Volume 98 ·  Issue 42 ·  2018

Natural fructose is found in ripe fruits, honey and a small amount of vegetables such as carrots, onions, sweet potatoes and chili powder. In addition, sucrose, which is ubiquitous in plants, is also broken down and converted into fructose. Fructose is the main component in human food, which is mainly metabolized by the liver. After metabolism, it becomes the substrate of glycolysis or gluconeogenesis. Since fructose does not increase fasting blood glucose levels and does not require insulin metabolism, intravenous administration is effective in ameliorating diabetic ketosis. Fructose syrup has entered the food industry in large quantities as a substitute for sugar since the 1960s, resulting in a large increase in fructose intake per capita, that is, a high fructose diet. However, subsequent studies found that a high fructose diet can increase the levels of plasma triacylglycerides, free fatty acids, uric acid, etc., and induce heart, brain, kidney and vascular diseases. Recent studies have revealed that metabolic syndrome induced by high fructose diet may be related to abnormal intestinal microecology, disruption of intestinal barrier and inflammatory response of the body. To this end, this article will focus on the interaction of fructose with intestinal microecology and its impact on chronic kidney disease (CKD).

Protein-energy wasting (PEW) has been shown to be a strong predictor of poor prognosis in maintenance hemodialysis (MHD) patients. PEW is present in 18% to 48% of patients with chronic kidney disease (CKD), and this proportion can be as high as 75% of patients with MHD, and it is closely related to dialysis-related complications and high mortality^[1]。 Therefore, it is important to attach importance to the assessment of protein energy consumption for the therapeutic goals and clinical prognosis of dialysis patients.

stress ulcer (SU) refers to acute gastrointestinal mucosal erosion, ulcer and other lesions that occur under various stress states such as severe trauma, critical illness or severe mental illness. In severe cases, it can be complicated by gastrointestinal bleeding or even perforation, which can aggravate and worsen the original disease and increase the mortality rate. Therefore, prevention of SU is a link that cannot be ignored in the treatment of critically ill patients. SU can be manifested as acute gastric mucosal lesions, acute erosive gastritis, acute hemorrhagic gastritis, peptic ulcer, etc. under endoscopy.

bone marrow failure (BMF) is a group of diseases mainly caused by hematopoietic stem/progenitor cell damage. Its clinical manifestations are complex and diverse, including hereditary and acquired. Acquired bone marrow failure diseases mainly include myelodysplastic syndrome (MDS), aplastic anemia (AA), pure red blood cell aplasia (PRCA), paroxysmal nocturnal hemoglobinuria (PNH), large granular lymphocytic leukemia (LGL) and primary myelofibrosis (PMF), etc., which together show progressive and persistent bone marrow failure, and most patients will develop refractory anemia. This consensus focuses on the therapeutic application of recombinant human erythropoietin (rHu EPO) in acquired bone marrow failure diseases.

To examine the relationship between low serum parathyroid hormone (PTH) and protein-energy wasting (PEW) in patients who underwent maintenance hemodialysis (MHD) treatment.

A cross-sectional study was conducted in MHD patients between June 2015 and August 2017 in 11 MHD centers from Guizhou province. Body composition and physical parameters were measured, clinical data and other related laboratory values were collected according to the medical record system. Participants were assigned to low serum PTH group (PTH<150 ng/L), target PTH group (150 ng/L≤ PTH ≤300 ng/L) and high serum PTH group (PTH>300 ng/L). Multivariate logistic regression analysis was used to analyze the relationship between low serum PTH and risk of PEW, which was diagnosed according to the diagnostic criteria recommened by the International Society of Renal Nutrition and Metabolism (ISRNM).

A total of 873 MHD patients (488 males and 385 females) were included in the final analysis, with a mean age of 55.0 (44.0, 67.0) years and a mean hemodialysis duration of 31.0(17.0, 54.0) months. In unadjusted model, low serum PTH group was associated with PEW (OR=2.12, 95% CI: 1.26-3.54, P=0.004), when compared with high serum PTH group. After adjustment for age and sex, low serum PTH group was still significantly associated with PEW (OR=2.09, 95% CI: 1.23-3.52, P=0.006). Further adjustment for diabetes and hypertension, the correlation between low serum PTH group and PEW was still significant (OR=2.02, 95% CI: 1.04-3.90, P=0.037). However, the correlation was not observed in target PTH group and high serum PTH group.

Low serum PTH was associated with risk of PEW, regardless of age, sex, history of diabetes and hypertension, and thus it might be a promising indicator of PEW in MHD patients.

