目的:探究居民就医行为的影响因素并提出对策建议,为促进居民就医行为合理化、推进分级诊疗制度建设提供依据.方法:利用2015年中国健康与营养调查(CHNS2015)数据,通过卡方检验和逻辑回归分析,探究居民就医意愿和就医选择的影响因素.结果:地区、医保类型和居民健康状况会影响居民的就医意愿,婚姻状况、年龄和地区会影响居民对医疗机构的选择.结论:居民就医行为受个人特征和政策因素的影响,因此既要引导居民养成良好的就医习惯,同时应进一步完善医保政策,以促进分级诊疗健康发展.

目的 深入剖析医务人员求职全过程的内在需求和心理感受,分析新冠肺炎疫情对招聘工作各方面的影响,对疫情常态化的阶段招聘工作提出建议.方法 将2017年1月1日至2020年12月31日参加招聘的3755名应聘者纳入研究,运用卡方检验分析疫情发生前2017年1月1日至2019年12月31日与疫情发生后2020年1月1日至2020年12月31日招聘效果各指标的差异.对2020年1月1日至12月31日招录的55名医护人员进行半结构化访谈.运用卡方检验、秩和检验、Spearman等级相关法分别分析医护人员在应聘行为上的差异、竞争力自我评价的差异、以及竞争力自我评价与人员基本特征的关系.结果 与新冠肺炎疫情发生前相比,应聘比基本持平,录用比(x2=14.295,P=0.000)、完成比(x2=7.512,P=0.006)明显降低.医护间对应聘单位概况和学科发展的了解程度存在差异(x2=30.306,P=0.000).求职准备阶段产生花销的项目主要为制作简历(38/50)、拍摄高端证件照(29/50)、购置服装和化妆品(20/50)以及参加专业就业指导(10/50).购置服装和化妆品(16/50)以及拍摄高端证件照(12/50)被认为是最应省略的两项准备工作.护士简历投递的数量高于医师,差异具有统计学意义(P=0.027).求职过程中医护主观体验基本一致.医师在专业知识、技能操作、英语水平、毕业院校、导师声誉、学习成绩、论文科研几方面的竞争力自我评价高于护士.新冠肺炎疫情影响下,大多数求职者求职信心降低.尤其非京籍求职者留京信心降低明显,并因此降低了期望薪酬(x2=6.070,P=0.014).结论 受新冠肺炎疫情影响,招聘完成度显著降低.医师的自我评价高于护士,但整体求职信心、留京信心、期望薪酬均有所降低.为适应疫情常态化,应努力完善线上招聘笔试、面试相关技术应用.建议根据医护人员专业特点和应聘行为特点,进行精细化分层就业指导,以提高招聘效率.

目的:评价研究小儿肺炎采用小剂量多巴胺联合酚妥拉明治疗的效果及安全性.方法:于2019年1月-2020年8月为时限,以接受治疗的肺炎患儿80例为对象,依据不同干预方案分设2组对照研究,各为40例.采取常规疗法治疗参照组,在此前提下采用小剂量多巴胺联合酚妥拉明治疗试验组.比较2组总有效率、治疗情况及安全性.结果:2组对比总有效率、肺啰音、气促、咳嗽等消失及住院时间的数据表明试验组更优,满足统计要求(P<0.05);2组均未发生严重不良反应.结论:小儿肺炎采用小剂量多巴胺联合酚妥拉明治疗的效果显著,即可快速、有效改善患者各种症状,且安全性高,无严重不良反应,可做进一步推广.

