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Cryptococcosis is an invasive fungal disease with increased morbidity in China. Cryptococci can infect immunocompromised hosts as well as immunocompetent ones. In this study, we reviewed data of inpatients with cryptococcosis at Ningbo First Hospital from May 2010 to May 2020 and compared the clinical profiles of pulmonary cryptococcosis (PC) and extrapulmonary cryptococcosis (EPC). Of 71 patients enrolled, 70 were non-HIV with dramatically increased prevalence especially in PC. 77.46% of cases were PC confirmed by pathology. The rest were EPC including intracranial infection (15.49%) and cryptococcemia (7.04%). Comparing to PC, a larger proportion of EPC patients were found to have immunocompromised conditions including predisposing factors (p All in all, underlying immunocompromised conditions may predict dissemination in PC without HIV which can be identified by LFA.

Additional file 1. Table S1. Local reastion grading scale. Table S2. Systemic event grading scale. Table S3. Detailed information of allergic status. Table S4. Local and systemic reactions following vaccination among patients with eczema, uriticaria, aoptic dermatitis, and asthma. Table S5. Anti-SARS-CoV-2 IgG after 4 weeks of the second dose of vaccination in patients with AD and CG. Figure S1. The diagram depicts the enrollment and analysis of participants.

Xuxia Yu,1 Danyang Zhang,2 Qifa Song3 1Department of Hospital Infection, Ningbo City First Hospital, Ningbo, Zhejiang Province, People’s Republic of China; 2Department of Microbiology, Ningbo Municipal Centre for Disease Control and Prevention, Ningbo, Zhejiang Province, People’s Republic of China; 3Central Laboratory, Ningbo City First Hospital, Ningbo, Zhejiang Province, People’s Republic of ChinaCorrespondence: Qifa Song Email qifasong@126.comPurpose: Fluoroquinolone-resistant Shigella is considered a serious public health problem and has been put on the WHO global priority list of antibiotic-resistant bacteria. This study was aimed to investigate the fluoroquinolone resistance in Shigella and its relevant genetic mechanisms.Materials and Methods: Shigella isolates that were isolated from diarrheal patient’s feces in Ningbo China from 2011 to 2018 were tested for susceptibility to ampicillin, gentamicin, tetracycline, nalidixic acid, ciprofloxacin, and cefotaxime. Genes related to quinolone resistance were amplified by PCR.Results: A total of 118 Shigella isolates were collected, including 76 S. flexneri isolates, 40 S. sonnei isolates, and 2 S. boydii isolates. Ciprofloxacin susceptibility test identified 10 (9%) susceptible, 65 (55%) intermediate, and 43 (36%) resistant isolates. Of 76 S. flexneri isolates, 37 were ciprofloxacin resistant, a prevalence significantly higher than 6 of 40 S. sonnei isolates (P=0.01). The isolates collected during 2014– 2018 displayed a significant increase in the prevalence of ciprofloxacin resistance (P=0.05) than those collected during 2011– 2013. All the ciprofloxacin-intermediate and resistant isolates had mutations of gyrA(S83L) and parC (S80I), whereas only the ciprofloxacin-resistant isolates had gyrA (D87N) mutation and qnrB gene. Additionally, 30% of the ciprofloxacin-resistant isolates were positive for aac(6´)-Ib-cr gene.Conclusion: This study shows the currently increasing prevalence of ciprofloxacin resistance. The reduced fluoroquinolone susceptibility is highly associated with gyrA (S83L) and parC (S80I) mutations, while the fluoroquinolone resistance is highly associated with gyrA (D87N) mutation, qnrB gene and perhaps aac(6´)-Ib-cr gene.Keywords: Shigella, ciprofloxacin resistance, gyrA mutations, plasmid-mediated quinolone resistance, PMQR, quinolone resistance-determining region, QRDR