To investigate the effect of hyperphosphatemia on long-term patency of arteriovenous fistula (AVF) of patients with late fistula dysfunction/failure after reoperation.

The study was carried out in the Department of Nephrology of the First Affiliated Hospital of Tsinghua University between March 2012 and March 2013. A total of 136 maintenance hemodialysis patients[73 males, 63 females, with an average age of (57.7±16.1) years]with late AVF dysfunction/faliure who received AVF reoperation were enrolled in the study. After follow-up for 3 years, 118 patients were left and divided into two groups: fistula dysfunction group (n=38), fistula patency group (n=80). Patients were aslo divided into two groups according to the blood phosphorus level: the blood phosphorus >1.78 mmol/L group ( n=53) and the blood phosphorus ≤1.78 mmol/L group (n=65). t test was used to compare the serum phosphorus levels of patients with dysfunction group and fistula patency group. Patency rate was calculated by survival analysis method and log-rank test was used to compare secondary patency rate between groups of blood phosphorus >1.78 mmol/L and blood phosphorus ≤1.78 mmol/L. Multivariate Cox regression was used to analyze the influencing factors.

The average blood phosphorus level was significantly higher in dysfunction group[(1.87±0.42) mmol/L vs (1.65±0.39) mmol/L, P=0.008], and patency rate was significantly lower in patients of blood phosphorus>1.78 mmol/L group than that in patients of blood phosphorus ≤1.78 mmol/L (42.2% vs 60.4%,P=0.009). Blood phosphorus>1.78 mmol/L (RR=2.527, 95% CI: 1.272-5.023, P=0.008), diabetes (RR=2.667, 95% CI: 1.339-5.313, P=0.005) and C-reactive protein (CRP)>5 mg/L (RR=2.749, 95% CI: 1.324-5.710, P=0.007) were risk factors affecting secondary patency rate of internal fistua.

Hyperphosphatemia is an independent risk factors for the patency rate of AVF after reoperation in hemodialysis patients.

To evaluate the relationship between surrogate markers of visceral obesity[hypertriglyceridemic waist (HW) phenotype, visceral adiposity index (VAL), lipid accumulation product (LAP)]and atherosclerosis in hemodialysis patients.

A multi-center cross-sectional study was carried out. A total of 961 maintenance hemodialysis (MHD) patients from 11 hemodialysis centers of Guizhou province between July 2016 and September 2017 were enrolled in the study. Anthropometric measures were performed in all subjects. Laboratory parameters including triglyceride, high-density lipoprotein cholesterol, low-density lipoprotein-cholesterol were extracted from the medical records by researchers. Pearson correlation analysis was used to investigate the correlation between HW phenotype, VAI, LAP and plasma atherosclerotic index (AIP). Multivariate linear regression analysis was used to evaluate factors affecting AIP.

Totally, 585 men and 376 women aged 18-90 years, with a mean age of (56.08±15.42) years were recruited in the study. Pearson correlation analysis showed that VAI (men: r=0.82, women: r=0.84), LAP (men: r=0.73, women: r=0.74) and having HW phenotype (men: r=0.62, women: r=0.63) correlated positively with AIP (all P<0.001). Multivariate linear regression analysis showed that VAI (men: β=0.77, women: β=0.82) and LAP (men: β=0.73, women: β=0.73) were independent associated factors of AIP after adjustment of BMI, age, smoking and history of diabetes and hypertension (allP<0.001).

Surrogate markers of visceral obesity such as having HW phenotype, VAI, LAP correlated positively with AIP. VAI, LAP has positive impacts on AIP independent of BMI, age, smoking and other traditional atherosclerosis risk factors.

To investigate the relationship of DNA oxidative product 8-oxo-dGsn and RNA oxidative product 8-oxo-Gsn with chronic kidney disease (CKD).

Between January 2015 and December 2016, 146 cases of CKD (30, 30, 31, 30 and 25 cases of CKD stage 1-5, respectively) were collected in the Department of Nephrology in Beijing Hospital. Among them, 70 cases were male, accounting for 47.95%. The age distribution ranged from 21 to 88 years, with an average age of (56.43±16.79) years. Their fasting blood and morning urine were collected. The levels of 8-oxo-dGsn and 8-oxo-Gsn in plasma and urine were quantified by isotope-diluted liquid chromatography mass spectrometry (MS)/MS (ID-LC-MS/MS).