目的:观察黄连解毒汤对高脂饮食导致的apoE基因敲除(apoE-/-)小鼠血脂水平、肠道菌群、单胺氧化酶(monoamine oxidase,MAO)活力及其脂肪肝和血管动脉粥样硬化(atherosclerosis,AS)斑块形成的影响.方法:8周龄雌性apoE-/-小鼠给予高脂饮食,治疗组同时给予黄连解毒汤或阿托伐他汀干预,4周后常规检测血脂水平,检测血浆和肝脏的MAO活力;取小鼠结肠内容物,16S rRNA相对应的DNA序列(16S rDNA)检测肠道菌群,干预18周后病理检测主动脉血管动脉粥样硬化(AS)斑块和脂肪肝形成情况.结果:高脂饮食导致apoE-/-小鼠血浆总胆固醇(cholesterol,TC)和低密度脂蛋白(low density lipoprotein,LDL)水平升高(P<0.001),差异有统计学意义;血浆和肝脏检测MAO活性增高(P<0.05),差异有统计学意义;结肠菌群α多样性增加,变形菌门增加,拟杆菌门减少.黄连解毒汤干预4周,血脂水平无明显改变,血浆和肝脏MAO活力降低(P<0.05),差异有统计学意义;结肠菌群α多样性降低,厚壁菌门和变形菌门减少,拟杆菌门和疣微球菌门增加;干预18周高脂导致apoE-/-小鼠肝脏脂肪肝病变和主动脉血管AS斑块形成,黄连解毒汤明显干预改善脂肪肝和主动脉血管AS斑块病变程度.结论:黄连解毒汤可能通过调节肠道菌群失衡,降低MAO活性,从而抑制高脂饮食导致apoE-/-小鼠非酒精性脂肪性肝病(non-alcholic fatty liver disease,NAFLD)和AS斑块的形成.

目的 探讨医务人员离职风险因素并对其进行定量分析,为开展离职风险管理提供决策依据.方法 搜集2007年1月至2016年12月期间我院所有医务人员信息,比较医师、护士、医技岗位间生存函数的差异,并建立Cox比例风险回归模型.结果 护士的离职风险是医师的10.431倍;职工年龄每增加1岁离职风险下降为前1年的69.9％;调入人员离职风险是应届毕业生的3.756倍;硕士研究生学历职工离职风险是本科及以下人员的2.721倍.医师年龄每增加1岁离职风险是前1年的88.7％;硕士研究生学历职工离职风险是本科及以下学历医师的5.019倍.护士年龄每增加1岁离职风险是前1年的55.0％;女护士离职风险是男护士的0.542倍;调入护士离职风险是应届毕业护士的9.702倍.医技岗位职工年龄每增加1岁离职风险为前1年的71.4％;调入人员离职风险是应届毕业生的3.210倍.结论 早期入职的护士,尤其是男护士的离职风险较高;硕士研究生学历医师的离职风险较高;调入护士和医技人员离职风险较高.

目的:研究重症肺部感染抗生素治疗中降钙素原(PCT)指导的临床效果.方法:于2019年1月-2020年10月为时限,以接受重症肺部感染抗生素治疗的患者60例为对象,依据不同干预方案分设2组对照,各为30例.采用抗生素常规治疗参照组,在此前提下采用PCT指导治疗试验组.比较2组相关指标变化及恢复情况.结果:2组对比治疗后CRP、PCT等水平、住ICU、使用抗生素及住院等时间的数据表明试验组更优,满足统计要求(P<0.05).结论:重症肺部感染抗生素治疗中PCT指导的效果显著,即可有效改善炎症,缩短治疗及恢复时间,可做进一步推广研究.

目的 衡量我国31省市卫生资源配置和卫生服务利用方面的公平性,以实现卫生资源的合理配置,有效满足人们日益增长的卫生服务需求.方法 利用中国国家统计年鉴及卫生和计划生育统计年鉴数据,对卫生资源配置和卫生服务利用进行集中指数的定量分析.结果 2016年我国31省市医疗卫生机构、卫技人员、医疗床位配置的集中指数分别是-0.0869,0.0497和-0.0084;门诊服务利用的集中指数为0.1462,住院服务利用的集中指数为0.0117.1998—2016年集中指数呈现出下降趋势,即卫生资源的配置和利用越来越公平.结论 政府要加强卫生区域规划,合理配置我国地区间卫生资源,加快组建医联体步伐,实现分级诊疗,提高居民卫生服务利用效率.