Purpose Several factors contribute to the complexity of quinolone resistance in Salmonella, including >2000 different Salmonella serotypes, a variety of hosts for Salmonella, and wide use of quinolones in human beings and animals. We thus aimed to obtain an overview of the development of quinolone resistance and relevant molecular mechanisms of such a resistance in Salmonella species. Materials and methods A total of 1,776 Salmonella isolates were collected in Ningbo, China, between 2005 and 2016. Antimicrobial susceptibility to quinolone and relevant genetic mechanisms in these isolates were retrospectively analyzed. Results The ratio for ciprofloxacin (CIP) resistant:reduced CIP susceptible:CIP susceptible was 26:522:1,228. CIP resistance was found in nine of 51 serotypes: Derby, London, Kentucky, Indiana, Corvallis, Rissen, Hadar, Typhimurium, and Agona. Of 26 CIP-resistant isolates, all were concurrently resistant to ampicillin and 21 were also concurrently resistant to cefotaxime and produced extended-spectrum β-lactamase (ESBL). The minimal inhibitory concentration values were at three levels: 2–4 μg/mL (serotypes except for Kentucky and Indiana), 16 μg/mL (one Kentucky isolate), and >32 μg/mL (Indiana isolates). As with the three most common serotypes, Salmonella Typhi showed quickly increased prevalence of reduced CIP susceptibility in recent years, Salmonella Enteritidis remained at a high prevalence of reduced CIP susceptibility throughout the study period, and several isolates of Salmonella Typhimurium were resistant to CIP. Transferable plasmid-mediated quinolone resistance gene qnrB was only found in all CIP-resistant isolates. In contrast, gyrA mutations were often found in reduced CIP-susceptible isolates and were not necessarily found in all CIP-resistant isolates. Conclusion We conclude that in Salmonella, there exists a high prevalence of reduced CIP susceptibility and a low prevalence of CIP resistance, which focuses on several serotypes. Our study also demonstrates that, rather than gyrA mutations, qnrB is the most common indicator for CIP resistance.

Li Li,1 Qifa Song,2 Xi Yang11Department of Endocrinology and Metabolism, Ningbo First Hospital, Ningbo, People’s Republic of China; 2Department of Microbiology, Ningbo Municipal Centre for Disease Control and Prevention, Ningbo, People’s Republic of ChinaCorrespondence: Qifa SongDepartment of Microbiology, Ningbo Municipal Centre for Disease Control and Prevention, No. 237, Yongfeng Road, Ningbo, Zhejiang Province 315010, People’s Republic of ChinaTel +86 05 748 727 4563Email qifasong@126.comObjective: Use of K-means clustering for big data technology to cluster an overweight and obese population metabolically.Methods: K-means clustering with the help of quantile transformation of attribute values was applied to overcome the impact of the considerable variation in the values of obesity attributes involving outliers and skewed distribution.Results: Overall, 447 subjects were categorized into six clusters; metabolically normal, mild, and severe categories. There were clearly separated metabolically normal Cluster 1 and severe Cluster 2, as well as intermediate Cluster 3, 4, and 5 that had profiles of fewer attributes with abnormal values. Cluster 3 was characteristic of sole hypertension. Cluster 3 and 4 exhibited contrasting HDL-C and LDL-C levels despite similarly elevated total cholesterol. Cluster 6 with slightly elevated triglyceride was closest to the normal group. Four- and 10-quantile-transformations yielded consistent clustering results. Compared with the original data, the quantile-transformed data produced more regular and spherical clusters and evenly distributed clusters in terms of object numbers.Conclusions: This big data analysis strategy makes use of quantile-transformation of data to overcome the issue of outliers and the irregular distribution and applies to the analysis of other non-communicable diseases.Keywords: overweight and obesity, big data technology, quantile-transformation, K-means clustering

Dingfeng Lv,1 Danyang Zhang,2 Qifa Song21Department of Clinical Laboratory, Ningbo First Hospital, Ningbo, Zhejiang Province, People’s Republic of China; 2Department of Microbiology, Ningbo Municipal Centre for Disease Control and Prevention, Ningbo, Zhejiang Province, People’s Republic of ChinaPurpose: This study was aimed to investigate the dynamics of antimicrobial resistance expansion among different lineages and isolates of S. Typhi.Materials and methods: The S. Typhi isolates were collected from the patients clinically suspected of typhoid fever in Eastern China during 2005–2017. All isolates were tested retrospectively for susceptibility to eight antimicrobials and the genes related to quinolone and ampicillin resistance, including gyrA, ParC, qnrA, qnrB, qnrS, aac(6´)-Ib-cr, qepA and blaTEM. The isolates were subtyped by PFGE.Results: Of 140 isolates, all were susceptible to ciprofloxacin, cefotaxime, chloramphenicol, and trimethoprim-sulfamethoxazole, 95 (68%) were nalidixic acid resistant, and 74 (53%) were ampicillin resistant. The resistance to ampicillin and nalidixic acid was first observed in 2006. Among the 95 nalidixic acid-resistant S. Typhi isolates, 62 possessed S83F mutation ingyrA and 25 possessed D87Y mutation. All ampicillin-resistant isolates harbored gene blaTEM-1. PFGE generated 47 distinguishable clonal lineages. Overall, 64% (89/140) belonged to seven prevalent lineages of clustering isolates. PFGE results illustrated the prevalence of nalidixic acid-resistant lineages increased steadily from 19% during 2005–2012 to 50% during 2013–2014, and thereafter to 74% during 2015–2017 and similar development of ampicillin-resistant lineages increased from 6% to 38%, and also to 39%.Conclusion: The present study indicated the clonal expansion of S. Typhi with ampicillin resistance and reduced ciprofloxacin susceptibility. The findings also suggested that the differential development of antimicrobial resistance to various antimicrobial agents in S. Typhi, showing the rapid increase in ampicillin resistance and reduced ciprofloxacin susceptibility, and the high susceptibility to other traditional antimicrobial agents.Keywords: ampicillin resistance, reduced ciprofloxacin susceptibility, Salmonella Typhi, clonal expansion