The urine 8-oxo-Gsn/Cr in patients with CKD stage 1-5 was (3.07±1.07) μmol/mol, (3.42±1.34) μmol/mol, (3.72±1.47) μmol/mol, (3.90±1.93) μmol/mol and (3.75±2.26) μmol/mol, respectively. The urinary 8-oxo-Gsn content in CKD stage 4 patients was significantly higher than those of other 4 stages ( P<0.05). The serum/urine ratio of 8-oxo-Gsn was 0.02±0.02, 0.03±0.02, 0.06±0.04, 0.10±0.05 and 0.34±0.03, respectively, and in CKD stage 4 and 5 patients, it increased significantly, especially in CKD stage 5 cases (P<0.05). Expression of 8-oxo-Gsn had a good correlation with renal function[the Spearman ′s correlation coefficient: serum 8-oxo-Gsn and serum creatinine was 0.629 (P<0.001); urine/serum 8-oxo-Gsn and eGFR was 0.799 (P<0.001); serum/urine 8-oxo-Gsn and serum/urine creatinine was 0.888 (P<0.001)]. With age increasing, CKD patients showed increased RNA oxidation, and 8-oxo-Gsn increased significantly in patients over 60 years (P<0.05). After multiple linear regression analysis, 8-oxo-Gsn was only associated with serum creatinine (β=0.656,t=8.275, P<0.001).

Our finding indicates that the RNA oxidation occurs in patients with renal disease, and its oxidation increased as the disease progressing. The significant increase in the ratio of plasma and urinary 8-oxo-Gsn is of great importance on evaluating renal function.

To investigate the association between Thymidine phosphorylase(TYMP)genetic variation and clinical outcomes of postoperative gastric cancer (GC) patients received capecitabine based regimens.

A total of 198 GC patients underwent surgical treatment and received capecitabine based adjuvant chemotherapy were included in this retrospective study. Peripheral blood and the postoperative tissue specimen of the GC patients were collected for the genotyping of polymorphism and TYMP mRNA expression, respectively. The correlation between polymorphism and clinical outcomes and safety of postoperative GC patients were analysed.

Located in the upstream, rs11479 was of clinical significance. The prevalence of rs11479 in TYMP among the GC patients were as follows: CC genotype 125 cases (63.13%), CT genotype 65 cases (32.83%), TT genotype 8 cases (4.04%), minor allele frequency of rs11479 is 0.20. The distribution of three genotypes were in accordance with Hardy-Weinberg Equilibrium (P=0.901). The analysis results of patients with different genotypes found that the 3-year disease free survival rate of the patients with CT/TT genotype and CC genotype were 73.97% and 65.60%, respectively, which was statistically significant (P=0.003). In terms of overall survival, the 3-year overall survival rate of the two genotypes were 83.56% and 72.80% (P=0.012), respectively. Adjusted in multivariate Cox regression analysis, CT/TT genotype was an independent favorable factor for disease free survival (OR=0.55, P=0.011). Safety analysis indicated that there was no significant association between genotypes and grade 2 adverse reaction. Additionally, of the 79 postoperative tissue specimens, the results showed that the expression of TYMP in cancer tissues of the patients with CT/TT genotypes were significantly higher than those of the wild type CC genotype patients (P<0.001).

The polymorphism rs11479 of TYMP have favorable influence on the clinical outcomes of gastric cancer patients received capecitabine based adjuvant chemotherapy treatment through changing the mRNA expression of TYMP.

To analyze the de novo point mutations in known genes among patients with unexplained intellectual disability (ID) or developmental retardation (DD).

A total of 120 outpatients with ID or DD were recruited in the Department of Neurology, Affiliated Children′s Hospital of Capital Institute of Pediatrics between September 2015 and April 2017. Target gene sequencing was used to screen the candidate gene. The sequencing data were analyzed by a variety of bioinformatics software. Combining with the phenotypes of the patients, the candidate genetic/genomic variants were identified from next-generation sequencing data. The final pathogenicity of the genetic/genomic variants were interpreted according to the guideline of the American College of Medical Genetics and Genomics (ACMG) for variants after segregation analysis in the parents and necessary family members by Sanger sequencing. The comprehensive physiological function and signaling pathways of 20 disease genes with de novo point mutation discovery was also studied.