Objective To determinate the role of autophagy-related gene 5 (Atg5) in the stenosis of vein graft after inferior vena cava transplantation in mice. Methods Thirty male C57BL/6 wild type mice and 20 Atg5+ /- mice were divided randomly into into a WT sham operation group (n=10), a WT surgery group (10 recipients, 10 donors), and an Atg5+ /- surgery group (10 recipients, 10 donors). HE staining was used to detect the stenosis of vein graft. The mRNA level of Atg5 and LC3 was detect by Real-time PCR. The protein of Atg5 and LC3 were measured by Westem-Blot. Immunofluorescence was used to analyze the specific cell type. Results The lumen of vein grafts in Atg5+ /- mice at 4 weeks after the inferior vena cava transplantation was wider than that in WT mice [(4.21±0.32)×104 μm2vs. (1.63±0.15) ×104 μm2, P<0.05], with increased Atg5 [(0.51±0.17)×10-3vs. (1.49±0.08)×10-3], LC3[(1.9±0.4)×10-2vs. (3.8±0.9)×10-2] mRNA expression in vein graft of WT mice (all P < 0.05). Compared with the WT mice, there were significant less Atg5 [(0.39±0.05) vs. (0.16±0.08)], LC3[(2.17±0.46) vs. (0.78±0.19)] in vein graft of Atg5+ /- mice (all P < 0.05). Similarly, the expression of LC3 in smooth muscle cells of Atg5+ /- vein graft was significantly decreased (P<0.05), and the lumen of vein graft in Atg5+ /- mice was significantly decreased than that in WT mice [(1.63±0.15) ×104 μm2vs.(2.96±0.12)×104 μm2,P<0.05]. Conclusions Our results demonstrate that Atg5 deficiency inhibited the stenosis of vein graft. Key words: Vein graft; Smooth muscle cells; Authopagy; Atg5

Objective:To compare the differences of doctors and nurses in term of career planning and to find out the focus of human resources management for different positions by means of analysis of newly recruited medical workers′ career expectations, in order to provide decision-making basis for hospital management.Methods:A questionnaire survey was conducted on 242 medical personnel who were enrolled in the orientation training from 2017 to 2019, and statistical analysis was conducted using chi square test, t test and principal component analysis. Results:The differences of doctors and nurses in age, education background, original intention of learning medicine, personal career orientation, and career planning objectives were statistically significant. There was a significant difference in the expectation of colleagues′ competency and cooperation between doctors and nurses. Doctors paid more attention to the professional research ability of their colleagues, and nurses paid more attention to cooperation. Doctors and nurses had a higher expectation of their leaders′ moral quality and teamwork consciousness. The difference between doctors and nurses was not statistically significant.Conclusions:Doctors had clear ideas and goals for career path planning and willingness to work hard for professional pursuit. We should pay attention to the physical and mental health of doctors; and to care more the interpersonal relationship needs of nurses, enhance their professional self-esteem, for stability of nursing teams.

目的 明确耐碳青霉烯类鲍曼不动杆菌(CRAB)临床主要流行株CC92克隆复合群(CC92)基因组中耐药基因和毒力基因的分布,并探讨CRAB耐药和毒力的分子特征.方法 本研究共纳入2019年1～7月自首都医科大学附属北京地坛医院检验科分离的33株CRAB分离株,行细菌全基因组测序研究.利用CLC Genomics Workbench v10.0软件对全基因组测序数据进行序列的质量修整后,开展序列拼接、组装与注释,并进行耐药基因与毒力基因研究,分析CC92克隆复合群CRAB基因组中携带的耐药基因和毒力基因的分布.结果 基因组测序数据分析表明,33株CRAB菌株中30株为CC92型克隆复合群(包括ST195、ST208、ST369和ST540),2株为ST229型,1株为国际上未报道新序列型别.以上CRAB中包括大量的耐药基因,包括大环内酯类、四环素和链霉素耐药基因在内的8～18个耐药基因,以及包括编码与侵袭和黏附等毒力功能相关的12种毒力基因.同时,本研究发现CC92克隆复合群,除携带碳青霉烯类耐药基因以外,还携带了其他非CC92克隆群不具备的耐药基因(如blaOXA-66和blaTEM-1D)和毒力基因(如bauA和bap基因).此外,在CC92克隆复合群中可能存在大环内脂类耐药基因[msr(E)和mph(E)]、氨基糖苷类的耐药基因(armA)、链霉素耐药基因(strA、strB)与四环素耐药基因[tet(B)]的重组.结论 CC92克隆复合群的CRAB基因组存在大量耐药基因和毒力基因,且存在耐药基因重组现象,迫切需要对CRAB进一步开展全基因组水平监测,为临床病原诊断和治疗提供必要的依据.