Dong Chen,1,* Qifa Song,2,* Zhaojun Xu,3 Dandan Zhang2 1Department of Clinical Laboratory, Sixth People’s Hospital of Wenzhou, Wenzhou, Zhejiang Province, People’s Republic of China; 2Department of Microbiology, Ningbo Municipal Center for Disease Control and Prevention, Ningbo, Zhejiang Province, People’s Republic of China; 3Intensive Care Unit, Ningbo No. 2 Hospital, Zhejiang, People’s Republic of China *These authors contributed equally to this work Purpose: This study aims to characterize the wild-type staphylococcal enterotoxin A (SEA)-producing Staphylococcus aureus.Materials and methods: We identified 29 wild-type sea-positive S. aureus isolates from dairy and meat samples, as well as from patients, measured the amount of SEA produced under favorable cultivation conditions using enzyme-linked immunosorbent assay and sea mRNA transcriptional level and investigated the phage type as well as genetic diversity by means of pulsed-field gel electrophoresis and multilocus sequence typing.Results: Among 29 sea-positive isolates, 22 were from food sources (including one outbreak case) and seven from clinical patients. Five enterotoxin gene profiles, namely, sea (14 isolates), sea+sec (9 isolates), sea+seb (4 isolates), sea+seb+sec (1 isolate) and sea+seb+sed (1 isolate), were identified. Multilocus sequence typing generated sequence type (ST)1 (13 isolates), ST6 (5 isolates), ST59 (3 isolates), ST239 (3 isolates), ST5 (2 isolates), ST188 (2 isolate) and ST15 (1 isolate). The amount of SEA per 108colony-forming unit (CFU) after 24h of incubation was 1.1–33.5 (mean, 8.74; SD, 7.7) ng/108CFU. The amount of SEA per hour incubation in the log growth phase was 0.1–12.0 (mean, 2.37; SD, 3.06) ng/108CFU. Overall, 54.2% of SEA was produced in the log growth phase. Both the transcriptional level of sea mRNA and the amount of SEA in the log growth phase correlated well with the amount of SEA after 24h of cultivation. Four isolates, namely, SA-212, SA-217, SA-340 and SA-341, were categorized to be of high SEA production (877–1,109 ng/mL, 24h). The total amount of SEA was mainly based on the amount of SEA in 108CFU, not the relatively fixed bacterial cell counts (21.1–43×108CFU/mL). Seven isolates from patients all carried the ФMu3A phage, whereas 21 of the 22 isolates from the environmental sources all carried the ФSa3ms phage.Conclusion: The present study exhibits varied SEA production capacity of the wild sea-positive S. aureus strains. An apparent boundary in phage types between strains from the clinical samples and strains from the environment was also identified. Keywords: Staphylococcus aureus, staphylococcal enterotoxin A, multilocus sequence typing, phage, SEA productioncapacity

Many fingerprint matching algorithms have been reported in articles in recent years. And people did fingerprint images matching through minutiae matching in most of the algorithms. In this paper, we proposed a new fingerprint minutiae matching algorithm, which is fast, accurate and suitable for the real time fingerprint identification system. In this algorithm we used the core point to determine the reference point and used a round bounding box for matching. Experiments done on a set of fingerprint images captured with a scanner showed that our algorithm is faster and more accurate than Xiping Luo's algorithm.