Digestive system involvement of novel coronavirus infection: Prevention and control infection from a gastroenterology perspective.

An epidemic of an acute respiratory syndrome caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in Wuhan, China, now known as coronavirus disease 2019 (COVID-19), beginning in December 2019, has attracted an intense amount of attention worldwide. As the natural history and variety of clinical presentations of this disease unfolds, extrapulmonary symptoms of COVID-19 have emerged, especially in the digestive system. While the respiratory mode of transmission is well known and is probably the principal mode of transmission of this disease, a possibility of the fecal-oral route of transmission has also emerged in various case series and clinical scenarios. In this review article, we summarize four different aspects in published studies to date: (a) gastrointestinal manifestations of COVID-19; (b) microbiological and virological investigations; (c) the role of fecal-oral transmission; and (d) prevention and control of SARS-CoV-2 infection in the digestive endoscopy room. A timely understanding of the relationship between the disease and the digestive system and implementing effective preventive measures are of great importance for a favorable outcome of the disease and can help climnicians to mitigate further transmission by taking appropriate measures.

Factors associated with low adherence to head-of-bed elevation during mechanical ventilation in Chinese intensive care units.

BACKGROUND: Elevating the head of bed (HOB) 30° - 45° has been widely supported as a means of ventilator associated pneumonia (VAP) prevention. However, it was poorly adhered in clinical practice. This observational study aimed to investigate the factors impeding this simple practice at the bedside. METHODS: This prospective study was conducted in 33 Chinese academic hospital intensive care units (ICUs). HOB angle was measured four times daily at 5 - 7 hour intervals. The predefined HOB elevation goal was an angle ≥ 30°. RESULTS: The overall rate of achieving the HOB goal was 27.8% of the 8647 measurements in 314 patients during 2842 ventilation days. The HOB goal of ≥ 3 times/d was consistently achieved only in 15.9% of the cases. Almost 60% of patients had at least one 24 hours period during which the HOB goal was never documented. This low rate of protocol compliance was not associated with acute physiology and chronic health evaluation (APACHE) II score or dependence on vasopressors. In a survey, "nurse workload" was identified as the most important factor for non-compliance with the HOB goal. In addition, the rates of compliance were significantly different (P < 0.001) between physicians self-reporting that they either did or did not know the Institutes of Healthcare Improvement (IHI) ventilator bundle. CONCLUSIONS: Low adherence to a HOB angle of ≥ 30° was found in this nationwide survey. Nursing workload and lack of knowledge on VAP prevention were important barriers to changing this practice.

[Construction of eukaryotic plasmid of human GPC3 and expression and purification of recombinant GPC3 protein].

AIM: To obtain enough human glypican-3 (GPC3) protein for structural and functional research. METHODS: The full-length cDNA coding for GPC3 was cloned by RT-PCR from human fetal hepatocytes. The open reading frame (ORF) of the cDNA consists of 1 700 bases, encoding a mature protein of 556 amino acids. The cDNA was inserted into the pPICZ A vector to construct a expression plasmid, named pPICZ A-GPC3. Then the plasmid was transformed into a Pichia pastoris strain, GS115 and the positive strains were screened on the YPD plates with Zeocin. The positive strains were further screened on cellulose acetate and nitrocellulose membrane with HRP labeled His-tag antibody. The selected strains were induced by methanol and the supernatants were analyzed by SDS-PAGE and Western blotting. RESULTS: SDS-PAGE analysis showed an anticipated band on the gel that could bind with goatanti-GPC3 antibody. Furthermore, the strain was fermented and the expression level was about 5 mg/L, and the recombinant GPC3 protein was purified by cation-exchange chromatography from the fermentation supernatant. CONCLUSION: Human GPC3 was expressed successfully in Pichia pastoris and purified to obtain the recombinant protein from fermentation supernatant, which made it possible for further structural and functional studies on GPC3.

[The clinical characteristics and treatment of community outbreaks of the new influenza A (H1N1) infection].

OBJECTIVE: To describe the clinical characteristics of 3 community outbreaks of the novel influenza A (H1N1), and to compare the treatment effects of the traditional Chinese medicine with or without Oseltamivir. METHOD: The clinical records of 234 patients in 3 community outbreaks of the novel influenza A (H1N1) infection in June (n = 56), August (n = 96) and October (n = 82) of 2009 were analyzed, and the treatment effects of the traditional Chinese medicine with or without Oseltamivir were evaluated. RESULTS: The baseline characteristics, including age, temperature, indices of blood tests, hepatic and renal functions were distributed evenly between the 2 treatment groups. The overall analysis suggested that there was no significant difference between the 2 treatment groups in the duration of clinical symptoms (P > 0.05), the duration of fever (P > 0.05), and the hospitalization days (P > 0.05). However, an analysis stratified by the temperature (≥ 39°C or < 39°C) suggested that patients treated by the traditional Chinese medicine with Oseltamivir tended to suffer a shorter duration of fever [40.5 (37.3, 42.0) vs 22.0 (10.5, 30.8) hr, P < 0.01) ] in the higher temperature group. CONCLUSIONS: The traditional Chinese medicine was equivalent to oseltamivir in treating patients with the novel influenza A (H1N1) infection with lower temperature (< 39°C). Oseltamivir was effective in shortening the duration of fever in patients with temperature higher than 39°C.

