患者的临床和实验室检查等资料，分析影响患者30 d死亡的危险因素。在碳青霉烯类耐药肠杆菌科细菌（CRE）亚组中进一步评价CRE主动筛查的临床意义。 结果 分离出的181株CRO中CRE占47.2％，铜绿假单胞菌占37.0％，肺炎克雷伯菌占32.6％，对碳青霉烯类药物高度耐药，对亚胺培南耐药最低抑菌浓度（MIC）≥16 µg/ml的占76.8％（139/181）。菌株标本来源主要是血样和痰液。CRO和CRE感染患者30 d的全因死亡率分别为（41.4±3.7）％、（44.7±5.4）％。Cox多因素回归分析结果显示：降钙素原水平>0.2 ng/ml及亚胺培南耐药的MIC≥16 µg/ml是CRO感染30 d死亡的独立危险因素。CRE亚组分析结果显示，亚胺培南耐药的MIC≥16 µg/ml为CRE感染30 d死亡的独立危险因素。CRE主动筛查患者的30 d累积生存率高于未筛查患者［（68.0±9.3）％对（50.0±6.5）％，P＝0.21］。 结论 高亚胺培南耐药MIC值的致病菌严重影响血液科CRO感染患者预后，病死率高。开展CRE主动筛查有助于早期预防、早期诊断和早期治疗高危患者。

肾动脉狭窄（RAS）可导致顽固性高血压和（或）肾功能不全，临床需重视其早期诊断和治疗。本文介绍肾动脉超声造影（CEUS）检查，通过规范检查思路，改良操作方法，显著提高RAS诊断准确率、副肾动脉检出率等，并同步进行肾皮质血流灌注研究，建立了超声造影一站式评估RAS和肾皮质血流灌注的检查方法。.

Summary Previous studies showed that Burkholderia pyrrocinia JK-SH007 is a potential biocontrol agent of poplar canker disease. In this report, B. pyrrocinia JK-SH007 was genetically modified by introducing the Bacillus subtilis Chi113 gene to enhance its antifungal activity. The green fluorescence of B. pyrrocinia JK-SH007E1 can be detected because of its transformation with plasmid pHKT2-Chi113 containing a gfp reporter gene. Real-time quantitative PCR (qPCR) showed that the B. subtilis Chi113 gene was highly expressed in B. pyrrocinia JK-SH007E1 at mRNA level. The chitinase activity and the antifungal activity of B. pyrrocinia JK-SH007E1 were significantly increased, and the clear halo was visible on the colloidal chitin agar plate. In addition, the constructed recombinant plasmid pHKT2-Chi113 was stably maintained for at least 100 generations in the absence of antibiotic selection in B. pyrrocinia JK-SH007E1. In western blot analysis, the Chi113-GFP fusion protein was detected in B. pyrrocinia JK-SH007E1 using the GFP polyclonal antibody. In conclusion, the B. subtilis Chi113 gene was successfully transformed into B. pyrrocinia JK-SH007 and was expressed both at mRNA level and protein level. Moreover, the antifungal activity of B. pyrrocinia JK-SH007 was improved through this genetic modification.

目的 分析福建医科大学附属协和医院血液科血培养的病原菌分布及药敏情况，以了解临床真实世界血流感染状况，为临床合理使用抗菌药物提供依据。 方法 收集2013年1月至2016年12月福建医科大学附属协和医院血液科临床送检血培养阳性标本分离出的657株病原菌资料并对患者临床资料进行分析。 结果 657株血培养阳性菌株中，革兰阴性菌（G−菌）410株（62.4%），革兰阳性菌（G+菌）163株（24.8%），真菌50株（7.6%）。前五位的致病细菌分别为肺炎克雷伯菌（17.5%）、大肠埃希菌（17.2%）、凝固酶阴性葡萄球菌（CNS）（14.9%），铜绿假单胞菌（14.2%）及金黄色葡萄球菌（3.5%）。G−菌中肺炎克雷伯菌和大肠埃希菌产超广谱β内酰胺酶（ESBL）菌株的检出率分别为25.2%和55.8%，产ESBL菌株对抗菌药物的耐药率大多高于非产ESBL菌株。肠杆菌科细菌对碳青霉烯类抗生素、哌拉西林/他唑巴坦、替加环素的耐药率均在14%以下。非发酵菌中，铜绿假单胞菌对各种抗菌药物的耐药率均在12.0%以下；鲍曼不动杆菌对头孢克肟和头孢噻肟耐药率均为7.1%，未发现对替加环素耐药的鲍曼不动杆菌。CNS中84.7%（83/98）为耐甲氧西林凝固酶阴性葡萄球菌（MRCNS）。金黄色葡萄球菌中43.5%（10/23）为耐甲氧西林金黄色葡萄球菌（MRSA）。未发现对万古霉素、利奈唑胺、替加环素耐药的G+菌。 结论 福建医科大学附属协和医院血液恶性肿瘤患者化疗后合并血流感染病原菌种类分布较广，以G−菌为主，耐药情况较严峻。临床上对怀疑有G+菌血液感染的患者可经验性选择万古霉素、利奈唑胺或替加环素抗感染治疗。