Objective To study the detection rate of pathogens from sputum , blood, and bronchoalveolar lavage fluid ( BALF ) samples in acquired immunodeficiency syndrome ( AIDS ) patients complicated with pulmonary infection.Methods Seventy-three hospitalized AIDS patients complicated with pulmonary infection in Beijing Ditan Hospital , Capital Medical University were enrolled from February 2018 to September 2018.Blood, sputum and BALF samples were collected.Blood samples were cultured to detect anaerobic bacteria, aerobic bacteria, fungi and mycobacteria.Antigen agglutination method was applied in blood samples to detect cryptococcus neoformans.The sputum samples were tested for Mycobacterium tuberculosis by acid-fast staining and were cultured to detect bacteria and fungi.The sputum samples were observed under microscope for sporotrichosis and fungal spores.The BALF samples were cultured to detect bacteria and fungi. The BALF samples were tested for Mycobacterium tuberculosis by polymerase chain reaction amplification and acid-fast staining.Pneumocystis were detected in BALF samples by methenamine silver staining method .The BALF samples were observed under a microscope for sporotrichosis and fungal spores .The detection rate of pathogens from blood, sputum and BALF samples were compared.Chi-square test was conducted for statistical analysis.Results In 73 AIDS patients complicated with pulmonary infection , the pathogen detection rates in blood, sputum and BALF samples were 8 (11.0%), 23 ( 31.5%) and 48 (65.8%), respectively.The difference was statistically significant ( F ＝48.513, P ＜0.01 ).The detection rate in BALF samples was significantly higher than that in blood or sputum samples ( χ2 ＝43.349 and 17.136, respectively, both P＜0.01).The detection rate in sputum samples was significantly higher than that in blood (χ2 ＝9.215, P＜0.05). The highest detection rates of pathogens in blood , sputum and BALF samples were Talaromyces marneffei 4.1%(3), viridans group streptococci 16.4%(12) and 35.6%(26), respectively.Conclusions The detection rate of pathogens in BALF samples from AIDS patients complicated with pulmonary infection is the highest , followed by sputum and blood samples.

目的 探讨美沙拉嗪联合益生菌治疗炎症性肠病(IBD)的临床疗效.方法 120例IBD患者随机分为对照组和研究组,各60例.对照组口服美沙拉嗪肠溶片每日3次,每次0.1 g,研究组在对照组的基础上口服双歧杆菌三联活菌胶囊,每日3次,每次2粒.疗程为8周,比较两组患者临床疗效和不良反应.结果 研究组内镜复查疗效及临床总有效率显著高于对照组,不良反应发生率显著低于对照组(P<0.05).结论 美沙拉嗪联合益生菌治疗炎症性肠病能够进一步提高临床疗效,减少不良反应.

线粒体是细胞中重要的膜性细胞器,它的主要功能是提供细胞内各种物质代谢所需要的能量.线粒体结构及功能的变化与各种疾病的发生密切相关,因此,对线粒体结构及功能的研究已经成为细胞生物学研究中的重要课题.但目前在本科生开展的医学生物学实验中有关线粒体的实验较少.依据线粒体研究中的最新进展,拟在本科生中探讨开设"利用不同荧光探针分析几种不同类型细胞中线粒体的分布"实验的可行性与必要性.