[Clinical investigation on the compliance and the validity of ventilator bundle].

OBJECTIVE: To investigate the compliance of ventilator bundle implementation and its preventive effect on ventilator associated pneumonia (VAP). METHODS: A before and after design was used in this single center study. Patients aged from 18 to 80 years, with mechanical ventilation (MV) duration over 48 hours were recruited during 1 year before (control group) and 2 years after bundle implementation (intervention group). Measurements included the rate of successful ventilator bundle implementation in intervention group, incidence of VAP, duration of MV and mortality within 28 days in both groups. RESULTS: A total number of 237 patients, including 71 patients in control arm and 166 patients in intervention arm, were recruited in this study. There was no statistical significance in ratio of sex, mean age, category of diseases or mean acute physiology and chronic health evaluation II (APACHE II) score between two groups (all P>0.05). Significant changes were not found in MV duration [(5.9+/-5.6) days vs. (5.2+/-6.1) days], incidence of VAP (21.1% vs. 20.5%) and mortality within 28 days (16.9% vs. 19.8%) between control and intervention group as well. In intervention group, 57 of 166 (34.3%) patients were successfully implemented all of four ventilator bundle items. The successful rate of ventilator bundle implementation were 62.5% (35/56), 22.1% (21/95) and 6.7% (1/15) in patients received MV duration < or =3 days, 4-7 days and >7 days respectively. Among the four items of the bundle, head of bed elevation > or =30 degree angle had the lowest successful rate [43.4% (72/166)]. But it was much better in the implementation of daily wake-up plus weaning, prevention of peptic ulcer and prevention of deep vein thrombosis formation [92.2% (153/166), 88.0% (146/166) and 83.1% (138/166) respectively]. CONCLUSION: The poor compliance of ventilator bundle is an important factor in impacting the efficacy of ventilator bundle.

GC-rich promoter elements maximally confers estrogen-induced transactivation of LRP16 gene through ERalpha/Sp1 interaction in MCF-7 cells.

LRP16 gene has been characterized as an estrogen-responsive gene. One 1/2ERE/GC-rich site was previously identified to be indispensable for -676/-214 (region A) fragment within LRP16 regulatory region to confer E2 action. Here, we report that -213/-24 fragment (region B) has higher E2-responsiveness than that of region A in MCF-7 cells, but not in HeLa cells. Deletion and mutation analyses of region B showed that multiple GC-sites are involved in the E2-stimulated response and one 30-bp fragment (-213 to -184 bp) is essential for conferring maximum E2-responsiveness. Results from the cotransfection assays containing Sp1-siRNA revealed that Sp1 is required for the basal transcription activity and E2-responsiveness of both regions A and B. Northern blot analysis demonstrated that inhibition of Sp1 in MCF-7 cells not only decreased the basal expression of LRP16, but markedly impaired its upregulation by E2. Results from gel mobility shift assays exhibited the direct binding of Sp1 protein to the 28-bp fragment (-211 to -184 bp), which was enhanced by the ERalpha titer. Moreover, the functional interaction of ERalpha and Sp1 proteins in the presence of E2 at the GC-rich sites in region B was confirmed by chromatin immunoprecipitation (ChIP) assays. In general, these results demonstrate that GC-rich sites in the proximal promoter of LRP16 gene are sufficient for E2 activation of LRP16 and the -213/-184 fragment containing only one GC site is essential for the maximal induction in MCF-7 cells. We also provide a model for Sp1-dependent regulation of genes by E2 through GC-rich motifs.

Prevalence of BK virus and JC virus in peripheral blood leukocytes and normal arterial walls in healthy individuals in China.

Several studies have demonstrated that BK virus (BKV) and JC virus (JCV) establish latent infection in peripheral blood leukocytes (PBLs) of healthy individuals; however, the main populations studied are European. In this study, the prevalence of BKV and JCV DNA in PBLs from healthy adult individuals and umbilical cord blood from newborn children in China was detected by semi-nested polymerase chain reaction (snPCR) followed by restriction enzyme analysis. The results suggest that the healthy adult Chinese population harbors BKV and JCV DNA in peripheral leukocytes. Overall, the prevalence of BKV and JCV DNA in PBLs of healthy adult individuals was 42.1% and 7.8%, respectively. The overall prevalence of BKV DNA was significantly higher than that of JCV DNA. None of the umbilical cord blood samples from newborn children were positive for BKV and JCV DNA. To understand further the target tissues involved in establishment of BKV and JCV latency in healthy individuals, the presence of DNA from both viruses was detected in normal arterial wall samples from 20 young trauma victims by the same method used for leukocyte DNA. BKV DNA was detected alone in 20% of samples tested; JCV DNA was not detected alone in any of the samples. DNA from both viruses was found in 5% of samples. This is the first report to show that normal arterial walls of healthy individuals may be another target site of latency for BKV and JCV.