Among the 120 patients, 23 patients were found to carry clear pathological changes, and the incidence of de novo point variation was 19.2%. The patients included 12 males and 11 females, with an age of 2 months to 6-year-6-month. Five patients were diagnosed with early onset of epileptic encephalopathy. Seven had mental retardation type 5, 6, 8, 19, 20, 22, 39, respectively. Weill-Marchesani syndrome type 2 was found in one case, Wiedemann-Steiner syndrome in one case, Coffin-Siris syndrome in two cases, Rubinstein-Taybi syndrome in one case, GLUT1 deficiency syndrome in one case, Rett syndrome in one case, cardio-facio-cutaneous syndrome 3 in one case, neurodegeneration with brain iron accumulation in one case, corpus callosum local dysplasia in one case, and congenital fibrosis of the extra-ocular muscles in one case. A total of 20 novel mutations were reported in this study. No somatic mutation was found in the samples of 6 patients with mutation and their parents′ peripheral blood DNA samples by amplicon-based deep sequencing. This study found that the main disease genes were involved in chromatin remodeling, transcriptional regulation, autophagy body assembly, MAPK signal pathway, DNA methylation, potassium, sodium ion transport, cell skeleton assembly and skeletal muscle development. These genes were significantly enriched in the following biological processes: Ras signaling pathways, transcription factor binding and cancer related signaling pathway.

The etiology of children affected with intellectual disability or developmental delay is complex. Harmful de novo point mutation plays an important role in these diseases. Targeted exome/genome sequencing based on the core family is helpful for the molecular diagnosis of patients and the discovery of more genes.

To explore the safety and efficacy of mesogastrium excision above the pancreas by the right approach in radical distal gastrectomy for cancer.

A total of 154 distal gastric cancer patients in the Department of Gastrointestinal Surgery of the first affiliated Hospital of Chongqing Medical University, from October 2013 to October 2014, were included in this random controlled study. These patients were divided into the study group (n=78), who received mesogastrium excision above the pancreas by the right approach, and the control group (n=76), who received mesogastrium excision above the pancreas when by the left approach.

No significant differences were observed between the two groups in terms of the number of lymph node, postoperative recover, complications and 3-year survival rate(P>0.05), while significant differences were observed between the two groups in terms of operation time and surgical bleeding(P<0.05).

In radical distal gastrectomy for cancer, the safety and efficacy for mesogastrium excision above the pancreas were the same by the right approach, compared to by the left approach, however, the group by the right approach had the advantage on the operation time and surgical bleeding.

Intraplaque hemorrhage (IPH) is one of the most important causes of ischemic stroke. The purpose of this study was to explore the association between carotid IPH and CD147, which may be the serum marker related to IPH.

Serum samples were collected from 68 patients with carotid artery stenosis from April to September 2004. 3.0T MRI with the 8 channel surface coil was used to scan carotid artery. Images was processed by MRI-PlaqueView. The integrity of lipid, IPH, calcified components and fibrous cap in the plaque was analysed qualitatively and quantitatively. The correlation and difference analysis among serum CD147 and plaque components were carried out.

Serum CD147 level in IPH positive was higher than that in IPH negative, 5 510.1 vs 4 648.0 (P=0.04). There was no significant correlation among serum CD147 and the quantitative parameters of lipid, IPH and calcification in carotid plaque and fibrous cap rupture. Serum CD147 in patients using statins was lower than that in patients not using statins, 4 914.0 vs 5 926.7 (P<0.01). Serum total cholesterol and LDL were positively correlated with serum CD147. In patients without statin, serum CD147 had a better diagnostic value for carotid IPH (AUC=0.81,P=0.04, 95% CI 0.62-0.99).

Serum CD147 would probably be one biomarker of IPH and shows good diagnostic value of carotid IPH in the specific population.

To improve the understanding and treatment of IgG4-related lung disease (IgG4-RLD) by analyzing the clinical characteristics of patients.

A total of 13 patients with IgG4-related lung disease (IgG4-RLD) diagnosed by pathology at Zhongshan Hospital affiliated to Fudan University during December 2007 to December 2017 were included. The clinical characteristics, chest CT, pathological features, serum IgG4 levels, therapy and prognosis of these 13 patients were analyzed.