目的:β淀粉样蛋白(β-amyloid protein,Aβ)聚集形成的老年斑是阿尔茨海默病(Alzheimer's disease,AD)的重要病理特征之一,由淀粉样前体蛋白(amyloid precusor protein,APP)经成淀粉途径多次水解形成.人APP基因表达受可变剪接调控,人脑内有三种APP可变剪接异构体产物.根据这些APP可变剪接异构体是否表达外显子7,可分为APP-KPI+和APP-KPI-两种类型.据报道,APP-KPI+在脑内的表达水平与Aβ的产生呈正相关.GSK3β是脑内和AD相关的最主要的激酶之一,它的活性在AD脑内增加,是AD治疗中的一个潜在的重要靶点.我们的前期研究发现,二苯乙烯苷(stibene glucoside,TSG)能够减少APP转基因小鼠脑内Aβ含量和淀粉样斑块数量,改善学习记忆功能,但TSG对APP可变剪接和GSK3β的影响尚不清楚.方法:构建包含APP外显子7、8可变剪接的微型基因(mini-gene).人胚胎肾细胞(HEK-293FT)、小鼠神经母细胞瘤细胞(Neuro-2a,N2a)内转染APP mini-gene来模拟APP外显子7、8在体内的剪接.在神经细胞N2a内过表达GSK3β或下调其表达,用RT-PCR和qPCR观察GSK3β对APP可变剪接的影响.在HEK-293FT细胞内共表达剪接因子ASF和磷酸激酶GSK3β,用HA抗体免疫共沉淀ASF,GSK3β抗体检测ASF与GSK3β之间是否存在相互作用.将ASF、GSK3β单独或者共转染至HeLa细胞中,用荧光二抗进行染色,观察ASF和GSK3β的细胞定位.APP/PS1转基因鼠TSG(50 mg·kg-1·day-1)灌胃处理12个月,用Western blot或qPCR观察鼠脑内相关蛋白在mRNA和蛋白水平发生的改变.结果:APP mini-gene在HEK-293FT和N2a细胞系内进行表达,RT-PCR结果可见三个条带,经测序分别是APP770,APP751和APP695.过表达GSK-3β促进APP微型基因产物APP-KPI+在N2a细胞内的表达,siGSK3β则抑制APP-KPI+表达量;不同浓度LiCl处理SH-SY5Y细胞,内源性APP-KPI表达量随LiCl浓度增高而降低.SR蛋白ASF对APP-KPI+的表达影响最大,是最为重要的APP可变剪接调控因子.GSK3β可以被ASF免疫共沉淀,存在生理上的相互作用,并且免疫共定位实验显示ASF与GSK3β有很好的细胞内共定位.TSG抑制细胞内APP-KPI+的表达量,同时发现细胞内AKT-GSK3β信号通路可被TSG激活.在体内实验中,5月龄APP/PS1转基因小鼠灌胃给药TSG12个月后,脑内AKT和GSK3β磷酸化水平增加,APP-KPI+表达水平降低.结论:成功构建了研究APP-KPI表达的微型基因.TSG可以激活神经细胞和APP/PS1转基因鼠脑内的AKT-GSK3β通路;GSK3β通过与剪接因子ASF相互作用,从而抑制其促进APP-KPI+生成的能力;在体内长期喂食TSG可降低APP-KPI+表达.