The up-flow biological aerated filter (UBAF) reactor was established to explore the pollutant removal and the extracellular polymeric substances (EPS) distribution at the initial stage of biofilm, maturity of biofilm, and stable operation periods. The parallel factor (PARAFAC) model was applied to analyze the three-dimensional fluorescence characteristics of EPS. Canonical correlation analysis (CCA) was used to study the correlation between the distribution of EPS and pollutant removal. The results showed that the removal efficiency of chemical oxygen demand (COD), ammonia nitrogen (NH4 +-N), and total phosphorus (TP) at the maturity of biofilm were higher than other periods, and reached to 95.68%±0.87%, 73.48%±4.32%, and 63.80%± 14.27%, respectively. The operation period had a significant correlation with EPS distribution. All of biofilm samples detected four kinds of fluorescent substance of tryptophan-like (C1), protein-like (C2), humilic acid (C3), and humic acids-like (C4). The CCA result showed that NH4 +-N removal had a very significant positive correlation with EPS concentration and composition (R≥0.9261).

To evaluate the prevalence of macrosomia in Beijing in 2013 and identify its risk factors.Retrospective six months analysis of 14 188 full-term singleton pregnant women from 15 hospitals with different levels in Beijing in 2013. Each participant's demographic data and medical information were collected individually by questionnaires. Multiple logistic regression analysis was used to examine the associations between variables and the risk of macrosomia.(1)The total prevalence of macrosomia was 7.069% (1 003/14 188) in Beijing in 2013. (2)The prevalence varied between the 15 hospitals, the lowest was 5.36% (89/1 659), while the highest reached 8.80%(46/523). Furthermore, the incidence of macrosomia was 1.284 times (95% CI: 1.114- 1.480, P=0.001) higher in the second graded hospitals than that in the tertiary hospitals. (3) Multiple logistic regression analyses showed that risk factors for macrosomia were maternal height≥160 cm (adjusted OR=1.875, 95% CI: 1.559- 2.256), pre-pregnant body mass index (p-BMI) ≥24.0 kg/m(2) (24.0- 27.9 kg/m(2): adjusted OR=1.696, 95% CI: 1.426- 2.018; p-BMI≥28.0 kg/m(2): adjusted OR=2.393, 95% CI: 1.831- 3.127), gestational weight gain (GWG) ≥15.9 kg (adjusted OR=2.462, 95% CI: 2.125- 2.853), gravidity1 (adjusted OR=1.408, 95% CI: 1.224- 1.620), gestational weeks≥40 (adjusted OR=2.007, 95%CI: 1.745-2.308) and gestational diabetes mellitus (adjusted OR=1.522, 95%CI: 1.298-1.784). GWG≥15.9 kg, p-BMI≥28.0 kg/m(2) and gestational weeks≥40 were three risk factors that had the strongest associations with macrosomia (all P0.01).The prevalence of macrosomia in hospitals with different levels is obvious different. Gestational weeks, p-BMI and GWG are three main controllable risk factors for macrosomia, thus should receive more attentions.

This paper reports an improved constitutive model for the shear creep behavior of offwhite marbles which are selected from slope and underground cavern and contain green schist’s weak structural planes. The shear creep behavior of the samples is characterized using the rheological tests. Based on the experimental measurements on mechanical properties under different normal stress conditions, an improved model is proposed to analyze the experimental results. It is demonstrated from a further discussion that such model can reflect the non-linear creep characteristics of structural planes, and especially, it is suitable for description of the viscoelastic and viscoplastic deformation behavior of structural planes.