The 13 patients with IgG4-RLD included 8 men and 5 women, with an average age of (51.1±14.8) years. The clinical manifestations were varied, 10 patients showed respiratory symptoms, mainly including cough (n=9), expectoration (n=6), hemoptysis (n=6), chest tightness (n=2) and breathless (n=2). Multiple organs were involved in 12 cases. Chest CT showed solid lung nodules (n=9), ground glass shadows (n=1), alveolar-interstitial infiltration (n=3), bronchovascular lesions (n=3), and the solid lung nodules was predominant. Enlargement of lymph nodes in the mediastinal and bilateral hilum of the lung were present in 10 cases. Serum IgG4 levels were elevated in all the 13 cases, with an average concentration of (7.92 ±13.98)g/L. Quite amount of lymphocytes, plasma cell infiltration and fibrosis were common pathologic findings. Immunohistochemical staining showed a large number of IgG4 positive plasma cells infiltration with IgG4 positive plasma cells count 10-320/HP in 13 cases. The ratio of IgG4 positive plasma cells to IgG positive plasma cells was higher than 40%. Eight patients received glucocorticoid therapy alone, five received glucocorticoids with immunosuppressant therapy. After treatment, 10 patients were with remission, and disease progressed in 3 patients, but no death.

The clinical manifestations and imaging features of IgG4-RLD are diverse, and lesions can often involve multiple organs. The diagnosis could be made based on pathological features and IgG4 serum levels. Glucocorticoid can be used as the first choice for the treatment of IgG4-RLD.

To investigate the effect of microRNA-221 (miR-221) overexpression on gefitinib resistance in PC-9 cells and study its underlying mechanisms.

PC-9 cells were transfected with LV-NC and LV-miR-221 to establish cell stabilizing strains (PC-9/NC and PC-9/miR-221), then they were used to detect the relative expression of miR-221 and apoptotic protease activating factor-1 (APAF-1) mRNA by real-time fluorescence quantitative PCR (qRT-PCR). The effects of gefitinib (0-4 μmol/L) on the growth and proliferation of cell stabilizing strains were detected by CCK-8 Assay. After gefitinib treatment, cell apoptosis was detected by Flow Cytometry Assays. The expression of epidermal growth factor receptor (EGFR), phosphorylated epidermal growth factor receptor (p-EGFR), APAF-1 and cleaved cysteinyl aspartate specific proteinase-3 (Cleaved-caspase-3) were detected by Western blot. Dual-Luciferase Reporter Assay was used to evaluate the relationship between APAF-1 and miR-221.

The relative expression of miR-221 in PC-9/NC cells was significantly lower than that in PC-9/miR-221 cells[(1.00±0.082) vs (40.24±0.017)](P<0.01). The half maximal inhibitory concentration (IC₅₀) in PC-9/NC cells was significantly lower than that in PC-9/miR-221 cells[(IC₅₀=0.1 μmol/L) vs (IC ₅₀>4 μmol/L)](P<0.05). Apoptosis rate of PC-9/NC cell was significantly higher than PC-9/miR-221[(33.42±4.28)% vs (10.27±1.12)%](P<0.05); APAF-1 mRNA expression was significantly higher in PC-9/NC cells than PC-9/miR-221[(1.000+ 0.069) vs (0.701±0.072)](P<0.05), and the expression of APAF-1 protein in PC-9/NC cells was significantly higher than that of PC-9/miR-221 cells. The dual luciferase reporter gene results showed that miR-221a inhibited luciferase activity significantly stronger than transfected miRNA negative control group after co-transfection of luciferase plasmids pmir-REPORT-APAF-1-wt and miR-221a mimics (P<0.01). p-EGFR was down-regulated in both PC-9/NC and PC-9/miR-221 cells after treatment with gefitinib. APAF-1 and Cleaved-caspase-3 proteins were significantly down-regulated in PC-9/miR-221 cells compared with PC-9/NC cells, while APAF-1 and Cleaved-caspase-3 proteins were up-regulated in PC-9/NC cells treated with gefitinib compared with PC-9/miR-221 cells (P<0.05).

miR-221 induces resistance to gefitinib in PC-9 cells by downregulating APAF-1 expression.