Objective To investigate the effects of tetrahydroxy-stilbene glucoside (TSG) on the behavioral and pathological changes in A53T mutantα-synuclein (α-syn) transgenic mice.Methods Six months old A53Tα-syn transgenic mice were divided into model group (Tg+ group), model+ low dose group (50 mg/kg) and model+high dose group (100 mg/kg). Brood negative transgenic mice were divided into control group (Tg-) and high dose group (100 mg/kg). The administration groups were given TSG by gavage everyday for 9 months, while the control and model groups were given equal volume of distilled water. The movement abilities of mice were measured by pole test and nest building test. The immunohistochemical method was used to detect ty-rosine hydroxylase (TH)-labeled neurons in the substantia nigra of mice.Results Compared to negative trans-genic mice, the latency prolonged in pole test and the score of nest building were decreased, and the number of TH positive neurons were declined in substantia nigra compacta of A53Tα-syn transgenic mice. Intragastrical administration of TSG for 9 months significantly shortened the latency in pole test, increased the score of nest building, and increased the number of TH positive neurons in substantia nigra compacta ofα-syn transgenic mice.Conclusions TSG could obviously improve the motor function and increase the number of dopaminergic neurons in substantia nigra of A53Tα-syn mice. It is suggested that TSG may be beneficial to the treatment of synuclein-related neurodegenerative diseases such as Parkinson disease.

Objective To investigate the immune effect of angiotensin Ⅱ (Ang Ⅱ) on immature dendritic cells (DC) compared with tumor necrosis factor-α (TNF-α)in vitro.Methods Prepared DC2.4 stimulated with different stimuli,such as 20 ng/mL TNF-α and 100 nmol Ang Ⅱ for indicated time.The effects of TNF-α and Ang Ⅱ on the proliferation,maturation,phagocytosis,cytokine secretion,migration,and communication with T ceils of DCs are test by MTT,flow cytometry,ELISA,transwell assay and mixed lymphocyte culture respectively.Results First,the data showed that Ang Ⅱ stimulation significantly inhibited proliferation of DC,induced phenotypic maturation of DC,markedly increased the migration of DC,inhibited macrophage phagocytosis,promoted the secretion of interleukin-6 (IL-6) and interferon-γ(IFN-γ) and initiated the proliferation and activation of T-cell.Conclusion Compared with TNF-α,Ang Ⅱ positively modulated the function of DC to the same extent.

目的:评价二苯乙烯苷(2,3,4',5-tetrahydroxystilbene-2-O-β-D-glucoside,TSG)在长期给药过程中对APP/PS1小鼠学习记忆功能的影响及其对阿尔茨海默病病理改变的影响,同时比较其与多奈哌齐药效学及药理作用的不同.方法:给APP/PS1小鼠灌胃给药(TSG,50 mg·kg-1,100 mg·kg-1;donepezil,1 mg·kg-1)在给药后用Morris水迷宫实验,新物体识别实验,自主活动,评价小鼠的学习记忆功能及小鼠的活动性.硫磺素染色和Aβ40/42免疫荧光共定位观察全脑斑块沉积,免疫组化染色观察皮层和海马部位斑块沉积情况,ELISA方法检测脑内可溶及不可溶Aβ42的含量,用Western Blot方法检测皮层及海马部位Aβ生成及代谢途径的关键酶的含量,以此来判断TSG药物在改善老年痴呆的作用及其作用的关键点.结果:Morris水迷宫实验结果显示APP/PS1模型组与Wild Type对照组相比逃避潜伏期明显延长,给药后逃避潜伏期明显缩短,TSG与DON相比,逃避潜伏期更短.新物体识别实验显示APP/PS1模型组与Wild Type对照组相比分辨指数明显缩短,给药后分辨指数提高,TSG与DON相比,分辨指数明显提高.硫磺素染色与Aβ40/42免疫荧光共定位,斑块能够完全重合,说明斑块的主要成分是Aβ40/42,实验结果统计分析APP/PS1模型组与Wild Type对照组相比脑内斑块显著,给药后全脑斑块减少,以小剂量最为显著,Don也能减少斑块沉积,减少程度较TSG稍差.免疫组化染色皮层斑块沉积,APP/PS1模型组与Wild Type对照组相比皮层斑块显著,给药后皮层斑块减少;免疫组化染色海马斑块沉积,APP/PS1模型组与Wild Type对照组相比海马斑块显著,给药后海马斑块减少.另外Western Blot检测了Aβ代谢通路,前体蛋白和关键代谢酶,给药后APP,BACE-1,PS1表达量减低.用ELISA方法检测脑内可溶及不可溶性Aβ42的含量,结果显示APP/PS1模型组与Wild Type对照组相比可溶性Aβ42含量明显增高,给药后有一定程度减低;不可溶性Aβ42,APP/PS1模型组与Wild Type对照组相比明显增加.给药后不可溶性Aβ42明显减低,DON对不可溶性Aβ42的脑内含量减低,效果与TSG相比不明显.结论:TSG在长期给药后能够改善小鼠的空间学习记忆功能,对斑块所导致的记忆功能减退,有显著的提高作用,而与TSG相比DON的改善学习记忆能力更为显著.TSG对小鼠的活动能力无不良影响.TSG能够减少斑块沉积,其中不可溶性Aβ42减低最为明显.进一步研究Western Blot结果显示TSG能够减少APP的表达,在板块生成途径能够影响关键代谢酶BACE-1和PS1.TSG长期药效优于DON.