We investigated the mechanisms of action of immuno-modulatory drug (lenalidomide) on the protein expression of cereblon (CRBN) and their therapeutic targets in the multiple myeloma cell line RPMI8226. The multiple myeloma cell line RPMI8226 was cultured and treated with different concentrations of lenalidomide and bortezomib to determine the proliferation inhibition rate, apoptosis rate, and protein expression of CRBN. The results revealed that both lenalidomide and bortezomib inhibited the proliferation of RPMI8226 and promoted cell apoptosis. However, the protein expression of CRBN decreased signifi-cantly after treatment with lenalidomide, while bortezomib had no effect on the expression of CRBN. We confirmed that CRBN may be a target of lenalidomide.

A two-stage sequencing batch reactor (SBR) system was used for treatment of oily wastewater with COD and oil and grease (OG) concentrations ranging from 1,722-7,826 mg/L and 5,365-13,350 mg/L, respectively. A suitable start-up protocol was developed using gradual increase in oily wastewater composition with methanol as the co-substrate. This strategy enabled a short acclimation period of 12 days for the sludge in the two-stage SBR to adapt to the oily wastewater. After acclimation, the 1st stage and 2nd stage SBRs were able to achieve COD removals of 47.0+/-2.4% and 95.3+/-0.5%, respectively. The 1st stage SBR was able to achieve 99.8+/-0.1% of OG removal and effluent OG from the 1st stage SBR was only 6+/-2 mg/L. The 2nd stage SBR was used to further remove COD in the effluent from the 1st stage SBR. The final effluent from the 2nd stage SBR had a COD concentration of 97+/-16 mg/L with no detectable OG content. Thus, a two-stage SBR system was shown to be feasible for treating high strength oily wastewater to meet the local discharge standards.

To investigate the clinical effect of streptomycin perfusion of the labyrinth (SPL) in the treatment of Meniere's disease.13 patients with Meniere's disease and 3 patients with delayed endolymphatic hydrops (DEH) underwent SPL. The follow-up time was between 5 and 7 years (average 6.3 years).Vertigo was completely controlled in 9 patients, substantialy controlled in 4, limitedly controlled in 2 and not controlled in 1. Hearing was improved in 1 patients, stabilized in 5 and worse in 10. Tinnitus was improved in 3 patients, stabilized in 5 and worse in 8.SPL is a safe and effective method in the treatment of Meniere's disease and DEH, but the hearing may be insulted and tinnitus may be worse in some patients.

The natural occurring incidence of chromosome abnormalities (ICA) and its clinical significance were investigated in 330 chorionic villi samples (CVS) from the first trimester of pregnancy. It was found that the ICACVS was 5.67 per cent (11/194) in the normal group and 11.77 per cent (16/136) in the risk group. The difference between two groups was highly significant (P less than 0.01). The result shows that the pregnant women with threatened abortion, history of spontaneous abortion and greater than or equal to 40 years old are the high-risk factors. Special attention should be paid to these cases in clinical genetic counselling and prenatal diagnosis.

The effects of intermittent infusions of dobutamine were studied in young normal male subjects during a period of bedrest deconditioning to determine whether this synthetic catechol affects physical conditioning processes in humans. 24 volunteers were placed at bedrest and randomized to daily 2-h treatments of saline infusions (control), dobutamine infusions, or maintenance exercise (control). Exercise, hemodynamic, and metabolic studies were performed at base line and at the termination of the 3-wk treatment period. Maximal exercise (duration, oxygen consumption, and workload) fell for the saline group and remained unchanged for the dobutamine and exercise groups. Hemodynamics during exercise were maintained the same as pretreatment base line for the dobutamine and exercise groups, whereas stroke volume and cardiac output dropped and heart rate rose for the saline group. The metabolic profile showed an increased blood lactate response at rest and during submaximal exercise after 3 wk of bedrest for the saline group, and essentially no change for the exercise and the dobutamine groups. Extraction of oxygen across the exercising lower limb rose for the dobutamine group, as did the activity of the skeletal muscle oxidative enzymes, citrate synthetase, and succinate dehydrogenase. In contrast to the exercise control group, the saline and dobutamine groups developed orthostatic hypotension, tachycardia, and accentuation of the renin-aldosterone response over the 3-wk treatment period; for the saline group, this is best explained by the observed fall in blood volume and for the dobutamine group, by the blunting of vascular vasoconstrictive responses. During a period of bedrest deconditioning in humans, infusions of dobutamine maintain many of the physiologic expressions of physical conditioning.