A 44-year-old female was admitted to the hospital on December 9, 2017 due to "hearing loss in both ears, pus discharge for more than 1 month, fever, cough and expectoration for more than 20 days". In mid-October 2017, he complained of hearing loss, headache, fever in his right ear, body temperature of 38.5 ℃, accompanied by chills, chills, cough, cough of yellow purulent phlegm, phlegm is not easy to cough up, smelly, and then pus appeared in both ears, which was yellow-green pus, viscous, not much, accompanied by pain, no discomfort such as hemoptysis, night sweats, chest tightness, chest pain, etc., and was hospitalized in the Department of Otolaryngology of the local people's hospital.⁹Neutrophils 0.850/L. C-reactive protein>200 mg/L, purulent secretion culture of left ear: Pseudomonas aeruginosa, chest CT examination considering infection of both lungs and multiple abscess formation; Nasopharyngeal magnetic resonance: (1) nasopharyngeal mass, it is recommended to enhance scanning for further examination; (2) bilateral otomastoiditis; (3) Thickening of nasal mucosa of ethmoid sinus and effusion of sphenoid sinus. The pathology of nasopharyngeal biopsy showed chronic inflammation of the nasal mucosa. After administration of piperacillin, sulbactam and metronidazole against infection, the body temperature fluctuated in 38.5~39℃, cough and sputum increased, cough was accompanied by chest tightness and shortness of breath when it was severe, cough was more yellow-green thick purulent sputum with a foul smell, the amount was about 150~250 ml/d, and it was found that the frontal lines on the left forehead were reduced, the eyelids were difficult to close, the corners of the mouth were skewed to the right, the speech was vague, eating or drinking water was easy to leak out, the sputum cultured Pseudomonas aeruginosa and Candida albicans, and no acid-fast bacilli were found. Meropenem combined with diflucon was given for anti-infective treatment, but the symptoms were not improved. Reexamination of chest CT showed that the lesions of both lungs progressed compared with before. The patient went to the First Affiliated Hospital of Guangxi Medical University for further diagnosis and treatment, and was admitted to the Department of Respiratory Medicine with "multiple abscesses in both lungs". Since the onset of the disease, the body mass has decreased by about 3 kg. Past physical health, denying the history of infectious diseases and tobacco and alcohol addiction.

A 37-year-old male developed cough and sputum with chest tightness without obvious trigger 2 months ago. The cough was paroxysmal, and the sputum was mostly yellow sputum, but the amount was not much. The sputum appeared intermittently with blood, but the amount was not much, and the color was bright red, occasionally dark red. The symptoms of chest tightness were mild, aggravated after activity, and relieved after rest. After repeated symptomatic treatment such as anti-infection and cough relief outside the hospital for 2 months, the symptoms were not significantly relieved. In the past, he underwent resection of right inguinal schwannoma in the Fourth Hospital of Jilin University 15 years ago, and resection of posterior bladder schwannoma in China Medical University 5 years ago. There was no family history of neurofibroma or schwannoma. The patient drank alcohol intermittently for 15 years, about 2 times/week, 250 g/time; Denial of smoking history.

In recent years, a large number of studies have found that malnutrition is an important reason that affects the long-term survival rate and quality of life of patients with chronic kidney disease. In 2008, the International Society for Renal Nutrition and Metabolism proposed a new concept, "protein energy wasting", to reflect the nutritional status of patients with chronic kidney disease. Protein energy consumption refers to the state of nutritional deficiency in patients with chronic kidney disease due to insufficient intake, increased body demand or additional loss of nutrition, resulting in protein and/or energy failing to meet the body's metabolic demand.

Maliasis is a class of zoonotic infectious diseases caused by Burholderia mallei (Bp). Southeast Asia, centered in Thailand, and northern Australia are the two major endemic areas. In tropical developing countries, melioidosis is a potential emerging infectious disease. Southern China is considered to be a high endemic area of melioidosis. Due to the convenience of transportation, the development of tourism and other factors, melioidosis has been reported in other provinces in China. Malix is known as "like hundreds of diseases", and it is very similar to tuberculosis in clinical manifestations, pathology and imaging features, especially when pulmonary infection is very similar to pulmonary tuberculosis. It is difficult to correctly diagnose malx in areas with high incidence of tuberculosis; Nervous system infection can be misdiagnosed as malignant tumor^[1]； Skin and soft tissue infections are also easily misdiagnosed as Staphylococcus aureus infections, so gangrene is often missed, thus delaying the opportunity of treatment. In addition, Bp is naturally resistant to a variety of antibiotics such as penicillin, ampicillin, first and second generation cephalosporins, macrolides, aminoglycosides, polymyxin, etc. Although quinolone antibiotics have slight antibacterial activity in vitro, the treatment failure rate is high, so the types of drugs selected for the treatment of mallei are limited. At present, the reference standard for domestic drug susceptibility test is the American Clinical and Laboratory Standards Committee (CLSI). In this standard, the only antibiotics for Bp are amoxicillin/clavulanic acid, ceftazidime, imipenem, doxycycline, tetracycline and compound sulfamethylazole^[2]。 Moreover, the mortality rate of human infected with rhinoid varies from 30% to 80%, and even if it is effectively controlled, rhinoid has a high recurrence rate^[3]In order to avoid recurrence, a long course of treatment is required. The clinical and laboratory research progress of mallex is summarized as follows.