Objective To explore the effects of tetrahydroxystilbene glucoside (TSG) on the expression of amyloid precursor protein (APP) and its mechanism in cultured nerve cells.Methods The expression of APP and cAMP responsive element-binding protein (CREB) was detected by Western blotting assay.The CRE cis-elements of APP promoter were analyzed by Matinspector software.The plasmids expressing serial deletion mutants of APP promoter were constructed.The luciferase activity in cells was measured by luciferase double reporter gene system.Results Activation of CREB by Forskolin down-regulated APP expression in SH-SY5Y cells.The luciferase expression plasmids of APP promoter containing CRE elements were successfully constructed.TSG treatment decreased APP level in SH-SY5Y cells,and reduced luciferase activity of APP reporter gene containing CRE1 and CRE2 cis-elements in APP promoter plasmidstransfected cells.Conclusion TSG down-regulated APP expression in nerve cells,and its mechanism may be related to affecting the binding of CREB with CRE eis-elements.

Objective To analyze the characteristics of toxin, the PCR-ribotyping(RT) and the multilocus sequence typing(MLST) of Clostridium difficile strains isolated from China-Japan Friendship Hospital in order to provide a basis for monitoring the outbreak of nosocomial Clostridium difficile infection.Methods A total of 321 samples were collected from the patients with suspected Clostridium difficile infection(CDI) in China-Japan Friendship Hospital(CJFH) during 2012 to 2013.All Clostridium difficile strains were isolated and identified by the standard phenotypic culture method.Cytotoxicity test was performed to detect toxin B.Toxin genes (tcdA and tcdB) and binary toxin genes (cdtA and cdtB) harbored by those strains were analyzed.RT and MLST were used for homologous analysis.Clinical data of the patients were collected to analyze the isolation rate of Clostridium difficile in different populations.Results Forty-eight strains of Clostridium difficile were isolated from 46 patients with diarrhea and three of them were isolated from the same patient.The incidence of CDI among all patients, outpatients and inpatients were 14.3%(46/321), 12.8%(5/39) and 14.5%(41/282), respectively.Toxin B was detected in all of the strains as indicated by the cytotoxicity test.Strains of sequence type 1(ST1) showed the strongest cytotoxicity of all the isolated Clostridium difficile strains.Ten out of the 48 strains (20.8%) were tcdA(-)/tcdB(+) strains, which belonged to either ST37 or ST81.The results of RT and MLST were consistent in assigning the strains into nine types, in which the predominant type was ST1/RT027 accounting for 27.1% (13/48).All of the ST1/RT027 strains presented a toxin gene profile of tcdA(+)/tcdB(+) and cdtA(+)/cdtB(+).Most of the ST1/RT027 strains were isolated from the Traditional Chinese Medicine Department of Respiratory, where smallnosocomial outbreaks of ST1/RT027 strain infection might happen.Conclusion CDI diagnosed in CJFH mainly belongs to nosocomial infection.Most of the isolated strains harbor tcdA(+)/tcdB(+) genes.Surveillance for the outbreaks of CDI caused by ST1/RT027 strains over producing toxins A and B should be strengthened in hospitals.